Evidence based interventions for childhood obesity

Berge, phd, lmft, department of family medicine and community health, university of minnesota, phillips wangensteen building, 516 delaware street se, minneapolis, mn 55455, email:email: @9000lhomauthor information ► copyright and license information ►copyright 2011, mary ann liebert, article has been cited by other articles in ctbackground: with the rising prevalence of childhood obesity over the last several decades, and the call for more family-based intervention research to combat childhood obesity, it is important to examine the extant research on family-based interventions in order to make recommendations and improve future ive: to conduct a meta-analysis of family-based interventions targeting childhood obesity in the last decade in order to inform the research in the next s: a literature review was conducted between december 2009-april 2010. Studies published between the years 2000–2009 that used family-based interventions to treat childhood obesity were included. A total of 20 studies met inclusionary s: although results varied by study design, the majority of studies had a moderate to large effect size for change in the target child's bmi (bmi percentile, zbmi, percent overweight) after participating in a family-based intervention. Change in secondary variables (dietary intake, sugar-sweetened beverage intake, physical activity) were substantially different between studies and are reported as sion: to date, there is preliminary evidence suggesting that family-based interventions targeting childhood obesity are successful in producing weight loss in the short and long-term. Limitations with the research, recommendations for future research, and implications for practitioners working with overweight/obese children are uctionover the last two decades obesity prevalence in children has more than doubled,1–3 childhood overweight and obesity are associated with increased risk for adverse health problems, including hypertension, cardiovascular disease, metabolic syndrome, and type ii diabetes. These expert panels and committees, along with other researchers, have identified family involvement in the treatment of childhood obesity as a neglected area of research and have called for more family-based interventions. 10 thus, the purpose of this meta-analysis is to assess the state of the science on family-based interventions targeting childhood obesity in the last decade, in order to determine the success of these interventions and inform research in the next systems theoryfamily systems theory indicates that families live in complex systems in which multiple interactions occur simultaneously. These mutually influencing patterns within the family are important to consider when designing childhood obesity interventions because targeting child health behaviors may be contingent on family interactions and modeling. Thus, this meta-analysis uses family systems theory to guide the understanding of findings from family-based interventions used in treating childhood obesity in the last of the researchprior to the year 2000there have been very few family-based interventions to treat childhood obesity prior to the year 2000. 14,15 family-based interventions include the target children and one or more family member(s) directly involved in the treatment intervention. The most successful family-based obesity treatment interventions have been conducted by epstein and his colleagues in a clinical setting using the stoplight diet. Although these findings are promising, participants in epstein's studies have been primarily white and from higher socio-economic classes and there have been few other family-based intervention studies conducted in order to compare findings. Thus, this meta-analysis focuses on studies conducted in the last decade in order to identify the state of the research on family-based interventions during the time when calls for family-based interventions were sstudy abstractionwe followed the recommendations of lipsey and wilson for study abstraction. Searches were performed on pubmed, medline, psycinfo, cochrane library, cinahl and social science abstracts search engines using various combinations of the following key terms: child, childhood, obesity, overweight, family, family-based, parent, treatment, weight-loss, interventions. Second, the tables of content for journals that commonly publish in childhood obesity studies were reviewed (e. Journal of pediatrics, preventive medicine, journal of pediatric psychology, journal of family psychology, american journal of public health, journal of the american dietetic association, obesity). Fourth, established researchers in the field of childhood obesity treatment were contacted and asked for copies of unpublished articles (under review or in press). After applying the inclusion criteria (described below) to all studies, a final sample of 20 family-based intervention studies were eligible for the current analysis (table 1). Based intervention studies to reduce childhood overweight/obesity included in the meta-analysisinclusion/exclusion criteriastudies were selected for inclusion in the meta-analysis if they met the following criteria: 1) published in peer-reviewed journals between 2000 and 2009; 2) written in english; 3) studies were childhood obesity interventions (treatment not prevention). Studies were not required to be randomized control trials (rct's) because this is a relatively new area of research and there were few rct's that included family members directly in interventions; 4) included a member or members of the target child's family in the intervention; the parent or family member component was defined as an intervention strategy that directly engaged parent or family member support or assistance in child health behavior change; 5) recruited children between the ages 5–18; and 6) included pre- and post- measurements of body mass index (bmi) (e. Due to the relatively small amount of studies using family-based interventions, we included all