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Topic on a Page - Food & Nutrition

Data Sources:

Public Health England: Public Health Profiles

NHS Digital:

Statistics on Obesity, Physical Activity and Diet – England Published: April 2018

Public Health England:

Public Health Outcomes Framework: Percentage of adults classified as overweight or obese

Public Health Outcomes Framework: Excess weight in 4-5 year olds

Public Health Outcomes Framework: Excess weight in 10-11 year olds

National Obesity Observatory:

Review of dietary assessment methods in public health Factsheet
Published: August 2010

Association for Young People's Health:

Key data on Young People 2017

World Cancer Research Fund:

Interactive infographic summarising risk factors for certain cancers

Further data sources:

Scroll to the bottom of the page to view and compare further datasets

Supporting
Information:

Centre for Diet and Activity Research (CEDAR):

Dietary Public Health Research

Evidence Briefing: Children's diets and school Published: December 2012

Evidence Briefing: Multiple social ties and healthy eating in older people Published: October 2013

Evidence Briefing: Food, income and education: who eats more of what?

Evidence Briefing: How takeaway food outlets where we live and work may affect our health Published: June 2014

Evidence Briefing: Financial hardships, diet and obesity Published: November 2014

HM Government Policy:

Resources: Reducing obesity and improving diet

National Institute of Care and Health Excellence (NICE):

NICE Pathways: Diet Overview

NHS Evidence:

Diet and Nutrition

Eating Disorders

Healthy Eating

Public Health England (PHE):

Resources: Nutrition

Adult obesity: applying All Our Health Updated: January 2018

Childhood obesity: applying All Our Health Published: April 2015

National Diet and Nutrition Survey Factsheet
Published: May 2014

Social Care Institute for Excellence (SCIE):

Nutritional Care

The Food Foundation:

Affordability of the UK's Eatwell Guide

Linked Topics:

Topic last reviewed: Jul-18

Lincolnshire JSNA: Food & Nutrition

Background

Good nutrition is vital for good health. A poor diet is an independent risk factor for stroke, coronary heart disease and some cancers (Source: Healthy Lives, Healthy People 2011) (Source: UK Health Forum and CRUK 2015).

Poor diet is a major cause of obesity/excess weight, which in turn is the greatest risk factor for type-2 diabetes. Levels of excess weight as well as type-2 diabetes are unsustainably high in terms of costs to the NHS as well as to the broader economy. In Lincolnshire 63.7% of adults are either overweight or obese and 9.1% of adults are estimated to have type-2 diabetes; both figures being significantly above the level in England as a whole. Improving diet has additional benefits independent of losing weight; for example in lowering blood cholesterol (Source: NICE Guideline: Preventing Excess Weight Gain [NG7] ).

The '5 a day' campaign has been running for fifteen years; however, 42% of the Lincolnshire population is still failing to meet this target (Source: Public Health Outcome Framework (PHOF) - Health Improvement). Similarly, recommended intake levels for salt, saturated fat, oily fish, fibre and some vitamins and minerals remain unmet (Source: National Diet and Nutrition Survey 2018). Recently, consumption of sugar has become a priority, and the government has halved the recommended daily sugar intake; currently all age groups are exceeding this, with children aged 4-18 consuming almost three times the recommended level (Source: National Diet and Nutrition Survey 2018).

The effects of poor diet are not limited to obesity. Malnutrition, particularly in older people, can result in their underweight status, contributing to frailty, falls and increased use of primary and acute health services (Source: Malnutrition task force: Malnutrition in later life: Prevention and Early Intervention).

The causes of poor diets are complex; choices being affected by, amongst other things, cultural norms, busy lifestyles, marketing practices, food labelling, lack of cooking skills and personal tastes (Source: National Obesity Observatory 2018).

Context

National Strategies, Policies & Guidance

The bulk of recent NICE guidance has focused on weight management and obesity rather than a healthy diet per se.

NICE Guideline: Preventing Excess Weight Gain [NG7] (2015): emphasis on prevention of weight gain and reducing risk of obesity comorbidities rather than treating obesity; addresses diet and physical activity.

