“Whole-of-Community” Obesity Prevention: A Review of Challenges and Opportunities in Multilevel, Multicomponent Interventions

Abstract

The causes of obesity worldwide are complex and multilevel, including changing food environments, physical activity levels, policies, and food production systems. This intricate context requires multilevel and multicomponent (MLMC) interventions to improve health outcomes. We conducted a literature review of MLMC interventions for obesity prevention and mitigation; 14 studies meeting search criteria were identified. We found examples of successes in preventing obesity, reducing overweight, improving healthful behaviors, and enhancing some psychosocial indicators. Of eight studies that reported health and behavioral results, five showed no significant impact and three showed reductions in obesity. Four studies showed significant improvement in dietary behavior, and five reported significant desirable effects in physical activity or screen time. Five studies reported psychosocial impacts, and three of these showed significant improvements. MLMC approaches show promising results, particularly when they are able to integrate components at the policy, community, and interpersonal levels.

Consideration of Social Disadvantages for Understanding and Preventing Obesity in Children

“…In addition to interventions targeting various levels related to obesity, successful multilevel interventions in low-SES groups are characterized by community collaboration and the participation of actors from different levels and for being sustainable over time ( 12 , 77 ). The majority of multilevel interventions that have benefited participants from low-SES groups had community engagement in common ( 19 ).…”

Communing with Bees: A Whole-of-Community Approach to Address Crisis in the Anthropocene

“…To build on the ideas of sharing and community, as described by the works of Marx (1867), Leopold (1949), Plumwood (2002), Naess (1989), Rose et al (2012), and others, I propose that we find new ways to operationalize a whole-of-community (WOC) approach to living in urban settings. A new WOC approach will build on some of the principles of earlier conceptualizations of whole society or previously used whole community approaches, such as those used in emergency management and public health initiatives (Boelsen-Robinson et al, 2015;Dube et al, 2010;Federal Emergency Management Agency [FEMA], 2011;Ewart-Pierce, Mejía Ruiz, & Gittelsohn, 2016;Ollerenshaw, 2012).…”

“…Whole community strategies have been used in emergency management as well as to address illiteracy and obesity (Boelsen-Robinson et al, 2015;Ewart-Pierce et al, 2016;Ollerenshaw, 2012). This approach is recognized as a way to empower and integrate people from the community to strengthen social infrastructure and facilitate community resilience, particularly by building social capital (FEMA, 2011).…”

A Community-Level Initiative to Prevent Obesity: Results From Kaiser Permanente’s Healthy Eating Active Living Zones Initiative in California

“…12 Other studies looking at multicomponent initiatives targeting entire communities (i.e., including both youth and adults) found some promising results for these approaches, but noted a difficulty in determining the specific strategies or combined effect of strategies that work. 13 A Cochrane review focusing on community-wide physical interventions found few credible studies showing impact at the population level, noting that this may be because of the difficulty reaching enough people in a community setting. 14 Evidence is accumulating on individual interventions (e.g., physical activity programs in schools), 15 and simulation studies have demonstrated that specific strategies can be cost effective.…”