The committee was convened to develop a set of recommended childhood obesity prevention practices for local governments. In tackling the committee’s charge, a set of over 600 articles from peer-reviewed published literature and reports from organizations relevant to local governments was identified. The focus of the literature review was to identify potential childhood obesity prevention actions for consideration by the committee, retrieve review articles and seminal articles on the evidence available on potential actions, and find criteria and tools that would be useful in making determinations on the most promising actions.
Scopus and the Transportation Research Information Services (TRIS) online database were primarily used to search the literature, supplemented by EMBASE, PsycINFO, and Medline. Scopus is a multidisciplinary research tool indexing more than 15,000 peer-reviewed journals from 4,000 publishers. Subject areas covered by Scopus include chemistry, physics, mathematics, engineering, life and health sciences, social sciences, psychology, economics, biological, agricultural and environmental sciences, and general sciences. The TRIS database is the world’s largest and most comprehensive bibliographic resource on transportation information. TRIS is produced and maintained by the Transportation Research Board at the National Academy of Sciences. EMBASE (Excerpta Medica) is a major biomedical and pharmaceutical database containing more than 9 million records from over 4,000 journals. This database indexes international journals in the following fields: drug research, pharmacology, pharmaceutics, toxicology, clinical and experimental human medicine, health policy and management, public health, occupational health, environmental health, drug dependence and abuse, psychiatry, forensic
medicine, and biomedical engineering/instrumentation. PsycINFO is a database of psychological literature and it contains more than 1,900,000 records including citations and summaries of journal articles, book chapters, books, and technical reports, as well as citations to dissertations, all in the field of psychology and psychological aspects of related disciplines. Medline is the U.S. National Library of Medicine’s bibliographic database, covering the fields of medicine, nursing, dentistry, veterinary medicine, the health care system, and the preclinical sciences. PubMed, provides online access to over 12 million Medline citations. Medline contains bibliographic citations and author abstracts from more than 4,600 biomedical journals published in the United States and 70 other countries.
The initial search strategy paired the terms obesity and overweight with terms related to food access (neighborhoods, supermarkets, grocery stores, farmers’ markets, breastfeeding, menu labeling, after-school programs, youth programs, community gardens, federal food programs), and terms related to physical activity, including topics concerning the built environment (recreation, parks, playgrounds, planning, sprawl, zoning, walkability, paths, trails) and transportation (sidewalks, roads, traffic patterns, safety, complete streets).
A scan also was conducted to identify recommended childhood obesity prevention actions that have been undertaken in the last ten years by organizations that work with local governments. These organizations included the National Association of County and City Health Officials (NACCHO), Centers for Disease Control and Prevention (CDC), Leadership for Healthy Communities, International City/County Management Association (ICMA), National League of Cities, National Association of Counties (NACo), Local Government Commission, Association of State and Territorial Health Officials (ASTHO), Prevention Institute, U.S Conference of Mayors, and National Association of Latino Elected Officials (NALEO). These organizations have all published reports and/or toolkits that discuss what local governments can do to prevent childhood obesity. The committee also reviewed several sets of criteria and tools developed by others that could be relevant to the committee’s task of making determinations on the most promising actions. (A list of these resources can be found in Appendix B.)
In addition, the committee invited presentations from experts on the role of local government in childhood obesity prevention (see Appendix F).
Based on these searches and presentations, a broad spectrum of action steps and the research on them was compiled. These actions clustered around 15 distinct strategies.
Informed by these efforts, the committee developed criteria for consideration as it reviewed specific strategies and action steps for whether they had the potential to make a positive difference in healthy eating or physical activity. The committee’s criteria were that the strategies and actions must be
Within the jurisdiction of local governments;
Likely to affect children directly;
Targeted to changing the food or physical activity environments of children outside the school walls and the school day (in accordance with the committee’s charge);
Actionable based on the experience of local governments or knowledgeable sources that work with local governments; and
Likely to make positive contributions to the achievement of healthy eating and/or optimum physical activity based on research evidence or, where such evidence is lacking or limited, have a logical connection with the achievement of healthier eating or increased physical activity.
Using the available evidence, the committee took into account the following characteristics of the strategies and actions: their evidence of effectiveness and effect size; outcomes and externalities; potential reach, impact, and cost; and feasibility. The committee made a final assessment and determination of its recommended actions (58 in all) using a nominal voting procedure. Lastly, the committee chose 12 action steps it believes have the most promising potential to make a difference, based on consideration of the criteria described above and the results of the nominal voting.