NICE Guidelines: Weight Management: lifestyle services for overweight or obese adults [PH53] (2014). This guideline makes recommendations on the provision of effective multi-component lifestyle weight management services for adults who are overweight or obese (aged 18 and over). It covers weight management programmes and courses as well as clubs or groups that aim to change someone’s behaviour by reducing their energy intake and encouraging them to be physically active.

Healthy Lives Healthy People: a Call to Action on Obesity 2011: sets out the need for society-wide measures that will reduce the population's calorie intake. It includes recommendations for individual and community level interventions as well as for the food industry through the Responsibility Deal.

DEFRA Plan for Public Procurement 2014: encourages the public sector to take a lead in promoting healthier diets and sustainability through their food procurement and catering services. This policy is supported by the Government Buying Standards (2015) which lays out the requirements for food procurement.

School meals healthy eating standards: Address children's diet through the provision of free school lunches to pupils in reception to year two. School Food Standards (2015) lay down nutritional requirements for school meals.

PHE 'whole system' obesity project: development of population level measures around diet, food quality and availability. North Kesteven is one of four UK areas taking part in the study by Leeds Beckett University.

Change 4 Life Sugar App: national campaign which enables people to monitor the sugar levels in food; links into broader Change 4 Life campaigns around diet and physical activity.

PHE and the TCPA: prioritisation of local planning policies as a way of creating healthy food environments.

The Eatwell Guide (2016): defines government recommendations on a balanced diet.

The Childhood Obesity Strategy: A plan for action (2016, update expected 2018) outlines the government's plans to address childhood obesity. The majority of recommendations focus on food. The strategy includes a range of interventions such as instigating a voluntary challenge to the food industry to reduce sugar levels in their products and to initiate front of pack 'traffic-light' labelling. It also includes the Soft Drink Industry Levy ('Sugar Tax') which was implemented in April 2018 and has resulted in over 50% of manufacturers reducing the sugar content of their drinks. There are also recommendations around the nutritional quality of food in schools, early years' settings and the public sector more broadly.

Local Strategies & Plans

There is currently no healthy eating strategy for Lincolnshire; however, we are working with PHE on a programme to establish the East Midlands as a sustainable food region that aims to champion affordable, locally grown, sustainable and healthy food for the whole population. A Food Strategy Partnership has been established in City of Lincoln; its focus includes nutrition, food poverty, food waste and sustainability and environmental issues.

What is the picture in Lincolnshire?

What the data is telling us

Active People Survey data (Source: Public Health Outcome Frameworks (PHOF), indicates that 58.1% of people aged 16 and over in Lincolnshire meet the '5 a day' target, slightly better than the national average. Across the county, Lincoln and South Holland have the lowest levels at 55.3% followed by West Lindsey (56.7%), Boston (57.4%), North Kesteven (58%) and East Lindsey (59.9%), with South Kesteven having the highest average consumption at 61.4% (Source: PHOF). Data from PHOF also indicates that the average number of portions of fruit and vegetables eaten daily in Lincolnshire is 2.67 and 2.78 respectively. Whilst it is encouraging that average consumption is above '5 a day', the data gives no indication of the range and so could potentially mask significant variation. It should also be noted that these figures are at odds with national data available in Statistics on obesity, physical activity and diet (Source: NHS Digital 2018) which are derived from the National Diet and Nutrition Survey. NHS Digital reports that only 26% of the adults meet the '5 a day' target and that 48% women and 42% men eat fewer than 3 portions of fruit and vegetables each day.

Local levels of excess weight remain a cause for concern. 63.7% of the adult population is overweight or obese, higher than the nation as a whole. In 2015/16, 21.5% of children aged 4-5 and 34.7% of 10–11 year olds in the county were overweight or obese. The Lincolnshire average masks considerable variation across the districts, with City of Lincoln slightly below national levels but South Holland and East Lindsey having amongst the highest levels in the country.

Trend

It is not possible to ascertain trends in healthy eating at a local level as data collection methods used within the Active People Survey, reported in PHOF were changed in 2015 and therefore cannot usefully be compared to previous figures. However, national NHS Digital data suggests that achievement of the '5 a day' target has remained largely stable for the past 9 years.

