Multilevel Interventions Targeting Obesity: Research Recommendations for Vulnerable Populations

Abstract

Introduction The origins of obesity are complex and multifaceted. To be successful, an intervention aiming to prevent or treat obesity may need to address multiple layers of biological, social, and environmental influences. Methods NIH recognizes the importance of identifying effective strategies to combat obesity, particularly in high-risk and disadvantaged populations with heightened susceptibility to obesity and subsequent metabolic sequelae. To move this work forward, the National Heart, Lung, and Blood Institute, in collaboration with the NIH Office of Behavioral and Social Science Research and NIH Office of Disease Prevention convened a working group to inform research on multilevel obesity interventions in vulnerable populations. The working group reviewed relevant aspects of intervention planning, recruitment, retention, implementation, evaluation, and analysis, and then made recommendations. Results Recruitment and retention techniques used in multilevel research must be culturally appropriate and suited to both individuals and organizations. Adequate time and resources for preliminary work are essential. Collaborative projects can benefit from complementary areas of expertise and shared investigations rigorously pretesting specific aspects of approaches. Study designs need to accommodate the social and environmental levels under study, and include appropriate attention given to statistical power. Projects should monitor implementation in the multiple venues and include a priori estimation of the magnitude of change expected within and across levels. Conclusions The complexity and challenges of delivering interventions at several levels of the social—ecologic model require careful planning and implementation, but hold promise for successful reduction of obesity in vulnerable populations.

Dynamics of Anthropometric Indices in a Large Paired Cohort With 10 Years of Follow-Up: Paving the Way to Sarcopenic Obesity

“…Another focus of interest remains in the ability to identify subjects at risk of gaining weight over time. More vulnerable population segments comprise children, low-income individuals, racial/ethnic minority groups, low educational level, rural populations, and adults aged >65 years (31,32). In our 10year paired cohort study, we have shown that preventive healthy public strategies must be focused and intensified in younger women with lower BMI.…”

Editorial: Psychosomatic Aspects of Obesity

“…This is particularly important as obesity is increasingly recognized as a chronic health condition and a growing public health problem worldwide. Interdisciplinary, multicomponent interventions are needed at the individual, community, and policy levels (10). We hope that this Research Topic will stimulate further work in this important area.…”

A collaborative approach to developing sustainable behaviour change interventions for childhood obesity prevention: Development of the Choosing Healthy Eating for Infant Health (CHErIsH) intervention and implementation strategy

“…As such, it is of vital importance for interventions to be developed with a focus on implementation, and the multiple levels of behaviours required to facilitate implementation and intervention delivery, from the outset (Brownson et al , ; Chambers & Norton, ; Pluye, Potvin, & Denis, ; Schell et al , ). Incorporating insights from a variety of stakeholders including practice, policy, and patient/public enables several levels of behavioural factors influencing implementation to be considered, and has been consistently acknowledged as one of the most important aspects in developing sustainable public health interventions (Iwelunmor et al , ; Proctor et al , ; Schell et al , ; Stevens et al , ). However, incorporating multiple stakeholder perspectives within intervention development is not straightforward (Cottrell et al , ; Deverka et al , ).…”