The challenge of childhood obesity is defined as a ‘wicked’ problem, up there with the likes of climate change and biodiversity loss. What makes these issues so wicked? To start with there are many (often contested) ways of defining the issue and how it should be ‘solved’, there is no one authority to act upon it, and often those coming up with the dominant solutions have a role in causing the problem in the first place.
The number of children living with obesity has been increasing in England. The latest figures show that 10 percent of younger children (age 4-5) and 23 percent of older children (age 10-11) are living with obesity. The distribution across the society is highly unequal, the prevalence of younger children living with obesity is twice as high in the areas of highest deprivation, compared to the least deprived areas. This can follow children throughout their lives and lead to problems such Type II diabetes, cardo-vascular disease and some cancers, as well leave children facing stigmatisation and emotional challenges. The habits and preferences laid down in childhood often pave the way for adult replication, so it is vitally important that a supportive environment is created to allow for choices that support healthy lifestyles.
Limitations of national policies
There have been decades of tried and failed policies and interventions to tackle the issue (14 strategies including 689 policies in England from 1992 to 2020 to be exact). The lack of progress in shifting the upward trend at a population level has largely been to individualised efforts that put the onus on people to change their patterns in terms of diet and exercise, without creating a supportive environment in which to live and thrive, to prevent obesity in the first place.
Acknowledging this limitation, there has now been a shift in perspective, to consider the factors ‘upstream’. The much broader social determinants of obesity -also known as – taking a ‘whole system approach’. While easy to recommend for national and global policy applications – how this is achieved in practice, and how obesity trends can be reversed as a result, has not been documented… until now.
Brighton and Hove childhood obesity reduction
The city of Brighton and Hove (B&H), a seaside town in the South East of England, nestled between the English Channel and the South Downs (and home to the Institute of Development Studies), is one of very few cities to see a reduction in childhood obesity. A group of us in IDS’ Health and Nutrition Cluster partnered with the Public Health team at the Brighton & Hove City Council to explain this story of change in child obesity.
First, we mapped local data, policies and programs, and interviewed key stakeholders across different departments of local government (health, planning, transport), school meals, community and food organisations to tell this story. We found a ‘whole system’ rhetoric that ran through the policies and views of stakeholders. Key policies that have anchored this include multiple Food Strategies starting as early as 2006, and updated in 2015 and 2018. A subsequent Food Poverty Strategy 2018 was also implemented – allowing for food issues to be identified and rallied around as they evolved. Others included having a dedicated breastfeeding strategy.
The mechanisms for bucking the trends in obesity
Beyond landmark policies we explored what the mechanisms for change have been. While we found no magic wand to buck the trends in obesity – what we did find was a long-term commitment to working together in ways that build trust, avoid duplication, and champion a far-reaching healthy weight agenda. From our findings, examples for success in Brighton & Hove include:
- A supportive local context – including the physical landscape (sea and Downs) and a progressive, pro-good-food local culture which then spill over to local government with strong commitments to the environment, cycling, physical activity, and breastfeeding, amongst other health-promoting factors.
- Responding to community needs – having a long history of grassroots initiatives and activism connecting local organizations and residents, creating a ‘bottom-up’ prioritisation of need. Acting upon these is facilitated through a supportive commissioning environment from the local council.
- Cross-sectoral working and capacity – which rallies different stakeholders to pull in the same direction around a blueprint for action. Being a unitary authority and having the city’s Public Health Team sitting inside local government had helped to coordinate this, as has a dedicated Healthy Weight Program Board drawing together civil society, the private sector, and multiple government departments.
- Innovation – culminating the above has allowed Brighton to think creatively and try new things, which has paid off with initiatives such as Sugar Smart and the voluntary Sugar Levy – which have gone on to influence the national agenda in positive ways through scaling these projects.
Despite success, the job is not done
While these are features of success worth celebrating – there is certainly no complacency that the job is done. Brighton still has a huge inequalities gap across many health outcomes, including child obesity – with children in the most disadvantaged areas being three times more likely to be overweight or obese.
A food-based community organisation in Brighton, said: “You have to be very careful not to get too carried away with the fact that our average is better than Southeast, our average is better than the national picture. Because it is, and loads and loads of really good work has been done, but there is still more to do, more to dig into, which particular groups are still having ongoing issues.”
This study began before the Covid-19 pandemic when a downward trend was still evident, the most recent data at the national level shows obesity rates for both reception and year 6 children increased by a staggering 4.5 percent between 2019–20 – 2020–21, with B&H also seeing an increase. Brighton’s emergency food network is active more than ever (serving over 5,000 people weekly) as people grapple with the cost-of-living crisis. We know that for people in these areas life had got much harder
All those interviewed as part of our research spoke of ongoing work in these areas (pre covid and cost of living crisis) and most acknowledge that standard channels are not sufficient to target these communities. More needs to be done to build trust and enhance self-efficacy of these communities whilst also removing barriers to services and being willing to work through more informal networks. However, the most resounding takeaway is that without tackling the route causes determinants of child obesity such as poverty, insecure housing and income, and cuts to benefits and services we will not be able to close this inequalities gap in prevalence. To tackle this a national commitment is urgently needed.
Working in partnership with the public health team has helped to bridge the research and implementation chasm – striking the balance between being highly grounded in the local context, while also being able to take a bird’s eye view to see the broader system mechanisms. We see these partnerships as essential for challenge-led research – so this is your friendly reminder to reach out, make connections, and break out of the boundaries of your disciple to help tell a similar story – we learn from successes, frustrations, and nuances when tackling these wicked problems.
Read the full details of the study in the article in Food Security here.
The study is part of a broader series of malnutrition stories around the world. Read a synthesis here.
