Obesity Review Paper 2018 Part B

Obesity Prevention Strategies

There is no definite path for the prevention of obesity as yet and debate continues on what the most appropriate set of actions and outcomes should be (Swinburn, Gill, & Kumanyika, 2005)). When designing strategies for obesity prevention interventions thought should be given to factors such as gender, age, culture so that strategies and key messages can be appropriately tailored. With an understanding of the socio-ecological framework and the complex determinants of obesity as portrayed by the Foresight model, the next section will present obesity prevention strategies for each component of the socio-ecological framework.

The methodology for evidence-based medicine, which relies on making clinical decisions utilising an evidence base which primarily involves rigorous randomised control trials, is not appropriate for the public health field given that this methodology is too artificial or unrealistic for the complex systems affecting population health (Swinburn, Gill, & Kumanyika, 2005)). Therefore, it is suggested that obesity prevention strategies should still be evidence based however, this means using the best evidence available, not always the best evidence possible (Swinburn, Gill, & Kumanyika, 2005)). To maximise the interactions between sites and promote rapid dissemination of findings into policy and practice, the CO-OPS Collaboration plays a vital role in capturing and synthesising this information to accelerate the translation of what has been learned on the ground, and put it into practice and policy (Swinburn, et al., 2007)).

Individual strategies

Issue - Reduced breastfeeding rates

• Recommended strategy - Access to information and professional support to promote breastfeeding.
• Example - Australian Breastfeeding Association provides the following services: classes; pump hire; email counselling, helpline, access to local support groups, online forums; many breastfeeding information resources.
• Useful resources - Australian Breastfeeding Association website

Issue - Increased intakes of energy-dense and nutrient-poor foods/drinks, and reduced levels of physical activity among children

• Recommended strategy - Communication to parents – about healthy lunchboxes, reducing screen time, promoting physical activity (walking, strength-based and other), active transport, reducing intakes of energy-dense nutrient poor foods/drinks at and away from home, promoting family meal times (without TV on).
• Example - Nutrition Australia website also has a diverse range of resources and services available regarding healthy eating, physical activity. Examples include Reclaim the lunchbox workshop for parents and newsletters.
• The National Health and Medical Research Council (2013) Australian Dietary Guidelines use the best available scientific evidence to provide information on the types and amounts of foods, food groups and dietary patterns that aim to promote health and wellbeing, reduce the risk of diet-related conditions, and reduce the risk of chronic disease, across all age groupings.

Issue - Increased intakes of energy-dense and nutrient-poor foods/drinks, and reduced levels of physical activity among adults

• Recommended strategy - Telephone and web-based lifestyle behaviour change programs.
• Example - NSW Get Healthy Information and Coaching Service. This is a free service for six months and includes support (ten free coaching calls), information (booklet, progress journal, online modules and resources), tools and calculators to track progress and success stories from other participants. Key themes include health eating, physical activity and achieving and maintaining a healthy weight.
• The Life! program is an alternative health coaching program to reduce the risk of type 2 diabetes, heart disease and stroke.

Issue - Increased intakes of energy-dense and nutrient-poor foods/drinks, and reduced levels of physical activity among adults

• Recommended strategy - Brief advice/guidelines for nutrition, physical activity and weight management.
• Example - The Australian Government's Department of Health Healthy Weight Guide contains guidelines to nutrition and physical activity (even over the different life stages), calculators (e.g. BMI, calorie/kilojoule calculator), and tip sheets.

Issue - Increased levels of overweight and chronic disease risk

• Recommended strategy - Health checks for individuals at high risk for chronic disease.
• Example - The Chronic Conditions Manual 1st edition 2015 - Prevention and Management of Diagnosed Conditions in Australia (Queensland Government) are an essential resource for staff to use in planning or delivery of prevention, detection and management activities and programs for chronic disease, including child and adult check procedure manuals, diagnosed condition guidelines, and care plan and screening summaries, with a specific focus upon the Indigenous population.

