Last updated: 10/09/2024
Increase referrals to family-based obesity prevention programmes
Provide £85 million of funding per year for increased rollout of family-based programmes to the local authorities (LAs) with the highest childhood obesity rates
- Low impact on obesity
A percentage estimate of how much the policy would reduce national obesity rates
- Relative reduction in obesity prevalence: 0.04%
- Moderate evidence quality
A rating of the strength of evidence, accounting for both reliability and validity of the evidence
- Reliability and validity rating: 3/5
- Moderate cost to governments
Cost to UK and devolved governments over 5 years
- Costs to governments over 5 years: £425m
- Benefit to governments per year: £20m
What is the policy?
This policy would involve providing additional funding to local authorities (LAs) with highest rates of childhood obesity to increase the access of family-based obesity prevention programmes. Family-based programmes are typically commissioned by LAs or Integrated Care Systems (ICSs), with more funding currently being allocated to areas with high levels of obesity. Increasing the funding available to these bodies for such programmes could vastly increase the number of children with access.
The most well-established family-based programme is HENRY (Health, Exercise and Nutrition for the Really Young). This is an eight-week programme targeted towards parents and families from deprived areas whose children are at most risk of developing obesity or other dietary-related poor health (eg, tooth decay). Programmes focus on changing eating and physical activity habits, utilising the principles of behaviour change psychology to help individuals develop skills to achieve and maintain a healthy weight over the long term.
Most families access these programmes through self-referral; however, GP or school referral is possible.
Recent context
There are a range of private, public and voluntary-led programmes in existence across England, Scotland and Wales.
In England, 11 LAs were awarded £4.4 million to pilot the expansion of behavioural weight management services and the delivery of extended brief interventions in 2021, through the Child and Family Weight Management Services Grant. Funding allocation took population size, prevalence of obesity and level of deprivation into account.
The All Wales Weight Management Pathway 2021 outlines weight management services targeted at young people and their families, with the Aneurin Bevan University Health Board being the first Health Board to develop a specific tier 3 level service for children and young people and their families. There are also current services which are broader than weight management but include healthy lifestyle, preventative components including Families First (delivered by LAs), Flying Start (universal in areas of high deprivation) and Every Child (delivered by Public Health Wales).
In Scotland, all NHS Health Boards have established Child Healthy Weight (CHW) programmes, with most offering a range of preventative and treatment services. In their Diet and Healthy Weight Delivery Plan, the Scottish Government noted their intention to continue investment in these programmes and to design better and more tailored pathways for children and families to access weight management services. This included the appointment of a professional advisor in 2018 to support the development of consistent and systematic approaches to identification, referral and support for children and young people who are living with overweight and obesity, and their families.
Case studies
HENRY, UK
HENRY is a UK-based organisation that offers community-based programmes to prevent early years obesity. Their strategy is to focus on both the ‘message’ and ‘messenger’, offering both family programmes and training for health and early years practitioners. HENRY programmes are currently offered across 50 LA areas in all four UK nations, and cover parenting, family lifestyle habits, healthy eating, physical activity, and emotional wellbeing.
HENRY’s Healthy Families programme is an eight-week child obesity intervention designed to help parents with children under five years old to develop the skills and knowledge needed to improve family lifestyle and wellbeing.
There is evidence that HENRY results in parents’ increased confidence in their ability to encourage healthier behaviours such as eating fruit and vegetables and increasing physical activity, and improvements to family health behaviours. A randomised controlled trial (RCT) is currently in progress which will report weight-loss outcomes. Evaluations of HENRY show parents and carers regularly reporting increased self-efficacy in terms of confidence in their ability. Many changes are reportedly sustained. An RCT testing the effectiveness of the HENRY programme on obesity outcomes is currently underway.
Considerations for implementation
Commissioned programmes need to be able to meet the varying needs of local children and young people, including those of different ages, stages of development and from different cultural backgrounds.
