Consensus-based framework for sustainable childhood obesity prevention in Europe: a delphi study

Abstract In the JA Health4EUKids, two evidence-based interventions, Germany's Grunau Moves and Finland's Smart Family, are being piloted in ten European Union member states. To support sustainable implementation, a three-phase Delphi study was conducted to define and validate core sustainability criteria for these practices. Thirty-five multidisciplinary European experts were involved in: 1) an open-ended questionnaire identifying key enablers and barriers; 2) a structured survey quantifying the perceived importance and feasibility of derived criteria; 3) a consensus panel discussion refining and validating the final framework. Across all three rounds, experts reached consensus on critical domains for sustainability: securing long-term political and legislative support, ensuring cultural and socioeconomic adaptability, institutionalizing workforce capacity-building, integrating programmes formally into health, education and community systems, engaging communities through participatory methods, diversifying funding mechanisms grants and establishing robust, mixed-methods evaluation strategies. Specific findings emphasized the necessity of embedding programmes into policy mandates to protect them from political turnover, leveraging existing infrastructures to minimize costs and promoting community co-design to foster local ownership and relevance. Experts also highlighted the importance of balancing fidelity to the original programme model with contextual adaptation to local needs. The findings inform the development of strategic recommendations aimed at guiding policymakers, programme implementers, and funders in strengthening the sustainability of health promotion efforts. These actions contribute to prevention strategies and enhancing coordination across sectors. A consensus-based framework embeds child health programmes into policy and systems. Expert-driven criteria support sustainability of obesity prevention, promoting system-wide health promotion.