JSNA topic report: obesity health needs and systems mapping in Buckinghamshire

A growing body of evidence, including from the Foresight Tackling Obesities Report Foresight: Tackling Obesities: Future Choices, suggests that whole systems approaches could help tackle complex problems like obesity. The PHE guidance does not specify which specific policies, interventions or actions local areas should include in their approach, this is an important part of the approach which needs to be agreed with local stakeholders reflecting the needs of the local community.

One of the major challenges when setting up a Whole Systems Approach to Obesity is how to bring all stakeholders together, with the mind set and motivation to address the issue and create a joined up, dynamic plan and on-going network. It is clear that obesity is only one of a number of very challenging issues, and for many stakeholders, it may be difficult to see why it should receive priority. The PHE guidance therefore emphasises the importance of the initial phases of the approach to create the necessary environment for change.

The approach is a long-term commitment, with actions across the short-, medium- and long-term, throughout this journey we will continue to test new approaches and learn from the experiences of wider areas across the country.

Within Buckinghamshire, taking the Whole Systems Approach to obesity will enable us to build on the evidence and growing recognition that working collaboratively and involving stakeholders from across the local system, will help tackle obesity:

• Foresight: Tackling Obesities: Future Choices
• childhood obesity: a plan for action
• the need for a complex systems model of evidence for public health

Evidence of outcomes in the UK to date are limited, however internationally areas such as Amsterdam are further advanced in implementing such approaches.

The approach in Amsterdam puts child and adolescent health at the heart of all municipal policies and collaboration among many sectors and early evidence is it supports whole systems working ("Whole city working against childhood obesity", The BMJ).

In terms of weight management services and the surveillance of unhealthy weight, the Healthy Lifestyle Service HNA highlighted the following evidence for future service provision.

The National Child Weight Management programme (NCMP) continues to provide an excellent source of surveillance data which increases the understanding of patterns and trends in weight, from underweight to those who are obese, among the child population.

The efficacy of weight management programmes for children, young people and their families and the different approaches used has been extensively reviewed.

There is also a plethora of guidance and advice to service providers and commissioners regarding weight management for children and young people.

Most of the guidance identifies the complexities of identifying overweight and obese children and the need for multiple indicators to assess the need for intervention (view the NICE website).

The standard approach and guidance for supporting adults to lose weight remains 12 weeks.

The Local Government Association’s Towards a Healthy Weight acknowledges that the standard approach to two tiered services is to provide support for 12 weeks to encourage healthy eating and physical activity.

Follow-up support is also offered to sustain any weight loss achieved (1.109 Weight management).

However, within these standard approaches innovation and a more flexible approach is recommended to address the specific needs of particular cohorts.

One caveat included in the guidance published by NICE and regarding the 12 week minimum standard relates to very low-calorie diets (800 kcal/day or less), they should only be considered as part of a multi-component weight reduction strategy when a need for rapid weight loss is clinically identified.