The National Academies Press

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Pages 1-16

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From page 1... ... Unfortunately, a review of the existing evidence base reveals a striking contrast between the high prevalence and consequent importance of addressing obesity and the paucity of the knowledge base with which to inform prevention efforts. Specifically for evidence-based obesity prevention efforts, a body of intervention research on poli cy and environmental approaches is largely absent from the literature. Read the entire page →
From page 2... ... The Institute of Medicine Committee on an Evidence Framework for Obesity Prevention Decision Making was formed to address these challenges. The overall charge of the committee was to develop a framework for evidence-informed decision making in obesity prevention, with a focus on assessing policy, environmental, and Box S-1 The Need for Evidence to Support Decision Making on Obesity Prevention Imagine that you are the mayor, or a health commissioner, in a city in which both children and adults have high rates of obesity -- perhaps higher than in some peer cities that appear to have a better handle on the problem. Read the entire page →
From page 3... ... , the committee was instructed to provide an overview of the current nature of the evidence base; identify the challenges faced in integrating scientific evidence into the broader array of factors that influence com munity interventions and policy change; provide practical, action-oriented recommen dations for using this framework to choose, implement, and evaluate obesity efforts; identify new research and evaluation tools and methods, and existing ones that can be deployed more effectively; and develop a plan for communicating, disseminating, evaluating, and refining the framework. The committee's charge emphasized the need for a framework that guides decision making on children and adults. Read the entire page →
From page 4... ... Second, this is not a framework that can be used as an algorithm for making decisions; rather, it is a framework for using evidence to inform decision making. A richer, more relevant evidence base will inform and vastly improve decision making, but will not make the design, selection, and assessment of interventions automatic or free decision makers from exercising judgment. Read the entire page →
From page 5... ... The presence of the term "opportunities to generate evidence" surrounding the framework steps emphasizes the importance of identifying research opportuni ties throughout the process. Following are brief explanations of each aspect of the L.E.A.D. Read the entire page →
From page 6... ... The L.E.A.D. frame work adapts an evidence-based public health typology to differentiate among three categories of interrelated questions -- "Why," "What," and "How." These general questions can help decision makers identify related questions that may inform their policy and program decisions, underscore the fact that no one type of evidence will be Bridging the Evidence Gap in Obesity Prevention Read the entire page →
From page 7... ... Locating evidence requires a clear concept of the types of information that may be useful for a particular purpose, as well as an awareness of where the information can be found. The framework calls for expanding the evidence paradigm by broadening the perspective on forms of evidence that are potentially relevant and useful, tak ing full advantage of available research methods for studying population problems, not just those used in medical research. Read the entire page →
From page 8... ... For example, some obesity prevention decisions will require evidence that relates directly to weight outcomes, while others may allow evidence related to intermediate behav ioral outcomes. Evaluations of interventions should also be sensitive to the nature of the inter vention. Read the entire page →
From page 9... ... (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. Read the entire page →
From page 10... ... framework should take full advantage of opportunities to generate evidence from ongoing policy and practice, as well as evidence and research designs from a variety of disciplines, including systems approaches that can handle complexity. This report includes an extensive discussion of research designs that can be used as alternatives to randomized experiments and that may be more feasible and applicable for studying complex environmental and policy interventions such as those aimed at obesity pre vention. Read the entire page →
From page 11... ... framework as a guide in their utilization and generation of evidence to support decision making for complex, multifactorial public health challenges, including obesity prevention. Key assumptions that should guide the use of the framework include the following: • A systems perspective can help in framing and explaining complex issues. Read the entire page →
From page 12... ... to support evidence-based public policy decision making and research for complex health challenges, including obesity prevention. To implement this recommendation: • The Secretary of Health and Human Services, in collaboration with other public- and private-sector partners, should establish a sustainable registry of reports on evidence for environmental and policy actions for obesity prevention. Read the entire page →
From page 13... ... Support the Generation of Evidence Recommendation 5: Obesity prevention research funders, researchers, and publishers should consider, wherever appropriate, the inclusion in research studies of a focus on the generalizability of the findings and related implementation issues at every stage, from conception through publication. To implement this recommendation: • Those funding research in obesity prevention should give priority to support for studies that include an assessment of the limitations, potential utility, and applicability of the research beyond the particular population, setting, and cir cumstances in which the studies are conducted, including by initiating requests for applications and similar calls for proposals aimed at such studies. Read the entire page →
From page 14... ... Recommendation 7: Research funders should encourage collaboration among researchers in a variety of disciplines so as to utilize a full range of research designs that may be feasible and appropriate for evaluating obesity prevention and related public health initiatives. To implement this recommendation: • As part of their requests for proposals on obesity prevention research, funders should give priority to and reward transdisciplinary collaborations that include the creative use of research designs that have not been extensively used in pre vention research but hold promise for expanding the evidence base on potential environmental and policy solutions. Read the entire page →
From page 15... ... This plan should be based on the major pur poses of the framework: to significantly improve the evidence base for obesity prevention decision making on policy and environmental solutions, and to assist decision makers in using the evidence base. Summary Read the entire page →

From page 1...

... Unfortunately, a review of the existing evidence base reveals a striking contrast between the high prevalence and consequent importance of addressing obesity and the paucity of the knowledge base with which to inform prevention efforts. Specifically for evidence-based obesity prevention efforts, a body of intervention research on poli cy and environmental approaches is largely absent from the literature.

Summary Pages 1-16

Summary
Pages 1-16