Background:
The prevalence of overweight children and adolescents in Denmark is estimated as high, and every
eighth child is obese when it starts in school. The incidence increases throughout the school years. Since there is
evidence that being overweight can lead to both obesity-related diseases and diminished self-esteem, this is
considered as a public health problem. The health related consequences can occur as early as in childhood or in
adolescence, but studies also point to the obesity carried into adulthood. Danish municipality’s has implemented
several initiatives targeting obese children and adolescents, in order to reduce the overweight through a change
in BMI or weight. Despite these efforts, the prevalence of overweight children and adolescents are still not
decreasing.

Aim:
To investigate how to create changes on the basis of evidence-based literature, in local secondary
prevention interventions, aiming to reduce overweight among children and adolescents. This includes examining
the elements that municipal efforts must contain to have an evidence-based effect, as well as the bases for
municipalities in the decisions making in the effort to reduce overweight among children and adolescents.

Method:
A literature study, supplemented by a qualitative interview with a pilot municipality. The study
consisted of two searches in relation to the effects of the Danish efforts in conjunction with evidence from
systematic reviews of interventions targeting overweight children and adolescents.
The first search aimed to identify evaluation reports related to secondary prevention initiatives in Denmark. This
search resulted in 28 evaluation reports. A model was developed to assess the evaluation reports, which resulted
in nine reports for further use in analysis and discussion.
The second search was performed in the databases PubMed, Cochrane Library, PsycInfo, Embase and
Videnssøgeren. The search resulted in 756 studies, and the title and abstract of studies were read. Subsequently,
keen limits and studies were selected for full reading, which eventually resulted in six systematic reviews for reuse
in analysis and discussion.

Results:
Results are presented for the evaluation reports and the systematic reviews.
The evaluation results: Results in relation to BMI or weight loss varied in the selected interventions. Six
evaluation reports revealed that some participants after efforts had reduced weight or BMI. However none of the
results were statistically significant. In an evaluation report all participants increased their BMI after the
interventions and in the second evaluation, the results showed that all participants maintained their weight loss
up to three years after completion of work.
The systematic reviews Results: There was evidence that the element of "family involvement" had a positive effect
on BMI or weight. Interventions focusing on the elements "diet" and "exercise" meant significant reduction in
BMI. There was no evidence of how the interventions should be structured in relation to the intervention length
and composition of the elements to achieve an effect in weight loss.

Conclusion:
Inclusion of the elements "diet", "exercise" and "family involvement" in the secondary prevention
activities could, in view of the systematic reviews, lead to a positive effect on reducing BMI or weight. The results
in the Danish context was sparse, thus it was not possible to conclude that the effects of the identified initiatives.
On this basis it was concluded that there was a need for change in the documentation of the effects of municipal
interventions, with the aim of sharing knowledge and future work within the secondary prevention work.