Global Obesity Centre, Institute for Health Transformation, School of Health and Social Development, Faculty of Health, Deakin University, Geelong, Australia.
School of Medicine and Public Health, College of Health, Medicine and Wellbeing, University of Newcastle, Callaghan, Australia.
Health Promot J Austr. 2024 Apr;35(2):365-370. doi: 10.1002/hpja.760. Epub 2023 Jun 21.
Obesity in children is one of the most significant public health issues globally. Given the high prevalence of overweight and obesity in children, there is a need to identify effective obesity prevention efforts that can be delivered at scale to improve child health. We aimed to (i) identify obesity prevention interventions targeted at children aged 0-2 that have been scaled-up, and their relative efficacy compared to their pre-scale trial, (ii) describe adaptations made, and the extent to which factors related to scalability have been reported.
We conducted a rapid review of pre-scale randomised controlled trials targeting nutrition, physical activity and obesity prevention in infants, and calculated the relative effect size for relevant outcomes in the corresponding scaled up trial. We documented adaptations made to the pre-scale trial for scale up, and explored how different components of scalability had been reported according to the Intervention Scalability Assessment Tool.
Of the 14 identified pre-scale trials, only one formal evaluation of the scale-up trial was identified. For body mass index, <10% of the effect was retained, however for nutrition and behavioural outcomes, the proportion of effect retained varied from -11.1% to 144%. Significant adaptations to modality were made in the scaled up trial primarily to reduce cost and increase reach of the intervention. Reporting of scalability components varied across the 14 trials, with only one trial reporting information for all assessed components.
The majority of effective interventions targeting obesity prevention in infants have not been evaluated in a scaled up form. The magnitude of effect retained for the single trial that was scaled up was variable. In general, reporting of components of scalability was sub-optimal. SO WHAT?: The findings suggest that there is substantial need for the development and rigorous evaluation of obesity prevention interventions in children aged 0-2 which are amenable for scale.
儿童肥胖是全球最重要的公共卫生问题之一。鉴于儿童超重和肥胖的高患病率，需要确定可以大规模实施的有效肥胖预防措施，以改善儿童健康。我们的目的是：(i) 确定已扩大规模的针对 0-2 岁儿童的肥胖预防干预措施及其与预扩大试验相比的相对效果，(ii) 描述所做的调整，以及报告与可扩展性相关的因素的程度。
我们对针对婴儿营养、身体活动和肥胖预防的预扩大随机对照试验进行了快速审查，并计算了相应扩大试验中相关结果的相对效果大小。我们记录了为扩大规模而对预试验进行的调整，并根据干预可扩展性评估工具探讨了不同可扩展性因素的报告情况。
在确定的 14 项预试验中，仅确定了一项对扩大试验的正式评估。对于体重指数，保留的效果不到 10%，但是对于营养和行为结果，保留的效果比例从-11.1%到 144%不等。在扩大试验中，对模式进行了重大调整，主要是为了降低成本并增加干预措施的覆盖面。14 项试验的可扩展性报告内容各不相同，只有一项试验报告了所有评估组成部分的信息。
针对婴儿肥胖预防的大多数有效干预措施尚未以扩大规模的形式进行评估。在扩大规模的单一试验中保留的效果幅度各不相同。总体而言，可扩展性组成部分的报告情况并不理想。那么：研究结果表明，需要针对 0-2 岁儿童制定和严格评估可大规模实施的肥胖预防干预措施。
