Are climate-change actions present in community-based obesity prevention interventions? Development and application of the DoublE-duty actions in CommunIty-baSed obesity InterVEntions (DECISIVE) framework

Aim Community-based obesity prevention interventions (CBOPIs) target the causes of obesity. Actions implemented in CBOPIs could simultaneously impact both climate change and obesity, making them a potentially important approach. To date, limited work has been undertaken to identify and categorise double-duty actions (those that simultaneously influence obesity and climate change) in CBOPIs. The prevalence of double-duty actions in CBOPIs is currently unknown. This paper outlines the development and application of the DoublE-duty actions in CommunIty-baSed obesity InterVEntions (DECISIVE) framework to address this gap. Subjects and methods A scoping review focusing on obesity and climate change was performed, and the results informed the development of DECISIVE. DECISIVE was applied to studies included in the Cochrane review of obesity prevention interventions in children, and both the published and unpublished data of a completed intervention. Results The scoping review identified one study and one systematic review which contributed to the development of DECISIVE. The framework lists nine double-duty actions, plus an ‘Other’ action. Each action’s potential impact on both obesity and climate change is summarised and example strategies are provided. Reduce the availability and consumption of ultra-processed foods was the most prevalent double-duty action when applying DECISIVE to published studies. Conclusion DECISIVE is the first framework to recognise double-duty actions on obesity and climate change in CBOPIs. The development of DECISIVE holds important implications for community stakeholders who may be able to better identify, incorporate, and promote double-duty actions. This may enhance stakeholder acceptability, feasibility, and value-for-money of interventions.