OBJECTIVE: Systematic reviews (SRs) should include policy-relevant information in order to more readily inform policy and practice. We investigated whether SRs of overweight and obesity prevention interventions are framed in such a way that maximises their usefulness for policymakers.
METHOD: We conducted a systematic review of SRs of overweight and obesity prevention interventions published in 4 databases any time up to December 2014. We analysed the SRs for their usefulness to policymakers, using a coding frame developed based on literature around what policymakers want and need from systematic reviews. Systematic reviews were assessed for a) policy links and framing; b) quality assessment and conflict of interest statements: and c) discussion of policy implications.
RESULTS: Of the 153 SRs that met the inclusion criteria, very few (7%) had authors from policy-based organisations, 48% had funding from such organisations, and almost a third (31%) framed their introduction or aims around policy. Most (69%) discussed issues affecting generalisability of the SR findings but only a quarter (24%) discussed cost or cost-effectiveness of the intervention under investigation. Less than a third (29%) of SRs discussed the policy implications of their findings. SRs that were policy-framed were significantly more likely to discuss costs (PR=1.8, 95%CI 1.0-3.0) and policy implications (PR=2.5, 95%CI 1.5-4.0).
CONCLUSION: SRs should discuss the policy and practice implications of their findings to maximise the influence of SRs on policy making. It is recommended that SR guidelines are updated to include generalisability and discussion of policy and practice implications as a requirement.
BACKGROUND: Lifestyle-related health issues affect the economic position of organizations and contribute to reduced productivity, increased absenteeism and health care costs.
AIMS: To summarize the effectiveness of different workplace health interventions for promoting healthy lifestyle, preventing diseases and reducing health care costs.
METHODS: We searched MEDLINE via Pubmed, EMBASE, Cochrane Library, NelH, HighWire Press and Google Scholar in March 2012. Systematic reviews and meta-analyses of workplace interventions aimed at promoting physical activity, healthy weight and good nutrition were included. Three authors assessed the quality of the reviews and extracted data on methods, interventions, outcomes, results and effect sizes.
RESULTS: We identified 15 publications covering a total of 379 original studies. Three systematic reviews found beneficial effects of workplace nutrition interventions on employees' dietary behaviour. Three reviews found multi-component physical activity interventions to be effective in increasing employees' physical activity and fitness. The other activity promotion interventions were less effective regarding physical activity and weight-related outcomes. In terms of weight management, our findings favour multi-component interventions that focus on both physical activity and nutrition over single dietary programmes.
CONCLUSIONS: Workplace health promotion interventions may improve physical activity, dietary behaviour and healthy weight. There is no evidence of increased efficacy associated with specific intervention types. Workplace health promotion should focus on either physical activity or weight or nutrition behaviour to maximize effectiveness. Best evidence is available for multi-component interventions.
BACKGROUND: This study applied an equity lens to existing research to investigate what is known about the impact of population-level physical activity interventions on social inequalities.
METHODS: We performed a pilot systematic review to assess the availability of information on the social distribution of intervention effects, the targeting or allocation of interventions, and the baseline characteristics of participants. This comprised (i) a rapid review of systematic reviews and (ii) a review and synthesis of a sample of primary studies included in the eligible systematic reviews.
RESULTS: We found 19 systematic reviews of environmental and policy interventions. Relatively few of these (26%, n=5) were prospectively designed to examine effects on inequalities, and none were able to fully synthesise evidence of distributional effects. Over 40% of primary studies reported subgroup intervention effects; 18% reported socio-demographic interaction effects. Studies most often compared effectiveness by gender, followed by age, ethnicity, and socio-economic status. For gender, effects appeared to be evenly distributed overall, although heterogeneity in gradients between studies suggested that some interventions affect males and females differently.
CONCLUSIONS: Our findings suggest that it is feasible to generate better evidence about how public health interventions may affect health inequalities using existing data and innovative methods of research synthesis.
WHAT DO WE WANT TO KNOW?: Both internationally and in the UK, there is widespread concern about rising rates of obesity and overweight. Since 2004, tackling obesity has been a policy priority for the UK government and efforts have particularly focused on halting the increases in childhood obesity.
