- Kingston Council

Transcription

- Kingston Council

Healthy Weight and
Physical Activity Needs
Assessment and Strategy
2013-2016
Contents
Contents
Acknowledgements4
Introduction5
Strategy development
9
Demographics12
Achieving and Maintaining a Healthy Weight
18
Encouraging Physical Activity
48
Action plan
70
Abbreviations92
List of tables, figures and maps
93
Appendices94
1.Update on progress since ‘Tackling Obesity:
A Strategy for Children and Adults in Kingston (2006-2010)’
2.
Index of Multiple Deprivation (IMD) 2010
3
Healthy Weight and Physical Activity Needs Assessment and Strategy 2013-2016
Authors and Contributors
A strategy like this can only be produced with the
dedication and commitment of the following people:
Authors:
Jo Lockhart, Public Health Programme Lead, Obesity
& Physical Activity, Kingston Public Health Team
Alison Gahagan, Public Health Dietitian, Kingston
Public Health Team
Shirley Piotrowski, Physical Activity Lead, Kingston
Public Health Team
Mapping Assistance:
Stephanie Stedman, GIS and Data Management
Officer, Royal Borough of Kingston
Helen Whiteley, GIS and Data Management Officer,
Royal Borough of Kingston (no longer in post)
Contributors
Our thanks also go to everyone that contributed
during the mapping process, gave up their time
to attend the workshops or responded to the
consultation. Special thanks go to the following
people and teams for their assistance and guidance:
Seema Buckley, Chief Pharmacist, Kingston CCG
(formerly NHS Kingston)
Carlin Conradie, Head of Dietetics, Kingston Hospital
Anne-Marie Dixon, Practice Nurse, Brunswick
Surgery
Sundus Hashim, Associate Director of Public Health,
Kingston Public Health Team
Dr Jonathan Hildebrand, Joint Director of Public
Health, Kingston Public Health Team
Kathy Hilton, Chief GP Dietitian, Kingston Hospital
Nadine Lane, Lifestyle Programme Coordinator,
4
Scott Leonne, Bariatric Dietitian, St George’s
Healthcare NHS Trust
Iona Lidington, Joint Associate Director of Public
Health, Kingston Public Health Team
Dr Annette Pautz, GP, Holmwood Corner Surgery
Jo Rota, Get Active Co-ordinator, Kingston Public
Health Team
Harman Toor, Community Food Project Worker,
Dr Andrew Winrow, Consultant Paediatrician,
Kingston Hospital NHS Trust
Active Kingston Team, Royal Borough of Kingston
Community Sport and Physical Activity Network
Equalities and Community Engagement Team,
Royal Borough of Kingston
Medicines Management Team, Kingston Clinical
Commissioning Group
School Health Team, Your Healthcare
Smarter Travel Team, Royal Borough of Kingston
Commitment
Kingston Public Health Team, the Royal Borough
of Kingston and Kingston’s Clinical Commissioning
Group are committed to working with all stakeholders
and partners to achieve the aims of this strategy and
deliver the recommendations. The objectives outlined
in this strategy will be reviewed annually to check
progress and reported to the Health and Wellbeing
Board (HWB) via the Community Sport and Physical
Activity Network (CSPAN). This strategy should be
reviewed and refreshed by the 31st March 2016.
Introduction
Introduction
The aim of the ‘Tackling Obesity: A Strategy for
Children and Adults in Kingston, 2006-2010’ was
to reduce the burden of death, illness and distress
from overweight and obesity in the Royal Borough
of Kingston by halting the rise in the prevalence of
obesity in adults and children by 2010 – particularly
targeting high-risk groups and people experiencing
inequalities in health. The objectives were to:
●● Promote an environment and culture where healthy
choices are the norm.
●● Identify early those at high risk of overweight or
obesity and encourage and direct them towards
appropriate interventions.
●● Ensure provision of quality weight management
services for those who want to lose or maintain
their weight to achieve improvements in health.
●● Develop effective mechanisms across the sector
for monitoring and evaluation and sharing
good practice so that success is maintained and
sustainable.
NHS Kingston and the Royal Borough of Kingston
have made significant progress towards achieving
these aims and objectives. This new Joint Healthy
Weight and Physical Activity Needs Assessment and
Strategy 2013-2016 intends to build on this progress,
reporting on what has been achieved and highlighting
areas that should be addressed over the next three
years.
Why should we continue to tackle
overweight, obesity, physical
inactivity and sedentary behaviour in
Kingston?
Obesity is a complex and chronic condition. Carrying
extra fat leads to serious health consequences such
as cardiovascular disease (mainly heart disease and
stroke), type 2 diabetes, musculoskeletal disorders
like osteoarthritis, and some cancers (endometrial,
breast and colon)1. Furthermore, being overweight or
obese can have serious implications for an individual’s
mental wellbeing and some eating disorders are
inextricably linked with poor mental health.
Whilst it is recognised that physical activity can be a
very effective tool to assist weight maintenance, it is
also vital to recognise that physical inactivity creates
significant health risks for people regardless of their
weight. Physical inactivity constitutes a major public
health threat, increasing the risks of chronic disease
and disability. It is a major risk factor for all-cause
mortality, cardiovascular disease, obesity, high blood
pressure, stroke, type 2 diabetes, metabolic syndrome,
colon and breast cancer along with a number of
mental health conditions.
These health risks are preventable and it is therefore
vitally important to encourage and support children
and adults in Kingston to make healthier choices,
ensuring services are accessible and well known.
Where appropriate, hard to reach groups at higher
risk of poorer health outcomes should be targeted to
ensure equality throughout Kingston. Furthermore,
education and support is required from the very
early life stages in order to reduce the likelihood of
childhood overweight, obesity and physical inactivity
continuing into adulthood.
1http://www.who.int/features/qa/49/en/index.html
5
What progress has been made in
Kingston and where are we now?
The Health Profile for Kingston in 20082 was the
first to report childhood obesity prevalence for the
borough (7.7% for reception children aged 4-5
years). The most recent National Child Measurement
Programme (NCMP) data (for the 2010/2011
academic year) reports an obesity prevalence of 7.1%
for children in Reception (aged 4-5 years). Whilst it is
important to note that each year the NCMP measures
a new cohort of children and can therefore fluctuate
annually, the previous five year’s prevalence data imply
that the prevalence of obesity in 4-5 year old children
in Kingston has remained fairly constant. Furthermore,
this can also be seen for Year 6 children aged 10-11
years (see Table 1).
(Table 2). However, in Kingston, there is a doubling
in prevalence of obesity from Reception Year (7.1%)
to Year 6 (15.8%). This trend is also seen nationally
and regionally but it highlights the importance of
continuing to ensure services are targeting children of
all ages.
Furthermore, the prevalence of underweight in
Reception and Year 6 children in Kingston is above
the national prevalence (Table 2). It is therefore vital
to ensure that we dedicate resources for tackling
underweight as well as overweight and obesity.
The prevalence of overweight and obesity in both
Reception Year and Year 6 in Kingston (2010/2011)
is below both the national and regional prevalence
The prevalence of obesity in adults in Kingston in
2006 was 18.4%. In 2012, this prevalence is now
slightly reduced at 16.7%3 illustrating possible local
success in halting the rise in obesity in adults. This
data may suggest that progress has been made
beyond the aims of the previous strategy by reducing
the prevalence of obesity in adults in Kingston but
2 Health Profile – Kingston upon Thames, 2008
3 Health Survey for England 2006-2008
Table 1
Comparison of Kingston’s NCMP data with previous years
Reception
Year 6
2006/2007
2007/2008
2008/2009
2009/2010
2010/2011
Overweight
9.7%
10.3%
Obese
7.7%
7.6%
10.2%
9.9%
10.4%
7.6%
6.8%
7.1%
Overweight
14.6%
14.7%
13.3%
14.5%
15.1%
Obese
15.4%
16.4%
16.4%
16.4%
15.8%
Table 2
Comparison of Kingston’s 2010/2011 NCMP data with national and
regional prevalence
Underweight
Overweight
Obese
9.4%
National prevalence:
(England)
Reception
1.0%
13.2%
Year 6
1.3%
14.4%
19%
Regional prevalence:
(London)
Reception
1.5%
12.4%
11.1%
Year 6
1.7%
15.1%
21.9%
Reception
1.5%
10.4%
7.1%
Year 6
1.4%
15.1%
15.8%
Regional prevalence:
(Kingston)
6
Introduction and Background
more robust trend data is required to confirm this.
Whilst Kingston can celebrate success locally in
halting the rise in the prevalence of obesity in adults
and children, it is vital to maintain momentum to
make further improvements that will work towards
four specific objectives:
●● Reducing the overall prevalence of obesity in
children and adults (reversing the tide).
●● Minimising the current increase in obesity
prevalence from Reception Year to Year 6.
●● Ensuring all professionals (both health professionals
and non-health professionals) can access relevant
training and support the implementation of clear
care pathways to follow for adults and children in
Kingston.
●● Ensuring robust surveillance data is available to
inform service planning and commissioning.
With adults we must also consider additional risk
factors such as waist circumference. In England in
2008, 39% of adults had a raised waist circumference
compared to 23% in 19934 which demonstrates an
increase in the number of adults at greater risk of
developing type 2 diabetes mellitus and cardiovascular
disease (CVD). When considering dietary factors
nationally, 25% of men and 27% of women in
2010, reported meeting the government’s ‘5 a day’
guidelines of consuming five or more portions of
fruit and vegetables a day and this has decreased
slightly from 2006 when 28% of men and 32% of
women consumed at least five portions daily5. Local
surveillance and analysis is required to link overweight
and obesity prevalence data and lifestyle behaviours
with patient outcomes to identify how these national
trends are reflected locally.
Tackling obesity involves a variety of measures such
as alterations to diet, changing behaviours (such
as shopping and transport choices) and increasing
physical activity. It is positive to recognise that
according to self-reported measures, physical activity
4Statistics on Obesity, Physical Activity and Diet: England 2010,
The NHS Information Centre for Health and Social Care.
5Statistics on Obesity, Physical Activity and Diet: England 2012,
The NHS Information Centre for Health and Social Care.
participation has increased nationally among both
men and women since 1997, with 39% of men and
29% of women meeting the recommended levels (at
least 30 minutes of at least moderate intensity activity
at least 5 times a week) in 2008 compared with 32%
and 21% respectively in 19974. However, overall
people are still much more inactive than previous
generations and adults who are overweight or obese
spend more time doing sedentary activities than
those who are a healthy weight. In 2008, adults who
were not overweight or obese spent fewer minutes
on average in sedentary time (591 minutes for men,
577 minutes for women) than those who were obese
(612 minutes for men, 585 minutes for women). In
children, boys aged 2 to 15 were more likely than girls
to meet the recommended levels of physical activity
with 32% of boys and 24% of girls reporting taking
part in 60 minutes or more of physical activity on each
of the seven days in the previous week5.
Physical activity should be a significant component
of weight management programmes. Combining
diet and exercise produces greater long-term weight
losses and improvements in cardiovascular risk factors
than programmes using diet alone6,7. The benefit of
adding exercise to a weight loss programme is seen
particularly in the maintenance of weight loss over
time creating a more sustainable improvement for
people8.
Physical activity can provide us with many other health
and wellbeing benefits as well. The reduction of
cardiovascular disease risk provided by physical activity
may be independent of weight loss9. Regular physical
activity can reduce the risk of many chronic conditions
including coronary heart disease, stroke, type 2
diabetes, cancer, obesity, mental health problems
6Stefanik ML. Physical activity for preventing and treating
obesity-related dyslipoproteinemias. Med Sci Sports
1999;31:609-618.
7Wing RR. Physical activity in the treatment of adult
overweight and obesity. Med Sci Sports 1999;31:547-552.
8Perri MG, Sears SF, Jr., Clark JE. Strategies for improving
maintenance of weight loss. Toward a continuous care model
of obesity management. Diabetes Care 1993;16:200- 209.
9Grundy SM, Blackburn G, Higgins M, Lauer R, Perri MG, Ryan
D. Physical activity in the prevention and treatment of obesity
and its comorbidities. Med Sci Sports Exerc 1999; 31:S502-S508.
7
and musculoskeletal conditions. Even relatively small
increases in physical activity are associated with some
protection against chronic diseases and an improved
quality of life5. The benefits of physical activity in
reducing social isolation, promoting community
cohesion and increasing self efficacy are unequivocal
as it can be undertaken in whatever form suits the
individual. For example, a child under five years could
enjoy active play at their local Children’s Centre, a
young family could have a fun afternoon out taking
part in a community bike ride, a teenager may enjoy
sport at school, an adult may like to finish the work
day with a walk home and an older person could
enjoy socialising at their local allotment. Physical
activity opportunities can present themselves in a
great variety of ways.
How can we tackle overweight,
obesity and physical inactivity in
Kingston?
Obesity is arguably the biggest challenge among the
epidemics facing the world today because it is on
the rise in both low and high income countries. No
country has a track record in terms of attenuating
and reversing the epidemic, and it has several
major downstream health consequences in terms
of diabetes, cardiovascular diseases, some cancers
and arthritis that are very common and expensive to
treat10.
The Foresight report ‘Tackling Obesities: Future
Choices’ (2007) explains that the national obesity
epidemic cannot be prevented by individual action
alone. Progress will only be possible if a societal
approach is taken, involving action at multiple levels:
personal, family, community and national11. A whole
system approach is essential if wider cultural changes
to shift societal values around food and activity are to
be realised in Kingston8.
10Swinburn, B. A., Caterson, I., Seidell, J.C., and James, W.P.T.
Diet, nutrition and the prevention of excess weight gain and
obesity: Public Health Nutrition: 7(1A), 123–146.
11Foresight Report, Tackling Obesities: Future Choices –
Summary of Key Message, 2007, Government Office for
Science.
8
The development of this needs assessment has
highlighted key areas of work that will fill some of
the identified gaps in service such as ensuring there
is a local weight management service for 16 to 18
year olds. Partners involved in these care pathways
are committed to working together, sharing expertise
and pooling resources for the development of new
services in Kingston and the recommendations and
action plan in this strategy provide a strong strategic
direction and recognition of the priorities in Kingston.
It is also important for stakeholders to think more
widely than just encouraging people to eat more
healthily and become more active. In Kingston, we
need to consider how the wider determinants of
health such as the built environment can encourage
opportunities for healthier behaviour choices. This
could include the provision of secure cycle parking
and well lit paths to ensure people feel safe to walk
in the borough and reducing access to fast food
establishments on routes near schools. Whilst this
area of work often has less focus than others with
a more tangible immediate impact, it is important
to recognise that all partners across Kingston have
a responsibility to provide healthy opportunities.
These opportunities are best met through effective
partnership working and strong communication and
could include workplace health initiatives, healthy
catering and vending provision in public areas, and
maximising use of green and public spaces including
facilities not usually available to the general public.
After such a successful summer of sport with the
London 2012 Olympic and Paralympic Games, it is
critical to ensure a successful legacy in Kingston. The
message to ‘inspire a generation’ should be carried
through this strategy in order to increase participation
in sport and encourage people to try new sports.
Strategy Development
The development of this strategy involved three
specific stages; service mapping, consultation and a
review of the evidence base.
Stage 1 – Service mapping
In order to establish the needs of the local population,
the current local service provision was mapped and
documented. This involved services that directly
target the problem (in this case overweight, obesity,
physical inactivity and sedentary behaviour) and those
that have a more indirect effect (such as the wider
determinants of health). This process required a high
level of input from many different partners and by
its very nature, will inevitably still have some gaps
depending on the level of engagement achieved. This
will therefore become a working document that can
be updated as and when more services engage with
the process but also to inform a refreshed strategy in
2016.
In order to begin the mapping process, the Public
Health Action Support Team (PHAST) Obesity Support
package12 was used as guidance to collate a list of
all the relevant stakeholders and this was updated
throughout the development of the strategy. The
mapping template was sent to key stakeholders to
complete in order to inform the Stakeholder Mapping
Workshop that was held on 10th February 2012. This
mapping workshop allowed a variety of stakeholders
to add further knowledge and information to the
mapping process. This included listing the services
available to people who live and work in Kingston
and discussing which services were well established
and successful and those not running as successfully
as they could. This led to identifying where gaps
may be in current service provision, and discussing
potential areas where partners could work together to
fill some of these. The information was then collated
and circulated for comment to ensure accuracy and
completeness and portrayed in the form of maps of
the Royal Borough of Kingston to visually display the
geographical spread of services.
12Pheasant, H. Enock, K. PHAST Obesity Care Pathway Support
Package. 2010.
These maps were analysed in comparison with
the population demographics and geographical
prevalence data for overweight, obesity and physical
inactivity for residents in Kingston in order to
provide context. For example, Chessington South
visually appears to have a lack of service provision in
comparison to other areas of the Borough but this
must be considered amongst other relevant factors.
Chessington South has a larger rural area which is
less densely populated with an IMD 2010 score13 in
the middle of the scale (both Full National and Local
scales).
Both the Reception and Year 6 obesity prevalence for
this ward are above the Borough average (prevalence
of 8.0% and 17.3% respectively against the Borough
prevalence of 7.1% and 15.8%). This suggests that
whilst the need here would be less than in Norbiton,
other aspects of service provision will need to be
considered such as accessibility. Norbiton is the only
ward in Kingston categorised as ‘most deprived’
according to the IMD 2010 Full National Scale and
has an obesity prevalence of 9.8% for Reception (the
second highest prevalence in Kingston) and 23.0% for
Year 6 (the highest in Kingston), but there are already
a number of services available to families in the area.
Stage 2 – Consultation
The consultation phase involved engaging with
stakeholders, professionals and members of the
public. Between 12th April 2012 and 25th May 2012,
a total of six focus groups and six electronic surveys
were completed. Three of the focus groups targeted
different professional groups including clinicians,
commercial service providers, and professionals
working on the wider determinants of health such
as environment and planning. A fourth group for
education professionals was cancelled due to low
attendance but an electronic survey was provided as
13The English Indices of Deprivation attempt to measure a
broad concept of multiple deprivation, made up of several
distinct dimensions, or domains, of deprivation. It uses 38
separate indicators, organised across seven distinct domains of
deprivation which were combined, using the weighting in Table
5, to calculate the Index of Multiple Deprivation 2010 (IMD
2010).
9
an alternative and was well received. The remaining
three focus groups were held for members of the
public. These included the Tamil community, the
Somali community, and a third for black and minority
ethnic (BME) groups at the Milaap Centre. Two other
groups for local communities in Norbiton and on the
Alpha Road Estate were planned but cancelled due to
low attendance. Anyone interested in contributing to
the consultation process was directed to the electronic
survey for members of the public.
The six electronic surveys also focussed on different
groups. The survey designed for members of the
public achieved a good response rate of 246
responses. The primary school survey received 133
responses and the secondary school survey 56
responses. The early years settings survey had a low
response rate of only 5 but Children’s Centres had
actively participated in the mapping process and
attended the mapping workshop so it was felt that
their views had been adequately represented. The
surveys for youth settings and wider determinants
of health all had minimal or no responses despite a
wide circulation but it was agreed to link directly with
colleagues working with young people outside of
the original consultation process. Professionals who
worked on the wider determinants of health had
also participated in a focus group and therefore had
alternative opportunities for contributing their views.
The focus group discussions were recorded and
transcribed before undergoing thematic analysis
to identify the key themes that participants raised.
Electronic surveys were created through
www.SurveyMonkey.com and the responses were
evaluated through quantitative analysis. Please see
page 46 (healthy weight) and page 60 (physical
activity) for the key themes identified through this
consultation process.
10
A second stakeholder event held on the 14th May
2012 to report back on the progress of the service
mapping and consultation process. Some electronic
surveys were extended beyond this date to increase
the response rate before final analysis was completed
and circulated to update stakeholders. The second
stakeholder event discussed which of the emerging
key themes should be prioritised by considering the
impact of not tackling the theme and the resources
and capacity available to prioritise it. Stakeholders
were then asked to consider solutions to some of
the barriers that had been highlighted and to think
about new partnerships that might enable a piece of
work to be completed sooner than previously thought
possible. Figure 1 was used to stimulate discussion.
Stage 3 – Evidence base
Professionals from Kingston Public Health Team
conducted literature reviews to ensure the evidence
base was up to date and accurately interpreted for
local policy. National Institute for Health and Care
Excellence (NICE) guidance was used to identify
what local partners should be commissioning or
providing to meet the need. This was reviewed in
line with the completed service mapping and local
consultation (perceived local need), the demographics
of Kingston residents, the resources available locally
and Kingston’s local priorities (from various related
strategies and reports such as the Joint Annual Public
Health Reports, Joint Strategic Needs Assessments,
Children and Young People’s Plan, and Kingston Plan).
Local action plans were developed giving clear
SMART recommendations for tackling overweight,
obesity, physical inactivity and sedentary behaviour in
Kingston. Reporting and governance procedures will
need to be established to ensure the completion of
these recommendations is accurately monitored over
the next three years.
Figure 1
Circle of considerations
Can it be
monitored and
measured?
Is there
potential
to develop
existing
activity?
Are your
objectives
SMART?
Does it
address health
inequalities?
Circle of
Considerations
Does it
require
funding?
Is it cost
effective?
Is it
sustainable?
Does it align
with priorities?
Who is the
service for?
11
Demographics
Demographics
When considering the populations’ need for specific
services, it is vital to consider the demographics of
the population in order to prioritise appropriately.
Table 3 and Figure 2 illustrate that 47% of Kingston’s
usual resident population are aged between 20 years
and 49 years. Adults over the age of 50 years make
up 29% of the population and babies, children and
young adults under the age of 19 years make up
24% of the local population. There are slightly more
females (51%) than males (49%).
Obesity and overweight can cause greater risks
in particular ethnic groups and this requires us to
consider the current ethnic population in Kingston
and how it may change over time. Table 4 illustrates
the predicted change in the ethnic population
between 2011 and 2031. Whilst the majority
of Kingston’s population is white, 23.6% of the
population is currently from black or minority ethnic
(BME) groups and this is expected to increase to
30.7% by 2031.
Obesity prevalence for children is known to be closely
linked to socioeconomic status with higher obesity
prevalence in more deprived areas. Deprivation covers
a broad range of issues and refers to unmet needs
caused by a lack of resources of all kinds, not just
financial.
Table 3
Kingston’s usual resident population by age and gender (2011 Census)
Age group
Male
Female
Person
0-4
5,600
5,400
11,000
5-9
4,500
4,400
9,000
10 - 14
4,200
4,400
8,500
15 - 19
4,900
5,000
9,900
20 - 24
6,400
7,100
13,500
25 - 29
6,200
6,200
12,400
30 - 34
6,600
6,800
13,400
35 - 39
6,700
6,700
13,400
40 - 44
6,100
6,100
12,200
45 - 49
5,500
5,700
11,100
50 - 54
4,800
4,700
9,500
55 - 59
4,000
4,000
8,000
60 - 64
3,900
4,100
8,000
65 - 69
2,800
2,900
5,700
70 - 74
2,100
2,400
4,500
75 - 79
1,700
2,100
3,800
80 - 84
1,200
1,800
3,000
85 - 89
700
1,400
2,100
90 and over
300
900
1,200
78,100
82,000
160,100
All ages
Source: Office for National Statistics © Crown Copyright 2012
Notes:
1.The main population base for outputs from the 2011 Census is the usual resident population as at census day (27 March 2011).
2.Figures in this table may not add exactly because they have been rounded to the nearest 100.
12
Demographics
Figure 2
The age and gender of Kingston’s resident population (2011 Census)
900 1,400 1,800 2,100 2,400 2,900 300 700 1,200 1,700 2,100 2,800 4,100 4,000 4,700 5,700 6,100 6,700 6,800 6,200 7,100 5,000 4,400 4,400 5,400 8,000 6,000 3,900 4,000 4,800 5,500 6,100 6,700 6,600 6,200 6,400 4,900 4,200 4,500 5,600 4,000 2,000 0 Female 2,000 4,000 6,000 8,000 Male Source: GLA 2011 Round Ethnic Group Projections - SHLAA high Fertility, © Greater London Authority, 2012
Table 4
Projected ethnic population of Kingston over time
Ethnic Group
2011
2016
2021
2026
2031
All Ethnicities
158,851
165,236
169,446
172,063
173,723
White
Ethnic Composition
in 2031
121,336
122,131
122,540
122,770
123,015
70.80%
Black Caribbean
1,162
1,293
1,374
1,422
1,456
0.80%
Black African
2,365
2,689
2,883
2,989
3,044
1.80%
Black Other
1,369
1,475
1,540
1,576
1,590
0.90%
Indian
7,695
8,554
9,122
9,469
9,710
5.60%
Pakistani
2,794
3,076
3,238
3,322
3,374
1.90%
Bangladeshi
598
712
804
875
929
0.50%
Chinese
3,368
3,944
4,379
4,685
4,898
2.80%
Other Asian
7,079
7,901
8,496
8,877
9,091
5.20%
Other
11,086
13,461
15,072
16,079
16,614
9.60%
Black & Minority Ethnic
Population (BME)
37,516
43,105
46,906
49,294
50,709
23.60%
26.10%
28.40%
29.80%
30.70%
BME Proportion
30.70%
Source: GLA 2011 Round Ethnic Group Projections - SHLAA high Fertility, © Greater London Authority, 2012
13
Map 1 and Map 2 illustrate the geographical spread
of different levels of deprivation in Kingston using the
Full National Scale and the Local Scale respectively.
Norbiton remains the most deprived area in Kingston
and includes one Lower Super Output Area (LSOA)
ranked amongst the 20% most deprived areas in
England. Other deprived areas include LSOAs in Grove,
Canbury and Berrylands.
Map 3 and Map 4 illustrate the prevalence of obesity
by ward level for Reception aged children and Year 6
children respectively. St James and Norbiton wards
have the highest prevalence of obesity in Reception
year and Norbiton and Old Malden wards have
the highest prevalence of obesity in Year 6. The
relationship between obesity and socioeconomic status
may be well documented but it is clear from these
maps that the link between obesity and deprivation
(unmet needs caused by a lack of resources of all
kinds, not just financial) is not quite so easily explained.
As described earlier in this strategy, Norbiton is the
only ward in Kingston categorised as ‘most deprived’
according to the IMD 2010 Full National Scale and
has an obesity prevalence of 9.8% for Reception (the
second highest prevalence in Kingston) and 23.0% for
Year 6 (the highest in Kingston). Whilst this concurs
with the theory, it should be noted that St James
and Old Malden are generally much less deprived
(apart from one pocket that has a lower IMD score
than the close surrounding areas) but still have a high
prevalence of obesity. This information is useful for
ensuring services are targeted appropriately and areas
of high need don’t ‘slip through the net’.
Map 1
IMD 2010 Deprivation in Kingston (Full National Scale)
Most Deprived
Less Deprived
14
Deprivation in Kingston
2010 IMD - Full National Scale
Demographics
Map 2
IMD 2010 Deprivation in Kingston (Local Scale)
Deprivation in Kingston
2010 IMD - Local Scale
Most Deprived
Less Deprived
15
Map 3
Prevalence of childhood obesity (percentage) by ward level (Reception age)
Child obesity (%) Reception
Higher prevalence
Lower prevalence
9.76 to 1 1.3 9.33 to 9 .76 7.29 to 9 .33 6.25 to 7 .29 3.62 to 6 .25 values suppressed due to low numbers 16
Demographics
Map 4
Prevalence of childhood obesity (percentage) by ward level (Year 6)
Child obesity (%) Year 6
Higher prevalence
20.4 to 2 3.1 17.1 to 2 0.4 15 to 1 7.7 12.3 to 1 5 9.6 to 1 2.3 Lower prevalence
17
Achieving and maintaining a Healthy Weight
Why is obesity such an important
issue?
