Agenda item

This report sets out a new approach to supporting people achieving and maintaining a healthy weight in York, led by the public health team at city of York Council but with implications for the whole system of health and beyond in the city. It gives an overview of services to support children, families, and adults, with a particular focus on the shift to a compassionate approach to weight.

The focus of this report is on the framing of, and approach to, healthy weight support in the city, rather than on the wider issues behind weight, diet and exercise – for instance poverty, housing, the ‘obesogenic environment’, our food systems. These things are the focus of Goal 5 in the Joint Health and Wellbeing Strategy 2022-32, and are reported on regularly to the board.

The board are asked to note and endorse the approach set out within this report and are encouraged to promote the ethos of a compassionate approach to healthy weight, and the services available within their own departments/organisations.        

The Head of Public Health presented the item, noting that there was increasing recognition that obesity was a chronic repeating condition. He discussed how the council was providing services around support to healthy weight within the city at each stage of life, the stigmatising effect of the wording on letters that had previously been sent out to residents and the impact of weight loss drugs. He summarised that the next step for the HWBB was for all partners to agree to approve and promote the compassionate approach to weight loss across all organisations, and where possible look to embed trauma-informed practice, weight stigma reduction, a focus on holistic health rather than just weight outcomes and have a real consideration of those commercial influences on food and activity choices.

The Managing Director, TEWV welcomed the change in approach. She acknowledged that in cases where people had severe and enduring mental illness there was a direct link between obesity and any measure that was more engaging and less stigmatising. She noted that TEWV had recently been involved in research and took a particular approach for mental health, so they already had some foundational work on this in place.

The Chair asked whether evidence supported the improved long-term outcomes from a greater focus on health gains and becoming healthy, rather than solely a weight loss programme. The Head of Public Health said this was supported by evidence, stating that when interventions focused solely on weight, they missed so much else in terms of the holistic view of health and someone could be of healthy weight and chronically unhealthy or vice versa. He stressed that embedding these basic principles around physical activity and nutrition was key and being able to communicate the benefits to families, individuals, groups and organisations would result in better outcomes all across the city.

He noted that there were different sections of the community which experienced greater challenges than others achieving and maintaining a healthy weight, so the services listed in the report would need to be proportionate and directed to where the need was greatest.

Board members asked how Public Health was engaging with other parts of council (such as active transport or weaning children). The Head of Public Health answered that they were working closely with colleagues, noting that last year the city hosted the National Active Travel Conference and public health had worked with that team to look at how active travel could be embedded. Public Health were also working on the active schools programme, which linked in closely around looking at how walking and cycling into school was promoted.

The board identified a potential gap between breast feeding and healthy eating vouchers where parents of young children may be less supported than other age groups, and specifically discussed children who were weaning.

The Head of Public Health responded that he was working closely with colleagues across Children's Services concerning the Raise York Partnership (supporting parents, carers, children, young people and anyone who works with these groups) and the Best Start in Life interventions for healthy weight in under-fives was one of the key priorities for the partnership.

Regarding weaning he noted that as part of that pathway, one of the one of the offers was the HENRY program (Health, Exercise, Nutrition in the Really Young) which specifically addressed the topic of weaning, though he admitted this support was relatively limited and could be expanded more.

Board members supported the changes, noting that this plan was a lot more progressive and positive than historic strategies, where in the past there was no an attempt to understand the reasons for people being overweight and the complex relationship with food they had developed, they were simply put on a strict diet which helped them lose weight. Consequently, the impact on their mental well-being had been disastrous, since the focus had been on getting them to be thinner rather than actually helping them be healthy, well-adjusted adults. It was Going forward, concern was also raised against the normalising of weight loss jabs in an environment where young people are very sensitive to body image.

The board asked about the supplementary planning documents referred to in the report, and the sort of content that expected there in terms of planning.

The Director of Public Health discussed the Health Impact Assessment and the guidance laid out in the Supplementary Planning Document. He explained that the Local Plan contained a specific policy (HW7) which concerned the need for developers of major strategic sites to offer a Health Impact Assessment (HIA). York would soon be publishing what its HIA frameworks would look like, but ultimately this would allow the council to assess the impact of a new development and guidance would be laid out either in a supplementary planning document, or simply guidance on how the layout of a development might best enable people to make a journey without using a motor vehicle. He stated that this would focus on aspects of the planning policy that were currently in the National Planning Policy Framework around hot food takeaways such as where these can be sited or additional planning objectives; for example, local areas would typically stop these from being sited near schools.

The Director of Public Health also said that beyond the specific development there was a citywide strategy to enable people to travel without using a car and enable them to access sports provision and green space. He stated that there was already a process around developer contribution to these strategies, but it was important to ensure future developments continue to have the right green space in the right places and that contribution to sports and active leisure provision remained in the city.

The Chair concluded that the board was clearly supportive of these changes, the proposal was timely and suggested taking a holistic trauma-informed approach.

Resolved:   To approve and endorse the ethos and service   changes lying behind the proposed ‘compassionate approach’ to healthy weight

Reason:      To provide effective, supportive and non-stigmatising services and support around weight in the city

Resolved:   To consider the implications of this ‘compassionate approach’ for each individual organisation

Reason:     To embed and disseminate our agreed approach across city organisations.