Advertisement

Equity-Specific Effects of 26 Dutch Obesity-Related Lifestyle Interventions

      Context

      Reducing health inequalities is a policy priority in many developed countries. Little is known about effective strategies to reduce inequalities in obesity and its underlying behaviors. The goal of the study was to investigate differential effectiveness of interventions aimed at obesity prevention, the promotion of physical activity or a healthy diet by SES.

      Evidence acquisition

      Subgroup analyses in 2010 and 2011 of 26 Dutch studies funded by The Netherlands Organization for Health Research and Development after 1990 (n=17) or identified by expert contact (n=9). Methodologic quality and differential effects were synthesized in harvest plots, subdivided by setting, age group, intensity, and time to follow-up.

      Evidence synthesis

      Seven lifestyle interventions were rated more effective and four less effective in groups with high SES; for 15 studies no differential effects could be demonstrated. One study in the healthcare setting showed comparable effects in both socioeconomic groups. The only mass media campaign provided modest evidence for higher effectiveness among those with high SES. Individually tailored and workplace interventions were either more effective in higher-SES groups (n=4) or no differential effects were demonstrated (n=9). School-based studies (n=7) showed mixed results. Two of six community studies provided evidence for better effectiveness in lower-SES groups; none were more effective in higher-SES groups. One high-intensity community-based study provided best evidence for higher effectiveness in low-SES groups.

      Conclusions

      Although for the majority of interventions aimed at obesity prevention, the promotion of physical activity, or a healthy diet, no differential effectiveness could be demonstrated, interventions may widen as well as reduce socioeconomic inequalities in these outcomes. Equity-specific subgroup analyses contribute to needed knowledge about what may work to reduce socioeconomic inequalities in obesity and underlying health behaviors.
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to American Journal of Preventive Medicine
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

      1. Finucane MM, Stevens GA, Cowan MJ, et al. National, regional, and global trends in body-mass index since 1980: systematic analysis of health examination surveys and epidemiological studies with 960 country-years and 9.1 million participants. Lancet 2011;377:557-67

