A systematic review of the effectiveness of individual, community and societal level interventions at reducing socioeconomic inequalities in obesity amongst children

BMC Public Health

Carolyn D Summerbell¹  Helen J Moore¹  Adetayo Kasim¹  Joanne-Marie Cairns¹  Clare L Bambra¹  Frances C Hillier-Brown¹ 

[1] Wolfson Research Institute for Health and Wellbeing, Durham University Queen’s Campus, Stockton-on-Tees TS17 6BH, UK

关键词: Interventions;    Adolescent;    Child;    Infant;    Inequalities;    Socioeconomic status;    Obesity;   

Others  :  1128645
DOI  :  10.1186/1471-2458-14-834

 received in 2014-02-03, accepted in 2014-07-29,  发布年份 2014

【 摘 要 】

Background

Tackling childhood obesity is one of the major contemporary public health policy challenges and vital in terms of addressing socioeconomic health inequalities.

We aimed to systematically review studies of the effectiveness of interventions (individual, community and societal) operating via different approaches (targeted or universal) in reducing socio-economic inequalities in obesity-related outcomes amongst children.

Methods

Nine electronic databases were searched from start date to October 2012 along with website and grey literature searches. The review examined the best available international evidence from interventions that aimed to prevent obesity, treat obesity, or improve obesity-related behaviours (diet and/or physical activity) amongst children (aged 0-18 years) in any setting and country, so long as they provided relevant information and analysis on both socioeconomic status and obesity-related outcomes. Data extraction and quality appraisal were conducted using established mechanisms and narrative synthesis was conducted.

Results

We located 23 studies that provided the ‘best available’ (strongest methodologically) international evidence. At the individual level (n = 4), there was indicative evidence that screen time reduction and mentoring health promotion interventions could be effective in reducing inequalities in obesity. For the community level interventions (n = 17), evidence was inconclusive - with some studies suggesting that school-based health promotion activities and community-based group-based programmes were effective in reducing obesity - others not. Societal level evaluations were few (n = 1). However, there was no evidence to suggest that any of these intervention types increase inequalities and several studies found that interventions could at least prevent the widening of inequalities in obesity. The majority of studies were from America and were of 6-12 year old children.

Conclusions

The review has found only limited evidence although some individual and community based interventions may be effective in reducing socio-economic inequalities in obesity-related outcomes amongst children but further research is required, particularly of more complex, societal level interventions and amongst adolescents.

【 授权许可】

   
2014 Hillier-Brown et al.; licensee BioMed Central Ltd.

【 图 表 】

Figure 1.

