Healthy together Victoria and childhood obesity—a methodology for measuring changes in childhood obesity in response to a community-based, whole of system cluster randomized control trial

Abstract

BackgroundHealthy Together Victoria (HTV) - a complex ‘whole of system’ intervention, including an embedded cluster randomized control trial, to reduce chronic disease by addressing risk factors (physical inactivity, poor diet quality, smoking and harmful alcohol use) among children and adults in selected communities in Victoria, Australia (Healthy Together Communities).ObjectivesTo describe the methodology for: 1) assessing changes in the prevalence of measured childhood obesity and associated risks between primary and secondary school students in HTV communities, compared with comparison communities; and 2) assessing community-level system changes that influence childhood obesity in HTC and comparison communities.MethodsTwenty-four geographically bounded areas were randomized to either prevention or comparison (2012). A repeat cross-sectional study utilising opt-out consent will collect objectively measured height, weight, waist and self-reported behavioral data among primary [Grade 4 (aged 9-10y) and Grade 6 (aged 11-12y)] and secondary [Grade 8 (aged 13-14y) and Grade 10 (aged 15-16y)] school students (2014 to 2018). Relationships between measured childhood obesity and system causes, as defined in the Foresight obesity systems map, will be assessed using a range of routine and customised data.ConclusionThis research methodology describes the beginnings of a state-wide childhood obesity monitoring system that can evolve to regularly inform progress on reducing obesity, and situate these changes in the context of broader community-level system change.

Evaluation of complex community‐based childhood obesity prevention interventions

“…Figure describes the search results – 33 interventions were entered into the data corpus as meeting all inclusion criteria. Each intervention took place across multiple community settings and focused on systems change to promote healthy behaviours at the individual level applying a range of study designs . The interventions were participatory in nature, with a foundational component built on community engagement, empowerment and capacity building.…”

“…Quasi-experimental was the most commonly used design for outcome evaluation (N = 26) ( Table 1). The remaining obesity reviews seven studies were either cluster randomized controlled trial (RCT) protocols (15,18,41,65) or used an RCT design (47,51,57).…”

Whole of Systems Trial of Prevention Strategies for Childhood Obesity: WHO STOPS Childhood Obesity

“…Thirteen additional Victorian communities were selected in the 2014/2015 financial year as comparison (i.e., no intervention) sites [37]. Baseline data was collected in parallel to the baseline for this study from 2561 of 2959 eligible students in Victorian primary schools (response rate = 87%).…”

“…Secondary outcomes: change in children’s diet and physical activity (PA) behaviours, community systems, and settings environments for food and PA. The previously published detailed methodology of the sustainable monitoring system is briefly outlined below [17,37]. …”

Applying influence for systems change in a large-scale community-based prevention intervention

“…8,9 Healthy Together Victoria (HTV) was a large-scale Victorian State Government prevention initiative, which adopted systems thinking to reduce obesity and related preventable chronic disease from 2011 to 2016. The initiative used a complex, whole-ofsystem approach that required engaging community-level organisations via multifaceted and interconnected interventions 10,11 to improve physical inactivity, poor diet, smoking and harmful alcohol use. 12 Self in the system was a recommended means of systems change within HTV.…”