Helen Mavoa

Reduction in overweight and obesity from a 3-year community-based intervention in Australia: the 'It's Your Move!' project.

‘Its Your Move!’ was a 3‐year intervention study implemented in secondary schools in Australia as part of the Pacific Obesity Prevention In Communities Project. This paper reports the outcome results of anthropometric indices and relevant obesity‐related behaviours. The interventions focused on building the capacity of families, schools and communities to promote healthy eating and physical activity. Baseline response rates and follow‐up rates were 53% and 69% respectively for the intervention group (n = 5 schools) and 47% and 66% respectively for the comparison group (n = 7 schools). Statistically significant relative reductions in the intervention versus comparison group were observed: weight (−0.74 kg, P < 0.04), and standardized body mass index (−0.07, P < 0.03), and non‐significant reductions in prevalence of overweight and obesity (0.75 odds ratio, P = 0.12) and body mass index (−0.22, P = 0.06). Obesity‐related behavioural variables showed mixed results with no pattern of positive intervention outcomes. In conclusion, this is the first study to show that long‐term, community‐based interventions using a capacity‐building approach can prevent unhealthy weight gain in adolescents. Obesity prevention efforts in this important transitional stage of life can be successful and these findings need to be translated to scale for a national effort to reverse the epidemic in children and adolescents.

Creating community action plans for obesity prevention using the ANGELO (Analysis Grid for Elements Linked to Obesity) Framework

Community-based interventions are an important component of obesity prevention efforts. The literature provides little guidance on priority-setting for obesity prevention in communities, especially for socially and culturally diverse populations. This paper reports on the process of developing prioritized, community-participatory action plans for obesity prevention projects in children and adolescents using the ANGELO (Analysis Grid for Elements Linked to Obesity) Framework. We combined stakeholder engagement processes, the ANGELO Framework (scans for environmental barriers, targeted behaviours, gaps in skills and knowledge) and workshops with key stakeholders to create action plans for six diverse obesity prevention projects in Australia (n = 3), New Zealand, Fiji and Tonga from 2002 to 2005. Some sites included sociocultural contextual analyses in the environmental scans. Target groups were under-5-year-olds (Australia), 4-12-year-olds (Australia) and 13-18-year-olds (all four countries). Over 120 potential behavioural, knowledge, skill and environmental elements were identified for prioritization leading into each 2-day workshop. Many elements were common across the diverse cultural communities; however, several unique sociocultural elements emerged in some cultural groups which informed their action plans. Youth were actively engaged in adolescent projects, allowing their needs to be incorporated into the action plans initiating the process of ownership. A common structure for the action plan promoted efficiencies in the process while allowing for community creativity and innovation. The ANGELO is a flexible and efficient way of achieving an agreed plan for obesity prevention with diverse communities. It is responsive to community needs, combines local and international knowledge and creates stakeholder ownership of the action plan.

The Pacific Obesity Prevention in Communities project: project overview and methods.

Obesity is increasing worldwide with the Pacific region having the highest prevalence among adults. The most common precursor of adult obesity is adolescent obesity making this a critical period for prevention. The Pacific Obesity Prevention in Communities project was a four‐country project (Fiji, Tonga, New Zealand and Australia) designed to prevent adolescent obesity. This paper overviews the project and the methods common to the four countries. Each country implemented a community‐based intervention programme promoting healthy eating, physical activity and healthy weight in adolescents. A community capacity‐building approach was used, with common processes employed but with contextualized interventions within each country. Changes in anthropometric, behavioural and perception outcomes were evaluated at the individual level and school environments and community capacity at the settings level. The evaluation tools common to each are described. Additional analytical studies included economic, socio‐cultural and policy studies. The project pioneered many areas of obesity prevention research: using multi‐country collaboration to build research capacity; testing a capacity‐building approach in ethnic groups with very high obesity prevalence; costing complex, long‐term community intervention programmes; systematically studying the powerful socio‐cultural influences on weight gain; and undertaking a participatory, national, priority‐setting process for policy interventions using simulation modelling of cost‐effectiveness of interventions.

