Healthy Weight for Life Strategy - An Overview Dr R. Busuttil Superintendent of Public Health - Health.gov.mt
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Healthy Weight
for Life Strategy
An Overview
Dr R. Busuttil
Superintendent of Public Health
Excelsior Hotel – 22nd February 2012What is obesity?
• abnormal or excessive fat accumulation
that presents a risk to health.
BMI
ObeseHow do we get obesity? • Occurs when food intake exceeds energy requirements
Why a Strategy to address obesity?
Why do we need a strategy to address Obesity? Proportion of Obese and Overweight 15 year olds Proportion of Obese and Overweight Adult Males Proportion of Obese and Overweight 13 year olds Proportion of Obese and Overweight 11 year olds Proportion of Obese and Overweight Adult Females
Epidemiology of Overweight and
Obesity
• % of overweight and obesity in cohort
of children aged 6years in 2007
(Grech and Farrugia 2011)
2007 2008 2010
(6 years) (7 years) (9 years)
Overweight Girls 18.6 14.3 22.1
Boys 20.6 17.3 27.6
Obese Girls 12.9 15.5 17.4
Boys 19.5 17.2 20.3Epidemiology of Overweight and
Obesity
• Overweight and obesity in children aged
11,13 and 15 years in Malta and Gozo
( HBSC)
11 years 13 years 15 years
(2002) (2006) (2002)(2006) (2002)(2006)
Weight over Girls 30.0 23.5 30.9 16.7 27.8
85th Centile
Boys 25.4 33.8 31.0 27.9 32.1Epidemiology of Overweight and
Obesity
• Self Reported Overweight and obesity in
Adults in Malta and Gozo
(HIS 2008)
Overweight Obese Total
Total 36% 22% 56%
Male 69%
Female 46.1%Developing
the
StrategyIntersectoral Committee to Counteract Obesity (ICCO) • health, • education, • agriculture, • finance, • transport, • environment, • urban development, • broadcasting media, and • catering sector. • patient representative
Background to Strategy
All for Health
(Whole of Government approach)
and
Health for All
(Health in all Policies)The Strategy
Healthy Weight for Life Strategy • Aim – to curb and reverse the growing proportion of overweight and obese children and adults in the population in order to reduce the health, social and economic consequences of excess body weight
Healthy Weight for Life Strategy
• Overall Targets
– < self-reported overweight adult population from36%
to at least 33%.
– < self-reported obese adult population from 22% to at
least 18%.
– < measured overweight and obese 7 year olds from
32% to 27%.
– maintain proportion of obese 13 year olds below15%.The Strategy Document 1. Public Health Case for Action 2. Economic Considerations 3. Promoting Healthy Eating 4. Promoting Physical Activity 5. Health Care Services 6. Implementation
1. Public Health Case
for ActionEpidemiological Considerations • High levels of obesity in children • High levels of obesity in Adults
Determinants of Obesity
• Consumption of Food and Drink
• Opportunities for Physical Activity
• Lower socio-economic status
• Education
• Employment
• Income
• Maternal Weight at time of birth
• Birth weight and infant feedingHealth impact of Obesity
• 1 million deaths (WHO EURO Region)
• 12 million life years
• 80% of Type II Diabetes Mellitus
• 55% of Hypertension
• 35% of Ischaemic Heart Disease
– Cataracts, Cancer, Fatty liver disease,
Gallstones, Hirsutism, Asthma,
Musculoskeletal disorders, Benign prostatic
hypertrophy, Mental disorders, Impaired
reproductive function, Sleep associated
breathing disorders2. Economic Considerations
Economic Impact of Obesity
More and longer In Patient stays
+
More Day Patient stays
+
More consultations with GPs/Specialists
=
€19,540,000 (€25,390,000)
(excludes medicines, surgery, consumables, loss of income)Economic Impact of Obesity
€19,540,000 (2008)
€26,910,00 (2020)Economic Instruments to be
explored
• Food Pricing Food Consumption
Weight Gain/loss
• Food Access
Healthier Choices Healthier Eating
• Tax Policy
– Sin Taxes
– Tax Incentives
• Subsidy Policy3. Promoting Healthy Eating
Promoting Healthy Eating • achieve energy balance and a healthy weight • limit energy intake from total fats and shift fat consumption away from saturated fats to unsaturated fats and towards the elimination of trans-fatty acids/trans fats • increase consumption of fruits and vegetables, legumes, whole grains and nuts • limit the intake of free sugars • limit salt (sodium) consumption from all sources and ensure that salt is iodized.
