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Government announces £100 M funding for achieving a healthy weight

By Blog, Press

On the 4th of March 2021, The UK Government announced £100 million of new funding to support people to achieve a healthier weight.

Over the last 12 months it has become apparent that excess weight is a serious matter given the over representation of people living with obesity in ICU worldwide. Public Health England analysis found that living with obesity increases the risk of severe complications of COVID-19 including hospital admission.

The link between excess weight and COVID-19 severity should be no surprise given the well-established relationship with excess weight and a range of chronic diseases, including respiratory health, and the association with reduced life expectancy and quality of life. It has health implications at every stage across the life course, from pregnancy, childhood and adulthood.

For adult weight management services funding is split between the NHS and local authority commissioned services. Funds are also set aside to support services from pregnancy through to those aimed at primary school aged children. Funds for the NHS build on commitments already set out in the NHS Long Term Plan to offer weight management services to people living with obesity and hypertension and/or diabetes. This adds to services already on offer for those at risk of type 2 diabetes through the NHS Diabetes Prevention Programme.

How extra funding for local authorities will be used

Around two thirds of the extra funds for supporting people are ear marked to enhance Tier 2 weight management services (that is, multi-component services: including diet, physical activity and behaviour change components) for adults.

PHE in collaboration with the Local Government Association (LGA) and Association for Directors of Public Health (ADPH) will be supporting the roll out of the Adult Weight Management Services Grant which will distribute £30.5 million among all local authorities in England to commission adult behavioural weight management services in 2021/2022.

The amount each local authority receives will depend on their population size, prevalence of obesity and level of deprivation.  The funds can be used to allocate more places on existing weight management services or to buy new services. PHE will support local authorities in setting up new services by developing, in consultation with local authorities, procurement systems that will help authorities to run timely, effective competitions to secure the weight management services that they need.

For children, the Child and Family Weight Management Services Grant will distribute £4.4 million to pilot the expansion of  behavioural weight management services and the delivery of extended brief interventions for children identified as being above a healthy weight and their families in 5 to 10 local authorities. Local authorities are invited to apply for funding. As with adults, the level of funding will be allocated based on local need.

For both the adult and child and families grants, conditions will include providing data on weight management service provision at the start and end of the programme, and monthly participant level data. Local authorities will be encouraged to provide equitable access to population groups most in need, including men, people living with obesity from deprived areas and people from Black, Asian and Minority Ethnic groups, and also to enable inclusive services for people with protected characteristics.

What else will PHE do?

PHE and NHS England and NHS Improvement (NHSE&I) are working in partnership to help align NHS and local authority funded services.

Data from services will be used to help make the case for more sustained funding into the future, to learn lessons on service performance and to understand what works best to support good outcomes for all. Evidence on local practice will be collected and knowledge shared.

PHE will work with local authorities and service providers and will develop guidance to support local implementation including on how to ensure that underserved population groups have access to weight management services and how services can be tailored to meet specific needs. Efforts will be made to ensure the voices of people living with obesity are heard and services take a person-centred approach, using non-stigmatising and person-first language.

In partnership with Health Education England, PHE will also support the embedding of Healthy Weight Coaches into primary care and the community by developing training for a broad range of healthcare professionals. The Coaches will engage with people living with overweight or obesity who are interested in improving their health and wellbeing by supporting and motivating them to prioritise weight management and signpost or refer them into weight management services.

PHE will also build the evidence base and identify tools needed to promote healthy lifestyles in the early years to help prevent overweight or obesity concerns in families with young children.

PHE will continue to build on the successes of the Better Health campaign to date by encouraging and supporting people living with overweight or obesity to make positive changes. Campaign activity throughout the next twelve months will promote evidence-based tools and advice including an enhanced NHS 12 Week Weight Loss Plan app to help people develop healthier eating habits, get more active and lose weight.

Where appropriate, PHE will also work in partnership with NHSE&I, local authorities and commercial weight loss providers to help direct people who need additional support to lose weight, into weight management services.

Wider impact of the pandemic on obesity prevalence

Going into the pandemic most adults and a third of children were living with excess weight.

Societal changes associated with the pandemic may have increased the risk of weight gain and made it harder to access weight management services. Over the past year, we have seen changes in the patterns of food purchases  and physical activity that may be associated with increased calorie intake and excess weight gain. There have also been changes in societal, economic and psychosocial factors that have been linked to excess weight gain. For instance, rates of unemployment and mental illness have increased during the pandemic.

Therefore, there is incremental change to be achieved by upscaling weight management services as part of place based whole systems approaches to addressing obesity and promoting a healthier weight.

Importance of societal wide actions

Obesity is a complex public health challenge driven by a mixture of the social, economic, biological and environmental factors that shape our lives and individual behaviours. Due to the multiple factors that impinge on individuals’ choices within the environment where we live, work and play, it is easy to feel the odds are stacked against us when trying to achieve and maintain a healthier weight.

BMI’s Fat Secret

By Press

Let’s say you are an office worker that may have gained a little bit of weight since starting your new job and you want to assess your body weight. If you are like most, you will use the Body Mass Index (BMI), which is commonly used by physicians, insurance companies, and regular people around the world to determine if a person is considered overweight or obese.

BMI scores are calculated from the US National Institute of Health

After you calculate your score, you compare your BMI score against the Body Mass Index ranges set by the World Health Organization.

Source: WHO

Your BMI score of 23.9 falls between 18.5 – 24.9, so you are safe in the normal range. You will take it! But before you celebrate too much, consider this.

