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Vocal Asesor
Coordinador de la Estrategia
NAOS. AESAN.
MODERADOR:
D. JUAN MANUEL BALLESTEROS
Director del Observatorio
Nacional de la Obesidad
Reino Unido
MR. HARRY
RUTTER
The National Obesity ObservatoryProf Harry Rutter, Director, NOO
Adult obesity prevalence, latest available data*
Source: http://www.noo.org.uk/NOO_about_obesity/international/
Systems
Complicated v Complex
Me riding
my bike
Me riding
my bike
Me being offered
biscuits in return
for ‘earning’
them through my
cycling
Me being offered
biscuits in return
for ‘earning’
them through my
cycling
Me eating
biscuits –
yum yum
Me eating
biscuits –
yum yum
Woops!Woops!
So did the cycling
infrastructure
intervention
work?
So did the cycling
infrastructure
intervention
work?
So did the social
marketing
intervention
work?
So did the social
marketing
intervention
work?
So did the front
of pack labelling
intervention
work?
So did the front
of pack labelling
intervention
work?
How do we
answer these
questions?
How do we
answer these
questions?
How do we
measure the
interactions
between them?
How do we
measure the
interactions
between them?
•Individuals/populations/environments
•Small effect sizes
•Important interactions
•Compensatory behaviours
•Emergence
•Flows, feedbacks…
•Etc etc
•Analytical / modelling techniques
•Novel research approaches
•Steal ideas from other sectors
•What is (are) the most appropriate
research paradigm(s)?
•Individuals/populations/environments
•Small effect sizes
•Important interactions
•Compensatory behaviours
•Emergence
•Flows, feedbacks…
•Etc etc
•Analytical / modelling techniques
•Novel research approaches
•Steal ideas from other sectors
•What is (are) the most appropriate
research paradigm(s)?
The Obesity Observatory
Mapping
Signposting
Advice
Guidance
NOO: Translation / Interpretation / Analysis for both data and evidence
ToolsAnalysis/Briefings
Reports
NOO’s role: translating complexity
Data Evidence
Mapping
Signposting
Advice
Guidance
Tools
Briefings
Reports
Translation
Mapping
Signposting
Tools
Analysis
Reports
Translation
Advice
Guidance
Strategic networking
Dept of Health
NOO
Regions Local areas
Academics,
experts
WHO, EC, UK,
Europe,
International
Expert Panel
Public health
observatories
NGOs
Providers
Others
Govt departments
National
statistics, surveys
etc
Client
Stakeholder
Key
NB PHO/
APHO role
National Local
NOO
International Regional
Policy
Practice Academia
NOO
18
NOO structure
PH = Public Health
DirectorWTE
DirectorWTE
Consultancy Expertise on
Obesity, Physical Activity & Nutrition
Consultancy Expertise on
Obesity, Physical Activity & Nutrition
Deputy DirectorP/T
Deputy DirectorP/TPH Consultant
P/T
PH ConsultantP/TDeputy Director
P/T
Deputy DirectorP/T
PH Specialist Obesity
P/T
PH Specialist Obesity
P/T
Website Database Specialist
P/T
Website Database Specialist
P/T
PH Analyst NOO@EMPHO
P/T
PH Analyst NOO@EMPHO
P/T
PH Specialist Researcher
WTE
PH Specialist Researcher
WTE
PH Analysts (Intelligence)
WTE
PH Analysts (Intelligence)
WTE
Expert/Principal Analyst
P/T
Expert/Principal Analyst
P/T
Team Administrator/PA
WTE
Team Administrator/PA
WTE
What do we do?
BMI distribution: Reception childrenNational Child Measurement Programme 2007/08 to 2009/10 (pooled)
© NOO 2011
-5 -4 -3 -2 -1 0 1 2 3 4 5
BMI z score
England 1990 Baseline
BMI distribution: Year 6 childrenNational Child Measurement Programme 2007/08 to 2009/10 (pooled)
© NOO 2011
-5 -4 -3 -2 -1 0 1 2 3 4 5
BMI z score
England 1990 Baseline
12 18.5 25 30 40 50
BMI (kg/m2) Males 1991-94 Males 2007-09 Females 1991-94 Females 2007-09
Underweight<18.5kg/m2
Healthy weight18.5 to <25kg/m2
Overweight25 to <30 kg/m2
Obese30 to <40kg/m2
Morbidly obese≥40kg/m2
Adult (aged 18+) BMI distributionHealth Survey for England 1991-94 and 2007-09
23.6%22.9%
21.7%
20.5%
18.9%
17.9%
16.6%
15.7%
14.6%
12.6%12.6%12.0%
11.4%10.7%
9.7%9.0%
8.3%7.9%
7.5%6.8%
Most
deprived
Least
deprived
© NOO 2011
Prevalence of obesity by deprivation decile Children in Reception and Year 6 (National Child Measurement Programme 2009/10)
Child obesity: BMI ≥95th centile of the UK90 growth reference
Deprivation deciles assigned using the Index of Multiple Deprivation 2010
Reception Year 6
Prevalence of obesity by ethnic groupReception (National Child Measurement Programme 2009/10)
Child obesity: BMI ≥ 95th centile of the UK90 growth reference© NOO 2011
8.6% 8.7%
11.0%
8.1%
11.5%
8.8%
16.4%
14.9%
10.3% 10.5%9.6%10.6%
11.8%
9.7%
15.1%
12.5%
18.0%
14.9%
10.6%
13.9%
White
British
White
Other Pakistani Indian
Bangla-
deshi
Asian
Other
Black
African
Black
Other Mixed
Any other
ethnic
group
Girls Boys
Prevalence of obesity by Local AuthorityYear 6 children, resident in London, NCMP 2009/10
Low prevalence
High prevalence
Child obesity: BMI ≥ 95th centile of the UK90 growth reference© NOO 2011
http://www.noo.org.uk/visualisation/eatlas
Low prevalence
High prevalence
Insufficient data less than 100 children measured
Prevalence of obesity by Middle Super Output AreaYear 6 children, resident in London, NCMP 2007/08 -2009/10
Child obesity: BMI ≥ 95th centile of the UK90 growth reference© NOO 2011
http://www.noo.org.uk/visualisation/eatlas© NOO 2011
Evidence
Evidence trajectories
Time
Speculative
Lev
el
of
act
ivit
y
Evidence-based
Learn from success
Celebrate failure
Cost effectiveness
Summary of the challenges
• Obesity and NCDs pose major problems
• Complex system
• Data are confusing and evidence is lacking
• Money is tight
• Many perspectives: personal, professional,
political, commercial
• Fear of failure - we act conservatively
• Lack of dialogue between academia, policy,
and practice
Solutions
• Acknowledge the scale of the problem
• Embrace complexity
• Analyse, interpret, translate the data and evidence
• Promote evidence-driven practice to provide
objectivity
• Learn from doing – pragmatic approach to
evaluation
• Maximise value through economies of scale
• Respond to user needs, but also push boundaries
