Implementation Strategies Used in Effective Policies to Combat Obesity in Socioeconomically Disadvantaged...

The effectiveness of obesity prevention or obesity reduction policies is co-determined by policy content, the implementation process, and contextual factors. This systematic review provides insight into implementation strategies used in whole-of-community obesity prevention policies aimed at changes in two types of outcomes: (1) a reduction in obesity/overweight prevalence, body mass index-related outcomes, and other weight-related outcomes, or (2) a change in nutrition behaviors, physical activity, and sedentary behaviors or screen time. We specifically examined implementation strategies using the Expert Recommendations for Implementing Change (ERIC) framework, focusing on policies implemented in low socioeconomic status communities.

Following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, eight databases were searched. Risk of bias was assessed using the Joanna Briggs Institute (JBI) critical appraisal tool. The efficacy of implementation strategies was considered supported if at least 66% of the studies that applied respective strategies reported significant improvements for a given outcome type across at least three studies.

A total of 29 original studies were included. Fifteen implementation strategies from the ERIC framework were consistently associated with favorable outcomes. These strategies included altering incentive structures, assessing community readiness, and using data warehousing techniques. Six additional non-ERIC strategies (e.g., cultural adaptation and grassroots mobilization) received support across different outcome domains. Most studies (72%) had a low risk of bias.

Findings may help prioritize implementation strategies that may drive the success of whole-of-community obesity policies targeting disadvantaged populations. The results suggest a need to expand existing implementation taxonomies to include community-driven strategies.