The causes of obesity are complex. It is widely
acknowledged that the development of child,
adolescent and adult obesity is an interaction
between the obesogenic environment, our biology
and personal lifestyle choices which ultimately make
it harder for people to make healthy choices. The
Foresight report (2007)14 highlighted over 100 factors
that directly or indirectly influence energy balance
and consequently our vulnerability to gain weight
(refer to Table 5). Thus the prevention and treatment
of obesity depends on sustained action at all levels of
society and government from health professionals, to
educating teachers, local authority, and community
workers, to the individual (adults, parents and
children). Furthermore, regulating and working with
the food industry and media is also essential. This is
all necessary to achieve a cultural shift in improved
nutrition and increased physical activity to change the
energy balance system in order to decrease the levels
of overweight and obesity in children and adults.
Table 5
Factors influencing obesity and energy balance based on Foresight (2007)
Foresight themes
Factors influencing obesity
Biology
Genetics, pregnancy (foetal programming15), early life experiences and growth patterns16 (including breast feeding,
weaning, adiposity rebound)
Activity environment
Safety to be active, facilities available, costs, home & school environment, opportunities to be active and play e.g.
parks, playing fields, footpaths, increase in screen time (TV, computers and electronic devices) from an early age
Physical activity
Type, frequency and intensity of daily activities (including playtime and physical education in schools)
Societal influences
Media (food advertising), education, peer pressure, culture
Individual psychology
Personal (psychological) drive for particular foods, likes and dislikes, ingrained habits, stress, self-esteem, parenting and
feeding styles
Food environment
Availability and accessibility to healthy food, exposure to fruit and vegetables, mealtime environment at home, in
the workplace and school, food consumed out of home, school or the workplace (fast-food takeaways, convenience
foods), low-cost availability of high energy foods (e.g. BOGOF’s = buy-one-get-one-free)
Food consumption
Nutritional quality of foods, energy density and quantity (portion sizes), meal and snacking patterns and routines
14Foresight (2007). Government Office for Science. Tackling
obesities. Future choices-project report. http://www.bis.gov.
uk/foresight/our-work/projects/published-projects/tacklingobesities/reports-and-publications (accessed July 2012)
15http://www.thebarkertheory.org/publications.php
16Barker D. Obesity and early life. Obesity Reviews. 2007, 8
(Suppl. 1), 45–49
18
What defines overweight and obesity?
Overweight and obesity are defined as abnormal
or excessive fat accumulation that may impair
health17.
Body Mass Index (BMI) is a person’s weight in
kilograms divided by the square of their height in
metres (weight (kg) ÷ height (m)2). It is the most
commonly used measure to monitor the prevalence
of overweight and obesity at population level. People
classified as overweight or obese are more likely to
experience health problems compared to somebody
of a healthy weight17.
BMI is advantageous in that it is an acceptable,
easy, cheap and non-invasive means of estimating
excess body fat. Direct measures of body fat such
as computer tomography (CT), magnetic resonance
imaging (MRI), bio-electrical impedance analysis (BIA)
or dual energy X-ray absorptiometry (DEXA) scan can
be expensive and impractical to perform on a large
population scale17.
Although BMI is commonly used to classify individuals
as overweight or obese, it can have limitations at an
17World Health Organisation (WHO). http://www.who.int/
mediacentre/factsheets/fs311/en/index.html (accessed
November 2012)
individual level. Factors such as muscle mass, ethnic
origin and puberty can alter the relationship between
BMI and body fatness so these factors need to be
considered18. Using multiple or alternative ways to
measure weight status and body composition in
these groups can be useful (e.g. waist circumference).
However, whilst alternative anthropometric measures
can be useful for assessment at an individual level,
they can also have accuracy limitations when used on
a large scale and therefore care must be taken when
analysing data.
There is widespread national and international support
for the use of BMI to clinically diagnose obesity in
adults, children and adolescents18,19. Despite its well
documented limitations as an absolute measure of
body fat it is also the most practical measure of excess
body fat in children20, 21.
18National Institute for Health and Care Excellence (NICE).
Obesity: guidance on the prevention, identification,
assessment and management of overweight and obesity in
adults and children. Clinical guideline 43. London: NICE; 2006.
19Scottish Intercollegiate Guidelines Network (SIGN).
Management of obesity. SIGN publication no. 115. Edinburgh:
SIGN; 2010
20Reilly JJ. Assessment of obesity in children and adolescents:
synthesis of recent systematic reviews and clinical guidelines. J
Hum Nutr Diet 2010;23:205-11.
21Dinsdale H, Ridler C, Ells L J. A simple guide to classifying body
mass index in children. Oxford: National Obesity Observatory,
2011
19
Adult BMI diagnostic criteria
Child BMI diagnostic criteria
Table 6 illustrates how BMI measurements are used to
classify an adult (aged 18+) as underweight, healthy
weight, overweight or obese.
BMI in children changes as they grow, it is a not a
constant figure. It differs between boys and girls and
changes as children get older so it is crucial that BMI
is adjusted for age and gender to accurately assess
and interpret the degree of obesity and the relative
health risk when measuring children. Child BMI is
measured and compared to a growth reference in
order to determine a child’s weight status which is
then reported as BMI centiles. In the UK, the UK1990
growth reference is used for children aged five years
and over. From May 2009 new UK growth charts
using the WHO standard were introduced for children
from birth to four years in the Personal Child Health
Records. In May 2012 new charts for assessing the
growth of school-age children and young people
combining data from the UK-WHO 0-4 years and
UK1990 4-18 years were launched by the Royal
College of Paediatrics and Child Health (RCPCH)25.
Both charts include a BMI centile look-up which makes
assessing BMI and degree of overweight a lot easier in
the clinical setting without having to calculate BMI
and use multiple growth charts for a diagnosis.
Table 6
Clinical diagnostic criteria for overweight
and obesity in adults combining BMI and
waist measurement to classify the risk
of developing type 2 diabetes, CVD and
other co-morbidities.
Weight
Classification
BMI (kg/
m²)
Disease risk relative to a
healthy weight & waist
circumference (cm)
Women 80-88 Women >88
Men 94-102
Men >102
Underweight
<18.5
Healthy Weight
18.5 - 24.9
Overweight
25 - 29.9
Increased
High
Obesity I
30 – 34.9
High
Very high
Obesity II
35 – 39.9
Very high
Very high
Obesity III
40 or more Extremely high
Increased
Extremely high
Source: NICE18, NHMRC22 and WHO23
BMI may underestimate body fatness in some
population groups e.g. South Asian and older
people. Co-morbidity risk is higher at lower BMIs.
Until specific-cut-offs are validated, South Asian,
Chinese and Japanese individuals may be considered
overweight at BMI >23 kg/m2 and obese at >27.5
kg/m2 and Asian men with a waist circumference of
>90cm at risk19.
Table 7.
Clinical diagnostic criteria for overweight
and obese children and young people
(aged <18) in the UK.
Clinical terminology
Overweight*
Obesity*
Severe obesity*
Very severe obesity**
Extreme obesity**
BMI centiles*
SDS or z-score*
≥91st centile
≥+1.33 SDS
≥98th centile
≥+2 SDS
≥99.6th centile
≥+2.67 SDS
≥+3.5 SDS
≥+4 SDS
*defined relative to the UK 1990 reference chart for age and sex.
**Definitions as per SIGN 115 Quick Reference Guide p.9,
201019 & Obesity Services for Children and Adolescents (OSCA),
Appendix E, 201026.
22National Health & Medical Research Council. Clinical practice
guidelines for the management of overweight and obesity in
adults
23Obesity: preventing and managing the global epidemic.
Report of a WHO Consultation. WHO Technical Report Series
894[3], i-253. 2000. World Health Organisation.) 2003
24WHO Expert Consultation. Appropriate body-mass index
for Asian populations and its implications for policy and
intervention strategies. The Lancet. 2004; 363(9403) 157-163.
20
25http://www.rcpch.ac.uk/growthcharts
26Obesity Services for Children and Adolescents (OSCA) Network
Group. OSCA consensus statement on the assessment of
obese children & adolescents for paediatricians. London:
Royal College of Paediatrics and Child Health (RCPCH) 2010
Impact of obesity
Obesity is a complex and chronic condition. Carrying
extra fat leads to serious health consequences such
as cardiovascular disease (mainly heart disease and
stroke), type 2 diabetes, musculoskeletal disorders
like osteoarthritis, and some cancers (endometrial,
breast and colon)27. This risk of disease rises with
Body Mass Index (BMI). A recent review of 57
international prospective studies found that BMI is a
strong predictor of mortality among adults. Overall,
moderate obesity (BMI 30-35 kg/m2) was found to
reduce life expectancy by an average of three years,
while morbid obesity (BMI 40-50 kg/m2) reduces life
expectancy by 8-10 years, equivalent to the years lost
by a lifetime of smoking28.
insulin resistance and early onset type 2 diabetes,
fatty liver, impaired fertility and psychological effects
such as a low self-esteem, poor body image, and
emotional distress from bullying and teasing29.
Costs of obesity
In the UK the Foresight report estimated that direct
health care costs attributable to being overweight
or obese were £4.2 billion, potentially rising to £6.3
billion in 2015 and up to £9.7 billion by 205010. A
more recent analysis estimated that being overweight
or obese costs the NHS £5.1 billion per year30.
However, obesity isn’t solely an economic burden of
the NHS; indirect costs have been estimated to be as
much as £27 billion by 2015. This is because obesity
also affects an individual’s ability to work and their
underlying mental health, thus attributing to sickness
absence and working days lost due to premature
deaths attributable to obesity31.
There is substantial evidence to suggest that adult
obesity is a long term consequence of obesity in
childhood and that it is even more likely an obese
child will become an obese adult if at least one of
their parents is obese29. The health consequences of
children carrying excess fat is significant, evidence
shows that children carrying excess weight are at
a higher risk of developing cardiovascular disease,
hypertension, asthma, joint problems, dyslipidaemia,
The estimated annual costs to the NHS of diseases
related to overweight and obesity (BMI 25kg/m2 or
more) and obesity alone (BMI 30kg/m2 or more), for
Kingston are provided in Table 8. By 2015 it could be
in excess of £44 million.
27http://www.who.int/features/qa/49/en/index.html
28Prospective Studies Collaboration. Body-mass index and causespecific mortality in 900 000 adults: collaborative analyses of
57 prospective studies. Lancet: 2009:1083-1096
29Reilly JJ, Methven, E. McDowell ZC, B Hacking B, Alexander D,
Stewart, L Kelnar CJH. Health consequences of obesity. Arch
Dis Child 2003;88:748–752
30 Scarborough P, Bhatnagar P, Wickramasinghe K et al. The
economic burden of ill health due to diet, physical activity,
smoking, alcohol and obesity in the UK: an update to 200607 costs, Journal of Public Health, vol. 33 no. 4, May 2011, pp.
527–535.
31Morgan E. and Dent M. The economic burden of obesity.
Oxford: National Obesity Observatory, 2010.
Table 8.
Kingston’s estimated costs of obesity and diseases related to overweight and obesity
(e.g. diabetes, CVD, cancer)
Estimated annual costs to NHS of diseases
related to overweight and obesity £ million
Kingston
Estimated annual costs to NHS of diseases
related to obesity £ million
2007
2010
2015
2007
2010
2015
39.7
41.1
44
20.6
22.3
25.6
These costs have been estimated using the national estimates
calculated by Foresight32
32K. Swanton. Healthy Weight, Healthy Lives: A toolkit for
developing local strategies, Dept. of Health 2008
21
National and local trends
Adults
Nationally, trends in adult overweight and obesity
continue to rise with the majority of the adult
population are carrying excess weight. Recent
prevalence data indicates 63% of adults are
overweight or obese with obesity rates at an all-time
high of 26% in England for both men and women33.
Table 9
Prevalence of overweight and obesity in
children and adults
Children 4-5
years old
Children 10-11
years old
Children 11-15
years old
All adults
Adults 45-74
years old
% obese
9%
19%
18%
26%
Over 30%
% overweight
or obese
23%
33%
34%
63%
Over 70%
Source: Health Survey for England (2010) and National Child
Measurement Programme 2010-11
One of the biggest public health challenges faced
with the increasing prevalence is the lack of weight
status recognition. A considerable proportion
of overweight adults (men in particular) do not
recognise that their body weight is too high. A recent
comparison of data from two population surveys
showed that fewer overweight and obese people
defined themselves as overweight in 2007 than in
1999. The changes indicate a marked decline in the
ability of overweight individuals to recognise that their
weight is too high34.
Despite media and health campaigns aiming to raise
awareness of healthy weight, increasing numbers
of overweight people fail to recognise that their
weight is a cause for concern. It is likely this is due to
social comparisons and the development of societal
33Information Centre. Department of Health. Health Survey for
England. Summary of key findings for 2010. 2011
34Johnson F, Cooke L, Croker H, and Wardle J. Changing
perceptions of weight in Great Britain: comparison of two
population surveys. BMJ. 2008;337:a494.
22
weight norms, which suggests that the threshold
for perceived overweight is rising in line with the
increasing weight in the population. International
data has suggested that perceptions of overweight
are related to levels of overweight in the local
population35. Extreme images used in the media to
depict obesity leads to people being ‘reassured’, the
message is not for them this makes it less likely that
an individual will view campaigns for weight control
as personally relevant. This highlights the utmost
importance of training health professionals to help
them raise the issue of weight in an appropriate way
without disengaging the patient.
Locally in Kingston 16.7% of adults are obese36. UK
data shows that obesity increases with age for both
men and women, with the highest prevalence in
people aged 45-74 years at over 70%28. In Kingston it
is expected that the largest increase in the population
will be within this age group37. Coupling this, rates
of morbid obesity (defined as a BMI >40kg/m2) are
around 2.5% nationally and shown to be consistently
higher in women than men (3.1% and 1.4%
respectively)38.
The impact of increasing levels of obesity on weightrelated diseases (cancer, heart disease and stroke) is
estimated for Kingston in Table 10 using the Health
Profiles Data Tables (data period 2006-2008)39. These
figures demonstrate that interventions are needed to
not only reduce disease prevalence but also reduce
the number of deaths caused that are directly related
to obesity by achieving a clinically effective weight
loss of 5-10%.
35Wardle J, Haase AM, Steptoe A. Body image and weight
control in young adults: international comparisons
in university students from 22 countries. Int J Obes
(Lond)2006;30:644-5.
36Kingston Upon Thames. Health Profile. Dept. of Health 2012
37Joint Annual Public Health Report for Kingston 2011/2012.
Live Long and Prosper; The Next Generation.
38Information Centre for health and social care. The health
survey for England - 2009 trend tables. London: Health and
Social Care Information Centre, 2010.
39Supporting commissioning of adult weight management
services. Department of Health. 2010
Table 10.
Risk of cancer, heart disease and stroke
attributable to obesity in Kingston
Number of
deaths
Estimated number
of those deaths
caused by obesity
Cancer
411
34
Heart Disease and
Stroke
257
79
Adult obesity and socio-economic class
In the UK there is a higher prevalence of obesity in
women from deprived areas, however the pattern is
less straightforward for men with only some measures
of deprivation showing a relationship with obesity40.
Despite Kingston’s overall affluence, some wards are
among the 20 per cent most deprived in the country
(see Demographics chapter) so it is essential this
is taken into consideration in service planning and
provision.
Adult obesity and ethnicity
There is little nationally representative data on obesity
prevalence in adults from minority ethnic groups
in the UK. The Health Survey for England in 2004
included a ‘boost’ sample from ethnic minority
groups which showed that women from Black African
groups appear to have the highest prevalence of
obesity and men from Chinese and Bangladeshi
groups the lowest. However, research has shown that
BMI may overestimate obesity among Africans and
underestimate obesity in South Asians. Using adjusted
thresholds for these ethnic groups could improve
obesity estimates as referred to in the adult diagnostic
criteria section. Kingston has an increasing proportion
of the population (estimated to be approximately
16% by 2031) from a South Asian origin which
should be reflected in future weight management
service planning.
40National Obesity Observatory (2011). NOO Data Briefing.
Adult Obesity and Socioeconomic Status.
With increasing levels of obesity and morbid obesity
and an ageing population it is likely that this will
not only increase the need further, for the number
of people eligible for bariatric surgery but also the
prevalence of maternal obesity which is now an
increasing public health concern.
Morbidly obese population and
bariatric surgery
The number of NHS commissioned bariatric surgery
procedures in England has increased in recent years
from around 470 in 2003/2004 to over 6,500 in
2009/2010, which is equivalent to less than 1%
of adults with morbid obesity41. At a local level
it has been estimated (using the NICE Bariatric
commissioning tool) that approximately 1000-1200
people have BMI >35 with comorbidities or BMI >40
in Kingston. A further 50-60 people are estimated
to have a BMI >50 and are therefore potentially
eligible for referral to bariatric surgery in the future.
Approximately 30-50% of the population that meets
the criteria would typically take up surgery if it was
offered to them, so for Kingston this would be in the
region of over 300 individuals42. Figure 3 clearly shows
a year on year increase in the number of procedures
being carried out over the past 3 years in Kingston,
with 27 procedures already recorded up until the end
of October 2012. If this trend continues the number
of procedures could increase to around 50 a year by
2013/2014.
41Bariatric Surgery. National Obesity Observatory briefing paper.
2010
42Bariatric surgical service for the treatment of people with
severe obesity. Commissioning Guide. NICE. December 2007
23
Figure 3.
Number of bariatric procedures for Kingston patients
Maternal obesity
Children
Although statistics for the prevalence of maternal
obesity are not collected routinely in the UK, a
recent large epidemiological study showed that
the prevalence of obesity in the first trimester has
doubled from 7.6% to 15.6% over a period of
19 years (between 1989 and 2007)43. Kingston
data highlighted within the Joint Strategic Needs
Assessment for Kingston 2010-2011, showed that
9.5% of the 2,005 pregnant women booked who
delivered at Kingston Hospital in 2010 had a BMI >30
kg/m2 44,45. Maternal obesity puts both the health of
the mother and infant at risk and increases pressure
on service providers. Women who are obese are
significantly more likely to be older in pregnancy, have
a higher parity and are more likely to live in areas of
high deprivation, compared with women who are not
obese.
At a national level Table 9 shows that levels of
overweight and obesity increase with age as children
grow older. Locally 30.9% of children in Year 6
(aged 10-11) are either overweight or obese, with
the change in the number obese between age 4-5
to age 10-11 almost doubling46. A key issue here is
the lack of parental ability to recognise their child’s
weight status with research showing that more than
half of parents do not recognise when their child is
overweight47. The lack of weight concern in adults
and the social norming effect of more children and
adults now carrying unhealthy amounts of weight
presents a huge challenge locally. The first barrier
to cross is raising the awareness of a child’s weight
status, particularly what defines overweight and
obesity and what it means to health risks now and
in the future. The local NCMP scheme plays an
important role in providing feedback to parents about
their child’s weight.
43 Heslehurst N, Rankin J, Wilkinson JR, Summerbell CD. A
nationally representative study of maternal obesity
in England, UK: trends in incidence and demographic
inequalities in 619 323 births, 1989-2007. Int J Obes (Lond).
2010 Mar;34(3):420-8
44 Bhogal. S. Obesity in pregnancy – needs assessment for
Kingston. March-July 2011
45 Joint Strategic Needs Assessment for Kingston, 2010-11
24
46 Information Centre for health and social care. NCMP: England,
2010/11 school year. December 2011
47 Parry LL, Netuveli G, Parry J, Saxena S. A systematic review
of parental perception of overweight status in children. J.
Ambul. Care. Manage 2008;31:253-68.
Due to the recording of child postcode as part of the
NCMP the National Obesity Observatory (NOO) have
published reliable estimates of child obesity by area
of residence for small geographic areas. This data
combines three years of measurements (2008/2009,
2009/2010, 2010/2011) and therefore provides a
much clearer picture of the current child population
weight status of residents and the breakdown at
ward level. Please refer to Table 11, Figures 4 and 5
and back to Maps 3 and 4 to show the spread across
Kingston48,49.
Data indicates that there are 2,087 children in
Kingston that are carrying excess weight between
the ages of 4 to 6 years old (833) and 10-12 years
old (1,254). The likely population distribution of this
across the borough is represented in Figures 4 and
5, this information is crucial when planning and
targeting services appropriately.
48Electoral Ward and Middle Super Output Area NCMP obesity
prevalence. National Obesity Observatory. 2012
49Clinical Commissioning Group (CCG) child prevalence data by
BMI category NCMP. National Obesity Observatory. 2012
Total number
measured
Excess weight (including
overweight and obesity)
Underweight
Obese
Excess weight
(including
overweight and
obesity)
Underweight
Total number
measured
Table 11
Detailed breakdown of child weight status in Kingston by BMI category for KCCG of
residence, including total number of children and prevalence (%)
Obese
No.
%
No.
%
No.
%
Reception (age 4-5)
4,857
78
1.6
833
16.6
347
7.1
Year 6 (age 10-11)
4,145
68
1.6
1254
24.4
660
15.9
25
Figure 4
NCMP Reception year prevalence of obesity at ward level in Kingston based on
combined data from 2008/2009 to 2010/2011
Where no data is shown on this graph, ward values have been suppressed due to the number of children classified as obese being
N.B.
less than or equal to five.
26
Ward level NCMP data shows that some areas in
Kingston are above both the national and regional
(London) obesity prevalences. Figure 4 shows that
for Reception Year, St James has the highest level of
obesity (11.3%), with Norbiton the second highest
(9.8%), and Alexandra and Tolworth and Hook Rise
being joint third highest (9.6%). Figure 5 shows that
for Year 6, Norbiton ward has the highest levels of
obesity (23%) and Old Malden has the second highest
(20.7%), with Chessington North and Hook third
highest (20.1%). Some of these areas tend to fall in
line with already identified areas of deprivation in
Kingston namely Norbiton and Chessington. Please
see Maps 3 and 4 on pages 16 and 17.
Figure 5
NCMP Year 6 prevalence of obesity at ward level in Kingston based on combined data
from 2008/09 to 2010/11
27
Child obesity and socio-economic class
Obesity prevalence is strongly associated with
deprivation in children. National NCMP data for both
Reception and Year 6 shows a steady rise in obesity
with increasing deprivation according to the Index
of Multiple Deprivation (IMD)40. Local data paints
a similar picture with levels of obesity rising with
deprivation, notably the level of obesity is much
higher than the Kingston averages of 7.1% for
Reception age and 15.8% for Year 6 for children
living in the most deprivation. (Figures 6 and 7)
Figure 6
Prevalence of obesity for all Reception children in Kingston by national deprivation
decile (based on combined data from 2008/09 to 2010/11)
Prevalence of obesity (≥95th centile)
N.B data has been suppressed where the count (number measured) is <50 for any deprivation decile, this explains the missing
data in Figure 6
28
Figure 7
Prevalence of obesity for all Year 6 children in Kingston by national deprivation decile
(based on combined data from 2008/09 to 2010/11)
Prevalence of obesity (≥95th centile)
N.B data has been suppressed where the count (number measured) is <50 for any deprivation decile, this explains the missing
data in Figure 7
29
Child obesity and ethnicity
Interestingly the NCMP overweight and obesity
prevalence data by ethnic group for Kingston it clearly
shows higher levels of excess weight in children
from minority ethnic groups compared to children
from a white background at both Reception and
Year 6. In Reception year the highest proportion of
children overweight and obese are from the Black
communities at 26.9%. In Year 6 there is a less
dominant pattern with the highest prevalence seen
in children from the ‘Other’ ethnicity group which
includes Chinese (36.2%) but closely followed by
the Black (34.9%) and Asian (34.5%) communities.
All three of these ethnic groups are above the local
average for Kingston.
Figure 8
Prevalence of overweight and obesity for all Reception children by ethnic group (based
on combined data from 2008/09 to 2010/11)
Prevalence of overweight including obese (≥85th centile)
Figure 9
Prevalence of overweight and obesity for all Year 6 children by ethnic group (based on
combined data from 2008/09 to 2010/11)
30
Prevalence of overweight including obese (≥85th centile)
Child obesity and disability
A recent report by ChiMat (Child and Maternal
Health Observatory) analysed participants in the
Health Survey for England aged 3 to 18 years old
to explore the prevalence of obese and overweight
children in a population classified as having a limiting,
longstanding illness and learning disability. Results
showed that 40% of children aged under 8 years
old with a limiting illness and learning disability are
obese or overweight compared to 22.4% of children
who have neither condition. This actually increases
to almost 45% of children classified as overweight
or obese in the 8 to 13 years age group50. In effect
this report indicates that children who have a limiting
illness are more likely to be obese or overweight,
particularly if they also have a learning disability. This
highlights the importance of ensuring this population
is considered when reviewing the monitoring,
provision and accessibility of healthy weight services
available in Kingston.
Policy drivers: National and regional
Foresight projected that if no action was taken 25%
of all children under 16, 60% of men and 50% of
women could be obese by 205014. ‘Healthy Lives,
Healthy People: A call to action on obesity in England’
(2011) high-lights the need to adopt a life course
approach (from pre-conception through pregnancy,
infancy, early years, childhood and adolescence,
through to adulthood and older age) rather than just
focusing on preventing childhood obesity. There is
a national need and priority to ensure that effective
and tailored support for adults and children who are
already overweight and obese is in place. At a local
level successful strategies need to strike a balance
between ‘treatment’ interventions that help people
reach a healthier weight while continuing preventative
approaches to help reverse the downward trend of
individual’s maintaining a healthy weight51.
50ChiMat (Child and Maternal Health Observatory). Disability
and obesity: the prevalence of obesity in disabled children.
July 2011
51Department of Health (2011). Healthy Lives, Healthy People:
A call to action on obesity in England.
The new national ambition for obesity
is to achieve;
●● a sustained downward trend in the level of
excess weight in children by 202012
●● a downward trend in the level of excess weight
averaged across all adults by 2020
At population level the Department of Health’s
Change4Life campaign has evolved rapidly since its
launch in 2009 and is now slowly becoming a
recognised and established brand in the UK (see www.
nhs.uk/Change4Life/Pages/change-for-life.aspx).
It is a society-wide movement that aims to prevent
people from becoming overweight by encouraging
them to eat better and move more. Initially aimed at
families with children aged 5-11 years it has grown to
targeting parents of children aged 1-4 years old (Early
Years) and new parents with babies (Start4Life).
Change4Life will continue to be the marketing
programme for all health-related behaviours for families
with children aged under 11 years and for middle-aged
adults (Don’t stop it, Swap it)52, alongside an alcohol
campaign for reducing ‘lower risk’ drinkers. Extensive
resources are available for the public and providers from
various settings who would like to become involved in
the campaign (www.nhs.uk/change4life/pages/
resource-casestudy.aspx). Change4Life has been
promoted at a local level through Change4Life
Kingston and in schools (Change4Life Primary/Sports
Clubs), children centres, workplace health initiatives and
local health events. To date there are 2,735 Kingston
residents who have registered with the national online
Change4Life scheme since it was launched in 2009.
At a regional level, the Greater London Authority have
identified childhood obesity as a priority area for action
at a city level to improve the health of children in
London boroughs. Efforts will focus on refreshing the
Healthy Schools programme for London, building upon
the physical activity and sports programme galvanised
by the 2012 Olympic Games legacy and developing a
strategic framework to join up interventions that
focus on the concept of ‘healthy places’53.
