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Multi-component obesity prevention interventions

Health Factors: Diet & Exercise
Decision Makers: Educators Employers & Businesses Healthcare Professionals & Advocates Nonprofit Leaders Public Health Professionals & Advocates
Evidence Rating: Scientifically Supported
Population Reach: 20-49% of WI's population
Impact on Disparities: No impact on disparities likely

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Description

Multi-component obesity prevention interventions combine educational, environmental, and behavioral activities, and typically address both physical activity and nutrition. Often led by trained professionals, such interventions involve in-person meetings and offer opportunities for counseling, coaching, and support. Multi-component obesity prevention interventions frequently also include nutrition education, aerobic or strength training exercise sessions, training in behavioral techniques, and specific dietary prescriptions (CG-Obesity).

Expected Beneficial Outcomes

Increased physical activity
Improved weight status
Increased self-confidence
Increased fruit & vegetable consumption

Evidence of Effectiveness

There is strong evidence that multi-component obesity prevention interventions increase physical activity (Kriemler 2011Katz 2008Kamath 2008Cochrane-Waters 2011) and weight loss for children and adolescents (Murray 2017, Wang 2015b, Brown 2009De Bourdeaudhuij 2011Katz 2008Kelly 2008Seo 2010). Multi-component interventions also modestly improve weight status among adults (Stephens 2014), including overweight or obese adults (Johns 2014) and adults with a higher risk of type 2 diabetes (CG-Physical activity). Additional evidence is needed to confirm long-term effects (Stephens 2014).

In general, multi-component interventions are more effective than single component efforts, especially over longer durations (Stephens 2014, Johns 2014, Kriemler 2011De Bourdeaudhuij 2011Seo 2010Kamath 2008). Longer term studies show greater weight loss among participants in multi-component interventions that address nutrition and physical activity than among participants in nutrition-only interventions; however, in the short-term, both interventions appear to have similar benefits (Johns 2014).

Multi-component interventions increase fruit and vegetable intake among younger children (Van Cauwenberghe 2012). Such interventions have demonstrated positive effects on child and adolescent weight status (Kelly 2008Brown 2009Katz 2008), possibly over the long-term (Brown 2009Katz 2008). Multi-component interventions delivered in schools that include both home and community components have been shown to reduce body mass index (BMI) and improve weight status for children; interventions with only a home or community component and interventions delivered in community settings can also improve BMI and weight status (Wang 2015b). Multi-component interventions with a specific focus on self-esteem can improve self-esteem for overweight or obese adolescents; interventions without such a focus improve weight status but not self-esteem (Murray 2017). Workplace-based multi-component interventions have been shown to improve weight status and self-confidence among participating employees (CG-ObesityLombard 2009).

Interventions that include culturally tailored or lifestyle specific components have been shown to be most effective for minority students (Seo 2010). Multi-component interventions that rely primarily on providing information for behavior change may be less successful among populations with lower socio-economic status than interventions that include structural changes to the environment and community-based strategies (Beauchamp 2014).

Costs for multi-component obesity prevention programs vary based on several factors, including setting, duration, meeting structure, and number of sessions. Multi-component interventions that address both nutrition and physical activity for people with an increased risk of type 2 diabetes have been shown to be cost-effective (CG-Physical activity).

Implementation

United States

Multi-component interventions to prevent obesity are implemented throughout the country. For example, the New York State Department of Health’s Eat Well Play Hard initiative is an example of a successful multi-component obesity prevention intervention (NYS DOH-EWPH). The 5-2-1-0 obesity prevention program is a multi-component intervention for improving diet, increasing physical activity, and reducing screen time; the program was designed for children and has been expanded to include adults. The 5-2-1-0 program encourages developing daily habits that include 5 servings of fruits and vegetables, 2 hours or less of screen time, 1 hour or more of physical activity, 0 sugary drinks, and increased water consumption. It started in Maine (MMC-5210) and has expanded to cities and states across the country, including Florida (FL DOH-5210); Kentucky (KY DPH-5210); New Hampshire (FHC-5210); Baton Rouge, LA (MHCI-5210 plus 10); Chesterfield County, VA (COACH-5210 everyday); and Palo Alto, CA (PAMF-5210 resources).

