Speakers: Prof. Mike Kelly of NICE and Dr. Jacqui Lavin of Slimming World
Meeting of the All-Party Group on a Fit and Healthy Childhood
Tuesday 21 October
Chair: Baroness Benjamin
Baroness Benjamin opened with a summary of the activity around the report issued by the first working group from the APPG Healthy Patterns for Healthy Families. She commented that people are “taking notice”; Lord Howe had answered her Question in the Chamber, and had now offered to broker a meeting with Minister Jane Ellison on the matters raised.
Helen Clark continued the summary by explaining that there had been so many requests for the report by Parliamentarians that the Printed Paper Office (at Westminster) had requested copies. She also thanked all the colleagues who had made submissions in contribution to the report.
The Baroness introduced the first speaker, Prof. Mike Kelly of NICE.
Prof Kelly began by outlining the scientific developments that will be important over the next decade; specifically ‘executive function’.
Psychologists believe that the executive system can over-ride the automatic system. Executive function allows us to think about the long–term rather than just the immediate future. It is now clear that the executive function gets set very early in life; making the early period of childhood very important.
Executive function is a direct response to the environment. It is especially strong in nurturing and warm family environments, where children are talked to. Children who are not brought up in such environments are doubly disadvantaged from the start of life.
Epigenetics shows that interventions (relatively early on) can change things and for the past 10 years, NICE has studied children and ‘healthy’ environments. Patterns of obesity in children are not random, they are clearly linked to social situation and create lifelong programming. They are not spread evenly across the population and follow a very clear path, which in later life repeats itself in rates of early heart disease, cancer, stroke and so on. It is a lifelong programme which people often carry with them.
NICE guidance focuses on four key areas:
- Oral Health – the critical importance of dental health (which is linked to diet) against the pernicious effect of the over consumption of refined sugar on teeth.
- Physical activity, promoting its importance to children.
- Safety – the physical environment needs appropriately supervised play.
In addition to these key areas NICE has issued reports or guidance on other topics which are relevant to the interests of the APPG:
- Looked-after children.
- Managing overweight and obesity amongst children
- Prevention of unintended injury in the home or on the road
- Increasing uptake of immunisation
- Prevention of children using alcohol
- Social and emotional wellbeing of children
- Prevention of children smoking
- Guidance on walking and cycling
Last year NICE issued a landmark guidance on obesity and weight management for children.
Elements from that guidance include:
Firstly, to tackle the problem with children in a multi-component way, not just concentrating solely upon food and physical activity. A team and community approach is required, with specialists in diet, nutrition, physical activity, and psychological counselling as appropriate.
Sometimes the best intervention is to work with the family, not just the child. The environment in which children develop may be food rich, television rich, activity poor; which may not be the most healthy way forward. A ‘whole family’ approach to intervention therefore crucial.
Commissioned services should reflect the needs of the population and the differences within the population.
Diet and physical activity must be carefully balanced; reducing the amount of time spent being sedentary; there are links between BMI and the amount of TV watched.
This necessitates ‘behaviour change’, the kind of strategies developed by psychologists (see NICE guidance).
Dr. Jacqui Lavin of Slimming World
Dr Lavin added to the previous thoughts about television by pointing out that it caused distraction whilst eating and that mindfulness and mindful eating (and the resultant biological mechanism indicating satiety) is affected by television.
Dr Lavin said that she was responding, as a commercial weight management provider, to recent NICE guidance on adults, which plays a huge role in a fit and healthy childhood. Slimming World welcomed recent NICE guidance.
- Clear guidance on how effective evidence-based providers can play an important role in weight management control.
- Recognition of non-judgemental support and communications around weight.
Why do we need guidance?
There are many barriers to weight control; emotional, psychological and environmental. Messages are conveyed via the media about weight gain without an accompanying understanding of the psychological and emotional aspects of weight control. Faddy unrealistic diets publicised in newspapers add to the burden of those who are overweight.
The benefit of the NICE guidance is that it reviews all available information, sets out recommendations and makes clear what changes are needed for effective and healthy weight management. It is important that these cover multi-component programmes, the behaviour change tools needed and the value of support. Programmes and weight-loss strategies must be realistic.
There is a positive role here for evidence-based commercial providers. The challenge for Slimming World is how to support the necessary behaviour change, using expertise and understanding of an overweight person, their hurdles, emotions and feelings, creating a beneficial change which is compatible with their lifestyle.
One of the attributes of a commercial organisation is the scale and infrastructure in existence. Slimming World provides 12,000 weekly support sessions throughout the UK, with a footfall of half a million members per week.
Another benefit of commercial organisations is that groups are tailored to meet the needs of a particular local community, in accessible venues, run by someone from the community who has had the same experience as the client. Through this structure, Slimming World has access to those who are hard to reach and it provides a community service, which could be used by other service providers.
In 2011, the British Medical Journal published research on commercial providers, where results were far more cost effective than NHS-led services.
