Garry Egger

Preventive strategies against weight gain and obesity

A well‐resourced, comprehensive, population‐based set of strategiesis needed to attenuate and eventually reverse the current trendsof increasing obesity prevalence now apparent in most countries.The Epidemiological Triad (host, vector, environment) has provento be a robust model for other epidemics and is applied to obesity. Host‐based strategies are primarily educational and these tend to bemost effective among people with higher incomes and higher educational attainment.The main vectors for a high‐energy intake are energy‐dense foodsand drinks and large portion sizes and, for low energy expenditure,machines that promote physical inactivity. Vector‐based strategiesthat alter food formulation can have a significant impact, particularlythrough influencing common, high‐volume foods. The increasingly ‘obesogenic’ environmentsare probably the main driving forces for the obesity epidemic. Thereare many environmental strategies that can influence the physical,economic, policy or socio‐cultural environments, but the evidencebase for these potentially powerful interventions is small. Childrenshould be the priority population for interventions, and improvingthe general socio‐economic conditions for disadvantaged, marginalizedor poor population sectors is also a central strategy for obesityprevention. The key settings for interventions are schools, homes,neighbourhoods, primary health care services and communities. Thekey macroenvironments for interventions are the transport and infrastructuresector, the media and the food sector.

A Conceptual Framework for Achieving Performance Enhancing Drug Compliance in Sport

AbstractThere has been, and continues to be, widespread international concern about athletes’ use of banned performance enhancing drugs (PEDs). This concern culminated in the formation of the World Anti-Doping Agency (WADA) in November 1999. To date, the main focus on controlling the use of PEDs has been on testing athletes and the development of tests to detect usage. Although athletes’ beliefs and values are known to influence whether or not an athlete will use drugs, little is known about athletes’ beliefs and attitudes, and the limited empirical literature shows little use of behavioural science frameworks to guide research methodology, results interpretation, and intervention implications. Mindful of this in preparing its anti-doping strategy for the 2000 Olympics, the Australian Sports Drug Agency (ASDA) in 1997 commissioned a study to assess the extent to which models of attitude-behaviour change in the public health/injury prevention literature had useful implications for compliance campaigns in the sport drug area. A preliminary compliance model was developed from three behavioural science frameworks: social cognition models; threat (or fear) appeals; and instrumental and normative approaches. A subsequent review of the performance enhancing drug literature confirmed that the overall framework was consistent with known empirical data, and therefore had at least face validity if not construct validity. The overall model showed six major inputs to an athlete’s attitudes and intentions with respect to performance enhancing drug usage: personality factors, threat appraisal, benefit appraisal, reference group influences, personal morality and legitimacy.The model demonstrated that a comprehensive, fully integrated programme is necessary for maximal effect, and provides anti-doping agencies with a structured framework for strategic planning and implementing interventions. Programmes can be developed in each of the six major areas, with allocation of resources to each area based on needs-assessment research with athletes and other relevant groups.n

Dusting off the epidemiological triad: could it work with obesity?

The search for effective ways of dealing with obesity has centred on biological research and clinical management. However, obesity needs to be conceptualized more broadly if the modern pandemic is to be arrested. The epidemiological triad (hosts, agent/vectors and environments) has served us well in dealing with epidemics in the past, and may be worth re‐evaluating to this end. Education, behaviour change and clinical practices deal predominantly with the host, although multidisciplinary practices such as shared‐care might also be expected to impact on other corners of the triad. Technology deals best with the agent of obesity (energy imbalance) and its vectors (excessive energy intake and/or inadequate energy expenditure), and policy and social change are needed to cope with the environment. The value of a broad model like this, rather than specific isolated approaches, is that the key players such as legislators, health professionals, governments and industry can see their roles in attenuating and eventually reversing the epidemic. It also highlights the need to intervene at all levels in obesity control and reduces the relevance of arguments about nature vs. nurture.

