Tackling Childhood Obesity

The Childhood Obesity Trailblazer Programme is an ambitious programme which aims to support the mobilisation of cross-sector action in localities across England to tackle childhood obesity. The five Trailblazer projects are in Birmingham, Bradford, Lewisham, Nottinghamshire, and Pennine Lancashire.

The most recent Trailblazer Assembly, held in September 2021, provided an opportunity for people involved in the Trailblazers and others working on childhood obesity to explore the lessons from the programme to date.

Over 90 people participated in the online event. The event included:

• Provocations from
  • Cllr David Forthergill, Leader of Somerset County Council and Chair of the LGA Community Wellbeing Board;
  • Professor Corinna Hawkes, Director, Centre for Food Policy at City, University of London and Vice-Chair of the Child Obesity Taskforce; and
  • Alison Tedstone, Deputy Director Diet, Obesity and Physical Activity/ Chief Nutritionist, Public Health England.
• Presentations from each Trailblazer area
• Two sets of workshops.

This report begins by presenting summaries of the provocations made by the three speakers. The main body of the report then presents the key questions asked in the workshops and summaries of the discussions that took place. Links to relevant resources such as published learning notes from the Trailblazer and useful tools that were referred to in discussions are provided throughout this note.

The presentations from the five trailblazers, as well as other learning resources for this programme, can be found on the Local Government Association Childhood Obesity Trailblazer Assembly website.

Provocations were presented at the start of both days of the event. These were designed to ‘provoke’ reactions and stimulate thinking among attendees ahead of the Trailblazer presentations and workshop sessions. The three provocations were delivered by Councillor David Fothergill, Corinna Hawkes, and Alison Tedstone. The boxes below present the key messages from each provocation.

Councillor David Fothergill, drew on personal experience to discuss that there hasn’t been enough improvement in knowledge or action surrounding nutrition since the 1960s. He emphasized that better education on healthy living is ‘patchy’, that many families who are facing financial hardship are often forced to resort to cheaper, more unhealthy food options. Big societal issues have lead to behaviour changes such as advances in technology (leading to less physically active past times like playing video games), the growth of fast-food delivery companies, and lockdowns due to COVID have impacted levels of physical activity and family food behaviours. Furthermore, Councillor Fothergill argued that access to fast food and sugary drinks is still just as problematic as 60 years ago. To tackle these wider issues he posed three big questions:

• Do we believe delivery companies help to drive obesity?
• Are fast-food and unhealthy food adverts essentially the new cigarette adverts?
• How can we engage councillors to prioritise these issues and take more of a responsibility in driving change?

Corinna Hawkes emphasised the message that action to address the underlying issues of childhood obesity requires a joined-up approach, working across the system with families to provide them with better support. Corinna then concentrated on the impact of financial insecurity on the behaviours of families. Being financially insecure can impact people’s mental health and thought processes. Stress caused by financial insecurity gives people less bandwidth for day-to-day activities like planning and cooking a meal, on top of the issue of families having less money to spend on (often) more expensive healthy food. Stress caused by financial insecurity is therefore a leading influence on healthy behaviours and presents significant barriers to behaviour change. Corinna identified four key areas for action:

• Action in the system to address financial insecurity.
• Action on the food-system to tackle cheap, unhealthy options like fast-food.
• Action in the education system to influence education of healthy eating practices.
• Challenging the perception of food – enjoying healthy food for pleasure, not just nutrients.

Alison Tedstone also presented advertising as a fundamental issue. Alison posited that advertising of junk food will get more aggressive to make up for lost sales during the pandemic. In a context of public sector budget constraints, it will become more difficult for local authorities to refuse such advertisements. Despite this, Transport for London has done well to mitigate this negative impact across London. TFL have actively removed all fast-food adverts from their transport. However, the issues are still significant across the country.

On a national level, she stated that legislation is being progressed, for example, calorie labelling. Alison encouraged people to draw attention to issues on a local level to promote action. She stressed the importance of reducing childhood obesity in order to reduce the wider pressure on the NHS when it comes to further diseases, of which, excess body weight is a contributing factor.

