Systematic Review of Natural Experiments for Childhood Obesity Prevention and Control

Bramante, Carolyn T.; Thornton, Rachel L. J.; Bennett, Wendy L.; Zhang, Allen; Wilson, Renée F; Bass, Eric B.; Tseng, Eva

doi:10.1016/j.amepre.2018.08.023

Cited by 30 publications

(52 citation statements)

References 55 publications

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“…We hope that this analysis prompts policymakers and practitioners to re ect upon the role of the evidence base when designing new policies or approaches. In line with the conclusions of others, the collective ndings would advocate that future efforts (research, policy, and practice) target upstream determinants of the obesogenic system (16,33,48,49).…”

Section: Implications For Policy Practice and Researchsupporting

confidence: 71%

“…Signs of this are starting to emerge. Two reviews have synthesised childhood obesity prevention efforts which were evaluated through natural experimental designs, both of which include 33 studies (33,48). Karacabeyli et al (33) synthesised complex community-based interventions and concluded that interventions which target a wide range of determinants across multiple levels of the WDoH were more likely to be effective than single-sector / setting interventions.…”

Section: Summary Of Resultsmentioning

confidence: 99%

“…Karacabeyli et al (33) synthesised complex community-based interventions and concluded that interventions which target a wide range of determinants across multiple levels of the WDoH were more likely to be effective than single-sector / setting interventions. Other studies concur (48,49). But despite the two reviews focusing on non-RCT design studies, the evaluated interventions (which include policy changes) were typically downstream efforts implemented within schools (Karacabeyli et al (33) = 29/33 studies, and Bramante et al (48) = 24/33 studies).…”

Section: Summary Of Resultsmentioning

confidence: 99%

“…Although Cochrane Reviews are widely commended for their rigour, this meant that our sample focused on RCTs only which may have skewed our analysis towards studies targeting ILF (53). However, the work of Bramante et al (48) and Karacabeyli et al (33) -which included studies of natural experimental design -indicated that they too had a similar focus. Second, the Cochrane Review (16) synthesised studies which were published until June 2015, and since then, an additional 162 studies have been identi ed.…”

Section: Strengths and Limitationsmentioning

confidence: 99%

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A Secondary Analysis of the Childhood Obesity Prevention Literature through a Wider Determinants of Health Lens: Implications for Research Funders, Researchers, Policymakers and Practitioners

Nobles

Summerbell

Brown

et al. 2020

Preprint

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Background: Over the last 25 years, we have made great advances in our understanding of the complex adaptive systems which drive childhood obesity. Within this, the important role of upstream interventions which focus on the wider determinants of health (WDoH) has been acknowledged. Concurrently, the number of intervention studies aiming to prevent childhood obesity has increased exponentially. One might anticipate that our understanding of theory has been embedded into the development and implementation of interventions in real time. Methods: We tested this hypothesis by conducting secondary analysis of the interventions included in the Cochrane Review on “Interventions for Preventing Obesity in Children”, published since 1993. All 153 randomised controlled trials (RCTs) were independently coded by two authors against the WDoH model using an adaptive framework synthesis approach. We used aspects of the Action Mapping Tool from Public Health England to facilitate our coding and to visualise our findings in contrast to 226 perceived causes of obesity. Results: We found that the proportion of interventions which targeted downstream (e.g. individual and family behaviours) as opposed to upstream (e.g. infrastructure, environmental, policy) determinants has not changed over time (from 1993 to 2015), with most intervention efforts (57.9%) aiming to change individual lifestyle factors via education-based approaches. Almost half of the interventions (45%) targeted two or more levels of the WDoH. Where interventions targeted some of the wider determinants, this was often achieved via upskilling teachers to deliver educational content to children. No notable difference in design or implementation was observed between interventions targeting children of varying ages (0-5 years, 6-12 years, 13-18 years). Conclusions: This study highlights that interventions, evaluated via RCTs, have persisted to focus on downstream, individualistic determinants of obesity over the last 25 years, despite the step change in our understanding of its complex aetiology. We hope that the findings from our analysis will challenge research funders, researchers, policymakers and practitioners to reflect upon, and critique, the evidence-based paradigm in which we operate, and call for a shift in focus of new evidence which takes a WDoH lens.

