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Tackling inequalities in obesity: a protocol for a systematic review of the effectiveness of public health interventions at reducing socioeconomic inequalities in obesity amongst children.

Bambra CL, Hillier FC, Moore HJ, Summerbell CD - Syst Rev (2012)

Bottom Line: The studies will be selected only if (1) they included a primary outcome that is a proxy for body fatness and (2) examined differential effects with regard to socioeconomic status (education, income, occupation, social class, deprivation and poverty) or the intervention was targeted specifically at disadvantaged groups (for example, children of the unemployed, lone parents, low income and so on) or at people who live in deprived areas.Interventions will be characterised by their level of action and their approach to tackling inequalities.PROSPERO registration number: CRD42011001740.

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of Geography, Wolfson Research Institute, Durham University Queen's Campus, University Boulevard, Stockton-on-Tees, TS17 6BH, UK.

ABSTRACT

Background: There is growing evidence of the impact of overweight and obesity on short- and long-term functioning, health and well-being. Internationally, childhood obesity rates continue to rise in some countries (for example, Mexico, India, China and Canada), although there is emerging evidence of a slowing of this increase or a plateauing in some age groups. In most European countries, the United States and Australia, however, socioeconomic inequalities in relation to obesity and risk factors for obesity are widening. Addressing inequalities in obesity, therefore, has a very high profile on the public health and health services agendas. However, there is a lack of accessible policy-ready evidence on what works in terms of interventions to reduce inequalities in obesity.

Methods and design: This article describes the protocol for a National Health Service Trust (NHS) National Institute for Health Research-funded systematic review of public health interventions at the individual, community and societal levels which might reduce socioeconomic inequalities in relation to obesity amongst children ages 0 to 18 years. The studies will be selected only if (1) they included a primary outcome that is a proxy for body fatness and (2) examined differential effects with regard to socioeconomic status (education, income, occupation, social class, deprivation and poverty) or the intervention was targeted specifically at disadvantaged groups (for example, children of the unemployed, lone parents, low income and so on) or at people who live in deprived areas. A rigorous and inclusive international literature search will be conducted for randomised and nonrandomised controlled trials, prospective and retrospective cohort studies (with and/or without control groups) and prospective repeat cross-sectional studies (with and/or without control groups). The following electronic databases will be searched: MEDLINE, Embase, CINAHL, PsycINFO, Social Science Citation Index, ASSIA, IBSS, Sociological Abstracts and the NHS Economic Evaluation Database. Database searches will be supplemented with website and grey literature searches. No studies will be excluded on the basis of language, country of origin or publication date. Study inclusion, data extraction and quality appraisal will be conducted by two reviewers. Meta-analysis and narrative synthesis will be conducted. The main analysis will examine the effects of (1) individual, (2) community and (3) societal level public health interventions on socioeconomic inequalities in childhood obesity. Interventions will be characterised by their level of action and their approach to tackling inequalities. Contextual information on how such public health interventions are organised, implemented and delivered will also be examined.

Discussion: In this review, we consider public health strategies which reduce and prevent inequalities in the prevalence of childhood obesity, highlight any gaps in the evidence base and seek to establish how such public health interventions are organised, implemented and delivered. PROSPERO registration number: CRD42011001740.

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A framework for tackling inequalities in obesity.
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Figure 1: A framework for tackling inequalities in obesity.

Mentions: We have developed a framework for how inequalities in relation to obesity might be tackled (Figure 1). This framework shows that interventions are characterised by their level of action and their approach to tackling inequalities. Following Whitehead [18], there are four levels of interventions that can be used to tackle inequalities: strengthening individuals (person-based strategies to improve the health of disadvantaged individuals), strengthening communities (improving the health of disadvantaged communities and local areas by building social cohesion and mutual support), improving living and school environments (reducing exposure to health-damaging material and psychosocial environments across the whole population) and promoting healthy macroscopic policies (improving the macroeconomic, cultural and environmental contexts which influence the standard of living of the whole population). According to Graham and Kelly, these interventions are underpinned by one of three different approaches to health inequality: disadvantage (improving the absolute position of the most disadvantaged individuals and groups), gap (reducing the relative gap between the best- and worst-off groups) or gradient (reducing the entire social gradient) [19]. Interventions are thus either targeted (such as individual-level interventions which are underpinned by health as a disadvantage) or universal (such as interventions based on living and school conditions which potentially influence the entire social gradient in health). In the proposed systematic review, the obesity interventions will be grouped according to this framework (with acknowledgement that some interventions such as Sure Start might be cross-cutting [18]). For example, as Figure 1 shows, exercise and diet advice is a targeted intervention aimed at strengthening individuals or communities in disadvantaged circumstances and underpinned by a disadvantage approach to health inequality.


