Child Obesity Statistics for PCT Clusters

Child Obesity Statistics for PCT Clusters September 2011 Delivered by NOO on behalf of the Public Health Observatories in England

Obesity prevalence Introduction and methods Introduction The (NCMP) measures approximately one million children per year, and so provides a robust indicator of child obesity prevalence at the level of Primary Care Trust (PCT) clusters. Data have previously been published for PCTs, Local Authorities and also at Middle Super Output Areas (MSOA), but with the recent creation of PCT clusters it is likely that data will also be required at this level of aggregation. This document contains a set of maps and charts to show the variation in both child obesity prevalence and child healthy weight across all PCT clusters in England. It also illustrates the relationship between obesity prevalence and levels of socioeconomic deprivation and describes the levels of participation in the NCMP for all PCT clusters. There is substantial variation in the prevalence of both obesity and healthy weight between PCT clusters. Prevalence in those PCT clusters with the highest levels of child obesity is almost double that of those areas with the lowest prevalence. Healthy weight prevalence shows less variation (at least in relative terms), however the pattern of variation is similar for both measures. Child obesity is closely linked with socioeconomic deprivation explaining around 7 of the variation in prevalence between areas. The higher the level of deprivation, the higher the prevalence of child obesity. Despite this, it is important that all areas work towards tackling child obesity - not just those deprived areas where prevalence is high. Even the areas with the lowest prevalence of obesity still contain a large number of children who are at an increased risk of future ill health as a result of having a high body mass index (BMI). There is also variation in obesity prevalence within PCT clusters. PCT clusters do not contain homogeneous populations and within each there will be sections of the child population where obesity prevalence is different to the area as a whole. Obesity prevalence differs for boys and girls, between different ethnic groups, and by location. The (NOO) has developed a number of tools with which to investigate such variation, that can be used to better plan and target interventions aimed at tackling child obesity. A brief description of these tools and other NOO resources related to childhood obesity is provided at the end of this document. Methods and further information In this analysis data from three years of NCMP measurements have been combined in order to provide more accurate estimates. These data are therefore based on all children measured by the NCMP in the academic years 2007/08, 2008/09 and 2009/10. Children have been classified as obese if their BMI is greater than or equal to the 95 th centile of the British 1990 growth reference (UK90). This is the most common definition used for population surveillance in England, and is used for the published child obesity figures using Health Survey for England and NCMP data. Healthy weight is defined as a BMI between the 2 nd and 85 th centile of this growth reference. The map on each page of this document shows the geographic distribution of the indicator around England at the level of PCT clusters. To assist in identifying individual PCT clusters a key to the maps is provided on the next page. The chart on each page shows the range of values for the indicator, and the distribution between these extremes of the 51 PCT clusters. The same shading as the maps has been used. Example map Example chart 15% 5% 51 PCT Clusters The charts are not labelled with the PCT cluster names, however the penultimate page of this document contains a table which provides the obesity and healthy weight prevalence figures as well as participation rates for all PCT clusters. The pages showing the link between child obesity and socioeconomic deprivation, and the NCMP participation rate contain slightly different graphics, but these are described in more detail on the relevant pages. If you have any comments, suggestions, or questions about this publication, please email: ncmp@.

