Breaking down the evidence: The use of short summaries to promote evidence informed public health programming
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The document discusses research on interventions to prevent obesity in children. It describes a systematic review that evaluated 22 controlled trials testing interventions involving diet, physical activity, and lifestyle/social support. The review found that combining dietary and physical activity approaches did not significantly improve BMI in most studies. Some studies focusing on either diet or physical activity alone showed small positive impacts on BMI, particularly for girls. The document also discusses a prototype executive summary developed for decision-makers that included short summaries of review findings, methodological quality assessments, implications for policy and practice, and contact information. Focus groups found the prototype summary was clear, could be passed on without translation, and included helpful elements like implications.
![Date this summary statement was written:
November 2006
Summary Statement Title:
Interventions for Preventing Obesity in Children: Evidence and implications for public health
Review on which this summary statement is based:
Summerbell, C.D., Waters, E., Edmunds, L.D., Kelly, S., Brown, T. & Campbell, K.J. (2005). Interventions for Preventing Obesity in Children. The
Cochrane Database of Systematic Reviews 2005, Issue 3. Art. No: CD00187.pub2. DOI: 10.1002/14651858.CD00187.pub2.
Review Author Contact Information:
Carolyn Summerbell, School of Health, University of Teesside, Borough Road, Middlesbrough, TS1 3BA, UK carolyn.summerbell@tees.ac.uk
This is a summary statement written to condense the work of the authors of this systematic review, referenced above. The intent of this summary is to
provide an overview of the findings and implications of the full review. For more information on individual studies included in the review, please see the
review itself.
Review Content Summary
This systematic review summarized individual studies on the effectiveness of interventions designed to prevent obesity in
childhood through diet, physical activity, and/or lifestyle changes and social support. Twenty-two controlled trials were
included in the review, most of which were school/preschool-based. The majority of studies were short-term. Studies that
focused on combining dietary and physical activity approaches did not significantly improve body mass index (BMI). A few
studies that focused on either diet or physical activity showed a small but positive impact on BMI status, but this effect was
restricted to girls in some studies. This review is the updated version of one, with the same title, conducted in 20021.
Comments on this review’s methodology
This is a methodologically strong systematic review of 22 controlled trials. A clearly focused clinical question was identified.
A comprehensive search strategy that included multiple electronic databases (from 1990 to 2005), expert informants,
unpublished studies, reference lists, as well as English and non-English publications is described. Two reviewers
independently extracted data and assessed the methodological quality of primary studies. The methodological quality of
primary studies was assessed based on research design, study sample, sources of bias, data analysis, and rates of attrition.
No tests of heterogeneity were reported and there is no evidence of weighting of results. It was not possible to statistically
combine the studies due to variation in the design, quality, target population, theoretical underpinnings, and outcome
measures.
Why this issue is of interest to public health
The Canadian Population Health Initiative [CPHI] recognized obesity as a widespread public health problem in Canada as well
as a major contributing factor to Canada’s burden of disease2. Health consequences for youth related to obesity include risks
to the cardiovascular, endocrine, pulmonary, orthopaedic and gastroenterological systems and impediments to the
development of healthy lifestyles and body image3. Morbidity and quality-of-life effects of obesity are similar to those caused
by smoking, poverty, and problem drinking4. Further, the health care costs associated with obesity-related mortality and
morbidity are significant and increasing. CPHI, based on effectiveness evidence related to the prevention of obesity among
children and youth, recommended breastfeeding, regular school-based physical education, comprehensive school health
programs, reduced television viewing time and community-wide interventions as effective solutions to the problem of obesity2.
Evidence and Implications
Evidence points are weighted or ranked according to strength
What’s the evidence? Implications for practice and policy:
1. Physical activity interventions vs. control (2 long 1. Physical activity interventions vs. control (2 long term;
term; 4 short term studies) 4 short term studies)
1.1. The results of this review were mixed regarding 1.1. Caution should be taken when considering the
the effectiveness of physical activity development of obesity prevention programs with
interventions implemented on their own in only physical activity interventions.
preventing obesity, reducing BMI, or increasing 1.2. Physical activity interventions need to be of sufficient
moderate to vigorous physical activity in intensity, frequency, and duration to achieve the
children and youth. desired outcomes.
