Wednesday, 31 August 2016

UK Childhood Obesity Plan - A Bit Thin?

The UK Government has recently published its long-awaited Childhood Obesity Strategy. It’s unusual for a policy document because it’s very short and to the point. It explains concisely what is planned to be done to combat the very real health threat emerging from young people being overweight and obese – this puts them at risk of Type 2 diabetes, cardiovascular disease and many other conditions. It has even been said (although not in the strategy) that this generation of young people may even be at risk of dying before their parents, due to the health risks of overweight, obesity and inactivity. A very serious situation

The overall target stated in the strategy is to reduce ‘significantly’ the number of obese children by 2020. It doesn’t explicitly state what ‘significantly’ means in actual numbers, however it does say, close to the start of the strategy, that the publication of this ‘plan for action’ represents the beginning of a conversation, rather than the final word. This must mean that further details will follow

So, what does this ‘conversation opener’ include? A number of high profile plans, some of which have been the matter of discussion in the press for many months, namely:

A tax on soft, sugary drinks – due for legislation in February 2017. Interestingly, the policy seems to suggest this will not be paid by consumers, but by producers and importers;

A 20% reduction in the sugar content of the 9 highest consumed products by children – including yoghurt, cereal and sweet spreads. This is an initial list of products, more will apparently, follow later;

Helping all children have an hour of physical activity every day. This intention includes working with schools to identify key times of inactivity and work on making them more active. Schools will be responsible for providing at least 30 minutes of activity, parents and carers the other 30 minutes;

Other aims include focusing on healthy school meals, providing breakfast clubs and making the contents of vending machines healthier, thereby creating a healthy eating environment wherever young people are

So far, so good. These are all admirable plans and there is some degree of joined up working between, for example, schools, the Department of Health, Public Health and private companies, such as leisure centres. We wish these initiatives well, as every step definitely matters

However, we’re concerned about aspects that aren’t on the list – perhaps yet, we hope. Here’s our wish list for additions:

Something more than acknowledgement that eating behaviour arises not just from the amount and content of food provided, but from an emotional context, too. Children learn their eating habits from their early experiences, and food is often used as a surrogate for expressing emotions within families. Sadly, too, food can become a comfort for children who aren’t experiencing unconditional love and nurturing that plays an important part in shaping their view of themselves, others and the world. The strategy says nothing about the psychology of eating in young people who are overweight and obese, choosing instead to focus on equalizing the energy in/out balance to gain a healthy weight;

An emphasis on how young people can identify the link between their eating and their feelings and get help, both emotionally and physically. True, the NHS is mentioned, particularly the role of health visitors and school nurses in helping families to start good habits early. However, mention of skills training in dealing with ‘difficult conversations’ seems to be limited (perhaps to online courses?) and reviewing the content of existing materials, plus bigging up the ‘making every contact count’ initiative. NHS professionals are urged to ask families about eating behaviours at every opportunity, which could become counter productive if people feel ‘nagged’, or more importantly, if there is insufficient time, insight or skills to deal with the ‘difficult’ answers they might give;.

More focused, detailed training and a proper resource list of emotional and psychological support for eating behaviours – which could be for families as well as individual young people, not to mention health professionals themselves – would be very helpful. This could include mental health, eating disorder and young peoples’ charities, as well as statutory agencies;

Finally, what of the money that will be raised through the ‘soft drinks industry levy’ – known popularly as the ‘sugar tax’? Most of it seems to be committed to schools, with increase in the primary PE and sport premium and the investment in breakfast clubs. Could some of it be used for wider support as we have suggested? Schools are important, but not more important than families and emotional health for the future. Wider application of the finances raised is much needed. A further question is what happens when the money runs out? Is there a longer term plan to maintain these young peoples’ health throughout their lives?

Since schools are so much mentioned in the policies, and there is much to commend the efforts it describes, we’d offer the Government 7/10 so far….but wait expectantly to see if their plans for reducing weight will be fattened up


Reference
HM Government. Childhood Obesity: A Plan for Action. London 2016

UK Childhood Obesity Plan - A Bit Thin?

