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. 2018 Nov;33(11):1990-2001.
doi: 10.1007/s11606-018-4619-z. Epub 2018 Sep 11.

Effectiveness of Policies and Programs to Combat Adult Obesity: a Systematic Review

Eva Tseng  1   2 , Allen Zhang  3   4 , Oluwaseun Shogbesan  5 , Kimberly A Gudzune  6   7 , Renee F Wilson  3   4 , Hadi Kharrazi  3 , Lawrence J Cheskin  8 , Eric B Bass  6   3   4 , Wendy L Bennett  6   7
Affiliations

Effectiveness of Policies and Programs to Combat Adult Obesity: a Systematic Review

Eva Tseng et al. J Gen Intern Med. 2018 Nov.

Abstract

Background: This systematic review identifies programs, policies, and built-environment changes targeting prevention and control of adult obesity and evaluates their effectiveness.

Methods: We searched PubMed, CINAHL, PsycINFO, and EconLit from January 2000 to March 2018. We included natural experiment studies evaluating a program, policy, or built-environment change targeting adult obesity and reporting weight/body mass index (BMI). Studies were categorized by primary intervention target: physical activity/built environment, food/beverage, messaging, or multiple. Two reviewers independently assessed the risk of bias for each study using the Effective Public Health Practice Project tool.

Results: Of 158 natural experiments targeting obesity, 17 reported adult weight/BMI outcomes. Four of 9 studies reporting on physical activity/built environment demonstrated reduced weight/BMI, although effect sizes were small with low strength of evidence and high risk of bias. None of the 5 studies targeting the food/beverage environment decreased weight/BMI; strength of evidence was low, and 2 studies were rated high risk of bias.

Discussion: We identified few natural experiments reporting on the effectiveness of programs, policies, and built-environment changes on adult obesity. Overall, we found no evidence that policies intending to promote physical activity and healthy eating had beneficial effects on weight/BMI and most studies had a high risk of bias. Limitations include few studies met our inclusion criteria; excluded studies in children and those not reporting on weight/BMI outcomes; weight/BMI reporting was very heterogeneous. More high-quality research, including natural experiments studies, is critical for informing the population-level effectiveness of obesity prevention and control initiatives in adults.

Keywords: obesity; prevention; systematic reviews.

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Conflict of interest statement

Dr. Lawrence Cheskin served on the scientific advisory board of Medifast during the conduct of the study. All other authors declare no conflicts of interest.

Figures

Figure 1
Figure 1
Evidence search and selection.
Figure 2
Figure 2
Forest plot displaying mean pre/post BMI change within each group (a) and between groups (b).
Figure 3
Figure 3
Summary of results for secondary outcomes of dietary and physical activity behaviors, by intervention target. Each outcome symbol represents an individual study and their main result (favors, does not favor or no difference) for the particular outcome. Studies reporting inconsistent results are described in footnotes.*
See this image and copyright information in PMC

References

    1. World Health Organization . Global Status Report on Noncommunicable Diseases 2014. Geneva: World Health Organization; 2014.
    1. Kopelman P, Jebb S, Butland B. Executive summary: Foresight ‘Tackling Obesities: Future Choices’ project. Obes Rev. 2007;8(Suppl 1):vi–ix. - PubMed
    1. Jensen MD, Ryan DH, Apovian CM, et al. 2013 AHA/ACC/TOS guideline for the management of overweight and obesity in adults: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines and The Obesity Society. J Am Coll Cardiol. 2014;63(25 Pt B):2985–3023. doi: 10.1016/j.jacc.2013.11.004. - DOI - PubMed
    1. Swinburn BA, Sacks G, Hall, et al. The global obesity pandemic: shaped by global drivers and local environments. Lancet. 2011;378(9793):804–14. doi: 10.1016/S0140-6736(11)60813-1. - DOI - PubMed
    1. Craig P, Cooper C, Gunnell D, et al. Using natural experiments to evaluate population health interventions: new Medical Research Council guidance. J Epidemiol Community Health. 2012;66(12):1182–6. doi: 10.1136/jech-2011-200375. - DOI - PMC - PubMed

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