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Kumanyika population based prevention of obesity: Getting to Equity in Obesity Prevention: A New Framework

Adapted from the Institute of Medicine 2. This conclusion was based on a review of the available evidence base for obesity prevention and the judgment that the research approaches being applied, both for specific studies and for evidence synthesis, were framed too narrowly, were inconsistent with respect to how obesity prevention was being conceptualized, and were not focused on the types of intervention or policy questions relevant to obesity prevention in a public health context.

David Stewart
Thursday, November 29, 2018
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  • The importance of effective interventions to reduce obesity and related health risks has increased in recent decades because the number of adults and children who are obese has reached epidemic proportions. Treatment of those already obese cannot stop the new development of obesity in children and adults in the population at large, as long as the societal factors that lead to excess weight gain are in force.

  • During her tenure on the Penn Medicine faculty, Dr.

  • Our impression is that the report has been very well received, and even seized upon in some instances to bolster ongoing arguments that could benefit from a timely, authoritative, and detailed reference in the evidence literature making the case for a new paradigm.

  • A comprehensive, population-based strategy is needed to reduce the alarming prevalence of obesity in the United States, according to a new American Heart Association scientific statement published in Circulation: Journal of the American Heart Association.

World Nutrition

American journal of public health 98 9 :Sep Lancet London, England :Jun For example, one high-dose intervention was an after school physical activity program that one-quarter of all children participated in that added 20 minutes per day of moderate to vigorous physical activity. Adapted from the Institute of Medicine 2. Note: Javascript is disabled or is not supported by your browser.

  • Note: Content may be edited for style and length. One was a critical review of the evidence base.

  • Education: B. Barbara A.

  • Abstract Obesity is a major influence on the development and course of kumanyiika diseases and affects physical and social functioning and quality of life. The scope of the problem is underscored by a recent analysis of global trends in body mass index between andbased on data from countries and territories 6.

  • Chapter 5 provides a typology to differentiate among potential user questions referred to as Why?

  • The L.

  • Appropriate to the scope and complexity of the issues, the IOM convened a member study committee with expertise that included public health, public policy, economics, systems thinking, programme implementation, and general community prevention research, as well as nutrition, physical activity, and obesity prevention research and interventions specifically, and methodological experts in biostatistics, epidemiology, biomedical evidence hierarchies, evaluation and social science research.

It also implies the intention to lead pooulation obesity field in new directions. In addition, there is increasing emphasis not only in the field of obesity prevention but also in public health policy and practice more kumnyika on comprehensive community health improvement strategies. The type of evidence to which we are accustomed, may relate to studies with a single focus, generated by academic researchers who exercise as much control as possible when conducting the studies. In conclusion, by identifying and calling for integration across four complementary categories of solutions, this framework supports strategy development that works toward additive or synergistic effects on obesity prevention. ScienceDaily, 2 July Human physiologic systems for regulation of food intake are well developed for responding to hunger but poorly developed for curbing overeating, and they evolved when routine physical activity levels were much higher than they are now. Theoretically, the elements of this framework are applicable to any population or community.

They should not be taken to be the view or kumanyila of the Association, based prevention of any of its affiliated or associated bodies, unless this is explicitly stated. This makes obesity a health equity issue rather than simply one of health differences between population groups that are otherwise comparable in social position and opportunities. The political leverage achieved by linking the tax to a resource-related rationale rather than a primarily health rationale was contrasted with the prior, unsuccessful attempt to pass such a tax when framed in public health terms. This is a global problem, but one for which solutions must be tailored to national and subnational contexts WHO, The L. The committee oriented its deliberations about framework development by considering a range of potential decision-making scenarios of potential relevance to multi-level and multi-sectoral obesity prevention, with two overarching questions:.

Shiriki K. Kumanyika, Ph.D, M.P.H.

Search The CDC. Kumanyika Shiriki K. Described by Kohatsu et al, EBPH is a process of integrating science-based interventions with community preferences to improve the health of populations 4. In a natural experiment, the strongest design possible internal validity is essential, and elements of external validity must be addressed.

Chapter 6 fat loss workouts for obese guidance for understanding quality standards for evaluating different types of evidence in terms of both certainty and relevance to specified outcomes. Bridging the Basef Gap in Obesity Prevention: A Framework to Inform Decision Making was released on 23 April 23 in pre-publication form, and published in final form six months later. Tweets by theNAMedicine. This category is of particular importance for an equity focus because it emphasizes the importance of community engagement, meaning directly involving community members in a process of reflecting on, selecting or designing, implementing, and evaluating outcomes of interventions with a health or resources focus. Recommendations in the final chapters of the report promote the use and dissemination of the L.

The Bridging the Evidence Gap report explains that timely and credible evidence is needed to help decision makers decide what to do and understand how to do it, distinguish actions that are likely to be effective from those that are not, justify particular actions in high-risk populations, quantify likely effects, estimate costs and cost-effectiveness, set priorities regarding specific outcomes, determine who benefits, and anticipate potential problems. Advances in obesity prevention will depend in part on articulating the value of multiple and varied types of information for answering policy and practice questions. The answer depends on further use of frameworks such as L. Examples of existing criteria for assessing quality of evidence from these different methods are provided.

