In February 2020 we set out our commitments to take forward the 2020-2022 Delivery Plan as part of our ten-year Healthy Weight Healthy Wales strategy. The deliverables set out in the plan have been significantly impacted upon during the COVID-19 response, where services, funding and capacity across government and with key partners were shifted to meet the response. We therefore paused commitments set out in the plan. However, our ambition has not changed and this update intends to set out our immediate priorities for 2020-21.
There are strong links between excess weight and poorer outcomes for individuals as a result of COVID-19. This has brought into sharp focus the reasons why supporting people to be a healthy weight remains an absolute public health priority for the benefit and health of our population. We know that some individuals may be motivated to lose weight by the pandemic but others may find the situation leads to increased weight gain, our focus is therefore to support and enable positive change in a compassionate way.
However, our approach is not only about the short term. The links to mortality and poorer health outcomes across a range of preventable diseases remains, and results in people living an increasing number of years in disability which is shortening life expectancy across the population.
Information on the health-related lifestyles and behaviours of adults living in Wales recorded in the National Survey for Wales 2019-20 continues to show that 61% of adults are classified as overweight or obese including 25% who are obese. Our continued focus will remain on supporting and empowering people to think about their health and diet, but the role our environment plays to influence the decisions we make is significant.
The impact of COVID-19
There is consistent evidence that living with excess weight is associated with an increased COVID-19 risk: testing positive, hospitalisation, severe symptoms, advanced levels of treatment (including mechanical ventilation or admission to intensive care) and death. The risks increase progressively with increasing body mass index (BMI) above the healthy weight range (even after adjustment for potential confounding factors, including demographic and socioeconomic factors).
There is also some evidence to suggest that excess weight may explain some of the observed differences in outcomes linked to COVID-19 for older adults and some BAME groups. Obesity increases the risk of diseases such as type 2 diabetes, heart disease and respiratory diseases which themselves increase the risk of complications in someone who contracts COVID-19.
Excess weight is therefore one of the few preventable risk factors for COVID-19. Supporting people who are living with overweight or obesity to lose weight in a sustainable manner, together with interventions to prevent weight gain across the population, can reduce future population risks of COVID-19.
There has been a range of insight work undertaken to consider shifts in behaviour around food and physical activity during the lockdown period. There is a risk that the pandemic will have exacerbated existing inequalities and issues around food insecurity. In addition, poor food choices and restrictions on the physical environment have impacted behaviours during this time and could have a detrimental, long-term impact.
The proposals set out in 2020-22 remain our focus and we will publish a revised timeframe for delivery in 2021-22 in due course. This will take account of any opportunities or challenges which will be taken forward as a consequence of COVID-19.
However, to ensure that we can focus our efforts and deliver key commitments across 2020-21, we will concentrate on five priority areas:
- Set out our proposals to make the food environment healthier
- Increase active travel opportunities
- Increase physical activity and exercise opportunities
- Begin to deliver the revised obesity pathway
- Develop population communications and digital resources
Priority Area 1: Set out our proposals to make the food environment healthier
- develop and launch a consultation on a suite of potential measures, including regulating price promotion and discounting practices and mandating calorie labelling for food purchased and eaten outside of the home, to address the current bias towards unhealthy options in the food environment. All our measures will seek to support people in Wales to eat a healthy and sustainable diet as set out in the Government’s Eatwell Guide
- we aim to launch the consultation in autumn 2020 and publish the findings early in 2021.
Pre-lockdown around three-quarters of energy intake came from foods consumed at home, mainly from supermarkets and other retailers. Around a quarter of energy intake came from eating out, mainly from outlets such as cafes, restaurants and canteens, or as complete readyto-eat meals from takeaways or deliveries. Shopping and consumption habits have seen unprecedented change as a result of restrictions. The impact on our diets in the short term has been marked, but in the long term there are concerns over food insecurity and access to healthy food purchasing, which will be crucial.
According to Kantar surveys, one in three in the UK said they were using the lockdown to eat ‘more healthily’ and exercise more. Another one in three disagrees with these statements, showing some of us are finding it hard to stay healthy during lockdown. Kantar nutrition panel data shows that we are buying more calories during lockdown. While take-home food and drink volume sales grew by 13% in the 12 weeks to June 2020 compared with a year ago, total calories purchased over the same time period increased by 17%. This means the calorie-density of baskets has increased by 3.7%, a significant change from the declines seen over the past few years.
