Preventing Childhood Obesity - Evidence Policy and Practice.pdf

Evidence of multi-setting approaches for obesity prevention: translation to best practice
Pathways was successful in reducing the energy density
of foods consumed by changing the school food environment.
21,22 While the main outcome of the study,
change in the percentage of body fat, produced no
significant difference between intervention and
control schools, other measurable benefits were demonstrated
including a reduction in daily energy intake
and percentage of energy from total fat, and increases
in physical activity and for intervention verses control
schools. The Pathways study demonstrated a successful
marriage of theoretical underpinnings, community
and family involvement, and cultural and
situational appropriateness, and thereby provided an
excellent community research framework upon which
to build.
Shape Up Somerville ( SUS ): Eat Smart, Play
Hard TM , was one of the first community - based participatory
research ( CBPR ) initiatives designed to
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change the environment to prevent obesity in early
elementary school children. 9 Academics were partnered
with community members of three culturally
diverse urban communities to conduct a controlled
trial to evaluate whether an environmental change
intervention could prevent a rise in BMI z - scores in
young children through enhanced access and availability
of physical activity options and healthy food
throughout their entire day. The SUS intervention
focused on creating multi - level environmental change
to support behavioral action and maintenance and to
prevent weight gain among early elementary school
children through community participation. Specific
changes within the before -, during -, and after - school
environments provided a variety of increased opportunities
for physical activity. The availability of lower -
energy - dense foods, with an emphasis on fruits,
vegetables, whole grains and low - fat dairy was
increased; foods high in fat and sugar were discouraged.
Additional changes within the home and the
community, promoted by the intervention team,
provided reinforcing opportunities to be more physically
active and improve access to healthier food.
Many groups and individuals within the community
(including children, parents, teachers, school food
service providers, city departments, policy - makers,
health care providers, before - and after - school programs,
restaurants and the media) were engaged in the
intervention (see http://nutrition.tufts.edu/research/
shapeup for details).
These changes were aimed at bringing the overall
energy equation into balance, specifically, this intervention
was designed to result in an increased energy
expenditure of up to 125 kcals per day beyond the
increases in energy expenditure and energy intake that
accompany growth. A central aim of the intervention
was to create a community model that could be replicated
nationwide as a cost - effective, community -
based action plan to prevent obesity at local levels.
After the first school year of intervention (8 months)
in the intervention community, BMI z - score decreased
by − 0.1005 ( P = 0.001, 95% confidence interval
− 0.1151 to − 0.0859) compared to children in the
control communities after controlling for baseline
9
covariates. This approach addressed the complex
environmental influences on energy balance and
ensured maximal reach within a population of
children.
Community - based interventions are also being
effectively implemented in other parts of the world.
Recently, an Australian intervention program utilizing
the socio - ecological model (Be Active, Eat Well) 24
was evaluated and found to be successful in a number
of areas. Intervention children had significantly lower
increases in body weight, waist, waist/height, and BMI
z - score than comparison children. Further, the intervention
was shown not to increase health inequalities
related to obesity and was also deemed to be safe as
changes in underweight and attempted weight loss
were not different between the two groups of
children. 24
More interventions that focus on multi - faceted
community - based environmental change approaches
using key elements of other successful social change
models (a recognized crisis, economic impact, evidence
based, government involvement) are needed. 1
Advanced community - based research approaches to
turn the tide on childhood obesity will require training
of future leaders in community research methodology,
increased funding to conduct rigorous trials,
and acceptance of the study model as viable from the
broad scientific community.
The b enefits of this a pproach to
o besity p revention
There is broad agreement that, to reduce obesity, priority
needs to be given to multi - strategy, multi - setting
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