The obesity epidemic: evaluating effective interventions

Obesity is acknowledged to be a highly complex problem and there is limited understanding of effective interventions, although practice guidance is developing (DOH 2008). Public awareness of obesity may be increasing, yet this does not necessarily translate into the required behaviour change (Jebb, Steer & Holmes 2007). This presentation reports on a multi-intervention coordinated approach to tackling childhood obesity. Its distinctiveness consisted of the combination of a variety of target groups (parents, overweight children, obese children, all children in a particular class), interventions (cooking, exercising with weight monitoring or engagement in exercise practices, community engagement in the healthy agenda) and outcomes (raising awareness, reducing weight, increasing fitness, improving exercising opportunities, changing family eating practices), all focussed upon a geographically circumscribed community. The context-mechanismoutcome (CMO) approach (Pawson & Tilley 1999) strongly guided the design of the evaluation in terms of providing a systematic approach to studying connections between activities, outcomes and contexts. In the process of delivering their intervention, the providers gained a greater insight into obesity causal factors in the target population. These included; lack of appreciation of acceptable BMI, or of the need to engage in weight management, large portion sizes, lack of cooking skills and facilities, limited knowledge on healthy recipes and menu development, lack of access to structured and appealing physical activity, inadequate resources to participate in physical activity, lack of knowledge and skills to maintain equipment such as cycles. The intervention addressed a wide menu of outcomes pertinent to addressing lifestyle choices relevant to obesity development at short, medium and long term time lines. This is a very positive finding as it accommodates participants at various stages of need and readiness to become involved.