A. C. Bell

Reducing unhealthy weight gain in children through community capacity-building: results of a quasi-experimental intervention program, Be Active Eat Well.

Background:Be Active Eat Well (BAEW) was a multifaceted community capacity-building program promoting healthy eating and physical activity for children (aged 4–12 years) in the Australian town of Colac.Objective:To evaluate the effects of BAEW on reducing childrens unhealthy weight gain.Methods:BAEW had a quasi-experimental, longitudinal design with anthropometric and demographic data collected on Colac children in four preschools and six primary schools at baseline (2003, n=1001, response rate: 58%) and follow-up (2006, n=839, follow-up rate: 84%). The comparison sample was a stratified random selection of preschools (n=4) and primary schools (n=12) from the rest of the Barwon South Western region of Victoria, with baseline assessment in 2003–2004 (n=1183, response rate: 44%) and follow-up in 2006 (n=979, follow-up rate: 83%).Results:Colac children had significantly lower increases in body weight (mean: −0.92 kg, 95% CI: −1.74 to −0.11), waist (−3.14 cm, −5.07 to −1.22), waist/height (−0.02, −0.03 to −0.004), and body mass index z-score (−0.11, −0.21 to −0.01) than comparison children, adjusted for baseline variable, age, height, gender, duration between measurements and clustering by school. In Colac, the anthropometric changes were not related to four indicators of socioeconomic status (SES), whereas in the comparison group 19/20 such analyses showed significantly greater gains in anthropometry in children from lower SES families. Changes in underweight and attempted weight loss were no different between the groups.Conclusions:Building community capacity to promote healthy eating and physical activity appears to be a safe and effective way to reduce unhealthy weight gain in children without increasing health inequalities.

What are the key food groups to target for preventing obesity and improving nutrition in schools

Objective: To determine differences in the contribution of foods and beverages to energy consumed in and out of school, and to compare consumption patterns between school canteen users and noncanteen users.Design: Cross-sectional National Nutrition Survey, 1995.Setting: Australia.Subjects on school days: A total of 1656 children aged 5–15 y who had weekday 24-h dietary recall data.Results: An average of 37% of total energy intake was consumed at school. Energy-dense foods and beverages such as fat spreads, packaged snacks, biscuits and fruit/cordial drinks made a greater contribution to energy intake at school compared to out of school (P≤0.01). Fast foods and soft drinks contributed 11 and 3% of total energy intake; however, these food groups were mostly consumed out of school. Fruit intake was low and consumption was greater in school. In all, 14% of children purchased food from the canteen and they obtained more energy from fast food, packaged snacks, desserts, milk and confectionary (P≤0.05) than noncanteen users.Conclusions: Energy-dense foods and beverages are over-represented in the Australian school environment. To help prevent obesity and improve nutrition in schools, biscuits, snack bars and fruit/cordial drinks brought from home and fast food, packaged snacks, and confectionary sold at canteens should be replaced with fruit and water.

Contribution of ‘noncore’ foods and beverages to the energy intake and weight status of Australian children

Objectives:The Australian Guide to Healthy Eating is based on five core food groups and water. Foods or beverages that do not fit into these groups are considered extra or ‘noncore’. We tested the hypotheses that noncore foods and beverages make a greater proportional contribution to mean daily energy intakes of: (1) children, compared with other age groups; and (2) overweight and obese children, compared with healthy weight children.Design, setting and subjects:We used data from 13 858 participants aged 2 to 80+ y who had 24-h dietary recall data collected in the 1995 cross-sectional Australian National Nutrition Survey. ANOVA was used to compare the percentage of energy provided by noncore foods and beverages by age and weight status.Results:Children (5 to 12 y) and adolescents (13 to 18 y) obtained significantly more (P<0.001) of their daily food energy from noncore foods (41.5 and 43.4%, respectively) than all other age groups. These age groups also obtained significantly more (P<0.001) of their daily beverage energy from noncore beverages (30.7 and 36.9%, respectively). Results were not consistent with weight status, although very young (2–4 y) obese children obtained significantly more energy (P<0.05) from noncore beverages than children in a healthy weight range. Younger children may also have consumed a greater quantity of foods and beverages. Under-reporting may have obscured similar results for older children.Conclusions:By definition, noncore foods and beverages are surplus to the requirements of a healthy diet. We found that Australian children consume these foods and beverages in excess.

