McDonalds Monopoly is a hugely popular fast food promotion that’s terrible for our health and encouraging our children to gamble. Our tip for beating the system? Try out SHINE’s take on MaccyD’s Monopoly – KathyS’s Scra(m)bble! We’ve got a list of great snack and meal ideas – plus prizes that children and young people will love – right here on our worksheet! Click here to read more.
A recent article in the Sheffield Star reported that despite 150 children requiring hospital treatment for obesity in Sheffield over the last three years, the number actually undergoing gastric surgery has plummeted (link).
The first thing to say on this story is how sad it is we’re even having discussions around bariatric surgery as a possible treatment pathway for children and young people. UK child obesity statistics support the view that UK child obesity is approaching epidemic levels. This year the National Child Measurement Programme (NCMP) measures have identified children with severe obesity or morbid obesity (>99.6 centile), where previously they only identified the differences between overweight and obese. That revision has revealed some shocking information for Sheffield –
21.2% of the city’s Reception year children are now obese. That’s an increase of 0.5% on last year’s figure and well above the national average of 20%.
35.6% of Year 6 pupils are either overweight or obese. Of those, 4.97% are severely obese – compared with a national average of 4.07 per cent.
Many of these young people with severe obesity would benefit from specialist Tier 3 services like ours but we can only see around 150-200 families with complex needs a year! That’s thanks to our Children in Need grant, of course. Providing services for these children via the NHS would be brilliant – but it would have a major impact on the health budget. Which is perhaps one of the reasons why these services are not currently funded by CCG’s.
So why are the figures for surgery dropping? The Clinical Commissioning Policy document ‘Obesity surgery for children with severe complex obesity’ (link here) identifies children eligible for bariatric surgery as those with BMI > 40 or BMI greater than 35 with a co-morbidity (ie type 2 diabetes, fatty liver, sleep apnoea). It advocates potential need for surgery and sets recommendations to be met before surgery is considered –
Children must have completed management treatment within Tier 3 services prior to assessment
Children must have undertaken assessments by a multi disciplinary team (including psychological assessments)
Surgery must not be offered until all non-surgical avenues have been explored and have been found to be unsuccessful
Patients must receive follow up care for five years
This feels like an impossible set of criteria to meet. How can this criteria be achieved when there is no national funding for Tier 3 services for children? And there’s no consistency for obesity treatment for children with severe obesity across the country – we desperately need the government to take this seriously and provide adequate guidelines and funding for children with severe obesity.
Is this lack of funding/services why the number of bariatric surgeries offered are reducing as number of children with severe obesity is increasing? If there were no bariatric surgery procedure undertaken for young people in the last two years is this because there is no statuary Tier 3 obesity service for children to access so the criteria for surgery cannot be met?
We’ve certainly noticed a change in the number and needs of children and young people we work with. When SHINE started in 2003 we saw 30 families a year with Body Mass Index (BMI) between 91st and 98th centile and managed to get most of the children into healthy weight ranges within 6 months – we now see around 200 families a year with complex needs requiring two or three years’ worth of support.
Our new term started January 2019 with 60 young people all with a BMI of higher than 99.6 centile, which means they were all severely obese when they came to us. Of these, more than half have a BMI of over 3.5 Standard Devisation Score (SDS) with co-morbidities or over 4 SDS who are working through our non invasive programmes. The latter fit the criteria for bariatric surgery according to the CCP’s report.
But the point here is that SHINE believe children shouldn’t be being offered surgery as a first line of treatment. SHINE provides demonstrably successful alternatives to the knife.
The National Child Measurement Programme (NCMP) is a boring name for what is actually a huge and extremely useful annual survey. It contains measurements taken in schools for Reception and Year 6 children and is published by NHS Digital annually. This year is the first time they’ve identified children with severe obesity (>99.6 centile) and there are some shocking figures for Sheffield.
- 21.2% of Reception year schoolchildren are now obese. That’s 0.5% higher than the previous year, and above the national average of 20%.
- 35.6% of Year 6 pupils in the city are either overweight or obese and 4.97% of these children are severely obese – compared with a national average of 4.07 per cent.
- At the time of the survey there were 40,724 children in Sheffield aged 6-11, which means that 2,023 children on this ratio are severely obese.
