Reacción a "Programs focused on parents are insufficient to prevent childhood obesity, according to a meta-analysis"

"The study is of good quality. Clear evidence of this is that it is published in a scientific journal with an impact factor of 18.0, which places it at number 6 out of 419 scientific journals indexed in the field of PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH. As it is a systematic review with meta-analysis, it includes the best scientific evidence available up to a year ago (September 30, 2024) and data from the 17 studies with the greatest methodological rigor; therefore, the data are more than solid".

How does it fit in with the existing evidence?

"It adds to the evidence obtained for other age groups, which has already pointed out that primary prevention interventions for childhood obesity have difficulty achieving statistically significant improvements in weight status and, above all, clinically relevant improvements. As the article concludes, it is advisable to rethink this type of intervention, and I would add that this rethinking should consider the conceptualization, theoretical foundations, methodologies, and activities as a whole".

Are there any important limitations to consider?

"It does not include quasi-experimental intervention studies, and we agree that it should only include the best available scientific evidence. However, it would be interesting to know what the results would be if these quasi-experimental trials were also included".

Can the conclusions be extrapolated to Spain, even though data from Spain were not analyzed in the study?

"In behavioral sciences based on a social determinants of health approach, it is always advisable to take into account the economic, cultural, and political context in which the study is conducted. However, for this particular meta-analysis and due to the globalization that has taken place worldwide in recent decades, we believe that the results would also be similar in Spain".

Does this mean that family interventions do not work, or that they do not work on their own?

"It means that the scientific evidence to date does not find favorable results for the interventions analyzed, which can be highly questioned in terms of conceptualization, theoretical foundations, and methodology.

On the one hand, family interventions aimed at families with children under 12 months of age should address the root causes and avoid merely recommending specific health habits to be carried out. Such interventions should promote the self-efficacy of the adults in the family unit. This means ensuring that they are deeply convinced that they have the necessary skills to introduce healthy lifestyle habits in their children's development from the earliest stages of life. They should also promote maternal and parental skills around positive parenting that help them to properly introduce complementary feeding, motor development, the incorporation of sleep habits, and the building of a positive emotional bond within the family unit. Finally, it is important to promote their resilience, as this will enable them to adapt in the healthiest way possible to an obesogenic environment that makes it difficult for them to deploy their innate skills in the parenting process. This is how we are evaluating it at the Gasol Foundation through an innovative intervention study focused on early childhood.

On the other hand, through political, legislative, economic, and social measures, it would be advisable to transform the environments and systems in which children currently develop from birth and which clearly influence families who try to develop their skills but encounter many difficulties in doing so effectively.

In short, interventions must be based on an approach that takes into account the social determinants of health, moving away from the mere clinical prescription of behaviors to be carried out, and transforming them into intervention models that facilitate the full deployment of the maternal-parental role of families".

What might the implications be for the design of public policies?

"On the one hand, priority must be given to transforming the social and economic systems in which children currently grow up with their families, and this must be reflected in changes to the environments in which they spend their first months/years of life. Far-reaching policy measures such as the National Strategic Plan for the Reduction of Childhood Obesity (PENROI) should be more common worldwide, and in the case of Spain, efforts should be made to implement the 200 measures it includes by 2030. National, regional, or local plans and strategies specifically aimed at promoting health in a broad and holistic sense in early childhood would also contribute significantly to ensuring that the next meta-analysis on this type of intervention presents more favorable results. It also implies a change of model in the design and evaluation of preventive interventions in public health and, specifically, in community health. We need to move from purely biological approaches with biomedical and clinical approaches to much more social approaches based on the psychosocial determinants of health behaviors that make effective health promotion at the community level possible".