Obesity: working with local communities

Action learning

A process by which someone performs an activity and then analyses their actions and gains feedback to improve future performance.

Action research

Action research aims to respond to the practical concerns of participants involved in a change process, such as a new approach to obesity prevention. It involves a partnership between researchers and participants in which problem identification, planning, action and evaluation are all interlinked.

Body mass index

Body mass index (BMI) is commonly used to indicate whether adults are a healthy weight or underweight, overweight or obese. It is defined as the weight in kilograms divided by the square of the height in metres (kg/m²).

'Bottom-up' activities or approaches

Activity is initiated by the community, or people working directly with the community, rather than being introduced by senior management.

Capacity-building

Actions or interventions that improve the ability of an individual, an organisation or a community to identify and address health or other issues on a sustainable basis, for example through skills development, improved networking and communication or shared decision making.

Community

A group of people who have common characteristics. Communities can be defined by location, race, ethnicity, age, occupation, a shared interest (such as using the same service), a shared belief (such as religion or faith) or other common bonds.

Local community refers to a group of people from the same geographic location that is not necessarily related to any official, administrative boundary. The community may be located in a ward, borough, region or city.

Community assets

A community asset (or resource) is anything that can be used to improve the quality of community life. It could be a physical structure or place (such as a recreation centre, library, hospital, meeting place, monument or business). Or it could be a group or an individual, for example, a local community group or a community leader.

Community champions

The term 'community champion' covers a range of roles, and includes inspirational figures, community entrepreneurs, mentors or leaders who 'champion' the priorities and needs of their communities and help them build on their existing skills. It also includes those 'on the ground' who drive forward community activities and pass on their expertise to others. They may provide mentoring or a range of other support, for example, by helping people to get appropriate training or by helping to manage small projects.

Community development

Community development is about building active and sustainable communities based on social justice, mutual respect, participation, equality, learning and cooperation. It involves changing power structures to remove the barriers that prevent people from participating in the issues that affect their lives.

Community engagement

The process of getting communities involved in decisions that affect them. This includes the planning, development and management of services, as well as activities that aim to improve health or reduce health inequalities (Popay 2006).

Community health champions

Community health champions are local people who are recruited and trained as volunteers to 'champion' the health priorities and need of their communities.

Co-production

For this guidance, co-production means developing and delivering action on obesity in an equal and reciprocal relationship between professionals, the local community, people using local services and their families.

Joint strategic needs assessments

Joint strategic needs assessments (JSNAs) identify the current and future health needs of a local population. They are used as the basis for the priorities and targets set by local areas, expressed in local health and wellbeing strategies. They are also used for commissioning to improve health outcomes and reduce health inequalities.

Local system

The local system comprises a broad set of interrelated organisations, community services and networks operating at a range of levels and involving a number of delivery processes.

Overweight and obesity: adults

For adults, overweight and obesity are assessed by body mass index. The sections on classifying overweight, obesity and central adiposity in adults, and classifying overweight, obesity and central adiposity in children and young people, in NICE's guideline on obesity assessment and management give the cut-off points for healthy weight, overweight and obesity.

BMI is a less accurate indicator of adiposity in adults who are highly muscular, so BMI should be interpreted with caution in this group. Some other population groups, such as Asians and older people, have comorbidity risk factors that would be of concern at different BMIs (lower for Asian adults and higher for older people). Healthcare professionals should use clinical judgement when considering risk factors in these groups, even in people not classified as overweight or obese using the classification in the table.

Assessment of the health risks of being overweight or obese can also be based on waist circumference. For men, waist circumference of less than 94 cm is low, 94–102 cm is high and more than 102 cm is very high. For women, waist circumference of less than 80 cm is low risk, 80–88 cm is high and more than 88 cm is very high.

Overweight and obesity: children

More than one classification system is used in the UK to define 'overweight' and 'obesity' in children. The National Child Measurement Programme (NCMP) for primary care states that body mass index (BMI) should be plotted onto a gender-specific BMI chart for children (UK 1990 chart for children aged over 4 years). Children over the 85th centile, and on or below the 95th centile, are categorised as 'overweight'. Children over the 95th centile are classified as 'obese'. Other surveys, such as the Health Survey for England also use this system. In clinical practice, however, the 91st and 98th centiles may be used to define 'overweight' and 'obesity' respectively. Children on or above the 98th centile may also be described as very overweight.

Partner

For the purpose of this guidance, a partner is a local department, service, organisation, network, community group or individual that could help prevent obesity.

'Top-down' activities or approaches

Where an activity is initiated from a senior level in an organisation and cascaded down to those working directly with the local community.

Two-tier

Two-tier counties in England consist of an 'upper-tier' county council and various 'lower-tier' city, borough and district councils.

Wider determinants of health

The social determinants of health are the circumstances in which people are born, grow up, live, work, and age, as well as the systems put in place to deal with illness. These circumstances are in turn shaped by a wider set of forces: economics, social and political forces.