- And there were 36,472 children in Sheffield aged 12-17 so 1,812 of children in this age bracket could be severely obese. What’s even more worrying is that these children are not included in NCMP measures.
Many of these young people would benefit from specialist Tier 3 services like ours but we can only see 200 families a year! Providing services for these children would have a major impact on the health budget, which is perhaps one of the reasons why these services are not currently funded. But that’s a lot of children and young people who are being left behind.
This survey proves there’s a substantial proportion of children who fit the criteria for interventions for ‘severe’ level of obesity. In fact the children we’re seeing at SHINE are above +3 and +4, which is even higher.
But what services will be available for children like those in this report whose weight poses significant health risks?
Alongside services provision, the main thing we’d like to see here is more information. There are no measures as yet for young people once they enter secondary school. NCMP measures stop at Year 6 so after that children are not measured at any other stage of their childhood life. We know obesity increases with age so measuring children again after this age is crucial. We agree with Tam Fry at the National Obesity Forum who is pushing for children to be measured every school year as they used to be in the past – early intervention is paramount to prevent children needing Tier 3 services.
So, have the government finally realised the obesity epidemic is at crisis point after publishing their very first statistics relating to ‘severe’ levels of obesity in children and young people?
Let’s start with the good news. It was hugely heartening, following SHINE’s visit to London to give evidence to Diana Johnson (member of the Health Select Committee) and Sharon Hodgson (Shadow Health Minister) to get a promise that provision for Tier 3 services for severely obese children would be included in chapter two of the Government’s obesity plan.This is important because it’s a pathway to funding treatment. Clinical Commissioning Groups (CCGs) fund at a local level based on money allocated from central government. There is currently no ring- fenced money for Tier 3 services for children. We desperately need the government to set clear performance indicators and targets for multidisciplinary services so that CCGs have to fund these services. SHINE’s track record of delivery means we’re perfectly placed to deliver these services.
Anyway, just before the report came was published last summer, we found out it wouldn’t actually include provision for Tier 3 services. It did include the following passage –
“Signposting to appropriate advice, and where necessary, timely referrals for treatment was inconsistent for children living with childhood obesity. The Government must ensure there are robust systems in place not only to identify children who are overweight or obese, but to ensure that these children are offered effective help through a multidisciplinary, family-centric approach….’”
But there were no further details of how this would be managed.
The release of the report coincided with reports of the tragic death of an obese 13-year old boy from a blood clot whose weight was identified in post mortem as a “significant associated condition” – link.
The need for Tier 3 services is self-evident. We don’t just see it in the news, we see it every day at SHINE. When we started in 2003 we provided 12-week courses for 30 young people a year with ‘mild to moderate’ levels of obesity (BMI lower than 98th centile). We had rapid results and helped young people achieve their goal weight within six months. Today, we’re seeing around 200 families every year and children and young people weighing over 20 stone (BMI’s > 99.6 & 3.5 SDS known as clinical or morbid obesity) with extremely complex needs requiring intense interventions and long term support for up to two years.
So, going back to the question we started with – have the government finally realised the obesity epidemic is at crisis point for ‘severe’ levels of obesity in children and young people? Unfortunately it would appear not. How many more children need to die needlessly before we address this problem?
There’s no such thing as a child with simple needs. But developing a learning difficulties-focussed weight management programme has shown us how complex the world can be for some of the most challenged children in our community…
More and more children with learning difficulties are obese. In 2016 the British Paediatric Neurology Association and British Academy of Childhood Disability measured 264 pupils attending a local Special Educational Needs (SEN) secondary school. They reported 40% of pupils with learning disability were overweight or obese, which is much higher than published reports for the general population of the same age at 33%. And SHINE have been partnering with Sheffield Mencap & Gateway on a new project to adapting our materials to deliver weight management programmes for this important specialist group.
With the support of Mencap Chief Exec Janet Sullivan and funding from Children in Need, we’ve trained four Mencap staff teachers here in Sheffield to deliver a new SHINE weight management programme, which includes an increased visual focus and more interactive exercises and games.
Textures, colours and aromas all play a massive part in eating for children with learning difficulties so understanding sensory eating has been really important for this. Through engagement and observations we’ve found out loads about how children with learning difficulties can be selective or fussy eaters, disliking ‘wet’ food like gravy, sauces and yoghurt and preferring ‘beige’ foods like potatoes, bread and pasta. Children with learning difficulties can have entrenched disordered eating patterns at mealtimes, further complicated by medical conditions such as Pica and Prader-Willi Syndrome.