Inter-personal strategies

Issue - Reduced breastfeeding rates and unhealthy feeding practices among infants

• Recommended strategy - Community-based mother’s groups promoting breastfeeding and infant healthy eating practices.
• Example - Deakin University's Infant Program. Researchers from Deakin University in conjunction with the Royal Children’s Hospital developed and trialled the program across Victoria with very encouraging results. The program aim is to influence parents’ knowledge and parenting confidence and improve lifestyle behaviours of parents and children, by promoting healthy eating and active play behaviours. The program consists of six sessions delivered to parents of young infants over the first 18 months of the child’s life.
• The Growing Strong - Pregnancy, breastfeeding, food and drink for children (Queensland Government) resources were developed for Aboriginal and Torres Strait Islander families. Resources are available online; however health staff members are also able to talk to families about nutrition for mothers, babies (breastfeeding and the introduction of solids) and young children. Resources include brochures, information booklets, and flipcharts for health staff members.
• Fun not Fuss with Food (Queensland Government) - a program for health staff to provide nutrition information for parents. Resources include a powerpoint presentation, DVD and parent resource kit (fact sheets), tips for child friendly meals, food activities and games, healthy nutrition ideas.

Issue - Increased levels of sedentary behaviour and physical inactivity

• Recommended strategy - Group-based physical activity programs/classes.
• Example - Heart Foundation Walking website - The Heart Foundation has created an easy system online where you can join up to a walking group in your area. Walking groups are made up of a variety of individuals with varying physical activity abilities, diverse cultures and age groups.
• Heartmoves - The Heart Foundation has developed a low-to-moderate intensity exercise program for individuals who have health conditions. Individuals can search online for their closest local group.
• BEAT IT - The BEAT IT physical activity program was accredited Australian Diabetes Council and is a program suitable for individuals with diabetes, obesity, high blood pressure. BEAT IT classes are run twice a week and include aerobic and resistance training. Individuals can look online for the closest class in their area.

Issue - Increased intakes of energy-dense and nutrient-poor foods/drinks, and reduced levels of physical activity among adults

• Recommended strategy - Community-based lifestyle behaviour change programs.
• Example - Lighten Up to a Healthy Lifestyle Program (Queensland Health) developed this program for adults who want to eat well, be active, manage stress and have a sustainable healthy lifestyle. The program is delivered over 9-10 weeks by health professionals, with a mix of workshops and individual appointments.

Issue - Increased levels of overweight and chronic disease risk

• Recommended strategy - Community-based lifestyle behaviour change program for fathers and children.
• Example - Healthy Dads, Healthy Kids - This program has been developed with a primary aim of decreasing weight in fathers, along with helping fathers become a role model for health promoting behaviours to their children. These behaviours include physical activity, healthy eating, and ways to have fun and get fit with children. The program consists of seven weekly sessions (three for fathers only, four for fathers and children) which are delivered by trained facilitators.

Issue - Increased intakes of energy-dense and nutrient-poor foods/drinks, and reduced levels of physical activity among children and adolescents

• Recommended strategy - Culturally appropriate family-focused weight management programs.
• Example - Parenting, Eating and Activity for Child Health (PEACH) The PEACH program was initially run as a research project (2004), funded by National Health and Medical Research Council. The aim of the program was to take a whole-of-family approach and support families to manage their child’s weight by upskilling in nutrition, parenting and problem solving. The website contains resources such as nutrition and activity guidelines, healthy lunch box ideas, recipes, ideas to be physically active at home. Success of the project was demonstrated by a reduction in degree of overweight at the end of the program (six months) which was maintained over the next 18 months. Children’s behaviours were improved (increased fruit and vegetable intake, decreased intake of sweetened beverages and high fat/sugar foods, decreased screen time), improvements in parenting skills, good attendance rates at program sessions and a high level of satisfaction (99% parents would recommend the program to others).
• The Ethnic Communities Council of Queensland Living Well Multicultural Program. This program is designed for adults from culturally and linguistically diverse backgrounds (languages the program has been translated into include Arabic, Bosnian, Indian, Samoan, Sudanese, Vietnamese, Spanish). Sessions will help family and the community to make healthy lifestyle choices, manage any chronic disease and improve health. Sessions are chosen by the community and include presentations, food activities, discussions, DVDs, cooking demonstrations, games and quizzes.
• Useful resource - Living Strong Program (Queensland Health)

