A Qualitative Study of Local Obesity Policy Processes across South Yorkshire

Introduction
Obesity is a serious public health problem facing England, the UK, and other high-income countries. In South Yorkshire, childhood and adult obesity prevalence is consistently reported amongst the highest in England. Local authorities have a responsibility for population health with numerous levers available to influence obesity. Currently there is limited evidence on how local obesity policy processes operate in England. This research explores local obesity policy processes in practice, through a set of case studies in South Yorkshire. It draws on Bacchi’s (2009) WPR (what the problem represented to be) approach, in order to understand how obesity is framed as a policy issue and how this shapes local policy practices.

Methods
An interpretative qualitative approach was taken. Documentary analysis of local policies was completed (n=52) using a Framing Matrix (Jenkin et al. 2011). Semi structured interviews were completed with a purposive sample of local authority and Clinical Commissioning Group leaders, public health commissioners and weight management service providers (n=40), using thematic analysis.

Results
Despite nuances, obesity was dominantly represented across South Yorkshire as an individual health issue related to choices about diet and physical activity. This representation was operationalised in the context of: a lack of clarity on responsibilities for effectively addressing obesity; reducing resources; challenges of public health leadership in local authorities; and a lack of effective local leadership and governance for obesity. Combined, these factors influence local (in)action, prioritisation and resource allocation for approaches or interventions, and subsequent outcomes and impacts on local obesity prevalence.

Conclusion
Local obesity policy is developed and implemented within a complex, socio-political local public health system. The changes from the Health and Social Care Act (2012) led to local obesity policy ‘inertia’, set in the context of challenges of local views of obesity, evidence of effectiveness, financial constraints, and a lack of clarity regarding local responsibility for action. Whole systems approaches have been advocated as having potential to address these complex issues in a system, however, without any evidence of impact to date.