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Obesity: working with local communities
This guidance focuses on an overarching approach to overweight and obesity in adults and overweight and obesity in children in local communities. It focuses on the importance of integrating action on obesity in other local agendas (such as initiatives to prevent type 2 diabetes, cardiovascular disease and cancers, or initiatives to improve the environment and promote sustainability).
The guidance will support the Government's Call for Action on Obesity and the public health outcomes framework. It provides an organisational framework for existing NICE guidance (community-based or individual interventions) that directly or indirectly impacts on obesity prevention or management.
The ongoing structural changes to the public sector, particularly local authorities and the NHS, have influenced the direction and tone of the recommendations. Throughout this pathway, audiences most likely to find particular information helpful have been flagged, but given the ongoing structural changes it is recommended that all interested parties review the pathway in its entirety. This guidance is intended to support organisations that have a role in obesity prevention in the wider public health agenda, including Public Health England, the National Commissioning Board, local authorities, local Healthwatch, local health and wellbeing boards and clinical commissioning groups.
The NICE guidance that was used to create the pathway.
Obesity: working with local communities. NICE public health guidance 42 (2012)
Effective interventions library
Successful effective interventions library details
The baseline and self-assessment tools are Excel spreadsheets that can be used by organisations to identify if they are in line with practice recommended in NICE guidance and to help them plan activity that will help them meet the recommendations.
Audit support provides ready-to-use criteria, including exceptions, definitions, suggested data sources and a data collection tool.
Commissioning guides provide information on key clinical and service-related issues to consider during the commissioning process. Each guide contains a commissioning and benchmarking tool, which is a resource that can be used to estimate and inform the level of service needed locally as well as the cost of local commissioning decisions.
Costing support includes national cost impact reports that summarise the national costs and savings and discuss the assumptions used; costing templates to assess the impact on local budgets; and costing statements when the impact is not significant or impossible to quantify at a national level.
NICE has developed online learning modules, in collaboration with a range of providers, including BMJ Learning, to update knowledge on evidence and NICE guidance.
Slide sets provide a framework for discussion and assist in local dissemination of the guidance. The slides contain the key messages from NICE guidance and can be tailored for local presentations.
The recommendations should be undertaken in parallel, wherever possible as part of a system-wide approach to preventing obesity. Ideally, to be as cost effective as possible, they should be implemented as part of integrated programmes that address the whole population, but with a scale and intensity that is proportionate to addressing locally identified inequalities in obesity and associated diseases and conditions.
The guidance provides a framework for existing NICE guidance (community based or individual interventions) that directly or indirectly impacts on obesity prevention or management.
Other NICE guidance can also be used to ensure effective delivery of the recommendations made in this guidance (see community engagement, behaviour change and cultural appropriateness below).
The prerequisites for effective community engagement are covered in NICE's guidance on community engagement. These include:
- coordinated implementation of the relevant policy initiatives
- a commitment to long-term investment
- openness to organisational and cultural change
- a willingness to share 'power', as appropriate, between statutory and community organisations
- the development of trust and respect among all those involved.
The guidance states that the following should also be in place to ensure effective local practice:
- support to ensure those working with the community – including members of that community – receive appropriate training and development opportunities
- formal mechanisms that endorse partnership working
- support for effective implementation of area-based initiatives.
The prerequisites for effective interventions and programmes aimed at changing behaviour are covered in NICE's guidance on behaviour change. In summary, NICE recommends that interventions and programmes should be based on:
- careful planning, taking into account the local and national context and working in partnership with recipients
- a sound knowledge of community needs
- existing skills and resources, by identifying and building on the strengths of individuals and communities and the relationships within communities.
In addition, interventions and programmes should be evaluated, either locally or as part of a larger project, and practitioners should be equipped with the necessary competencies and skills to support behaviour change. This includes knowing how to use evidence-based tools. (NICE recommends that courses for practitioners should be based on theoretically informed, evidence-based best practice.)
The prerequisites for culturally appropriate action are outlined in the preventing type 2 diabetes pathway. The guidance emphasises that culturally appropriate action takes account of the community's cultural or religious beliefs and language and literacy skills by:
- Using community resources to improve awareness of, and increase access to, interventions. For example, they involve community organisations and leaders early on in the development stage, use media, plan events or make use of festivals specific to black and minority ethnic groups.
- Understanding the target community and the messages that resonate with them.
- Identifying and addressing barriers to access and participation, for example, by keeping costs low to ensure affordability, and by taking account of different working patterns and education levels.
- Developing communication strategies that are sensitive to language use and information requirements. For example, they involve staff who can speak the languages used by the community. In addition, they may provide information in different languages and for varying levels of literacy (for example, by using colour-coded visual aids and the spoken rather than the written word).
- Taking account of cultural or religious values, for example, the need for separate physical activity sessions for men and women, or in relation to body image, or beliefs and practices about hospitality and food. They also take account of religious and cultural practices that may mean certain times of the year, days of the week, settings, or timings are not suitable for community events or interventions. In addition, they provide opportunities to discuss how interventions would work in the context of people's lives.
