Our research in the Centre for the Economics of Obesity

Blue Space

Lead researcher: Mrs Nafsika Afentou

Natural environments are considered important assets for population health and wellbeing. Living near and regularly visiting green and blue spaces in urban settings, such as parks and canals, offers opportunities for physical activity, active transport through walking and cycling, while providing broader societal benefits. Interventions to improve green and blue spaces in urban settings are complex, requiring substantial investment and often involving multiple stakeholders with varied objectives. The aim of this project was to develop a systematic approach for prioritising investment across blue space programmes aimed at improving physical activity, and wider health and wellbeing.

Working closely with stakeholders, we developed a blue space investment prioritisation tool using an adapted multi-criteria decision analysis (MCDA) framework. The BSIP tool provides an explicit approach to prioritising blue space programmes aimed at promoting physical activity, and broader health and wellbeing for funding, based on assessment of their performance against various criteria. Development of the approach and BSIP tool involved three key stages; criteria development, criteria weighting, and performance scoring. The approach was applied to budget allocation decisions within a capital canal investment programme led by the Canal & River Trust. The criteria development stage was informed by public experiences with using local canals for physical activity, expert input on blue space policy implementation and outcome measurement, as well as continuous feedback from the programme’s steering committee.

This project provided a concise and actionable stakeholder-informed approach to blue space investment prioritisation by combining various criteria into one overall decision framework. The approach offers a solution for prioritising projects that promote physical activity and broader health and wellbeing, while enabling more efficient and equitable allocation of resources. In addition, the BSIP tool can serve as a model for enhancing the transparency and accountability in investment prioritisation decisions within other areas with similar policy objectives, such as green space.

Green Space

Lead researcher: Ms Humera Sultan

COVID-19 has highlighted the importance of green spaces for population physical activity, health and wellbeing. Despite increasing evidence for the relationship between green space and wellbeing, there is insufficient economic evidence to justify investment in these spaces as part of a population-wide prevention programme to help boost physical activity, promote quality of life and wellbeing, and save long term health and social care costs. Given the multi-sectoral nature of how green spaces are developed and maintained, tracking the flow of resources and resulting impact from investments is complex. This workstream forms part of a NIHR pre-doctoral fellowship awarded to Ms Humera Sultan with the aim of developing a competitive PhD fellowship application to work with all stakeholders within green space to justify investment. This is an area of priority for local authorities to ‘build back better’ and crucially ‘build back fairer’ following the COVID-19 pandemic. This work will consider cost-effectiveness, equity, and affordability of investments within the green space context.

At the Centre for Economics of Obesity, we provide valuable economic insights into how food policy can encourage healthier choices. With growing awareness of the harmful effects of unhealthy diets, particularly in low-income communities, a variety of interventions have been implemented across retail, education, and workplace environments. Our research uses diverse economic methods to assess the impact of these interventions, helping shape policies that address the root causes of poor dietary habits.

Below are some examples of research in this workstream:

Macro-level interventions

Dr Bisola Osifowora is leading on a Cost-Benefit Analysis exploring different policy options for expanding access to primary school meals. Here, the CEO is estimating the return on investment from providing school meals to children, and tracking impact on healthy growth and improved academic performance. The CBA also enables an assessment of long-term benefits such as improved health outcomes, enhanced productivity, economic benefits, and social equity.

University/HEI Food Policy

Universities represent a unique setting as they include diverse populations in terms of age, ethnicity, and cultural backgrounds. With being both a place of education and a workplace, universities act as ‘anchor institutions’ within a food system with responsibility for providing a healthy environment for their staff and students.

One of the projects within this workstream is exploring the preferences of university staff and students for on-campus lunch in 6 universities in the UK and Europe. This project is funded through the EUniWell Research Incubator Scheme and is a collaboration of 6 universities, including the University of Birmingham (UK), the University of Florence (Italy), Linnaeus University, University of Murcia (Spain), Nantes University (France), and Semmelweis University (Hungary), led by Dr Irina Pokhilenko (University of Birmingham).