We want to consider how we can rebalance the food environment to enable healthy choices and make healthy food more available. UK Government have set out an obesity strategy outlining a number of areas which they will be taking forward to improve the food environment. We want to consult on a range of measures which will be specific to Wales, however, we will work with the UK and other devolved nations to consider where we can align or work collaboratively.
Priority Area 2: Increase active travel opportunities
- use the opportunities presented in this climate to promote and encourage active travel, by investing £38 million in 2020-21 to make Wales a safer place to cycle, scoot and walk. These schemes will be funded through the Active Travel Fund, Safe Routes in Communities Grant and Road Safety Grant
- take forward actions to implement a 20mph default speed limit in residential areas and encourage ideas to promote spaces for travel or play
- enhance support available to employers in Wales to enable active travel in work places
- align with the commitment in the Clean Air Plan for Wales, Healthy Air, Healthy Wales (published on 8 Aug 2020), where over £84m will be invested into active travel infrastructure. This will include promoting walking and cycling to school through our Active Journeys Programme in collaboration with over 400 schools.
The COVID-19 pandemic has driven changes in people’s travel habits, with many more of us walking and cycling to work, shops and for recreation than before. We will look at the positive impacts of this opportunity for change and make sure people continue to choose cycling or walking. Together with the £15.4m announced in June, this is the largest ever investment in local active travel improvements in Wales.
The aim of the Clean Air Plan for Wales is to improve air quality and reduce the impacts of air pollution on human health, biodiversity, the natural environment and our economy. The plan has a number of commitments which align with and build on proposals in Healthy Weight: Healthy Wales. In particular, ‘reducing emissions and delivering vital improvements in air quality’ to support ‘healthier communities and better environments’. The synergies between active travel, clean air, climate change and healthy weight are crucial components to align the close working of Health, Transport and Environment departments to deliver actions which achieve mutually beneficial outcomes.
At the start of the pandemic, Healthy Working Wales developed a section of its website to provide employers and employees with a one-stop location for COVID-19 related guidance and resources. We will develop further resources and information for employers to support psychological and emotional wellbeing. This will reflect lockdown changes and will provide advice and guidance as more people work from home and to encourage the use of active travel to build upon opportunities for positive change.
Priority Area 3: Increase physical activity and exercise opportunities
- invest £500,000 per annum into a national leisure offer for over 60s which will encourage physical activity and healthy lifestyle choices, to ensure that this is a targeted approach to reduce health inequalities and reduce social isolation
- develop the National Exercise Referral Scheme (NERS) offer mitigating risks and in line with lockdown measures and support opportunities for post COVID 19 recovery
- deliver the Healthy and Active Fund and increase opportunities for physical activity in line with lockdown measures. This will involve the Welsh Network of Healthy Schools Scheme; seek to encourage movement in a safe way, and take into account results of the bespoke Omnibus survey conducted by Beaufort Research
- work with the Valleys Regional Park to develop a wide range of pilot projects that will provide valleys communities with landscape based physical activity opportunities
Sport Wales will deliver targeted provision of physical activity opportunities to contribute to the reduction of health inequalities amongst the local 60-plus population that are currently inactive or the least active. This will be linked with supporting leisure centres to reopen safely, complementing existing provision such as the Free Swimming Initiative (FSI), social prescribing, and other local 60-plus provision to provide a menu of opportunities for this population.
A significant amount of virtual delivery of NERS has been undertaken since the start of the pandemic through home-based activities. Various packages of support for home-based exercise for NERS clients have been developed including social prescribing and live classes. A NERS recovery plan will be developed which will make clear recommendations to local providers about the mechanisms required to be in place to reduce any risks to NERS clients and staff from potential exposure to COVID-19.
Additionally, we will continue to use the partnership of the Healthy and Active Fund (HAF); between Welsh Government, Sport Wales and Public Health Wales, which delivers in an integrated way the Welsh Government commitments to introduce a Well-being Bond and a Challenge Fund for Sport. Since the introduction of social distancing measures, there has been a reduction in planned activities, however, projects have been finding creative and innovative ways to deliver and engage with participants including delivering resources and sessions on line.