1.2. Results differed for males and females (5 1.3. Physical activity interventions should be theory-
5th Canadian Cochrane Symposium studies)
1.3. The two long term studies reported positive
based, school-based, have multiple components,
involve younger children, and involve trained staff.
Feb 13, 2007 findings at various intervals but failed to report 1.4. Physical activity interventions may be need to be](https://image.slidesharecdn.com/pp11breakingdowntheevidencetheuseofshortsummariestopromoteevidence-informedpublichealthprogramming-110104110617-phpapp02/85/Breaking-down-the-evidence-The-use-of-short-summaries-to-promote-evidence-informed-public-health-programming-9-320.jpg)
![eral Implications:
dies that focused on combining dietary and physical activity approaches did not significantly improve BMI, but some studies that
ed on physical activity approaches showed a small but positive impact on BMI status.
Benefit or Cost-Effectiveness Information
ffectiveness information was not included in this review.
ences Used to Outline Issue
ampbell, K., Waters, E., O’Meara, S., Kelly, S., & Summerbell, C. (2002). Interventions for preventing obesity in
hildren. The Cochrane Database of Systematic Reviews, Issue 2. Art. No.: CD001871. DOI:
0.1002/14651858.CD001871.
anadian Population Health Initiative. (2004). Improving the Health of Canadians. Canadian Institute for Health
formation [CIHI], Ottawa, Ontario.
aine, K.D. (2004) Overweight and obesity in Canada: A population health perspective. Canadian Institute for Health
formation. Ottawa, Ontario. http://www.cihi.ca/cihiweb/dispPage.jsp?cw_page=GR_1130_E
all, G.D.C., & McCargar, L.J. (2003). Childhood obesity in Canada: a review of prevalence estimates and risk factors for
ardiovascular diseases and type 2 diabetes. Can J Appl Physiol, 28,117-40.
Quality Reviews on this Topic
iliska, D., Miles, E., O'Brien, M.A., Turl, C., Tomasik, H. H., Donovan, U., & Beyer, N. (1999). The effectiveness of
ommunity interventions to increase fruit and vegetable consumption in people four years of age and older. EPHPP, 1-
5. http://old.hamilton.ca/phcs/ephpp/Research/Full-Reviews/98-99/Fruit-&-Vegetable-review.pdf
obbins, M., Lockett, D., Michel, I., Beyers, J., Feldman, L., Vohra, J., & Micucci, S. (2001). The effectiveness of
chool-based interventions in promoting physical activity and fitness among children and youth: A systematic
eview. EPHPP, 1-103. http://old.hamilton.ca/phcs/ephpp/Research/Full-Reviews/Physical-Activity-Review.pdf
ynn, M. A., McNeil, D. A., Maloff, B., Mutasingwa, D., Wu, M., Ford, C., & Tough, S. C. (2006). Reducing obesity and
lated chronic disease risk in children and youth: A synthesis of evidence with ‘best practice’ recommendations. Obesity
eviews, 7(Suppl. 1), 7-66.
ardeman, W., Griffin, S., Johnston, M., Kinmonth, A. L., & Wareham, N. J. (2000). Interventions to prevent weight gain:
systematic review of psychological models and behaviour change methods. International Journal of Obesity, 24(2),
31-143.
icucci, S., Thomas, H., & Vohra, J. (2002). The effectiveness of school-based strategies for the primary prevention of
besity and for promoting physical activity and/or nutrition, the major modifiable risk factors for type 2 diabetes: A review
f reviews. EPHPP, 1-55. http://old.hamilton.ca/phcs/ephpp/Research/Full-Reviews/Diabetes-Review.pdf
homas, H., Ciliska, D., Micucci, S, Wilson-Abra, J, & Dobbins, M. (2004). Effectiveness of physical activity enhancement
nd obesity prevention programs in children and youth. EPHPP, 1-206.
