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Obesity: working with local communities overview

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Obesity: working with local communities HAI

About

What is covered

This pathway focuses on an overarching approach to overweight and obese adults and overweight and obese 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 pathway 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 pathway 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.

Updates

Information for the public

NICE produces information for the public that summarises, in plain English, the recommendations that NICE makes to healthcare and other professionals.
NICE has written information for the public explaining its guidance on obesity.

Guiding principles

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).

Community engagement

The prerequisites for effective community engagement are covered in NICE's pathway 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.

Behaviour change

The prerequisites for effective interventions and programmes aimed at changing behaviour are covered in NICE's pathway 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.)

Cultural appropriateness

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.

Updates to this pathway

11 March 2014 Minor maintenance update.
Part of BMI and waist circumference – black, Asian and minority ethnic groups, NICE public health guidance 46 (2013) added to this pathway in the obesity: communication path.
Links to the 'Preventing type 2 diabetes pathway' have been added to the advocacy, language and training for health and other professionals nodes.
A link to the 'Diet pathway' has been added to the training for health and other professionals node.
Part of Obesity, NICE clinical guideline 43 (2006) added to the primary care and community-based programmes and interventions nodes.

Short Text

This pathway sets out how local communities, with support from local organisations and networks, can work together aims to achieve effective, sustainable and community-wide action to prevent obesity.

What is covered

This pathway focuses on an overarching approach to overweight and obese adults and overweight and obese 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 pathway 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 pathway 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.

Sources

The NICE guidance that was used to create the pathway.
Obesity. NICE clinical guideline 43 (2006)
Obesity: working with local communities. NICE public health guidance 42 (2012)
Weight management before, during and after pregnancy. NICE public health guidance 27 (2010)

Quality standards

Quality statements

Effective interventions library

Effective interventions library

Successful effective interventions library details

Implementation

Education and learning

NICE produces resources for individual practitioners, teams and those with a role in education to help improve and assess users' knowledge of relevant NICE guidance and its application in practice.

Pathway information

Information for the public

NICE produces information for the public that summarises, in plain English, the recommendations that NICE makes to healthcare and other professionals.
NICE has written information for the public explaining its guidance on obesity.

Guiding principles

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).

Community engagement

The prerequisites for effective community engagement are covered in NICE's pathway 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.

Behaviour change

The prerequisites for effective interventions and programmes aimed at changing behaviour are covered in NICE's pathway 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.)

Cultural appropriateness

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.

Updates to this pathway

11 March 2014 Minor maintenance update.
Part of BMI and waist circumference – black, Asian and minority ethnic groups, NICE public health guidance 46 (2013) added to this pathway in the obesity: communication path.
Links to the 'Preventing type 2 diabetes pathway' have been added to the advocacy, language and training for health and other professionals nodes.
A link to the 'Diet pathway' has been added to the training for health and other professionals node.
Part of Obesity, NICE clinical guideline 43 (2006) added to the primary care and community-based programmes and interventions nodes.

Supporting information

Glossary

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).
Bottom-up activities or approaches are initiated by the community, or people working directly with the community, rather than being introduced by senior management.
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 [2006]).
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.
Body mass index is used to asses if adults are overweight or obese. The following table shows the cut-off points for healthy weight, overweight and obesity.
Classification
BMI (kg/m2)
Healthy weight
18.5–24.9
Overweight
25–29.9
Obesity I
30–34.9
Obesity II
35–39.9
Obesity III
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 children as 'overweight' or 'obese'. 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.

Paths in this pathway

Pathway created: November 2012 Last updated: March 2014

Copyright © 2014 National Institute for Health and Care Excellence. All Rights Reserved.

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