The results of the bespoke Omnibus survey around eating and physical activity habits of households during the pandemic lockdown showed 37% of respondents said their children ate the same amount or more than they did for their evening meal. This seems a high percentage of young children eating an adult’s portion. Additionally, 8% of parents disagree or are ‘unsure’ if it’s important for their children’s long-term health to be a healthy weight growing up, highlighting the need to raise awareness of the importance of a healthy weight.
New social prescribing opportunities through the Valleys Regional Park will provide referral pathways for landscape based physical activities (woodland skills, bushcraft, fruit/veg growing) designed to help our valleys communities improve their physical and mental health through the use of green spaces.
Priority Area 4: Commence delivery of the revised obesity pathway
- invest an additional £2.9m per year for local health boards and partners to implement the delivery of a refreshed All Wales Obesity Pathway
- begin to work with local health boards and partners to develop outcome focussed plans based on local need
- invest in fully digitalising the all Wales Nutrition Skills for Life programme TM, enabling continuation, through virtual delivery, of all community-based initiatives including Foodwise for Life, Foodwise in Pregnancy and Community Food and Nutrition Skills programmes
We know that most adults in Wales are overweight or obese; some groups have higher levels of overweight and obesity than others. Whilst we need to ensure support is in place, we will do this in partnership with our health boards, working together to enable the implementation of services for the pathway.
Families living with obesity are facing challenging times and we want to explore how we can deliver and develop services which help to support local need to minimise the negative effects of obesity now and in the future. Whilst the pandemic has shone a light on the health conditions and complications caused by overweight and obesity, we must ensure that our support services are able to be maintained, even during further potential health emergencies and allow for continued support for the long term for those in need.
Enabling essential services in each health board will also help address health inequalities in Wales. We will support increased access to treatment options, including psychological support for the mental health related complexities of obesity. We will need to support and enable healthcare delivery sites to be equipped to accommodate the physical and mental health needs of people with severe obesity. As pathways develop in each health board region, multidisciplinary obesity clinics will be required with additional resources for staffing and education, equipment, infrastructure and research.
We will prioritise the collection of health and disease progression data between obesity, other chronic diseases and COVID-19 to inform both clinical and policy decision-making.
Nutrition Skills for Life programme TM is an all-Wales programme, developed and delivered by NHS dietitians. It aims to build capacity in the community workforce to promote and support healthy eating by providing accredited nutrition training and professional support. This enables frontline workers, volunteers and peer leaders from health, social care and third sector organisations to incorporate evidence based food and nutrition messages into their work. It supports healthier food and drink provision in community settings and widens access to a nutritious food through the development of community food and nutrition initiatives.
Nutrition Skills for Life programme TM is particularly relevant to delivering on the revised All Wales Obesity Pathway as it underpins delivery of obesity prevention and management services. The Programme makes a vital contribution towards the key objectives outlined by Welsh Government, namely:
- accessible and equitable services for all
- all-Wales clinical pathway fully operational to national standards
- people feeling motivated, enabled and supported to make healthy choices
With the changes to delivery needed as a result of Covid-19, we are aiming to transform all of the programme’s accredited nutrition-training courses for online delivery in a fully interactive education platform. This would provide a ‘once for Wales’ approach, preventing duplication of effort across each of the seven health boards.
Priority Area 5: Communications and digital package
- launch a Healthy Weight Cymru website and social media channels, which will bring together partnership work and link with the work of the three Healthy Weight Ambassadors for Wales
- consult widely on proposals in the food environment consultation
- work with NHS to develop digital tools which will provide access to information and on-line support
COVID-19 has demonstrated the need for better and more informed information and communications across Wales. The communications package will need to include a focus on increasing awareness around risks with COVID-19 and the development of digital tools which will provide access to information and on-line support. We will continue to work with partners on their communications packages around health improvement.
We will continually engage with the public through focus groups and engagement events, utilising the three Healthy Weight Ambassadors for Wales. We want to understand the impact of COVID 19 on behaviour as lockdown restrictions are eased; on both the food environment and our physical activity levels. We will set up a series of media content, fully accessible and tailored to the skill set of each ambassador to reach targeted groups. We will continue to consider health inequalities and protected characteristics, and use the opportunity as an ongoing intelligence gathering exercise.