Erin Hoare

Associations between obesogenic risk factors and depression among adolescents: a systematic review

Adolescence is a transitional life phase that is associated with heightened risk for two major health conditions – obesity and mental health problems. Given the established comorbidity of obesity and depression, one avenue that warrants further exploration is the association between obesogenic risk and obesity in the expression and maintenance of depressive symptoms. The aim of the current systematic review was to identify and evaluate the empirical literature reporting the relationships between obesogenic risk factors (physical activity, sedentary behaviour, diet and weight status) and depression in adolescents. A search of five databases for studies published over the last decade found 24 studies eligible for review. Relationships were found between lack of physical exercise, heightened sedentary behaviour, poor diet quality, obese or overweight and depression in adolescence. However, the finding that obesogenic risk factors are associated with poor adolescent mental health should be interpreted with caution as data typically come from non‐representative samples with less than optimal study design and methodology.

Associations between obesogenic risk and depressive symptomatology in Australian adolescents : a cross-sectional study

Background Depression and obesity are significant health concerns currently facing adolescents worldwide. This paper investigates the associations between obesity and related risk behaviours and depressive symptomatology in an Australian adolescent population. Methods Data from the Australian Capital Territory Its Your Move project, an Australian community-based intervention project were used. In 2012, 800 students (440 females, 360 males) aged 11–14 years (M=13.11 years, SD=0.62 years), from 6 secondary schools were weighed and measured and completed a questionnaire which included physical activity, sedentary behaviour and dietary intake. Weight status was defined by WHO criteria. A cut-off score ≥10 on the Short Mood and Feelings Questionnaire indicated symptomatic depression. Logistic regression was used to test associations. Results After controlling for potential confounders, results showed significantly higher odds of depressive symptomatology in males (OR=1.22, p<0.05) and females (OR=1.12, p<0.05) who exceeded guidelines for daily screen-time leisure sedentary activities. Higher odds of depressive symptoms were seen in females who consumed greater amounts of sweet drink (OR=1.18, p<0.05), compared to lower female consumers of sweet drinks, and males who were overweight/obese also had greater odds of depressive symptoms (OR=1.83, p<0.05) compared to male normal weight adolescents. Conclusions This study demonstrates the associations between obesogenic risks and depression in adolescents. Further research should explore the direction of these associations and identify common determinants of obesity and depression. Mental health outcomes need to be included in the rationale and evaluation for diet and activity interventions.

Systematic review of mental health and well-being outcomes following community-based obesity prevention interventions among adolescents

Objectives This paper aimed to systematically evaluate the mental health and well-being outcomes observed in previous community-based obesity prevention interventions in adolescent populations. Setting Systematic review of literature from database inception to October 2014. Articles were sourced from CINAHL, Global Health, Health Source: Nursing and Academic Edition, MEDLINE, PsycARTICLES and PsycINFO, all of which were accessed through EBSCOhost. The Cochrane Database was also searched to identify all eligible articles. PRISMA guidelines were followed and search terms and search strategy ensured all possible studies were identified for review. Participants Intervention studies were eligible for inclusion if they were: focused on overweight or obesity prevention, community-based, targeted adolescents (aged 10–19 years), reported a mental health or well-being measure, and included a comparison or control group. Studies that focused on specific adolescent groups or were treatment interventions were excluded from review. Quality of evidence was assessed using the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) guidelines. Primary and secondary outcome measures Primary outcomes were measures of mental health and well-being, including diagnostic and symptomatic measures. Secondary outcomes included adiposity or weight-related measures. Results Seven studies met the inclusion criteria; one reported anxiety/depressive outcomes, two reported on self-perception well-being measures such as self-esteem and self-efficacy, and four studies reported outcomes of quality of life. Positive mental health outcomes demonstrated that following obesity prevention, interventions included a decrease in anxiety and improved health-related quality of life. Quality of evidence was graded as very low. Conclusions Although positive outcomes for mental health and well-being do exist, controlled evaluations of community-based obesity prevention interventions have not often included mental health measures (n=7). It is recommended that future interventions incorporate mental health and well-being measures to identify any potential mechanisms influencing adolescent weight-related outcomes, and equally to ensure interventions are not causing harm to adolescent mental health.

