Obesity: working with local communities

careful planning, taking into account the local and national context and working in partnership with recipients

a sound knowledge of community needs

existing skills and resources, by identifying and building on the strengths of individuals and communities and the relationships within communities.

Using community resources to improve awareness of, and increase access to, interventions. For example, they involve community organisations and leaders early on in the development stage, use media, plan events or make use of festivals specific to black and minority ethnic groups.

Understanding the target community and the messages that resonate with them.

Identifying and addressing barriers to access and participation, for example, by keeping costs low to ensure affordability, and by taking account of different working patterns and education levels.

Developing communication strategies that are sensitive to language use and information requirements. For example, they involve staff who can speak the languages used by the community. In addition, they may provide information in different languages and for varying levels of literacy (for example, by using colour-coded visual aids and the spoken rather than the written word).

Taking account of cultural or religious values, for example, the need for separate physical activity sessions for men and women, or in relation to body image, or beliefs and practices about hospitality and food. They also take account of religious and cultural practices that may mean certain times of the year, days of the week, settings, or timings are not suitable for community events or interventions. In addition, they provide opportunities to discuss how interventions would work in the context of people's lives.

Considering how closely aligned people are to their ethnic group or religion and whether they are exposed to influences from both the mainstream and their community in relation to diet and physical activity.

Council leaders and elected members.

Local authority chief executive officers.

Health and wellbeing boards.

Directors of public health.

Executive directors of local authority services.

Local NHS trusts.

Local Healthwatch.

Leaders of local voluntary and community organisations.

Clinical commissioning groups.

Local education and training boards.

All of the above should ensure, through the health and wellbeing board, a coherent, community-wide, multi-agency approach is in place to address obesity prevention and management. Activities should be integrated within the joint health and wellbeing strategy and broader regeneration and environmental strategies. Action should also be aligned with other disease-specific prevention and health improvement strategies such as initiatives to prevent type 2 diabetes, cancers and cardiovascular disease, as well as broader initiatives, such as those to promote good maternal and child nutrition or mental health or prevent harmful drinking. (See NICE's guidelines on type 2 diabetes prevention: population and community interventions, cardiovascular disease prevention, maternal and child nutrition, and alcohol use disorders: prevention.)

Health and wellbeing boards, supported by directors of public health, should ensure joint strategic needs assessments (JSNAs) address the prevention and management of obesity. They should ensure JSNAs:

Health and wellbeing boards should ensure tackling obesity is one of the strategic priorities of the joint health and wellbeing strategy (based on needs identified in JSNAs).

Health and wellbeing boards and local authority chief executive officers should encourage partners to provide funding and other resources for activities that make it as easy as possible for people to achieve and maintain a healthy weight. This includes, for example, activities to improve local recreation opportunities, community safety or access to food that can contribute to a healthier diet. Partners should be encouraged to provide funding and resources beyond one financial or political cycle and have clear plans for sustainability.

Health and wellbeing boards should work in partnership with local clinical commissioning groups to ensure a coherent approach to tackling obesity that spans both prevention and treatment.

Health and wellbeing boards should work with partners to optimise the positive impact (and mitigate any adverse impacts) of local policies on obesity levels. This includes strategies and policies that may have an indirect impact, for example, those favouring car use over other modes of transport, or decisions to remove park wardens, that affect people's use of parks.

Health and wellbeing boards, through their performance infrastructure, should regularly (for example, annually) assess local partners' work to tackle obesity (taking account of any relevant evidence from monitoring and evaluation). In particular, they should ensure clinical commissioning group operational plans support the obesity agenda within the health and wellbeing strategy.

Directors of public health and public health teams.

Chairs of local health and wellbeing boards.

Executive directors of local authority services.

Council leaders and elected members.

Leaders of local voluntary and community organisations.

Clinical commissioning group leads for obesity (where they exist).

Clinical commissioning representatives on local health and wellbeing boards.

Local education and training boards.