【 参考文献 】

• [1]Lobstein T, Baur L, Uauy R: Obesity in children and young people: a crisis in public health. Obes Rev 2004, 5:4-85.
• [2]Wang Y, Lobstein T: Worldwide trends in childhood overweight and obesity. Int J Pediatr Obes 2006, 1:11-25.
• [3]Reilly JJ, Kelly J: Long-term impact of overweight and obesity in childhood and adolescence on morbidity and premature mortality in adulthood: systematic review. Int J Obes 2011, 35:891-898.
• [4]Rossen LM, Schoendorf KC: Measuring health disparities: trends in racial - ethnic and socioeconomic disparities in obesity among 2- to 18-year old youth in the United States, 2001–2010. Ann Epidemiol 2012, 22:698-704.
• [5]El-Sayed A, Scarborough P, Galea S: Socioeconomic inequalities in childhood obesity in the United Kingdom: a systematic review of the literature. Obes Facts 2012, 5:671-692.
• [6]Howe LD, Tilling K, Galobardes B, Smith GD, Ness AR, Lawlor DA: Socioeconomic disparities in trajectories of adiposity across childhood. Int J Pediatr Obes 2011, 6:e144-e153.
• [7]Moschonis G, Tanagra S, Vandorou A, Kyriakou AE, Dede V, Siatitsa PE, Koumpitski A, Androutsos O, Grammatikaki E, Kantilafti M, Naoumi A, Farmaki AE, Siopi A, Papadopoulou EZ, Voutsadaki E, Chlouveraki F, Maragkopoulou K, Argyri E, Giannopoulou A, Manios Y: Social, economic and demographic correlates of overweight and obesity in primary-school children: preliminary data from the Healthy Growth Study. Public Health Nutr 2010, 13:1693-1700.
• [8]Friel S, Chopra M, Satcher D: Unequal weight: equity oriented policy responses to the global obesity epidemic. BMJ 2007, 335:1241-1243.
• [9]OECD: Obesity and the Economics of Prevention: Fit not Fat. Paris: OECD Publishing; 2010. http://www.oecd.org/els/health-systems/obesityandtheeconomicsofpreventionfitnotfat.htm webcite ISBN: 978-92-64-06367-9 (print); ISBN: 978-92-64084865 (PDF); Publication date: 23 September 2010
• [10]Shrewsbury V, Wardle J: Socioeconomic status and adiposity in childhood: a systematic review of cross-sectional studies 1990–2005. Obesity 2008, 16:275-284.
• [11]Gordon D, Shaw M, Dorling D, Davey Smith G: Inequalities in Health: The Evidence Presented to the Independent Inquiry into Inequalities in Health, chaired by Sir Donald Acheson. Bristol: University of Bristol: Policy Press; 1999. http://www.policypress.co.uk/display.asp?K=9781861341747&sf1=keyword&st1=+ISBN+1+86134+174+1&m=1&dc=2 webcite ISBN 1 86134 174 1
• [12]White M, Adams J, Heywood P: How and why do Interventions That Increase Health Overall Widen Inequalities Within Populations? In Health, Inequality and Public Health. Volume 65. Edited by Barbones S. Bristol: Policy Press; 2009.
• [13]European strategies for tackling social inequities in health: levelling up part 2 Available at: http://www.who.int/social_determinants/resources/leveling_up_part2.pdf webcite
• [14]Graham H, Kelly M: Health Inequalities: Concepts, Frameworks and Policy. London: Health Development Agency; 2004.
• [15]Whitehead M, Dahlgren G: Concepts and Principles for Tackling Social Inequities in Health: Levelling Up Part 1. Copenhagen: WHO Regional Office for Europe; 2006.
• [16]Lorenc T, Petticrew M, Welch V, Tugwell P: What types of interventions generate inequalities? Evidence from systematic reviews. J Epidemiol Community Health 2013, 67:190-193.
• [17]Brown T, Platt S, Amos A: Equity impact of population-level interventions and policies to reduce smoking in adults: a systematic review. Drug Alcohol Depend 2014, 138:7-16.
• [18]Barr B, Bambra C, Whitehead M, Duncan WH: The impact of NHS resource allocation policy on health inequalities in England 2001-11: longitudinal ecological study. BMJ 2014., 348
• [19]Magnée T, Burdorf A, Brug J, Kremers SP, Oenema A, van Assema P, Ezendam NP, van Genugten L, Hendriksen IJ, Hopman-Rock M, Jansen W, de Jong J, Kocken PL, Kroeze W, Kwak L, Lechner L, de Nooijer J, van Poppel MN, Robroek SJ, Schreurs H, van Sluijs EM, Steenhuis IJ, van Stralen MM, Tak NI, te Velde SJ, Vermeer WM, Wammes B, van Wier MF, van Lenthe FJ, Jansen W, et al.: Equity-specific effects of 26 Dutch obesity-related lifestyle interventions. Am J Prev Med 2013, 44:57-66.
