Aspiring to new lows in North West waistlines

Guest post by Naoimh McMahon, Postgraduate student, NIHR CLAHRC NWC

In theory weight management is a ‘simple’ balance between consuming enough energy to adequately fuel ourselves and moving enough to ensure that extra energy is used up. However, in reality there is a complex web of influences that determine our eating and activity habits. We are becoming increasingly more sedentary and are prone to consuming more energy-dense foods. This combination is making the energy balance harder to achieve. When it comes to weight management interventions, what works for one individual is rarely guaranteed to work for the next and so there are real challenges to understand what the right mix of actions are to enable people to achieve and maintain a healthy weight.

Last summer, when preparing a doctoral fellowship application I met with providers and service users from a range of local health improvement initiatives in the North West of England. I was really intrigued by one initiative in particular called Aspire. Aspire is a weight loss programme delivered by a local charity. The design of the programme was unlike any other weight loss programme I had encountered and there was a real sense of personal investment in the programme from both the providers and participants. The thinking behind Aspire is that for individuals who have a lot of weight to lose, intensive and ongoing support is needed to make a positive and sustainable change. The programme runs for 26 weeks and each group has 12 participants. Aspire includes all the traditional elements that you would expect to find in a weight loss programme such as advice and education on food and healthy eating. It also supports participants, many of whom have a body mass index (BMI) of over 35, to engage in graded physical activity.

I think what I found most intriguing about this programme was the emphasis it placed on the person, trying to build confidence and esteem to really convince people that they could achieve their weight loss goals. For example one of the activities that participants spoke about with most feeling was a step climb in a local park at the beginning of the programme. The Aspire providers discussed how this activity served two purposes: (i) to act as a ‘shock to the system’ by allowing the participants to really reflect on their current fitness levels and (ii) to provide a goal to work towards and make a commitment that it will never be that hard again. The group returned to this step climb at the end of the 26 weeks with smart phones in tow and there is some really fantastic footage that captures the excitement and pride at the progress they had made along with the disbelief at how it had once taken hours to complete.

There is never a ‘one size fits all’ and any programme will work for some but not for others. It certainly seems like now it is less about finding a single ‘effective’ or ‘perfect’ programme and more about trying to understand what it is about programmes that enable different people to make positive and sustainable changes. I think we will all know people personally who have taken control over their weight by stumbling upon park runs and ‘getting the bug’ or by using commercial weight loss programmes such as Weight Watchers or Slimming World - finding a system that really works for them. Like other weight loss programmes, there were Aspire participants who did not achieve their goal weight and there were participants who regained the weight that they had worked so hard to lose. What is important is not to write-off such efforts as ‘ineffective’ but to get a better understanding of how and why these outcomes came about. Aspire is only one example of a novel approach to enable people to lose weight but there are certainly elements that have been particularly effective for some participants.


Find out more about the programme and how participants felt about what worked for them.

Obesity: many perspectives, no magic solution

Lorraine McSweeney, Research Associate, Newcastle University

To coincide with Nutrition and Hydration week Lorraine reports back from the Westminster Food and Nutrition Forum.

On the 9 March I attended a Westminster Food and Nutrition Forum titled: ‘Next Steps on Policy for Obesity - Prevention, Sugar Consumption and Priorities for Children’s Health’. The original purpose of the forum was to discuss the Government’s childhood obesity strategy. However, as publicised in the Guardian on the 26 February, this has been delayed; with the Department of Health calling it a ‘complicated issue’ that they want to ensure is a ‘game changing moment’. Despite the strategy delay the forum went ahead to allow ‘experts’ in the field to share ideas and possible approaches for the strategy.

Speakers and panel members were a diverse group ranging from Public Health England (PHE); School Food Plan; Southampton Health and Wellbeing Board; Children’s Food Trust; ukactive kids; Family Lives; primary care; Advertising Standard’s Authority; British Retail Consortium; Kantar World Panel; Food and Drink Federation; and London Food Board… the list goes on...

The McLympics - advertising and sponsorship

PHE stated that the average diet in the UK is poor with too much saturated fat and sugar and too little fibre, fruit and vegetables. This is having a knock-on effect on our children, with one in five primary school kids overweight or obese, by the time children leave primary school, this figure rises to one in three. Contrary to popular belief, this is not just an issue of poverty; obesity is happening in both the most and least affluent areas. We are bombarded with opportunities to eat 24 hours a day and there are many drivers to buy and eat. Advertising and sponsorship, which some people don’t associate with advertising, can have a negative impact on child health.

The Chief Executive Officer from the Children’s Food Trust argued that good food should be a part of a child’s life from day one, right through their life. Food should not be tailored to be ‘child-friendly’. Children should be encouraged to eat smaller portions of adult food and should not be targeted by the food industries. Parents need to be listened to and families should be helped to cook more.

