Bridge Learning Campus visit to ENHS

Mark EdwardsRecently a group of Year 8 students from Bridge Learning Campus spent the day with staff in the centre for Exercise, Nutrition, and Health Sciences. Two of the girls (Amy Manning and Jess Martin) were winner and runner-up respectively of the Bristol Bright Night (Healthy Bodies, Healthy Minds) award. As part of their prize Mark Edwards (ENHS) and Chloe Anderson (Centre for Public Engagement) arranged for the girls to visit the health-focused Centre. Mark reflects here on the fun and insightful day that ENHS spent with the girls.

Five girls, accompanied by their Science teacher, Ms Williams, spent the day learning about the research we do and gave us some great insights into the barriers they face to being physically active. Almost all of our work into physical activity is assessed by accelerometers (which give a sophisticated measure of physical activity). Byron Tibbitts from ENHS offered a tour de force of the little red device we use to measure activity. In true Blue Peter fashion, the girls made a rudimentary accelerometer and then did their own mini controlled trial with the real things! The girls not only conducted the experiment with Byron, but then went on to analyse and interpret the data too.

Next up, Emma Solomon, Bex Newell and Rosina Cross (the B-Proac1v team) taught the girls all about blood pressure (a measure used in the BHF-funded study into young children’s physical activity). The girls confirmed our hypotheses that music and physical activity both affect blood pressure levels.

Finally, Kate Banfield built on the work we do in our FAB Kids outreach project to discuss sugar content in drinks. In an illuminating study, the girls were genuinely shocked to see the amount of sugar in drinks commonly consumed by people their age.diagram

After a great lunch in the Refectory we headed back to have a roundtable discussion on the barriers girls face to being physically active. The declining physical activity levels of female adolescents is a real public health concern (and the focus of the Acitve7 and PLAN-A studies), so this gave staff in ENHS a great opportunity to hear about the issues girls face. Mark Edwards and Sarah Harding led the discussion and were hugely impressed with the candid and insightful observations the girls made.

The final part of the day was always going to be the most nerve racking for the girls. But they excelled. Speaking to a room packed full of academics – scary for even a seasoned prof! – the girls gave a brief presentation on what they learnt throughout the day, with a wonderful practical example of how accelerometers work. The girls then spoke about the barriers they face to being active and presented some possible solutions for getting around them. The key messages we heard were that physical activities need to be FUN! There also needs to be the opportunity for girls-only activity, a chance to try new activities in a welcoming arena, and girls want to dress in whatever they feel comfortable. In making our research effective and getting it to truly speak to the people it is aimed at, it is vital we hear the voices of the girls.

It was a pleasure having the Bridge Learning Campus girls and Ms Williams come in – the girls did themselves, their teachers, and the school proud. We hope that they not only learnt some interesting things about physical activity but also had a good deal of fun too. None of the girls knew anybody who had been to university, and none of them had ever visited a university before. We hope to have inspired them to consider university as a viable option for them when they begin thinking about their future beyond secondary school.DSC_0290

Due to the success of the day, we hope to team up with the Centre for Public Engagement to make this an annual event.

From Bristol City to Mexico City: New challenges for obesity research

In this blog, Simon Sebire from the Centre for Exercise, Nutrition & Health Sciences and three PhD students reflect on new avenues of research into childhood physical activity and obesity in Low and Middle Income Countries and the opportunities and challenges this work presents.

New ideas emerge in the least likely places. As I listened to Professor Andy Gouldson present his research to the School for Policy Studies in spring 2014, I was inspired to sketch connections between some of Andy’s concepts (economic development and environmental issues) and my own (the psychology of motivating people to adopt healthy behaviours like being physically active). After the talk, I shared my scribbles with my colleague Prof. Russ Jago, only to find that he had an almost identical set.

Our thoughts had independently been transported from Bristol to Mexico and musings about the potential associations of urban development and rural-urban migration on the lifestyle behaviours of children and their families. This international perspective is not something either of us had previously pursued is but clearly had prompted some scribbling! The Mexico connection was inspired by three CONACyT-funded students, from Mexico, who at the time were studying our MSc in Nutrition, Physical Activity and Public Health and were considering PhDs.

Nearly 1 year on the three students (Ana Ortega Avila, Maria Hermosillo Gallardo and Nadia Rodriguez Ceron) are now PhD students in the School for Policy Studies Centre for Exercise, Nutrition and Health Sciences supervised by Prof. Russ Jago, Dr Angeliki Papadaki and I. They secured further funding from CONACyT to pursue their programme of research to study how various social, psychological and environmental factors might be related to physical activity and nutrition behaviours in children adolescents and their families in Mexico.