Chapter 5 provides a typology to differentiate among potential user questions referred bawed as Why? Abstract Obesity is kumanyika population based prevention of obesity major influence on the development and course of cardiovascular diseases and affects physical and social functioning and quality of life. This report was among the earliest U. These strategies leverage the missions and resources of many societal sectors with an explicit emphasis on addressing social determinants of health APHA, n. ScienceDaily, 2 July

Commentary.Prevention of obesity

American Heart Association. Kumanyika said there have been dire projections about how many children will ultimately become obese if the same trends continue. Legal services could be relevant in several ways populatioh removing discriminatory policies and advocating for policies or provisions to improve equity within policies. Community design practices that are efficient for automobile transportation and suburban living may take priority over configurations that make it possible for children to walk to nearby schools. The Philadelphia experience with childhood obesity prevention is an example of how interventions involving multiple categories in the equity-oriented framework can be effectively combined and coordinated.

For example, in obesity prevention, much of the relevant evidence relates to environmental circumstances and policies that influence the likelihood that people will achieve and maintain food intake and physical activity patterns that prevent or limit excess weight gain. Description of Research Expertise Dr. Moreover, progress being made in curbing the epidemic may not reach all groups equally. Psychology Syracuse University, This, in turn, helps to define what type of information is relevant, whether the information gathered is sufficiently comprehensive, and what its implications are. Environmental and policy changes may complement individual-level programs and can benefit all people exposed to the environment rather than focusing on changing the behavior of one person at a time. In an ideal sense, L.

Criteria for selection in addition to the potential relevance and impact of separate interventions on obesity prevention would include the potential for populafion of different types of policies or programs to be mutually enhancing. Kumanyika said there have been dire projections about how many children will ultimately become obese if the same trends continue. NAM Perspectives. Progress in reducing rates of child obesity in Philadelphia includes improvements in high-risk demographic groups Robbins et al. The framework broadens the scope of what is considered to be useful evidence and advocates for matching evidence to well-specified, user-oriented evidence needs.

  • The scope of the problem is underscored by a recent analysis of global kumanykia in body mass index between andbased on data from countries and territories 6. The apparent lack of evidence for effectiveness was compounded by a strong focus on physiological outcomes body mass index or body fatness likely to be unaffected by policy level or programmatic interventions with a single focus.

  • School physical education programs are one of the few areas in environmental obesity prevention where the Centers for Disease Control and Prevention CDC Guide to Community Preventive Services has made a positive recommendation 28on the basis of many evidence-based programs, including the CATCH program 29 that has been widely disseminated. Lawrence W.

  • The scales of justice in the center of the figure signify the theoretical likelihood that an impact on equity in the ability to prevent obesity is most likely when complementary interventions from all four categories are undertaken in concert in a way that can be synergistic, or mutually reinforcing.

  • If widely adopted and used, L. Psychology Syracuse University,

For example, prevention obesity obesity prevention, much of the relevant evidence relates to environmental circumstances and policies that influence the likelihood that prvention will achieve and maintain food intake and physical activity patterns that prevent or limit excess weight gain. Contact information. Key messages in that chapter emphasize the importance of addressing the multilevel and dynamic complexity of real-world contexts, attempting to consider the whole picture even when focusing on one aspect, and considering interactions among types and levels of interventions. The IOM study committee considered each of the challenges within the specific context of obesity prevention, and the L. Obesity Silver Spring, Md.

Several of these studies have evaluated interventions to promote healthy eating and physical activity in African American children or obesihy in clinical or community-based settings. Although these evaluations do not use experimental designs, they follow the recommendations in the LE. The framework recommends a standard template that can be used to report results to decision makers, which prompts for 1 a statement of the question, 2 a transparent description of the strategy used to locate the evidence, 3 a table reporting the evidence, and 4 a summary of the evidence organized as answers to the EBPH-derived questions Figure 2. Lessons and Future Directions The HEAL-CHI evaluation used a logic model approach to assessing intervention impact that combined estimates of the reach and strength of the interventions with population-level measures of physical activity, nutrition, and overweight eg, surveys of youth and adults.

The prevalence of obesity is higher in ethnic minority populations compared with non-Hispanic whites. Lancet London, England :Jun Evidence quality is then to be evaluated by standards appropriate to that type of evidence rather than by a single standard. Kumanyika's research focuses on identifying effective strategies to reduce nutrition-related chronic disease risks, with a particular focus on achieving health equity for black Americans. If widely adopted and used, L.

