Nutritional Report

INTRODUCTION

Obesity has increasingly become a very significant public health concern. Coronary heart disease is one of the leading causes of death in the United Kingdom and obesity is an important contributor to this. Likewise, obesity significantly contributes to conditions such as high blood pressure and type 2 diabetes, the prevalence of which is also increasing. Type 2 diabetes causes significant morbidity such as amputations and blindness. The costs of obesity are grave not only through the suffering of individuals affected, but also to society as a whole through loss of productivity and earnings. Financial costs to the National Health Service (NHS) are immense as these conditions are often chronic and associated with numerous complications. This is thus an emerging epidemic that must be urgently addressed. 20% of the UK adult population is believed t be obese with 38% being overweight. Premature death is increased 2-3 fold and this although mainly attributable to cardiovascular disease is also related to breast, colon and kidney cancer. (Jebb 2003).
The problem with obesity is not only limited to the United Kingdom but is one that is faced by the developed world as a whole. It appears to be increasing due to a more sedentary lifestyle and little physical activity coupled with greatly increased intake of energy rich food. Obesity is a health issue that results from environmental, cultural, socio-economic as well as genetic influences and is thus a complicated problem. It has no easy or simple solution and nations affected have had difficulty coming up with effective solutions to this public health issue.
Obesity has been recognised by the government and Department of Health (DH) as an issue that must be addressed and dealt with in order to prevent a future health catastrophe. The committee of public accounts released their ninth report entitled Tackling Obesity in England for the 2001-2002 period to recommend ways whereby this problem should be addressed. The impact of this report will be reviewed in this paper.

Main Body

The report begins by addressing the fact that obesity is an increasing public health concern with causes influenced by geographical region, gender, ethnic group and socio-economic background. The committee concluded from existing knowledge on the subject that this is a long term issue and solutions must help people who are overweight in addition to preventing people becoming obese in the first instance.

What impact has this report had?

Children have been recognised as a target group for intervention in this report. Recommendations made included tackling obesity at school through increased physical activity, improved uptake of sporting activity and better nutrition at school. This is an important group to target because the prevalence of obesity and overweight amongst children of all ages in increasing possibly due to a more sedentary lifestyle, dietary patterns and eating habits. (NHS Centre for Reviews and Dissemination, 2002). There is little convincing evidence regarding the most efficacious weight-loss strategies. Trials are often small with high drop out rates and are poorly reported. The royal college of paediatrics and child health published advice on weight management in children. (Edmunds 2002) It mentioned the fact that early intervention is better and and that successful must involve the child’s family and tailored to the individual. Both the child and family must however want help and be willing to make lifestyle changes.
Family based weight reduction programmes that involve parents in increasing physical activity, providing dietary advice and reducing sedentary behaviour is believed to be an effective weapon in tackling childhood obesity. There are now a number of government initiatives highlighting the key role that school based programmes can help. (Wilson 2003) There is evidence that multifaceted school based programmes that promote physical activity, modification of dietary intake and a reduction in sedentary behaviour may reduce obesity in kids with the greatest effect seen in girls.
One of the recommendations of the report is to increase the use of cycling as a healthier, greener form of transport. Cars are used more in Britain than elsewhere in Europe despite lower car ownership. (Tackling Obesity, 2002) Delivery of the National Cycling Strategy is a health initiative launched in 1996 that is supported by the report. The department of health has supported cycling by funding Sustrans, a charity to run green travel seminars for NHS trusts as part of the National Service Framework (NSF) for coronary heart disease.
In the new 3 year funding for primary care trusts (PCT) announced in February 2005, £21 million has been allocated in 2006/07 to PCTs for action on diet, physical activity obesity. Some of this money is open to be spent on cycling related work. Lastly, the Department of Health has funded Life Cycle UK to pilot cycle training as part of rehabilitation heart patients. Despite all this investment however there has not been an increase in cycling trips made. According to the department of transport there has been an increase in cycling funding in order to encourage more cycling amongst the population. It therefore seems like although the report made a substantial impact on investment in cycling, this has not translated to an actual increase in cycling. (Delivery of National Cycling Strategies)
At a conference for government, education, sport and leisure partners held in February 2004 to look at designing policies and initiatives to improve the health of the nation, Rosie Winterton, MP, spoke about a cross government food and health action plan. (DH press release, 2004) This included measures to improve the nutritional value of food at the production, preparation and manufacture level through reductions in fat, salt and added sugar. Government initiatives already in place included a cross government activity co-ordination team established to increase participation in sport and physical activity to a target of 70% of people by 2020. There is also a welfare food scheme to ensure children from lower income groups have access to a healthier diet. With regards to increasing activity levels, the department of health in partnership with sport and countryside agency set up a program of exercise action pilots to increase activity amongst priority groups. For instance a pilot in Durham Dales PCT gave sedentary teenagers from disadvantaged areas the knowledge and skills to become physically active.
The health secretary reported in a department of health press release in May 2004 that measures being taken by the government to tackle obesity include free fruit to 4-6 year olds in school, encouraging more exercise through initiatives like free swimming lessons, improving the nutritional quality of school meals, replacing fizzy drinks in school vending machines with water or fruit juice, improving sports facilities in schools and better cycle lanes and walking routes to encourage an active lifestyle.

