Russell Simon J, Hope Steven, Croker Helen, Crozier Sarah, Packer Jessica, Inskip Hazel, Viner Russell M
Obesity Policy Research Unit Population, Policy and Practice Great Ormond Street Institute of Child Health University College London London UK.
MRC Lifecourse Epidemiology Unit Medicine University of Southampton Southampton UK.
Obes Sci Pract. 2021 May 17;7(5):545-554. doi: 10.1002/osp4.520. eCollection 2021 Oct.
In the United Kingdom, rates of childhood obesity are high and inequalities in obesity have widened in recent years. Children with obesity face heightened risks of living with obesity as adults and suffering from associated morbidities. Addressing population prevalence and inequalities in childhood obesity is a key priority for public health policymakers in the United Kingdom and elsewhere. Where randomized controlled trials are not possible, potential policy actions can be simulated using causal modeling techniques.
Using data from the Southampton Women's Survey (SWS), a cohort with high quality dietary and lifestyle data, the potential impact of policy-relevant calorie-reduction interventions on population prevalence and inequalities of childhood obesity was investigated.
Predicted probabilities of obesity (using UK90 cut-offs) at age 6-7 years were estimated from logistic marginal structural models adjusting for observed calorie consumption at age 3 years (using food diaries) and confounding. A series of policy-relevant intervention scenarios were modeled to simulate reductions in energy intake (differing in effectiveness, the targeting mechanisms, and level of uptake).
At age 6-7 years, 8.3% of children were living with obesity, after accounting for observed energy intake and confounding. A universal intervention to lower median energy intake to the estimated average requirement (a 13% decrease), with an uptake of 75%, reduced obesity prevalence by 1% but relative and absolute inequalities remained broadly unchanged.
Simulated interventions substantially reduced population prevalence of obesity, which may be useful in informing policymakers.
在英国，儿童肥胖率很高，且近年来肥胖方面的不平等现象有所加剧。肥胖儿童成年后肥胖的风险增加，且易患相关疾病。解决儿童肥胖的人群患病率和不平等问题是英国及其他地区公共卫生政策制定者的关键优先事项。在无法进行随机对照试验的情况下，可以使用因果建模技术模拟潜在的政策行动。
利用南安普敦妇女调查（SWS）的数据（该队列具有高质量的饮食和生活方式数据），研究与政策相关的热量减少干预措施对儿童肥胖人群患病率和不平等现象的潜在影响。
根据逻辑边际结构模型估计6 - 7岁时肥胖的预测概率（使用英国90标准），该模型对3岁时观察到的热量消耗（使用食物日记）和混杂因素进行了调整。模拟了一系列与政策相关的干预情景，以模拟能量摄入的减少（在有效性、目标机制和接受程度方面存在差异）。
在考虑了观察到的能量摄入和混杂因素后，6 - 7岁儿童中有8.3%患有肥胖症。一项将中位能量摄入降低到估计平均需求量（减少13%）的普遍干预措施，接受率为75%，肥胖患病率降低了1%，但相对和绝对不平等现象基本保持不变。
模拟干预措施大幅降低了肥胖的人群患病率，这可能有助于为政策制定者提供信息。
