Developing a Shared Developing a Shared Approach to Tackling Approach to Tackling

Obesity in BirminghamObesity in BirminghamLinda HindleLinda Hindle

Consultant Dietitian in ObesityConsultant Dietitian in ObesityBirmingham East and North Birmingham East and North

PCTPCTEmail: Email:

linda.hindle@benpct.nhs.uklinda.hindle@benpct.nhs.ukTel: 0121 446 1025Tel: 0121 446 1025

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FormatFormat

About BirminghamAbout BirminghamObesity Strategy, Care Pathway and Obesity Strategy, Care Pathway and

Service Development – local NHS Service Development – local NHS collaborationcollaboration

Children and Young People’s Children and Young People’s Nutrition & Health Task ForceNutrition & Health Task Force

ImplementationImplementationNext stepsNext steps

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About BirminghamAbout Birmingham Population of almost 1 Population of almost 1

millionmillion Multi racial Multi racial

Inner City deprivationInner City deprivation Served by:-Served by:-

1 City Council1 City Council 1. Leisure Services 1. Leisure Services

ProviderProvider 3 PCTS3 PCTS Regional Children's Regional Children's

HospitalHospital 4 Acute Trusts4 Acute Trusts 1 Mental Health 1 Mental Health

TrustTrust

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Obesity Strategy Obesity Strategy DevelopmentDevelopment

Obesity strategygroup

Strategy and Care Pathway

NHS Birmingham City CouncilOverview and Scrutiny

Committee - Health

Children and Young People’s Nutrition and Health

Task Force

Children's Nutrition Action Plan

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NHS Obesity Strategy NHS Obesity Strategy DevelopmentDevelopment

BackgroundBackgroundStakeholdersStakeholdersTimescaleTimescale

Birmingham & Solihull Strategic Birmingham & Solihull Strategic Framework individualised to each PCTFramework individualised to each PCT

Care Pathways for Adults and Care Pathways for Adults and ChildrenChildren

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A Strategy describes ……….A Strategy describes ……….

Where we are nowWhere we are now

Where we want to beWhere we want to be

How we will get thereHow we will get there

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StructureStructure

BackgroundBackground

Policy ContextPolicy Context

Aims and ObjectivesAims and Objectives

EvidenceEvidence

Action PlansAction Plans

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Strategic AimsStrategic Aims

• To work in partnership, to develop a range To work in partnership, to develop a range of approaches, to prevent and reduce of approaches, to prevent and reduce obesity in the population as a whole, with obesity in the population as a whole, with particular reference to children and at risk particular reference to children and at risk groups.groups.

• To develop a coordinated approach to the To develop a coordinated approach to the management of people identified as being management of people identified as being overweight or obese with particular overweight or obese with particular emphasis on encouraging self-management emphasis on encouraging self-management principlesprinciples

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Strategic ObjectivesStrategic Objectives

To develop partnerships with key stakeholders To develop partnerships with key stakeholders to realise a shared goal of halting the rise in to realise a shared goal of halting the rise in obesity in Birmingham and Solihull.obesity in Birmingham and Solihull.

To ensure that obesity is embedded within To ensure that obesity is embedded within other lead strategies and plans and linkages other lead strategies and plans and linkages between these are made implicit. between these are made implicit.

To develop information systems for the To develop information systems for the collection and use of data relating to collection and use of data relating to overweight and obesityoverweight and obesity

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Strategic Objective cont. Strategic Objective cont. To identify inequity in access to opportunities To identify inequity in access to opportunities

for prevention and treatment of overweight for prevention and treatment of overweight and obesity in local communities and to work and obesity in local communities and to work with local people, communities, voluntary and with local people, communities, voluntary and private sector agencies and local services to private sector agencies and local services to address these inequities. address these inequities.

To ensure a consistent and effective approach To ensure a consistent and effective approach to the to the prevention prevention of overweight and obesity of overweight and obesity and weight management within primary care and weight management within primary care and partner services, particularly for children.and partner services, particularly for children.