The UK Government has recently published its long-awaited Childhood Obesity Strategy. It’s unusual for a policy document because it’s very short and to the point. It explains concisely what is planned to be done to combat the very real health threat emerging from young people being overweight and obese – this puts them at risk of Type 2 diabetes, cardiovascular disease and many other conditions. It has even been said (although not in the strategy) that this generation of young people may even be at risk of dying before their parents, due to the health risks of overweight, obesity and inactivity. A very serious situation

The overall target stated in the strategy is to reduce ‘significantly’ the number of obese children by 2020. It doesn’t explicitly state what ‘significantly’ means in actual numbers, however it does say, close to the start of the strategy, that the publication of this ‘plan for action’ represents the beginning of a conversation, rather than the final word. This must mean that further details will follow

So, what does this ‘conversation opener’ include? A number of high profile plans, some of which have been the matter of discussion in the press for many months, namely:

A tax on soft, sugary drinks – due for legislation in February 2017. Interestingly, the policy seems to suggest this will not be paid by consumers, but by producers and importers;

A 20% reduction in the sugar content of the 9 highest consumed products by children – including yoghurt, cereal and sweet spreads. This is an initial list of products, more will apparently, follow later;

Helping all children have an hour of physical activity every day. This intention includes working with schools to identify key times of inactivity and work on making them more active. Schools will be responsible for providing at least 30 minutes of activity, parents and carers the other 30 minutes;

Other aims include focusing on healthy school meals, providing breakfast clubs and making the contents of vending machines healthier, thereby creating a healthy eating environment wherever young people are

So far, so good. These are all admirable plans and there is some degree of joined up working between, for example, schools, the Department of Health, Public Health and private companies, such as leisure centres. We wish these initiatives well, as every step definitely matters

However, we’re concerned about aspects that aren’t on the list – perhaps yet, we hope. Here’s our wish list for additions:

Something more than acknowledgement that eating behaviour arises not just from the amount and content of food provided, but from an emotional context, too. Children learn their eating habits from their early experiences, and food is often used as a surrogate for expressing emotions within families. Sadly, too, food can become a comfort for children who aren’t experiencing unconditional love and nurturing that plays an important part in shaping their view of themselves, others and the world. The strategy says nothing about the psychology of eating in young people who are overweight and obese, choosing instead to focus on equalizing the energy in/out balance to gain a healthy weight;

An emphasis on how young people can identify the link between their eating and their feelings and get help, both emotionally and physically. True, the NHS is mentioned, particularly the role of health visitors and school nurses in helping families to start good habits early. However, mention of skills training in dealing with ‘difficult conversations’ seems to be limited (perhaps to online courses?) and reviewing the content of existing materials, plus bigging up the ‘making every contact count’ initiative. NHS professionals are urged to ask families about eating behaviours at every opportunity, which could become counter productive if people feel ‘nagged’, or more importantly, if there is insufficient time, insight or skills to deal with the ‘difficult’ answers they might give;.

More focused, detailed training and a proper resource list of emotional and psychological support for eating behaviours – which could be for families as well as individual young people, not to mention health professionals themselves – would be very helpful. This could include mental health, eating disorder and young peoples’ charities, as well as statutory agencies;

Finally, what of the money that will be raised through the ‘soft drinks industry levy’ – known popularly as the ‘sugar tax’? Most of it seems to be committed to schools, with increase in the primary PE and sport premium and the investment in breakfast clubs. Could some of it be used for wider support as we have suggested? Schools are important, but not more important than families and emotional health for the future. Wider application of the finances raised is much needed. A further question is what happens when the money runs out? Is there a longer term plan to maintain these young peoples’ health throughout their lives?

Since schools are so much mentioned in the policies, and there is much to commend the efforts it describes, we’d offer the Government 7/10 so far….but wait expectantly to see if their plans for reducing weight will be fattened up


Reference
HM Government. Childhood Obesity: A Plan for Action. London 2016

Tuesday, 26 January 2016

Bring On The Diabetes Storm?

