Childhood obesity prevention studies: lessons learned and to be learned

Abstract

Objective: To provide an overview of methodological issues in the design, delivery and evaluation of childhood obesity prevention programmes. Design: Review of existing literature. Setting: International. Results: Interventions have varied considerably with regard to their design, subject selection criteria, sample size, attrition rates, intervention components and duration of both the intervention and the follow-up phases. However, overall, there is only a limited body of consistent, high-quality evidence on which valid and generalisable conclusions can be drawn about best practices for the prevention of childhood obesity. Conclusions: Although the rationale for targeting children and adolescents through primary prevention is now compelling, effective obesity prevention remains elusive. There is increasing consensus that prevention of childhood obesity necessitates multifaceted health promotion interventions based on population health principles. By definition, such interventions should have a range of outcome indicators of effectiveness, generalisability and sustainability, not just the traditional ones focused on individual lifestyle behaviour change. Given the complexity and intricacy of population-based intervention programmes, multiple methods of data collection which combine both qualitative and quantitative approaches will need to be fully exploited in order to move towards evidence-based practice in the future.

Childhood obesity: Current and novel approaches

“…Complex problems need complex solutions. The reasons for obesity are multidimensional and consequently, efforts to prevent or treat obesity need multifaceted strategies focussing on different levels of influence (individual, familial, institutional, and environmental) [37,38]. 2.…”

Strengthening the rigour of population-wide, community-based obesity prevention evaluations

“…Such analytical techniques account for intra-class correlation and allow for individual-and community-level influences to be examined simultaneously. Encouragingly, trials included in the present review employed such techniques and avoided unit of analysis errors previously documented in the obesity literature (4) . Methodological reviews of previous community-based chronic disease prevention interventions have attributed modest intervention impacts, in part, to high rates of population migration into and out of intervention and comparison communities, or to inconsistent intervention exposure, diluting the intervention effect (13,32) .…”

“…While evidence regarding the effectiveness of obesity prevention initiatives is equivocal (4) , there have been calls from international organisations (5) , professional associations (6) , academic experts (7,8) and the community (9) for governments to take decisive action to mitigate the adverse impacts of obesity. Indeed, across the globe, governments have developed policy, set obesity prevalence targets (10) and are implementing obesity prevention initiatives (11) .…”

Obesogenic environments: environmental approaches to obesity prevention

“…Taking into account that obesity is "the result of people responding normally to the obesogenic environments they find themselves in" (39, p. 804), preventing or treating obesity requires multidimensional strategies focusing on individual, familial, institutional, and environmental levels of influence (40,41).…”