There is a clear need for effective prevention and treatment interventions to manage the high prevalence of childhood overweight globally. It is well recognised that changes in the social and economic environment in the last three decades have been a major contributor to altered eating and activity patterns resulting in positive energy balance. The most recent update to the Cochrane review of interventions for preventing obesity in children identified that the majority of childhood obesity prevention intervention evaluations were short-term (12 months or less) and largely focussed on individual behaviour change. Also from this review there is now some early evidence that settings-based obesity prevention interventions are effective at reducing body mass index in the short term. However, given the short-term nature of these interventions, sustainability of this change is unclear, and stronger evidence from larger-scale evaluations is needed about what intervention components are feasible to be embedded into children’s settings and systems (e.g. the school environment) to be able to translate and scale up research findings into effective public health approaches. Until recently, effective obesity prevention interventions have largely drawn upon behaviour change theories, which appear to be unlikely to produce sustainable change in outcomes if they do not consider the broader social and environmental context. Models based on ecological theory show the complex interaction between individuals’ behaviour and their broader environments, that influence eating and activity. A community-based, capacity-building approach aims to promote sustainable skill development and increase the ability of individuals to improve environments that promote health outcomes.This presents a promising approach to obesity prevention, and evidence is needed on processes and outcomes of interventions guided by such theories
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