Primary Care Trust Clusters in England By Strategic Health Authority Cluster NHS North of England North West, North East, Yorkshire and The Humber Cluster Cheshire Cumbria Greater Manchester Lancashire Merseyside County Durham & Darlington North of Tyne South of Tyne & Weir Tees Bradford Calderdale, Kirkless & Wakefield Leeds North Yorkshire & York South Yorkshire & Bassetlaw The Humber PCTs Central and Eastern Cheshire Warrington Western Cheshire Wirral Cumbria Ashton, Leigh and Wigan Bolton Bury Heywood, Middleton and Rochdale Manchester Oldham Salford Stockport Tameside and Glossop Trafford Blackburn with Darwen Blackpool Central Lancashire East Lancashire North Lancashire Haltonand St Helens Knowsley Liverpool Sefton County Durham Darlington Newcastle North Tyneside Northumberland Gateshead South Tyneside Sunderland Hartlepool Middlesbrough Redcar and Cleveland Stockton-On-Tees Bradfordand Airedale Calderdale Kirklees Wakefield District Leeds North Yorkshire & York Barnsley Bassetlaw Doncaster Rotherham Sheffield East Riding of Yorkshire Hull North East Lincolnshire North Lincolnshire NHS Midlands and East West Midlands, East Midlands, East of England Cluster Derbyshire Leicestershire Lincolnshire Northamptonshire & Milton Keynes Nottinghamshire Arden Birmingham Black Country Staffordshire West Mercia Bedfordshire & Luton Cambridgeshire & Peterborough Hertfordshire Norfolk, Great Yarmouth & Waveney North Essex South Essex Suffolk PCTs Derby City Derbyshire County LeicestershireCounty and Rutland Leicester City Lincolnshire Milton Keynes Northamptonshire Nottingham City Nottinghamshire County Coventry Warwickshire BirminghamEast and North Heart of Birmingham Solihull South Birmingham Dudley Sandwell Walsall Wolverhampton North Staffordshire South Staffordshire Stoke on Trent Herefordshire Shropshire County Telford and Wrekin Worcestershire Bedfordshire Luton Cambridgeshire Peterborough East and North Hertfordshire West Hertfordshire Great Yarmouth and Waveney Norfolk Mid Essex North East Essex West Essex South East Essex South West Essex Suffolk London inset London inset NHS London London Cluster Inner North East London North Central London North West London Outer North East London South East London South West London PCTs City and Hackney Newham Tower Hamlets Barnet Camden Enfield Haringey Islington Brent Ealing Hammersmith and Fulham Harrow Hillingdon Hounslow Kensington and Chelsea Westminster Barking and Dagenham Havering Redbridge Waltham Forest Bexley Bromley Greenwich Lambeth Lewisham Southwark Croydon Kingston Richmond and Twickenham Sutton and Merton Wandsworth NHS South of England South Central, South East Coast, South West Cluster Kent & Medway Surrey Sussex Berkshire Oxfordshire & Buckinghamshire SHIP Bath, NE Somerset & Wiltshire Bournemouth, Poole & Dorset Bristol N Somerset & S Gloucestershire Cornwall & Isles of Scilly Devon & Torbay Gloucestershire & Swindon Somerset PCTs Eastern and Coastal Kent Medway West Kent Surrey Brighton and Hove East Sussex Downs and Weald Hastings West Sussex Berkshire East Berkshire West Buckinghamshire Oxfordshire Hampshire Isle of Wight Portsmouth Southampton Bath and North East Somerset Wiltshire Bournemouth and Poole Dorset Bristol North Somerset South Gloucestershire Cornwall and Isles of Scilly Devon Plymouth Torbay Gloucestershire Swindon Somerset

Obesity prevalence Child obesity prevalence by PCT cluster year (children aged 4-5 years) NCMP: 2007/08 to 2009/10 Obesity prevalence Per cent There is substantial variation in obesity prevalence between PCT clusters for children in the year, as shown by the map and chart on this page. Among this age group obesity prevalence varies from below 8% to over 13%, (national average 9.7%). There are also differences in prevalence between boys and girls. Across England, 10.4% of boys are obese compared to only 9. of girls. 9.7% 14% 12% 8% 6% 4% 2% 51 PCT Clusters

Obesity prevalence Child obesity prevalence by PCT cluster (children aged 10-11 years) NCMP: 2007/08 to 2009/10 Obesity prevalence Per cent As with year, there is substantial variation in obesity prevalence between PCT clusters for children in. Among this age group obesity prevalence varies from below 15% to over 25% (national average 18.5%). There are differences in prevalence between boys and girls. Across England, 20.1% of boys are obese compared to only 16.7% of girls. Obesity prevalence among children in is substantially higher than in the Year. 18.5% 3 25% 2 15% 5% 51 PCT Clusters

