A Peer Reviewed Journal Article on Childhood Obesity

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Peer-reviewed

Enquiry Article

Early on childhood obesity prevention efforts through a life course health evolution perspective: A scoping review

• Sheri Volger,
• Diane Rigassio Radler,
• Pamela Rothpletz-Puglia

x

• Published: Dec 28, 2018
• https://doi.org/10.1371/journal.pone.0209787

Figures

Abstract

Introduction

The obesity rate in preschool children in the United States (US) is 13.nine%, while even higher rates are associated with racial and ethnic minorities and children from low-income families. These prevalence patterns underscore the demand to identify effective babyhood obesity prevention programs.

Method

A scoping review was conducted following Arksey and O'Malley's framework to provide an overview of the types, effectiveness and cost-effectiveness of obesity prevention interventions and policies in children upwardly to 6 years former. Inclusion criteria were studies at least 6-months duration; included a weight-based issue, conducted in the US, English language publications from Jan 2001 to February 2018. Exclusions: studies in overweight/obese children and obesity treatments, no comparator group. Evidence was characterized across the early on life grade and multiple-levels of influence.

Results

From the 2,180 records identified, 34 met the inclusion criteria. Less than half of the interventions initiated during pregnancy, infancy or preschool reported a significant improvement in a weight-based event. All interventions included strategies to influence individual- or interpersonal-level wellness behaviors, all the same few removed obstacles in the healthcare system, physical/built environment, or sociocultural environment. The majority (78%) of the interventions occurred during preschool years, with 63% conducted in early childcare teaching settings serving low-income families. The wellness impact of the land-wide and national policies on children nether historic period half-dozen years remains unclear. There was considerable uncertainty around estimates of the health and economic impacts of obesity prevention interventions and policies.

Determination

There is a demand to intensify early on childhood obesity preventive efforts during critical periods of health development in the US. Future studies should approximate the feasibility, program effectiveness, and cost of implementing multilevel obesity prevention interventions and policies. Addressing these research gaps will provide stakeholders with the scientific evidence necessary to facilitate funding and policy decisions to decrease the prevalence of early on childhood obesity.

Commendation: Volger S, Rigassio Radler D, Rothpletz-Puglia P (2018) Early on childhood obesity prevention efforts through a life course health development perspective: A scoping review. PLoS ONE 13(12): e0209787. https://doi.org/10.1371/periodical.pone.0209787

Editor: Louisa Ells, Teesside University, Uk

Received: September 12, 2018; Accepted: Dec xi, 2018; Published: Dec 28, 2018

Copyright: © 2018 Volger et al. This is an open up access article distributed nether the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in whatever medium, provided the original author and source are credited.

Information Availability: All relevant information are within the manuscript and its Supporting Data files.

Funding: The authors received no specific funding for this work.

Competing interests: The authors accept declared that no competing interests exist.

Introduction

Despite recommendations to prioritize obesity prevention efforts, [1–4] epidemiological data from the 2015–2016 National Wellness and Nutrition Examination Survey (NHANES) found that the prevalence of early childhood obesity remains at a 10-year high [5]. Furthermore, obesity rates among schoolhouse-aged children aged 6–11 years are approximately 25% college compared with preschool children anile 2–5 years [five]. In add-on, even higher obesity rates are differentially associated with minorities and children from low-income families [half dozen]. These prevalence patterns underscore the need to focus on early babyhood obesity prevention efforts with the goal of meeting the Good for you People 2020 obesity rate target of 9.4% [2]

The evaluation of such efforts should be guided by framework models that consider the various levels that influence an private's health trajectory [7, 8]. For example, the National Found on Minority Health and Health Disparities (NIMHD) Research Framework represents the multiple levels of modifiable and interacting determinants that contribute to health disparities (Fig 1) [9]. While the multi-level Life Form Wellness Development Framework perspective also recognizes that health-development unfolds over the life course, is sensitive to time and environment, adaptive, and requires a residual among all levels of health [ten]. Together, these models are well-suited for evaluating and characterizing childhood obesity prevention efforts and informing futurity interventions.

Fig i. Framework used to narrate components of early childhood obesity prevention interventions beyond the early life course.

