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Evidence-based interventions for prevention of childhood obesity

Three new reports from work package 2 Best Practice invest what successful, evidence-based initiatives that exist today to prevent children from developing overweight and obesity. The reports are based on extensive literature studies as well as questionnaires and interview surveys.

In order to get a comprehensive picture, both initiatives aimed directly at children and families, for example from health care and preschools, and initiatives at the overall societal level have been examined. Both national and international initiatives have been included in the survey.

-The goal is to reach a common view of what should be done to prevent childhood obesity in Sweden, says Peter Bergsten, professor at Uppsala University, national coordinator for Prevention of childhood obesity and project manager for work package 2.

Efforts at the societal level

The report “Efforts at the societal level to prevent overweight and obesity among children aged 0–6” examines whether there are effective interventions at the societal level that are particularly suitable for the prevention of overweight and obesity among children aged 0–6 and whether they are useful in a Swedish context. .

-Through the literature study, we found several successful interventions, especially in Australia and the USA, which have adopted a broader view of society and focused preventive efforts across several sectors and environments, says Andreas Vilhelmsson, Public Health Scientist (MPH, PhD), Innovation Leader at Innovation Skåne and researcher at Lund University, which facilitated the work on the report.

One conclusion in the report is that there are currently too few sufficiently comprehensive community interventions that shows promising results and there are even fewer that are sufficiently evaluated or aimed at younger children aged 0–6. However, some initiatives are beginning to be evaluated that provides opportunities to build on the knowledge base, as the literature compilation and the survey have shown.

Challenges to overcome

What has shown the best results is so-called community intervention or whole-of-community. To build that kind of initiatives, there are some minimum common denominators to consider. Leading words in the process are cooperation and capacity building. The social interventions on which this data is based also reveal a number of common potential challenges that need to be overcome:

  • Long-term financing
  • Unclear roles
  • Staff turnover of key people
  • Declining political commitment
  • To create ownership in the receiving municipality / region / community
  • Engaging preschools
  • Long-term support from parties involved
  • Food supply is a key factor
  • The change must be sustainable
  • Ongoing and final evaluation
  • Take into account the socio-economic factors
  • Be able to build on and develop existing systems
  • Obtain data – Initially, it is valuable to produce information about the prevalence of overweight and obesity among school children in the municipality. These data are available but must be compiled
  • Reach all groups in society and that all of them get to have a say and influence

Interventions at the individual level

The report “Best Practice for interventions aimed at the individual” presents a systematic compilation of research that has studied the effect of interventions aimed at expectant parents or families with children five years or younger. The initiatives have focused on the child’s weight status, such as a change in BMI sds or the presence of overweight or obesity. The report includes studies that focus on both universal and targeted interventions. Studies on the treatment of overweight or obese children are not included.

Large number of articles

A total of 158 articles were identified, which was a larger amount than expected and the group working on the report has therefore focused on the primary studies identified. These have been categorized according to the arena in which the intervention was performed.

The studies that have been reviewed in full text so far generally show small effect sizes. The work has begun with assessing the risk of systematic errors in the studies, so-called risk of bias. Just as a faulty design can lead to methods incorrectly appearing to have an effect, methods that have an effect can be missed.

-Therefore, it is important that we draw our conclusions based on studies with as good a design as possible to reduce the risk of systematic errors affecting the results. At present, we therefore need to refrain from drawing any preliminary conclusions until we have had time to examine all studies in more detail, says Karl-Erik Flodmark, Associate Professor of Pediatrics and Medical Expert at the National Board of Health and Welfare, who is one of the report’s authors.

Survey

The third report is based on a comprehensive survey, with follow-up interviews. A total of 33 actors, who work in different ways with children’s health, answered the questionnaire and all questionnaire responses were also followed up with interviews.

-Thanks to the survey, we have gained a clearer picture and some insights that could not be obtained in the literature studies we have already conducted. Although it is not a comprehensive survey, the answers are so consistent that they give us good guidance on how we can best move forward, says Elin Glad, health process leader in Region Östergötland, who convened the survey group, which is part of work package 2 – Best Practice .

Actors who responded to the survey come from the region, municipality, child health care and maternal health care, among others. What they all have in common is that they have run or are running some form of initiative to promote children’s health.

Challenges, obstacles and lessons learned

The report identifies a number of challenges and obstacles that the actors performing the interventions have or have had in their work. These can be summarized in three overarching themes:

  • Lack of resources
  • Lack of competence
  • Lack of impact

In addition, the report highlights a number of lessons that the interviewees have found in the work with the various initiatives, as well as future needs to succeed with future initiatives.

-Unfortunately, we have not been able to identify any initiatives in our survey that show direct evidence to reduce childhood obesity (BMI). However, there are positive trends and changes when we look at other variables and indicators that can contribute to reduced childhood obesity, concludes Elin Glad.

Insatser på samhällsnivå för att förebygga övervikt och fetma bland barn 0–6 år (PDF öppnas i ny flik)

Best Practice för interventioner riktade till individen (PDF öppnas i ny flik)

Prevention Barnfetma – Best Practice: Sammanställning från enkätgruppen (PDF öppnas i ny flik)