52Department of Health (2011). Change4Life Three Year
Marketing Strategy.
53London Health Improvement Board (LHIB). Tackling Childhood
Obesity in London. Executive Summary. 24th Oct, 2011
31
Policy drivers: Local
Kingston has made substantial progress in
commissioning and implementing child and adult
weight management treatment services since its first
strategy in 2006. These services have been developed
to help meet the needs of the local population,
following on going recommendations in the local
Joint Strategic Needs Assessments (JSNAs, 20072010) and the Joint Annual Public Health Reports
(JAPHRs 2007-2011). At local authority level it is a
clear goal in the Kingston Plan that reducing levels
of obesity at all ages (starting at primary age) is part
of the Safe, Healthy and Strong strategic objective
(Theme 3, Objective 8)54. Within the local NHS, it is
also outlined in the Kingston Clinical Commissioning
Group (KCCG) commissioning strategy55 as part of
the prevention of ill health to continue to commission
weight management interventions targeting different
age groups to treat and prevent obesity.
54Kingston Plan. Kingston’s vision for 2020. 2009
55Kingston Clinical Commissioning Group (CCG) commissioning
strategy plan 2012/2013 to 2013/2014 (Dec.2011)
Figure 10
National, regional and local policy drivers for tackling obesity
Priority to reduce levels of obesity at all ages by treating and preventing
Public Health
Responsibility Deal
(DH)
Change4Life
(DH)
National
• Healthy Lives, Healthy People:
A call to action on obesity. DH 2011
• Healthy Weight-related statutory services
e.g. Healthy Start, NCMP, NHS Health Checks
Obesity
Clinical
Guidelines
NICE CG43 &
SIGN 115
Regional
• London obesity framework
• Healthy Schools
Local NHS
Kingston Clinical
Commissioning Group (KCCG)
Strategy Plan 2012/13 to 2013/14.
Weight-related medical conditions
Diabetes
Coronary Heart Disease
Certain cancers
(womb, breast , bowel)
Mental Health
32
Kingston
Public Health
JSNA
JAPHR
Kingston
Health & Wellbeing Board
Local authority
Kingston Plan.
Kingston’s vision for 2020.
Related RBK strategies
Children & Young Peoples Plan
Child poverty
Equality & Community
Engagement Plan
Housing strategy & regeneration
Evidence: what works and what’s
needed?
The factors influencing obesity and energy balance
have already been outlined in Table 5. There is a
wide range of evidence that relates to the causes of
excess weight gain which can help generate solutions
however there is still a current lack of scientific
evidence for strategies and solutions on how to
effectively prevent and treat it10. This is not surprising
considering the difficulty in undertaking long term
evaluation studies, plus there is a strong argument
that in evaluations of public health interventions,
randomised controlled trials are not sufficient by
themselves56. Given the importance of tackling obesity,
interventions that aim to reduce overall energy intake,
alongside increasing physical activity need to be
implemented even when some of the evidence base
may be lacking.
Promotion of healthy weight/
prevention of obesity
Foresight provides a comprehensive review of the
current evidence-base for the prevention of obesity
which includes the context of the life course,
behaviour change and the wider environment10. This
alongside other more recent systematic reviews of
evidence by NICE (2007)18, SIGN for the management
of obesity (2010)19, The World Cancer Research Fund
(2009)57 and a Cochrane review on interventions
for preventing obesity in children58 provides sound
guidance on how to tackle it at a local level. Overall
evidence suggests that interventions for promoting a
healthier weight should focus on:
56Victoria C, Habicht J, Bryce J. Evidence-based public health:
moving beyond randomized trials. Am J Public Health.` 2004;
94: 400–405.
57World Cancer Research Fund, American Institute for
Cancer Research. Food, Nutrition, Physical Activity and the
Prevention of Cancer: a Global Perspective. London; WCRF.
Washington DC, AICR; 2009. [cited 22 Dec 2009]. Available
from url: http://www.dietandcancerreport.org/
58Waters E, de Silva-Sanigorski A, Hall BJ, Brown T, Campbell KJ,
Gao Y, Armstrong R, Prosser L, Summerbell CD. Interventions
for preventing obesity in children. Cochrane Database of
Systematic Reviews 2011, Issue 12. Art. No.: CD001871. DOI:
10.1002/14651858.CD001871.pub3
●● Multicomponent interventions, using
behavioural approaches aimed at changing diet
and physical activity patterns and achieving long
term changes that are tailored and marketed to the
target population.
●●A combination of approaches, in the
community (neighbourhood, workplace, school),
at the individual and the wider environment
(planning, access to healthy food, quality of food
establishments, transport etc.) to help people make
healthier food choices and be more active.
●● Whole family approaches. Interventions
involving parents, carers, siblings or peers with
similar issues (for weight, diet or inactivity) prove
more successful than those that target individuals
alone. Parents and carers should be encouraged to
take responsibility for lifestyle choices in children
and young people. Programmes should be age
appropriate, accounting for the level of maturity
of the child and acknowledging the differing
preferences of child and adolescent populations.
●● Major socio-economic determinants of
unhealthy eating and physical inactivity at
population level considering the influence of
age, sex, socio-economic status and ethnicity.
Interventions should be tailored to the target
population; different approaches will be required
for different populations.
More specifically interventions aimed at adults and
children aged 5 years and above should focus on
tackling the target behaviours outlined in Table 12
that either decrease or increase the risk of overweight
and obesity as there is comprehensive evidence to
support these59.
59Brown T, Kelly S and Summerbell C. Prevention of obesity: a
review of interventions. Obesity Reviews. 2007. 8 (Suppl.1).
127-130
33
Table 12
Dietary and physical activity factors
that either protect or cause weight gain,
overweight and obesity in adults and
children aged 5 years and above
Decreases risk of
overweight and obesity
Increases risk of
overweight and obesity
⚉⚉ Increased total physical activity
⚉⚉ Television viewing (sedentary
over time
behaviour)
⚉⚉ Breastfeeding*
⚉⚉ Diets rich in high energy⚉⚉ Diets rich in low energy-dense
dense foods (high-fat foods
foods (wholegrains, cereals,
e.g. fast-food/takeaways
fruits and vegetables, salad and
and confectionary) when
dietary fibre)
large portions are consumed
regularly
⚉⚉ Frequent consumption of
sugary drinks (including alcohol
in adults)
*in terms of preventing obesity in children from 5 years60
60Rudolf M. Tackling obesity through the Healthy Child
Programme. A framework for action. 2009
34
Tackling obesity through the life
course
Evidence indicates that there are a number of time
points in the life course linked to a key developmental
or biological stage (e.g. early life, pregnancy,
menopause), times linked to key life changes (e.g.
leaving home, becoming a parent) and phases
of significant shifts in attitudes (e.g. peer group
influences, diagnosis of ill health) where there may be
specific opportunities to influence behaviours10.
1.Early years and school age children
In children the evidence base is largely from school
age children (6 to 12 years) from studies based in the
school environment14. However an inclusive critical
review of the evidence relating to the early indicators
of lifestyle development to reduce the risk of obesity
in babies, toddlers and preschool children has been
carried out to provide guidance and a framework for
the Healthy Child Programme. Table 13 summarises
the key components of interventions, policies and
strategies that are promising based on the existing
evidence.
Table 13
Key components, policies and strategies to achieve a healthier weight from
age 0 to 12 years
Key components, policies & strategies to achieve a healthier weight
Early
years*59
School
age**58
Epidemiological, experimental and practical evidence from interventions to support the development of a healthy lifestyle include
action in the following areas;
Parenting
1. Encourage parents and carers to model a healthy lifestyle
2. Help parents enhance their parenting skills and develop an authoritative approach to shaping their children’s lifestyles
3. Encourage parents and carers to take a whole family approach
Eating & feeding behaviour
4. Encourage responsive feeding
5. Encourage positive family mealtimes
6. Find alternatives to food for comfort and to encourage good behaviour
Nutrition
7. Encourage exclusive breast feeding for 6 months
8. Introduce solid foods at 6 months
9. Ensure portion sizes are appropriate for age
10.Increase acceptance of healthy foods – including fruit and vegetables
11.Reduce availability and accessibility of energy dense foods in the home
12.Reduce consumption of sweet drinks and increase consumption of water
Play, inactivity and sleep
13. Encourage active play
14. Create safer play-space at home
15. Reduce sedentary behaviour and screen-time
17. Ensure children get a good night’s sleep
Enhancing practitioners’ effectiveness
18. Recognise babies and toddlers who are at particular risk for obesity (linked to familial obesity e.g. either one or more biological
parents are obese or siblings)
19. Provide training on how to help parents make lifestyle changes
20. Encourage practitioners to model healthy lifestyles themselves
Strong evidence to support beneficial effects of child obesity prevention programmes on BMI include;
⚉⚉ school curriculum that includes healthy eating, physical activity and body image
⚉⚉ increased sessions for physical activity and the development of fundamental movement skills throughout the school week
⚉⚉ improvements in nutritional quality of the food supply in schools e.g. school meals, vending machines, availability of water
⚉⚉ environments and cultural practices that support children eating healthier foods and being active throughout each day
⚉⚉ support for teachers and other staff to implement health promotion strategies and activities (e.g. professional development,
capacity building activities)
⚉⚉ parent support and home activities that encourage children to be more active, eat more nutritious foods and spend less time in
screen based activities
* Tackling obesity through the healthy child programme, a framework for action.
**Cochrane review
2.Young people through to adulthood
and older people
There is no evidence to suggest that there is an exact
‘one point’ in the life course where intervention
to achieve a healthier weight is particularly more
successful than another. It is paramount to promote
a healthy start in life but there are numerous
occasions through-out life where changes in eating
and activity behaviour can be achieved to protect or
reduce unhealthy weight gain. Table 14 summarises
some of these key opportunities for intervention to
influence an individual’s behaviour from the onset of
adolescence through to older age.
35
Table 14
Critical opportunities for intervention
during an individual’s life course from age
11 to 60+ years
Age
Stage
Opportunity for intervention to
achieve a healthier weight
11-16
years
Secondary
school
Development of independent behaviours
16-20
years
Leaving
home
Exposure to alternative cultures/behaviour/
lifestyle patterns (e.g. work patterns,
living with friends etc.)
16+ years
Smoking
cessation
Health awareness, prompting
development of new behaviours. Evidence
suggests that weight management
interventions should be offered to people
who are planning to stop smoking, where
appropriate
16-40
years
Pregnancy
Maternal nutrition, prevention of
excessive weight gain
16-40
years
Parenting
Development of new behaviours
associated with child-rearing
45-55
years
Menopause
Biological changes and growing
importance of physical health prompted
by diagnosis of disease in self or others
60+ years
Ageing
Lifestyle change prompted by changes
in time availability, budget, work-life
balance. Occurrence of ill health
Source: Adapted from Foresight. Tackling Obesities (2007)14
Tackling obesity through the
wider determinants (obesogenic
environment)
As previously mentioned, to achieve a change in the
energy balance system in order to decrease levels of
overweight and obesity, change is required at all levels
not just the individual factors that lead to obesity but
also the social, economic and physical environment
in which people live. Introducing changes to the
food and activity environment and societal influences
such as advertising, health inequalities and culture
is essential to ensure sustainable progress can be
made. Examples of this include the promotion of
active transport where feasible and optimising land
use with regards to opportunities to be physically
active in a safe place and ensuring the community
can benefit from local facilities wherever possible.
Consideration to the design and layout of buildings
(such as ensuring the stairs are more prominent than
lifts or escalators) and community spaces should be
36
a key part of local planning. Regulations on food
advertising and nutrient profiling, healthier catering in
workplaces, restaurants and cafes, vending machine
provision, and the accessibility and availability of
healthy sustainable foods to all should also be
prioritised. The key wider issues that should be
focussed on are listed on ‘Healthy Places’ http://
www.healthyplaces.org.uk/key-issues/, which
includes information regarding the legalities and
guidance on how to work with local authorities to
start tackling some of these wider issues.
Sustainability is also a key priority. The Joint Annual
Public Health Report 2009-2010 highlighted some
very successful examples across the borough where
consideration has been given to sourcing local food,
supporting the local economy, growing food, and
reducing waste. Such projects should be encouraged
locally and include education and training where
required to encourage the local population to
actively participate. The Royal Borough of Kingston’s
Allotment Strategy 2008-2018 and Green Spaces
Strategy 2008-2018 provide a clear direction for
encouraging active use.
To achieve optimal and sustainable outcomes, it
is essential to influence the relevant stakeholders
involved in these wider environmental issues and
ensure that tackling obesity and physical inactivity are
core considerations within their policy and practice.
Exploring the evidence base further in these areas
is essential to provide a clear direction here and
networking with other local authorities that have had
success in this area can ensure partners learn from
previous experience.
Fast food outlets
At a local level, discussions in Kingston have begun
between Public Health and Environmental Health
to start tackling the quality of food provided and
the concentration of fast food outlets, particularly
around schools. Recent national data analysed on
the location of fast food outlets and deprivation
(IMD) demonstrates that there is a strong association
between deprivation and the density of fast food
outlets*, essentially showing that more deprived areas
have more fast food outlets per 100,000 population.
When considered in the context of how obesity is
linked to deprivation, it is clear that this should be
a key focus area. In Kingston there are 75 outlets
per 100,000 population and a total of 127 fast food
outlets61.
* Defined by NOO as (i) Fast food and takeaway outlets, (ii) Fast
food delivery services, and (iii) Fish and chip shops, sourced from
Ordnance Survey InterestMap™
Please refer to the chapter on physical activity for the key
evidence and action on the promotion of physical activity, active
travel and active recreation in Kingston.
Clinical management of overweight
and obesity (adults and children)
Comprehensive evidence-based guidance on the
clinical management of overweight and obesity in
children and adults is available in the UK. Clinical
overweight and obesity guidelines by NICE18, SIGN19
and a Map of Medicine for Obesity in adults62 and
children63 advise appropriate treatments to increase
the effectiveness of interventions used to prevent and
treat obesity and improve the care provided to adults,
children and young people.
Figure 11
Multi-component interventions are the
gold-standard treatment of choice for
the management of obesity to achieve
clinically effective weight loss.
Obesity care pathways are necessary to provide
a framework to ensure that individuals who are
overweight and obese are identified and then able to
enter clearly defined referral routes based on degree
of obesity, health risks, individual needs and treatment
outcomes12. A range of tiered (1-4) treatments
offering different levels of care and support is required
to manage obesity effectively. This spans from
providing brief advice and brief interventions to fully
integrated multicomponent approaches that include
behaviour change strategies to increase physical
activity levels, improve eating behaviours and quality
of diet (see Figure 11). The specialist management
of obesity in primary and secondary care should also
include options for psychological interventions for
children64 and adults65, plus pharmacotherapy and
surgical options in the management of adult obesity
(and where deemed appropriate in young adults (over
12 years) on a case by case basis19). Child weight
management should be based on a family-focused
behavioural approach that does not single out the
obese child18.
64 Oude Luttikhuis H, Baur L, Jansen H, Shrewsbury VA, O’Malley
C, Stolk RP, Summerbell CD. Interventions for treating obesity
in children. Cochrane Database of Systematic Reviews 2009,
Issue 1. Art. No.: CD001872. DOI: 10.1002/14651858.CD001872.
pub2
65 Cochrane reviews related to Adult weight management e.g.
Shaw KA, O’Rourke P, Del Mar C, Kenardy J. Psychological
interventions for overweight or obesity. Cochrane Database
of Systematic Reviews (2005, Issue 3. Art. No.: CD003818. DOI:
10.1002/14651858.CD003818.pub2)
*intensity of treatment should be based on individual level of risk,
readiness to change and previous attempts at weight loss.
61 National Obesity Observatory . Obesity and the environment,
Fast food outlets map. 2012
62 http://healthguides.mapofmedicine.com/choices/map/obesity_
in_adults1.html
63 http://healthguides.mapofmedicine.com/choices/map/obesity_
in_children1.html
37
Maternal obesity management
An enquiry by the Centre for Maternal and Child
Enquiries (CMACE) on obesity in pregnancy was
prompted by a report showing that women with
obesity were over-represented among maternal
deaths. National standards were subsequently
published in 2010, by CMACE/RCOG in the form of a
Joint Guideline ‘Management of Women with Obesity
in Pregnancy’ to cover the pre-conception, pregnancy,
and postnatal periods66.
There is a lack of published evidence on the
management of maternal obesity and the safety of
weight loss during pregnancy but the CMACE/RCOG
guidelines along with NICE guidelines on weight
management before, during and after pregnancy67
provide a framework for best practice and evidence
base where it exists to develop services to help treat
and manage maternal obesity at a local level.
Multiple treatment options are
essential
Due to the complex and multifactorial nature of
obesity it is important to ensure that there is a range
of interventions and treatments to support individuals
locally. A Department of Health commissioning
report entitled ‘Maximising the appeal of weight
management services’ suggests that the ‘one size fits
all’ approach will lack appeal to a broad demographic
spectrum and not effectively treat obesity68. Weight
management services for lower income adults,
families and BME groups are essential given the trends
evident in Kingston.
66CMACE/RCOG. Joint Guideline: Management of women with
obesity in pregnancy. London: CMACE/RCOG; 2010
67National Institute for Health and Clinical Excellence (NICE).
Weight management before, during and after pregnancy.
Public health guideline 27. London: NICE; 2010.
68Rowe B, Basi T (2010). Maximising the appeal of weight
management services. A report for the Department of Health
and Central Office of Information. ESRO.
38
Target treatment goals of weight
management
The criteria for ‘success’ is based on the
recommendations made in the clinical obesity
guidance for the UK (NICE CGO4318 and SIGN 11519).
This differs between adults and children.
Adult weight management - achieving a 5-10%
weight loss of original weight over an intensive
period of between 3-6 months provides significant
clinical health benefits reducing cardiovascular risk,
osteoarthritis-related disability, improving glycaemic
control, reduces blood pressure and risk of type
2 diabetes. This is based on research from large
multicentre diabetes prevention trials which show that
this level of weight loss is clinically effective69,70.
Factors that should be taken into account include
weight history, degree of overweight, the level of
intervention an individual has engaged in (a more
intntensive intervention should achieve a more
substantial weight loss).
Child weight management - children are growing
so achieving weight maintenance in a large
percentage of overweight and obese children can
result in a BMI reduction that will have a significant
impact on health outcomes. Depending on the age
and stage of growth small amounts of weight loss
may be appropriate in severely obese children and
young people.
69Knowler WC, Barrett-Connor E, Fowler SE, Hamman RF, Lachin
JM, Walker EA, et al. Reduction in the incidence of type 2
diabetes with lifestyle intervention or metformin. N Engl J
Med 2002;346(6):393-403.
70Tuomilehto J, Lindstrom J, Eriksson JG, Valle TT, Hamalainen H,
Ilanne-Parikka P, et al. Prevention of type 2 diabetes mellitus
by changes in lifestyle among subjects with impaired glucose
tolerance. N Engl J Med 2001;344(18):1343-50.
Local action - where we are now?
spread in services across all tiers from population-wide
to primary prevention up to secondary and tertiary
care.
Extensive mapping has been conducted across the
Royal Borough of Kingston consulting with a widerange of commercial, leisure, community, local
authority, clinical and health care professionals to
gain an insight into the existing services across the
community, primary, secondary and tertiary care that
are available to both prevent and treat overweight
and obese children and adults in Kingston (as noted
earlier in the strategy development section).
Following a consultation period and workshop with
stakeholders from a range of different health and
non-health care settings, gaps in service have been
identified accompanied with the local needs of the
population. A top-line summary of existing services is
described for adults and then children.
Overall the mapping demonstrated that Kingston
provides a range of preventative and treatment-based
multicomponent weight management interventions
to tackle overweight and obesity. A tiered style
approach is used to demonstrate the range and
Figure 12
Outline of the current adult healthy weight interventions and treatment
services available across the different tiers of care in Kingston.
Bariatric referral
pathway via KCAS
Tier 4
Tier 3
No Specialist WM service
in Kingston
(Specialist service for secondary care mental health
pts at Tolworth Hospital)
Screening & referrals
•NHS vascular
Health Checks
•CQUIN Health
Promotion
Tier 2
Primary Care - Weigh-2-Go in GP & Pharmacy,
Dietetics 1:1, Get Active (Exercise-referral)
Community - NHS referral Rosemary Conley
Obesity-related
services
•Diabetes (T2)
•Cardiac Rehab
•Expert Pt Prog
Tier 1
Primary care - Brief interventions (Practice Nurses, HCA, GP, Community Pharmacy)
Community - Fit as a Fiddle (SO+), Commercial groups & Leisure slimming groups
Workplace- Weigh-2-Go@work
Universal Prevention
Change4Life, Cook and Eat classes, Food Bank, Physical Activity services
(refer to mapping)
39
Adults
Table 15
Summary of the service mapping for adult obesity in Kingston
Level of
Intervention
Summary of service
Universal
Prevention
Change4Life - The national campaign is promoted locally across Kingston at workplace, community and health events.
Change4life Kingston (refer to physical activity, active recreation map)
Cook and eat community - Cook and eat programmes running for target populations (BME and older adults) across
Kingston. 8 programmes running at time of mapping
Physical activity services - Please refer to the physical activity mapping section
Tier 1 Community
Commercial and leisure sector - Adults with a BMI of >25 kg/m2 have a range of options available to them such as
commercial slimming providers –Rosemary Conley, Weight Watchers and Slimming World run in community venues across
Kingston
Fit as a fiddle (50+) - Free, six week long healthy eating and activity-focused weight management programme for older
adults (led by Age Concern) running in leisure and community settings in small, friendly groups focusing on hard to reach
groups
Workplace - Weigh-2-Go@work is being piloted in 2 workplaces in Kingston (Kingston Hospital and Kingston University).
Occupational Health Nurses have been trained to implement this. Preliminary evaluation to be completed following pilot
programmes
Tier 2 Community
NHS referral to Rosemary Conley (discounted rates)
Dietary advice, support and physical activity sessions for adults with a BMI >25 kg/m2
Tier 2 - Primary
Care
Get Active - GP-exercise on referral scheme running in Kingston, includes a 12 week, 1:1 structured, tailored physical activity
programme and discounted rates at local health and fitness venues (for further details see physical activity –active recreation map)
Weigh-2-Go - Free GP and pharmacy-led 10 week weight management programme running in 10 sites at time of mapping.
General Dietetic-led clinics - Based in all GP practices or community clinics providing 1:1 services for complex obese
(BMI>30 kg/m2) patients. Only 16% of patients seen in these clinics are solely for weight management advice, however 46%
are seen for weight-related conditions (e.g. diabetes, lipid modification and impaired glucose intolerance) which may also
involve weight management support. Existing capacity enables support for approximately 1-2 appointments only due to lack
of clinical time available to keep waiting times to 8-12 weeks for all referrals to general clinics. The Dietetic Service Manager
identified that they are not able to meet the needs they would like to treat complex obese patients in primary care unless
there is an increase in resource. Guidelines recommend a higher intensity contact every 2-3 weeks for 6 months71.
Dietetic-led out patient service is provided for obese adults with significant co-morbidities such as diabetes and CVD. GP or
Consultant-led referral at Kingston Hospital.
Tier 3
There is currently no Specialist Weight Management service available in Kingston.
There have been ongoing discussions at NHS SWL cluster level regarding the patient referral pathways to bariatric surgery
at St Georges Healthcare NHS Trust. Although each SWL borough has its own local approval processes in place it has been
identified there are no Tier 3 specialist weight management services across South West London and this leaves a significant
gap in service provision.
Obesity and Mental Health - Specialist dietetic and exercise therapy service at Tolworth hospital for obese secondary care
mental health patients delivered by SWL St Georges Mental Health Trust.
Tier 4
Bariatric GP-referral pathway via Kingston Clinical Assessment Service (KCAS)
Other obesityNHS Vascular Health Checks
related services/ Screening programme running across Kingston in GP Practices, pharmacies, community and workplace settings. Individuals
schemes
identified as being above a healthy weight (with other cardiovascular risk factors) are referred into community weight
management programmes in tier 2.
Services that also address weight, diet and physical activity include;
⚉⚉ Type 2 Diabetes (DESMOND)
⚉⚉ Cardiac Rehab (Secondary prevention)
⚉⚉ Expert Patient Programme
71Dietitians in obesity management. Dietetic Weight
Management Intervention for Adults in the one-to-one
setting (DOMUK, 2010)
40
Map 5
AdultAdult
Obesity
Obesity
Milaap
!
(
Hawker Centre
Acre Road Clinic
Kingston Hospital
Tudor
Richmond Road Medical Centre
Coombe Hill
) (
!
!
("
(!
"
) !
(!
(
Islamic Resource Centre
Canbury
"
) !
()
"
))) !
)
"
) ("
!
(
Kingfisher Centre
Hawks Road Clinic
Kingston United Reformed Church
Age Concern, Bradbury Centre
Piper Hall
Norbiton Children's Centre
Coombe Vale
Norbiton
Grove
Kingston University
)
St Marks
Newans Chemist
(
!!
!
() (
Ritechem
Hawks Pharmacy
"
)
"
"
) )
(
!
( !
!
(
"
)
St James
Old Malden
Claremont Medical Centre
!
(!
(
Chessington North
and Hook
Merritt Medical Centre
Age Concern,
Raleigh House
Alexandra
)
)
Surbiton Hill
"
)
!
(
Malden Centre
Beverley
Berrylands
!
())
Ace Pharmacy
Francis House,
Springfield Place
)))
!
(
!
(
!
(
)
Adult Obesity
Prevention Services
Tolworth and Hook Rise
)))
Boots the Chemist
Tolworth Hospital
"
)
"
)
"
)
Cook & Eat Community
Cook & Eat Primary Care
Food Bank
Community Services
)
Commercial Slimming Groups
Primary Care Services
!
(
!
(
!
(
!
(
!
(
!
(
!
(
Community Weight Management (1:1 / groups)
Community Dietetics (1:1)
Psychological Services (GP referral)
Obesity-related projects
Chessington South
NHS Health Checks
Cardiac Rehab
DESMOND (diabetes T2)
Secondary Care
Secondary Care (dietetic out patients)
Map Key
!
( Community Dietetics at all GP Surgeries
!
( NHS Health Checks at all GP Surgeries
±
1:47,000
#
#
*
*
#
®
v
*
#
Community
Clinics
GP Surgeries
Hospitals
Pharmacies
Wards
Local Open Space
School Open Space
This map is reproduced from Ordnance Survey material with the permission of Ordnance Survey on behalf of the Controller
of Her Majesty's Stationery Office Crown copyright. Unauthorised reproduction infringes Crown copyright and may lead to
prosecution or civil proceedings. Royal Borough of Kingston upon Thames. RBK Licence No - 100019285. 2012.
41
The adult obesity map (Map 5) shows the overall
distribution and provision of services across Kingston.
Community weight management services tend
to cluster more around built-up areas in Kingston
Town, New Malden, Surbiton and Chessington this
is most likely due to the fact that they run in either
leisure centres, community centrews or primary care
settings (GP surgeries or Community Pharmacies).