To work with partners to develop and To work with partners to develop and implement an evidence based care pathway for implement an evidence based care pathway for the the management and treatmentmanagement and treatment of obesity. of obesity.

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Delivery StrandsDelivery StrandsThe delivery element of the strategy has been divided into 5 strands 

1. Baseline data and Monitoring: schools

Primary care

2. Prevention : macro measures at population level (diet and physical activity) community approaches

workplaceschoolswhole family

3. Management of Weight Loss: communityworkplaceschoolsprimary care

4. Specialist treatment: primary and secondary care – drugs & surgery

5. Long-term maintenance: community/environment supportiveLong-term support & follow-up

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Level 1Early Intervention and Prevention

Level 4

Level 3Primary Care Specialist

Obesity Service

Level 2Community/Primary Care

Weight Management Services

Physical ActivityStrategy

Exercise on Prescription, walking, cycling programmes etc. Leisure Services

Food Strategy

Food Skills Courses, Food Access projects

Smoking Cessation Service

Front line Staff (NHS, Council, Vol. Sector), Health Trainers, On-line advice

Commercial slimming clubs

Pharmacy services

Adult Obesity Service Care Pathway

Secondary CareMorbid Obesity

Service

Tobacco strategy

Commercial slimming on prescription

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Level 1Early Intervention and Prevention

Level 4Secondary CareMorbid Obesity

Service

Level 3Specialist obesity service –

Watch It, Input from dietician, child psychologist & Community Paediatrician

Level 2First line weight

management service provided by School Nurse,

Health Visitor

Physical ActivityStrategy

Sports Clubs - Activity

Programmes

Community groups

Food Skills Courses, Food Growing Projects

Healthy Schools

Front line Staff (NHS, Council, Vol. Sector), Health Trainers, On-line advice

Media campaigns/ signposting

service

Healthy Start

(Sure Start, Children’s Centre, Breast Feeding)

Food in Schools

Childhood Obesity Service Pathway

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Birmingham Children and Young Birmingham Children and Young People’s Nutrition and Health Task People’s Nutrition and Health Task

ForceForce Review of childhood obesity within Review of childhood obesity within

Birmingham initiated by Health Overview Birmingham initiated by Health Overview and Scrutiny Committee in July 2003and Scrutiny Committee in July 2003

Identify local factors contributing to Identify local factors contributing to obesity which could be avoidedobesity which could be avoided

Map impact of national policies and local Map impact of national policies and local programmesprogrammes

Explore, from community perspective, Explore, from community perspective, barriers to maintaining normal body barriers to maintaining normal body weightweight

Explore services availableExplore services available

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Report produced May 2004Report produced May 2004Findings/conclusionsFindings/conclusions

Current measures to tackle Current measures to tackle obesity in Birmingham are failingobesity in Birmingham are failing

No coherent pan Birmingham No coherent pan Birmingham inter-agency approachinter-agency approach

Services are not well developed Services are not well developed or accessedor accessed

Poor surveillance monitoring Poor surveillance monitoring childhood obesity prevalencechildhood obesity prevalence

Schools should be part of Schools should be part of solution to tackle obesity, solution to tackle obesity, however schools are also part of however schools are also part of the problemthe problem

Importance of food poverty Importance of food poverty cannot be underestimatedcannot be underestimated

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RecommendationsRecommendations

Establish a task force to develop a Establish a task force to develop a city action plancity action plan

PCTs ensure data on childhood PCTs ensure data on childhood obesity is collected and services for obesity is collected and services for obese children are providedobese children are provided

Guidance for schools on food, drink Guidance for schools on food, drink and activity in schoolsand activity in schools

