Whole systems approach to obesity

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In the UK two thirds of adults, a quarter of 2-10-year olds and third of 11-15-year olds are overweight or obese. The harmful effects of obesity are not only felt by individuals, through worsened health risks, but also financially to the wider economy. The way we live of lives has a major impact on our health, however, there is increasing recognition that the circumstances in which live also impacts on our health - it impacts on the opportunities we must make healthy choices. While individual behaviour does matter, the reality is that our health is impacted by behavioural, social, economic and environmental factors. The most comprehensive investigation into obesity and its causes [Foresight] described obesity as a complex problem that requires action from individuals and society across multiple sectors. Because of this paradigm shift, obesity is now viewed through a social lens (oppose to a medical one), and it is generally accepted that lifestyle (i.e. individual), environmental, economic and social factors contribute to the consequences of obesity. However, with almost 10 years since the publication of Foresight, most of the research informing this ongoing policy debate fails to consider the interplay between these domains. Insightful analyses have considered these factors in isolation; this proposal will extend the utility of current evidence and understanding by jointly considering environmental, behavioural, economic and social determinants of obesity.The need for effective weight management programmes - which encourage strong participant engagement and demonstrate positive health-related improvement is critical. However, participant dropout, and consequent programme attrition, challenges programme effectiveness, in child weight management, for example, attrition ranges from 8-83 %. Higher participant attendance is associated with greater weight loss and health-related benefits in contrast to those with lower attendance or those who dropout. Of concern to policy makers and programme commissioners (those funding the programmes), dropout and attrition compromise the economic effectiveness of WM programmes. Policy makers have engaged with the idea that individual, social, economic and environmental factors contribute to obesity. However, almost all the research evaluating weight management interventions fails to consider this interplay and focus on individual factors.In addition, Public Health England have acknowledged the need to understand all the factors that contribute to obesity and have committed to 'support local authorities to deliver a whole systems approach to tackle obesity'. The objectives of this PhD align to this commitment, as the key outcome will be a quantitative whole systems approach to modelling public health measures to determine what factors are associated with obesity, and how they inter-relate at the local and individual levels. Research Aims:- To create new knowledge and understanding about the drivers of obesity and engagement in weight management programmes, these factors need to be brought together within an integrated framework: the primary objective of this PhD is to use agent-based modelling to simulate environmental, behavioural, economic and social determinants of obesity and engagement in weight management programmes, at the local level. - The methodological approach (agent based modelling) will inform policies to affect change from a whole systems perspective. Understanding the complex and interacting systems that result in an obesogenic environment is the necessary start, hopefully leading to the adoption of a whole system approach to address obesity at the local level. This will be the first UK based study to investigate the quantitative relationships as part of a wider 'system', with a whole system approach driving its development.