Trend Impact Analysis (TIA) of community-based futures study for pediatric obesity in Iran.

BACKGROUND: Childhood obesity has been regarded as one of the main healthcare challenges in the last century, leading to critical health problems and reduced life expectancy. Many factors can play a role in its development or prevention. Using the Trend Impact Analysis (TIA), this study aimed to conduct a community-based futures study for pediatric obesity in Iran. METHODS: We obtained the prevalence of overweight and obesity from the database of the Ministry of Health and Medical Education. Moreover, we reviewed 21 documents, texts, and comments from three key stakeholders in Iran and prepared a list of key experts, who were stakeholders in the field of obesity prevention of childhood in different organizations. Then, we collected the expert opinions by Delphi method. Data analysis was performed using the Excel and R software. RESULTS: Fourteen experts participated in the first stage and nine experts in the second stage. We identified two positive drivers, including the prevalence of coronavirus disease 2019 (COVID-19) and the widespread expansion of online educational programs. Meanwhile, we identified five negative drivers as follows: (1) controlling and limiting obesogenic environments in the community, school, and family; (2) running annual compulsory anthropometry programs for students of all educational levels in health centers; (3) integrating nutrition education interventions in the curricula of all educational levels; (4) taxation of unhealthy and fast foods; and (5) preparing safe and appropriate sports environments for children and adolescents (on the streets, schools, parks, and sports clubs). Without considering the drivers, the prevalence of overweight and obesity is predicted to reach 29.10% in 2031. However, it is expected that the negative drivers can increase the prevalence trend from 23.40% in 2018 to 19.57% in 2031, the positive drivers to 32.61%, and the combination of all drivers to 23.07%. CONCLUSION: It seems that measures such as the effective communication of policy makers, basic evaluation of the programs and policies related to the prevention of childhood obesity, and localization of the programs of international organizations for the prevention of obesity can greatly control the prevalence of childhood obesity.

Stakeholders perspectives of barriers and facilitators of childhood obesity prevention policies in Iran: A Delphi method study.

BACKGROUND: The prevalence of obesity among children and adolescents is one of the most important health challenges of the present century. Many factors affect the prevention policies related to this health problem and make their implementation difficult. This study examined perceived barriers and facilitators of childhood obesity prevention policies by stakeholders. METHODS: A qualitative descriptive research design based on Delphi method was conducted. In addition, semi-structured one-to-one interviews were conducted with childhood obesity prevention policy stakeholders (n=39) and initial identification of barriers and facilitators in this area. Interviews were digitally recorded, transcribed verbatim, and finally analyzed, followed by using thematic analysis. Subsequently, two-round Delphi panel was done by sending e-mails to stakeholders (21 stakeholders participated in the first round and 15 stakeholders in the second round) for the final selection of barriers and facilitators of obesity prevention policies among children and adolescents in Iran. RESULTS: The identified barriers and facilitators were divided into three levels: individual, executive, and structural. Barriers and facilitators of the structural level showed a high score and priority regarding obesity prevention policies among children and adolescents. CONCLUSION: The existence of significant barriers at all three levels and especially at the structural level were among the concerns of stakeholders.

Childhood obesity prevention policies in Iran: a policy analysis of agenda-setting using Kingdon's multiple streams.

BACKGROUND: Pediatric obesity is one of the most important health challenges of the twenty-first century. Primary prevention of childhood obesity, can lessen its consequences. This study aims to assess childhood obesity prevention policies in Iran through a policy analysis of agenda-setting using Kingdon's multiple streams. METHODS: A qualitative study was conducted using in-depth interviews with 39 key informants and document review from different stages of the policymaking process of childhood and adolescent obesity prevention programs in Iran. The analysis of documents and interviews were guided based on Kingdon's multiple streams (problem, policy and political streams). RESULTS: The important factors of the problem stream were the high prevalence of childhood and adolescent obesity and its risk factors in Iran. In the policy stream, a focus on preventing non-communicable diseases in the health system, increasing the workforce in health centers, promoting health school programs, and creating healthy eating buffets in schools was identified. Under the political stream, the impact of the WHO ECHO program in 2015 and the implementation of the health system transformation plan in Iran in the new government took place after 2013, caused the Iran ECHO program entered the agenda and implemented from 2016. CONCLUSIONS: Now that a window of opportunity for childhood and adolescent obesity prevention policymaking has been created, the problems such as the therapeutic approach in the health system, the existence of sanctions against Iran and outbreak of coronavirus disease-19 (COVID-19), have hindered the successful implementation of this policy and the opportunity window has not been well used. However, actors need political support from the high levels of government to keep this policy on the agenda.

The effectiveness of pediatric obesity prevention policies: a comprehensive systematic review and dose-response meta-analysis of controlled clinical trials.

BACKGROUND: Childhood obesity persists as a serious public health problem. In the current meta-analysis, we summarized the results of controlled trials that evaluated the effect of obesity prevention policies in children and adolescents. METHODS: Three databases (SCOPUS, PubMed and Embase) were searched for studies published before the 6th April 2020, by reported outcome measures of body mass index (BMI) and BMI-Zscore. Forty-seven studies reported BMI, while 45 studies reported BMI-Zscore as final outcome. RESULTS: The results showed that the obesity-prevention policies had significant effect in reducing BMI (WMD: - 0.127; CI - 0.198, - 0.056; P < 0.001). These changes were not significant for BMI-Zscore (WMD: - 0.020; CI - 0.061, 0.021; P = 0.340). In dose-response meta-analysis, a non-linear association was reported between the duration of intervention and BMI (Pnonlinearity < 0.001) as well as BMI-Zscore (Pnonlinearity = 0.023). In subgroup analysis, the more favorite results were observed for 5-10 years old, with combination of physical activity and diet as intervention materials. CONCLUSION: In conclusion, the obesity prevention policies in short-term periods of less than 2 years, in rather early age of school with approaches of change in both of diet and physical activity, could be more effective in prevention of childhood obesity. Trial registration PROSPERO registration number: CRD42019138359.