Depressive symptomatology, weight status and obesogenic risk among Australian adolescents: a prospective cohort study

Objectives Adolescence is a period of increased risk for mental health problems and development of associated lifestyle risk behaviours. This study examined cross-sectional and longitudinal associations between obesogenic risk factors, weight status, and depressive symptomatology in a cohort of Australian adolescents. Design Prospective cohort study. Setting The study used repeated measures data from the Australian Capital Territory (ACT) Its Your Move project, an Australian community-based obesity prevention intervention. Intervention effect was non-significant therefore intervention and comparison groups were combined in this study. Participants Total sample was 634 secondary school students (female n=338, male n=296) with mean age 13 years (SD=0.6) at baseline (2012) and 15 years (SD=0.6) at follow-up (2014) recruited from 6 government secondary schools in the ACT. Primary and secondary outcomes measures Primary outcome was depressive symptomatology measured by Short Mood and Feelings Questionnaire. Secondary outcomes were weight status, physical activity, screen time and diet related measures. Results Increased physical activity was associated to lower depressive symptomatology among males (OR=0.35, p<0.05). Sweet drink (OR=1.15, p<0.05) and takeaway consumption (OR=1.84, p<0.05) were associated with higher levels of depressive symptomatology among females at follow-up. Males who were classified as overweight or obese at baseline, and remained so over the study period, were at increased risk of depressive symptomatology at follow-up (b=1.63, 95% CI 0.33 to 2.92). Inactivity among males over the 2-year study period was predictive of higher depressive symptomatology scores at follow-up (b=2.55, 95% CI 0.78 to 4.32). For females, those who increased their consumption of takeaway foods during the study period were at increased risk for developing depressive symptomatology (b=1.82, 95% CI −0.05 to 3.71). Conclusions There are multiple, probably complex, relationships between diet, physical activity and outcomes of obesity and mental health as well as between the outcomes themselves. Healthier diets and increased physical activity should be foundations for healthier body weight and mental health. Trial registration number ACTRN12615000842561; Results.

School‐based systems change for obesity prevention in adolescents: outcomes of the Australian Capital Territory ‘It's Your Move!’

Objective: The Australian Capital Territory ‘Its Your Move!’ (ACT‐IYM) was a three‐year (2012–2014) systems intervention to prevent obesity among adolescents.

Sugar- and Intense-Sweetened Drinks in Australia: A Systematic Review on Cardiometabolic Risk

Sugar-sweetened beverages (SSBs) are consumed globally, and have been associated with adverse health outcomes, including weight gain, high blood pressure, type 2 diabetes (T2D), and cardiovascular disease (CVD). There is global variation in beverage formulation in terms of glucose and fructose concentration, which may pose unique health risks linked to glycemic control for Australian consumers. However, previous systematic reviews have overlooked Australian-based literature. A systematic review was performed to synthesise evidence for the associations between consumption of SSBs and intense-sweetened beverages with clinical cardiometabolic risk factors in the Australian population. Articles were sourced from Global Health, Health Source: Nursing/Academic Edition, Medline, and Culmative Index to Nursing and Allied Health Literature. To be eligible for review, studies had to report on the consumption of sugar-sweetened (including fruit juice and fruit drinks) and/or intense-sweetened beverages, and at least one clinical cardiometabolic risk factor. Eighteen studies were included in this review. Research has mostly focused on the relationship between SSB consumption and adiposity-related outcomes. No studies have examined indices of glycaemic control (glucose/insulin), and the evidence for the health impact of intense-sweetened drinks is limited. In addition, studies have primarily been of cross-sectional design, and have examined children and adolescents, as opposed to adult populations. In the Australian population, there is modest but consistent evidence that SSB consumption has adverse associations with weight, but there is insufficient data to assess relationships with cardiometabolic outcomes.

Blood Pressure Down Under, but Down Under What?: US and Australian Hypertension Guideline Conversation

