ABSTRACT
Background: Primary school-based obesity interventions target influences on obesity and have
the potential to reduce inequalities in obesity. However, the extent to which they target obesity
risk factors remains unclear. This dissertation used a strategic behavioural analysis methodology applying
a validated behavioural science framework to i) identify and describe influences on
obesity relevant to children in primary schools, ii) identify and describe obesity prevention
intervention content, iii) assess the extent to which intervention content was theoretically
congruent with relevant risk factors.
Methods: A systematic scoping review identified relevant school-based interventions from
January 2006 to June 2021. Three databases were searched. Studies were screened for eligibility
and included studies underwent data extraction and quality assessment. Key influences on
childhood obesity relevant to primary school children were identified from the Foresight Obesity
System Map (FOSM). Foresight variables and intervention actions were classified according to
the Capability-Opportunity-Motivation-Behaviour (COM-B) model and the Behaviour Change
Wheel (BCW), which enabled the identification of approaches likely to be effective for
childhood obesity prevention. Interventions and influences on obesity were overlaid to create a
HEAT map that enabled the identification of gaps in obesity prevention. Recommendations were
generated to address the most significant of these gaps.
Results: A wide range of intervention actions (n=74) were identified to address relevant
influences on obesity. Over half (52%) of the relevant Foresight variables were not appropriately
targeted by intervention actions. There was scope to strengthen interventions relating to
individual and social psychology, food consumption and production, and individual physical
activity. The most theoretically congruent intervention actions were related to modelling and
training. Interventions acted via all aspects of the COM-B model. However, there was scope to
improve interventions to increase ‘physical opportunity’ through enablement and restriction,
‘automatic motivation’ through coercion and training, and ‘reflective motivation’ through
persuasion and coercion.
Conclusion: Recommendations were made to address the most missed opportunities within
children’s food environment and their automatic and reflective motivational processes. Future
studies should establish a more detailed and nuanced understanding of the influences on
childhood obesity-related behaviour and intervention content. To further optimise primary
school-based obesity interventions, efforts should be made to link their theoretical congruence
with their real-world effectiveness.