The B’More Fit initiative in Baltimore provides women with children who receive public assistance licensed childcare and lessons for children about fitness and eating healthy, while mothers participate in exercise classes, group meetings, and nutrition and stress management classes that are offered in English or Spanish (BHB-B'More Fit).

Niños Sanos, Familia Sana (Healthy Children, Healthy Family) is a five year effort that engages Mexican-origin farmworker families using culturally tailored messages, fruit and vegetable incentives, supportive environments, parenting skill classes, and nutrition and physical activity education and opportunities (Kaiser 2015).

Wisconsin

The Wisconsin Department of Health Services’ Nutrition, Physical Activity and Obesity Program provides materials, training workshops, and resources for local communities to use in a variety of settings to implement multi-component interventions with an emphasis on environmental change to increase access to and opportunities for physical activity and healthy foods (WI DHS-Obesity program).

Implementation Resources

CC-WOTN resources - Community Commons (CC). The Weight of the Nation (WOTN) screening to action resources: Quickstart guides. Accessed on May 10, 2018
ChangeLab-Healthy communities toolkit - ChangeLab Solutions. How to create and implement healthy general plans: A toolkit for building healthy, vibrant communities. Accessed on May 8, 2018
ChangeLab-OPR - ChangeLab Solutions. Why adopt an obesity prevention resolution (OPR)? A fact sheet about our model resolution. Accessed on May 8, 2018
ChangeLab-Planning guide - ChangeLab Solutions. A roadmap for healthier general plans: A guide & infographic about the planning process. Accessed on May 8, 2018
NYS DOH-EWPH - New York State Department of Health (NYS DOH). Eat well play hard (EWPH). Accessed on April 11, 2018

Citations - Description

CG-Obesity - The Guide to Community Preventive Services (The Community Guide). Obesity. Accessed on April 11, 2018

Citations - Evidence

Beauchamp 2014* - Beauchamp A, Backholer K, Magliano D, Peeters A. The effect of obesity prevention interventions according to socioeconomic position: A systematic review. Obesity Reviews. 2014;15(7):541-554. Accessed on May 8, 2018
Brown 2009 - Brown T, Summerbell C. Systematic review of school-based interventions that focus on changing dietary intake and physical activity levels to prevent childhood obesity: An update to the obesity guidance produced by the National Institute for Health and Clinical Excellence. Obesity Reviews. 2009;10(1):110-41. Accessed on April 11, 2018
CG-Obesity - The Guide to Community Preventive Services (The Community Guide). Obesity. Accessed on April 11, 2018
CG-Physical activity - The Guide to Community Preventive Services (The Community Guide). Physical activity. Accessed on April 4, 2018
Cochrane-Waters 2011* - Waters E, de Silva-Sanigorski A, Burford BJ, et al. Interventions for preventing obesity in children. Cochrane Database of Systematic Reviews. 2011;(12):CD001871. Accessed on April 11, 2018
De Bourdeaudhuij 2011* - De Bourdeaudhuij I, Van Cauwenberghe E, Spittaels H, et al. School-based interventions promoting both physical activity and healthy eating in Europe: A systematic review within the HOPE project. Obesity Reviews. 2011;12(3):205-16. Accessed on April 11, 2018
Johns 2014 - Johns DJ, Hartmann-Boyce J, Jebb SA, Aveyard P. Diet or exercise interventions vs combined behavioral weight management programs: A systematic review and meta-analysis of direct comparisons. Journal of the Academy of Nutrition and Dietetics. 2014;114(10):1557-1568. Accessed on May 8, 2018
Kamath 2008 - Kamath CC, Vickers KS, Ehrlich A, et al. Behavioral interventions to prevent childhood obesity: A systematic review and meta-analyses of randomized trials. Journal of Endocrinology and Metabolism. 2008;93(12):4606-15. Accessed on April 11, 2018
Katz 2008* - Katz D, O’Connell M, Njike V, Yeh M-C, Nawaz H. Strategies for the prevention and control of obesity in the school setting: Systematic review and meta-analysis. International Journal of Obesity. 2008;32(12):1780-9. Accessed on April 11, 2018
Kelly 2008 - Kelly SA, Melnyk BM. Systematic review of multicomponent interventions with overweight middle adolescents: Implications for clinical practice and research. Worldviews on Evidence-Based Nursing. 2008;5(3):113-35. Accessed on April 11, 2018
Kriemler 2011* - Kriemler S, Meyer U, Martin E, et al. Effect of school-based interventions on physical activity and fitness in children and adolescents: A review of reviews and systematic update. British Journal of Sports Medicine. 2011;45(11):923-30. Accessed on April 11, 2018
Lombard 2009 - Lombard CB, Deeks AA, Teede HJ. A systematic review of interventions aimed at the prevention of weight gain in adults. Public Health Nutrition. 2009;12(11):2236-46. Accessed on April 11, 2018
Murray 2017* - Murray M, Dordevic AL, Bonham MP. Systematic review and meta-analysis: The impact of multicomponent weight management interventions on self-esteem in overweight and obese adolescents. Journal of Pediatric Psychology. 2017;42(4):379-394. Accessed on May 8, 2018
Seo 2010* - Seo D-C, Sa J. A meta-analysis of obesity interventions among US minority children. Journal of Adolescent Health. 2010;46(4):309-23. Accessed on April 11, 2018
Stephens 2014* - Stephens SK, Cobiac LJ, Veerman JL. Improving diet and physical activity to reduce population prevalence of overweight and obesity: An overview of current evidence. Preventive Medicine. 2014;62:167-178. Accessed on May 8, 2018
Van Cauwenberghe 2012 - Van Cauwenberghe E, Maes L, Spittaels H, et al. Effectiveness of school-based interventions in Europe to promote healthy nutrition in children and adolescents: Systematic review of published and “grey” literature. British Journal of Nutrition. 2010;103(6):781-97. Accessed on April 11, 2018
Wang 2015b* - Wang Y, Cai L, Wu Y, et al. What childhood obesity prevention programmes work? A systematic review and meta-analysis. Obesity Reviews. 2015;16(7):547-565. Accessed on May 8, 2018

