Healthy diet and physical activity

Healthy Diet and Nutrition

Amongst Children and Young People

The 2018 Somerset Children and Young People Survey found that:

• The proportion of children who have at least 5 portions of fruit or veg falls from 31% at primary school to 26% at secondary.
• The proportion of children that report they have exercised enough to breathe harder five times in the week before the survey marginally increases from 40% at primary to 41% at secondary
• However, the reported enjoyment of physical activity falls from 81% at primary to 70% at secondary.
• Secondary school children frequently report using food as a coping mechanism with 37% of boys and 47% of girls reporting eating more when worried and 24% of boys and 49% of girls reporting eating less.

In addition to this, the 2016 survey found that for Further Education students (aged 17/18):

• 41% of students were happy with their weight

• 1 in 6 students had no fruit or veg portions at all.
• The proportion of students who say they had at least 5 portions of fruit and vegetables on the day before the survey was 1 in 8
• 57% of students would like to eat more healthily

Physical Activity in Children and Young People

Children and young people aged 5-18 need to do:

• At least 60 minutes (1 hour) of physical activity every day, which should range between moderate-intensity activity, such as cycling and playground activities and vigorous-intensity activity, such as fast running and tennis.
• On three days a week, these activities should involve muscle-strengthening activities, such as push-ups, and bone-strengthening activities, such as running.

The organisation UKactive estimate that inactivity levels are due to increase by a further 15 per cent by 2030.

The recommended physical activity levels for all ages are not widely known. The latest guidelines have been in place since 2011 but anecdotal work regularly undertaken by the Public Health team in Somerset clearly shows that both members of the public and front line health and social care staff are not aware that the guidelines have changed and what the current guidance is.

Often there is a mismatch between people’s perception of how active they are and their actual physical activity levels. Self-reported measures of physical activity tend to be both higher and lower than directly measured levels of physical activity, which poses a problem for reliance on self-report measures (see a systematic review by Prince et al (2008) http://www.ijbnpa.org/content/5/1/56) which tends to be how physical activity is measured at a population level.

The Health Survey for England 2015 data revealed that, nationally:- 

• 23% of boys and 20% of girls aged 5-15 years met the physical activity recommendation
• the proportion of girls meeting the recommendation was 26% in those aged 5-7 years and 9% in those aged 13-15 years
• the proportion of boys meeting the recommendation was 30% in those aged 5-7 years and 15% in those aged 13-15 years

Applying this data to the Somerset population using the 2011 Census, this equates to approximately 91,400 local children and young people aged 5 to 15 not meeting the recommended physical activity levels for their age group.

The Somerset Children and Young People's Survey, involving almost 9,000 primary pupils aged 9 to 11, secondary pupils aged 12 to 15,  carried out in the spring and summer terms of 2018, found:- 

• 71% of primary boys responded that they are 'fit' or 'very fit', compared with 65% of the girls.
• 45% of primary boys responded that they exercised enough to breathe harder at least five times in the week before the survey, compared with 35% of the girls
• 60% of secondary boys responded that they are happy with their weight as it is, compared with 46% of the girl
• 20% of secondary boys responded that they exercised for an hour or more that made them feel out of breath and sweaty on at least five days in the 7 days before the survey, compared with 12% of the girls
• 34% of primary pupils responded that they spent time playing sport or doing other physical activity after school on the day before the survey in 2018, compared with 41% in 2016

Healthy Diet and Nutrition Amongst Adults

Poor diet and obesity are leading causes of premature death and mortality(Global Burden of Disease, 2017), and are associated with a wide range of diseases including cardiovascular disease and some cancers, which can have a significant impact on an individual’s physical and mental health and wellbeing.

In 2017/18, 61.5% of adults in Somerset have the recommended 5-a-day on a usual day which is better than the England average of 54.8%. Despite this, Somerset adults are more likely than the England average to carry excess weight at 67.4% compared to 62.0% for England.

Malnutrition amongst Older Adults

Many people become under nourished in older age; this is usually defined by low body weight and due to social or physiological causes such as lone living, affordability and access to food, difficulty preparing meals, or illnesses and disease.  At any given time, more than three million people in the UK are either malnourished or at risk of malnutrition and an estimated 93% of those are living in the community. It is also estimated that 1 in 10 people over 65 are malnourished or at risk of being so. Dehydration is also associated with a number of causes of harm, although the scale is less well understood.

Consequences of malnutrition: 

• Research has found that individuals who are malnourished will experience: increased ill health, increased hospital admissions, increased risk of infection and antibiotic use, longer recovery time from surgery and illness and increased risk of mortality. 

• When compared with well-nourished people, malnourished individuals in the community saw their GP twice as often, had 3 times the number of hospital admissions and stayed in hospital more than 3 days longer. 

• Malnutrition in care homes has been linked to increased hospitalisation, readmission and long term ill health.
• Poor nutritional status is associated with the onset of frailty. Screening and early diagnosis of malnutrition and frailty in older adults will help to prevent the onset of disability.

 Cost of malnutrition: 

• Malnutrition leads to increased use of health and care services and the national estimated costs run into billions of pounds. Addressing it could lead to really significant savings. 

