Melanie Nichols

El exceso de peso y la obesidad infantil representan un urgente desafío de Salud Pública en Europa, con consecuencias para la salud, el bienestar y la calidad de vida de esta población, que proyectan una carga significativa en los sistemas sanitarios y económicos. Disponer de datos fiables y comparables es clave para orientar respuestas eficaces. En consecuencia, la Oficina Regional para Europa de la Organización Mundial de la Salud (OMS) lanzó en 2007 la Iniciativa de Vigilancia de Obesidad Infantil (COSI) para armonizar la recopilación de datos antropométricos de menores entre seis y nueve años. Desde su inicio, COSI ha pasado de trece a cuarenta y ocho países participantes, con datos de aproximadamente 1,6 millones de menores a lo largo de más de quince años. España participa en COSI desde 2009-2010 a través del estudio ALADINO, proporcionando datos de gran calidad y representatividad nacional. La última ronda (2022-2023) incluyó 12.684 escolares, con una prevalencia de exceso de peso de 33,6% a los seis años y 40,5% a los nueve, y de obesidad entre el 14,1% y el 18,8%, respectivamente. A pesar de lograr una de las mayores reducciones en exceso de peso entre la ronda 5ª y 6ª de COSI, España continúa entre los países con mayores prevalencias de la región.Esta publicación destaca el valor de la colaboración internacional mediante la iniciativa COSI, consolidada como un sistema de vigilancia armonizado y de gran solidez científica, imprescindible para el impulso de políticas dirigidas a prevenir la obesidad infantil en toda Europa. Sus resultados en España han apoyado intervenciones nacionales, favorecido el conocimiento de la situación ponderal y hábitos de vida de los menores en la región, y posicionado al país como uno de los pioneros del Plan de Aceleración de la OMS para Detener la Obesidad, contribuyendo así a la protección de la salud de la infancia en España y en la región europea.

Objective: This systematic review and meta‐analysis aimed to identify common life‐course body mass index (BMI) trajectories (childhood/adulthood to adulthood) and their impact on risk of cancer overall and cancer at different sites in adulthood. Methods: Observational studies were identified that assessed the association of BMI trajectories with cancer risks from databases published in English. The pooled effect sizes were estimated using a random‐effects model. Findings: A total of 24 eligible studies were included in the meta‐analysis. Transitioning from normal weight to obesity was significantly associated with an increased risk of colorectal cancer (effect size [ES] = 1.170, 95% CI: 1.096, 1.245), pancreatic cancer (ES = 1.337, 95% CI: 1.247, 1.426), kidney cancer (ES = 2.122, 95% CI: 1.619, 2.624), and liver cancer (ES = 1.777, 95% CI: 1.261, 2.293), compared to those in the stable normal weight trajectory. No significant difference in the risk of breast or prostate cancer was observed when comparing various BMI trajectories to a stable normal BMI trajectory. Conclusion: The findings suggest that lifetime BMI trajectories influence cancer risk, with a transition from normal BMI to higher levels associated with an increased risk of cancer. The impact varied by trajectory and cancer type. Further studies are needed to confirm these findings.

Parent engagement in community-based obesity prevention interventions (CBOPIs) enhances obesity prevention outcomes. Actions from CBOPIs may also have climate change-related impacts, but little is known about specific elements of CBOPIs that promote parental engagement, and whether parents prefer CBOPIs that aim to address obesity alone or obesity and climate change warrants further investigation. An unlabelled 12-choice task discrete choice experiment (DCE) was undertaken, using a D-efficient design and incorporating two CBOPI alternatives plus an opt-out alternative. CBOPIs were described by six attributes: cost, aim, involvement, effectiveness, convenience, and social opportunities. Attributes were informed by a literature review of enablers and barriers to parent participation. The survey was electronically distributed to parents of primary-school-aged children in each Australian state and territory during April–May 2024. Data were analysed using conditional logit models, and willingness-to-pay for attributes was estimated. Parents (n = 438) preferred less costly CBOPIs (P < .001) that aim to address both healthy lifestyles and climate change (P = .086). Parents preferred short-term, manageable disruptions to family schedules to accommodate CBOPI participation (P = <.001) over no intervention. They were willing to pay an additional $3.97 per fortnight (∼$104.000 per year) for CBOPI participation to be convenient (standard error 1.380, P = .004). Our findings suggest that parents preferred CBOPIs that aim to address both healthy lifestyles and climate change. This suggests that incorporating climate change action into CBOPIs may increase parent support and consequently support CBOPI outcomes for both obesity prevention and climate change action.

