Danielli Shaun, Coffey Tom, Ashrafian Hutan, Darzi Ara
Imperial College, Exhibition Rd, London, United Kingdom.
London Mayoral Health Advisor, London, United Kingdom.
EClinicalMedicine. 2021 Jan 8;32:100710. doi: 10.1016/j.eclinm.2020.100710. eCollection 2021 Feb.
Obesity threatens to undo the improvements that have been made in life expectancy over the last two centuries. It disproportionately affects lower socioeconomic and ethnic minority groups and has become one of the most important global health challenges of the 21century. Whilst obesity is not confined to city populations, cities are home to more than half of the world's population with concentrated groups at high risk of obesity. Cities have also long been the forefront of social and technological change that has led to our current obesogenic environment. The aim of this study was to systematically identify city-wide interventions to address obesity, from which recommendations for policy makers, health system leaders and political leaders in cities could be made.
Systematic review, conducted according to PRISMA guidelines, examining Embase, Ovid Medline, Central, Scopus, Campbell Library, CINALH, Health Business Elite; Health Management Information Consortium (HMIC), PyschINFO and Prospero. No restrictions on article type, date range or geographic location were applied. Along with classic academic sources, books and policy white papers were sought and reviewed. Studies that described a city-wide intervention to reduce obesity were included, irrespective of study design or perceived methodological quality. Only studies in English language were included. The primary outcome indicators that were sought and extracted were: reduction in obesity, reduction in weight and/or reduction in BMI. Where a primary outcome indicator was not stated, any other secondary impact measure was identified and recorded. This manuscript represents thematic analysis of a sub-set of data from the Prospero study, registration number: CRD42020166210.
Our search yielded 42,137 original citations of which 1614 met the inclusion criteria and 96 were coded as relating to obesity. The 96 citations, ranging in year of publication 1997 to 2019, were conducted in 36 cities, with 13 citations either not stating a city or covering multiple cities, across 5 continents. The highest proportion of publications were from North America (59 / 96) and in particular the USA (56/96) and New York City (23/96). Primary outcome indicators were only stated in one quarter of the identified studies (24/96). Overall, there was heterogeneity of study design, descriptive methodologies and publication types, with a majority being descriptive texts using qualitative instruments of assessment.
Multi-level and multi-component interventions, at the individual, community and city level, done in concert, are needed to address obesity. A composite of interventions that cities can utilise to address obesity is provided. These interventions will also be beneficial to the environment and make the case that personal health and planetary health are inextricably linked and should be considered as one.
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肥胖症有可能抵消过去两个世纪在预期寿命方面取得的进步。它对社会经济地位较低的群体和少数族裔的影响尤为严重，已成为21世纪最重要的全球健康挑战之一。虽然肥胖症并不局限于城市人口，但世界上一半以上的人口居住在城市，其中有集中的肥胖高危群体。长期以来，城市也是导致我们当前致胖环境的社会和技术变革的前沿阵地。本研究的目的是系统地确定全市范围内应对肥胖症的干预措施，以便为城市的政策制定者、卫生系统领导者和政治领导人提供建议。
根据PRISMA指南进行系统综述，检索Embase、Ovid Medline、Central、Scopus、Campbell Library、CINALH、Health Business Elite；健康管理信息联盟（HMIC）、PyschINFO和Prospero。对文章类型、日期范围或地理位置不设限制。除了经典学术资源外，还查找并审阅了书籍和政策白皮书。纳入描述全市范围内减少肥胖症干预措施的研究，无论其研究设计或感知的方法学质量如何。仅纳入英文研究。所查找和提取的主要结局指标为：肥胖症减少、体重减轻和/或体重指数降低。如果未说明主要结局指标，则确定并记录任何其他次要影响指标。本手稿代表对Prospero研究的一部分数据的主题分析，注册号：CRD42020166210。
我们的检索共得到42,137条原始文献，其中1614条符合纳入标准，96条被编码为与肥胖症相关。这96条文献的发表年份从1997年到2019年，涉及36个城市，其中13条未说明城市或涵盖多个城市，分布在5个大洲。发表文献比例最高的是北美（59/96），尤其是美国（56/96）和纽约市（23/96）。在确定的研究中，只有四分之一（24/96）说明了主要结局指标。总体而言，研究设计、描述方法和发表类型存在异质性，大多数是使用定性评估工具的描述性文本。
需要在个人、社区和城市层面协同开展多层次、多组分的干预措施来应对肥胖症。提供了城市可用于应对肥胖症的综合干预措施。这些干预措施对环境也将有益，并表明个人健康和地球健康有着千丝万缕的联系，应将二者视为一个整体。
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