tp://old.hamilton.ca/phcs/ephpp/Research/Summary/2004/HealthyWeightsFull2004.pdf
d links
anadian Institute of Health Information. (2003). Obesity in Canada: Identifying Policy Priorities: Proceedings of a
oundtable. CIHI, Ottawa, ON. www.cihr-irsc.gc.ca/e/documents/CPHI_proceed_e.pdf
he Public Health Agency of Canada promotes an increase in physical activity and healthy eating through the Canadian
eart Health Initiative (www.phac-aspc.gc.ca/ccdpc-cpcmc/cvd-mcv/index_e.html) and the Canadian Diabetes Strategy
www.phac-aspc.gc.ca/ccdpc-cpcmc/diabetes-diabete/english/strategy/index_comp.html).
he Registered Nurses Association of Ontario (RNAO) has developed Best Practice Guidelines for the Primary
revention of Childhood Obesity (http://www.rnao.org/Page.asp?PageID=828&ContentID=811).
mary Statement Author
en Dobbins, RN, PhD
ant Professor
Robeson RN, MScN
edge Broker
-evidence.ca
pinion and ideas contained in this document are those of the summary statement author(s) and health-evidence.ca. They do not necessarily reflect or
sent the views of the author’s employer or other contracting organizations. Links from this site to other sites are presented as a convenience to health-
5th Canadian Cochrane Symposium evidence.ca internet users. Health-evidence.ca does not endorse nor accept any responsibility for the content found at these sites.
Feb 13, 2007](https://image.slidesharecdn.com/pp11breakingdowntheevidencetheuseofshortsummariestopromoteevidence-informedpublichealthprogramming-110104110617-phpapp02/85/Breaking-down-the-evidence-The-use-of-short-summaries-to-promote-evidence-informed-public-health-programming-10-320.jpg)
Breaking down the evidence: The use of short summaries to promote evidence informed public health programming
- 2. Objectives • Decision maker preferences • Prototype development • Current examples 5th Canadian Cochrane Symposium Feb 13, 2007
- 3. Looking for answers • What are decision makers’ preferences for receiving research evidence? • How can we promote use and overcome barriers to use? • How can ownership of knowledge be distributed amongst users? 5th Canadian Cochrane Symposium Feb 13, 2007
- 4. User’s Preferences • Short summaries • Access to full document • Divided: hard copy vs. electronic • Commentary, and rating of methodological quality • E-mailed updates • Want to receive research only in areas of interest 5th Canadian Cochrane Symposium Feb 13, 2007
- 5. Testing an Executive Summary Prototype • 9 focus groups in 7 Canadian cities: Halifax, Montreal, Ottawa, Winnipeg, Calgary, Edmonton, Vancouver, Oct 2002 - Jan 2003 • 5-7 participants • range of decision making levels • semi-structured interview guide • audiotaped sessions with interview notes 5th Canadian Cochrane Symposium Feb 13, 2007
- 6. What decision makers liked most: • length, writing style, plain language use • could pass it on without having to ‘translate’ • 2-4 page synthesis of each review • issue framed in a Canadian context • implications spelled out • contact information for asking questions (Dobbins, et al 2004) 5th Canadian Cochrane Symposium Feb 13, 2007
- 7. Selecting Target Audiences Who can act on the basis of the available research knowledge? Who can influence those who can act? With which of these target audience(s) can we expect to have the most success? Which messages pertain most directly to them? 5th Canadian Cochrane Symposium Feb 13, 2007
- 8. Components • Review Content Summary • Methodological Quality • Issue (Canadian context) • What is the evidence • Implications: policy and practice 5th Canadian Cochrane Symposium Feb 13, 2007
- 9. Date this summary statement was written: November 2006 Summary Statement Title: Interventions for Preventing Obesity in Children: Evidence and implications for public health Review on which this summary statement is based: Summerbell, C.D., Waters, E., Edmunds, L.D., Kelly, S., Brown, T. & Campbell, K.J. (2005). Interventions for Preventing Obesity in Children. The Cochrane Database of Systematic Reviews 2005, Issue 3. Art. No: CD00187.pub2. DOI: 10.1002/14651858.CD00187.pub2. Review Author Contact Information: Carolyn Summerbell, School of Health, University of Teesside, Borough Road, Middlesbrough, TS1 3BA, UK carolyn.summerbell@tees.ac.uk