Treatment and Prevention of Childhood Obesity in Appalachia: A Literature Review of Interventions

BACKGROUND: It is essential to combat the growing epidemic of childhood obesity in the United States by focusing on regions with the highest obesity rates and the lowest amount of resources. Attention should be geared towards these rural communities as they face unique challenges and require tailored interventions specific to the culture and lifestyle of their residents. The aim of this study is to assess the effectiveness of childhood obesity interventions within Appalachia and evaluate the challenges associated with the interventions conducted in this region. 

METHODS: Due to the small quantity of studies conducted in this region, the study inclusion criteria were broadened. Interventions included were randomized or non-randomized clinical trials with a minimum duration of 8 weeks, quasi-experimental studies and pilot studies conducted in Appalachia.  Studies must indicate results for weight, behavior or weight-related outcomes pre- and post- intervention. Interventions were considered any program specifically targeted at obesity prevention and management in children aged 2-19 years. Data sources used were MEDLINE (PubMed of the U.S. National Library of Medicine), PsychINFO, CINAHL and The Cochrane Central Register of Controlled Trials (CENTRAL), GOOGLE Scholar.

RESULTS: Of the sixteen interventions reviewed, six were community-based, five were school-based, three were family-based and two were combinations of all three types. Eleven interventions were a combination of diet and physical activity. Three studies focused on diet alone and two on physical activity alone. Nine of the sixteen studies showed improvement in dietary behavior, physical activity or a weight-related outcome. The challenges of these interventions did not appear to be related to the intervention type or demonstrated success. Rural communities suffered lack of access to healthy foods and exercise facilities therefore executing intervention recommendations proved difficult for participants. Projects often faced challenges subject retention and follow up. Parent involvement and motivation was a frequently reported issue throughout studies.  In addition, due to scarce community resources, collaborative efforts between projects and communities proved complex. 

CONCLUSIONS:  There exists a paucity of research focusing on childhood obesity interventions in Appalachia. Of those found, approximately half of interventions were successful however they all faced similar challenges. Child obesity programs in rural areas such as Appalachia can overcome these challenges by tailoring their interventions to the specific culture of the region. Cultural competence is critical to change and achieved only via the collaboration of communities, health professionals, researchers and families.