Body Mass Index was never intended to be used to measure individuals at all.

Here’s a quote from The World Health Organization

The BMI provides the most useful population-level measure of overweight and obesity, as it is the same for both sexes and for all ages of adults. However, it should be considered as a rough guide because it may not correspond to the same body fat percentage in different individuals.

Despite this clear message, many doctors, physicians, and regular people continue to use BMI as a diagnostic tool simply out of convenience.

However, relying on BMI as your only health indicator can mask your risk for serious health issue because BMI can’t tell the difference between muscle mass and fat, and more importantly where the fat is distributed. You might have unpleasant secret hiding behind that healthy BMI.

Let’s test the same individual using a medical grade body composition analyzer.

Visceral Fat is based on the estimated amount of fat surrounding internal organs in the abdomen. It’s also suggested to maintain a level under 100 cm² to be healthy.

Although a higher than the recommended body fat percentage is what most people (and the media) focus on, this individual’s high visceral fat is actually the worst of the two.  That’s because visceral fat acts like another living organ inside your abdominal cavity.

What is Visceral Fat?

Visceral fat is a special kind of fat that is hidden deep inside your abdomen and surrounds your inner organs. Everyone has some.  Unlike surface level (subcutaneous) fat, it’s not easy to gauge how much visceral fat someone has just by looking at them. That’s because visceral fat is hidden away in the abdominal cavity, in between your organs.

If you rely on BMI as your primary tool to assess weight, you may have significant amounts of visceral fat and not know it.

Unlike the organs that you were born with that sustain life, visceral fat actively works from the inside out to sabotage those organs and ruin your bodily functions.

According to Harvard University, visceral fat secretes a number of hormones and chemicals.  One group of these chemicals is called cytokines. Cytokines play an important role in the human body, but increased levels of cytokines due to excess visceral fat can be problematic. Once cytokines enter the liver, they influence the production of blood lipids, which has been linked to higher cholesterol and insulin resistance. This can lead to Type 2 diabetes.

Type 2 diabetes is typically associated with people who are overweight or obese, and individuals whose BMIs above the normal range (18.5-24.9) are said to be at a significantly greater health risk. However, BMI can misrepresent people who are either near or slightly over the 24.99 mark.

But that’s not all. Individuals with normal BMI but high visceral fat level share similar risk profiles as those who are visibly obese.  Maintaining a high visceral fat can contribute to a myriad of health complications including high blood pressure, heart disease, cancer, and depression.

Depending on lifestyle factors, many people have a body profile like our example: large amounts of abdominal fat, yet a “normal” BMI because they don’t have much skeletal muscle mass. Due to the trend towards sedentary lifestyles, this is becoming more and more common.

The Visceral Fat Recipe

Excess visceral fat is unnecessary fat and develops as a result of having a caloric surplus.  Unsurprisingly, visceral fat develops as a result of adopting unhealthy lifestyle habits.  Some of these factors include:

For people living sedentary lifestyles, it is quite easy to pick up several of these unhealthy habits.  Over time, these habits will lead to increased amounts of body fat, including visceral fat.

Assessing Your Risk

How can you figure out if you have large amounts of visceral fat?  

Here are three options:

1. Waist Measurement

According to the Mayo Clinic, using a measuring tape to measure your waistline is a fairly good way to estimate your visceral fat content.  If your waist measures over 35 inches for women or over 40 inches men, you may be carrying too much visceral fat.

2. Dual Energy X-ray Absorptiometry (DEXA) Scan

Source: Flickr

One of the most precise methods of determining the amount of visceral fat deposits is by taking a DEXA test. But this requires access to a facility that has a unit, and a test can be expensive.

3. Professional Bioelectrical Impedance Analysis (BIA)

A great alternative to a DEXA test may be a medical BIA test.  These tests measure the resistance experienced by an electric current as it travels through your body to determine your body fat percentage, which includes your visceral fat.  Advanced BIA devices that take direct segmental measurements are able to report visceral fat content, although you would need to ensure that the device you are using has this capability.

Knowing your body composition will give you a much better idea about your amount of visceral fat than BMI can.  If your weight and/or BMI is considered “normal,” but your body composition test reveals if you have a high body fat percentage and low muscle mass (as with people who are skinny fat), you might want to consider making some lifestyle changes to reduce your risk of developing potentially serious health complications like heart disease in the future. If your body composition test provides your BMR, use that number to determine your daily calories needs as part of your weight loss strategy.

Conclusion

Hopefully, this clears things up for you. BMI cannot determine if you are lean, overweight, or somewhere in between.  It’s all just raw numbers with BMI.

if you have a “normal” weight and BMI, don’t let your guard down!  It’s easy to just fall into the trap and think “I may be chubbier but I’m not obese so I don’t have to think about weight loss; ” or “I guess I just have good genes so I’m always going to look underweight.”

No one should expect to eat a diet high in calories and saturated fat, totally ignore exercise, and expect to be healthy their entire life.

The good news is, if you exercise, watch your calories,  and live a generally healthy lifestyle, you’re going to avoid gaining too much visceral fat as the result of the good choices you’re making.  Body composition testing will always give you much more information than your BMI ever will, and can give you a much better picture of everything that makes up your weight, including your visceral fat. Remember “what gets measured, gets managed” so go take a body composition test and find out visceral fat level!

Source: https://inbodyusa.com/blogs/inbodyblog/38654081-bmis-fat-secret/

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