Recommendation 1: Decision makers and those involved in generating evidence, including researchers, research funders, and publishers of research, should apply the L.E.A.D. framework as a guide in their utilization and generation of evidence to support decision making for complex, multifactorial public health challenges, including obesity prevention.
Key assumptions that should guide the use of the framework include the following:
A systems perspective can help in framing and explaining complex issues.
The types of evidence that should be gathered to inform decision making are based on the nature of the questions being asked, including Why? (“Why should we do something about this problem in our situation?”), What? (“What specifically should we do about this problem?”), and How? (“How do we implement this information for our situation?”). A focus on subsets of these questions as a starting point in gathering evidence explicitly expands the evidence base that is typically identified and gathered.
The quality of the evidence should be judged according to established criteria for that type of evidence.
Both the level of certainty of the causal relationship between an intervention and the observed outcomes and the intervention’s generalizability to other individuals, settings, contexts, and time frames should be given explicit attention.
The analysis of the evidence to be used in making a decision should be summarized and communicated in a systematic, transparent, and transdisciplinary manner that uses uniform language and structure. The report on this analysis should include a summary of the questions asked by the decision maker; the strategy for gathering and selecting the evidence; an evidence table showing the sources, types, and quality of the evidence and the outcomes reported; and a concise summary of the synthesis of selected evidence on why an action should be taken, what that action should be, and how it should be taken.
If action must be taken when evidence is limited, this incomplete evidence can be blended carefully and transparently with theory, expert opinion, and collaboration based on professional experience and local wisdom to support making the best decision.
Sustained commitments will be needed from both the public and private sectors to achieve successful utilization of the various elements of the L.E.A.D. framework in future evidence-informed decision making and evidence generation. This responsibility lies with the academic and research community, as well as with government and private funders and the leadership of journals that publish research in this area. Necessary supports will include increasing understanding of systems thinking and incorporating it into research-related activities, creating and maintaining resources to