Research and Practice Methods| Volume 51, ISSUE 5, e145-e150, November 2016

New Strategies to Prioritize Nutrition, Physical Activity, and Obesity Interventions

      Interventions for obesity have not often been based on considerations that could predict their effectiveness. However, advances in research provide several new approaches that can inform priorities for public health interventions directed at nutrition, physical activity, and obesity. These approaches include estimation of the effect size, comparison of the calorie gap with the caloric deficit induced by the intervention, population reach and impact, cost and cost effectiveness of the intervention, time required to evaluate the effect of the intervention on weight change, and feasibility of the intervention. Incorporation of these considerations by policymakers and public health practitioners will help identify those interventions most likely to achieve changes in the prevalence of obesity.
      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 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


        • Koplan J.P.
        • Dietz W.H.
        Caloric imbalance and public health policy.
        JAMA. 1999; 282: 1579-1581
      1. Centers for Disease Control and Prevention (CDC). Environmental and policy approaches to increase physical activity: creation of or enhanced access to places for physical activity combined with informational outreach activities. Published 2004. Accessed April 5, 2015.

        • Kettel Khan L.
        • Sobush K.
        • Keener D.
        • et al.
        Recommended community strategies and measurements to prevent obesity in the United States.
        MMWR Morb Mortal Wkly Rep. 2009; 58: 1-26
      2. (IOM.)
        Local Government Actions to Prevent Childhood Obesity.
        National Research Council, Washington, DC2009
        • Gortmaker S.L.
        • Swinburn B.A.
        • Levy D.
        • et al.
        Changing the future of obesity: science, policy, and action.
        Lancet. 2011; 378: 838-847
        • Gortmaker S.L.
        • Long M.W.
        • Resch S.C.
        • et al.
        Cost effectiveness of childhood obesity interventions: evidence and methods for CHOICES.
        Am J Prev Med. 2015; 49: 102-111
        • Glasgow R.E.
        • Vogt T.M.
        • Boles S.M.
        Evaluating the public health impact of health promotion interventions: the RE-AIM framework.
        Am J Public Health. 1999; 89: 1322-1327
        • Li W.
        • Buszkiewicz J.H.
        • Leibowitz R.B.
        • Gapinski M.A.
        • Nasuti L.J.
        • Land T.G.
        Declining trends and widening disparities in overweight and obesity prevalence among Massachusetts public school districts, 2009-2014.
        Am J Public Health. 2015; 105: e76-e82
        • Gortmaker S.L.
        • Wang Y.C.
        • Long M.W.
        • et al.
        Three interventions that reduce childhood obesity are projected to save more than they cost to implement.
        Health Aff (Millwood). 2015; 34: 1932-1939
        • Guyatt G.H.
        • Oxman A.D.
        • Kunz R.
        • et al.
        What is “quality of evidence” and why is it important to clinicians?.
        BMJ. 2008; 336: 995-998
        • de Ruyter J.C.
        • Olthof M.R.
        • Seidell J.C.
        • Katan M.B.
        A trial of sugar-free or sugar-sweetened beverages and body weight in children.
        N Engl J Med. 2012; 367: 1397-1406
        • Long M.W.
        • Gortmaker S.L.
        • Ward Z.J.
        • et al.
        Cost effectiveness of a sugar-sweetened beverage excise tax in the U.S.
        Am J Prev Med. 2015; 49: 112-123
        • Dobbins M.
        • Husson H.
        • DeCorby K.
        • LaRocca R.L.
        School-based physical activity programs for promoting physical activity and fitness in children and adolescents aged 6 to 18.
        Cochrane Database Syst Rev. 2013; 2: CD007651
        • Kriemler S.
        • Zahner L.
        • Schindler C.
        • et al.
        Effect of school based physical activity programme (KISS) on fitness and adiposity in primary schoolchildren: cluster randomised controlled trial.
        BMJ. 2010; 340: c785
        • Barrett J.L.
        • Gortmaker S.L.
        • Long M.W.
        • et al.
        Cost effectiveness of an elementary school active physical education policy.
        Am J Prev Med. 2015; 49: 148-159
        • Johns D.J.
        • Hartmann-Boyce J.
        • Jebb S.A.
        • Aveyard P.
        • Behavioural Weight Management Review Group
        Diet or exercise interventions vs combined behavioral weight management programs: a systematic review and meta-analysis of direct comparisons.