There is a lack of a community weight management
programmes in the north east (Coombe Hill and
Coombe Vale) but this may be a reflection of the
resident population and their specific needs. Norbiton
and Old Malden Ward have no provision apart from
access to dietetics via a GP Surgery. Get Active
(exercise referral scheme) is running in numerous
leisure centres across the borough (please refer to
active recreation map). Cook and Eat schemes are
more prominent in the north of the borough in Grove,
Norbiton and Canbury wards but this may be due to
the specific populations the schemes are targeting
(e.g. BME groups and older people). There is a lack
of cooking programmes in the south of the borough
particularly for people who aren’t eligible to attend
the family cook and eat programmes (see child obesity
map, Map 6). As referred to in Table 15 there is a lack
of specialist weight management (MDT) services in
Kingston across the community and secondary care.
Children
Figure 13
Outline of the current child healthy weight interventions and treatment services
available across the different tiers of care in Kingston.
Tier 4
Referral to secondary
care for assessment
(severely obese>99th centile)
Tier 3
Health & fitness clinic
(dietetic-led not MDT)
Kingston Hospital
Screening & referrals
Tier 2
•NCMP (Reception & Yr.6)
Primary Care -Community Dietetics 1:1
Community - Factor programmes (ages 5-16)
Tier 1
Primary Care - Brief interventions (School Health Team -Nurses and Health Visitors, GP)
Community - Cook and Eat families (Children Centres)
Schools - Change4Life Primary (sports for hard to reach), Cook and Eat schools (Chef’s Club)
Universal Prevention
Healthy Child Programme - breastfeeding and weaning support ,Healthy Start, Children’s Centres,
Schools: free school meals, free fruit (infant schools), Healthy Schools, Physical
Activity/Active Play schemes, extended schools (breakfast clubs & afterschool activities), Food Bank.
Refer to physical activity mapping for sports clubs and active travel.
42
Table 16
Summary of the service mapping for childhood obesity in Kingston
Level of
Intervention
Summary of service
Universal
Prevention
Early years (0-5 years)
Healthy Child Programme aspects relevant to obesity prevention;
⚉⚉ Breast-feeding support groups and weaning talks
⚉⚉ Children Centres services on healthy eating and active play
Healthy Start scheme (low income groups)
⚉⚉ Healthy start vitamins for low income pregnant mums
⚉⚉ Healthy start drops for children from low income families
⚉⚉ Healthy start voucher scheme for fruit, vegetables and milk
Available from all 11 Children’s Centres and 3 clinics
Schools (5-18)
Free school meals (for low income families)
Free fruit in infant schools for all children
Healthy schools (where continued)
Extended schools (breakfast clubs and after school activities)
Food for life – catering scheme in schools
Tier 1 Community
Cook and Eat families
Cook and Eat programme running in 13 children’s centres or nurseries
Cook and Eat schools (Chefs Club)
Chef’s Club running in 4 schools in the Malden and Coombe area
Change4Life Primary
Sports clubs running in 12 primary and secondary schools across Kingston targeting children who don’t usually participate in
sport and/or activity. See physical activity mapping for further information
Tier 1 - Primary
Care
School Health Team and Health Visitors
Offer 1:1 support for all children aged 2+ who are overweight or at risk of being overweight. Support in the home, school or
clinic
Tier 2 Community
Factor programmes
Multi-component 10-12 wk child weight management programmes running in 2 leisure centres for 3 different age-groups,
termly across Kingston. Provided by DC Leisure
Fun-factor (5-7s), Fwd-factor (8-12), 4U-factor (13-16)
Tier 2 - Primary
Care
General Dietetic-led Clinics
Based in all GP practices and community clinics providing 1:1 services. Existing capacity enables support for approximately 1-2
appointments only due to lack of clinical time available. Complex cases should be referred into the Health and fitness clinic at
Kingston Hospital
Tier 3
Health and fitness clinic (Kingston Hospital)
Dietetic led clinic (not MDT) for very overweight children (clinically severely obese) approx. 90 children and young people on
books, regular and ongoing support provided
Tier 4
No child obesity MDT specialised care available, however when required complex cases can be referred to paediatrics for
assessment and management of complex weight-related conditions
The childhood obesity map (Map 6) shows the spread
of services already in place across Kingston. Notably
there is a good spread of cook and eat programmes
for families running at children’s centres across
Kingston, however school cook and eat programmes
are only running in the east of the borough via a
contract with the Malden and Coombe cluster, the
rest of the borough is lacking. The Healthy Start
scheme for low income families is accessible at a
number of venues, however the uptake remains
low. Community (family) weight management
groups provide good access across Kingston with
programmes running in the north, east and south
of the borough, although uptake needs improving.
There is a good specialist dietetic service available in
secondary care (Health and Fitness clinic) however it is
lacking MDT input for more complex cases requiring
medical and psychological input.
43
Map 6
Childhood Obesity
Childhood Obesity
Robin Hood Primary School
Kingston Hospital
North Kingston
Children's Centre
Tudor
Coombe Hill
Kingfisher Leisure Centre
Canbury
Kings Oak Primary School
Hawks Road Clinic
Coombe Vale
King Athelstan Primary School
Christ Church New Malden
COFE Primary School
Norbiton
St Joesephs RC Primary School
Grove
Malden Centre
Beverley
St Marks
Kingston Town Children's Centre
Berrylands
Burlington School
St James
Oak Hill Health Centre
Old Malden
Surbiton Children's Centre
Alexandra
Old Malden
Children's Centre
Surbiton Hill
Dysart School
Malden Parochial Primary School
Tolworth
and Hook Rise
Tolworth Children's Centre
Childhood Obesity
Prevention Services
St Pauls Primary School
West Chessington Children's Centre
!
(
"
)
#
*
#
*
"
)
W
X
!
(
!
(
!
(
!
(
Tolworth Leisure Centre
Lovelace Primary School
Chessington North
and Hook
Chessington Children's Centre
The Moor Lane Centre
Healthy Start Scheme
Cook & Eat Families
Cook & Eat Schools
Change4Life Primary
Food Bank
Community Services
Ellingham Primary School
Community Weight Management (groups)
Primary Care Services
Chessington South
Community Nursing
(CYP with disabilities)
Health Visiting Team
School Health Team
Community Dietetics (1:1)
Secondary Care
!
(
Health and Fitness Clinic
Map Key
( Community Dietetics at all surgeries
!
Free school meals at all schools
Free fruit in all infant schools
±
1:47,000
_
^
Children's Centres
#
*
#
*
v
®
Clinics
Schools
GP Surgeries
Hospitals
Wards
Local Open Space
School Open Space
44
Maternal obesity
Prior to the current mapping exercise for this
strategy a needs assessment for maternal obesity
was conducted by Kingston Public Health Team44 in
spring 2011 to identify the prevalence of obesity in
pregnancy in Kingston and establish the knowledge
of health professionals and care currently offered to
overweight and obese women before, during and
after pregnancy. Community midwives also took
part in the consultation phase. This has helped to
ascertain any major gaps in order to support obese
women appropriately. The main recommendations are
summarised in Table 17.
Table 17
Recommendations to tackle maternal obesity in Kingston
Clinical area
Key recommendations
Midwifery
1.Midwives need training around the importance of explaining to women the risks of obesity to their pregnancy. This needs
to be discussed with relevant women at the booking visit. The training could be provided by the dietetics department.
2. Midwives need to ensure that all women with a BMI ≥30 kg/m2 are offered dietetic referral.
3. The need for a specialist obesity MDT antenatal clinic.
The compliance to midwifery recommendations that are relevant to hospital practice are currently in the process of being
audited.
Health Visitors
1. Training around the evidence base for the risks associated with maternal obesity.
2. Communication skills training on how to sensitively broach the issue of obesity with women.
3. Once women are approached about the issue, Health Visitors should be re-surveyed.
Pharmacy
1.Training around the RCOG/CMACE guidance pertaining to folic acid and vitamin D doses for women with a BMI ≥30 kg/m2.
2. Training about the healthy start voucher scheme.
3. Pharmacies to signpost patients to post natal weight management services.
General Practice Training on all parts of the RCOG/CMACE and NICE guidance on maternal obesity relevant to primary care, especially focusing on:
a) The discussion of the risks of obesity with a woman when she presents as pregnant.
b) To offer advice around folic acid and vitamin D.
c) To be aware of criteria for referral to dietetics.
d)Encourage GPs to address weight in women of child-bearing age, opportunistically, (especially women under 25), as
appropriate.
Dietetics
PCT to consider commissioning a dietetic clinic specific to pregnancy (and possibly women in the postnatal period). This
should include provision for new and follow-up appointments. N.B. During the development of this strategy, an antenatal
dietetic clinic was set up at Kingston Hospital in November 2012. Outcomes from this clinic should be monitored and fed into
the action plan.
Community
1.KCCG/Local authority to consider how to commission antenatal and postnatal exercise classes (e.g. aqua aerobics) with
appropriate childcare provision, or consider ‘family’ exercise classes for women with older children (e.g. >4 years).
2.Promotion of local ‘cook and eat’ schemes in children’s centres amongst obese women in pregnancy and postnatally, to
encourage healthy eating for families.
National
1.National ‘healthy start’ literature should be updated to include information about vitamin content of supplements, and to
signpost women who may need alternative doses of folic acid to their GPs.
2. Consider developing a separate leaflet to provide information on vitamin D and folic acid alone, during pregnancy.
45
Local action - what we need
The service mapping results along with the main
outcomes from the focus group and electronic
consultations (with the general public, professionals
and targeted communities), were used during
the stakeholder workshops to help identify the
key priorities in the provision of obesity treatment
and prevention services in Kingston. The priorities
that emerged have been incorporated into the
recommendations within this strategy action plan.
These main themes are summarised in Table 18 below.
Table 18
Key themes from the consultation exercises
Focus Groups
(Public)
Focus Groups
(Professional)
Key themes identified
Priorities for Kingston
1. Accessibility
Localised community settings e.g. neighbourhood-based programmes for adults that
are overweight not just obese targeting BME and gender
2. Health & Wellbeing
Less isolation, more social programmes for young people and adults with a disability
e.g. Cook and Eat
3. Communication
Improved publicity and awareness of services available
4. Participation
Provide more encouragement, support and confidence by offering holistic
programmes to vulnerable groups e.g. mental health, BME
5. Facilities
Use of local and convenient facilities to host programmes and initiatives
1. Accessibility
More free activities/services
2. Supply & Demand:
More dietetic 1:1 time and more primary care/community weight management groups
3. Gaps in Service:
Engaging those not engaged in services (more services for hard to reach groups) and
established care-pathways and referral routes for obesity
4. Communication
Directory of services for patients (simple booklets), NHS endorsing of commercial
programmes and localising national branding e.g. Change4Life
5. Partnership
Links across Public Sector organisations e.g. NHS, RBK, Education and partnerships
with Planning, Environmental Health and Active Travel
Key themes emerging (for promoting a healthy weight)
Online Survey
(Public)
⚉⚉ There was a general lack of awareness of the adult and child weight management programmes running in Kingston (<10%
were aware)
⚉⚉ 37% of respondents want more weight management programmes, 38% more healthy eating programmes
⚉⚉ Respondents were more likely to access information about healthy lifestyles services at their GP surgery followed by the
library, schools, leisure centres and the council website.
⚉⚉ The top two barriers to participation were cost and time
Key themes emerging (for promoting a healthy weight)
Online Survey
Education
⚉⚉ 85% of primary school teachers and 61% of secondary school teachers thought it was important to promote healthy
lifestyles to families at school
⚉⚉ 88% of primary school teachers would like more after school cooking clubs
⚉⚉ 100% of secondary school teachers consider it is important for more cooking classes during school time
⚉⚉ In primary schools 82% would like a school food policy, 100% of secondary school respondents thought this was important
⚉⚉ 89% would like to see free fruit and vegetables available in primary schools for all ages (currently just infants)
⚉⚉ 84% of secondary schools want healthy vending machines
⚉⚉ 59% of primary schools are using Change4Life for schools resources, interestingly only 12% of secondary schools are
Breakfast clubs, school meals and healthy packed lunches were all considered important in both secondary and primary
schools
⚉⚉ 80% of Primary Schools reported that school newsletters are the best way of informing them and parents about community
programmes.
46
In summary, based on national and local priorities
for promoting a healthy weight and commissioning
treatment services for overweight and obesity,
Kingston should:
●● target a range of ages across the life course (older
and younger adults and families with children of
different ages)
●● be tailored to the needs of different populations
e.g. gender, ethnicity, vulnerable groups e.g.
mental health, limiting illness or disability
●● improve the geographical spread of adult and
child weight management services at community
and primary care level particularly in pockets of
deprivation
●● prioritise filling gaps in services for maternal
obesity and specialist weight management services,
increase dietetic time and establish clear referral
pathways
●● ensure there is a strong focus on the prevention
of overweight and obesity and the promotion
of a healthy weight and healthy diet within the
community
●● ensure there is a strong focus on wider
environmental issues such as planning for healthy
local spaces, sustainable food options, and healthy
catering
Action plan
The mapping exercise, evidence review, information
gathered from the consultation exercise, identified
gaps in services and areas for improvement
and potential for developing existing and new
opportunities to promote a healthy weight and treat
obesity in Kingston have all informed the Healthy
Weight and Physical Activity Strategy Action Plan
(please see separate document).
The action plan provides a framework within which to
deliver the key strategic targets.
47
Encouraging Physical Activity
Why is Physical Activity such an
important issue?
As described earlier in this document, it is recognised
that physical activity can be a very effective tool
to assist weight maintenance but it is also vital to
recognise that physical inactivity creates significant
health risks for people regardless of their weight.
Physical inactivity constitutes a major public health
threat, increasing the risks of chronic disease and
disability. It is a major risk factor for all-cause mortality,
cardiovascular disease, obesity, high blood pressure,
stroke, type 2 diabetes, metabolic syndrome, colon
and breast cancer along with a number of mental
health conditions. A recent study estimates that
physical inactivity is responsible for 6% of coronary
heart disease, 7% of type 2 diabetes and 10% of
breast and colon cancers. In addition 9% of all
premature deaths worldwide are attributed to
physical inactivity72. In other words, these deaths were
72The Lancet Physical Activity Series working Group July 2012.
preventable. Even small increases in physical activity
can provide a protective effect. For example, it is
estimated that if all sedentary people took just one
step up from inactivity to regular everyday activity
such as walking, this could reduce deaths from
coronary heart disease among adults by 14%73.
Between 2003 and 2008 in the UK, figures for those
who achieved the Government’s physical activity
target (30 minutes of moderate intensity activity,* 5
times a week) have increased from 32% to 39%
for men and 26% to 29% for women. This is very
positive data but must be viewed in the wider context
of how each generation has become increasingly less
active due to cultural and societal changes.
73Department of Health, Health Survey for England 2008
*This includes all types of physical activity that makes
breathing and heartbeat faster and you feel warmer than
normal e.g. sport, walking, housework or gardening
Figure 14
Historic and projected physical activity levels for the UK
1961
-20.2%
in 44 years
200
- 20%
2005
-35%
MET
hours
per
week
-35.1%
in 69 years
150
100
Key: Activity Area
Active Leisure
Transportation
Domestic
Occupational
50
2030 Projection
1961 Baseline
Total decline in Physical Activity
48
2005
2030
Projection
The decline in Physical Activity by activity area
Just a few generations ago, physical activity was
a constant part of daily life and in a relatively
short period of time, the global population have
become dangerously inactive. In just over 44 years
(approximately 1.5 generations), physical activity in
the UK has declined by 20% and is trending towards
a 35% decline by 2030 (see Figure 14)74. Societal
change has contributed towards a decline in everyday
activity levels, not least because of an increase in
office based work where the minimum of physical
effort is required. Convenient lifestyles, technology
to perform our work and play functions enables us
to move less, and the growing reliance on cars to
get about have resulted in a decline in walking and
cycling as modes of travel. Nationally, over 50% of
journeys made by car equate to five miles or less and
20% are one mile or under which is equivalent to a
20 minute walk.
We are facing an epidemic of inactivity that is a
dangerous threat to everyone’s health, well-being
and quality of life. This not only causes serious and
unnecessary suffering and impairs quality of life, but
also comes at a significant economic cost. The direct
costs to the NHS and indirect costs to society as a
result of inactivity total more than £8 billion annually
(see Table 19).
In a time of budget cuts, investing in physical activity
is smart public policy. Raising levels of activity and
participation in physical activity and sport not only
improves health outcomes and reduces costs to the
74Chief Medical Officer (2010) Annual Report for 2009;
Department of Health
NHS and the wider economy, but can also contribute
to a range of positive social outcomes including
reducing anti-social behaviour, improved levels of
wellbeing and mental health, increased education
attainment and more cohesive communities75.
With the recent delivery of a successful 2012 Olympic
games for London, there are key challenges facing
the Government’s ambition of leaving a lasting
legacy from the games, for both sport and public
health. Underpinning the games was a commitment
to ‘inspire a generation’ through a large-scale and
sustained increase in sport and physical activity
participation. Although 1.3 million more people
are playing sport every week in England than when
the bid was won in 2005, currently 57% of the
population do no sport at all76. A key measure of the
Games will be if participation in sport and physical
activity increases in the years ahead. Messages
communicated on the expectations from the legacy
are disjointed and separate the sports targets from
the physical activity and health ambitions. For
example, the Department of Culture, Medicine and
Sport’s (DCMS) ambition is focussed on driving up
participation in sport per se and not concerned
with the health benefits deriving from sport as a
form of physical activity77. Understandably this has
led to public confusion as to the clarity of what the
Government’s ambition is for a more active and
healthier nation.
75The Centre for Social Justice; Nevill, C & Van Poortvliet, CSJ
Sport Working Group 2011; M 2011
76Sport England Active People Survey 6 (APS6)
771st Report, Sport and Exercise science and medicine; building
on the Olympic legacy to improve the nation’s health, House
of Lords 2012
Table 19
Inactivity as a comparative major public health threat
Titles
% Adults affected
Estimated annual costs to NHS (£bn)
Estimated annual cost to the economy (£bn)
Alcohol Misuse
Smoking
Obesity
Inactivity
6-9%
20%
24%
61-70%
£2.7bn
£2.7bn
£4.2bn
£1-1.8bn
£20.0bn
£5.2bn
£15.8bn
£8.2bn
49
What defines physical activity?
Physical activity can be defined as ‘aerobic activity
which involves using large muscle groups in legs,
arms and back steadily and rhythmically resulting in
a noticeable increase in heart rate and breathing’.
Physical activity can be improved through many
dimensions and for the purpose of this strategy,
physical activity includes sport, exercise, dance, active
play, everyday activities such as walking, cycling,
domestic chores and gardening, including workplace
activities. These different activities can be plotted
along a spectrum (Figure 15) ranging from physical
activities undertaken as part of active living, such
as housework to those we do for fun when we
undertake recreational activities and sport. Increasing
activity at any point of the spectrum is desirable as
research shows that the more active a population is
the healthier and happier it tends to be.
Figure 15
The physical activity spectrum
Living
Travel
Moderate to vigorous housework,
gardening or DIY, occupation
activity and lifestyle programmes
Active travel, walking, cycling, stair Exercise, active play, dance, leisure
climbing, school/work travel plans and outdoor play
50
Recreational
Sport
Organised competitive team sport,
informal street sport, kick about
Sedentary behaviour
Figure 16
Proportion of adults spending six or
more hours in sedentary pursuits per day
during weekdays
Percentage % In emphasising the need for people to be more
active, it is important to highlight the growing levels
of sedentary behaviour across the life course from
infants to adulthood. Sedentary behaviour is not
WEEKDAYS simply a lack of physical activity but multi-faceted
70 60 behaviours where sitting is the dominant posture
50 and the expenditure of energy is very low, such
40 Men 30 as watching TV, using a computer, travelling in
Women 20 transport. Habitually sitting for long periods at a desk
10 0 or travelling in a car reduces overall flexibility and
16-‐24 25-‐34 35-‐44 45-‐54 55-‐64 65-‐74 75+ increases the risk of injury leading to other potential
Age Group health problems. Evidence suggests that sedentary
behaviour through too little exercise is independently
16-24
25-34
35-44
45-54
55-64
65-74
75+
42
21
20
20
35
51
63
associated with all-cause mortality, type 2 diabetes Men
Women
39
20
17
21
35
51
66
Figure 17
some types of cancer and metabolic dysfunction.
Proportion of adults spending six or
For example, spending large amounts of time being
more hours in sedentary pursuits per day
sedentary may increase the risk of some health
during weekends
outcomes, even among people who are active at the
recommended levels.
70 60 Percentage % According to self-reported measures of sedentary
behaviour, a significant proportion of adults report
spending substantial proportions of the day in
sedentary pursuits78. Average total sedentary time
combines both time spent watching the television
and other sedentary time. Overall, similar proportions
of men and women were sedentary for six or more
hours on weekdays. However, on weekends, men
were more likely to be sedentary than women at 44%
of men and 39% of women respectively (see Figures
16 and 17).
Weekends 50 40 30 Men 20 Women 10 0 16-‐24 25-‐34 35-‐44 45-‐54 55-‐64 65-‐74 75+ Age Group 16-24
25-34
35-44
45-54
55-64
65-74
On weekdays,
of children
under 10
49 fewer
40 than 10%
37
35
44
53
41
33
27
32
39
51
years are sedentary for six or more hours, but the
proportion rises steeply to around 30% at age 15
years. At weekends, there is a steady increase from
age 2 years to age 15 years of around 40% for both
boys and girls73 (see Figures 18 and 19). Children
who tend to be more sedentary are highly likely to
continue to be sedentary as adolescents and these
negative habits tend to be relatively unchanged over
time into adulthood.
Men
Women
75+
78 Sedentary behaviour and Obesity Expert Working Group
(2010) Department of Health
51
62
63
Figure 18
Proportion of children and young people
spending six or more hours sedentary per
day during weekdays
Fig 18
Table 20
Government physical activity guidelines
Population Group
Recommendation
Early years (under 5s
not yet walking)
Children under 5 years capable of
walking: at least three hours per day are
recommended.
Children and young
people (5-18 years)
At least 60 minutes up to several hours of
moderate to vigorous activity daily.
Adults (19-64 years)
Daily activity totalling 150 minutes of
moderate activity per week including
resistance exercises.
Older adults (65+
years)
Daily activity up to 150 minutes per week
of moderate activity.
Obese Adults
45-60 minutes a day of moderate
intensity physical activity on 5 or more
days per week.
Weekdays 35 Percentage % 30 25 20 15 Boys 10 Girls 5 0 2 3 4 5 6 7 8 9 10 11 12 13 14 15 Age (years) Fig 19
Figure 19
Proportion of children and young people
spending six or more hours sedentary per
day during weekends.
Percentage % Weekends 45 40 35 30 25 20 15 10 5 0 Boys Girls 2 3 4 5 6 7 8 9 10 11 12 13 14 15 Age (years) National Context
The revised national physical activity guidelines, ‘Start
Active, Stay Active’ published in July 2011 provides
new Government guidelines for physical activity
across the life course, with a strong emphasis on
reducing the pervasiveness of sedentary behaviour.
Physical activity in England is low with only one in
20 adults meeting the government recommended
levels79. The UK population has become 20% less
active over the last 60 years and without intervention
the figure is predicted to rise by a further 35% by
203051. According to latest data from the Health
Survey for England 2008, (the primary source to
measure progress towards achieving physical activity
guidelines), only 6% of men and 9% of women in
Boysthe UK Government
England could correctly define
Girls
physical activity guidelines. Self-reported data by
adults and children revealed:
● 39% of men and 29% of women met the physical
activity guidelines.
● 32% of boys and 24% of girls (aged 2-15 years)
achieved the recommended levels.
● For the Under 5s group, UK data is only currently
available for 3 & 4 year olds, which shows the
mean total time spent being active is 120-150
minutes per day with 10-11 mean hours spent
being sedentary.
A key ambition of the previous government’s legacy
action plan was to get two million more people
79 Health Survey for England 2008,Department of Health reference 78
52
ore active by 201280. The Coalition Government
has since dropped the physical activity target and
recent data from the Active people Survey (the
chosen measure for the legacy outcome) suggest
there is little chance of the sport goal being met;
only 111,800 more adults (~ 11% of one million
target) are participating in sport since 2007/200881.
Experts suggest that this is probably due to an
over-emphasis on the achievements and heroism of
elite athletes to motivate and inspire as well as the
majority of investment going towards developing
sports facilities, neither of which is likely to engage
people82. Data shows that 50.6% of the population
do not participate in at least one session of sport
each week and thousands of people drop out of
playing sport each year. There is a particular problem
at the age of 16, where 25,000 drop out of sport
each year83. This could be linked to young people
making the transition from school and moving into
the workplace, particularly for teenage girls where
the most significant drop occurs. The Government’s
new scheme for Raising the Participation Age (RPA)
is coming into effect in summer 2013, when the
participation age of pupils in school will increase to
the end of the academic year in which young people
turn 17 years old. It will be interesting to see the
potential impact this may have on increasing physical
activity and sport participation rates. In response to
the issue of young people’s declining interest in sport,
Sport England’s 2012 -2017 Strategy, aims to boost
participation among students and reduce the number
of people who drop out in their late teens and early
twenties by ensuring a better transition from school
sport to local clubs and creating a sporting habit
for life by increasing overall participation. Research
shows that those students who do play sport at
university are far more likely to continue participating
throughout their lives84.
Research shows that the most popular reasons
people do not take part in sport is because they do
not consider themselves to be healthy or fit enough
and moreover that sport is seen as competitive. This
is largely true for under-represented groups such as
women, girls, BME groups and older people who are
not typically orientated towards competitive sport.
There is an obvious correlation between physical
activity and sport and while competitive or elite
sport can inspire and encourage a proportion of the
population, it does not motivate and encourage the
least active and those groups who could achieve the
highest health benefits from being more active. Sport
makes up a large proportion of all physical activity
and as such has a positive and valued impact on
health across the life-course. It has a significant role
to play in helping to improve public health and realise
the Government’s ambition to increase the number of
people taking part in sustained and regular physical
activity.
Sport England’s new Youth and Community Strategy
2012-2017 aims to encourage everyone, particularly
young people to take up sport and develop a sporting
habit for life. Aligned with the aspiration of getting
more people participating in sport, Sport England
has focussed work on those who are the least
active and through their Get Healthy, Get into Sport
programme aims to contribute towards reducing
health inequalities and promoting the benefits of
health. Sport England’s new target of increasing sport
participation by 1 x 30 minutes per week fits well
with the Government’s aims of moving people from
doing no activity to some activity and the physical
activity ambition within the Public Health Outcomes
Framework.
80Department of Culture, Media and Sport: Before, during and
after; making the most of the London 2012 Games, 2008
81Sport England: Active People Survey 5, 2011
82Fox K, Biddle S, Murphy M: Creating a legacy for physical
activity and health from the London 2012 Games. The Sport
and Exercise Scientist 2012
83Sport England Strategy 2008 - 2011
84Sport England Active People’s Survey 3
53
National and local trends
Adults
Sport England’s Active People Survey (APS) collects
data on adult sport and active recreation at a local
authority level. The APS key performance indicator
NI8 identifies the percentage of people achieving 3
x 30 minutes of adult sport and active recreation of
moderate intensity over the previous 28 day period.
It is importance to point out that the NI8 indicator is
a different measure to the APS KPI1, which reports
on sport alone. The activities reported on within NI8
are: sport, recreational cycling, recreational walking,
walking for active travel purposes, cycling for active
travel purposes, dance and gardening. The latest
rolling 12 month interim result for NI8 APS6 quarter
2 (APS6Q2) shows a slight decline for Kingston
from 24.6% to 23.1% but when compared to the
London and England averages at 21.1% and 22.4%
respectively, we are performing reasonably well.
