Obesity Prevention Initiatives Research Articles

Community‐based efforts to prevent obesity: Australia‐wide survey of projects

Community-based programs that affect healthy environments and policies have emerged as an effective response to high obesity levels in populations. Apart from limited individual reports, little is currently known about these programs, limiting the potential to provide effective support, to promote effective practice, prevent adverse outcomes and disseminate intervention results and experience. The aim of the present study was to identify the size and reach of current community-based obesity prevention projects in Australia and to examine their characteristics, program features (e.g. intervention setting), capacity and approach to obesity prevention. Detailed survey completed by representatives from community-based obesity prevention initiatives in Australia. There was wide variation in funding, capacity and approach to obesity prevention among the 78 participating projects. Median annual funding was Au$94900 (range Au$2500-$4.46 million). The most common intervention settings were schools (39%). Forty per cent of programs focused on a population group of ≥50000 people. A large proportion of respondents felt that they did not have sufficient resources or staff training to achieve project objectives. Community-based projects currently represent a very large investment by both government and non-government sectors for the prevention of obesity. Existing projects are diverse in size and scope, and reach large segments of the population. Further work is needed to identify the full extent of existing community actions and to monitor their reach and future 'scale up' to ensure that future activities aim for effective integration into systems, policies and environments. SO WHAT? Community-based programs make a substantial contribution to the prevention of obesity and promotion of healthy lifestyles in Australia. A risk of the current intervention landscape is that effective approaches may go unrecognised due to lack of effective evaluations or limitations in program design, duration or size. Policy makers and researchers must recognise the potential contribution of these initiatives, to both public health and knowledge generation, and provide support for strong evaluation and sustainable intervention designs.

Socio‐cultural differences in Australian primary school children's weight and weight‐related behaviours

To examine whether there are socio-cultural differences in overweight/obesity and weight-related behaviours of Australian primary school children. Secondary data analysis of the 2010 NSW Schools Physical Activity and Nutrition Survey (n = 4898). Height and weight were measured. Parents of Year K, 2, 4 children and Year 6 students completed a questionnaire on demographics and weight-related behaviours. Cardio-respiratory fitness was assessed by the 20-meter shuttle run test and categorised as adequately fit or unfit. Children were categorised according to the main cultural/ethnic backgrounds (Middle-Eastern, Asian and English-speaking backgrounds) and socio-economic status (SES) tertile. Within ethnic groups, SES was associated with weight-related behaviours, but not consistently, and not with body mass index status. Within ethnic groups, the odds were higher among low SES, compared with high SES to be inactive, unfit and have poorer dietary habits. Weight-related behaviours among each ethnic group also differed by gender. Compared with low SES children from English-speaking backgrounds, ethnic boys were two times as likely to be overweight/obese, and the odds were significantly higher among ethnic children to be inactive, unfit and have poor dietary patterns. The results indicate the need for obesity prevention initiatives to specifically target and reach children from low SES and Asian and Middle-Eastern backgrounds, and the importance of ensuring that such initiatives are culturally appropriate and address relevant issues.

Education for childhood obesity prevention across the life-course: workshop conclusions.

The objectives of this paper are to present the conclusions from the workshop ‘Education for childhood obesity prevention: a life-course approach', coordinated by the Pan-American Health Organization and the Pan-American Health and Education Foundation, and held on 14 June 2012 in Aruba, as part of the II Pan-American Conference on Childhood Obesity (http://www.paco.aw/). This workshop focused on the need to recognize the life-course framework and education as a social determinant of health to address the childhood obesity epidemic through diverse education-based initiatives. Workshop participants agreed that both education per se and the education sector are key for obesity prevention and must form part of multidisciplinary interventions and collaboration between schools, families and the entire society. Capacity building in obesity prevention is required and should include the entire learning community, teachers, leaders, health-care providers, related services personnel, university professors and other interested community members. Obesity prevention initiatives should also engage key community institutions outside the formal education system, including early childhood centers, churches, pediatric/family medicine clinics, among others, to support family nutrition education, healthy food access and daily physical activity—all of which are key to promote a child's ‘healthy weight'.

Evidence-Based Obesity Treatment Interventions for Latino Adults in the U.S.

