Community Based Approaches to Childhood and Adolescent Healthy Weight Promotion: A Realist Review

Background

Despite decades of prevention efforts, more than 390 million children and adolescents globally live with overweight or obesity. While prevalence has plateaued in some regions, rates remain high and unequally distributed. Increasing recognition that childhood obesity is shaped by complex, interacting determinants has strengthened interest in community‑based approaches (CBAs). However, evidence on what works, for whom, and under which circumstances remains limited. This realist review identifies the key mechanisms that enable effective CBAs to promote healthy weight among children and adolescents.

Methods

A realist‑inspired review was conducted to develop theoretical explanations of how CBAs operate. An initial programme theory guided systematic searches in PubMed, Web of Science, and Embase. The review examined what works, for whom, and under which circumstances and was registered in PROSPERO (CRD42023460456).

Results

Seventy‑seven studies published between 2007 and 2023 were included, predominantly from Australia, the United States, Canada, and Western Europe. Fifteen context–mechanism–outcome configurations were identified across three interconnected levels: (1) strategic—requiring political commitment and durable partnerships; (2) organizational—emphasizing shared responsibility, common goals, and validated tools within cross‑sector collaboration; and (3) frontline—focused on local engagement, resource capacity, and strong backbone support.

Conclusions

Effective CBAs rely on interconnected mechanisms across strategic, organizational, and frontline levels. Political leadership, shared accountability, practical tools, adequate resources, and capable backbone organizations trigger seven core mechanisms: meaning‑making, recognition and voice, shared awareness, shared goals, relational trust, legitimacy, and empowerment, enabling sustainable community‑level impact.

Key messages

• Sustained, coordinated community work activates key mechanisms—trust, shared goals and local ownership—that strengthen daily practice and support lasting healthy‑weight impact

• Our review shows that long‑term, well‑aligned community approaches can create lasting weight‑health impact by activating key mechanisms across policy, organizations, and local practice.