Who benefits? differential impacts of universal childhood obesity interventions: A systematic review

Background: In recent years, jurisdictional action has largely addressed childhood obesity through universal interventions, with the expectation to benefit all children. Although, given that childhood obesity disproportionately impacts society's most vulnerable children, it is worth examining which socio-demographic groups benefit, or do not benefit, from universal childhood obesity interventions; ultimately revealing the impact on health inequities. Objective: The purpose of this systematic review is to assess the differential impacts of universal childhood obesity interventions on various socio-demographic groups.

Methods: Four electronic databases were systematically searched (MEDLINE, EMBASE, PsycINFO and CINAHL) for articles on universal obesity interventions, targeting children (0-18 years), that stratified outcomes (e.g. body mass index, physical activity level, diet) by socio-demographic groups (e.g. socioeconomic status, race/ethnicity, gender). To be included, the articles also had to explicitly focus on health equity. Only peer-reviewed publications, published between 2005 and 2012, were considered. No study design restrictions were imposed. The search retrieved a total of 4715 abstracts and titles, of which 7 met the inclusion criteria (to date).

Preliminary Results: The seven studies included stratified by at least one socio-demographic variable. By and large, the studies demonstrated mixed results; however, an initial trend shows that universal childhood obesity interventions may be less beneficial for vulnerable children, if at all, as compared to their more advantaged counterparts.

Discussion: These preliminary results reveal an ethical and moral public health issue. Universal childhood obesity interventions may be less effective for children most in need, thus potentially exacerbating inequities in obesity rates.