Whole systems approaches to obesity and other complex public health challenges: A systematic review

Anne Marie Bagnall; Duncan Radley; Rebecca Jones; Paul Gately; James Nobles; Margie Van Dijk; Jamie Blackshaw; Sam Montel; Pinki Sahota

doi:10.1186/s12889-018-6274-z

Whole systems approaches to obesity and other complex public health challenges: A systematic review

Anne Marie Bagnall^*, Duncan Radley, Rebecca Jones, Paul Gately, James Nobles, Margie Van Dijk, Jamie Blackshaw, Sam Montel, Pinki Sahota

^*Corresponding author for this work

Research output: Contribution to journal › Review article › peer-review

160 Citations (Scopus)

Abstract

Background: Increasing awareness of the complexity of public health problems, including obesity, has led to growing interest in whole systems approaches (WSAs), defined as those that consider the multifactorial drivers of overweight and obesity, involve transformative co-ordinated action across a broad range of disciplines and stakeholders, operate across all levels of governance and throughout the life course. This paper reports a systematic review of WSAs targeting obesity and other complex public health and societal issues, such as healthy lifestyles for prevention of non-communicable disease. Methods: Seven electronic databases were searched from 1995 to 2018. Studies were included if there had been an effort to implement a WSA. Study selection was conducted by one reviewer with a random 20% double checked. Data extraction and validity assessment were undertaken by one reviewer and checked by a second reviewer. Narrative synthesis was undertaken. Results: Sixty-five articles were included; 33 about obesity. Most examined multicomponent community approaches, and there was substantial clinical and methodological heterogeneity. Nevertheless, a range of positive health outcomes were reported, with some evidence of whole systems thinking. Positive effects were seen on health behaviours, body mass index (BMI), parental and community awareness, community capacity building, nutrition and physical activity environments, underage drinking behaviour and health, safety and wellbeing of community members, self-efficacy, smoking and tobacco-related disease outcomes. Features of successful approaches reported in process evaluations included: full engagement of relevant partners and community; time to build relationships, trust and capacity; good governance; embedding within a broader policy context; local evaluation; finance. Conclusions: Systems approaches to tackle obesity can have some benefit, but evidence of how to operationalise a WSA to address public health problems is still in its infancy. Future research should: (a) develop an agreed definition of a WSA in relation to obesity, (b) look across multiple sectors to ensure consistency of language and definition, (c) include detailed descriptions of the approaches, and (d) include process and economic evaluations.

Original language	English
Article number	8
Journal	BMC Public Health
Volume	19
Issue number	1
DOIs	https://doi.org/10.1186/s12889-018-6274-z
Publication status	Published - 3 Jan 2019

Bibliographical note

Funding Information:
This report was commissioned from Leeds Beckett University by Public Health England as part of a larger project looking at Whole System Approaches to Obesity. We would like to thank Ben Mitchell for designing the search strategy and carrying out the electronic database searches, and Leonie O’Dwyer and Robin Kaye for their help with data extraction and validity assessment of included studies. We would also like to thank the Interlibrary loans team (Susan Ellis and Karl Derbyshire) in the Sheila Silver Library at Leeds Beckett University, for their excellent help in locating articles. We would also like to acknowledge the support given by the PHE Whole Systems Advisory Group, chaired by Jim McManus, and thank the following individuals for their helpful input: Adrienne Cullum, Diet, Obesity and Physical Activity Health Improvement Directorate PHE; Jim McManus, Director of Public Health, Hertfordshire County Council and Chair, PHE Whole Systems Advisory Group; Verity Hawkes, Higher Nutrition Scientific Officer, Diet & Obesity, Public Health England.

Funding Information:
The review was funded, as part of a larger project, by Public Health England. The funding body was not involved in the design of the study or in collection or analysis of the data. Some members of the funding body (listed as authors) were involved in discussions around interpretation of some of the data and in writing the manuscript. Some of James Nobles' time was supported by the National Institute for Health Research (NIHR) Collaboration for Leadership in Applied Health Research and Care West (CLAHRC West) at University Hospitals Bristol NHS Foundation Trust.

Publisher Copyright:
© 2018 The Author(s).