There’s been a flurry of diabetes-related reports, guidelines and activity in the last few weeks, kicked off with the release of the new NICE guidance for Type 2 diabetes at the start of December. Hotly debated in its draft stages, the guidance was delayed by the need to re-work some of the recommendations as a result

However eggy-faced this might have made the authors, the result is hugely improved and more importantly, will probably benefit people with Type 2 diabetes and professionals alike to a much greater degree

It’s not perfect by any means. Foremost in our minds here at SD, is the disastrously limited use for personal blood glucose monitoring, about which we have expressed concern before on this blog. However, the authors and guideline committee have clearly listened to their critics, and allowed a much greater freedom of choice, for example of which medication class to use as treatment intensifies. They’ve also very helpfully articulated exactly what education programmes should comprise and when these should be offered. And at least, the topic of self-blood glucose monitoring in Type 2 diabetes is recommended for more research. So, good – as far as it goes

Of course, no guideline is of any use at all unless it’s followed – so take a look at the full thing and see whether it applies to your life or work with Type 2, or check out our ’10 Guideline Headlines’ for an overview to whet your appetite.

Elsewhere, Diabetes UK reported recently that diabetes numbers are ever growing, and have now topped 4 million, with the majority having Type 2 diabetes and people with this form are becoming younger and younger at diagnosis. This knowledge is bittersweet – on the one hand it focuses the minds of policy makers and the NHS alike, but on the other, to world-weary, longstanding diabetes campaigners and organisations, it brings a huge temptation to shout ‘I told you so!’, as they recall so many other warning reports that this would in fact, come to pass, and feel sad that these warnings were not heeded

But we are where we are, and so the recent report of the Public Accounts Committee of the UK Government, concluding that diabetes is costing the nation far too much and there is far too much variance in the standards of care, shines a welcome light on what needs to be done urgently, albeit the cry of ‘again’ might be heard from some quarters

Just today, it’s been announced that the All Party Parliamentary Group (APPG) for Diabetes will be hosting an international diabetes conference in Parliament on 3rd February, with the aim of sharing best practice in diabetes and raising awreness. It’s open to attendance by people living and working with diabetes alike, providing a welcome chance for these groups to meet each other on common ground. That’s an opportunity not often seen, despite grand rhetoric about collaboration and partnership in care. Despite the short notice, this is likely to be a buzzing event and something new and different to herald what looks likely to be a landmark year for diabetes developments.

Judging by the way it’s started, there’s every reason to hope this new year diabetes flurry becomes a full-on storm! Bring it on


References

Management of Type 2 Diabetes in Adults
Type 2 Diabetes – Time to Test?”
SD Downloads
Number of People with Diabetes Reaches Over 4 Million
Diabetes: Government and NHS Too Slow to Act, say MPs
APPG to Host International Diabetes Conference in UK Parliament

Monday, 4 January 2016

Bongs and Gongs: But Aren’t We All Winners?

When the bongs sound at midnight at the end of the year, one thing about the year to come is already known – who has received a New Year Honour, as typically these are announced on or around New Year’s Eve

Last year was no exception and it was absolutely delightful to hear that a prominent professor of diabetes and the chair of one of Diabetes UK’s local groups had both been awarded a national medal. Both are extremely well deserved and we offer them our hearty congratulations

When congratulated, recipients almost always say the award is not just for them but for the people they work with and for. This seems to be especially true for diabetes, which requires so much more than personal input, but also the support and contribution of many others, whether diabetes is personal or professional. Obviously not everyone can get a medal - and nor would everyone want one

What’s indisputable, however, is that where honours are accepted, they give a wonderful opportunity to highlight diabetes and its self care and medical care needs, and to put the people who live and work to improve both experience and outcomes firmly in the spotlight. Many people work hard in the cause of diabetes and in that sense we are all winners – those honoured help to show that

Wishing everyone the honour of a Happy and Healthy New Year!

