Healthy weight and good food

There is strong evidence that living at a healthy weight, and eating a good diet, are both important to our health. The Global Burden of Disease Study 2019 estimated high Body Mass Index (BMI) to be the third highest risk factor for illness and disease for Stockon-on-Tees (as it is for the UK). Other top risk factors such as high blood sugar and high blood pressure, are also linked to excess weight and diet.  

Obesity is a risk factor for several health conditions including:

• cardiovascular disease
• diabetes
• some cancers
• musculoskeletal disorders

In addition, obesity during pregnancy can result in increased risks for both pregnant mothers and their babies.

In the UK, almost two thirds of adults are above a healthy weight, and obesity rates have been rising for over 20 years. In Stockton-on-Tees, more adults are overweight or obese than in England as a whole. Amongst children, prevalence of excess weight increased significantly during COVID-19. For reception age children average prevalence of obesity in Stockton-on-Tees has come back down to similar levels to pre-Covid.  However, the impact of COVID-19 has been more long lasting for some children, with prevalence of obesity amongst year 6 children remaining significantly higher than pre-Covid, and higher than the England average.

There are significant inequalities in relation to healthy weight and good food, with those living in areas of high deprivation having a higher likelihood of experiencing obesity and being less likely to have access to good food. These inequalities are evident from a young age, with children starting school in some of our more deprived areas in Stockton-on-Tees already more than twice as likely to be experiencing obesity as children in some of our most affluent areas.

The Government Obesity Strategy was launched in 2020. The strategy describes how helping people to achieve and maintain a healthy weight is one of the most important interventions to improve our nation's health. The government also introduced several measures to tackle childhood obesity outlined in its Plan for Action on Child Obesity (2016), recognising that the burden is falling hardest on those children from low-income backgrounds.

The Government Food Strategy was published in 2022 and responded to Henry Dimbleby's independent review of the food system.

It included policy initiatives to boost:

• health
• sustainability
• accessibility of diets
• security of food supply

There are a wide and complex range of determinants of obesity. Many of these are not "lifestyle choices", but wider determinants of health that make it more likely for someone to experience obesity. For example, poor diet and low physical activity are key drivers of being overweight or obese but the food options or physical environment where someone lives often makes it more or less likely for someone to eat well or be active.

A systems map developed as part of the Foresight report of 2007, identified over 100 causes of obesity.   

These causes were grouped into factors relating to:

• food production
• food consumption
• societal influences
• individual psychology and or activity
• activity environment
• biology

Many of the complex causes of obesity can not be addressed solely through individual responsibility, particularly when considered in relation to inequalities. There is not one solution to tackle such an ingrained and wide-ranging problem.The Public Health England Whole Systems Approach to Obesity outlines how local action to promote healthy weight across the life course requires a coordinated and collaborative approach to support change.

Examples of the challenges and opportunities relating to wider determinants

Food environment and food insecurity

There is a high concentration of fast-food outlets in the most deprived areas in Stockton-on-Tees, which makes unhealthy food convenient and available. There is a high level of food insecurity in the Borough, with over 30% of adults going hungry, struggling to afford food or worrying about their food situation. (Please note - there is a separate JSNA section planned on Poverty which will deal with the topic of Food Insecurity in more detail.)

Transport

Not all households have access to a car, bus journeys have been declining and active travel (walking and cycling to work or school) in Stockton-on-Tees is lower than the regional and national average.

Greenspace

Greenspace is not equally accessible for all communities across Stockton-On-Tees and more than 1 in 10 household residents within the more deprived areas have no access to private outdoor space. 

Planning

Planning levers have the potential to be used to help achieve healthy weight environments. 

Examples of how they could be used are:

• helping to ensure that community and healthcare facilities are part of new developments
• ensuring well designed buildings with adequate space for bike storage and kitchen facilities
• helping to avoid over concentration of hot food takeaways

Work and education

An individual's job role and income can have an impact on their weight and their diet, depending on the work environment and role that they occupy.

Health literacy

Over 40% of people aged 16 to 64 in Stockton-on-Tees are thought to have low levels of health literacy skills which results in people finding it more difficult to understand health risks or advice.

The prevalence of overweight and obesity is unequal, with some people at higher risk, including:

• people living in areas of high deprivation and or in lower socio-economic groups
• people living with disabilities
• people from some ethnic minorities, including children of Bangladeshi, Pakistani and black ethnicity, and adults of black ethnicity  

Many people in Stockton-on-Tees are overweight or obese. Some groups have much higher rates than others, showing clear inequalities. 