Association between the family environment and television viewing in Australian children.

Aim:  To describe the time children spend watching television (TV) and to assess associations between TV viewing time, the family environment and weight status.

Lunchbox contents of Australian school children: room for improvement

Objective:In light of the increasing prevalence of obesity in children and the potential of schools as a setting for intervention, we aimed to identify the main foods and beverages consumed at primary school and to determine differences in consumption patterns between children who used the school canteen and those who did not.Design:Cross-sectional survey of school foods in 1681 5–12 y old children, 2003–2004.Setting:Barwon South—Western region of Victoria, Australia.Results:The school food provided an average (±s.e.m.) of 3087±26 kJ. Bread was the most frequently consumed food and contributed 20% of total energy at school, biscuits 13%, fruit 10%, muesli/fruit bars 8%, packaged snacks 7%, and fruit juice/cordial 6%. About 10% of children used the school canteen and these children obtained more total energy and more energy from cakes, fast foods and soft drink than noncanteen users (P<0.001). In all, 68% of children had fruit in their lunchboxes, however, over 90% of children had energy-dense, micronutrient-poor snacks (‘junk food’).Conclusions:Fruit intake in primary schools seems reasonably high but could be targeted for further increase as part of promoting a healthy diet. Of concern, however, are the excessive amounts of energy-dense foods in school lunchboxes. These should be considered a priority for health promotion efforts along with reducing the consumption of sweetened drinks. These measures are urgently needed to improve the school-based diets of Australian children and attempt to curb the increasing prevalence of childhood obesity.

Creating community action plans for obesity prevention using the ANGELO (Analysis Grid for Elements Linked to Obesity) Framework

Community-based interventions are an important component of obesity prevention efforts. The literature provides little guidance on priority-setting for obesity prevention in communities, especially for socially and culturally diverse populations. This paper reports on the process of developing prioritized, community-participatory action plans for obesity prevention projects in children and adolescents using the ANGELO (Analysis Grid for Elements Linked to Obesity) Framework. We combined stakeholder engagement processes, the ANGELO Framework (scans for environmental barriers, targeted behaviours, gaps in skills and knowledge) and workshops with key stakeholders to create action plans for six diverse obesity prevention projects in Australia (n = 3), New Zealand, Fiji and Tonga from 2002 to 2005. Some sites included sociocultural contextual analyses in the environmental scans. Target groups were under-5-year-olds (Australia), 4-12-year-olds (Australia) and 13-18-year-olds (all four countries). Over 120 potential behavioural, knowledge, skill and environmental elements were identified for prioritization leading into each 2-day workshop. Many elements were common across the diverse cultural communities; however, several unique sociocultural elements emerged in some cultural groups which informed their action plans. Youth were actively engaged in adolescent projects, allowing their needs to be incorporated into the action plans initiating the process of ownership. A common structure for the action plan promoted efficiencies in the process while allowing for community creativity and innovation. The ANGELO is a flexible and efficient way of achieving an agreed plan for obesity prevention with diverse communities. It is responsive to community needs, combines local and international knowledge and creates stakeholder ownership of the action plan.

Assessing the intake of obesity-related foods and beverages in young children: comparison of a simple population survey with 24 hr-recall

BackgroundWith an increasing focus on obesity prevention there is a need for simple, valid tools to assess dietary indicators that may be the targets of intervention programs. The objective of this study was to determine the relative validity of previous day dietary intake using a newly developed parent-proxy questionnaire (EPAQ) for two to five year old children.MethodsA convenience sample of participants (n = 90) recruited through preschools and the community in Geelong, Australia provided dietary data for their child via EPAQ and interviewer-administered 24-hour dietary recall (24 hr-recall). Comparison of mean food and beverage group servings between the EPAQ and 24 hr-recall was conducted and Spearman rank correlations were computed to examine the association between the two methods.ResultsMean servings of food/beverage groups were comparable between methods for all groups except water, and significant correlations were found between the servings of food and beverages using the EPAQ and 24-hr recall methods (ranging from 0.57 to 0.88).ConclusionThe EPAQ is a simple and useful population-level tool for estimating the intake of obesity-related foods and beverages in children aged two to five years. When compared with 24-hour recall data, the EPAQ produced an acceptable level of relative validity and this short survey has application for population monitoring and the evaluation of population-based obesity prevention interventions for young children.