Training for school governorsTraining for school governors

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Task Force MembershipTask Force Membership City Council CouncillorsCity Council Councillors BCC Learning & CultureBCC Learning & Culture BCC TransportationBCC Transportation BCC Local ServicesBCC Local Services BCC CommunicationsBCC Communications PCTsPCTs Children's HospitalChildren's Hospital Parent RepresentativeParent Representative BBC West MidlandsBBC West Midlands School GovernorSchool Governor School Meal ProvidersSchool Meal Providers Health Education UnitHealth Education Unit Community CareCommunity Care West Midlands, Cycling & Walking CoalitionWest Midlands, Cycling & Walking Coalition Nursery RepresentativeNursery Representative Leisure ServicesLeisure Services Peer Advocate – Children’s rightsPeer Advocate – Children’s rights

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Action PlanAction Plan Children and young people are Children and young people are

physically active for at least physically active for at least one hour a dayone hour a day

A choice of sport and physical A choice of sport and physical recreation activities is included recreation activities is included in ‘before and after’ school in ‘before and after’ school programmesprogrammes

All nurseries, Children's Centres All nurseries, Children's Centres and youth settings are healthy and youth settings are healthy places for children and young places for children and young people to play, learn and people to play, learn and developdevelop

All children and young people All children and young people have access to fresh healthy have access to fresh healthy food and easy access to food and easy access to drinking water at schooldrinking water at school

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Action Plan cont.Action Plan cont. The NHS provides practical The NHS provides practical

advice, support and accessible advice, support and accessible services for children, young services for children, young people and parents who need people and parents who need help with weight managementhelp with weight management

Parents and others who care for Parents and others who care for children and young people are children and young people are educated and trained on how to educated and trained on how to choose, prepare and cook healthy choose, prepare and cook healthy foodfood

The number of supermarkets and The number of supermarkets and fast food outlets that promote fast food outlets that promote and provide healthy food is and provide healthy food is increasedincreased

They influence and change They influence and change catering practices at mass catering practices at mass entertainments events and entertainments events and outlets in the cityoutlets in the city

So What?So What?

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Benefits of Care Pathway for Service Benefits of Care Pathway for Service DevelopmentDevelopment

Consensus on service needsConsensus on service needs

Identifying gaps in serviceIdentifying gaps in service

Staff groups and partner Staff groups and partner organisations can also identify where organisations can also identify where they can contributethey can contribute

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ChildrenChildren

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Villa Vitality!Villa Vitality! Partnership between HOB tPCT, BEN PCT, Partnership between HOB tPCT, BEN PCT,

Aston Villa, Healthy Education Unit and Aston Villa, Healthy Education Unit and Schools. Up to 160 children per weekSchools. Up to 160 children per week

Interactive activities:-Interactive activities:-Physical activity coachingPhysical activity coaching ‘‘classroom’ and computer based classroom’ and computer based

healthy eatinghealthy eatingDevelop Radio Programme – Develop Radio Programme –

Villain RadioVillain RadioHealthy LunchHealthy LunchTeacher PackTeacher Pack

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Level 1: Rowing Machines in Level 1: Rowing Machines in SchoolsSchools

Partnership programme with Partnership programme with BCC Education Dept., Concept BCC Education Dept., Concept 2 and HoB schools2 and HoB schools

Aims to increase physical Aims to increase physical activity levels, providing activity levels, providing alternative to competitive/ alternative to competitive/ team based sportteam based sport

Each school can claim up to 5 Each school can claim up to 5 machinesmachines

Concept 2 provides an internet Concept 2 provides an internet support package for schools: support package for schools: includes training programmes, includes training programmes, lesson plans, distance awards, lesson plans, distance awards, tips and training on technique.tips and training on technique.

“I like rowing because it’s healthy and I can keep fit. Other than Basketball, it’s the only thing I’m good at. I feel more confident because I can do it by myself.” Michael Gardener, Year 9

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Level 1: Active Kids Initiative Level 1: Active Kids Initiative Training local teenagers to deliver physical activity Training local teenagers to deliver physical activity

and healthy eating messages to other kids –Yr 5and healthy eating messages to other kids –Yr 5

• Those delivering attain coaching qualification and training by dietitian in return for commitment to project

Reinforces the importance of being active and Reinforces the importance of being active and finding an activity the you enjoy!finding an activity the you enjoy!