All of the above should provide visible, strategic leadership to tackle obesity at all levels and ensure an effective team is in place.

Directors of public health and public health teams should ensure all those responsible for activity that impacts on obesity understand the needs and priorities of the local community, as outlined in JSNAs. They should ensure all partners understand JSNA priorities and be prepared to decommission services, if necessary, to divert resources to priority areas.

Local authority chief executive officers and directors of public health should:

Directors of public health should seek to secure high-level commitment to long-term, integrated action on obesity, as part of the joint health and wellbeing strategy. This includes:

Leaders of local voluntary and community organisations should ensure the local approach to obesity:

All clinical commissioning groups should be encouraged to identify an obesity or public health lead to work with the public health team on joint approaches to tackling obesity.

Directors of public health and public health teams.

Health and wellbeing board chairs.

Clinical commissioning groups.

Executive directors of local authority services.

Council leaders and elected members.

Chief executive officer of the local education and training board.

Public health teams should identify and work with 'champions' who have a particular interest or role in preventing obesity in local authority and NHS strategy groups and public, private, community and voluntary sector bodies. This includes, for example, those involved in planning, transport, education and regeneration.

All of the above should work to build and support a network of leaders from all organisations and partnerships that could make a contribution to preventing obesity. This should include relevant local authority and NHS services, voluntary and community organisations and the private sector.

Directors of public health should support leaders at all levels (including senior and middle managers and frontline staff) of all the partnerships involved in local action on obesity, to ensure local people and organisations are empowered to take action. This means:

Health and wellbeing boards.

Executive directors of local authority services.

Directors of public health and public health teams.

Community-based health workers, volunteers, groups or networks.

Community engagement workers such as health trainers.

Local authority chief executive officers should ensure there is an effective public health team in place to develop a coordinated approach to the prevention of obesity. This should include:

Coordinators should advise commissioners on contracts that support the local obesity agenda to ensure a 'joined-up' approach. They should encourage commissioners to promote better integration between providers through the use of joint contracts and supply chain models that provide a range of local options. The aim is to tackle the wider determinants of obesity and support local people to make changes in their behaviour to prevent obesity.

Directors of public health should ensure coordinators engage frontline staff (such as health visitors, environmental health officers and neighbourhood wardens) who can contribute to local action on obesity.

Directors of public health should ensure frontline staff set aside dedicated time to deliver specific aspects of the obesity agenda and receive training to improve their understanding of the needs of the local community and improve their practical implementation skills.

Coordinators and community engagement workers (such as health trainers and community development teams) should work together to develop and maintain a map of local people and assets that could support a community-wide approach to combating obesity. This includes:

Coordinators and community engagement workers should jointly plan how they will work with population groups, or in geographic areas, with high levels of obesity. Plans should consider the motivations and characteristics of the target groups, in relation to obesity. Coordinators should also map where public, private, community and voluntary organisations are already working in partnership to improve health or on other relevant issues.

Coordinators, supported by the director of public health, should encourage and support partnership working at both strategic and operational levels. They should ensure partner organisations are clear about their contribution and responsibilities. They should consider asking them to sign an agreement that pledges specific relevant actions in the short and long term.

Directors of public health and public health teams.

Local government and NHS communications leads.

Directors of public health and local government communications leads should ensure elected members and all management and staff working with local communities, both within and across partner organisations, are aware of the importance of preventing and managing obesity. The commitment of middle managers and those with a strategic role is particularly important. For example, they should:

Local government communications leads should ensure obesity prevention programmes are highly visible and easily recognisable. Recognition may be increased – and costs kept to a minimum – by adapting a widely known brand for use locally (such as NHS healthier families). Where appropriate, branding should be agreed by elected members and the health and wellbeing board.

Communications leads should ensure partners have shared vision, speak with 'a common voice' and are clearly identifiable to the community. This can be fostered by promoting all relevant activities under the obesity programme 'brand' and using this branding consistently over the long term.

