Midstream Intervention And Childhood Obesity

According to Gabriel V. Jasul, Interventions for a multifactorial condition such as obesity can be categorized according to so-called ecological levels, i.e., downstream, upstream and midstream. Briefly, downstream factors involve individual decision-making that influences personal preferences and habits. Upstream factors, on the other hand, are at the community and national levels that may include infrastructure and community planning that may influence lifestyle (diet, physical activity) in the population. Midstream factors are the remaining components that operate in homes, schools or workplaces. Much of current obesity interventions are downstream, focused on attaining individual desirable weight and often have limited success, are short-term and characterized by relapse to previous weight status.
Midstream interventions, often family-based, offer some success especially in childhood obesity because they alter the home environment making it conducive for changes in food consumption and physical activity for extended periods of time. Upstream interventions are becoming the preferred solutions for population-based weight management because they influence policies shaping environment conducive for healthier choices for many people. Obesity prevention would be more successful if multilevel interventions, combining programs and approaches from these ecological levels, are utilized. Community-based intervention studies on obesity prevention programs in both adults and children have been reported across