Adapted from The National Institute on Minority Health and Health Disparities (NIMHD) Inquiry Framework [9].

https://doi.org/10.1371/journal.pone.0209787.g001

Nosotros conducted a scoping review to provide an overview of the current country of obesity prevention efforts in the United States (US) with children less than 6 years of age, and to reply two questions: "What types of interventions and policies are being used for obesity prevention beyond the early life course and at multiple levels of influence?" and "How effective are they?" The secondary aim was to describe the all-time bachelor evidence on the cost and cost-effectiveness of implementing obesity prevention interventions and policies.

Methods

A scoping review was conducted to aggrandize on previous systematic and narrative reviews of obesity prevention efforts in young children and to identify scientific show from a wide range of interventional studies, government and non-governmental programs, and local and national policies in the US. The scoping written report design was chosen because information technology offers a framework to place, "map", merge evidence, and synthesize a broad range of show. Furthermore, the scoping review methodology is focused on providing conceptual clarity and allows researchers to focus on questions with relevance to target populations and locations [11–12].

The scoping review process is based on the Arksey and O'Malley's 5-stage methodological framework [eleven]. The 5-stages that served as a roadmap for the present review are: 1. identifying the research question; two. identifying relevant studies; 3. report option; 4. charting the data, and five. collating, summarizing and reporting the results. [11]. While the Joanna Briggs Institute's Reviewer's Manual of best research practice guidelines for conducting a systematic scoping review, served as a guide for the present review [12]. To ensure consistency, transparency, and reproducibility an a priori scoping review protocol was developed and directed the review process.

Data sources

After formulating the review objectives and the research questions (Stage ane), a literature search was conducted to identify relevant studies (Stage 2) in the Cochrane Central Annals of Controlled Trials, MEDLINE PubMed, CINAHL, PsycINFO, and EconLit databases from January 2001 to Feb 2018. The timeframe was called considering in 2001 the Department of Wellness and Human Services published "The Surgeon General's Phone call To Action To Forestall and Decrease Overweight and Obesity" [13] prioritizing the public wellness response to the growing obesity epidemic.

Search strategy

A search strategy was devised with the assistance of an Information & Education Librarian (MG) for PubMed using keywords from obesity prevention articles and modified for the boosted electronic databases. Tabular array one shows the search syntax and strategy.

Written report selection

During study pick (Stage three), publication titles and abstracts were screened, duplicates deleted, and full-text articles reviewed for eligibility based on the review'south inclusion criteria. References from the bibliographies of included trials were hand searched. Two researchers (SV, PRP) independently reviewed, discussed, and agreed upon the eligibility of all studies. While systematic reviews adhere to rigid inclusion criteria, scoping studies' inclusion criteria are broad to allow for the evaluation of a wide range of information [12]. Eligible studies were included if they incorporated a comparator group; were conducted in children with a normal or healthy weight (BMI-for-age percentile betwixt the 5th percentile to less than the 85th percentile); children under the age of 6 or adult female in whatsoever setting, and reported at least one weight-based consequence measure of growth or weight status (Table 1). While critical appraisement of methodology is not the focus of scoping reviews, we followed a standardized research protocol and applied the Dixon Woods threshold to exclude articles judged "fatally flawed" [14].

Data extraction

Data extraction (Phase 4) was done using a two-step process. First, a Microsoft Excel, version 2016 (Microsoft, Redmond, WA) data extraction template was developed to nautical chart continuous and categorical variables and perform summary statistics. S1 Appendix shows a listing of the primal information extraction variables. Next, included articles were imported into Nvivo 11 Pro (QRS International, Doncaster, Australia) and qualitative data were extracted by selecting, coding and creating nodes (files) representing key concepts. A coding structure and organizational hierarchy was created to characterize major themes by life course, concepts and context pertaining to the NIMHD Framework (Fig 1).

Results

Collating, summarizing and reporting the results (Stage v)

Fig 2 describes the literature search and study selection procedure. We identified a total of 2,467 records. After removing duplicate records, the titles and abstracts of two,180 records were screened for inclusion. The full text of 73 articles were reviewed for eligibility and 34 studies were included in the review.

Fig 2. Menses diagram showing literature and study selection.

Adapted from Moher D, Liberati A, Tetzlaff J, Altman DG. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. BMJ (Clinical research ed). 2009;339:b2535, [15].

https://doi.org/10.1371/journal.pone.0209787.g002

Study characteristics

The included studies examined the collective experiences of approximately 900 meaning women, 1,600 infants and ten,000 preschool anile children beyond 16 states, in ten urban centers, and a mix of suburban and rural communities (Tables two–4). The interventions (due north = 25) were initiated during three stages in the early life course: pregnancy (n = 3),[16–18], infancy (n = 3), [19–21] and preschool (n = 19), [22–40]. The bulk (88%, 22/25) of the interventions used an experimental study blueprint (19–40).

