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1.  Affordability and Obesity: Issues in the Multifunctionality of Agricultural/Food Systems 
The conference discussed public goods and externalities created as byproducts of the food system, including local development, obesity, air and water pollution, climate change, antibiotic resistance, and other public health issues. Multifunctionality is a framework that integrates these diverse issues and has been influential in international policy. This commentary focuses on arguably the most prominent public health issue at the moment: obesity. While obesity could be considered another multifunctional dimension, its link to other conference topics are tenuous. Using obesity as an argument to promote local produce or achieve other multifunctional outcomes is very questionable. Framing obesity as an issue of poverty or food insecurity trivializes the continuing major problem of hunger worldwide.
PMCID: PMC2990964  PMID: 21113389
Income; Prices; Obesity; Fruits; Vegetables; Diet; BMI
2.  Affordability and Obesity: Issues in the Multifunctionality of Agricultural/Food Systems 
The conference discussed public goods and externalities created as by-products of the food system, including local development, obesity, air and water pollution, climate change, antibiotic resistance, and other public health issues. Multifunctionality is a framework that integrates these diverse issues and has been influential in international policy. This commentary focuses on arguably the most prominent public health issue at the moment: obesity. Though obesity could be considered another multifunctional dimension, its link to other conference topics is tenuous. Using obesity as an argument to promote local produce or achieve other multifunctional outcomes is very questionable. Framing obesity as an issue of poverty or food insecurity trivializes the continuing major problem of hunger worldwide.
PMCID: PMC2990964  PMID: 21113389
income; prices; obesity; fruits; vegetables; diet; BMI
3.  Ethical Agreement and Disagreement about Obesity Prevention Policy in the United States  
An active area of public health policy in the United States is policy meant to promote healthy eating, reduce overconsumption of food, and prevent overweight/obesity. Public discussion of such obesity prevention policies includes intense ethical disagreement. We suggest that some ethical disagreements about obesity prevention policies can be seen as rooted in a common concern with equality or with autonomy, but there are disagreements about which dimensions of equality or autonomy have priority, and about whether it is justifiable for policies to diminish equality or autonomy along one dimension in order to increase it along another dimension. We illustrate this point by discussing ethical disagreements about two obesity prevention policies.
PMCID: PMC3937920  PMID: 24596849
Obesity Prevention; Public Health Ethics; Food Policy; Food Tax; Autonomy; Justice
4.  Tackling inequalities in obesity: a protocol for a systematic review of the effectiveness of public health interventions at reducing socioeconomic inequalities in obesity amongst children 
Systematic Reviews  2012;1:16.
There is growing evidence of the impact of overweight and obesity on short- and long-term functioning, health and well-being. Internationally, childhood obesity rates continue to rise in some countries (for example, Mexico, India, China and Canada), although there is emerging evidence of a slowing of this increase or a plateauing in some age groups. In most European countries, the United States and Australia, however, socioeconomic inequalities in relation to obesity and risk factors for obesity are widening. Addressing inequalities in obesity, therefore, has a very high profile on the public health and health services agendas. However, there is a lack of accessible policy-ready evidence on what works in terms of interventions to reduce inequalities in obesity.
Methods and design
This article describes the protocol for a National Health Service Trust (NHS) National Institute for Health Research-funded systematic review of public health interventions at the individual, community and societal levels which might reduce socioeconomic inequalities in relation to obesity amongst children ages 0 to 18 years. The studies will be selected only if (1) they included a primary outcome that is a proxy for body fatness and (2) examined differential effects with regard to socioeconomic status (education, income, occupation, social class, deprivation and poverty) or the intervention was targeted specifically at disadvantaged groups (for example, children of the unemployed, lone parents, low income and so on) or at people who live in deprived areas. A rigorous and inclusive international literature search will be conducted for randomised and nonrandomised controlled trials, prospective and retrospective cohort studies (with and/or without control groups) and prospective repeat cross-sectional studies (with and/or without control groups). The following electronic databases will be searched: MEDLINE, Embase, CINAHL, PsycINFO, Social Science Citation Index, ASSIA, IBSS, Sociological Abstracts and the NHS Economic Evaluation Database. Database searches will be supplemented with website and grey literature searches. No studies will be excluded on the basis of language, country of origin or publication date. Study inclusion, data extraction and quality appraisal will be conducted by two reviewers. Meta-analysis and narrative synthesis will be conducted. The main analysis will examine the effects of (1) individual, (2) community and (3) societal level public health interventions on socioeconomic inequalities in childhood obesity. Interventions will be characterised by their level of action and their approach to tackling inequalities. Contextual information on how such public health interventions are organised, implemented and delivered will also be examined.
