Public Health England and the Local Government Association have stated that a ‘whole systems approach’ to obesity is an example of a ‘health in all policies’ approach. This means that tackling obesity is a priority for the whole local authority, not just for public health departments. Local authorities need to lead their communities and local partners, working with local NHS organisations and through integrated care systems. This section covers NIHR funded research into specific or multi-pronged actions that local authorities could take at local level within a whole systems approach.

What’s the context?

• For local authorities, a ‘whole systems approach’ to obesity means using all the assets of the local area, supporting a community-centred approach to tackling health inequalities, and developing transferable workforce skills and capacity (Public Health England and the Local Government Association).
• Preventing obesity through planning and development is one lever. It relies on systems policies that join up actions from health and planning perspectives (LGA and Town and Country Planning Association). Local authorities can shape the design of environments and what they provide, in ways that support people to avoid overweight or obesity.
• The Town and Country Planning Association and Public Health England have set out the elements necessary to help achieve healthy weight environments through planning. These are: movement and access (promoting active travel and physical activity); open spaces, recreation and play; food retail and growing food; neighbourhood spaces (community facilities and public spaces); the design of homes and other buildings to promote healthier living; local economy (employment and healthy town centres or high streets).

What does NIHR research tell us?

Research into system-wide approaches is still in its infancy

One review included 33 studies which had aimed to implement a whole systems approach. Approaches were defined as those ‘that consider the multifactorial drivers of overweight and obesity, involve transformative co-ordinated action across a broad range of disciplines and stakeholders, operate across all levels of governance and throughout the life course’. A range of positive health outcomes were reported, including: health behaviours; reducing BMI; parental and community awareness; nutrition; physical activity environments. The researchers concluded that the approaches showed promise. But they said that the evidence on how to implement systems approaches to address public health problems is still in its infancy, and further research is needed. Consistent definitions and language relating to obesity systems approaches is essential.(1)

The review identified features of successful approaches. These included: the full engagement of relevant partners and community; time to build relationships, trust and capacity; good governance; finance; and embedding the systems approach within broader policy.(1)

Whole town approaches by local authorities rely on leadership, national level support, community engagement and sufficient resource

A programme aiming to stimulate novel ‘whole town’ approaches to obesity (the Healthy Communities Challenge Fund, also known as the ‘Healthy Towns’ programme) was successful in generating a diverse set of interventions. They covered: physical activity, active travel, growing (e.g. vegetable growing), urban planning, and other one‐off initiatives or co‐ordinating activities. Systems approaches were regarded as a promising solution to tackle obesity, but a wide range of enabling and disabling factors influenced each town’s ability to implement them. Enabling factors included: engagement with local stakeholders; identifying leaders within each town; and funding to maintain and develop interventions.

Barriers included: leads having limited time to develop as systems‐thinkers; tight timeframes in which to take a more strategic approach; and a lack of national level support. Individual interventions were often delivered in isolation, which reduced the connections across programmes and the synergies between interventions. Despite a mandate to be innovative, towns felt under pressure from stakeholders to demonstrate positive results, leading them to revert to ‘tried‐and‐tested’ interventions that had a higher chance of success, rather than testing truly innovative interventions that had a higher risk of failure.(2)

Local communities can identify multi-pronged approaches specific to local challenges

Affordability of healthy food, of sports and physical activities (such as football clubs and swimming), and of transport was an issue for young people in one town considering systems-wide approaches to obesity. Suggestions for addressing obesity included: cultivating a healthy environment in the town by banning cars in the town centre; regulating the advertising of unhealthy foods; and taking a community and school-based approach, such as raising awareness of local sports clubs and more education on healthy eating and obesity.(3)

Mass media campaigns may support systems-approaches

Research has explored the impact of mass media campaigns (television, radio, social media, newspapers) on health topics such as diet, activity, smoking and alcohol. There is little evidence regarding behaviour change following diet campaigns, but media campaigns may reduce sedentary behaviour. Media campaigns increased knowledge and awareness across several topics, including diet, and influenced intentions to increase physical activity. Longer, intensive campaigns, targeted at particular populations with specific messages, were more likely to be effective.(4) The UK’s Change4Life campaign to promote healthy lifestyles, and associated diet-related campaigns (e.g., 5 a day, Sugar Swaps), reached the population: approximately 1 in 5 of the people surveyed were aware of government healthy eating campaigns, with greater awareness among people with higher versus lower educational level.(5) Further research is needed to understand whether this increased awareness translated into health benefits.

Useful resources

• The Association of Directors of Public Health (ADPH) and Public Health England (PHE) have co-produced a series of ‘What Good Looks Like’ (WGLL) publications including ‘What Good Healthy Weight for all ages Looks Like’. They are intended to facilitate the collective efforts of local organisations and wider society (the system) towards improvements in their population health outcomes.
• Public Health England signposts a range of supporting frameworks, resources and tools for addressing health inequalities. This is part of a briefing on how partners can work together to systematically address health inequalities and identify the components of a cross-system and place-based approach.
• Public Health Wales has produced a blueprint for local authorities to use to help create healthy weight environments.
• The Town and Country Planning Association has published lessons from ‘planning healthy weight environments’ workshops for local councils, in particular, councillors, and those working in planning and environment teams, and in public health.

NIHR research in progress

• Will the intervention, Together An Active Future, increase physical activity levels in 6 districts of Lancashire? Different approaches will be tried in each district to identify which are most successful in increasing physical activity.(6)
• Two research projects in Scotland are assessing systems approaches. A community pilot project in East Scotland is taking a whole systems approach to diet and healthy weight.(7) Another project, in two council areas in Tayside, is seeking to apply learning from a whole systems approach (‘Healthy Weight Tayside’) in Dundee City.(8)
• What impact do obesity policies have in various sectors: retail, the environment, transport, education and the workplace? This research aims to develop methods to measure value-for-money to support decisions on how to spend limited funds.(9)

1. Bagnall AM, Radley D, Jones R, Gately P, Nobles J, Van Dijk M, et al. Whole systems approaches to obesity and other complex public health challenges: a systematic review. BMC Public Health. 2019 Jan. 19(8).
2. Cummins S, Ogilvie D, White M, Petticrew M, Jones A, Goodwin D, et al. National Evaluation of the Healthy Communities Challenge Fund: The Healthy Towns Programme in England. Technical Report. 2016.
3. Hamilton L, Williams CH, Wills W, Mathie E. Addressing Obesity in Stevenage, Hertfordshire: A Consultation with Young People. Report. 2019.
4. Stead M, Angus K, Langley T, Katikireddi SV, Hinds K, Hilton S, et al. Mass media to communicate public health messages in six health topic areas: a systematic review and other reviews of the evidence. Public Health Res. 2019 May 2;7(8):1–206.
5. Goodman S, Armendariz GC, Corkum A, Arellano L, Jáuregui A, Keeble M, et al. Recall of government healthy eating campaigns by consumers in five countries. Public Health Nutr. 2021 Sep;24(13):3986–4000.
6. Barr B, et al. Together an Active Future. NIHR School for Public Health Research. 2020 [cited 2022 Feb 10].
7. Brown K. Whole Systems Approach to Diet and Healthy Weight Community Pilot Project. NIHR Funding and Awards Search Website. [cited 2022 Mar 11].
8. Adamson A. Healthy Weight Tayside: Where children, young people and families can eat well, drink well and be active . NIHR Funding and Awards Search Website. [cited 2022 Mar 11].
9. Frew E. Economic evaluation of multi-sector obesity policy. NIHR Funding and Awards Search Website. [cited 2022 Mar 11]