available studies in the meta-analysis as a first step in understanding the existing literature on family-based treatment extractiondata from the studies were extracted using standardized forms developed by the authors. Thus, effect sizes are calculated based on the difference in pre- and post- intervention measures for treatment conditions as compared to control groups or in isolation, as appropriate given each study sresults of the meta-analysis are presented in order by research design and the primary outcome variable (bmi percentile, zbmi, % overweight). Variablesa number of studies examined links between family-based interventions for child obesity and secondary health outcomes for the target child(ren), such as fruit/vegetable intake, consumption of water and sugar-sweetened beverages, physical activity and sedentary behaviors. None of the reviewed articles compared changes in secondary health variables between two treatment sionthe main aim of this meta-analysis was to identify the state of the research on family-based interventions targeting childhood obesity in the last decade, in order to inform research in the next decade. The majority of the studies, 70%, showed statistically significant moderate to large effect size changes in child bmi, after participating in a family-based intervention for weight loss.

The most effective interventions for childhood obesity are

Thus, the scientific evidence suggests the usefulness of using family-based interventions in childhood obesity treatment. Overall, there has been movement to respond to the calls by expert panels and committees to include the family in childhood obesity interventions. Strengths and limitations of the studies in the meta-analyses provide implications to guide future research and clinical practice in the next ths of the researchthe studies in the meta-analysis had several strengths including: being family-based, using comparison groups and randomized controlled designs, follow-up designs, and well-researched le family members. There are still unanswered questions regarding whether it is important if the involved parent is the same-sex or opposite-sex of the target child, or whether the intervention should target only the parent in treating childhood obesity. Long term follow-up studies are important for establishing the success of family-based interventions in producing sustainable weight loss over time in children. With the issue of childhood obesity especially, it is important to be able to show continued weight loss or maintenance in order to counteract the devastating outcomes of adult obesity such as: hypertension, cardiovascular disease, metabolic syndrome, and type ii diabetes. The curriculum used in the family-based interventions included three main components: (1) nutritional and physical activity education, (2) psychoeducational parenting groups, and (3) behavioral control/monitoring of diet and exercise. The interventions that targeted both parenting skills and nutrition/physical activity education showed more statistically significant results with larger effect sizes compared to interventions that used education only or education plus behavioral control/monitoring. This implies the importance of teaching parents both structure/setting limits skills and empathic/caring skills in treating childhood n and colleagues' stoplight diet was used in 40% (8 of 20) of the studies. This family-based curriculum has been shown to produce significant weight loss in children and their family members at 6 month, -2 year and -10 year follow-up time points. These include: increasing sample diversity, measurement of bmi, need for theory driven research, need for long-term follow up studies, importance of sex comparisons, and a need for more family-based research conducted by various diversity. This is a limitation of the current research on family-based interventions that needs to be addressed. It is well known that ethnic/racial minorities are at highest risk for overweight/obesity. 3 thus, it is crucial to identify family-based interventions that are suitable for children from diverse ethnic/racial and low socioeconomic backgrounds. 48 based on the results of this meta-analysis, and the importance of “family” to many ethnic/racial groups, family-based interventions targeting minority children need to be developed and ement of bmi. Although a few (n=4) studies examined links between family-based childhood obesity interventions and secondary health outcomes (e. These significant findings suggest that it would be important to measure secondary outcomes in childhood obesity intervention research. This is important because it is likely that there are multiple pathways to child weight change, rather than a magic variable or program that will solve the childhood obesity problem. Dietary intake, physical activity) as primary study outcomes, rather than secondary, in childhood obesity treatment studies. As family-based intervention research continues to show significant results for treating childhood obesity, it will be important to use theory in conceptualizing study designs that will allow for sustainability of weight loss in children. Although the last decade has shown an increase in family-based interventions for childhood obesity, more is needed. More studies, conducted by more researchers, are necessary in order to firmly establish the evidence in favor of family-based interventions. While epstein's work has provided a good solid path for family-based intervention research, it would be important for different researchers to replicate findings and conduct studies with more diverse populations. This would help confirm the evidence supporting family-based interventions to target childhood ations for clinical practiceresults from the current meta-analysis provide implications for practitioners who treat children with overweight and obesity issues. First, results suggest that referring children with overweight or obesity concerns to family-based interventions is a good option for practitioners.

