Developing the logic framework underpinning a whole-systems approach to childhood overweight and obesity prevention: Amsterdam Healthy Weight Approach.

BACKGROUND

Whole-systems approaches (WSAs) are well placed to tackle the complex local environmental influences on overweight and obesity, yet there are few examples of WSAs in practice. is a long-term, municipality-led program to improve children's physical activity, diet, and sleep through action in the home, neighborhood, school, and city. Adopting a WSA, local political, physical, social, educational, and healthcare drivers of childhood obesity are viewed as a complex adaptive system. Since 2013, has reached >15,000 children. During this time, the estimated prevalence of 2-18-year-olds with overweight or obesity in Amsterdam has declined from 21% in 2012 to 18.7% in 2017. Declining trends are rarely observed in cities. There is a need to formally articulate program theory in order to: (i) inform future program evaluation which can interpret this decline within the context of and (ii) contribute a real-life example of a WSA to the literature.

METHODS

This study aimed to formally document the program theory of to permit future evaluation. A logic framework was developed through extensive document review and discussion, during program implementation.

RESULTS

The working principles of the WSA underpinning were made explicit in an overarching theory of change, articulated in a logic framework. The framework was operationalized using an illustrative example of sugar intake.

CONCLUSIONS

The logic framework will inform development, monitoring, and evaluation and responds to a wider need to outline the working principles of WSAs in public health.