Issue - Increased intakes of energy-dense and nutrient-poor foods/drinks, and reduced levels of physical activity among families

• Recommended strategy - Community-based lifestyle behaviour change programs.
• Example – FOODcents. The Department of Health funds the Cancer Council WA and Diabetes WA to coordinate the program in WA. The aim of the program is to help educate families how to achieve a healthy diet which is good value for money. The website contains some great resources regarding how to eat smart, shop smart, cook smart and move smart.

Organisational strategies

Issue - Reduced breastfeeding rates

• Recommended strategy - Support for breastfeeding at the workplace and child-care centres.
• Example - The Australian Breastfeeding Association can provide a consultancy service for employers to examine how workplaces can be made more breastfeeding friendly, and receive a formal accreditation of being a Breastfeeding Friendly Workplace.
• Useful resources - Australian Breastfeeding Association Breastfeeding and Work website.

Issue - Increased intakes of energy-dense and nutrient-poor foods/drinks among infants and young children

• Recommended strategy - Strategies to reduce energy-dense, nutrient-poor foods/drinks in lunchboxes in child-care and schools.
• Example - The Australian Government Department of Health has developed Get Up & Grow resources for early childhood settings, families, staff and carers to provide a national consistent approach to childhood nutrition and physical activity. The Get up & Grow website with numerous resources including a director/coordinator book, a staff and carer book, a cooking for children book, a family book, posters, brochures and stickers. Resources have also been specifically developed for Aboriginal and Torres Strait Islander childcare educators, families and carers. The resources are also available in nine additional languages.
• Useful resources- Get Up & Grow: Healthy Eating and Physical Activity for Early Childhood resources

Issue - Increased intakes of energy-dense and nutrient-poor foods/drinks

• Recommended strategy - Professional development and capacity building of teachers, caterers, food service providers and other staff.
• Example - Nutrition Australia can provide a diverse variety of workshops for any nutrition topic of interest; can conduct menu assessments, parent workshops, nutrition and food handling courses.

Issue - Low levels of food literacy among children

• Recommended strategy - Nutrition, cooking and food preparation skills in education curriculum.
• Example -The Stephanie Alexander Kitchen Garden Foundation includes regular kitchen and garden classes with eight-twelve year old school children. The aim of the program is to establish positive eating habits that will last for life. Teachers are provided comprehensive training and resources to deliver the program, as well as the requirement of setting good examples and engaging children’s curiosity, energy and taste buds. It is hoped the skills learnt during the classes will enable children to grow and cook their own seasonal fruits and vegetables.

Issue - Reduced intakes of fruit and vegetables among children

• Recommended strategy - Subsidised fruit and vegetable programs in primary schools.
• Example - Free Fruit Friday was an initiative run by the previous Victorian Brumby government where the schools received a grant to purchase fruit for students in prep-grade 2 (fund allocation 70c/child) over a period of 3 years. However this initiative has ceased to exist in its current form and Boost Juice is currently running a campaign to fund and deliver fresh fruit to 300 Victorian schools (prep-grade 2). A website allows fruit sponsors to sign up and sponsor this activity in a particular school and options to sustain the program are currently being developed.

Issue - Increased levels of sedentary behaviour and physical inactivity among children

• Recommended strategy - Multi-component physical activity programs in schools.
• Example - Smart Moves - Physical Activity Programs in Queensland State Schools. From 2009 in all Queensland state schools, the Queensland Department of Education and Training implemented the Smart Moves initiative which had an aim of increasing physical activity participation, and the quality of activities delivered to all students.