In this review, we consider public health strategies which reduce and prevent inequalities in the prevalence of childhood obesity, highlight any gaps in the evidence base and seek to establish how such public health interventions are organised, implemented and delivered.
PROSPERO registration number: CRD42011001740
PMCID: PMC3351709  PMID: 22587775
5.  "Harnessing genomics to improve health in India" – an executive course to support genomics policy 
The benefits of scientific medicine have eluded millions in developing countries and the genomics revolution threatens to increase health inequities between North and South. India, as a developing yet also industrialized country, is uniquely positioned to pioneer science policy innovations to narrow the genomics divide. Recognizing this, the Indian Council of Medical Research and the University of Toronto Joint Centre for Bioethics conducted a Genomics Policy Executive Course in January 2003 in Kerala, India. The course provided a forum for stakeholders to discuss the relevance of genomics for health in India. This article presents the course findings and recommendations formulated by the participants for genomics policy in India.
The course goals were to familiarize participants with the implications of genomics for health in India; analyze and debate policy and ethical issues; and develop a multi-sectoral opinion leaders' network to share perspectives. To achieve these goals, the course brought together representatives of academic research centres, biotechnology companies, regulatory bodies, media, voluntary, and legal organizations to engage in discussion. Topics included scientific advances in genomics, followed by innovations in business models, public sector perspectives, ethics, legal issues and national innovation systems.
Seven main recommendations emerged: increase funding for healthcare research with appropriate emphasis on genomics; leverage India's assets such as traditional knowledge and genomic diversity in consultation with knowledge-holders; prioritize strategic entry points for India; improve industry-academic interface with appropriate incentives to improve public health and the nation's wealth; develop independent, accountable, transparent regulatory systems to ensure that ethical, legal and social issues are addressed for a single entry, smart and effective system; engage the public and ensure broad-based input into policy setting; ensure equitable access of poor to genomics products and services; deliver knowledge, products and services for public health. A key outcome of the course was the internet-based opinion leaders' network – the Indian Genome Policy Forum – a multi-stakeholder forum to foster further discussion on policy.
We expect that the process that has led to this network will serve as a model to establish similar Science and Technology policy networks on regional levels and eventually on a global level.
PMCID: PMC434533  PMID: 15151698
6.  Global health impacts of policies: lessons from the UK 
The UK government committed to undertaking impact assessments of its policies on the health of populations in low and middle-income countries in its cross-government strategy “Health is Global”. To facilitate this process, the Department of Health, in collaboration with the National Heart Forum, initiated a project to pilot the use of a global health impact assessment guidance framework and toolkit for policy-makers. This paper aims to stimulate debate about the desirability and feasibility of global health impact assessments by describing and drawing lessons from the first stage of the project.
Despite the attraction of being able to assess and address potential global health impacts of policies, there is a dearth of existing information and experience. A literature review was followed by discussions with policy-makers and an online survey about potential barriers, preferred support mechanisms and potential policies on which to pilot the toolkit. Although policy-makers were willing to engage in hypothetical discussions about the methodology, difficulties in identifying potential pilots suggest a wider problem in encouraging take up without legislative imperatives. This is reinforced by the findings of the survey that barriers to uptake included lack of time, resources and expertise. We identified three lessons for future efforts to mainstream global health impact assessments: 1) Identify a lead government department and champion – to some extent, this role was fulfilled by the Department of Health, however, it lacked a high-level cross-government mechanism to support implementation. 2) Ensure adequate resources and consider embedding the goals and principles of global health impact assessments into existing processes to maximise those resources. 3) Develop an effective delivery mechanism involving both state actors, and non-state actors who can ensure a “voice” for constituencies who are affected by government policies and also provide the “demand” for the assessments.
This paper uses the initial stages of a study on global health impact assessments to pose the wider question of incentives for policy-makers to improve global health. It highlights three lessons for successful development and implementation of global health impact assessments in relation to stewardship, resources, and delivery mechanisms.
PMCID: PMC3977948  PMID: 24612523
Global health; Impact assessment; Policy coherence; Development
7.  Addressing the policy cacophony does not require more evidence: an argument for reframing obesity as caloric overconsumption 
BMC Public Health  2012;12:1042.