Barriers and facilitators of childhood obesity prevention policies: A systematic review and meta-synthesis.

Objectives: Childhood obesity is one of the worldwide considerable public health challenges and many factors can play a role in its management. Therefore, this article examined the facilitators and barriers of childhood obesity prevention (COP) policies. Methods: This systematic review of qualitative studies was conducted via a search of the SCOPUS, PubMed, and Google Scholar databases between 1 January 2010 and 11 February 2022 and examined factors that influence the implementation of COP policies at a community approach. Results: The parents' reluctance to engage in COP activities, lack of sufficient knowledge, and financial problems were the most reported barriers at the individual level. In addition, the beliefs about COP at the sociocultural level and limited funding and resources, time limitations in stakeholders at the implementation level, and lack of policy support at the structural level were the most frequently reported barriers. Further, effective communication between stakeholders and parents and school staff at the sociocultural level and flexibility of the intervention, delivery of healthy food programs in schools, low-cost and appropriate resources, and the availability of appropriate facilities are the most frequently reported facilitators in the structural level. Conclusion: Individual, sociocultural, and structural level-related barriers and facilitators influence the implementation of COP policies. Most of the barriers and facilitators in this systematic review were related to the structural level.

Stakeholder analysis of childhood obesity prevention policies in Iran.

BACKGROUND: Childhood obesity is one of the most serious health challenges and risk factors for various diseases. International health organizations, such as the World Health Organization (WHO), recommend more stakeholder engagement to discuss this health problem. Therefore, this study aims to identify and analyze the stakeholders of childhood obesity prevention (COP) policy making process in Iran. METHODS: In this study, semi-structured interviews were conducted with 24 Iranian stakeholders in the field of COP from February 2019 to May 2020. PolicyMaker V.4 and MAXQDA V.10 software were used for the analysis of stakeholders. RESULTS: Out of 24 interviewed stakeholders, 17 were active and seven were inactive. The most powerful and supportive stakeholders were the Ministry of Health and Medical Education (MoHME) and the national and regional Offices of Community Nutrition Improvement. Although stakeholders like the Ministry of Sports and Youth, the municipalities, the Secretariat of the Health and Food Safety, the Islamic Republic of Iran Broadcasting (IRIB), and Student Organization were among powerful bodies, they showed the least support for COP policies. The remaining stakeholders showed medium or low support and power in the policy making process. CONCLUSIONS: Disconnect between stakeholders, less attention to prevention strategies, and high advertising of unhealthy foods were among the main challenges facing the COP policies in Iran and worldwide. Insufficient financial resources, little attention to the young people under 18, non-aligned policies of the Student Organization and the IRIB, and insufficient support of COP policies were among the key challenges to be handled.

Predictors of Childhood High Blood Pressure among Overweight and Obese Children and Adolescents according to the Lifestyle-Scoring Algorithm Using Data from Iranian Health Care Reform Plan.

In this study, the association between dietary pattern and lifestyle in predicting hypertension (HTN) among 425 overweight and obese children and adolescents aged 6 to 18 years was evaluated. In the current cross-sectional study, the lifestyle-scoring algorithm was developed considering the Iranian Health Reform Plan (HRP) criterion. HTN was defined according to standard protocols. Hierarchical linear regression models were used for the analysis. The prevalence of overweight/obesity was 5.82%. The results showed that systolic and diastolic blood pressure (SBP, DBP) had significant positive correlation with age (p < 0.001 and p < 0.001) and body mass index (BMI) (p < 0.005 and p < 0.007), respectively. Moreover, DBP had a significant correlation with fruit consumption of less than 2 servings per day versus no consumption (p = 0.014, B = 0.444), fruit consumption of more than 2 servings per day versus no consumption (p = 0.014, B = 0.480), and vegetable consumption less than 3 servings per day versus no consumption (p = 0.045, B = -0.374). Moreover, DBP had a significant correlation with fast foods/junk foods consumption of 1-2 items per week versus almost daily consumption (p = 0.047, B = -0.177). The final model could predict 32.1% of HTN by SBP and DBP (R2 = 0.32). According to our findings, lower intake of vegetables and fruits, higher amounts of fast foods, higher age and BMI could be potent predictors of high blood pressure among Iranian children and adolescents.

The Role of Lipids in the Pathogenesis of Metabolic Syndrome in Adolescents.

The increasing prevalence of childhood obesity is a driving force behind the increase in adolescent's metabolic syndrome (MetS). Although there is no clear consensus about the pediatric definition for MetS, this syndrome is becoming very common among adolescents. It is characterized by insulin resistance (IR), dyslipidemia, abdominal obesity and hypertension, and is associated with a high risk of type 2 diabetes mellitus and CVD in adulthood. Due to the increasing prevalence of obesity, there is strong incentive to reduce the impact of the adverse health effects associated with MetS. We explored the etiological role of nutrient-derived metabolic stressors, especially fatty acids, in the development of obesity and MetS. We also reviewed the evidence that pro-inflammatory stressors may predispose to obesity-induced insulin resistance. This article presents the opinion that reducing the impact of metabolic and inflammatory stressors may reduce the adverse health effects of obesity, and slow the progression towards MetS and CVD in adolescents. Evidence so far is limited from pediatric dietary epidemiological and interventional studies investigating the potential preventive and therapeutic effects of dietary fatty acid modification. This review will further investigate our understanding of the interaction between fatty acids in the pathogenesis and progression of MetS in adolescents.