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A Secondary Analysis of the Childhood Obesity Prevention Cochrane Review through a Wider Determinants of Health Lens: Implications for Research Funders, Researchers, Policymakers and Practitioners
James David Nobles
University of Bristol Faculty of Health Sciences
Corresponding Author
ORCiD: https://orcid.org/0000-0001-8574-4153
License:
This work is licensed under a CC BY 4.0 License. Read Full License
The most recent version of this article is available here.
Background: Randomised controlled trials (RCTs) are often regarded as the gold standard of evidence, and subsequently go on to inform policymaking. Cochrane Reviews synthesise this type of evidence to create recommendations for practice, policy, and future research. Here, we critically appraise the RCTs included in the childhood obesity prevention Cochrane Review to understand the focus of these interventions when examined through a wider determinants of health (WDoH) lens.
Methods: We conducted a secondary analysis of the interventions included in the Cochrane Review on “Interventions for Preventing Obesity in Children”, published since 1993. All 153 RCTs were independently coded by two authors against the WDoH model using an adaptive framework synthesis approach. We used aspects of the Action Mapping Tool from Public Health England to facilitate our coding and to visualise our findings against the 226 perceived causes of obesity.
Results: The proportion of interventions which targeted downstream (e.g. individual and family behaviours) as opposed to upstream (e.g. infrastructure, environmental, policy) determinants has not changed over time (from 1993 to 2015), with most intervention efforts (57.9%) aiming to change individual lifestyle factors via education-based approaches. Almost half of the interventions (45%) targeted two or more levels of the WDoH. Where interventions targeted some of the wider determinants, this was often achieved via upskilling teachers to deliver educational content to children. No notable difference in design or implementation was observed between interventions targeting children of varying ages (0-5 years, 6-12 years, 13-18 years).
Conclusions: This study highlights that interventions, evaluated via RCTs, have persisted to focus on downstream, individualistic determinants of obesity over the last 25 years, despite the step change in our understanding of its complex aetiology. We hope that the findings from our analysis will challenge research funders, researchers, policymakers and practitioners to reflect upon, and critique, the evidence-based paradigm in which we operate, and call for a shift in focus of new evidence which better accounts for the complexity of obesity.
Keywords
Wider Determinants of Health, Childhood Obesity, Prevention, Action Mapping, Whole Systems Approach, Intervention Design
Figure 1
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On 04 Jan, 2021
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On 04 Jan, 2021
Version 2
Posted 06 Dec, 2020
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Editorial decision: Minor revision
On 10 Dec, 2020
Review #3 received
Received 07 Dec, 2020
Review #1 received
Received 06 Dec, 2020
Reviewer #3 agreed
On 03 Dec, 2020
Review #2 received
Received 30 Nov, 2020
Reviewer #2 agreed
On 23 Nov, 2020
Editor assigned
On 22 Nov, 2020
Reviewers invited
Invitations sent on 22 Nov, 2020
Reviewer #1 agreed
On 22 Nov, 2020
Submission checks complete
On 22 Nov, 2020
Editor invited
On 22 Nov, 2020
No comments provided
Editorial decision: Major revision
On 16 Oct, 2020
Review #2 received
Received 12 Oct, 2020
Review #1 received
Received 23 Sep, 2020
Review #3 received
Received 16 Sep, 2020
Reviewer #3 agreed
On 27 Aug, 2020
Reviewer #1 agreed
On 26 Aug, 2020
Reviewer #2 agreed
On 26 Aug, 2020
Reviewers invited
Invitations sent on 19 Aug, 2020
Editor assigned
On 13 Aug, 2020
Submission checks complete
On 13 Aug, 2020
Editor invited
On 12 Aug, 2020
First submitted
On 12 Aug, 2020
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This preprint is under consideration at International Journal of Behavioral Nutrition and Physical Activity. A preprint is a preliminary version of a manuscript that has not completed peer review at a journal. Research Square does not conduct peer review prior to posting preprints. The posting of a preprint on this server should not be interpreted as an endorsement of its validity or suitability for dissemination as established information or for guiding clinical practice.
