A new study finds that empowering communities with systems-based tools to fight childhood obesity not only reduced weight trends but also improved quality of life in boys—suggesting a resilient, community-first approach to lasting health changes.
Study: Three-year behavioural, health-related quality of life, and body mass index outcomes from the RESPOND randomized trial. Image Credit: chanchai plongern / Shutterstock
The RESPOND randomized trial is a community-based systems intervention to prevent childhood obesity and non-communicable diseases.
Scientists at Deakin University recently evaluated the trial's three-year behavioral, health-related quality of life, and body mass index outcomes. The study is published in the journal Public Health.
Background
Childhood obesity is a serious public health concern as it often persists into adulthood and increases the risk of several non-communicable diseases.
The complex and multifactorial nature of childhood obesity risk factors may lead to resistance to intervention. This complexity includes multiple factors that can influence a child’s food consumption, including early-life exposure to a variety of foods, food availability at home and within the community, and socioeconomic status.
Existing evidence indicates that multi-level interventions that apply multiple strategies across communities can significantly reduce children's body weight.
Systems science and systems thinking are methods of understanding the relationships and connections between component factors driving complex systems. Thus, they can provide promising and innovative interventions to prevent childhood obesity.
The Reflexive Evidence and Systems Interventions to Prevent Obesity and Non-communicable Disease (RESPOND) trial was initiated to examine whether building the capacity of key community health staff at scale through systems-based training can develop a sustainable model for delivering such interventions for childhood obesity prevention.
In this study, scientists have evaluated the impact of the RESPOND trial on BMI z-scores (standardized body mass index), health-related quality of life, and related behaviors.
Study Design
RESPOND was designed as a four-year randomized childhood obesity prevention trial involving 10 local government areas in northeast Victoria, Australia. The aim was to build community capacity to apply systems science to prevent childhood obesity and non-communicable diseases.
The intervention was initially implemented in the selected areas in July 2019 (step one) or July 2021 (step two). Baseline child-level data were collected between March and June 2019, and the follow-up data collection was planned for 2021 and 2023.
Due to the COVID-19 pandemic, however, step two communities could not begin their intervention as planned and were therefore treated as controls.
The step one communities partially implemented the intervention actions and were defined as “intervention communities.” The trial was altered to a cluster-parallel randomized design, allowing the researchers to compare outcomes in intervention and control communities.
In this study, scientists compared intervention versus control communities over three years (2019–2022). The study analyzed data obtained from 31 primary schools that participated in both March to June 2019 and March to August 2022 data collection waves.
The three-year outcomes included BMI z-scores, health-related quality of life, and self-reported health behaviors.
Important Observations
The analysis conducted within intervention communities revealed a small reduction in BMI z-scores and the percentage of overweight or obesity from 2019 to 2022. Within control communities, a small increase in BMI z-scores and the percentage of overweight or obesity was observed during the same period.
Self-reported health behaviors revealed limited effects of the intervention on any analyzed outcomes (physical activity, recreational screen time, and frequency of takeaway food consumption). However, a noteworthy intervention effect on daily water consumption was observed in boys.
Between 2019 and 2022, overall health-related quality of life deteriorated for children, likely due to COVID-19-related challenges. However, for boys, a significant improvement in quality of life and psychosocial health was observed within intervention communities.
Study Significance
The study finds a limited but positive effect of the community-based systems intervention (RESPOND) on psychosocial health, overall quality of life, and water consumption among boys who participated in the trial. However, the intervention had no significant impact on these metrics for girls.
The study also finds a general decline in several obesity-related behaviors among boys and girls in both intervention and control communities over the study period, which researchers attribute in part to the pandemic’s impact on lifestyle behaviors.
A non-significant but favorable effect of the intervention has been observed for BMI z-scores, overweight or obesity prevalence, and several other behavioral outcomes (active transport to and from school, sleep, and consumption of takeaway food and sweetened drinks).
The RESPOND trial utilized systems thinking to help communities identify and target local childhood obesity risk factors. The researchers emphasize that understanding these local factors is crucial in assessing the intervention’s overall merit.
The findings suggest that empowering communities to use systems thinking in obesity prevention could have a protective effect on children’s health, even in the face of major challenges like the COVID-19 pandemic.
Given the scarcity of effective interventions to address childhood obesity and non-communicable diseases, building capacity within communities to deliver systems-based interventions seems to be a promising approach.
Further analyses and investments in RESPOND’s findings could lead to broader training of community health workers in systems thinking and enable the creation of a learning system for effective and rapid knowledge acquisition. Further investigation is also needed into the observed gender differences in intervention effects.