Tuesday, May 14, 2013

No strong evidence that effectiveness of Dutch behavioral nutrition and physical activity interventions differ according to socio-economic status

Reducing health inequalities is a policy priority in many countries. Socio-economic status (SES) differences in obesity and its underlying health behaviors, i.e. diet, physical activity and sedentary behaviors, are among such important health inequalities in many affluent as well as developing countries. Although such inequalities have been well-documented, we are still largely in the dark when it comes to how we can reduce such inequalities. One way to shed some more light on this issue is to  investigate differential effectiveness of interventions aimed at obesity
prevention, the promotion of physical activity or a healthy diet by SES, i.e. to study is such interventions work for different SES groups.
In a paper just published in the American Journal of Preventive Medicine, first authored by Tessa Magnee and led by Frank van Lenthe, 26 Dutch studies conducted since 1990 were re-analysed for this purpose.  Seven of these lifestyle interventions were rated more effective and four less effective in groups with high SES; for 15 studies no differential effects could be demonstrated. If we looked at the specific settings and strategies of these interventions the following pattern appeared: the one study conducted in the healthcare setting showed comparable effects in both socioeconomic groups. The only mass media campaign provided modest evidence for higher effectiveness among those with high SES. Individually tailored and workplace interventions were either more effective in higher-SES groups or no differential effects were demonstrated. School-based studies showed mixed results. Two of six community studies provided evidence for better effectiveness in lower-SES groups; none were more effective in higher-SES groups. One high-intensity community-based study provided best evidence for higher effectiveness in low-SES groups.
We concluded that for the majority of interventions aimed at obesity prevention, no strong systematic differences in effects could be established. Interventions may widen as well as reduce socioeconomic inequalities in these outcomes.