Obesity: working with local communities

Appendix D Gaps in the evidence

The Programme Development Group (PDG) identified a number of gaps in the evidence related to the programmes under examination, based on an assessment of the evidence reviews, commissioned primary research and expert testimony. These gaps are set out below.

1. Community-wide programmes

a) Few community-wide obesity programmes have been evaluated (that is, programmes involving multiple actions locally). Those that do exist are mainly school-based, the components are often inadequately described, and the terminology varies from study to study. Follow-up times are too short and clients who dropped out are often ignored.

b) There is a lack of evidence on community based obesity prevention programmes for children and adults with disabilities.

(Source: review 1 and 2; commissioned report; PDG discussions)

2. Partnerships

There is a lack of evidence on community-wide partnership working. In particular, the following questions need answering:

a) What are the most cost-effective components of a partnership?

b) How can oversight and management committees or groups effectively manage a partnership? How can the best local representatives for these committees or groups be identified?

c) On what basis should a decision be made to form a local partnership – as opposed to working unilaterally?

d) Is there a difference between 'adaptive' (that is, voluntary) partnerships that emerge spontaneously and 'mandated' (imposed from above) partnerships in terms of effectiveness?

e) What are the best incentives or techniques to encourage partnership working?

(Source: PDG discussions)

3. Complexity of local systems

There is a lack of evidence on how complexity theory, management theory, change theory and a whole-systems approach works in practice. Specifically, we need to know:

a) What are the synergies between common actions to tackle obesity?

b) Where are the greatest opportunities for tackling obesity in any given community?

c) How can the local system – and components of the local system – evolve to better tackle obesity?

d) Does a local community programme that focuses on prevention tend to work against efforts in the same community to treat people who are already obese (and vice versa)?

(Source: PDG discussions)

4. Health economics

There is a lack of evidence on the economics of community-wide partnership working to prevent obesity. This type of activity involves complex interactions and is not amenable to current economic evaluation techniques.

(Source: PDG discussions)

5. Scalability

There is a lack of evidence on the practicality and effectiveness of extending or 'scaling up' small obesity prevention programmes. 'Scalability' in this sense means increasing the:

(Source: PDG discussions)

6. Programme composition

There are unresolved questions about the composition of an effective, local community-wide programme aimed at tackling obesity, specifically:

a) How can a 'community development' approach best be applied?

b) How can learning from other programmes be used (for example, how transferrable is the learning from tobacco or alcohol control programmes)?

c) What combination of features ensures a programme is effective – and how do they relate to each other?

d) What aspects of a community-wide intervention (or parts of an intervention) need guidance to ensure health and community workers can implement them effectively?

e) How 'intense' does a programme need to be, both in terms of the number of interventions (or sub-interventions), and the amount of activities involved in each one?

(Source: PDG discussions)

7. Sustainability

There is a lack of evidence on how to ensure programmes can be sustained over the longer term. This includes effective ways of ensuring: continuation of funding, the partnership remains strong, volunteer and 'Please link to glossary participation and long-term leadership.

(Source: PDG discussions)

8. Business

There is a lack of evidence on how to get local businesses (in particular, small businesses) and chambers of commerce involved in obesity prevention work.

(Source: PDG discussions)

9. Measurement

There is a lack of evidence on effective measurement and segmentation tools that could be used as part of the JSNAs and for programme evaluation. Similarly, there is a lack of research on appropriate benchmarks that could be used.

(Source: PDG discussions)