Issue - Increased intakes of energy-dense and nutrient-poor foods/drinks, and reduced levels of physical activity among adults

• Recommended strategy - Workplace nutrition and physical activity programs (large, blue-collar industries).
• Example - The Australian Government's Healthy Workers initiative website. A comprehensive website which has resources for employees, and resources for employers with regarding to employee health and creating a healthier workplace. Topics include eating well, moving more, healthy weight, smoking e.g. being smoke free), alcohol, case studies with examples of what other workplaces have implemented, and resources for individual states and territories. There is also a calculator which will calculate the savings associated with a successful health program (including absenteeism and staff turnover).
• Nutrition Australia Workplace Health services includes deliverance of presentations to employees on a wide range of topics, cooking demonstrations, smoothie/soup/salad demonstrations, healthy food cook offs between employees, health displays, canteen menu assessments and one-to-one consultations.

Issue - Increased intakes of energy-dense and nutrient-poor foods/drinks, and reduced levels of physical activity among adults

• Recommended strategy - Workplace awards/incentives for environmental/infrastructure changes to the workplace (e.g. healthy catering/vending machine guidelines; end of trip facilities).
• Example - Healthy Choices Healthy Futures (HCHF) program, run by the Western Australian School Canteen Association (WASCA) provides support to workplaces in the area of nutrition. HCHF can provide advice, support and recommendations for any set up – whether it be the basic workplace kitchen or tea room, an on-site café or staff canteen, vending machines, fundraising gifts or the catering ordered for meetings and events.

Issue - Reduced levels of physical activity among adults

• Recommended strategy - Active travel
• Example - Warrnambool City Council Healthy Moves program. This is an initiative in Warrnambool, Victoria, which encourages primary school-aged children and their families to be active and healthy with a particular focus on encouraging children to use active transport (“use their feet and legs”) to get to school, and learn ways in which they can be more active, healthier and safe on streets and roads. Some of the strategies include walking groups to school, the Ride2School program (Bicycle Victoria), healthy food choices (pre-active travel to school), TravelSmart which raises active travel opportunities.

Community strategies

Issue - Increased levels of sedentary behaviour and physical inactivity

• Recommended strategy - Playground and green open space; Land use zoning near schools and public playgrounds; Walkable active urban design.
• Example - Heart Foundation's Healthy By Design. The goal of this initiative is to increase environmental support and opportunities for individuals to be physically active by integrating health into planning and designing spaces which encourage walking and cycling to local amenities, schools, parks and public transport. The website has resources such as a planner’s guide to developing an environment which promotes active living, and tools for assessment and design.

Issue - Reduced breastfeeding rates

• Recommended strategy - Parenting (breastfeeding) facilities in public venues.
• Example - Breastfeeding Welcome Here program. The Breastfeeding Welcome Here program was developed by the Australian Breastfeeding Association to improve community acceptability of breastfeeding in public by promoting breastfeeding friendly premises. Breastfeeding Welcome Here stickers can be displayed on the premises of these venues, upon the basis that three criteria are met: a) A welcoming attitude from staff and management of the venue, b) the venue is smoke free, and c) there is room to move a pram. Venues which display these stickers and fulfil the criteria can register themselves and subsequently mothers can find a list of venues which are breastfeeding friendly online.

Issue - Low levels of food literacy among adults

• Recommended strategy - Specific food access and availability interventions in disadvantaged communities (e.g. community kitchens).
• Example - Community Kitchens Australia. A national website has been developed for anyone interested in being involved in a Community Kitchen. Once registered as a member, individuals can access information on how to find a kitchen, how to set one up, how to volunteer in one, recipes and an online discussion forum. Community kitchens generally meet three times a month at a community venue (e.g. community centres, churches, welfare organisations, men’s sheds, clubs schools) with a session consisting of one facilitator and six participants. Two recipes are prepared (decided by a group vote) which are economical (approximately $2-$5/serve). Participants benefit from social skills, teamwork and leadership skills, how to budget, cook and shop, increased motivation to cook at home, how to access food, improved literacy and numeracy, and improved confidence and self-esteem.
• Useful resources - Jamie’s Ministry of Food Australia. Communities can apply to have a Ministry of Food pop-up kitchen for 12 months which will provide hands-on cooking classes, information about food (e.g. where it comes from, how to cook it, how it affects their bodies) and give families the skills to cook tasty, exciting and nutritious food.

