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Group model building is a participatory workshop technique used in system dynamics for developing community consensus to address complex problems by consensus building on individual assumptions. This study examines changes in individual mental models of the complex problem of childhood obesity following participation in group model building (GMB), as part of a larger community-based system dynamics project. Data are drawn from GMB participants across six community sites in the Whole of Systems Trial of Prevention Strategies for Childhood Obesity (WHO STOPS) in rural and regional Victoria, Australia. Each community participated in two GMB sessions resulting in a causal loop diagram (CLD) of drivers of childhood obesity for each community. Presurvey and postsurvey captured participants' perspectives before and after (n = 25) participation in both GMB sessions and a blend of inductive and deductive qualitative content analysis was used to code individual responses. Three calculations were used to determine the number of responses, whether responses were a result of persuasion from others, and comparison of responses to those found in the CLD. Our study found participant mental models shifted during the course of the GMB sessions, with some responses persuaded by others and 75% of new insights identified in CLDs created by communities. The GMB process created a platform for participants to share ideas and learn from each other. In addition, participants listed new insights about childhood obesity in their community through developing CLDs.

Introduction In south-east Asia, low- and middle-income countries have a high burden from all forms of malnutrition, such as underweight, wasting, stunting and micronutrient deficiencies, obesity and diet-related noncommunicable diseases. [...], Objective To identify and analyse ongoing nutrition-related surveillance programmes led and/or funded by national authorities in countries in South-East Asian and Western Pacific Regions. Methods We systematically searched for publications in PubMed(r) and Scopus, manually searched the grey literature and consulted with national health and nutrition officials, with no restrictions on publication type or language. We included low- and middle-income countries in the World Health Organization South-East Asia Region, and the Association of Southeast Asian Nations and China. We analysed the included programmes by adapting the United States Centers for Disease Control and Prevention's public health surveillance evaluation framework. Findings We identified 82 surveillance programmes in 18 countries that repeatedly collect, analyse and disseminate data on nutrition and/or related indicators. Seventeen countries implemented a national periodic survey that exclusively collects nutrition-outcome indicators, often alongside internationally linked survey programmes. Coverage of different subpopulations and monitoring frequency vary substantially across countries. We found limited integration of food environment and wider food system indicators in these programmes, and no programmes specifically monitor nutrition-sensitive data across the food system. There is also limited nutrition-related surveillance of people living in urban deprived areas. Most surveillance programmes are digitized, use measures to ensure high data quality and report evidence of flexibility; however, many are inconsistently implemented and rely on external agencies' financial support. Conclusion Efforts to improve the time efficiency, scope and stability of national nutrition surveillance, and integration with other sectoral data, should be encouraged and supported to allow systemic monitoring and evaluation of malnutrition interventions in these countries. Objectif Identifier et analyser les programmes de surveillance nutritionnelle en cours, menes et/ou finances par les autorites nationales de pays des regions de l'Asie du Sud-Est et du Pacifique occidental. Methodes Nous avons effectue une recherche systematique de publications sur PubMed(r) et Scopus, mene des recherches manuelles dans la litterature grise et consulte des responsables nationaux de la sante et de la nutrition, sans restriction quant au type de publication ou a la langue. Nous avons inclus les pays a revenu faible et intermediaire de la region de l'Organisation mondiale de la sante pour l'Asie du Sud-Est et de l'Association des nations de l'Asie du Sud-Est, ainsi que la Chine. Nous avons analyse les programmes inclus en adaptant le cadre d'evaluation de la surveillance de la sante publique des Centers for Disease Control and Prevention des Etats-Unis. Resultats Nous avons identifie 82 programmes de surveillance dans 18 pays qui collectent, analysent et diffusent regulierement des donnees sur la nutrition et/ou des indicateurs lies. Dix-sept pays ont mis en reuvre une enquete nationale periodique qui recueille exclusivement des indicateurs de resultats nutritionnels, souvent parallelement a des programmes d'enquete lies a l'echelle internationale. La couverture des differentes sous-populations et la frequence de