The need to get children moving more was discussed and included comments about modern life not encouraging children to be active; and schools too scared to work with parents and tell them how to keep their children active. It was stated that only a third of children enjoy sports and other solutions need to be encouraged. The primary care representative felt that too many patients are being treated with the consequences of obesity. She believes that primary care professionals are missing opportunities to discuss weight with parents; however, GPs reported not wanting to cause offence and felt they did not have the time to deal with the issues.

An overarching theme from the ‘health’ representatives was that prevention is key and that the food industry was part of the problem and should be involved in solving the problem. We were informed that in an average supermarket consumers have 30,000 products to choose from and consumer change is very hard to drive.

The impact of volume of sales of products such as sugar and bread, which have no immediate substitute, are shown not to be affected by price rise. The introduction of a sugar tax was highly debated; some felt it would not change consumer behaviour, whilst others argued it would offer one solution. However, following the success of the reformulation of products to reduce salt and saturated fat, it was agreed that the reformulation of products containing sugar could be a way forward. However, representatives from the food and drink industries stated that sugars would be more difficult as it has a structural function in food.

In addition, if a product was made ‘healthier’ consumers may be inclined to eat more of the product but it was agreed that alongside reformulation, portion size control could be beneficial. There was much discussion of whether legislation should be enforced on food and drink companies – the representatives believed that due to diversity of companies, a voluntary approach was better. However, it was argued that ‘if consumers continued to make incorrect choices – legislation was all that was left’.

As you can see from this very brief summary, obesity continues to be a very complex issue; it was thought-provoking to hear the different perspectives from health, policy, practice and industry. However, the discussions emphasised the point that there is no magic solution; the publication of the Government’s childhood obesity strategy is eagerly awaited.

Photo attribution: flickr.com, Santo Chino, "McLympics": https://www.flickr.com/photos/santochino/2797034750

Practice what you preach

Guest post by Robin Ireland, Chief Executive, Health Equalities Group and Director, Food Active

I am invited to review the morning papers on a regular basis for BBC Radio Merseyside. I mainly pick health subjects to discuss and went for air pollution last week. A recent report suggests that 40,000 premature deaths annually in the UK are attributable to outdoor air pollution. The biggest contributor is diesel engines and we obviously need national policy in place to support people to make the switch; ideally to walking, cycling and public transport but - at a stretch - to engines not kicking out toxic fumes.

I had cycled to the studio that morning, as I usually do, but mentioned I own a car as well. The DJ focused on me and said, “I bet it’s a diesel …..”

Which got me thinking about practising what we preach. Instead of constantly haranguing people to eat better, exercise more, not smoke etc., are we putting our own house in order?  Yes, this can be important on an individual level, but it is critical at a population level.

We look to Government for legislation to support our healthier lifestyles and I was disappointed to hear about the latest delay in the publication of the Childhood Obesity Strategy. Yes, I would like to see a tax on sugary drinks and yes, I would like to see more controls on the marketing of junk food and drinks to young people.

But I would also like to see more powers to local authorities in their efforts to promote healthy weight. This is in fact what the Health Select Committee on Obesity recommended back in November: “Greater powers for local authorities to tackle the environment leading to obesity”

Blackpool Council sign the Local Authority Declaration on Healthy Weight

Back in August 2014, the North West’s Healthy Weight campaign, Food Active, invited Action on Smoking and Health (ASH) to give a presentation in Manchester on their Local Authority Declaration on Tobacco Control. Could this approach also work for overweight and obesity? Essentially, can local authorities look in-house at their own polices to see how they impact on healthy weight?

Healthy Weight has proved to be a lot more complicated than Tobacco Control – I am not in any way suggesting that the latter is straightforward either – as of course we don’t have a product that is toxic in every way!

What has now become the Food Active Local Authority Declaration on Healthy Weight, has gone through many iterations and discussions. Our governance team, which includes myself and local public health practitioners and academics, considered a number of options. Should a Declaration be focused purely on sugar for example? Food Active decided not, as local authority policies on healthy weight would be much the same and could be positive (around encouraging active transport for example) as well as negative.

Of course Sugar Smart Cities, launched at the end of last year in Brighton, is an alternative equally valid approach where, given the evidence base around the amount of sugar in our diet, it has been singled out as a target.

On 20 January 2016, Blackpool Council became the first local authority in the country to pass the Local Authority Declaration on Healthy Weight. It was signed in front of cameras in February by the local Director of Public Health and the Cabinet Member for Reducing Health Inequalities.

The Declaration commits an authority to take measures (there are 12 listed) where possible to, for example: “protect residents from the commercial pressures and vested interests of the food and drink industry ….” and “consider how strategies, plans and infrastructures for regeneration and town planning positively impact on physical activity”. For the full list please visit www.foodactive.org.uk.

So Blackpool Council are practising what they preach and they are doing their best to take on a complex and challenging task. As the declaration states: “We recognise that we need to exercise our responsibility in developing and implementing policies which promote healthy weight”. It won’t be a piece of paper that lies on a shelf …..

And, no, I don’t have a diesel engine in my car.