Preventing Childhood Obesity - Evidence Policy and Practice.pdf

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Evidence framework for childhood obesity prevention Table 6.1 Types of evidence and information relevant to obesity prevention. 3 Type of evidence or information Description Observational Observational epidemiology Monitoring and surveillance Epidemiological studies that do not involve interventions but may involve comparisons of exposed and non - exposed individuals, for example, cross - sectional, case - control, or cohort studies Population - level data that are collected on a regular basis to provide time series information, for example, mortality and morbidity rates, food supply data, car and TV ownership, birth weights and infant anthropometry Experimental Experimental studies Program/policy evaluation Intervention studies where the investigator has control over the allocations and/or timings of interventions, for example, randomized controlled trials, or non - randomized trials in individuals, settings, or whole communities Assessment of whether a program or policy meets both its overall aims (outcome) and specific objectives (impacts) and how the inputs and implementation experiences resulted in those changes (process) Extrapolated Effectiveness analyses Economic analyses Indirect (or assumed) evidence Modeled estimates of the likely effectiveness of an intervention that incorporate data or estimates of the program efficacy, program uptake, and (for population effectiveness) population reach Modeled estimates that incorporate costs (and benefits), for example, intervention costs, cost – effectiveness, or cost – utility Information that strongly suggests that the evidence exists, for example, a high and continued investment in food advertising is indirect evidence that there is positive (but proprietary) evidence that the food advertising increases the sales of those products and/or product categories Experience Parallel evidence Theory and program logic Informed opinion Evidence of intervention effectiveness for another public health issue using similar strategies, for example, the role of social marketing or policies or curriculum programs or financial factors on changing health - related behaviors such as smoking, speeding, sun exposure, or dietary intake. It also includes evidence about the effectiveness of multiple strategies to influence behaviors in a sustainable way, for example, health - promoting schools approach, comprehensive tobacco control programs, or coordinated road toll reduction campaigns. The rationale and described pathways of effect based on theory and experience, for example, linking changes in policy to changes in behaviours and energy balance, or ascribing higher levels of certainty of effect with policy strategies like regulation and pricing compared with other strategies such as education The considered opinion of experts in a particular field, for example, scientists able to peer review and interpret the scientific literature, or practitioners, stakeholders, and policy - makers able to inform judgments on implementation issues and modeling assumptions (incorporates “ expert ” and “ lay knowledge ” ) 51
Chapter 6 ioral determinants rather than the more distal, but very important, social and environmental determinants. One poorly researched but very obvious set of determinants are the socio - cultural attitudes, beliefs, values and perceptions that may explain the very large differences in obesity prevalence rates seen across different cultures. These socio - cultural determinants may help to explain why both rich and poor countries have obesity prevalence rates in women of less than 5% (e.g., India, China, Yemen, Ethiopia, Japan and Korea) and greater than 40% (e.g., Samoa, Tonga, Qatar and Saudi Arabia). 4 Knowing a lot about the determinants of obesity should help to guide interventions but, as Robinson and Sirard point out, 5 “problem-oriented ” evidence (what is to blame?) is often quite different to “ solution - oriented ” evidence (what to do?) It is the solution evidence that decision makers are urgently seeking and it is this evidence that is currently lacking. Opportunities for a ction — who, w here, h ow? This is the third issue on the IOTF framework (Figure 6.1 ). Many countries have now created strategic plans for action on obesity either as an issue by itself or as part of promoting physical activity or health eating or reducing chronic diseases. Classic frameworks for health promotion specify “ who ” in terms of target groups (e.g., children, adolescents, pregnant women, minority ethnic groups, those on low incomes), “ where ” in terms of settings or sectors (e.g., schools, the commercial sector, the health sector), and “ how ” approaches or strategies (e.g., school education, community development, the use of mass media, environmental change, policy and infrastructure change). 3 These issues are addressed in other chapters in this book but a few brief comments about target groups are warranted. A potential limitation of identifying target groups is that they become too much the focus of the action (e.g., by encouraging them to make the healthy choices) rather than the players that influence the environments that determine those behaviors (those who can make the healthy choices easier for the target group). In this respect, the definition of target groups may need to be widened to include the providers of the determinants of health, such as the providers of health information — the health services, schools, the media, commercial producers — and widened still further to include those that set the policies which shape access to healthy lifestyles through, for example, pricing, distribution and marketing. In this sense, target groups may include shareholders in companies, professional groups, policy - makers and public opinion leaders, including politicians. Prevention strategies targeting adults make economic sense (if they work) because the consequences of obesity occurring in middle aged and older adults generate economic costs — especially through Type 2 diabetes and cardiovascular diseases. 