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Level 1: Face Fruits Level 1: Face Fruits Local mums trained to deliver Local mums trained to deliver

2.5hr interactive sessions in Schools 2.5hr interactive sessions in Schools aimed at increasing understanding of fruit aimed at increasing understanding of fruit & veg, their benefits, how to eat them, & veg, their benefits, how to eat them, portions and variety.portions and variety.

Sessions explain why we should try and Sessions explain why we should try and eat 5 a day eat 5 a day

Children's faces are painted with images Children's faces are painted with images of 3 fruits (from the School Fruit and of 3 fruits (from the School Fruit and Vegetable Scheme) Vegetable Scheme)

Certificates are taken home with a picture Certificates are taken home with a picture of the children and 3 key health messagesof the children and 3 key health messages

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Level 1: Schools Dietitian Level 1: Schools Dietitian • Works across HoB and BEN primary and secondary schools

• Interactive events (assemblies, classroom sessions, parent sessions) on BoGH, 5-a-Day, Sugar and Fat Content

•1-to-1 meetings with Healthy Schools Co-ordinators in schools

•Supporting establishment of School Nurse Led Weight Management Programme

• School food policy development, breakfast club establishment, menu planning, tuckshop advice etc.

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Level 1: Food Net 4 ChildrenLevel 1: Food Net 4 Children Nutrition team working alongside under 5s staff Nutrition team working alongside under 5s staff

(HVs, Linkworkers, Nursery Nurses, children’s (HVs, Linkworkers, Nursery Nurses, children’s centres) centres)

Responsible for training and support to deliver on Responsible for training and support to deliver on healthy eating and obesity prevention e.g. healthy eating and obesity prevention e.g. breastfeeding, weaning, toddler nutritionbreastfeeding, weaning, toddler nutrition

Work with health education service to develop Work with health education service to develop and implement early years healthy setting statusand implement early years healthy setting status

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Level 1: Growing Gains Level 1: Growing Gains CSV environment scheme in schools CSV environment scheme in schools that aims to increase: that aims to increase: The range/variety of fruit and veg The range/variety of fruit and veg consumed by childrenconsumed by childrenIncrease pupil / parent knowledge healthy Increase pupil / parent knowledge healthy diet and how fruit and veg contributes to this. diet and how fruit and veg contributes to this. Children’s understanding of how fresh foods Children’s understanding of how fresh foods are produced and how eating fresh foods can are produced and how eating fresh foods can positively affect health.positively affect health.Teacher and pupil involvement in initiatives Teacher and pupil involvement in initiatives aimed at encouraging healthy eatingaimed at encouraging healthy eating

CSV environment will work alongside schools CSV environment will work alongside schools to create vegetable plot and deliver 18 to create vegetable plot and deliver 18 sessions in schoolssessions in schools

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Level 1: Training Playground Level 1: Training Playground AssistantsAssistants

Working with Healthy Working with Healthy Schools Team to train Schools Team to train playground assistants playground assistants and midday and midday supervisors in HoBsupervisors in HoB

Project aims to Project aims to increase physical increase physical activity levels among activity levels among primary school aged primary school aged childrenchildren

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Level 2: School Nurse Led Level 2: School Nurse Led Weight Management Weight Management

Programme Programme Developed by Dietetic serviceDeveloped by Dietetic service

6 session programme 6 session programme

Detailed session plans with worksheets, Detailed session plans with worksheets, food diaries etc and comprehensive list of food diaries etc and comprehensive list of resources for each session resources for each session

Can be delivered on an individual or Can be delivered on an individual or group basisgroup basis

Coventry University also working in Coventry University also working in partnership to develop SN-led weight partnership to develop SN-led weight management programme for Primary management programme for Primary School childrenSchool children