Tuesday, 10 November 2015

8757 or 8760 - What’s the Difference?

Diabetes is a self managed condition. You live with it 24/7 and make decisions about how to manage it during that time. If you’re lucky, you receive help, support and learning, both informal and formal, from your nearest and dearest, other people with diabetes, diabetes health services and organisations. But it’s still yours every day.

Campaigns like the recently launched ‘Taking Control’ by Diabetes UK highlight how important the education side of things is, helping people to understand more and learn the skills to make those daily decisions. ‘SD Comments’ has talked many times about the tiny numbers of people who actually receive such learning opportunities, even though they are recommended for everyone, So, we’re really pleased to see this campaign get off the ground, support it wholeheartedly, and wish it every success. There is just one thing, however…..

…and that is, the first sentence of the introduction to the campaign reads ‘..people with diabetes only spend around three hours with their doctor, nurse or consultant. For the other 8757 hours, they must manage their condition themselves’. This implies that when someone with diabetes is consulting, somehow the responsibility for their diabetes belongs to the health professional they are with.

It’s not deliberate, but this is another example of what might be called ‘unconscious paternalism’ – the idea that it’s ok for ‘patients’ to do their own thing unless they are under the jurisdiction (ie in the consulting room) of a health professional.

Apart from being at odds with the personalised care policy, the push for greater collaboration between health professionals and people with diabetes and promotion of self care, this assumption also makes the mistake of thinking that the health professional being consulted actually knows what is best for the person. They may be valued experts in diabetes, but not in living with diabetes and particularly not in an individual’s life with diabetes, not on that day, in that hour, or ever. Nor should they try or expect to be.

What’s needed is for this oft-trotted statistic to be reflected upon. Is this really what we want those numbers to mean? We suggest not. It’s perfectly valid to count the hours (or lack of them, some would say) that someone spends with a health professional, It’s also perfectly valid to consider how well these hours are used to promote and support self management and daily decision making. What’s not valid is to perpetrate the unconscious but well-rehearsed assumption, however well-meant, that really, it’s the health professional who matters most, who is somehow ‘in charge’

People with diabetes are perfectly capable of looking after their diabetes within a consultation as outside it, 8760/8760. The job of the consultation is to reflect and work together on the experiences these hours raise for the person themselves, so that they are equipped to make each one of them a success

Reference

Diabetes UK’s Taking Control Campaign

Tuesday, 20 October 2015

Should There be Sugar Everywhere?

The campaign to encourage the UK Government to tax sugary soft drinks stepped up a notch this week, with Jamie Oliver continuing his quest at the Houses of Parliament, first with the Health Select Committee and then with the All Party Parliamentary Group (APPG) on Diabetes. He reckons the tax will raise up to £1bn and also change the nations habits and choices towards low sugar varieties of fizzy drinks or water. Jamie’s leading by example in his own restaurants, by making sugary drinks more expensive than ‘diet’ varieties.

Whether this will even be adopted, much less work, remains to be seen. A new tax, particularly on a ‘pleasure’ related activity, may not be popular with the all-important voters. And might it smack of ‘nanny state-ism’, trying to organize the behaviour of the population, rather than allowing them to choose for themselves what is good for them and their families? Discussion boards are full: of ‘righteous restrainers’, who ask why they should pay more tax just because others cannot control themselves in relation to calories, as well as ‘generous gifters’, who see the benefits to all – dental, environment, economic – of a change in availability of so much sugar – and everything in between. Public opinion is divided.

