Public Health Dialogue: notes on obesity and healthy eating

The role of industry in public health • There is a role for the private sector to encourage better public health. However, there wasn't agreement whether this involvement should be regulated or voluntary. One participant was concerned that some companies were signing up to the responsibility deal as "window dressing". It was argued that far from regulation being a constraint for industry, it would lead to a level playing field on which to compete • Food production needs to alter its focus and move away from cheap, convenient food to healthier options. These options may not necessarily be more expensive – just more time-consuming. • People need to be educated how to manage food budgets and produce healthier meals • Healthy food is not available on high streets. People have limited opportunities to improve their diets through mainstream outlets Activity and exercise • Healthy eating isn't the only factor affecting society's weight problems: physical activity and active travel are as important • Public health can have an influence on planning decisions to make healthier environments and encourage a more active community. An all-systems approach can lead to empowered communities. • People generally work too far from where they live so rely on cars or trains, which makes them less active • There is an over-emphasis on sport – things such as changing people's everyday attitude to car use is just as important • The Olympics is being used to encourage people, in particular young people, to take up sporting activities. It is unlikely to encourage people to take up sports, especially in the long-term, because they are "discouraged by excellence" • There are additional benefits of physical activities – people are generally healthier physically and mentally, feel better about themselves, are more productive, etc • The benefits of physical activity are mis-sold: most people join sports teams for the social interaction Evidence • It will be impossible to get clear evidence for public health initiatives, because the wider benefits need to be considered, but these are impossible to measure • Obesity needs to stop being seen as an individual topic. It is usually part of a bigger set of factors affecting people's health – a symptom rather than a disease • Education is important but of little value without assessment Localism • There is a lot of local talent and knowledge that is untapped by directors of public health • Community groups talk about the social benefits of public health while local authorities talk about the economic benefits of improved health outcomes. There needs to be a refocusing of priorities by authorities. They should be encouraged to see that savings can be achieved by investing in health initiatives • At a local level, authorities can influence physical movement through the built environment. In terms of healthy food, there needs to be a national lead • There's a lot of talk about using locally sourced food – is it actually grown locally or brought in from local storage units? An example was given of co-operatives joining together to buy local food in bulk to reduce wastage, a mix of localism and collaboration reducing costs and providing healthier food • Is behaviour driven by what's available? Use planning decisions to influence availability The clinical role • Should weight issues be tackled directly – gastric surgery – and are clinicians justified in restricting operations and treatments where obesity needs tackling first? • In some cases, weight loss needs addressing before clinical treatments will actually be beneficial to the patient • NHS trusts need to be more involved with clinical commissioning groups to deliver the treatment that is best for the patient People • Weight is a very personal issue; people don't like to talk about it. Smoking has been stigmatised – and legislated against – but obesity isn't treated in the same way • Bosses who take their employees' health seriously see benefits of better performing staff, less absenteeism, improved productivity, etc Managing public health • Health and wellbeing boards have a massive agenda. There's a danger authorities will mould them into health and social care boards as there isn't enough room on them for all the people who should be involved. There needs to be dynamic, charismatic and clinical leads to ensure this is taken seriously • People don't share their learning, leaving us with a "variably distributed future". A siloed approach will cost more in the long-term, because each authority will keep reinventing approaches. It is essential that best practice is captured and shared Communications • How does the public learn about local amenities? Social media has a role to play in this – there has been an increase in users aged over 55 • Authorities and trusts need to make sure they're getting the right message to the right groups through the right means to engage communities. This may mean taking an unusual approach and looking at behaviour to place the message correctly, working with different partners Summary • A little bit of everything works better than one big gesture • There is no one approach to public health – it has to be the result of "collective will" • Choice has a huge role to play. If it isn't there, people won't have healthier options • Physical activity is as important as healthy eating