Children’s diets are in decline across many high-income countries [1]. In England, this decline is evidenced by high levels of overweight and obesity, rising tooth decay and decreasing height, especially among children living in the most socioeconomic disadvantaged circumstances. Despite local councils having implemented local food interventions to improve children’s diets, the benefits are not felt equally, with poor diet, obesity and tooth decay persisting among poorer children [2]. This mixed-methods project adopted a novel approach to intervention evaluation by assessing how the contexts within which children live impacts the effectiveness of local food interventions delivered by local councils. Survey and ethnographic data were collected from a population sample of families living in London to understand the realities of families’ lives and their awareness and experiences of local food interventions. An umbrella review of studies evaluating the process of implementing local food interventions targeting children was also completed alongside interviews with local council policymakers to explore their experiences of implementing interventions.
Cross-sectional survey data (n=728) and in-depth ethnographic data (n=23) from families with children aged 4-11 years across the socioeconomic spectrum revealed that inequalities in diet among children is the result of circumstances and not parental choices. All parents want their children to eat plenty of good foods and be healthy. Many parents repeatedly offer fruit, vegetables and whole grains to their children, but the high cost of nutritious food puts it out of reach for poorer families. All families face challenges, but living with daily uncertainty about housing, work, and money impacts poorer parents’ ability to cook healthy meals. All parents show love by giving children the foods they enjoy. For poorer parents, long working hours and limited social support makes them reliant on cheap, unhealthy foods their children prefer. Poorer neighbourhoods have limited healthy food options and higher advertising and availability of unhealthy foods than wealthy neighbourhoods. Children’s food preferences and diets are shaped by their daily exposure to these settings. Study data were synthesised into a short accessible animation and policy brief. Recommendations for local councils to optimise future local food intervention effectiveness among poorer children include: i) prioritising interventions which provide financial support or healthy foods to families in need and personalising communications from trusted sources to increase uptake, ii) implementing interventions that limit the marketing and availability of unhealthy foods in schools, childcare settings and high streets using contractual and regulatory mechanisms and iii) co-creating behavioural interventions to ensure they match the needs and contexts of poorer families. By developing public advisory groups and establishing long-term funding streams local councils will be able to better support effective and sustained implementation of equitable local food interventions.