Transforming the management of obesity prevention
Submitting InstitutionUniversity of Lincoln
Unit of AssessmentSport and Exercise Sciences, Leisure and Tourism
Summary Impact TypeHealth
Research Subject Area(s)
Medical and Health Sciences: Public Health and Health Services
Psychology and Cognitive Sciences: Psychology
Summary of the impact
The Health Advancement Research Team (HART) members critically evaluated
the North-East Lincolnshire Obesity Prevention Strategy, the first such
evaluation in the UK. The research led directly to measureable
improvements: specific new training programmes and resource allocations;
partnership development and co-ordination; health-worker behaviour change;
increases in employment amongst obesity prevention healthcare staff; a new
communications strategy; and an increase in healthy eating opportunities.
The Care Trust considers that the research has had a beneficial impact on
obesity levels in North-East Lincolnshire. The research team/Care Trust
partnership has strengthened and is continuing, and the results are
replicable nationally and internationally.
The obesity `epidemic' has been identified as one of the major public
health challenges, both nationally and internationally, and is a
particular problem in North-East Lincolnshire, one of the most
socio-economically deprived areas in the UK. In response to the
Government's 2004 white paper, Choosing Health, The North-East
Lincolnshire Care Trust produced its Obesity Prevention and Reduction
Strategy in 2006. The Strategy's aim was to secure health benefits for the
population (via targeted obesity interventions) through partnerships
between a number of stakeholders.
Members of HART were commissioned by the Care Trust (project value of
£11,800) to critically evaluate the strategy. This was the first time in
the UK that such a strategy had been evaluated. The research questions set
were as follows:
- What were the main barriers amongst the key stakeholders to effective
strategy implementation, and what were the principal positive
characteristics of the strategy?
- In what way, and to what extent, were the strategic aims being met?
- What was the impact of activity stemming from the strategy - on both
the key stakeholders involved in its implementation and on the community
- How did stakeholders' views influence the effectiveness of the
A qualitative research design was used and a mixed-methods approach
adopted, drawing on two focus groups (n=4; n=7), individual interviews
(total n=31), and secondary data and documentary analysis. The
semi-structured focus groups and interviews established an in-depth
understanding of the experiences and opinions of those directly involved
with implementation of the strategy. Purposive sampling, supplemented by
snowball sampling via health professionals, was used to draw up a sample
for the focus groups and interviews comprising: 1) community participants
(intervention beneficiaries), and, 2) health professionals and local
stakeholders (at strategic and senior level). Focus groups and interviews
explored attitudes toward and experiences of both the delivery and
the receipt of the strategy. Thematic data analysis was used to
identify salient themes cohering around: 1) the implementation of the
strategy, and, 2) impact on the intended beneficiaries.
- There was a need for an expanded staffing base for the successful
delivery of the programme.
- Open College Network Level 1 accredited training was required for
health workers in areas relating to healthy lifestyles.
- There was a need to protect and enhance resources in this area of
- Specific recommendations were made in regard to enhancing partnership
working amongst a range of health stakeholders.
- Health workers needed to accommodate more fully the social and
environmental contexts of obesity.
- A new communications strategy would be beneficial.
- Opportunities for healthier eating should be developed.
Findings were disseminated in various fora: a comprehensive research
report was produced for the client; an international conference
presentation was delivered, and international, peer-reviewed journal
articles were produced.
Who and when conducted
The research was conducted from June 2009 to March 2010 by members of
HART: Geoff Middleton (lead researcher), Hannah Henderson (née Rigby), and
Donna Evans (co-researchers), all of whom were early career researchers at
References to the research
Middleton, G., Evans, A., Keegan, R., Bishop, D. and Evans, D. (2014
forthcoming). The importance of parents and teachers as stakeholders in
school-based healthy eating programs. In Y. B. Larock and D. C. Gustave
(eds). Health Education: Parental and Educators' Perspectives, Current
Practices and Needs Assessment. Hauppauge, NY: Nova Science
Middleton, G., Henderson, H. and Evans, D. (2013). Implementing a
community-based obesity prevention programme: experiences of stakeholders
in the North East of England. Health Promotion International.
Advance access: doi:10.1093/heapro/das072.
Middleton, G., Keegan, R. and Henderson, H. (2012). A qualitative
exploration of stakeholder perspectives on a school-based multi-component
health promotion nutrition programme. Journal of Human Nutrition and
Dietetics, 25 (6): 547-556. doi:10.1111/j.1365-277X.2012.01266.x.
Middleton, G., Rigby, H. and Evans, D. (2011). A qualitative evaluation
of a regional obesity prevention programme, Proceedings of the
Nutrition Society 70 (OCE4), E20.
Middleton, G., Keegan, R. and Rigby, H. (2010). Evaluation of the
Food for Fitness Team in North East Lincolnshire. Report for North East
Lincolnshire Care Trust Plus NHS; Specialist Health Promotion Service.