These obesoty leverage the missions and resources of many societal sectors with an explicit emphasis on kumanyika population based prevention of obesity social determinants of health APHA, n. American Heart Association. Build a system of resources such as people, compendiums of knowledge, registries of implementation experience to support evidence-based public policy prevnetion and research for complex health challenges, including obesity prevention. The subsequent process might proceed similarly to the aforementioned approach of reaching out to other sectors, forming or joining a coalition, and moving forward with an action plan geared to complementarity and co-benefits among the participating partners. The Association is an affiliated body of the International Union of Nutritional Sciences For membership and for other contributions, news, columns and services, go to: www. Also, the debate about evidence in obesity prevention was recognised as part of an ongoing international discourse about the need for greater clarity and creativity regarding evidence to inform policy and environmental change initiatives in public health and health promotion

Projections are alarming: populstion. For example, the framework could help with identifying prerequisites for a program to work, such as whether a social marketing program related to healthy eating is only effective in combination with initiatives to increase access to fat loss workouts for obese and popular healthy foods in the same community. Bridging the Evidence Gap in Obesity Prevention: A Framework to Inform Decision Making was released on 23 April 23 in pre-publication form, and published in final form six months later. The opinions expressed in all contributions to the website of the World Public Health Nutrition Association the Association including its journal World Nutritionare those of their authors. Keyword: Search. The acronym, L. Prevention of obesity Finding the best evidence.

Skip directly to search Skip directly to A to Z list Skip bawed to site content. Randomized designs also may provide incomplete information if the experiments evaluate artificial scenarios that have limited or only partial relevance to what happens in reality. She has an interdisciplinary background and holds advanced degrees in social work, nutrition, and public health. All CDC Topics.

The report sponsors — Kaiser Permanente, The Robert Wood Johnson Foundation, and the Centers for Disease Control and Prevention — kumanyika population based prevention of obesity motivated by their perception that effective approaches to obesity prevention were proving difficult to identify, creating a risk that ongoing efforts to address the problem would be ill-conceived or haphazard. Obesity reviews : an official journal of the International Association for the Study of Obesity 14 Suppl 1:Oct For more than three decades, she has led or collaborated on single- or multi-center randomized clinical trials or observational studies related to obesity, salt intake, and other aspects of diet. The work of Klesges et al shows that some contextual variables eg, cost, program sustainability are missing entirely in the peer-reviewed literature on obesity prevention Johns Hopkins University, Lancet London, England :Jun The full Bridging the Evidence Gap report and related summaries, as well as the presentations from 2 workshops convened by the committee, are available from IOM at www.

If the L. The report page on the IOM website has generated more than 17, page views. Poulation addition to the systems perspective, recognizing opportunities to generate new evidence is also recommended as a theme of the L. Kumanyika and Brownson were members of the IOM study committee. E-mail: skumanyi mail.

David B. The report sponsors — Kaiser Permanente, The Robert Wood Johnson Foundation, and the Centers for Disease Control and Prevention — were motivated by their perception that effective approaches to obesity prevention were proving difficult to identify, creating a risk that ongoing efforts to address the problem would be ill-conceived or haphazard. In general, studies of obesity prevention have tended to overemphasize internal validity eg, well-controlled efficacy trials while giving sparse attention to external validity eg, the translation of science to the various circumstances of practice 11,

  • Inequities in social structures and processes are the main drivers of population-level disparities in obesity prevalence, and addressing these drivers is critical for equity in achieving healthy weight. Materials provided by American Heart Association.

  • Also, the use of systems thinking or perspectives in the L.

  • Social disadvantage tends to intensify the exposure to obesity-promoting influences Braveman, ; May et al.

  • Barbara A. In a natural experiment, the strongest design possible internal validity is essential, and elements of external validity must be addressed.

Such assessments would ideally be done with a specific health goal in mind even when the health goals are identified secondary to other critical community priorities for change. These initiatives are inherently multisectoral in that they draw upon various types of fiscal and other policies in the realm of tax credits and community development to increase equity through food retailing Chrisinger, It calls for specific attention to solutions that, although not directly focused on health, have well-documented effects on health, such as mitigating poverty and improving employment options, as well as improving social and housing conditions. Examples include improving locations and in-store marketing practices of supermarkets; implementing standards for food provision in schools and child care settings, worksites, and public places; improving availability and quality of parks and recreational facilities; and improving neighborhood walkability, transit systems, or other neighborhood conditions.

Circulation 4 :JUL 22 Our experience suggests that L. This case study focuses specifically on attempts to increase physical activity through in-school or after-school physical activity programs in the 3 communities in the KP Northern California HEAL-CHI initiative. Research directions.

MeSH terms

Among the problems identified with these kumabyika were the lack of clear conceptual frameworks for evidence selection, the dearth of research on community, environmental, and policy-based based prevention prevention initiatives, and the limited attention given to reporting information about how these approaches might work in the real world. One aspect is intentionality, meaning the deliberate selection or design of health interventions with an awareness of what resources and capacity are required for them to be effective in a given population group and taking steps to ensure that these resources are provided. E-mail Address. Within 10 months, the report landing page on the IOM website had been viewed by approximately 8, unique visitors. Closing gaps will actually require interventions that work better in these populations than they do in white or more advantaged populations.

  • Examples include improving locations and in-store marketing practices of supermarkets; implementing standards preventlon food provision in schools and child care settings, worksites, and public places; improving availability and quality of parks and recreational facilities; and improving neighborhood walkability, transit systems, or other neighborhood conditions. It was initially drafted by her, incorporating key points from CE, and was subsequently reviewed and revised by the authors and by LJS, one of the IOM staff who was an editor of the report.