        • Wang Y.C.
        • McPherson K.
        • Marsh T.
        • Gortmaker S.L.
        • Brown M.
        Health and economic burden of the projected obesity trends in the U.S. and the UK.
        Lancet. 2011; 378: 815-825
        • Mackenbach J.P.
        • Stirbu I.
        • Roskam A.J.
        • et al.
        Socioeconomic inequalities in health in 22 European countries.
        N Engl J Med. 2008; 358: 2468-2481
        • Roskam A.J.
        • Kunst A.E.
        • Van Oyen H.
        • et al.
        Comparative appraisal of educational inequalities in overweight and obesity among adults in 19 European countries.
        Int J Epidemiol. 2010; 39: 392-404
        • Mackenbach J.P.
        • Stronks K.
        A strategy for tackling health inequalities in the Netherlands.
        BMJ. 2002; 325: 1029-1032
        • Macintyre S.
        Evidence based policy making.
        BMJ. 2003; 326: 5-6
        • Department of Health
        Healthy lives, healthy people: our strategy for public health in England.
        Department of Health, England2010
        • Katikireddi S.V.
        • Higgins M.
        • Bond L.
        • Bonell C.
        • Macintyre S.
        How evidence based is English public health policy?.
        BMJ. 2011; 343: d7310
        • Petticrew M.
        • Tugwell P.
        • Kristjansson E.
        • Oliver S.
        • Ueffing E.
        • Welch V.
        Damned if you do, damned if you don't: subgroup analysis and equity.
        J Epidemiol Community Health. 2012; 66: 95-98
        • Kremers S.
        • Martens M.
        • Reubsaet A.
        • De Weerdt I.
        • De Vries N.
        • Jonkers R.
        Programmeringstudie Overgewicht [Programming Study Overweight].
        Maastricht University, Maastricht: ResCon2008
        • Chesterman J.
        • Judge K.
        • Bauld L.
        • Ferguson J.
        How effective are the English smoking treatment services in reaching disadvantaged smokers?.
        Addiction. 2005; 100: 36-45
        • Ferguson J.
        • Bauld L.
        • Chesterman J.
        • Judge K.
        The English smoking treatment services: one-year outcomes.
        Addiction. 2005; 100: 59-69
        • Victora C.G.
        • Wagstaff A.
        • Schellenberg J.A.
        • Gwatkin D.
        • Claeson M.
        • Habicht J.P.
        Applying an equity lens to child health and mortality: more of the same is not enough.
        Lancet. 2003; 362: 233-241
        • Magnée T.
        • Lenthe F.J.
        van. De effectiviteit van leefstijlinterventies voor mensen met lage sociaaleconomische status: een systematische inventarisatie [The effectiveness of lifestyle interventions for persons with a lower socioeconomic status: a systematic inventory]. Tijdschrift der Gezondheidswetenschappen. 2011; 89: 2
        • Ogilvie D.
        • Fayter D.
        • Petticrew M.
        • et al.
        The harvest plot: a method for synthesising evidence about the differential effects of interventions.
        BMC Med Res Methodol. 2008; 8: 8
        • Briss P.A.
        • Zaza S.
        • Pappaioanou M.
        • et al.
        Developing an evidence-based Guide to Community Preventive Services—methods. The Task Force on Community Preventive Services.
        Am J Prev Med. 2000; 18: 35-43
        • Thomas H.
        Quality assessment tool for quantitative studies.
        Effective Public Health Practice Project. McMaster University, Hamilton, Ontario, Canada2003
        • Wammes B.
        • Breedveld B.
        • Looman C.
        • Brug J.
        The impact of a national mass media campaign in The Netherlands on the prevention of weight gain.
        Public Health Nutr. 2005; 8: 1250-1257
        • Thomas S.
        • Fayter D.
        • Misso K.
        • et al.
        Population tobacco control interventions and their effects on social inequalities in smoking: systematic review.
        Tob Control. 2008; 17: 230-237
        • Brug J.
        • Glanz K.
        • Van Assema P.
        • Kok G.
        • van Breukelen G.J.
        The impact of computer-tailored feedback and iterative feedback on fat, fruit, and vegetable intake.
        Health Educ Behav. 1998; 25: 517-531
        • Jong J.
        • Lemmink K.A.
        • King A.C.
        • Huisman M.
        • Stevens M.
        Twelve-month effects of the Groningen active living model (GALM) on physical activity, health and fitness outcomes in sedentary and underactive older adults aged 55-65.
        Patient Educ Couns. 2007; 66 (de): 167-176
        • de Jong J.
        • Lemmink K.A.
        • Stevens M.
        • et al.
        Six-month effects of the Groningen active living model (GALM) on physical activity, health and fitness outcomes in sedentary and underactive older adults aged 55-65.
        Patient Educ Couns. 2006; 62: 132-141
      2. De Kraker H. Het effect van een lunchwandelcampagne op het beweeggedrag van werknemers. 2005.