Numerous policies have been proposed to address the public health problem of obesity, resulting in a policy cacophony. The noise of so many policy options renders it difficult for policymakers to determine which policies warrant implementation. This has resulted in calls for more and better evidence to support obesity policy. However, it is not clear that evidence is the solution. This paper argues that to address the policy cacophony it is necessary to rethink the problem of obesity, and more specifically, how the problem of obesity is framed. This paper argues that the frame “obesity” be replaced by the frame “caloric overconsumption”, concluding that the frame caloric overconsumption can overcome the obesity policy cacophony.
Frames are important because they influence public policy. Understood as packages that define issues, frames influence how best to approach a problem. Consequently, debates over public policy are considered battles over framing, with small shifts in how an issue is framed resulting in significant changes to the policy environment. This paper presents a rationale for reframing the problem of obesity as caloric overconsumption. The frame “obesity” contributes to the policy cacophony by including policies aimed at both energy output and energy input. However, research increasingly demonstrates that energy input is the primary cause of obesity, and that increases in energy input are largely attributable to the food environment. By focusing on policies that aim to prevent increases in energy input, the frame caloric overconsumption will reduce the noise of the obesity policy cacophony. While the proposed frame will face some challenges, particularly industry opposition, policies aimed at preventing caloric overconsumption have a clearer focus, and can be more politically palatable if caloric overconsumption is seen as an involuntary risk resulting from the food environment.
The paper concludes that policymakers will be able to make better sense of the obesity policy cacophony if the problem of obesity is reframed as caloric overconsumption. By focusing on a specific cause of obesity, energy input, the frame caloric overconsumption allows policymakers to focus on the most promising obesity prevention policies.
PMCID: PMC3527165  PMID: 23199375
Obesity; Caloric overconsumption; Framing; Food environment; Public health policy
8.  National, regional, and global trends in adult overweight and obesity prevalences 
Overweight and obesity prevalence are commonly used for public and policy communication of the extent of the obesity epidemic, yet comparable estimates of trends in overweight and obesity prevalence by country are not available.
We estimated trends between 1980 and 2008 in overweight and obesity prevalence and their uncertainty for adults 20 years of age and older in 199 countries and territories. Data were from a previous study, which used a Bayesian hierarchical model to estimate mean body mass index (BMI) based on published and unpublished health examination surveys and epidemiologic studies. Here, we used the estimated mean BMIs in a regression model to predict overweight and obesity prevalence by age, country, year, and sex. The uncertainty of the estimates included both those of the Bayesian hierarchical model and the uncertainty due to cross-walking from mean BMI to overweight and obesity prevalence.
The global age-standardized prevalence of obesity nearly doubled from 6.4% (95% uncertainty interval 5.7-7.2%) in 1980 to 12.0% (11.5-12.5%) in 2008. Half of this rise occurred in the 20 years between 1980 and 2000, and half occurred in the 8 years between 2000 and 2008. The age-standardized prevalence of overweight increased from 24.6% (22.7-26.7%) to 34.4% (33.2-35.5%) during the same 28-year period. In 2008, female obesity prevalence ranged from 1.4% (0.7-2.2%) in Bangladesh and 1.5% (0.9-2.4%) in Madagascar to 70.4% (61.9-78.9%) in Tonga and 74.8% (66.7-82.1%) in Nauru. Male obesity was below 1% in Bangladesh, Democratic Republic of the Congo, and Ethiopia, and was highest in Cook Islands (60.1%, 52.6-67.6%) and Nauru (67.9%, 60.5-75.0%).
Globally, the prevalence of overweight and obesity has increased since 1980, and the increase has accelerated. Although obesity increased in most countries, levels and trends varied substantially. These data on trends in overweight and obesity may be used to set targets for obesity prevalence as requested at the United Nations high-level meeting on Prevention and Control of NCDs.