Figure 20 illustrates how the trend for zero levels of
activity across the adult population in Kingston has
slightly declined overall, although remains almost on
a par for females between 2005 and 2011. There is
a vast difference of nearly 100% seen between 2009
and 2011 in those achieving 3 x 30 minutes of sport
per week (Sport England’s former target) and NI8.
Figure 20
Trend for zero levels of activity in adults in Kingston
All Activity
50%
Year All
45%
Year Male
40%
Year Female
Percentage
35%
30%
25%
20%
15%
10%
5%
0%
2005/06
2009/11
0 days/
0x30
2005/06
2009/11
1-3 days
2005/06
2009/11
4-7 days/
1x30
2005/06
2009/11
8-11 days/
2x30
2005/06
2009/11
12-19 days/
3x30
Comparitive activity levels between 2005 - 2011
Comparative activity levels between 2005 - 2011
54
2005/06
2009/11
12+ days/
3x30 - N18
2005/06
2009/11
20+ days/
5x30
All
Figure 21
Zero participation by ethnicity
Zero Participation
60 50 Percentage % 2005/06
2009/11
When measuring zero participation in APS5, the
percentage of non white and ethnic minorities doing
no activity was nearly 8% greater than the general
population. The trend in non-white populations
achieving none or lower levels of physical activity has
been consistent from the APS1 (2005) through to
APS5 (2011). The survey also indicates that there is a
signficant gap between the socio-economic classes
with 55% of those in the lower supervisory/ technical/
routine/ unemployed category undertaking zero
participation
against 33% across the managerial/
White
Non-white
42.2
40.1
54.2
professional
38.7
36.8 group.
44.5
40 30 2005/06 20 2009/11 10 0 All White Ethnicity Figure 22
Zero participation by age
While there is a broad need to increase levels of
physical activity, it is particularly relevant for those
who lead sedentary lifestyles and face health
inequalities. Those most at risk include older
populations who experience a notable decline in
activity after the age of 55; women, 70% of whom
are not doing enough to benefit their health (see
Figure 22); girls aged 16-24 where research has
shown a drop off in activity, BME groups (see Figure
21) and particular disadvantaged socio-economic
communities. People with disabilities are also at risk
from low levels of physical activity and face a number
of barriers. As many as 1.8 million Londoners are
classified as disabled and 78.3% do not participate in
physical activity or sport85. Action to address sedentary
behaviour and identify the barriers to participation
is therefore included in our strategic action plan for
these priority groups.
Non-‐white The future intentions for the continued commissioning
of physical activity is very positive and will focus on
a year on year increase in the number of people
achieving the 5 x 30 minutes a day target. This will
include targeted interventions for all age groups
and backgrounds, with particular importance on
expanding delivery to low socio-economic groups and
marginalised populations86.
85 Inclusive and Active 2, a sport and physical activity strategy
for disabled people in London 2010-2015
86 NHS SWL, Kingston Clinical Commissioning Group,
Commissioning Intentions 2012/13
55
Children
There is a shortage of data available locally for
patterns of physical activity and sport for children
and young people. Since the termination of the
Government’s PE and Sport Strategy for Young
People (PESSYP) in 2010, which measured the level
of children and young people accessing the ‘five
hour’ offer of PE and sport, there is no governing
body currently collecting this information. Such data
would be extremely useful to form a local picture
of the prevalence of physical activity across children
and young people. However, the Health Survey for
England (HSE) provides a national reflection of health
related behaviours such as physical activity. Figure
23 below presents self-reported data from the HSE
2008 report achieving at least an hour of moderate
activity each day. Boys are more likely than girls to be
active at almost every age, although the difference is
more marked among older children. According to this
data, physical activity declines with age in both sexes,
but more steeply in girls. This gap in physical activity
surveillance for young people has been recognised in
our strategy action plan as a key priority.
Figure 23
Children in England achieving at least an hour of moderate activity each day by age
and gender
50 45 Children % 40 35 30 Boys 25 Girls 20 15 10 5 0 2 3 4 5 6 7 8 9 Ages (years) 56
10 11 12 13 14 15 In Kingston, the Change4Life Sports Clubs
programme is being delivered across primary and
secondary schools with successful outcomes for
participation in a number of multi-sport themed
activities. The purpose of Change4Life Sports Clubs
is to harness the inspiration of the Olympic and
Paralympic Games whilst encouraging the less active
primary and secondary aged school children to do
more physical activity and engage in sport. Between
2011 and 2012, nearly 2,000 primary school children
participated in the programme along with just
over 1,500 secondary school pupils. Funded by the
Department of Health and DCMS, the programme
is set to continue to run until 2015 with a continued
ambition to provide children with the skills and
confidence to establish a regular habit of participation.
MODE OF TRAVEL TO SCHOOL (5)
the easiest ways to reach the recommended daily
amount of physical activity is to incorporate it into
daily routine, such as walking or cycling to school. The
data in Figure 24 shows that active travel by walking
to school is very positive across primary school
children. However, in contrast the level of cycling is
seen as extremely poor when compared to walking.
The pattern for secondary school children was far less
inspiring, with most taking the bus. When compared
to primary school activity, only a third chose walking
as their mode of travel and cycling was almost on a
par. The increased use of passive modes of transport
in secondary school age children is likely to reflect an
increase of autonomy in relation to the use of public
transport. Achieving a shift to increase active travel
requires that physical and cultural improvements are
made with investment and partnerships to support
Data on the mode of travel for school children across
the development of cycling training, safety and the
region in England
Kingston is available via the Annual Schools Census
environmental infrastructure. Kingston, as a biking
(ASC). The 2011 report provides a snapshot of the
borough, is committed to providing access to cycling
ways in which both primary and secondary school
and promoting free cycle training programmes in
Walk children are
Cycle
Car/Van
Bus
Train
travelling to school. Active travel lends
schools and low cost access for those who live and
8,591
255 as health-enhancing
3,093
455 work in the borough.
3
itself to being promoted
physical
2,991
334
1210life. One of4856
574
activity that can form
part of everyday
per thousand Figure 24
Number of pupils by mode of travel to school
9,500 9,000 8,500 8,000 7,500 7,000 6,500 6,000 5,500 5,000 4,500 4,000 3,500 3,000 2,500 2,000 1,500 1,000 500 0 Number of pupils by mode of travel to school
Primary Schools Secondary Schools Walk Cycle Car/Van Bus Train Mode of Transport 57
Policy drivers: National and regional
Promoting physical activity has become a national
cross cutting theme within a number of strategies
and plans. These policies support the ambitions that
contribute to improving physical activity across the
wider dimensions along with sport and influence
our local policy drivers to promote and improve
participation across all communities.
National policy drivers
●● Start Active, Stay Active, Department of
Health, 2011. A report on physical activity for
health from the four home countries’ Chief
Medical Officers on the revised national physical
activity guidelines and sedentary lifestyles.
●● Healthy Lives, Healthy People, a strategy
for Public Health, Department of Health, 2011.
The government’s vision for the future of public
health.
●● Be Active, Be Healthy; A Plan for Getting the
Nation Moving, Department of Health, 2009.
A strategy to improve the activity levels of the
population through physical activity and sport.
●●Active Travel Strategy, Department of Health
and Department for Transport, 2010. A plan
to put walking and cycling at the heart of local
transport and public health strategies.
58
Regional policy drivers
●●Go London, An Active & Healthy London for
2012 and beyond, NHS London, 2009. NHS
London’s strategy to lead a shift in physical
activity behaviour towards a public health legacy
of the 2012 Olympic and Paralympic Games.
●● Sport England, A sporting habit for life 20122017. A Youth and Community strategy to
increase the number of people who play sports
regularly and reduce the number of young
people who stop playing when they finish school.
●● Inclusive and Active 2, Greater London
Authority, 2010. A sport and physical activity
strategy for disabled people in London 20102015.
●● Delivering healthcare for London: An
integrated strategic plan 2010-15, NHS London.
An integrated strategic plan setting out the 3 to
5 year implementation path.
Policy drivers: Local
A wide range of partner organisations in Kingston
have priorities to increase the number of people
being physically active or taking part in sport. There
are also a number of local strategies that contribute
towards the physical activity agenda and interlink
across the physical activity spectrum. This strategy will
sit alongside these and provide a focus for partners
who have been involved in its development to jointly
deliver outcomes through physical activity and sport.
Figure 25
National, regional and local policy drivers for physical activity.
National
• Start Active, Stay Active
• Healthy Lives, Healthy People
Public Health
Responsibility Deal
NICE
pathways for
physical activity
Change4Life
Regional
• Go London. An Active and Healthy London
• London Health Improvement Board
Local NHS
Kingston Clinical
Commissioning Group (KCCG)
Strategy Plan 2012/13 to 2014.
Weight-related medical conditions
• Diabetes
• Coronary Heart Disease
• Certain cancers
(womb, breast , bowel)
• Mental Health
Kingston
Public Health
JSNA
JAPHR
Kingston
Health & Wellbeing Board
Joint Healthy Weight
& Physical Activity
Strategy
Local authority
Kingston Plan.
Kingston’s vision for 2020.
Related RBK strategies
• Children & Young Peoples Plan
• Transport Strategy
• Equality & Community
Engagement Plan
• Play Strategy
• Parks and Open Spaces Strategy
59
Local Action - Where we are now?
In developing this strategy we consulted with a wide
range of people on what they thought about physical
activity and sport in Kingston. We engaged with
community groups, professionals and the general
public through focus groups and electronic surveys
to gauge their opinions on issues such as access to
local services, barriers to activity, gaps in provision
and future development. A practical mapping
exercise was also carried out to identify the current
service provision of physical activity and sport across
Kingston which looked to establish key information
such as the type of activity, cost, demographics and
locality of service. It is important to highlight that we
did not manage to reach all partners and providers
through these exercises so these results do not reflect
a complete and total picture of activities available
in Kingston. The results of the mapping exercise are
outlined within this section under the key themes of
Active Recreation, Active Travel and Active Sport and
collectively into a map to combine the sum provision
of the physical activity spectrum.
Outcomes from the focus groups and electronic
consultations identified key priorities in the provision
of physical activity and sport by the general public,
professionals and targeted communities in Kingston.
The priorities that emerged have been incorporated
into the recommendations within this strategy action
plan. These are summarised in Table 21.
Table 21
Key themes from consultation exercises.
Event and who
took part
What they told us
Focus Groups
(Public)
⚉⚉ Accessibility: There is a need for more localised ‘door step’ community settings for physical activity.
⚉⚉ Health & Wellbeing: We should focus on reducing isolation by providing more social programmes.
⚉⚉ Communication: Improved publicity and awareness of activities and opportunities is required.
⚉⚉ Participation: More mentoring and encouragement to support participation would be helpful.
⚉⚉ Facilities: Local and convenient facilities should be used to host low cost activities.
Focus Groups
(Professional)
⚉⚉ Accessibility: Free and incentive based activities were thought to be a priority.
⚉⚉ Supply & Demand: More patient and public choice for physical activity, particularly for relevant groups such as women
and young girls.
⚉⚉ Gaps in Service: A number of gaps in provision were identified, such as workplace health, engagement with 16-18 year
olds and hard to reach groups.
⚉⚉ Communication: Sharing information between partners and raising awareness of what’s available is key.
⚉⚉ Partnerships: Stronger partnership working and wider networking with planning, environmental, third sector, the public
and voluntary sector are equal priorities.
Electronic Survey
(Public)
⚉⚉ A combined 92% of respondents felt it is very important or quite important to maintain a healthy lifestyle.
⚉⚉ The top two barriers to participation were cost and time, totalling 53% respondents.
⚉⚉ Nearly 20% of respondents did not know what programmes were available and hadn’t seen any marketing.
⚉⚉ 25% of respondents would like more walking programmes; 28% would like more opportunities for dancing and 22%
would like more cycle rides.
⚉⚉ 50% said they wanted access to information via GP practices and 40% equally from libraries and schools.
⚉⚉ Parks, open spaces and leisure centres were identified as the preferred venue for activities, with school facilities also being
popular.
Electronic Survey
(Education)
⚉⚉ 100% of primary school and 90% of secondary school respondents rated healthy lifestyles as important.
⚉⚉ Nearly 50% of primary schools wanted more active play and after school activity sessions.
⚉⚉ Nearly 90% of secondary school respondents promoted healthy lifestyles through sport.
⚉⚉ Similar to the general public, parks were the most preferred location to participate in activities.
⚉⚉ Interestingly 77% of primary and 90% of secondary schools were either unsure or did not know how to access
programmes.
⚉⚉ Lack of information or knowledge was also rated the biggest barrier to accessing programmes amongst both primary
and secondary schools.
⚉⚉ 93% of primary and 85% of secondary schools would like more after school sport/physical activities.
⚉⚉ The most preferred communication method was school newsletters, with email and presentations to pupils rated equally
for secondary schools.
60
Overall provision of physical activity in relation to
Active Recreation seems well distributed across the
Borough (please see Map 7). However, in comparison
to activities for all communities, those specifically
for disabled groups and women and girls are sparse.
There are a number of activities on offer for children
and young people particularly in the north-west
and south but relatively few in the north-east of the
borough. As identified from the Active Peoples Survey
5, we know that a large proportion of Kingston’s
adult population undertakes no activity at all and less
than a quarter participate in at least 3 x 30 minutes
of activity per week. Small changes to lifestyles can
bring about big improvements in health and the
greatest improvements are seen in those who move
from doing no activity to some activity. We will work
with partners and stakeholders to ensure that local
programmes are in place to enable people to make
lifestyle changes towards increasing their physical
activity levels. We will develop programmes which
are targeted at those people in Kingston who have
traditionally been under-represented in physical
activity and sport, such as women and girls and
disability groups to enable improved access and
participation. We will also explore ways to create
and expand opportunities for after school activities
for young people to promote sustained participation
levels.
61
Map 7
Active Recreation Map
Active Recreation
Barnfield Youth Centre
Kingston Local History Room and Archives
Tudor Hall
North Kingston Children's Centre
AC
Tiffin Girls Community Sports Centre
AC
AC AC
The Hawker Centre
DCYP
AC
50+
AC
Tudor
ER
Albany Park Canoe and Sailing Centre
AC
CYP
AC
Kingston University ,
Kingston Hill
DCYP
Kingsnympton Youth Centre
AC
AC
AC
CYP
Canoe and Sailing Centre
Coombe Hill
DA
50+
AC
AC
Canbury
Kingston Hill Children's Centre
AC
AC
CYP
50+
AC DCYP
Tiffin Sports Centre
Dickerage Adventure Playground
David Lloyd Leisure
50+
ER
The Kingfisher Sports Centre
AC
CYP
Kingsmeadow Fitness and Athletic Centre
AC
ER
AC
AC
50+
ER
New Malden Children's Centre
Fountain Youth Centre
AC
St Marks
AC
The Malden Centre
AC
Beverley
AC
AC
Berrylands
AC
AC
St James
50+
AC
ER
AC
AC
AC
DCYP
CYP
50+
AC
Surbiton Hill
School Lane Youth Centre
ER
Grove
50+
Surbiton Town Children's Centre
AC
AC
AC
AC
Coombe Vale
50+ DCYP
AC
50+
Searchlight Youth Centre
AC
AC
AC W & G
Norbiton
50+
ER
Arena Sports & Gym
ER
AC
Alexandra
AC
AC
ER
50+
AC
Old Malden Children's Centre
AC
Richard Challoner Sports Centre
Old Malden
The Venner Youth Centre
ER
AC
ER
AC
AC
Chessington Equestrian Centre
Tolworth Recreation Centre
ER
King George Field Indoor Bowls Club
AC
AC
Chessington North and Hook
Devon Way centre
CYP
AC
CYP
DCYP
AC
AC
ER
Active Recreation
CYP
Chessington Sports Centre
"
)
"
)
"
)
"
)
"
)
"
)
"
)
CYP
AC
Chessington South
AC
AC
±
1:47,000
!
50+ - Fifty Plus Population
AC - All Communities
CYP - Children & Young People
DA - Disabled Adults
DCYP - Disabled Children & Young People
ER - Exercise Referral
W & G - Women & Girls
Leisure, Community Centres & Youth Clubs
Wards
Local Open Space
School Open Space
62
Map 8 shows the opportunities in the borough
for walking and cycling. Whilst it is positive that
there is very good access to cycling training for all
communities, it is evident that there is a general
lack of organised community cycle rides available.
Since the expiry of the Kingston Sky Rides, there is
an obvious need to develop a programme of social
and sustainable bike rides in the borough. Overall
there is good provision for health walks, and with the
established Kingston Walk4Life programme, there is
certainly potential to expand the offer of health walks
across other suitable locations in the borough. The
emphasis on active travel is of national importance
and also features high on the government agenda.
Walking and cycling for local journeys are accessible
and affordable ways to incorporate physical activity
into daily routine. As part of Kingston’s commitment
as a biking borough, there is a vast amount of
development work underway to increase the number
of people cycling in a safe way. Cycle training
for children and adults, improving infrastructure,
additional cycle parking and improved signage are
just some of the improvements already made to build
cycling into everyday life for those who live and work
in Kingston. Continued local partnerships will be
key to addressing the gaps in provision in our drive
towards getting people about more on foot and bike.
63
Map 8
Active Travel
Active Travel
Tudor Hall
The Hawker Centre
Kingston University,
Kingston Hill
AC CYP
AC AC
DCYP
Tiffin Girls Community Sports Centre CYP
AC
DCYPW&G
W&G
Tudor
AC
CYP
AC
Coombe Hill
DCYP
W&G
AC
AC CYP
Canbury
AC
DCYP W&G
David Lloyd Leisure
AC CYP
CYP
AC
Grove AC
TC
W&G
Arena Sports & Gym
AC
Coombe Vale
AC
W&G DCYP
AC
W&G DCYP
Norbiton
AC CYP
DCYP
CYP
W&G
St Marks
DCYP
CYP
AC
The Malden Centre
Beverley
W&G
DCYP W&G
DCYP
CYP
W&G AC CYP
AC
St James
Berrylands
DCYP W&G
DCYP
W&G
CYP
AC
Surbiton Hill
W&G AC
Alexandra
AC
DCYP
CYP
CYP
Old Malden
CYP
AC CYP
W&G DCYP
DCYP W&G
AC
CYP
TC
CYP AC CYP
DCYP AC
AC
W&G
!
Schools
!
Leisure Centres
Chessington South
Wards
Local Open Space
School Open Space
"
)
"
)
"
)
"
)
)
1:47,000 "
±
AC - All Communities
CYP - Children & Young People
DCYP - Disabled Children & Young People
TC - Target Communities
W&G - Women & Girls
64
Map 9
Active Sport
Active Sport
Barnfield Youth Centre
Kingston Local History Room and Archives
Tudor Hall
North Kingston Children's Centre
Tiffin Girls Community Sports Centre
Kingston University Kingston Hill)
Kingsnympton Youth Centre
The Hawker Centre
Albany Park Canoe and Sailing Centre
Tudor
Coombe Hill
Kingston Hill Children's Centre
Canbury
Dickerage Adventure Playground
David Lloyd Leisure
Searchlight Youth Centre
Coombe Vale
Norbiton
Arena Sports & Gym
The Malden Centre
Grove
Beverley
New Malden Children's Centre
Fountain Youth Centre
St Marks
St James
Berrylands
Surbiton Town Children's Centre
Old Malden Children's Centre
Surbiton Hill
School Lane Youth Centre
Alexandra
Old Malden
The Venner Youth Centre
Devon Way centre
Active Sport
Chessington South
±
1:47,000
"
)
"
)
"
)
#
V
U
!
S
"
(
!
(
!
(
!
(
!
(
!
m
n
#
*
London Youth Games, CYP
Athletics, CYP
Multi Sports, AC
Athletics, DA
Multi Sports, CYP
Athletics, DYP
Basketball, DYP
Multi Sports, DA
Boccia, DA
Cycling, CYP
Football, CMH
Football, CYP
Football, TC
Football, DYP
Football, U5
Multi Sports, U5
X
W
?
!
F
G
F
G
D
Golf, DA
Rugby, M + YP
Running, AC
Tennis, AC
Tennis, DYP
Water Sport, CYP
Wards
!
Leisure, Children's Centres & Youth Clubs
Local Open Space
School Open Space
65
Map 9 shows the current level of sport provision
in the borough which is provided by a number of
partners such as Active Kingston, sports clubs and
community groups. The map shows a relatively good
spread of activities for a range of groups across the
borough, although there seems to be obvious gaps
along the east side of the borough. There are 110
voluntary sports clubs in Kingston that cater for
people of all ages and ability levels to encourage
people to take up sport, of which 27 are located
in the east of the borough . In addition there are a
number of schools, community organisations and
faith groups spread across the borough offering
opportunities for sport and physical activity within
their own settings.
Kingston has a number of other schemes in place
to assist specific community groups to access leisure
provision such as the Active Kingston Card for
people aged 60+, disabled people, carers, students
and people on a low income receiving Job Seekers
Allowance (JSA) or Income Support. The Free Access
for National Sports People (FANS) Scheme provides
sports people of a national level with FREE access to
gyms in Kingston.
66
Through the Kingston Community Sport and Physical
Activity Network (CSPAN), we will continue to develop
strong links with partners, groups and organisations
to initiate programmes for specific target groups
such as disability. Programmes like INSPIRE – low cost
multi sports sessions for people with special needs,
Special Olympics Surrey – year round sports training
and competition for children and adults with learning
disabilities, and the creation of a physical activity/
sports directory of disability provision will continue
to create opportunities for disabled people. Efforts
will continue to enable accessible and affordable
opportunities for our communities to raise the profile
of sport and increase participation levels.
Map 10 illustrates a collective view of all three activity
categories showing the distribution of the services
offered across the borough. It is very encouraging
to see the density of opportunities that exist in the
most deprived wards in the borough i.e. Norbiton,
Grove, Berrylands and Canbury. Whilst our ambition
is to increase physical activity participation levels in
everyone, it is particularly pertinent for those who are
currently inactive, at risk of chronic disease and suffer
health inequalities.
Map 10
Active Sport, Recreation and Travel
Active Sport, Recreation & Travel
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Active Sport
Active Recreation
Active Travel
Wards
67
In summary, there are some key priorities for partners
to focus on in order to deliver against the identified
gaps in services. As mentioned in the mapping
sections above, actions to develop opportunities
across the physical activity spectrum should be agreed
in partnership with organisations who share the
same commitment and enthusiasm for increasing
participation and bringing about healthier lifestyles.
Key principles to guide commissioners in Kingston
include:
68
●● Encouraging those who are sedentary or have low
levels of physical activity to become more active
through a range of programmes and services.
●● Provide more opportunities across the life stages to
increase activity levels but ensure that those least
likely to participate are targeted.
●● Identify priority groups such as women and girls,
ethnic minority groups, those with disabilities and
low socio-economic groups and tailor activities so
they are accessible and affordable.
●● Ensure that physical activity and health
outcomes are integral to economic, regeneration,
environmental, transport and planning.
●●Strengthen the links between physical activity and
the wider health and leisure services such as obesity,
mental health and sport.
●● Ensure that children and young people have
positive experiences of physical activity, sport, active
travel and recreation and encourage a habit for life
approach.
●●Target the most disadvantaged communities within
Kingston, addressing inequalities and access to
healthy and active lifestyles.
●● Ensure older people have a range of suitable
options available to increase participation to
support them to lead more independently mobile
lives.
●● Nurture existing partnerships and develop
sustainable working relationships across a range of
partners to support and assist in the delivery of the
strategy action plan.
●● Ensure that a robust monitoring and evaluation
process is in place to underpin an evidence based
approach to the delivery of activities.
69
Action Plan
The mapping exercise, evidence review, information
gathered from the consultation exercise, identified
gaps in services and areas for improvement
and potential for developing existing and new
opportunities to promote a healthy weight and treat
obesity in Kingston have all informed the Healthy
Weight and Physical Activity Strategy Action Plan
(please see separate document).
The action plan provides a framework within
which to deliver the key strategic targets.
Recommendation 1:
Improve and enhance surveillance of healthy weight and physical activity levels
in Kingston
Objective
Action
Lead &
Partners
(Lead team
in bold)
1.1. Continue to
1.1.1 Complete annual weighing and
School Health
Ongoing
Core part of
YHC Contract
Routinely
collect childhood
measuring of Reception and year 6
Team, Public
Annually
YHC contract
KPI achievement
completed
Health
Timeframe
Resources
required
Measuring
success
Notes
measurements as
children in Kingston Schools (continue
(supplemented
Quality data
with very high
part of National
to maintain and improve upon current
by funding from
participation rates.
Child Measurement
participation rates)
Public Health)
illustrating:
⚉⚉ Participation
Programme (NCMP).
rates
⚉⚉ Annual
prevalence
This achievement
should be
sustained in future
years
⚉⚉ Ward level data
1.1.2 Review and update information in School Health
parent feedback letters annually
Q3 annually
Core part of
Letters updated
Routinely
Team, Public
YHC contract
completed in Q3
Health
(supplemented
annually
by funding from
Public Health)
1.1.3 Review and update supporting
Public Health
Q3 annually
Core part of
Letters updated
Routinely
information in school feedback letters
YHC contract
completed in Q3
annually
(supplemented
annually
by funding from
Public Health)
1.1.4 Improve reporting of child obesity
Public Health,
Every 2 years Capacity of
Quality data
Discussions in
prevalence based on children’s centres
Children’s Centres
from 2012
progress
catchment areas
Services Manager,
Information
illustrating;
⚉⚉ Pooled 3 year
RBK
Analyst
Public Health
prevalence by
catchment area
1.1.5 Ensure effective use of data
CSPAN, Public
and information in all aspects of
Health, all
service planning (including targeted
stakeholders
Ongoing
recruitment to services)
Effective data
Increased uptake
collection
of services,
techniques and
improved sharing
statistical support
of information
Commitment
Annual prevalence
Data being
from KCCG and
data by practice
collected
1.2 Improve the number 1.2.1 Audit data from GP surgeries
Public Health,
of patients measured
who routinely collect BMI of patients
KCCG
and the reporting of
aged 16 years and over with a BMI
GP practices
but service
BMI measuring for
greater than or equal to 30 kg/m2
(core part of
specification to be
adults (QOF).
and use this data to inform service
PMS contract
submitted to QMS
development and expansion
but not GMS
for quote on cost
contract). Capacity
to download data
70
Annually
of Public Health
in an aggregated
Information
format (by age/
Analyst
gender/BMI)
Objective
Action
Lead &
Partners
(Lead team
in bold)
Timeframe
Resources
required
Measuring
success
1.2.2 Audit NHS Health Check dataset
Public Health,
Q2 - Q3
Public Health
Annual prevalence
Not started, work
to provide information on BMI for
NHS Health
2013/14
Information
data
is required to
adults aged 40-74 years and ensure
Checks Lead
Notes
explore the most
Analyst capacity
adequate sign posting and referral into
effective way of
lifestyle services
gaining this data
Public Health
1.3. Improve and report
1.3.1 Audit BMI data from Kingston
Resources and/ or
Annual prevalence
on BMI measuring
Hospital for pregnant women aged
funding will need
data
for women at the
above 18 years with a BMI greater than
to be identified
once for Maternal
first contact and/or
or equal to 30 kg/m2 and use this data
for this
Obesity Health
antenatal booking
to inform the development of maternal
appointment.
weight management pilot programmes
Annually
This data has
been collected
Needs Assessment
but is not routine
process. Further
work is required
to explore this
1.4. Develop
1.4.1 Continue to update the map of
Public Health,
Q1/Q2
Staff capacity,
Services identified, This process is
mechanisms to record
the current physical activity, sport and
CSPAN, RBK GIS
2013 /14
partner
maps updated,
now ongoing.
physical activity and
active travel provision in the borough
team
engagement, GIS
knowledge of
Annual updates
sport participation,
to identify gaps and assist with the
measure impact and
future direction and development
support
celebrate success.
service provision
should be
circulated to
completed and
partners
a full refresh
(through
consultation)
completed by
2016
1.4.2 Audit and utilise data collected
Pro-Active South Annually
Staff capacity,
APS trend data
Exploration with
annually by Sport England’s Active
London, CSPAN,
training for
for participation
partners required
People’s Survey (APS) to support the
Sport England
to ensure this
partners to
and frequency of
direction of physical activity and sport
ensure accurate
activity
in Kingston ensuring areas of low
interpretation
is effectively
completed
or zero participation are targeted for
intervention
1.4.3 Establish a local performance
CSPAN, Pro-Active Q3 2013/14
Staff capacity to
Agreed toolkit/
Research is
management system and identify
South London
research systems,
system developed
required to
indicators to monitor and report on
funding streams
and utilised by
ensure new
physical activity and sport outcomes. If
will need to be
physical activity
developments are
appropriate, set a locally agreed target
explored
partners
effective
for participation in Kingston
1.5. Develop
1.5.1 Consult with local communities
CSPAN,
Effective
Completion of
mechanisms to assess
including children and young people
Environmental
consultation tools
surveys and action
accessibility of public
regarding accessibility of public and
Health, Public
and resources to
plans in place to
and green spaces for
green spaces
Health and
act on findings
act on the findings
Access to
Clear direction
family and community
Climate Change
interaction, physical
teams, RBK, Save
activity opportunities
2014/15
the World Club
and sustainable food
1.5.2 Review parallels between RBK
CSPAN,
growing opportunities
policies and strategies to ensure clear
Environmental
strategies, staff
(linking with current
aims and priorities
Health, Public
capacity
RBK strategies).