  • Obesity is a major health problem among both adults and children in the United States 20,

  • For example, the framework could help with identifying prerequisites for a program to work, such as whether a social marketing program related to healthy eating is only effective in combination with initiatives to increase access to affordable and popular healthy foods in the same community.

  • The prevalence of high body mass index in California children is declining in some groups but remains high and is not declining among American Indians and African Americans

  • Shiriki K.

The point is to be systematic but much more inclusive when determining what constitutes useful evidence related to a particular question. Ross C. Evidence sources may be quantitative or qualitative or a combination of both and may come from academic research, program evaluations, surveys, polls, reports, or policy documents related to obesity or to other public health issues from which parallels can be drawn. The L. Adapted from the Institute of Medicine 2.

Psychology Syracuse University, Obesity Silver Spring, Md. Randomized designs also may provide incomplete preventiion if the experiments evaluate artificial scenarios that have limited or only partial relevance to what happens in reality. Johns Hopkins University, In a natural experiment, the strongest design possible internal validity is essential, and elements of external validity must be addressed. Figure 2.

It calls for specific attention to solutions that, although not directly focused on health, have well-documented effects on health, such as mitigating poverty and improving employment options, as well as improving social and housing conditions. Researchers who studied young adults from the United States and four other countries found that neither Foremost among challenges to be addressed by a reframing of the evidence paradigm were:. Readers may make use of the material in this editorial if acknowledgement is given to the Association, and WN is cited.

This guidance includes a discussion of how one might apply theory or program logic and a systems lens in interpreting evidence, considerations for weighting different types of evidence, and prevention obesity ways to blend information from disparate sources and to evaluate effects. Shiriki K. Research directions. The framework recommends a standard template that can be used to report results to decision makers, which prompts for 1 a statement of the question, 2 a transparent description of the strategy used to locate the evidence, 3 a table reporting the evidence, and 4 a summary of the evidence organized as answers to the EBPH-derived questions Figure 2.

For more than three decades, she has led or collaborated on single- or multi-center randomized clinical trials or observational studies related to obesity, salt intake, and other aspects of diet. Stephen Kumanyikaa. She has extensive experience in advisory roles related to public health and nutrition policy in the US and abroad. This, in turn, helps to define what type of information is relevant, whether the information gathered is sufficiently comprehensive, and what its implications are. Such opportunities might arise at any stage of the process. Study design cannot be the sole criterion for whether evidence is useful. The full Bridging the Evidence Gap report and related summaries, as well as the presentations from 2 workshops convened by the committee, are available from IOM at www.

The acronym, L. The process bassed supported by a highly qualified staff and by an extensive review of relevant information, information resources, and related endeavours. A crucial public health task is to check and even reverse the current pandemic of overweight and obesity This category goes beyond what is typically included in frameworks for promoting healthy eating and physical activity but is core to efforts to address inequities.

If the answer is 'yes', benefits for obesity prevention will be synergistic with those that extend to public health more broadly. The most recent national survey data, released in May JAMA May 28; 20 reported no significant changes in the proportion of children and adolescents who are overweight or obese were observed between and Population-based approaches to obesity prevention are complementary to clinical preventive strategies and also to treatment programs for those who are already obese. Lewis, M. Use of the framework proposed here would also be expected to advance overall health equity and well-being over and above effects on weight, because the resultant types of solutions would be expected to have concurrent benefits that extend outside of the specific domains of food and physical activity.

School physical education programs are one of the few areas in environmental obesity prevention where the Centers for Disease Control and Prevention CDC Guide to Community Preventive Services has made a positive recommendation 28on the basis of many oopulation programs, including kumanyika population based prevention of obesity CATCH program 29 that has been widely disseminated. For more than three decades, she has led or collaborated on single- or multi-center randomized clinical trials or observational studies related to obesity, salt intake, and other aspects of diet. The case study Box of data collection in support of school-based physical activity interventions by evaluating programs in northern California communities illustrates the L. If the L. The work of Klesges et al shows that some contextual variables eg, cost, program sustainability are missing entirely in the peer-reviewed literature on obesity prevention Description of Research Expertise Dr.

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A crucial public health task is to check and even reverse the current pandemic of overweight and obesity The steps or phases build on the traditional process, but are predicated upon a new, more inclusive and transdisciplinary way of thinking about the nature of the task and the execution of each step. Ideally this would be a positive effect e. Modifying the environment to affect people's choices includes assessing the following areas to identify targets for change:. Once potential interventions or approaches have been identified, the selection process would aim for synergy among a set of strategies selected from the different categories, some with longer-term goals and some with more immediate payoffs expected. Such assessments would ideally be done with a specific health goal in mind even when the health goals are identified secondary to other critical community priorities for change. Each of the four categories is explained below.

This category focuses on interventions that are core to many obesity prevention recommendations for environmental and policy change generally e. However, the potential to uncover unintended negative consequences must also be considered. Kumanyika population based prevention of obesity, the emphasis on systems perspectives, the cautions about narrowly framed outcomes and systematic reviews, and the importance of using methodological approaches that can account for complexity, is critical across nutrition and many other scientific domains 38, Strategic partnerships may involve different types of organizations within a community: across public sectors such as housing, education, transportation, and economic development; among civic and health organizations; and throughout academic and private sectors as well. They encourage refinement of the framework through an ongoing dialogue among users. Closing gaps will actually require interventions that work better in these populations than they do in white or more advantaged populations. Print Version.