6 Adults, especially those with other existing risk factors, are at high absolute risk of these diseases; therefore, they have the potential for high absolute gains. In addition, there is now very strong efficacy evidence that individual lifestyle interventions in high - risk adults prevent diabetes and heart disease. 7,8 However, despite this evidence and logic, children have risen as the priority target group for most action on obesity and this has occurred for a number of reasons — some based on evidence, some based on societal principles, and some based on practicalities. Excess weight, once gained, is hard to lose but children who are overweight do have a chance to “ grow into ” their weight. Children ’ s behaviors are also much more environmentally dependent than adults ’ behaviors and most of the evidence on obesity prevention has been in children. However, far more powerful than the sum of the evidence are two other drivers of children as the priority target group: societal protection of children and access for interventions — especially through schools. Policy - makers have been especially sensitive to children because society has an obligation to protect them from ill - health. For adults, the societal obligation shifts towards protecting personal choice — even if that choice is for unhealthy foods and physical inactivity. Effectiveness of p otential i nterventions This is the fourth issue in the IOTF framework (Figure 6.1 ) and asks: “ What are the potential, specific interventions and what is the evidence for their effectiveness? ” This question is covered in many other chapters 52
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Preventing Childhood Obesity Eviden
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Preventing Childhood Obesity Eviden
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Contents Foreword, vii Contributors
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Foreword Obesity became a major hea
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Contributors Rob Carter PhD Head, H
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Contributors Shiriki Kumanyika PhD,
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Preface If we had all the evidence,
Page 22 and 23: CHAPTER 1 The c hildhood o besity e
Page 24 and 25: Childhood obesity epidemic Table 1.
Page 26 and 27: Childhood obesity epidemic explain
Page 28 and 29: Childhood obesity epidemic Table 1.
Page 30 and 31: Childhood obesity epidemic hepatiti
Page 32 and 33: Childhood obesity epidemic 15 Shiel
Page 34 and 35: CHAPTER 2 Lessons from the c ontrol
Page 36 and 37: Lessons from the control of other e
Page 42 and 43: Childhood obesity prevention overvi
Page 50 and 51: CHAPTER 4 No c ountry for f at c hi
Page 52 and 53: No country for fat children? Ethica
Page 60 and 61: A human rights approach to childhoo
Page 62 and 63: A human rights approach to childhoo
Page 64: A human rights approach to childhoo
Page 67 and 68: Part 2 community and government age
Page 69: Chapter 6 Questions Evidence needed
Page 73 and 74: Chapter 6 These issues are particul
Page 75 and 76: Chapter 6 15 Carrel AL , Bernhardt
Page 77 and 78: Chapter 7 at the state level to app
Page 79 and 80: Chapter 7 prevention efforts, parti
Page 81 and 82: Chapter 7 interventions. This appro
Page 83 and 84: CHAPTER 8 Evidence of the i nfl uen
Page 85 and 86: Chapter 8 choices in adolescence, 1
Page 87 and 88: Chapter 8 itself is unlikely to res
Page 89 and 90: Chapter 8 20 Cullen K , Baranowski
Page 91 and 92: Chapter 9 meal frequency, decreased
Page 93 and 94: Chapter 9 were behavioral (parent -
Page 95 and 96: Chapter 9 changes regarding partici
Page 97 and 98: Chapter 9 36 Campbell KJ , Hesketh
Page 99 and 100: Chapter 10 condition obesity in chi
Page 101 and 102: Chapter 10 the release of energy an
Page 103 and 104: Chapter 10 whereas Flynn et al 25 a
Page 105 and 106: Chapter 10 11 Baranowski T : Advanc
Page 107 and 108: CHAPTER 11 Obesity p revention in s
Page 109 and 110: Chapter 11 translation (see Chapter
Page 111 and 112: Chapter 11 overweight and obesity r
Page 113 and 114: CHAPTER 12 The p revention of c hil
Page 115 and 116: Chapter 12 Selective prevention pro
Page 117 and 118: Chapter 12 Table 12.1 Recommendatio
Page 119 and 120: Chapter 12 Table 12.1 Continued Gui
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Chapter 12 short - and long - term
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Chapter 12 33 Woo KS , Chook P , Yu
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Chapter 13 There is a relatively sm
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Chapter 13 Modifying the b uilt e n
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Chapter 13 capacity to support chil
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Chapter 13 45 Staunton C , Hubsmith
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Chapter 14 Changes in the food envi
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Chapter 14 Promising interventions
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Chapter 14 10 USDA - ERS : Food CPI
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CHAPTER 15 Food and b everage m ark
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Chapter 15 Box 15.1 The findings of
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Chapter 15 Food, however, is not to
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Chapter 15 competitive analysis eac
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Chapter 15 behaviour: exploring the
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Chapter 16 pawn or sell possessions
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Chapter 16 obesity and that this ma
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Chapter 16 impact of this deprivati
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Chapter 16 10 Marin - Leon L , Sega
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CHAPTER 17 Socio - c ultural i ssue
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Chapter 17 The s ocio - c ultural e
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Chapter 17 with limited access and/
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Chapter 17 What else can be done to
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Chapter 17 55 Grier S , Kumanyika S