Tackling inequalities in obesity: a protocol for a systematic review of the effectiveness of public health interventions at reducing socioeconomic inequalities in obesity amongst children.

Bambra CL, Hillier FC, Moore HJ, Summerbell CD - Syst Rev (2012)

A framework for tackling inequalities in obesity.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC3351709&req=5

Figure 1: A framework for tackling inequalities in obesity.
Mentions: We have developed a framework for how inequalities in relation to obesity might be tackled (Figure 1). This framework shows that interventions are characterised by their level of action and their approach to tackling inequalities. Following Whitehead [18], there are four levels of interventions that can be used to tackle inequalities: strengthening individuals (person-based strategies to improve the health of disadvantaged individuals), strengthening communities (improving the health of disadvantaged communities and local areas by building social cohesion and mutual support), improving living and school environments (reducing exposure to health-damaging material and psychosocial environments across the whole population) and promoting healthy macroscopic policies (improving the macroeconomic, cultural and environmental contexts which influence the standard of living of the whole population). According to Graham and Kelly, these interventions are underpinned by one of three different approaches to health inequality: disadvantage (improving the absolute position of the most disadvantaged individuals and groups), gap (reducing the relative gap between the best- and worst-off groups) or gradient (reducing the entire social gradient) [19]. Interventions are thus either targeted (such as individual-level interventions which are underpinned by health as a disadvantage) or universal (such as interventions based on living and school conditions which potentially influence the entire social gradient in health). In the proposed systematic review, the obesity interventions will be grouped according to this framework (with acknowledgement that some interventions such as Sure Start might be cross-cutting [18]). For example, as Figure 1 shows, exercise and diet advice is a targeted intervention aimed at strengthening individuals or communities in disadvantaged circumstances and underpinned by a disadvantage approach to health inequality.

Bottom Line: The studies will be selected only if (1) they included a primary outcome that is a proxy for body fatness and (2) examined differential effects with regard to socioeconomic status (education, income, occupation, social class, deprivation and poverty) or the intervention was targeted specifically at disadvantaged groups (for example, children of the unemployed, lone parents, low income and so on) or at people who live in deprived areas.Interventions will be characterised by their level of action and their approach to tackling inequalities.PROSPERO registration number: CRD42011001740.

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of Geography, Wolfson Research Institute, Durham University Queen's Campus, University Boulevard, Stockton-on-Tees, TS17 6BH, UK.

ABSTRACT

Background: There is growing evidence of the impact of overweight and obesity on short- and long-term functioning, health and well-being. Internationally, childhood obesity rates continue to rise in some countries (for example, Mexico, India, China and Canada), although there is emerging evidence of a slowing of this increase or a plateauing in some age groups. In most European countries, the United States and Australia, however, socioeconomic inequalities in relation to obesity and risk factors for obesity are widening. Addressing inequalities in obesity, therefore, has a very high profile on the public health and health services agendas. However, there is a lack of accessible policy-ready evidence on what works in terms of interventions to reduce inequalities in obesity.

Methods and design: This article describes the protocol for a National Health Service Trust (NHS) National Institute for Health Research-funded systematic review of public health interventions at the individual, community and societal levels which might reduce socioeconomic inequalities in relation to obesity amongst children ages 0 to 18 years. The studies will be selected only if (1) they included a primary outcome that is a proxy for body fatness and (2) examined differential effects with regard to socioeconomic status (education, income, occupation, social class, deprivation and poverty) or the intervention was targeted specifically at disadvantaged groups (for example, children of the unemployed, lone parents, low income and so on) or at people who live in deprived areas. A rigorous and inclusive international literature search will be conducted for randomised and nonrandomised controlled trials, prospective and retrospective cohort studies (with and/or without control groups) and prospective repeat cross-sectional studies (with and/or without control groups). The following electronic databases will be searched: MEDLINE, Embase, CINAHL, PsycINFO, Social Science Citation Index, ASSIA, IBSS, Sociological Abstracts and the NHS Economic Evaluation Database. Database searches will be supplemented with website and grey literature searches. No studies will be excluded on the basis of language, country of origin or publication date. Study inclusion, data extraction and quality appraisal will be conducted by two reviewers. Meta-analysis and narrative synthesis will be conducted. The main analysis will examine the effects of (1) individual, (2) community and (3) societal level public health interventions on socioeconomic inequalities in childhood obesity. Interventions will be characterised by their level of action and their approach to tackling inequalities. Contextual information on how such public health interventions are organised, implemented and delivered will also be examined.

Discussion: In this review, we consider public health strategies which reduce and prevent inequalities in the prevalence of childhood obesity, highlight any gaps in the evidence base and seek to establish how such public health interventions are organised, implemented and delivered. PROSPERO registration number: CRD42011001740.

Show MeSH
Related in: MedlinePlus