Becoming embedded: A process evaluation of weight management services developed with, not for, communities

There is growing interest in whole systems-based approaches to obesity, yet little understanding about how these can be achieved or about the tensions inherent in navigating the social, emotional, and behavioural issues within behaviour change interventions. We were commissioned to evaluate a programme of place-based, whole-systems approaches to tackling obesity and health inequalities for adults, children and families in areas with higher-than-average obesity rates and socioeconomic deprivation. Underpinned by an embedded ethnography approach, this process evaluation explored how best to engage diverse communities in service delivery and development using evidence-informed approaches, and whether services can be co-produced with communities and people with lived experience. Our approach combined: focus groups and interviews with staff, service users, commissioners and other external partners (n=64); participant observation; membership of a Strategic Oversight Group; and qualitative research training for staff. This unique project demonstrates factors important for shaping a whole systems approach, including the value and challenges of community engagement, and the limitations caused by how services are commissioned. Consideration is needed regarding how systems and structures can facilitate or create barriers to ‘embedded’ research and the implementation of whole systems approaches, involvement and co-production, and take account of wider determinants of health and inequalities.