A Framework for Decision-Making for Obesity Prevention: Integrating Action with Evidence
The Institute of Medicine is conducting an ad hoc study to develop a framework for evidence-informed decision-making in obesity prevention efforts. While focused on obesity prevention, this framework could guide more general efforts to assess and use scientific evidence in complex, multifactorial public health challenges. The obesity prevention framework focuses on approaches for assessing policy- and community-level interventions designed to influence food, eating, and physical activity environments. It is guided by the need for a systems approach that explicitly takes into account the social contexts in which decisions are made and the multiple interacting determinants of policy and community action. In developing the framework, the committee will:
1) Provide an overview of the current nature of the evidence base, i.e., the types of evidence that are available on the results of community- and policy-based obesity prevention initiatives. This overview includes current methods used to characterize the evidence base and the challenges involved in applying traditional evidence hierarchies to population-based prevention efforts. This overview is not meant to be carried out by an exhaustive literature review but rather through the examination of case studies and existing reviews.
2) Identify the challenges faced in integrating scientific evidence into the broader array of factors that influence community interventions and policy change. For example:
- Obesity prevention decision-making and research occurs in diverse and dynamic social contexts.
- Determinants of obesity are embedded in and interventions are fielded in complex and multi-level systems.
- Acceptable levels of internal and external validity need to be achieved.
- Public and private vested interests in the status quo exist.
- Ethical and practical limits of experimentation are present in potential pathways of change.
3) Provide practical, action-oriented recommendations for choosing, implementing and evaluating obesity prevention efforts employing this framework. Innovative assessment and funding strategies for overcoming barriers to funding research and evaluation efforts have been suggested. The recommendations included examples and/or case studies, where available, of how scientific evidence has been effectively integrated with other sources of knowledge to achieve positive social change.
4) Identify what new research tools and methods, including better ways to take advantage of natural and spontaneous experiments, may be needed to build a useful and timely evidence base given the particular challenges of assessing complex, multi-level interventions.
5) Develop a plan for communicating and disseminating the framework and recommendations.
6) Specify a plan for evaluating and refining the framework by applying it to current decision-making processes.
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