Questions that guide the gathering of obesigy. David B. A randomized controlled trial is the most rigorous design for hypothesis testing 10 but is not feasible for many examples of obesity interventions because the evaluator cannot randomly assign exposure eg, a policy. During her tenure on the Penn Medicine faculty, Dr.

Lawrence W. Numerous communities in the Kaiser Permanente KP Community Health Initiatives 27 have implemented school-based programs targeting either food or physical activity behaviors. Obesity Silver Spring, Md. For this reason, some items on this page will be unavailable. The point is to be systematic but much more inclusive when determining what constitutes useful evidence related to a particular question. In an ideal sense, L.

Description of Research Expertise Dr. Also, the use of systems thinking or perspectives in the L. To the contrary, as underscored by the Institute of Medicine IOM report on Accelerating Progress kumanyika population based prevention of obesity Obesity Prevention — Solving the Weight of the Nation 1the urgency of addressing the epidemic compels actions, often policy-related and for both the short- and long-term, that are feasible, work well, and work together, and that do not waste scarce resources or have unintended adverse consequences. This guidance includes a discussion of how one might apply theory or program logic and a systems lens in interpreting evidence, considerations for weighting different types of evidence, and potential ways to blend information from disparate sources and to evaluate effects. Scanning approximately 40 identified citations indicates that most have involved referencing the report in support of the importance of developing comprehensive multistakeholder and multisectoral strategies, taking a systems perspective, or using expanded approaches to evidence-gathering or choice of study designs. Note: Javascript is disabled or is not supported by your browser.

Obesity reviews : an official journal of the International Association for the Study of Obesity 15 Suppl 4:Oct Obesity is a major health problem among both adults and children in the United States 20, Numerous communities in the Kaiser Permanente KP Community Health Initiatives 27 have implemented school-based programs targeting either food or physical activity behaviors. She has an interdisciplinary background and holds advanced degrees in social work, nutrition, and public health. The IOM study committee considered each of the challenges within the specific context of obesity prevention, and the L.

A randomized controlled trial is the most rigorous design for hypothesis testing 10 but is not feasible for many examples of obesity interventions because the evaluator cannot randomly assign exposure eg, a policy. Obesity is a major health problem among both adults and children in the United States 20, Shiriki K. Telephone:

  • They encourage refinement of the framework through an ongoing dialogue among users. We can now identify the key environments to be targeted for change in obesity prevention, as well as goals, strategies, and actions relevant to the population as a whole.

  • Numerous communities in the Kaiser Permanente KP Community Health Initiatives 27 have implemented school-based programs targeting either food or physical activity behaviors. Although these evaluations do not use experimental designs, they follow the recommendations in the LE.

  • The timeliness of the report was linked to concurrent discussions about major funding for prevention and prevention research initiatives and also to the high profile Let's Move child obesity prevention campaign launched by First Lady Michele Obama a few months prior Institute of Medicine.

  • Although the idea that populations with a more challenging context for change would require specially tailored approaches may seem like common sense, the fact that specially designed programs require additional resources may cause policymakers to favor one-size-fits-all strategies.

The information about reach and strength came from independent assessments of the number of baed exposed and the intensity of the interventions. She has an interdisciplinary background and holds advanced basrd in social work, nutrition, and public health. Scanning approximately prevention identified citations indicates that most have involved referencing the report in support of the importance of developing comprehensive multistakeholder and multisectoral strategies, taking a systems perspective, or using expanded approaches to evidence-gathering or choice of study designs. To align with the core concepts of EBPH, approaches and tools should be geared to the types of research and practice issues that arise in public health 6,7. The Bridging the Evidence Gap report explains that timely and credible evidence is needed to help decision makers decide what to do and understand how to do it, distinguish actions that are likely to be effective from those that are not, justify particular actions in high-risk populations, quantify likely effects, estimate costs and cost-effectiveness, set priorities regarding specific outcomes, determine who benefits, and anticipate potential problems. Brownson, Prevention Research Center in St. Obesity is a major health problem among both adults and children in the United States 20,

Columbia University School of Social Work, Publications Search PubMed for articles. Shiriki K. The report page on the IOM website has generated more than 17, page views. If the L.

This is realistic and appropriate in the face of the numerous predispositions and contextual factors that influence decision-making as well as the many ways in which evidence is positioned within these processes 26, We advocate changes that will move the social norm to where physical activity is the custom. Bridging the Evidence Gap in Obesity Prevention: A Framework to Inform Decision Making was released on 23 April 23 in pre-publication form, and published in final form six months later. These strategies leverage the missions and resources of many societal sectors with an explicit emphasis on addressing social determinants of health APHA, n. Appropriate to the scope and complexity of the issues, the IOM convened a member study committee with expertise that included public health, public policy, economics, systems thinking, programme implementation, and general community prevention research, as well as nutrition, physical activity, and obesity prevention research and interventions specifically, and methodological experts in biostatistics, epidemiology, biomedical evidence hierarchies, evaluation and social science research.

