F.J. van Lenthe

Environmental correlates of physical activity in youth – a review and update

Obesogenic environments are thought to underlie the increased obesity prevalence observed in youth during the past decades. Understanding the environmental factors that are associated with physical activity (PA) in youth is needed to better inform the development of effective intervention strategies attempting to halt the obesity epidemic. We conducted a systematic semi‐quantitative review of 150 studies on environmental correlates of youth PA published in the past 25 years. The ANalysis Grid for Environments Linked to Obesity (ANGELO) framework was used to classify the environmental correlates studied. Most studies retrieved used cross‐sectional designs and subjective measures of environmental factors and PA. Variables of the home and school environments were especially associated with children’s PA. Most consistent positive correlates of PA were father’s PA, time spent outdoors and school PA‐related policies (in children), and support from significant others, mother’s education level, family income, and non‐vocational school attendance (in adolescents). Low crime incidence (in adolescents) was characteristic of the neighbourhood environment associated with higher PA. Convincing evidence of an important role for many other environmental factors was, however, not found. Further research should aim at longitudinal and intervention studies, and use more objective measures of PA and its potential (environmental) determinants.

Early‐life determinants of overweight and obesity: a review of systematic reviews

The aim of this paper was to review the evidence for early‐life (from conception to 5 years of age) determinants of obesity. The design is review of published systematic reviews. Data sources included Medline, Embase, Web of Science, Cochrane Library, CINAHL, PsycINFO. Identification of 22 eligible reviews from a database of 12 021 independent publications. Quality of selected reviews assessed using the Assessment of Multiple Systematic Reviews score. Articles published after the reviews were used to confirm results. No review was classified as high quality, 11 as moderate and 11 as low. Factors associated with later overweight and obesity: maternal diabetes, maternal smoking, rapid infant growth, no or short breastfeeding, obesity in infancy, short sleep duration, <30 min of daily physical activity, consumption of sugar‐sweetened beverages. Other factors were identified as potentially relevant, although the size of their effect is difficult to estimate. Maternal smoking, breastfeeding, infant size and growth, short sleep duration and television viewing are supported by better‐quality reviews. It is difficult to establish a causal association between possible determinants and obesity, and the relative importance of each determinant. Future research should focus on early‐life interventions to confirm the role of protective and risk factors and to tackle the high burden obesity represents for present and future generations.

A systematic review of environmental factors and obesogenic dietary intakes among adults: are we getting closer to understanding obesogenic environments?

This study examined whether physical, social, cultural and economical environmental factors are associated with obesogenic dietary behaviours and overweight/obesity among adults. Literature searches of databases (i.e. PubMed, CSA Illumina, Web of Science, PsychInfo) identified studies examining environmental factors and the consumption of energy, fat, fibre, fruit, vegetables, sugar‐sweetened drinks, meal patterns and weight status. Twenty‐eight studies were in‐scope, the majority (n= 16) were conducted in the USA. Weight status was consistently associated with the food environment; greater accessibility to supermarkets or less access to takeaway outlets were associated with a lower BMI or prevalence of overweight/obesity. However, obesogenic dietary behaviours did not mirror these associations; mixed associations were found between the environment and obesogenic dietary behaviours. Living in a socioeconomically‐deprived area was the only environmental factor consistently associated with a number of obesogenic dietary behaviours. Associations between the environment and weight status are more consistent than that seen between the environment and dietary behaviours. The environment may play an important role in the development of overweight/obesity, however the dietary mechanisms that contribute to this remain unclear and the physical activity environment may also play an important role in weight gain, overweight and obesity.

Overweight and obesity in infants and pre-school children in the European Union: a review of existing data

The objective of this study was to synthesize available information on prevalence and time trends of overweight and obesity in pre‐school children in the European Union. Retrieval and analysis or re‐analysis of existing data were carried out. Data sources include WHO databases, Medline and Google, contact with authors of published and unpublished documents. Data were analysed using the International Obesity Task Force reference and cut‐offs, and the WHO standard. Data were available from 18/27 countries. Comparisons were problematic because of different definitions and methods of data collection and analysis. The reported prevalence of overweight plus obesity at 4 years ranges from 11.8% in Romania (2004) to 32.3% in Spain (1998–2000). Countries in the Mediterranean region and the British islands report higher rates than those in middle, northern and eastern Europe. Rates are generally higher in girls than in boys. With the possible exception of England, there was no obvious trend towards increasing prevalence in the past 20–30 years in the five countries with data. The use of the WHO standard with cut‐offs at 1, 2 and 3 standard deviations yields lower rates and removes gender differences. Data on overweight and obesity in pre‐school children are scarce; their interpretation is difficult. Standard methods of surveillance, and research and policies on prevention and treatment, are urgently needed.

