Context
The National Academy of Medicine recommends childhood obesity prevention efforts making
healthier options the passive choice. This review evaluated the effectiveness of population-level
policies and programs from natural experiments for childhood obesity prevention.
Evidence acquistion
The search included PubMed, CINAHL, PsycINFO, and EconLit from 2000 to 2017 for policies
evaluated by natural experiments reporting childhood BMI outcomes. The studies were
analyzed in 2017–2018. Interventions were classified by environmental focus (food/beverage,
physical activity, or both) and stratified by setting (school, community, both). Risk
of bias was evaluated for each study.
Evidence synthesis
Of 33 natural experiments, most (73%) took place in the school setting only. The most
common environmental focus in any setting was food/beverage (48%). All four studies
that focused on both food/beverage and physical activity in schools demonstrated decreased
prevalence of overweight/obesity or BMI z-score by 0.04–0.17. BMI decreased in all four studies in both school and community
settings. The largest effect size was a decrease in BMI z-score of 0.5, but most were <0.25. The risk of bias was high for most (76%) studies.
Most (63%) of the eight studies with low/medium risk of bias took place in the school
setting focused on the food/beverage environment; effects on BMI were mixed.
Conclusions
Natural experiments evaluating school-based policies focusing on both the food/beverage
and physical activity environments (versus targeting only one) consistently showed
improvement in BMI. However, most studies had high risk of bias, highlighting the
need for improved methods for evaluation of natural experiments for childhood obesity
prevention.
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© 2018 American Journal of Preventive Medicine. Published by Elsevier Inc. All rights reserved.