surveillance varient considerablement d'un pays a l'autre. Nous avons constate dans ces programmes une integration limitee des indicateurs portant sur l'environnement alimentaire et le systeme alimentaire au sens large, et aucun programme ne surveille specifiquement les donnees prenant en compte la nutrition dans l'ensemble du systeme alimentaire. La surveillance nutritionnelle des personnes vivant dans des zones urbaines defavorisees est egalement limitee. La plupart des programmes de surveillance existent sous une forme numerisee, recourent a des mesures pour garantir la qualite des donnees et font preuve de flexibilite, mais beaucoup sont mis en reuvre de maniere incoherente et dependent du soutien financier d'agences exterieures. Conclusion Les efforts visant a ameliorer l'efficacite temporelle, la portee et la stabilite de la surveillance nutritionnelle a l'echelle nationale, ainsi que l'integration avec d'autres donnees sectorielles, devraient etre encourages et soutenus afin de permettre un suivi et une evaluation systemiques des interventions en matiere de malnutrition dans ces pays. Objetivo Identificar y analizar los programas de vigilancia en curso relacionados con la nutricion que dirigen o financian las autoridades nacionales de los paises de las regiones de Asia Sudoriental y el Pacifico Occidental. Metodos Se realizaron busquedas sistematicas de publicaciones en PubMed(r) y Scopus, busquedas manuales en la literatura gris y consultas con funcionarios nacionales de salud y nutricion, sin restricciones de tipo de publicacion ni de idioma. Se incluyeron paises de ingresos bajos y medios de la Region de Asia Sudoriental de la Organizacion Mundial de la Salud y de la Asociacion de Naciones de Asia Sudoriental y China. Para analizar los programas incluidos se adapto el marco de evaluacion de la vigilancia de la salud publica de los Centros para el Control y la Prevencion de Enfermedades de Estados Unidos. Resultados Se identificaron 82 programas de vigilancia en 18 paises que recopilan, analizan y difunden repetidamente datos sobre nutricion o indicadores relacionados. Diecisiete paises aplicaron una encuesta periodica nacional que recopila exclusivamente indicadores de resultados nutricionales, por lo general junto con programas de encuestas internacionales. La cobertura de las diferentes subpoblaciones y la frecuencia del seguimiento varian sustancialmente de un pais a otro. Se hallo una integracion limitada de los indicadores del entorno alimentario y del sistema alimentario en general en estos programas y ningun programa supervisa especificamente los datos que tienen en cuenta la nutricion en todo el sistema alimentario. Tambien es limitada la vigilancia relacionada con la nutricion de las personas que viven en areas urbanas desfavorecidas. La mayoria de los programas de vigilancia estan digitalizados, utilizan medidas para garantizar la alta calidad de los datos y presentan evidencias de flexibilidad; sin embargo, muchos se aplican de forma incoherente y dependen del apoyo financiero de organismos externos. Conclusion Se deben fomentar y apoyar los esfuerzos para mejorar la eficiencia temporal, el alcance y la estabilidad de la vigilancia nacional de la nutricion, asi como la integracion con otros datos sectoriales, para permitir un seguimiento y una evaluacion sistemicos de las intervenciones contra la malnutricion en estos paises. [phrase omitted]

: Objective: To report the prevalence of healthy weight and related behaviours among Victorian Aboriginal and non‐Aboriginal children and explore associations between these factors and health‐related quality of life (HRQoL). Methods: Analysis of cross‐sectional data from two cluster randomised controlled trials using logistic and linear mixed models. The sample included Aboriginal (n=303) and non‐Aboriginal (n=3,026) children aged 8–13 years. Results: More than two‐thirds of Aboriginal children met guidelines for fruit (75.9%), sweetened drinks (66.7%), sleep (73.1%), screen time (67.7%) and objectively measured physical activity (83.6%); and 79.1% reported consuming take‐away foods less than once per week. Aboriginal children were more likely to meet vegetable consumption guidelines (OR=1.42, 95%CI: 1.05, 1.93), but less likely to have a healthy weight (OR=0.66, 95%CI: 0.52, 0.85) than non‐Aboriginal children. Mean HRQoL scores were significantly higher among non‐Aboriginal children and both Aboriginal and non‐Aboriginal children meeting health guidelines. Conclusions: Most Aboriginal children in this study met guidelines for fruit, physical activity, screen time and sleep, and those meeting these guidelines had significantly higher HRQoL. Implications for public health: Promoting nutrition, physical activity and sleep is likely to benefit all children. Aboriginal community‐controlled organisations can use these data to design culturally‐specific programs that may improve disparities in healthy weight and HRQoL., Aboriginal and Torres Strait Islander peoples have lived on the lands, now known as Australia, for over 65,000 years, and are one of the world's oldest continuous populations.[sup.1] Compared to [...]

