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Scaling-up evidence-based obesity interventions: A systematic review assessing intervention adaptations and effectiveness and quantifying the scale-up penalty
journal contribution
posted on 2023-02-20, 00:42 authored by S McCrabb, C Lane, A Hall, A Milat, A Bauman, R Sutherland, Serene YoongSerene Yoong, L WolfendenMaximizing the benefits of investments in obesity research requires effective interventions to be adopted and disseminated broadly across populations (scaled-up). However, interventions often need considerable adaptation to enable implementation at scale, a process that can reduce the effects of interventions. A systematic review was undertaken for trials that sought to deliver an obesity intervention to populations on a larger scale than a preceding randomized controlled trial (RCT) that established its efficacy. Ten scaled-up obesity interventions (six prevention and four treatment) were included. All trials made adaptations to interventions as part of the scale-up process, with mode of delivery adaptations being most common. A meta-analysis of body mass index (BMI)/BMI z score (zBMI) from three prevention RCTs found no significant benefit of scaled-up interventions relative to control (standardized mean difference [SMD] = 0.03; 95% CI, −0.09 to 0.15, P = 0.639 − I 2 = 0.0%). All four treatment interventions reported significant improvement on all measures of weight status. Pooled BMI/zBMI data from prevention trials found significantly lower effects among scaled-up intervention trials than those reported in pre–scale-up efficacy trials (SMD = −0.11; 95% CI, −0.20 to −0.02, P = 0.018 − I 2 = 0.0%). Across measures of weight status, physical activity/sedentary behaviour, and nutrition, the effects reported in scaled-up interventions were typically 75% or less of the effects reported in pre–scale-up efficacy trials. The findings underscore the challenge of scaling-up obesity interventions.
History
Journal
Obesity ReviewsVolume
20Pagination
964-982Location
EnglandPublisher DOI
ISSN
1467-7881eISSN
1467-789XLanguage
enIssue
7Publisher
WileyUsage metrics
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No categories selectedKeywords
adaptationobesityscale-upsystematic reviewEvidence-Based PracticeHumansObesityRandomized Controlled Trials as TopicTreatment OutcomeWeight Reduction ProgramsNutritionPreventionClinical Trials and Supportive ActivitiesComparative Effectiveness ResearchClinical Research3.1 Primary prevention interventions to modify behaviours or promote wellbeing3 Prevention of disease and conditions, and promotion of well-beingCancerOral and gastrointestinalCardiovascularStrokeMedical and Health SciencesPsychology and Cognitive Sciences
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