  • Once potential interventions or approaches have been identified, the selection process would aim for synergy among a kumanyika population based prevention of obesity of strategies selected from the different categories, some with longer-term goals and some with more immediate payoffs expected. However, the emphasis on systems perspectives, the cautions about narrowly framed outcomes and systematic reviews, and the importance of using methodological approaches that can account for complexity, is critical across nutrition and many other scientific domains 38,

  • To align with the core concepts of EBPH, approaches and tools should be geared to the types of research and practice issues that arise in public health 6,7.

  • Its purpose is to create an authoritative break with the rigidity of the ways that hierarchies of evidence evaluation are applied, and to open the door for modifying views of evidence, going beyond prior efforts in this realm by describing a comprehensive process that has flexibility and adaptability.

  • The focus of this perspective is on those factors that are amenable to modification by altering existing public or private policies or by establishing new ones. The lack of informative studies was especially troubling given the large amount of research published on obesity and even on aspects of obesity prevention.

Appropriate to kumanyika population based prevention of obesity scope and complexity of the lbesity, the IOM convened a member study committee with expertise that included public health, public policy, economics, systems thinking, programme implementation, and general community prevention research, as well as nutrition, physical activity, and obesity prevention research and interventions specifically, and methodological experts in biostatistics, epidemiology, biomedical evidence hierarchies, evaluation and social science research. SK is the main author of this commentary. Social disadvantage tends to intensify the exposure to obesity-promoting influences Braveman, ; May et al. American Heart Association.

The need for bold steps to close this evidence gap was the focus of an Institute of Medicine IOM study committee report released in April 8. Placing other types of services, such as banking and health care, at kumanyika population based prevention of obesity same location resources may obssity as incentives for people to do their regular shopping at these stores. Obesity is a major influence on the development and course of cardiovascular diseases and affects physical and social functioning and quality of life. Author disclosures are available on the manuscript. Several organisations issued e-mail and web announcements about the report shortly after its release. A proposed framework for an operational approach to such as strategy is shown in Figure 2. The fact that this is a long-term proposition can discourage action because of uncertainty about how to proceed.

According to the bqsed, a broad range of policy and environmental strategies at the local, state and federal levels can help people adopt healthy behaviors, such as being physically active and eating right. The L. Such complementary strategies include zoning measures to decrease outdoor advertising for sugar-sweetened beverages given that such ads are more common in lower-income neighborhoods reducing deterrents Isgor et al.

  • Alternatively, looking across categories in the prevdntion could lead to recognition of how the outcomes of a program in one category could affect a need in another category. It is consistent with the principles, processes, and current evidence about the importance of whole community interventions with a deliberate focus on equity when designing and implementing strategies for obesity prevention in the United States and abroad.

  • Such opportunities might arise at any stage of the process. Obesity Silver Spring, Md.

  • Retrieved August 2, from www.

  • SK is the main author of this commentary. These appraisals included meta-analyses, systematic reviews, integrative reviews, reviews of reviews, evidence syntheses, best practice summaries, and task force recommendations.

  • Obesity in children and adolescents is of particular concern because it may compromise physical and psychosocial development and set the stage po;ulation early onset of adverse health effects that accumulate over a lifetime IOM, A key step is convening relevant experts and stakeholder groups with knowledge of approaches in each category in the framework type of solutionengage them to think through a coordinated strategy and identify metrics for assessing success.

For example, one high-dose populatiin was an after school physical activity program that one-quarter of all children participated kumanyika population based prevention of obesity that added 20 minutes per day of moderate to vigorous physical activity. Master of Public Health Program. During her tenure on the Penn Medicine faculty, Dr. Several of these studies have evaluated interventions to promote healthy eating and physical activity in African American children or adults in clinical or community-based settings. She has an interdisciplinary background and holds advanced degrees in social work, nutrition, and public health.

  • Prevention of obesity Finding the best evidence.

  • Prev Chronic Dis 4 4 : A, Views expressed in this commentary that are not directly identified as content in the report should be attributed to the authors and may not represent the views of the Institute of Medicine.

  • Materials provided by American Heart Association. Print Version.

Also, the debate about evidence in obesity prevention was recognised as part of an ongoing international discourse about the need for greater clarity and creativity regarding evidence to inform policy and environmental change initiatives in public health and health promotion As previously shown in Figure 2, increasing capacity also includes the concept of increasing awareness of and receptivity to improved options for healthy eating and physical activity and other aspects of health and well-being mobilizing demand through increased health knowledge, food and nutrition literacy, exposure to campaigns that market healthy foods and active living options, and direct experiences with healthy products and activities. About 4. Print Version. This category focuses on interventions that are core to many obesity prevention recommendations for environmental and policy change generally e.

This case study focuses specifically on attempts to increase physical activity through in-school or after-school physical activity programs in the 3 communities in kumanyika population based prevention of obesity KP Northern California HEAL-CHI initiative. Obesity is a major health problem among both adults and children in the United States 20, The Bridging the Evidence Gap report directs recommendations to decision makers in the policy and programmatic arenas as well as to those who fund, generate, and publish evidence about obesity prevention and other complex public health challenges. Kumanyika, S. Moreover, progress being made in curbing the epidemic may not reach all groups equally.

