Confronting Obesity: Co-creating policy with youth

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Ethical considerations in engaging young people in European obesity prevention research: The CO‐CREATE experience

Publication . Budin‐Ljøsne, Isabelle; Ayuandini, Sherria; Baillergeau, Evelyne; Bröer, Christian; Helleve, Arnfinn; Klepp, Knut‐Inge; Kysnes, Bjarte; Lien, Nanna; Luszczynska, Aleksandra; Nesrallah, Samantha; Rito, Ana; Rutter, Harry; Samdal, Oddrun; Savona, Natalie; Veltkamp, Gerlieke

Engaging youth in obesity prevention research and policy action is essential to develop strategies that are relevant and sensitive to their needs. Research with young people requires critical reflection to safeguard their rights, dignity, and wellbeing. The CO-CREATE project used various methods to engage approximately 300 European youth aged 15–19 years in the development of policies to prevent adolescent obesity. This paper discusses ethical considerations made in the project pertaining to the youth's voluntary participation, their protection from obesity stigma, respect for their time, data privacy and confidentiality, power balance, and equality of opportunity to participate in the research. We describe measures implemented to prevent or limit the emergence of ethical challenges in our interaction with youth and discuss their relevance based on our experience with implementation. While some challenges seemingly were prevented, others arose related to the youth's voluntary participation, time burdens on them, and the sustainability of participation under the Covid-19 pandemic. Concrete and ongoing ethical guidance may be useful in projects aiming to interact and build collaborative relationships with youth for long periods of time.

2022-11-22Journal article

Open access

Identifying the views of adolescents in five European countries on the drivers of obesity using group model building

Publication . Savona, Natalie; Macauley, Talia; Aguiar, Anaely; Banik, Anna; Boberska, Monika; Brock, Jessica; Brown, Andrew; Hayward, Joshua; Holbæk, Helene; Rito, Ana Isabel; Mendes, Sofia; Vaaheim, Fredrik; van Houten, Marloes; Veltkamp, Gerlieke; Allender, Steven; Rutter, Harry; Knai, Cecile

Background: To make effective progress towards a global reduction in obesity prevalence, there needs to be a focus on broader structural factors, beyond individual-level drivers of diet and physical activity. This article describes the use of a systems framework to develop obesity prevention policies with adolescents. The aim of this research was to use the group model building (GMB) method to identify young people's perceptions of the drivers of adolescent obesity in five European countries, as part of the EU-funded Co-Create project. Methods: We used GMB with four groups of 16-18-year-olds in schools in each of the five European countries (The Netherlands, Norway, Poland, Portugal and the UK) to create causal loop diagrams (CLDs) representing their perceptions of the drivers of adolescent obesity. The maps were then merged into one, using a new protocol. Results: Two hundred and fifty-seven participants, aged 16-18 years, engaged in 20 separate system mapping groups, each of which generated 1 CLD. The findings were largely congruent between the countries. Three feedback loops in the merged diagram particularly stand out: commercial drivers of unhealthy diets; mental health and unhealthy diets; social media use, body image and motivation to exercise. Conclusions: GMB provides a novel way of eliciting from young people the system-based drivers of obesity that are relevant to them. Mental health issues, social media use and commercial practices were considered by the young people to be key drivers of adolescent obesity, subjects that have thus far had little or no coverage in research and policy.

2021-04-24Journal article

Open access

Socioeconomic differences in food habits among 6- to 9-year-old children from 23 countries-WHO European Childhood Obesity Surveillance Initiative (COSI 2015/2017)

Publication . Fismen, Anne‐Siri; Buoncristiano, Marta; Williams, Julianne; Helleve, Arnfinn; Abdrakhmanova, Shynar; Bakacs, Márta; Bergh, Ingunn Holden; Boymatova, Khadichamo; Duleva, Vesselka; Fijałkowska, Anna; García‐Solano, Marta; Gualtieri, Andrea; Gutiérrez‐González, Enrique; Hejgaard, Tatjana; Huidumac‐Petrescu, Constanta; Hyska, Jolanda; Kelleher, Cecily C.; Kierkegaard, Lene; Kujundžić, Enisa; Kunešová, Marie; Milanović, Sanja Musić; Nardone, Paola; Nurk, Eha; Ostojic, Sergej M.; Ozcebe, Lütfiye Hilal; Peterkova, Valentina; Petrauskiene, Ausra; Pudule, Iveta; Rakhmatulleoeva, Sanavbar; Rakovac, Ivo; Rito, Ana Isabel; Rutter, Harry; Sacchini, Elena; Stojisavljević, Dragana; Farrugia Sant'Angelo, Victoria; Shengelia, Lela; Spinelli, Angela; Spiroski, Igor; Tanrygulyyeva, Maya; Usupova, Zhamilya; Weghuber, Daniel; Breda, João