Experiences and challenges in implementing complex community-based research project: the Pacific Obesity Prevention in Communities project

Policy makers throughout the world are struggling to find effective ways to prevent the rising trend of obesity globally, particularly among children. The Pacific Obesity Prevention in Communities project was the first large‐scale, intervention research project conducted in the Pacific aiming to prevent obesity in adolescents. The project spanned four countries: Australia, New Zealand, Fiji and Tonga. This paper reports on the strengths and challenges experienced from this complex study implemented from 2004 to 2009 across eight cultural groups in different community settings. The key strengths of the project were its holistic collaborative approach, participatory processes and capacity building. The challenges inherent in such a large complex project were underestimated during the projects development. These related to the scale, complexity, duration, low research capacity in some sites and overall coordination across four different countries. Our experiences included the need for a longer lead‐in time prior to intervention for training and up‐skilling of staff in Fiji and Tonga, investment in overall coordination, data quality management across all sites and the need for realistic capacity building requirements for research staff. The enhanced research capacity and skills across all sites include the development and strengthening of research centres, knowledge translation and new obesity prevention projects.

Socio-cultural agents and their impact on body image and body change strategies among adolescents in Fiji, Tonga, Tongans in New Zealand and Australia

This paper reports on the findings of studies that were conducted as part of the Pacific Obesity Prevention in Communities project. The studies evaluated the types of messages that adolescents received in relation to body image, physical activity and eating. The participants were male and female adolescents from Fiji (two cultural groups), Tonga, New Zealand (Tongans) and Australia (European Australians). Three studies were conducted: interviews with 48 adolescents (24 male, 24 female) from each cultural group, questionnaires with 600 adolescents (300 male, 300 female) from each cultural group and the perceptual distortion study with 100 adolescents (50 male, 50 female) from the two cultural groups in Fiji and European Australians. The results demonstrate that parents, peers, the media, as well as religious influences impact on the type of body valued by adolescents in each of the cultural groups, as well as their levels of body satisfaction. These influences also shape the type and volume of food consumed, and the type and frequency of physical activity. The results of these studies highlight the major role played by the broader societal values in shaping the nature of the messages that adolescents receive in relation to their body size, eating and physical activity.

The cost-effectiveness of a successful community-based obesity prevention program: the be active eat well program.

To examine the cost‐effectiveness of Be Active Eat Well (BAEW), a large, multifaceted, community‐based capacity‐building demonstration program that promoted healthy eating and physical activity for Australian children aged 4‐12 years between 2003 and 2006.

Large reductions in child overweight and obesity in intervention and comparison communities 3 years after a community project

Childhood obesity has been increasing over decades and scalable, population‐wide solutions are urgently needed to reverse this trend. Evidence is emerging that community‐based approaches can reduce unhealthy weight gain in children. In some countries, such as Australia, the prevalence of childhood obesity appears to be flattening, suggesting that some population‐wide changes may be underway.

Knowledge brokering between researchers and policymakers in Fiji to develop policies to reduce obesity: a process evaluation

