A secondary analysis of the childhood obesity prevention Cochrane Review through a wider determinants of health lens: implications for research funders, researchers, policymakers and practitioners.
A secondary analysis of the childhood obesity prevention Cochrane Review through a wider determinants of health lens: implications for research funders, researchers, policymakers and practitioners.
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DOI：
10.1186/s12966-021-01082-2
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发表时间：
2021-02-10
期刊：
影响因子：
--
通讯作者：
Moore T
中科院分区：
文献类型：
--
作者：
Nobles J;Summerbell C;Brown T;Jago R;Moore T
随机对照试验（RCTs）通常被视为证据的黄金标准，并随后为政策制定提供信息。Cochrane综述综合了这类证据，为实践、政策和未来的研究提供建议。在这里，我们批判性地评估了儿童肥胖预防Cochrane综述中包含的随机对照试验，以了解这些干预措施在通过更广泛的健康决定因素（WDoH）视角进行检查时的重点。我们对1993年以来发表的Cochrane综述“预防儿童肥胖的干预措施”中的干预措施进行了二次分析。所有153项随机对照试验由两位作者使用自适应框架综合方法根据WDoH模型独立编码。我们使用了来自英国公共卫生的行动绘图工具的各个方面来促进我们的编码，并将我们针对226种已知肥胖原因的发现可视化。针对下游（如个人和家庭行为）而不是上游（如基础设施、环境、政策）决定因素的干预措施比例随着时间的推移（从1993年到2015年）没有改变，大多数干预措施（57.9%）旨在通过基于教育的方法改变个人生活方式因素。几乎一半的干预措施（45%）针对两个或两个以上的世界卫生组织水平。如果干预措施针对的是一些更广泛的决定因素，这通常是通过提高教师的技能，向儿童提供教育内容来实现的。针对不同年龄儿童（0-5岁、6-12岁、13-18岁）的干预措施在设计或实施上没有显著差异。这项研究强调，通过随机对照试验评估的干预措施，在过去的25年里，一直专注于肥胖的下游个人决定因素，尽管我们对其复杂病因的理解发生了重大变化。我们希望我们的分析结果能够挑战研究资助者、研究人员、政策制定者和实践者，让他们反思和批评我们所采用的以证据为基础的范式，并呼吁将重点转移到更好地解释肥胖复杂性的新证据上。在线版本包含补充材料，可在10.1186/s12966-021-01082-2获得。
Randomised controlled trials (RCTs) are often regarded as the gold standard of evidence, and subsequently go on to inform policymaking. Cochrane Reviews synthesise this type of evidence to create recommendations for practice, policy, and future research. Here, we critically appraise the RCTs included in the childhood obesity prevention Cochrane Review to understand the focus of these interventions when examined through a wider determinants of health (WDoH) lens. We conducted a secondary analysis of the interventions included in the Cochrane Review on “Interventions for Preventing Obesity in Children”, published since 1993. All 153 RCTs were independently coded by two authors against the WDoH model using an adaptive framework synthesis approach. We used aspects of the Action Mapping Tool from Public Health England to facilitate our coding and to visualise our findings against the 226 perceived causes of obesity. The proportion of interventions which targeted downstream (e.g. individual and family behaviours) as opposed to upstream (e.g. infrastructure, environmental, policy) determinants has not changed over time (from 1993 to 2015), with most intervention efforts (57.9%) aiming to change individual lifestyle factors via education-based approaches. Almost half of the interventions (45%) targeted two or more levels of the WDoH. Where interventions targeted some of the wider determinants, this was often achieved via upskilling teachers to deliver educational content to children. No notable difference in design or implementation was observed between interventions targeting children of varying ages (0–5 years, 6–12 years, 13–18 years). This study highlights that interventions, evaluated via RCTs, have persisted to focus on downstream, individualistic determinants of obesity over the last 25 years, despite the step change in our understanding of its complex aetiology. We hope that the findings from our analysis will challenge research funders, researchers, policymakers and practitioners to reflect upon, and critique, the evidence-based paradigm in which we operate, and call for a shift in focus of new evidence which better accounts for the complexity of obesity. The online version contains supplementary material available at 10.1186/s12966-021-01082-2.
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影响因子：
15.8
作者：
Adams J;Mytton O;White M;Monsivais P
通讯作者：
Monsivais P
影响因子：
3.2
作者：
De Coen, Valerie;De Bourdeaudhuij, Ilse;Maes, Lea
通讯作者：
Maes, Lea
营养和体育活动随机对照试验在儿童保育中心进行了改善知识，政策和儿童体重指数。
影响因子：
4.5
作者：
Alkon A;Crowley AA;Neelon SE;Hill S;Pan Y;Nguyen V;Rose R;Savage E;Forestieri N;Shipman L;Kotch JB
通讯作者：
Kotch JB
影响因子：
4.5
作者：
Carey, Gemma;Crammond, Brad
通讯作者：
Crammond, Brad
影响因子：
5.4
作者：
Evans, Gary W.;Jones-Rounds, McKenzie L.;Vermeylen, Francoise
通讯作者：
Vermeylen, Francoise