Health and wellbeing board chairs and executive directors of local authority services should advocate for action on obesity in any discussions with partners or the local media.

Directors of public health and local government communications leads should carefully consider the type of language and media to use to communicate about obesity, tailoring language to the situation or intended audience. Local insight may be particularly important when developing communications to subgroups within a community or specific at-risk groups. For example, in communications to some local communities, it might be better to refer to a 'healthier weight' rather than 'preventing obesity', and to talk more generally about health and wellbeing or specific community issues. Making explicit the relevance of a wide range of initiatives for tackling obesity, for example in annual reports, may be helpful.

The local coordinator and public health teams should ensure the results of all monitoring and evaluation are made available to all those who can use them to inform their work, both in the local community and nationally. For example, log evaluation reports in the Obesity Learning Centre or Public Health England's healthy places databases, or the NICE shared learning database.

The local coordinator and communications leads should ensure information from monitoring and evaluation is accessible and easy to use by everyone in the community, including those involved with obesity prevention, local groups and networks, the media and the public. This includes presenting information in accessible formats and different languages.

Local Healthwatch.

Local authority community involvement teams.

Directors of public health and public health teams.

Local voluntary and community organisations, champions and networks.

Council leaders and elected members.

Clinical commissioning groups.

Local Healthwatch, community involvement and public health teams should engage local people in identifying their priorities in relation to weight issues. For example, residents may feel that issues such as crime, the siting of hot food takeaways or alcohol outlets, the lack of well-maintained green space, pavement parking, speeding, or the lack of a sense of community are their top priorities. Where possible, it should be made explicit that local concerns often can (and do) impact on levels of obesity in the community.

Community involvement and public health teams should work with local people, groups and organisations to decide what action to take on obesity. They should recognise local concerns both in terms of the focus of programmes or services and how they might be delivered. This includes involving local groups, networks or social enterprises in any discussions about service redesign and ensuring that they receive feedback about decisions taken.

Public health teams should use community engagement and capacity-building methods to identify networks of local people, champions and advocates who have the potential to co-produce action on obesity as part of an integrated health and wellbeing strategy. These networks include:

Public health teams should ensure those identified are provided with the resources and training they need to take action on obesity.

Clinical commissioning groups should make their GP practices aware of local obesity prevention and treatment services. They should encourage GPs to:

Council leaders and elected members should raise the profile of obesity prevention initiatives through informal meetings with local people and groups and at formal ward meetings.

Local authority, NHS and other local commissioners.

Directors of public health and public health teams.

Commissioners and public health teams should foster an integrated approach to local commissioning that supports a long-term (beyond 5 years) system-wide health and wellbeing strategy.

Public health teams should ensure commissioners understand the demographics of their local area, and consider local insight on the motivations and characteristics of subgroups within local communities that may impact on obesity levels.

Commissioners and public health teams should create an environment that allows the local system to take a truly community-wide approach to obesity. They should consider:

Commissioners should focus on all of the following areas (focusing on just one at the expense of others may reduce effectiveness):

Commissioners should fund both targeted and universal services that can help people achieve or maintain a healthy weight. The specific package of services should be based on local needs, but should include both top-down approaches such as planning cycle routes and food procurement specifications and bottom-up approaches such as running activities in local parks and breastfeeding peer support (as appropriate). They should include interventions that are known to be effective as outlined in existing NICE guidance, including:

Commissioners should allocate some of their budget to help establish and sustain local community engagement activities such as small community projects or local community groups. This can be done by, for example, funding the expenses of the leaders of community walking groups, or providing small grants to hire meeting spaces.

Commissioners should allocate some of their budget to innovative approaches to obesity prevention that are based on sound principles, have the support of the local community and are likely to be effective, but for which there is limited evidence. Funds for innovative approaches should be allocated within a framework of action learning and evaluation.

