A stakeholder analysis of the perceived outcomes of developing and implementing England’s obesity strategy 2008–2011

Abstract

BackgroundInternational recommendations urge governments to implement population-based strategies to reduce the burden of obesity. This study assesses the development and implementation of the obesity strategy in England 2008–2011, Healthy Weight, Healthy Lives (HWHL). The aim was to identify if stakeholders perceived HWHL to have made any difference to the action to address obesity in England, with the ultimate objective of identifying insights that could inform the development and implementation of future obesity strategies in England and elsewhere.MethodsQualitative study using semi-structured interviews and thematic framework analysis. 40 stakeholders involved in the development and implementation of the obesity strategy were interviewed.ResultsEvidence from this study suggests that HWHL was perceived to have made a positive difference to efforts to address obesity in England. It was credited with creating political buy-in, engaging more stakeholders, stimulating and facilitating action, enhancing knowledge and changing attitudes. But it was reported to have failed to fully catalyse action across all government departments and sectors, or to develop adequate mechanisms for learning about the effectiveness of the different elements and actions in the Strategy. Key elements of the Strategy contributing towards to the perceived positive differences included its multi-faceted, inclusive nature; governance structures; monitoring programme to assess progress against national and local targets; child-focus; and funding. The development of the Strategy was said to be stimulated and aided by the prior synthesis of a critical mass of scientific evidence.ConclusionsThe English experience of HWHL lends support to the recommendations to develop population-based obesity strategies. It indicates that in order to stimulate comprehensive, inter-sectoral action, obesity strategies need to take a population-based, multi-faceted approach, be implemented through a clear governance structure, follow a systematic process of aligning goals, objectives and agendas between government departments and sectors with a stake in obesity, and have a clear system of reporting changes in obesity rates against a target. In order to design effective policies and to build the case for continued investment, obesity strategies also need to incorporate a national framework for learning and evaluation from the outset.

Generating political commitment for ending malnutrition in all its forms: A system dynamics approach for strengthening nutrition actor networks

“…Greater capacities may in‐turn support the production of robust data and evidence, thereby supporting actions to develop a unifying discourse and hence greater cohesion . The expansion of donor or government nutrition budgetary commitments, adequate funding, and effective financing have enabled many NAN activities . In contrast, inadequate financing, or the failure to effectively utilize or administer financial resources, is a major challenge for NANs .…”

“…45,54,93 The expansion of donor or government nutrition budgetary commitments, adequate funding, and effective financing have enabled many NAN activities. 45,48,56,94 In contrast, inadequate financing, or the failure to effectively utilize or administer financial resources, is a major challenge for NANs. 44,45,61,65,88,[95][96][97] Inadequate nutrition budgets have undermined their human, technical, and administrative capacities.…”

Evaluation of nutritional care of overweight adults from the perspective of comprehensive health care

“…Nonetheless, there has been constructive and effective dialogue between the university and the services provided aiming to achieve comprehensive care in Santos [18,43]. It is worth noting that managing overweight without intersectoral collaboration worldwide has proved to be ineffective [44,45].…”

For a Step Change to Curb the Obesity Epidemic

“…Yet, as evidenced by Cecchini and Sassi [18], Baum et al [20], Chawla et al [19], and Chawla et al [21] in this issue, and others [17] elsewhere, interventions have faced and continue to face significant challenges and, to date, have failed to curb obesity. While many interventions appear to have provided some benefits, the gains have often been marginal [18,22]. In large part, this appears to be caused by the frequently small scale of the interventions, the complex-and still poorly understood-nature of the disease (with genetic, biological, and environmental factors at play), and significant barriers and challenges facing interventions (e.g., in terms of perception, access/funding, etc.)…”

“…Misperception of obesity as a cosmetic or lifestyle issue, rather than a serious health problem, has been a significant hurdle to mobilizing patients, communities, and payers to embrace prevention and treatment initiatives [19,20]. Many researchers, including those in this issue, note the need for (1) more comprehensive, multi-factorial interventions [17,22,24], and (2) treatment as opposed to purely preventive approaches (to both address the needs of the already obese and the limited effectiveness of prevention) [25], as key learnings from past failed experience in obesity prevention/management.…”