Effectiveness of Policies and Programs to Combat Adult Obesity: a Systematic Review

Eva Tseng, Allen Zhang, Oluwaseun Shogbesan, Kimberly A. Gudzune, Renee F. Wilson, Hadi Kharrazi, Lawrence J. Cheskin, Eric B. Bass, Wendy L. Bennett

Research output: Contribution to journalReview articlepeer-review


Background: This systematic review identifies programs, policies, and built-environment changes targeting prevention and control of adult obesity and evaluates their effectiveness. Methods: We searched PubMed, CINAHL, PsycINFO, and EconLit from January 2000 to March 2018. We included natural experiment studies evaluating a program, policy, or built-environment change targeting adult obesity and reporting weight/body mass index (BMI). Studies were categorized by primary intervention target: physical activity/built environment, food/beverage, messaging, or multiple. Two reviewers independently assessed the risk of bias for each study using the Effective Public Health Practice Project tool. Results: Of 158 natural experiments targeting obesity, 17 reported adult weight/BMI outcomes. Four of 9 studies reporting on physical activity/built environment demonstrated reduced weight/BMI, although effect sizes were small with low strength of evidence and high risk of bias. None of the 5 studies targeting the food/beverage environment decreased weight/BMI; strength of evidence was low, and 2 studies were rated high risk of bias. Discussion: We identified few natural experiments reporting on the effectiveness of programs, policies, and built-environment changes on adult obesity. Overall, we found no evidence that policies intending to promote physical activity and healthy eating had beneficial effects on weight/BMI and most studies had a high risk of bias. Limitations include few studies met our inclusion criteria; excluded studies in children and those not reporting on weight/BMI outcomes; weight/BMI reporting was very heterogeneous. More high-quality research, including natural experiments studies, is critical for informing the population-level effectiveness of obesity prevention and control initiatives in adults.

Original languageEnglish (US)
Pages (from-to)1990-2001
Number of pages12
JournalJournal of general internal medicine
Issue number11
StatePublished - Nov 1 2018


  • obesity
  • prevention
  • systematic reviews

ASJC Scopus subject areas

  • Internal Medicine


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