2014/15
Health and
Climate Change
teams, RBK, Save
the World Club
71
Objective
Action
Lead &
Partners
(Lead team
in bold)
1.6. Audit current
1.6.1 Establish a mechanism to share
Public Health
working practices of
information on the roles of relevant
and all partners
local health and non
health and non health professionals to
health professionals
increase awareness of services available
services available
for the purposes of
and relevant pathways
in Kingston
information sharing
and improving
knowledge and
awareness of local
support and services
available to children
and adults in Kingston.
72
Timeframe
Resources
required
Measuring
success
Q1 2014/15
Staff capacity, full
Clear pathways
engagement from
and increased
all partners
awareness of
Notes
Recommendation 2:
Improve and develop partnerships
Lead &
Partners
(Lead team
in bold)
Objective
Action
2.1 Set up a Kingston
2.1.1 Set up a working group to review, Maternity
Timeframe
Resources
required
Measuring
success
Q3 2013/14
Group to identify
Group formed,
Maternal Obesity
prioritise and implement the findings
Service Liaison
relevant resources
minutes of
Action group.
from the ‘Obesity in Pregnancy – Needs
Committee
and funding
meetings held
Assessment, 2011’. Ensure membership (MSCL), Public
is comprehensive (i.e. to include
Health, Kingston
members from Maternity Services,
Hospital, YHC
Notes
streams
Midwifery (acute & community), Health
Visiting, Dietetics, Public Health, and
KCCG)
2.1.2 Explore the need to set-up a
Kingston
Group to identify
Business case
specialist antenatal MDT clinic for
Maternal
relevant resources
submitted and
women with a BMI >30kg/m2 in
Obesity Action
and funding
approved, clinic
Kingston hospital
group, Maternity
streams
delivered
Q4 2013/14
services, Kingston
Hospital
2.1.3 Explore possibility of setting up a
Dietetics and
Q4 2013/14
specialist dietetic maternal obesity clinic Maternity
Group to identify
Business case
relevant resources
submitted and
(preconception/fertility, antenatal and
Services,
and funding
approved, clinic
post-natal)
Kingston
streams
delivered
Hospital
2.2 Work with partners
2.2.1 Continue to develop closer
CSPAN, RBK
to consolidate and
working relationships between key
neighbourhood
expand the offer for
partners and seek to expand the cohort management
of partners across private, academic,
sport in Kingston.
voluntary, community and faith groups
Ongoing
teams, schools,
Staff capacity
Increased
Partners in
and commitment.
partnership
Kingston regularly
Regular
working between
work well
networking
services. Improved
together but
more networking
ECET, Kingston
meetings and
engagement with
Voluntary Action
events
community groups is required to
ensure all possible
(KVA)
opportunities are
explored
2.2.2 Review and develop the role of
CSPAN, Public
Staff capacity
Refreshed
the CSPAN and respective sub-groups
Health, Active
to explore and
network and sub-
have taken an
to support the Healthy Weight and
Kingston team,
identify potential
groups identified
active role in the
Physical Activity Needs Assessment
RBK
development
Q2 2013/14
CSPAN members
options and
in line with need.
and Strategy Action Plan including
consult with
Healthy Weight
of this strategy
governance structures and membership
partners involved
and Physical
and will be fully
consulted as to
ensuring effective reporting and
Activity Needs
accountability structures are put in
Assessment and
the most effective
place. Proposed new subgroups to
Strategy Action
model
include Environment (and sustainability)
Plan incorporated
and Healthy Weight
2.2.3 Ensure that the borough’s
Active Kingston,
Staff capacity
Relationships
physical infrastructure is conducive to
Smarter Travel
and networking
established
links need to be
supporting Active Living and Active
Team and
meetings. Funding
with planning/
developed and
Planning, RBK,
streams will need
environmental
embedded to
Public Health,
to be explored
teams.
ensure all future
Involvement in
development
planning process
in Kingston’s
Travel
Quadron
Ongoing
Established
infrastructure
considers the need
to support Active
Living and Active
Travel
73
Objective
Action
Lead &
Partners
(Lead team
in bold)
Timeframe
Resources
required
Measuring
success
Notes
2.2.4 Develop and strengthen links
Active Kingston
Ongoing
Funding sources
Number of clubs
Active Kingston
with community sports clubs
team, RBK
via local partner
engaging with
already engage
support and
Active Kingston.
with many
local clubs.
combine resources.
Opportunities
for information
sharing and
links should be
explored
2.2.5 Develop links with wider
CSPAN, KEG and
partnership groups (such as Kingston
other relevant
Environment Group) to establish
partner groups
Engagement from
Effective links
other partnership
made and new
groups, staff
projects and
potential projects and programmes to
capacity and
programmes
focus on sustainability of outcomes
resources
established.
2.2.6 Develop and strengthen
Public Health
partnerships to work towards using
team, RBK
physical activity and sport as a means
and relevant
identified through
young people at
to reduce risk tacking behaviour
partners
partnership
risk of making
(smoking, substance misuse, risky
sexual behaviours, anti-social behaviour
etc) in line with the Risky Behaviour
Needs Assessment
74
2014/15
2014/15
Funding sources
Programmes
and capacity to be
available for
discussions
risky behaviour
choices
Recommendation 3:
Improve communications
Objective
Action
Lead &
Partners
(Lead team in Timebold)
frame
3.1 Improve
3.1.1 Use the Get Active London web
Active Kingston
awareness of physical
portal to create a directory of local
team, RBK, Public
administrators to
into portal and
London web
activity, sport and
activities and sports clubs identified
Health, Pro-Active
be identified and
tested. Widget
portal is currently
weight management
from the physical activity and sport
South London
trained
available on all
available but
programmes,
mapping exercise
Q2 2013/14
Resources
required
Measuring
success
Notes
System
Activities entered
The Get Active
campaigns and
relevant websites
Kingston is
(RBK and KCCG)
not using it as
services across
effectively as
Kingston.
possible. Work is
required to make
best use of this
low cost resource
3.1.2 Widely promote the Get Active
CSPAN, Pro-Active
Pro-active
All partners
Partners will
London web portal using a variety
South London,
marketing
proactively
need to engage
of platforms to better communicate
Public Health,
materials. Web
marketing this
with this portal
what clubs, services and activities are
KCCG & RBK
links to be
portal. Widget
to ensure it is
available and how to access them
Communications
established for
available on all
regularly updated
teams
partner use
relevant websites
and the link is
(RBK and KCCG).
circulated at
Q2 2013/14
Outcome of public every possible
feedback surveys
opportunity
Promotional
Campaign
Partners should
Change4Life
materials and
materials obtained
be encouraged
Kingston, CSPAN,
campaign
and promoted.
to promote
information and
Public and schools
all related
events
engaged in
programmes
3.1.3 Utilise national campaigns on
Public Health,
a local level, such as Change4Life
(including Start4Life), Healthy Start,
Ongoing
Bike Week etc, to reinforce the benefits KCCG & RBK
of physical activity, healthy lifestyles
Communications
and maintaining a healthy weight
teams
programmes
when possible
to make every
contact count
3.1.4 Ensure information about weight
Public Health,
Ongoing
Staff capacity,
School
management programmes, healthy
Active Kingston
and termly
promotional
partnerships
with children
eating, physical activity and sport are
team, RBK,
materials, school
established.
and young
made available to children and young
Schools, sports
contacts
Information and
people about the
people through a range of preferred
clubs, CSPAN
Consultation
presentations
best means to
delivered. Results
communicate with
newsletters, e mail and assembly
of feedback
them will ensure
presentations
surveys
communication methods i.e. school
the most effective
methods are used
3.1.5 Launch the updated adult and
Obesity
new child weight management care
partnership
Q4 2012/13
Staff capacity
Results of
Draft pathways
to complete
feedback surveys.
will be launched
pathways to professionals and develop
groups such as
pathways
Pathways
when consultation
a patient friendly version for the
the Children’s
(professional and
complete and
with clinicians
general public
and Adult’s
public versions).
launched
Weight
Funding for
formal sign off
agreed
Management
training and
Groups, NHS,
awareness raising
KCCG and RBK
events
is complete and
Communications
75
Objective
Action
Lead &
Partners
frame
Resources
required
Measuring
success
3.1.6 Make effective use of broader
Public Health and
Effective links
Increased
RBK website is
generic marketing opportunities
Active Kingston
with relevant
awareness of
currently under
such as KCCG website, RBK website,
team, RBK, KCCG,
communications
programmes and
re-development.
Healthy Lifestyle services in Kingston
CSPAN
teams, funding for services. Increased
Ongoing
Notes
Effective links
uptake of
need to be
the communications strategy (action
programmes and
maintained
3.2.1)
services
marketing
booklet, and press releases in line with
with KCCG
communications
team after
transition process
3.2 Improve marketing
3.2.1 Develop an effective
RBK
and communication
communications and marketing
methods to help
strategy for healthy weight, physical
achieve an uptake in
activity and sport messages
CSPAN, KCCG
Staff capacity with
Completed
Commencement
Communications,
communications
communications
of this action will
Public Health,
expertise
strategy launched
Q4 2013/14
need commitment
and capacity of
participation.
all partners and
the expertise of
communications
staff
3.2.2 Continue to ensure information
Public Health,
on physical activity, sport, weight
management and healthy eating
The consultation
Staff capacity,
Information
Active Kingston,
promotional
circulated. Results
process in this
CSPAN
materials, funding
of feedback
strategy has
is widely circulated to the general
for printing and
surveys
public through community outlets, in
distribution
Ongoing
highlighted useful
format ideas
particular GP surgeries, community
and places for
pharmacies, libraries and leisure
displaying this
information and
facilities
these should be
adopted where
appropriate
3.2.3 Establish a system of visits to
Public Health,
GPs, community pharmacies and
KCCG
This is particularly
Staff capacity,
Schedule of visits
effective
established. GPs,
important during
networking and
pharmacists
the NHS transition
relationships and communicate the
events. System of
and health
phase in order
services within physical activity and
delivery
professionals
to maintain and
Q1 2013/14
other health professionals to cultivate
better informed of strengthen links
weight management care pathways
services. Increase
already made as
in referrals and
well as creating
use of care
new relationships
pathways
3.2.4 Establish regular feedback
Public Health,
systems and consultation with
Staff capacity,
Survey licence
These systems
Active Kingston,
partner and
obtained.
should all
the public to gauge the impact of
CSPAN, KCCG
stakeholder
Consultations
feed into the
programmes and identify any further
and RBK
engagement,
designed and
consultation
needs to becoming more active and
Communications
communication
launched. Needs
process when
achieving a healthy weight
teams
teams support,
identified
this strategy is
Q3 2013/14
funding for survey
licence
76
refreshed
Objective
Action
Lead &
Partners
frame
Resources
required
Measuring
success
Notes
3.2.5 Establish regular feedback
Public Health,
Staff capacity,
Established
These systems are
Q2 2013
systems for referring health and non-
CSPAN, KCCG
effective referral
pathway for
in development.
health professionals to ensure a holistic
and RBK
database that
information.
Work is required
approach to raising the issue and
Communications
allows for regular
Referrers receiving
to resolve
completeness of documentation
teams
feedback
information as
current gaps in
to the outcomes
information and
for patients they
to widen the
referred
feedback to loop
to all referrers
3.2.6 Identify and develop the role
ECET, CSPAN,
Q4 2013/
Establish links
Volunteer
of local volunteer ‘Community
Kingston
2014
with Community
Champions
Health Champion
Champions’ and role models to inspire
Voluntary Action,
Empowerment
recruited and
project will be
others to be more active and healthy
Change4Life
Project and link
active in the
established
Kingston
with the pilot
community
The Chessington
in 2013 and if
successful, further
Chessington
Health Champion
roll out will be
project.
considered. The
Partner and
Community
stakeholder
Development
engagement.
and Health
Marketing and
Course (CDHC)
in September
publicity materials
2013 will focus
on volunteer,
champion and
community
development
3.2.7 Utilise sporting clubs and national Active Kingston,
Ongoing
Staff capacity.
Regular
attendance of
athletes as role models to inspire,
National Governing
Networking and
influence and motivate others to be
Bodies, Kingston
events.
successful local
more active more often
sports clubs, Sport
Marketing and
athletes at events
England, RBK
Publicity materials.
including the
Communication
Partner
annual Sports
team
engagement.
Awards.
Communication
teams support
3.3 Develop a locally
3.3.1 Produce local campaign materials
Public Health,
Q4 2013/
Funding to
Materials
targeted campaign
and resources to target vulnerable
KCCG and RBK
2014
produce materials,
developed.
in line with national
and hard to reach groups to raise
Communications
staff capacity
Campaign
initiatives to raise
awareness of the links between health,
teams, Public
public awareness
physical inactivity and the impact of
Health,
Information
of the health risks
carrying excess weight (using 5-10%
Change4Life
circulated
associated with excess
weight loss to demonstrate the
Kingston, ECET
weight and inactivity.
benefits of small changes)
launched.
3.3.2 Set-up a rolling awareness raising
KCCG and RBK
On-going
Staff capacity,
Materials
campaign to link in with other annual
Communications
from launch
funding to
developed.
health events in Kingston
teams. Public
produce materials
Campaign
Health,
launched.
Change4Life
Information
Kingston, ECET
circulated. Results
of feedback
surveys
77
Recommendation 4:
Promoting a healthier weight across the life course (key recommendations for the
prevention of obesity)
Objective
Action
Lead &
Partners
frame
Resources
required
Measuring
success
Notes
To promote an environment where healthy choices are easier to make
4.1 Explore Healthier
4.1.1 Explore piloting a Healthier
Environmental
Pilot scheme
Full evaluation
Catering schemes in
Catering scheme in Kingston’s food,
Health team, RBK, 2014
set up and
post pilot will
Kingston businesses
leisure and workplace establishments
Public Health
completed with
guide future
Q1 2013/
Staff capacity
including healthier
learning outcomes
initiatives in
vending provision.
informing future
Kingston
plans
4.1.2 Develop local standards based on
Environmental
Draft standards
Partners to review
the Government’s Healthier Catering
launched for
capacity available
Commitment (HCC) and the Public
Public Health
consultation and
and adjust
Q4 2013/
Staff capacity
Health Responsibility Deal: Food
final standards
timescales as
pledges http://responsibilitydeal.
launched for use
required
dh.gov.uk/2011/12/20/food-pledges/
4.1.3 Environmental Health to inspect
Environmental
food establishments and work with
Health team, RBK,
Public Health to recommend healthier
Public Health
Ongoing
Staff capacity
Number of
Kingston
establishments
achieving
catering practices and standards
Healthier Catering
Commitment
Standards
4.2 Encourage schools
4.2.1 Increase the number of schools
RBK
to implement the
applying for the award scheme and
Commissioning
‘Food for Life Catering
Ongoing
support them in implementing healthier team (school
Mark award criteria’
and sustainable catering practices in
meals), Public
(Soil Association).
school catering
Health
6 Kingston schools
Staff capacity
Number of
within schools,
Kingston schools
have signed up
schools
meeting the
to the FFLP award
bronze Catering
scheme but none
engagement.
Mark
have yet achieved
the Bronze award.
The school meals
contract provider
Cygnet has met
the Bronze award
4.3 Raise awareness
4.3.1 Verify existing calorie contents of
Environmental
amongst food
menus by taking samples for analysis
Q3 2012/
Staff capacity
businesses of energy
Number of
This work is in
premises
progress
compliant
values in food and
how to label/advertise
appropriately.
78
4.3.2 Encourage establishments to
Environmental
follow Government guidance (FSA and
Q4 2012/
Staff capacity
Number of
premises meeting
DH) on energy, saturated fat, sugar and Public Health
Government
salt intake
standards
4.3.3 Promote the Public Health
Environmental
Responsibility Deal ‘Out of
premises signing
home calorie labelling’ http://
Public Health
up to the
Q4 2012/
Staff capacity
Number of
responsibilitydeal.dh.gov.
Public Health
uk/2012/02/03/f1-factsheet/
Responsibility Deal
Objective
Action
Lead &
Partners
frame
4.4 Ensure new
4.4.1 Ensure all new and redesigned
Planning team,
developments and
kitchens in social housing create an
RBK, Public Health,
and capacity.
regeneration
project is
Housing
underway and
Q4 2012/ 13
Resources
required
Measuring
success
Staff networking
New and
RBK regeneration
Notes
regeneration projects
environment conducive to cooking
Links with PNA3
projects all have
consider ensuring
and eating healthily at home with the
in Maldens &
kitchens to meet
Public Health
the environment is
family.
Coombe
appropriate
aim to engage
conducive to cooking
standards
with families and
and eating healthily at
provide cooking
home.
skills courses to
ensure they gain
maximum benefit
from their new
kitchen. PNA3 due
to start Summer
2013
4.4.2 Ensure all planning applications
Planning team,
for fast food establishments consider
RBK, Public Health
Q4 2013/ 14
Involvement of
Reduced number
Public Health
of fast food
the local environment and the link to
staff in planning
establishments
healthy weight and physical activity
application
near schools and
before approval is given.
process
along school
access routes
4.4.3 In line with the RBK Allotment
Allotment
Strategy 2008-2018, explore
strategy
opportunities to optimise allotment use
stakeholders,
and increase cultivation opportunities
CSPAN
2015/16
Stakeholder
Increased
engagement
cultivation
opportunities in
Kingston and
optimal use of
allotments
To increase the skills and knowledge of children, young people, families and adults to make healthy choices to
maintain a healthy weight
Early Years
Clinical Support
4.5 Promote healthy
4.5.1 Continue to expand and increase
eating and active play
the uptake of the Healthy Start Scheme Officers, Healthy
for 0-5 year olds in
across Kingston
Staff capacity,
Uptake of vitamins Children’s Centres
funding for
through the
and Health Clinic’s
Start Leads from
promotional
scheme. Number
already involved
Children’s Centres and
each Children’s
materials,
of families
early years settings.
Centre, Public
potential to
targeted from
Health.
expand the
deprived areas in
number of
Kingston
Ongoing
collection points.
4.5.2 Promote ‘Start4Life’
Health Visitors,
Core element
Staff awareness
(Change4Life) messages in all Early
Community
within the Your
training. Results
Years settings. Support and training
Nursery Workers,
Healthcare
from feedback
provided by Public Health where
Children’s Centre
contract,
surveys
required/ requested to achieve this
Lead
Start4Life
Q4 2013/ 14
resources.
Staff capacity
4.5.3 Establish whether the milk
Early Years lead,
scheme for under fives is running
RBK, Children’s
engagement with
of settings
under fives, fully
national scheme
implementing the
funded by Cool
Q2 2013/ 14
Early years settings Number
Free milk for all
in early years settings in Kingston
Centre Lead,
(including nursery’s, pre-schools and
children’s centres) as part of the drinks
Managers, Private
subsidy scheme,
recommendation in the Schools Food
Nurseries
to encourage a
Free Milk scheme
Milk (government
Trust nutritional guidelines ‘Eat Better,
healthy diet) www.
Start Better’ to all early years settings
coolmilk.com/cms/
index.php?q=Day_
Care
79
Objective
Action
Lead &
Partners
frame
Resources
required
Measuring
success
4.5.4 Continue to commission
Kingston Adult
Funding to
Increase in
Ongoing
Family Learning to run Cook & Eat in
Education Family
continue as in
cooking skills
Children’s Centres for parents with
Learning, RBK
previous years
and confidence
children from 0-5 years including
Children’s Centre
Increasing
advice on how to tackle fussy eating,
Lead, Public Health
participation rates
Notes
portion sizes and introducing new
foods to children
4.5.5 Expand the Cook and Eat
Public Health
Q1 2014/15
programme to other early years
Funding to be
Further
identified
programmes
commissioned
settings in Kingston (such as private
nurseries)
4.5.6 Assess the need for a targeted
Public Health,
early years obesity prevention
RBK Children’s
programme in areas of high prevalence
Centre Lead Health
based on NCMP Reception year data
Visitors Children
2014/15
Consultation with
Targeted health
The need for this
needs assessment
service needs to
summary
be explored
centre’s Managers
4.5.7 Establish effective links with
Public Health and
social care, ensuring parenting classes
Social Care, RBK
Q4 2013
Staff capacity
Up to date advice
and information
provide guidance on healthy eating
on healthy eating
and physical activity
and physical
activity included as
a core element of
parenting classes
4.6 Continue the
4.6.1 Increase community
Infant feeding
promotion and
breastfeeding drop-ins, work
coordinator,
maintenance of
towards achieving the Certificate of
Health Visitors
breastfeeding and
Commitment for Baby Friendly in the
weaning, ensuring
Community
Ongoing
Core element of
Meeting YHC
the YHC contract
contract indicators
support is available for
all new parents.
Public Health
Audit of health
Training needs
training of health professionals
professionals
analysis
involved in breastfeeding and weaning
confidence skills
4.6.2 Establish the need for further
Ongoing
to provide this
and provide if required
support
4.7 Ensure all early
4.7.1 Promote the voluntary Schools
Early Years lead,
years (including
Food Trust nutritional guidelines ‘Eat
RBK, Children’s
nurseries) providers
Better, Start Better’ to all early years
Centre Lead,
implementation of
have a healthy food
settings
guidelines
policy and encourage
Managers, Private
active play as a
Nurseries
Q4 2013/14
Staff capacity
Training of early
years staff and
routine service.
4.7.2 Review current active play
Children’s
Staff capacity and
Improved
provision in early years settings and
Centres, Public
resources during
knowledge
establish if more opportunities can be
Health
transition period
of active play
provided
80
2013/14
provision
Action
Lead &
Partners
frame
Resources
required
4.8 Ensure all schools
4.8.1 Work with schools and
Schools, RBK,
School
Increased number
and colleges have a
colleges to support the development
Public Health,
engagement, staff
of schools
healthy food policy.
and implementation of a whole
Young People’s
capacity.
with a healthy
school approach to food, including
Health Link
Training and best
food policy
recommended best practice using the
Workers
practice examples
Objective
Measuring
success
Notes
School Age
Q4 2013/ 14
implemented.
School Food Trust statutory nutritional
Adequate support
standards for primary and secondary
to maintain these
schools (including those that have
policies over time
become academies)
Schools, RBK
4.9 All schools to
4.9.1 Continue with the School Fruit
School
Scheme in place in
Free fruit
provide healthy meals
and Vegetable Scheme in infant schools
engagement with
all infants schools
implemented
and snack options.
in Kingston to ensure all 4-6 year olds
national scheme
Ongoing
have access to a free piece of fruit or
vegetable every school day. Support
schools that have not implemented the
scheme
Schools, RBK
School
Scheme in place in Cool Milk Free
scheme in infant schools in Kingston
engagement with
all infants schools
milk for all under
to ensure all under five pupils during
national scheme.
for under fives
fives, fully funded
school time are offered milk. Support
Funding for over
and increase in
by Cool Milk
primary schools to implement the
fives
number of schools
(government
subsidised milk scheme for all children
offering the
subsidy scheme,
aged 5-11
scheme to over
to encourage
fives
a healthy diet)
4.9.2 Continue with the School Milk
Ongoing
Subsidised milk
for children aged
5-11 Working in
partnership for
the children of the
UK Cool Milk
4.9.3 Monitor uptake of free school
School meals
Staff capacity to
Increased uptake
Monitoring of
meals and provision of healthy school
contract manager,
monitor uptake,
of school meals
the uptake of
meals based on the School Food Trust
RBK, Public Health
accuracy of data
Ongoing
free school meals
underway
(and Soil Association) guidelines
4.9.4 Survey schools to establish where
Public Health,
support could best be provided such
Schools
Q4 2013/14
Staff capacity
as monitoring the content of packed
Increased number
Results reported
of schools offering
by survey to
breakfast clubs,
inform guidance
lunches and running breakfast clubs.
food provision
for schools to
Consider information provision to
meeting Schools
inform their
parents such as appropriate portion
Food Trust
healthy food
sizes
guidance, Packed
policies
lunches survey
report
4.10 Encourage
4.10.1 Continue to run Change4Life
Kingston
children at risk of
Primary (Sports Clubs) in 12 schools
School Sports
overweight/ obesity to in Kingston and look into potential
Partnership,
become more active.
expansion of this project
Schools
4.11 Increase cooking
4.11.1 Increase awareness of the
Schools, Public
classes and skills in
importance of cooking skills in
Health
schools.
Ongoing
Capacity of school
Evaluation report
staff
completed
Survey required
Establishing
Increased number
further funding
of primary schools
to establish which
schools and continue to work towards
opportunities for
running cooking
schools currently
expanding cooking programmes in
schools
programmes
run cooking
Primary schools such as Chef’s Club
Ongoing
programmes
81
Objective
Action
Lead &
Partners
frame
Resources
required
Public Health
Staff capacity and
Continuation of
Contracts
resources
successful Cook &
currently under
Eat programmes
discussion
Measuring
success
Notes
Young People
4.12 Increase cooking
4.12.1 Continue to commission current
opportunities for
Cook & Eat provision for young people
hard to reach and
(Moor Lane and Young Carers)
Ongoing
vulnerable young
people to improve
their knowledge, skills
and confidence (aged
16-25).