What were the strengths of the report?

This report identified right from the onset that obesity is a lifestyle issue greatly influenced by non-medical factors such as socio-economic factors. This helped to set the stage for addressing the problem in so far as effective solutions would need to have a multi-faceted approach. The committee pointed out that a “joined up approach involving government departments and local agencies across a range of different policy areas” would be required. (The Committee of public accounts, 2001) Solutions lie not only in healthcare but also and perhaps more importantly in education, media, and the provision of sporting and recreational opportunities.
One of the greatest strengths of this report is the emphasis placed on helping people to avoid becoming overweight. As in any medical condition after-all, prevention is much better than cure! This committee made recommendations for targeting children through healthier nutrition, increased physical activity including sports and education regarding dangers obesity. This is an effective strategy as it will help generate healthier attitudes and behaviour and tackle unhealthy habits from a young age and this is more sustainable. For instance, getting children involved in sporting activities at school will introduce them to sport as an enjoyable activity and they will be more likely to retain this interest through adult life. Infrequent participation in sports at school is known to be associated with physical inactivity in adulthood. (Javelin 2003) Children are also an important group to target as figures show that obesity is rising amongst this group as well as well as obesity related illnesses such as type 2 diabetes starting to appear with more frequency in children. (Matthews 2002)
Tackling obesity in children through improved nutrition forms the bases of several recommendations in this report. One of the strengths of this strategy was the fact that this issue was confronted from variety of angles. Firstly the some of the reasons for unhealthy diet was addressed. Financial constraints were addressed through initiatives like free fruit at school, and the influence of commercial sponsorship by companies such as Walkers and Cadbury’s was addressed. Secondly recommendations were made to improve access to healthy options at school through healthier school dinners and healthier options in school vending machines. Thirdly the committee sought to encourage the food standards agency to encourage clearer labelling of foodstuffs to allow people to make informed choices. The way in which food is advertised o children was also an issue of concern in the report. Tackling this issue in a number of ways acknowledges the fact that what children eat is influenced by several factors and so a successful outcome is more likely if these different factors are recognised and addressed. It has been recognised that people from lower social classes are less likely to participate in sporting activities than their peers from higher social classes. (Becker 2005) Addressing financial issues is therefore a valuable tool in addressing obesity.
In this report the role of general practitioners in the battle against obesity was clarified however it was recognised that these doctors and indeed other healthcare providers needed more information about the effectiveness of different obesity management strategies and recommended the commissioning of further research into this area.

What were the weaknesses of the report?