We identified 6 publications examining the affect of city, state and national obesity prevention policies [41–46]. Three boosted studies calculated the internet cost or toll-effectiveness of obesity prevention interventions [47–49].

In total, 11 (44%) interventions reported a positive benefit on a weight-based measure of growth or weight condition (due east.k., weight, weight/weight percentiles, BMI/ BMI z-score, and BMI categories) [17, nineteen, twenty, 22–25, 28, 31, 36, 38]. The effectiveness of the interventions was inconsistent and contradictory beyond all stages of the early life course. Tables two–iv provide descriptions of the characteristics and outcomes of the interventions.

Studies initiated during pregnancy

This review identified 3 studies initiated during pregnancy conducted in children from depression-income families and members of racial-ethnic minority groups who are at higher risk of obesity [6] and in a variety of settings [urban healthcare clinic-bases [16]; customs-wide plus home-visits [17]; customs-broad plus primary care practise], (Table 2), [18)]. All iii interventions focused on similar private- and interpersonal-level behaviors (preventing excess gestational weight gain [sixteen, 18] and accelerated baby growth [16–18]), ii studies also focused on customs-level influences [17–18] but only the ane study [17] that implemented interventional components at multilevel domains of influence demonstrated a positive upshot on Torso Mass Index z-score (BMI-z) in American Indian/Alaskan Native tribal communities in the multi-level, community broad-plus home-visit intervention.

Interventions during infancy

Two [19, 20] of the 3 [nineteen–21] studies identified were initiated during infancy and showed a positive result on infant growth (Table 3). All studies included behavioral strategies at the individual and interpersonal level aimed at increasing knowledge of salubrious food choices and appropriate growth patterns. The Well Baby Group (WBG) intervention also targeted community levels of influence by delivering sociocultural adapted diet education and providing a peer social support network while maximizing the physical environment and healthcare system resources at a federally qualified customs health center [19]. At two years, the infants of low-income, predominately Hispanic mothers attending the WBG were significantly less likely to take a BMI-for-age ≥ 85th percentile compared with a randomly selected comparisons group of infants. Also, at one yr, infants of mothers who received both the home-based intervention Soothe/Sleep and Introduction to Solids interventions had lower mean weight-for-length percentiles (33^rd vs. fifty^thursday) compared to the no intervention group [20].

Interventions in preschool anile children

Childcare eye-based interventions.

Over half (63%, 12/xix) of the preschool-aged interventions enrolled children from low-income, racially and ethnically diverse families from Caput Starting time centers (due north = 7), YMCA-affiliated childcare centers (north = 2) or other subsidized childcare programs (n = 3), (Tabular array 4). The childcare center-based interventions included in this review were designed with interventional components that primarily focused on influencing private- or interpersonal-level wellness behaviors of the children and preschool teachers. Only 42% (five/12) of these interventions reported a meaning comeback in either BMI-z score [22], BMI [23–24, 28] and BMI percentile [36].

Of the interventions demonstrating a positive effect on BMI, two studies administered 30 minutes of moderate to vigorous physical activity (MVPA) for primarily African American (AA) children attending YMCA-affiliated preschools [23, 24]. Similarly, the "Hip-Hop to Health" efficacy trial [28] enrolled predominately AA preschoolers attending Head Outset and used trained educators to deliver 20-minute healthy-lifestyle behavior themed lessons and twenty minutes of directed physical activity (PA). However, the aforementioned intervention did not have a benign effect on BMI in Latino preschoolers [29], nor did other like effectiveness trial in Latino [30] and AA preschoolers [33, 50]. Another study found that five, 1-hour long healthy-lifestyle themed workshops presented by trained nurse childcare wellness consultant to parents, childcare teachers and staff, significantly decreased hateful BMI-z scores in children from underserved minority families [22]. Finally, a multilevel, childcare-based intervention [36] showed a significantly smaller increase in the BMI percentile when intervention centers implemented early childcare heart policies focused on modifying individual-level kid, parent, and teacher behaviors with concrete/built and sociocultural environment changes.

Master care providers dispensary-based.