This is a summary statement written to condense the work of the authors of this systematic review, referenced above. The intent of this summary is to provide an overview of the findings and implications of the full review. For more information on individual studies included in the review, please see the review itself. Review Content Summary This systematic review summarized individual studies on the effectiveness of interventions designed to prevent obesity in childhood through diet, physical activity, and/or lifestyle changes and social support. Twenty-two controlled trials were included in the review, most of which were school/preschool-based. The majority of studies were short-term. Studies that focused on combining dietary and physical activity approaches did not significantly improve body mass index (BMI). A few studies that focused on either diet or physical activity showed a small but positive impact on BMI status, but this effect was restricted to girls in some studies. This review is the updated version of one, with the same title, conducted in 20021. Comments on this review’s methodology This is a methodologically strong systematic review of 22 controlled trials. A clearly focused clinical question was identified. A comprehensive search strategy that included multiple electronic databases (from 1990 to 2005), expert informants, unpublished studies, reference lists, as well as English and non-English publications is described. Two reviewers independently extracted data and assessed the methodological quality of primary studies. The methodological quality of primary studies was assessed based on research design, study sample, sources of bias, data analysis, and rates of attrition. No tests of heterogeneity were reported and there is no evidence of weighting of results. It was not possible to statistically combine the studies due to variation in the design, quality, target population, theoretical underpinnings, and outcome measures. Why this issue is of interest to public health The Canadian Population Health Initiative [CPHI] recognized obesity as a widespread public health problem in Canada as well as a major contributing factor to Canada’s burden of disease2. Health consequences for youth related to obesity include risks to the cardiovascular, endocrine, pulmonary, orthopaedic and gastroenterological systems and impediments to the development of healthy lifestyles and body image3. Morbidity and quality-of-life effects of obesity are similar to those caused by smoking, poverty, and problem drinking4. Further, the health care costs associated with obesity-related mortality and morbidity are significant and increasing. CPHI, based on effectiveness evidence related to the prevention of obesity among children and youth, recommended breastfeeding, regular school-based physical education, comprehensive school health programs, reduced television viewing time and community-wide interventions as effective solutions to the problem of obesity2. Evidence and Implications Evidence points are weighted or ranked according to strength What’s the evidence? Implications for practice and policy: 1. Physical activity interventions vs. control (2 long 1. Physical activity interventions vs. control (2 long term; term; 4 short term studies) 4 short term studies) 1.1. The results of this review were mixed regarding 1.1. Caution should be taken when considering the the effectiveness of physical activity development of obesity prevention programs with interventions implemented on their own in only physical activity interventions. preventing obesity, reducing BMI, or increasing 1.2. Physical activity interventions need to be of sufficient moderate to vigorous physical activity in intensity, frequency, and duration to achieve the children and youth. desired outcomes. 1.2. Results differed for males and females (5 1.3. Physical activity interventions should be theory- 5th Canadian Cochrane Symposium studies) 1.3. The two long term studies reported positive based, school-based, have multiple components, involve younger children, and involve trained staff. Feb 13, 2007 findings at various intervals but failed to report 1.4. Physical activity interventions may be need to be
