A. Colin Bell

Reducing obesity in early childhood: results from Romp & Chomp, an Australian community-wide intervention program

BACKGROUND There is growing evidence that community-based interventions can reduce childhood obesity in older children. OBJECTIVE We aimed to determine the effectiveness of the Romp & Chomp intervention in reducing obesity and promoting healthy eating and active play in children aged 0-5 y. DESIGN Romp & Chomp was a community-wide, multisetting, multistrategy intervention conducted in Australia from 2004 to 2008. The intervention occurred in a large regional city (Geelong) with a target group of 12,000 children and focused on community capacity building and environmental (political, sociocultural, and physical) changes to increase healthy eating and active play in early-childhood care and educational settings. The evaluation was repeat cross-sectional with a quasiexperimental design and comparison sample. Main outcome measures were body mass index (BMI), standardized BMI (zBMI; according to the Centers for Disease Control and Prevention 2000 reference charts), and prevalence of overweight/obesity and obesity-related behaviors in children aged 2 and 3.5 y. RESULTS After the intervention there was a significantly lower mean weight, BMI, and zBMI in the 3.5-y-old subsample and a significantly lower prevalence of overweight/obesity in both the 2- and 3.5-y-old subsamples (by 2.5 and 3.4 percentage points, respectively) than in the comparison sample (a difference of 0.7 percentage points; P < 0.05) compared with baseline values. Intervention child-behavioral data showed a significantly lower intake of packaged snacks (by 0.23 serving), fruit juice (0.52 serving), and cordial (0.43 serving) than that in the comparison sample (all P < 0.05). CONCLUSION A community-wide multisetting, multistrategy intervention in early-childhood settings can reduce childhood obesity and improve young childrens diets. This trial was registered with the Australian Clinical Trials Registry at anzctr.org.au as ACTRN12607000374460.

High childhood obesity in an Australian population

Objective: The objective was to determine the prevalences of overweight and obesity in regional Australian children and to examine the association between BMI and indicators of socioeconomic status (SES).

Preventing childhood obesity: the sentinel site for obesity prevention in Victoria, Australia.

In spite of greater awareness of the need for action to reduce obesity, the evidence on sustainable community approaches to prevent childhood and adolescent obesity is surprisingly sparse. This paper describes the design and methodological components of the Sentinel Site for Obesity Prevention, a demonstration site in the Barwon-South West region of Victoria, Australia, that aims to build the programs, skills and evidence necessary to attenuate and eventually reverse the obesity epidemic in children and adolescents. The Sentinel Site for Obesity Prevention is based on a partnership between the regions university (Deakin University) and its health, education and local government agencies. The three basic foundations of the Sentinel Site are: multi-strategy, multi-setting interventions; building community capacity; and undertaking program evaluations and population monitoring. Three intervention projects have been supported that cover different age groups (preschool: 2-5 years, primary school: 5-12 years, secondary school: 13-17 years), but that have many characteristics in common including: community participation and ownership of the project; an intervention duration of at least 3 years; and full evaluations with impact (behaviours) and outcome measures (anthropometry) compared with regionally representative comparison populations. We recommend the Sentinel Site approach to others for successfully building evidence for childhood obesity prevention and stimulating action on reducing the epidemic.

An implementation intervention to encourage healthy eating in centre-based child-care services: impact of the Good for Kids Good for Life programme.

OBJECTIVE To determine the impact of an implementation intervention designed to introduce policies and practices supportive of healthy eating in centre-based child-care services. Intervention strategies included staff training, resources, incentives, follow-up support, and performance monitoring and feedback. DESIGN A quasi-experimental design was used to assess change over 20 months in healthy eating policy and practice in intervention and comparison child-care services. SETTING The Hunter New England (HNE) region of New South Wales (NSW), Australia. SUBJECTS All centre-based child-care services (n 287) in the intervention region (HNE) were invited and 240 (91% response rate) participated. Two hundred and ninety-six services in the rest of NSW were randomly selected as a comparison region and 191 participated (76% response rate). A sub-analysis was conducted on those services that provided children food (n 196 at baseline and n 190 at follow-up). Ninety-six provided menus for analysis at baseline (HNE, n 36; NSW, n 50) and 102 provided menus at follow-up (HNE, n 50; NSW, n 52). RESULTS Services in the intervention region were significantly more likely to provide only plain milk and water for children (P = 0.018) and to engage parents in nutrition policy or programmes (P = 0.002). They were also more likely (P = 0.056) to have nutrition policy on home packed food. In addition, menus of services that provided lunch were significantly more likely to comply with healthy eating guidelines for sweetened drinks (P < 0.001), fruit (P < 0.001) and vegetables (P = 0.01). CONCLUSIONS An implementation intervention was able to modify policy and practice in a large number of child-care services so that they were more supportive of healthy eating.

Child physical activity levels and associations with modifiable characteristics in centre-based childcare.

Objective: To describe childrens physical activity levels during childcare and associations with modifiable characteristics.

The Impact of Modernisation on the Diets of Adults Aged 20-40 Years from Samoan Church Communities in Auckland

The objective of this study was to describe the food and nutrient intakes of adults in three Samoan church communities located in Auckland, New Zealand. The study had a cross-sectional design and measured usual dietary intake in 437 participants, aged 20 years and over, using a self-completed, 89-item quantitative food frequency questionnaire. Median daily energy and nutrient intakes were calculated and compared by gender and age groups. Men obtained a significantly (p<0.05) lower proportion of their energy from breads and cereals, fruits and vegetables and fats and oils than women. Compared to those aged 40+ years, those aged <40 obtained a significantly (p<0.01) lower proportion of their energy from meat, pulses and eggs, fruit and vegetables, and starchy staples. A significantly (p<0.01) higher proportion of their energy intake came from takeaways, soft drinks, snacks and dairy products. Nutrient analysis revealed that those aged <40 years obtained significantly (p<.001) more energy from fat and sugar, and less energy from protein (p<0.001) than the older group. They also had significantly lower intakes, per 1000 kilocalories, of a wide selection of vitamins and minerals. A dietary transition has occurred for New Zealand Samoans, reflecting a shift from traditional to modern dietary patterns and a decline in the nutritional quality of the diet.

Encouraging general practitioners to complete the four-year-old Healthy Kids Check and provide healthy eating and physical activity messages

Objective: To describe the impact of a training and support intervention to encourage completion of the Healthy Kids Check (HKC) by general practitioners (GP) or practice nurses (PN) and provision of brief advice on diet and physical activity.