Great Weight Debate A London Conversation on Obesity

1. Great Weight DebateA London Conversation on Obesity

2. More obese children in London than in New York London has the highest rate of childhood obesity of any peer global city, and the highest proportion of obese children in all the regions of England. London has a childhood obesity emergency and we need to act fast. Obesity has a substantial impact on the health of children – now and in the future. Estimated treatment cost of overweight children in London will be £36-195m. Obese children are much more likely to be obese adults, where even more serious health consequences occur.

3. Conversation design principles Working in partnership, the Healthy London Partnership and the London councils, Public Health England, London Obesity Leadership Group, CCGs, and the London Health Board follow design principles that underpin our approach: • Borough focused and tailored conversations with agreement to cover some common themes and lines of enquiry pan-London so its possible to document collective findings on a bigger footprint • Phased conversation with Londoners enabling increasing borough participation at different paces • A conversation that includesawareness raising, co-production of solutions moving toward generating wider social action • A conversation that identifies proposals on the wider environment and food choices that could be supported and delivered through the devolution deal • A conversation that draws in a wide range of sectors in London with the potential capability to contribute to and effect solutions A phased conversation to galvanise individual and collective action

4. Conversation Approach and Objectives Emerging design principles A Phased conversation to galvanise individual and collective action • In partnership with London Councils, Public Health England, NHS England, London’s CCGs, London Health Board, London Obesity Leadership Group, we are following the following principles to underpin our approach to the London conversation on childhood obesity: • Borough focused and tailored conversations with agreement to cover some common themes and lines of enquiry pan-London so its possible to document collective findings on a bigger footprint. • Phased conversation with Londoners enabling increasing borough participation at different paces. • A conversation that includesawareness raising, co-production of solutions moving toward generating wider social action . • A conversation that identifies proposals on the wider environment and food choices that could be supported and delivered through the devolution deal. • A conversation that draws in a wide range of sectors in London with the potential capability to contribute to and effect solutions. 4

5. Great Weight Debate 17th May 2016 - Steps • Professionals representing policy & legislation, industry and public health expertise participated to support the citizens in a debate on childhood obesity and co-created ideas together • Evidence building with professionals • Collected and explore ideas for how to create an environment that will reduce the propensity of London’s children to become obese • Explored ideas for galvanizing Londoners to demand a healthier future for our children • 3 x roundtables • 10 depth interviews • Online community to warm up participants • To understand where participants are starting from, warm them up for the debate on 17th May and begin to explore some ideas for change • 110 participants • Duration of 2 weeks • 10 participants engaged offline • Day-long event – Great Weight Debate • Deliberative event to develop and prioritise actions to be taken at national, regional and local levels to tackle childhood obesity in London • 110 citizens – reflective of London’s population • 18 – 60+ yo across differing BME and social grades and at least 60 with children • 30 experts • Reporting • In-depth report • Participant-facing summary report • Toolkit to support local engagement (Stage 2) 5

6. GWD participants were worried about obesity “[There’s] easy access to fast food which is very cheap e.g. chicken shops on every corner.” “Not enough facilities for people to workout for free outside as many of the open spaces are gone and kids no longer play outside as before.”

7. GWD participants awareness of childhood obesity as a major challenge for London was low • Londoners recognised childhood obesity as an important issue for the country but did not spontaneously identify it as a particular challenge for London • When statistics on childhood obesity were shared with Londoners they were deeply shocked and surprised that there is not more awareness of this issue • Professionals were much more familiar with the scale of the problem facing London “I knew obesity is a major problem for London, but I didn’t anticipate the severity [of childhood obesity].” 1 in 4 4-5 year olds in London are overweight or obese 2 in 5 children in London are overweight or obese when they start secondary school “[I was really surprised by] the number of children who are obese. They don’t all look obese, but I suppose they must be.” When this information was shared in the context of a quiz, all Londoners (and even some professionals) under-estimated the scale of the problem.

8. GWD participants were concerned that London is a difficult city in which to be healthy Londoners all spoke of their city as an exciting but stressful place to live • Overcrowded • Expensive • Polluted • Long hours • Long commutes And saw the pace of life as having particular challenges for health • Less time for home cooking • Less time for exercise / family activities • Less time to think about health “A lot of the time when it comes to food it is about time. Me and my partner both work, and it’s so easy to get something already prepared from the supermarket and then you regret it later.” *Online community. Q: What are the things you don’t like about living in London?

