Preventing Childhood Obesity - Evidence Policy and Practice.pdf

Chapter 18
countries precludes the development of well - informed
prevention strategies. As a result, most of the initiatives
undertaken to date have been implemented
without confirmation that they are the most effective
or appropriate ones to serve the needs of the populations
targeted. Children are influenced by their immediate
environment and those individuals who are
closest to them. The school, household, community
and health care settings are among the most popular
sites for conducting all types of child - centered interventions
and obesity preventions strategies are not the
exception. Evaluating the impact of interventions in
all of these settings in developing countries is unquestionably
needed. However, the basis for identifying
effective long - term strategies is to fully comprehend
the nature of the underlying factors accelerating the
childhood obesity that is problematic in the developing
world and must seek to understand the multifactorial
nature of the problem.
For example, issues of safety and accessibility to
adequate facilities might disallow some children to
participate in physical activity. Similarly, physical and
financial barriers are known to prevent families from
purchasing nutritious foods such as fruit and vegetables
— as well as safe drinking water in cases when
potable drinking water is not available — and coerce
them to rely on more convenient cheap, non - perishable,
calorie - dense products for sustenance. In some
societies erroneous perceptions bring about dangerous
practices such as overfeeding children or mothers
opting out of breastfeeding. Moreover, taking into
account information on motivation, eating behaviors
and food preferences can be a valuable element in the
design of interventions. These types of issues, while
not initially considered as research - based studies
are designed, are also an essential component of conducting
comprehensive solution - oriented scientific
research.
Learning by doing
Evidence - based intervention projects can yield information
on efficacy or on efficiency. Efficacy refers to
the impact of an intervention in a controlled setting;
effectiveness refers to the impact of an intervention in
a real world setting. Both types of information are
valuable and necessary in the process of understanding
the issue at stake. However, the rate at which
the obesity epidemic is evolving means that many
countries cannot afford to wait for the most efficacious
programs in childhood obesity prevention to be
identified to then implement them. There is a need to
conceptualize and implement flexible methodologies
that allow for the evaluation of large - scale interventions
as they are implemented. Establishing rigorous
monitoring and evaluation systems, while allowing for
enough flexibility in ongoing programs to make
changes as necessary, is a feasible alternative in settings
where there is an urgency to intervene.
Sustainability
Effectiveness is not the sole factor determining an
intervention ’ s long - term sustainability. Even when an
intervention or pilot project has proved to be effective,
a number of additional factors need to be in place in
order to ensure long - term sustainability or potential
to be scaled - up. Lack of organizational structure and
insufficient funding are usually the primary factors
that lead to the cessation of otherwise successful nutrition
interventions. In many cases, childhood obesity
prevention interventions will call for the investment
of significant resources to promote and facilitate
improved nutrition and physical activity. In the
context of limited resources, it is necessary that intervention
undertaken among those with low and middle
incomes takes into account the cost of upkeeping the
initiative devised beyond the initial pilot, particularly
when science - based interventions evaluated exclusively
for their efficacy, energy and financial resources
are invested in programs that will not be sustainable
long term. In the interest f serving large numbers of
individuals, emphasis should be placed on the evaluation
of pilot interventions that have the potential to
be sustained even when scaled up at a national level.
Building partnerships is another crucial factor to
developing sustainable childhood obesity interventions
and prevention efforts in developing countries.
Whether carried out at school, community or household
level, the relevant key actors need to be involved
in the decision - making process regarding the potential
strategies to be implemented. Particularly when
interventions are carried out at the school and community
level, building partnerships among public
agencies, community members, industry and other
constituents is likely to bring about a supportive environment
in which any program will have better odds
of having a positive impact.
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