PMCID: PMC3543235  PMID: 23167948
Overweight; Obesity; Prevalence; Population health; Risk transition; Global health; Noncommunicable diseases
9.  Considerations for an Obesity Policy Research Agenda 
The rise in obesity levels in the U.S. in the past several decades has been dramatic, with serious implications for public health and the economy. Experiences in tobacco control and other public health initiatives have shown that public policy may be a powerful tool to effect structural change to alter population-level behavior. In 2007, the National Cancer Institute convened a meeting to discuss priorities for a research agenda to inform obesity policy. Issues considered were how to define obesity policy research, key challenges and key partners in formulating/implementing an obesity policy research agenda, criteria by which to set research priorities, and specific research needs and questions. Themes that emerged were: (1) the embryonic nature of obesity policy research, (2) the need to study “natural experiments” resulting from policy-based efforts to address the obesity epidemic, (3) the importance of research focused beyond individual-level behavior change, (4) the need for economic research across several relevant policy areas, and (5) the overall urgency of taking action in the policy arena. Moving forward, timely evaluation of natural experiments is of especially high priority. A variety of policies intended to promote healthy weight in children and adults are being implemented in communities and at the state and national levels. Although some of these policies are supported by the findings of intervention research, additional research is needed to evaluate the implementation and quantify the impact of new policies designed to address obesity.
PMCID: PMC2824162  PMID: 19211215
10.  Myths, Presumptions, and Facts about Obesity 
The New England journal of medicine  2013;368(5):446-454.
Many beliefs about obesity persist in the absence of supporting scientific evidence (presumptions); some persist despite contradicting evidence (myths). The promulgation of unsupported beliefs may yield poorly informed policy decisions, inaccurate clinical and public health recommendations, and an unproductive allocation of research resources and may divert attention away from useful, evidence-based information.
Using Internet searches of popular media and scientific literature, we identified, reviewed, and classified obesity-related myths and presumptions. We also examined facts that are well supported by evidence, with an emphasis on those that have practical implications for public health, policy, or clinical recommendations.
We identified seven obesity-related myths concerning the effects of small sustained increases in energy intake or expenditure, establishment of realistic goals for weight loss, rapid weight loss, weight-loss readiness, physical-education classes, breast-feeding, and energy expended during sexual activity. We also identified six presumptions about the purported effects of regularly eating breakfast, early childhood experiences, eating fruits and vegetables, weight cycling, snacking, and the built (i.e., human-made) environment. Finally, we identified nine evidence-supported facts that are relevant for the formulation of sound public health, policy, or clinical recommendations.
False and scientifically unsupported beliefs about obesity are pervasive in both scientific literature and the popular press. (Funded by the National Institutes of Health.)
PMCID: PMC3606061  PMID: 23363498
11.  Systems Science and Childhood Obesity: A Systematic Review and New Directions 
Journal of Obesity  2013;2013:129193.
As a public health problem, childhood obesity operates at multiple levels, ranging from individual health behaviors to school and community characteristics to public policies. Examining obesity, particularly childhood obesity, from any single perspective is likely to fail, and systems science methods offer a possible solution. We systematically reviewed studies that examined the causes and/or consequences of obesity from a systems science perspective. The 21 included studies addressed four general areas of systems science in obesity: (1) translating interventions to a large scale, (2) the effect of obesity on other health or economic outcomes, (3) the effect of geography on obesity, and (4) the effect of social networks on obesity. In general, little research addresses obesity from a true, integrated systems science perspective, and the available research infrequently focuses on children. This shortcoming limits the ability of that research to inform public policy. However, we believe that the largely incremental approaches used in current systems science lay a foundation for future work and present a model demonstrating the system of childhood obesity. Systems science perspective and related methods are particularly promising in understanding the link between childhood obesity and adult outcomes. Systems models emphasize the evolution of agents and their interactions; such evolution is particularly salient in the context of a developing child.
PMCID: PMC3655564  PMID: 23710344
12.  Prioritizing Obesity in the City 
A decade ago, the World Health Organization declared obesity to be a global epidemic. Accordingly, there is a growing body of research examining how “obesogenic environments” contribute to the increasing prevalence of obesity. Using the ANGELO Framework, this research explores the role of municipal policies and practices in constructing obesogenic environments in two Southern Ontario cities in order to examine how socio-cultural and political environments shape excess body weight. Data was collected from municipal policy documents, public health websites, and key informants in Hamilton and Mississauga, Ontario, Canada. Results indicate that while the cities took different approaches to dealing with obesity, they both reflected the cities' overall prioritizing of health. Additionally, the findings reveal the pervasiveness of values and attitudes held in the socio-cultural environment in further shaping (and being shaped by) political as well as economic and physical environments in the cities. The importance of explicitly acknowledging the official discourse of the city, which this study demonstrates to be a significant factor in constructing obesogenic environments, is highlighted. Theoretical contributions and policy implications are also discussed.
