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“Whole-of-Community” Obesity Prevention: A Review of Challenges and Opportunities in Multilevel, Multicomponent Interventions

  • The Obesity Epidemic: Causes and Consequences (A Peeters and A Cameron, Section Editors)
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Abstract

The causes of obesity worldwide are complex and multilevel, including changing food environments, physical activity levels, policies, and food production systems. This intricate context requires multilevel and multicomponent (MLMC) interventions to improve health outcomes. We conducted a literature review of MLMC interventions for obesity prevention and mitigation; 14 studies meeting search criteria were identified. We found examples of successes in preventing obesity, reducing overweight, improving healthful behaviors, and enhancing some psychosocial indicators. Of eight studies that reported health and behavioral results, five showed no significant impact and three showed reductions in obesity. Four studies showed significant improvement in dietary behavior, and five reported significant desirable effects in physical activity or screen time. Five studies reported psychosocial impacts, and three of these showed significant improvements. MLMC approaches show promising results, particularly when they are able to integrate components at the policy, community, and interpersonal levels.

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Acknowledgments

The work described was supported by Grant Number U54HD070725 from the Eunice Kennedy Shriver National Institute of Child Health & Human Development (NICHD). The project is co-funded by the NICHD and the Office of Behavioral and Social Sciences Research (OBSSR). The content is solely the responsibility of the authors and does not necessarily represent the official views of the NICHD or OBSSR.

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  1. Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe St., Baltimore, MD, 21205, USA

    Ella Ewart-Pierce, María José Mejía Ruiz & Joel Gittelsohn

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  1. Ella Ewart-Pierce
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  2. María José Mejía Ruiz
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  3. Joel Gittelsohn
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Correspondence to Ella Ewart-Pierce.

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Ella Ewart-Pierce, María José Mejía Ruiz, and Joel Gittelsohn declare that they have no conflict of interest.

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This article is part of the Topical Collection on The Obesity Epidemic: Causes and Consequences

Appendix 1: Search Terms

Appendix 1: Search Terms

Inclusion Search Syntax

The search below is numbered by component for clarity. When utilized in the PubMed database, these components were run together as a single search procedure. See PubMed’s Medical Subject Heading (MeSH) Database Resource for additional details on search syntax.

1. Obesity Sphere

((“obesity”[MeSH Terms] AND (“prevention and control”[Subheading] OR “therapy”[Subheading]))

2. Multilevel Multicomponent Approach

((multi level[tw] OR multi leveled[tw] OR multi leveling[tw] OR multi levelled[tw] OR multi levels[tw]) OR (multilevel[tw] OR multilevel’[tw] OR multileveled[tw] OR multileveling[tw] OR multilevelled[tw] OR multilevelness[tw] OR multilevelpsa[tw] OR multilevels[tw] OR multilevelsupertree[tw]) OR (multi component[tw] OR multi componented[tw] OR multi componential[tw] OR multi components[tw]) OR (multicomponent[tw] OR multicomponent’[tw] OR multicomponental[tw] OR multicomponented[tw] OR multicomponential[tw] OR multicomponentness[tw] OR multicomponents[tw]) OR “health promotion”[MeSH Terms] OR “health education”[MeSH Terms]))

3. Obesity as a Risk Condition Within the MLMC Approach

(“overweight”[MeSH Terms] OR “obesity”[MeSH Terms] OR “obesity”[MeSH Terms] OR “risk”[MeSH Terms] OR Overweight[tw] OR obesity[tw] OR obese[tw])

4. Behavioral or Environmental Risk for Obesity

(“food habits”[MeSH Terms] OR “health behavior”[MeSH Terms] OR “diet”[MeSH Terms] OR “cooperative behavior”[MeSH Terms] OR “sedentary lifestyle”[MeSH Terms] OR “environment design”[MeSH Terms] OR “residence characteristics”[MeSH Terms] OR “risk reduction behavior”[MeSH Terms])

5. Study Type, Time frame, Focus Species, Language, and Article Type

Clinical Study[ptyp] AND “2006/01/28”[PDAT] : “2016/01/25”[PDAT] AND “humans”[MeSH Terms] AND English[lang] AND “journal article”[Publication Type]

Exclusion Filters Syntax

1. Smoking behavior

smoking[mh] OR tobacco[mh] OR Tobacco Smoke Pollution[mh] OR Smoking Cessation[mh]

2. Cancer

Mammography[mh] OR mastectomy[mh] OR neoplasms[mh] OR Lymphedema[mh] OR Breast Neoplasms[mh] OR Neoplasm Staging[mh]

3. Non-Food Diets

food, formulated[mh] OR “Meal replacements”[tw] OR edible grain[mh] OR Sweetening Agents[mh] OR Carbonated Beverages[mh] OR Beverages[mh] OR Dietary Carbohydrates[mh] OR Plant Extracts[mh] OR Sodium Chloride[mh] OR

4. Clinical Care

patient compliance[mh] OR postoperative complications[mh] OR nurses[mh] OR nursing[mh] OR nurse practitioners[mh] OR medication adherence[mh] OR adherence[tiab] OR Preoperative Period[mh] OR Insulin Resistance[mh] OR mass screening[mh] OR “Dietary Inflammatory Index”[tiab] OR Patient satisfaction[mh] OR Intention to Treat Analysis[mh] OR hospital[tiab] OR “bariatric surgery”[tiab] OR bariatric surgery[mh] OR bariatrics[mh] OR gastric bypass[mh]

5. Disease Conditions and Treatments Outside of the Scope

Cognitive Therapy/methods*[mh] OR Psychological Theory[mh] OR Inflammation*[mh] OR Bone Resorption[mh] OR atherosclerosis[mh] OR leptin[mh] OR “spinal stenosis”[tiab] OR “Endothelial dysfunction”[tiab] OR “spinal cord”[tiab]

6. Statistical Methods Focus

Reproducibility of Results[mh] OR Models, Statistical*[mh]

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Ewart-Pierce, E., Mejía Ruiz, M.J. & Gittelsohn, J. “Whole-of-Community” Obesity Prevention: A Review of Challenges and Opportunities in Multilevel, Multicomponent Interventions. Curr Obes Rep 5, 361–374 (2016). https://doi.org/10.1007/s13679-016-0226-7

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