The causes of and response to increasing levels of obesity in low and middle income countries have been the focus of a recent Guardian Global Development Podcast. The podcast draws on the experiences of children, families, health practitioners and campaigners from South Africa and Mexico. In Mexico 73% of men, 69% of women and approximately 35% of adolescents are obese or overweight which is higher than in the USA. It is clear that there is much to be done to both treat those who are already overweight and prevent the development of obesity in young people. However, extrapolating our existing research and knowledge of what we think drives obesogenic behaviours in places like Bristol to the context of people’s lives in Mexico presents a number of challenges.

Ana, Maria and Nadia have a wealth of experience from previously working in Mexico as nutritionists or within the food industry, so I asked them to listen to the podcast and share their insider’s view of the challenges ahead:

Maria referred to the potentially damaging effects of families in Mexico aspiring to an American lifestyle dominated by unhealthy foods and sedentary behaviour:

The blog says that processed foods and junk food are one of the main causes of overweight and obesity increasing in Mexico, which is partially true, but I think it has to do a little bit more with what I call “junk behaviours”. For example, how mums from rural areas prefer to give their children processed foods instead of home-made meals because they heard somewhere that people from USA consumed them, and because Americans always choose right (at least that’s the belief in some parts of Mexico); junk food and processed foods are the way to go for feeding their children.

Ana suggested that this influence may be strongest in regions closest to America and highlighted the broader problems associated with researching an issue which is geographically diverse:

Mexico is among the largest countries in the world geographically and demographically (118 million people); where differences in dietary pattern exist between rural and urban areas or between north, central and south regions.I have always lived in the northwest and the influence of the U.S.A. is visible in a lot of aspects in our life compared to the centre or south of the country. Our dietary patterns are based on American food choices and less on the Mexican traditional diet.

Ana, Maria and Nadia all added that the potential mismatch between perceptions of wealth and health may be making being overweight an aspiration:

Ana: In my experience as a nutritionist there are a number of cultural misconceptions among population when it comes to healthy nutrition. For example, being a little overweight still means you are healthy and well-nourished whereas being thin means you are unhealthy or sick. People don’t see overweight as a problem, on the contrary, they see it as something normal.

Nadia suggested that such perceptions may prevent parents from identifying obesity as a potential health problem in their children:

I think the healthy body image is distorted as family, friends or in the streets, the most common thing is to see someone obese; and that is really concerning because how will they do something to improve their health if they don’t even think there’s a problem. 

Ana, Maria and Nadia reflected on the challenges of applying our physical activity and nutrition research findings which are largely based on evidence from developed countries such as the UK or USA to the context of middle income countries such as Mexico. A good example is parents’ perceptions of safety when letting their children play outside of the home. In UK research, including some in Bristol by my ENHS colleagues, we tend to focus attention on the presence of traffic or children’s risk of injury while unsupervised. In contrast, perceptions of safety in Mexico are measured nationally with questions including those related to the risk of kidnap, existence of violent gangs in the neighbourhood, armed robbery and frequency of firearms shootings. 73.3% of the participants in the 2014 National Survey on Victimization and Perception of Public Safety (ENVIPE) in Mexico reported not feeling safe in their local areas. In addition to the safety implications of conducting research in this context, it is clear that current measures of parents’ perceptions of their child’s safety to be active outside the home will not be sufficient and Nadia has plans to develop a new tool.

In addition, the political landscape challenges us to consider different ways in which our research may be best able to impact on health policy:

Ana: The political context in Mexico is complex, the government is dealing with high levels of insecurity and corruption, events that prevent the government from focusing on other matters such as the implementation of new health policies.

Maria believes that more is needed to be done to educate policy makers in addition to the public: There is a huge educational barrier, both governmental and individual, which makes difficult to take seriously the obesity and overweight problem.

Nadia: All those factors are completely different to high-income countries, and makes the context a complex matter to understand when almost all the research has developed in a completely different contexts with a wider range of opportunities to change or create policies that have a real impact in the population’s health. 

In summary, over the last year or so, I have been transported from Bristol city to Mexico City thanks to a fortuitous combination of research daydreaming and inspiring MSc (now PhD) students.  As a supervisor, my initial conversations with our new students has forced me out of my research comfort zone, an experience which has been echoed and reported by researchers in the International Physical Activity and the Environment Network in Latin America. Undoubtedly, our success in co-producing research which could have international impact will require us to work together to combine our collective knowledge to understand the context and key drivers of obesity-related behaviour change in Mexico.