The current meta-analysis showed moderate to large effect sizes for effectiveness of family-based interventions in reducing child weight. This means that the change in child weight was more likely due to the family-based intervention versus another factor. Interventions that include one parent visit, or only send home materials for parents, are not considered family-based interventions. The current meta-analysis showed that including at least one parent in the childhood obesity intervention was important and that the sex of the parent may also be important. In addition, family-based interventions that showed child weight loss in the short and long term were more likely to target weight change/management in the child, as well as, the parent/family. Thus, identifying family-based interventions that include both individual level change and system level change (e. Epstein's stop light diet) would be important in order for practitioners to have resources to provide referrals to families with children who are overweight/gh findings from the met-analysis show positive results for using family-based interventions to combat childhood obesity, family-based interventions or treatment centers are not always readily available to providers. Many pediatric specialty clinics, or clinics located at research universities have family-based obesity treatment programs. In addition, many community mental health clinics are beginning to include obesity treatment options, but it is important to identify whether they are individually-based treatments or family-based treatments. Further, there is likely to be more childhood obesity intervention options available in the near future as the topic has become one of national and international importance. Is preliminary evidence suggesting that family-based interventions treating childhood obesity are successful in producing weight loss in the short and long term. Ogden cl, carroll md, curtin lr, mcdowell ma, tabak cj, flegal ence of overweight and obesity in the united states, 1999–2004. Review of familial correlates of child and adolescent obesity: what has the 21st century taught us so far? Kitzmann km, beech -based interventions for pediatric obesity: methodological and conceptual challenges from family psychology. Epstein lh, paluch ra, roemmich jn, beecher -based obesity treatment, then and now: twenty-five years of pediatric obesity treatment. Epstein lh, valoski a, wing rr, mccurley -year outcomes of behavioral family-based treatment for childhood obesity. Bermudez de la vega ja, vazquez ma, bernal s, gentil fj, gonzalez-hachero j, montoya pometric, bone age, and bone mineral density changes after a family-based treatment for obese children. Germann jn, kischenbaum d, rich and parental self-monitoring as determinants of success in the treatment of morbid obesity in low-income minority children. Levine md, ringham rm, kalarchian ma, wisniewski l, marcus family-based behavioral weight control appropriate for severe pediatric obesity? Goldfield gs, epstein lh, kilanowski ck, paluch ra, kogut-bossler -effectiveness of group and mixed family-based treatment for childhood obesity. Epstein lh, paluch ra, saelens be, ernst mm, wilfley s in eating disorder symptoms with pediatric obesity treatment. Beech bm, klesges r, kumanyika sk, murray dm, klesges l, mcclanahan b, slawson d, nunnally c, rochon j, mclain-allen b, pree-cary - and parent-targeted interventions: the memphis gems pilot study. Epstein lh, paluch ra, raynor differences in obese children and siblings in family-based obesity treatment. Kalavainen mp, korppi mo, nuutinen al efficacy of group-based treatment for childhood obesity compared with routinely given individual counseling. Janicke dm, sallinen bj, perri mg, lutes ld, huerta m, silverstein jh, brumback ison of parent-only vs family-based interventions for overweight children in underserved rural settings: outcomes from project story.

