How can we deliver a whole system approach to childhood obesity?

Three themes emerged from the discussion on these questions:

• the challenge of establishing clarity in relation to a complex issue and enable meaningful engagement
• the need to begin with a focus on the child, the family and the community
• the need for an approach which is: multifaceted, incremental and links the strategic with the bottom-up.

Clarity in the face of complexity

It is clear that the multi-faceted nature of childhood obesity necessitates a multi-agency response. Given the importance of engagement with families and communities, however, it is essential to communicate the issues involved and the actions required in as clear and accessible a way as possible. A whole system approach requires buy-in at both a senior or strategic level and in the community. Linking the two is very important: in one place the link has been made through “community walks” giving senior actors a community level view of, for example, the barriers to action.How can we deliver a whole system approach to childhood obesity?

Begin with the child, the family and the community

An effective whole systems approach must begin with an understanding of the forces which shape the things a child experiences: food, physical activity, sleep and the home environment. This requires an understanding of families’ lived experiences, what impacts on their life choices and the extent to which these factors are susceptible to interventions and support. This in turn means that attention must be given to the impact of communities: on for example the provision of open spaces and how those spaces are designed and used.

Community champions can help to gain a real understanding of the different attitudes of different communities to food and physical activity. Action mapping is a useful way of identifying important people and voices in a community.

A multi-faceted and incremental approach

Drawing on the conversation at the Assembly it is possible to identify a number of features of a whole system approach which can gain traction at organisational, community and family levels. They are:

• Securing community buy-in by working with families and local communities to enable them to develop solutions: a first step must be to work with families to understand the choices they face. This must be about “doing with”, not “doing to”.
• Being persistent and consistent, pursuing an incremental approach. Realism is also important, seeking quick wins and achievable objectives which contribute to a longer term, more ambitious set of goals
• Ensuring that the way in which progress is measured addresses the goals that are being set. This is not just about weight management and BMI, but also, for example, about overall health, physical activity and the local environment.
• Treating whole system working as an emergent process. This means trying things that may fail but doing so in a way that ensures that there is learning from this and that the approach is adjusted as a result, wherever possible in real time. This will help to develop a better understanding of what works.
• Understanding the approach to marketing adopted by food businesses and consider what lessons can be applied to action to address childhood obesity.

It is possible to design and deliver community level whole system approaches. One participant at the Assembly quoted an example of a community food and gardening project. It increasingly focussed on the environment, generating people’s pride in where they lived and influencing lifestyles. Working with a range of local partners the project delivered training in horticulture, cooking and food hygiene while also managing allotments. Fifteen years later the project is still running and had enabled people to get jobs in the food industry.