Thanks to Ana Avila Ortega, Maria Hermosillo Gallardo and Nadia Rodriguez Ceron for their contributions.

  • Ana’s PhD focusses on the development of a social media intervention to reduce consumption of sugar-sweetened beverages in  Mexican older adolescents
  • Maria is studying the associations between urbanicity in Mexico and lifestyle behaviours and the influence of the rural urban transition on family health.
  • Nadia’s PhD focusses on the environmental and social correlates of physical activity in children in Mexico City.

Dr Simon Sebire is Lecturer in Physical Activity & Exercise Psychology in the Centre for Exercise, Nutrition & Health Sciences (ENHS) in the School for Policy Studies.The results of the 2014 Research Excellence Framework (REF) confirm the Centre’s international reputation for research excellence within the field of physical activity, nutrition and health. ENHS was rated 1st overall in the UK.


Nudge and the state


Professor Alex Marsh, Head of the School for Policy Studies

Last week I took part in an enjoyable discussion on nudge policy as part of Thinking Futures, the annual festival of social sciences. Through a slightly mysterious process I ended up speaking in favour of nudge-type policies, while Fiona Spotswood from UWE made the case against relying on behaviour change initiatives. Fiona made a robust case. I have to say mine was a little less than compelling, in part because in reality I have quite a lot of sympathy with the critics. I find debating from a position you don’t entirely agree with more successful on some days and some topics than on others. This was not one of the better days.

Nonetheless, I find the topic of nudge, and behaviour change policy more broadly, fascinating because it raises so many issues.

Thaler and Sunstein’s Nudge was published in 2008 and has subsequently generated a vast critical response. Such a response is not uncommon. But what is rarer is that it has got everyone worked up. There is barely a discipline across the social sciences and humanities that hasn’t had something to say on the matter. Thaler is an economist and Sunstein a lawyer, but the critical response has gone beyond those fields to include philosophers, sociologists, political scientists, geographers, management, marketing, public health and public policy scholars. We have also seen cognitive and behavioural scientists offering views on the issue.

The critical response has addressed nudge from a wide variety of angles. Much of literature addresses the ethics of nudge. Is it ethical for governments to seek to exploit known systematic biases in human cognition in order to assist individuals in meeting ends they would desire, if they had stopped to think about it? A whole host of questions follow: how are those ends identified and by whom? Does this constitute manipulation? Is it acceptable or unacceptable for governments to manipulate in the ‘public interest’? Is it coercion? Is this the thin end of a wedge that leads to authoritarianism or even fascism (which is part of the critical response primarily among more libertarian-inclined lawyers/economists in the US)?

Is a failure on the part of government to nudge simply allowing other (private sector) economic actors a free hand to nudge individuals in all directions, without any countervailing action to mitigate the worst effects of private nudges? Perhaps the simplest way to make that point is to consider the nudge argument that if you place healthy food more prominently near the checkout in a cafeteria, rather than the confectionary that is usually there, then it increases the likelihood that people will eat healthily. Critics object to government manipulating choices in this way. But the prior question is why is the confectionary there in the first place? It is, of course, because the manufacturers of sweets know that we are prone to temptation and impulse purchases while standing in line. They are manipulating a systematic bias in our decision-making.

Of course, the alternative response to this problem is to seek to do something about the way private actors manipulate choice in the first place, rather than surreptitiously nudging in the opposite direction. But that would require a braver government than any we have seen in recent years.

A second strand of the argument focuses on the evidence base underpinning policy proposals. How well attested are these behavioural effects? One simple criticism of the literature is that much of the original experimental data comes from studies of the decision making practices of US undergraduates. To what extent do these conclusions generalise? Behavioural economics tends to assume that generalisation is unproblematic, but that is hardly a sound starting point for policy. Under the UK Coalition government the policy debate about behaviour change has been one area where considerable prominence has been placed on the role of evidence and on policy pilots. But it is an area in which one type of evidence – that drawn from randomised controlled trials – is seen as pretty much the start and finish of the conversation.

A third strand of argument is about the efficacy of nudge. Even if we accept that there is robust evidence of systematic biases in cognition (such as the tendency to weight current consumption more heavily than future costs when making decisions) what can be done with this information? Most importantly, is it a substitute or complement to other forms of government action? Can nudge be used instead of more paternalistic regulation, for example? This is a point that governments have been rather vague on. Nudge, when it arrived on the scene, was viewed as being able to stand in for more interventionist approaches. But this position has subsequently been modified in the face of criticism. It may be possible to improve social outcomes in modest ways using nudge techniques, but it is hopelessly underpowered for addressing some of the major challenges facing society.