        • Engbers L.H.
        • van Poppel M.N.
        • Chin A.P.M.
        • van Mechelen W.
        The effects of a controlled worksite environmental intervention on determinants of dietary behavior and self-reported fruit, vegetable and fat intake.
        BMC Public Health. 2006; 6: 253
        • Engbers L.H.
        • van Poppel M.N.
        • van Mechelen W.
        Modest effects of a controlled worksite environmental intervention on cardiovascular risk in office workers.
        Prev Med. 2007; 44: 356-362
        • Ezendam N.P.
        • Brug J.
        • Oenema A.
        Evaluation of the web-based computer-tailored FATaintPHAT intervention to promote energy balance among adolescents: results from a school cluster randomized trial.
        Arch Pediatr Adolesc Med. 2012; 255: 166-248
        • Ezendam N.P.
        • Oenema A.
        • van de Looij-Jansen P.M.
        • Brug J.
        Design and evaluation protocol of “FATaintPHAT”, a computer-tailored intervention to prevent excessive weight gain in adolescents.
        BMC Public Health. 2007; 7: 324
        • Hopman-Rock M.
        • Stiggelbout M.
        • Popkema D.Y.
        • de Greef M.
        Meer bewegen voor ouderen gymnastiek: verslag van een evaluatiestudie [More physical activity for elderly: report of an evaluation study].
        Tijdschr Gerontol Geriatr. 2006; 37: 253-259
        • Jansen W.
        • Borsboom G.
        • Meima A.
        • et al.
        Effectiveness of a primary school-based intervention to reduce overweight.
        Int J Pediatr Obes. 2011; 6: e70-e71
        • Jansen W.
        • Raat H.
        • Zwanenburg E.J.
        • Reuvers I.
        • van Walsem R.
        • Brug J.
        A school-based intervention to reduce overweight and inactivity in children aged 6-12 years: study design of a randomized controlled trial.
        BMC Public Health. 2008; 8: 257
        • Kocken P.
        Promoting the purchase of low-calorie foods from school vending machines: a cluster-randomized controlled study.
        J Sch Health. 2012; 82: 115-122
        • Kroeze W.
        • Oenema A.
        • Campbell M.
        • Brug J.
        The efficacy of web-based and print-delivered computer-tailored interventions to reduce fat intake: results of a randomized, controlled trial.
        J Nutr Educ Behav. 2008; 40: 226-236
        • Kwak L.
        • Kremers S.P.
        • Candel M.J.
        • Visscher T.L.
        • Brug J.
        • van Baak M.A.
        Changes in skinfold thickness and waist circumference after 12 and 24 months resulting from the NHF-NRG In Balance-project.
        Int J Behav Nutr Phys Act. 2010; 7: 26
        • Oenema A.
        • Brug J.
        • Dijkstra A.
        • de Weerdt I.
        • de Vries H.
        Efficacy and use of an internet-delivered computer-tailored lifestyle intervention, targeting saturated fat intake, physical activity and smoking cessation: a randomized controlled trial.
        Ann Behav Med. 2008; 35: 125-135
        • Oenema A.
        • Tan F.
        • Brug J.
        Short-term efficacy of a web-based computer-tailored nutrition intervention: main effects and mediators.
        Ann Behav Med. 2005; 29: 54-63
        • Oosterman J.
        • Schreurs H.
        • Groeneboom G.
        • Hillen S.
        • De Geus G.
        • Van der Goot K.
        • Van Ameijden E.
        Eindevaluatie Gezond Gewicht Overvecht: monitoring en evaluatie van het vijfjarige community-project Gezond Gewicht Overvecht [Monitoring and Evaluating the 5 Year During Community Project Healthy Weight].
        Utrecht. 2010;
        • Reinaerts E.
        • Crutzen R.
        • Candel M.
        • De Vries N.K.
        • De Nooijer J.
        Increasing fruit and vegetable intake among children: comparing long-term effects of a free distribution and a multicomponent program.
        Health Educ Res. 2008; 23: 987-996
        • Robroek S.J.
        • Bredt F.J.
        • Burdorf A.
        The (cost-)effectiveness of an individually tailored long-term worksite health promotion programme on physical activity and nutrition: design of a pragmatic cluster randomised controlled trial.
        BMC Public Health. 2007; 7: 259
        • Schuit A.J.
        • Wendel-Vos G.C.
        • Verschuren W.M.
        • et al.
        Effect of 5-year community intervention Hartslag Limburg on cardiovascular risk factors.
        Am J Prev Med. 2006; 30: 237-242
        • Steenhuis I.
        • van Assema P.
        • van Breukelen G.
        • Glanz K.
        The effectiveness of nutrition education and labeling in Dutch supermarkets.
        Am J Health Promot. 2004; 18: 221-224
        • Stiggelbout M.
        • Popkema D.Y.
        • Hopman-Rock M.
        • de Greef M.
        • van Mechelen W.
        Once a week is not enough: effects of a widely implemented group based exercise programme for older adults; a randomised controlled trial.
        J Epidemiol Community Health. 2004; 58: 83-88
        • Tak N.I.
        • Te Velde S.J.
        • Brug J.
        Long-term effects of the Dutch Schoolgruiten Project—promoting fruit and vegetable consumption among primary-school children.
        Public Health Nutr. 2009; 12: 1213-1223
        • Tak N.I.
        • Te Velde S.J.
        • Singh A.S.
        • Brug J.
        The effects of a fruit and vegetable promotion intervention on unhealthy snacks during mid-morning school breaks: results of the Dutch Schoolgruiten Project.
