Ethical concern around governments controlling individual choice reduces political action to implement restrictive policies for obesity. This research builds on the concept recently proposed by Griffith & West (1) to investigate the influence of enhancing or diminishing autonomy on effectiveness of interventions. We conducted a review of 56 school-based RCTs for obesity prevention. Interventions were sub-grouped according to their influence on autonomy, and their effect on weight status explored. A meta-analysis demonstrated an association between autonomy and effect size. When sub-grouped by influence to autonomy, those which negatively influenced autonomy and those which positively influenced autonomy produced a similar effect size (-0.15[-0.21,-0.09]; -0.16[-0.25,-0.07]). However, those which were least intrusive and solely informed choice, were least effective (-0.10[-0.24;0.03]. This suggests that regardless of whether we positively or negatively influence autonomy, the interventions that are the extremes may be most effective. Where many potential options exist, a framework for categorising obesity prevention interventions by their influence on autonomy may be beneficial to prioritise effective strategies for policy makers.
(1) Griffiths & West (2015) http://dx.doi.org/10.1016/j.puhe.2015.08.007