Population-level intervention strategies and examples for obesity prevention in children.

Division of Nutrition, Physical Activity, and Obesity, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia 30341, USA.
Annual Review of Nutrition (Impact Factor: 10.46). 04/2012; 32:391-415. DOI: 10.1146/annurev-nutr-071811-150646
Source: PubMed

ABSTRACT With obesity affecting approximately 12.5 million American youth, population-level interventions are indicated to help support healthy behaviors. The purpose of this review is to provide a summary of population-level intervention strategies and specific intervention examples that illustrate ways to help prevent and control obesity in children through improving nutrition and physical activity behaviors. Information is summarized within the settings where children live, learn, and play (early care and education, school, community, health care, home). Intervention strategies are activities or changes intended to promote healthful behaviors in children. They were identified from (a) systematic reviews; (b) evidence- and expert consensus-based recommendations, guidelines, or standards from nongovernmental or federal agencies; and finally (c) peer-reviewed synthesis reviews. Intervention examples illustrate how at least one of the strategies was used in a particular setting. To identify interventions examples, we considered (a) peer-reviewed literature as well as (b) additional sources with research-tested and practice-based initiatives. Researchers and practitioners may use this review as they set priorities and promote integration across settings and to find research- and practice-tested intervention examples that can be replicated in their communities for childhood obesity prevention.

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    ABSTRACT: Objective Increasing prevalence of obesity particularly affects underprivileged families and children. This study aimed to estimate the efficiency of an obesity prevention program for school-aged children in deprived urban areas. Methods This was an intervention trial with a before-and-after comparison of a cohort of school-aged children in preschool and primary school in three deprived urban areas in Grenoble, France. All school-aged children in the first and third year of preschool and the third year of primary school during the 2008–2009 and 2009–2010 school years, whose parents agreed to participate in the study, were included. Children were seen again 2 years later. The staff of the school health service measured and weighed the children during a medical check-up, thus determining their body mass index (BMI) and Z score. A school doctor suggested specific care to the parents of overweight children. A lifestyle questionnaire was completed. The primary outcome was changes in BMI and the Z score over 2 years. The secondary outcome was changes in lifestyle and eating habits. Results A total of 2434 children were included in the screening campaign. Of the 2434 children included in screening, 1824 children were reviewed and evaluated at 2 years. At inclusion, overweight prevalence increased with age, from 6.4% in the first year of preschool to 21.9% in the third year of primary school. More than 60% of overweight children had a high social vulnerability score. Prevalence of overweight increased from 13.8% to 21.5% in 2 years in the entire cohort (P < 0.001). In the 252 overweight children, the mean BMI increased from 20 kg/m2 to 21.8 kg/m2 (P < 0.001), as did the mean Z score, which increased from 2.72 to 2.9 (P < 0.001). There was no significant interaction depending on whether the family physician was in private practice or employed by a health center. According to their eating habits, fewer of the overweight children had a snack in the morning and more had a school lunch. More than half of the children thought they had improved their eating habits. They played more sports (30% versus 49.5%). Conclusion This study failed to demonstrate that incentive for medical management of excess weight had an effect on the short-term (2 years) evolution of the children's corpulence.
    Archives de Pédiatrie 07/2014; 21(7):727–735. · 0.41 Impact Factor
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    ABSTRACT: Underserved minority populations in the US Affiliated Pacific Islands (USAPI), Hawaii, and Alaska display disproportionate rates of childhood obesity. The region's unique circumstance should be taken into account when designing obesity prevention interventions. The purpose of this paper is to (a), describe the community engagement process (CEP) used by the Children's Healthy Living (CHL) Program for remote underserved minority populations in the USAPI, Hawaii, and Alaska (b) report community-identified priorities for an environmental intervention addressing early childhood (ages 2-8 years) obesity, and (c) share lessons learned in the CEP. Four communities in each of five CHL jurisdictions (Alaska, American Samoa, Commonwealth of the Northern Mariana Islands, Guam, Hawai'i) were selected to participate in the community-randomized matched-pair trial. Over 900 community members including parents, teachers, and community leaders participated in the CEP over a 14 month period. The CEP was used to identify environmental intervention priorities to address six behavioral outcomes: increasing fruit/vegetable consumption, water intake, physical activity and sleep; and decreasing screen time and intake of sugar sweetened beverages. Community members were engaged through Local Advisory Committees, key informant interviews and participatory community meetings. Community-identified priorities centered on policy development; role modeling; enhancing access to healthy food, clean water, and physical activity venues; and healthy living education. Through the CEP, CHL identified culturally appropriate priorities for intervention that were also consistent with the literature on effective obesity prevention practices. Results of the CEP will guide the CHL intervention design and implementation. The CHL CEP may serve as a model for other underserved minority island populations.
    Maternal and Child Health Journal 09/2013; · 2.24 Impact Factor
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    ABSTRACT: Background This umbrella review aimed at eliciting good practice characteristics of interventions and policies aiming at healthy diet, increasing physical activity, and lowering sedentary behaviors. Applying the World Health Organization¿s framework, we sought for 3 types of characteristics, reflecting: (1) main intervention/policy characteristics, referring to the design, targets, and participants, (2) monitoring and evaluation processes, and (3) implementation issues. This investigation was undertaken by the DEDPIAC Knowledge Hub (the Knowledge Hub on the DEterminants of DIet and Physical ACtivity), which is an action of the European Union¿s joint programming initiative.MethodsA systematic review of reviews and stakeholder documents was conducted. Data from 7 databases was analyzed (99 documents met inclusion criteria). Additionally, resources of 7 major stakeholders (e.g., World Health Organization) were systematically searched (10 documents met inclusion criteria). Overall, the review yielded 74 systematic reviews, 16 position review papers, and 19 stakeholders¿ documents. Across characteristics, 25% were supported by¿¿¿4 systematic reviews. Further, 25% characteristics were supported by¿¿¿3 stakeholders¿ documents. If identified characteristics were included in at least 4 systematic reviews or at least 3 stakeholders¿ documents, these good practice characteristics were classified as relevant.ResultsWe derived a list of 149 potential good practice characteristics, of which 53 were classified as relevant. The main characteristics of intervention/policy (n¿=¿18) fell into 6 categories: the use of theory, participants, target behavior, content development/management, multidimensionality, practitioners/settings. Monitoring and evaluation characteristics (n¿=¿18) were grouped into 6 categories: costs/funding, outcomes, evaluation of effects, time/effect size, reach, the evaluation of participation and generalizability, active components/underlying processes. Implementation characteristics (n¿=¿17) were grouped into eight categories: participation processes, training for practitioners, the use/integration of existing resources, feasibility, maintenance/sustainability, implementation partnerships, implementation consistency/adaptation processes, transferability.Conclusions The use of the proposed list of 53 good practice characteristics may foster further development of health promotion sciences, as it would allow for identification of success vectors in the domains of main characteristics of interventions/policies, their implementation, evaluation and monitoring processes.
    BMC Public Health 01/2015; 15(1):19. · 2.32 Impact Factor


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