Targeting childhood obesity through primary schools: reviewing alignment amongst English policies for physical activity and healthy eating

Abstract

Introduction: Primary schools have been widely identified as a key site to tackle childhood obesity. While specific school-based interventions have been widely researched, there is an absence of collective analysis of national policies targeting childhood obesity and its determinants in primary schools. Therefore, this narrative review of English policy documentation from 2010 to 2017 examines the extent of alignment across governmental aspirations and implementation approaches towards childhood obesity, physical activity and healthy eating. Methods and analytic framework: Using Arksey and O’Malley’s scoping review methodology, 43 relevant policy documents were identified. From these documents, statements of policy aspirations were coded according to the different levels of the socio-ecological model (SEM). Information on policy implementation was coded according to Hood’s “NATO” taxonomy of “Nodality”, “Authority”, “Treasure” and “Organisation” tools which governments can utilise to implement policy. Findings: Common articulations of aspirations to address recognised problems of childhood obesity were identified across policy documents, with the need for multi-level action articulated more clearly for healthy eating than physical activity. The government’s signature Childhood Obesity Plan published in 2016 was an isolated example of a policy document that encompassed aspirations across all SEM levels, but still replicated a wider trend in which only aspirations for individual-level behaviours were articulated with precision. Policy documents evidenced uses of information dissemination, funding, organisational direction and, less prominently, governmental authority to drive policy implementation in primary schools. However, the use of these policy tools was often vaguely specified and disjointed both across different tools and between physical activity and healthy eating policies. Conclusion: High-level aspirations in national policy documents align across the dual approach of tackling childhood obesity by enhancing physical activity and healthy eating. However, the effectiveness of policies is likely constrained by limited alignment across different levels of the SEM and across different policy implementation tools.