The NHS Digital report provides national data around household spending on food. This shows that since 2011, there has been a 3.5% decrease per individual in spending on food and drink. There has been a short term decline in spending on meat and meat products, potatoes, and bread and an upward trend since 2011 on spending on fresh fruit. Since 2001 there has been a constant decline in spending on food eaten out.

Key Inequalities

In 2008 the Marmot Review was commissioned to produce an evidence based strategy for reducing health inequalities. Although food and nutrition was not identified as a specific policy objective, it clearly links into Objective F, which focuses on strengthening the role and impact of ill-health prevention.

The relationship between healthy eating and deprivation is complex. Differences are clearest between the lowest and highest income quintiles with respect to fruit and vegetable consumption. The difference is greatest in children, with 48% of those in the most deprived quintile groups consuming at least five portions a day, compared to 58% in the least deprived. Generally, where there is a difference, people in the lowest quintiles have worse diets than those in the highest; however, there is no simple pattern across all age and sex groups. And where nutrient levels are not met, this tends to be across all income groups. Similarly all socio-economic groups consume higher levels of high fat and high sugar food and drinks than are recommended. In terms of ethnicity, the What About Youth Survey, reported by NHS Digital indicates that Afro-Caribbean and white British children have the worst diets with respect to fruit and vegetable consumption, whilst Asian and non-specified, 'other' ethnic minority children have the best.

According to Health Survey for England data, women are slightly more likely than men to meet the '5 a day' target (28% compared to 24%) and are less likely than men to eat three or fewer portions of fruit and vegetables (NHS Digital 2018).

National Research conducted by the Fabian Society in Hungry for Change suggests that food poverty has an impact on the lowest income groups whose real disposable income fell by £20 to £156 between 2004 and 2013. People on low incomes are more likely to have difficulty physically accessing nutritious and affordable food. This is because of higher food prices and reduced choice in local shops, and unavailable or unaffordable transport to larger, more affordable stores. For these reasons low-income households often have to pay more for everyday goods.

Current Activity & Services

Lincolnshire is a rural county and one of the largest food producers in the UK.

The success of local farmers' markets and small food businesses as well as cultural and agricultural events such as the Lincolnshire Show and the Pumpkin Festival in South Holland, provide opportunities for widespread engagement in healthy food activities.

The NHS Diabetes Prevention Programme has been rolled out across Lincolnshire. It involves personalised help for people identified as being at an increased risk of developing type 2 diabetes; it includes education on healthy eating and maintaining a healthy weight. LCHS provide a similar lifestyle support service, 'Spotlight on Diabetes,' for people newly diagnosed with type 2 Diabetes.

Making Every Contact Count (MECC) is delivered countywide by Public Health; MECC enables frontline professionals and volunteers to offer brief advice and signposting around five key healthy lifestyle issues, one of which is diet and nutrition. Similarly, the NHS Health Checks programme, which is commissioned by Public Health and delivered across the county through GP services to people aged 40 – 74, provides advice and support around diet and weight.

One You is a national awareness campaign created by PHE; it provides a range of on-line information and apps to support people to lead healthier lifestyles, including through improving their nutrition. Public Health hosts an active Lincolnshire One You network which includes members from a wide range of organisations and ensures a coordinated approach to the dissemination of key messages.

Numerous healthy eating schemes exist at a district or lower level; however, coverage is patchy and their reliance on piecemeal sources of funding raise questions about their sustainability.

North Kesteven District Council is one of four pilot areas working with PHE and Leeds Beckett University on research into whole system approaches to obesity. The whole system approach involves addressing all aspects of the food system including environmental factors. The findings are expected in 2018.

Schools can buy advice and training on diet and nutrition in school meals from Lincolnshire County Council's Food Education Team. Constraints on school budgets have had an impact on uptake, with many schools unable to access on-going support. Since January 2017 the service has engaged 27 schools and three caterers and has delivered four sessions with LCC Family Learning Plus.

Free school meals are universally available to children in the first three years of primary school (i.e. Reception Class, Year 1 and Year 2). They are only available in subsequent school years if the family is in receipt of any income based state benefits. Lincoln and East Lindsey have the highest eligibility amongst the districts (17%), and Mablethorpe (27%), Gainsborough (26%) and Skegness (22%) are the areas with highest eligibility (Source: DCLG, Indices of Multiple Deprivation in England, 2015).