Healthy weight prevalence Child healthy weight prevalence by PCT cluster year (children aged 4-5 years) NCMP: 2007/08 to 2009/10 Healthy weight prevalence Per cent Although obesity prevalence is the most common statistic based on NCMP data, the prevalence of healthy weight is increasingly reported. Healthy weight is useful when assessing the health of a child population as it identifies the proportion of children who are neither underweight, overweight or obese. There is variation in the prevalence of healthy weight between PCT clusters. Among children aged 4-5 years the proportion of children whose BMI is classed as healthy ranges from less than 73% to over 79% (national average 76.1%). Across England, fewer boys (74.6%) than girls (77.7%) are considered to be of a healthy weight within the year. 76.1% 9 8 7 6 5 4 3 2 51 PCT Clusters

Healthy weight prevalence Child healthy weight prevalence by PCT cluster (children aged 10-11 years) NCMP: 2007/08 to 2009/10 Healthy weight prevalence Per cent As with year, there is variation in the prevalence of healthy weight between PCT clusters within. Among children aged 10-11 years, the proportion of children whose BMI is classed as healthy ranges from less than 59% to over 7 (national average 65.8%). Again, across England, fewer boys (64.3%) than girls (67.4%) are considered to be of a healthy weight. 65.8% 8 7 6 5 4 3 2 51 PCT Clusters

Obesity prevalence Deprivation and child obesity by PCT cluster Obesity prevalence 2007/08 to 2009/10 and 2010 deprivation score with the trend from linear regression by PCT cluster 3 PCT cluster deprivation Index of Multiple Deprivation 2010 25% 2 R² = 0.77 15% R² = 0.67 5% 0 5 10 15 20 25 30 35 40 45 Deprivation score (high = more deprived) Inequality gap in obesity prevalence (across the whole English population) 12.5% Most deprived 23.4% 6.7% Least deprived 12.6% Obesity prevalence is closely linked with socioeconomic deprivation. The more deprived the population, the higher the prevalence of child obesity. As a result, the above map of Index of Multiple Deprivation (IMD) 2010 scores for PCT clusters shows a similar pattern to the maps of obesity prevalence presented earlier within this report. The scatter chart shows the correlation between the IMD 2010 scores and obesity prevalence for and children for the 51 PCT clusters. In both school years the IMD score is strongly associated with obesity prevalence about 7 of the variation in prevalence between PCT clusters can be explained by the IMD score, as shown by the coefficient of determination (R 2 value) on the chart. Obesity prevalence within the most deprived of the child population is approximately twice that for the least deprived areas for both school years. Healthy weight shows a similar pattern; in, about 6 of the variation in healthy weight prevalence between PCT clusters is explained by levels of deprivation, and about 76% in. There are a number ofother sociodemographic factors that are linked with obesity prevalence, most notably ethnicity. There is substantial variation in levels of child obesity between ethnic groups. In general the White British population has a lower prevalence of obesity than other ethnic groups. However, it is important to consider the possibility of confounding effects for example many Black and Minority Ethnic (BME) groups have higher levels of deprivation than the White British population. Analysis suggests that both deprivation and ethnicity are independently associated with obesity, the precise nature of these relationships are not yet fully understood.

Participation by PCT cluster Data collected for 1,026,366 children in 2009/10, at 17,140 state maintained schools. Total participation 91.4% Children aged 4-5 years Children aged 10-11 years 92.9% 89.9% Participation rate Per cent, 2009/10 43.7% 41.5% Of the pupils that did not participate in 2009/10 these are the reasons for non-measurement (8 of PCTs provided data on reasons for non-measurement) 8.8% 5.5% Parental opt-out Absent Other Child opt-out 0.5% Unable to stand on scales In order to continue to provide robust data on children s BMI, the NCMP is dependent on good levels of participation around the country. A low level of participation within a PCT cluster increases the risk that the children measured are not entirely representative of the underlying population. Analysis of NCMP from the early years of the programme showed that areas with low levels of participation had lower prevalence of obesity, it is therefore important to maintain the current good level of participation. PCTs are expected to achieve at least a 85% participation rate in the NCMP which the majority of PCT clusters accomplished in 2009/10. However, most PCTs had levels of participation well in excess of this target. The higher the level of participation, the more robust the resulting data are likely to be, and so local areas should try to achieve a participation rate as close to 10 as possible. The NCMP collects some information on the reasons for non-measurement in the programme. As the chart above shows, parental opt-out from the programme is the most common reason for children not being measured, followed by children who are absent from school on the day of measurement.