Finally, there is the fact that “nudge” is rather elusive. By that I mean that it doesn’t refer to a very clearly defined set of actions. Or rather it has been applied to a wide range of actions and interventions that don’t really accord very well with the original definition of a nudge offered by Thaler and Sunstein – a definition which has, itself, been heavily criticised. The Government’s Behavioural Insights Team was colloquially referred to as the “nudge unit” but it drew much more broadly on insights from social psychology and behavioural science than simply focusing on nudges of the Thaler and Sunstein variety. There are now quite a number of other approaches to behaviour change circulating. Some of them have similarly catchy labels (think, steer, budge, shove). Some of them start from very different premises to nudge itself. Some have had an impact on policy in particular fields – with much of the running being made by the debate in public health. Some of them have yet to make much of an impact on policymaking in practice. The academic discussion is a riot of theoretical innovation, with various frameworks and heuristics being proposed. Some are engaged in the hard graft of evaluation and synthesis, with the aim of being clearer regarding what works, when and how.

An outstanding question is whether as the accounts of behaviour change become more complex and nuanced they start to lose their purchase on policy – which typically wants simple messages leading to clear prescriptions. But that is simply another case of the perennial tension between research and policy.

This post was originally published on Alex’s Archives.

Progress on the FAB kids outreach project

FAB1Mark Edwards, Active7 Trial Manager in the School for Policy Studies, reflects on the first term of delivering the FAB Kids outreach workshop in schools. Mark previously blogged on this project here

It’s been a busy term. Aside from their full-time jobs, Exercise, Nutrition and Health Sciences (ENHS) staff and students have worked hard to get the FAB (Food, Activity, and Bodies) Kids project up and running in schools. Taking the workshop from drawing board to school hall has been an arduous task, but seeing the children (and teachers) learn from and enjoy the workshop activities makes the efforts worthwhile. It has been a rewarding process for FAB staff; going into schools and being in dialogue with small groups of children, learning from them and hearing their stories (sometimes fascinating, other times bizarre), and quickly(!) getting to grips with controlling groups of over-excited children.

Between May and early July, 13 staff and student volunteers have delivered the FAB workshop to 355 children. Workshops have been delivered in 8 mainstream primaries, one Special Educational Needs school, and one fee paying school. We’ve also taken FAB to the Big Bang (Cirencester) and Bridgwater Science Festivals.

What has been the impact?


So what have the children learnt? At the end of each workshop we ask them just this question. As you’d expect (or hope) from a health-focused workshop, lots of children came away with the message that they should ‘always keep healthy and fit and drink what’s right for you’.  Many took away messages they can use in their day-to-day lives, such as ‘some drinks that appear to be healthy have a lot of added sugar’ and the ‘more you exercise the less likely you are going to have heart problems’. Others memorised interesting snippets  such as ‘Diet Coke contains an ingredient that is in fireworks’, ‘there are over 600 muscles in your body’ and ‘the average heart rate for children is 70-100 beats per minute’. One child was simply speechless (or ironic beyond his years); ‘Absolutely epic! I can’t get any of it out of my head because I learnt so much!’ Whilst most were more conservative in their comments, we hope and think that all children have taken something – however little – from the workshop that may help them to improve their lifestyle.

What did the teachers think?

School staff provide more formal evaluation of the workshop. The three individual workshop activities and the workshop overall (separate questions) were rated ‘very good’ by all teachers. It was interesting to see how teachers engaged with the workshop, with some using it as a way to develop their own knowledge, and experimenting with props and asking questions as if they themselves were participants. The qualitative feedback they provided is testament to the enthusiasm of the staff delivering the workshop. Comments from teachers include:

‘A perfect morning’s learning where the children enjoyed themselves! They loved learning the new facts. All brilliant, staff energetic and formed great relationships with children.’

‘All interactivity was brilliant! Children really enjoy learning in a different way with various approaches.’

‘All the activities were interactive, stimulating and fun for the children. They were enthusiastic and engaged throughout and certainly enjoyed what they were doing.’


‘Really loved the jigsaw/children very engaged. Children liked the booklets and enjoyed all the activities.’

‘All members of the team had a lovely manner with children and quickly established a positive rapport. Not always easy! The resources were all well organised, interesting and engaging.’