We’ve also learnt a lot from parents, who’ve openly discussed how difficult it is to manage these behaviours and how tempting it can be to give in to demands for a ‘quiet life’. But with guidance and support from SHINE staff, our parents have made amazing changes – challenging demands, setting boundaries around family mealtimes and introducing new foods in a fun way. Following positive results, we’re about to progress to our September course with new learning and greater confidence in our ability to help families make changes. Well done to our first group – you did us proud!
Why is the government decommissioning weight management services for children when obesity rates are increasing? Why are there still no tier three services for children? When will the government move beyond prevention to providing help and support for children who are overweight now? Who will fund this work?
Everyone wants to feel like they’re listened to. SHINE’s recent visit to London to share our thoughts with members of the UK Parliament’s Health and Social Care Committee was a chance for us to get the ear of people with the power to change the direction of UK obesity policy.
The call to visit came about as a result of our recent petition to fund obesity services for UK children and young people and it’s just one step in a larger process. But when we went down we tried to provide the committee with useful answers to their questions, as well as asking a few of our own.
That committee included some big names, including Diana Johnson, who’s member of the UK Parliament’s Health and Social Care Select Committee, Andrew Selous, who’s Chair of the All Party Parliamentary Group on Obesity and Shadow Health Minister, Sharon Hodgson.
We presented alongside MoreLife with support from Dr James Nobles and Professor Paul Gately from Leeds Beckett University and brought seven young people from SHINE along with us. Destiny – one of the young people on our maintenance programme – told the story of her battle with binge eating and powerfully highlighted the need for more complex interventions for young people in addition to promoting healthy eating and physical activity.
The committee’s report ‘Childhood Obesity: A time for action’ came out shortly after our visit (link) and as expected concentrates mainly on preventative action. Marketing, advertising and sugar tax all feature heavily. But our eye did go to a brief statement on page 33, which read, ‘The Government must ensure there are robust systems in place not only to identify children who are overweight or obese, but to ensure that these children are offered effective help. Addressing health inequalities must include providing help for those children who are already obese…’ Our hopes for meaningful change to policy were pinned on this sentence but the ‘Obesity Strategy :Chapter 2′, subsequently published in June 2018, didn’t pick up this thread. There was no mention of any guidelines for intervention pathways or strands of funding. This leaves us wondering how on earth they will achieve their target of reducing childhood obesity by half by 2030.
Huge thanks to Labour MP Paul Blomfield for helping us get SHINE’s voice – and those of Sheffield’s young people – heard and also to Ben Mackay for all his support.
One in five children enter school overweight or obese, increasing to one in three when they leave school at Year 6. What’s going on?
Over the last three years we have been working with two schools in Sheffield to find out.
Our project involves measuring children every year to see if we can pick up any patterns with an aim of changing this upward trend. Children spend approximately a quarter of their life in school, so they’re are a great place to promote, encourage and build good health and wellbeing. Leeds Beckett University have been helping us to find out if this whole school approach is beneficial.
The two schools involved are from the same area; with one ‘working as usual’ and the second working together with SHINE to become healthier. Here are some of the things we’ve delivered together so far –
- Improved breakfast clubs by providing age related food portions and by reducing sugary cereals.
- Increased availability and range of healthy snacks.
- Encouraged teachers to avoid rewarding achievements with sweets and chocolate.
- Increased the level of physical activity through walking buses, running a mile a day, offering ‘stay and play’ sessions for children and their parents and teaching curriculum subjects through physical activity.
We’ve also trained up four SHINE Healthy Weight Leaders (teachers and classroom assistants) to have the appropriate knowledge and skills to talk with parents about the weight of children, and to do so in a sensitive and confident manner without judgement or stigma. Lastly, we’ve helped children who have experienced weight gain by offering family-based support.
The results so far suggest that the programme is working. In both schools, we’ve seen that rates of obesity have not increased. But in the school that is having additional support from SHINE, it looks like the programme is really helping to support the children in maintaining a healthy weight. We have noticed though that some children would benefit from additional support from SHINE, and this is what we will be looking to offer as we enter our third year.
