Innovations and new initiatives to prevent obesity NSW Health Innovation

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Innovations and new initiatives to prevent
obesityNSW Health Innovation Health Symposium
November 2015

• Louise A Baur
• University of Sydney Discipline of Paediatrics
  Child Health, Sydney Medical School, AND Sydney
  School of Public Health
• The Childrens Hospital at Westmead, Sydney
  Weight Management Services
• Email louise.baur_at_health.nsw.gov.au

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How others have described the problem of obesity

• One of todays most blatantly visible yet most
  neglected public health problems
• The public health equivalent of climate change
• The Millennium Disease

WHO www.who.int/nut/obs.htm Laing Rayner,
Obesity Reviews 2007 www.iotf.org
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• !!!!

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With such a complex issue we cant tackle
itby staying in our silos
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With such a complex issue we cant tackle
itby staying in our silos
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Obesity and the chronic disease care pyramid
Primary prevention health promotion
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Obesity and the chronic disease care pyramid
Self-care supported by GPs, other 1o care,
group programs
Level 1 70-80 of people with oweight/obesity Sel
f-care community based care
Primary prevention health promotion
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Obesity and the chronic disease care pyramid
Level 2 High risk patients Care management
Multidisciplinary teams specialist allied
health group programs
Self-care supported by GPs, other 1o care,
group programs
Level 1 70-80 of people with oweight/obesity Sel
f-care community based care
Primary prevention health promotion
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Obesity and the chronic disease care pyramid
Tertiary level facilities special obesity
clinics specialist teams key worker case
manages joins up care
Complex patients Case management
Level 3
Level 2 High risk patients Care management
Multidisciplinary teams specialist allied
health group programs
Self-care supported by GPs, other 1o care,
group programs
Level 1 70-80 of people with oweight/obesity Sel
f-care community based care
Primary prevention health promotion
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But we tend to stay in our silos!
Silo 3 Hospitals
Tertiary level facilities special obesity
clinics specialist teams key worker case
manages joins up care
Complex patients Case management
Level 3
Level 2 High risk patients Care management
Multidisciplinary teams specialist allied
health group programs
Silo 2 Primary care Community care
Self-care supported by GPs, other 1o care,
group programs
Level 1 70-80 of people with oweight/obesity Sel
f-care community based care
Silo 1 Health promotion
Primary prevention health promotion
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What are some of the new, or newer, strategies in
tackling obesity?
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Tackling gestational weight gain? Providing a
Get Healthy Coaching Service to pregnant women
affected by obesity
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Why gestational weight gain?

• A critical period when future health trajectories
  can be influenced
• Pregnant women are very open to health messages
  AND they are being seen often frequently - by
  the health system!
• Excess weight in pregnancy ? influences current
  future maternal health AND offspring health

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Trial of for women with gestational weight
gain

• Trial underway using the Get Healthy platform
• Can we see a future when .
• all women in early pregnancy who are affected by
  obesity are provided with a high quality,
  accessible intervention to help them avoid excess
  weight gain and have as healthy a pregnancy as
  possible?
• the Get Healthy Service is used successfully by
  many, many people including young people (i.e.
  prior to pregnancy)?

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Integrating anticipatory guidance about
breastfeeding and healthy infant/ young child
eating and activity into routine clinical service
delivery? Universal and Targeted home visiting
to mothers of new babies
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Home visiting programs?

• Can be effective in improving social and health
  outcomes of disadvantaged parents and children
• What about weight, eating and activity outcomes?
• ? The Healthy Beginnings Trial
• south-western Sydney
• intervention from 3rd trimester to child age 2y
• 8 home visits by early childhood nurse,
  developmentally staged

1Olds DL, et al. JAMA 1997, 278673-643.
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And, Healthy Beginnings led to

• significant reduction in body mass index at age 2
  y ? the first intervention to decrease child BMI
  in early childhood
• improvements in some child and mother eating and
  activity/TV behaviours

• . but the effect didnt persist beyond 2 y -
  when the home visits stopped

Wen LM et al. BMJ 2012 344e3732
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Home visiting programs to prevent obesity?

• Trial being planned in Sydney LHD
• Can we see a future when .
• Anticipatory guidance about breastfeeding,
  healthy infant/child feeding activity is
  integrated into home visiting programs for
  targeted pregnant women/mothers of young babies?
• Are there other ways to support large numbers of
  women? What about phone coaching? The Get Healthy
  Service for new mothers?

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On-line training of clinicians (nurses, allied
health, doctors ) who see children and
adolescents - to monitor weight status, raise the
issue of obesity and provide initial and more
detailed advice? Weight4KIDS training modules
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Why the interest in training health professionals?

• Treatment services very limited, poorly
  co-ordinated, across NSW and Australia-wide
• Most health professionals are poorly trained in
  managing paediatric obesity and its complications
• ? Development of Weight4KIDS
• a series of on-line training modules suitable for
  all types of health professionals working with
  children, in any setting
• well-evaluated in metro and regional NSW settings

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Upskilling of health professionals?

• Can we see a future when .
• All clinicians and health promotion staff are
  able to access relevant training as needed and
  feel confident in
• raising the issue of obesity
• monitoring the problem
• helping people find the support they need to
  tackle the issue

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Some last reflections
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Of course we need many other strategies too! BUT

• Lets be as flexible and innovative as we can
  within our existing budgets
• How can we avoid being stuck in our different
  craft silos and comfort zones?
• Where does health promotion end and clinical
  service delivery begin? And vice versa?

• How can health promotion infiltrate/ embed itself
  - or be integrated - into routine clinical
  service delivery?
• How can health promotion be integrated across
  many other sectors?

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Of course we need many other strategies too! BUT

• Lets be as flexible and innovative as we can
  within our existing budgets
• How can we avoid being stuck in our different
  craft silos and comfort zones?
• Where does health promotion end and clinical
  service delivery begin? And vice versa?

• How can health promotion infiltrate/ embed itself
  - or be integrated - into routine clinical
  service delivery?
• How can health promotion be integrated across
  many other sectors?

• Thank you!