Epstein lh, gordy cc, raynor ha, beddome m, kilanowski ck, paluch sing fruit and vegetable intake and decreasing fat and sugar intake in families at risk for childhood obesity. Temple jl, wrotniak bh, paluch ra, roemmich jn, epstein onship between sex of parent and child on weight loss and maintenance in a family-based obesity treatment program. Mcgarvey e, keller a, forrester m, williams e, seward d, suttle ility and benefits of a parent-focused preschool child obesity intervention. Danielzik s, pust s, muller -based interventions to prevent overweight and obesity in prepubertal children: process and 4-years outcome evaluation of the kiel obesity prevention study (kops). Lytle la, murray dm, perry cl, et -based approaches to affect adolescents' diets: results from the teens study. School-based intervention to reduce overweight and inactivity in children aged 6–12 years: study design of a randomized controlled trial. Barlow committee recommendations regarding the prevention, assessment, and treatment of child and adolescent overweight and obesity: summary report. Katz -based interventions for health promotion and weight control: not just waiting on the world to change. In press [pmc free article] [pubmed]articles from childhood obesity are provided here courtesy of mary ann liebert, s:article | pubreader | epub (beta) | pdf (1. Findings may be used for research purposes, but should not be considered ood obesity is a serious health problem in the united states and worldwide. We assessed the effectiveness of childhood obesity prevention programs by reviewing all interventional studies that aimed to improve diet, physical activity, or both and that were conducted in schools, homes, primary care clinics, childcare settings, the community, or combinations of these settings in high-income countries. Body mass index [bmi], waist circumference, percent body fat, skinfold thickness, prevalence of obesity and overweight); intermediate outcomes (e. Together, the reviewers graded the strength of the evidence (soe) supporting interventions--diet, physical activity, or both--in each setting for the outcomes of interest. The majority of the interventions (104 studies) were school based, although many of them included components delivered in other settings. Other studies tested interventions delivered at home (n=6), in primary care (n=1), in childcare (n=4), and in the community (n=9). For obesity prevention, the following settings and interventions showed benefit: school-based--diet or physical activity interventions (soe moderate); school-based with a home component--physical activity interventions (soe high) and both diet and physical activity (soe moderate); school-based with home and community components--diet and physical activity interventions (soe high); school-based with a community component--diet and physical activity interventions (soe moderate); community with a school component--diet and physical activity interventions (soe moderate). The strength of the evidence is either low or insufficient for the remainder of the interventions and evidence is moderate about the effectiveness of school-based interventions for childhood obesity prevention. Physical activity interventions in a school-based setting with a family component or diet and physical activity interventions in a school-based setting with home and community components have the most evidence for effectiveness. More research is needed to test interventions in other settings, such as those testing policy, environmental, and consumer health informatics l, wu y, wilson rf, et al. Pmid: may also be interested in:Obesity prevention and atic ative effectiveness, safety and indications of pre-mixed insulin analogues for adults with type 2 es in nutrition: an international review to main page ce-based obesity prevention in childhood and adolescence: critique of recent etiological studies, preventive interventions,Physical activity for health group, school of psychological sciences and health, university of strathclyde, glasgow, uk. E-mail: {at}tion of obesity in childhood and adolescence remains a worthwhile and realistic goal, but preventive efforts have by a number of problems, which are the subject of this review. The review draws on recent systematic reviews and sals and has a united kingdom (uk) perspective because there is a rich evidence base in the united kingdom that helpful to obesity prevention researchers elsewhere. Recent evidence of a leveling off in child and adolescent ence in some western nations should not encourage the belief that the obesity prevention problem has been solved, although. An adequate body of es behavioral targets of preventive interventions, and there are frameworks for prioritizing these targets models for translating them into generalizable interventions with a wide reach (e. An improved understanding of the “energy gap” that children and adolescents experience would be the design of preventive interventions and to their tailoring to particular groups.