All contracts should include requirements for regular monitoring or evaluation (see recommendations 10 and 11). Commissioners should ensure some flexibility in contracts to allow programmes or services to be adapted and improved, based on early or ongoing monitoring. Any changes should be clearly documented and carefully monitored. Clear processes should be put in place for learning and evaluation, especially for new approaches.

Commissioners should ensure service specifications and contracts encourage local partnership working and reduce unnecessary duplication and overlap, particularly for local services provided by the voluntary and community sector (for example, by specifying a joint rather than separate approach for physical activity and food and nutrition initiatives).

Where possible, commissioners should consider extending effective programmes or services, recommissioning effective small-scale projects and commissioning small-scale projects or prototypes that fill a gap in provision. (Such actions should be based on local experience, monitoring and evaluation.)

Commissioners should consider redesigning or decommissioning programmes or services that are identified by local Healthwatch or other local bodies with a scrutiny function (such as health overview and scrutiny committees) as ineffective or not meeting the community's needs.

Directors of public health and public health teams.

Local authority communications leads.

Chambers of commerce.

Environmental health departments.

Council leaders and elected members.

Public health coordinators, with support from directors of public health, should establish methods for involving business and social enterprises in the implementation of the local obesity strategy. This includes, for example, caterers, leisure providers, weight management groups, the local chamber of commerce, food retailers and workplaces. They should consider developing local activities based on national initiatives to achieve this.

Public health teams and local authority communications leads should develop mechanisms of governance for working with business and social enterprises that are in the public interest. For example, they could address issues around appropriate sponsorship or competing priorities, with transparent mechanisms to address real or perceived conflicts of interest.

All of the above should encourage all businesses and social enterprises operating in the local area to recognise their corporate social responsibilities in relation to health and wellbeing. This should be in relation to:

Chief executive officers.

Executive directors of local authority services.

Local authority and NHS commissioners.

Directors of public health and public health teams.

Council leaders and elected members.

Public health teams should ensure local authorities and NHS organisations develop internal policies to help staff, service users and the wider community achieve and maintain a healthy weight.

Local authorities, NHS executive directors and commissioners should promote healthier food and drink choices (and discourage less healthy choices) in all onsite restaurants, hospitality suites, vending machines, outreach services and shops. They should do this through contracts with caterers, pricing and the positioning of products, information at the point of choice and educational initiatives. See also the recommendation on public sector food provision in NICE's guideline on cardiovascular disease prevention (recommendation 20) and the recommendation on promoting a healthy diet: local action in NICE's guideline on type 2 diabetes prevention: population and community interventions (recommendation 8).

Local authorities and NHS organisations should introduce and monitor an organisation-wide programme that encourages and supports staff and, where appropriate, service users, to be physically active. This includes, for example, introducing physically active travel plans for staff to promote walking and cycling to and from work. It also includes considering the design of working environments to increase opportunities for physical activity. See also the recommendation on physical activity in NICE's guideline on cardiovascular disease prevention (recommendation 21); the recommendation on promoting physical activity: local action in NICE's guideline on type 2 diabetes prevention: population and community interventions (recommendation 10); and NICE's guideline on physical activity in the workplace).

Local authorities and NHS organisations should offer lifestyle weight management services (in line with best practice outlined in NICE's guideline on weight management: lifestyle services for overweight or obese adults) for overweight or obese staff who would like support to manage their weight.

Local authority and NHS commissioners should consider how their decisions impact on obesity in the local community. For example, ensuring the provision of healthier choices is included in food contracts for leisure centres may have a positive impact on the diet of people who visit or work at these centres.

Directors of public health and public health teams.

Local authority, NHS and other local commissioners.

Providers of local authority or NHS commissioned services that have a direct or indirect impact on obesity.

All of the above should ensure sufficient resources are set aside for planning, monitoring and evaluation, and that all partners and providers appreciate the importance of monitoring and evaluation.

All of the above should ensure all monitoring and evaluation considers the impact of strategies, policies and activities on inequalities in obesity and related health issues.