Some key areas for further exploration include:

• The extent of the impact of huge growth in snack foods being easily accessible via delivery companies.
• The extent of the impact of changes in the machinery of government e.g., introduction of the Office for Health Improvement and Disparities.
• The extent of the impact of an increase in mental health issues and pressures on income on prevalence of childhood obesity and on health service resources.

Participants at the September 2021 Trailblazer Assembly took part in two workshop sessions. The workshop topics on day one were decided by organisers of the event. The workshops on day two were informed by what participants wanted to discuss.

This section of the report is structured around nine key questions from the workshops.

1. How can we remove stigma from childhood obesity and healthy weight conversations?
2. How do we support food and nutrition in a time of pressing food and financial insecurity?
3. How do we take a system approach to understanding families and how best the system can support them?
4. How can we develop a shared narrative to influence and mobilise the whole food system?
5. How do we get childhood obesity on the corporate agenda and keep it there?
6. What are the challenges and opportunities involved in tackling childhood obesity in two tier areas?
7. How do we develop a community-driven approach in practice?
8. What are the most effective ways of mobilising local assets to reflect and understand local culture and diversity?
9. How can we embed action on childhood obesity?

1. How can we remove stigma from childhood obesity and healthy weight conversations?

To embed actions in childhood obesity in all levels of national policy, there is a need to destigmatise the issue of obesity and healthy eating. Tackling the issue requires changes in attitude at all levels, not just within the council services involved in actioning initiatives.

The type of language used when engaging parents and children can be especially important. Much of the language around obesity currently used can over stigmatise and overcomplicate the problem. As society and families are increasingly looking toward quick fixes and fast solutions, it is important not to treat obesity as just an illness. To have a true effect on childhood obesity, it is important that the national conversation about the topic steps away from viewing the problem as a weight issue and begin looking at overall wellness in a more holistic way.

Negative stigmatisation around obesity can often lead to other issues such as body consciousness and mental health impacts on children. These can also affect parents as well. Telling families that they are doing something wrong when it comes to diet and exercise can be demoralising and demotivating. Whilst giving them the right information is of course vital, it is also just as important to ensure they are receiving this in a constructive and positive way.

Although the issue of stigma has been mentioned as far more than just around issues of healthy weight conversations, there are some practical tips that have been provided through the assembly workshops. Three approaches were identified as being important in achieving parent buy-in in leading a healthy lifestyle and providing a positive role for their children:

• Shift the focus of the conversation to a “health opportunity” rather than solely about weight, and avoid using blame narratives.
• Use visual aids to explain to families what the figures show, and according to the results, where they sit in comparison. Having visual evidence can make it easier for families to comprehend the messages and takes away the idea that you may be passing an opinion of judgment of their children’s weight or health.
• Understand that families can often have a lot of things going on that can factor into this conversation. It is important to approach every family individually and to make sure to pick up on the positives of what they are doing.
• The Food Active Checklist for the Workforce was mentioned as a useful tool to understanding whether helpful language is currently being used in health centred workplaces.

The learning from work on childhood obesity emphasises the need to fund creative ways of helping children to think about the relationship between what they eat and their health. This needs to be done in a way that is sensitive to issues associated with trauma and mental health and the stigma attached to obesity and body image issues.

2. How do we support food and nutrition in a time of pressing food and financial insecurity?

There were three broad themes that came out of the workshop discussions. These were:

• Specific ideas that could improve access to healthier food;
• The need for a greater understanding of the barriers of accessing healthy food;
• The need to address wider systemic issues.

Specific ideas that could improve access to healthier food

There is a strong link between financial insecurity and childhood obesity. Initiatives can look to tackle both at the same time. A range of ideas were discussed drawing on the levers that are already available. There was agreement that these options should ensure that the food provided reflects the diversity of cultures who are intending to access them:

• Food banks to provide healthy nutritious food.
• Initiatives in schools: for example, Breakfast Clubs. A school in Oxford have been delivering ‘Family Dining’ to encourage the idea that mealtimes are an occasion for quality time with the family.
• Utilising the opportunities in the excess food market, for example, the initiatives delivered by FareShare: it was stated that FareShare tap into only 2 per cent of the market which means 98 per cent of excess food is going to landfill.