Prevalence and participation by PCT cluster PCT Cluster % healthy weight (LCI,UCI) 2007/08-2009/10 % healthy weight (LCI,UCI) 2007/08-2009/10 % obese (LCI,UCI) 2007/08-2009/10 % obese (LCI,UCI) 2007/08-2009/10 % participation 2009/10 % participation 2009/10 NHS North of England 75.7 (75.6,75.9) 65.2 (65.1,65.3) 9.8 (9.7,9.9) 19.1 (19.0,19.2) 94.1 91.1 Bradford 76.3 (75.7,76.9) 63.8 (63.1,64.5) 9.9 (9.5,10.4) 20.2 (19.6,20.8) 87.0 87.4 Calderdale, Kirklees & Wakefield 77.1 (76.6,77.6) 66.3 (65.8,66.9) 9.1 (8.8,9.5) 18.1 (17.7,18.5) 96.0 90.7 Cheshire 76.7 (76.3,77.2) 66.9 (66.4,67.4) 8.9 (8.7,9.2) 18.0 (17.6,18.4) 95.7 94.2 County Durham & Darlington 76.3 (75.7,76.9) 64.4 (63.7,65.1) 9.4 (9.0,9.8) 20.5 (19.9,21.1) 98.8 98.7 Cumbria 75.3 (74.5,76.0) 64.7 (63.9,65.5) 9.4 (8.9,9.9) 19.6 (18.9,20.3) 89.2 85.6 Greater Manchester 76.0 (75.7,76.3) 65.1 (64.8,65.4) 9.8 (9.6,10.0) 18.9 (18.6,19.1) 94.3 93.1 Lancashire 76.3 (75.9,76.7) 67.0 (66.5,67.4) 9.4 (9.1,9.7) 17.6 (17.2,17.9) 94.4 92.4 Leeds 76.5 (75.9,77.0) 64.2 (63.6,64.9) 9.6 (9.2,10.0) 20.1 (19.5,20.6) 94.4 66.9 Merseyside 73.1 (72.7,73.6) 63.1 (62.6,63.7) 11.6 (11.2,11.9) 20.8 (20.4,21.2) 95.5 91.6 North of Tyne 74.5 (74.0,75.1) 64.8 (64.2,65.4) 10.4 (10.0,10.8) 19.5 (19.0,20.0) 94.3 94.3 North Yorkshire & York 78.0 (77.4,78.6) 69.3 (68.7,69.9) 8.2 (7.8,8.5) 15.4 (14.9,15.9) 93.8 91.1 South of Tyne & Weir 74.5 (73.8,75.1) 62.3 (61.6,63.0) 10.4 (10.0,10.9) 21.4 (20.9,22.0) 85.5 83.2 South Yorkshire & Bassetlaw 76.0 (75.6,76.4) 65.0 (64.5,65.4) 9.8 (9.5,10.1) 19.5 (19.1,19.8) 93.9 94.5 Tees 73.2 (72.5,73.8) 62.6 (61.9,63.3) 11.2 (10.8,11.7) 21.1 (20.5,21.7) 96.1 93.7 The Humber 74.5 (74.0,75.0) 65.3 (64.7,65.8) 10.2 (9.9,10.6) 19.4 (18.9,19.8) 96.7 94.9 NHS Midlands and East 76.2 (76.1,76.3) 66.0 (65.9,66.1) 9.6 (9.5,9.6) 18.2 (18.1,18.3) 92.7 89.0 Arden 77.4 (76.9,78.0) 66.2 (65.6,66.8) 8.9 (8.6,9.3) 17.9 (17.4,18.4) 83.0 83.7 Bedfordshire & Luton 75.6 (75.0,76.2) 67.5 (66.8,68.2) 10.4 (10.0,10.9) 17.4 (16.9,18.0) 94.5 58.7 Birmingham 75.5 (75.1,75.9) 62.1 (61.7,62.6) 10.5 (10.2,10.8) 21.2 (20.8,21.6) 93.1 91.0 Black Country 74.9 (74.5,75.3) 61.1 (60.7,61.6) 10.9 (10.6,11.2) 22.5 (22.1,22.9) 98.3 95.9 Cambridgeshire & Peterborough 77.1 (76.6,77.7) 67.7 (67.0,68.3) 9.0 (8.6,9.4) 17.0 (16.5,17.5) 93.4 91.3 Derbyshire 77.1 (76.6,77.6) 66.7 (66.1,67.2) 8.9 (8.6,9.3) 17.6 (17.2,18.0) 94.0 92.9 Hertfordshire 76.9 (76.4,77.3) 68.5 (68.0,69.0) 8.7 (8.4,9.0) 15.9 (15.5,16.3) 93.6 89.2 Leicestershire 76.4 (76.0,76.9) 67.3 (66.8,67.9) 9.2 (8.9,9.6) 16.9 (16.5,17.4) 91.0 90.1 Lincolnshire 75.0 (74.4,75.6) 65.4 (64.8,66.1) 10.1 (9.7,10.6) 18.7 (18.1,19.2) 94.2 88.3 Norfolk, Great Yarmouth & Waveney 76.4 (75.8,76.9) 66.9 (66.3,67.5) 9.1 (8.8,9.5) 18.0 (17.5,18.5) 88.7 87.0 North East Essex 77.9 (77.4,78.4) 67.7 (67.2,68.3) 8.5 (8.2,8.8) 16.4 (15.9,16.8) 92.8 88.3 Northamptonshire & Milton Keynes 77.2 (76.7,77.7) 66.7 (66.1,67.2) 8.9 (8.6,9.3) 17.3 (16.9,17.8) 93.1 88.7 Nottinghamshire 75.5 (75.0,76.0) 65.3 (64.8,65.9) 9.7 (9.4,10.1) 18.8 (18.3,19.3) 90.7 90.8 South Essex 76.7 (76.1,77.3) 67.1 (66.5,67.7) 9.5 (9.1,9.9) 17.2 (16.8,17.7) 92.4 87.9 Staffordshire 75.1 (74.7,75.6) 65.1 (64.6,65.6) 10.2 (9.9,10.6) 19.0 (18.6,19.4) 95.1 91.4 Suffolk 77.8 (77.1,78.4) 70.1 (69.4,70.8) 8.5 (8.1,8.9) 14.7 (14.2,15.3) 95.6 94.7 West Mercia 74.8 (74.3,75.3) 66.6 (66.0,67.1) 9.9 (9.5,10.2) 17.7 (17.3,18.1) 91.7 91.1 NHS London 74.9 (74.7,75.1) 62.0 (61.8,62.2) 11.3 (11.1,11.4) 21.6 (21.4,21.8) 91.8 91.5 Inner North East London 72.1 (71.5,72.6) 58.0 (57.4,58.6) 13.7 (13.3,14.2) 25.1 (24.5,25.6) 90.9 93.9 North Central London 74.9 (74.4,75.3) 61.9 (61.4,62.4) 11.4 (11.1,11.7) 21.4 (21.0,21.8) 91.8 90.7 North West London 75.1 (74.8,75.5) 61.7 (61.3,62.1) 11.1 (10.9,11.4) 21.6 (21.2,22.0) 93.6 93.9 Outer North East London 74.4 (73.9,74.8) 62.4 (61.8,62.9) 11.5 (11.2,11.9) 21.3 (20.9,21.8) 91.3 89.8 South East London 74.2 (73.8,74.6) 61.6 (61.1,62.0) 11.5 (11.2,11.7) 22.1 (21.7,22.5) 91.9 90.4 South West London 77.8 (77.4,78.2) 65.3 (64.8,65.8) 9.1 (8.9,9.4) 18.8 (18.4,19.2) 90.4 90.4 NHS South of England 77.2 (77.1,77.3) 68.6 (68.4,68.7) 8.7 (8.6,8.8) 16.2 (16.1,16.3) 92.1 88.8 Bath, NE Somerset & Wiltshire 77.0 (76.4,77.6) 69.8 (69.1,70.4) 8.6 (8.2,9.0) 15.4 (14.9,15.9) 92.8 90.2 Berkshire 78.8 (78.3,79.4) 67.9 (67.3,68.5) 8.5 (8.1,8.9) 16.5 (16.0,17.0) 97.1 88.5 Bournemouth, Poole & Dorset 77.9 (77.3,78.5) 70.1 (69.4,70.7) 