There is a lack of data on how the barriers to, and facilitators for, participating in a weight management programme vary according to socioeconomic group, ethnicity, gender and age. Not all parents and carers will identify with their child being overweight or obese, and this may not be the primary motivation for engaging with a programme. It may be beneficial to focus on the health, wellbeing and lifestyle aspects of programmes.
Estimating the population impact
We estimated that this policy would reduce the population obesity rates by approximately 0.04% (by reducing the prevalence of childhood UK obesity rates by approximately 0.3%)
Estimating the per-person impact
In lieu of an evaluation of the HENRY programme we used data from Morgan et al. (2013), a meta-analysis of 17 studies that tested the effectiveness of lifestyle programmes for weight management in young people. Review of studies found an average of 0.01 reduction in child BMI after six months (we assumed that this was the effect at one year).
Estimating the population reach
We estimated that the cost of running a lifestyle programme is about £320 per family, based on costs reported for the HENRY programme. We assumed therefore that £85 million would reach approximately 260,000 additional families per year. Based on the average number of children per household, we estimated that the policy would impact an additional 460,000 children. We also assumed that the children exposed to the policy would be children living in areas of high deprivation, with a parent living with overweight or obesity.
We were only able to model impacts for England as the requisite variables to choose parent BMI is not available for Scotland. We are in the process of modelling the impact for Scotland using proxy information and will update the site when this is complete.
Changes in the prevalence of people living with obesity
| Adults (England and Wales) | Children (England and Wales) | Adults (Scotland) | Children (Scotland) |
| Not applicable | 0.3% | Not applicable | In progress |
Cost and benefits
Cost over 5 years
We estimated that this policy would cost the governments approximately £425 million over five years
Table 2 shows a breakdown of costs. The direct costs to the UK and devolved governments would be approximately £85 million for increased provision of funding.
| Group affected | Cost | Horizon | Detail |
| Costs | |||
| Governments | £0.4bn | Annual (5 years) | Increased provision of funding |
Total annual benefit
We estimated that this policy would have an annual benefit of approximately £20 million
Using analysis conducted by the Tony Blair Institute and Frontier Economics we estimate this policy would result in benefits of approximately £20 million per year. Approximately two-thirds of this saving would benefit individuals (via quality-adjusted life years, and informal social care). The remaining third relates to savings that benefit the state via NHS treatment costs, productivity and formal social care. See our Methods page for more information about the cost breakdowns.
Impact on disease incidence
We commissioned HealthLumen to report disease incidence avoided if the policy were implemented. These estimates do not represent the total health benefits.
Table 3 presents a summary of disease incidence avoided. The specific diseases selected are those where there is good evidence that living with obesity is associated with the development of the disease.
| Disease | Incidence avoided |
| Type 2 diabetes | Not statistically significant |
| Hypertension | Not statistically significant |
| Coronary heart disease | Not statistically significant |
| Colorectal cancer | Not statistically significant |
| Gall bladder disease | Not statistically significant |
| Ovarian cancer | Not statistically significant |
| Stroke | Not statistically significant |
| Liver cancer | Not statistically significant |
| Depression | Not statistically significant |
| Musculoskeletal disease | Not statistically significant |
Behind the averages: impact on inequalities
These programmes are targeted and should be aimed at those at greatest risk of overweight or obesity. A targeted increase in funding will have a positive effect on health inequalities, allowing services to reach those most in need. With a focus on individual responsibility, it is possible that lifestyle programmes such as these may exacerbate weight stigma.
Rating the strength of evidence
We asked experts working in the fields of obesity, food, and health research to rate the strength of the evidence base for each policy, taking into account both reliability (size and consistency) and validity (quality and content) of the evidence. Policies were rated on a Likert scale of 1–5 (none, limited, medium, strong, and very strong evidence base). The Blueprint Expert Advisory Group rated this policy as having a Medium evidence base.
Increase referrals to total diet replacement programmes
Everyone with a BMI of 30 or above is offered a free referral to a total diet replacement programme via primary care.