Lanarkshire Healthy Weight Strategy

It has been a while-nearly 7 years-since I wrote about obesity as a public health problem in my Letter from Glasgow but given its importance to Scotland (and to most of the world), I am returning to it again. ^[1] I said in that Letter that Scotland, with the Obesity Route Map (ORM) was beginning to take the problem seriously. Although time has moved on, I can say that, certainly in Scotland, the issue of obesity has become more important. And while the principles of effecting change have not altered, how we discuss obesity and implement change has developed and become more refined.

In 2015, the Scottish Public Health Network (ScotPHN) published a review of the ORM by the Scottish Public Health Obesity Special Interest Group (SPHOSIG). ^[2] It noted that the prevalence of overweight and obesity remains high with links to health inequalities, overweight and obesity contribute to Scotland′s ill-health particularly type 2 diabetes and complications in pregnancy, and the role of the obesogenic environment still needs to be countered and not just eating behaviours of individuals. The ScotPHN review concluded that the ORM concentrated on prevention and not on treatment, and only some of the actions were completed. Nonetheless, the ORM was still relevant particularly the four ′pillars′ of energy in, energy out, early years and workplace.

The ScotPHN report was complemented by the Food Standards Scotland′s (FSS) ′Situation Report: The Scottish diet: It needs to change′. ^[3] This report discussed the Scottish diet in terms of morbidity and mortality (related to cancers, coronary heart disease, stroke, hypertension and dental decay in children), and what needs to change. In a nutshell, the Scottish diet is high in calories, fats, sugar and salt and low in fibre, fruit, vegetable and oil-rich fish. It is a deep-seated problem in Scotland and is exacerbated by poorer people having poorer diets. The report also observed that discretionary foods, i.e. ′food and drink which are high in calories and/or salt, low in nutritional value, and which are not required for our health′ are heavily promoted in supermarkets and when people eat out.

To round off the challenge Scotland faces in this area, Obesity Action Scotland published its report card entitled ′Obesity in Scotland-Six years later′. ^[4] Obesity Action Scotland′s assessment of the ORM 6 years after its launch in 2010 reviewed the ORM commitments on the prevalence of overweight and obesity among adults and children, the development of a national indicator for the whole population, levels of physical activity by adults and children, improvement of the Scottish diet, and the development and monitoring of an action plan to effect change. Obesity Action Scotland′s report card stated bluntly, ′Slow progress. Limited success. Requires more effort′, indicating the scale of the task Scotland faces.

It is in this context that Lanarkshire reviewed its strategy of dealing with overweight and obesity. We recognized the challenges that Scotland faces are often worse in Lanarkshire with a poorer population than Scotland as a whole and with greater health inequalities. As part of the review, an obesity health needs assessment was undertaken and included the needs of four target groups or concerns-adults, young people, maternal and infant nutrition, and the environment.

The result is the Lanarkshire Healthy Weight Strategy, ready for publication but not quite yet in the public domain (Karen McGuigan, NHS Lanarkshire, personal communication, January 2017). I am assured by my colleagues that by the time this Letter is in print, it will be on the NHS Lanarkshire website (www.nhslanarkshire.org.uk/Pages/default.aspx). The strategy has been developed jointly with our partners. NHS Lanarkshire has worked with the two local authorities, North Lanarkshire Council and South Lanarkshire Council, and the two Health and Social Care Partnerships (HSCPs) covering North Lanarkshire and South Lanarkshire, respectively.

About two-thirds of adults in Lanarkshire are overweight or obese with all the attendant risks to health and well-being. The Lanarkshire Strategy, as recommended by Scottish government, adopts a four-tiered approach to weight management:

• Tier 1: Population-wide health improvement work with individuals and groups in the community
• Tier 2: Primary care/community capacity developed in the NHS to deliver healthy weight programmes
• Tier 3: Specialist weight management with access to multidisciplinary teams including physical activity, dietetics and psychology
• Tier 4: Specialist surgical services, i.e. bariatric surgery, gastric banding and specialist follow-up.

The key issue for reducing weight is to reduce what we eat and drink. The strategy puts this issue into perspective. The vision for the strategy is ′to have a Lanarkshire where individuals and families can live healthy, active and fulfilling lives free from the issues associated with being overweight and obese′. To attain that vision, it has strategic objectives to reduce the exposure to energy-dense food and drink and encourage healthier options, improve opportunities for physical activity, provide appropriate weight management service, reduce health inequalities, and implement actions based on an asset-based approach.

The strategy also includes an Outcomes Framework over the short (0-3 years), medium (3-5 years) and long term (5-10 years). It will not be easy to achieve these objectives but it offers us a chance to comprehensively tackle overweight and obesity. As countries such as India face up to its own epidemic of overweight and obesity, it may wish to look at the challenges, failures and successes of other countries, including Scotland.