Latinos have one of the highest prevalences of obesity in the U.S. Efforts to address U.S. Latino health have expanded to include obesity prevention and treatment initiatives. The objectives of this review were to (1) conduct a systematic review of obesity-related treatment interventions targeting U.S. Latino adults and (2) develop evidence-based recommendations to inform culturally relevant strategies for obesity treatment targeting U.S. Latino adults. Obesity treatment interventions, published between 1990 and 2010, were identified through a systematic search of electronic databases conducted between January 2010 and December 2011. Details of the screening process and selection/exclusion criteria are reported in the Guide to Obesity Prevention in Latin America and the U.S. (GOL) parent study. Of the 325 studies identified in the GOL parent study, 105 met the inclusion criteria, and 22 involved obesity treatment interventions for Latinos and were included in the present review. The 22 studies were evaluated (between January 2010 and December 2011) for strength of study design and execution; effect sizes were also estimated for treatment effects on obesity-related outcomes. Interventions for physical activity or diet behavioral changes with strong or sufficient evidence included (1) community-based, culturally relevant, RCTs, and non-randomized controlled trials; (2) church-based interventions; and (3) promotora-led interventions. Most interventions targeted physical activity and/or diet behavioral modification in Latinas and were led by bicultural/bilingual professionals. Potential key intervention settings include community clinics/centers and churches. Although there was limited literature on obesity treatment interventions for U.S. Latinos, the review findings provide valuable insight to researchers and practitioners involved in obesity treatment for U.S. Latino adults.

Knowledge Translation: Childhood Obesity Prevention and Treatment Strategic Research Initiative

Knowledge Translation: Childhood Obesity Prevention and Treatment Strategic Research Initiative

Community Asset Identification in Support of a Place-Based, Early Childhood Obesity Prevention and School Readiness Initiative

Despite extensive community efforts that have resulted in obesity decreases in Cambridge, MA over the last decade, obesity among Black youth remains disproportionately high. Likewise, racial/ethnic academic achievement disparities persist and are evident at early ages. Prior research and emerging national policy recommendations confirm the need for place-based, early childhood interventions to address persistent racial/ethnic disparities in obesity and school readiness. A community-based participatory research initiative is developing an intervention targeted to pre-kindergarten children and their families in a diverse Cambridge neighborhood. The intervention will partner with a Cambridge Public Schools (CPS) program designed to support school readiness through extended preschool, health care, and community-based services. To identify community partners and plan our efforts to promote healthy eating and active living (HEAL) and support school readiness, we conducted a community asset assessment. Through mixed-methods, we (1) identified 239 potential HEAL assets in Area 4; (2) mapped assets to analyze the distribution and proximity of assets to neighborhood children (age 0-5); and (3) interviewed community leaders to provide context. Our findings informed our understanding of the community and helped prioritize the public housing authority, a childcare “clearinghouse”, and a coalition of faith-based organizations as high-impact intervention partners and settings. This article is available in Frontiers in Public Health Services and Systems Research: http://uknowledge.uky.edu/frontiersinphssr/ vol2/iss3/5

Physical Activity for Young Children: A Quantitative Study of Child Care Providers’ Knowledge, Attitudes, and Health Promotion Practices

Many preschool children fail to achieve the National Association for Sport and Physical Education physical activity recommendations placing themselves at increased risk of overweight and its associated health consequences. The early learning and care system is well positioned to intervene. Yet few child obesity prevention efforts have focused on systematically integrating physical activity into early learning and care. A pre/post design examined the association between changes in physical activity practices and providers’ beliefs regarding their role in supporting children’s physical activity. Survey and observational data from 43 sites participating in the Encouraging Healthy Activity and Nutrition in Child Care Environments pilot project were analyzed. Statistically significant increases were found in providers’ perceptions of role salience and the need for adult leadership to increase children’s physical activity. Significant improvements in indoor child care physical activity practices, physical education, and family communication occurred. A binary logistic regression indicated that changes in adult leadership and role salience were significantly associated with changes in physical activity practices. Understanding and modifying child care providers’ beliefs regarding their role in children’s physical activity is a critical component for the successful implementation of obesity prevention initiatives designed to increase child activity levels.

Developing Stories From the Field to Highlight Policy, Systems, and Environmental Approaches in Obesity Prevention

As obesity prevention initiatives increasingly shift toward approaches focused on policy, systems, and environmental change, opportunities to share experiences from the field and lessons learned are growing. Stories are a tool to illustrate processes and outcomes of initiatives that can complement quantitative results. The use of stories, however, is not widely recognized, and the methods and tools available to develop stories are limited. Therefore, we describe the methods used to collect, develop, and disseminate stories featuring comprehensive obesity prevention efforts that various state health departments are planning and implementing. We also discuss potential challenges and provide recommendations that public health practitioners may consider when developing similar stories.

