Amelia A. Lake

Obesogenic environments: exploring the built and food environments

Obesity is a significant health and social problem which has reached pandemic levels. The obesogenicity of an environment has been defined as ‘the sum of influences that the surroundings, opportunities, or conditions of life have on promoting obesity in individuals or populations’.1 Prevention and treatment of obesity has focused on pharmacological, educational and behavioural interventions, with limited overall success. A novel and a longer-term approach would be to investigate the environments that promote high energy intake and sedentary behaviour; this has not yet been fully understood. The obesity epidemic has attracted attention at all levels, from general media interest to policy and practice from health and other professions including urban designers and planners. Shaping the environment to better support healthful decisions has the potential to be a key aspect of a successful obesity prevention intervention. Thus in order to develop effective environmental interventions, in relation to obesity, we need to understand how individuals, and different groups of individuals, interact with their environments in terms of physical activity and food intake.

Tracking of obesity-related behaviours from childhood to adulthood: A systematic review

Obesity in childhood carries a wide range of physical, psychological and social disbenefits and also increases the risk of adult obesity with its well-recognised, enhanced risk of several common complex diseases as well as adverse socioeconomic and psychosocial sequelae. Understanding the tracking of the two key modifiable behaviours, food consumption and physical activity, between childhood and adulthood may illuminate the childhood determinants of adult obesity and contribute to the development of effective interventions. We performed a systematic review of the available literature on tracking of both physical activity and of dietary intake between childhood and adulthood by searching MEDLINE, EMBASE, CINAHL, PSYCInfo, Google and Google Scholar. For inclusion, studies had to report baseline measurements when the children were less than, or equal to, 18 years and to report follow-up for at least 5 years to any age over 18 years. After removal of duplicates, 9625 search hits were screened by title and/or abstract and 79 potentially relevant papers were identified and full papers obtained. In total 39 papers were included in this analysis. Of these, 11 papers (from 5 studies) reported data on tracking of diet from childhood to adulthood and 28 papers (from 16 studies) reported data on tracking of physical activity or inactivity. Despite the diversity of study design and measurement methodology, we found evidence of tracking of both physical activity and of diet between childhood and adulthood with estimates of strength of tracking of a similar order for both behaviours. Because of the inherent methodological difficulties in quantifying habitual behaviour, it is likely that the reported estimates of strength of tracking under-estimate the true degree of tracking. The evidence of tracking reported here may give greater impetus to the development of interventions aimed to prevent the persistence of obesity from childhood into adulthood and its attendant adverse socioeconomic, psychosocial and health sequelae.

Obesogenic urban form: theory, policy and practice.

There is a growing body of research, which suggests that many contemporary urban environments do not support healthy lifestyle choices and are implicated in the obesity pandemic. This paper reviews the evidence from this field in relation to theory, policy and practice, from three different disciplinary perspectives: urban design, geography and public health nutrition. In the UK, our development has been higher density and our urban form more varied, yet the paper concludes that it still may be making a contribution to our own obesity crisis. The dynamics of this, however, are highly complex and currently little understood.

The foodscape: classification and field validation of secondary data sources.

The aims were to: develop a food environment classification tool and to test the acceptability and validity of three secondary sources of food environment data within a defined urban area of Newcastle-Upon-Tyne, using a field validation method. A 21 point (with 77 sub-categories) classification tool was developed. The fieldwork recorded 617 establishments selling food and/or food products. The sensitivity analysis of the secondary sources against fieldwork for the Newcastle City Council data was good (83.6%), while Yell.com and the Yellow Pages were low (51.2% and 50.9%, respectively). To improve the quality of secondary data, multiple sources should be used in order to achieve a realistic picture of the foodscape.