What do we eat? • Health Interview Survey 2002, 2008 • Health Behaviour in School Children 2006 • Food Consumption Survey – MSA 2010
What do we eat? Adults • most popular methods of cooking - steaming, baking/roasting and grilling. • Fish consumption was low when compared to meat consumption. • 72% consumed chicken or rabbit once or twice a week • 15% eat highly processed meat products such as burgers and sausages on a daily basis. • 50.5% consumed fried potatoes at least once a week
What do we eat?
• 47% almost always add salt during cooking
• 24% almost always add salt at table.
• 2 slices per day of Maltese white bread
• 60% consume sweet pastries at least once a week
• 20% drink sugared soft drinks on a daily basis
• 16% drink sugar free soft drinks.
• 50% consume vegetables daily
• 40% consume vegetables 1 to 4 times a week.
• significant consumption of sweets, biscuits and
chocolate for breakfast, morning and afternoon snacksWhat do we eat? Children (11-15years) • 21% eat fruit daily • 6.2% consume vegetables every day • 30% eat sweets daily • 40% have soft drinks every day
Nutrition Targets - 2020 • Reduce the frequency of intake of processed meat products by 5% • Decrease the percentage of the population who never consume fish by 20% • Increase consumption of vegetables on a daily basis by 25% especially in younger age groups. • Reduce the consumption of sweets, sweet pastries, and sugared soft drinks of six times a week or more by 10%. • Reduce salt consumption in the population by 10% • Reduce the mean per capita daily fat intake by 10%
Areas for Action • Review our Food and Nutrition Policy Aimed at Infants (0 – 4 years) • To promote exclusive breastfeeding and ensure that more babies are breastfed for at least six months (exclusively) and longer; • To provide educational programmes on maternal and infant nutrition for health professionals; • Augment parent craft courses on breastfeeding techniques, infant weaning and healthy lifestyles; • Establish Mater Dei Hospital as a recognised baby- friendly hospital
Areas for Action
Aimed at Infants (0 – 4 years)
• Review the Breastfeeding Policy for Malta;
• Legislation on marketing of breast milk
substitutes;
• Include knowledge on breastfeeding in the
health/nutrition education programme within
the PSD curriculum in schools;
• Promote the establishment of a breast-feeding
friendly environment within our societyAreas for Action
Aimed at Children (school years)
• Develop clear guidelines for parents and
carers on the age-appropriate content of
lunchboxes for school-age children.
• Adopt the HELP document as national policy
and ensure its implementation and monitoring
within all schools, with particular reference to
the choice of food products in school tuck
shops
• Establish a healthy lifestyle programme within
the school environment
• Assess the feasibility of providing a regular
healthy breakfast to all kindergarten children
on the same lines as the School Fruit Scheme;Areas for Action
Aimed at Children (school years)
• Roll out the WHO Nutrition Friendly School
Initiative in all schools eligible to participate;
Establish an annual award for schools helping
children adopt healthy lifestyles on school
premises.
