Abstract
BackgroundThe UK government released Chapter 1 of the ‘Childhood Obesity: a plan for action’ (2016), followed by Chapter 2 (2018) and preliminary Chapter 3 was published for consultation in 2019 (hereon collectively ‘The Policy’). The stated policy aims were to reduce the prevalence of childhood obesity in England, addressing disparities in health by reducing the gap (approximately two-fold) in childhood obesity between those from the most and least deprived areas.MethodsCombining a realist approach with an analysis of policy discourses, we analysed the policies using a social determinants of health (SDH) perspective (focusing on socio-economic inequalities). This novel approach reveals how the framing of policy ‘problems’ leads to particular approaches and interventions.ResultsWhile recognising a social gradient in relation to obesity measures, we critique obesity problem narratives. The Policy included some upstream, structural approaches (e.g. restrictions in food advertising and the soft-drinks industry levy). However, the focus on downstream individual-level behavioural approaches to reduce calorie intake and increase physical activity does not account for the SDH and the complexity and contestedness of ‘obesity’ and pays insufficient attention to how proposals will help to reduce inequalities. Our findings illustrate that individualising of responsibility to respond to what wider evidence shows is structural inequalities, can perpetuate damaging narratives and lead to ineffective interventions, providing caution to academics, practitioners and policy makers (local and national), of the power of problem representation. Our findings also show that the problem framing in The Policy risks reducing important public health aims to encourage healthy diets and increase opportunities for physical activity (and the physical and mental health benefits of both) for children to weight management with a focus on particular children.ConclusionsWe propose an alternative conceptualisation of the policy ‘problem’, that obesity rates are illustrative of inequality, arguing there needs to be policy focus on the structural and factors that maintain health inequalities, including poverty and food insecurity. We hope that our findings can be used to challenge and strengthen future policy development, leading to more effective action against health inequalities and intervention-generated inequalities in health.
Highlights
We hope that our findings can be used to challenge and strengthen future policy development, leading to more effective action against health inequalities and intervention-generated inequali‐ ties in health
Childhood obesity has been identified as a public health priority in high income countries across the world [1]
From our findings we propose an alternative conceptualisation that obesity rates are illustrative of inequality, as shown by the social gradient, with BMI trends at a population level highlighted in the policy illustrating this
Summary
Childhood obesity has been identified as a public health priority in high income countries across the world [1]. Countries have developed national and local policies, and have implemented multiple public health interventions, to try and tackle the problem [1]. Taking England as an example, childhood obesity has been identified as a policy priority since 1991 [2]. Croker and colleagues [5] conducted a mapping study of national policies for preschool children obesity in England from a behavioural science perspective. They found that much of the policy activity is focussed on education and suggested that upstream policies which act on food systems should be strengthened. The importance of the socioeconomic patterning of childhood obesity is acknowledged in these existing analyses of policy, it was not the focus of their analyses
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