Keywords

Complexity
Obesity
Public health
Systematic review
Systems science
Whole systems approaches

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

Access to Document

10.1186/s12889-018-6274-z

Cite this

@article{2a7d77c223b94d04801ce468b3b5ef36,

title = "Whole systems approaches to obesity and other complex public health challenges: A systematic review",

abstract = "Background: Increasing awareness of the complexity of public health problems, including obesity, has led to growing interest in whole systems approaches (WSAs), defined as those that consider the multifactorial drivers of overweight and obesity, involve transformative co-ordinated action across a broad range of disciplines and stakeholders, operate across all levels of governance and throughout the life course. This paper reports a systematic review of WSAs targeting obesity and other complex public health and societal issues, such as healthy lifestyles for prevention of non-communicable disease. Methods: Seven electronic databases were searched from 1995 to 2018. Studies were included if there had been an effort to implement a WSA. Study selection was conducted by one reviewer with a random 20% double checked. Data extraction and validity assessment were undertaken by one reviewer and checked by a second reviewer. Narrative synthesis was undertaken. Results: Sixty-five articles were included; 33 about obesity. Most examined multicomponent community approaches, and there was substantial clinical and methodological heterogeneity. Nevertheless, a range of positive health outcomes were reported, with some evidence of whole systems thinking. Positive effects were seen on health behaviours, body mass index (BMI), parental and community awareness, community capacity building, nutrition and physical activity environments, underage drinking behaviour and health, safety and wellbeing of community members, self-efficacy, smoking and tobacco-related disease outcomes. Features of successful approaches reported in process evaluations included: full engagement of relevant partners and community; time to build relationships, trust and capacity; good governance; embedding within a broader policy context; local evaluation; finance. Conclusions: Systems approaches to tackle obesity can have some benefit, but evidence of how to operationalise a WSA to address public health problems is still in its infancy. Future research should: (a) develop an agreed definition of a WSA in relation to obesity, (b) look across multiple sectors to ensure consistency of language and definition, (c) include detailed descriptions of the approaches, and (d) include process and economic evaluations.",

keywords = "Complexity, Obesity, Public health, Systematic review, Systems science, Whole systems approaches",

author = "Bagnall, {Anne Marie} and Duncan Radley and Rebecca Jones and Paul Gately and James Nobles and {Van Dijk}, Margie and Jamie Blackshaw and Sam Montel and Pinki Sahota",

note = "Funding Information: This report was commissioned from Leeds Beckett University by Public Health England as part of a larger project looking at Whole System Approaches to Obesity. We would like to thank Ben Mitchell for designing the search strategy and carrying out the electronic database searches, and Leonie O{\textquoteright}Dwyer and Robin Kaye for their help with data extraction and validity assessment of included studies. We would also like to thank the Interlibrary loans team (Susan Ellis and Karl Derbyshire) in the Sheila Silver Library at Leeds Beckett University, for their excellent help in locating articles. We would also like to acknowledge the support given by the PHE Whole Systems Advisory Group, chaired by Jim McManus, and thank the following individuals for their helpful input: Adrienne Cullum, Diet, Obesity and Physical Activity Health Improvement Directorate PHE; Jim McManus, Director of Public Health, Hertfordshire County Council and Chair, PHE Whole Systems Advisory Group; Verity Hawkes, Higher Nutrition Scientific Officer, Diet & Obesity, Public Health England. Funding Information: The review was funded, as part of a larger project, by Public Health England. The funding body was not involved in the design of the study or in collection or analysis of the data. Some members of the funding body (listed as authors) were involved in discussions around interpretation of some of the data and in writing the manuscript. Some of James Nobles' time was supported by the National Institute for Health Research (NIHR) Collaboration for Leadership in Applied Health Research and Care West (CLAHRC West) at University Hospitals Bristol NHS Foundation Trust. Publisher Copyright: {\textcopyright} 2018 The Author(s).",

year = "2019",

month = jan,

day = "3",

doi = "10.1186/s12889-018-6274-z",

language = "English",

volume = "19",

journal = "BMC Public Health",

issn = "1471-2458",

publisher = "BioMed Central",

number = "1",

}

TY - JOUR

T1 - Whole systems approaches to obesity and other complex public health challenges

T2 - A systematic review

AU - Bagnall, Anne Marie

AU - Radley, Duncan

AU - Jones, Rebecca

AU - Gately, Paul

AU - Nobles, James

AU - Van Dijk, Margie

AU - Blackshaw, Jamie

AU - Montel, Sam

AU - Sahota, Pinki

N1 - Funding Information: This report was commissioned from Leeds Beckett University by Public Health England as part of a larger project looking at Whole System Approaches to Obesity. We would like to thank Ben Mitchell for designing the search strategy and carrying out the electronic database searches, and Leonie O’Dwyer and Robin Kaye for their help with data extraction and validity assessment of included studies. We would also like to thank the Interlibrary loans team (Susan Ellis and Karl Derbyshire) in the Sheila Silver Library at Leeds Beckett University, for their excellent help in locating articles. We would also like to acknowledge the support given by the PHE Whole Systems Advisory Group, chaired by Jim McManus, and thank the following individuals for their helpful input: Adrienne Cullum, Diet, Obesity and Physical Activity Health Improvement Directorate PHE; Jim McManus, Director of Public Health, Hertfordshire County Council and Chair, PHE Whole Systems Advisory Group; Verity Hawkes, Higher Nutrition Scientific Officer, Diet & Obesity, Public Health England. Funding Information: The review was funded, as part of a larger project, by Public Health England. The funding body was not involved in the design of the study or in collection or analysis of the data. Some members of the funding body (listed as authors) were involved in discussions around interpretation of some of the data and in writing the manuscript. Some of James Nobles' time was supported by the National Institute for Health Research (NIHR) Collaboration for Leadership in Applied Health Research and Care West (CLAHRC West) at University Hospitals Bristol NHS Foundation Trust. Publisher Copyright: © 2018 The Author(s).