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Chapter 18 Ironically, these countr
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Chapter 18 key environmental factor
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Chapter 18 countries precludes the
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Chapter 18 7 Jafar TH , Qadri Z , I
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CHAPTER 19 Evaluation of c ommunity
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Evaluation of community-based obesi
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CHAPTER 20 Economic e valuation of
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Economic evaluation of obesity inte
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CHAPTER 21 Monitoring of c hildhood
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Monitoring of childhood obesity Non
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Monitoring of childhood obesity Noo
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Monitoring of childhood obesity Tab
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Monitoring of childhood obesity 11
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Knowledge translation and exchange
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The role of advocacy Why d o w e n
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The role of advocacy mate long - te
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The role of advocacy position put o
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The role of advocacy 6 Yach D , Haw
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Part 4 infrastructure, funding or r
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Chapter 24 by examining why policy
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Chapter 24 has privileged the manuf
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Chapter 24 case study is an analysi
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Chapter 24 by being highly visible
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CHAPTER 25 Developing the political
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Chapter 25 Involuntary: all society
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Chapter 25 Shiriki Kumanyika and co
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Chapter 25 The next steps Given the
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CHAPTER 26 Community i nterventions
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Chapter 26 Table 26.1 The health pr
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Chapter 26 consider and build on th
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Chapter 26 programs and messages be
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Chapter 26 Victoria, Australia. The
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Chapter 26 participants for appropr
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CHAPTER 27 Community c apacity b ui
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Chapter 27 level and macro - change
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Chapter 27 & Chomp ” where the co
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Chapter 27 Box 27.4 Excerpt from Go
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Chapter 27 Table 27.1 Capacity buil
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Chapter 27 38 Borys Jean - Michel :
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Chapter 28 Box 28.1 The EPODE progr
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Chapter 28 Figure 28.1 For parents:
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Chapter 28 Figure 28.2 Promoting ph
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Chapter 28 marketing, there is ofte
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Chapter 28 social problems. The art
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Chapter 29 length gain observed in
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Chapter 29 tissue deposition relate
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Chapter 29 A study in the USA found
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Chapter 29 7 Cole TJ , Bellizzi MC
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Chapter 29 environmental approaches
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Chapter 30 it all on their own, sin
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Chapter 30 Forty - three countries
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Chapter 30 Box 30.2 Elements of the
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Chapter 31 childhood obesity rates
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Chapter 31 became inactive or was t
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Chapter 31 healthy diets and portio
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CHAPTER 32 Working with m inority g
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Chapter 32 and reflect the circumst
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Chapter 32 inclusion and exclusion
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Chapter 32 3 Mercer SL , Vinney JD
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Chapter 33 % of total DALYs lost 2
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Chapter 33 Finally, within a given
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Chapter 33 urbanized and have aband
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Chapter 33 Box 33.1 Recommendations
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CHAPTER 34 Preventing c hildhood o
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Chapter 34 with a plateau in cigare
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Chapter 34 segments of the populati
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Index academic performance 11, 264
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Index evidence-based and evidence-i
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Index community-based 33, 58, 151,
Page 323 and 324:
Index parental support 67 PE 25, 81
Page 325:
Index Minnesota Heart Heath Project
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