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. 2019 Jan 3;19(1):8.
doi: 10.1186/s12889-018-6274-z.

Whole systems approaches to obesity and other complex public health challenges: a systematic review

Anne-Marie Bagnall  1 , Duncan Radley  2 , Rebecca Jones  3 , Paul Gately  2 , James Nobles  4   5 , Margie Van Dijk  6 , Jamie Blackshaw  6 , Sam Montel  6 , Pinki Sahota  7
Affiliations

Whole systems approaches to obesity and other complex public health challenges: a systematic review

Anne-Marie Bagnall et al. BMC Public Health. .

Abstract

Background: Increasing awareness of the complexity of public health problems, including obesity, has led to growing interest in whole systems approaches (WSAs), defined as those that consider the multifactorial drivers of overweight and obesity, involve transformative co-ordinated action across a broad range of disciplines and stakeholders, operate across all levels of governance and throughout the life course. This paper reports a systematic review of WSAs targeting obesity and other complex public health and societal issues, such as healthy lifestyles for prevention of non-communicable disease.

Methods: Seven electronic databases were searched from 1995 to 2018. Studies were included if there had been an effort to implement a WSA. Study selection was conducted by one reviewer with a random 20% double checked. Data extraction and validity assessment were undertaken by one reviewer and checked by a second reviewer. Narrative synthesis was undertaken.

Results: Sixty-five articles were included; 33 about obesity. Most examined multicomponent community approaches, and there was substantial clinical and methodological heterogeneity. Nevertheless, a range of positive health outcomes were reported, with some evidence of whole systems thinking. Positive effects were seen on health behaviours, body mass index (BMI), parental and community awareness, community capacity building, nutrition and physical activity environments, underage drinking behaviour and health, safety and wellbeing of community members, self-efficacy, smoking and tobacco-related disease outcomes. Features of successful approaches reported in process evaluations included: full engagement of relevant partners and community; time to build relationships, trust and capacity; good governance; embedding within a broader policy context; local evaluation; finance.

Conclusions: Systems approaches to tackle obesity can have some benefit, but evidence of how to operationalise a WSA to address public health problems is still in its infancy. Future research should: (a) develop an agreed definition of a WSA in relation to obesity, (b) look across multiple sectors to ensure consistency of language and definition, (c) include detailed descriptions of the approaches, and (d) include process and economic evaluations.

Keywords: Complexity; Obesity; Public health; Systematic review; Systems science; Whole systems approaches.

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Conflict of interest statement

Ethics approval and consent to participate

Not applicable.

Consent for publication

Not applicable.

Competing interests

MVD, JB and SM are part of the Public Health England team responsible for the Whole Systems Obesity programme.

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Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Figures

Fig. 1
Fig. 1
Study selection flow chart
Fig. 2
Fig. 2
Total number of WSA features met versus direction of health effects
Fig. 3
Fig. 3
Individual WSA features met versus direction of health effects
See this image and copyright information in PMC

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