Retail Interventions

Eating a healthy, balanced diet is an important part of maintaining good health. Eating patterns have changed over time and the trend of using meal kits or recipe boxes is growing. This is supported by the appeal of healthier, time-saving options, especially amount busy families. As part of the Mandala consortium, Dr Lin Fu from the CEO is helping to evaluate the impact of providing discounts on commercial recipe boxes by measuring the healthiness of meals consumed, the environmental impact, and consumer satisfaction levels. The results will help understand the role of recipe boxes as part of a system wide food strategy.

Also, as part of Mandala, Lin is involved in measuring the impact of replacing meat with plant-based menu options within Birmingham Children’s Hospital. Within this project, Lin is leading the economic analysis tracking any changes to cost and outcomes, as a result of these menu changes.

Dr Hamideh Mohtashami Borzadaran is using various experimental methods to understand the impact of different interventions on consumers healthy food purchasing behaviour. In Hamideh’s most recent project, she designed an online experiment where different forms of accessibility to nutritional labels were tested to understand which can lead to a healthier purchased basket with higher levels of satisfaction for the consumer.

Hamideh is also collaborating with the SALIENT team to understand the impact of eco-labels on consumers' purchasing behaviour and sustainability. In a previous project, Hamideh partnered with a major supermarket to assess what happened when the value of the Healthy Start Vouchers was increased across the supermarket stores. Using a natural experiment design, the project measured how this value-increase affected voucher users' spending patterns.

Community Sector Interventions

Dr Bisola Osifowora is working within the SALIENT project. Within this consortium project, Bisola is leading the economic analysis of the following interventions:

Community Shop: Decreasing the absolute and relative availability of target discretionary product categories in a UK surplus food social supermarket.

This intervention focuses on decreasing the availability of discretionary product categories in a UK surplus food social supermarket. By reducing the presence of less healthy food options, the Community Shop promotes healthier choices among its patrons, contributing to better dietary behaviours in the community.

Your Local Pantry: Assessing the impact of access to membership in a community food shop.

This intervention assesses the impact of providing membership access to community food shops. These pantries offer affordable, nutritious food to members, aiming to alleviate food insecurity and improve dietary habits. Also fostering a sense of community and support, enhancing the overall well-being of participants.

Sufra: Comparing payment cards and food parcels to evaluate their effects on food insecurity, mental health, and well-being.

This project compares the effects of payment cards versus food parcels on food insecurity, mental health, and well-being. By evaluating these different approaches, Sufra aims to identify the most effective methods for supporting vulnerable populations and improving their quality of life.

Understanding Determinants of Demand

Ms Bethany Parkes is a PhD student within the CEO and is working to understand the cost of healthy versus unhealthy diets.  Beth is funded by a NIHR School of Public Health Research PhD studentship and is registered at University of Exeter and supervised by Professor Richard Smith, Professor Antonieta Medina-Lara (University of Exeter) and Dr Laura Cornelsen (London School of Hygiene and Tropical Medicine) and Prof Emma Frew at the CEO.  Price is conventionally seen as a key barrier to healthy eating, particularly among lower socioeconomic groups, and healthier diets have been suggested to be more expensive than unhealthy dietary patterns.  Beth’s PhD has three main projects: 1. A review of drivers of food choice to understand where there may be similarities and differences for healthy vs unhealthy foods; 2. An exploration of the hidden costs of meals (e.g., costs associated with time, travelling to a shop or using an oven) and how these influence the overall expense of different at-home meal types and 3. An investigation of consumer preferences and trade-offs with regards to these hidden costs to understand their relative importance. This will help to support the design and implementation of policy to support healthier eating

Lead: Luiz Flavio Andrade

There has been strong evidence suggesting that obesity levels are increasing in the industrialised countries, and one of the factors associated with it is the lack of consistent physical activity. We live in motorised cities and car dependency is strongly associated with sedentary behaviours.

Public health and local authorities are encouraging people to leave the car at home and prioritise journeys by physically active means, such as walking and cycling, which can act as generators of substantial health and economic benefits.

In this active travel workstream, we are collaborating with local authorities to evaluate the impact of interventions such as new cycleways and exploring the cost-effectiveness of different ways to encourage people to actively travel. 

