How can planning add value to obesity prevention programmes? A qualitative study of planning and planners in the Healthy Towns programme in England

Municipal health promotion programs: is childhood obesity a concern at local level in Portugal?

Health promotion programs, targeted at distinct health outcomes such as childhood obesity, at local level are increasingly used worldwide. Therefore, there is a need to better understand the role of local governments (municipalities) as key public health promoters namely in the prevention of obesity in children. We aimed to provide some input regarding this issue in Portugal. First, we identified health-enhancing programs promoted by Portuguese municipalities in which children could participate. Then, we conducted a document analysis to provide clues about how municipalities conceptualized child health by retrieving information on which topics the programs were focused in, or acted upon, and identifying which socio-ecological model levels were addressed (or not) by each program. The 77 identified programs were promoted by 30 of the 308 Portuguese municipalities and only 11 programs addressed childhood obesity. Most programs focused in the individual health determinants and provided limited information which disabled its deeper analysis. Portuguese municipalities seem to disregard their potential as public health promoters. Childhood obesity is a major public health concern at national (and global) level but the same does not emerge locally. Municipalities are the closest government entities to the population, and it is their responsibility to ensure the population's quality of life, by addressing the social determinants and the physical environments. Therefore, municipalities should acknowledge health in their actions and delineate health improvement programs considering current evidence, specifically in the case of childhood obesity prevention that besides being a health problem in itself, is a risk factor for non-communicable diseases.

Associations between food environment typologies and body mass index: Evidence from Yorkshire, England

International research linking food outlets and body mass index (BMI) is largely cross-sectional, yielding inconsistent findings. However, addressing the exposure of food outlets is increasingly considered as an important adult obesity prevention strategy. Our study investigates associations between baseline food environment types and change in BMI over time. Survey data were used from the Yorkshire Health Study (n=8,864; wave one: 2010-2012, wave two: 2013-2015) for adults aged 18-86. BMI was calculated using self-reported height (cm) and weight (kg). Restaurants, cafés, fast-food, speciality, convenience and large supermarkets were identified from the Ordnance Survey Point of Interest database within 1600m radial buffer of home postcodes. K-means cluster analysis developed food environment typologies based on food outlets and population density. Large supermarkets, restaurants, cafés, fast-food, speciality and convenience food outlets all clustered together to some extent. Three neighbourhood typologies were identified. However, multilevel models revealed that relative to cluster one all were unrelated to change in BMI (cluster 2, b= -0.146 [-0.274, 0.566]; cluster 3, b= 0.065 [-0.224, 0.356]). There was also little evidence of gender-based differences in these associations when examined in a three-way interaction. Policymakers may need to begin to consider multiple types of food outlet clusters, while further research is needed to confirm how these relate to changed BMI.

How does local government use the planning system to regulate hot food takeaway outlets? A census of current practice in England using document review

Takeaway food outlets typically sell hot food, ordered and paid for at the till, for consumption off the premises due to limited seating provision. Growing numbers of these outlets has raised concerns about their impact on diet and weight gain. This has led to proposals to regulate their proliferation through urban planning. We conducted a census of local government areas in England with planning power (n = 325) to identify planning policies specifically addressing takeaway food outlets, with a 'health', and 'non-health' focus. We reviewed planning policies using content analysis, and developed a typology. One hundred and sixty-four (50.5%) local government areas had a policy specifically targeting takeaway food outlets; of these, 56 (34.1%) focused on health. Our typology revealed two main foci: 'Place' with five targeted locations and 'Strategy' with four categories of approach. The most common health-focused approach was describing exclusion zones around places for children and families (n = 33). Non-health focused approaches primarily involved minimising negative impacts associated with takeaway food outlets within a local government area boundary (n = 146). To our knowledge, this is the first census of planning policies explicitly focused on takeaway food outlets in England. Further work is required to determine why different approaches are adopted in different places and their acceptability and impact.