Using pedometers to increase physical activity in overweight and obese women: a pilot study

BackgroundMost public health guidelines recommend that adults participate in 30 minutes of moderate intensity physical activity on most days of the week. Establishing new ways to achieve these targets in sedentary populations need to be explored. This research evaluated whether the daily use of pedometers could increase physical activity and improve health outcomes in sedentary overweight and obese women.MethodsTwenty six overweight and obese middle-aged women were randomized into two groups: The control group was not able to record their steps daily, whilst the pedometer group, were asked to record the number of steps on a daily basis for 12 weeks.ResultsOur data showed that the pedometer group significantly increased their steps/day, by 36%, at the end of the 12 weeks, whereas the control groups physical activity levels remained unchanged. There was no significant difference in weight or body fat composition in the pedometer group compared to the control group. However, there was a significant decrease in systolic blood pressure in the pedometer group (112.8 ± 2.44 mm Hg) compared to the control group (117.3 ± 2.03 mm Hg) (p = 0.003).ConclusionIn conclusion, this pilot study shows that the combination of having step goals and immediate feedback from using a pedometer was effective in increasing physical activity levels in sedentary overweight and obese women.Trial registrationACTRN12609000176268

Developing National Physical Activity Guidelines for Australians

The process and outcome of developing National Physical Activity Guidelines for Australians is described. The guidelines provide a means of incorporating new data on physical activity into public health education.

Preventive Care in the Context of Men's Health.

This study assessed the effectiveness of a health intervention, in diabetes education and risk assessment, to motivate men to take positive action, within the framework of the Health Belief Model. The worksite-based intervention targeted 525 men aged between 40 and 65 years from 27 organizations in the south-west of Western Australia in 1999/2000. Men identified as high risk were referred to their general practitioner. The adopted strategy had a number of strengths, namely that the health risk assessment was topic-specific, personalized, conducted on the worksite and combined with an educational component and a medical follow-up. The focus groups component of the study gave further understanding as to why the adopted strategy had been appropriate for men’s needs.

TARPARE: A method for selecting target audiences for public health interventions

Objective:This paper presents a model to assist the health promotion practitioner systematically compare and select what might be appropriate target groups when there are a number of segments competing for attention and resources.

Happiness and Mental Health: The Flip Side of S-AD

Abstract The “Happiness” movement sprang up in the 1980s as a response to the negativity of much depression research. This came largely from the early work of Dr. George Vaillant and the longitudinal study of Harvard alumni, and that of Drs. Martin Selligman and Mihalyi Csikzentmihalyi in positive psychology. In Australia the Act-Belong-Commit program, a major public health mental health promotion campaign, offers the first comprehensive, evidence-based mental health promotion lifestyle intervention for adoption in clinical practice.The “Happiness” movement sprang up in the 1980s as a response to the negativity of much depression research. This came largely from the early work of Dr. George Vaillant and the longitudinal study of Harvard alumni, and that of Drs. Martin Selligman and Mihalyi Csikzentmihalyi in positive psychology. In Australia the Act-Belong-Commit program, a major public health mental health promotion campaign, offers the first comprehensive, evidence-based mental health promotion lifestyle intervention for adoption in clinical practice.

Stress: Its Role in the S-AD Phenomenon

Stress is often confused as an outcome of a behavioral state, where it is more realistically a process, leading to the outcomes of anxiety and depression, discussed in subsequent chapters. Stress can be healthy (eustress) or deleterious (distress). Distress can result in “strain,” which is partly negated by resilience from genetics and partly by learned skills, which can be taught by the Lifestyle Medicine clinician.

Relationships, Social Inequity, and Distal Factors in Lifestyle Medicine: Tackling the Big Determinants

Abstract While not immediately relevant to the clinician, the quality of social relationships and relative income inequalities within a society are clear determinants of chronic disease outcomes. Mediating factors appear to be lifestyle behaviors like smoking, drinking, inadequate nutrition, inactivity, stress, depression, etc., considered throughout this book. Without awareness of these more distal drivers and involvement of the broader health system, lifestyle medicine will not fulfill its potential to mitigate chronic disease.