Helping people achieve or maintain a healthier weight, and ensuring people have access to good food, is complex and requires system wide, collaborative action.

Whilst overall the levels of overweight and obesity are high, there are also particular groups at increased risk, including those living in areas of high deprivation.  Therefore, both universal and targeted approaches are required, proportionate to the level of need.

It is important to recognise that weight and diet cannot be viewed in isolation as they are interconnected with many aspects of people's lives. Therefore, it is essential to take a community-centred, whole person approach, rather than focusing on excess weight in isolation.

Access to good food is an important factor, and a variety of initiatives are in place to support children and families on low incomes to eat healthily.

Examples are:

• the Healthy Start Scheme
• free school meals
• breakfast clubs
• Growing Well Growing Healthy team supporting healthy habits
• the Holidays are Fun programme (HAF)
• the work of the Stockton-on-Tees Food Power Network

The auto-enrolment for Free School Meals in Stockton-on-Tees will support more children to receive a healthy meal, as will the government's expansion of breakfast clubs.

There is strong evidence of the link between breastfeeding and reduced likelihood of developing obesity. Breastfeeding support in Stockton is available from the 0-19 infant feeding team. There is also a breastfeeding Friendly Scheme helping to identify those businesses that are pledging to help normalise breastfeeding and support our breastfeeding families in the community. However, breastfeeding rates in Stockton at 6-8 weeks old remain lower than the national average.

As outlined, the causes of obesity are complex, and more needs to be done to transform Stockton-on-Tees into a healthy place that supports people to eat well and achieve a healthy weight. This transformation will need to include changes in many areas, particularly in relation to the food environment, but also including changes to planning, green spaces, walking and cycling infrastructure, and school and work environments.  

Work with communities also has a central role to play, as communities themselves are best placed to identify and mobilise assets and opportunities that are accessible and acceptable to members of their communities.   

The Public Health Small Grants Scheme is one initiative that is supporting local Voluntary, Community and Social Enterprise (VCSE) organisations to take forward their ideas for supporting their communities to:

• eat well
• be more active
• connect with one another

Another important need in relation to healthy weight relates to the importance of taking a sensitive and supportive approach. The stigma associated with obesity can affect people's mental and physical health. This can lead to further weight gain and make people less likely to engage with healthcare professionals.

There are high, and increasing, rates of overweight and obesity in Stockton-on-Tees.This is a significant concern, as obesity and poor diet are risk factors for a number of health conditions, including cardiovascular diseases and diabetes. Helping people achieve or maintain a healthier weight, and ensuring people have access to good food, is complex and requires system wide, collaborative action. 

Support available

Adults experiencing overweight or obesity in Stockton-on-Tees who would like support to reduce their weight can access a range of services.   

These include:

• support in primary care
• the Lite4Life Service at Tees Active
• the specialist Weight Management service provided by South Tees NHS Hospital Trust

There are also medical treatments available where appropriate, including bariatric surgery, and weight loss medications.

There is also support available to children and families to help prevent and treat childhood obesity.  The Growing Well Growing Healthy team support children, young people, and their families to make healthy habits part of everyday life.

Tackling underlying causes

While there are services available in Stockton-on-Tees to support both adults and families experiencing obesity, there needs to be a greater focus on tackling the underlying causes of obesity and poor diet.

There are positive changes happening in Stockton-on-Tees, such as:

• the introduction of Health Impact Assessments for planning applications
• changes to national guidance on locations of hot food takeaways
• expansion of breakfast clubs, and the auto enrolment for Free School Meals

In addition, initiatives such as Good Food Local, and the Place Partnership with Sport England are also encouraging greater collaboration and partnership working.  However more still needs to be done to transform Stockton-on-Tees into a place that supports people to eat well, and to have a healthy weight.

One of the initiatives that has been successful in encouraging leadership and good practice on the food environment in other areas, is the Healthy Weight Declaration developed by Food Active. This has already been adopted by a number of local authorities in the north east, and is currently being explored locally in Stockton-on-Tees and regionally through the Integrated Care Board (ICB).

By adopting the declaration, a series of commitments are made that cover:

• strategic and system leadership
• commercial determinants
• health promoting environments
• culture shift
• monitoring and evaluation

This will be a key next step in our approach to healthy weight and good food in Stockton-on-Tees.

1. Childhood obesity: a plan for action - Gov.uk website
2. Government food strategy - Gov.uk website
3. Tackling obesity: empowering adults and children to live healthier lives - Gov.uk website