Preventing Childhood Obesity - Evidence Policy and Practice.pdf

PART 4
Policy and practice
This final section investigates the application of the
existing and emerging evidence into the various settings
and sectors where policy and practice can be
implemented for change. Chapters 24 and 25 set the
wider scene with Mark Lawrence and Boyd Swinburn
defining the role of policy in obesity prevention and
Phil James and Neville Rigby taking on one of the
biggest challenges in obesity prevention — creating the
political will for action. Policy is such an important
driver for change but the role that evidence plays in
the policy development process is disturbingly minor.
This is a blow for health scientists who spend their
lives generating the data to inform policy change only
to have it swamped by other considerations — often
political. No one knows this better than Phil James,
President of the International Association for the
Study of Obesity and former Chair of the International
Obesity Taskforce. His extraordinary insights from
trying to get obesity action onto government agendas
around the world are laid out in Chapter 25 . He also
draws stark contrasts between the government
responses to bovine spongiform encephalopathy with
its relative apathy over obesity and chronic diseases
such as coronary heart disease and diabetes.
The chapters led by Colin Bell and Annie Simmons
(Chapters 26 and 27 ) examine some of the key
approaches to whole-of-community programs —
planning for sustainability and community capacity
building. They draw on the experiences from the
obesity projects in Victoria, Australia and the French
EPODE (Ensemble Prévenons l ’Obésité Des Enfants )
program. A capacity building approach allows a
common process to be applied with community interventions,
yet gives the flexibility that is needed to
incorporate the wide differences in community contexts.
The EPODE program has the credentials inter-
nationally of a program which extends across many
communities and several countries, and its lessons in
social marketing are also used in the following chapter
by Nadine Henley and Sandrine Raffin (Chapter 28 ).
We are at the stage in social marketing for obesity
prevention that we were 15 years ago for tobacco
control, so we have much to learn. However, “ getting
the right messages ” and “ getting the messages right ”
will be a much tougher task for changing diet and
physical activity patterns than changing smoking
patterns.
There are several stand - out settings that must be
included in any assessment of policy and practice
for preventing childhood obesity. Andrea de Silva -
Sanigorski leads Chapter 29 on preschool settings,
which provide great opportunities for obesity prevention
because the children are very environmentally
dependent and the parents are relatively accessible
and at a “ teachable ” stage of life. Schools are an
obvious setting, and Goof Buijs and Sue Bowker
(Chapter 30 ) examine the practical issues of creating
health promoting schools with a focus on healthy
eating and physical activity. The evidence for effectiveness
is much stronger for interventions in primary
schools than secondary schools and, indeed, adolescents
are likely to present a challenge for prevention
close to that for adults — very hard.
Interventions with minority groups in high - income
countries add several more layers of complexity,
including culture, migration effects, marginalization
and socio - economic disadvantage. Lisa Gibbs and colleagues
(Chapter 32 ) examine some of these issues
but, in reality, we are only just scratching the surface
in this vital area of research and action. Similarly,
there is a rapidly rising childhood obesity epidemic in
many lower - income countries, which do not have the