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J Gen Intern Med. 2018 Nov;33(11):1990-2001. doi: 10.1007/s11606-018-4619-z. Epub 2018 Sep 11.

Effectiveness of Policies and Programs to Combat Adult Obesity: a Systematic Review.

Author information

1
Division of General Internal Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA. etseng3@jhmi.edu.
2
Welch Center for Prevention, Epidemiology, & Clinical Research, The Johns Hopkins University, Baltimore, MD, USA. etseng3@jhmi.edu.
3
Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
4
Johns Hopkins University Evidence-based Practice Center, Johns Hopkins Bloomberg School of Public Health, The Johns Hopkins University, Baltimore, MD, USA.
5
Department of Medicine, Reading Hospital, West Reading, PA, USA.
6
Division of General Internal Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
7
Welch Center for Prevention, Epidemiology, & Clinical Research, The Johns Hopkins University, Baltimore, MD, USA.
8
Department of Health, Behavior & Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.

Abstract

BACKGROUND:

This systematic review identifies programs, policies, and built-environment changes targeting prevention and control of adult obesity and evaluates their effectiveness.

METHODS:

We searched PubMed, CINAHL, PsycINFO, and EconLit from January 2000 to March 2018. We included natural experiment studies evaluating a program, policy, or built-environment change targeting adult obesity and reporting weight/body mass index (BMI). Studies were categorized by primary intervention target: physical activity/built environment, food/beverage, messaging, or multiple. Two reviewers independently assessed the risk of bias for each study using the Effective Public Health Practice Project tool.

RESULTS:

Of 158 natural experiments targeting obesity, 17 reported adult weight/BMI outcomes. Four of 9 studies reporting on physical activity/built environment demonstrated reduced weight/BMI, although effect sizes were small with low strength of evidence and high risk of bias. None of the 5 studies targeting the food/beverage environment decreased weight/BMI; strength of evidence was low, and 2 studies were rated high risk of bias.

DISCUSSION:

We identified few natural experiments reporting on the effectiveness of programs, policies, and built-environment changes on adult obesity. Overall, we found no evidence that policies intending to promote physical activity and healthy eating had beneficial effects on weight/BMI and most studies had a high risk of bias. Limitations include few studies met our inclusion criteria; excluded studies in children and those not reporting on weight/BMI outcomes; weight/BMI reporting was very heterogeneous. More high-quality research, including natural experiments studies, is critical for informing the population-level effectiveness of obesity prevention and control initiatives in adults.

KEYWORDS:

obesity; prevention; systematic reviews

PMID:
30206789
PMCID:
PMC6206360
DOI:
10.1007/s11606-018-4619-z

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