A nutrition and exercise intervention program for controlling weight in Samoan communities in New Zealand

OBJECTIVE: To promote weight loss in Samoan church communities through an exercise program and nutrition education.METHODS: A quasi-experimental design was used to assess weight change, over 1 y, in cohorts of people aged 20–77 y from three non-randomised Samoan church communities (two intervention, n=365 and one control, n=106) in Auckland, New Zealand. The intervention churches received aerobics sessions and nutrition education about dietary fat.RESULTS: Baseline body mass index for the intervention and control churches was (mean±s.e.) 34.8±0.4 and 34.3±0.9 kg/m2, respectively. The intervention churches lost an average of 0.4±0.3 kg compared to a 1.3±0.6 kg weight gain in the control church (P=0.039, adjusted for confounders). The number of people who were vigorously active increased by 10% in the intervention churches compared to a 5% decline in the control church (P=0.007). Nutrition education had little apparent impact on knowledge or behaviour.CONCLUSION: Samoan communities in New Zealand are very obese and have high rates of annual weight gain. A community-based intervention program arrested this weight gain in the short term.

Effectiveness of a multi-strategy intervention in increasing the implementation of vegetable and fruit breaks by Australian primary schools: a non-randomized controlled trial.

BackgroundLimited evidence exists describing the effectiveness of strategies in facilitating the implementation of vegetable and fruit programs by schools on a population wide basis. The aim of this study was to examine the effectiveness of a multi-strategy intervention in increasing the population-wide implementation of vegetable and fruit breaks by primary schools and to determine if intervention effectiveness varied by school characteristics.MethodsA quasi-experimental study was conducted in primary schools in the state of New South Wales, Australia. All primary schools in one region of the state (n = 422) received a multi-strategy intervention. A random sample of schools (n = 406) in the remainder of the state served as comparison schools. The multi-strategy intervention to increase vegetable and fruit breaks involved the development and provision of: program consensus and leadership; staff training; program materials; incentives; follow-up support; and implementation feedback. Comparison schools had access to routine information-based Government support. Data to assess the prevalence of vegetable and fruit breaks were collected by telephone from Principals of the intervention and comparison schools at baseline (2006–2007) and 11 to 15 months following the commencement of the intervention (2009–2010). GEE analysis was used to examine the change in the prevalence of vegetable and fruit breaks in intervention schools compared to comparison schools.ResultsAt follow-up, prevalence of vegetable and fruit breaks increased significantly in both intervention (50.3 % to 82.0 %, p < 0.001) and comparison (45.4 % to 60.9 % p < 0.001) schools. The increase in prevalence in intervention schools was significantly larger than among comparison schools (OR 2.36; 95 % CI 1.60-3.49, p <0.001). The effect size was similar between schools regardless of the rurality or socioeconomic status of school location, school size or government or non-government school type.ConclusionThe findings suggest that a multi-strategy intervention can significantly increase the implementation of vegetable and fruit breaks by a large number of Australian primary schools.

How useful are systematic reviews of child obesity interventions

To facilitate the translation of research evidence into practice, policy makers and practitioners require practice‐relevant information such as the effectiveness of interventions delivered in specific settings, by various personnel, using various intervention modalities, and descriptions of intervention costs or adverse outcomes. The aim of this study was to review the relevance of information reported in systematic reviews of child obesity interventions in terms of these requirements. A systematic search was conducted for systematic reviews of child obesity interventions published in English between 1990 and 2008. A total of 3150 citations were examined. Of the 44 eligible reviews, 16 examined prevention interventions, 18 examined treatment interventions, and 10 examined both prevention and treatment interventions. Less than 50% of prevention and treatment reviews reported the effect of interventions conducted in specific settings, the effect of interventions conducted by various personnel and the effect of those delivered via various intervention modalities. Similarly, few (4–15%) reviews reported cost or adverse event outcomes. Existing systematic reviews of childhood obesity interventions provide limited practice‐relevant information. The potential for benefit from the translation of evidence into practice is therefore limited. Involving end users in systematic review development may improve the relevance of outcomes reported in systematic reviews.