Healthy diet and physical activity

Healthy Diet and Nutrition

Amongst Children and Young People

The 2016 Somerset Children and Young People Survey found that:

• The proportion of children happy with their weight falls from 68% in Year 6 to 41% in Further Education (see chart 1 below).
• Amongst girls, the proportion wanting to lose weight increases with age (see chart 2 below).
• The proportion of children who say they had at least 5 portions of fruit and vegetables on the day before the survey decreases steadily with age, from 1 in 3 at age 10-11 (Year 6) to just 1 in 8 at age 17-18 (FE/6th Form).
• 1 in 6 students in Further Education/6th form had no fruit or veg portions at all.
• The proportion of girls who have no food or drink before lessons rises sharply from 2% in Year 6 to 20% in Year 10.
• At FE age, 57% of students would like to eat more healthily
• At secondary school, 54% of boys and 24% of girls said they never worry about how much they eat.

Chart 1 How happy are children with their weight?

Chart 2 Proportion who want to lose weight

Source: SCYPS/SHEU 2016

Amongst Adults

An estimated 29.7% of adults in the county eat a health and balanced diet, slightly higher than the national average of 28.7% (Health Profile for Somerset 2013). However, Somerset adults are more likely than the England average to carry excess weight (2012-2014, Health Profile for Somerset 2016).

Results taken from the Somerset Lifestyle Survey (2009) showed an increasing proportion of people reported using less salt in cooking (up to 52% from 41% in 2002). 61% had consumed five or more portions of fruit and vegetables the previous day and there was a change observed in the fat content consumed; semi-skimmed milk was the most popular and was used by 68% of participants and 47% of participants were using a low fat spread.

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.

 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

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).  

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.

Current Needs in Somerset

Key facts Amongst Adults (aged 16+)

• Somerset is currently in line with national and regional averages for participation levels of one session per week (see table below).
• The numbers of people who report doing at least 30 minutes of activity three times per week or more has improved in recent years.
• Participation in physical activity is lowest amongst women, older people and those living in the areas of highest multiple deprivation.

Adult (16+) participation levels of one session per week

Source: Active People Survey

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.

• In Somerset, 1 in 8 people aged 65 or older undertake at least three sessions of physical activity a week, compared with 1 in 4 of all adults. 
• The proportion of Somerset adults walking at least five times a week for ‘utility’ purposes (for example, walking to work) increased to 20.0% in 2014/15 according to estimates published by the Department for Transport. This represents the second consecutive annual increase. The proportion of adults walking for recreational purposes has been largely unchanged in recent years (21.8% of adults in 2014/15).
• The proportion of adults in Somerset cycling at least five times a week appears to have declined, for both utility and recreational purposes. An estimated 2.2% of adults cycled at least five times a week in 2014/15 (for any purpose), down from 3.9% the previous year.
• Various physical activity opportunities are commissioned across Somerset (see Current Service Provision section below).  Details are available via the Zing website.   the Integrated Rehabilitation Service. 

Amongst children (under the age of 16)

Key Facts amongst children

• An estimated 91,400 children in Somerset do not meet the recommended physical activity levels for their age group.
• 6% of Somerset pupils (more than 7,000) described themselves as ‘unfit’ or ‘very unfit’
• 4% of pupils responded that they didn’t exercise enough to breathe harder and faster at all in the past week.

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, sixth-form and college students, carried out in the spring and summer terms of 2016, found:- 

• 7% of Primary pupils described themselves as ‘unfit’ or ‘very unfit’.
• 6% of Secondary pupils responded that they didn’t do any physical activity in the 7 days before the survey.
• 1 in 4 Secondary pupils responded that they didn’t do an exercise for an hour or more that made them out of breath and sweaty in the 7
  days before the survey
• The proportion of Secondary pupils who did an exercise 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 rose from 9% in 2014 to 14% in 2016.
• Just over half of pupils at Years, 6, 8 and 10 said that they walked, scootered or cycled to school on the day of the survey.

The survey also identified barriers which may need to be addressed:-

• Enjoyment of physical activity generally declined as pupils progressed through the school system: 87% of Year 6 pupils said they enjoyed physical activities, compared to 73% in Year 8, and 65% in Year 10.
• When asked about barriers to exercise, 31% of pupils in Years 8 and 10 said that they didn’t have time. 10% of pupils said transport was a problem. Children in rural areas were more likely than the average to travel to school by car or van. Transport access to sporting activity, such as swimming pools, was also an issue in West Somerset.

Current Service provision

Zing Somerset is the healthy eating and physical activity service managed by Somerset County Council. It is delivered by Somerset County council with SASP (Somerset Activity and Sports Partnership), Sedgemoor and South Somerset District Councils.

The service aims to deliver universal health promotion through active lifestyle officers, national and local campaigns, initiatives and events, and provide advice and signposting  - via phone, online (social media, website, app), the Zing activity finder and activity tracker.

 ZING Somerset is supported by the ZING website, which anyone can browse by town or postcode. Zing Somerset is a both a physical activity finder and a motivational tool (to record the number of minutes completed) that allows Somerset residents to find a wide range of physical activity and sporting opportunities near them. This includes activities targeted at the whole population and includes specific sections on:

• Home exercises
• Exercise classes
• Use of the outdoors (including active travel)
• Individual sports
• Team sports
• Inclusive sports for those with a disability
• Adventure sports
• Workplace initiatives
• Golden Age Olympics for older people

Work is underway in targeted schools to increase both physical activity levels and healthy eating. Schools are targeted on the results of the National Child Measurement Programme.

The Somerset Exercise Referral Scheme offers activities for those with a diagnosed medical condition. Health Professionals can refer people who will benefit from a personalised physical activity programme to the Somerset Exercise Referral Scheme. There are over 30 recognised leisure providers in Somerset that are accredited to deliver exercise on referral. Venues include leisure centres, gyms, swimming pools and community venues. 

The range of activities available depends on: the individual's health needs, and what is offered by the local accredited leisure provider. All programmes will be designed to meet individual needs and may include gym based exercises, walking, swimming, exercise classes, Tai Chi and other activities. Most importantly the activity will be at then user's own pace. 

The cost of the Somerset Exercise Referral Scheme will vary between leisure providers. The number of sessions can last between 8 and 16 weeks. 

Recommendations for Action

• Improved awareness and knowledge of the current recommended guidelines
• Increased awareness and knowledge of the risks of being physically inactive
• Optimise opportunities to Make Every Contact Count to discuss the importance of being regularly active
• Increased awareness and knowledge of how to increase activity in everyday life
• Increase opportunities for active travel
• Improved built environments which encourage physical activity as the norm

For more information:

• Physical activity and Children  
• Active People Survey  
• Turning the Tide of Inactivity  
• Health Survey for England 2012 
• For information about obesity and healthy weight in Somerset, please click here.