Presentation by Professor Kamlesh Khunti on Prevention of Chronic Disease. Professor Khunti is Director of NIHR CLAHRC East Midlands and leads the Preventing Chronic Disease research theme.

1. Prevention Theme
Theme Lead: Kamlesh Khunti
CLAHRC East Midlands is hosted by
Nottinghamshire Healthcare

2. NHS Priorities
Public Health England Priorities 2013/4
•
•
•
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Reducing preventable deaths
Reducing the burden of disease
Protecting the country's health
Giving children and young people the
best start in life
• Improving health in the workplace

3. Overweight and obesity among adults
Health Survey for England 2010-2012
More than 6 out of 10 men are overweight or obese (66.5%)
More than 5 out of 10 women are overweight or obese (57.8%)
Adult (aged 16+) overweight and obesity: BMI ≥ 25kg/m 2

4. Prevalence of excess weight among children
National Child Measurement Programme 2012/13
One in five children in Reception is overweight or obese (boys 23.2%, girls 21.2%)
One in three children in Year 6 is overweight or obese (boys 34.8%, girls 31.8%)
Child overweight (including obesity)/ excess weight: BMI ≥ 85th centile of the UK90 growth reference

5. Causes of death
References:
1. ASH Factsheet, Smoking Statistics: illness & death, June 2011
(http://ash.org.uk/files/documents/ASH_107.pdf) NB area
represents value
Alcohol:
6,541
Smoking:
81,400
Obesity:
34,100
Traffic:
2,502
Suicide:
5,377
HIV:
529
Drug misuse:
1,738

6. Sedentary time and outcomes
HR DM 2.12
HR CVD 2.47
HR CVD MORT 1.9
HR 1.73 for Metabolic Syndrome
HR ALL CAUSE MORT 1.49
18 Studies incl 794,577
Wilmot E et al Diabetologia 2012 DOI 1007/soo125-012-2677-x, Edwardson C et al PLoS ONE 2012:7:4e34916

7. Helping pregnant smokers to stop:
integrating behavioural sciences
evidence into NHS counselling
Tim Coleman, Kasia Campbell
& Sue Cooper
Division of Primary Care
CLAHRC East Midlands is hosted by
Nottinghamshire Healthcare

8. Training: integrating evidence
• NHS health professionals are trained to help
pregnant smokers by the National Centre For
Smoking Cessation Training, NCSCT
• Systematic reviews of behavioural sciences
literature
– Identify behaviour change techniques
(BCTs)
• Pregnant smoker focus groups
– Add relevant BCTs to NCSCT training
• More effective UK ‘stop smoking’ counselling
– Health professionals trained via enhanced
online and face to face training courses

9. Healthy Schools Programmes
Professor Stuart Biddle
Professor Cris Glazebrook
CLAHRC East Midlands is hosted by
Nottinghamshire Healthcare

10. Healthy Schools Programme
• Interventions aimed at reducing
sitting and increasing overall
movement have also been
shown to be beneficial for young
people’s health
• A wide scale translation of these
findings into the curriculum and
physical activity in schools is in
need of development.

11. Aim
• To develop and implement an integrated
approach to:
– promoting health behaviour, including
sitting less, moving more, and a healthy
diet
– increasing knowledge and understanding
of chronic disease within the school
curriculum
– Resources: Teaching guides, student &
parent booklets, website
• Main outcomes: whether teachers
engage with the project; knowledge;
behaviour change

12. Industry
• This project will be run in
collaboration with NB Group
which specialises in
healthcare and retail
marketing
communications, including
services in strategic
consultancy, creative, design
, copywriting, multimedia, pro
duction and deployment

13. Implementation of a type 2
diabetes prevention pathway
in a South Asian population
Tom Yates
Joe Kai
CLAHRC East Midlands is hosted by
Nottinghamshire Healthcare

14. Background
• Type 2 diabetes mellitus (T2DM) is
one of the fastest growing LTC
• Cost NHS £15.1 billion by
2035, =17% of total health care
expenditure
• Prevention is an NHS priority
• The risk and prevalence of T2DM is
2-3X greater in South Asians
• Urgent need to engage and embed
prevention strategies in South Asian
communities

15. Objectives
• Embed a systematic EB approach to
identifying at high risk people
• Embed within routine care a structured
education programme for SAs
• Identify barriers and facilitators to
implementation
• To explore and assess the
acceptability, feasibility and impact of the
approach
• To determine whether the programme
promotes increases in health behaviour
and quality of life
• To determine the cost-effectiveness of
implementing the programme

16. Evaluation
•
Analysis and outcomes will be structured around the RE-AIM (Reach,
Efficacy/Effectiveness, Adoption, Implementation, Maintenance) evaluation
framework (http://www.re-aim.org/).
•
Adoption and Implementation: Number of practices approached, number
that take part and number actually implementing the diabetes prevention
pathway. Number of educators trained and number of courses undertaken
will also be recorded.
•
Reach: Numbers of individuals identified at high risk, invited to attend,
agree to attend and actually attend the programme will be recorded.
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Effectiveness: Do measures of health status change?
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Maintenance: Is the prevention pathway continued after the study period
has finished?

17. Trial to investigate the effect of
structured education on people at
risk of cardiovascular disease
Professor Stuart Biddle
Professor of Physical Activity and Health, University of Loughborough
Dr Stephen Rogers,
Visiting Professor, University of Northampton;
Consultant in Public Health, Northamptonshire County Council
CLAHRC East Midlands is hosted by
Nottinghamshire Healthcare

18. Objectives
• To develop a structured
education programme for
individuals at high risk of CVD
• To determine (by randomised
controlled trial) whether the
programme can reduce total
cholesterol and other
modifiable risk factors

19. Study Design
• Individually randomised trial run in primary care
• Eligibility criteria – modelled CVD risk > 20%
(Framingham or QRisk) in previous 24 months
• Primary outcome is total cholesterol; secondary
outcomes include body weight, physical activity, diet and
smoking status
• Intervention - Structured lifestyle intervention programme
• Data collected at baseline with follow-up at 6 and 12
months

20. Thank you for listening
kk22@le.ac.uk
www.clahrc-em.nihr.ac.uk
@CLAHRC_EM
This research was funded by the National Institute for Health Research Collaboration for Leadership in Applied
Health Research and Care East Midlands (NIHR CLAHRC EM). The views expressed in this presentation are
those of the speaker(s) and not necessarily those of the NHS, the NIHR or the Department of Health.