Journal of General Internal Medicine

, Volume 33, Issue 11, pp 1990–2001 | Cite as

Effectiveness of Policies and Programs to Combat Adult Obesity: a Systematic Review

  • Eva Tseng
  • Allen Zhang
  • Oluwaseun Shogbesan
  • Kimberly A. Gudzune
  • Renee F. Wilson
  • Hadi Kharrazi
  • Lawrence J. Cheskin
  • Eric B. Bass
  • Wendy L. Bennett
Review Paper



This systematic review identifies programs, policies, and built-environment changes targeting prevention and control of adult obesity and evaluates their effectiveness.


We searched PubMed, CINAHL, PsycINFO, and EconLit from January 2000 to March 2018. We included natural experiment studies evaluating a program, policy, or built-environment change targeting adult obesity and reporting weight/body mass index (BMI). Studies were categorized by primary intervention target: physical activity/built environment, food/beverage, messaging, or multiple. Two reviewers independently assessed the risk of bias for each study using the Effective Public Health Practice Project tool.


Of 158 natural experiments targeting obesity, 17 reported adult weight/BMI outcomes. Four of 9 studies reporting on physical activity/built environment demonstrated reduced weight/BMI, although effect sizes were small with low strength of evidence and high risk of bias. None of the 5 studies targeting the food/beverage environment decreased weight/BMI; strength of evidence was low, and 2 studies were rated high risk of bias.


We identified few natural experiments reporting on the effectiveness of programs, policies, and built-environment changes on adult obesity. Overall, we found no evidence that policies intending to promote physical activity and healthy eating had beneficial effects on weight/BMI and most studies had a high risk of bias. Limitations include few studies met our inclusion criteria; excluded studies in children and those not reporting on weight/BMI outcomes; weight/BMI reporting was very heterogeneous. More high-quality research, including natural experiments studies, is critical for informing the population-level effectiveness of obesity prevention and control initiatives in adults.


obesity prevention systematic reviews 



The authors thank Dr. Elizabeth Stuart and Ms. Emily Knapp for their input. They also thank Dr. Lionel Bañez, their task order officer at AHRQ.

Prior Presentation

This work was presented as a poster at the Society for General Internal Medicine Meeting, April 12, 2018.

Funding Information

This report is based on research conducted by the Johns Hopkins University Evidence-based Practice Center under contract 290-2012-00007I to AHRQ, Rockville, Maryland.

Compliance with Ethical Standards

Conflict of Interest

Dr. Lawrence Cheskin served on the scientific advisory board of Medifast during the conduct of the study. All other authors declare no conflicts of interest.


The findings and conclusions in this document are those of the authors, who are responsible for its contents; the findings and conclusions do not necessarily represent the views of AHRQ. Therefore, no statement in this report should be construed as an official position of AHRQ or of the US Department of Health and Human Services.

Reproducible Research Statement: Study protocol: Available at Statistical code: Not applicable. Data set: Full technical report available at

Funding Source: National Institutes of Health Office of Disease Prevention and the Agency for Healthcare Research and Quality. PROSPERO registry #CRD42017055750.


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Copyright information

© Society of General Internal Medicine 2018

Authors and Affiliations

  • Eva Tseng
    • 1
    • 2
  • Allen Zhang
    • 3
    • 4
  • Oluwaseun Shogbesan
    • 5
  • Kimberly A. Gudzune
    • 1
    • 2
  • Renee F. Wilson
    • 3
    • 4
  • Hadi Kharrazi
    • 3
  • Lawrence J. Cheskin
    • 6
  • Eric B. Bass
    • 1
    • 3
    • 4
  • Wendy L. Bennett
    • 1
    • 2
  1. 1.Division of General Internal MedicineJohns Hopkins University School of MedicineBaltimoreUSA
  2. 2.Welch Center for Prevention, Epidemiology, & Clinical ResearchThe Johns Hopkins UniversityBaltimoreUSA
  3. 3.Department of Health Policy and ManagementJohns Hopkins Bloomberg School of Public HealthBaltimoreUSA
  4. 4.Johns Hopkins University Evidence-based Practice Center, Johns Hopkins Bloomberg School of Public HealthThe Johns Hopkins UniversityBaltimoreUSA
  5. 5.Department of Medicine, Reading HospitalWest ReadingUSA
  6. 6.Department of Health, Behavior & SocietyJohns Hopkins Bloomberg School of Public HealthBaltimoreUSA

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