Food shopping and preparation among the 30‐somethings: whose job is it? (The ASH30 study)

Purpose – The paper aims to explore the food shopping and preparation responsibility in a sample of adults, average age 32.5 years.Design/methodology/approach – A sample of 198 adults (81 men and 117 women) who were involved in a longitudinal dietary study self‐completed a questionnaire about their food habits. Chi‐squared analysis explored relationships between variables using SPSS (version 10). Open‐ended responses were analysed in QSR NUD*IST using a content analysis framework.Findings – The majority of respondents were married or co‐habiting (79 per cent), 6 per cent were lone parents, 9 per cent lived alone and the remainder lived with parents and others. Significantly more women than men were responsible for food shopping and preparation (both p<0.001). Within shared households food responsibility was predominately a female dominated area, with a considerably higher proportion of women responsible for food shopping and preparation compared with men. Reasons given for this included aspects of time an...

Obesogenic environments: complexities, perceptions and objective measures.

In a world where obesity has now reached epidemic proportions, a thorough understanding of the underlying causes of the problem is essential if society, public health initiatives and government policies are to successfully address the issue. The obesogenic environment describes all the possible influences that our environment presents which encourage overweight and obesity in individuals and populations. Beginning with an overarching introduction to obesity and its implications for health and wellbeing, the book will move on to consider such crucial areas as eating behaviours and food environments, physical activity and the environment, the urban environment, methods, policy and future research directions. •Brings together expertise from across a range of disciplines •Written by a truly multidisciplinary team of international authors •Presents some of the most innovative thinking in the battle against obesity This groundbreaking book brings together for the first time the knowledge of experts with backgrounds in nutrition and dietetics, policy, epidemiology, environmental sciences, medical sciences, town planning and urban design, transport, geography and physical activity in order to offer a multidisciplinary approach to public health, suggesting new and exciting ways to shape our environment to better support healthful decisions.

Creating ‘obesogenic realities’; do our methodological choices make a difference when measuring the food environment?

BackgroundThe use of Geographical Information Systems (GIS) to objectively measure ‘obesogenic’ food environment (foodscape) exposure has become common-place. This increase in usage has coincided with the development of a methodologically heterogeneous evidence-base, with subsequent perceived difficulties for inter-study comparability. However, when used together in previous work, different types of food environment metric have often demonstrated some degree of covariance. Differences and similarities between density and proximity metrics, and within methodologically different conceptions of density and proximity metrics need to be better understood.MethodsFrequently used measures of food access were calculated for North East England, UK. Using food outlet data from local councils, densities of food outlets per 1000 population and per km2 were calculated for small administrative areas. Densities (counts) were also calculated based on population-weighted centroids of administrative areas buffered at 400/800/1000m street network and Euclidean distances. Proximity (street network and Euclidean distances) from these centroids to the nearest food outlet were also calculated. Metrics were compared using Spearman’s rank correlations.ResultsMeasures of foodscape density and proximity were highly correlated. Densities per km2 and per 1000 population were highly correlated (rs = 0.831). Euclidean and street network based measures of proximity (rs = 0.865) and density (rs = 0.667-0.764, depending on neighbourhood size) were also highly correlated. Density metrics based on administrative areas and buffered centroids of administrative areas were less strongly correlated (rs = 0.299-0.658).ConclusionsDensity and proximity metrics were largely comparable, with some exceptions. Whilst results suggested a substantial degree of comparability across existing studies, future comparability could be ensured by moving towards a more standardised set of environmental metrics, where appropriate, lessening the potential pitfalls of methodological variation between studies. The researchers’ role in creating their own obesogenic ‘reality’ should be better understood and acknowledged.

