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What has happened since the ORM; where are we now?

Explore the impact of weight-related interventions on health inequalities and obesity, discussing changes in BMI rates and the role of stigma. Identify effective strategies for reducing inequalities and promoting a weight-inclusive approach.

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What has happened since the ORM; where are we now?

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  1. What has happened since the ORM; where are we now? Fiona Clarke RD, Senior Health Improvement Specialist.

  2. Weight inclusive approach: Views health and wellbeing as multifaceted; directs efforts at improving health; improving access to services and decreasing weight stigma Tylka et al (2014) The weight inclusive versus weight-normative approach to health. J of Obesity

  3. Higher, lower or the same? Same Same Increased Same • Rates of high BMI in adults since 2008 • Rates of high BMI in children since 2008 • Rates of high BMI in people who experience deprivation • In 2012, 63% adults met current physical activity guidelines

  4. Decreased Same Between 2010-14: • volume of sales for regular soft drinks • Sales of confectionery, biscuits and cakes

  5. ScotPHO, Obesity and health inequalities in Scotland.2017 • The widening inequality in child obesity prevalence, and the different ways that deprivation shapes men and women’s obesity levels, are important patterns that need to be taken into account when designing policies to tackle obesity and help the population maintain a healthy weight.

  6. ScotPHO, Obesity and health inequalities in Scotland.2017 • The largest weight gains have occurred among the heaviest people

  7. Lifestyle • Life circumstances

  8. Type 2 Diabetes and deprivation

  9. CRP and cumulative risk of type 2 diabetes % diabetic Q5: > 4.18 mg/l 5 4 3 2 1 Q1 : <0.66 mg/l 0 0 0.5 1 1.5 2 2.5 3 3.5 4 4.5 5 Years in study Freeman et al. Diabetes 2002,51;1596

  10. Adipocyte programming insulin resistance, inflammation and ALP skeletal muscle Insulin resistance triglyceride Atherogenic Lipoprotein Phenotype NEFAs Low HDL small LDL Adipose stores liver IL-6/IL-6sR CRP SAA Pro-inflammatory state TNF-a/ TNF-a sR-I

  11. poverty Power and control access trauma stigma racism lack of control

  12. Size stigma • ‘…negative attitudes towards, and beliefs about, others because of their weight’ • Ubiquitous • Stigma is a fundamental cause of health inequality, and is associated with significant physiological and psychological consequences Weight bias and obesity stigma: considerations for the WHO region European Region 2017

  13. Interventions less likely to be effective in addressing health inequalities Actions likely to be effective in addressing health inequalities • Structural changes • Legislation • Income support • Improving accessibility of public services • Targeting disadvantaged population groups • intensive support • Starting young • Campaigns/messages designed for the whole population • Written information • Whole-school approaches • Approaches that involve significant cost or other barriers Ref: Sally Macintyre for Equally Well, 2008

  14. ScotPHO, Obesity and health inequalities in Scotland.2017 • Increasing people’s awareness of the fact that obesity can be harmful to health, and highlighting the kinds of actions individuals can take to reduce and prevent it can open or worsen an inequalities gap.

  15. A healthier future…… • Deliver inequalities sensitive practice • Complete a health impact assessment • Address weight bias • Change the language and imagery • Engage with the people involved • Deliver weight inclusive interventions

  16. “The overarching aim of the Scottish Government is to create a fairer Scotland and reduce inequality”

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