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

In England, 63% of adults and a third of children live with unhealthy excess weight or obesity.

Obesity has a strong socio-economic profile and disproportionally affects the lives of poorer groups in society, contributing to growing health inequalities. It is estimated that obesity is responsible for more than 30,000 deaths nationally each year.

On average a person who is obese has a reduced life expectancy of nine years. The UK wide NHS costs attributable to overweight and obesity are projected to reach £9.7 billion by 2050, with wider costs to society estimated to reach £49.9 billion per year.

The strategy Tackling obesity: empowering adults and children to live healthier lives, published in July 2020, recognises that excess weight is one of the few modifiable factors for COVID-19 and highlights that tackling obesity is one of the greatest long-term health challenges we face.

Obesity results from complex interactions of policy, economic, environmental, social, cultural, behavioural and biological factors.

In recent years, a whole systems approach (Whole systems approach to obesity: A guide to support local approaches) has surfaced as a realistic and promising approach to address complex issues, enabling investigators to examine the dynamic interrelationships of system components, while simultaneously studying the behaviour of the system as a whole over time.

The approach enables local authorities to deliver the 7 key principles identified as what a good quality, local approach to promoting healthy weight looks like (What-Good-Healthy-Weight-Looks-Like):

• systems leadership
• a long-term whole systems approach
• a health promoting environment
• community engagement
• focus on inequalities
• a life course approach
• monitoring, evidence, evaluation and innovation

A whole systems approach to obesity takes a ‘Health in All Policies’ approach, drawing on the local areas strengths, supporting key priorities and recognising that we can create better and more effective approaches by engaging with the community and the local assets.

Buckinghamshire Council are following the Public Health England 2019 guidance to delivering a whole systems approach to obesity, with this project’s focus being on Phase 2 of the approach – Building the Local Picture.

The aim of this phase was to gather the information required to understand the local picture of obesity, including its prevalence, the local impact, relevant organisations and people, community assets and existing actions to address it.

Thereby creating a shared understanding of the issue and of how obesity is addressed at a local level.

Key steps of the phase include:

• collating key information about obesity locally (across the life-course)
• starting to understand the local assets including community capacity and interest
• establish a comprehensive understanding of current actions
• identify the departments, local organisations and individuals currently engaged in supporting work around obesity

A mixed methods approach was employed, capturing quantitative and qualitative information from primary and secondary sources. Specifically:

• publicly available health-related electronic databases, along with local data, were used to collate key information about obesity locally and nationally
• content analysis was undertaken of local authority policies to obtain an understanding of how overweight and obesity is embedded within or aligned with other priorities
• reviews of the research literature were conducted to determine: 1) the health impacts of obesity, 2) the wider impacts beyond health, and 3) the association between excess weight and COVID-19
• a stakeholder map of the key agencies and local organisations that make up a system was created
• community asset maps were generated to capture relevant organisations that have a focus on improving the health of those living with overweight or obesity
• local actions on obesity were captured and considered with reference to the causes of obesity and the wider determinants of health
• focus groups were undertaken with children and young people, and adults who were and were not attending weight management services