Unmet Needs & Gaps

It is difficult to establish the extent and nature of unmet needs as the local evidence around food and diet as well as on the long-term impact of healthy eating programmes is scarce.

There is little local data around the extent or impact of malnutrition, particularly amongst older people.

Local data on 'food poverty' and food bank use is generally not robust and there is little evidence on the effects of school holidays on children's nutrition, particularly with respect to those children in receipt of free-school-meals.

The priority would therefore be to address gaps in local knowledge, in particular around national priority areas; for example, planning and local environmental factors, about which there is little local evidence. Population level measures that rely on making changes to the spatial environment or to food formulation will rely on closer collaboration between Planning departments, Public Health and Environmental Health.

Local Views & Insights

Stakeholders' views about local diet and nutrition issues were gathered through a variety of methods.

Survey data and feedback from the Community Cooking and Growing programme, which was obtained from participants as well as partner agencies, and evidence from district councils taken from decommissioning impact assessments frame the main benefits of this programme in terms of social isolation and personal efficacy as opposed to long-term impact on diet.

Stakeholders from a range of agencies, including clinical nutritionists, academic experts and food and weight management service providers were invited in June 2016 to comment on local food issues as part of the JSNA review process. In general it was felt that it would be useful for Lincolnshire to have a coherent healthy eating strategy which encompassed the social and cultural as well as nutritional aspects of food. They believed that whilst there were a number of activities taking place around the county, these were small scale, 'patchy' and difficult to sustain or scale up in the long term.

Risks of not doing something

Excess calorie intake is the main cause of adult and childhood obesity. Currently 63.7% of Lincolnshire adults and 34% of year 6 children are overweight. Excess weight is a major risk factor for a number of serious conditions including some cancers, coronary heart disease and, in particular, type 2diabetes. Nationally, obesity and excess weight related disease currently costs the NHS over £5bn pa and it is estimated to have cost over £208 million to local health services in 2015 (Source: STP Prevention plan 2016).

If nothing is done, there is a risk that obesity levels remain the same or even increase, with concomitant costs to the NHS in Lincolnshire. Public Health England estimates the annual national cost of obesity to be £27 billion including £13.3 billion in obesity medication and £5.1 billion costs to the NHS. NICE projects that the overall figure could rise to £50 billion by 2050.

Likewise, the risk to health of underweight, particularly in relation to eating disorders, or malnutrition in elderly people, with consequences for frailty and falls which may limit independence, are likely to impact significantly on people's overall quality of life, and on the cost of providing health and care services.

What is coming on the horizon?

The national Childhood Obesity Strategy is expected to be updated during 2018; this is likely to include a healthy rating scheme for schools as well as revisions to the School Food Standards.

The new Joint Health and Wellbeing Strategy for Lincolnshire (2018) includes obesity amongst its seven priorities.

Lincolnshire County Council's Wellbeing Commissioning Strategy aims to address unhealthy lifestyles, including improving diet and achieving healthy weight, through collaboration with the NHS.

The five year Sustainability and Transformation Plan for local health service funding requires health providers to deliver services that meet the needs of local populations as well as supporting the Five Year Forward View vision, which includes a ‘radical upgrade’ in prevention. This provides the opportunity to invest resources in weight management programmes, which contain a strong focus on achieving and maintaining a healthy diet, and that will result in financial savings to the NHS through contributing to primary and secondary prevention outcomes.

Public Health England, in partnership with Leeds Beckett University, are currently conducting research into 'whole systems' approaches to addressing obesity. This may provide insight to support future strategies around food and nutrition; findings are expected in 2018.

What should we be doing next?

In the absence of any commissioned services around food and nutrition it will be necessary to identify and work with a broad range of partners to maximise existing assets, resources and expertise to promote awareness around the importance of a healthy diet and ways of achieving this, including taking opportunities through Health Checks, MECC and One You initiatives which are commissioned locally.

 

If you need to contact us about this topic, please email JSNA@lincolnshire.gov.uk