There is increasing interest from both policy-makers and researchers in the social and environmental factors which influence obesity. These factors include the physical environment, social values, technology and the economy. Interventions that aim to change social and environmental factors in order to reduce obesity may include taxes or subsidies to encourage healthy eating or physical activity, extra provision of sporting facilities, efforts to improve safety and accessibility of walking and cycling or play areas or attempting to influence the social meanings and values attached to weight, food or physical activity. However, there is still not a robust understanding of the extent to which social and environmental interventions work to reduce obesity.
The aim of this piece of work, therefore, is to locate and describe existing review-level evidence on the effectiveness of social and environmental interventions for the prevention or reduction of obesity and overweight. The focus of the work is on evidence relating to children and young people. WHO WANTS TO KNOW?: Policy makers, funders and researcher will be able to use this systematic map as a guide to the diverse mass of available evidence when planning policies and designing or appraising research proposals. The report brings together wide-ranging research from health, transport, urban planning, physical activity and food policy and is of use to decision makers and researchers from all these areas. WHAT DID WE FIND?: We located 54 reviews of obesity-relevant research with a social and environmental focus, of which 32 were systematic reviews. Our results reflect the rapid recent growth in interest in this topic. Over half the reviews were published in 2004 or later.
Most of the reviews covered the population as a whole and did not have a specific focus on children or young people. The reviews covered a wide range of intervention types and settings. Some were focused on specific intervention strategies such as mass media campaigns, financial instruments or point-of-sale information. Some investigated multi-component interventions which integrated social and environmental change with education and strategies for individual behaviour change, in either school or community settings. A number of reviews included studies covering all of these areas.
Many reviews focused on studies which evaluated interventions which aimed to alter the social values attached to food and exercise, using, for example, education or social marketing techniques. We found few reviews which included studies evaluating large-scale structural changes to the physical environment or the availability or cost of food, exercise or sport.
WHAT ARE THE IMPLICATIONS?: Reviews of all interventions, not only those based in schools, should assess the impact of interventions on children and young people
More reviews are needed of ‘structural’ or ‘macro’ interventions, such as policy interventions or changes to the built environment.
The lack of data on large-scale structural or fiscal interventions may be due to the difficulty in setting up experiments to test the effects of these population-level changes. In future, research might explore how correlation data (examining relationships and trends) and qualitative data (examining people’s views and experiences) could be combined with more traditional measures of effectiveness (such as measuring the outcome before and after an intervention) in order to improve the evidence-base in this field.
Policy-makers should use this report as a map to navigate this complex field and identify which reports from the considerable review-level evidence might be worth retrieving and reading in order to answer their particular questions HOW DID WE GET THESE RESULTS?: We located reviews through searches of 21 databases in several fields, as well as 17 websites and contact with experts. Database searches used a broad strategy to maximise inclusiveness. Reviews were included if they: investigated some obesity-relevant topic; reviewed the effectiveness of interventions; included the 4-18 age group; were published in 1996 or later; and focused on social and environmental interventions. Two reviewers independently extracted information from the reviews and assessed quality. Any discrepancies were resolved in discussion. We did not look in detail at the studies included in the reviews because of the wide variation in the way that authors presented their study findings.
Systematic reviews (SRs) should include policy-relevant information in order to more readily inform policy and practice. We investigated whether SRs of overweight and obesity prevention interventions are framed in such a way that maximises their usefulness for policymakers.
METHOD:
We conducted a systematic review of SRs of overweight and obesity prevention interventions published in 4 databases any time up to December 2014. We analysed the SRs for their usefulness to policymakers, using a coding frame developed based on literature around what policymakers want and need from systematic reviews. Systematic reviews were assessed for a) policy links and framing; b) quality assessment and conflict of interest statements: and c) discussion of policy implications.
RESULTS:
Of the 153 SRs that met the inclusion criteria, very few (7%) had authors from policy-based organisations, 48% had funding from such organisations, and almost a third (31%) framed their introduction or aims around policy. Most (69%) discussed issues affecting generalisability of the SR findings but only a quarter (24%) discussed cost or cost-effectiveness of the intervention under investigation. Less than a third (29%) of SRs discussed the policy implications of their findings. SRs that were policy-framed were significantly more likely to discuss costs (PR=1.8, 95%CI 1.0-3.0) and policy implications (PR=2.5, 95%CI 1.5-4.0).
CONCLUSION:
SRs should discuss the policy and practice implications of their findings to maximise the influence of SRs on policy making. It is recommended that SR guidelines are updated to include generalisability and discussion of policy and practice implications as a requirement.
