Sue Turner and Rebecca Woolley, Public Health Specialists, to present
Minutes:
Sue Turner, Public Health, and Rebecca Woolley, Public Health, gave the following powerpoint presentation:-
Context
- There was a growing movement and evidence base that supported taking a ‘compassionate approach’ to weight
- Our working definition of a compassionate approach was: ‘An approach that promotes health gains for all people, without stigma or judgement, and which takes into account the wider context of their lives’
- This approach involves:
· Actively tackling weight stigma and body shaming
· Focussing on healthy habits and sustained behaviour change over time rather than on weight loss as the primary success measure
· Emphasising the importance of social change over individual ‘lifestyle choices’
· Taking a person-centred and holistic approach
· Addressing the wider and commercial determinants
- We are at the beginning of an evolving process so we want to engage with professional stakeholders and local people to understand how to make this approach ‘real’, consistent and right for Rotherham
Why take a compassionate approach to weight?
- Weight stigma is a significant public health issue
· Weight stigma was significantly associated with greater disordered eating, comfort eating, alcohol use and sleep disturbance, after controlling for covariates
· Weight stigma was likely to drive weight gain and poor health and thus should be eradicated. This effort could begin by training compassionate and knowledgeable healthcare providers who would deliver better care and ultimately lessen the negative effects of weight stigma
· Every year the CAMHS Eating Disorder Team will see a number of referrals where the young person had either misinterpreted anti-obesity messages or had been advised to seek help after the NCMP and this had been taken very literally, triggering them to develop an eating disorder
· Weight stigma may also contribute towards reduced help-seeking and health-seeking behaviour
Should weight loss be the primary success measure
- BMI was only one indicator of health risk. For many people becoming healthier would involve losing weight but many people classed as “overweight” were healthy and many classed as “healthy” actually had higher mortality risks than the overweight or even slightly obese
- Conventional dieting did not work for most people in the long term and estimates suggested that most people would regain weight lost through dieting within 2-5 years
- A systematic review and meta-analysis of trials exploring the efficacy of 14 popular named diets found that “weight loss diminished at 12 months among all macronutrient patterns and popular named diets while the benefits for cardiovascular risk factors of all interventions, except the Mediterranean diet, essentially disappeared”
- By focussing solely on weight and weight loss to improve health, measures not only failed to achieve sustainable weight reduction or health benefits but could also be harmful. Harms may include, but were not limited to, disordered eating, weight cycling, preoccupation with food, distorted body image, poor psychological health, weight stigmatisation and discrimination
Weight was complex and influenced by a wide range of issues
- There was a 4% increase in fast food outlets in Rotherham between March 2020 and March 2022
- 26.9% of households would need to spend more than a quarter of their disposable income after housing costs to meet the Eatwell Guide (2018)
- About 8% of deprived areas in England and Wales were “food deserts” (2018)
- Research showed that stress, financial hardship and a lack of a sense of control over one’s life and work could increase the likelihood of weight gain
What does this mean in practice – a compassionate approach means
- Actively tackling weight stigma and body shaming
- Focussing on healthy habits and sustained behaviour change over time rather than on weight loss was the primary success measure
- Emphasising the importance of social change over individual ‘lifestyle choices’
- Taking a person-centred and holistic approach
- Addressing the wider and commercial determinants
Examples of current activity
- 0-19 Service taking forward this approach which had included a change to the NCMP letters which were sent to teachers and parents and a more holistic approach for support
- The compassionate approach had been embedded within the tender for smoking cessation and tier 2 weight management services
- A review of the BeWell@Work award was taking place with a focus on promoting a compassionate approach within workplaces
- Engagement with partners and communities was underway to ensure this approach worked for Rotherham
- The compassionate approach was now part of the healthy foundations accreditation
- Opportunities were being explored around the approach to measuring and evaluating this approach
- Refining the JSNA to incorporate the compassionate approach into the weight section
- Working to ensure MECC training took a compassionate approach to weight and wider ‘healthy lifestyle’ interventions
- Reflected in strategic documents including the Best Start and Beyond Framework and the Prevention and Health Inequalities Strategy
Discussion ensued with the following issues raised:-
· More investment required in Mental Health Services for children looking at why so many young people were experiencing poor mental health and body image
· Child obesity appeared to be more prevalent in deprived families
· Work was currently taking place with the 0-19 Service to incorporate the Compassionate Approach into the Service. Training was awaited but the aim was to embed it into the Healthy School Nursing Service together with opportunities with Early Help and the wider workforce
· The need to support rather than judge families
· There would be 3 extra Nursery Nurses whose remit would include working with families on their needs including diet
· Discussions were taking place with the School Meals Service
· Importance of engagement with workforces across all organisations but the need for a consistent approach which would take time
Sue and Becky were thanked for their presentation (sue.turner@rotherham.gov.uk and rebecca.woolley@rotherham.gov.uk).
Resolved:- (1) That the report be noted.
(2) That an update be submitted in 12 months’ time.