Headteachers’ and chairs of governors’ perspectives of adolescent obesity and its prevention in English secondary school settings: A mixed methods study

Introduction - Secondary schools are an important setting for the prevention of obesity during the critical age of adolescence. National guidance in the United Kingdom proposes a clear role for headteachers and chairs of governors in delivering school-based preventative action. Despite this, their views are underrepresented in the existing evidence base. The aim of this study therefore was to explore headteachers’ and chairs of governors’ perspectives regarding adolescent obesity and its prevention in English secondary school settings. Methods - This study utilised a mixed methods exploratory sequential design and was informed by the completion of a systematic review and qualitative synthesis. In the qualitative phase, semi-structured interviews were conducted (n = 22) and transcripts were analysed using thematic analysis. Based on the resultant themes and sub-themes, a descriptive online cross-sectional survey was developed for use in the quantitative phase. Descriptive and inferential statistics were employed to analyse the survey responses obtained (n=127). Results - Headteachers and chairs of governors viewed unhealthy dietary habits and sedentary behaviour as a more significant problem than obesity in adolescence. Obesity was understood to be complex and multi-causal, although primary responsibility for its prevention was attributed to parents. Despite not an explicit school priority, the role of secondary schools in obesity prevention was supported given the acknowledged reciprocal relationship between health and educational outcomes. However various internal and external barriers were identified, which strongly influenced participants’ desire and ability to deliver school-based preventative action. Conclusion - Secondary schools may be well positioned to influence adolescent lifestyle behaviours and weight status. Nevertheless public health policy makers and professionals need to understand the unique challenges schools face when contributing to the obesity prevention agenda. To maximise the effectiveness of school-based prevention, schools require additional support and resources. Furthermore public health action is required to address systematically the extensive social and environmental factors influencing adolescent obesity.