8.4 (8.0,8.8) 14.9 (14.4,15.4) 94.9 90.1 Bristol, N Somerset & S Gloucestershire 75.9 (75.4,76.4) 67.6 (67.0,68.2) 9.3 (8.9,9.6) 17.1 (16.6,17.6) 90.7 89.8 Cornwall & Isles of Scilly 74.8 (74.1,75.6) 66.8 (65.9,67.6) 10.2 (9.7,10.8) 17.7 (17.0,18.4) 83.8 82.9 Devon & Torbay 76.0 (75.5,76.5) 68.9 (68.4,69.4) 9.1 (8.7,9.4) 16.0 (15.6,16.4) 90.6 89.7 Gloucestershire & Swindon 76.4 (75.8,76.9) 68.2 (67.6,68.8) 9.1 (8.7,9.5) 16.2 (15.7,16.7) 92.0 87.1 Kent & Medway 76.3 (75.9,76.7) 66.6 (66.2,67.0) 9.3 (9.1,9.6) 17.9 (17.6,18.3) 92.8 92.2 Oxfordshire & Buckinghamshire 79.2 (78.7,79.6) 70.0 (69.5,70.5) 7.8 (7.5,8.1) 14.8 (14.4,15.2) 90.0 87.1 SHIP 76.4 (76.0,76.7) 68.0 (67.6,68.4) 9.2 (8.9,9.4) 16.9 (16.6,17.2) 91.9 87.5 Somerset 76.3 (75.6,77.0) 69.2 (68.5,70.0) 8.8 (8.4,9.3) 15.9 (15.3,16.5) 93.2 88.5 Surrey 79.5 (79.1,80.0) 70.9 (70.4,71.5) 7.4 (7.1,7.7) 14.1 (13.7,14.5) 91.0 87.6 Sussex 78.1 (77.7,78.5) 69.1 (68.6,69.5) 8.1 (7.9,8.4) 15.6 (15.2,15.9) 94.6 89.5

Key resources NCMP data visualisation and reporting tools e-atlases: Middle Super Output Area, Local Authority, Primary Care Trust www./visualisation/eatlas Local Authority and Primary Care Trust level NCMP reporting Excel tools Available on request from the regional public health observatory obesity lead Excel tool for producing school feedback letters Available on request from the regional public health observatory obesity lead Latest NCMP analysis reports and guidance Analysis using the ONS Area Classification www./ncmp/national_report Changes in children s body mass index between 2006/07 and 2008/09 www./ncmp/national_report Variation in children s BMI by month of measurement www./ncmp/national_report Guidance for analysis www./ncmp/analytical_guidance Small area analysis guidance www./ncmp/analytical_guidance A simple guide to classifying body mass index in children www./noo_pub Other useful resources Standard Evaluation Framework for weight management interventions www./core/sef PowerPoint slide set presenting analysis on childhood obesity www./noo_pub Data factsheets www./noo_pub/key_data Coming soon (October 2011) Changes in children s body mass index between 2006/07 and 2009/10 www./ncmp/national_report