The intent of the transparent and uniform reporting of the process and conclusions of evidence gathering and synthesis is to provide decision makers with information they can understand as they make choices among alternative policies and programs. The proposed report template aligns with the main elements of the framework, describing the question(s) asked by the decision maker, the strategy for gathering and selecting evidence, and the evaluation of the evidence, and ends with a summary of the synthesized evidence. This summary should address the broad categories of effectiveness in the proposed setting, population affected and potential impact, and implementation.

The ability to use evidence to inform decision making depends in part on the availability of relevant evidence. Use of the L.E.A.D. framework can broaden what is considered to be useful, high-quality evidence and gradually increase the amount of such evidence. Yet, despite the best efforts to amass available evidence, those grappling with an emerging problem such as obesity will face decisions that must be made on the basis of inconsistent or incomplete evidence. Similar to what has been observed in tobacco control, one can anticipate cycles of planning that begin with incomplete evidence, blended with theory, expert opinion, experience, and understanding of local traditions and the probable response to proposed actions, and extend to evaluating the consequences of interventions. Decision making is complex and takes many factors, in addition to evidence, into account. The goal is to enable the best possible use of evidence within decision making processes.

Opportunities to Generate Evidence

Key Actions: (1) Take full advantage of opportunities to generate evidence from ongoing policy and practice. (2) If obesity prevention actions are taken when the evidence is very limited, evaluate the success of the intervention and build credible evidence for use in future decision making. (3) Treat natural experiments, emerging innovations, and ongoing programs as potential sources of useful evidence. (4) Consider forms of evidence and research designs from a variety of disciplines, including systems approaches that can handle complexity. (5) Explore research designs that can be used as alternatives to randomized experiments and that may be more feasible in relation to complex environmental and policy interventions. (6) When reporting results of obesity prevention efforts, include useful aspects of the research related to its generalizability to individuals, settings, contexts, and time frames.

Researchers in a variety of fields, as well as those who fund and publish their research, are among the intended users of the L.E.A.D. framework. In addition to fostering a systems approach and making the best possible use of diverse types of relevant evidence, application of the L.E.A.D. framework can suggest opportunities for research. This may occur during any step of the process.

What is usually regarded as the current evidence base for obesity prevention is limited in both size and utility. New approaches based on the expanded perspective outlined in this report are urgently needed to address these limitations. Among other



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