PMCID: PMC3284596  PMID: 22042539
Obesity; Environmental determinants; ANGELO Framework; Municipal priorities; Socio-cultural factors; Political factors
13.  Rationale and Consequences of Reclassifying Obesity as an Addictive Disorder: Neurobiology, Food Environment and Social Policy Perspectives 
Physiology & behavior  2012;107(1):126-137.
The rapid increase in the prevalence of obesity is a priority for investigators from across numerous disciplines, including biology, nutritional science, and public health and policy. In this paper, we systematically examine the premise that common dietary obesity is an addictive disorder, based on the criteria for addiction described in the Diagnostic and Statistical Manual (DSM) of Mental Disorders of the American Psychiatric Association, version IV, and consider the consequences of such a reclassification of obesity for public policy. Specifically, we discuss evidence from both human and animal studies investigating the effects of various types and amounts of food and the food environment in obese individuals. Neurobiological studies have shown that the hedonic brain pathways activated by palatable food overlap considerably with those activated by drugs of abuse and suffer significant deficits after chronic exposure to high-energy diets. Furthermore, food as a stimulus can induce the sensitization, compulsion and relapse patterns observed in individuals who are addicted to illicit drugs. The current food environment encourages these addictive-like behaviors where increased exposure through advertisements, proximity and increased portion sizes are routine. Taking lessons from the tobacco experience, it is clear that reclassifying common dietary obesity as an addictive disorder would necessitate policy changes (e.g., regulatory efforts, economic strategies, and educational approaches). These policies could be instrumental in addressing the obesity epidemic, by encouraging the food industry and the political leadership to collaborate with the scientific and medical community in establishing new and more effective therapeutic approaches.
PMCID: PMC3409327  PMID: 22583861
14.  Obesity and Reproductive Function 
Obesity is associated with multiple adverse reproductive outcomes, but the mechanisms involved are largely unknown. Public health scientists studying obesity and its effects on health outcomes have referred to obesity as a “complex system”, defined as a system of heterogeneous parts interacting in nonlinear ways to influence the behavior of the parts as a whole1,22. By this definition, human reproduction is also a complex system which may explain some of the difficulty in identifying the mechanisms linking obesity and adverse reproductive function. Despite the difficulties, research on obesity and reproduction is important as there is an epidemic of obesity among reproductive age women with associated consequences for future generations. In this review we discuss the adverse reproductive outcomes associated with obesity and data from translational studies of the mechanisms involved. We conclude with a brief discussion of public health policy as it relates to the treatment of infertility in obese women.
PMCID: PMC3520133  PMID: 23182555
fertility; obesity; reproduction; public health
15.  Knowledge exchange in the Pacific: The TROPIC (Translational Research into Obesity Prevention Policies for Communities) project 
BMC Public Health  2012;12:552.
Policies targeting obesogenic environments and behaviours are critical to counter rising obesity rates and lifestyle-related non-communicable diseases (NCDs). Policies are likely to be most effective and enduring when they are based on the best available evidence. Evidence-informed policy making is especially challenging in countries with limited resources. The Pacific TROPIC (Translational Research for Obesity Prevention in Communities) project aims to implement and evaluate a tailored knowledge-brokering approach to evidence-informed policy making to address obesity in Fiji, a Pacific nation challenged by increasingly high rates of obesity and concomitant NCDs.
The TROPIC project draws on the concept of ‘knowledge exchange’ between policy developers (individuals; organisations) and researchers to deliver a knowledge broking programme that maps policy environments, conducts workshops on evidence-informed policy making, supports the development of evidence-informed policy briefs, and embeds evidence-informed policy making into organisational culture. Recruitment of government and nongovernment organisational representatives will be based on potential to: develop policies relevant to obesity, reach broad audiences, and commit to resourcing staff and building a culture that supports evidence-informed policy development. Workshops will increase awareness of both obesity and policy cycles, as well as develop participants’ skills in accessing, assessing and applying relevant evidence to policy briefs. The knowledge-broking team will then support participants to: 1) develop evidence-informed policy briefs that are both commensurate with national and organisational plans and also informed by evidence from the Pacific Obesity Prevention in Communities project and elsewhere; and 2) collaborate with participating organisations to embed evidence-informed policy making structures and processes. This knowledge broking initiative will be evaluated via data from semi-structured interviews, a validated self-assessment tool, process diaries and outputs.