Two master intendance clinic-based studies [25, 37] reported contradictory results. Both studies targeted individual- and interpersonal-level behavioral changes, implemented in a healthcare environment. Only Cloutier and colleagues found a significantly greater reduction in BMI percentile in the intervention group that participated in bilingual, culturally adjusted, motivational interviewing (MI) sessions during principal care provider (PCP) visits and phone-coaching session [25].

Customs center-based.

Similarly, two interpersonal-level, family-based studies were conducted a community center-based environment with mixed results. Slusser and colleagues [38] randomized Latino mothers of preschoolers to receive nine culturally tailored, Spanish linguistic communication, parent-preparation sessions or be in a Wait List Group (WLG). Despite reporting 33.3% attrition, the intervention group experienced a greater reduction in BMI percentile differences compared with the WLG at nine months. In contrast, Haines and colleagues [32] failed to demonstrate a pregnant comeback in BMI with a family-based, community health center intervention.

Other settings.

Additional preschool-anile interventions were conducted at a WIC site [twoscore], online [39] and in the home and over the phone [31]. Simply one study reported a positive upshot on BMI. In the "Healthy Habit, Salubrious Home" [31] wellness educators used MI coaching techniques during home and phone coaching sessions, along with text letters to promote interpersonal-level changes in good for you family routines and PA, encourage family meals and potable choices, adequate sleep and change the concrete-built surround by asking families to remove TVs from the child'due south bedroom. Although a WIC-based intervention within the community-wide Massachusetts Babyhood Obesity Research Demonstration [51] found no effect on BMI-z scores, a post-hoc analysis excluding Asians (due to disproportionate distribution of Asian children in the comparing community) found a pregnant improvement in BMI-z scores [forty].

Costs of obesity prevention interventions.

Table 5 includes a summary of three studies appraising the toll of preventing obesity. Cradock and colleagues [47] estimated the total annual cost per child associated with implementing and nationally disseminating the PA component of the childcare center-based "Hip-Hop Jr." PA intervention was $22.65 yearly [33]. As well, Wright and colleagues [45] calculated the internet cost of a primary-care based intervention [52], aimed at reducing obesity related behaviors and BMI in overweight and immature, obese children at $196 per kid [49]. In the tertiary study, Ma and Frick [48] modeled the breakeven point of a hypothetical intervention producing a 1% reduction in the prevalence of obesity amid children 0–vi years. Accounting for future medical costs, population-based interventions could price upwards to $339 per child and nevertheless have a favorable health benefit/price contour.

Policy interventions.

Vi studies [41–46] estimated the cost and health benefits of urban center-wide, and state and national policies aimed at preventing future weight gain and obesity (Table 5). Kuo and colleagues [41] developed a simulation model estimating the affect on almanac weight proceeds in Los Angeles (LA) County of a California menu constabulary mandating big restaurant bondage to display the caloric content of menu items. The model assumed x% of all customers would swallow 100 calories less per meal and establish the law was projected to avoid every bit much as 500,000 lbs. of the estimated almanac LA County population weight gain (ane.25 million lbs.) in children 5 to 17 years old.

The Northeast Iowa Food and Fitness program enacted multilevel changes during a half-dozen-year long program. The changes targeted schools and abode meals and PA, established school gardens, and at the community-level provided access to outdoor recreational spaces and programs, local farmers markets and affordable healthy nutrient. It was shown that children ages iv–12 years who had longer periods of program exposures (2 to 6 years) demonstrated a greater improvement in appropriate growth rate compared with children with shorter periods of program exposure (0 to one year) [46].

Dharmasena et al. utilized an economic demand model based on household purchasing habits to assess the impact of a xx% taxation on SSB consumption, caloric intake and weight. Results using the most conservative estimate showed an overall reduction in SSB with corresponding increases in fruit juice and low-fat milk consumption. The interrelated changes in beverage consumption patterns was forecast to produce an average reduction of 449 calories per month resulting in a mean body weight reduction of 1.54 lbs/year.

Costs and cost effectiveness analysis.