        J Acad Nutr Diet. 2014; 114: 1557-1568
        • Washburn R.A.
        • Lambourne K.
        • Szabo A.N.
        • Herrmann S.D.
        • Honas J.J.
        • Donnelly J.E.
        Does increased prescribed exercise alter non-exercise physical activity/energy expenditure in healthy adults? A systematic review.
        Clin Obes. 2014; 4: 1-20
        • Long M.W.
        • Sobol A.M.
        • Cradock A.L.
        • Subramanian S.V.
        • Blendon R.J.
        • Gortmaker S.L.
        School-day and overall physical activity among youth.
        Am J Prev Med. 2013; 45: 150-157
        • Shaw K.
        • Gennat H.
        • O’Rourke P.
        • Del Mar C.
        Exercise for overweight or obesity.
        Cochrane Database Syst Rev. 2006; 4: CD003817
        • Ekelund U.
        • Luan J.
        • Sherar L.B.
        • et al.
        Moderate to vigorous physical activity and sedentary time and cardiometabolic risk factors in children and adolescents.
        JAMA. 2012; 307: 704-712
        • Hall K.D.
        • Butte N.F.
        • Swinburn B.A.
        • Chow C.C.
        Dynamics of childhood growth and obesity: development and validation of a quantitative mathematical model.
        Lancet Diabetes Endocrinol. 2013; 1: 97-105
        • Wang Y.C.
        • Orleans C.T.
        • Gortmaker S.L.
        Reaching the Healthy People goals for reducing childhood obesity: closing the energy gap.
        Am J Prev Med. 2012; 42: 437-444
        • Hall K.D.
        • Sacks G.
        • Chandramohan D.
        • et al.
        Quantification of the effect of energy imbalance on bodyweight.
        Lancet. 2011; 378: 826-837
        • Wang Y.C.
        • Hsiao A.
        • Orleans C.T.
        • Gortmaker S.L.
        The caloric calculator: average caloric impact of childhood obesity interventions.
        Am J Prev Med. 2013; 45: e3-e13
        • Bassett D.R.
        • Fitzhugh E.C.
        • Heath G.W.
        • et al.
        Estimated energy expenditures for school-based policies and active living.
        Am J Prev Med. 2013; 44: 108-113
        • Chen X.
        • Beydoun M.A.
        • Wang Y.
        Is sleep duration associated with childhood obesity? A systematic review and meta-analysis.
        Obesity. 2008; 16: 265-274
        • Oken E.
        • Levitan E.B.
        • Gillman M.W.
        Maternal smoking during pregnancy and child overweight: systematic review and meta-analysis.
        Int J Obes (Lond). 2008; 32: 201-210
      3. (IOM)Weight Gain During Pregnancy: Reexamining the Guidelines. National Academies Press, Washington, DC2009
        • Abrams D.B.
        • Orleans C.T.
        • Niaura R.S.
        • Goldstein M.G.
        • Prochaska J.O.
        • Velicer W.
        Integrating individual and public health perspectives for treatment of tobacco dependence under managed health care: a combined stepped-care and matching model.
        Ann Behav Med. 1996; 18: 290-304
        • Black J.A.
        • White B.
        • Viner R.M.
        • Simmons R.K.
        Bariatric surgery for obese children and adolescents: a systematic review and meta-analysis.
        Obes Rev. 2013; 14: 634-644
        • Cradock A.L.
        • McHugh A.
        • Mont-Ferguson H.
        • et al.
        Effect of school district policy change on consumption of sugar-sweetened beverages among high school students, Boston, Massachusetts, 2004-2006.
        Prev Chronic Dis. 2011; 8: A74
        • Schwartz P.
        • Rauzon S.
        • Cheadle A.
        Dose Matters: An Approach to Strengthening Community Health Strategies to Achieve Greater Impact.
        National Academy of Medicine, Washington, DC2015
        • Drummond M.
        • Scuplher M.
        • Torrance G.
        • O’Brien B.
        • Stoddard G.
        Methods for the Economic Evaluation of Health Care Programmes.
        Oxford University Press, Oxford2005
        • Bipartisan Policy Center
        A Prevention Prescription for Improving Health and Health Care in America.
        Bipartisan Policy Center, Washington, DC2015
        • Lobstein T.
        • Jackson-Leach R.
        • Moodie M.L.
        • et al.
        Child and adolescent obesity: part of a bigger picture.
        Lancet. 2015; 385: 2510-2520
        • Siegel J.E.
        • Weinstein M.C.
        • Russell L.B.
        • Gold M.R.
        Recommendations for reporting cost-effectiveness analyses. Panel on Cost-Effectiveness in Health and Medicine.
        JAMA. 1996; 276: 1339-1341
        • Wu S.
        • Cohen D.
        • Shi Y.
        • Pearson M.
        • Sturm R.
        Economic analysis of physical activity interventions.
        Am J Prev Med. 2011; 40: 149-158