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Section: Implications For Policy Practice and Researchsupporting

confidence: 71%

Section: Summary Of Resultsmentioning

confidence: 99%

Section: Summary Of Resultsmentioning

confidence: 99%

Section: Strengths and Limitationsmentioning

confidence: 99%

See 2 more Smart Citations

A Secondary Analysis of the Childhood Obesity Prevention Literature through a Wider Determinants of Health Lens: Implications for Research Funders, Researchers, Policymakers and Practitioners

Nobles

Summerbell

Brown

et al. 2020

Preprint

View full text Add to dashboard Cite

show abstract

“…State and local governments have enacted policies such as taxes on sugar‐sweetened beverages, regulations for the nutritional content of school meals, mandated physical activity time, and improvements in walking and bicycling infrastructure . Public health practitioners have developed a myriad of programs to target weight gain prevention in children through after‐school programs promoting physical activity as well as community campaigns to increase walking or healthy eating .…”

Section: Introductionmentioning

confidence: 99%

Methods and Risks of Bias in Natural Experiments in Obesity: Opportunities for the Future Informed by a Systematic Review

Knapp

Bennett

Wilson

et al. 2019

Obesity

Self Cite

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Objective This paper promotes rigorous methods and designs currently underutilized in obesity research, informed by a recent systematic review of the methods and risks of bias in studies of policies, programs, and built environment changes for obesity prevention and control. Methods To determine the current state of the field, relevant databases from 2000 to 2017 were searched to identify studies that fit the inclusion criteria. Study design, analytic approach, and other details of study methods were abstracted. These findings inform recommendations for obesity researchers and the field as a whole. Results Previously identified were 156 natural experiment studies. Most were cross‐sectional (35%), pre‐post single group comparison (31%), or difference‐in‐differences designs (29%). Few used rigorous causal designs such as interrupted time series with more than two time points, propensity score methods, or instrumental variables. The potential relevance for obesity research is discussed, and recommendations for obesity researchers are provided. Conclusions To strengthen natural experiment study designs and enhance the validity of results, researchers should carefully consider and control for confounding and selection of comparison groups and consider study designs that address these biases.

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The effectiveness of food system policies to improve nutrition, nutrition-related inequalities and environmental sustainability: a scoping review

et al. 2023

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A global transformation of food systems is needed, given their impact on the three interconnected pandemics of undernutrition, obesity and climate change. A scoping review was conducted to synthesise the effectiveness of food system policies/interventions to improve nutrition, nutrition inequalities and environmental sustainability, and to identify double- or triple-duty potentials (their effectiveness tackling simultaneously two or all of these outcomes). When available, their effects on nutritional vulnerabilities and women’s empowerment were described. The policies/interventions studied were derived from a compilation of international recommendations. The literature search was conducted according to the PRISMA extension for scoping reviews. A total of 196 reviews were included in the analysis. The triple-duty interventions identified were sustainable agriculture practices and school food programmes. Labelling, reformulation, in-store nudging interventions and fiscal measures showed double-duty potential across outcomes. Labelling also incentivises food reformulation by the industry. Some interventions (i.e., school food programmes, reformulation, fiscal measures) reduce socio-economic differences in diets, whereas labelling may be more effective among women and higher socio-economic groups. A trade-off identified was that healthy food provision interventions may increase food waste. Overall, multi-component interventions were found to be the most effective to improve nutrition and inequalities. Policies combining nutrition and environmental sustainability objectives are few and mainly of the information type (i.e., labelling). Little evidence is available on the policies/interventions’ effect on environmental sustainability and women’s empowerment. Current research fails to provide good-quality evidence on food systems policies/interventions, in particular in the food supply chains domain. Research to fill this knowledge gap is needed.

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Systematic Review of Natural Experiments for Childhood Obesity Prevention and Control

Cited by 30 publications

References 55 publications

A Secondary Analysis of the Childhood Obesity Prevention Literature through a Wider Determinants of Health Lens: Implications for Research Funders, Researchers, Policymakers and Practitioners

A Secondary Analysis of the Childhood Obesity Prevention Literature through a Wider Determinants of Health Lens: Implications for Research Funders, Researchers, Policymakers and Practitioners

Methods and Risks of Bias in Natural Experiments in Obesity: Opportunities for the Future Informed by a Systematic Review

The effectiveness of food system policies to improve nutrition, nutrition-related inequalities and environmental sustainability: a scoping review

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