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      Using natural experiments to improve public health evidence: a review of context and utility for obesity prevention

      Health Research Policy and Systems
      BioMed Central
      natural experiments, obesity prevention, evaluation methods, study design, physical activity, nutrition, population health interventions, narrative review

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          Abstract

          Background

          Natural experiments are increasingly valued as a way to assess the health impact of health and non-health interventions when planned controlled experimental research designs may be infeasible or inappropriate to implement. This study sought to investigate the value of natural experiments by exploring how they have been used in practice. The study focused on obesity prevention research as one complex programme area for applying natural experiment studies.

          Methods

          A literature search sought obesity prevention research from January 1997 to December 2017 and identified 46 population health studies that self-described as a natural experiment.

          Results

          The majority of studies identified were published in the last 5 years, illustrating a more recent adoption of such opportunities. The majority of studies were evaluations of the impact of policies ( n = 19), such as assessing changes to food labelling, food advertising or taxation on diet and obesity outcomes, or were built environment interventions ( n = 17), such as the impact of built infrastructure on physical activity or access to healthy food. Research designs included quasi-experimental, pre-experimental and non-experimental methods. Few studies applied rigorous research designs to establish stronger causal inference, such as multiple pre/post measures, time series designs or comparison of change against an unexposed group. In general, researchers employed techniques to enhance the study utility but often were limited in the use of more rigorous study designs by ethical considerations and/or the particular context of the intervention.

          Conclusion

          Greater recognition of the utility and versatility of natural experiments in generating evidence for complex health issues like obesity prevention is needed. This review suggests that natural experiments may be underutilised as an approach for providing evidence of the effects of interventions, particularly for evaluating health outcomes of interventions when unexpected opportunities to gather evidence arise.

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          Most cited references83

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          Health Effects of Overweight and Obesity in 195 Countries over 25 Years.

          Background While the rising pandemic of obesity has received significant attention in many countries, the effect of this attention on trends and the disease burden of obesity remains uncertain. Methods We analyzed data from 67.8 million individuals to assess the trends in obesity and overweight prevalence among children and adults between 1980 and 2015. Using the Global Burden of Disease study data and methods, we also quantified the burden of disease related to high body mass index (BMI), by age, sex, cause, and BMI level in 195 countries between 1990 and 2015. Results In 2015, obesity affected 107.7 million (98.7-118.4) children and 603.7 million (588.2- 619.8) adults worldwide. Obesity prevalence has doubled since 1980 in more than 70 countries and continuously increased in most other countries. Although the prevalence of obesity among children has been lower than adults, the rate of increase in childhood obesity in many countries was greater than the rate of increase in adult obesity. High BMI accounted for 4.0 million (2.7- 5.3) deaths globally, nearly 40% of which occurred among non-obese. More than two-thirds of deaths related to high BMI were due to cardiovascular disease. The disease burden of high BMI has increased since 1990; however, the rate of this increase has been attenuated due to decreases in underlying cardiovascular disease death rates. Conclusions The rapid increase in prevalence and disease burden of elevated BMI highlights the need for continued focus on surveillance of BMI and identification, implementation, and evaluation of evidence-based interventions to address this problem.
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            The global obesity pandemic: shaped by global drivers and local environments

            The Lancet, 378(9793), 804-814
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              The need for a complex systems model of evidence for public health

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                Author and article information

                Contributors
                melanie.crane@sydney.edu.au
                erika.goldbaum@sydney.edu.au
                anne.grunseit@sydney.edu.au
                adrian.bauman@sydney.edu.au
                Journal
                Health Res Policy Syst
                Health Res Policy Syst
                Health Research Policy and Systems
                BioMed Central (London )
                1478-4505
                18 May 2020
                18 May 2020
                2020
                : 18
                : 48
                Affiliations
                GRID grid.1013.3, ISNI 0000 0004 1936 834X, The Australian Prevention Partnership Centre, Sydney School of Public Health, Charles Perkins Centre, , The University of Sydney, ; Camperdown, NSW Australia
                Article
                564
                10.1186/s12961-020-00564-2
                7236508
                32423438
                1008dfb4-5fe4-4fe2-96fe-16bd3129d6e3
                © The Author(s) 2020

                Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data.

                History
                : 18 September 2019
                : 13 April 2020
                Funding
                Funded by: National Health and Medical Research Council of Australia
                Award ID: GNT9100001
                Categories
                Review
                Custom metadata
                © The Author(s) 2020

                Health & Social care
                natural experiments,obesity prevention,evaluation methods,study design,physical activity,nutrition,population health interventions,narrative review

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