Finally, three studies describe the economic impact and wellness consequences of obesity prevention policies using a Markov-based accomplice model to approximate the cost effectiveness of: an excise tax on SSBs, [44] eliminating the taxation subsidy for Television ad, [42] and implementing a set of hypothetical childcare centre-based policy changes [45], (Tabular array 5). Sonneville and colleagues [42] found that eliminating the ability of food manufactures to deduct the cost of advertising unhealthy foods would upshot in a mean BMI reduction 0.028 per child [42]. Likewise, Wright and colleagues [45] estimated that a hypothetical childcare center-based policy (eliminating SSBs, limiting fruit juice, serving low-fat milk, limiting screen time and increasing MVPA) would event in a mean BMI reduction of 0.019 BMI units per child [45]. Finally, Long and colleagues [44] estimated that a taxation of $0.01/ounce on SSBs would reduce the total calories consumed by children ages 2–iv and 5–9 years, past -1 to -13 kcal/day, respectively, and consequence in a hateful reduction in BMI of approximately 0.sixteen units for children two–19 years. The toll per unit BMI reduction based on these policies ranged from $1.16 for eliminating the advertising subsidy to $57.fourscore for the childcare eye-based policy.

Discussion

This scoping review identified the characteristics and effectiveness of obesity prevention interventions, programs and policies beyond the early life form and at multiple levels of influence in the United states of america. In that location were a number of key findings (S2 Appendix). Nosotros plant slightly less than half of the interventions initiated during pregnancy, infancy or preschool were constructive at improving a weight-based measure of growth or weight status in young children [17, nineteen, 20, 22–25, 28, 31, 36, 38]. All interventions included strategies to influence health behaviors at an individual or interpersonal level. However, few studies removed obstacles in the physical/built environment, sociocultural environs or healthcare organisation. The majority of the interventions were conducted in children at higher take chances of obesity, in early on childcare educational activity settings. The touch of menu labeling laws, taxing SSBs and eliminating incentives for TV advertisement of unhealthy foods, on a direct weight-based measure of growth or weight status in children under historic period 6 years remains unclear. Finally, this review confirmed the lack of available data on the cost of implementing obesity preventions efforts in the United states.

We used the NIMHD Research framework [53] to guide our test of obesity prevention efforts considering factors relevant to obesity and wellness equality research. Nosotros found that all interventions initiated during pregnancy and infancy focused on modifying biological take a chance factors of obesity past enhancing private-level knowledge of salubrious eating patterns, advisable gestational weight gain, prolonged breastfeeding, delayed introduction of complementary feeding, responsive feeding techniques and appropriate infant growth patterns [19, 20]. For example, in the primary intendance setting, MI coaching techniques were practical to reduce obesogenic behaviors [25, 37], while in the childcare center setting, parents and teachers gained the necessary knowledge and skills to serve as role-models of healthy-lifestyle behaviors [19, 28, 36, 38]. Likewise, preschool children were encouraged to modify their behaviors using culturally adjusted, nutrition and PA lessons [19, 28, 31, 36, 38], nutrient group-themed, hand puppet activities [29], English and Spanish-language CDs [30], salubrious snacks [22, 28, 36] and structured MVPA [23, 24, 28].

All constructive interventions identified in this review incorporated interpersonal-level strategies affecting family behaviors and home routines. Parental and family participation was either a master or secondary component of all successful interventions. Parents attended culturally tailored education sessions [38], home visits [17, 20, 31], or were assigned homework, received instructional handouts and newsletters promoting frequent family meals, acceptable sleep, family PA and limiting screen fourth dimension [20, 22, 25, 28, 31, 36, 38]. The inclusion of parent-direct strategies in successful interventions is consistent with the findings of a recent review of obesity prevention interventions in early childcare centers. Ward and colleagues [54] found that higher parent engagement in the early childcare settings enhanced the effectiveness of interventions by achieving a positive weight related upshot [54].

Recognizing the influence of physical environments on the risk of childhood obesity and health disparities is critical to the design of multilevel obesity prevention interventions. Yet, less than i-third of the studies aimed to modify a component in the physical/built environment. These interventions finer removed barriers to facilitate healthier lifestyle behaviors. They included components such as removing TVs from bedrooms, providing alternative playtime activities, and implementing childcare centers polices limiting SSBs, serving h2o, low-fat milk, fruits and vegetables equally snacks; increasing hours of PA, and limiting screen time [22, 31, 36]. At the community-level, Karanja and colleagues [17] enacted tribal-wide policies providing access to breast feeding rooms and reallocating resources by stocking vending machines with h2o and providing water coolers at customs-sponsored activities. Collectively, these types of physical environment changes rendered healthy behaviors every bit the default behavior.