Lead: Nafsika Afentou

Obesity treatment encompasses a range of surgical, pharmacological and lifestyle interventions designed to help individuals achieve and maintain a healthier weight. Each intervention requires substantial financial investment to realise health benefits, and estimating their cost-effectiveness is crucial for efficient resource allocation. Our work focuses on undertaking model-based cost-effectiveness analyses to compare the costs of obesity treatments with outcomes such as weight loss, improved quality of life, and reduced risk of obesity-related diseases, providing insights into the potential value of these treatments from a healthcare system perspective.

Lead researcher: Dr Lin Fu

The Mandala Consortium is focusing on transforming urban food systems for planetary and population health. Centred on the city of Birmingham and the regional economy of the West Midlands, Mandala hopes to demonstrate how food can be made healthier, more affordable and less harmful to the environment but still profitable.

Getting food from where it’s grown to people’s plates is complex, involving many companies, sectors and processes. We call this the ‘food system’. However, the food we eat is creating huge challenges for our health, environment, and climate. One in four children in Year 6 in our city are living with obesity, more people than ever are struggling to afford enough, good food and issues like food waste, pollution from agriculture and plastic packaging are causing serious harm to the planet and the systems that support life on Earth. Making this food system work better is a difficult and urgent challenge that will take a lot of thought and coordination to solve.

Working closely with Birmingham City Council, the Mandala programme aims to help find and co-ordinate a number of solutions to these pressing problems. Through our work, we want to (1) map and better understand all aspects of the city’s food system; (2) find the most powerful ways to help people eat a healthier, more environmentally friendly and affordable diet, whilst supporting, sustaining and celebrating the amazing food businesses they have on their doorsteps; (3) collect evidence on how feasible certain ideas and solutions to improve our food system are; (4) develop, co-ordinate and prioritise the most important ways to make positive changes happen; (5) and evaluate the impact that these solutions have had.

European Health Economics Association Conference, Vienna

In July, the team attended the European Health Economics Association (EuHEA) conference in Vienna, Austria.  This was an excellent conference and it was fantastic to see so many of the team present their own research projects and for our work to generate so much interest from our health economics colleagues.  We got to enjoy the conference and participate in sight-seeing activities – highlight being a visit to the historic town hall in the City for an evening of traditional Austrian entertainment.

What's for Lunch?

On July 11-12, 2024, the University of Birmingham's campus hosted an engaging and productive meeting as part of the EUniWell Alliance funded project, ‘What’s for Lunch? Eliciting Preferences for Food on University Campus’. The CEO team warmly welcomed international delegates from partner universities: the University of Florence (Italy), University of Nantes (France), Semmelweis University (Hungary), University of Murcia (Spain), and Linnaeus University (Sweden).

The visit began with a team meeting—our first chance to meet in person after a year of remote collaboration. The excitement of finally connecting face-to-face added energy to the discussions and reinforced our collective commitment to the project.

In the afternoon, we hosted an open hybrid event where each partner showcased their university’s best practices in offering food that aligns with the principles of health, well-being, and sustainability. This exchange of ideas not only highlighted innovative approaches but also deepened our shared understanding of how food provision can enhance student and staff experiences across campuses.

Outside of work, we took the opportunity for team-building activities, which included a delightful dinner, an authentic English high tea, and a visit to the Barber Institute of Fine Arts. The campus tour, which coincided with the vibrant graduation season, provided a unique glimpse into the university's atmosphere.

This memorable visit strengthened our bond, and we look forward to continuing our collaboration with renewed energy and focus, working together as a stronger and more unified team.

Strategy Day 2023

On 18 October 2023, the team held a strategy day at The Studio, Birmingham. Amazing productive day with lots of ideas for future research direction of the Centre and team building activities.

Public Advisory Group Meeting, April 2023.

The team met with our public advisory group in April to share learnings about our research on green space funding, online food shopping, social care modelling, and mental health resource use for people living with obesity.

European Health Economics Association (EuHEA) Conference, University of Oslo, July 2022.

The CEO team presented an organised session at the EuHEA conference in July 2022. The session offered a comprehensive review of the methodological research being conducted across several workstreams that are designed to address different but related determinants of obesity. Throughout, attention was drawn to the evidence needs of the decision makers. Overall the session offered an exciting interactive opportunity to discuss the economics of obesity on the wide-ranging methodological issues that are linked to undertaking research in this area.