On the other hand, it’s undeniable that we are in the middle of a resolutely ticking, weight-related time bomb, set to go off at any time and unleashing untold illness, misery, and expense to the NHS among middle aged and younger people. Some say there is a generation alive now, who will be the first to die before their parents, because of the wrath of Type 2 diabetes, cardiovascular disease and immobility, caused by excess calories, of which they are largely unaware because of (allegedly) limited labelling and ruthless marketing on the part of the giant fast food industries

How can these issues be resolved in the interests of everyone? One thing’s for sure, this will not be a ‘one solution fits all’ situation – tax sugary drinks and all will be well. Equally, we believe strongly that people are the best decision makers for themselves, given the information they need to weigh up their choices. So there needs to be a much wider range of information and approaches. Here are some of our ideas to contribute to a way forward:

The National Prevention Programme for Type 2 Diabetes needs to be heavily involved in messages about the seriousness of Type 2 diabetes and the possibility of its prevention, directed at everyone, rather than to those immediately at risk. There are still too many myths about Type 2, including ‘it comes on in later life’ and ‘it’s only the mild form’. The nation’s psyche in this respect needs all the help it can get to change.

Fast food, ready made food and drinks companies need to invest in much clearer labelling to help people make choices – Jamie Oliver’s suggestion that sugar content is shown in spoonfuls rather than grams, for example, would make much more sense to every buyer as they can envisage those spoonfuls being added.

Comparison tools (maybe linked to the self-scanners on trolleys or on the shop floors?) to be freely available in food stores . These would show the relative sugar content of different products by name, so that people can make on the spot choices while actually shopping. These comparator tools could also be online or even (remember the old ways?) in pictorial leaflet –form, but would be most important in-store, where the shopping head is in full control.

The answer to the question this blog poses? There can be sugar everywhere, but it doesn‘t mean we have to eat it. Other substances are also available – as long as we know it!


Reference

Be Bold on Sugar Tax, Jamie Oliver Says

Jamie Oliver meets with Diabetes UK at Parliament

Tuesday, 29 September 2015

Old Things in New Ways?

The promotion of self-management of diabetes by the person with the condition themselves is not new. As far back as the 1940s, when insulin was relatively new in town and medications for Type 2 diabetes were hardly thought of, a young doctor called Robin Lawrence wrote in his book ‘The Diabetic Life’ – ‘the patient must be at once his own doctor, dietitian and lab technician’. This urge and acceptance that diabetes is absolutely a self-managed condition somehow got lost over proceeding decades, when health professionals tended to take charge of both medications and expectations

More recently there’s been a massive upsurge in ‘people power’ in society generally. The expectation and indeed, often, political will, is that people will do things for themselves. We are our own cashiers in the supermarket, our own bankers and even our own hotel receptionists. This upsurge has been replicated in medicine, not least because most illnesses these days are the long term variety, such as diabetes, that people have to manage themselves each day. This is well recognised, being mentioned in health policy documents as well as official guidelines and enacted in practical situations such as GP’s clinics and hospital wards. Indeed, our own work here at SD is all about promoting success in living with diabetes

Given this situation, the news this week that a major international meeting of the great and the good of diabetes care and education, held here in the UK, had formed an alliance which resolved to make diabetes care more person centred and promote self management, would seem rather unnecessary. Surely things are going in the right direction already? Do we need another layer of ‘initiative’ in this direction?

The truth is, as we’ve no doubt said before, that there is a lot of TALK about promoting self-management and being person-centred, but often the ‘old ways’ – a rather paternalistic approach, people being ‘told off’ for not achieving text book results, scant regard for the emotional turmoil which many people experience their diabetes, etc etc – persist, even supported by protestations that ‘the patients need me to tell them what to do, otherwise they wouldn’t know’

Hence a new, eye-catching way of promoting this way of being in relation to helping people really run their own condition has got to be good. The words might not be new, but the actions could reflect new times to come. We await this Alliance’s progress with our full support

Talking of old and new, SD is changing its ways this week, too. 30th September 2015 sees the last issue of our monthly newsletter, which has been running since 2008. Our refreshed communication plan is to make much more use of the instant means available to us, to update much more often using the 21st century tools of social media, Facebook, Twitter and the like – and add more frequent, but shorter, comment on the blog here. The need to communicate is as old as the hills, but the ways of doing it can be ever newly minted!

References

The Diabetes Times: Alliance formed to promote diabetes self management