Public health interventions have rarely targeted evidence-informed policy making structures and processes to reduce obesity and NCDs. This study will empirically advance understanding of knowledge broking processes to extend evidence-informed policy making skills and develop a suite of national obesity-related policies that can potentially improve population health outcomes.
PMCID: PMC3444395  PMID: 22830984
Policy; Obesity; Knowledge exchange; Knowledge broker; Pacific
16.  Complex Systems Modeling for Obesity Research 
Preventing Chronic Disease  2009;6(3):A97.
The obesity epidemic has grown rapidly into a major public health challenge, in the United States and worldwide. The scope and scale of the obesity epidemic motivate an urgent need for well-crafted policy interventions to prevent further spread and (potentially) to reverse the epidemic. Yet several attributes of the epidemic make it an especially challenging problem both to study and to combat. This article shows that these attributes — the great breadth in levels of scale involved, the substantial diversity of relevant actors, and the multiplicity of mechanisms implicated — are characteristic of a complex adaptive system. It argues that the obesity epidemic is driven by such a system and that lessons and techniques from the field of complexity science can help inform both scientific study of obesity and effective policies to combat obesity. The article gives an overview of modeling techniques especially well suited to study the rich and complex dynamics of obesity and to inform policy design.
PMCID: PMC2722404  PMID: 19527598
17.  Intervention, integration and translation in obesity research: Genetic, developmental and metaorganismal approaches 
Obesity is the focus of multiple lines of inquiry that have -- together and separately -- produced many deep insights into the physiology of weight gain and maintenance. We examine three such streams of research and show how they are oriented to obesity intervention through multilevel integrated approaches. The first research programme is concerned with the genetics and biochemistry of fat production, and it links metabolism, physiology, endocrinology and neurochemistry. The second account of obesity is developmental and draws together epigenetic and environmental explanations that can be embedded in an evolutionary framework. The third line of research focuses on the role of gut microbes in the production of obesity, and how microbial activities interact with host genetics, development and metabolism. These interwoven explanatory strategies are driven by an orientation to intervention, both for experimental and therapeutic outcomes. We connect the integrative and intervention-oriented aspects of obesity research through a discussion of translation, broadening the concept to capture the dynamic, iterative processes of scientific practice and therapy development. This system-oriented analysis of obesity research expands the philosophical scrutiny of contemporary developments in the biosciences and biomedicine, and has the potential to enrich philosophy of science and medicine.
PMCID: PMC3037871  PMID: 21276254
18.  Trends in child and adolescent obesity prevalence according to socioeconomic position: protocol for a systematic review 
Systematic Reviews  2014;3:52.
Obesity is a significant public health issue and is socially patterned, with greater prevalence of obesity observed in the most socioeconomically disadvantaged groups. Recent evidence suggests that the prevalence of childhood obesity is levelling off in some countries. However, this may not be the case across all socioeconomic strata. The aim of this review is to examine whether trends in child and adolescent obesity prevalence since 1990 differ according to socioeconomic position in developed countries.
An electronic search will be conducted via Ovid Medline, Embase, Cumulative Index to Nursing and Allied Health Literature, Scopus and Cochrane Collaboration to identify articles that report trends in obesity prevalence in children and adolescents according to socioeconomic position. We will also search grey literature databases including the Virtual Library for Public Health and the System for Information on Grey Literature, as well as websites from relevant organisations. Articles that report on a series of cross sectional studies; describe one or more measure of obesity with data recorded at two or more time points since 1990; and report trends by at least one indicator of socioeconomic position will be included. Quality of included studies will be evaluated according to criteria that consider both internal and external validity. Descriptive analysis will be performed to examine trends since 1990 in childhood obesity prevalence according to socioeconomic position.
The review will provide a picture of change over time in developed countries of childhood obesity prevalence across socioeconomic strata and identify whether changes in childhood obesity prevalence are experienced equally across socioeconomic groups.
Systematic review registration
PROSPERO CRD42014007625.
PMCID: PMC4038826  PMID: 24887511
Trends; Socioeconomic position; Childhood; Adolescence; Obesity
19.  Unpacking vertical and horizontal integration: childhood overweight/obesity programs and planning, a Canadian perspective 
Increasingly, multiple intervention programming is being understood and implemented as a key approach to developing public health initiatives and strategies. Using socio-ecological and population health perspectives, multiple intervention programming approaches are aimed at providing coordinated and strategic comprehensive programs operating over system levels and across sectors, allowing practitioners and decision makers to take advantage of synergistic effects. These approaches also require vertical and horizontal (v/h) integration of policy and practice in order to be maximally effective.
