Last updated: 15-Jan-2007
Summary
Interventions to Reduce Energy Intake
1. Interventions of proven effectiveness with strong evidence
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Counselling for reduced energy intake by primary healthcare providers.
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Behaviour therapy combined with healthy eating for weight loss.
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Sustained, community-initiated programs for reduced energy intake.
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Weight Watchers program.
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Encouragements to breastfeed for weight maintenance in children.
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Comprehensive school programs, especially with parental involvement.
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Family / parental involvement for weight maintenance in children.
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Reduced vending machine prices for healthy foods.
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Drug treatment with orlistat or sibutramine, where indicated.
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All forms of surgery for morbid obesity, and especially gastric bypass.
2. Interventions of promising effectiveness with moderate or mixed evidence
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Workplace interventions that include cafeteria changes.
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Family support programs.
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Counselling for increased consumption of fruit, vegetables and fibre.
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Low fat and low calorie diets alone for short-term weight loss.
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Single product promotions for short-term change in sales.
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Labelling healthy foods on restaurant menus.
3. Interventions of no or low effectiveness and / or with insufficient evidence
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Mass media campaigns for increased vegetable and fruit consumption (but these do raise awareness levels, a precursor to action).
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Increased access to vegetables and fruit in low-income areas.
Interventions to Increase Energy Expenditure
1. Interventions of proven effectiveness with strong evidence
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Exercise alone for weight maintenance.
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Signs encouraging stairway usage.
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Behavioural/social approaches focusing on moderate-intensity physical activity such as walking.
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Behavioural/social approaches based at home and reinforced by frequent telephone contact.
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Community social support (e.g., walking groups).
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School-based physical education.
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Enhanced access to places for physical activity.
2. Interventions of promising effectiveness with moderate or mixed evidence
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Community-wide campaigns with multiple components.
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School-based physical activity for prevention of childhood obesity.
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Reducing sedentary activities for weight maintenance in children.
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Counselling by primary care physicians.
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Physician training, reminders and incentives.
3. Interventions of no or low effectiveness and / or with insufficient evidence
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Classroom-based health education.
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Mass media campaigns in isolation.
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Health education to reduce TV viewing and video game playing.
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Family-based social support.
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College-based physical and / or health education.
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Exercise alone for weight loss.
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Workplace programs geared to individuals.
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Workplace “environmental” interventions.
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Transportation policy (various studies pending).
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Other urban planning (various studies pending).
Combined Interventions
1. Interventions of proven effectiveness with strong evidence
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Exercise combined with healthy eating for weight loss.
2. Interventions of promising effectiveness with moderate or mixed evidence
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Programs to encourage reduced television watching
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Combining healthy eating, exercise and counselling.
3. Interventions of no or low effectiveness and / or with insufficient evidence
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Environmental approaches to weight gain prevention (research pending; see the next section).
Regulatory and Economic Interventions
A review of the above summary indicates few interventions at the regulatory and economic level. Indeed, current efforts in this area, such as the move by the Canadian government to eliminate trans fats in processed foods, are at the forefront in this field and thus have not been tested or evaluated for effectiveness. In Australia, the approach taken involves the implementation of promising strategies even in the absence of this evidence. They suggest using the best available evidence while not excluding untried but promising interventions that are “deemed worthy of systematic implementation and evaluation”.[1]
Using such an approach, a European review suggested several regulatory and economic interventions, including:[2]
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Taxes on foods with a low content of a range of nutrients, e.g. soft drinks.
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Restrictions on advertising, promotion, and sponsorship of energy-dense foods and beverages (especially when directed at young people).
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Nutrition signposting based on an agreed standard for fat, fibre, vegetable and fruit content which the consumer can recognize as appropriate in a healthy diet.
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Enhanced nutrition messages that foster an understanding of the relationship between food and health.
This list can be compared with the inventory of ideas in a Canadian report on obesity from August, 2004:[3]
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Legislation to regulate portions to a “reasonable” size and enforce disclosure of nutritional content of fast food at point-of-purchase.
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Using taxes and subsidies, change price structures to favour healthy food.
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Remove sales tax on exercise equipment.
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Offer tax incentives to employers providing exercise facilities.
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Taxation to encourage densification and active commuting, e.g., traffic congestion and gasoline taxes, rush hour tolls, subdivision fees.
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Urban design to promote walking and bicycling.
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Polices to support adequate income for individuals and families.
It is noteworthy that many of the preceding approaches are based on taxation, confirming the point made in a recent OECD report, namely, that some commentators believe fiscal or legislative changes should have a higher priority that other types of health promotion strategies.[4]
[1] New South Wales Centre for Public Health Nutrition. Best Options for Promoting Healthy Weight and Preventing Weight Gain in NSW. June 2004.
[2] International Union Against Cancer. Evidence-based Cancer Prevention: Strategies for NGOs, 2004.
[3] Raine KD. Overweight and Obesity in Canada: A Population Health Perspective. Centre for Health Promotion Studies, University of Alberta, 2004.
[4] Bennett J. Investment in Population Health in Five OECD Countries. OECD Health Working Papers. 2003