Preventing Childhood Obesity - Evidence Policy and Practice.pdf

Evidence of multi-setting approaches for obesity prevention: translation to best practice
can be equity focused and reduce the socio - economic
gradient that currently exists for almost all health
outcomes.
This approach can also positively influence individual
behaviors through addressing the societal and
environmental influences at the community level.
Interventions that target multiple aspects of individual
environments have the ability to make the more
health promoting options easier, and over time can
also shift behavioral and cultural norms in a sustainable
manner. Targeting environments also represents
an upstream approach, as children in low - income
families live in environments that limit social and
economic opportunities, access to healthy foods
and opportunities for physical activity. 34 In the Shape
Up Somerville intervention program, a significant
reduction in z - BMI was seen after one year in the
intervention children. 9 This intervention engaged
the community widely and was specifically focused
on changing children ’ s environments at school and
also enhancing access and availability of healthy eating
and physical activity options throughout the entire
day for children, including before - and after - school
programs. 9 Also, as a result of the intervention, there
were changes in the home and community, which
provided reinforced opportunities for increased physical
activity and improved access to more nutritious
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food.
Best p ractice r ecommendations
for i ntervention a ctivities
In their comprehensive synthesis of the evidence of
reducing obesity and related chronic disease risk
in children and youth, Flynn et al (2006) present recommendations
for a broad range of sectors, organizations
and health professionals, which are based on the
available evidence and gaps in knowledge identified
during the synthesis. With regard to intervention
activities, the recommendations 29 can be summarized
as follows:
• Population-based interventions should be developed
to balance, support and extend the current
emphasis on individual - based programs.
• Obesity prevention programs need to be developed
with rigorous evaluation components in community
and home settings where limited program
activity is evident and effectiveness is unknown.
• Interventions need long-term implementation and
follow - up to determine the sustainability of program
impacts as on body weight.
• To maximize funding and health impact, interventions
should be developed within an integrated
chronic disease prevention model and with a CBPR
framework.
• Program design process should be developed to
allow continual incorporation of new elements
associated with greater program effectiveness, using
an action research model.
Taking this further, Glass and McAtee have developed
a multi - level three - dimensional framework to
examine health behaviors and disease in social and
biological context. They challenge us to develop better
theory and data to understand how social factors regulate
behaviors, or distribute individuals into risk
groups, and how these social factors come to be
embodied. 31 This is needed because while we are
knowledgeable about the behaviors that lead to ill
health and disease, relatively little is known about how
these behaviors arise, become maintained and can
be changed. By advancing the study of the social
determinants, Glass and McAtee suggest that more
effective population interventions can be developed.
Accordingly, continuing to conduct interventions that
attempt to alter health behaviors in isolation from the
broader social and environmental context will continue
to provide disappointing results. The authors
emphasize the need to focus on the health behaviors
and the mediating structures that lie between the
behavioral sphere and the macro - social context. These
mediating structures are termed “ risk regulators ”, and
in the obesity context are, for example, cultural norms,
area deprivation, food availability, laws and policies,
and workplace conditions. 31 These risk regulators
influence the two key behaviors related to obesity,
nutrition and physical activity, in a way that is dynamic
and extends over the life course. Accordingly, population
interventions to prevent obesity cannot attempt
to influence health behaviors without attempting to
address at least some of these risk regulators and a
more contextual understanding of health behaviors
and health service usage, for example, would increase
the effectiveness of obesity prevention interventions
and public health policies. 31
There is growing recognition of the need for
a common risk factor approach to public health
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