• [20]Vander Ploeg KA, Maximova K, McGavock J, Davis W, Veugelers P: Do school-based physical activity interventions increase or reduce inequalities in health? Soc Sci Med 2014, 112:80-87.
• [21]Egan M, Bambra C, Petticrew M, Whitehead M: Reviewing evidence on complex social interventions: appraising implementation in systematic reviews of the health effects of organisational-level workplace interventions. J Epidemiol Commun Health 2009, 63:4-11.
• [22]Durand MA, Carpenter L, Dolan H, Bravo P, Mann M, Bunn F, Elwyn G: Do interventions designed to support shared decision-making reduce health inequalities? A systematic review and meta-analysis. PLoS One 2014., 9
• [23]Butland B, Jebb S, Kopelman P, McPherson K, Thomas S, Mardell J, Parry V: Tackling Obesities: Future Choices - Project Report. London: Government Office for Science; 2007.
• [24]Law C, Power C, Graham H, Merrick D: Obesity and health inequalities. Obes Rev 2007, 8:19-22.
• [25]Whitehead M: A typology of actions to tackle social inequalities in health. J Epidemiol Community Health 2007, 61:473-478.
• [26]Hillier-Brown F, Bambra C, Cairns-Nagi J-M, Kasim A, Moore H, Summerbell C: A systematic review of the effectiveness of individual, community and societal level interventions at reducing socioeconomic inequalities in obesity amongst adults. Int J Obes (Lond) 2014. Epub ahead of print
• [27]Bambra C, Hillier F, Moore H, Summerbell C: Tackling inequalities in obesity: a protocol for a systematic review of the effectiveness of public health interventions at reducing socioeconomic inequalities in obesity amongst children. Syst Rev 2012, 1:16.
• [28]PHR - Funded projects http://www.phr.nihr.ac.uk/funded_projects/obesity.asp webcite
• [29]McLaren L, McIntyre L, Kirkpatrick S: Rose’s population strategy of prevention need not increase social inequalities in health. Int J Epidemiol 2010, 39:372-377.
• [30]Waters E, de Silva-Sanigorski A, Hall B, Brown T, Campbell K, Gao Y, Armstrong R, Prosser L, Summerbell C: Interventions for preventing obesity in children. Cochrane Database Syst Rev 2011., 12CD001871
• [31]Effective public health practice project quality assessment tool for quantitative studies http://www.ephpp.ca/tools.html webcite
• [32]Taveras EM, Gortmaker SL, Hohman KH, Horan CM, Kleinman KP, Mitchell K, Price S, Prosser LA, Rifas-Shiman SL, Gillman MW: Randomized controlled trial to improve primary care to prevent and manage childhood obesity: the High Five for Kids study. Arch Pediatr Adolesc Med 2011, 165:714-722.
• [33]Wake M, Baur LA, Gerner B, Gibbons K, Gold L, Gunn J, Levickis P, McCallum Z, Naughton G, Sanci L, Ukoumunne OC: Outcomes and costs of primary care surveillance and intervention for overweight or obese children: the LEAP 2 randomised controlled trial. BMJ: Bri Med J 2009., 339
• [34]Epstein LH, Roemmich JN, Robinson JL, Paluch RA, Winiewicz DD, Fuerch JH, Robinson TN: A randomized trial of the effects of reducing television viewing and computer use on body mass index in young children. Arch Pediatr Adolesc Med 2008, 162:239-245.
• [35]Black MM, Hager ER, Le K, Anliker J, Arteaga SS, Diclemente C, Gittelsohn J, Magder L, Papas M, Snitker S, Treuth MS, Wang Y: Challenge! Health promotion/obesity prevention mentorship model among urban, black adolescents. Pediatrics 2010, 126:280-288.
• [36]Kain J, Uauy R, Albala , Vio F, Cerda R, Leyton B: School-based obesity prevention in Chilean primary school children: methodology and evaluation of a controlled study. Int J Obes Relat Metab Disord 2004, 28:483-493.
• [37]Jansen W, Borsboom G, Meima A, Zwanenburg EJV, MacKenbach JP, Raat H, Brug J: Effectiveness of a primary school-based intervention to reduce overweight. Int J Pediatr Obes 2011, 6:e70-e77.
• [38]Nemet D, Geva D, Eliakim A: Health promotion intervention in low socioeconomic kindergarten children. J Pediatr 2011, 158:796-801. e791
• [39]Bingham M: Mediators and Moderators of the Effects of a children’s Heart Health Intervention. Chapel Hill: University of North Carolina; 2002.