9. London ADPH framework was used as a structure for developing ideas to tackle childhood obesity 1: Early years 2: Being active 3: Public services 4: Local environments • Breastfeeding • Weaning • Knowledge • Journeys by foot or by bike • Supporting people to be active • Health services • Public and community settings • Schools • Engagement and commitment • Accessibility of healthy food • Physical environment • Workplaces

10. Brilliant ideas were discussed and recommended Change curriculum to increase amount of PE in school and include PE homework • Would lead to an increase in physical activity and help to embed healthy habits • Homework could be used to engage the whole family • It would be need to be implemented consistently and made fun for children • Some concern that setting homework would limit those children whose parents / carers are unwilling or unable to support them to do it “More PE lessons, including homework and nutritional facts, learning what exercises do what, learning how to stay in shape...Children need to know more.” Ban adverts directed at children for foods high in fat, salt and sugar • Young children are very susceptible to advertising so this could play a powerful role in shaping their behavior from a young age • However, Londoners and professionals identified food industry opposition as a potential barrier “My 4 year old grandson already knows who is on the billboards along the main roads. He talks about it when they change. It just shows how early it’s all going into their brains.” Make healthier foods more available and accessible in all publically funded areas e.g. Schools, hospitals, parks, care homes, police stations • Would help establish a united approach to the healthy living message • And set an important example to Londoners • Whilst also making it easier for them to make healthy choices “Vending machines need to still be there, but the contents of them need to change…It’s what we see that makes us buy things.”

11. …and more ideas “At the end of the day, you don’t want to shut down people’s livelihoods, so you need to show them another way. Tell them that if it’s between certain times, they can only serve this or that.” Change way London’s fast food outlets operate • Work with existing outlets & make them healthier • Healthy traffic light scheme • Subsidized workshops with owners to support them to develop healthy alternatives to existing products • Restrict opening times and / or when they can serve certain foods • Prevent the opening of new outlets Use TfL signage to encourage active travel • Would send out a powerful signal about how seriously the issue is taken • And would also ensure that a consistent message is being delivered • Whilst also limiting children’s exposure to harmful advertising “As they’ve done with cigarettes and banned all the adverts – I think all fast food adverts should be banned.” “It might be nice to advertise at bus stops and on the tube, when you are one stop before a certain school station, if you got off and walked the rest of the way, it would take you a certain about of time and would burn a certain amount of calories.” Ban promotions of unhealthy food in London and retain a proportion of advertising space in all public places for public health messages • Bus stops showing the time to walk to next stop and calories you would burn if you did, or steps to walk up an escalators • Concentrate measures around schools to encourage a more active approach to the school run • Perception that this would be affordable as it could largely use existing infrastructure

12. Galvanising Londoners • They were extremely concerned about the issues raised in the Great Weight Debate • There was agreement that urgent action should be taken to tackle childhood obesity • And that Londoners themselves should be – and would want to be – mobilised in support of this action Participants were clear that urgent action should be taken to tackle childhood obesity “We have to do anything we can to reduce this catastrophe.” “There really needs to be a change in the approach against childhood obesity. You can’t just be neutral, you have to actually be against it, otherwise you are part of the problem.”

13. NEXT STEPSBuild on local conversations currently ongoing and reinforce them to help build local and collective understanding Identify current infrastructure, strategies, and tools for leveraging opportunity Share conversation findings, recommendations and common themes 13

14. Stage 2 – Local conversations The following stakeholder management framework will help shape the local conversations work in stage 2 Focus Areas Key actions 1 • Identify key stakeholders (Government, policy, decision makers..) • Define stakeholders • Assess level of commitment and engagement • Stakeholder analysis and mapping 2 Communication strategy and planning • Identify methods of engagement with each stakeholder group • Identify timings and frequency • Complete communications plan • Use comms plan to engage with stakeholders and obtain feedback 3 Engagement tools and materials • Develop material and collateral for engagement in collaboration with boroughs • ‘How to’ roundtable, focus groups, hackathon • Surveys / questionnaires for boroughs – used across London • Resource hub 4 • Validate and evaluate engagement and make changes as/when required Continuous assessment 14