In the united kingdom, some gical evidence has been taken as indicative of the need for paradigm shifts in obesity prevention, but this single studies has not been replicated, and paradigm shifts probably occur only rarely. Ensuring that the evidence etiology and prevention influences policy effectively remains one of the greatest challenges for childhood obesity us sectionnext y prevalence in childhood and adolescence has increased markedly across most of the globe in the past few decades (1), and prevalence is now high. A large number of excessively fat children and adolescents will not be identified as obese based on their bmi (3). The recent systematic review also found that the widely used cole-international obesity task force bmi–based childhood and adolescent obesity are even more conservative than most definitions based on national reference data (3). Where national reference data for bmi have been obtained after the obesity epidemic, use of the cole-international force definitions may be less conservative than use of national reference data (4). A recent concern is the increasing evidence that adverse cardiometabolic consequences are probably manifest to some a wide range of body fatness, below the thresholds of bmi that would usually be defined as overweight or obese (5). Systematic reviews have identified a wide range of comorbidities of childhood obesity, both in the short term [for child (6)] and the long term [for the adult obese as a child (7)]. A rapid, appropriate, and evidence-based (rather than belief-based), public health response to the epidemic of adolescent obesity has been problematic in the united kingdom and elsewhere. This review aims to provide a critique of the major challenges in evidence-based child and adolescent obesity prevention. Rich evidence base in the united kingdom that may provide lessons that are not well known but that may be helpful to tion in other countries. The critique aims to address the following questions: what is the appropriate response to ce that childhood obesity prevalence may be leveling off? What are the best evidence- based behavioral targets of entions and how should targets for interventions be chosen? Should the size of the energy gap, which has to be reduced to prevent obesity, ered when designing preventive interventions? How should the flood of new evidence on the etiology of obesity be obesity prevention interventions in future? The of addressing these questions is to help provide a framework that might make public health responses to the obesity evidence based and less belief based in us sectionnext childhood obesity prevalence leveling off or decreasing in the western world? Recent systematic review (8) summarized a relatively large body of evidence from a number of western nations showing that the rate of increase in ence of child and adolescent obesity has decreased and in some countries may have leveled off. This is a somewhat ation, given clear trends to rapid increases in obesity prevalence in the past decade (9). The course of the obesity epidemic in us children in the 1970s and detectable from population-based studies that used skinfold thickness measures, when it was not detectable in s that used bmi (10). In the united kingdom, secular trends toward increased obesity during the mid-1980s were detectable from trends in ference when these were not detectable from trends in bmi (11). In the united kingdom, for example, despite evidence of the leveling off of prevalence overall, there have been continuing increases in prevalence among children and adolescents of low socioeconomic status (12). However, population surveillance of childhood obesity surveillance in the united kingdom, based on national surveys , is not ideal for detecting differences in secular trends between subgroups because our surveys are rather small. From routine primary care health checks in early childhood and nurse checks later in childhood) provides much larger numbers that are helpful for surveillance (13), but concerns over the recent underrepresentation of the obese remain (2). The secular trends toward an increasing child and adolescent obesity prevalence are slowing in some western nations, be helpful to explore the likely reasons, because these could provide a useful guide to future health policy. It suggested that greater public awareness of childhood obesity may have contributed to the apparently encouraging , perhaps via changes in lifestyle. Although substantial media interest in this subject must have increased public some level, a systematic review found that parental awareness of childhood obesity was consistently limited (14), and more recent uk studies do not provide encouragement that parental perceptions of child weight status are realistic.

