title: 'McDonalds and KFC, it's never going to happen': the challenges of working with food outlets to tackle the obesogenic environment.
abstract: BACKGROUND
  Food outlets may make an important contribution to an obesogenic environment. This study investigated barriers and facilitators to public health work with food outlets in disadvantaged areas.
  
  
  METHODS
  In-depth qualitative interviews with 36 directors, managers and public health service delivery staff in a coterminous primary care trust and local authority in northwest England. Data were analysed using the constant comparative method.
  
  
  RESULTS
  Three interventions were available to engage with businesses; awards for premises that welcomed breastfeeding mothers or offered healthy menu options and local authority planning powers. Sensitivity to the potential conflict between activities that generate profit and those that promote health, led to compromises, such as awards for cafés that offer only one healthy option on an otherwise unhealthy menu. An absence of existing relationships with businesses and limited time were powerful disincentives to action, leading to greater engagement with public rather than private sector organizations. Hiring staff with commercial experience and incentives for businesses were identified as useful strategies, but seldom used.
  
  
  CONCLUSIONS
  Encouraging food outlets to contribute to tackling the obesogenic environment is a major challenge for local public health teams that requires supportive national policies. Commitment to engage with the local public health service should be part of any national voluntary agreements with industry.
authors.affiliation: Department of Public Health and Policy, University of Liverpool, UK. barbara.hanratty@york.ac.uk
authors.forename: Barbara
authors.initials: B
authors.lastname: Hanratty
authors.forename: Beth
authors.initials: B
authors.lastname: Milton
authors.forename: Matthew
authors.initials: M
authors.lastname: Ashton
authors.forename: Margaret
authors.initials: M
authors.lastname: Whitehead
mesh_terms: D001363:Awards and Prizes; D004739:England; D004779:Environment Design; D057140:Fast Foods / Q000009:adverse effects* / Q000592:standards; D006801:Humans; D007373:Interinstitutional Relations; D009042:Motivation; D009765:Obesity / Q000209:etiology / Q000517:prevention & control*; D011204:Poverty Areas; D015980:Public Health Practice; D055818:Public-Private Sector Partnerships; D036301:Qualitative Research; D012147:Restaurants / Q000592:standards*; D012931:Social Environment