Healthy Child Weight (CHW)

Heather DonaldSeptember 2011

The Scottish Health Survey (SHeS) -2009 1

• 28.2 % of children classed overweight or obese (≥85th Centile)

• Rates increase with age• Rates in girls and boys appear similar (27%

and 29.4% respectively) ≥ 85th Centile• Significant associations between SIMD

quintile and obesity

National Policy Drivers for Tackling Child Overweight and Obesity in Scotland

• Preventing Overweight and Obesity in Scotland: A Route Map towards Healthy Weight 2

• Early Years Framework 3

• Improving Maternal and Infant Nutrition: A Framework for Action4

NHS Scotland Healthcare Quality Strategy 5

• Quality Ambition 1:– Mutually beneficial partnerships between

patients, their families and those delivering healthcare services which respect individual needs and values and which demonstrate compassion, continuity, clear communication and shared decision making

• Quality Ambition 2:– There will be no avoidable injury or

harm to people from healthcare they receive, and an appropriate, clean and safe environment will be provided for the delivery of healthcare services at all times.

• Quality Ambition 3:– The most appropriate treatments,

interventions, support and services will be provided at the right time to everyone who will benefit, and wasteful of harmful variation will be eradicated

Sources of evidence for guidance 2011-2014

• SIGN 115 (2010) 6

• NICE (2006) 7

• NHS Health Scotland Evaluation of the Implementation of HEAT 3 8

• Data from the impact of HEAT 3 Interventions from individual boards

Integrated systems approach to child overweight and obesity prevention and management

• Obesity prevention

• Overweight and obesity management

• Specialist assessment

Qualifying interventions – key requirements

• Intervention components– Behaviour change– Family-based– Decrease overall dietary energy

intake– Increase the levels of physical

activity – Decrease the amount of time spent

in sedentary behaviours

• BMI Criteria– BMI at or greater than the 91st

centile for BMI (based on the UK 1990 Reference Growth charts)

– Participate at Tier 2 level programme

– Complete at least 75% of the Programme

• Weight management/intervention goals– Key goal for child healthy weight

interventions is to achieve a stabilisation or reduction in a child or young person’s BMI and BMI standard deviation score (SDS-BMI) (also known as BMI z-score)

Duration of programmes (one-to-one/group)

– Number of Sessions

– Duration of Sessions

– Timing of sessions

• Age range – 2-15 years

• Inequalities – 40% of CHW completions should be achieved by children/families in the two most deprived SIMD quintiles, 1 and 2 by local SIMD datazone

Integrated Care Pathway – Child Healthy Weight

• Scottish Government require each board to have a care pathway that embeds CHW into practice

• NHS Grampian ICP for CHW– Pilot initially to 3 areas

Tier 1: General information on healthy eating and physical activity. Every child/ family should be provided with this information if BMI has been measured. (Not suitable to give to a child/young person whose BMI is ≤ 2nd centile).This information can be given out by schools/after schools clubs/health visitors/Active schools co-ordinators.

Tier 2: An Opt-In intervention which addresses healthy eating, physical activity and a whole family approach. Sessions may be delivered as a group or to the individual. Intervention tailored for those with a BMI ≥ 91st centile. Can also be delivered by school based interventions which will select a class or year to deliver

Tier 3: One to one support with specialist Dietitian providing behaviour change support

Tier 4: Specialist support provided by paediatric dietitian for those who are regularly seen by a paediatrician for a significant co-morbidity (endocrine/diabetes/renal).

Identified problems

• Training for Staff 9

• Measurements

• Equipment

• Raising the Issue 10

Tier 1

• Expectation of preventative work from all

• Schools are delivering “Grow Well Choices”

• Resources

• Social Marketing

Tier 2

• Intervention is “Eat Play and Grow Well”

• For those with a BMI above the 91st Centile

• How do you refer?

Contact Details

• Community Dietetics, Westholme, Woodend Hospital – 01224 556304

• Moray Dietetic Dept, Dr Gray’s Hospital – 01343 567350

• Email:- nhsg.communitydietitians@nhs.net

• Thank you

References

• 1Scottish Health Survey (SHeS) (2009). http://www.scotland.gov.uk/Publications/2010/09/23154223/0

• 2Scottish Government (2010) Preventing Overweight and obesity in Scotland: A route map towards healthy weight . http://www.scotland.gov.uk/Resource/Doc/302783/0094795.pdf

• 3 The Scottish Government. (2008) http://www.scotland.gov.uk/Resource/Doc/257007/0076309.pdf

• 4 Improving Maternal and Infant Nutrition: A Framework for Action (2011) http://scotland.gov.uk/Resource/Doc/337658/0110855.pdf

• 5 The Health Care Quality Strategy for NHS Scotland (2010) http://www.scotland.gov.uk/Resource/Doc/311667/0098354.pdf

• 6Scottish Intercollegiate Guidelines Network (SIGN) (2010). Management of Obesity: A National Clinical Guideline. NHS QIS: Edinburgh. www.sign.ac.uk/guidelines/fulltext/115/index.html

• 7 National Institute for Health and Clinical Excellence (NICE) (2006). Obesity guidance on the prevention, identification, assessment and management of overweight and obesity in adults and children. Available: www.nice.org.uk/nicemedia/live/11000/30365/30365.pdf

• 8 NHS Health Scotland H3 evaluation (2010). www.healthscotland.com/documents/4836.aspx

• 9 NHS Health Scotland. Healthy Weight National occupational Standards (2011) http://www.healthscotland.com/uploads/documents/15725-National%20OccupationStandards.pdf

• 10 Health Scotland http://www.healthscotland.com/topics/child_healthy_weight.aspx