Preventing obesity through schools.

This paper describes highlights from the Weight of the Nation 2012 Schools Track. Included is a summary of 16 presentations. Presenters shared key actions for obesity prevention through schools. The information provided at the Weight of the Nation can help school health practitioners access tools, apply evidence-based strategies, and model real-world examples to successfully start obesity prevention initiatives in their jurisdiction.

Using Photovoice as a Participatory Evaluation Tool in Kaiser Permanente’s Community Health Initiative

Photovoice is a community-based participatory research method that provides participants who traditionally have little voice in community policy decisions, with training in photography, ethics, critical dialogue, photo captioning, and policy advocacy. Photovoice has been used primarily as a needs assessment and advocacy tool and only rarely as a pre-/postintervention evaluation method. This article describes the use of Photovoice as a participatory evaluation method in the Community Health Initiative, a 6-year, multisite community-based obesity prevention initiative, sponsored by Kaiser Permanente. Fifty community participants (including six youth) from six Community Health Initiative communities used photos and captions to identify, from their perspective, the most significant accomplishments from the initiative at both baseline and follow-up. Accomplishments identified included increased access to fresh/healthy food in local neighborhoods; policy changes supporting a "healthy eating, active living" community; increased access to physical activity; changes to the built environment creating increased neighborhood walkability/safety; and leadership development.

Using the Concept of “Population Dose” in Planning and Evaluating Community-Level Obesity Prevention Initiatives

When planning and evaluating community-level initiatives focused on policy and environment change, it is useful to have estimates of the impact on behavioral outcomes of particular strategies (e.g., building a new walking trail to promote physical activity). We have created a measure of estimated strategy-level impact—“population dose”—based on our work in evaluating obesity prevention initiatives that uses elements of the RE-AIM method of combining reach and effectiveness to estimate the impact of a strategy on risk behaviors within a target population. We provide a definition and examples of measuring population dose, discuss measurement options in the face of uncertainty about key parameters, review ways of increasing population dose, and illustrate how the concept of population dose has been used in the Kaiser Permanente Community Health Initiative.

Process and Impact Evaluation of theRomp & ChompObesity Prevention Intervention in Early Childhood Settings: Lessons Learned from Implementation in Preschools and Long Day Care Settings

The Romp & Chomp controlled trial, which aimed to prevent obesity in preschool Australian children, was recently found to reduce the prevalence of childhood overweight and obesity and improve children's dietary patterns. The intervention focused on capacity building and policy implementation within various early childhood settings. This paper reports on the process and impact evaluation of this trial and the lessons learned from this complex community intervention. Process data was collected throughout and audits capturing nutrition and physical activity-related environments and practices were completed postintervention by directors of Long Day Care (LDC) centers (n = 10) and preschools (n = 41) in intervention and comparison (n = 161 LDC and n = 347 preschool) groups. The environmental audits demonstrated positive impacts in both settings on policy, nutrition, physical activity opportunities, and staff capacity and practices, although results varied across settings and were more substantial in the preschool settings. Important lessons were learned in relation to implementation of such community-based interventions, including the significant barriers to implementing health-promotion interventions in early childhood settings, lack of engagement of for-profit LDC centers in the evaluation, and an inability to attribute direct intervention impacts when the intervention components were delivered as part of a health-promotion package integrated with other programs. These results provide confidence that obesity prevention interventions in children's settings can be effective; however, significant efforts must be directed toward developing context-specific strategies that invest in policies, capacity building, staff support, and parent engagement. Recognition by funders and reviewers of the difficulties involved in implementing and evaluating such complex interventions is also critical to strengthening the evidence base on the effectiveness of such public health approaches to obesity prevention.

The Relationship between Practices and Child Care Providers’ Beliefs Related to Child Feeding and Obesity Prevention

To examine the association between child care practices and child care provider knowledge and beliefs about their role in supporting children's healthful eating. Longitudinal design using survey and observation data from baseline and year 1 of the Encouraging Healthy Activity and Eating in Childcare Environments (ENHANCE) pilot project. Seventy-two child care providers from 45 child care settings. Child care setting variables included the feeding environment, nutrition education, and family communication. Child care provider variables were efficacy, knowledge, and misconceptions about child feeding; and the priority placed on supporting children's healthful eating. Correlation and multiple linear regression were used to examine the association between variables. Models indicated that changes in efficacy and feeding knowledge accounted for a significant portion of the variance in nutrition education changes (R(2) = 0.59) and family communication changes (R(2) = 0.29). A reduction in misconceptions was significantly associated with improved feeding practices (β = .71; P < .01; R(2) = 0.40). Understanding child care providers' knowledge and beliefs regarding their role in children's healthful eating is an essential component of child care-based obesity prevention initiatives. Training should assess and address provider efficacy and misconceptions as well as educate providers about evidence-based practices related to child feeding, nutrition education, and family communication.