PY - 2019/1/3

Y1 - 2019/1/3

N2 - Background: Increasing awareness of the complexity of public health problems, including obesity, has led to growing interest in whole systems approaches (WSAs), defined as those that consider the multifactorial drivers of overweight and obesity, involve transformative co-ordinated action across a broad range of disciplines and stakeholders, operate across all levels of governance and throughout the life course. This paper reports a systematic review of WSAs targeting obesity and other complex public health and societal issues, such as healthy lifestyles for prevention of non-communicable disease. Methods: Seven electronic databases were searched from 1995 to 2018. Studies were included if there had been an effort to implement a WSA. Study selection was conducted by one reviewer with a random 20% double checked. Data extraction and validity assessment were undertaken by one reviewer and checked by a second reviewer. Narrative synthesis was undertaken. Results: Sixty-five articles were included; 33 about obesity. Most examined multicomponent community approaches, and there was substantial clinical and methodological heterogeneity. Nevertheless, a range of positive health outcomes were reported, with some evidence of whole systems thinking. Positive effects were seen on health behaviours, body mass index (BMI), parental and community awareness, community capacity building, nutrition and physical activity environments, underage drinking behaviour and health, safety and wellbeing of community members, self-efficacy, smoking and tobacco-related disease outcomes. Features of successful approaches reported in process evaluations included: full engagement of relevant partners and community; time to build relationships, trust and capacity; good governance; embedding within a broader policy context; local evaluation; finance. Conclusions: Systems approaches to tackle obesity can have some benefit, but evidence of how to operationalise a WSA to address public health problems is still in its infancy. Future research should: (a) develop an agreed definition of a WSA in relation to obesity, (b) look across multiple sectors to ensure consistency of language and definition, (c) include detailed descriptions of the approaches, and (d) include process and economic evaluations.

AB - Background: Increasing awareness of the complexity of public health problems, including obesity, has led to growing interest in whole systems approaches (WSAs), defined as those that consider the multifactorial drivers of overweight and obesity, involve transformative co-ordinated action across a broad range of disciplines and stakeholders, operate across all levels of governance and throughout the life course. This paper reports a systematic review of WSAs targeting obesity and other complex public health and societal issues, such as healthy lifestyles for prevention of non-communicable disease. Methods: Seven electronic databases were searched from 1995 to 2018. Studies were included if there had been an effort to implement a WSA. Study selection was conducted by one reviewer with a random 20% double checked. Data extraction and validity assessment were undertaken by one reviewer and checked by a second reviewer. Narrative synthesis was undertaken. Results: Sixty-five articles were included; 33 about obesity. Most examined multicomponent community approaches, and there was substantial clinical and methodological heterogeneity. Nevertheless, a range of positive health outcomes were reported, with some evidence of whole systems thinking. Positive effects were seen on health behaviours, body mass index (BMI), parental and community awareness, community capacity building, nutrition and physical activity environments, underage drinking behaviour and health, safety and wellbeing of community members, self-efficacy, smoking and tobacco-related disease outcomes. Features of successful approaches reported in process evaluations included: full engagement of relevant partners and community; time to build relationships, trust and capacity; good governance; embedding within a broader policy context; local evaluation; finance. Conclusions: Systems approaches to tackle obesity can have some benefit, but evidence of how to operationalise a WSA to address public health problems is still in its infancy. Future research should: (a) develop an agreed definition of a WSA in relation to obesity, (b) look across multiple sectors to ensure consistency of language and definition, (c) include detailed descriptions of the approaches, and (d) include process and economic evaluations.

KW - Complexity

KW - Obesity

KW - Public health

KW - Systematic review

KW - Systems science

KW - Whole systems approaches

UR - http://www.scopus.com/inward/record.url?scp=85059497061&partnerID=8YFLogxK

U2 - 10.1186/s12889-018-6274-z

DO - 10.1186/s12889-018-6274-z

M3 - Review article

C2 - 30606173

AN - SCOPUS:85059497061

SN - 1471-2458

VL - 19

JO - BMC Public Health

JF - BMC Public Health

IS - 1

M1 - 8

ER -

Whole systems approaches to obesity and other complex public health challenges: A systematic review

Abstract

Bibliographical note

Keywords

UN SDGs

Access to Document

Other files and links

Fingerprint

Cite this