A Systems Based Typological Framework for Understanding the Sustainability, Scalability, and Reach of Childhood Obesity Interventions
This article proposes a systems based framework to examine 3 structural dimensions of childhood obesity interventions that can impact intervention sustainability, scalability, and reach. These 3 dimensions are the locus of intervention drivers (top down vs. bottom up) the locus of change effected (policy vs. individual behavior) and the public versus private sector. Interventions focused on individual behavior change often rely on bottom up approaches and have generally been less sustainable than policy interventions. However, top down (government or industry) support can lead to better funding and shifts in social norms. In the public sector, top down efforts targeting individual behavior are generally also more scalable and have wider reach to diverse communities. In the private sector, behavior change interventions tend to have greater resources and are sustained over longer periods, even when efficacy is in question; they may also be quite scalable. In a systems approach, a combination of approaches that encompass the structural dimensions in systems space will likely be needed to significantly impact childhood obesity. Next generation childhood obesity interventions should be able to demonstrate sustainability, scalability, and reach as benchmarks of plausible success and criteria for investment.