Abstract
Evidence indicates that early life is critical for determining future obesity risk. A sharper policy focus on pregnancy and early childhood could help improve obesity prevention efforts. This study aimed to systematically identify and categorise policy levers used in England with potential to influence early life course (pregnancy, 0-5 years) and identify how these interface with energy balance behaviours. The objective is to identify gaps and where further policy actions could most effectively focus. A behavioural science approach was taken using the Capability-Opportunity-Motivation-Behaviour (COM-B) model and Behaviour Change Wheel (BCW) framework. The key determinants of energy balance in the early years were identified from the Foresight Systems Map. Policy actions were scoped systematically from available literature, including any health or non-health policies which could impact on energy balance behaviours. Foresight variables and policy actions were considered in terms of COM-B and the BCW to determine approaches likely to be effective for obesity prevention and treatment. Existing policies were overlaid across the map of key risk factors to identify gaps in obesity prevention and treatment provision. A wide range of policy actions were identified (n = 115) to address obesity-relevant risk factors. These were most commonly educational or guidelines relating to environmental restructuring (i.e. changing the physical or social context). Scope for strengthening policies relating to the food system (e.g. the market price of food) and psychological factors contributing to obesity were identified. Policies acted via all aspects of the COM-B model, but there was scope for improving policies to increase capability through skills acquisition and both reflective and automatic motivation. There is substantial policy activity to address early years obesity but much is focused on education. Scope exists to strengthen actions relating to upstream policies which act on food systems and those targeting psychological factors contributing to obesity risk.
Highlights
Rates of overweight and obesity in children have increased worldwide since the 1980s, and despite a slowing recently, it remains an important public health issue with serious consequences for health [1, 2]
Foresight variables and policy actions were considered in terms of COM-B and the Behaviour Change Wheel (BCW) to determine approaches likely to be effective for obesity prevention and treatment
Scope exists to strengthen actions relating to upstream policies which act on food systems and those targeting psychological factors contributing to obesity risk
Summary
Rates of overweight and obesity in children have increased worldwide since the 1980s, and despite a slowing recently, it remains an important public health issue with serious consequences for health [1, 2]. Life is likely to be critical; a recent systematic review showed consistent associations between rapid growth in the first two years of life and later obesity, with the strongest effects in children of lower socioeconomic status (SES) and ethnic minority groups [10]. Evidence suggests that children of lower SES have greater exposure to several early life risk factors for obesity, including pre-pregnancy maternal obesity and diabetes, low birth weight and poorer early life nutrition [11]. This suggests that a sharper policy focus on pregnancy and early childhood could be useful for improving the effectiveness of obesity prevention efforts and for addressing health inequalities. The objective is to identify gaps and where further policy actions could most effectively focus
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