This paper examines v/h integration of interventions for childhood overweight/obesity prevention and reduction from a Canadian perspective. It describes the implications of v/h integration for childhood overweight and obesity prevention, with examples of interventions where v/h integration has been implemented. An application of a conceptual framework for structuring v/h integration of an overweight/obesity prevention initiative is presented. The paper concludes with a discussion of the implications of vertical/horizontal integration for policy, research, and practice related to childhood overweight and obesity prevention multiple intervention programs.
Both v/h integration across sectors and over system levels are needed to fully support multiple intervention programs of the complexity and scope required by obesity issues. V/h integration requires attention to system structures and processes. A conceptual framework is needed to support policy alignment, multi-level evaluation, and ongoing coordination of people at the front lines of practice. Using such tools to achieve integration may enhance sustainability, increase effectiveness of prevention and reduction efforts, decrease stigmatization, and lead to new ways to relate the environment to people and people to the environment for better health for children.
PMCID: PMC2883960  PMID: 20478054
20.  Health, wealth, and air pollution: advancing theory and methods. 
Environmental Health Perspectives  2003;111(16):1861-1870.
The effects of both ambient air pollution and socioeconomic position (SEP) on health are well documented. A limited number of recent studies suggest that SEP may itself play a role in the epidemiology of disease and death associated with exposure to air pollution. Together with evidence that poor and working-class communities are often more exposed to air pollution, these studies have stimulated discussion among scientists, policy makers, and the public about the differential distribution of the health impacts from air pollution. Science and public policy would benefit from additional research that integrates the theory and practice from both air pollution and social epidemiologies to gain a better understanding of this issue. In this article we aim to promote such research by introducing readers to methodologic and conceptual approaches in the fields of air pollution and social epidemiology; by proposing theories and hypotheses about how air pollution and socioeconomic factors may interact to influence health, drawing on studies conducted worldwide; by discussing methodologic issues in the design and analysis of studies to determine whether health effects of exposure to ambient air pollution are modified by SEP; and by proposing specific steps that will advance knowledge in this field, fill information gaps, and apply research results to improve public health in collaboration with affected communities.
PMCID: PMC1241758  PMID: 14644658
21.  Global health priorities – priorities of the wealthy? 
Health has gained importance on the global agenda. It has become recognized in forums where it was once not addressed. In this article three issues are considered: global health policy actors, global health priorities and the means of addressing the identified health priorities. I argue that the arenas for global health policy-making have shifted from the public spheres towards arenas that include the transnational for-profit sector. Global health policy has become increasingly fragmented and verticalized. Infectious diseases have gained ground as global health priorities, while non-communicable diseases and the broader issues of health systems development have been neglected. Approaches to tackling the health problems are increasingly influenced by trade and industrial interests with the emphasis on technological solutions.
PMCID: PMC1143784  PMID: 15847685
22.  Systematic review and meta-analysis of the association between childhood overweight and obesity and primary school diet and physical activity policies 
Obesity is a major public health concern and there are increasing calls for policy intervention. As obesity and the related health conditions develop during childhood, schools are being seen as important locations for obesity prevention, including multifaceted interventions incorporating policy elements. The objective of this systematic review was to evaluate the effects of policies related to diet and physical activity in schools, either alone, or as part of an intervention programme on the weight status of children aged 4 to 11 years. A comprehensive and systematic search of medical, education, exercise science, and social science databases identified 21 studies which met the inclusion criteria. There were no date, location or language restrictions. The identified studies evaluated a range of either, or both, diet and physical activity related policies, or intervention programmes including such policies, using a variety of observational and experimental designs. The policies were clustered into those which sought to affect diet, those which sought to affect physical activity and those which sought to affect both diet and physical activity to undertake random effects meta-analysis. Within the diet cluster, studies of the United States of America National School Lunch and School Breakfast Programs were analysed separately; however there was significant heterogeneity in the pooled results. The pooled effects of the physical activity, and other diet related policies on BMI-SDS were non-significant. The multifaceted interventions tended to include policy elements related to both diet and physical activity (combined cluster), and although these interventions were too varied to pool their results, significant reductions in weight-related outcomes were demonstrated. The evidence from this review suggests that, when implemented alone, school diet and physical activity related policies appear insufficient to prevent or treat overweight or obesity in children, however, they do appear to have an effect when developed and implemented as part of a more extensive intervention programme. Additional evidence is required before recommendations regarding the focus of policies can be made and therefore, increased effort should be made to evaluate the effect of policies and policy containing intervention programmes upon weight status.