Tracking of Dietary Intake and Factors Associated with Dietary Change from Early Adolescence to Adulthood: The ASH30 Study

Objective: This paper describes the tracking of food intake from adolescence to adulthood according to location as an adult (at the time of the follow-up study) and gender. Additionally this paper explores factors associated with change in food intake. Method: Two 3-day food diaries, demographic and socio-economic information were collected in 1980 and 2000 from the same 198 participants (81 male, 117 female). Foods consumed were assigned to the five categories in The Balance of Good Health (BGH) food model. The tracking of food intake was assessed using Pearson correlation analyses. In 2000 two questionnaires were completed. Demographic and key attributional factors, derived from closed and open-ended responses to the questionnaire, were compared with measured change using regression analysis. Results: There was significant tracking of intake by food group from adolescence to adulthood according to location as an adult and gender. Eight combinations of descriptive variables and questionnaire factors were associated with change in intake of four of the five BGH food groups. Conclusion: Between adolescence and adulthood, dietary tracking is influenced by variables including gender and location. Attributions for change in food intake were associated with measured changes in food intake. In order to support healthier eating habits, it is important to be aware of factors contributing to changes in food intake, such as parental influences and perceived influences of time and work.

Diet, physical activity, sedentary behaviour and perceptions of the environment in young adults.

BACKGROUND Few studies have explored both food behaviour and physical activity in an environmental context. Most research in this area has focused on adults; the aim of the present study was to describe perceptions of the environment, diet, physical activity and sedentary behaviour patterns in 16-20 year olds in full-time education (Newcastle, UK). METHODS Participants (n = 73) recruited from a college and sixth-form college completed a UK version of the Youth Neighbourhood Environment Walkability Survey, which included measures of sedentary behaviour. A validated food frequency questionnaire was completed and a factor applied to produce an estimated mean daily frequency of intake of each item, which was converted to nutrient intakes. A rank for Index of Multiple Deprivation (IMD) was assigned to their home postcode. Analysis explored associations between sedentary behaviours and nutrient intake. RESULTS In this descriptive cross-sectional study, most participants reported being physically active for at least 1 h day(-1) on 3-4 (n = 28) or 5-7 days (n = 31). There were no significant differences in nutrient intake according to sample quartile IMD position. Sedentary behaviours were significantly associated with less healthy eating patterns. Higher total energy (P = 0.02), higher fat (P = 0.005), percentage energy from fat (P = 0.035) and lower carbohydrate intakes (P = 0.004) were significantly associated with more time spent watching DVDs at the weekend. CONCLUSIONS This combination of sedentary behaviour and less healthy eating patterns has important implications for long-term health (e.g. the tracking of being overweight and obesity from adolescence into adulthood). Understanding behaviour relationships is an important step in developing interventions in this age group.

Raised adolescent body mass index predicts the development of adiposity and a central distribution of body fat in adulthood: a longitudinal study

Objective: To test the hypothesis that adolescent body mass index (BMI) tracks into adulthood and can be used as a predictor of obesity and/or central adiposity in adulthood. Method: A prospective cohort study following up 111 female and 84 male subjects who participated in dietary and anthropometric surveys when aged 12 years (in 1979–1981) and 33 years (in 2000–2001). At both time points, height and weight were measured and BMI calculated. At 33 years, waist circumference (WC) and hip circumference were also measured and waist-to-hip ratio (WHR) calculated. Results: In the male and female participants, BMI at 12 years was associated significantly with BMI at 33 years (R = 0.58 and 0.53, respectively, both p < 0.01) and WC at 33 years (R = 0.58 and 0.53, both p < 0.01). The probability of being an obese adult increased with rising adolescent BMI: normal weight male (BMI < 20.89 kg/m2) and female subjects (BMI < 21.20 kg/m2) at 12 years had a 20% and a 7% chance of being obese at 33 years, respectively; the probabilities for obese male (BMI ≥25.58kg/m2) and female subjects (BMI ≥26.05kg/m2) were 83 and 64%. The corresponding probability of becoming centrally obese (measured by WC) increased from 17 and 16% in male and female subjects of a normal weight to 58 and 59% in those being obese. Conclusions: Adolescent BMI is a good predictor of adult BMI and WC and the likelihood of becoming obese and/or centrally obese in adulthood.