Background: Community-based obesity prevention interventions (CBOPIs) demonstrate promise as effective, cost-effective approaches to prevent obesity. Whilst CBOPI actions often focus on obesity-related outcomes, they may also have positive impacts on climate change. Actions that simultaneously address obesity and climate change are known as double-duty actions. For example, switching to active modes of transport benefits individual health, while also reducing emissions from vehicle use. Support from CBOPI funding decision-makers is crucial for intervention success; the factors influencing funding decisions are currently not well understood. This study aimed to identify factors that influence funding decisions within organisations, to determine whether funders recognise double-duty actions in CBOPIs, and which double-duty actions are preferred. Methods: Potential participants with CBOPI funding decision-making roles were purposively sampled and invited to participate. Potential interview participants from government and non-government organisations were identified by search engine (Google) and invited via email to partake in an interview. Sixty-five invites were emailed and seven interviews with eight participants were conducted between April–May 2023. The participating stakeholders all had health roles; four State-wide and four local government. Semi-structured interviews with eight participants were conducted over Zoom between February-May 2023. Interviews were transcribed using Zoom Transcription and analysed with the assistance of NVivo. Reflexive Thematic Analysis underpinned the data analysis and the Social Ecological Model was used to further develop the theory. Results: Results suggested that participants recognised double-duty actions and believed inclusion of climate change action in CBOPIs would improve both intervention outcomes and participant acceptability. However, participants believed that stringent funding models limit flexibility to include climate change action. This could be mitigated by incorporating climate change into strategic health plans. Community partnerships may also be an effective tool to enhance double-duty actions in CBOPIs, as they allow participants to tailor interventions to community concerns including climate change. Conclusion: CBOPIs that use double-duty actions to intentionally target obesity prevention and climate change action may play an important role in addressing two critical public health issues at the community level. Whilst CBOPI funders are supportive of double-duty actions, modifications from strategy and partnerships may be required to realise the successful implementation.

Aim: Community-based obesity prevention interventions (CBOPIs) target the causes of obesity. Actions implemented in CBOPIs could simultaneously impact both climate change and obesity, making them a potentially important approach. To date, limited work has been undertaken to identify and categorise double-duty actions (those that simultaneously influence obesity and climate change) in CBOPIs. The prevalence of double-duty actions in CBOPIs is currently unknown. This paper outlines the development and application of the DoublE-duty actions in CommunIty-baSed obesity InterVEntions (DECISIVE) framework to address this gap. Subjects and methods: A scoping review focusing on obesity and climate change was performed, and the results informed the development of DECISIVE. DECISIVE was applied to studies included in the Cochrane review of obesity prevention interventions in children, and both the published and unpublished data of a completed intervention. Results: The scoping review identified one study and one systematic review which contributed to the development of DECISIVE. The framework lists nine double-duty actions, plus an ‘Other’ action. Each action’s potential impact on both obesity and climate change is summarised and example strategies are provided. Reduce the availability and consumption of ultra-processed foods was the most prevalent double-duty action when applying DECISIVE to published studies. Conclusion: DECISIVE is the first framework to recognise double-duty actions on obesity and climate change in CBOPIs. The development of DECISIVE holds important implications for community stakeholders who may be able to better identify, incorporate, and promote double-duty actions. This may enhance stakeholder acceptability, feasibility, and value-for-money of interventions.

Bold and comprehensive action is needed to prevent diet-related diseases in rural areas, which includes improving food environments to enable healthier dietary practices. Rural health services are integral to the health of rural populations, yet their role in community disease prevention is not swell understood. This study sought to understand health service, local government, and food outlet stakeholders’ perspectives on (1) the drivers of unhealthy retail environments in a rural setting; (2) the role of rural health services in supporting changes in local food environments; and to (3) identify characteristics of potential interventions. Two Group Model Building workshops were held with health service and local government leaders (n = 9), and interviews were conducted with local food outlet participants (n = 13). Key themes included ‘enablers to healthier food environments’, ‘barriers to healthier food environments’, ‘Rural health services are a leading broker of knowledge for healthy food environments’, and ‘characteristics of desirable healthy food environment interventions.’. Rural health services can play a key role in addressing the current barriers to healthy food environments in rural areas. Effective promotion of healthier diets in rural populations will require consideration of key stakeholder perspectives and the development of further evidence on the role that rural health services can play in improving the healthiness of food environments.