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Is obesity policy in England fit for purpose? Analysis of government strategies and policies, 1992-2020

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Theis, D 


Context: In England, the majority of adults, and more than a quarter of children aged 2 to 15 years live with obesity or excess weight. From 1992-2020, government published fourteen obesity strategies in England, yet obesity prevalence has not been reduced. We aimed to determine whether such government strategies and policies have been fit for purpose regarding their strategic focus, nature, basis in theory and evidence, and implementation viability. Method: We undertook a mixed-methods study, involving a document review and analysis of government strategies either wholly or partially dedicated to tackling obesity in England. We developed a theory-based analytical framework, using content analysis and applied thematic analysis (ATA) to code all policies. Interpretation drew on quantitative findings and thematic analysis. Results: We identified and analysed fourteen government strategies published from 1992-2020 containing 689 wide-ranging policies. Policies were largely proposed in a way that would be unlikely to lead to implementation; the majority were not interventionist and made high demands on individual agency, meaning they relied on individuals to make behaviour changes rather than shaping external influences, and are thus less likely to be effective or to reduce health inequalities.
Conclusions: The absence of impact on obesity prevalence of government obesity strategies for England over almost 30 years may be due to policy design weaknesses leading to lack of effectiveness, but may also be due to failures of implementation and evaluation. This appears to have led to insufficient or no policy learning and government proposing similar or identical policies repeatedly over many years. Governments should learn from earlier policy failures. They should prioritise policies that make minimal demands on individuals and have the potential for population-wide reach so as to maximise their potential for equitable impacts. Policies should be proposed in ways that readily lead to implementation and evaluation.



government, obesity, policy, policymaking, public health, COVID-19, England, Government, Health Policy, Humans, Obesity, Pandemics, Program Evaluation, Public Health, SARS-CoV-2

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The Milbank Quarterly

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Medical Research Council (MR/K023187/1)
Department of Health (via National Institute for Health Research (NIHR)) (PD-SPH-2015-10029 BH154142)
Wellcome Trust (087636/Z/08/Z)
MRC (MC_UU_00006/7)
Medical Research Council (MC_UU_12015/6)
The research is funded by/supported by a PhD studentship awarded to DRZT by the National Institute for Health Research (NIHR) School for Public Health Research (Grant No. PD-SPH-2015-10025). MW is supported by the MRC Epidemiology Unit (Grant No. MC/UU/12015/6) and the Centre for Diet & Activity Research (CEDAR), with funding from the British Heart Foundation, Cancer Research UK, Economic & Social Research Council, Medical Research Council, NIHR and Wellcome Trust (Grant Nos. ES/G007462/1, MR/K023187/1 & 087636/Z/08/Z). The views expressed are those of the author(s) and not necessarily those of any of the above named funders.