4.12.2 Establish further Cook & Eat
Public Health
programmes for hard to reach and
Community
2013/14
Funding and staff
Increased number
capacity
of programmes
vulnerable young people (e.g. Looked
Disabilities team,
available within
After Children, youth settings in areas
Social Care,
the Borough
of high deprivation etc) ensuring
Neighbourhood
consultation with young people from
Managers
these groups in the development,
delivery and evaluation of these
programmes
Refer to physical activity actions (6 & 7) for objectives to increase participation rates in young people (especially girls)
Adult Obesity
4.13 Promote and
Public Health,
Look to source
Increased number
Current
support healthy eating community Cook and Eat programmes
local community
further funding
of programmes
groups to be
in the community.
groups, KVA
opportunities
available within
recommissioned
4.13.1 Continue to run adult
for hard to reach and vulnerable
Ongoing
the Borough
groups. Consider links with Kingston
in line with
evaluation
Foodbank
reports ensuring
new cohorts
of participants
benefit. New
groups to be
identified through
need
Public Health
Change4Life
Increased
healthy weight via promoting the
resources,
awareness of the
Change4Life messages
Communication
benefits of being
teams support
a healthy weight.
Change4Life
Training sessions
4.13.2 Raise awareness of being a
4.13.3 Run healthy eating/ obesity
Public Health
Ongoing
Ongoing
training for frontline staff using the
resources,
and evaluations
Change4Life messages
Communication
completed
teams support
4.13.4 Continue to commission Fit
Public Health,
as a Fiddle (in line with successful
Age Concern
instructors, staff
in line with
evaluation) for older people (focussing
Kingston upon
capacity and
contractual
funding
requirements
on hard to reach groups)
Thames
4.13.5 Continue to promote active use
Green Spaces
of allotments in Kingston to encourage
team, RBK, Public
sustainable healthy choices
Health, CSPAN
Ongoing
Ongoing
Facilities and
KPIs achieved
Space for
Optimal use
cultivation
of allotments
and increased
opportunities for
cultivation
4.13.6 Consider a cooking skills
Public Health,
initiative designed in consultation with
local community
and targeting adult men in Kingston
groups
Q4 2013/14
Staff capacity,
Pilot programme
resources
established
and evaluated
informing future
developments
82
Recommendation 5:
Reaching a healthier weight across the life course (key recommendations for the
treatment of obesity)
Objective
Action
Lead &
Partners
frame
Resources
required
Measuring
success
Notes
To ensure the provision of appropriate/ adequate weight management services across the life course (from preconception through pregnancy, infancy, early years, childhood, adolescence, to adulthood and preparing for older age)
Maternal obesity
5.1 Set up targeted
5.1.1 Expand Weigh-2-Go in Children’s
Public Health,
community weight
Centres and community venues
Children’s Centre
management
specifically targeting women e.g.
programmes for
HiIlcroft College
2013/14
Funding will need
to be identified
⚉⚉ Number of
Discussions with
women
Hillcroft as a
Lead, Community
achieving 5%
potential pilot site
partners, ECET
wt loss
women of child
⚉⚉ BMI change
bearing age 16-44
⚉⚉ Dietary changes
(Preconception)
⚉⚉ Patient
satisfaction
5.1.2 Link with women-only physical
Public Health,
activity sessions/ services
Partnership links
Number of
Change4Life
will need to be
women accessing
Kingston, Leisure
established and
women only
partners
funding needs to
physical activities
2013/14
be identified
5.2 Pilot a post-
5.2.1 Explore adapting Weigh-2-Go
Public Health,
natal community
for post-natal weight management, to
Community
2014/15
Staff capacity and
Postnatal
funding to adapt
Weigh-2-Go
weight management
include a physical activity session and/
Midwives, Health
programme and
tailored manual
programme
or link with existing schemes
Visitors, MSCL
resources
and resources,
programmes
launched
5.2.2 Run a pilot programme for
Public Health,
post-natal weight management in the
Community
community
Midwives, Health
2014/15
Funding to set-up
a pilot programme
Participation
numbers, patient
satisfaction,
number of women
Visitors
achieving 5%
weight loss, BMI
change
Children
5.3 Establish and
5.3.1 Develop and implement child
Child weight
implement an
weight management (CWM) care-
management
integrated approach
pathway for children aged 5-18 years
steering group
to the management of
old
(CWMSG), Public
5.3.2 Develop referral guidelines
Child weight
childhood obesity
2013/14
Staff capacity
Pathway launched, Draft in progress
training provided
Health
2013/14
Staff capacity
management
Referral guidelines
launched
steering group
(CWMSG), Public
Health
5.3.3 Develop referral links to other
Child weight
relevant pathways e.g. Child and
management
linked and referral
Adolescent Mental Health Services
steering group
processes in
(CAMHS)
(CWMSG), Public
practice
2013/14
Staff capacity
Care pathways
Health
5.3.4 Ensure appropriate referrals to
Child weight
secondary care (tier 3) by developing
management
produced and
guidance
steering group
appropriate
(CWMSG), Public
referrals being
Health
2013/14
Staff capacity
Guidance
received in Tier 3
services
83
Objective
Action
Lead &
Partners
frame
Resources
required
Measuring
success
5.3.5 Explore the need for a specialist
Child weight
Resources/
Business case
multi-disciplinary team (MDT) child
management
2013/14
obesity clinic (to include a paediatrician, steering group
Dietitian, Psychology, Physiotherapy)
funding needs to
successfully
be identified
approved and
(CWMSG), Public
development
Health
underway
5.4 Increase dietetic
5.4.1 Continue dietetic-led Health and
Dietetics at
capacity in the
Fitness Clinic’ at Kingston Hospital
Kingston
2014/15
Staff capacity
Notes
Dietetic-led
Health and
management of child
Hospital, Public
Fitness Clinic’ at
obesity.
Health, CWMSG
Kingston Hospital
continuing to
be available to
patients
5.4.2 Explore opportunities for funding
Public Health,
to increase dietetic capacity in GP
Dietetics at
Kingston Clinical
clinics to provide specialist weight
Kingston
Commissioning
management support in Primary Care
Hospital,
Group (KCCG),
2013/14
Commitment from Clinic audit
Kingston Clinical
funding and staff
Commissioning
capacity will need
Group (KCCG)
to be identified
5.5 Continue to run
5.5.1 Continue to commission the
Public Health, DC
Ongoing
Successful
KPI’s outlined
Contract
community child
Factor child weight management
Leisure (partner),
annually
ongoing
in CWM service
negotiation under
weight management
Programmes in Kingston for children
RBK, School Health
evaluation and
specification
way for 2013/14
programmes.
aged 5-16 and work to increase
Team (YHC)
commitment to
including
year
fund
participation rates
awareness of and referrals to these
programmes
5.5.2 Target hard to reach families
CSPAN, Public
Funding and staff
Participation
through a summer holiday CWM
Health, Active
capacity needs to
rates, patient
activity programme pilot
Kingston team,
be identified
satisfaction,
2014/15
RBK, School Health
targeted post-
Team (YHC)
code areas
5.5.2 Pilot a CWM programme for
Community
Funding and staff
Programme
children and families with learning
Disabilities team,
capacity needs to
piloted,
RBK, Public
be identified
participation rates
disabilities
2015/16
Health
Young People
5.6 Establish a weight
5.6.1 Consult with young people on
Youth Service,
management service
how they manage their weight whilst
Public Health,
report from
for 16-18 year olds.
potentially recruiting participants to the
Local Colleges and
consultation
2013/14
Staff capacity
HELP Trial www.helptrial.org.uk whilst youth settings
Focus group
process
there is no service available locally
5.6.2 Develop and pilot a weight
Youth Service,
management service for 16-18 year
Public Health,
olds
Staff capacity and
New service
funding needs
piloted, data
Local Colleges and
to be identified.
available for
youth settings
Consider
evaluation
2014/15
Sportivate funding
5.6.3 Develop Change4Life Kingston
Change4Life
and provide activities targeted at young
Kingston, Public
people
Inclusion
Participation rates,
in current
evaluation report
Health, Active
Change4Life
completed
Kingston team,
contractual
RBK
2013/14
requirements
and funding
to support
this. Consider
Sportivate funding
84
Objective
Action
Lead &
Partners
frame
Resources
required
Measuring
success
Notes
Adults
5.7 Establish and
5.7.1 Update and implement adult
Public Health,
Staff capacity,
Pathway launched, Draft pathway
implement an
weight management (AWM) care-
Adult Obesity
commitment from
training provided
integrated approach
pathway including the bariatric referral
Steering group,
partner to consult
to the management of
pathway
Medicines
and engage
adult obesity.
Q4 2012/13
being updated
Management team
5.7.2 Develop referral links to other
Public Health,
relevant pathways e.g. mental health,
Adult Obesity
place and data
diabetes, cardiac care
Steering group,
tracked
2013/14
Staff capacity
Referral links in
Medicines
Management team
5.7.3 Develop referral guidelines
Public Health,
2013/14
Referral guidelines
launched
Adult Obesity
Steering group,
Medicines
Management team
5.8 Increase
5.8.1 Continue to expand Weigh-2-Go
Public Health,
Staff capacity and
Number of
Weigh-2-Go at
accessibility and
in primary care (GPs & Pharmacies) and
KCCG, RBK
funding needs
patients referred/
work in progress
availability to free
the workplace
Workplace Health
to be identified,
self-referred,
community weight
2013/14
potential to renew
Number of
management
current LES with
people achieving
programmes in
a new contract
5% weight
Kingston.
(reflecting
loss, patient
transition
satisfaction
Charter
changes) and
expanding sites
offering Weigh2-Go
5.8.2 Support expansion for ‘Walking
Community
Away’ – DESMOND pre-diabetes
diabetes
intervention
specialist nurse,
2013/14
Staff capacity to
raise awareness
% of participants
transferred to type
2 diabetes services
Public Health
5.8.3 Explore and implement
Public Health,
Q2/Q3
Funding streams
Number of
No formal
NHS endorsed commercial weight
local Commercial
2013/14
will need to be
referrals, number
discussions with
management packages in Kingston
groups
of people
commercial
(e.g. Slimming World, Weight Watchers,
achieving
groups yet
Rosemary Conley) in line with NICE
5% weight
explored for this
loss, patient
guidelines
satisfaction data
5.8.4 Continue to commission ‘Fit as a
Public Health,
Ongoing
Successful
KPI’s outlined
Contract
annually
ongoing
in FAAF service
negotiation under
Kingston upon
evaluation and
specification
way for 2013/
Thames
commitment to
including
2014 year
fund
participation rates
Fiddle’ for adults 50+ in the community Age Concern
5.9 Pilot ‘Weigh-2-Go’
5.9.1 Pilot AWM mental health group
Mental Health
in hard to reach and
programme (CMHT/SGMHT) and
vulnerable groups.
Previous Sport
Funding and
Weigh-2-Go
specialist team
resources will
receiving
England bid was
increase referrals to Weigh-2-Go for
(inc. SGMHT
need to be
appropriate
unsuccessful,
people with a mental health condition
dietetics), Public
identified for this
referrals for
further funding
people with
opportunities
Health
2013/14
mental health
need to be
conditions and
explored
a specific group
established for
more specialist
mental health
needs
85
Objective
Action
Lead &
Partners
frame
Resources
required
Measuring
success
5.9.2 Explore pilot for people with
Community
Funding and
Pilot developed
learning disabilities
Disabilities team,
resources will
and launched,
Public Health
need to be
data available for
identified for this
evaluation
5.9.3 Explore community pilot in
ECET,
areas of high deprivation in Kingston
Neighbourhood
2013/14
2014/15
targeting young adults e.g. 18-25 years management
Funding and
Pilot developed
resources will
and launched,
need to be
data available for
teams, Public
identified for
evaluation
Health
this. Consider
Sportivate funding
for physical
activity elements
Public Health
Staff capacity,
Pilot developed
men only tailored weight management
funding and
and launched,
programme
resources
data available for
5.9.4 Explore pilot opportunities for a
2014/15
evaluation
5.10 Increase dietetic
5.10.1 Explore opportunities for
Dietetics at
KCCG
Audit of clinics,
capacity in the
funding to increase dietetic capacity in
Kingston
engagement,
number of
management of adult
GP clinics to provide specialist weight
Hospital, KCCG,
funding and
patients referred/
obesity.
management support in Primary
Public Health
resources will
self-referred,
Care (in line with Dietetic Weight
need to be
number of
Management Intervention for Adults in
identified for this
2013/14
people achieving
5% weight
the one-to-one setting, DOMUK, 2010)
loss, patient
satisfaction
5.11 Support work
5.11.1 Work with Public Health teams
SWL Public
Clinician
Business case
to establish a Tier
in South West London and relevant
Health, SWL
engagement, staff
developed and
2013/14
3 MDT specialist
CCGs and secondary care settings to
Public Health
capacity, funding
approved, service
weight management
establish a Tier 3 MDT service
Dietitians,
and resources
development
service for South West
Dietetics at
will need to be
underway
London.
Kingston Hospital,
identified for this
SWL CCGs
86
Notes
Recommendation 6:
Increase participation in physical activity
Objective
Action
Lead &
Partners
frame
6.1 Work with
6.1.1 Co-ordinate an online
Public Health,
2013/14
Resources
required
Measuring
success
Pro-Active
Number of
schools engaged.
partners to increase
consultation across secondary schools
Pro Active South
South London
opportunities that
to identify current levels of activity and
London, Secondary
funding and
Outcome of
attract groups
identify needs
Schools, Active
resources need
consultation
identifying need
who traditionally
Kingston team,
to be identified.
participate less in
RBK, CSPAN
Consider the Me
& My Lifestyle
sport.
survey
6.1.2 Support schools through Healthy
CSPAN, Pro Active
Schools London, School Sports
South London,
Partnership or independently to ensure
Government funding will deliver
Funding to
Schools well
underpin
advised and
Active Kingston
the Healthy
confident to
team, RBK, Public
Schools London
deliver optimal
increased participation outcomes whilst Health
programme,
outcomes
ensuring effective links are made with
training and
2013/14
Notes
support, staff
community sports clubs
capacity and
resources
6.1.3 Develop and promote
CSPAN,
Explore local and
Target group
opportunities to increase participation
Chessington
national funding
engaged, number
for women and girls aged 16 years
Sports Centre,
sources
of participants,
and over
Family learning
results of feedback
team, RBK, ECET,
surveys
2013/14
Youth outreach
teams, Learning &
Children’s Services,
South West London
Athletics Network
6.1.4 Support CSAF bid for Kingston
CSPAN, Kingston
College Sport Activator project
College, Public
funding to
project launched
targeting young people who are less
Health, Active
complete the bid
and data available
active or not active
Kingston team,
Q2 2013/14
Partnership
Successful bid,
for evaluation
RBK
6.1.5 Develop and promote
CSPAN, Age
opportunities to increase participation
Concern
Ongoing
Successful
KPI’s outlined
FAAF contract
ongoing
in FAAF service
negotiation
underway
for older people (50+) particularly in
Kingston upon
evaluation and
specification
areas of deprivation both within the
Thames, Public
commitment
including
for 2013/14.
Fit as a Fiddle (FAAF) programme and
Health, ECET,
to fund FAAF
participation
Change4Life
contract
more widely
Neighbourhood
annually.
rates. Further
management
Exploration of
opportunities
negotiation
teams, RBK, social
other resources
across the
underway for
services teams,
and funding
borough piloted
2013/14
sheltered housing
sources including
and evaluated
team, Community
Change4Life
Outreach groups
87
Objective
Action
Lead &
Partners
frame
Resources
required
Measuring
success
6.1.6 Develop programmes that
Community
Explore additional
Audit of needs
completed.
2013/14
promote social inclusion and seek to
Mental Health
sources of local &
tackle mental health and wellbeing
Teams, Public
national funding
Health, Kingston
Notes
Programmes
developed. Results
Right Steps,
of feedback
Community
surveys
Outreach teams,
Change4Life
Kingston, CSPAN
6.1.7 Continue to work with partners
ECET, Public
Explore local and
Number and
such as ECET and Youth Inclusion to
Health,
national funding
range of
expand the range of activities for BME,
Kingston United
sources
marginalised communities and young
Reform Church,
people at risk
Ongoing
programmes
developed. Results
Refugee Action
of feedback
Kingston, Islamic
surveys. New
Resource Centre,
partnerships
Neighbourhood
established with
Management
community and
teams, Youth
neighbourhood
Services, Police
groups
6.2 Strengthen links
6.2.1 Ensure pathways are developed
Active Kingston
Funding sources
Sport England
Develop satellite
between partners to
which strengthen links between
team, RBK, Club
need to be
Active People’s
club work with
reduce ‘drop out’ from
schools, Kingston College, Kingston
Link Makers, KSSP,
identified
Survey data.
funding for
physical activity at
University and local clubs and service
CSPAN, Pro-active
Number of
school/ club links
delivery to increase participation in
South London
satellite clubs
certain life stages.
2013/14
established
sport and reduce drop out post school
6.3 Create
6.3.1 Build on existing opportunities
CSPAN, Schools,
opportunities to
and enhance activities which are free
enable more children
and low cost through the life stages,
Consider active
Explore additional
Increased number
School Sports
local and national
and range of
play, after school
Co-ordinators,
funding
programmes
activities in the
local community
2013/15
and young people to
particularly for children, under fives
Chessington
available to
take part in physical
and young people in Kingston
Sports College,
children and
activity after school
Change4Life
young people.
and in the community.
Kingston, youth
Results of
engagement teams,
feedback survey
Children’s centres
6.3.2 Establish strong links with schools CSPAN, Schools,
Explore local and
Number of
to develop and promote after school
Active Kingston
national funding
schools engaged,
activities ensuring active engagement
team, RBK, Public
sources
in schools not part of the School Sports
Health, School
of after school
Sports Partnership,
activities increased
Partnership as well as those that are
2013/14
number and range
Young People
Health Link
Workers
6.3.3 Explore further opportunities for
CSPAN, Public
physical activity and recreational sport
Health, Fulham
for young people at risk of making
Football
engagement from
informing the
risky behaviour choices
Foundation,
schools and youth
development or
Schools Sports
settings
existing and new
Partnership, Young
88
2014/15
Staff capacity,
Consultation with
Explore the data
funding and
young people
from KICKZ
programmes.
People Health Link
Data available for
Workers
evaluation
Objective
Action
Lead &
Partners
frame
6.4 Increase the
6.4.1 Develop a specific publicity
KCCG and RBK
number of people
campaign to address zero participation
Communication
funding resources
launched,
moving from no
and lift people out of inactivity
Teams, CSPAN,
and explore
enquiries
activity to some
Public Health,
opportunities
increased. Increase
activity.
Change4Life
to secure other
in participation.
Kingston
funding sources
Results of
2013/14
Resources
required
Measuring
success
Pool existing local
Campaign
Notes
feedback surveys.
Sport England
Active People’s
Survey
6.4.2 Increase awareness of the Get
Public Health,
Active exercise referral programme
Leisure Centre
2013/14
KCCG, GP and
Raised awareness
Community
of programme
to target sedentary adults living and
providers, GPs
Pharmacy
among partners
working in Kingston
and health
engagement
and general
professionals,
public. Increase in
Community
number of patient
Pharmacies,
referrals. Results
Community
of feedback
surveys
Outreach teams
6.4.3 Work to encourage GPs and
Public Health,
Ongoing
Public Health
Stronger links
developed
health professionals in recommending
GPs, Community
training and
physical activity as a means of health
Pharmacies, health
support,
with health
improvement to patients
professionals
engagement
professionals.
from health
Number of
professionals to
presentations
attend training
or training
delivered to GPs,
CPs and HPs.
Referral pathway
developed and
circulated
6.4.4 Establish links with local
Public
Q3/ Q4
Local and national
Business links
businesses to raise the profile of
Health, CSPAN,
2013/14
resources need to
established.
PAS-L Workplace
workplace health and encourage
Change4Life
be identified
Increased number
Challenge
participation in physical activity
Kingston Chamber
of businesses
programmes and healthy eating
of Commerce,
signed up to the
options
Kingston First, RBK
Workplace Health
Business Links
Charter. Number
Consider the
of Lifestyle events
delivered to
workplaces
6.4.5 Work with the CSPAN disability
CSPAN Active4All, Q3/ Q4
sub group and wider partners to
Active Kingston
enable increased activity opportunities
team, RBK,
for people with disabilities
Public Health,
2013/14
Local and national
Audit of current
resources need to
provision
be identified
completed.
Collation of
Kingston Youth
registers at
Service, Kingston
sessions. Increase
Association for
in participation
the Blind, Leisure
rates
providers, Inclusive
Activities teams,
sports clubs
89
Objective
Action
Lead &
Partners
frame
6.5 Utilise legacy
6.5.1 Maximise opportunities for
Change4Life
Q1/ Q2
2013/14
opportunities of
walking and cycling in Kingston
Kingston, CSPAN
the 2012 Olympic &
through Change4Life Kingston
Cycling Sub-
Resources
required
Measuring
success
Notes
Local partnership
Increased uptake
Change4Life
funding and
of Bike4Life cycle
contract
support
hire scheme.
negotiation for
Bike4Life
2013/14 underway.
Paralympic games to
Group, Smarter
inspire participation.
Travel team,
Go Kingston
Bike4Life Go
Ramblers, Kingston
community cycle
Kingston project
Cycling Campaign,
ride scheme
received CSPAN
British Cycling,
established.
approval in
Increase in
February 2013
Public Health
number of
people cycling in
Kingston. Increase
in the number
of registered
participants on
the Walk4Life
scheme
6.5.2 Increase promotion and
Change4Life
Local and national
Dance4Life brand
Change4Life
participation in dance activities through
Kingston,
resources need to
recognised across
contract
Change4Life Kingston
CSPAN, Kingston
be identified
Kingston. Funding
negotiation
2013/14
University, Leisure
secured to
for 2013/ 2014
Centre providers,
develop additional
underway
Dare2Dance,
programmes.
Schools,
Increase in
Community and
participation rates
Outreach groups,
Public Health
6.5.3 Capitalise on the Mayors
Active Kingston,
Legacy Ride London to engage
CSPAN Cycling
local and national
for Ride London
with the community to offer cycling
Sub-Group, Public
resources need to
through Kingston,
opportunities including running taster
Health
be identified
numbers of
Q2 2013
Staff capacity,
Strong support
people taking part
sessions to encourage people to take
in cycling taster
up cycling
sessions
6.5.4 Support the development of the
Active Kingston,
Weir Archer Academy at Kingsmeadow
CSPAN, ProActive
South London
Ongoing
To be identified
Successful
development and
launch of the Weir
Archer Academy
at Kingsmeadow
and increased
opportunities for
both able bodied
and disabled
people
90
Recommendation 7:
Invest in people and places to promote healthy lifestyles
Objective
Action
Lead &
Partners (Lead
team in bold)
7.1 Work with
7.1.1 Work with the borough’s
Quadron, Active
Timeframe
Resources
required
Measuring
success
Q4 2013/14 Staff capacity.
Increased local
partners to increase
parks and open spaces team to
Kingston, Public
Network
accessibility to public
heighten awareness of opportunities
Health
meetings and
of recreation
and private facilities
for active recreation and sport
events. Marketing
and sport
materials
opportunities in
Staff to supervise
Active Kingston
to meet the needs of
local people.
Notes
awareness
parks/open spaces
7.1.2 Increase access to private
Active Kingston
sector facilities, such as sports and
team, RBK, Public
facilities.
pledge established
school grounds, for community use
Health, Schools,
Marketing &
and implemented
through the launch of an Active
sports clubs, Pro-
campaign materials.
Kingston pledge (2 hours free use for
Active South London
2013/14
Explore local and
national funding
communities per week)
7.1.3 Increase the number of
Active Kingston
Mapping exercise.
Improved access
existing leisure and sport facilities
team, RBK,
Network meetings.
for disabled
University offers
that are fully accessible and inclusive
Inclusive Activities
National and
groups across
facililties in kind
to disabled groups
teams, Leisure
local government
sports facilities in
for Wheels for All
providers CSPAN,
support and
Kingston
project
health and disability
guidance
2016
Kingston
services, Community
Mental Health Teams,
sports clubs
7.2 Identify external
7.2.1 Work with local and regional
CSPAN, Pro-Active
New and existing
Improved
Bid approved for
funding opportunities
partners to combine resources and
South London,
local and national
collaborative
new inclusive
for capital and
consolidate the development and
national governing
funding sources.
partnership
cycle track at
revenue projects
delivery of existing and new projects
bodies of sport, RBK,
Networking
working. Effective Moor Lane
Public Health
meetings
and economic
(e.g. improving bike
Ongoing
storage facilities).
delivery of
programmes
7.2.2 Work with partners to ensure
CSPAN, Planning,
2015/16
all regeneration projects and planning RBK, Environmental
Staff capacity,
Effective
knowledge of
incorporation of
considerations for open spaces and
Health, Active
current practice,
health messages
environment supports the promotion
Kingston team,
funding and
into planning
of physical activity in the borough
Public Health
resources
and regeneration
7.3 Increase provision 7.3.1 Promote clearer routes to local
Kingston Volunteer Ongoing
Network meetings.
Year on year
and promote and
volunteering opportunities and
Action, CSPAN,
Marketing/
increase in
provide clearer
increase the number of volunteers
Public Health,
promotional
the number
volunteering
supporting community programmes
Change4Life, ECET
materials. Explore
of volunteers
local funding
supporting activity
processes
opportunities.
programmes
7.4 Increase
7.4.1 Review opportunities for
CSPAN, all
knowledge and
effective information sharing and
awareness of the
networking across Kingston (such
roles of both health
as strategy update days, electronic
and non-health
professionals to
ensure clear care
Commitment from
Increased
stakeholders and
all partners and
knowledge
partners
stakeholders to
and awareness
share information
of services in
updates, use of CSPAN groups, audit
and work together
Kingston
outlined in objective 1.6)
to develop clear
Ongoing
pathways
pathways and
knowledge of
appropriate links
whilst avoiding
duplications.