The report places a lot of emphasis on the unique role that general practitioners and other healthcare professionals involved in primary care could play in the battle against obesity. The first point of contact with medical services for the majority of the population with general practice and so GP’s and other primary healthcare professionals are expected to identify people who are at risk of obesity and the health risks associated with it. The problem however as discussed in the report is that most GPs are unclear about the role expected of them in this situation and believe that their role is to treat people with excess weight and refer obese people for specialist treatment. The report mentions that a lot of GP’s believe that the promotion of a healthy lifestyle was for the government and health authorities. The committee therefore concluded in this report that the role and expectations of GP’s should be set out clearly in health improvement programmes.
The report does not however discuss how GP’s and health professionals can be helped to care for patients with obesity. In addition to the lack of evidence regarding effectiveness of different weight reduction strategies there is an important lack of training or knowledge amongst healthcare professionals of how to approach the subject of obesity with their patients and options available to them. This leads to a lack of confidence in dealing with the topic and may explain why it is seldom dealt with in general practice. A survey by the national audit office found that there was uncertainty amongst GP’s and practice nurses about the effectiveness of available treatment options. (National Audit Office, 2001)
In a paper published by a practice nurse from leads reflects on the experiences of herself and her colleagues regarding this issue. (Hudson 2004) This paper discussed the fact that despite being aware of the health problems associated with obesity, practice nurses often feel poorly equipped to support patients. This and fear of causing offence causes them to avoid raising the subject with patients. When patients enquired about diets they lacked the knowledge and confidence to advice on effective methods. Furthermore they were not able to skilfully advise patients on weight loss and relied on pre printed information leaflets, which were often unhelpful. The result of this was that patients were not successful at losing weight and stopped seeking advice.
This illustrates the importance of adequately training these healthcare providers who are likely to be the first point of contact for these patients. Failure to discuss this issue or make recommendations such as improved obesity management training in nursing or medical curriculum as well as on the job training for current care providers is therefore a very significant omission in this report. The committee in this report does make recommendations for updated NICE guidelines on obesity treatment but this is clearly just one aspect in the continuum of care. Existing NICE guidelines regarding obesity management concern the use of pharmacological or surgical treatment. The aim of tackling this public health issue is to intervene before patients get to this point and that is why it is important that primary care provided are trained on how to intervene effectively.
One of the recommendations made by the committee of public accounts in this report was the encouragement of cycling as a healthy method of transport. This is to be achieved through partnership working between the department of health, department of environment and transport. Suggested ways of achieving this included an increase in cycle lanes and giving cyclists more priority on roads. They however failed to look at important reasons why people do not choose to cycle such as safety issues and the understandable fear that this generates and this is a particularly disappointing omission especially given the fact that high fatality rates amongst cyclists, especially children is mentioned in the report. Fear and safety reasons may at least partly account for the fact that despite much increased and sustained investment in cycling since the past few years, actual cycling trips have not increased in line with this as would have been expected. (Delivery of the National Cycling Strategy) In London in 2004/05 £13 million was invested in cycling.
The availability of physical exercise in school forms a significant part of this report. Children are entitled to two hours of physical exercise each week at school however the authors of the report stated that there is great disparity in the provision of this. It was suggested that the department for education and skills should work to ensure that all schools provide this. There is minimal mention of possible reasons such as curriculum strains why some schools may be having difficulty providing this entitlement and so nothing was recommended to deal with this.

CONCLUSION

Obesity has quite rightly become a department of health priority and much effort and investment appears to have gone into realising the recommendations off the committee of public accounts ninth report. This report has and will have an impact on patient care through the clarification of the role of primary healthcare professionals in dealing with the problem. Better training of these people to equip them with necessary skills, as well as well as research into proven methods will enhance the benefit to patients. Has this report had an impact on obesity levels? As previously mentioned obesity is a long term problem and thus more time will be needed to determine if the rising trend in obesity is being halted by these efforts. Read more at: http://www.essaywriter.co.uk/nutritional-report.aspx?id=j5qYaMrss9hw2