Recent longitudinal studies of cohorts of children in the united kingdom tend to show progressive increases with age prevalence of excess body fatness, bmi, and waist circumference z-scores and in the prevalence of overweight and obesity. Sectionnext are the most appropriate behavioral targets for obesity prevention interventions and how should targets be selected? Targets for preventive interventions should ideally involve an understanding of the complex evidence of the child and adolescent obesity combined with a logical framework for prioritizing potential targets. It should go , but recent experience in the united kingdom suggests that it is worth restating, that greatest confidence in come from systematic review and/or critical appraisal of the entire body of etiological evidence rather than from gical studies. 19), for example, highlighted the strength, quality, and consistency of evidence supporting the view that a number of s contribute to childhood obesity: excess tv viewing, low physical activity, excess consumption of sugar sweetened–drinks,Formula feeding in infancy, lack of sleep, maternal smoking during pregnancy, and rapid early growth. These lifestyle at least potentially modifiable, and reviews of the body of evidence should provide increased impetus for focus on enabling changes in these behaviors. In all cases, plausible mechanisms exist that explain why these bute to obesity risk in early life. Whether rapid early growth reflects a cause of later obesity or is simply an of an energy balance trajectory leading to later obesity is less clear, but regardless of which explanation applies,This evidence is still helpful in highlighting the potential importance of early life for public health efforts in established important and potentially modifiable behaviors as candidates for preventive intervention, a logical be to prioritize these. Anecdotally, the experience of the author in the united kingdom has been that some many policymakers have a tendency to prioritize candidate behaviors based on their beliefs and personal experiences, little or no reference to the evidence base, perhaps in part because the apparent simplicity of the etiology of not to require a detailed knowledge of the evidence. View to selecting the most appropriate behavioral targets in interventions, which has been largely ignored in the se in the united kingdom, was suggested by whitaker (20). In the united kingdom, obesity prevention interventions often focus on trying to change behaviors that are probably ant to the development of obesity and/or not readily modifiable. Whitaker (20) proposed that the behaviors that should be rated as most important in obesity prevention interventions should be those likely to be modifiable, be implicated in the etiology of childhood obesity, do no harm, and be helpful to child development in other us sectionnext are the most appropriate models in childhood obesity prevention? Identified and prioritized target behaviors, translation of this information into interventions requires evidence ention programs, ideally model interventions from the literature. Interventions that are likely to be to have a potentially wide reach and evidence of efficacy and, ideally, of effectiveness and cost-effectiveness, prioritized in policy. Such interventions are admittedly scarce in childhood obesity prevention, but systematic critical appraisals of the literature (21) suggest that the most promising model to date for school-based obesity prevention interventions is probably planet health,A potentially generalizable intervention with evidence of efficacy and cost-effectiveness, at least in the united states (22). Other interventions that are likely to be generalizable and that have evidence of efficacy should also be of great the united kingdom, for example, a very simple and low-cost primary school–based intervention showed efficacy at 1 y -up (23), although not at longer term follow-up (24). Recent experience united kingdom suggests that such model interventions are often ignored by researchers and policymakers in favor of are created de novo. One notable exception is the attempted translation of a successful us program to the united atic reviews of preventive interventions (21, 26) provide a convenient means of accessing the body of evidence. These reviews have noted weaknesses and gaps in the evidence,But have been encouraging about the prospects for preventive interventions (21, 26); evidence-based optimism might be the most informed view to take at present. In addition, a number of very recent entions have evidence of efficacy across a wide age range (27–29); this provides further grounds for optimism. One trend that is discernible in the evidence on intervention studies is cy for earlier interventions [in utero, in infancy, in early childhood (30, 31)]. Promotion of breastfeeding) could have s because many such interventions would have benefits for child health and development beyond the issue of obesity e the establishment of obesogenic behaviors may occur early in life (32). Few such early interventions have reported outcome data at us sectionnext is the energy gap responsible for childhood obesity? Evidence of the magnitude of positive energy balance would be helpful in determining how substantive the lifestyle ed by preventive interventions need to be and also be useful in understanding obesity etiology (33, 34). Because preventive interventions aim to reduce this energy gap, it is surprising that interventions are not tailored size of the gap more often and more explicitly.