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Level 2: Children’s Gym Level 2: Children’s Gym Gym at Aston Villa (NRF Gym at Aston Villa (NRF

funded) for 8-16 yr oldsfunded) for 8-16 yr olds

Exercise on referral Exercise on referral scheme for kidsscheme for kids

Open access for HoB Open access for HoB residentsresidents

Usage for HoB schools Usage for HoB schools during the dayduring the day

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Level 3: Watch-It Level 3: Watch-It ProgrammeProgramme

Watch ITWatch IT MENDMEND Paediatric Dietetic ServicePaediatric Dietetic Service

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Level 4: Specialist Obesity Level 4: Specialist Obesity ServiceService

Level 4 service currently being Level 4 service currently being devised by Consultant devised by Consultant Endocrinologist, Children’s HospitalEndocrinologist, Children’s Hospital

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ADULTS ADULTS

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Level 1: Size Down Level 1: Size Down 6 week self-referral course delivered by 6 week self-referral course delivered by

FHAs in community venues FHAs in community venues

Based on pre-prepared session plansBased on pre-prepared session plans

Weighing optional each week but need 2 Weighing optional each week but need 2 measures for evaluationmeasures for evaluation

LOSE WEIGHT FOR GOOD WITH

A NEW FREE WEIGHT LOSS GROUP COMING TO A VENUE NEAR YOU

TAKE THE CHANCE TO GET FREE HELP, SUPPORT AND ADVICE ON HOW TO LOSE

WEIGHT AND KEEP IT OFF!!GROUPS ARE RUN BY FULLY TRAINED NHS

PROFESSIONALS………………………………………………………………

I would like to be contacted about the new weight loss groups:Name:__________________________________Address:_______________________________________________________________________________________Contact No: _____________________________________

SIZE DOWN PROGRAMME

Planning for your futureWeek 6

Planning your meals Making your f avorite f oods

healthier

Week 5

Understanding f ats and sugars in your f ood

Learning to read food labels

Week 4

Making those changes! Using physical activity to help you

become more active

Week 3

Learn how to choose and eat healthier f oods

Week 2

Getting started Looking at personal challenges so

that you can change your lif estyle

Week 1

SIZE DOWN PROGRAMME

Planning for your futureWeek 6

Planning your meals Making your f avorite f oods

healthier

Week 5

Understanding f ats and sugars in your f ood

Learning to read food labels

Week 4

Making those changes! Using physical activity to help you

become more active

Week 3

Learn how to choose and eat healthier f oods

Week 2

Getting started Looking at personal challenges so

that you can change your lif estyle

Week 1

Planning for your futureWeek 6

Planning your meals Making your f avorite f oods

healthier

Week 5

Understanding f ats and sugars in your f ood

Learning to read food labels

Week 4

Making those changes! Using physical activity to help you

become more active

Week 3

Learn how to choose and eat healthier f oods

Week 2

Getting started Looking at personal challenges so

that you can change your lif estyle

Week 1

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Level 1: Cook and TastesConsist of:•Practical Cooking sessions led by Food Health Advisor (HOB 0.6 wte)

•Programme of 5 sessions or one-offs/taster sessions

•Participants cook healthy dishes, discussion & education, looking at salt, sugar & fat, increasing fruit and veg in meals

Benefits:•Addresses lack of knowledge and skills, food culture, lack of access, and financial constraints

•Evaluation shows increase in fruit and veg intake (average 1.7 portions), and in cooking confidence

•Groups make comments showing wide ranging benefits e.g. reducing fat, sugar and salt, increasing fruit, veg, CHO and fibre, losing weight, understanding labels, taking up exercise

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Examples of Level 1 Service Examples of Level 1 Service cont. cont.

Walk 2000Walk 2000

Way marked 2 Km walking Way marked 2 Km walking routes in parks and open spaces to routes in parks and open spaces to encourage people to become more encourage people to become more active. Can be used with or without active. Can be used with or without Walk Leaders.Walk Leaders.