Background: Achieving nutrition and health equity warrants understanding lived experiences of marginalisation. Yet, people with diverse lived experiences are often inadequately included in food policy advocacy, agenda setting, and development. We aimed to explore cross-sectoral perceptions of engaging people with lived experiences of marginalisation in food policymaking in Australia, specifically in terms of challenges, enablers, required actions, and potential outcomes of doing so. Methods: In-depth semi-structured interviews were conducted with 24 people with expertise in food policy and/or community engagement from academic, government, advocacy, and community sectors. Interviews were inductively and deductively coded using the Knowledge-to-Action framework. Results: Participants identified few food policymaking examples where people with lived experience have been meaningfully engaged. Reported barriers included the lack of time, resources, and prioritisation across sectors and the lack of political commitment to inclusive policymaking. Having access to successful examples, existing networks of actors and flexible funding were among the few enablers identified. Several actions were deemed necessary to effectively engage people with lived experience in food policymaking and improve current practice: (1) having a dedicated budget; (2) enabling true collaboration where people with lived experience are valued, effectively engaged, sufficiently represented, have the opportunity to work alongside decision-makers, and where power is equalised; (3) striving to do no harm to the people engaged; and (4) ensuring results from engaging people with lived experience are effectively disseminated. Conclusions: We provide a list of practical recommendations to guide more inclusive, equitable and fit-for-purpose food policymaking into the future. These recommendations seek to challenge dominant systems of discrimination by demonstrating how we can tangibly shift to ways of working that value and elevate the power of people who are often excluded from many decision-making systems, specifically when it comes to food and nutrition. [ABSTRACT FROM AUTHOR]

Background: Childhood obesity is a preventable global public health challenge, increasingly recognized as a complex problem, stemming from complex drivers. Obesity is characterized by multiple interdependencies and diverse influences at different societal levels. Tackling childhood obesity calls for a holistic approach that engages with complexity and recognizes that there is no single "magic bullet" intervention to prevent obesity. To facilitate a shared understanding of the complex structures and relationships that determine children's weight development, systems approaches have shown promising potential. However, systems approaches require more development and research in public health. Aim: This paper describes the processes of gathering national stakeholders to create a system map of childhood obesity drivers in Denmark to map existing obesity prevention initiatives and define real-world actions to prevent childhood obesity in local communities in Denmark. The system map and action ideas will inform the development of community-based activities in a large-scale national study, the Generation Healthy Kids Study. Methods: During two workshops in the autumn of 2022, national stakeholders (n = 45) were involved in generating and revising a system map. We used a scripted approach inspired by group model building and community-based systems dynamics methods to engage stakeholders, collect and visualize their knowledge on childhood obesity, create consensus on the drivers of childhood health, identify local and national intervention opportunities for prevention of childhood obesity and develop actions to create system changes. Results: The study identified the following six sub-systems of factors influencing childhood obesity: (1) family; (2) diet and dietary habits; (3) physical activity and active living; (4) mental health and wellbeing; (5) screen, media and sleep; and (6) competencies of professionals. Conclusions: A systems approach to childhood obesity was useful to generate a shared understanding of the underlying drivers of childhood overweight and obesity and has potential for informing initiatives at local and national level in Denmark. However, challenges were experienced regarding the usefulness of the system mapping process, with a tension between the map as a step in a shared process towards actions and the map as means to gain a deeper understanding of the complex system of childhood overweight and obesity and how to change the system. [ABSTRACT FROM AUTHOR]

