Using the 2012 draft evidence report “Childhood Obesity Prevention Programs: A Comparative Effectiveness Review and Meta-Analysis,” we identified and prioritized Future Research Needs. We identified 12 research questions considered to be of potential health impact by a multidisciplinary group of stakeholders. We believe that this report will help researchers to develop studies evaluating the Key Questions identified, as well as enable funding agencies to dedicate their resources to areas most likely to make a health impact.
Our stakeholders were clear on prioritizing certain groups of the population for further study: the stakeholders favor future research about obesity prevention in toddlers and young children, particularly low income toddlers and children, with attention to Hispanic youngsters. Although the stakeholders acknowledge that additional research is needed for prevention of obesity in adolescents as well, they prioritize research directed at younger children. Similarly, they acknowledge that obesity strikes middle and upper income children and yet recommend that attention be first directed to low income children. Given that the sites of recruitment and the optimal interventions may differ for low income children relative to middle and upper income children, studying this population separately makes sense.
Our stakeholders greatly favored studying interventions that target caloric restriction over other targeted behaviors. This is not because the evidence already strongly supports or refutes the use of physical activity interventions, but the stakeholders were wary of the efficacy of these interventions particularly for toddlers and young children. They suggested that the settings in which the intervention targeting calorie restriction is delivered is the most pressing question to address: should the intervention be delivered in the home or should it involve a community intervention as well. This community intervention might be as high level as implementation of legislation regarding food availability (e.g., large soft drinks) or it may be more local such as the implementation of a healthy-eating campaign among local churches. We caution that the interventions must be culturally appropriate for the targeted children, particularly studies that will enroll primarily Hispanic children. The stakeholders do not want to see additional studies conducted in schools at present. They feel that the sufficiency of the evidence makes the other settings greater priorities.
The methodological limitations in the current evidence base should be addressable, and the stakeholders endorsed the methodological challenges that we presented to them. They particularly support the need for improved methods for the evaluation of community based interventions as well as better description (and testing) of barriers and facilitators to implementing proven programs, as well as greater rigor in analyses.
There are some limitations of this project. The large number of evidence gaps made it unfeasible to create and present all research questions from these gaps to our stakeholders, as would be a more standard approach to identifying Future Research Needs. We modified the approach piloted in a prior Future Research Needs report for this purpose.9 This method relied heavily on input from the authors of the Comparative Effectiveness Review and the stakeholders, who all have their own priorities and biases that influence their reflections on the Comparative Effectiveness Review process. Additionally, we had hoped to have more stakeholders involved in this process.
There are several strengths to this report. Our research team included several members of the original report’s research team, which provided ready access to their insight on the process of the Comparative Effectiveness Review and challenges experienced by that original team. We also recruited stakeholders to represent a variety of interests. The prevention of childhood obesity is important to not only to clinicians and researchers, but is also of particular interest to parents. We were fortunate to have an engaged parent of an obese child among our stakeholders. We feel that our diverse array of engaged stakeholders helps to ensure that the Key Questions we developed will be of significant public health impact. Finally, we encouraged stakeholders to provide comments in addition to performing rankings. This qualitative component gave important insight on thought process behind many of the stakeholders’ choice, and added an additional element of richness to the data we collected.
Agency for Healthcare Research and Quality (US), Rockville (MD)
Wu Y, Lau BD, Bleich S, et al. Future Research Needs for Childhood Obesity Prevention Programs: Identification of Future Research Needs From Comparative Effectiveness Review No. 115 [Internet]. Rockville (MD): Agency for Healthcare Research and Quality (US); 2013 Jun. (Future Research Needs Papers, No. 31.) Discussion.