Exploring the impact of multilevel environments influencing the adoption of health practices in adults with obesity in the United Kingdom

Abstract

Obesity is a leading health challenge that causes millions of deaths and obesity-related long-term conditions. Reversing its upward trajectory requires understanding its multiple causes. One is the obesogenic environment, which refers to the set of influences that the opportunities, surroundings, or life conditions have on promoting obesity in individuals and populations. Some of these environments and how adults interact with them have not been explored enough in the past. This study aims to gain an in-depth understanding of how multilevel environments influence the adoption of health practices in adults with obesity in the United Kingdom. The study was divided into three phases that inform and complement each other.

The beginning of the research focused on social networks. A critical interpretative synthesis review was used to explore what and how social networks influence the adoption of obesity-related practices. This review showed cross-level influences between different types of ties, network processes, environmental and individual factors. It identified a pattern of health scenarios where networks were implicated and suggested the importance of developing multi-agent coalitions for tackling obesity. In the second phase, the review results informed a qualitative enquiry attempting to explain the impact of social networks on adults with obesity.
This study highlighted the power of family and friends and the negative role of healthcare professionals. The third phase explored further aspects of interactions of individuals with the obesogenic environment utilising lay perspectives. Narrative accounts centred on living with normalcy and convenience through easy access to unhealthy food, people interacting with digital media for positive practice change, and the need to prioritise prevention in schools, the National Health Service and the food industry.

This thesis adds knowledge to the current social science understanding of the obesogenic environment. The results consider the importance of recognising healthy environments within it, a life span understanding of reciprocal interactions between the person-environment, the nature and processes of social networks, the National Health Service as a negative environment and the
relevance of including mental health as part of health outcomes. The results could inform the design of more adequate and long-term sustainable interventions that consider, more than in the past, the everyday interactions between the environment and individuals. This allows moving away from the discourse of individual responsibility, reducing blaming and stigma from society and creating a more conducive context for political and societal change.

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Identifiers

ORCID for Nestor Serrano-Fuentes: orcid.org/0000-0003-3085-7593

ORCID for Maria Carmen Portillo Vega: orcid.org/0000-0003-1583-6612

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