Commissioning and disseminating robust, evidence-based research is essential to improving the nation’s physical and emotional wellbeing. In order to affect meaningful change, we must be able to put what we know works into practice through collaboration and dialogue.
In conversation with local authorities, the National Institute for Health and Care Research (NIHR) has published a review that brings together research on tackling obesity. The aim is to help local authorities make well-informed decisions to reduce or prevent the condition in their communities.
NIHR Research Dissemination Manager, Deniz Gursul, and Communications Manager, Martha Powell, take us through the process and the evidence, and what the findings mean for wellbeing.
With more than a quarter of UK adults estimated to be affected by obesity, it is a major health crisis and can have a significant impact on people’s physical and mental wellbeing.
Local authorities are well placed to act to prevent or reduce obesity. They are responsible for functions that serve multiple generations across society and that can directly influence people’s health. However, some local authorities have reported difficulties identifying evidence-based actions they can take for their communities.
Making research available to maximise impact
The National Institute for Health and Care Research (NIHR) invests more than £1 billion a year in research to improve the health and wellbeing of the nation.
Over the last decade, the NIHR has invested heavily in research aimed at preventing or managing obesity.The NIHR wants to support good local decision-making by ensuring that investment decisions can be based on sound evidence. This will maximise the impact of stretched local resources.
Consolidating the data in conversation with stakeholders
Over the course of six months, the team reviewed 143 NIHR-funded studies covering a wide array of interventions and settings. We also spoke with staff from local councils, research institutes and national organisations to collate insights.
As the review aimed to facilitate decision-making, studies that were exploratory, developmental, and early-stage were not included. We also did not consider studies that were not relevant for local authorities.
We held meetings with key stakeholders to understand the context in which the research would be received. This included groups of staff from the Local Government Association, the Convention of Scottish Local Authorities, and local councils in specific areas. Their feedback was incorporated with the research messages, to offer a unique, evidence-based perspective on the challenge.
The studies were grouped into nine themes (Figure 1), based on the nature of the research, and the way in which local authorities oversee different aspects of their localities:
Figure 1. How many studies were funded across different areas of obesity research.
Establishing what works
The review identified that:
- improving the local environment can increase physical activity and enhance wellbeing;
- free access to leisure services can help people be more active, but evidence is mixed over whether free public sports are effective in the long-term or reach those most in need;
- interventions in schools have achieved limited results: efforts may be best placed considering the wider environmental factors that influence children in their daily lives;
- weight management programmes can be effective for short-term weight loss, but further work is needed into how effects can be sustained;
- taking action on the food environment could reduce excess calorie consumption.
What do these findings mean for wellbeing?
Improving the local environment
Conversations we had with local authorities highlighted how small changes can have a big impact on both wellbeing and activity. For example, removing bushes from parks can encourage greater use by making them feel safer, more open, and more pleasant.
Access to green space is strongly and significantly associated with wellbeing, as measured by life satisfaction, happiness and sense of worth. Not only can improving local environments help increase physical activity, designing urban spaces with a focus on health and wellbeing, and prioritising natural green areas, can help to enhance daily life and the effectiveness of a city.
Physical activity
Regular physical activity is associated with lower rates of depression and anxiety across all age groups. Taking part in sport and dance can have a positive impact on young people’s wellbeing, and physical activity provides resilience to the ups and downs of life. Getting outdoors and getting active with others can boost positive mood, feelings of worth and purpose, and longer term resilience.
The role of education for children and young people
When it comes to children’s wellbeing, previous research has suggested the benefit of an integrated strategy that brings everything that isn’t educational attainment into a single coordinated plan, rather than ad hoc initiatives. This would consider a wider range of domains and drivers, including physical health.
The impact of inequality
Many interventions to tackle obesity are aimed at changing individual behaviours, but people’s ability to make choices is dictated by their circumstances and socioeconomic status. For example, when household income is stretched, the ability to make decisions about food is threatened.
The context in which different local authorities operate – levels of deprivation, resources, urban and rural geography, and competing priorities – influences the approaches that can be taken and which interventions are successful.
Research has shown that socioeconomic inequalities (deprivation, income and unemployment) are all associated with inequalities in wellbeing at the local authority level. Tackling obesity therefore goes hand in hand with the levelling up agenda, reducing inequalities, and improving wellbeing.
What do we need to know more about?
While there is a wealth of data, there are still gaps in what we know. Based on the review, the team recommend that future research considers:
- conducting studies longer than 12 months to better understand the long-term impact of interventions;
- looking at ‘top-down’ interventions to bring about change, rather than those aiming to change individual behaviour;
- conducting studies that assesses local authority actions as part of a whole systems approach.
Research aiming to influence obesity is notoriously difficult to evaluate, as obesity is caused by a complex web of environmental, behavioural, social, and genetic factors. While there is no one intervention or piece of research that can solve the problem, each study adds a ‘brick’ of evidence to the wall. Together, these pieces can help tackle the issue from all angles.