Evidenced-Based Strategies for Obesity in Context
In the final stretch, the U.S. and Mexico are head to head! Who will pull away to capture the number one spot? Unfortunately, this is a race not meant to be won. In our recent AJPM theme issue and pubcast video, “Obesity Control in Latin American and U.S. Latinos: A Systematic Review,” we expressed the need to identify culturally appropriate strategies to fight the obesity epidemic and emphasized the advantage of working across borders. But since the publication, according to the World Health Organization, Mexico has taken the lead over the U.S. with a now higher prevalence of obesity. This is not a fact to boast, but further illustrates the urgency in understanding, developing, and implementing effective programs to fight obesity and obesity-related morbidity and mortality. We know that the obesity epidemic sees no borders, neither land nor sea.
If, as researchers, we already known that physical activity and healthy eating work to combat obesity, what does our recent publication add? Our review aimed to identify effective strategies aimed at U.S. Latinos and Latin America. Recognizing that both U.S. and Mexican agencies would benefit from working together, we used our collective efforts to evaluate existing obesity-related interventions. Through a systematic literature review with criteria targeting obesity-related outcomes (e.g., BMI, weight, percent body fat, etc.), we were able to recommend strategies in the school and healthcare context for Latino children, generally and for those at risk. For Latino adults, we identified only obesity control (secondary) interventions in the healthcare context or individually tailored programs. That is, these are the categories that demonstrated “enough evidence” according to our criteria.
The findings of our review give us confidence that these particular evidence-based strategies are effective for Latino populations. However, it is also important to recognize what it does not mean. It does not mean that other obesity-related interventions targeting behavioral outcomes are not as effective and it also does not mean that the interventions that were excluded or not included in our recommendations do not work. It simply means there was not enough evidence to recommend certain categories of intervention, given our criteria and framework. As alluded to, the framework that we used is important to note (www.thecommunityguide.org). It is one that does not capture “promising” and “emerging” strategies, such as the review framework by Brennan and colleagues.
More work is needed along with purposeful, effective partnerships to combat the obesity epidemic, locally and globally. As we work to develop and implement obesity-related interventions, it is imperative to look toward evidenced-based strategies, while understanding the criteria and framework from which the evidence was derived. Furthermore, it is equally imperative not to forget the value of innovation and promising strategies that need further research. It is only with a complexity of strategies across disciplines, sectors, partnerships, and with cultural awareness that the even more complex epidemic of obesity can be conquered.
— Dr. Christina Holub, PhD
Institute for Behavioral and Community Health
San Diego State University