Community Policies and Programs to Prevent Obesity and Child Adiposity

Abstract

Introduction Evidence regarding impact of community policies and programs (CPPs) to prevent child obesity is limited, and which combinations of strategies and components are most important is not understood. The Healthy Communities Study was an observational study to assess relationships of characteristics and intensity of CPPs with adiposity, diet, and physical activity in children, taking advantage of variation across the U.S. in community actions to prevent child obesity. The study examined the association of CPPs to prevent child obesity with measured BMI and waist circumference, hypothesizing that communities with more-comprehensive CPPs would have children with lower adiposity. Methods The study included 130 communities selected by probability-based sampling or because of known CPPs targeting child obesity. Data were collected at home visits on 5,138 children during 2013–2015. CPPs were scored for multiple attributes to create a CPP intensity score. A CPP target behavior score reflected the number of distinct target behaviors addressed. Scores were standardized with the smallest observed score across communities being 0 and the largest 1. Multilevel regression analysis in 2016 adjusted for community, household, and individual characteristics. Results Higher CPP target behavior score was significantly associated with lower BMI and waist circumference in a dose–response relationship, with magnitude for the past 3 years of CPPs of 0.843 kg/m2 (p=0.013) for BMI and 1.783 cm (p=0.020) for waist circumference. Conclusions This study provides plausible evidence that comprehensive CPPs targeting a greater number of distinct physical activity and nutrition behaviors were associated with lower child adiposity.

The longitudinal relationship between community programmes and policies to prevent childhood obesity and BMI in children: the Healthy Communities Study

“…These data provide evidence of a statistically significant and meaningful (15,26,27) relationship between the intensity of community interventions and childhood obesity, and amplify results observed on cross-sectional analyses of the HCS data (28). Based on the minimally adjusted model, we estimated a reduction of 1.6 kg/m 2 across children in grades K-8 in communities with the most intensive programmes and policies aimed at reducing childhood obesity, compared with communities with the lowest intensity, based on the range of CPP intensity scores observed over a decade in the HCS.…”

Measuring the intensity of community programs and policies for preventing childhood obesity in a diverse sample of US communities: the Healthy Communities Study

“…Community efforts appear to be more comprehensive over time – to target more behaviours related to physical activity and nutrition. This is important, because the HCS investigators found that the CPP target behaviour score was significantly associated with lower BMI in children . The CPP intensity scores suggest that the intensity or dose of community efforts has generally grown over time.…”

“…The target behaviour objectives were identified by the scientific team, based on their expertise in each topic. As described in Frongillo et al (19), this targeting score was calculated using the total number of unique target behaviours across all CPPs in each community in each year. Each CPP was coded for one or more of 24 unique target behaviours (Table 1), 11 related to nutrition and 13 related to physical activity.…”

Supplement overview: what the Healthy Communities Study is telling us about childhood obesity prevention in U.S. communities

“…The article by Strauss et al complements the initial HCS report that – in general – more is better when it comes to CPPs that target different nutrition and physical activity behaviours. As reported previously by Frongillo et al , a higher number of current and past CPPs targeting distinct behaviours was associated with lower child body mass index (BMI) and waist circumference as measured at the home visit, in a statistically significant, dose–response manner. In this supplement, Strauss et al report relationships of CPP intensity to BMI trajectories over time estimated from the home visit and the historical medical record data .…”