Heterogeneity in the energy gap within populations (34), with a much larger gap in the overweight (33), for example, would provide a basis for more tailored interventions. Designing interventions to fit the energy gap enced by each population may therefore be helpful in future, and estimates of the size of the energy gap can be vely easily from long-term changes in body composition in children and adolescents participating in cohort ating new evidence of etiology and prevention into preventive interventions and sing interest in the topic of child and adolescent obesity has led to a rapid increase in the evidence base. One nge to the development of evidence-based preventive interventions is the issue of how to integrate new evidence existing body of evidence. As a general rule, research-based interventions and policies should be guided by the of evidence, based on the amount, quality, and consistency of the evidence as summarized in systematic reviews and sals (21, 26). Researchers and policymakers in the united kingdom have, in contrast, been tempted to see single studies as a for a paradigm shift in prevention; this is particularly problematic when single studies are inconsistent with the of evidence or when they are not replicated in subsequent recent examples from etiological studies in the united kingdom are worthy of note. However, this small single study was inconsistent with the larger body of evidence, including a much larger cohort southwest of england (39) born at around the same time, and so the extent to which it should induce a paradigm shift is second example concerns the question of when to carry out obesity prevention interventions, i. This is a complex issue that a number of factors, and preventive interventions should ideally be at least considered across the life course. Evidence focused on identifying periods of the life cycle when excessive weight gain is most marked to inform the when to set preventive interventions (40, 41). A recent review found that researchers were rarely explicit about the rationale for setting preventive interventions life stage rather than another (42). However, this observation was not replicated in a study of a much larger cohort from southwest england studied at same time (with a difference in birth periods of 3 y between cohorts), which found that mid to late childhood was greatest excess weight and bmi gain (41). In addition, annual incidence of new cases of obesity in the united kingdom, at least for children born in the early 1990s,Appears to be much higher in mid to late childhood (43) compared with early childhood and adolescence. This observation creates further doubts about the suggestion that the early childhood should be prioritized for preventive interventions in the united kingdom. Moreover, greater awareness -related and/or period-related differences or changes in the incidence and persistence of obesity would be helpful in in the life course to set interventions (43). Avoiding difficulties in the prioritizing of intervention efforts and making prioritization more evidence based in depend on a more cautious approach that recognizes that paradigm shifts are rare and that integrates new evidence existing evidence base more health policy in childhood obesity prevention should be developed cautiously and logically, informed by the body ce and useful logic frameworks that are specific to childhood obesity (20) and others not specific to obesity but likely to be helpful. This is not an argument for inaction: sufficient evidence has existed for some time to for concern over the epidemic of child and adolescent obesity; evidence is adequate at present to inform public us sectionnext ing policy by uk experience has been that matching the research evidence on child and adolescent obesity to national and local ses has been difficult. A number of problems have become apparent for obesity researchers, notably the lack of reviews on etiology, weighting single studies excessively relative to the rest of the body of evidence, identifying ors and model intervention programs that should be prioritized, disseminating research syntheses to policymakers, ention models from other settings such as the united states, failure to consider explicitly the stage of the life appropriate for interventions, and influencing policymakers in the face of what appears to many policymakers to be energy balance problem that must have simple solutions. More effective matching of evidence to policy would be policy responses are to become more logical and more effective in future. The field of policy development for obesity growing rapidly and has local, national, and global policy dimensions, but is beyond the scope of the current review (45, 46). Sectionnext review highlights a number of challenges for the development of more effective, evidence-informed strategies aimed tion of child and adolescent obesity. The possible leveling off of the childhood obesity epidemic in some nations create complacency that the problem has been solved. Preventive interventions and prevention policy should be explicitly by systematically reviewed and critically appraised summaries of the evidence and by the translation of important evidence of etiology into interventions and with greater use of the most important prevention us sectionnext sole author had responsibility for all parts of the us sectionnext section. Presented at the conference “2nd forum on child obesity interventions” held in mexico city, mexico, august 22–24, conference was organized and cosponsored by fundación mexicana para la salud a. Supplement coordinator disclosures: frania pfeffer is employed by funsalud,Which received a research donation from coca cola, pepsico, and peña fiel, 3 major beverage companies in mexico, to program of childhood obesity research and communication. Accuracy of simple clinical and epidemiological definitions of childhood obesity: systematic review and evidence appraisal. Impact of using national versus international definitions of adolescent underweight, overweight and obesity: an example .