Approximately half of the interventions integrated strategies to modify sociocultural environmental-level factors, with considerable variability in the intensity of the components. Few included principal objectives examining the effectiveness of culturally-tailored training programs [38, 39] or other high-intensity activities such every bit media campaigns encouraging drinking water and breastfeeding as cultural values [17] or establishing grouping sessions intended to back up shared sociocultural values [xix]. While the majority of studies included the following types of moderate- to low-intensity components: using bi-cultural/bilingual interventionalist [19, 25, 29, thirty, 32, 36, 38, 39], culturally adapted curriculum [25, 26, 28–31, 33, 34, 36, 38, 39] and providing culturally relevant recipes [19, 25, 26, 35, 39].

Healthcare system-level changes facilitate access to healthcare resources, appoint parents in healthcare decisions and improve parent-healthcare provider relationships. Furthermore, the early initiation of interventions in the healthcare setting might alter the grade of wellness and disease, and reduce future health disparities [55]. All the same, of the five healthcare-based interventions [16, 19, 21, 25, 37], only two reported improvements in a measure out of obesity. 1 was informed by the chronic care model and used brief MI format [25], while the other used a patient-centered approach and group sessions [19]. In contrast, others failed to meliorate babyhood growth trajectories [16, 21, 37]. Such results advise that even in a healthcare setting, the intensity of the plan and written report population are important considerations for the success of any intervention.

This review identified studies that estimated the health and economical impact of regional and national SSBs pricing strategies, labeling laws and food marketing policies. These strategies were shown to change purchasing behavior and improve the prevalence of obesity, and potentially to generate taxation acquirement, drive the reformulation of unhealthy foods, and change social norms [42, 44]. Although the population reach and societal-level affect of obesity prevention policies are high, the long-term outcome on the prevalence of early childhood obesity remains uncertain.

None of the included interventions reported on the costs or cost effectiveness of the written report. The lack of economic evaluations is a surprising finding given that the almanac price of obesity-related medical spending was estimated to exceed $147 billion [56]. Consistent with our findings, Wolfenden and colleagues [57] noted that 88% of the systematic reviews of obesity prevention intervention in children did non report whether a price analysis has been conducted. In the absence of CEA data, a reliable price threshold could help stakeholders to decide the corporeality of coin to spend on obesity prevention interventions. Ma and Frick [48] established the break-even cost of $339 per kid as a "good value" for interventions resulting in a 1% reduction in childhood obesity prevalence.

At that place were several limitations to our review. First, our scoping review presented a comprehensive overview of the quantity and context of current childhood obesity prevention efforts in the US, which limits the generalizability of our findings to other countries. Adjacent, our review did not identify any obesity prevention interventions conducted during pre-pregnancy and identified very few studies conducted during pregnancy. It is likely that our search strategy may not have been sensitive plenty to place the full breadth of inquiry activities during these early life stages. Since nosotros followed standardized methodology for scoping reviews, we did non assess the upshot size of the interventions or systematical evaluate the quality of the individual studies including the risk of bias quality. Nosotros acknowledge that many of the studies were of varying quality based on study pattern, sample size, intensity, analytical approaches, high attrition rates and depression parent attendance rates. Although we excluded studies judged to exist fatally flawed, our results are subject to a range of biases due to these many threats to the internal and external validity of the written report results. Furthermore, given that studies reporting positive results are more likely to be published, conclusions may also be subject to publication bias [44]. Finally, our synthesis was based on interventions reporting a weight-based measure out of growth or weight status in normal weight children. Because we did not consider favorable behavioral or PA outcomes the generalization of our results may be limited.

Conclusions

This review presents an overview of the current state of obesity prevention efforts across multiple levels of influence and the early life course in the U.s.. The majority of efforts focused on individual and interpersonal-level health beliefs changes in preschoolers. Thus, there is a demand to intensify obesity preventive efforts during critical periods of health development and target multiple levels of influence, peculiarly regarding concrete, sociocultural and healthcare organization-level obesity risk factors. Furthermore, at that place is considerable dubiety around estimates of the economical impacts of obesity prevention interventions and policies. Futurity studies should estimate the feasibility, effectiveness, and cost-effectiveness of obesity prevention interventions and policies. Addressing these enquiry gaps may provide regime agencies, policy makers, and healthcare payers with the necessary scientific evidence to make informed decisions regarding the allocation of funds for initiatives aimed at decreasing the prevalence of early babyhood obesity.

Supporting information

Acknowledgments

We give thanks Mina Ghajar (Librarian, George F. Smith Library of the Wellness Sciences, Academy Libraries Rutgers) for her assistance with the literature search strategy.

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Source: https://journals.plos.org/plosone/article?id=10.1371%2Fjournal.pone.0209787

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