        J Hum Nutr Diet. 2010; 23: 609-615
        • Te Velde S.J.
        • Brug J.
        • Wind M.
        • et al.
        Effects of a comprehensive fruit- and vegetable-promoting school-based intervention in three European countries: the Pro Children Study.
        Br J Nutr. 2008; 99: 893-903
        • Van Assema P.
        • Steenbakkers M.
        • Stapel H.
        • van Keulen H.
        • Ronda G.
        • Brug J.
        Evaluation of a Dutch public-private partnership to promote healthier diet.
        Am J Health Promot. 2006; 20: 309-312
        • Van Genugten L.
        • van Empelen P.
        • Flink I.
        • Oenema A.
        Systematic development of a self-regulation weight-management intervention for overweight adults.
        BMC Public Health. 2010; 10: 649
        • Van Sluijs E.M.
        • van Poppel M.N.
        • Twisk J.W.
        • APMJ Chin
        • Calfas K.J.
        • van Mechelen W.
        Effect of a tailored physical activity intervention delivered in general practice settings: results of a randomized controlled trial.
        Am J Public Health. 2005; 95: 1825-1831
        • van Stralen M.M.
        • de Vries H.
        • Bolman C.
        • Mudde A.N.
        • Lechner L.
        Exploring the efficacy and moderators of two computer-tailored physical activity interventions for older adults: a randomized controlled trial.
        Ann Behav Med. 2010; 39: 139-150
        • van Stralen M.M.
        • de Vries H.
        • Mudde A.N.
        • Bolman C.
        • Lechner L.
        Efficacy of two tailored interventions promoting physical activity in older adults.
        Am J Prev Med. 2009; 37: 405-417
        • Van Wier M.F.
        • Ariens G.A.
        • Dekkers J.C.
        • et al.
        [email protected]: a randomised controlled trial of a distance counselling lifestyle programme for weight control among an overweight working population [ISRCTN04265725].
        BMC Public Health. 2006; 6: 140
        • Van Wier M.F.
        • Ariens G.A.
        • Dekkers J.C.
        • Hendriksen I.J.
        • Smid T.
        • van Mechelen W.
        Phone and e-mail counselling are effective for weight management in an overweight working population: a randomized controlled trial.
        BMC Public Health. 2009; 9: 6
        • Vermeer W.M.
        • Steenhuis I.H.
        • Leeuwis F.H.
        • Heymans M.W.
        • Seidell J.C.
        Small portion sizes in worksite cafeterias: do they help consumers to reduce their food intake?.
        Int J Obes (Lond). 2011; 35: 1200-1207
        • Wendel-Vos G.C.
        • Dutman A.E.
        • Verschuren W.M.
        • et al.
        Lifestyle factors of a five-year community-intervention program: the Hartslag Limburg intervention.
        Am J Prev Med. 2009; 37: 50-56
        • Giskes K.
        • van Lenthe F.J.
        • van, Turrell G.
        • Kamphuis C.B.
        • Brug J.
        • Mackenbach J.P.
        Socioeconomic position at different stages of the life course and its influence on body weight and weight gain in adulthood: a longitudinal study with 13-year follow-up.
        Obesity (Silver Spring). 2008; 16: 1377-1381
        • Heraclides A.
        • Witte D.
        • Brunner E.J.
        The association between father's social class and adult obesity is not explained by educational attainment and an unhealthy lifestyle in adulthood.
        Eur J Epidemiol. 2008; 23: 573-579
        • Power C.
        • Graham H.
        • Due P.
        • et al.
        The contribution of childhood and adult socioeconomic position to adult obesity and smoking behaviour: an international comparison.
        Int J Epidemiol. 2005; 34: 335-344
        • Schrijvers C.T.
        • Stronks K.
        • van de Mheen H.D.
        • Mackenbach J.P.
        Explaining educational differences in mortality: the role of behavioral and material factors.
        Am J Public Health. 1999; 89: 535-540
        • Van Oort F.V.
        • Lenthe F.J.
        • van, Mackenbach J.P.
        Material, psychosocial, and behavioural factors in the explanation of educational inequalities in mortality in The Netherlands.
        J Epidemiol Community Health. 2005; 59: 214-220
        • Krishnaswami J.
        • Martinson M.
        • Wakimoto P.
        • Anglemeyer A.
        Community-engaged interventions on diet, activity, and weight outcomes in U.S. schools: a systematic review.
        Am J Prev Med. 2012; 43: 81-91
        • Sun X.
        • Briel M.
        • Walter S.D.
        • Guyatt G.H.
        Is a subgroup effect believable? Updating criteria to evaluate the credibility of subgroup analyses.
        BMJ. 2010; 340: c117
        • Whitehead M.
        A typology of actions to tackle social inequalities in health.
        J Epidemiol Community Health. 2007; 61: 473-478
        • Main C.
        • Thomas S.
        • Ogilvie D.
        • et al.
        Population tobacco control interventions and their effects on social inequalities in smoking: placing an equity lens on existing systematic reviews.
        BMC Public Health. 2008; 8: 178

      Linked Article

      • Corrections
        American Journal of Preventive MedicineVol. 45Issue 3
        • Preview
          Hajna S, Dasgupta K, Halparin M, Ross NA. Neighborhood Walkability: Field Validation of Geographic Information System Measures. Am J Prev Med 2013;44(6):e51–e55.
        • Full-Text
        • PDF