BackgroundThe importance of using research evidence in decisionmaking at the policy level has been increasingly recognized. However, knowledge brokering to engage researchers and policymakers in government and non-government organizations is challenging. This paper describes and evaluates the knowledge exchange processes employed by the Translational Research on Obesity Prevention in Communities (TROPIC) project that was conducted from July 2009 to April 2012 in Fiji. TROPIC aimed to enhance: the evidence-informed decisionmaking skills of policy developers; and awareness and utilization of local and other obesity-related evidence to develop policies that could potentially improve the nation’s food and physical activity environments. The specific research question was: Can a knowledge brokering approach advance evidence-informed policy development to improve eating and physical activity environments in Fiji.MethodsThe intervention comprised: recruiting organizations and individuals; mapping policy environments; analyzing organizational capacity and support for evidence-informed policymaking (EIPM); developing EIPM skills; and facilitating development of evidence-informed policy briefs. Flexible timetabling of activities was essential to accommodate multiple competing priorities at both individual and organizational levels. Process diaries captured the duration, frequency and type of each interaction and/or activity between the knowledge brokering team and participants or their organizations.ResultsPartnerships were formalized with high-level officers in each of the six participating organization. Participants (n = 49) developed EIPM skills (acquire, assess, adapt and apply evidence) through a series of four workshops and applied this knowledge to formulate briefs with ongoing one-to-one support from TROPIC team members. A total of 55% of participants completed the 12 to18 month intervention, and 63% produced one or more briefs (total = 20) that were presented to higher-level officers within their organizations. The knowledge brokering team spent an average of 30 hours per participant during the entire TROPIC process.ConclusionsActive engagement of participating organizations from the outset resulted in strong individual and organizational commitment to the project. The TROPIC initiative provided a win-win situation, with participants expanding skills in EIPM and policy development, organizations increasing EIPM capacity, and researchers providing data to inform policy.

The possibility of regulating for obesity prevention - understanding regulation in the Commonwealth Government

A complex regulatory package is likely to be necessary to effectively reduce obesity prevalence in developed countries. This study investigated the barriers and facilitators to implementing regulatory interventions to prevent obesity within the executive arm of the Australian Commonwealth Government. Policy reviews were conducted on nine government departments to understand their roles and interests in obesity. From this process we identified regulatory review carried out by the Office of Best Practice Regulation as possibly posing a barrier to law reform for obesity prevention, along with the complexity of the food policymaking structures. The policy reviews informed subsequent in‐depth semi‐structured interviews with senior Commonwealth government officers (n = 13) focused on refining our understanding of the barriers to enacting obesity prevention policy. In addition to the two barriers already identified, interviewees identified a lack of evidence for interventions, which would reduce obesity prevalence, and the influence of politicians on executive decisions as posing obstacles. Most interviewees believed that the barriers to regulating to prevent obesity were strong and that intervention by elected politicians would be the most likely method of implementing obesity prevention policy.

Relationship between overweight and health-related quality of life in secondary school children in Fiji: results from a cross-sectional population-based study

Objective:To investigate the relationship between excess weight (overweight and obesity) and health-related quality of life (HRQoL) in a sample of secondary school children in Fiji, by gender, age and ethnicity.Methods:The study comprised 8947 children from forms 3–6 (age 12–18 years) in 18 secondary schools on Viti Levu, the main island of Fiji. Body mass index (BMI) was calculated from measured height and weight, and weight status was classified according to the International Obesity Task Force recommendations. HRQoL was measured by the self-report version of the Pediatric Quality of Life Inventory 4.0.Results:HRQoL was similar in children with obesity and normal weight. Generally, this was replicated when analyzed separately by gender and ethnicity, but age stratification revealed disparities. In 12–14-year-old children, obesity was associated with better HRQoL, owing to better social and school functioning and well-being, and in 15–18-year olds with poorer HRQoL, owing to worse physical, emotional and social functioning and well-being (Cohen’s d 0.2–0.3). Children with a BMI in the overweight range also reported a slightly lower HRQoL than children with a BMI in the normal weight range, but although statistically significant, the size of this difference was trivial (Cohen’s d <0.2).Discussion:The results suggest that, overall there is no meaningful negative association between excess weight and HRQoL in secondary school children in Fiji. This is in contradiction to the negative relationship between excess weight and HRQoL shown in studies from other countries and cultures. The assumption that a large body size is associated with a lower quality of life cannot be held universally. Although a generally low HRQoL among children in Fiji may be masking or overriding the potential effect of excess weight on HRQoL, socio-economic and/or socio-cultural factors, may help to explain these relationships.