'Choice': what we mean by it, and what that means for preventing childhood obesity.

(i) To map how US adults value 'choice' in the context of obesity policy and (ii) to discuss implications for obesity prevention in children. Semi-structured interviews (n =105) were conducted between 2006 and 2009 about causes of and solutions to childhood obesity. Quotes captured in field notes from community meetings (n = 6) on childhood obesity prevention were also analysed. Each use of the word 'choice' and its variants was identified in these texts. Content and discourse were analysed to identify the implied values and meaning in each use. North-eastern USA. One hundred and five adults, some involved in childhood obesity prevention initiatives. Three distinct frames of 'choice' emerged: (i) having choices (choice as freedom), (ii) making choices (choice as responsibility) and (iii) influencing choices (contextual constraints and impacts on choice). Many speakers used more than one frame over the course of an interview. Most people using the third frame seemed to share the values behind the first two frames, but focused on conditions required to enable people to be accountable for their choices and to make truly free choices. A small subset thought outside the frame of individual choice, valuing, as one person put it, a 'social contract'. Public debate in the USA about responsibility for and solutions to rising obesity rates often hinges on notions of 'choice'. These frames, and the values underlying them, are not mutually exclusive. Respecting the values behind each 'choice' frame when crafting obesity prevention policy and employing all three in public communications about such policy may facilitate greater consensus on prevention measures.

A systematic approach for the development of a kindergarten‐based intervention for the prevention of obesity in preschool age children: the ToyBox‐study

SummaryThe increasing childhood obesity epidemic calls for appropriate measures and effective policies to be applied early in life. Large‐scale socioecological frameworks providing a holistic multifactorial and cost‐effective approach necessary to support obesity prevention initiatives in this age are however currently missing. To address this missing link, ToyBox‐study aims to build and evaluate a cost‐effective kindergarten‐based, family‐involved intervention scheme to prevent obesity in early childhood, which could potentially be expanded on a pan‐European scale. A multidisciplinary team of researchers from 10 countries have joined forces and will work to realize this according to a systematic stepwise approach that combines the use of the PRECEDE‐PROCEED model and intervention mapping protocol. ToyBox‐study will conduct systematic and narrative reviews, secondary data analyses, focus group research and societal assessment to design, implement and evaluate outcome, impact, process and cost effectiveness of the intervention. This is the first time that such a holistic approach has been used on a pan‐European scale to promote healthy weight and healthy energy balance‐related behaviours for the prevention of early childhood obesity. The results of ToyBox‐study will be disseminated among key stakeholders including researchers, policy makers, practitioners and the general population.

Research to practice: application of an evidencebuilding framework to a childhood obesity prevention initiative in New South Wales

Building evidence-based health promotion programs involves a number of steps. This paper aims to develop a set of criteria for assessing the evidence available according to a five-stage evidence-building framework, and apply these criteria to current child obesity prevention programs in NSW to determine the usefulness of the framework in identifying gaps in evidence and opportunities for future research and evaluation. A set of scoring criteria were developed for application within the five stages of an 'evidence-building' framework: problem definition, solution generation, intervention testing (efficacy), intervention replication, and dissemination research. The research evidence surrounding the 10 childhood obesity prevention programs planned for state-wide implementation in the New South Wales Healthy Children Initiative (HCI) was identified and examined using these criteria within the framework. The evidence for the component programs of the HCI is at different stages of development. While problem definition and, to a lesser extent, solution generation was thoroughly addressed across all programs, there were a number of evidence gaps, indicating research opportunities for efficacy testing and intervention replication across a variety of settings and populations. The five-stage evidence-building framework helped identify important research and evaluation opportunities that could improve health promotion practice in NSW. More work is needed to determine the validity and reliability of the criteria for rating the extent and quality of the evidence for each stage.