- 10. eral Implications: dies that focused on combining dietary and physical activity approaches did not significantly improve BMI, but some studies that ed on physical activity approaches showed a small but positive impact on BMI status. Benefit or Cost-Effectiveness Information ffectiveness information was not included in this review. ences Used to Outline Issue ampbell, K., Waters, E., O’Meara, S., Kelly, S., & Summerbell, C. (2002). Interventions for preventing obesity in hildren. The Cochrane Database of Systematic Reviews, Issue 2. Art. No.: CD001871. DOI: 0.1002/14651858.CD001871. anadian Population Health Initiative. (2004). Improving the Health of Canadians. Canadian Institute for Health formation [CIHI], Ottawa, Ontario. aine, K.D. (2004) Overweight and obesity in Canada: A population health perspective. Canadian Institute for Health formation. Ottawa, Ontario. http://www.cihi.ca/cihiweb/dispPage.jsp?cw_page=GR_1130_E all, G.D.C., & McCargar, L.J. (2003). Childhood obesity in Canada: a review of prevalence estimates and risk factors for ardiovascular diseases and type 2 diabetes. Can J Appl Physiol, 28,117-40. Quality Reviews on this Topic iliska, D., Miles, E., O'Brien, M.A., Turl, C., Tomasik, H. H., Donovan, U., & Beyer, N. (1999). The effectiveness of ommunity interventions to increase fruit and vegetable consumption in people four years of age and older. EPHPP, 1- 5. http://old.hamilton.ca/phcs/ephpp/Research/Full-Reviews/98-99/Fruit-&-Vegetable-review.pdf obbins, M., Lockett, D., Michel, I., Beyers, J., Feldman, L., Vohra, J., & Micucci, S. (2001). The effectiveness of chool-based interventions in promoting physical activity and fitness among children and youth: A systematic eview. EPHPP, 1-103. http://old.hamilton.ca/phcs/ephpp/Research/Full-Reviews/Physical-Activity-Review.pdf ynn, M. A., McNeil, D. A., Maloff, B., Mutasingwa, D., Wu, M., Ford, C., & Tough, S. C. (2006). Reducing obesity and lated chronic disease risk in children and youth: A synthesis of evidence with ‘best practice’ recommendations. Obesity eviews, 7(Suppl. 1), 7-66. ardeman, W., Griffin, S., Johnston, M., Kinmonth, A. L., & Wareham, N. J. (2000). Interventions to prevent weight gain: systematic review of psychological models and behaviour change methods. International Journal of Obesity, 24(2), 31-143. icucci, S., Thomas, H., & Vohra, J. (2002). The effectiveness of school-based strategies for the primary prevention of besity and for promoting physical activity and/or nutrition, the major modifiable risk factors for type 2 diabetes: A review f reviews. EPHPP, 1-55. http://old.hamilton.ca/phcs/ephpp/Research/Full-Reviews/Diabetes-Review.pdf homas, H., Ciliska, D., Micucci, S, Wilson-Abra, J, & Dobbins, M. (2004). Effectiveness of physical activity enhancement nd obesity prevention programs in children and youth. EPHPP, 1-206. tp://old.hamilton.ca/phcs/ephpp/Research/Summary/2004/HealthyWeightsFull2004.pdf d links anadian Institute of Health Information. (2003). Obesity in Canada: Identifying Policy Priorities: Proceedings of a oundtable. CIHI, Ottawa, ON. www.cihr-irsc.gc.ca/e/documents/CPHI_proceed_e.pdf he Public Health Agency of Canada promotes an increase in physical activity and healthy eating through the Canadian eart Health Initiative (www.phac-aspc.gc.ca/ccdpc-cpcmc/cvd-mcv/index_e.html) and the Canadian Diabetes Strategy www.phac-aspc.gc.ca/ccdpc-cpcmc/diabetes-diabete/english/strategy/index_comp.html). he Registered Nurses Association of Ontario (RNAO) has developed Best Practice Guidelines for the Primary revention of Childhood Obesity (http://www.rnao.org/Page.asp?PageID=828&ContentID=811). mary Statement Author en Dobbins, RN, PhD ant Professor Robeson RN, MScN edge Broker -evidence.ca pinion and ideas contained in this document are those of the summary statement author(s) and health-evidence.ca. They do not necessarily reflect or sent the views of the author’s employer or other contracting organizations. Links from this site to other sites are presented as a convenience to health- 5th Canadian Cochrane Symposium evidence.ca internet users. Health-evidence.ca does not endorse nor accept any responsibility for the content found at these sites. Feb 13, 2007
- 11. 5th Canadian Cochrane Symposium Feb 13, 2007