Preventing obesity: the effectiveness of whole system approaches

Abstract

1. Summary 1.1. Introduction This systematic review builds on Review 1 considering a working definition of whole system approaches to tackling public health problems. Review 1 concluded that a whole system approach is characteristed by ten core features Explicit recognition of the public health system; capacity building; encouragement of local creativity and/or innovation; developing working relationships; community engagement; enhancing communication; embeddedness of policy and action; robustness and sustainability; facilitative leadership; monitoring and evaluation 1.2. Aim This systematic review aimed to systematically identify, summarise, and synthesise relevant evaluation studies in order to answer the following: How do the effectiveness, implementation and sustainability of whole system or whole community approaches to preventing obesity appear to vary in relation to:  The specific combination of local actions and local strategies used to try and bring about change  The characteristics of the population and/or places targeted (including level of social disadvantage)  The local and national policy context  Other factors which influence the effectiveness, implementation and sustainability of the relevant actions and strategies 1.3. Methods This systematic review was primarily based on bibliographic searches for comparative evaluations of obesity prevention programmes. These searches were supplemented by searches of the grey literature, internet searches and by contacting authors, contacts at the European EPODE Network and topic experts. Study selection against predefined inclusion and exclusion criteria was conducted by two reviewers in three stages. (i) screening titles and abstracts; (ii) screening full-text papers and reports against all inclusion and exclusion criteria (iii) assessing and mapping the presence of WSA features in potentially includable studies of community-wide multi-level prevention programmes. All obesity prevention programmes that met the inclusion criteria were included. Each study was also quality-assessed using standard NICE methods and each study given an overall rating for internal validity and external validity. 1.4. Results The searches generated 2,429 unique references. After screening 8 community-wide obesity prevention programmes (covered in 28 texts) were included.