Seventeen years of our research into childhood obesity is starting to deliver dividends. We now know what kinds of interventions are effective for reducing the number of overweight and obese children in our society so it’s time to start implementing them.
What we’ve learnt is that childhood obesity has increased dramatically and is associated with poor health and wellbeing outcomes, as well as a range of indicators of social disadvantage and cultural background. And we’ve been working on policy-level and school-level interventions to identify prevention and health promotion solutions.
We know with clarity and confidence that prevention interventions addressing settings, systems, capacity building, professional development, children and parents are effective. And, were we to implement such interventions systematically, we can anticipate a population-level reduction of childhood obesity rates equivalent to the increases we’ve seen over these 17 years.
While there are some caveats and considerations, there’s more than enough evidence to back healthy eating strategies and reorienting environments so they prevent, or at least don’t encourage, junk food consumption. We also know that we need to increase physical activity as well as leadership and teaching in that field.
We know these things because we have just published a systematic compilation and analysis of 55 research studies internationally demonstrate that obesity prevention initiatives in children’s settings are likely to work. Our review summarised all the results of comparable studies worldwide aiming to reduce childhood obesity in children’s settings – such as childcare, preschools and primary schools.
What works?
Consistent with recent recommendations by the Preventative Health Taskforce and the Australian National Preventive Health Agency (ANPHA), the types of initiatives we found to be effective in children’s settings included:
initiatives delivered across multiple settings;
combining healthy eating and physical activity approaches to obesity prevention;
multi-level, multi-faceted interventions: using multiple ways to improve the food and activity environment at the same time. By combining initiatives such as healthy school policies, canteen changes, training for school staff, communication and engagement of parents and teaching nutrition and physical activity to students; and
engaging not just individual children but the whole community (schools, local agencies, local governments, among others).
What’s in a program?
A broad range of program components (interventions such as increased physical activity time and activities, for instance) were used in the studies included in our review and the initiatives varied in their approach. We weren’t able to distinguish which of the components contributed most to observed beneficial effects but pooled analysis indicated the following were the most promising.
These can act as a set of guiding principles for future implementation:
school curriculum that includes healthy eating, physical activity and body image awareness;
increased sessions for physical activity and the development of fundamental movement skills throughout the school week;
improvements in nutritional quality of the food supply in schools;
environments and cultural practices that support children eating healthier foods and being active throughout the day;
support for teachers and other staff to implement health promotion strategies and activities (these may include professional development and capacity-building activities); and
parental support and home activities that encourage children to be more active, eat more nutritious foods and spend less time in front of the television or computer.
Some of the approaches we studied were conducted in single settings and were more focused on encouraging individuals to change behaviour. We didn’t have enough evidence to compare these with the ones seeking to change environments where children spend time as well as challenging social and cultural practices, but it makes sense that the latter strategies are likely to have more sustained effects in the long term.
There’s been a decrease, or at least a plateau, in overweight and obesity prevalence in some sections of the Australian child population. This is a promising sign that multi-faceted programs and investment in schools and communities are having a positive effect. But there’s more to do to ensure that all children have the opportunity to benefit.
What’s the catch?
Political leadership and support is obviously needed to conduct the sort of multi-strategy coordinated initiative that works. And many jurisdictions have already implemented programs – the Victorian government’s KG4YL, BAEW and Romp&Chomp; New South Wales’s Good for kids; South Australia’s eat well be active community programs and now OPAL. So there is political will out there in some form, but rather than implementing short-term initiatives in particular areas, it’s time for a more coordinated and comprehensive approach.
Effective strategies, such as those identified above, need to become standard practice in settings where children spend time. We know what needs to be done and it’s time to do it across all social and educational settings. Healthy eating and physical activity initiatives in children’s settings should be guided by the evidence, theory and public health principles.
Future research and program evaluation should focus on understanding what’s needed to increase the scale of effective initiatives, and what sustains their impact over time, inspires new ideas, and informs and energises the workforce.
We need to regularly examine – on, say, a five-yearly basis – whether these strategies are working equitably, and whether they need additional investments or strategies to combat the changed external environment. The types of initiatives that will work are not resource-intensive single programs that have less impact on a population scale, and cannot be maintained long term. Rather, we need a comprehensive approach that will create a positive environment for healthy living.