Where next?

Although we are delighted with this term’s progress, we are not complacent and have identified several areas for improvement (which will be made over the summer). In September, MSc students will be invited to assist with the delivery of the workshop. As such, we will be designing training sessions and delivery manuals over the next few months. The plan is to allow trained MSc students to deliver the workshop, giving some supervisory roles, and gradually reducing the hands-on involvement of ENHS staff. In September we will begin to book in more schools to receive the workshop.


If you would like any further information on the FAB Kids workshop please visit or email

FAB team members: Bethan Baker Williams, Rachael Pound (MSc student), Mark Edwards, Laura Pool, Kate Banfield, Byron Tibbitts, Jo Kesten and Sarah Harding.

ENHS is a research centre in the School for Policy Studies. Staff work on a variety of projects focusing on physical activity and nutrition, and their associations with health across the life course. Much research in ENHS is conducted with children in local schools.

Food security and food poverty as seen from Bristol


Richard Sheldon, Lecturer in Social and Economic History, reports on an event on food access and security held at the University of Bristol

The Trussell Trust charity has recently announced that it has seen demand for support from its food banks triple over the past year. Similar reports have recently been published by Bristol based food charities.  Last week the Archbishop of Canterbury equated the suffering of those who use food banks with that in Syria and the Ukraine, and an All-Party Parliamentary group has been launched to investigate the growing problem of hunger and food poverty in Britain.  All this lent a real interest, even urgency, to the proceedings of the recent Cabot Institute day seminar on the security of household food access in Bristol and beyond, organised by Patricia Lucas from the School for Policy Studies at the University of Bristol. How did we come to face such a predicament seventy years on from the Beveridge Report and the founding of the Welfare State? Should these circumstances even arise in what is the world’s sixth largest economy? What can scholars do to improve public debate on these issues?

The seminar attracted a wide range of participants ranging from academics to activists and scientists working on sustainable livestock. All were united by a concern with the problem of food security from the local to the global. Patricia Lucas introduced the day and the session on food welfare and food poverty. Eldin Fahmy reported some of the findings of the Poverty and Social Exclusion project, painting a gloomy picture about the impact of the long recession and state-imposed austerity measures on deprivation and social exclusion. Liz Dowler, University of Warwick and Hannah Lambie-Mumford, University of Sheffield came to the meeting hot off the train from presenting evidence to the Parliamentary Inquiry into Hunger and Food Poverty in Britain to speak on food poverty and food charity. Kevin Morgan delivered a keynote lecture on securing a healthy diet: the personal, the political and the planning challenges

I attended the seminar as a social and economic historian hoping to learn from the sessions, but also to speak and attempt to underline the ways in which Bristol is a very useful place to stand in in order to understand the evolution of the production, distribution and consumption of modern foodstuffs. The origin of so many pressing global problems such as rapid population growth and global warming all stem from the period of the Industrial Revolution. Bristol was an early importer of foodstuffs from Europe and beyond beginning in the middle ages. The city and port also played an important role in importing and processing the modern luxuries of sugar and tobacco which helped ease the transition from an agrarian to an urban and industrial society. There were lots of sometimes surprising overlaps in all of our concerns and sometimes our concepts. The notion of food sovereignty was widely endorsed alongside the need to make food a central rather than an incidental part of health and education policy. In particular Kevin Morgan addressed ‘the public plate’ and closed by using the concept of a ‘moral economy’.

Michael Lee from Bristol’s School for Veterinary Sciences spoke about the development of ’the robust cow’  – an improved breed of cattle that would graze upon grass rather than be fed on grains. Xiajun Wang from the School of Economics, Finance and Management spoke about the management of the global food chain.

The day closed with participation from public office holders, activists and campaigners in Bristol. Gus Hoyt, Angela Raffle and Mark Goodway all discussed new initiatives in the city including the ‘Good Food Plan’ for Bristol and an initiative by the Matthew Tree charity to form a new supermarket run on ethical and sustainable lines in Knowle West, a Bristol suburb currently ill-served the large chains.

Much of the evidence presented, challenges posed, and conclusions drawn made for sombre reflection, but above all I was hugely lifted by the presence of so many articulate and informed voices all seeking to make a difference on stages from the local to the global. I hope we will be able to build on this beginning and take the project further through networking and future collaborations. The seminar lunch menu, comprising locally-sourced delicious produce, also made a pleasant change from the usual conference fare. There was such an exciting buzz around the proceedings that I am sure new initiatives will be forged and research partnerships launched.