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Implementing the Whole Systems Approach to Obesity

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Tackling obesity is everyone’s business – there is no single individual, group or organisation that can do this alone.

As well as national interventions, to make a real impact on reducing obesity rates we need sustained local actions that bring together a diverse range of stakeholders, both within and outside of local authorities.

Whole Systems Approach to Obesity

In our previous blog, we gave an update on our Whole Systems Approach to Obesity (WSO) programme, which aims to help local authorities deliver coordinated actions, involving stakeholders across the whole local system.

We partnered with the Local Government Association (LGA) and Association of Directors of Public Health (ADPH) to develop the programme. Leeds Beckett University (LBU) was commissioned to work with four pilot areas, with the aim of learning from local practices and creating practical, tried-and-tested guidance that could be used by any local authority in England.

Seven other local authorities have since been welcomed into the programme. Three years into the programme, we are now preparing to share some of the learnings from these pilot areas.

Route map to help local authorities

Working closely with the eleven local authorities and engaging with many more, we have co-produced a step-by-step process to support other local authorities in tackling obesity. This ‘route map’, with a set of supportive resources, forms the basis of a definitive guide to implementing a WSO.

Many local authorities are already doing great work to tackle obesity and will therefore be at different stages. Certain elements of the approach outlined in this guide may already have been undertaken, such as engaging political support, setting up local stakeholder groups or developing a local narrative to build the case for other departments to get involved.

While the whole systems approach is designed to be flexible, we encourage local authorities to  review each stage within the process to ensure no areas have been missed. This will maintain the integrity and ensure full benefits of the approach.

Six phases

The route map takes stakeholders through six phases. The early phases focus on preparation – securing senior leadership support, developing stakeholder groups, building an understanding of the local obesity picture.  This is key to setting up the foundations for the approach.

Understanding the local obesity picture could include looking at the local prevalence of excess weight, and identifying aspects of the surrounding environment that may be a barrier to achieving a healthy weight e.g.  a stocktake of local weight management services, or examining planning policies that may be inadvertently allowing a build-up of fast food outlets in an area.

The next phases are all about collective working.  Stakeholders from across the system are brought together to create a map of the local causes of obesity in their area and identify and prioritise areas of action.  This mapping process is important to the whole approach – it allows stakeholders to recognise their role in the system and how they can make a difference. It also highlights how their actions can be aligned with those of other partners so everyone is working in the same direction.

The latter stages of the process focus on taking actions forward as a group, continuously monitoring and revising them and reflecting on how things can be improved.

A set of systems behaviours underpins the whole approach.

Strengthen and align existing and new actions

Many local authorities will already have local strategies in place.  A whole systems approach is designed to strengthen and align both existing and new actions over the short, medium and long term. It will also help identify whether any actions may have unintended consequences.

For example, helping lower income families to access affordable sports and leisure facilities could be a positive action. But if those facilities are surrounded by fast food outlets or have vending machines and cafes offering unhealthier options on site, this could inadvertently nudge people into making unhealthy choices. The process will also help local authorities consider whether they are addressing inequalities.

Jim McManus, Chair of the Whole Systems Approach to Obesity, said:

This is an exciting step forward that could really help us make a step change in the way we tackle obesity. It is clear that focusing on individual choices alone will not reduce levels of obesity – we need the whole system working together to make a significant difference.

Local leadership

One key piece of learning so far is the importance of senior and political leadership – it cannot be underestimated. This leadership is vital to integrating a whole systems approach, as it gives local authorities permission to devote the time necessary to make this way of working the norm. It also sends a clear message that tackling obesity is a priority for the whole council and wider local partners. To support this, PHE and the LGA – one of our partners on the programme – has published a briefing for elected members.

Cllr Izzi Seccombe, Chairman of the Local Government Association’s Community Wellbeing Board, said:

Councils are at the heart of communities and are best placed to improve the health of their population. This is an important milestone in tackling obesity and allows local authorities to lead the way in turning the tide on obesity.

Obesity has a profound impact not just on health, but on other local priorities including social care and economic development. Everyone stands to benefit, yet it is often still primarily thought of as a public health concern. It can therefore be a challenge to engage other local authority departments and local stakeholders in this process, but doing so is essential to the success of the programme.

How local authorities can get involved?

We know many local authorities are keen to start developing a WSO. The final guide and supporting resources will be published in summer 2019, alongside a full evaluation to support the approach.

However, there is still more we can learn before then. The final product needs to work for local authorities and other partners across the local system, to help everyone get involved and play their part. For this reason, we have asked local authorities to review the draft guidance before it is peer reviewed.