Issue - Increased intakes of energy-dense and nutrient-poor foods/drinks

• Recommended strategy - Incentives for stores in disadvantaged areas to create a healthy food retail environment (e.g. encouraging farmer markets in “food deserts areas”).
• Example - Remote Indigenous Stores and Takeaways (RIST) Project. To improve access to healthy foods in Aboriginal and Torres Strait Islander People in remote communities, the Australian Government Health Departments (SA, WA, NT, QLD, NSW) designed a project to improve standards for healthy remote stores. The website for this project has an abundance of tools and resources such as:
  • Guidelines for stocking healthy food in community stores
  • How to maximise the shelf-life of fruit and vegetables
  • How to promote the sale of healthy food items (marketing ideas)
  • Healthy fast food manual – how to promote and support healthy eating with guidelines and recipes for takeaway venues
  • A healthy store checklist for store owners
  • A checklist to determine how healthy the takeaway venue is
  • A freight improvement toolkit to improve access to remote community stores
  • Heart Foundation buyer’s guide to help managers/owners of stores and takeaways decide which brands of foods and beverages are encouraged by the Heart Foundation
  • A practical tool to keep track of healthy food by retailers, store committees, health practitioners and researchers by entering sales data and providing data about the turnover of different foods.

Issue - Increased levels of sedentary behaviour and physical inactivity

• Recommended strategy - Point-of-decision prompts to encourage stair usage.
• Example - A systematic review of 16 studies revealed strong evidence to suggest that stairwell enhancements (e.g. painting the walls, adding carpet, artwork and playing music) combined with point of decision prompts were effective in increasing stair usage and may indirectly change attitudes towards using stairs.
• Useful resources - Soler RE, Leeks KB, Buchanan LR, Brownson RC, Heath GW, Hopkins DH. Point-of-decision prompts to increase stair use: a systematic review update. Am J Prev Med 2010; 38 (S2): S292-300.

Issue - Increased intakes of energy-dense and nutrient-poor foods/drinks

• Recommended strategy - Pricing strategies, prompts and promotions at point-of-purchase, and store layout redesign in grocery stores, vending machines, cafeterias and restaurants to support healthier choices.
• Example - Healthier Options for Vending - an Employer Resource (HOVER) by Eat Well Tasmania. HOVER takes a collaborative, cross sectoral approach to supporting healthy eating in Tasmanian workplaces by educating employers about the importance of supplying healthier food options and subsequently a healthier food environment to employees in the workplace. HOVER has resources for employers, vending machine suppliers and health professionals and helps support the establishment of mixed vending (i.e. dry pre-packaged products with fresh options such as dairy and fruit), or fresh vending (i.e. fresh sandwiches, sushi, ready to heat meals, dairy, fruit).

Issue - Increased levels of sedentary behaviour and physical inactivity

• Recommended strategy - Mass media campaigns promoting physical activity, with community-based supportive activities, and associated policies to address barriers to participation.
• Example - Swap It Don't Stop It. Through the Measure Up campaign, the Australian Government ran a mass media campaign which encouraged people to “become a swapper”. The campaign encouraged making every day small changes to have a healthier lifestyle. Examples of swapping: swap sitting for moving (e.g. ride your bike for short trips rather than driving the car), swap nutritional behaviours (e.g. swap takeaway for home-made). The website includes information and resources about healthy eating, physical activity, and tools to help promote a healthy lifestyle.
• Let’s Move (USA) is a comprehensive initiative to help raise a generation of healthier kids, and was launched by the First Lady, Michelle Obama. This initiative includes a social marketing campaign.
• Change for Life (UK) - An initiative run in England and Wales and you can register to become a member. The program includes lots of online information and resources about healthy eating, physical activity, alcohol, finding local activities, an App to help make smart swaps to your diet. With regards to physical activity, there are suggestions on how to be active (including active travel), how to plan an active holiday, the “fun generator” tool which lets you input environment (indoor/outdoor), number of kids participating, and will produce a list of suggested activities and ideas for hobbies and sports.

