Tackling Britain’s waistline to fight diabetes

Obesity is the biggest health issue of our time. The figures are something we cannot ignore; almost two thirds of adults are overweight or obese. One in ten four to five year-olds are obese and by the time they leave primary school this doubles to nearly one in five. We have to recognise that current approaches are not making enough impact and we need to tackle this with new and different solutions.

The risk of being overweight or obese has serious and negative consequences on an individual’s health. It increases the risk of life-threatening diseases such as heart disease, Type 2 diabetes, and some cancers. As well as the health risks to the individual, obesity currently costs the NHS and wider economy £27bn a year.

Sugar is a major contributor to excess calories in the diet which leads to weight gain and obesity. Earlier this year, the Scientific Advisory Committee on Nutrition (SACN) released a report looking at the link between carbohydrates, including sugar, and a range of health issues. They found that too much sugar in the diet can have serious health consequences. The recommendations include reducing the amount of sugar in the diet to no more than five per cent of daily calories, about half the previous maximum and minimising the consumption of sugar-sweetened drinks.

A whole systems approach
Children and teenagers are consuming almost three times as much sugar than the new maximum recommendation, and most of this is coming from sugary drinks. Children aged 11-18 get most of their sugar from soft drinks (29 per cent), which is not surprising since one can of sugary fizzy drink contains around seven cubes of sugar. Table sugar and confectionery (21 per cent) and fruit juice (10 per cent) are also large contributors to the sugar intake of 11-18 year olds.

The responsibility is not just on individuals and families to reduce sugar consumption and take in fewer calories. There are a range of complex factors that cause obesity, including the environment we live, work and play in, as well as advertising and promotions. A potential solution is a whole systems approach that takes into account all aspects of everyday life with a strong focus on prevention. It is essential we focus on actions that can prevent people developing conditions such as diabetes. Focusing on prevention will not only improve health outcomes, but it also means we are actively addressing well-being and tackling health inequalities. It means we can also potentially reduce the workload of frontline healthcare staff and help ensure the financial sustainability of the NHS.

The NHS and organisations within the wider health system have recognised that more needs to be done to respond to the prevention challenge. This means getting really serious about delivering early interventions and preventative services. Plans to act on this have already taken shape in the form of the NHS Prevention Programme Board, which was established in January 2015.

Chaired by Duncan Selbie, Public Health England’s chief executive, the Board has made a strong start since the first meeting to make sure we deliver on our promise to get serious about prevention. Work underway in the past year includes the NHS Diabetes Prevention Programme (NHS DPP).

The weight of the problem
There is a direct association between the growth in Type 2 diabetes and Britain’s expanding waistline, as those who are overweight or obese are at higher risk of developing the condition. Around 90 per cent of those already with Type 2 diabetes are overweight or obese.

Current trends in obesity are set to get worse; 70 per cent of people will be overweight or obese by 2034 and one in ten will develop Type 2 diabetes. Unless we begin to reduce excess weight and obesity we won’t reduce diabetes.

Most people would be shocked to know that around 22,000 people with diabetes die early every year. It is estimated that there are five million people at high risk of Type 2 diabetes in England – a disease that is often preventable. The figures, released earlier this year, were compiled by Public Health England’s National Cardiovascular Health Intelligence Network (NCVIN), and provide the most accurate and robust estimate of how many people over the age of 16 in England have blood sugar levels in a range indicating a high risk of developing Type 2 diabetes, otherwise known as non-diabetic hyperglycaemia.

Diabetes is a serious chronic health condition and is the leading cause of preventable sight loss in people of working age and is a major contributor to kidney failure, heart attack and stroke. As well as the human cost, Type 2 diabetes costs the NHS £8.8 billion every year, almost nine per cent of its annual budget. A large proportion of Type 2 diabetes can be prevented. This is why Public Health England (PHE), NHS England and Diabetes UK are setting up the (NHS DPP. This will be the first programme of its kind to be carried out on a nationwide scale, and will deliver on the prevention commitment set out in the NHS Five Year Forward View and PHE’s Evidence into Action last year.

An evidence review published by PHE earlier in the year shows programmes similar to the NHS DPP can be successful in preventing 26 per cent of people at high risk of Type 2 diabetes from going on to develop the condition compared to those receiving usual care. People supported by diabetes prevention programmes lose, on average, 1.57kg more weight than those not on a programme aiming to significantly reduce diabetes risk.

Lifestyle factors, including weight, physical activity levels and diet, are important like the inherent factors of ageing and ethnic background in determining the risk of developing Type 2 diabetes. The NHS DPP will focus on providing support to participants on changing their behaviour in these areas to reduce their risk. The NHS DPP will offer at least nine months of information, support, group and one-to-one sessions on weight loss, physical activity and diet. Practitioners, clinicians, academics and the public are currently being consulted on a proposed outline of the programme.

Demonstrator sites
Aside from reducing incidences of Type 2 diabetes, the NHS DPP also aims to reduce the life-changing complications associated with the disease, like heart, stroke, kidney, eye and foot problems, and reduce costs to the NHS in the long term. In 2015/16 we are working with seven demonstrator sites who will work with us on developing and implementing this national programme. This will then be followed by a procurement of behavioural interventions and the commencement of a phased national roll out in 2016-2017.

The ‘demonstrator sites’ will help us design and set up an effective Diabetes Prevention Programme nationally; giving us an opportunity to learn practical lessons from delivery in action in different communities across the country. In particular, the sites will provide local perspectives on the service model, including: any potential barriers; what works best to ensure effective implementation; strategies to recruit people onto the programme; how best to retain at-risk individuals for the full length of the programme; and aligning the NHS DPP with existing services.

People will be referred into the programme through three ways. Firstly, routine GP and clinic appointments will provide opportunities to identify those at high risk, and in many cases GPs will already have identified certain individuals. Secondly, those who have already been identified in the past 12 months as having a ‘non‑diabetic hyperglycemia elevated risk level’, which is when people without a diabetes diagnosis have a higher blood glucose level than what is normal, will be targeted.
   
Risk Assessment
In addition, the NHS Health Check programme is offered to adults between the ages of 40 and 74 and includes a diabetes risk assessment and blood test as part of the check, as well as referral to lifestyle interventions, such as weight management services. This already provides an established mechanism to assess up to a million and a half people every year.

The NHS DPP has the potential to be a truly game-changing programme, helping people regain better health, by reducing obesity and delaying or stopping the progression of Type 2 diabetes, all of which will help reduce pressure on the NHS.

Further information
www.england.nhs.uk/ndpp