Valerie Hutson – Written evidence (FPO0072)
- I have been employed as a public health nutritionist by Blackpool Council for the last three years and my role contributes to the Healthy Weight agenda in the Town. In addition to the separate response to this call for evidence from Blackpool Council I also wanted to respond in my individual capacity. Although there is a great deal of excellent work going on, I think more could be done from a prevention perspective. I have considered what additional activity Local Authorities, food manufacturers and central Government could do to address issues around food, poverty and health.
- My main concern is the lack of lifestyle interventions for children diagnosed with type 2 diabetes. This issue was reported to the All-Party Parliamentary Group for Diabetes in the House of Commons on 16th May 2019. Leading academics, specialists and healthcare professionals came together to discuss children with type 2 diabetes, covering the available evidence, challenges and opportunities. The Group heard how there were an estimated 7,000 people aged under 25 with the condition. Speaker, Dr Timothy Barrett, Professor of Pediatrics at the University of Birmingham, said: "NICE guidelines are very limited, we don’t know how to treat these children." He said there was a lack of lifestyle interventions.
- In 2018 the BBC reported that nationally that the figures of children being treated with type 2 diabetes in England and Wales had gone up from 507 to 715 in four years, especially in areas of deprivation. The report outlined that The Local Government Association, which receives funding for public health from the government, says the true number of young people affected could be even higher. It said it was "extremely worrying" that more young people are developing the condition as type 2 diabetes can lead to a range of health problems such as heart disease, strokes and kidney problems.
- Evidence from NICE suggests that with those in lower Socioeconomic position groups having a higher prevalence and incidence of Type 2 Diabetes. Also scientific literature shows how the lower spending power, stress, anxiety and depression associated with low social status makes people more vulnerable to bad diets.
- In the report ‘Child Health National Paediatric Diabetes Audit 2016-17 Care Processes and Outcomes’ produced by the National Paediatric Diabetes Audit Royal College of Paediatrics the audit records 715 young people (aged <25 yrs) with Type 2 diabetes nationally. The report does acknowledge that there may be others managed in primary care that they don’t know about. For this reason, it doesn’t give a prevalence rate of Type 2 diabetes. This audit data isn’t Blackpool specific and we don’t have any easily accessible information on children with diabetes locally that I am aware of.
- Following the publication of the above report within the Council we looked to establish the extent of the problem in Blackpool. Our investigations in Aug 2018 showed that sixty six children were being treated at Blackpool Teaching Hospital (BTH) with Type 1 diabetes but none with Type 2 . Type 1 patients are treated via secondary care however these may not all be Blackpool children, they could be from outside the area and being treated at Blackpool. The nil figure for children being admitted for BTH doesn’t provide a clear picture as children with Type 2 are managed in primary care.
- Unless a national register is introduced to gather data on those treated in primary care, Local Authorities will not fully understand the extent of the type 2 diabetes problem. Researching good practice from overseas has highlighted that the New Zealand Ministry of Health have a Virtual Diabetes Register (VDR) which includes all individuals identified by a number of diabetes flags including diabetes-associated hospital admissions, prescriptions for diabetes-related therapies, attendance at specialist or management clinics, laboratory tests for HbA1c and retinal screening. Having a similar VDR in the UK would provide Local Authorities with robust evidence to allocate funds and justify the development of appropriate lifestyle interventions for children already diagnosed with type 2 diabetes or those that are at risk or are already pre-diabetic.
- There is growing, robust evidence that a low carbohydrate diet is a drug free alternative that can put Type 2 Diabetes into remission. Making this way of eating central to the care of people with diabetes is now looking more likely. Which is in the main, due to advocates such as Dr David Unwin, Diabetes.co.uk and The Public Health Collaboration. My research confirms that some academics, health care professionals and those providers involved in sharing nutritional information are currently working on initiatives and digital solutions to inform and educate young people about how different foods can affect blood sugar levels. I would like to see a co-ordinated effort across Local Authorities to accelerate knowledge of prevalence levels and the development of specific low carb health care prevention tools and programmes. I would also like to see the food industry being encouraged to do more to support and promote healthy and sustainable lower carb diets with smaller portion packs and on pack labelling to include carbohydrate contents on the front of pack. Government regulation and NHS upskilling could also be effective drivers of change in this respect. Making lower carbohydrate foods cheaper could influence consumer choice, particularly for those in lower income groups. In my experience those families with chaotic lives have many competing demands and healthy eating is often not their top priority. I have found that primary school children are more open to accept nutritional messages and are able to influence their families in a positive way. I have shared my thoughts with my Public Health colleagues and will continue to use my nutritional expertise to influence and educate for the public good.
Valerie Hutson ANutr
Healthy Lifestyles Nutritionist, registered with the Association for Nutrition as a Registered Associate Nutritionists.
Although I am employed as a public health nutritionist in Blackpool Council’s Public Health team, I am responding to this call for evidence in an individual capacity.
28 September 2019