• Include more emphasis on the food chain in
the PSD, Physical Education and Home
Economics curriculum;
• Promote healthy meals/snacks during extra-
curricular school activities such as fund-raising
activities, school bazaars, sports days, etc.Areas for Action
Aimed at Children
• Assess the feasibility of restricting access by
children to nutritionally inappropriate meals
and energy-dense snack foods from retail
outlets located in the vicinity of schools;
• Encourage media service providers to develop
codes of conduct regarding inappropriate
audiovisual communications on foods and
beverages, accompanying or included in
children’s programmes.Areas for Action
Workplace and Institutions
• Provide support and incentives for employers to
promote healthy eating in the workplace and support
weight management programmes;
• Introduce national guidelines on food provision within
canteen/cafeteria facilities at workplaces;
• Update and monitor the implementation of healthy
dietary guidelines for use in homes for older people;
• Introduce regulations to ensure that all canteens and
cafeterias within institutions, hospitals and homes for
older people are in line with healthy dietary guidelines;
• Establish training programmes on healthy eating and
physical activity for care professionals4. Promoting Physical Activity
What is Physical Activity? Physical activity is generally defined as any bodily movement produced by skeletal muscles which results in energy expenditure above resting level • Moderate physical activity - requires a moderate amount of effort and noticeably accelerates the heart rate; – brisk walking (6km/hr), cycling (20kg) (WHO 2010).
How much PA do we need?
• Children (5 - 18):
– 60 minutes of moderate PA per day
– can be split up into shorter periods of not less than 10 minutes (WHO,
2007).
• Adults (18-65):
– 30 minutes of moderate-intensity physical activity 5 days per week; or
– 20 minutes of vigorous-intensity physical activity 3 days per week; or
– an equivalent combination
– can be split up into shorter periods of not less than 10 minutes (WHO,
2007).
• Adults (>65):
– recommendations for adults are also appropriate for older adults with
due consideration for the intensity and type of physical activity
appropriate for older people (WHO, 2010).
– specific activities that promote improved strength, coordination and
balance are particularly beneficial in this group (Department of Health
London, 2004).How much PA do we do? • 16.6% of adults carry out a moderate level of physical activity per week (F>M) • 26.9% of adults carry out a high level of physical activity per week (M>F) • 37% of university students engage in regular exercise • 34% of university students do no exercise
How much PA do we do? • 14% of 13 year olds never undertake any MVPA • 4.5% of 13 year olds participated in MVPA once a month • 8% perform MVPA at a frequency of less than once a month.
Physical Activity in Schools
Public 29% 62% 9%
Schools (%)
Church 50% 50%
Independent 9% 46% 45%
0% 20% 40% 60% 80% 100%
120 minutesModes of transport Household Travel Survey 2010 (1998) • walking - 7.6% (10.8%) • cycling - 0.3% • car - 74.6% (70.2%) • car trips arriving in Valletta 35.1% (52.2%) • walking into Valletta 6.9% (9.9%)
Targets for Physical Activity • Increase the proportion of the Maltese population who carry out moderate or high level of physical activity daily or on most days, from the current 43.5% to 70%. • To reduce the proportion of children and adolescents who never perform any exercise by 5%. • To increase the proportion of young people performing regular exercise from 37% to (at least) 50% by 2015 and 80% by 2020
Areas for Action
In Schools
• Develop a National Physical Activity Action Plan
• Revise the national curriculum to increase PA to
3hrs/week with at least 30 minutes of daily PA during
official school hours;
• Transform school yards and recreational areas to
facilitate the uptake of physical activity during breaks.
• Initial and in-service teacher training on the proposed
National Physical Activity Guidelines for school
children and young peopleAreas for Action
In Schools
• Increase knowledge of children, parents,
carers and teachers on the benefits of Health
Enhancing Physical Activity (HEPA).
• Encourage children and parents to use a
screen time log, reduce the number of hours of
watching TV, use of computer/video games to
not more than 2 hours per day
• Encourage sit down meals as family time as
opposed to TV dinners.Areas for Action
In the Community
• Provide opportunities and incentives to
encourage NGOs, Local Councils, Schools,
workplaces, sports clubs, gyms and the private
sector to provide physical activity classes,
active play and sports which are both
accessible and affordable to the general
population.
• Work with stakeholders to ensure the inclusion
of persons living with disability in physical
activity opportunities
• Work towards the improvement of the existing
cycle lanes and creation of others;Areas for Action
In the Community
• Review use of public spaces to maximise the
encouragement of physical activity uptake.