The discussion also highlighted the need to promote existing initiatives to encourage eligible families to access these schemes, such as the Healthy Start scheme.

The need for a greater understanding of the barriers to accessing healthy food

There is a need to delve deeper into the root causes of unhealthy eating for families who are experiencing financial insecurity. The workshop discussed that there is often a misconception that families are not accessing healthier food because it is usually more expensive. But often it is the associated costs that are the barrier when experiencing financial insecurity. Many families can’t afford freezers, ovens, or the costs of the gas need to cook. Furthermore, similar to the theme in Corrina Hawkes’ provocation, meal-planning for three meals a day takes up a lot of headspaces on top of the stress and anxiety that financial insecurity can already cause.

The discussion highlighted that better education on health literacy and skills was also required. Schools were identified as well-placed to provide this but that the food agenda needed to feature as a higher priority. Reduction in funding, and the observation that the food agenda is not a priority at government level were seen as big influential factors in many schools not playing a stronger role.

The need to address wider systemic issues

As highlighted in the theme above, the workshop discussed that the issues here go beyond access to food and that there is a need to understand and tackle the wider systemic issues. After all, providing emergency food parcels is not a permanent solution.

The workshop highlighted that:

• There needs to be more conversations between government departments and within local authorities to tackle financial insecurity.
• There needs to be overarching strategic insight and sustainable infrastructure to fully tackle this issue. This is currently missing. Market leaders, like FareShare, could pave the way to providing this insight.
• The food agenda must be a higher priority from the top-down.
• For action to work, it must seek to address the needs of families in a way that is suitable for them – not dictate what they need to do.
• Action must ensure it is reaching the families who stand to benefit most.

Lastly, there was discussion that changing the common perception of food could encourage healthier behaviours. We should step away from consistently linking food to its impact on weight. Food should be seen more positively. 

3. How do we take a system approach to understanding families and how best the system can support them?

This workshop was inspired by some of the key messages from Corinna Hawkes’ provocations surrounding parental stressors and the idea of shifting the focus towards working with families to offer better support.

This workshop identified three themes for further consideration:

• Taking an interlinked approach to tackle childhood obesity with families;
• Removing the stigma surrounding conversations about food and healthy eating;
• Making sustainable changes to people’s habits.

An interlinked approach

A more interlinked approach is required for addressing such a complex issue. A more joined-up approach should look at the many contributing factors that can impact children’s health such as food insecurity amongst less affluent families, accessibility to good quality healthcare, access to housing, and physical activity. Rather than focusing solely on the consumption of unhealthy food, it needs to be understood that there are numerous factors which can have a wider impact. Considering the different influencers there are on the lives of families will develop a broader understanding of health and how different aspects can affect children. Addressing these wider issues will then better position families in being able to focus on making positive lifestyle changes.

This approach is complicated and takes time. But investing time in building families’ trust and adapting to community needs, utilising local level assets and services, will allow for better, more appropriate support.

Many of the workshop attendees mentioned the Healthy Weight Declaration, which is a strategic, system-wide commitment made across all council departments to reduce unhealthy weight in local communities, protect the health and wellbeing of staff and citizens and to make an economic impact on health and social care and the local economy. They discussed the importance of this strategy in getting senior leadership buy-in to increase accountability.

Nevertheless, taking an interlinked approach must go beyond involving just local authorities and voluntary organisations. It should also involve local businesses and other local infrastructure in an area. Targeting schools, for example, could be beneficial as it is a place where the majority of children go and focus  can be placed on healthy living behaviours without the attached stigma. This could be done by incorporating more physical activity and healthy eating into the curriculum. Furthermore, by including these priorities in school provision, the burden may be lifted from families who are struggling with other priorities.

