Understanding how local authorities in England address obesity: A wider determinants of health perspective

Nobles, James; Christensen, Alex; Butler, Matthew; Radley, Duncan; Pickering, Katie; Saunders, Joanna; Weir, Carol; Sahota, Pinki

doi:10.1016/j.healthpol.2019.07.016

Cited by 17 publications

(31 citation statements)

References 24 publications

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“…Our ndings are paradoxical given the widespread agreement that upstream efforts are required to alter the obesogenic systems in which we live (2,20,31,34). This secondary analysis and the study of Nobles et al (10) provide little evidence to suggest research and practice is moving upstream with regards to obesity prevention. A paradigm shift is needed within the eld.…”

Section: Summary Of Resultsmentioning

confidence: 69%

“…We used an adapted framework synthesis method (21) to guide our analysis, meaning that qualitative data are both quanti ed and broadly described. This analytical method is consistent with that used in comparable studies (10,22,23). Coding was undertaken using the text available in the "Characteristics of Included Studies" table within the Cochrane Review (16), primarily based upon intervention descriptions.…”

Section: Discussionmentioning

confidence: 99%

“…For the purpose of the present study, we used the tool to code the 153 interventions included in the recent Cochrane Review (16) against the WDoH (see section data analysis section). This method was similar to the approach applied by Nobles et al (10) when analysing the efforts of local authorities in England (10). The tool also enabled us to contrast the causes of obesity against the actions to address obesity; we then present data visualisations of the interventions mapped against the ve levels of the WDoH model.…”

Section: Action Mapping Toolmentioning

confidence: 99%

“…This tool was initially designed to help local authorities in England systematically document their actions on obesity, and to critically re ect upon these in light of the WDoH. Nobles et al (10) used this tool to explore how 10 local authorities aimed to address obesity and identi ed that almost two thirds of action aimed to change individual lifestyle factors such as diet and physical activity. Seldom did local authorities aim to address the upstream determinants of obesity, despite the Action Mapping Tool illustrating that 60% of the causes reside upstream.…”

Section: Introductionmentioning

confidence: 99%

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A Secondary Analysis of the Childhood Obesity Prevention Literature through a Wider Determinants of Health Lens: Implications for Research Funders, Researchers, Policymakers and Practitioners

Nobles

Summerbell

Brown

et al. 2020

Preprint

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Background: Over the last 25 years, we have made great advances in our understanding of the complex adaptive systems which drive childhood obesity. Within this, the important role of upstream interventions which focus on the wider determinants of health (WDoH) has been acknowledged. Concurrently, the number of intervention studies aiming to prevent childhood obesity has increased exponentially. One might anticipate that our understanding of theory has been embedded into the development and implementation of interventions in real time. Methods: We tested this hypothesis by conducting secondary analysis of the interventions included in the Cochrane Review on “Interventions for Preventing Obesity in Children”, published since 1993. All 153 randomised controlled trials (RCTs) were independently coded by two authors against the WDoH model using an adaptive framework synthesis approach. We used aspects of the Action Mapping Tool from Public Health England to facilitate our coding and to visualise our findings in contrast to 226 perceived causes of obesity. Results: We found that the proportion of interventions which targeted downstream (e.g. individual and family behaviours) as opposed to upstream (e.g. infrastructure, environmental, policy) determinants has not changed over time (from 1993 to 2015), with most intervention efforts (57.9%) aiming to change individual lifestyle factors via education-based approaches. Almost half of the interventions (45%) targeted two or more levels of the WDoH. Where interventions targeted some of the wider determinants, this was often achieved via upskilling teachers to deliver educational content to children. No notable difference in design or implementation was observed between interventions targeting children of varying ages (0-5 years, 6-12 years, 13-18 years). Conclusions: This study highlights that interventions, evaluated via RCTs, have persisted to focus on downstream, individualistic determinants of obesity over the last 25 years, despite the step change in our understanding of its complex aetiology. We hope that the findings from our analysis will challenge research funders, researchers, policymakers and practitioners to reflect upon, and critique, the evidence-based paradigm in which we operate, and call for a shift in focus of new evidence which takes a WDoH lens.

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Section: Summary Of Resultsmentioning

confidence: 69%

Section: Discussionmentioning

confidence: 99%

Section: Action Mapping Toolmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

A Secondary Analysis of the Childhood Obesity Prevention Literature through a Wider Determinants of Health Lens: Implications for Research Funders, Researchers, Policymakers and Practitioners

Nobles

Summerbell

Brown

et al. 2020

Preprint

Self Cite

View full text Add to dashboard Cite

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“…Some previous work has been done to map obesity-related policies in England, this has been limited to interventions specifically promoting healthier ready to eat meals (17) and local level policies (18).…”

Section: Introductionmentioning

confidence: 99%

Obesity prevention in the early years: a mapping study of national policies in England from a behavioural science perspective

Croker

Russell

Gireesh

et al. 2020

Preprint

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Background Evidence indicates that early life is a critical time for determining future risk of obesity. A sharper policy focus on pregnancy and early childhood would be useful to improve obesity prevention efforts. This study aimed to systematically identify and categorise the policy levers being used in England that have potential to influence early lifecourse (pregnancy and 0-5 years) and identify how these policies interface with energy balance behaviours. The objective is to identify gaps and where further policy actions could most effectively focus. Methods A behavioural science approach was taken using the Capability-Opportunity-Motivation-Behaviour (COM-B) model and Behaviour Change Wheel (BCW) framework. The key determinants of energy balance in the early years were identified from the Foresight Systems Map. Policy actions were scoped systematically from available literature, including any health or non-health policies which could impact on energy balance behaviours. The Foresight variables and policy actions were considered in terms of COM-B and the BCW to determine approaches that would be likely to be effective for obesity prevention and treatment. Existing policies were then overlaid across the map of key risk factors to identify gaps in obesity prevention and treatment provision. Results A wide range of policy actions were identified (n=115) to address obesity-relevant risk factors. The most common policy actions were educational and guidelines relating to environmental restructuring (i.e. changing the physical or social context). Scope for strengthening policies relating to the food system (e.g. the market price of food) and psychological factors contributing to obesity were identified. Policies acted via all aspects of the COM-B model, but there was scope forimproving policies to increase capability through skills acquisition and both reflective and automatic motivation. Conclusions There is substantial policy activity to address early years obesity but much is focused on education. Scope exists to strengthen actions relating to upstream policies which act on food systems and those targeting psychological factors contributing to obesity risk.

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Promoting healthy eating habits among youth according to their preferences: Indications from a discrete choice experiment in Tuscany

2021

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Understanding how local authorities in England address obesity: A wider determinants of health perspective

Cited by 17 publications

References 24 publications

A Secondary Analysis of the Childhood Obesity Prevention Literature through a Wider Determinants of Health Lens: Implications for Research Funders, Researchers, Policymakers and Practitioners

A Secondary Analysis of the Childhood Obesity Prevention Literature through a Wider Determinants of Health Lens: Implications for Research Funders, Researchers, Policymakers and Practitioners

Obesity prevention in the early years: a mapping study of national policies in England from a behavioural science perspective

Promoting healthy eating habits among youth according to their preferences: Indications from a discrete choice experiment in Tuscany

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