• Support Local Councils and other stakeholders in
developing opportunities and creatively utilising spaces
for physical activity within their locality.
• Enhance awareness of shared spaces on our roads to
promote safe use by different road users such as car
and bicycle users and pedestrians;
• Promote wider use the existent opportunities of
afterschool sports and dance programmes.Areas for Action
In the Community
• Explore the possibility of introducing incentives
to promote the uptake of physical activity.
• Raise awareness on the importance of
physical activity on the health status of the
individual among health professionals.Areas for Action
• Strengthen and expand workplace health
promotion initiatives which specially
target both nutrition and physical activity;
• Establish partnerships with organisations
– to increase awareness on the role of
nutrition and physical activity on healthy
lifestyles;
– provide sessions of enjoyable physical
activity which are available to the general
population.5. Health Care Services
Health Care Services
• Aims of Service Provision
– To enhance access to a personalised service
for overweight and obese persons of all ages;
– To enhance access to appropriate advice and
support on healthy lifestyles;
– To support such persons in achieving a real
and sustained weight loss followed by the
maintenance of a healthy weight;
– To prevent those who are overweight from
adding on more weight and becoming obese.Re-orientation of Services
curative se rvices
lth pr
hea omoti onServices – Community level • Weight Management Programmes • Physical Activity Programmes • Lifestyle advice by health professionals • Service delivery from primary care • Overweight and obesity clinics for adults • Overweight and obesity clinics for children • Cookery clubs
Areas for Action - professionals
• To work with stakeholders to include health promotion and
prevention in undergraduate curricula and CPD training for all
health professionals.
• To work with stakeholders to supply health care workers with the
necessary resources to encourage weight loss and healthy living.
• To set up post secondary training courses for care professionals
in order to increase the human resource pool in the sector
• To work with stakeholders to develop a national curriculum and
certification in relation to the training of professionals, facilitators
and advisors in the field nutrition, weight management and
physical activity.Areas for Action - professionals
• To ensure that only persons certified as having received the
relevant training in their field of activity provide such a service to
the people.
• To provide health professionals with guidelines on healthy
choices i.e. nutrition, exercise and alcohol, so that a uniform and
coherent message is communicated.
• To provide health professionals with the necessary resources to
advise people on healthy choices.
• To ensure that health professionals proactively screen for and
manage risk factors associated with overweight and obesity such
as hypertension, hyperlipidaemia and diabetes.Areas for Action - services
• regular and accessible weight management
programmes, physical activity programmes and
walking schemes especially for adults with BMI > 25 in
different settings
• issue guidelines for weight management courses
carried out in private as and public sector
• strengthen and diversify the provision of up to date
advice by the Health Promotion and Disease
Prevention Directorate
• encourage active transport action groupsAreas for Action –special services
• To set up specialised Obesity Clinics in primary health care sector to
provide initial medical assessment and follow up of the referred patients
and the necessary follow-up including specialist referral for more invasive
therapy if necessary.
• To carry out a health technology assessment and assess the feasibility of
including bariatric surgery on the list of services available from the public
health care sector
• To ensure that all primary and secondary students are measured at the
beginning of each scholastic year and to ensure monitoring and appropriate
referral for overweight and obese children, and regular communication and
lifestyle advice and help for the family
• To set up multidisciplinary paediatric weight clinics aimed at creating a
supportive environment that helps overweight or obese children (>percentile
85) and their families to make lifestyle changes6. Implementation
of the
StrategyImplementation
• Human Resources
– work force to be strengthened in both skills and
number
• Surveillance
– monitor the prevalence and trends of overweight and
obesity within the population
– examine the effectiveness of interventions
• Research
– to fill gaps within our knowledge, including the
causation of obesity and effective preventive actions.Way Forward • Three year rolling action plans to be endorsed by ICCO • Implementation Group to ensure actions are achieved within allocated timeframe and budget • Monitoring of the targets in 2015, 2018 and 2020
Obesity has been with us for a long time
Together we can reverse itYou can also read
