Introduction: The increasing prevalence of obesity world-wide has prompted its prevention as a priority. A common approach to obesity prevention is the implementation of whole-of-community (WOC) interventions. A recent meta-analysis concluded that WOC interventions lead to modest reductions in population weight gain among children. Whether such interventions exhibit differential effectiveness across the socio-economic strata within a community remains unknown. We aimed to summarise evidence of differential effectiveness of WOC interventions by socioeconomic position (SEP).
Methods: WOC interventions were defined as those targeting nutrition and/or physical activity behaviours within multiple environmental contexts (e.g. schools, workplace), and utilising multiple strategies. Medline electronic database was searched using terms for obesity, health promotion and SEP. Studies were included if they reported the effects of an intervention on an anthropometric outcome or on energy balance behaviours according to SEP strata.
Results: 15 studies were identified, which were a mix of cross sectional (n=9) and longitudinal (n=6) study design. Of these, five were rated as moderate to high quality using an adapted version of the Effective Public Health Practice Project quality assessment tool. Of these five studies, two found that changes in anthropometric outcomes were equally effective across socioeconomic strata. A further two studies found greater effectiveness among lower SEP groups. Of these, one reported a stabilisation of BMI among those with less education compared to those with higher education, while the other revealed a reduction in total energy, fat intake and mono-unsaturated fat intake among low income groups only. One study reported varied results, dependent on the indicator of SEP examined.
Conclusions: The effectiveness of WOC interventions across socioeconomic strata appears to be variable, however the majority of medium to high quality studies suggest that these interventions have the potential to provide equal or greater benefit for lower socioeconomic groups.