91
Abbreviations
APS
Active People’s Survey
ASC
Annual School Census
AWM
Adult Weight Management
BIA
Bio-electrical impedance analysis
BME
Black and Minority Ethnic
BMI
Body Mass Index
CAMHSChild and Adolescents Mental Health
Services
CCG
Clinical Commissioning Group
ChiMat
Child and Maternal Health Observatory
CHPB
Choosing Health Partnership Board
CMACE
Centre for Maternal and Child Enquiries
CMHT
Community Mental Health Teams
CQUINCommissioning for Quality and Innovation
CSPANCommunity Sport and Physical Activity
Network
CT
Computer Tomography
CVD
Cardiovascular Disease
CWM
Child Weight Management
CWMSG
Child Weight Management Steering Group
DCMSDepartment of Culture, Medicine and Sport
DESMONDDiabetes Education and Self Management
for Ongoing and Newly Diagnosed
DEXA Dual energy X-ray absorptiometry scan
ECETEqualities and Community Engagement
Team
FAAF
Fit as a fiddle
FANS
Free Access for National Sport
FFLP
Food for Life Partnership
FSA
Food Standard Agency
FSM
Free School Meals
GLA
Greater London Authority
GP
General Practitioner
HCA
Health Care Assistant
HCC
Healthier Catering Commitment
HSE
Health Survey for England
92
HWB
Health and Wellbeing Board
IMD Index of Multiple Deprivation
KPI
Key Performance Indicator
JAPHR
Joint Annual Public Health Report
JSA
Joint Strategic Needs Assessment
JSNA Joint Strategic Needs Assessment
KCAS
Kingston Clinical Assessment Service
KCCG
Kingston Clinical Commissioning Group
LSOA
Lower Super Output Area
MDT
Multi-Disciplinary Team
MRI
Magnetic resonance imaging
MSLC
Maternity Service Liaison Committee
NCMP
National Child Measurement Programme
NOO
National Obesity Observatory
NHS
National Health Service
NHS SWL NHS South West London Cluster
NI8
National Indicator 8
NICENational Institute for Health and Clinical
Excellence
PAS-L
ProActive South London
PESSYPPhysical Education and Sport Strategy for
Young People
PHAST Public Health Action Support Team
RCOGRoyal College of Obstetrics and
Gynaecology
RCPCHRoyal College of Paediatrics and Child
Health
RPA
Raising the Participation Age
SGMHT
St George’s Mental Health Trust
SIGNScottish Intercollegiate Guidelines Network
SMARTSpecific, Measureable, Achievable, Realistic,
Timely
SWL
South West London
WM
Weight Management
WHO
World Health Organisation
Abbreviations - Appendices
Lists of Figures, Maps and Tables
List of tables
1Comparison of Kingston’s NCMP data with previous
years
2Comparison of Kingston’s 2010/2011 NCMP data
with national and regional prevalence
3Kingston’s usual resident population by age and
gender (2011 Census)
4Projected ethnic population of Kingston over time
5Factors influencing obesity and energy balance
based on Foresight (2007)
6Clinical diagnostic criteria for overweight and obesity
in adults combining BMI and waist measurement to
classify the risk of developing type 2 Diabetes, CVD
and other co-morbidities
7Clinical diagnostic criteria for overweight and obese
children and young people (aged <18 years) in the UK
8NHS Kingston’s estimated costs of obesity and
diseases related to overweight and obesity (e.g.
diabetes, CVD, cancer)
9Prevalence of overweight and obesity in children and
adults
10Risk of cancer, heart disease and stroke attributable
to obesity in Kingston
11Detailed breakdown of child weight status in
Kingston by BMI category for KCCG of residence
including total number of children and prevalence %)
12Dietary and physical activity factors that either protect
or cause weight gain, overweight and obesity in adults
and children aged 5 years and above
13Key components, policies and strategies to achieve a
healthier weight from age 0 to 12 years
14Critical opportunities for intervention during an
individual’s life course from 11 to 60+ years
15Summary of the service mapping for adult obesity in
Kingston
16Summary of the service mapping for childhood
obesity in Kingston
17Recommendations to tackle maternal obesity in
Kingston
18Key themes from the consultation exercises
19Inactivity as a comparative major public health threat
20 Government physical activity guidelines
21Key themes from the consultation exercises
List of Figures
1 Circle of considerations
2The age and gender of Kingston’s resident
population (2011 Census)
3Number of bariatric procedures for Kingston patients
4NCMP Reception year prevalence of obesity at ward
level in Kingston based on combined data from
2008/09 to 2010/11
5NCMP Year 6 prevalence of obesity at ward level in
Kingston based on combined data from 2008/09 to
2010/11
6Prevalence of obesity for all Reception children in
Kingston by national deprivation decile based on
7Prevalence of obesity for all Year 6 children in
Kingston by national deprivation decile based on
8Prevalence of overweight and obesity for all
Reception children by ethnic group based on
9Prevalence of overweight and obesity for all Year 6
children by ethnic group (2008/2009 to 2010/2011)
10National, regional and local policy drivers for tackling
obesity
11Multi component interventions are the gold-standard
treatment of choice for the management of obesity
to achieve clinically effective weight loss
12Outline of the current adult healthy weight
interventions and treatment services available across
the different tiers of care in Kingston
13Outline of the current child healthy weight
interventions and treatment services available across
the different tiers of care in Kingston
14
Historic and projected physical activity levels for the UK
15The physical activity spectrum
16Proportion of adults spending six or more hours in
sedentary pursuits per day during weekdays
17Proportion of adults spending six or more hours in
sedentary pursuits per day during weekends
18Proportion of children and young people spending six
or more hours sedentary per day during weekdays
19Proportion of children and young people spending six
or more hours sedentary per day during weekends
20Trend for zero levels of activity in adults in Kingston
21 Zero participation by ethnicity
22 Zero participation by age
23Children in England achieving at least an hour of
moderate activity each day by age and gender
24Number of pupils by mode of travel to school
25National, regional and local policy drivers for physical
activity
List of Maps
1IMD 2010 Deprivation in Kingston (Full National Scale)
2IMD 2010 Deprivation in Kingston (Local Scale)
3Prevalence of childhood obesity by ward level
(Reception year)
4Prevalence of childhood obesity by ward level
(Year 6)
5 Adult obesity services in Kingston
6 Child obesity services in Kingston
7 Active Recreation
8 Active Travel
9 Active Sport
10 Active Sport, Recreation and Travel
93
Appendices
Appendix 1
Update on progress made since Tackling Obesity: A Strategy for Children and Adults in
Kingston (2006 - 2010)
Objective
To promote an
environment and
culture where
everybody is more
physically active
and makes healthy
food choices,
particularly
targeting high risk
populations
Progress
Early Years
In Kingston there are a wide range of services delivered by Your Healthcare, providing breastfeeding education and support
both prior to, and after the baby arrives. This includes advice from midwives, health visitors and nursery nurses. A range of
voluntary groups and private providers of breastfeeding services are also available in Kingston, including the National Childbirth
Trust, La Leche League and the Kingston group of the Association of Breastfeeding Mothers.
Breastfeeding support drop-ins run at the following centres in Kingston;
⚉⚉ Kingston Town Children’s Centre
⚉⚉ Chessington Children’s Centre
⚉⚉ Surbiton Children’s Centre
⚉⚉ Norbiton Children’s Centre
⚉⚉ Kingston Hill Children’s Centre
Health Visitors and Nursery Nurses also assist with weaning advice including promoting baby-led weaning and avoiding
introducing solids before six months, which is associated with overweight and obesity.
Healthy Start has been successfully rolled out in Kingston but has proved challenging to promote to eligible families. In 2011,
this statutory programme, originally provided in three Health Clinics, was extended to include all eleven Children’s Centres
bringing the total number of venues where families can access free vitamins to fourteen. Uptake is still low but work is
underway to improve outreach to communities that don’t routinely access services.
Cook & Eat has been running in Children’s Centres since 2008 and has been very positively received. Between April 2011 and
March 2012, the Family Learning team ran 7 Cook and Eat programmes in Children’s Centres across the Borough, reaching a
total of 47 families. 97% of participants self-reported increased confidence levels and improved cooking knowledge and skills.
Over the last five years, Active Play within the borough’s 10 Children’s Centres has become embedded within planning and
practice. Children’s Centres are able to actively encourage physical play in a range of ways including ensuring play equipment
both inside and outside of the centre are age appropriate with a level of positive challenge for children aged 0-5. Each
centre devises its own programme of activities that are tailored to the needs of its reach area population. They have hosted
and continue to host sessions with a physical focus such as stretching stars yoga kids, they facilitate walks around the local
communities, and signpost families considered most in need of support to subsidised access to leisure facilities within the
borough alongside the generic universal promotion of healthy living and healthy lifestyles.
The national Healthy Schools scheme ceased in 2011 and consequently development for early years settings was not completed.
However, Children’s Centres have proactively worked in partnership with Public Health and other health professionals in order
to support the integration of health into generic service delivery. The Healthy Schools programme is now under review and
consideration is being given to reinstating either a local or regional Healthy Schools scheme that could be extended to early
years settings.
94
Appendices
Objective
Progress
Schools
As outlined above, the national Healthy Schools scheme ceased in 2011 and work is underway to review if schools have
successfully continued to work towards the development goals they set when they achieved Healthy Schools status.
Consideration is being given to potentially reinstating either a local or regional Healthy Schools scheme to ensure schools
have the support they require and routinely promote a healthy environment that can contribute to improved performance,
attendance and behaviour.
Kingston has demonstrated excellent commitment to the National Child Measurement Programme (NCMP) achieving a 99%
participation rate in 2010/11, higher than both the London and England average (93% each) and the highest in South West
London. This has allowed us to establish high quality local data that has been used in both service development and service
targeting.
98% of Kingston schools now have travel plans that support them in the practicalities of improving health and road safety on
the school journey. Bikeability cycle training is regularly delivered by RBK in all schools and 1,000 cycle parking spaces have
been installed at school grounds over the last 2 years.
RBK continues to promote travel awareness campaigns which includes Walk to School and Walk on Wednesdays and all schools
are encouraged to participate in national Walk to School Week and are provided with teaching resources to encourage the
inclusion of sustainability themes in the curriculum.
In the 2009 School Food Trust annual report, RBK reported an average uptake of school meals of 18.8% which was one of the
lowest in London. A concerted effort was made to increase the up take in Kingston and to improve the quality and freshness of
the meals for pupils. Through a number of Government funded grants, RBK invested money in schools to build a cook-on-site
kitchen from scratch or to refurbish existing areas within schools to incorporate new kitchens where possible. Out of the 30
schools in the LA school meals contract, 10 now have cook-on-site facilities, 14 have a Simplicity set up (the capacity to cook
off the main meals, prepare salads, jacket potatoes, and bake fresh bread on site giving the pupils a more enhanced meal)
and 6 schools have hot meals delivered. None of the schools receive packed lunches for school meals, unless it is required for
school trips. In the 2011 School Meals Trust annual report, RBK reported an increase in uptake to 34.1% (which only included
36 primary schools). Since September 2010, the school meals contractor also established a production kitchen in Tolworth to
produce more sustainable meals within the Borough, which reduced the carbon foot print and increased the quality of meals for
the Simplicity and ‘delivered in hot’ schools. The contractor also committed to the Food for Life Partnership - Bronze Award.
Free School Meals (FSM): The Department of Education report (November 2012) on pupils not claiming FSM showed that
11% (2,000) of pupils aged 4-15 years old in Kingston are entitled to receive FSM as they live in households claiming qualifying
benefits. In Kingston 4% (100) of those entitled to claim FSM are not registered with the scheme. Data on the number of
FSM actually consumed by pupils is unavailable. Moving forward, a survey will be published in December 2012 for parents
to complete. The survey will gather information on paid meals as well as FSM pupils and will target schools that are in the LA
school meals contract. This information will be used to review and improve school meal uptake. Work is under way to establish
actual consumption of meals by gathering data from the catering provider and working with schools to monitor consumption
where possible.
Milk: 23 primary schools in Kingston offer milk to pupils during school time, 14 schools serve milk to under fives and nine
schools serve milk to under and over fives. All under fives receive free milk through a government subsidy scheme, to encourage
a healthy diet.
For further information on the scheme wisit www.coolmilk.com
Fruit & Vegetable Scheme: This government scheme delivers fruit or vegetables to schools within the scheme to encourage
children to eat one of their five a day. 30 out 35 schools in Kingston are utilising this scheme.
For further information on the scheme wisit http://www.nhs.uk/Livewell/5ADAY/Pages/Schoolscheme.aspx
95
Objective
Progress
Community
The Factor Children’s Weight Management programmes were launched in September 2010 and have provided a suite of very
successful locally designed and family focused programmes for children in Kingston. Fun Factor is provided for children aged
5 to7 years and their parents, Fwd Factor is for children aged 8 to 12 years and their parents, and 4U Factor is for teenagers
aged 13 to 16 years. Since 2010, 22 programmes have been provided with a further 3 planned by the end of March 2013.
The evaluations to date have been very promising with positive changes in dietary and mealtime habits, an increase in time
spent being physically active and an increase in parental confidence in feeding their child (such as how to tackle fussy eating).
Learning from the current programmes is routinely used to improve and develop the content for future programmes.
As yet, links with youth service have been inconsistent and further work is required to develop these links adequately. Partners
are currently discussing the possibility of Youth Link Workers in the borough and this could be a very positive approach.
In 2006, the Sports Awards were used to recognise those who live or go to school/college in the borough and represent their
county or higher in their chosen sport. From 2007, the Sports Awards concentrated on those who had represented their country
in their chosen sport. As well as recognising our national athletes, the awards also recognise the hard work the sports clubs give
to the borough by recognising sports teams, junior and senior sports achievers, and unsung heroes. In 2012, the Sports Awards
recognised a fantastic summer of sport and Karina Bryant (GB Bronze Medallist for Judo) and Mo Sbihi (GB Bronze Medallist
Rowing) attended.
Physical activity has been proven to assist in the management of several mental health conditions such as depression, anxiety
and stress. We know from the Get Active exercise referral programme that those undertaking exercise have very positive affects
in their emotional status post exercise with an increase of approximately 15%. These outcomes reinforce the need to promote
the mind and body health benefits of exercise to individuals with mental health conditions and work to expand our partnerships
with mental health as their focus. Get Active has recently developed a pilot with Kingston Right Steps (Improving Access to
Psychological Therapies, IAPT) to provide group exercise sessions as part of their stress management course to aid service users
to regain control of their lives. As Kingston Right Steps becomes part of the Community Wellbeing Service, it will be important
to maintain the links here and evaluate this pilot so as to inform future practice. Good links have also been established with
South West London and St George’s Mental Health Trust’s Physical Health Team to support a bid for Sport England funding to
develop a local programme to tackle sedentary behaviour and weight management issues.
Signposting between stop smoking services and weight management services has been routinely available but the practice
has not been monitored. Data has not been collected to monitor how often signposts have been successful in helping patients
achieve lifestyle changes. Over the last three years, more services have been developed for patients to improve both patient
choice and outcomes. Further work is now required to ensure appropriate monitoring of cross referrals and signposting to
support patients to achieve successful outcomes. This work will also improve the quality of the feedback produced for the
original referrer (such as the patient’s GP or nurse).
Workplace
NHS Kingston has produced a workplace Travel Plan in partnership with RBK and TfL, which also includes a wider active
workplace programme. New cycle shelters have been installed across many sites and certificates for stages 1 & 2 of the NHS
Cycle Strategy have been successfully achieved. Stage 3 is currently underway. NHS Kingston have also signed up to the Cycle
to Work Guarantee Scheme towards increasing cycle usage amongst staff. RBK has an active programme of workplace travel
planning to support employers in Kingston. In 2010, 100 workplaces in Kingston were reported to have travel plans in place
and business travel networks have been developed to support smaller local businesses with the travel plans.
The workplace health scheme at NHS Kingston has provided staff with corporate discounts and subsidised exercise classes since
August 2009. This work has continually expanded and now provides a pooled bike scheme for staff to allow them to choose
healthier options for travelling between meetings. These schemes should be protected during upcoming transition processes.
96
Appendices
Objective
Progress
Older People The Active Living project was a Local Area Agreement partnership between Age Concern Kingston, NHS Kingston, and the
Royal Borough of Kingston. The project helped older people get more active through the introduction of an Active Living
Directory, Active Living Passports, and free activity programmes. Launched in October 2007 and concluding in February 2010,
the project helped 2,268 older people become more active. Subsequently, Age Concern Kingston was funded by the Big Lottery
to deliver a ‘Fit as a Fiddle’ project, which tackles obesity through physical activity and healthy lifestyles. It targets hard to reach
groups of older people, including those with mental health issues, and provides series of free six week courses of activities,
linked with healthy lifestyle workshops. 25 courses (Nordic walking, keep fit, dance, aquacise, body balance, singing) were run
between 2010 and 2012, reaching 400 older people, of whom 73% lost weight, 67% reduced their waist measurement, 58%
reduced their BMI, and 86% became more active. The project was favourably externally evaluated, and won the 2011 Guardian
Award for Care of Older people. Due to the demonstrable effectiveness of the approach, NHS Kingston has funded a further
series of targeted courses from June 2012 until March 2013.
Various Cook & Eat programmes have been run for older people in Kingston. Providers such as Age Concern Kingston, Kingston
United Reformed Church, Milaap Centre, Islamic Resource Centre, and Refugee Action Kingston have all provided this free, six
week programme for older people in targeted communities. Providers are supported to run Cook & Eat which can be adapted
according to the need of the individuals within that community. For example, interpreters have been provided where English is
not their first language. Work is now underway to develop this even further by working with Learn English at Home (LEAH) and
integrating English for speakers of other languages (ESOL) messages into the programme. The Cook & Eat programmes have
improved confidence, knowledge and skills in cooking and healthy eating as well as promoting social interaction and group led
walks.
The ‘Walk for Health’ scheme has been developed over the last four years and has adopted the ‘Change4Life’ branding.
Volunteer walk leaders are trained to provide regular walks at various locations throughout the Borough. These walks have
varying degrees of difficulty and are designed for all the family encouraging many generations of the same family to be
physically active together. This programme has now been expanded further to include Bike4Life, Dance4Life and Run4Life.
97
Objective
Progress
Universal
The need for a media and communications strategy is still a key requirement that is currently outstanding. This new Healthy
Weight and Physical Activity Strategy will need to be underpinned by a Communications Strategy in order to ensure the most
comprehensive progress. The consultation process highlighted the lack of communications support as a key cause of low
knowledge about services available and how to access them. This needs to become a priority to ensure all groups can, and
know how to, access the services they require.
Bikeability cycle training is regularly delivered by RBK to the majority of children in primary schools and 1,000 cycle parking
spaces have been installed at school grounds over the last two years. 98% of Kingston schools now have travel plans that
support them in the practicalities of improving health and road safety on the school journey. RBK continues to promote travel
awareness campaigns including Walk to School Month and Walk on Wednesdays. All schools are encouraged to participate in
national Walk to School Week and are provided with teaching resources to encourage the inclusion of sustainability themes in
the curriculum.
RBK recognises the importance of secure and convenient cycle parking facilities to encourage cycling and routinely works to
improve cycle parking provision across the Borough. All new development in the borough is required to provide appropriate
cycle parking and RBK is currently consulting on Supplementary Planning Guidance on Sustainable Transport that includes
detailed requirements and guidance on cycle parking provision for new development. There is a significant amount of ‘on street’
cycle parking available around the borough and the Council ensures that additional provision is included where possible in new
Highway schemes. During 2011/2012 the Council installed over 100 additional ‘on street’ cycle parking spaces. Over recent
years, the Council has worked with TfL and Schools on an extensive School Cycle Parking programme which has provided new
secure cycle shelter facilities to the majority of schools in the borough and continues to support schools to provide additional
facilities where required. The Council has also supported a number of workplaces and residential developments to install secure
cycle parking facilities on their sites.
The quality and standard of the food and menus for patients at Kingston Hospital are regularly monitored with various audits,
inspections and quality measures and currently meets the required standards. The staff restaurant has a ‘Taste of Health’ option
every day, and a healthy tip of the month and a display on healthy eating is posted in the staff restaurant. In September 2011,
the vending machine contents were reviewed and more healthy options were added, with water replacing some fizzy drinks. A
Weigh-2-Go weight management programme is available for staff on an on-going basis and has been offering a 1:1 service
from February 2012. To date, 57 staff have participated in the 1:1 service and a pilot weight management group for 11 staff
ran in February 2012. Detailed evaluation is underway but those participating have lost weight and it is evident that attendance
was improved when the service was provided on a 1:1 basis compared to the pilot group due to staff working shift patterns. A
survey of ward based staff entitled ‘What do you eat at work?’ is currently underway and the results will inform an action plan
for the implementation of improvements.
Since 2006, catering has changed and improved enormously within DC Leisure’s Leisure Centres, where the Group has moved
from deep fried food, burgers, and bacon to a range of sandwiches, fresh and dried fruit and a range of healthy snacks, a
change we are undertaking across the company. DC Leisure have signed up to the Government’s Public Health Responsibility
Deal and are the only Leisure Management Operator to have signed up to a number of specific ‘food promises’ such as salt
reduction, non-use of artificial trans fats and alcohol awareness. The standard menu offered in DC Leisure’s Coffee Shops
provides customers with a helpful traffic light identification system to help guide customers towards the healthier choices. In
January 2013, the menu will provide a separate healthier choices section offering examples of lighter snacks with calories
shown. Lower salt choices will also be identified as part of our sign up to the salt reduction pledges.
Environmental Health (RBK) routinely send out advice to businesses in Kingston on allergens in food (with a consultation
currently out on the implementation of the Food Information Regulations 2013), nutritional labelling, and the nudge towards
the reduction of the use of the ‘Southampton Six’ colours ie tartrazine, sunset yellow etc. Preliminary discussions have also
commenced between Public Health and Environmental Health regarding the possibility of piloting a Healthier Catering scheme,
targeting fast-food takeaways first.
98
Appendices
Objective
Progress
To identify early
and encourage
those at high risk
of overweight
or obesity and
direct towards
appropriate
interventions
The Adult Obesity Care Pathway has been in draft form since 2009 and is due to be finalised and launched by
Quarter 4 2012/2013. The Children’s Obesity Care Pathway has also been developed with the aim of launching it
in Quarter 4 2012/2013. Priority should be given to ensuring all relevant health professionals are aware of these
pathways and confident in implementing them in their day-to-day practice.
Training on ‘Behaviour change’ and ‘Raising the issue’ for health professionals has been a need for some time but
it is now available and ready to be rolled out to various health professionals and non-health professionals. All
partners that would like to access this training should contact Kingston Public Health Team.
The Step-O-Meter project was launched in 2006 by the Department of Health (DH) with the aim of increasing
physical activity through walking and tackling weight management issues. NHS Kingston took part in the pilot roll
out of the scheme and pedometers were made available to health care professionals such as GPs, nurses and health
visitors across Kingston. These HP were trained to work with patients using pedometers. Patients were supported
with goal setting, a log to monitor the number of steps walked, motivational tools and a free pedometer. The pilot
resulted in some successful outcomes, such as raising activity levels for participants and increasing the knowledge
and confidence of primary care professionals in recommending physical activity. However, it was concluded that
the project was not sustainable due to the shortage of time that the professional staff could allocate to maintain
the administration and training of the programme on an ongoing basis. Whilst the project was discontinued,
patients are encouraged to use pedometers if they would like to, as a means of positive reinforcement of their
achievements so far and also to assist them to set realistic goals.
GPPAQ (General Practice Physical Activity Questionnaire) is used to assess physical activity levels in adults
aged 16-74 years. A number of practitioners in Kingston have adopted the use of the questionnaire to assess
the physical activity levels of patients, particularly with regard to the NHS Health Checks Programme for those
aged between 40-74 years. The tool helps to inform practitioners when a brief intervention to increase physical
activity is appropriate i.e. all patients who receive a score less than active receive a recommendation to an activity
programme such as walking or gardening or to a more structured programme such as the Get Active exercise
referral programme. A validated single item physical activity questionnaire is also used to support a range of
activity programmes such as the Change4Life programmes and workplace health, as part of our drive to promote
more active lifestyles.
See Objective 1 for an update on signposting between services. A new ‘Healthy Lifestyle services in Kingston’
booklet has been produced and can be circulated to all providers to assist in early awareness raising and cross
referrals. Work is now required to ensure appropriate monitoring of cross referrals and signposting to support
patients to achieve successful outcomes and improve the quality of the feedback produced for the original referrer
(such as the patient’s GP or nurse).
99
Objective
Progress
To ensure provision
of and equal
access to weight
management and
treatment services
for those who
want to lose or
maintain their
weight
The Weigh-2-Go weight management service for adults in primary care was launched in 2010. This service was developed with
clinicians and patients and has gradually been expanded to 10 out of 28 GP practices and 10 out of 32 Community Pharmacies.
In 2012, cross referral was introduced to allow patients whose GP practice doesn’t provide the service to access one that does.
Some workplaces are now also providing Weigh-2-Go which has been adapted for the workplace setting and work is now
underway to develop this service for community settings. This should improve accessibility but will need to be accompanied
by a strong communications plan to ensure members of the public become aware of where the service will be offered within
their local community. To encourage further patient choice, the Rosemary Conley discount scheme for NHS referrals has been
maintained but uptake data clearly demonstrates that men will not choose to attend this programme despite the discount.
Kingston Public Health Team are working to endorse other commercial weight management services that provide effective high
quality programmes so that patients can choose a service that will suit them as an individual and access them with confidence.
The Factor Children’s Weight Management Programmes were launched in 2010 targeting children from 5 to 16 years. These
programmes have been designed locally, specifically to meet the needs of local families. They are designed to help families
and children learn how to develop healthier habits and lead an active lifestyle. They embed key nutrition, physical activity and
behavioural change principles to help children grow into a healthier weight for their age and gender and prevent excessive
weight gain. DC Leisure were commissioned by NHS Kingston to help develop and implement the Factor programmes
across Kingston for 18 months from August 2010 until March 2012. There are three programmes for different age groups,
encouraging consistency for families with children of different age groups. The Fun-factor, Fwd-factor and 4U-factor, are run
at various DC leisure sites across the Borough. Evaluation revealed evident positive changes in dietary and mealtime habits, an
increase in time spent being physically active, and an increase in parental confidence in feeding their child (this has included
tackling issues such as fussy eating). See Recommendation 5 for further information.
The development of the media and communications strategy highlighted in the update from Objective 1 will ensure services are
well known and barriers to accessing them are reduced. The communications strategy will need to be reviewed and refreshed
to ensure it is current and up to date, in line with this document.
The unclaimed bike project was developed by NHS Kingston, RBK and the police. BME groups were targeted for cycle training
and if they committed to the programme, they received a reclaimed, refurbished bike to help encourage independence and
provide means to integrate more successfully with the local community. Case studies were very positive as the access to a
bike allowed participants to attend their ESOL classes. After further evaluation however, it was not possible to establish the
sustainability of the programme and whether participants continued to use the bikes they had been given. The programme has
therefore been developed into the broader Bike4Life programme and includes a discounted bike hire scheme.
To develop
effective
mechanisms
for monitoring,
evaluation and
sharing good
practice
100
As reported in the update of Objective 1, Kingston has been highly successful in implementing the National Child Measurement
Programme (NCMP). Your Healthcare have worked hard to ensure Kingston achieve the highest participation rates in South
West London (99%) and parental and school feedback is provided in line with the National Obesity Observatory (NOO)
guidelines and information governance policies. In 2012, prevalence data was analysed to provide aggregated data for both
Reception Year and Year 6 by ward by combining the previous 3 years data. Further analysis is underway to provide this data for
Children’s Centre outreach areas. Work to continue to further improve the local quality of the NCMP data is ongoing.
Appendices
Appendix 2
Index of Multiple Deprivation (IMD) 2010
Domain
Weight
Income deprivation
22.5%
Employment deprivation
22.5%
Health deprivation and disability
13.5%
Education, skills and training deprivation
13.5%
(Skills sub domain)
6.75%
(Children and Young People sub domain)
6.75%
Barriers to housing and services
9.33%
(Wider Barriers sub domain)
4.67%
(Geographical Barriers sub domain)
4.67%
Crime
9.33%
Living Environment deprivation
9.33%
(Indoors sub domain)
6.22%
(Outdoors sub domain)
3.11%
Source: Department of Communities and Local Government, 2011
The IMD 2010 is calculated for every ‘Lower Layer
Super Output Area’ (LSOA) in England to estimate
their relative level of deprivation. It is a continuous
measure of relative deprivation and therefore there
is no definitive point on the scale below which an
area is considered to be deprived and above which,
it is not. The LSOA is a geographical area devised,
following the 2001 Census, to be of consistent size
and generated in consistent way across the whole of
England. The total resident population of an LSOA
averages around 1,500 people. There are a total of
32,482 LSOAs in England and these are nested, as far
as possible, within electoral wards. The LSOAs were
created to be ‘fixed’ geographical zones used for
statistical purposes. The population sizes of LSOAs will
vary over time.
101

- Kingston Council

Transcription

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