Core elements of an integrated policy for obesity prevention among adults in the Netherlands: developing a guidance for municipalities

More than half of the adult European population currently has overweight and almost 15% is obese, and these figures are expected to increase in the coming decade. Even though both national and international institutions recognize the need to design and implement integrated policies to tackle overweight and obesity, the required knowledge on how to do so is fragmented across different domains and not readily available to professionals. The proposed project will provide a comprehensive overview of the core elements (at the level of the content, structure and context) of an integrated policy for overweight and obesity prevention. The project will specifically focus on lower socioeconomic groups, since this population has the highest potential health gain and is expected to benefit most from an integrated health policy. To support professionals within municipalities to develop and implement effective interventions in their local context, a toolkit consisting of guidelines and tools will be developed. We focus on the level of municipalities, since the responsibility to promote public health in the Netherlands is largely decentralized to that level. The project has three key objectives: 1. To map the complex web of the “causes of causes” of obesity in a comprehensive overview. 2. To gain insight in the three core elements of an effective integrated policy for obesity prevention: content elements (which policy measures), structural elements (through which policy processes) and contextual elements (the necessary conditions within the local context). 3. To develop a toolkit for municipalities to support these in developing and implementing integrated policies in their local context to prevent and reduce overweight and obesity. The project is carried out by a multidisciplinary and transdisciplinary consortium to ensure a successful bridge between science, policy and practice. To incorporate the experience and perspective of important stakeholders and practitioners, we also create two ‘living labs’ in the cities of Rotterdam and Amsterdam. Both cities have expressed the ambition to curb the overweight and obesity epidemic and are actively seeking input on how to design and implement an integrated policy that is able to do so. The project is divided in five work packages: - In work package 1, a ‘systems map’ will be developed that depicts the ‘causes of causes’ of obesity at the local level, with specific attention for adults in lower socioeconomic groups. This work package will be used as input for the other work packages, ensuring that the entire system behind the obesity pandemic will be addressed. To develop this systems map, we will conduct a literature review and organise workshops with our stakeholders from the two livings labs. - In work package 2, we will make an inventory of the core (substantive) elements of current national and international integrated health policy approaches, and build a framework to identify specific actions that can be taken to change different levels of the system. We will use literature reviews and a combination of quantitative and qualitative research in this work package. - In work package 3, we will identify how the policy network that shapes policy interventions and policy implementation can successfully promote the development and implementation of integrated health policy (i.e. the structural elements). We will use literature reviews and quantitative and qualitative research in the livings labs in this work package. - In work package 4, we will identify the different local conditions that affect the effectiveness of the different elements of an integrated obesity-prevention approach and analyse how generalizability to different contexts can be accomplished. After a literature review, semi-structured interviews with international experts and a Delphi-study in the Netherlands will be conducted to prioritize and weight the importance of the contextual elements for integrated policies in the Dutch context. - In work package 5, we will develop a toolkit consisting of a practical guideline and tools (educational and information materials) to guide municipalities with implementing integrated policies on overweight and obesity prevention. An user-centered design approach will be applied for an iterative development process of the guideline. The proposed project matches the focus of the ZonMw call, is in line with the advices and ambitions in the ‘Nationaal Preventieakkoord’ and international organizations, and provides knowledge regarding important gaps among stakeholders in the field. The project will deliver urgently needed knowledge on how to develop and implement effective integrated policies to prevent overweight and obesity among adults in the Netherlands.