Jennifer Utter

Couch potatoes or French fries: Are sedentary behaviors associated with body mass index, physical activity, and dietary behaviors among adolescents?

OBJECTIVE To describe the demographic characteristics of adolescent boys and girls who engage in three sedentary behaviors (television/video use, computer use, and reading/homework), and to explore how each sedentary activity is associated with body mass index (BMI), dietary behaviors, and leisure time physical activity. DESIGN This study draws on data collected from Project EAT (Eating Among Teens), a school-based survey examining personal, behavioral, and socioenvironmental factors that are associated with nutritional intake among adolescents. SUBJECTS The study sample consists of 4746 middle and high school students from 31 public schools in a metropolitan area of the upper Midwest. All students were invited to participate. The overall response rate for Project EAT was 81.5%. Data collection was completed during the 1998-1999 school year. STATISTICAL ANALYSIS Multivariate linear regression was used for examining associations between independent and dependent variables, controlling for age, race/ethnicity, and socioeconomic status. All differences were considered statistically significant at P<.05. RESULTS Among boys, television/video use and time spent reading/doing homework were positively associated with BMI (P<.05), whereas for girls television/video and computer use were positively associated with BMI (P<.05). High television/video use among boys and girls was associated with more unhealthful dietary behaviors (eg, increased consumption of soft drinks, fried foods, and snacks) (P<.05). In contrast, time spent reading/doing homework was associated with more healthful dietary behaviors (eg, increased consumption of fruits and vegetables) (P<.05). Leisure time physical activity was not associated with television/video use among boys or girls, but was positively associated with computer use and time spent reading/doing homework (P<.05). Applications/Conclusions Messages and advice aimed at reducing time spent in sedentary activities should be targeted at television/video use instead of time spent reading, doing homework, or using a computer. Nutrition education should incorporate messages about the influence of the media and advertising on dietary behaviors.

Associations between television viewing and consumption of commonly advertised foods among New Zealand children and young adolescents

OBJECTIVES To explore how time spent watching television (TV) is associated with the dietary behaviours of New Zealand children and young adolescents. DESIGN Secondary data analysis of a nationally representative, cross-sectional survey. SETTING In homes or schools of New Zealand school students. PARTICIPANTS In total, 3275 children aged 5 to 14 years. RESULTS The odds of being overweight or obese increased with duration of TV viewing for children and adolescents when controlling for age, sex, ethnicity, socio-economic status and physical activity. Children and adolescents who watched the most TV were significantly more likely to be higher consumers of foods most commonly advertised on TV: soft drinks and fruit drinks, some sweets and snacks, and some fast foods. Both children and adolescents watching two or more hours of TV a day were more than twice as likely to drink soft drinks five times a week or more (P = 0.03 and P = 0.04, respectively), eat hamburgers at least once a week (both P = 0.02), and eat French fries at least once a week (both P < 0.01). CONCLUSIONS These findings suggest that longer duration of TV watching (thus, more frequent exposure to advertising) influences the frequency of consumption of soft drinks, some sweets and snacks, and some fast foods among children and young adolescents. Efforts to curtail the amount of time children spend watching TV may result in better dietary habits and weight control for children and adolescents. Future studies examining the impact of advertising on childrens diets through interventions and international comparisons of legislation would provide more definitive evidence of the role of advertising in child and adolescent obesity.

Relationships between frequency of family meals, BMI and nutritional aspects of the home food environment among New Zealand adolescents

BackgroundPrevious research has documented the positive effects of family meals on the dietary quality of adolescents. The objective of the current study is to examine associations between frequency of family meals and body mass index (BMI), other aspects of the home food environment, and related nutrition behaviors.MethodsData were collected during baseline measurements of the Pacific Obesity Prevention In Communities study. In total, 3245 ethnically diverse students completed a questionnaire about their nutrition behaviors and were weighed and measured for height.ResultsIn total, 42% of adolescents ate a family meal on all of the previous five school nights. Frequency of family meals was modestly associated with BMI in bivariate analysis (p = 0.045), but lost significance when demographic characteristics were included in the model. Frequency of family meals was associated with many positive aspects of home food environment and positive nutrition behaviors, including parental support for healthy eating, limits on television use, having fruit available at home, consuming five fruits and vegetables a day, eating breakfast, and bringing lunch from home. Surprisingly, no relationships were observed between frequency of family meals and accessibility and consumption of many high fat/high sugar foods.ConclusionOur findings suggest that the positive effect of family meals may reflect an overall positive home food environment. Families who have meals together have more healthful foods available at home and support their child in eating healthfully. There were no relationships between family meals and high fat/high sugar foods; this suggest that while families may prioritize eating together, messages about limiting the availability and consumption of these snack foods are not getting through.

Image-Assisted Dietary Assessment: A Systematic Review of the Evidence

Images captured during eating episodes provide objective information to assist in the assessment of dietary intake. Images are captured using handheld devices or wearable cameras, and can support traditional self-report or provide the primary record of dietary intake. A diverse range of image-assisted methods have been developed and evaluated but have not been previously examined together. Therefore, a review was undertaken to examine all studies that have evaluated or validated image-assisted methods of dietary assessment for assessing dietary energy intake. Identified image-assisted methods that employ similar methodologies were grouped for comparison. English-language full-text research articles published between January 1998 and November 2013 were searched using five electronic databases. A search of reference lists and associated websites was also conducted. Thirteen studies that evaluated 10 unique image-assisted methods among adults aged 18 to 70 years were included. Ten studies used handheld devices and three studies used wearable cameras. Eight studies evaluated image-based food records, two studies explored the use of images to enhance written food records, and three studies evaluated image-assisted 24-hour dietary recalls. Results indicate images enhance self-report by revealing unreported foods and identify misreporting errors not captured by traditional methods alone. Moreover, when used as the primary record of dietary intake, images can provide valid estimates of energy intake. However, image-assisted methods that rely on image analysis can be prone to underestimation if users do not capture images of satisfactory quality before all foods are consumed. Further validation studies using criterion measures are warranted. The validity among children, adolescents, and elderly persons as well as the feasibility of using image-assisted methods in large samples needs to be examined. Additional research is also needed to better understand the potential applications and pitfalls of wearable cameras.

