A Framework for Evaluating the Impact of Obesity Prevention Strategies on Socioeconomic Inequalities in Weight

Abstract

We developed a theoretical framework to organize obesity prevention interventions by their likely impact on the socioeconomic gradient of weight. The degree to which an intervention involves individual agency versus structural change influences socioeconomic inequalities in weight. Agentic interventions, such as standalone social marketing, increase socioeconomic inequalities. Structural interventions, such as food procurement policies and restrictions on unhealthy foods in schools, show equal or greater benefit for lower socioeconomic groups. Many obesity prevention interventions belong to the agento-structural types of interventions, and account for the environment in which health behaviors occur, but they require a level of individual agency for behavioral change, including workplace design to encourage exercise and fiscal regulation of unhealthy foods or beverages. Obesity prevention interventions differ in their effectiveness across socioeconomic groups. Limiting further increases in socioeconomic inequalities in obesity requires implementation of structural interventions. Further empirical evaluation, especially of agento-structural type interventions, remains crucial.

Socioeconomic differences in overweight and weight-related behaviors across adolescence and young adulthood: 10-year longitudinal findings from Project EAT

“…3,42 For these reasons, current obesity prevention efforts focusing on the individual may be contributing to socioeconomic inequalities in weight and structural interventions that target the environment in which behaviors occur are critically needed to reduce socioeconomic inequalities in obesity. 43 Lessons can learned from tobacco control efforts that demonstrated structural interventions, such as taxation and public policy, were most effective at reducing socioeconomic inequalities in smoking. 44 …”

A research framework for the development and implementation of interventions preventing work-related musculoskeletal disorders

“…Backholer et al 2014 (64) Framework for the likely impact of obesity prevention strategies (which could also be applied to MSD prevention). According to the model, the degree of impact required to influence behavior change is influenced by agentic (the problem is perceived as a personal one), agento-structural (the problem is considered to be caused by the environment in which unhealthy behaviour takes place, but also of individual behaviour is important), and structural factors (individuals behave within the constraints of the persuasive environment, and behaviour is not viewed as free will).…”

“…As such, multi-factorial interventions (not only focusing on the physical risk factor) may be proven to be effective in future research. Moreover, a profound understanding of how to effectively change people's behavior within the context of work (in addition to understanding how to change and/or capitalize on organizational attitudes and procedures) is required when designing a workplace intervention (63,64).…”

“…Both stakeholder groups mentioned several other barriers impeding the ability to actually use the ergonomic measures in practice, such as the extra work regarding maintenance and logistics. The supportiveness of the work environment (considering the compatibility with an effective production) should therefore be taken into consideration (64).…”

Childhood Obesity and Quality of Meals: The Saudi School Meal and Home Meal Study SSMHMS – A Cross Sectional Study

“…In our study 6.7% only was seen underweight, which may also play major roles in health and growth of the child. Students who attended the school involved in this pilot study is from a high socioeconomic background, where overweight and obesity is more relevant than underweight status [46]. With regards to the whole family, the role of the fathers and siblings are usually neglected, where more pressure is carried on mothers.…”