Can targeted policies reduce obesity and improve obesity‐related behaviours in socioeconomically disadvantaged populations? A systematic review

Abstract

This review synthesized evidence from controlled studies pertaining to the impact of targeted policies on anthropometric, dietary and physical activity outcomes amongst socioeconomically disadvantaged children and adults. Preferred Reporting Items for Systematic Reviews and Meta-Analyses-Equity guidelines were followed. Eligible studies were published from 2004 to August 2015 and examined the impact of targeted policies on anthropometric, dietary and physical activity outcomes amongst socioeconomically disadvantaged populations. Twenty articles (18 studies) were included. Eight studies examined organizational policies within multi-component interventions in schools. Common elements of successful policy-containing interventions included nutritional standards, enhancements to physical education, additional physical activity opportunities, school self-assessments, and nutrition and physical activity education. Of the 10 studies of government policies, policies providing information/education and fruit and vegetable subsidies had positive impacts amongst children, but no impact amongst adults. Policies involving changes to built environments yielded nearly uniformly null findings in children and adults. Overall, the largest quantity of high-quality evidence of effectiveness was for comprehensive interventions that included school policies, and government policies targeting disadvantaged children in schools. None of the government policies targeting disadvantaged adults proved effective. Interventions during childhood may ameliorate negative obesity-related manifestations of socioeconomic disadvantage. Gaps in knowledge remain surrounding effective policies in adults, adolescents and very young children.

Consideration of Social Disadvantages for Understanding and Preventing Obesity in Children

“…Specifically, the taxation of sugar-sweetened beverages in some high-income countries improved weight status across different SES groups ( 74 ). Besides strategies to improve the society-level environment, policies designed to promote changes in the school environment benefited children from disadvantaged backgrounds ( 75 ). For instance, policies aiming to improve school nutritional standards, provide opportunities for physical activity, as well as deliver nutritional and physical activity education improved the anthropometric measures, diet quality, and physical activity of children with socioeconomic disadvantages ( 66 ).…”

Reconceptualising precision public health

“…Precision public health is most closely aligned with the notion of targeting; however, the two are not synonymous, as in many cases, targeting problematises the broad behavioural and social risk factor profiles of individuals, rather than the structural forces responsible for situating them within disadvantaged social contexts. Although limited progress is evident in some cases,57 these programmes and policies have largely proven incapable, on their own, of substantially reducing health inequities,58–63 suggesting that new, complementary approaches may be needed.…”

Taxation on Ultra-processed Foods to Trim Obesity: Is it Plausible in Canada?

“…Because of this, consumers may engage in adverse substitution effects like other SSB/SF substances or jurisdictions (as happened in Denmark) that may be worse than the original commodities (Bødker et al, 2015). My rebuttal to this valid concern is that having government recognition (via subsidies and taxation) shows that the health of current and future populations is an important priority for policy makers (Olstad et al, 2017). Another way of looking at government intervention is that it is the government's responsibility to protect the public's health from harmful substances, most of which are produced by multi-national conglomerates (Moodie et al, 2013).…”