PMCID: PMC3844408  PMID: 23965018
Policy; Obese; Nutrition; Physical education
23.  The biology of sexual development of Plasmodium: the design and implementation of transmission-blocking strategies 
Malaria Journal  2012;11:70.
A meeting to discuss the latest developments in the biology of sexual development of Plasmodium and transmission-control was held April 5-6, 2011, in Bethesda, MD. The meeting was sponsored by the Bill & Melinda Gates Foundation and the National Institutes of Health, National Institute of Allergy and Infectious Diseases (NIH/NIAID) in response to the challenge issued at the Malaria Forum in October 2007 that the malaria community should re-engage with the objective of global eradication. The consequent rebalancing of research priorities has brought to the forefront of the research agenda the essential need to reduce parasite transmission. A key component of any transmission reduction strategy must be methods to attack the parasite as it passes from man to the mosquito (and vice versa). Such methods must be rationally based on a secure understanding of transmission from the molecular-, cellular-, population- to the evolutionary-levels. The meeting represented a first attempt to draw together scientists with expertise in these multiple layers of understanding to discuss the scientific foundations and resources that will be required to provide secure progress toward the design and successful implementation of effective interventions.
PMCID: PMC3315749  PMID: 22424474
24.  Environmental Health Impacts of Concentrated Animal Feeding Operations: Anticipating Hazards—Searching for Solutions 
Environmental Health Perspectives  2006;115(2):296-297.
A scientific conference and workshop was held March 2004 in Iowa City, Iowa, that brought together environmental scientists from North America and Europe to address major environmental health issues associated with concentrated animal feeding operations (CAFOs) in large, industrialized livestock production facilities. After one and a half days of plenary sessions, five expert workgroups convened to consider the most relevant research areas, including respiratory health effects, modeling and monitoring of air toxics, water quality issues, influenza pandemics and antibiotic resistance, and community health and socioeconomic issues. The workgroup reports that follow outline the state of the science and public health concerns relating to livestock production as they apply to each workgroup topic. The reports also identify areas in which further research is needed and suggest opportunities to translate science to policy initiatives that would effect improvements in public and environmental health. Viable solutions to some of the current environmental health problems associated with CAFOs are outlined. In addition, these reports bring to light several major concerns, including air and water contamination, the rise of antibiotic-resistant bacteria in livestock, and the specter of influenza outbreaks arising from siting industrialized poultry and swine production in proximity to each other and to humans.
PMCID: PMC1817701  PMID: 17384781
air quality; animal confinements; antibiotic resistance; antimicrobial growth promotants; avian influenza; bioaerosols; livestock; poultry; swine; water quality
25.  Social Inequalities in Obesity Persist in the Nordic Region Despite Its Relative Affluence and Equity 
Current Obesity Reports  2014;3:1-15.
Social inequalities in overweight and obesity (OWOB) have persisted in the affluent and reputedly egalitarian Nordic countries. In this review we examine associations between socioeconomic position (SEP) and OWOB, and secular trends in such associations. Determinants and possible causes of the relations are discussed together with opportunities to cope with OWOB as a public health problem. The findings show a persisting inverse social gradient. An interaction between SEP and gender is noted for adults in Denmark, Finland and Iceland and for children in Sweden. There are overall tendencies for increased inequality, however no consistent trend for an increased social gradient in OWOB. Reasons that increased inequality does not unequivocally mirror in a steepened social gradient in obesity may include methodological questions as well as societal efforts to counteract obesity. Multi-level efforts are needed to prevent OWOB.
PMCID: PMC3920028  PMID: 24533235
Adolescents; Adults; BMI; Children; Denmark; Education; Egalitarian; Finland; Gender; Gini coefficient; Iceland; Income; Inequality; Nordic countries; Norway; Obesity; Obesogenic; Occupation; Overweight; Secular trends; Social gradient; Socioeconomic position; Socioeconomic status; Sweden; Obesity; Social inequalities; Nordic region

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