Removing stigma

Removing the stigma which surrounds discussions of food, healthy eating and obesity is essential in supporting families when it comes to tackling the determinants of childhood obesity. Parents already face many stressors. To approach the issue of childhood obesity effectively these stressors need to be understood when providing support for families. There is a link to culture and the idea of food representing a ‘treat’ or ‘celebration’. For example, snacks can often provide an easy route to pleasing and appeasing children, especially if parents have many other stresses to worry about.

Many families also struggle to afford nutritious food. Meal planning is often stressful for parents; less healthy meals or fast food may be a simpler alternative. Additionally, some families don’t have the facilities to cook healthy, fresh meals such as those in shared accommodation who lack refrigerator space. However, many of these issues have a stigma surrounding ‘bad parenting’ attached to them. Tackling this stigma to facilitate a more open discussion or advice forum would enable these families to be better supported in a non-judgemental environment.

A useful example can be found in North Tyneside where a food forum was established to start looking at food poverty, local food supplies and the food environment. Working with local charities to provide cheaper, but healthier options for families could help to avoid stigmatising those that are struggling. The new NHS Change4Life service also has community led neighbourhood projects and offers a coaching scheme for families.

Sustainable changes

Sustainability is also an important aspect to consider, as indicated in the workshop. Supporting families as a whole system and creating organisational changes at system level ensures communities take on responsibility. This then contributes to sustainability of action.

4. How can we develop a shared narrative to influence and mobilise the whole food system?

The delegates in the workshop were all interested in different aspects of tackling childhood obesity. These areas of interest included influencing the local food system, tackling food insecurity and influencing individual decision-making or purchasing habits.

The discussion in this workshop focussed broadly on: the different reasons for developing a shared narrative; how a shared narrative could look to be developed; and important things to consider in developing a shared narrative.

What the development of a shared narrative needs to achieve

The discussion highlighted that there are a number reasons for setting out to develop a shared narrative. These included:

• to clarify ambitions and action required to meet these ambitions, helping to inform programmes and initiatives. One attendee mentioned that there was a need to refocus the action that was being undertaken towards areas that would make the greatest impact in reducing the prevalence of adult and childhood obesity.
• to bring different strands of current action together that all share the same ambitions. There is currently a lot of action being undertaken locally that seeks to achieve the same objectives, but the approaches are fragmented. There is a need to bring this action together under one ‘umbrella’ but in a way that represents everyone’s own efforts towards the shared goal. Bringing these initiatives together could help to develop the infrastructure that is needed to progress and sustain these initiatives.
• to help clarify the different roles and responsibilities of different organisations, including tiers of government, in undertaking action. One delegate discussed that roles and responsibilities are clear at local level (grassroots organisations, local government, community group) and national level, but less clear at a combined authority level. As a result, the resources that can be accessed to support action are less clear.

Shared narratives should reflect the need for cross-sector working involving health, economy, environment, agriculture, hospitality and industry. It should also involve all tiers of government.

But there was a question around whether this conversation should sit within the local authority teams or a ‘food-centric’ team with cross-sector partners. The latter seemed to enable quicker action, but it could miss out on input from other areas like environment and wellbeing.

• To sustain action and progress made on tackling childhood obesity. Having a clear and coherent story to tell which can easily be picked up by senior colleagues, can be the key to unlocking resources or embedding action into policy which can support sustained action.

How a shared narrative can be developed

The workshop group identified steps that could be taken in the development of a shared narrative. Suggestions were made around how to engage others in the conversation:

• Tapping into the partnerships that have been formed during COVID – where there has already been joint action. Responding to COVID has required quick action at a local level. This has required greater partnership working and coordination in action. This should be built on.
• Making links with the Health and Wellbeing Board and integrated care systems. Health and Wellbeing Boards are very well placed to be championing this work as they also have levers to connect into the wider determinants of health (economy, environment etc.).
• Drawing on the opportunities brought about by new integrated care systems. From April next year each place will set up their own integrated health partnership board. The board will produce a new partnership strategy – this will present opportunities for a shared regional narrative.
• Linking into the national network of food partnerships. There is a national network of food partnerships who help to influence food systems at a local level. These partnerships include local food actors, activities and local authority leads. Some partnerships have their own food strategies.

