CHILDHOOD OBESITY

Childhood Obesity



Table of Contents

EXECUTIVE SUMMARY3

MEMO6

PROBLEM STATEMENT6

LITERATURE REVIEW7

TIMELINE10

ENVIRONMENTAL SCAN13

DATA ABOUT THE PROBLEM13

ALTERNATIVES ANALYSIS CRITERIA16

ALTERNATIVES ANALYSIS20

RECOMMENDATION35

Childhood Obesity

Executive Summary

Leaders in population health have been exploring how to apply the inherent strengths of an evidence-based approach to public health. Although these reviews vary in their focus, a consistent theme is that evidence-based public health or policy cannot be approached simply as either 'watered-down' or 'scaled-up' versions of EBM. Evidence-based public health incorporates many of the same concepts of rigor and attention to threats to internal validity, but also expands evidence considerations to explicitly address issues of contextual and policy relevance, implementation, and sustainability. Evidence of effectiveness is not sufficient by itself to guide appropriate decision-making , and true evidence-based policymaking is probably quite rare. Therefore, getting the process right and engaging decision-makers from the start moves towards 'practice-based evidence' which is more relevant than the classical 'evidence-based practice' because an obesity prevention plan based only on the limited published trials available would patchy and probably ineffective. Additional tools can contribute to the appropriate evidence base for public health decision-making. For example, logic models and theory can provide support for likely pathways of change between interventions and short- or long-term outcomes and mathematical modelling can provide estimates of the strengths of the relationships. Hawe and Shiell developed the 'portfolio approach' to health promotion as a way to maintain health promotion momentum without having complete evidence about the effectiveness of interventions. This approach allows the selection of interventions to be based on the best available evidence whilst not excluding untried but promising strategies. This has particular appeal for the selection of the best options for the prevention of obesity. (Crawford 2003)

Memo

Problem Statement

Obesity is a major public health and economic problem of global significance because it is highly prevalent, it is rapidly increasing, and it is associated with a wide range of chronic conditions such as diabetes, hypertension, cardiovascular disease, and certain cancers. It greatly reduces both length and quality of life and may be approaching cigarette smoking as the major preventable cause of mortality in countries like the United States. Obesity also places enormous financial burdens on governments and individuals and accounts for up to 6% of total healthcare expenditure in some developed countries. The mounting concern about obesity and increased awareness of the need for societal-level action on obesity prevention are reflected in the outpouring of related reports from national governments and international agencies and organizations as well as a striking escalation of media attention to the topic. (James 2009)

It is now well accepted that the causal pathways driving the increases in obesity prevalence involve societal and environmental changes laid onto the underlying, but relatively stable, genetic and behavioural susceptibility among individuals. However, although it is clear that remedies will need to involve policies and programmes that change the relevant societal and environmental drivers in a direction that promotes healthy population weights, the ways to do this are not straightforward. The processes influencing food intake and physical activity are fundamental, complex, and ...