Peer-reviewed article
An early-phase process evaluation of a whole-systems approach to healthy weight among children and families in Wales
A Potts, G Sanders, S Bird, I Johnson, D Radley ·
Summary
Written by AI, not yet AICS's view · claude-sonnet-5-5This study looks at how the early phase of the Children and Families Programme was carried out in three areas of Wales: Anglesey, Cardiff and Merthyr Tydfil. The programme uses a whole-systems approach to raise the share of children leaving the foundation phase (ages 3 to 7) at a healthy weight. Thirteen people involved in the programme were interviewed online, and the interviews were analysed for themes. Strong leadership, co-production and cross-sector collaboration were seen as important. Siloed working, cultural views of weight, and little time to embed change were reported as challenges.
Key points
- Four themes were identified: development of the whole-systems approach, partnership working, systemic challenges, and recommendations for future implementation.
- Strong leadership, co-production and cross-sector collaboration were emphasised as important.
- Challenges included system maturity, siloed working, cultural perceptions of weight, and limited time for embedding systemic change.
- The authors say time, trust-building and deeper community engagement are needed.
- Childhood obesity prevalence is particularly high in socioeconomically disadvantaged communities in Wales.
Limitations
This is an early-phase process evaluation based on interviews with 13 stakeholders, so it cannot show whether children's weight or health outcomes changed. It reflects the views of professionals involved in delivery, not children or families.
Abstract
Background: Childhood obesity in Wales is a significant public health issue, with prevalence rates particularly high among socioeconomically disadvantaged communities. The Welsh Government has responded to this issue by launching the Healthy Weight: Healthy Wales strategy, which includes the Children and Families Programme. The Children and Families Programme takes a whole-systems approach to increase the proportion of children leaving the school foundation phase (aged between three and seven years) at a healthy weight. This study presents a process evaluation of the early-phase implementation of a childhood obesity-focused evaluation, the Children and Families Programme, across three contrasting localities in Wales: Anglesey, Cardiff, and Merthyr Tydfil. Methods: Thirteen stakeholders involved in the Children and Families Programme were recruited through purposive sampling. The participants represented key roles in public health, dietetics, and community engagement. Semi-structured interviews were co-produced with public health leads and conducted online. Reflexive thematic analysis was used to analyse the interview data. Results: Four key themes were identified: (1) development of the whole-systems approach, (2) partnership working, (3) systemic challenges, and (4) recommendations for future implementation. The findings emphasised the importance of strong leadership, co-production, and cross-sector collaboration. Challenges emerged around system maturity, siloed working, cultural perceptions of weight, and limited time for embedding systemic change. Conclusion: This process evaluation not only highlights the potential of whole-systems approaches in tackling childhood obesity as a complex public health issue, but also underscores the need for time, trust-building, and deeper community engagement. These findings offer actionable guidance for future whole-systems approach initiatives, particularly in the early stages, aimed at reducing health inequalities and improving childhood health outcomes in and beyond Wales.