See related article, pp e13–e115 Australia shares similar blood pressure (BP) profiles within the community as the United States, Europe, and many other countries.1 Hypertension is common, many people are not aware they have it and treatment often falls short of targets. Improvement in smoking rates and other cardiovascular risk factors is being countered by increased obesity and diabetes mellitus. Hypertension is seen more often in disadvantaged people, in rural communities, and particularly indigenous Australians.2 This is a familiar story around the world and it will not surprise that Australian hypertension guidelines have generally been fairly similar to recommendations in the major European and US guidelines. The American College of Cardiology/American Heart Association (ACC/AHA) recently revised guidelines for the diagnosis, treatment, and management of hypertension.3 Among a host revisions, which have been referred to as radical,4 there are; lower cut offs for the diagnosis of hypertension (BP ≥130/80 mm Hg, previously set at ≥140/90 mm Hg), similarly lower BP criteria for initiating antihypertensive medications, and revised BP targets for individuals already undergoing treatment. US population implications of these changes include an additional 31 million US individuals considered hypertensive just because of the change in threshold, 4.2 million of these newly diagnosed are now eligible for antihypertensive medication.5 Additionally, over half (53%) of those currently medicated (55 million individuals) are in need of improved antihypertensive control to meet newly defined targets. The process for developing these ACC/AHA guidelines was gold standard with extensive review of the evidence, broad consultation, and rigorous attention to conflict of interest. In this context, it will not surprise if other countries follow the same line and draw similar conclusions. After all the evidence is the evidence! There will always be some divergence as local factors and local evidence comes into play …

Exploring motivation and barriers to physical activity among active and inactive Australian adults

Physical inactivity is a major global public health issue associated with a range of chronic disease outcomes. As such, the underlying motivation and barriers to whether or not an individual engages in physical activity is of critical public health importance. This study examines the National Heart Foundation of Australia Heart Week Survey conducted in March 2015. A total of 894 (40% female) Australian adults aged 25–54 years completed the survey, including items relating to motivation and barriers to being physically active. The most frequently selected responses regarding motivation for physical activity among those categorised as active (n = 696) were; to lose or maintain weight (36.6%, 95% CI 33.1–40.3), avoid or manage health condition (17.8%, 95% CI 15.1–20.8), and improve appearance (12.8%, 95% CI 10.5–15.5). Some gender differences were found with a greater proportion of females (43.8%, 95% CI 38.0–49.8) reporting lose or maintain weight as their main motivation for being physically active compared to males (31.9%, 95% CI 27.7–36.6). Among those categorised as inactive (n = 198), lack of time (50.0%, 95% CI 43.0–56.8) was the most frequently reported barrier to physical activity. While empirical studies seek to understand the correlates and determinants of physical activity, it is critical that beliefs and perceptions enabling and prohibiting engagement are identified in order to optimise physical activity promotion in the community.

Potential implications of the new American hypertension guidelines in Australia

Prevalence of hypertension and recommendation for antihypertensive medications for Australian adults using both the 2017 American College of Cardiology (ACC) and American Heart Association (AHA) guidelines and the National Heart Foundation (NHF) guidelines T goalposts for common conditions and redefine normal values. This is particularly the case when the normative values for common chronic disease risk factors in the community, such as blood pressure or cholesterol, aremademore stringent. In the stroke of a pen,millions of people have a disease or a risk factor they did not have the day before. Is this “the medicalisation of life” referred to by Illich?

Sex-Specific Associations in Nutrition and Activity-Related Risk Factors for Chronic Disease: Australian Evidence from Childhood to Emerging Adulthood

Global assessments of burden of disease suggests there are sex differences in risk factors for chronic disease, including overweight/obesity, dietary patterns and habitual physical activity. Given that prevention efforts aim to target such factors to reduce disease risk, the age at which sex differences may occur is of particular interest. Early life to young adulthood is the optimal time for intervention, with lifestyle habits typically forming during this period. This study aimed to identify the sex differences in risk factors for chronic disease during childhood (5–9 years), adolescence (10–17 years) and emerging adulthood (18–25 years) in a large population-representative Australian sample. Among children in this study (n = 739), no sex-related differences were observed. Among adolescents (n = 1304), females were more likely than males to meet daily fruit and vegetable recommendations (12.9% vs. 7.5%; OR = 1.84, 95% CI = 1.16, 2.93, p < 0.05). Among emerging adults (n = 909), females were less likely to be overweight/obese (30.1% vs. 39.8%; OR = 0.65, 95% CI = 0.44, 0.95, p < 0.05) and more likely to meet physical activity recommendations (52.1% vs. 42.3%; OR = 1.44, 95% CI = 1.01, 2.06, p < 0.05). These findings suggest that sex differences for risk factors of chronic disease occur during adolescence and emerging adulthood, although the differences are not consistent across age periods. From adolescence onwards, it appears that females exhibit lower risk factors than males and a life span approach to risk factor monitoring is warranted.