School-based interventions promoting both physical activity and healthy eating in Europe: a systematic review within the HOPE project

It is the purpose of this study to systematically review the evidence of school‐based interventions targeting dietary and physical activity behaviour in primary (6–12 years old) and secondary school (12–18 years old) children in Europe. Eleven studies (reported in 27 articles) met the inclusion criteria, six in primary school and five in secondary school children. Interventions were evaluated in terms of behavioural determinants, behaviour (diet and physical activity) and weight‐related outcomes (body mass index [BMI] or other indicators of obesity). The results suggest that combining educational and environmental components that focus on both sides of the energy balance give better and more relevant effects. Furthermore, computer‐tailored personalized education in the classroom showed better results than a generic classroom curriculum. Environmental interventions might include organized physical activities during breaks, or before and after school; improved availability of physical activity opportunities in and around the school environment; increased physical education lesson time; improved availability or accessibility of healthy food options; and restricted availability and accessibility of unhealthy food options. More high‐quality studies are needed to assess obesity‐related interventions in Europe.

Neighbourhood deprivation and overweight: the GLOBE study

BACKGROUND: Increasing morbidity and mortality rates of coronary heart disease (CHD) by increasing levels of neighbourhood deprivation may be explained by a positive association between neighbourhood deprivation and risk factors of CHD. In this study we investigated the association between neighbourhood deprivation and overweight. Further, we examined whether this association was modified by educational level, age and sex of the neighbourhood residents.METHODS: Data were used from 8897 subjects who participated in the baseline measurement of the Dutch GLOBE Study in 1991 and lived in 86 neighbourhoods of the fifth largest city in The Netherlands (Eindhoven). Neighbourhood deprivation was based on aggregated self-reported information about educational and occupational level and employment status. Self-reported body height and body weight were used to define overweight body mass index ((BMI) ≥25).RESULTS: Adjusted for educational level, age and sex of neighbourhood residents, odds ratios of overweight increased significantly by increasing neighbourhood deprivation (odds ratio=1.20, 95% CI 1.02, 1.41 in the highest vs lowest quartile of neighbourhood deprivation). Stratified analyses showed a stronger association between neighbourhood deprivation and overweight in females compared to males, and in older (≥49 y of age) compared to younger participants. The pattern of increasing odds ratios of overweight by neighbourhood deprivation was generally similar in all educational groups, the highest educational group being the exception with no association between neighbourhood deprivation and overweight.CONCLUSIONS: Increased prevalence rates of overweight in more compared to less deprived neighbourhoods are likely to contribute to the positive association between neighbourhood deprivation and CHD. Our results justify the development of a community-based strategy of primary prevention of overweight in deprived neighbourhoods, which may have a larger impact in females and older residents in particular. Prior to implementation, however, longitudinal research needs to further examine responsible mechanisms for the development of neighbourhood inequalities in overweight.

Interventions for the prevention of overweight and obesity in preschool children: a systematic review of randomized controlled trials

The objective of this study was to analyse interventions for the prevention of overweight and obesity in children under 5 years of age. We carried out a systematic review focusing exclusively on randomized controlled trials (RCTs). Data sources include Medline, Cochrane Library, EMBASE, CINHAL, PsychInfo and Web of Science. Data were extracted from seventeen articles describing seven RCTs identified through electronic search, screening of references in systematic reviews, own files and contact with authors. RCTs were assessed with the Jadad scale. Four trials were carried out in preschool settings, one with an exclusive educational component, two with an exclusive physical activity component and one with both. Two trials were family‐based, with education and counselling for parents and children. The remaining trial was carried out in maternity hospitals, with a training intervention on breastfeeding. None of the interventions had an effect in preventing overweight and obesity. The failure to show an effect may be due to the choice of outcomes, the quality of the RCTs, the suboptimal implementation of the interventions, the lack of focus on social and environmental determinants. More rigorous research is needed on interventions and on social and environmental factors that could impact on lifestyle.

