Whole Systems Approaches to promote healthier weight conference, 19 May 2022
1. On the Dahlgren and whitehead mapping rainbow tool on causes and current actions - is there a list somewhere of the things that have been pre-entered as 'causes'?
Yes, these are available as a supplementary document to the following paper:
Nobles J. et al (2019) Understanding how local authorities in England address obesity: A wider determinants of health perspective. Health Policy 123, 10 pp998-1003 https://doi.org/10.1016/j.healthpol.2019.07.016
2. Is there a diagram setting out how the whole systems obesity topic areas fit together across Government departments as part of a whole systems policy approach?
In July 2020, the Government published Tackling obesity: empowering adults and children to live healthier lives. This is a Government obesity strategy that involved collaborative working across different Government departments. This was proceeded by a number of Government Childhood Obesity Plans: Childhood obesity: a plan for action and Childhood obesity: a plan for action, chapter 2 and Chapter 3 of the Childhood Obesity Plan in Advancing our health: prevention in the 2020s. These plans set out the role of different Government departments in tacking obesity.
A specific diagram on how different Government departments work together to promote healthier weight has not been published.
3. How was the local government democratic infrastructure and decision-making considered as part of the WSA?
The whole systems approach to obesity process and guide were co-developed with, and tested by, local authorities across England. Any important considerations at the time were reflected in the guide and the guide and the learning report that were published in 2019
4. I was interested to note that learning from the large body of previous work e.g., from research literature on causal determinants and interventions and case studies in other areas, is not clearly a feature of the pathway, is there an expectation these will be added into phase 2&3
The whole systems approach to obesity provides a step-by-step process to support local authorities to deliver a whole systems approach to obesity. The guide does not specify which actions and interventions local authorities should focus on as part of their whole systems approach. This should be determined locally as part of the systems mapping and action planning processes, to reflect local needs and priorities. The guide does refer to
PHE’s promoting healthy weight in children, young people and families: A resource to support local authorities, which can support local areas to identify relevant actions.
The recently published NIHR themed review on “how can local authorities reduce obesity” can also support this process.
5. I'm interested to know whether it is implicit in the model that we need to also take a whole system approach to physical activity and food? There are reasons as to why these are necessary for other reasons - not just obesity which some stakeholders might find easier to relate to?
Local authorities have the flexibility, considering needs and priorities, to decide locally whether to include wider areas of work in their local whole systems approach that have benefits beyond obesity reduction.
6. As an FYI, there is no way to access the action mapping tool through the additional resources section of the website – only the guide to how to use it is currently available
The Action Mapping Tool is Resource D and is available on page 2 under this link: Whole systems approach to obesity - Public library - UKHSA national - Knowledge Hub (khub.net)
7. What more can LAs do locally to champion/lobby for further funding/support for obesity and WSAs given the withdrawal of the tier 2 adult weight management grant - can we incorporate interventions into grants such as the UK Shared Prosperity fund and Living with COVID monies?
The whole systems approach the obesity guide includes key benefits of taking a whole systems approach to obesity that can be used to make the case locally.
Other national programmes and funding streams will have their own funding conditions which would need to be reviewed carefully to determine whether healthier weight/weight management interventions would be eligible.
8. Have NIHR, national team, or Leeds Beckett completed any dynamic system modelling to understand the level of change needed or scale of interventions that need to be reached to get us close to the national ambition of halving childhood obesity by 2030? We have developed something for our area and local initiatives and would like to compare notes with anyone doing it for national level interventions (All)
Any local area that has undertaken work in this area are invited to share this with OHID via the [email protected] inbox.
9. Is whole school health approach similar to Healthy Schools? More often than not we appear to reinvent the wheel. (All)
Yes, it is based on the same approach. A whole-school health approach includes promoting healthy eating, physical activity and emotional health and wellbeing. It is ‘everyone’s business’ from senior leadership through to the pupils.
Action taken at a whole school level is an effective way to support all children to grow healthily. Many schools are taking proactive steps to encourage whole school action; including through the curriculum, via school leadership practices, and by improving the school ethos and environment. Additionally, schools can create partnerships with parents and the wider community.
