Reacción a "Programs focused on parents are insufficient to prevent childhood obesity, according to a meta-analysis"

This is a high-quality study that provides very interesting systematic information on a key issue in global public health. The limitations are discussed in the article and in the press release, but they do not appear to have a significant impact on the validity of the results. The results and conclusions are perfectly valid for the context of developed countries and therefore for Spain.

The most important thing is to emphasize the conclusion of the study:

“Our findings indicate that existing early, behavioral, parent-focused interventions alone are insufficient to address childhood obesity.”

The conclusion is that this type of intervention is not sufficient. It is important not to overreach this conclusion and turn it into a decision that, since their effectiveness has not been proven, this type of intervention should be abandoned, as could be inferred from the headline of the press release.

“A meta-analysis of 17 trials including over 9,000 toddlers found no evidence that parent-focused early childhood obesity prevention programs have an impact on young children's BMI.”

On the contrary, as the author herself explains, it is necessary to investigate how to improve them, incorporating new psychosocial intervention methodologies or targeting other age groups and systematizing interventions to facilitate their evaluation. The problem is important enough to continue researching better forms of intervention.

However, the authors raise a second issue that is paramount: the importance of the obesogenic social environment, which makes it difficult for parents to take effective measures and places the burden on them to solve a problem that has a clearly social root:

“Yet, obesity is predominantly driven by upstream environmental and socioeconomic factors that are beyond the capacity of the individual to change.”

These assumptions are considered in the theoretical contributions of Geoffrey Rose, who says that health and disease phenomena are a continuum in the population, and contrasts the strategies commonly used by health services to intervene in sick individuals or those at highest risk with population-based strategies that work with the population as a whole and address the determinants of health problems. In the case of children's nutrition, as the author herself explains, factors such as regulating advertising of unhealthy foods, improving access to healthy foods, availability of spaces for physical activity, etc.

This perspective is perfectly illustrated in Katz's statement, which compares obesity to a flood in which each intervention is a sandbag in a much-needed dike; none of them can stop it, and only when we have done enough things in enough places will they add up to build a dike higher than the water level.

Unfortunately, interventions on structural factors clash with the interests of large corporations in the food industry. In a Lancet article from 2014, McPherson estimated that ‘to prevent health consequences that will be unsustainable, Body Mass Index must return to levels seen 30 years ago in the UK. This would mean an 8% reduction in consumption, costing the food industry £8.7 billion a year’. He therefore wonders whether this will be possible in a neoliberal and competitive world.