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A holistic or ‘whole systems approach’ to obesity prevention could offer a more effective means of tackling high, unequal, and increasing levels of obesity in Northern Ireland according to a new report.

Examining best international evidence and case studies of this approach, the report has been developed for the Department of Health by researchers at Ulster University, Institute of Public Health, Queen’s University Belfast, and University of Hertfordshire.

The report comes as the Department of Health prepares to draft a new obesity prevention strategy this year to replace its predecessor, ‘A Fitter Future for All 2012-22’, with the latest data showing one in four adults (27%) and around one in 16 children (6%) are living with obesity in Northern Ireland.

Official data further shows the development of obesity is strongly linked to deprivation status. Between 2011/12 and 2018/19, one in three (36%) primary year 1 children living in the most deprived areas were more likely to be overweight or obese compared to those living in the least deprived areas, representing a 12% increase since 2011/12 (24%).

Obesity increases the risk of developing chronic disease such as colon cancer, high blood pressure, or type 2 diabetes, and is linked to substantial direct and indirect costs – estimated to be around £370 million in Northern Ireland in 2009.

This new report explores how a whole systems approach (WSA) can be used in obesity prevention by focusing on the systems within which people are born, grow, live, work, and age. International examples show that a WSA can offer an alternative and potentially effective means of addressing obesity, where a multi-agency and partnership approach is adopted.

In real terms, this could mean introducing policy change, new ways of government departments working together, interventions at community level, improving local amenities and facilities to support healthier food and dietary choices, or enhancing opportunities for physical activity.

Lead researcher on the report Dr Gavin Breslin, Senior Lecturer in the School of Psychology at Ulster University, said:

“The rate of obesity in Northern Ireland is high and rising – more than a quarter (27%) of adults are living with obesity, putting this group at a higher risk of developing chronic disease. Inequalities in health are continuing to widen with socially disadvantaged communities experiencing an excess of obesity-related harms. Given these challenges, we need to consider a more holistic approach to tackling obesity - by tackling physical health concerns, mental health concerns that are linked can also be reduced.

“We have reviewed international good practice examples of applying a whole systems approach to preventing obesity. This report shows there is significant potential to use this approach to prevent obesity in Northern Ireland by working collaboratively across departments and agencies, targeting policies and implementing interventions at a community level. In my view, there is a need for a psychological shift in how we approach obesity through adopting a whole systems approach.”

Dr Jenny Mack, Public Health Consultant at the Institute of Public Health, added:  

“Addressing the environmental and commercial determinants of health is at the heart of the whole systems approach to obesity prevention. The City of Amsterdam has led the way in this regard with the ‘Amsterdam Healthy Weight Approach’; a whole systems approach to tackling obesogenic environments. The approach has focused on the importance of early intervention, ‘Health in All Policies’, and reducing inequalities in obesity and, so far, the results are promising. We now have an opportunity to learn from cities like Amsterdam, to take a more holistic, collaborative approach to preventing obesity in our local communities.”

Northern Ireland’s previous obesity prevention strategy, ‘A Fitter Future for All’, was launched in 2012 and ended last year. The Department of Health intends to launch a public consultation on a new obesity prevention strategy for Northern Ireland this year.

The full 'A whole systems approach to obesity prevention: a rapid synthesis of evidence to inform the Northern Ireland Obesity Prevention Strategy Project Board' report can be found here.

WSA case study – Amsterdam healthy weight approach (AWHA)

This city-wide, local government-led initiative aims to support a healthy childhood for all, but also provides extra support for children at higher risk of obesity.

It is a long-term approach organised through clusters of activity targeted to different priority groups and utilising existing city-wide programmes in a collective way.

For example, the AHWA has involved working with schools to encourage active recess play, nutrition education, and learning about the environment and food produce through school gardening programmes.

To create a healthier physical urban environment, this approach has involved working within neighbourhoods to influence local food advertising regulations, and has supported businesses with portion sizes, menu labelling and healthier food options.

Furthermore, AHWA has provided individual support to children with obesity, assigning a central care manager who works closely with a network of professionals including dietitians, physiotherapists, parenting support and young psychologists to support the child and their family.

This report provides further information on the Amsterdam Healthy Weight Approach -