title: Whole of Systems Trial of Prevention Strategies for Childhood Obesity: WHO STOPS Childhood Obesity.
abstract: Background: Community-based initiatives show promise for preventing childhood obesity. They are characterized by community leaders and members working together to address complex local drivers of energy balance.Objectives: To present a protocol for a stepped wedge cluster randomized trial in ten communities in the Great South Coast Region of Victoria, Australia to test whether it is possible to: (1) strengthen community action for childhood obesity prevention, and (2) measure the impact of increased action on risk factors for childhood obesity.Methods:The WHO STOPS intervention involves a facilitated community engagement process that: creates an agreed systems map of childhood obesity causes for a community; identifies intervention opportunities through leveraging the dynamic aspects of the system; and, converts these understandings into community-built, systems-oriented action plans. Ten communities will be randomized (1:1) to intervention or control in year one and all communities will be included by year three. The primary outcome is childhood obesity prevalence among grade two (ages 7-8 y), grade four (9-10 y) and grade six (11-12 y) students measured using our established community-led monitoring system (69% school and 93% student participation rate in government and independent schools). An additional group of 13 external communities from other regions of Victoria with no specific interventions will provide an external comparison. These communities will also allow us to assess diffusion of the intervention to control communities during the first three years of the trial.Conclusion: This trial will test effectiveness, over a five-year period, of community-owned, -supported and -led strategies designed to address complex and dynamic causes of childhood obesity.
authors.affiliation: Global Obesity Centre (GLOBE), World Health Organization Collaborating Centre for Obesity Prevention, Faculty of Health, Deakin University, Melbourne 3125, Australia. steven.allender@deakin.edu.au.
authors.forename: Steven
authors.initials: S
authors.lastname: Allender
authors.affiliation: Global Obesity Centre (GLOBE), World Health Organization Collaborating Centre for Obesity Prevention, Faculty of Health, Deakin University, Melbourne 3125, Australia. lynne.millar@deakin.edu.au.
authors.forename: Lynne
authors.initials: L
authors.lastname: Millar
authors.affiliation: Brown School's Social System Design Lab, Washington University, St Louis, MO 63130, USA. phovmand@wustl.edu.
authors.forename: Peter
authors.initials: P
authors.lastname: Hovmand
authors.affiliation: Global Obesity Centre (GLOBE), World Health Organization Collaborating Centre for Obesity Prevention, Faculty of Health, Deakin University, Melbourne 3125, Australia. colin.bell@deakin.edu.au.|School of Medicine, Faculty of Health, Deakin University, Melbourne 3125, Australia. colin.bell@deakin.edu.au.
authors.forename: Colin
authors.initials: C
authors.lastname: Bell
authors.affiliation: Global Obesity Centre (GLOBE), World Health Organization Collaborating Centre for Obesity Prevention, Faculty of Health, Deakin University, Melbourne 3125, Australia. marj.moodie@deakin.edu.au.|Deakin Health Economics, Centre for Population Health Research, Faculty of Health, Deakin University, Melbourne 3125, Australia. marj.moodie@deakin.edu.au.
authors.forename: Marj
authors.initials: M
authors.lastname: Moodie
authors.affiliation: Deakin Health Economics, Centre for Population Health Research, Faculty of Health, Deakin University, Melbourne 3125, Australia. rob.carter@deakin.edu.au.
authors.forename: Rob
authors.initials: R
authors.lastname: Carter
authors.affiliation: Global Obesity Centre (GLOBE), World Health Organization Collaborating Centre for Obesity Prevention, Faculty of Health, Deakin University, Melbourne 3125, Australia. boyd.swinburn@auckland.ac.nz.|Population Nutrition and Global Health, University of Auckland, Auckland, NZ 1142, USA. boyd.swinburn@auckland.ac.nz.
authors.forename: Boyd
authors.initials: B
authors.lastname: Swinburn
authors.affiliation: Global Obesity Centre (GLOBE), World Health Organization Collaborating Centre for Obesity Prevention, Faculty of Health, Deakin University, Melbourne 3125, Australia. claudia.strugnell@deakin.edu.au.
authors.forename: Claudia
authors.initials: C
authors.lastname: Strugnell
authors.affiliation: Southern Grampians and Glenelg Primary Care Partnership, Hamilton, NZ 3300, USA. Janette.Lowe@wdhs.net.
authors.forename: Janette
authors.initials: J
authors.lastname: Lowe
authors.affiliation: Department of Preventive Medicine, University of Southern California, Los Angeles, CA 90033, USA. delahaye@usc.edu.
authors.forename: Kayla
authors.initials: K
authors.lastname: de la Haye
authors.affiliation: Biostatistics Unit, Faculty of Health, Deakin University, Melbourne 3125, Australia. l.orellana@deakin.edu.au.
authors.forename: Liliana
authors.initials: L
authors.lastname: Orellana
authors.affiliation: Victorian Department of Health and Human Services, Geelong 3220, Australia. sue.morgan@dhhs.vic.gov.au.
authors.forename: Sue
authors.initials: S
authors.lastname: Morgan
mesh_terms: D002648:Child; D016000:Cluster Analysis; D003153:Community Health Services / Q000458:organization & administration*; D019058:Community Networks / Q000458:organization & administration*; D005260:Female; D006266:Health Education / Q000379:methods*; D006293:Health Promotion / Q000379:methods*; D006801:Humans; D008297:Male; D009937:Organizational Objectives; D063766:Pediatric Obesity / Q000453:epidemiology / Q000517:prevention & control*; D015995:Prevalence; D012307:Risk Factors; D014739:Victoria / Q000453:epidemiology; D014944:World Health Organization
keywords: anthropometry; childhood obesity; cluster randomized controlled trial; community prevention; economic analysis; obesogenic behaviours; social network analysis; systems thinking