Policy-based strategies

Issue - Increased intakes of energy-dense and nutrient-poor foods/drinks

• Recommended strategy - Government regulatory policies supporting a healthier composition of staple foods.
• Example - The Australian Government's Food and Health Dialogue’s primary activity is action on food innovation, including a voluntary reformulation program across a range of commonly consumed foods. The reformulation program aims to reduce the saturated fat, added sugar, sodium and energy, and increase the fibre, wholegrain, fruit and vegetable content across nominated food categories.
• Heart Foundation Tick program encourages food companies to improve and reformulate foods available to consumers. The Tick program has nutrition standards and particular criteria to which food must meet when independently tested. Once foods meet these standards and criteria, the company can pay a license fee for the Tick logo to appear on its package. The food needs to be a healthier choice when compared to similar foods. Tick products have reduced saturated fat, trans fat, salt and kilojoules, with more healthy nutrients such as fibre, vegetables and calcium. Portion size is also carefully monitored. Foods included in the Tick program include fresh foods (e.g. fruit, vegetables, eggs, plain nuts, seeds, lean meat); everyday foods (e.g. bread, low fat milk, pasta, rice, cereal) and occasional foods (e.g. pie).

Issue - Increased intakes of energy-dense and nutrient-poor foods/drinks

• Recommended strategy - Front of pack interpretative food labelling.
• Example - Health Star Rating system. The Institute of Medicine has concluded that front-of-package nutrition rating systems and symbols would be beneficial for consumers to promoting healthier choices in a user friendly way, rather than the potentially confusing nutritional panels. Systems such as the Traffic Light (UK) and proposed Health Star Rating (Australia) have been recommended as successful strategies.
• Useful resources:
  • Front-of-Package Nutrition Rating Systems and Symbols: Promoting Healthier Choices, Institute of Medicine
  • Front of Pack nutrition labelling guidance, UK Government
  • Front-of-pack labelling updates, Australia and New Zealand Food Regulation

Issue - Increased intakes of energy-dense and nutrient-poor foods/drinks

• Recommended strategy - Fast food menu and KJ labelling.
• Example - The NSW Government introduced legislation in 2010 mandating the disclosure of nutrition information at standard menu restaurants in NSW. The Better Regulation Statement (BRS) considers three options to regulate against better regulation principles. The new rules, contained in the Food Act 2003 (NSW), and Food Regulation Act 2010 (NSW) establish a level playing field by applying to ‘standard food items’ across traditional fast food chains as well as café and coffee chains, bakery chains, snack food chains, juice bars, ice-cream chains, salad chains and supermarket chains.

Issue - Reduced breastfeeding rates

• Recommended strategy - Institutional changes in maternity care practices and training of relevant staff to support breastfeeding.
• Example - Baby Friendly Health Initiative was developed jointly by the World Health Organisation and UNICEF globally to improve infant health by supporting mothers to breastfeed. The aim of the initiative is to create environments where breastfeeding is normalised, in order to promote health and wellbeing of mothers and infants. To become accredited as a Baby Friendly, hospitals and community health facilities are assessed by a set of criteria each. Evidence of success regarding this initiative includes increased initiation and duration of exclusive breastfeeding rates, increased maternal satisfaction, reduced healthcare costs, reduced infant morbidity and mortality rates.

