Childhood obesity in Merton including an update on the NCMP programme Eva van Velzen, Public Health registrar NHS Sutton and Merton Julia Groom, Public Health consultant Merton 27 April 2012

Merton One in five children in Reception year is overweight or obese One on three children in Year 6 is overweight or obese

So what? Children experience psychological effects: teasing and discrimination by peers; low self-esteem; anxiety and depression Childhood obesity is associated with a higher chance of premature death and disability in adulthood from: cardiovascular diseases diabetes musculoskeletal disorders certain types of cancer (e.g. breast and colon) Many overweight children will become overweight adults (and parents!) Sources: NOO, WHO

Outline Causes of childhood obesity Background NCMP National results Merton results NCMP actions Local support programme: Alive ‘n Kicking Discussion

Determinants of Obesity Source: http://www.cdc.gov/pcd/issues/2009/jul/09_0013.htm

In words: Childhood obesity is mainly associated with unhealthy eating and low levels of physical activity, but the problem is linked not only to children's behaviour but also, increasingly, to social and economic development and policies in the areas of agriculture, transport, urban planning, the environment, food processing, distribution and marketing, as well as education The problem is societal and therefore it demands a population-based multi sectoral, multi-disciplinary, and culturally relevant approach. Children and adolescents cannot choose the environment in which they live or the food they eat. They also have a limited ability to understand the long-term consequences of their behaviour. Source: WHO

Background National Child Measurement Programme (NCMP) is a national programme to measure the weight of children in Reception and Year 6 in English state schools Aim: to monitor overweight and obesity to guide effective policy making to reduce obesity Parents receive individual feedback about measurement Measure used = BMI, adjusted for normal growth variation between Reception and Year 6, and sex.

National child measurement results 2010 - 2011 © NOO 2012

Merton child measurement results 2010 - 2011 Higher than UK Lower than UK © NOO 2012

Merton 2007-08 and 2009-2010 combined results % of Reception yr children (4-5 yrs old) obese by MSOA % obesity varies from (no data) 5% to 14%

NCMP results – action National data for monitoring and policy Local feedback of measurements to parents (NHS community services) to headmasters (NHS Public Health) referrals to treatment programme ‘Alive n Kicking’

What is Alive ‘N’ Kicking? Specialist healthy weight programme for children aged 4-19 Physical activity sessions for children Interactive nutrition workshops for parents, focusing on practical ways to improve the family diet. Group programmes for 4-6yrs, 7-11yrs, 12-15yrs and 16-19yrs, with capacity of 20 participants per group

Results so far March 2012... 70% of graduates reduced their BMI 84% of graduates reduced their waist circumference Average weight loss was -1.05 kg

Discussion One in five Merton children in Reception year is overweight or obese One on three Merton children in Year 6 is overweight or obese

Extra slides

Merton – England, NCMP 2007/08 to 2010/11 Obesity trend data Merton – England, NCMP 2007/08 to 2010/11

Reception Year

Year 6

Prevalence of obesity by Local Authority Year 6 children (age 10-11 years) resident in London, NCMP 2009/10 Low prevalence High prevalence Child obesity: BMI ≥ 95th centile of the UK90 growth reference © NOO 2011 This slide shows an example of obesity prevalence mapped at LA level – extracted directly from the e-Atlas. http://www.noo.org.uk/visualisation/eatlas

Uptake and trends Referrals: on average 26 referrals per month Completers: Jul ’09 - Mar ‘11 = 105 / yr Apr’11 – June ‘12 = 161 / yr 53% increase in completers We’re aiming for 70 this term Training: 88 local candidates trained including EY staff and Health

Local feedback to schools National guidelines: detailed school data may not be shared with schools We use a national but ‘Mertonised’ tool for feedback about the 2010-2011 results to Merton headmasters The letter will include information about local support to help children and their families to keep a healthy weight Participation rate Merton - England: 87.1% Reception = lower than nationally 91.2 % Year 6 = same as nationally Reasons: Small numbers: no meaningful comparisons Pupils may be identifiable Results depend on deprivation, sex, ethnicity etc

Example feedback from 09-10 data School prevalence indicator: No data or insufficient data Below the regional average Similar to the regional average Higher than the regional average   Reception Underweight 2 Overweight Obese Year 6 3 Note: big increase in overweight and obesity between Reception and Year 6!

Prevalence of obesity by deprivation decile © NOO 2011 Prevalence of obesity by deprivation decile Children in Reception and Year 6 (National Child Measurement Programme 2009/10) Child obesity: BMI ≥95th centile of the UK90 growth reference Deprivation deciles assigned using the Index of Multiple Deprivation 2010 Reception Year 6 Child obesity prevalence is closely associated with socioeconomic status. More deprived populations tend to have higher obesity prevalence. Not shown: variation between regions: mostly explained by differences in socio-economic status