How do local public health teams in North Wales consider their role in influencing the obesogenic environment through planning processes? A qualitative study

Overweight and obesity affect 2·6 billion people worldwide, causing significant morbidity and 4 million deaths annually. In Wales, over 60% of people are affected. Betsi Cadwaladr University Health Board Public Health team recently began systematically to provide public health advice and evidence in response to planning applications to try to influence the obesogenic environment. This study aims to explore team members’ experiences of responding to fast-food outlet applications. Qualitative, semi-structured online interviews were conducted with 12 practitioners, registrars and consultants in the team. The interviews addressed the planning process, application prioritisation, power over the obesogenic environment and stakeholder relationships. Interview transcripts were in vivo coded and subjected to thematic analysis. Ethical approval granted on June 6, 2023 by the Institute of Population Health Research Ethics Committee at the University of Liverpool (ref: 12503). Participants’ interpretations of the nature, scope and determinism of the obesogenic environment varied considerably. Regardless, the concept was considered to have significant real-world applicability for problematising fast-food outlets. Complexity, the evidence base and defining unhealthy outlets were thought problematic. Participants considered their skills in evidence provision, impact assessment and networking essential. However, no relationship-building strategy was defined, and contradictory approaches were adopted, due to capacity, inadequate legal standing and fear of backlash. Most felt public health lacked power to effect lasting change through planning. Hopes were placed in a favourable future policy environment despite recognition that current supportive policy is routinely ignored. Intervention success was unclearly defined. This is the first study to consider public health professionals’ beliefs about using planning to modify the fast-food environment in Wales’ specific policy environment. It highlights the need for logic-based strategies which maximise effectiveness, rather than achieve adherence with established processes. Public health contributions tailored to other stakeholders’ priorities and language, especially in the absence of supportive policy and law, may be essential. Procedural, policy and research recommendations to strengthen public health impact on the obesogenic environment are made. None.