Jackson, A.A et al. Archives of Diseases in Childhood, 2014; 99(2): 95-98
This article discusses a recent report published by the Academy of Medical Royal Colleges (AoMRC), Measuring up, the medical profession’s prescription for the nation’s obesity crisis.
By National Obesity Forum (2013)
This report aims to audit the situation in the UK, to identify what initiatives and policy exists, and to assess their effectiveness in tackling obesity and weight management issues. It highlights a lack of support and guidance for those who are obese or morbidly obese as well as a deficiency in GP knowledge of support services.
By NICE (2013)
Overview: Lack of physical activity is a risk factor for chronic diseases, such as heart disease, stroke and diabetes. Physical inactivity in the UK has been estimated to have cost the NHS £0.9 billion in related ill health in 2006–07 (Scarborough et al. 2011).
Women are less likely to take part in physical activity than are men: only 28% of women in England meet the current recommended level of physical activity, compared with 40% of men (Start Active, Stay Active 2011). In addition, people from low socioeconomic groups have low rates of participation in physical activity (Kavanagh et al. 2005).
See the NICE Evidence Services topic page on physical activity for a general overview of the subject.
Current advice: The chief medical officers for the 4 UK nations recommend that all adults should aim to be active daily (UK physical activity guidelines 2011). Adults aged 19 years and over should do at least 150 minutes (2.5 hours) of moderate intensity physical activity a week, such as walking at 3–4 mph. Alternatively adults should complete 75 minutes of vigorous intensity activity spread across the week, such as cycling at 12–14 mph, or a combination of moderate and vigorous intensity activity.
NICE guidance on physical activity for adults in primary care recommends that adults who are not currently meeting the UK physical activity guidelines should be advised to do the recommended level of activity. These people should be provided with information about local opportunities to be physically active for people with a range of abilities, preferences and needs. NICE also has public health guidance on four commonly used methods to increase physical activity.
The NICE Pathway on physical activity brings together all related NICE guidance and associated products on the topic in a set of interactive topic-based diagrams.
New evidence: Cleland et al. (2013) did a systematic review and meta-analysis of trials that looked at interventions to increase physical activity in socioeconomically disadvantaged women. The authors searched for studies in women who had a low education status or a low income, were unemployed or in low status occupations, or who lived in an area of low socioeconomic status. A total of 19 studies, most of which were conducted in Europe and North America, were eligible for inclusion in the review. An initial random effects meta-analysis identified significant statistical heterogeneity, so the data could not be pooled to produce an overall measure of effect. Instead the authors conducted analyses of predefined factors that might influence the success of an intervention, such as setting and duration.
Delivery mode was the only factor found to have a significant effect on the success of an intervention to increase physical activity. Studies in which the intervention had a group component – such as group education meetings or practical sessions – found a greater difference between intervention and control groups (standardised mean difference [SMD] 0.36, 95% CI 0.17 to 0.54, p=0.0002) than studies in which the intervention was delivered individually (SMD –0.02, 95% CI –0.35 to 0.31, p=0.90) or in a community setting (SMD –0.02, 95% CI –0.10 to 0.05, p=0.58).
The authors estimated that this difference would be equivalent to an additional 70 minutes of physical activity a week for women in group interventions or an extra 1000 steps a day. The authors noted that most studies in their analysis used self-reported measures of physical activity and that only 5 of the 19 studies included had a low or medium risk of bias. Nevertheless they suggested that the use of group-based approaches is a key factor in interventions that successfully improve physical activity in socioeconomically disadvantaged women.
Commentary: “Evidence exists to support group interventions being successful for other public health measures compared with other interventions; for example, for people quitting smoking. However, it should be noted that group interventions are the format least likely to engage people in quitting, so personal preference needs factoring in. The level of preference for group interventions among the participants in the studies analysed here is not clear, because recruitment and drop out data are not included in a number of the studies.
“In addition, it is unclear whether the effect noted in this study was specifically the result of group approaches or whether the holistic nature of the intervention was the significant factor. Any future work should separate these aspects of intervention delivery.
“Practice in terms of approaches to increasing physical activity should not be changed solely on the basis of this study. The findings do, however, provide useful information for healthcare professionals considering options for increasing physical activity in communities of disadvantaged women. It would be helpful to have comparative cost effectiveness data between individual and group interventions to further support these deliberations.” – Elaine Michel, Director of Public Health, Derbyshire County Council
Study sponsorship: This study was not funded.
By Public Health England (2013)
This briefing summarises the importance of action on obesity and a specific focus on active travel, and outlines the regulatory and policy approaches that can be taken.
By Local Government Association (2013)
This discussion paper considers the impact that obesity has on social care and the challenges facing social care now and in the future.
By NICE (2013)
This guidance makes recommendations on lifestyle weight management services for overweight and obese children and young people aged under 18.
By NHS Choices (2013)
Guidelines on the amount of physical activity recommended for children under 5 years old, including related factsheets.
By Nuffield Health (2013)
This report reveals that early indicators of poor mental health are on the increase. It also finds that GPs are 46 times more likely to prescribe medication than explore medically proven alternative options, like exercise. This report calls for all GPs in the UK to take a ‘diagnose, consider exercise, refer, treat’ approach to physical activity when patients present with early signs of mental ill health.
Pollard, T. et al. BMC Public Health, 2012; 12: 1087
School recess provides an important opportunity for children to engage in physical activity. Previous studies indicate that children and adults of South Asian origin are less active than other ethnic groups in the United Kingdom, but have not investigated whether activity differs within the shared school environment. The aim of this study was to test the hypothesis that British Pakistani girls aged 9–11 years are less active during recess than White British girls.
Jebb, SA. et al. Obesity Reviews, 2013; doi: 10.1111/obr.12093
Tackling obesity has been a policy priority in England for more than 20 years. Two formal government strategies on obesity in 2008 and 2011 drew together a range of actions and developed new initiatives to fill perceived gaps. Today a wide range of policies are in place. Data from annual surveys shows the rate of increase in obesity has attenuated in recent years, but has not yet been reversed. This paper considers the actions taken and what is known about the impact of individual policies and the overarching strategy to tackle obesity in England.