Title: Family Food Experience study: how can local authorities improve the efficiency and effectiveness of interventions to address inequality in childhood obesity?
Funder: Department of Health and Social Care

Abstract: Many children in England have a bodyweight higher than is healthy. To address this problem, governments have done things like set school food standards, restrict unhealthy food advertising, and run campaigns to reduce the amount of sugar and unhealthy fast food people eat. Yet the difference in rates of unhealthy weight between children from the highest and lowest income neighbourhoods continues to grow._x000D_ We think this is because their efforts have not been designed to account for the realities of the lives of those with a limited income. For example, a child raised in a community full of stores selling cheap snacks, in a small flat with no proper kitchen, by parents working long hours, might not like the healthy food served at nursery as much as children from higher income households who have eaten healthy food at home. However, we know very little about how these aspects of poverty might be preventing existing efforts from reducing the gap between the wealthy and those with limited incomes._x000D_ This study will therefore try and find out how children's real lives in lower income communities’ impact on their ability to respond to efforts to help them eat a healthy diet. We will look at the types of foods easily accessible to them in their daily lives, the challenges they face from lack of money, and their family’s food habits. We think that all of these factors could impact on their ability to benefit from initiatives, including by local authorities, to help them eat a healthy diet. If we can find out what these factors are, then we can make sure that future efforts work better for both the wealthy as well as those with limited incomes._x000D_ We will focus our study on 4-11 year olds because this is the time when children who grow up to become teenagers and adults with excess weight are most likely to gain unwanted weight. We will conduct the study in London, where a lot of initiatives to encourage children to eat better are in place and the levels of unhealthy weight between the wealthy and lower-income children differ the most. We will study the food habits of 700 families living in the highest and lowest income parts of London. Then we will talk and travel, side by side with about 50 children and caregivers during their daily journeys to learn if and how existing initiatives might (or might not) be reaching them. We will analyse the information from these ‘go-alongs’, and work out common themes from what they have told us as well as from measurements we have made of the food available. We will also find out what is stopping implementation of initiatives in the real world._x000D_ Drawing on this information, we will ask these children and their caregivers and people involved locally to help us design better actions. This type of approach to designing initiatives is called co-production. We know that initiatives co-produced in this way are more effective. We will also ask a group of local caregivers to be involved in the study from start to finish. By taking this approach, we will make sure that we are asking the right questions. _x000D_ Ultimately, we will produce guidance for local authorities about what they most need to change to improve children's diets. We will also share our results more widely, through pictures, reports and meeting people. _x000D_ We think this new way of doing research will help us learn how to improve the health of children from low income backgrounds and lower inequality.

Lay abstract: Research question_x000D_ The main research question of the Family Food Experience study - London is: how do the contexts into which existing policies and interventions on diet are delivered influence their ability to have impact among children living in deprivation and how could these policies/interventions be improved to address inequality? The purpose is not to measure whether interventions are effective or not, but provide practical insights into how they could work better. _x000D_ Background_x000D_ England faces a severe problem of inequality in obesity, with the prevalence of childhood overweight/obesity in the most deprived neighbourhoods being over double the least deprived. This inequality exists despite at least 15 years of government action to improve children’s diets nationally and locally. There are a range of plausible, multifaceted reasons why this may occur, including contextual considerations that may undermine the intended impact of these action, such as local food systems, socioeconomic conditions, cultural norms in families at home, presence of complementary interventions, and implementation barriers._x000D_ Aims and objectives_x000D_ The aim is to produce guidance to local authorities on how they can adapt and augment their existing obesity plans so that they work more effectively and efficiently to reduce inequalities. The ultimate objective is to reduce inequalities in obesity and reduce costs to the NHS by improving the diets of children aged 4-11. The study will take place in Greater London and is framed and guided by ‘systems thinking.’_x000D_ Methods_x000D_ This is a mixed-methods study employing different methods to answer nine specific research questions. Sampling will identify 700 people representing higher- and lower-income neighbourhoods in London. 30 schools will be identified, from which study participants will be sampled and a novel quantitative survey of family food cultures at home and socioeconomic conditions conducted. Participants from eight wards in eight local authorities will be selected from this sample for in-depth qualitative studies: Group Model Building, with community members and local stakeholders; go-along interviews with 48 community members from study wards. Local stakeholders involved in the development and delivery of interventions in each local authority will be interviewed to understand implementation barriers. Local food environments will also be systematically mapped. The study will convene a ‘Caregiver Advisory Panel’ and a ‘Stakeholder Steering Group’ to consult with regularly throughout the duration of the study to ensure risks are managed, the study design is workable and findings are framed to appeal to local communities and enhance uptake among decision makers. _x000D_ Anticipated impact and dissemination_x000D_ Outputs (guidance reports and briefs, eye-catching visual assets, academic publications) will be designed for dissemination to decision-makers, local community residents, and the wider public. The main pathway to impact will be through engagement throughout the study of intended end-users and beneficiaries. The anticipated impact is that our end-users in local authorities will use the guidance, and the learnings along the way from being involved in the study, to improve their obesity plans so they are more effective and efficient in addressing dietary inequalities among children.

Research activity codes: 3.2 INTERVENTIONS TO ALTER PHYSICAL AND BIOLOGICAL ENVIRONMENTAL RISKS
Health categories: CANCER AND NEOPLASMS;CARDIOVASCULAR;METABOLIC AND ENDOCRINE;ORAL AND GASTROINTESTINAL;STROKE