All of the above should ensure all strategies, policies and activities that may impact on the obesity agenda (whether intended or not) are monitored in a proportionate manner. Monitoring arrangements should be built into all relevant contracts.

All of the above should ensure sufficient resources are set aside to thoroughly evaluate new or innovative pieces of work (for example, 10% of project budgets).

Local authority, NHS and other commissioners should ensure, when commissioning services, there is an appropriate lead-in time for baseline data collection, and data are stratified so that the impact on inequalities can be considered.

All of the above should use simple tests to assess value for money (such as resources saved by working in partnership).

All of the above should encourage a reflective learning approach that builds on effective practice and changes or discards practices that are found to be less effective.

All of the above should ensure monitoring arrangements address the information needs and expectations of a broad range of groups by:

Public Health England.

Directors of public health and public health teams.

Academic health networks and other academic institutions.

Local authority, NHS and other local commissioners.

Provider organisations.

Public Health England is encouraged to develop a framework for monitoring and evaluating integrated community-wide approaches to obesity to ensure consistency and comparability across all local areas.

Directors of public health and public health teams should develop methods to capture changes in know of what it means to be a healthy weight and the benefits of maintaining a healthy weight.

Academic health networks and academic institutions should:

All of the above should encourage all partners to measure a broad range of outcomes to capture the full benefits of a sustainable, integrated health and wellbeing strategy. Appropriate outcomes include:

Academic health networks and other academic institutions.

Directors of public health and public health teams.

Local authority, NHS and other local commissioners.

Provider organisations.

All of the above should use simple tests to assess value for money of local action to tackle obesity. This may include determining whether resources would be saved by working in partnership, or measuring whether benefits in one sector (such as health) are sufficient to offset costs incurred in another (such as transport or leisure services).

All of the above should ensure evaluation frameworks assess the value for money of partnership working and collaboration compared with working as separate entities.

All of the above should identify aspects of partnership working or cooperation that can achieve health benefits at negligible or low cost (extensive economic modelling is not needed on a routine basis).

Health and wellbeing boards.

Local education and training boards.

Directors of public health and local public health providers.

Academic health networks and other academic institutions.

Professional bodies providing training in weight management, diet or physical activity.

Health and wellbeing boards, local education and training boards, and public health teams should ensure partners across the local system have opportunities to increase their awareness and develop their skills to take forward an integrated approach to obesity prevention. Local organisations, decision makers, partners and local champions, including those from public, private, community and voluntary sector bodies working in health, planning, transport, education and regeneration, should receive training to:

Local education and training boards should ensure health promotion, chronic disease prevention and early intervention are part of the basic and post basic education and training for the public health workforce.

Local education and training boards and the other groups listed above should ensure health and other relevant professionals are trained to be aware of the health risks of being overweight and obese and the benefits of preventing and managing obesity. This training should include:

All of the above should ensure training addresses the barriers some professionals may feel they face when initiating conversations about weight issues. For example, they may be overweight themselves, or feel that broaching the subject might damage their relationship with the person they are advising.

All of the above should ensure all relevant staff who are not specialists in weight management or behaviour change can give people details of:

All of the above should promote, as appropriate, web resources which encourage a community-wide approach to obesity. Resources include: National Heart Forum's healthy weight, healthy lives toolkit for developing local strategies, the Obesity Learning Centre and Public Health England's healthy places resources.

Local bodies with a scrutiny function (such as health overview and scrutiny committees).

Local Healthwatch.

Local bodies with a scrutiny function (such as health overview and scrutiny committees) should assess local action on preventing obesity, ensuring that commissioning meets the breadth of the joint health and wellbeing strategy. This includes:

Local bodies with a scrutiny function should be encouraged to include plans of action to prevent obesity within their rolling programme of service reviews.

Local Healthwatch should ensure the views of the local community are reflected in the development and delivery of the local approach to obesity. They should also scrutinise the priority given to obesity prevention by local health and wellbeing boards and the implementation of local obesity strategies.