The benefits of the support are not confined to adults. Slimming World accepts children from the age of 11, if accompanied by their parents/guardians and a referral from a school nurse or GP. Family-friendly behaviour changes are passed on by members, who can then cascade to the rest of the family.
The majority of members are mums, the food providers in the family. Over 60% of Slimming World members, living with their family say that other family members are eating more healthily as a result of their membership of Slimming World.
There is a clear role for commercial providers to support NICE guidance.
Slimming World welcomes the recommendation in the guidance that healthcare workers should raise the issue of weight management in a respectful and non-judgemental way. Stigma, shame, self-criticism and poor self-esteem are increased by negative approaches.
Slimming World has included in its recent manifesto, a call for a national standard for training healthcare and educational professionals on how to raise the issue of weight loss and weight management, thus skilling them in recognising when it is appropriate to raise such issues. Slimming World is now running training workshops with healthcare professionals about this.
Slimming World hopes to be able to share this best practice in the next few months.
The organisation welcomes NICE guidance on weight management for adults and particularly appreciates its emphasis on the supportive, understanding and non-judgemental approach.
The presentations were followed by a Question and Answer session.
How to implement “making every contact count” if it is not mandatory that everyone comes into contact with local authority services which means the toolkit with which service providers are trained cannot be accessed by those who need them.
Prof Kelly: NICE guidelines are not mandatory; (although they should become mandatory, this is an issue for politicians) they are based on the best available evidence. Their persuasiveness is based on the fact that the recommendations are evidence-based and cost effective for a health service or local authority to use. Anything else is a waste of public money.
From the answer to this question, Baroness Benjamin said that she would raise the idea of making NICE recommendations mandatory in the meeting with the Minister.
Comment from the floor: there should be a lot more support for healthcare professionals to attend training, referencing a training event the contributor attended which had a surprising number of nurses attending because they were between jobs or had taken paid holiday in order to attend such training sessions.
Are NICE looking at executive function only as an issue on food choice? There is some work at Imperial on fatty acids which might also be influencing executive function.
No it is not just as a psychological, physiological approach, combined for behavioural change. Cambridge University are working on a piece of research on this area.
The power of the Slimming World story is the ambassador role, are there statistics of how many ambassadors have converted people to membership?
Dr Lavin: It is surprising; lots of people walk in, but are not yet ready to change. Membership still needs to support them; we have a powerful new member talk which lets them know the commitment they will make. The statistics are not readily available on the question of ambassadors, but there are more statistics on areas where members have been referred. We do know that our approach is effective.
Does Slimming World have statistics showing areas of obesity across the country, are there pockets of obesity? Are obese adults (in certain areas) reflected in there being similarly obese children in those areas?
Dr Lavin: There was some work a few years ago, with some information. As Slimming World groups are led by former members themselves, there will be very active pockets. There is some data looking at levels of deprivation; which shows that Slimming World is equally spread across all socio-economic areas, there are some lower income areas where we are well represented.
Prof Kelly: Public Health England web site produces information, broken down by local authority. These statistics show that the issues of obesity are evenly spread across all economic areas.
Prof Kelly: The 2020 Health Think Thank report on “Careless eating costs lives” recorded a strong relationship between take-aways and obesity in children. No new powers are needed for local authority control of this sector.
A contributor from the floor explained that there are divisions and restriction in the powers of local authorities: they have no power over establishments termed as “restaurants” by virtue of their having seats. Whereas they can refuse permission for those classed as “take-aways”. It was suggested that there needed to be more national support and local community fighting against fast food establishments.
Comment from the floor: “Think glucose campaign” at St Thomas’ trained health professionals to know about this campaign. It needs to come from the top
Access to bariatrics is through structured weight loss programmes (in- community tier 3) of which there is none in London. How can the NHS use commercial services and convince commissioners that commercial services are required?
Prof Kelly: That is an important point. Tier 3 is missing in lots of places around the country; meaning the stepped referral process breaks down and fails. It is worth talking to the Minister about this, it was supposed to be resolved in discussions between Department of Health and Public Health England, but there is no uniform service across the country.
In family situation the “weight loser” is driving the weight loss, 40% of the population are not bringing the improvements home. Should more be done to get families to work as a unit, rather than what happens now?
Prof Kelly. The NICE guidance makes it clear that the family-based approach is the one to take and that faddy diets are unproven, costly and not effective.
Comment from the floor: the family-based approach can use people who are already used to going into families, such as midwives and health visitors.
Further comments from the floor were on oral health, the need for training for healthcare professionals and the existence of further evidence clearly showing the effect of in vitro nutrition on executive function. There was also a reminder that there is an issue with underweight children as well.
Prof Kelly: The risk factors to children of poor oral health are those that indicate early death in people’s 50’s and 60’s.
Prof Kelly: Hospital CEO’s and Trust boards need to take ownership. Typically hospitals in the UK have food and beverage policies that are part of the problem.
Prof Kelly: Yes, there is further evidence that in vitro nutrition does play a significant role.
The meeting closed.