Socio-demographic variables and 6 year change in body mass index: longitudinal results from the GLOBE study

Background: Body mass index (BMI) differs by socio-demographic variables, but the origin of these associations remains relatively unknown.Objective: To investigate the association between socio-demographic variables and the subsequent change in BMI over six years.Design: A Dutch prospective cohort study (GLOBE) from which data were used from initially 20–49-year-old subjects (males: n=362; females: n=405). BMI was calculated from self-reported body height and weight data obtained in 1991 and 1997. Socio-demographic variables used were sex, age, educational level and the occupational level of the main breadwinner, family income, marital status, religious affiliation and degree of urbanization and measured in 1991.Results: Cross-sectionally, BMI was higher in males than in females. BMI was positively associated with age and negatively associated with educational level in both sexes, after adjustment for the other socio-demographic variables. A positive association of BMI with family income was found in males and a negative association with occupational level was found in females. During follow-up, BMI increased significantly more in females (from 23.0 (s.d. 3.3) to 24.2 (s.d. 3.8)) than in males (from 24.3 (s.d. 2.9) to 25.1 (s.d. 3.5)). With the exception of a significant lesser increase in BMI in initially 30–39-year-old women compared to initially 40–49-year-old women, no other statistically significant associations were found between socio-demographic variables and the 6-year change in BMI.Conclusions: Cross-sectional differences in BMI by socio-demographic variables are not due to different 6-year changes in BMI for categories of these variables in adulthood. Cross-sectional differences in BMI by educational level are probably established at the end of adolescence.

Household and food shopping environments: do they play a role in socioeconomic inequalities in fruit and vegetable consumption? A multilevel study among Dutch adults.

Background: Fruit and vegetables are protective of a number of chronic diseases; however, their intakes have been shown to vary by socioeconomic position (SEP). Household and food shopping environmental factors are thought to contribute to these differences. To determine whether household and food shopping environmental factors are associated with fruit and vegetable (FV) intakes, and contribute to socioeconomic inequalities in FV consumption. Methods: Cross-sectional data were obtained by a postal questionnaire among 4333 adults (23–85 years) living in 168 neighbourhoods in the south-eastern Netherlands. Participants agreed/disagreed with a number of statements about the characteristics of their household and food shopping environments, including access, prices and quality. Education was used to characterise socioeconomic position (SEP). Main outcome measures were whether or not participants consumed fruit or vegetables on a daily basis. Multilevel logistic regression models examined between-area variance in FV consumption and associations between characteristics of the household and food shopping environments and FV consumption. Results: Only a few household and food shopping environmental factors were significantly associated with fruit and vegetable consumption, and their prevalence was low. Participants who perceived FV to be expensive were more likely to consume them. There were significant socioeconomic inequalities in fruit and vegetable consumption (ORs of not consuming fruit and vegetables were 4.26 and 5.47 among the lowest-educated groups for fruit and vegetables, respectively); however, these were not explained by any household or food shopping environmental factors. Conclusions: Improving access to FV in the household and food shopping environments will only make a small contribution to improving population consumption levels, and may only have a limited effect in reducing socioeconomic inequalities in their consumption.

Dietary intakes of adults in the Netherlands by childhood and adulthood socioeconomic position

Objective: To determine whether there are socioeconomic differences in the intakes of total fat, fatty acids and fruit among adults in the Netherlands using childhood (parental) and participants own socioeconomic position (SEP). Furthermore, to quantify the independent effects of childhood and adulthood SEP on dietary behavior in adulthood.Design: Cross-sectional study among participants in the GLOBE study.Subjects: A total of 2512 men and women, aged 25–78 y, living in a region in the southeast Netherlands.Methods: Dietary intakes were collected by an interviewer-administered quantitative food frequency questionnaire. Average daily intakes of total energy, total, saturated, monounsaturated, polyunsaturated fat and fruit were calculated. The highest educational level was used to classify the participants adulthood SEP. Parental indicators (mothers education and fathers occupation when participants were 12 y of age) were used to classify childhood SEP.Results: Males with lower levels of education had moderately higher energy intakes than their more educated counterparts, but did not differ in their intakes of total fat, fatty acids and fruit. Among females, the least educated groups had marginally higher intakes of total and monounsaturated fat than the most educated group, and were less likely to consume fruit. For most of these significant differences, the participants own education demonstrated independent effects that were consistent with chronic disease inequalities. A small residual effect of mothers education was also demonstrated for intakes of some nutrients for males and females, and for fruit consumption among females. However, the effect size of mothers education was rather small and not always consistent with disease inequalities.Conclusions: The results imply that socioeconomic disparities in intakes of some dietary factors may contribute to inequalities in chronic disease. Adulthood SEP potentially has a more direct influence on dietary intake inequalities than childhood SEP.