Important things to consider in developing a shared narrative

The discussion highlighted that tackling childhood obesity and addressing the food system is complex and cultural. Different actors are focused on different aspects of making change meaning that there will be multiple stories. It is therefore important to find the common theme in all of them that connects these stories together.

The workshop also mentioned the importance of including the impact on wellbeing in this conversation. Health and wellbeing go hand in hand, so how can wellbeing stay at the forefront of these narratives too?

5. How do we get childhood obesity on the corporate agenda and keep it there?

Childhood obesity is beyond doubt a classic cross-cutting issue. Tackling it requires action by a wide range of council services including leisure, planning, regulatory services, children’s services and economic development as well as public health. It also requires action by the health service and the voluntary and community sectors.

This means that if action on childhood obesity is to be effective the topic must be high up a council’s corporate agenda. Two workshops at the Trailblazer Assembly discussed how to get the subject on a council’s corporate agenda and keep it there. Ensuring that the topic is high up the agenda of schools, community organisations, faith groups, health commissioners and maternity services was also seen as important.

From a cabinet member’s perspective the need to engage different departments and other portfolio holders is important. It is important, for example, to consider aspects such as healthy eating and physical activity for looked after children. Elected members may look to lead officers to help convene these wider conversations.

Making best use of the rich data available on the subject was seen as an essential first step. Key points include:

• Presenting the data in an accessible form;
• Supporting the data with human stories (while maintaining a focus on the wider system);
• Presenting data on action in other places to show what can be done.

Good use of data can help to secure member interest, particularly as childhood obesity is unlikely to be an issue that is raised with them by their constituents. One scrutiny chair went away from the workshop committed to setting up a task and finish group to collect, curate and use the data to inform the council’s activity. Another council used an annual report of the Director of Public Health to focus on and draw attention to the need for action on obesity and healthy living.

The task of engaging with business was seen as an important part of the corporate agenda. Possible actions identified included:

• Linking discussions with business on healthy eating with work on the future of high streets and the emergence of new business models in the hospitality sector;
• The possibility of accessing community funds that many major chains operate;
• Involving local chambers of commerce.

In councils where childhood obesity is not on the corporate agenda the message from this workshop to members and officers who are interested in the topic was clear: begin conversations with your colleagues across the council. And go equipped with compelling data.

6. What are the challenges and opportunities involved in tackling childhood obesity in two tier areas?

This workshop discussed that co-production of approaches between the two tiers of authority is essential in creating county-wide action that meets the needs of diverse, local communities. It was discussed this action is best developed from the ground-up and requires collaboration between both tiers.

The different roles that the two tiers of council play were discussed as an opportunity. Specifically borough and district councils have knowledge of local communities. County councils, with the public health function situated within them, are well-placed to provide oversight and a co-ordinating and enabling role.

Another opportunity discussed was that in recent times some areas have experienced greater collaboration as a result of the COVID pandemic. Responding to COVID has required immediate, focused responses from all. When this has been done well, there has been collaboration between different organisations. This experience has created positive working relationships which can be built on when addressing other issues, for example tackling childhood obesity.

However, workshop participants raised a number of issues they had experienced when trying to facilitate collaboration between two tiers of government. In particular, these issues presented barriers to achieving engagement from different teams and councils. These issues included: 

• The makeup of the political landscape can present challenges when trying to bring members together around one agenda.
• It is difficult achieving buy-in on agendas which don’t already feature as a priority at a senior level (for example senior officers and members). This creates barriers in engagement as well as securing the resources needed to undertake action.
• Public health teams are often struggling with capacity to focus on agendas that are outside of their priorities.
• Often the action is focussed on long-term outcomes which does not align to senior colleague interest in quicker, short-term achievements.

The takeaway message was the importance of flexibility when developing collaborative approaches and when trying to secure engagement. Furthermore, there is value in highlighting short-term wins and achievements showing progress and successes are being made. This can help achieve buy-in from other authorities and teams.