Issue - Increased intakes of energy-dense and nutrient-poor foods/drinks

• Recommended strategy - Targeted subsidies and health-related food taxes.
• Example - Sacks G, Veerman JL, Moodie M, Swinburn B. 'Traffic-light' nutrition labelling and 'junk-food' tax: a modelled comparison of cost-effectiveness for obesity prevention. Int J Obes (Lond) 2011; 35 (7): 1001-9

Issue - Increased intakes of energy-dense and nutrient-poor foods/drinks among children

• Recommended strategy - Restricted advertising to children that promotes unhealthy food and drinks in media, promotions and sponsorship.
• Example - Coalition on food advertising to children (CFAC). CFAC was a collaboration of public health groups (such as the Cancer Council, Nutrition Australia, Public Health Association of Australia) with a common belief that television food advertising is a significant threat to the health of Australian children. CFAC disseminate information about television advertising through various campaigns, and advocate for improved regulations through grassroots, the media and policies. An example of a campaign they ran in 2007 was Pull the plug on food advertising to children.
• Useful resources - Parents’ Voice is an online network of parents, grandparents and guardians with the common aim of improving the food and physical activity environments of children in Australia. Participants can register to become a member and join in the discussion to express opinions and advocate for change at a local, state and national level. Partners of Parents’ Voice include the Cancer Council Australia, Diabetes Australia, the Australian and New Zealand Obesity Society, VicHealth and YMCA Victoria. Parents’ Voice run advocacy campaigns around key issues such as healthy schools, physical activity, food marketing to kids, healthy checkouts, and healthy eating for kids. They lobby governments, food manufacturers and key decision makers for improvements in these areas. With regards to inappropriate food advertising, individuals can be directed to make an official complaint through suggested channels and can refer to a Fat Free TV guide.

Issue - Increased intakes of energy-dense and nutrient-poor foods/drinks among children

• Recommended strategy - Restrictions on fast food outlet density in the vicinity of schools, parks or services for young people.
• Example- Restriction of takeaway fast food outlets surrounding primary and secondary schools in the UK. Shires within the UK are currently putting together and implementing change to local planning policies regarding restricting the establishment of new hot food takeaway fast food outlets within 400m of primary and secondary schools.
• Useful resources:
  • NHS Promoting healthy eating in Lambeth – Focusing on the impact on health of hot takeaway fast food outlets
  • Public Health England Healthy places.

Issue - Increased levels of overweight and chronic disease risk

• Recommended strategy - Using a framework to shape a response to the food environment, food system and how to communicate changing behaviours.
• Example - World Cancer Research Fund International (WCRFI) NOURISHING database. An evidence based, interactive framework has been developed by WCRFI which focuses on three domains – the food environment, food systems and behaviour change communication. The website contains comprehensive resources regarding policy development to promote healthier eating and subsequently prevent obesity and non-communicable diseases. Examples of policies implemented globally can also be viewed.

Evaluation

There is concern that some obesity prevention programs are being planned and implemented without adequately considering the importance of evaluation and without allocating sufficient funds to allow a rigorous evaluation. Evaluation is a critical component of a program or intervention, as evidence of effectiveness is required given the limited evidence base on obesity prevention. Additionally, there is a responsibility to funders to provide high quality evaluations. If evaluations are not rigorous enough, they can waste precious resources and fail to improve the quality of a program.

Evaluation of community-based obesity prevention initiatives is challenging due to their complex nature and the fact that they often cannot be planned similarly to classic, well controlled trials. It has been suggested that 10-15% of a project budget should be allocated to evaluation so in-depth understanding of what worked, what did not work, and why is known. It has been suggested that program evaluation should include a comparison group, anthropometry measurements (height, weight, waist) and a deep understanding of process evaluation and contextual information (e.g. strategies, implementation factors, reach across groups) which will help interpret overall program results.

Best Practice Principles have been developed using published literature and professional experience to help others design and develop a clear decision making process for planning, implementing and evaluating community-based obesity prevention programs. A key best practice principle is evaluation, and includes guidance around the following areas:

• evaluation framework and approach
• planning
• data collection, management, analysis
• context
• importance of dissemination and building the evidence-base

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