Citations - Implementation

BHB-B'More Fit - B’More for Healthy Babies (BHB), Family League of Baltimore, Baltimore City Health Department, CareFirst BlueCross BlueShield. Our initiatives: B’More Fit. Accessed on May 8, 2018
COACH-5210 everyday - Chesterfield County's Coalition for Active Children (COACH). 5-2-1-0 Everyday! Accessed on May 10, 2018
FHC-5210 - Foundation for Healthy Communities (FHC). 5-2-1-0 Healthy NH. Accessed on May 10, 2018
FL DOH-5210 - Florida Department of Health (FL DOH), FloridaHealth Lee County. The 5-2-1-0 plan for a healthier active lifestyle. Accessed on May 10, 2018
Kaiser 2015 - Kaiser L, Martinez J, Horowitz M, et al. Adaptation of a culturally relevant nutrition and physical activity program for low-income, Mexican-origin parents with young children. Preventing Chronic Disease. 2015;12:140591. Accessed on May 8, 2018
KY DPH-5210 - Kentucky Cabinet for Health and Family Services Department for Public Health (KY DPH). 5-2-1-0: Kentucky has the prescription for significantly reducing childhood obesity. Accessed on May 10, 2018
MHCI-5210 plus 10 - Mayor's Healthy City Initiative (MHCI). Healthy Baton Rouge: 5-2-1-0+10: Numbers for your children's health! Accessed on May 10, 2018
MMC-5210 - Maine Medical Center (MMC), Healthy Maine Partnerships (HMP). 5-2-1-0 Let's go! Accessed on May 10, 2018
NYS DOH-EWPH - New York State Department of Health (NYS DOH). Eat well play hard (EWPH). Accessed on April 11, 2018
PAMF-5210 resources - Sutter Health Palo Alto Medical Foundation (PAMF). 5-2-1-0 Resources. Accessed on May 10, 2018
WI DHS-Obesity program - Wisconsin Department of Health Services (WI DHS). The Wisconsin Nutrition, Physical Activity and Obesity Program. Accessed on May 8, 2018

Page Last Updated

May 8, 2018

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