Community-based obesity prevention initiatives in aboriginal communities: The experience of the eat well be active community programs in South Australia

Childhood obesity is a growing concern world-wide, and obesity rates are higher in certain groups in the developed world, including Australian Aboriginal people. Community-based obesity prevention interventions (CBOPI) can help to address obesity, however the approach of such programs to reach diverse groups, including Aboriginal people, must be considered. This paper considers one mainstream1 CBOPI, the eat well be active (ewba) Community Programs in South Australia, which was delivered in two communities and sought to reach Aboriginal people as part of the overall program. This paper considers how well this approach was received by the Aboriginal people living and working in those communities. Semi-structured interviews were conducted with nine Aboriginal workers who had some connection to the ewba program, and seven ewba project staff. Qualitative data analysis was performed and factors found to affect how well the program was received by Aboriginal people include relationships, approach and project target group, including geographical area. A different response was observed in the two communities, with a more positive response being observed in the community where more relationships were developed between ewba and Aboriginal staff. For any CBOPI seeking to work with Aboriginal (or other Indigenous) communities, it is vital to consider and plan how the program will meet the needs and preferences of Aboriginal people in all stages of the project, in order to reach this group.

A parent focused child obesity prevention intervention improves some mother obesity risk behaviors: the Melbourne infant program

BackgroundThe diets, physical activity and sedentary behavior levels of both children and adults in Australia are suboptimal. The family environment, as the first ecological niche of children, exerts an important influence on the onset of children’s habits. Parent modeling is one part of this environment and a logical focus for child obesity prevention initiatives. The focus on parent’s own behaviors provides a potential opportunity to decrease obesity risk behaviors in parents as well.ObjectiveTo assess the effect of a parent-focused early childhood obesity prevention intervention on first-time mothers’ diets, physical activity and TV viewing time.MethodsThe Melbourne InFANT Program is a cluster-randomized controlled trial which involved 542 mothers over their newborn’s first 18 months of life. The intervention focused on parenting skills and strategies, including parental modeling, and aimed to promote development of healthy child and parent behaviors from birth, including healthy diet, increased physical activity and reduced TV viewing time. Data regarding mothers’ diet (food frequency questionnaire), physical activity and TV viewing times (self-reported questionnaire) were collected using validated tools at both baseline and post-intervention. Four dietary patterns were derived at baseline using principal components analyses including frequencies of 55 food groups. Analysis of covariance was used to measure the impact of the intervention.ResultsThe scores of both the "High-energy snack and processed foods" and the "High-fat foods" dietary patterns decreased more in the intervention group: -0.22 (−0.42;-0.02) and −0.25 (−0.50;-0.01), respectively. No other significant intervention vs. control effects were observed regarding total physical activity, TV viewing time, and the two other dietary patterns, i.e. “Fruits and vegetables” and “Cereals and sweet foods”.ConclusionsThese findings suggest that supporting first-time mothers to promote healthy lifestyle behaviors in their infants impacts maternal dietary intakes positively. Further research needs to assess ways in which we might further enhance those lifestyle behaviors not impacted by the InFANT intervention.

Evidence of the adoption and implementation of a statewide childhood obesity prevention initiative in the New York State WIC Program: the NY Fit WIC process evaluation

Process evaluations are critical in determining whether outcome evaluations are warranted. This study assessed the extent to which a childhood obesity prevention initiative, NY Fit WIC, was adopted and implemented by the New York State Supplemental Nutrition Program for Women, Infants and Children (WIC). Process data came from qualitative telephone interviews of 101 WIC local agency directors, following NY Fit WIC trainings. Activities were summarized and cross-tabulated by target level (i.e. participant, staff, agency or community) and by theoretical construct (i.e. knowledge promotion, skill building, self-efficacy or role modeling). Approximately 528 activities were reported across all WIC agencies. When activities were grouped into similar categories, 123 unique activities were identified. Agencies were more likely to implement physical activity-related activities (67%) than nutrition-related activities (33%). The majority of activities targeted WIC participants (47%) and staff (22%) and focused on skill building/self-efficacy (67%) among participants and on role modeling (61%) among staff. The involvement of all agencies shows a high level of adoption of the initiative. The diverse number of activities suggests that WIC local agencies tailored implementation to match their resources and clients' needs as planned. These results suggest that an outcome evaluation is warranted to determine whether meaningful behavioral changes occurred among WIC participants and staff.

Mapping the program logic for the South Australia Obesity Prevention and Lifestyle (OPAL) initiative

Mapping the program logic for the South Australia Obesity Prevention and Lifestyle (OPAL) initiative