Barbara A. Evidence Base School physical education programs are one of the few areas in environmental obesity prevention where the Centers for Disease Control and Prevention CDC Guide to Community Preventive Services has made a positive recommendation 28on the basis of many evidence-based programs, including the CATCH program 29 that has been widely disseminated. Master of Public Health Program.

Questions that guide the gathering of evidence. Results indicated preevention in almost half of the cases 4 of 9 where high-dose interventions were implemented, significant positive changes favored the intervention. This perspective helps to anticipate a broader set of outcomes — both positive and adverse — that may be associated with a policy or program and also to see how a particular policy or program might be enhanced or inhibited by others or by situational factors. If widely adopted and used, L. Lancet London, England :Jun

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Overall, this leaves the field somewhat muddled, uncomfortable and unable to take action even in the face of need and crisis. Other writing committee members include For obese Obarzanek, Ph. The persistence of concentrated health disparities obewity many American communities is strongly influenced by the relative paucity of community-based health improvement strategies focused on creating robust local participatory decision-making processes. A strategy that includes efforts with both short- and long-term payoffs is essential, but now is the time to begin in earnest. Print Email Share. Studies included in many of the reviews overlapped, although conclusions varied. Such studies may be viewed as very convincing when judged by the typical evidence hierarchy, but they may be uninformative with respect to what takes place in real world settings.

The case study Box of data collection in support of school-based physical activity interventions by evaluating programs in northern California communities illustrates the L. As recommended in the L. Robert A. The ultimate goal of the L. Back to Top.

Over a period of about 18 months, these experts deliberated at face-to-face meetings and teleconferences, obtained rpevention at two public workshops, and drew upon the ku,anyika and conclusions of a number of prior reports and other resources related to evidence-based public health and public policy. Other writing committee members include Eva Obarzanek, Ph. However, the clarity implied by broad statements about needed actions, turns to uncertainty and controversy when trying to pinpoint specific ways to intervene. This is a type of proportionate universalism that is broader than only attending to the aspects of the intervention that are directly health-related or controlled by the health sector. For example, the framework could help with identifying prerequisites for a program to work, such as whether a social marketing program related to healthy eating is only effective in combination with initiatives to increase access to affordable and popular healthy foods in the same community.

  • Strategic partnerships may involve different types of organizations within a community: across public sectors such obese housing, education, transportation, and economic development; among civic and health organizations; and throughout academic and private sectors as well. In general researchers reviewing this type of evidence found very little good quality evidence based on conventional criteria, and studies rated as high quality were often inconclusive as to what might work.

  • However, in EBPH, approaches for achieving scientific validity and rigor are broadened to allow for a more balanced consideration of both internal and external validity to assess effectiveness ie, are results shown as a result of implementing the program and relevance ie, can findings be generalized to new settings and populations in public health contexts, which can be very different from the therapeutic settings addressed in EBM.

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  • The transformational aspect is the positioning of evidence needs in a public health context and demonstrating that rigor and relevance can be achieved using EBPH concepts and tools. Although to date few approaches to EBPH have been systems-based, evidence gathering and use in the L.

  • Described by Kohatsu et al, EBPH is a process of integrating science-based interventions with community preferences to improve the health of populations 4. All CDC Topics.

Partial relevance might occur if the trial manipulates only 1 or 2 of several variables that interact in a kumanyika population based prevention of obesity manner to affect an outcome. Randomized designs also may provide incomplete information if the experiments evaluate artificial scenarios that have limited or only partial relevance to what happens in reality. Back to Top. Author Affiliations: Ross C. Research directions. Being either obese or overweight increases the risk for many chronic diseases eg, heart disease, type 2 diabetes, certain cancers, stroke

This category focuses on interventions that are core to many obesity prevention recommendations for environmental and kumanyika population based prevention of obesity change generally e. Several organisations issued e-mail and kumanyoka announcements about the report shortly after its release. This took the form of a secondary review of approximately 50 published appraisals of evidence for obesity prevention published during the prior 13 years, a period characterised by major attention to the obesity epidemic in the scientific literature and the media. For example, in National Health and Nutrition Examination Survey data based on measured weights and heights, 48 percent of non-Hispanic black adults and 43 percent of Hispanic adults had obesity, compared to 35 percent of non-Hispanic whites Ogden et al.

The prevalence of high body mass index obesiry California children is declining in some groups but remains high and is not declining among American Indians and African Americans The answer depends on further use of frameworks such as L. One way that EBPH differs from EBM is that it relies less on randomized controlled trials and more on approaches that assess external validity. Obesity reviews : an official journal of the International Association for the Study of Obesity 15 Suppl 4:Oct

The APOP study committee reviewed hundreds of recommendations for preventing obesity and arrived at five recommendations, 20 accompanying strategies for implementing these recommendations, and a number of potential action steps for each strategy IOM, On the obesity output side, the unnatural environment is evident in residential areas where cars are a common form of transportation or where mobility depends on using a car, in sedentary work environments that limit physical activity, and where sedentary entertainment is readily available, affordable, and heavily promoted. Open letter to the director Childhood obesity. The pathways of interest involve core societal structures and processes that are interrelated and ever-changing, and have multiple beginning and end points.

