The current prevalence of excess weight in Bexley for both adults and children represents a major public health challenge for the borough. Since obese children often become obese adults, this situation is set to remain a serious problem in the long term, unless effective action are undertaken to address it.
Whilst the London Borough of Bexley is less deprived than most London boroughs, it has some of the highest levels of excess weight in the capital. This is due to the interaction of a number of factors that contribute towards the development of obesity within an obesogenic environment. This interaction of poor diet, under-utilisation of outdoor space for exercise, inaccessibility of woodland, physical inactivity, low levels of active transport and an over dependence on cars, all contribute to a complex interplay of factors leading to a high prevalence of excess weight within the borough.
As excess weight is a complex problem, it requires a whole systems approach involving many stakeholders across multiple organisations working in partnership. The way these partners contribute to tackling obesity is illustrated in Figure 47 and shows a possible way forward.
 TRiFOCAL London (2018). About TRiFOCAL. Available at: http://trifocal.eu.com/about-trifocal/
Figure 15: How partners address obesity through a whole systems approach
Source: Public Health England (2017). Whole Systems Approach to Obesity: Co-creating a world class solution to a worldwide challenge. Available at: https://www.local.gov.uk/sites/default/files/documents/P11%20Using%20whole%20systems%20approaches%20to%20tackle%20obesity.pdf
In terms of co-ordinating the next steps and developing effective partnerships to tackle obesity in the borough, NICE provide guidance on working with local communities as well as a related set of pathways, which cover a number of relevant aspects including; developing a sustainable approach and leadership, communication, co-ordinating local action, integrated commissioning, training and development, monitoring and evaluation, cost effectiveness and scrutiny.
At a practical level, Leeds Beckett University have done considerable work on the introduction of a whole systems approach for addressing excess weight. They are developing a route map, which provides guidance on how local authorities can produce an effective action plan. Whilst they recognise that the development of an action plan for tackling excess weight is an on-going, iterative process, Leeds Beckett University suggest that it goes through a number of stages (see Figure 16).
 National Institute for Health and Care Excellence (NICE). Public health guideline [PH42]. Obesity: working with local communities. Published in November 2012; updated in June 2017. Available at: https://www.nice.org.uk/guidance/PH42
 National Institute for Health and Care Excellence (NICE, 2018). NICE pathways: Obesity: working with local communities overview. Available at: https://pathways.nice.org.uk/pathways/obesity-working-with-local-communities#path=view%3A/pathways/obesity-working-with-local-communities/obesity-working-with-local-communities-overview.xml&content=view-index
 Leeds Beckett University (2018). Drafting the Route Map. What might the route map look like? Available at: http://www.leedsbeckett.ac.uk/wholesystemsobesity/news-and-resources-drafting-the-route-map/
Figure 16: The Steps involved in creating an Action Plan using a Whole Systems Approach:
- Build partnerships and collating preparatory information and insight (engaging in “pre-systems thinking”.
- Bring together of a “Core Group” of leaders.
- Engage in a positive conversation about what works.
- Start work (by the Core Group) on identifying consequences and causes of obesity locally, with a view to bringing a wider group of the right people (stakeholders) round the table.
- Revisit the consequences and causes of obesity with the wider group of stakeholders, to gain greater shared understanding and ownership.
- Map out existing approaches, identifying opportunities and gaps for adaptation and partnerships. Answer the following questions; How can individual actions be strengthened? How can they come together for greater impact?
- Core Group and stakeholders work together through the ideas to create an action plan. Sense check the collective actions and consider whether they will be sufficient. Identify whether a balance is struck between tackling the wider environment and addressing the most at risk groups (a dual approach).
- Maintain and nurture relationships. Adapt the plan, system and network to reflect changing influences and emerging progress.
- Include approaches that provide on-going feedback into the system.
- Think of the action plan (“Route Map”) in both the short term and long term. In the short term, the council can see benefits from building capacity and developing links with stakeholders and communities, whereas in the long term, as the programme progresses, benefits may emerge in terms of changing behaviours and obesity measures.
Source: Leeds Beckett University (2018). Drafting the Route Map. What might the route map look like? Available at: http://www.leedsbeckett.ac.uk/wholesystemsobesity/news-and-resources-drafting-the-route-map/