Randomised controlled trials (RCTs) are the gold standard for evaluating health interventions but often face ethical and practical challenges. When RCTs are not feasible, large observational data sets emerge as a pivotal resource, though these data sets may be subject to bias and unmeasured confounding. Traditional statistical (or non-causal) learning methods, while useful, face limitations in fully uncovering causal effects, i.e., determining if an intervention truly has a direct impact on the outcome. This gap is bridged by the latest advancements in causal inference methods, building upon machine learning-based approaches to investigate not only population-level effects but also the heterogeneous effects of interventions across population subgroups. We demonstrate a causality approach that utilises causal treesand forests, enhanced by weighting mechanisms to adjust for confounding covariates. This method does more than just predict the overall effect of an intervention on the whole population; it also gives a clear picture of how it works differently in various subgroups. Finally, this method excels in strategising and optimising interventions, by suggesting precise and explainable approaches to targeting the intervention, to maximise overall population health outcomes. These capabilities are crucial for health researchers, offering new insights into existing data and assisting in the decision-making process for future interventions. Using observational data from the 2017-18 Australian National Health Survey, our study demonstrates the power of causal trees in estimating the impact of exercise on BMI levels, understanding how this impact varies across subgroups, and assessing the effectiveness of various intervention targeting strategies for enhanced health benefits. [ABSTRACT FROM AUTHOR]

Obesity prevention is an urgent public health priority that requires action at multiple levels. Collaboration between academics, policy and practice is necessary to ensure best-practice implementation. A national knowledge translation and exchange (KT) platform, the Collaboration of Community-based Obesity Prevention Sites (CO-OPS), was delivered and evaluated over three years (2013-15). A mixed-methods evaluation used communications and website data, knowledge-brokering data, event evaluations, interviews and tracer searches to assess process (reach, delivery, quality, cost, uptake) and impact (use of tools/resources, networking, improvements in practice). Results included: 1) average 27% yearly membership growth (330 new members per year) in response to KT activities including tailored communications, stakeholder engagement, knowledge brokering and networking opportunities; 2) sustained website use with approximately 1200 visits/month and 73% unique visitors; and high access to networking and professional development information (120 hits/month), and best practice guidelines (60 hits/month); 3) higher uptake of face-to-face interactive strategies (for example, workshops) than online interactive strategies (for example, knowledge broker service) and higher uptake of passive KT (for example, website resources) than interactive KT strategies (for example, workshops); 4) the KT function of CO-OPS was clearly valued, and appeared to address a gap in implementation. A central coordinating KT platform provided support for best practice and exchange opportunities to a broad network of practice, policy and academic professionals. Simple KT strategies such as tailored, targeted online resources were useful for practice, whilst more intensive KT strategies were important for network engagement. Findings are applicable to other information-sharing networks where professionals address complex public health problems.

Objective: To determine (i) the prevalence of overweight and obesity among children presenting to all EDs in a large regional Australian city and (ii) whether age, sex, socioeconomic status (SES) or hospital setting (public vs private) were associated with overweight and obesity. Methods: This prospective observational study included children aged ≥2 and <18 years who presented to any of three EDs over an 18 month period who had their height and weight measured. Age, sex and residential postcode were collected. Weight category was determined by sex and age standardised body mass index (BMI) z‐score. Weight category was assessed by sex, age, SES and hospital setting with chi‐squared tests, and ordinal logistic regression with cluster sandwich error estimators. Results were reported using odds ratios (OR) with 95% confidence intervals (CI). Results: Data were collected for 3827 children, of which 11.6% were obese and 19.8% overweight. The prevalence of obesity was highest in those aged 8–14 years and in those from lower SES postcodes. The likelihood of obesity was higher in the public than the private hospitals (OR 0.66, 95% CI 0.51–0.86), whereas the likelihood of overweight was similar (OR 1.00, 95% CI 0.83–1.22). Conclusions: Almost one‐third of children who presented to EDs were overweight or obese. Obesity was particularly high in those aged 8–14 years and those from lower SES postcodes. In the evolving obesity crisis, the high proportion of children presenting to EDs above a healthy weight might represent an opportunity for EDs to identify and refer children for body weight and lifestyle management. [ABSTRACT FROM AUTHOR]