This topic is also the focus of a learning note produced by Shared Intelligence in September 2021. The key lessons from collaboration in two of the Trailblazers, which are both two tier areas, are presented in this document: Action on childhood obesity in two tier areas.

7. How do we develop a community-driven approach in practice?

The purpose of this workshop was to share experiences and develop a deeper understanding about ‘how’ a truly community-driven approach could be achieved in practice.

The discussion gathered a whole range of valuable practical ideas, experiences and considerations useful to those exploring this approach to tackling child obesity in their areas. There were four overarching themes across the two workshops discussions:

• Important principles when developing a community-driven approach.
• How to begin developing the approach.
• How to go about delivering the approach.
• Important considerations.

Important principles

• The approach must be led by the aspirations and needs of communities in focus. It is likely the priority areas driven by policy or being organisational priorities differs to the priorities of the community. For example, a delegate from Gloucestershire, who was involved in running events to understand community aspiration about healthy weight, identified that the community were not interested in healthy weight, but rather ‘food and the family’.
• Relationship-building with communities is essential. In order to achieve the point above and to make progress on delivering a community-driven approach, good quality relationships built on trust are important.
• Messaging and language is important. Areas have experienced more success in participation when the health messages are more positive, or when their engagement has been tied into other campaigns, events and activities (see below).
• Be creative in your approach and in taking action - Incorporate tackling the issue into something fun and for the whole family where ‘tackling child obesity/unhealthy weight’ is not the focus. One delegate discussed the opportunity to work together with their arts and culture department in the council who have well-attended music and dance classes. These can incorporate physical activities and health messaging in a fun and creative way.
• Development of an overarching strategic vision and leadership can improve community-cohesion and sustainability of action. It was felt that this is one thing that is missing from current action on poverty. Having the strategic oversight can help direct the focus of action, bring current initiatives together, get the right people round the table and plan for the future to ensure sustainability of the action.

How to begin developing the approach

• Develop an understanding about the aspirations of the community and their experiences of barriers to behaviour change. For example, young people in Bradford who attended local Mosques and Madrassas were invited to take part in a neighbourhood mapping exercise. The young people went on a walk around the local neighbourhood and using an app they took a picture and recorded which things in the neighbourhood they thought were good or bad. They now have a understanding of what the young people felt needed to change in the local neighbourhood.
• Consider ‘what factors make a community?’ Who makes up this community? What assets are used by communities? Who operates within this community? Understanding the nature of a community and joining up the factors within it can help to inform the development of a holistic approach to action.
• Look at the data. You may need to focus resources on the areas in most need e.g. highest areas of deprivation.

How to go about delivering the approach

• Work with local leaders and groups. Go to the organisations that focus on the same issues or that already have relationships with specific communities.
• Starting small is ok. These areas for action are complex and often there is pressure to undertake action at scale. It is ok to start small and then grow. Once action is taken on a small scale, look for opportunities to connect with other action.
• Learn from engagement approaches in other programmes. For example, there has been a lot of learning from the Vaccine Equity Programme around how to identify the right groups and how to overcome cultural and language barriers. (Hertfordshire behavioural insights unit produced good insights into how to engage with individuals around the vaccine)
• Start tackling areas that people can see and feel. For example, obvious aspects of the environment or community safety. This helps to build trust with local communities. Over time action can then get into issues around health.

Important considerations

• It all takes time – so it is important to manage expectations.
  
  “if you work in a community-led way then it will be at the community’s pace”.
• KPIs need to be proportionate – With this area of action, it may not be known when setting up the project how the work will achieve good outcomes, and specifically what ‘good outcomes’ will be achieved.
• Trust community organisations to work with communities.
• Be clear and transparent – it is important to be clear about how views have been taken into consideration, why things are progressing the way they are, what is the result of engagement, and what happens next.
• Working with communities requires education, training and compassion to give support – therefore there is a need for specific attitudes and skills when working with communities. Development of these need resource.

8. What are the most effective ways of mobilising local assets to reflect and understand local culture and diversity?

Effective community engagement is an important feature of all five Childhood Obesity Trailblazers. The diversity and culture within the country means there is a need to really understand the community and local community organisations that interventions could be working with. Many different communities will have priorities and concerns other than childhood obesity. Therefore, it is hugely important to understand the groups you are trying to engage with to find the best method of gaining support.