Routes and Maps on Routes and Maps on www.birmingham.gov.uk/walk2000 www.birmingham.gov.uk/walk2000

Commercial Weight Management GroupsCommercial Weight Management Groups

Weight Management Groups such as Weight Management Groups such as Weight Watchers and Slimming World Weight Watchers and Slimming World provide an effective method of provide an effective method of supporting weight loss. These have supporting weight loss. These have been audited by the PCT to ensure they been audited by the PCT to ensure they meet criteria in the NICE guidance for meet criteria in the NICE guidance for obesity obesity

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Level 1: Stair Climbing Level 1: Stair Climbing

Workplace Workplace initiative to initiative to improve activity improve activity levels and levels and incorporate as part incorporate as part of daily routineof daily routine

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Level 1: Healthy Lifestyles Level 1: Healthy Lifestyles Grant ProgrammeGrant Programme

Grant programme Grant programme aimed at developing aimed at developing community based community based initiatives to prevent initiatives to prevent and tackle obesity and tackle obesity

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Examples of Level 2 ServicesExamples of Level 2 Services

Practice Based Weight Management ClinicsPractice Based Weight Management Clinics

Training and resources are being Training and resources are being provided to enable Practice Nurses provided to enable Practice Nurses to run effective Weight Management to run effective Weight Management Interventions within surgeriesInterventions within surgeries

Dietetic ServiceDietetic Service

Opt-in by patient to a 45 minute Opt-in by patient to a 45 minute assessment and up to 5-6 follow ups assessment and up to 5-6 follow ups (can be groups), 1-2 months apart. (can be groups), 1-2 months apart. Consists of behavioral/ lifestyle/ Consists of behavioral/ lifestyle/ complex issues and advice on complex issues and advice on undertaking physical activity.undertaking physical activity.

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Examples of Level 2 ServicesExamples of Level 2 Services

EXERCISE ON PRESCRIPTIONEXERCISE ON PRESCRIPTION

Exercise on Prescription Exercise on Prescription BEN GPs BEN GPs refer patients who would benefit refer patients who would benefit from increased activity levels to from increased activity levels to local leisure and fitness facilities. local leisure and fitness facilities. A leisure services health and A leisure services health and fitness professional works with fitness professional works with the patient to develop a the patient to develop a personalised activity plan.personalised activity plan.

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Example of Level 3 ServicesExample of Level 3 Services

Specialist Obesity ServiceSpecialist Obesity Service

Service to treat people with morbid obesity Service to treat people with morbid obesity within a Primary Care setting. Run by a multi within a Primary Care setting. Run by a multi – professional team including a GP, – professional team including a GP, Specialist Dietitian and Cognitive Behavioural Specialist Dietitian and Cognitive Behavioural Psychologist, the service aims to be able to Psychologist, the service aims to be able to provide a more intensive approach than provide a more intensive approach than would generally be possible in Primary Care. would generally be possible in Primary Care. Suitable for patients with morbid obesity for Suitable for patients with morbid obesity for whom interventions in Primary Care have whom interventions in Primary Care have been unsuccessful. This service will ensure been unsuccessful. This service will ensure that all options have been tried before that all options have been tried before someone is considered for bariatric surgerysomeone is considered for bariatric surgery . .

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Examples of Level 4 ServicesExamples of Level 4 Services

SurgerySurgery

Bariatric Surgery for certain Bariatric Surgery for certain cases and preferably where cases and preferably where patients have been through patients have been through all levels of the care all levels of the care pathway.pathway.(Heartlands, Walsall Manor)(Heartlands, Walsall Manor)

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Next StepNext Step

Combined obesity strategy for Combined obesity strategy for BirminghamBirmingham

Thank-YouThank-You

Linda HindleLinda HindleConsultant Dietitian in ObesityConsultant Dietitian in ObesityBirmingham East and North PCTBirmingham East and North PCTTel:0121446 1025Tel:0121446 1025Email: linda.hindle@benpct.nhs.ukEmail: linda.hindle@benpct.nhs.uk