JSNA topic report: obesity health needs and systems mapping in Buckinghamshire

As highlighted in the Healthy Lifestyle HNA, the Healthy Lifestyle Service in Buckinghamshire, Live Well Stay Well (LWSW), commissioned by Buckinghamshire Council and the Integrated Care Board (ICB) provides the main community-based access to both adult and child weight management services.

Over the past 3 years 2,383 adults started a weight management service with numbers severely reduced during the height of the COVID-19 pandemic.

Data for 2021/22 indicates that 49% of adults accessing weight management services through LWSW complete the programme with 79% of these achieving a 3% weight loss and 53% achieving a 5% weight loss.

The child weight management service, supporting 7 to 11 year olds supports over 100 children per year with data from 2021/22 indicating that 85% of children complete the programme, with 85% of them achieving either a reduction or maintenance of their BMI Z score[1].

Additionally, Buckinghamshire Council commission a number of community-based projects, targeting key population groups, such as:

• Grow to Give – increasing food bank and community fridge users access to fresh fruit and vegetables
• Grow It, Cook It, Eat It – supporting communities to grow their own fruit and vegetables, with the provision of basic cooking sessions to increase knowledge and skills to create healthy meals with the food they have grown.
• Simply Walks – provision of over 60 free guided walks across Buckinghamshire
• Playstreets – encouraging communities to utilise their local area to be more active

The council works collaboratively with a network of both internal departments and external organisations and communities to tackle obesity in Buckinghamshire.

The obesity HNA stakeholder mapping identifies key stakeholders and services that will be essential to developing a ‘Health in All Policies’ approach to addressing obesity.

This information is useful to determine the relevant departments, organisations and services that are part of the many subsystems at play – identifying those that need to work collaboratively and align their actions to bring about system change.

The analysis helped to determine the level of involvement each department, organisation and individual has in the present network and identified new contacts for future engagement in the approach.

From this initial stakeholder mapping, as recommended within the HNA and PHE Whole Systems Approach to Obesity guidance, we have subsequently brought stakeholders together over 2 half-day workshops to map out the local system that is thought to cause obesity, develop a shared vision, identify key priority areas and start the development of a shared action plan.

Key to this is identifying existing projects and activities being undertaken by this wide array of stakeholders that feed into tackling obesity and identifying where we have gaps in the local system and identifying actions which may have the greatest potential impact and thereby priority areas of focus.

This continuous process will result in a shared vision and mission that unites stakeholders with different backgrounds and agendas to a common aspiration for Buckinghamshire. It is essential stakeholders engaged are passionate about improving the health, wellbeing and prosperity of the local population and can commit time on a regular basis. This vision will provide clear direction for the development of a jointly owned action plan which will be overseen by a systems network/advisory group where members will offer positive challenge, advice, support and accountability for the work.

As part of the obesity HNA we carried out focus groups with only a small number of participants taking part (5 adults and 3 child and young people (CYP)). There were largely positive adult and CYP comments in relation to their physical capabilities and motivations to eat healthy and keep active.

Mixed comments were noted among adults in relation to psychological capabilities and opportunities to eat healthy and be active.

Largely negative comments were noted among CYP in relation to opportunities to eat healthy and be active, and mixed comments were noted by adults.

There were overall positive perceptions of support during COVID-19 among both adults and CYP. Support from community organisations throughout COVID-19 was noted as being particularly positive. However, largely negative comments were noted among adults in relation to the effect COVID-19 has had on their nutrition and physical activity habits.

Largely negative comments were noted among adults in relation to current weight management programme offers throughout Buckinghamshire. Comments in particular highlighted a lack of individually tailored services and them not enjoying the online nature of the sessions. Maintenance sessions were also noted by adults as being a key missing characteristic of currently offered weight management services.

As part of the Whole Systems Approach to a Healthy Weight work further community engagement activity is being undertaken ensuring we benefit from the communities expertise in what people in their community want, what they consider to be their assets and how efforts to intervene might be made more effective. Identifying common priorities to take forward.

Following the completion of the HNA work has continued to follow the PHE guidance for delivering a whole systems approach to obesity.

Working collaboratively to develop a shared action plan with stakeholders taking collective ownership of actions to align and strengthen actions, maximising impact.

Stakeholders involved in the system network now have the responsibility for local delivery of individual actions within their own organisation and collective ownership of actions and the approach with the system network.

Regular evaluation of actions within the plan will be undertaken by the newly formed core network group, essential to ensure progression, with assessment of the local system and how it aligns and works collaboratively for bigger impact.