Lincoln: University of Lincoln.
Middleton, G., Rigby, H. and Evans, D. (2009). Evaluation of the
Obesity Prevention Scheme in North East Lincolnshire: Executive Report
for North East Lincolnshire Care Trust Plus NHS; Specialist Health
Promotion Service. Lincoln: University of Lincoln.
Details of the impact
A number of impact outcomes have been identified by the client as arising
as a direct result of the research. Following the report, the Public
Health Directorate at the North East Lincolnshire Council implemented
changes in the areas of staffing, strategy, and training and resources:
- A specific `Obesity Lead' was appointed to drive,
implement and evaluate the co- ordination of local services.
- The employment of six staff (two of these were posts
that were due to finish but were retained on the basis of the research
findings). These posts co-ordinate the programme for the reduction in
obesity through physical activity, healthier eating and emotional
well-being across the lifecycle. Their purpose was to `embed skills or
tools into local areas, run by local volunteers or community people'
(research report, page 16).
Partnership development: there was a reconfiguration of
the partnership arrangements used to tackle obesity, which also led to
the employment of a further staff member dedicated to the co-ordination
of partnership roles and to work specifically on childhood obesity
Local obesity strategies were developed, specific to
- A `Healthy Weight' care pathway was established for 0
to 18 year olds in North-East Lincolnshire.
- A new communications strategy for the obesity programme
was created, including the use of electronic media, to improve
communications at all levels of the programme.
Healthy eating opportunities: a new Healthy Choices
Award Scheme was introduced to enable and encourage food retailers to
offer healthier choices.
- The introduction and implementation of a monitoring tool
took place to enhance ongoing evaluation of the strategy.
iii) Training and resources
Training: between 2009 and 2011 a skills package was
introduced for health professionals that comprised of four new
certificated courses and a series of guides that were produced for
Resource allocations to the obesity project were
enhanced, including the production of leaflets for both health workers
and clients, as well as the retention of resources that would otherwise
have been lost, for example, by establishing a library of advisory
- In respect of health-worker behaviour change, workers
were trained in the wider understanding of the social and environmental
contexts of obesity, as well as lifecycle influences, to improve
efficacy of the obesity programme.
The Care Trust also considers that the research has had a beneficial
impact on obesity levels in North-East Lincolnshire, and research is
currently underway to investigate this further.
How the research led to impact
The research was commissioned specifically due to the considerable
challenge of tackling the obesity `epidemic' in the North-East
Lincolnshire area, and the research technical report was provided directly
to key decision-makers in the Care Trust in 2009. It was also distributed
to a wide range of stakeholder groups accessing and using the Obesity
Prevention Strategy. Wider dissemination and impact, beyond the North-East
Lincolnshire region, has been achieved through academic journal articles
and conference presentations, and this is also ongoing.
Nature, extent and dates of the impact
The changes noted above were implemented from 2010. The project has also
stimulated local and regional debate relating to strategy monitoring,
collaborative service alliances, and marketing communication strategies,
which in turn led to further funding from North-East Lincolnshire Care
Trust allocated to the HART group to conduct additional research. These
subsequent projects have included investigating the changes made as a
consequence of the research (currently ongoing), as well as further grants
to research other related strategies, such as the Food for Fitness Team
and Health Promotion Portfolio in North-East Lincolnshire. In relation to
local and regional impact, the research has generated a strong working
relationship between the research team and the key regional agencies,
resulting in the team's input into strategic thinking in relation not only
to obesity programmes, but also to health promotion more generally in the
The scope of the research is potentially international (with regard to
its relevance to obesity reduction strategies) as well as national, and
the School intends to develop this aspect in future work. Findings have so
far been presented both in international journals and via an international
There are a number of direct stakeholder beneficiaries of the research,
in addition to the community more widely. These are:
North-East Lincolnshire NHS Care Trust:
- Public Health Directorate
- Specialist Health Promotion Service
- General Practice, Primary Care
- Health Trainer Service.
Northern Lincolnshire and Goole Hospitals NHS Foundation Trust:
- Community Dietetics Service.
North East Lincolnshire Council:
- Neighbourhood Development Unit
- Sports Development Unit
- Healthy Schools Scheme.
- The North East Lincolnshire School Sports Partnership
- Shoreline Housing Partnership
- Voluntary and Community sector.
Sources to corroborate the impact
Pathway for promoting healthy weight to children and young people: www.North-East Lincolnshireincs.gov.uk/council/children-s-workforce-development/view-best-practice-guidance-and-research/promoting-healthy-weight-to-children-and-young-people/level-1-giving-brief-advice/.
Public Health Directorate communications
Email communications, available on request, with Health Promotion
Specialist, Specialist Health Promotion Service Department, Public Health
Directorate, North East Lincolnshire Council.
Public Health England `research evidence'
Research journal output Middleton et al. 2013, included as research