- Considering how closely aligned people are to their ethnic group or religion and whether they are exposed to influences from both the mainstream and their community in relation to diet and physical activity.
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A process by which someone performs an activity and then analyses their actions and gains feedback to improve future performance.
Body mass index (BMI) is commonly used to indicate whether adults are a healthy weight or underweight, overweight or obese. It is defined as the weight in kilograms divided by the square of the height in metres (kg/m2).
Actions or interventions that improve the ability of an individual, an organisation or a community to identify and address health or other issues on a sustainable basis, for example through skills development, improved networking and communication or shared decision making.
A group of people who have common characteristics. Communities can be defined by location, race, ethnicity, age, occupation, a shared interest (such as using the same service), a shared belief (such as religion or faith) or other common bonds.
Local community refers to a group of people from the same geographic location that is not necessarily related to any official, administrative boundary. The community may be located in a ward, borough, region or city.
Community health champions are local people who are recruited and trained as volunteers to 'champion' the health priorities and need of their communities.
Community development is about building active and sustainable communities based on social justice, mutual respect, participation, equality, learning and cooperation. It involves changing power structures to remove the barriers that prevent people from participating in the issues that affect their lives.
The process of getting communities involved in decisions that affect them. This includes the planning, development and management of services, as well as activities that aim to improve health or reduce health inequalities (see Community engagement for health improvement: questions of definition, outcomes and evaluation - a background paper prepared for NICE by Professor Jenny Popay ).
For this guidance, co-production means developing and delivering action on obesity in an equal and reciprocal relationship between professionals, the local community, people using local services and their families.
Joint strategic needs assessments (JSNAs) identify the current and future health needs of a local population. They are used as the basis for the priorities and targets set by local areas, expressed in local health and wellbeing strategies. They are also used for commissioning to improve health outcomes and reduce health inequalities.
The local system comprises a broad set of interrelated organisations, community services and networks operating at a range of levels and involving a number of delivery processes.
For adults, overweight and obesity are assessed by body mass index. The following table shows the cut-off points for healthy weight, overweight and obesity.
40 or more
BMI is a less accurate indicator of adiposity in adults who are highly muscular, so BMI should be interpreted with caution in this group. Some other population groups, such as Asians and older people, have comorbidity risk factors that would be of concern at different BMIs (lower for Asian adults and higher for older people). Healthcare professionals should use clinical judgement when considering risk factors in these groups, even in people not classified as overweight or obese using the classification in the table.
Assessment of the health risks of being overweight or obese can also be based on waist circumference. For men, waist circumference of less than 94 cm is low, 94–102 cm is high and more than 102 cm is very high. For women, waist circumference of less than 80 cm is low risk, 80–88 cm is high and more than 88 cm is very high.
More than one classification system is used in the UK to define 'overweight' and 'obesity' in children. The National Child Measurement Programme (NCMP) for primary care states that body mass index (BMI) should be plotted onto a gender-specific BMI chart for children (UK 1990 chart for children aged over 4 years). Children over the 85th centile, and on or below the 95th centile, are categorised as 'overweight'. Children over the 95th centile are classified as 'obese'. Other surveys, such as the Health Survey for England also use this system. In clinical practice, however, the 91st and 98th centiles may be used to define 'overweight' and 'obesity' respectively. Children on or above the 98th centile may also be described as very overweight.
For the purpose of this guidance, a partner is a local department, service, organisation, network, community group or individual that could help prevent obesity.
Top-down activities or approaches are where an activity is initiated from a senior level in an organisation and cascaded down to those working directly with the local community.
Two-tier counties in England consist of an 'upper-tier' county council and various 'lower-tier' city, borough and district councils.
The social determinants of health are the circumstances in which people are born, grow up, live, work, and age, as well as the systems put in place to deal with illness. These circumstances are in turn shaped by a wider set of forces: economics, social and political forces.
Community-wide action to prevent obesity
Community-wide action to prevent obesity
Developing a sustainable approach and leadershipView the 'Obesity: Developing a sustainable approach and leadership' path
CommunicationView the 'Obesity: Communication' path
Coordinating local actionView the 'Obesity: Coordinating local action' path
Integrated commissioningView the 'Obesity: Integrated commissioning' path
Training and developmentView the 'Obesity: Training and development' path
Monitoring and evaluation, cost effectiveness and scrutinyView the 'Obesity: Monitoring and evaluation, cost effectiveness and scrutiny' path
Paths in this pathway
- Obesity: Developing a sustainable approach and leadership
- Obesity: Communication
- Obesity: Coordinating local action
- Obesity: Integrated commissioning
- Obesity: Training and development
- Obesity: Monitoring and evaluation, cost effectiveness and scrutiny
Pathway created: November 2012 Last updated: November 2012
Copyright © 2013 National Institute for Health and Care Excellence. All Rights Reserved.