Building strong relationships within the communities you are trying to engage is vital to ensuring messages can be heard. To signpost a group to, for example, mental health support can take time. It is essential to ensure the right relationships are in place in order to gain their support and confidence and willingness to devote some of their time to tackling childhood obesity.

Five I’s to engaging local assets from the Bradford Trailblazer:

• Initiate – a dialogue with community which creates a trusting relationship
• Inform – community/individual of the possibly opportunities ahead so they become the change makers
• Include – all relevant key stakeholders at every level of engagement and their narrative
• Inspire – community/individual to  develop a long-term collective ownership 
• Invest – in community orgs/individuals as game changers to sustain the legacy of the programme

Access and reach – how can we best reach those we are trying to engage with?

There are three main ways in which teams can engage with local assets and communities they are trying to reach:

• By working with existing organisations in the voluntary and community sector which already have good relationships in the areas and communities concerned.
• By using places and spaces that are used by local communities, both physical and on-line.
• By engaging with officers and councillors connected to the local council.

Effective methods that empower and are inclusive

There is additional learning from the Trailblazers and elsewhere about how to engage with communities and families in ways which empower the local communities and assets. Top tips include:

• Be flexible about the ways in which you engage, remember that community assets can often work outside of the regular ‘9-5’ job;
• Be honest with officer, councillors, and organisations about healthy eating messages reflecting the diversity of the council.
• Work with creative organisations, including those who work with young people, to reach different communities and families;
• Put yourself in the shoes of the people you are trying to reach and think how they might want to get involved;
• Keep in touch with communities and families so they can see the impact their contributions have had.

9. How can we embed action on childhood obesity?

Two key themes emerged from the workshop on how to embed action on the issue of childhood obesity into wider processes to ensure that work on the area continues after the Trailblazer. These were:

• A collaborative approach and community-driven strategies
• The importance of education and embedding discussions surrounding health, food, and obesity into the school curriculum.

A collaborative approach and community-driven strategies

It is important to work with businesses and the private sector, particularly in terms of consistent messaging around action. Having a joined-up approach both across the council and between other stakeholders ensures a cohesive message is broadcast. For example, in some areas there have more collaborative conversations having been taking place between public health and the planning department to ensure healthy developments. A council planner who was a workshop participant in this conversation discussed that they had been working closely with their local public health team and had provided supplementary planning guidance which included a section on healthy weight to assist in developing healthy environments.

To make the best use of the funding, which is being provided by central government, sustainable action is required. One off activities do not tackle the root of the issue and prolonged thought needs to occur. In terms of tackling the root causes, interventions for childhood obesity need to happen at every level. Previously, interventions have been ineffective as they appear to solely target individual lifestyle changes instead of addressing more midstream and upstream issues. A combination of strategies which target societal and cultural expectations as well as the wider structural and systematic aspects will lead to better outcomes. Principles such as learning from what works in other areas need to be embedded in action against childhood obesity. Furthermore, it is beneficial if strategies are community led in practice as this ensures that they have the ability to set priorities and come up with solutions which will work on the ground, reflective of localised problems.

The importance of education

There is a need to address education of children and families, but this should be through or in addition to tackling different parts of the system. One participant stated that targeting individuals leads to stigmatisation. Additionally, targeting individuals directly ignores the wider system influences that clearly play a role in the lives of all families.

There is an opportunity for schools to play a stronger role in health and food education in a way that does not risk stigmatising families and does not ignore wider system influences. Schools can ensure they provide healthy and nutritious foods to pupils and encourage a culture of positive food behaviours through a range of ways such as food education and cooking classes.

A recent event with Trailblazers explored the area of sustainable action further. Key themes from this event were:

• Creating a compelling narrative
• Identifying opportunities and hooks
• Discussions with senior stakeholders
• Nurturing and maintaining community relationships

A note of the event can be found on our Embedding practice and partnerships into processes webpage.