OUR APPROACH
All children should have the opportunity to grow up healthy regardless of who they are and where they live. This is not the case today – 1 in 5 children live with overweight or obesity, with strong socioeconomic disparities in health outcomes1.
The Childhood Obesity Prevention Initiative under Cities for Better Health aims to accelerate the prevention of childhood obesity in disadvantaged, urban communities globally. The initiative has been launched in six cities across Brazil, Canada, France, Japan, South Africa, and Spain.
The Childhood Obesity Prevention Initiative works with global partners Delivery Associates and The Behavioural Insights Team to support local partners with the design, delivery, and evaluation of interventions.
Guided by a global evidence-based framework, coalitions of cross-sector partners in each city will co-design, implement, and evaluate packages of holistic interventions to improve child health outcomes. Intervention packages must target children aged 6-13 and align with four principles:
1. Dual focus on diet and physical activity: Intervention packages must address both key behavioural risk factors to increase potential impact2,3.
2. Multi-level approach: Interventions should work at multiple levels of society, from structural changes to individual support.
3. Community-driven design: Interventions must be designed and implemented in collaboration with local stakeholders to ensure localisation and support long-term sustainability.
4. Equity oriented approach: Interventions should target disadvantaged groups and areas to promote equitable outcomes.
For children ages 6-13, within 24 months of initiating interventions, the initiative aims to:
Based on these objectives, a set of success metrics has been defined. A controlled evaluation design will be used to measure impact using a repeated cross-sectional study with a comparison group.
Applying the following principles, the study design is statistically powered for country-level analyses to detect change in mean BMI of 0.3 kg/m2 after 24 months, while at the global level (aggregating across all six countries), it is possible to detect a change in mean BMI of 0.13 kg/m2.
In each country, at each time point, data must be collected:
1. On at least 2,000 children at each time point
2. From at least 20 clusters (e.g., schools), each with minimum 100 children
3. From at least 10 intervention areas and 10 control areas
Ultimately, the Childhood Obesity Prevention Initiative aims to:
Childhood obesity is a complex problem shaped by a broad range of biological, environmental and socioeconomic factors. Overweight and obesity affect more than 390 million children and adolescents aged 5–19, representing 20% of all children in this age group1. Childhood obesity increases the risk of early onset of type 2 diabetes and is a strong predictor of adult obesity4. Children from lower socioeconomic backgrounds tend to face higher risks of developing obesity5,6,7.
World Health Organization (WHO). Factsheet: Obesity and overweight. Updated March 2024. Accessed October 2024. https://www.who.int/news-room/fact-sheets/detail/obesity-and-overweight
Cochrane Public Health Group and et al., “Interventions to prevent obesity in children aged 12 to 18 years old,” Cochrane Database of Systematic Reviews, vol. 2022, no. 7, 1996.
S. N. Bleich and et al., “Systematic review of community-based childhood obesity prevention studies,” Pediatrics, vol. 132, no. 1, 2013.
World Health Organization (WHO). Q&A: Noncommunicable diseases: Childhood overweight and obesity. 19 October 2020. Accessed October 2024. https://www.who.int/news-room/questions-and-answers/item/noncommunicable-diseases-childhood-overweight-and-obesity