Background: Socioeconomic differences in children's food habits are a key public health concern. In order to inform policy makers, cross-country surveillance studies of dietary patterns across socioeconomic groups are required. The purpose of this study was to examine associations between socioeconomic status (SES) and children's food habits. Methods: The study was based on nationally representative data from children aged 6-9 years (n = 129,164) in 23 countries in the World Health Organization (WHO) European Region. Multivariate multilevel analyses were used to explore associations between children's food habits (consumption of fruit, vegetables, and sugar-containing soft drinks) and parental education, perceived family wealth and parental employment status. Results: Overall, the present study suggests that unhealthy food habits are associated with lower SES, particularly as assessed by parental education and family perceived wealth, but not parental employment status. We found cross-national and regional variation in associations between SES and food habits and differences in the extent to which the respective indicators of SES were related to children's diet. Conclusion: Socioeconomic differences in children's food habits exist in the majority of European and Asian countries examined in this study. The results are of relevance when addressing strategies, policy actions, and interventions targeting social inequalities in children's diets.

2021Journal article

Open access

Encouraging greater empowerment for adolescents in consent procedures in social science research and policy projects

Publication . Samdal, Oddrun; Budin‐Ljøsne, Isabelle; Haug, Ellen; Helland, Trond; Kjostarova‐Unkovska, Lina; Bouillon, Claire; Bröer, Christian; Corell, Maria; Cosma, Alina; Currie, Dorothy; Eriksson, Charli; Felder‐Puig, Rosemarie; Gaspar, Tania; Hagquist, Curt; Harbron, Janetta; Jåstad, Atle; Kelly, Colette; Knai, Cecile; Kleszczewska, Dorota; Kysnes, Bjarte Birkeland; Lien, Nanna; Luszczynska, Aleksandra; Moerman, Gerben; Moreno‐Maldonado, Concepcion; NicGabhainn, Saoirse; Pudule, Iveta; Rakic, Jelena Gudelj; Rito, Ana; Rønnestad, Alfred Mestad; Ulstein, Madeleine; Rutter, Harry; Klepp, Knut‐Inge

The United Nations Convention on the Rights of the Child emphasizes the importance of allowing children and adolescents to influence decisions that are important to them following their age and maturity. This paper explores the principles, practices, and implications around using parental versus child/adolescent consent when participating in social science research and policy development. Experiences from two studies are presented: The Confronting Obesity: Co-creating policy with youth (CO-CREATE) and the Health Behaviour in School-aged Children (HBSC) study, a World Health Organization (WHO) Collaborative Cross-National study. Although parental consent may be an important gatekeeper for protecting children and adolescents from potentially harmful research participation, it may also be considered an obstacle to the empowerment of children and adolescents in case they want to share their views and experiences directly. This paper argues that evaluation of possible harm should be left to ethics committees and that, if no harm related to the research participation processes is identified and the project has a clear perspective on collaborating with the target group, adolescents from the age of 12 years should be granted the legal capacity to give consent to participate in the research project. Collaboration with adolescents in the development of the research project is encouraged.

2023-09-27Journal article

Open access

Adolescents' capacity to take action on obesity: A concurrent controlled before‐and‐after study of the European CO‐CREATE project

Publication . Herstad, Sondre Haugsbø; Grewal, Navnit Kaur; Banik, Anna; Klepp, Knut‐Inge; Knai, Cecile; Luszczynska, Aleksandra; Mendes, Sofia; Rito, Ana; Rutter, Harry; Lien, Nanna

This study evaluated the effect on reported readiness for action and attitudes toward obesity prevention among older adolescents (mean age 17) who took part in a youth-led participatory action research European initiative (CO-CREATE Youth Alliances)compared with a comparison group that acted as controls. This was a concurrent before-and-after controlled study across five countries and took place between September 2019 and October 2020. Adolescents (n=159) recruited from schools and youth organizations came together with researchers and formed 15 Youth Alliances. An online questionnaire measuring their readiness for action and attitudes toward obesity prevention was administered. Alliance members (n=62) who filled in the questionnaire at both baseline and postinitiative, and adolescents from the comparison group (n=132) who completed the questionnaire twice were included in the main analysis. Two-level linear mixed models controlling for country-related variance were fitted. Alliance members scored significantly higher than the comparison group on two factors in each of the readiness for action, responsibility, and drivers of behavior concepts. The findings suggest that involving youth in co-creating policies to prevent obesity may increase adolescents' readiness for action and promote a shift in adolescents' conceptualization of obesity from an individual perspective to a societal responsibility and drivers of behavior.

2023-09-24Journal article

Open access