Modifying the food environment for childhood obesity prevention: challenges and opportunities

The prevention of childhood obesity is a global priority. However, a range of complex social and environmental influences is implicated in the development of obesity and chronic disease that goes beyond the notion of individual choice. A population-level approach recognises the importance of access to and availability of healthy foods outside the home. These external food environments, in restaurants, supermarkets, and in school, or recreation and sports settings, are often characterised by energy dense, nutrient-poor food items that do not reflect the current nutritional guidelines for health. In addition, our understanding of these broader influences on nutritional intake is still limited. Particularly, lacking is a clear understanding of what constitutes the food environment, as well as robust measures of components of the food environment across different contexts. Therefore, this review summarises the literature on food environments of relevance to childhood obesity prevention, with a focus on places where children live, learn and play. Specifically, the paper highlights the approaches and challenges related to defining and measuring the food environment, discusses the aspects of the food environment unique to children and reports on environmental characteristics that are being modified within community, school and recreational settings. Results of the review show the need for a continued focus on understanding the intersection between individual behaviour and external factors; improved instrument development, especially regarding validity and reliability; clearer reported methodology including protocols for instrument use and data management; and considering novel study design approaches that are targeted at measuring the relationship between the individual and their food environment.

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‘Choice’: what we mean by it, and what that means for preventing childhood obesity

Public Health Nutrition ◽

10.1017/s1368980012000596 ◽

2012 ◽

Vol 16 (1) ◽

pp. 123-129 ◽

Cited By ~ 5

Author(s):

Christine M Porter

Keyword(s):

Childhood Obesity ◽

Obesity Prevention ◽

Small Subset ◽

Word Choice ◽

Individual Choice ◽

Prevention Measures ◽

Prevention Policy ◽

Structured Interviews ◽

Childhood Obesity Prevention ◽

The Usa

AbstractObjective(i) To map how US adults value ‘choice’ in the context of obesity policy and (ii) to discuss implications for obesity prevention in children.DesignSemi-structured interviews (n 105) were conducted between 2006 and 2009 about causes of and solutions to childhood obesity. Quotes captured in field notes from community meetings (n 6) on childhood obesity prevention were also analysed. Each use of the word ‘choice’ and its variants was identified in these texts. Content and discourse were analysed to identify the implied values and meaning in each use.SettingNorth-eastern USA.SubjectsOne hundred and five adults, some involved in childhood obesity prevention initiatives.ResultsThree distinct frames of ‘choice’ emerged: (i) having choices (choice as freedom), (ii) making choices (choice as responsibility) and (iii) influencing choices (contextual constraints and impacts on choice). Many speakers used more than one frame over the course of an interview. Most people using the third frame seemed to share the values behind the first two frames, but focused on conditions required to enable people to be accountable for their choices and to make truly free choices. A small subset thought outside the frame of individual choice, valuing, as one person put it, a ‘social contract’.ConclusionsPublic debate in the USA about responsibility for and solutions to rising obesity rates often hinges on notions of ‘choice’. These frames, and the values underlying them, are not mutually exclusive. Respecting the values behind each ‘choice’ frame when crafting obesity prevention policy and employing all three in public communications about such policy may facilitate greater consensus on prevention measures.

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School Food Environment the Frontline for Childhood Obesity Prevention - A Mixed-Methods Study of Nutritional Competencies and Skills of School Nutrition Professionals in Nebraska

Journal of the Academy of Nutrition and Dietetics ◽

10.1016/j.jand.2016.06.103 ◽

2016 ◽

Vol 116 (9) ◽

pp. A31

Author(s):

Z. Rida ◽

T. Carr ◽

C. Kohnke ◽

J. Albrecht

Keyword(s):

Mixed Methods ◽

Childhood Obesity ◽

Obesity Prevention ◽

Food Environment ◽

School Nutrition ◽

Mixed Methods Study ◽

School Food ◽

Childhood Obesity Prevention ◽

School Food Environment ◽

Nutrition Professionals

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Validation and refinement of the Stakeholder-driven Community Diffusion Survey for childhood obesity prevention

Implementation Science ◽

10.1186/s13012-021-01158-4 ◽

2021 ◽

Vol 16 (1) ◽

Author(s):

Ariella R. Korn ◽

Julia Appel ◽

Ross A. Hammond ◽

Erin Hennessy ◽

Louise C. Mâsse ◽

...

Keyword(s):

South Carolina ◽

Childhood Obesity ◽

Construct Validity ◽

Obesity Prevention ◽

Content Validity ◽

Diffusion Theory ◽

Intraclass Correlation ◽

Correlation Coefficients ◽

Validity And Reliability ◽

Childhood Obesity Prevention

Abstract Background Whole-of-community interventions hold promise in addressing childhood obesity. The COMPACT Stakeholder-driven Community Diffusion theory posits that stakeholders’ knowledge of childhood obesity prevention efforts and engagement with the issue contribute to successful intervention implementation. Building on completed formative research and pilot testing, we describe the validation and refinement of knowledge and engagement measures. Methods We assessed content validity using a modified Delphi process with science (n=18) and practice-based (n=16) experts. Next, we refined the survey based on input from science- and practice-based experts, cognitive response testing, and item analysis of extant survey data. Field testing of the refined survey involved community stakeholders in Greenville County, South Carolina (n=50), East Boston, Massachusetts (n=30), and Tucson, Arizona (n=84) between 2019 and 2020. Construct validity was assessed with confirmatory factor analysis (CFA). Two-week test-retest reliability was assessed among a subsample of 14 paired respondents in South Carolina. Results Experts rated existing knowledge domains (intervention factors, roles, sustainability, problem, resources) and engagement domains (dialogue/mutual learning, flexibility, influence/power, leadership/stewardship, trust) highly for their importance in addressing childhood obesity. Expert input resulted in 11 new knowledge items and 7 new engagement items that mapped onto existing domains. Correspondingly, two domain names were modified: implementation/sustainability and trust/trustworthiness. We also eliminated 8 extant items (4 knowledge and 4 engagement) and adapted item language for comprehension and consistency. Further modifications based on CFA results and item analyses resulted in 23 knowledge items across four domains (roles and resources merged) and 23 engagement items across five domains. Modified knowledge and engagement scales had adequate fit and strong item factor loadings (most >0.7 and all >0.5). Knowledge (α=0.86–0.87) and engagement (α=0.75–0.90) subscales had high internal scale consistency. Knowledge intraclass correlation coefficients (ICCs) for test-retest agreement of subscale scores ranged from 0.50 for intervention factors to 0.86 for roles/resources. For engagement subscale scores, ICCs ranged from 0.70 for trust/trustworthiness to 0.96 for leadership/stewardship. Conclusions Findings from this multi-method survey development process increase our confidence of the knowledge and engagement measures’ content validity, construct validity, and reliability.

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