Addressing the weight management needs of underserved populations: a systems perspective

Background: Nutritional inequality leads to poorer health and wellbeing outcomes, including acquisition of diseases such as obesity. Obesity is recognised in policy as a complex global health issue which continues to increase. Current practice is based on a conceptualisation of individualised responsibility for weight gain, and transactional behaviour-change interventions which rely on individual agency. These interventions are poorly engaged with, have high attrition rates, and likely contribute to further health inequality. These communities are often referred to as ‘underserved’ and are excluded from service or system design and delivery. Method: A series of mixed-method design research papers using qualitative and quantitative research methodologies to explore nutritional inequalities (e.g., obesity, diabetes) in selected places, with selected people and the food environment in the context of underserved communities. Results: Seldom heard and underserved communities provide valuable insight into their lived experience and can highlight failings in the current system and interventions, whilst suggesting alternative solutions which are likely to be more successful at reducing health and nutritional inequalities. The results of this research have contributed towards the development of NICE weight management guidelines, made recommendations for policy change and improving obesity management, developed a Theory of Change which highlights the impact of the seldom heard public voice in service design and development and food provision, and has extended the socioecological model of food choice for Muslim adolescents. Conclusion: A re-conceptualisation of obesity management supports a more systemic approach and interventions that are more successful because they are coproduced with empowered underserved communities. By coproducing solutions with- rather than for underserved communities, it is possible to overcome barriers and facilitate changes in policy and practice to elicit a healthier holistic environment for all which reduces nutritional inequalities.