Lambeth Healthy Weight Project: Dr Claire Dempster - Project Lead, Family & Systemic Psychotherapist Dr. Vanessa Impey - Community Paediatric ST8 Ms Hayley Tuffin - Project Family & Systemic Psychotherapist

1. Safeguarding and Childhood Obesity
Lambeth Healthy Weight Project:
Dr Claire Dempster - Project Lead, Family & Systemic Psychotherapist
Dr Vanessa Impey - Community Paediatric ST8
Ms Hayley Tuffin - Project Family & Systemic Psychotherapist

2. ‘Obesity’
 What is it: how and who is affected?
 What are the causes of obesity?
 What are the implications of obesity
 What we are doing about this Lambeth
Healthy Weight project
 Safeguarding issues

3. The global picture: facts about overweight and
obesity
 Overweight and obesity are leading risks for global deaths. Around 3.4
million adults die each year as a result of being overweight or obese. In
addition, 44% of the diabetes burden, 23% of the ischaemic heart disease
burden and between 7% and 41% of certain cancer burdens are
attributable to overweight and obesity.
 Overweight and obesity are linked to more deaths worldwide than
underweight. For example, 65% of the world's population live in countries
where overweight and obesity kill more people than underweight (this
includes all high-income and most middle-income countries).

4. Who is most likely to be affected?
 Everyone is at risk but certain groups are particularly at risk:
 those on a low income
 those people from a minority ethnic background
 those people have overweight parents
 The ‘triple threat’ for chronic disease - obesity, depression, being a member
of a black/minority ethnic group (Stecker 2006)

5. it’s complex...
 ‘The link between parental overweight and
childhood obesity is likely to be both genetic
and environmental, and untangling the two is
often difficult’
 Daniels 2006

6. Health implications
 Immediately we often see.......
 Aches and Pains in limbs
 Constipation Enuresis
 Sleep apnoea
 Mental health issues – sadness – to self harm and suicidation
 Longer term..........
 Type 2 diabetes, Hypertension,Dyslipidaemia (increase in cholesterol)
 Coronary heart disease and stroke, Respiratory effects e.g. sleep apnoea, pulmonary
hypertension
 Cancers, Reproductive functioning i.e. infertility and impotence
 Osteoarthritis,Liver and gall bladder disorders, Dementia

7. Lambeth healthy weight Project aims :
 to change in how we deliver a healthy weight service
 through whole system or integrated approach (joined up dietetic,
paediatric, physical activity, paediatric health care and family
therapy)
 using Systemic Family Therapy principles and practice
 and believing that families are resourceful

8. Principles and practice
•working with the whole family in mind
• non judgmental
• wider contextual and social factors - communities and cultures
• assertive outreach - bridging hospital, home, community and schools
• multi disciplinary and multi agency: joined up working between health, family, activity and diet
• team learning - what are our beliefs and experiences relating to health and diet?

9. What have we seen and heard - stories that include:
• parental mental health issues
• parental experiences of violence
• autism and learning difficulties (often undiagnosed until we see them)
• bereavement
• significant child mental health issues
• high levels of trauma including asylum seekers and NRPF

10. Safeguarding issues
 Families come to us with complex issues and
appear to have not been seen or thought about
elsewhere
 They are often known to many other clinics
 Often children have undiagnosed developmental
issues

11. Safeguarding: a broader perspective Example A
Example A:
 A aged 11. Black African/Caribbean family. Middle child of three,
single parent family, grandmother lives in home – has dementia
 Eldest child has ADHD, youngest has ASD
 File open to 6 different clinics due to range of needs
 Closed to social care despite level of need
 Fragmented services – difficult for family
 Weight issues not seen until child is age 11?

12. Safeguarding, when it becomes Child protection
Example C
 Child with Autism and Learning difficulty
 Single parent family with 3 other children, one with SLD, ASD and
behavioural challenges
 Family only partially engage with services
 Family disengage with us and child gains 9 kilos in 5 months; Social
care do not recognise this as safeguarding issue

13. Safeguarding, when it becomes Child protection
Example D
 D, an 11 year old child, youngest of two
 Single parent. Eldest child taken into care for mental health issues the
day D is born
 Known to obesity services since a toddler, weighs over 17 stone
 Family disengage with us after 6 months with no significant improvement
 Social care do not see this as safeguarding
 Referral to us a year later reveals child has been hospitalised for weight
related issues

14. Safeguarding, when it becomes Child protection
Example E
 E, an 11 year old girl of 6, single parent
 Weighs approx 17 stone
 Elder sister died a year previously
 Mother has undiagnosed PTSD due to death of child and other deaths
 Other siblings showing behavioural worries
 Family do not engage, Social care do not accept as safeguarding

15. Challenges and dilemmas: where to go for help?
 There is increased recognition of the links between obesity and child protection :
 1. NICE Guidance:
 When to Suspect Child Maltreatment 2009 does not mention obesity as presentation of child maltreatment. However, NICE: 2014 Obesity:
identification, assessment and management of overweight and obesity in children, young people and adults issued in November 2014:

‘Be aware of or suspect abuse as a contributory factor to or cause of obesity in children. Abuse may also coexist with obesity’
2. RCPCH expert group:
 Russell Viner, British Medical Journal, 21 August 2010, Volume 341
Review of evidence for obesity and success of treatment programmes concluded 'failure to engage could be neglect' and obesity should be a
concern, and likely to be part of a wider picture of psychosocial difficulty.
3. Local authority guidance and practice development
 e.g. Norfolk
http://www.nscb.norfolk.gov.uk/documents/Safeguarding%20Response%20to%20Obesity%20when%20Neglect%20is%20an%20Issue.pdf
 4. Emerging Clinical and social care practice experience and expertise:
Medical studies of obese children are increasing the knowledge around complications and evidence of immediate harm is likely to be more
available. e.g. it is now thought locally that all children with obesity warrant investigation for sleep studies (new clinical guidance Sleep clinic
Evelina London Childrens' Hospital)
 Definitions of harm and timescales of harm help define what is s17 and what s47 along with parental engagement.

16. Neglect –and emotional abuse definition?
 Failure to attend medical appointments
 Neglect of health and nutritional needs?
 Failure to recognise emotional needs?

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However... systemic failings?
 Many families seen are already well known to services but not been helped
 The meaning of obesity and our practice for an already disenfranchised group e.g. the
‘triple threat’ of obesity, depression and being a member of a black, minority ethnic group
(and being poor)
 Safeguarding and Child Protection needs to recognise the responsibility on the part of all
services to address their own histories and the systemic difficulties arising from these if
they are to be effective and ethical in addressing the needs of families where there are
obesity issues
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18. 18
Pointers for practice
 Recognising our role at workers in all setting and different levels of
organisational practice:
 do we talk about healthy weight with our clients and patients?
 to what extent do our own histories and patterns of eating shape
our practice in relation to obesity?
 to what extent do the organisation beliefs about obesity and what is
Safeguarding (or not) shape our practice?
 to what extent as practitioners and organisations are we prepared
to ‘do’ Safeguarding differently in order to address obesity?
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