• Severely malnourished patients identified in general practice incur additional health care costs of £1,449 per patient in the year following diagnosis. 

There is a clear indication that people in older age are at risk of poor diets, but when you consider its causes - such as dementia, social isolation and reduced mobility - there is a clear opportunity to identify those at risk and improve access to food by a joined up approach from a variety of stakeholders.

For more information on best practice and implementation guidelines, please read:-

• the Malnutrition Task Force document Malnutrition in Later Life.
• the NHS guidance document Commissioning Excellent Nutrition and Hydration 2015 – 2018 (published October 2015)

Fast Food Outlets

• There is strong evidence linking the availability of fast food outlets and increasing level of area deprivation.
• The local authorities with a higher deprivation score (i.e. more deprived) tend to have a greater density of fast food outlets.
• In Somerset, 329 fast food outlets were counted in 2016.
• The rate of 60 per 100,000 population is below the regional and national averages of 69 and 88 per 100,000, respectively.
• Within Somerset, the rates vary from 51 per 100,000 in Mendip to 70 per 100,000 in West Somerset
• 76 of Somerset's 142 electoral wards have at least one fast food outlet.
• Yeovil Central has the highest number of fast food outlets of any ward in Somerset, with 31. Only eight wards in the South West region have more.

For detailed data and reports, see the Public Health England.

Physical Activity in Adults

Physical inactivity (those who do fewer than 30 minutes of at least moderate intensity activity per week are referred to as inactive) reduces our life expectancy by 5 years and increases the risk of obesity, heart disease, type 2 diabetes, hypertension, and certain types of cancer. Regular participation in physical activity reduces the risk of becoming depressed by 30% and developing dementia by 40%. It also exhibits wider benefits such as happiness, socialisation, independence and reduces sickness absence.

Recommended Activity:-

In order to benefit health adults should be doing:

• 150 minutes of moderate intensity exercise each week (in 10 minute bouts) e.g. walking, cycling, gardening, sport as well as regular exercise and physical activity (Chief Medical Officer 2011)
• Or 75 minutes (1 hour and 15 minutes) of vigorous-intensity aerobic activity such as running or a game of singles tennis every week, and
• With both options muscle-strengthening activities should also be included on 2 or more days a week that work all major muscle groups (legs, hips, back, abdomen, chest, shoulders and arms).  

Key facts Amongst Adults (aged 19+)

• Somerset is currently worse than the national and regional averages for participation levels of at least 150 minutes per week (see graph below).
• Participation in physical activity is lowest amongst women, older people, non-white ethnicities and those living in the areas of highest multiple deprivation.

Graph 1: Trends in Percentage of physically active adults

The Department for Transport findings show that in 2016-17:

• The proportion of adults Walking at least five times a week was 33.3% for Somerset, slightly better than the England figure of 32.0%. This is an increase from the 2015-16 figure of 30.4%.
• The proportion of adults Cycling at least five times a week was 3.3% for Somerset, which is in line with the England figure of 3.4%. This is an increase from the 2015-16 figure of 3.0%.
• However, in 2017, 48% of cyclists feel it is too dangerous to cycle on the road which is an increase from the 2016 figure of 39%.

Amongst older adults

Maintaining good physical fitness is an essential part of maintaining independence and wellbeing as we age.  Being overweight can compromise this and places people at an increased risk of vascular diseases such as coronary heart disease and stroke, as well as diabetes, breast and colon cancer, depression and falls. 

In addition, there are many factors which may lead to an older person having reduced physical fitness for example; chronic health conditions, decreased mobility, painful feet, sight impairment, falls and a fear of falling reducing confidence, can all lead to a reduction in physical activity.  In addition, the ageing process itself results in a loss of muscle mass and muscle strength which contributes to reduced activity levels.

Research has shown that physical activity is very important in reducing the risk of an older person experiencing a fall, by helping to increase balance, strength and flexibility. There is also evidence to show the risk of hip fracture is up to 40% lower in older people who are more active.

Graph 2:  Percentage of physically active adults for England broken down by age

The Chief Medical Officer 2011 guidelines for physical activity in older people are:

1. Older adults who participate in any amount of physical activity gain some health benefits, including maintenance of good physical and cognitive function. Some physical activity is better than none, and more physical activity provides greater health benefits.
2. Older adults should aim to be active daily. Over a week, activity should add up to at least 150 minutes (2½ hours) of moderate intensity activity in bouts of 10 minutes or more – one way to approach this is to do 30 minutes on at least 5 days a week.
3. For those who are already regularly active at moderate intensity, comparable benefits can be achieved through 75 minutes of vigorous intensity activity spread across the week or a combination of moderate and vigorous activity.
4. Older adults should also undertake physical activity to improve muscle strength on at least two days a week.
5. Older adults at risk of falls should incorporate physical activity to improve balance and co ordination on at least two days a week.
6. All older adults should minimise the amount of time spent being sedentary (sitting) for extended periods.

For more information:

• Physical activity and Children  
• Active People Survey  
• Turning the Tide of Inactivity  
• Somerset Activity and Sports Partnership 
• For information about obesity and healthy weight in Somerset, please click here.