10. Is there a national drive to better understand obesity levels in children and adults with SEND and an evidence base for interventions that work with this cohort?
Local authorities are required to measure the height and weight of all eligible children in Reception and Year 6 from state-funded schools as part of the National Child Measurement Programme (NCMP). Children with special educational needs and disabilities (SEND) will be included if they are attending mainstream school unless they are unable to be measured or withdraw. The data currently collected doesn’t include clinical conditions, so it is not possible to analyse NCMP data and ascertain prevalence’s for different cohorts of children. It is not mandatory for data and measurements to be collected for children attending privately funded and special schools, this is a local authorities decision depending on funding. This data is not included in national level NCMP analysis.
11. Given the positive findings for Daily Mile, is there a policy case for embedding this as a national requirement for primary schools considering deeply worrying 2020/2021 NCMP picture and widening health inequality?
In Chapter 2 of the Childhood Obesity Plan, Government committed to promoting a national ambition for every primary school to adopt an active mile initiative, such as the Daily Mile. As part of the action to support this a series of briefings were developed providing information about the evidence on active mile initiatives, ideas for how to implement them and examples of practice. Active mile briefings - GOV.UK (www.gov.uk)
12. Is there evidence about family interventions in the early years as opposed to school ages? The current PHE commissioning guide is based on systematic review evidence for 4 to 11, not early years and teenagers.
OHID has commissioned reviews looking at associations between weight status and mental health outcomes before, during and after pregnancy. This includes an overview on the effectiveness of pre-, peri- and post-natal interventions in promoting a healthy maternal weight. Research on ‘what works’ for promoting healthy weight in early years, highlighting the skills and support that healthcare professionals need to prevent childhood obesity with an emphasis on targeting diet and physical activity, initiating early and taking family-based approaches was also commissioned. Local authorities will be notified when the research is published.
13. Does the national obesity team recognise and value the approach of the Sustainable Food Places approach?
There are other programmes underway that overlap and complement the whole systems obesity programme including Sustainable Food Places. These programmes are not mutually exclusive and, where it makes sense to do so, local authorities are encouraged to bring these programmes together, to address local needs and priorities.
14. Is there any work being done nationally to align the obesity work to the large investment coming to many LAs with the Family Hub model as this feels like it could be an opportunity to support pre-conception, pregnancy and 0-4s?
At Budget 2021, the Chancellor announced a £301.75 million package to transform services for parents and babies, cares and children in half of local authorities across England, including funding to create a network of family hubs. This builds on the £39.5 million the Government had already committed to champion the family hub model. Family hubs are a way of joining up locally to improve access to services for children of all ages, the connections between families, professionals, services, and providers, and putting relationships at the heart of family help. Family hubs can include nutrition and weight management support for children and their parents/carers. How services are delivered varies from place to place, but these principles are key to the family hub model.
15. What do we know now that we didn't 5, 10 or even 20 years ago about tackling this issue?
Tackling obesity requires a long-term holistic approach, drawing on a wide range of interventions and levers at a national and local level, working across the whole system, including with local citizens. It is essential to continue to build the evidence base and evaluate approaches, collaborate, co-design and learn from local place-based approaches.
16. Is the main thrust ultimately the reduction in long terms conditions to which it contributes? Prevention frameworks could help the join up?
The whole systems approach to obesity guide sets out some of the benefits to addressing obesity through a whole systems approach and the logic model in Annex 4 suggest some of the long-term outcomes that a local area would aim to achieve.
Reducing obesity will reduce the risk of a number of conditions and diseases in addition to a range of other outcomes. Local authorities can integrate tacking obesity through a whole systems approach into broader preventative approaches.
17. Do we need to be more explicit that WSA needs to be implemented alongside, and not instead of individual/targeted support? The evidence base for both appears to be relatively weak, but we seem to be more comfortable pushing WSA despite lack of clear evidence than we are with individual support.
A whole systems approach to addressing obesity and promoting a healthier weight can and should incorporate actions at both a population and at an individual level. Approaches like weight management are informed by NICE guidance and exist as part of a place-based system approach. See Q4 for further information.