Abstract
Investigators developed a review system to evaluate the growing literature on policy
and environmental strategies to prevent childhood obesity. More than 2000 documents
published between January 2000 and May 2009 in the scientific and grey literature
were identified (2008–2009) and systematically analyzed (2009–2012). These focused
on policy or environmental strategies to reduce obesity/overweight, increase physical
activity, and/or improve nutrition/diet among youth (aged 3–18 years). Guided by the
RE-AIM (Reach, Effectiveness, Adoption, Implementation, and Maintenance) framework,
investigators abstracted studies of 24 intervention strategies and assessed evidence
for their effectiveness (i.e., study design, intervention duration, and outcomes)
and population impact (i.e., effectiveness and reach—participation or exposure, and
representativeness) in 142 evaluation study groupings and 254 associational study
groupings (n=396 groupings of 600 peer-reviewed studies).
The 24 strategies yielded 25 classifications (school wellness policies yielded nutrition
and physical activity classifications): 1st-tier effective (n=5); 2nd-tier effective (n=6); “promising” (n=5); or “emerging” (n=9). Evidence for intervention effectiveness was reported in 56% of the evaluation,
and 77% of the associational, study groupings. Among the evaluation study groupings,
only 49% reported sufficient data for population impact ratings, and only 22% qualified
for a rating of high population impact. Effectiveness and impact ratings were summarized
in graphic evidence maps, displaying effects/associations with behavioral and obesity/overweight
outcomes. This paper describes the results and products of the review, with recommendations
for policy research and practice.
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