Whole Systems Approach to Diet and Healthy Weight – A longitudinal Process Evaluation in East Scotland

Gavin Breslin, Wendy Wills, Charis Bontoft, Olujoke Fakoya, Honey-Anne Greco, Nigel Lloyd, Adam Wagner, Amander Wellings, Sian Harding, Katherine Brown

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Aims: Obesity contributes to morbidity and early mortality, affecting people of all ages and socio-demographic backgrounds. Despite attempts to address obesity, efforts to date have only had limited success. Adopting a Whole Systems Approach (WSA) may potentially address obesity and emphasises complex inter-relating factors beyond individual choice. This study aimed to assess implementation of WSA to diet and healthy weight in two council areas of Scotland, longitudinally exploring enablers and barriers. One area followed a Leeds Beckett WSA model (LBM) of implementation, while the other used a hybrid model incorporating existing working systems. Methods: To assess the process of implementing a WSA, interviews and focus groups were conducted after initiation and one year later. Results: Main enablers included: belief in WSA effectiveness; positive relationships between key personnel; buying at community and national levels; funding availability; the working group responsible for coordinating the system development comprising individuals with diverse expertise; good communication; and existing governance structures. Barriers included: insufficient funding; high staff turnover; inadequate training in WSA methodology; engaging all relevant stakeholders and reverting to ‘old ways’ of non-WSA working. The LBM provided a framework for system setup and generating an action plan. Conclusion: This study provides the first independent longitudinal process evaluation of WSAs that have incorporated Leeds Beckett methodology, and offers insights into how a WSA can be implemented to address diet and healthy weight.
Original languageEnglish
Pages (from-to)294-357
Number of pages11
JournalPerspectives In Public Health
Issue number6
Early online date30 Oct 2023
Publication statusPublished - 29 Nov 2023


  • Obesity
  • Policy
  • Nutrition
  • Health Promotion
  • Whole Systems Approach
  • Public Health


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