This is an opportunity to help shape an innovative piece of work that could change the way we tackle one of our greatest modern health challenges. The WSO has been designed with local authorities in mind, so their input will be invaluable.

What’s next?

To further support the whole systems approach, PHE will also be publishing a new resource to support local authorities in the Autumn. This will make the case for taking action to reduce childhood obesity in every department/function of a local authority. It will include opportunities for action and bring together the evidence base and other useful resources into one document.  It has been developed with strong support and input from both the LGA and ADPH.

There will be opportunities to learn more about the programme at a pre-conference workshop at the PHE annual conference in September – this will look at systems leadership and whole systems approaches at a local level. For updates on the programme and opportunities to be involved, you can sign up to the community of learning.

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  1. Comment by Dr Michael C Watson posted on

    The commitments outlined in chapter 2 of the government’s childhood obesity plan are welcome, and represent a significant improvement on those in the first plan.(1) The ambition “to halve childhood obesity and significantly reduce the gap in obesity between children from the most and least deprived areas by 2030” are positive goals but further steps will be needed if they are to be achieved.(2)

  2. Comment by Mark Wilson posted on

    Just stop promoting processed, inflammatory grains and cereals and get government to stop subsidising cheap rubbish. Sugar and grains are killing us, do something!!!

  3. Comment by Paul posted on

    Get rid of the so called NHS Healthy Plate and watch obesity levels fall!

  4. Comment by Abi Hardy posted on

    This is all well and good but we refuse to face the real issue - because of the money of big pharma, big dairy and big farmer! It is absolutely proven that the only diet for tackling obesity and its related diseases, as well as for the health of the environment, is a one hundred percent plant based diet.

    Whole food plant based eating is the only basis on which our children can thrive. I have three kids who have been vegan their entire lives and they are healthy and robust and not overweight and not deprived. If government worries about facing the truth or even that delivering it will be too unpalatable for the general public - that’s rubbish and surely we don’t need the nanny state to protect us from the truth. Too many are drawn into fad diets (paleo!!) or bad information from the internet as there is not a structured, cohesive and truthful message available from the powers that be. Look it up. I recommend (a charitable foundation that accepts no advertising). Plant based eating is the one and only solution that will actually save society in so many ways. This is absolutely the case - I challenge anyone of knowledge or intellect to refute this truth.

  5. Comment by Christopher Palmer posted on

    It would amount to much better use of time, money, and attention, if interested parties concentrated upon an integrated complete physiological approach to the matter of obesity (ICPAO).

    Obesity represents an outcome whose nature we will never fully understand until we are fully conversant with how fat cells (adipocytes) becoming hypertrophied together with how the phenomenon is fundamental to the process involved. The notion of of fat cells becoming hypertrophied is a more precise biological description of what arises than the mere notion that people gain weight and become ‘fat’.
    Weight management is about maintaining ideal body fat mass. Ideal body fat mass rests with adipocytes each being of ideal mass (around 0.45mcg). While in turn the mass of adipocytes rests with how much triacylglycerol (TAG) is retained within them.
    The amount of TAG retained in store within adipocytes is under control of key hormones. For an axiom it seems the degree of hypertrophy displayed by adipocytes (how much TAG is stashed inside) reflects mean concentrations of insulin that have prevailed over time, . . . which in turn reflects the extent and frequency of the state of hyperglycemia, . . . and which in turn reflects how much highly glycemic carbohydrate and sugar have been passing through the individuals mouth.

    Everything about outcomes in obesity rest with physiological influence over TAG synthesis or TAG breakdown, in the first instance, and what effect a persons eating habits exert over those physiological factors in the second instance.
    The ‘interventions’ being proposed and implemented by PHE do not grapple with the front-line spheres of influence (sugar, carbohydrate, and insulin) that drive the hypertrophy of adipocytes. Instead such policies and initiatives set out to influence physiology from much further afield and without having a clear understanding of what the end-point needs to be. The end-point we desire (even if we do not know it) is prevention or reversal of excess hypertrophy among adipocytes.

    I cannot make any sense of your post upon WSO. Yes, more people are to be co-opted to having concern for the problem of obesity, yes, responsibility is to be devolved among them, there will be more meetings, more discussion, but little prospect that these stakeholders will come to understand the nature and physiology of obesity any better than we do now. It is that lack of appropriate understanding that has made the problem worse over recent years.
    PHE needs a good systems analyst that can assess and report back upon physiological systems at work behind obesity – while also being capable of saying plainly that the WSO is established upon complete and utter nanny state gibberish.