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 Nobles, Carolyn Summerbell, Tamara Brown, Russell Jago, Theresa Moore

Research output: Contribution to journalArticlepeer-review

Abstract / Description of output

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 educationbased
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.
Original languageEnglish
JournalInternational Journal of Behavioral Nutrition and Physical Activity
Volume18
Issue number22
DOIs
Publication statusPublished - 10 Feb 2021

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