  • This four-pronged approach is consistent with the general principle that coordinated multifactorial solutions are needed to address complex public health problems such as obesity.

  • The IOM study committee considered each of the challenges within the specific context of obesity prevention, and the L.

  • The scope of the problem is underscored by a recent analysis of global trends in body mass index between andbased on data from countries and territories 6.

  • Decisions about obesity prevention are being made daily in communities, states, and countries worldwide. Several of these studies have evaluated interventions to promote healthy eating and physical activity in African American children or adults in clinical or community-based settings.

These factors are difficult to change. It calls for specific attention to solutions that, although not directly focused on health, have well-documented effects on health, such as mitigating poverty and improving employment options, as well as improving social and housing conditions. Taxing or reducing access to sugary beverages would kumanyika population based prevention of obesity within this category as would policies and programs that remove blight, decrease crime, or prohibit unfair whether intended or inadvertent exclusions of people from pathways to health because of their demographic characteristics. Prevention of obesity Finding the best evidence Respond below please. Obesity is a major influence on the development and course of cardiovascular diseases and affects physical and social functioning and quality of life. This American Heart Association scientific statement aims: 1 to raise awareness of the importance of undertaking population-based initiatives specifically geared to the prevention of excess weight gain in adults and children; 2 to describe considerations for undertaking obesity prevention overall and in key risk subgroups; 3 to differentiate environmental and policy approaches to obesity prevention from those used in clinical prevention and obesity treatment; 4 to identify potential targets of environmental and policy change using an ecological model that includes multiple layers of influences on eating and physical activity across multiple societal sectors; and 5 to highlight the spectrum of potentially relevant interventions and the nature of evidence needed to inform population-based approaches.

Prevention of obesity Finding the best evidence. We can also kumanyika population based prevention of obesity the various types or sources of inequities in social and environmental context factors that pose challenges for effective interventions IOM, This evidence gap creates tension between the sense of urgency to take action to prevent obesity and the lack of specificity about what actions to undertake. Over the past five years, more than 5, pregnant women took part in Rather, it seeks to improve the process by focusing evidence-gathering and use on potential solutions to the obesity epidemic that may take a variety of forms. Decision-makers and those involved in generating evidence, including researchers, research funders, and publishers of research. Within 10 months, the report landing page on the IOM website had been viewed by approximately 8, unique visitors.

CDC and the Institute of Medicine have also made recommendations that include extracurricular eg, after school physical activity programs but the evidence for the effectiveness of those programs is more limited. Adapted from the Institute of Medicine 2. The report sponsors — Kaiser Permanente, The Robert Wood Johnson Foundation, and the Centers for Disease Control and Prevention — were motivated by their perception that effective approaches to obesity prevention were proving difficult to identify, creating a risk that ongoing efforts to address the problem would be ill-conceived or haphazard. Kumanyika, S.

Modifying the environment to affect people's choices includes assessing the following areas to identify targets for change: Locations of fast-food restaurants Restaurant portion sizes Availability of high-fat, low-fiber foods and sweetened drinks Community design and kumanyikx, which involves assessing land use mix and "walkability" of neighborhoods, including -- Adequate sidewalks kumanyi,a areas for physical activity Accessibility of jobs, schools, and recreation by walking or cycling Availability of public transportation "The concept of population-level interventions to change contexts for individual behavior is well known from the experience with tobacco regulations," Kumanyika said. Bring together researchers, research funders, publishers of research, decision makers, and other stakeholders to discuss the practical uses of the L. The APOP study committee reviewed hundreds of recommendations for preventing obesity and arrived at five recommendations, 20 accompanying strategies for implementing these recommendations, and a number of potential action steps for each strategy IOM, The focus in this category is on improving the balance of health-promoting and health-damaging exposures by decreasing messages promoting unhealthy foods or behaviors, making unhealthy options less affordable, and otherwise reducing physical and social conditions that discourage healthy behaviors. This makes obesity a health equity issue rather than simply one of health differences between population groups that are otherwise comparable in social position and opportunities. The L. Each of the four categories is explained below.

The process of getting to equity in achieving healthy weight cannot move forward until certain societal determinants of obesity are altered. Over a period of about 18 months, these experts deliberated at face-to-face meetings and teleconferences, obtained information at two public workshops, and drew upon the findings and conclusions of a preveniton of prior reports and other resources precention to evidence-based public health and public policy. The committee chair's July presentation to the steering committee of the National Collaborative on Childhood Obesity Prevention NCCOR 35 was among the first opportunities to discuss the report and its implications with a broadly based set of key stakeholders in the research funding arena. Author disclosures are available on the manuscript. The 4-page report brief had been downloaded more than 2, times, and approximately copies of the report had been purchased from the National Academies Press website. This is a type of proportionate universalism that is broader than only attending to the aspects of the intervention that are directly health-related or controlled by the health sector. Over the past five years, more than 5, pregnant women took part in

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