• [40]Simon C, Schweitzer B, Oujaa M, Wagner A, Arveiler D, Triby E, Copin N, Blanc S, Platat C: Successful overweight prevention in adolescents by increasing physical activity: a 4-year randomized controlled intervention [Erratum appears in Int J Obes (Lond). 2008 Oct;32(10):1606]. Int J Obes (Lond) 2008, 32:1489-1498.
• [41]Bellows LL: Development and Evaluation of Food Friends get movin’ With Mighty Moves(tm), a Physical Activity Program to Prevent Obesity in low-Income Preschoolers. Colorado: ProQuest Information & Learning; 2007.
• [42]de Meij JS, Chinapaw MJ, van Stralen MM, van der Wal MF, van Dieren L, van Mechelen W: Effectiveness of JUMP-in, a Dutch primary school-based community intervention aimed at the promotion of physical activity. Br J Sports Med 2011, 45:1052-1057.
• [43]Herrick H, Thompson H, Kinder J, Madsen KA: Use of SPARK to promote after-school physical activity. J School Health 2012, 82:457-461.
• [44]Lubans DR, Morgan PJ, Okely AD, Dewar D, Collins CE, Batterham M, Callister R, Plotnikoff RC: Preventing obesity among adolescent girls: one-year outcomes of the nutrition and enjoyable activity for teen girls (NEAT Girls) cluster randomized controlled trial. Arch Pediatr Adolesc Med 2012, 166:821-827.
• [45]Sichieri R, Paula Trotte A, de Souza RA, Veiga GV: School randomised trial on prevention of excessive weight gain by discouraging students from drinking sodas. Public Health Nutr 2008, 12:197-202.
• [46]Walter HJ, Hofman A, Connelly PA, Barrett LT, Kost KL: Primary prevention of chronic disease in childhood: changes in risk factors after one year of intervention. Am J Epidemiol 1985, 122:772-781.
• [47]Robinson TN: Reducing children’s television viewing to prevent obesity: a randomized controlled trial. JAMA 1999, 282:1561-1567.
• [48]Kalavainen MP, Korppi MO, Nuutinen OM: Clinical efficacy of group-based treatment for childhood obesity compared with routinely given individual counseling. Int J Obes (Lond) 2007, 31:1500-1508.
• [49]Alves JGB, Gale CR, Souza E, Batty GD: Effect of physical exercise on bodyweight in overweight children: a randomized controlled trial in a Brazilian slum. Original Title Efeito do exercicio fisico sobre peso corporal em criancas com excesso de peso: Ensaio clinico comunitario randomizado em uma favela no Brasil. Cad Saude Publica 2008, 24:S353-S359.
• [50]Robinson TN, Killen JD, Kraemer HC, Wilson DM, Matheson DM, Haskell WL, Pruitt LA, Powell TM, Owens AS, Thompson NS, Flint-Moore NM, Davis GJ, Emig KA, Brown RT, Rochon J, Green S, Varady A: Dance and reducing television viewing to prevent weight gain in African-American girls: the Stanford GEMS pilot study. Ethn Dis 2003, 13:S65-S77.
• [51]Willet SL: Health Risk Reduction Among African-American Females: A one Year Follow-up. ProQuest Information & Learning; 1995.
• [52]Hamad R, Fernald LCH, Karlan DS: Health education for microcredit clients in Peru: a randomized controlled trial. BMC Public Health 2011., 11
• [53]Bürgi F, Niederer I, Schindler C, Bodenmann P, Marques-Vidal P, Kriemler S, Puder JJ: Effect of a lifestyle intervention on adiposity and fitness in socially disadvantaged subgroups of preschoolers: a cluster-randomized trial (Ballabeina). Prev Med 2012, 54:335-340.
• [54]Puder J, Marques-Vidal P, Schindler C, Zahner L, Niederer I, Bürgi F, Ebenegger V, Nydegger A, Kriemler S: Effect of multidimensional lifestyle intervention on fitness and adiposity in predominantly migrant preschool children (Ballabeina): cluster randomised controlled trial. BMJ: British Med J (Overseas & Retired Doctors Edition) 2011, 343:945-945.
• [55]Sanigorski AM, Bell AC, Kremer PJ, Cuttler R, Swinburn BA: Reducing unhealthy weight gain in children through community capacity-building: results of a quasi-experimental intervention program, Be Active Eat Well. Int J Obes (Lond) 2008, 32:1060-1067.
• [56]Mantziki K, Vassilopoulos A, Radulian G, Borys J-M, du Plessis H, Gregório MJ, Graça P, de Henauw S, Handjiev S, Visscher TLS, Seidell JC: Promoting health equity in European children: design and methodology of the prospective EPHE (Epode for the Promotion of Health Equity) evaluation study. BMC Public Health 2014., 14