Association between general and central adiposity in childhood, and change in these, with cardiovascular risk factors in adolescence:Prospective cohort study. Long-term impact of overweight and obesity in childhood and adolescence on morbidity and mortality in adulthood: . The levelling off of the obesity epidemic since the year 1999: a review of evidence and perspectives. Estimated burden of paediatric obesity and co-morbidities in europe part 1: the rate of increase in prevalence of y is itself increasing. Use of the national child health surveillance system for monitoring obesity, overweight, and underweight in scottish children. Preventing childhood obesity: two year follow up results from the christchurch obesity prevention programme in schools (chopps). The infant feeding activity and nutrition trial (infant): an early intervention to prevent childhood obesity; cluster lled trial. Physical activity, sedentary behaviour, and energy balance in the pre-school child: early opportunities for obesity prevention. Epidemiologic and physiologic approaches to understanding the etiology of pediatric obesity: finding the needle in the haystack. No evidence of large differences in mother-daughter and father-son body mass index concordance in a large uk birth cohort. Selection of priority groups for obesity prevention: current approaches and development of an evidence-informed approach. Assessing the options for local government to use legal approaches to combat obesity in the uk: putting the theory into practice. 3945/​ or purchase ment: 2nd forum on child obesity this article to a me when this article is me if a correction is e usage r articles in this r articles in web of r articles in ad to citation se a print copy of this ts and citing article articles via web of articles via google es by reilly, j. Related web page te this childhood obesity prevalence leveling off or decreasing in the western world? Are the most appropriate behavioral targets for obesity prevention interventions and how should targets be selected? Suite 300, rockville, md 20850; phone: an alternate route to adv nutr online use this url:Skip directly to directly to a to z directly to directly to page directly to site receive email updates about this page, enter your email address:Micronutrient and local tion strategies & end on ion, physical activity, and obesity prevention strategiesearly care and education strategiesschool health guidelinescommunity guideclinical reverse the obesity epidemic, places and practices need to support healthy eating and active living in many settings. Below are recommended strategies to prevent ion, physical activity, and obesity prevention cdc guide to strategies to increase physical activity in the community [pdf-1. Provides guidance for program managers, policy makers, and others on how to select strategies to increase the consumption of fruits and cdc guide to breastfeeding interventions provides state and local community members information to choose the breastfeeding intervention strategy that best meets their ended community strategies and measurements to prevent obesity in the united states [pdf-376kb] contains 24 recommended obesity prevention strategies focusing on environmental and policy level change initiatives that can be implemented by local governments and school districts to promote healthy eating and active entation and measurement guide [pdf-2. Can help communities implement the recommended obesity prevention strategies and report on the associated y communities: what local governments can do to reduce and prevent obesity [ppt-8. Is a presentation developed for use by local government staff that makes the case for investing in cdc’s recommended community strategies and measurements to prevent obesity in the united states [pdf – 375kb] . Care and education ’s framework for obesity prevention, in the ece setting is known as the spectrum of opportunities [pdf-287kb]. The spectrum identifies ways that states, and to some extent communities, can support child care and early education facilities to achieve recommended standards and best practices for obesity prevention. The spectrum aligns with comprehensive national ece standards for obesity prevention address nutrition, infant feeding, physical activity and screen time, caring for our children: national health and safety performance standards (cfoc), 3rd ed. Health health guidelines to promote healthy eating and physical activity provides nine guidelines that serve as the foundation for developing, implementing, and evaluating school-based healthy eating and physical activity policies and practices for students in grades -based obesity prevention strategies for state policymakers [pdf-240kb] is designed to assist program coordinators in their efforts to inform and engage governors, state agencies, and state boards of education on how they can help address childhood community guide – obesity prevention and control is a free resource to help you choose programs and policies to prevent and control obesity in your al guidelines on the identification, evaluation, and treatment of overweight and obesity in adults: the evidence report [pdf-1. Mb} are the first guidelines developed by the federal government to address overweight and ing for obesity in pediatric primary care: recommendations from the u.

Guidance for primary care providers in screening for obesity and weight management y and weight management in children and adolescents: screening and receive email updates about this page, enter your email address:Micronutrient and local formats help:how do i view different file formats (pdf, doc, ppt, mpeg) on this site? Powerpoint last reviewed: may 19, 2015 page last updated: january 4, 2017 content source:Division of nutrition, physical activity, and obesity, national center for chronic disease prevention and health promotion.