Learn more about In Review
Research
A Secondary Analysis of the Childhood Obesity Prevention Cochrane Review through a Wider Determinants of Health Lens: Implications for Research Funders, Researchers, Policymakers and Practitioners
James David Nobles
University of Bristol Faculty of Health Sciences
Corresponding Author
ORCiD: https://orcid.org/0000-0001-8574-4153
Badges
Prescreen
This manuscript passed our Prescreen assessment
Complete author information
Appropriate declaration statements
Potential risks to human health
Prescreen
Peer Review Timeline
CURRENT STATUS: Under Review
No community comments so far
Editor assigned
On 04 Jan, 2021
Submission checks complete
On 04 Jan, 2021
Editor invited
On 04 Jan, 2021
Version 2
Posted 06 Dec, 2020
No comments provided
Editorial decision: Minor revision
On 10 Dec, 2020
Review #3 received
Received 07 Dec, 2020
Review #1 received
Received 06 Dec, 2020
Reviewer #3 agreed
On 03 Dec, 2020
Review #2 received
Received 30 Nov, 2020
Reviewer #2 agreed
On 23 Nov, 2020
Editor assigned
On 22 Nov, 2020
Reviewers invited
Invitations sent on 22 Nov, 2020
Reviewer #1 agreed
On 22 Nov, 2020
Submission checks complete
On 22 Nov, 2020
Editor invited
On 22 Nov, 2020
No comments provided
Editorial decision: Major revision
On 16 Oct, 2020
Review #2 received
Received 12 Oct, 2020
Review #1 received
Received 23 Sep, 2020
Review #3 received
Received 16 Sep, 2020
Reviewer #3 agreed
On 27 Aug, 2020
Reviewer #1 agreed
On 26 Aug, 2020
Reviewer #2 agreed
On 26 Aug, 2020
Reviewers invited
Invitations sent on 19 Aug, 2020
Editor assigned
On 13 Aug, 2020
Submission checks complete
On 13 Aug, 2020
Editor invited
On 12 Aug, 2020
First submitted
On 12 Aug, 2020
Metrics
Comments: 0
PDF Downloads: ...
HTML Views: ...
License:
This work is licensed under a CC BY 4.0 License. Read Full License
The most recent version of this article is available here.
Background: Randomised controlled trials (RCTs) are often regarded as the gold standard of evidence, and subsequently go on to inform policymaking. Cochrane Reviews synthesise this type of evidence to create recommendations for practice, policy, and future research. Here, we critically appraise the RCTs included in the childhood obesity prevention Cochrane Review to understand the focus of these interventions when examined through a wider determinants of health (WDoH) lens.
Methods: We conducted a secondary analysis of the interventions included in the Cochrane Review on “Interventions for Preventing Obesity in Children”, published since 1993. All 153 RCTs were independently coded by two authors against the WDoH model using an adaptive framework synthesis approach. We used aspects of the Action Mapping Tool from Public Health England to facilitate our coding and to visualise our findings against the 226 perceived causes of obesity.
Results: The proportion of interventions which targeted downstream (e.g. individual and family behaviours) as opposed to upstream (e.g. infrastructure, environmental, policy) determinants has not changed over time (from 1993 to 2015), with most intervention efforts (57.9%) aiming to change individual lifestyle factors via education-based approaches. Almost half of the interventions (45%) targeted two or more levels of the WDoH. Where interventions targeted some of the wider determinants, this was often achieved via upskilling teachers to deliver educational content to children. No notable difference in design or implementation was observed between interventions targeting children of varying ages (0-5 years, 6-12 years, 13-18 years).
Conclusions: This study highlights that interventions, evaluated via RCTs, have persisted to focus on downstream, individualistic determinants of obesity over the last 25 years, despite the step change in our understanding of its complex aetiology. We hope that the findings from our analysis will challenge research funders, researchers, policymakers and practitioners to reflect upon, and critique, the evidence-based paradigm in which we operate, and call for a shift in focus of new evidence which better accounts for the complexity of obesity.
Figure 1