Accepting additional support isn’t easy and we do face some initial resistance from parents. That’s normal though as children’s health and wellbeing is seen as a personal matter. Over the next year we’ll be focussing on building relationships so that our input will be viewed as helpful rather than intrusive.
Huge, out of this world thanks to Children In Need, who’ve provided SHINE with funding for the next three years. Their contribution will keep our doors open (and more – read on for the new courses we’re launching) but we’re thankful to EVERYONE who raised their voice to support us over the last few months of nail biting tension. Thankyou all!
We’re currently preparing to launch two new programmes for 2018 – an expansion of our current psycho social programme to include younger children and a new pilot with Sheffield MENCAP and Gateway which we’d love to tell you about.
Since SHINE started 15 years ago the profile of our recruits has changed significantly. Originally referrals to us were mainly low level obesity. Few of the young people we worked with had illness-related excess weight. Today ALL our referrals have severe obesity and 22% are morbidly obese with severe co-morbidities – such as type 2 diabetes, fatty liver and high blood pressure. We’re actually now seeing children as young as six years with these conditions.
The number of children with learning disabilities referred to us has also increased. Every child is different but children with learning disabilities in particular can exhibit sensory eating difficulties where specific colours, textures and smells can prevent them from eating nutritional food, for instance. Although there’s overlaps with our psychosocial programme’s approach there’s also lots of specialist work needed to provide a service for these special young people.
SHINE needs to change to make sure we continue to help children with complex needs appropriately. The new funding from Children In Need enables us to expand our services to include younger children with severe levels of obesity. We’re hoping this will provide early intervention to help reduce the number of referrals for older children with severe and co-morbid conditions.
Excitingly the funding has also offered us the opportunity to develop a pilot project with Sheffield MENCAP & Gateway to adapt SHINE to meet the specific needs of children with learning disabilities. We’re currently training four learning disability staff to deliver an adapted SHINE programme. Right now they’re gaining insight from families of children with learning disabilties, finding out what will and won’t work for this specialist client group.
A third of children in the UK are overweight or obese; for those with severe weight problems this can greatly impact on their life. Children with weight issues have high risk of type 2 diabetes, fatty liver and high blood pressure and are more likely to have low self esteem, depression and be vulnerable to bullying.
SHINE has been providing services for children and young people with severe levels of obesity for the past 14 years and have been dependant on Grant funding to enable us to provide a range of interventions including psychosocial intervention courses (PSIs) and a much needed counselling service, for children with emotional issues that leads to further weight gain. As funding becomes more difficult SHINE have been working closely with local MP Paul Blomfield to get Tier 3 services recognised at government level in order for them to provide clearer guidance on commissioning and appropriate funding to provide much needed services for these vulnerable young people not just locally but on a national basis.
At present specialist services for severely overweight children is only provided in 7% of Local Authorities throughout the UK. We are urging the Government to provide adequate funding so that more specialist services can be offered for obese children with complex needs. We need them to invest in the treatment services that are urgently needed to improve quality of life.
Please support our e-petition:
We need 100,000 support signatures to get this issue debated in parliament – please give us your support.
Sign the petition here (link)!
From MPs to NHS Clinical Directors, the great and the good all agree that SHINE’s approach to Tier 3 obesity makes a significant difference to the lives and health of at risk children and young people. But as it stands SHINE Health Academy’s positive impact could end in December. That’s when our current funding ends as it stands.
The problem with funding our work is that no-one at local or government level appears to recognise or accept financial responsibility for Tier 3 work with children who have a BMI of over 99.6 centile. There is a false belief that there is no demand for such services and that children do not require this level of input. But the 200 families SHINE works with every year would suggest otherwise.
This year SHINE has seen more families than at any time in our history. We’ve a backlog of young people wanting our services – and hospital admissions for obesity related illnesses in children are rising…
Three years ago we were successful with our Children in Need bid and avoided closure. If we do not receive future funding health professionals will no longer have access to our consultancy service, other providers who don’t fit the criteria for access to Tier 2 services will be unable to refer more vulnerable obese children to us, parents will lose a pivotal support network – and most importantly young people will become lost in a system that does not fully understand the complex journey of a morbidly obese child.
If you’re going to be affected by our potential closure, please let us know by emailing. Your voice might just save us.