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.

Correlates of body mass index among a nationally representative sample of New Zealand children

OBJECTIVES To describe how nutrition behaviours and physical activity are associated with body mass index (BMI) among New Zealand children and to determine if these relationships vary by ethnicity. METHODS Data were collected during the 2002 National Childrens Nutrition Survey. 3250 children provided information about their eating and activity behaviours and anthropometric measurements. RESULTS Approximately 31% of New Zealand children aged 5 to 14 years were overweight/obese, with the highest prevalences of overweight/obesity among Pacific children (62%) and Mäori children (41%). Higher prevalences of obesity were also observed among females and children experiencing socioeconomic deprivation. Television use, buying school food from the dairy/takeaway shops, skipping breakfast, consumption of fruit drinks/soft drinks, and low physical activity were associated with BMI in analyses controlling for demographic characteristics among the total population. Buying school food from the dairy/takeaway (p=0.04) and skipping breakfast (p=0.007) retained significance when all nutrition behaviours and physical activity were analysed simultaneously. Significant interactions between ethnicity and bringing school food from home and buying school food from school were observed in relation to BMI. In most cases, the relationships were most significant for Pacific children. CONCLUSIONS Strategies to address childhood obesity among all New Zealand children should primarily include efforts to increase breakfast consumption and decrease food purchases away from home. Given the high rates of obesity between Pacific and Mäori children, targeted interventions are warranted and should include strategies to improve the school food environment.

Under-reporting remains a key limitation of self-reported dietary intake: an analysis of the 2008/09 New Zealand Adult Nutrition Survey.

Background/Objectives:The most recent New Zealand Adult Nutrition Survey 2008/09 (ANS 08/9) revealed a decrease in reported energy intakes (EIs) compared with the previous 1997 National Nutrition Survey (NNS97). Conversely, measured body weights increased over the same period. We conducted an analysis on the ANS 08/9 data sets to evaluate reported EIs.Subjects/Methods:Analysis was conducted on data from 3919 (1715 men and 2204 women aged ⩾15 years) survey participants who completed the 24-h dietary recall in the ANS 08/9. Under-reporting was assessed using the ratio of reported EI to estimated resting metabolic rate (EI:RMRest), and a cutoff limit of <0.9 (EI:RMRest) was used to identify low energy reporters (LERs). Results were examined by gender, body size, age and ethnicity.Results:The mean EI:RMRest (s.e.m.) was 1.34 (0.02) for men, and 1.23 (0.02) for women. Overall, 21% of men and 25% of women were classified as LERs. There was a greater prevalence of LERs among people with overweight (25%), or obesity (30%) than people with normal body weight (16%, P<0.001). The oldest age group (⩾65 years) had a greater prevalence of LERs (33%) compared with all other age groups (19–24%, P<0.001). Pacific people had a greater prevalence of LERs (33%) compared with Maori (26%, P=0.007) and European (23%, P<0.001). Compared with the NNS97, a substantial increase in the prevalence of LERs was evident in most subgroups.Conclusions:Under-reporting of EI will continue to be a major limitation of nutrition surveys without technological innovation. Care should be taken when interpreting EI data.

Hand-held internet tablets for school-based data collection

BackgroundIn the last 20 years, researchers have been using computer self-administered questionnaires to gather data on a wide range of adolescent health related behaviours. More recently, researchers collecting data in schools have started to use smaller hand-held computers for their ease of use and portability. The aim of this study is to describe a new technology with wi-fi enabled hand-held internet tablets and to compare adolescent preferences of laptop computers or hand-held internet tablets in administering a youth health and well-being questionnaire in a school setting.MethodsA total of 177 students took part in a pilot study of a national youth health and wellbeing survey. Students were randomly assigned to internet tablets or laptops at the start of the survey and were changed to the alternate mode of administration about half-way through the questionnaire. Students at the end of the questionnaire were asked which of the two modes of administration (1) they preferred, (2) was easier to use, (3) was more private and confidential, and (4) was easier to answer truthfully.ResultsMany students expressed no preference between laptop computers or internet tablets. However, among the students who expressed a preference between laptop computers or internet tablets, the majority of students found the internet tablets more private and confidential (p < 0.001) and easier to answer questions truthfully (p < 0.001) compared to laptop computers.ConclusionThis study demonstrates that using wi-fi enabled hand-held internet tablets is a feasible methodology for school-based surveys especially when asking about sensitive information.

Feasibility of a SenseCam-assisted 24-h recall to reduce under-reporting of energy intake.

Background/Objectives:The SenseCam is a camera worn on a lanyard around the neck that automatically captures point-of-view images in response to movement, heat and light (every 20–30 s). This device may enhance the accuracy of self-reported dietary intake by assisting participants’ recall of food and beverage consumption. It was the objective of this study to evaluate if the wearable camera, SenseCam, can enhance the 24-h dietary recall by providing visual prompts to improve recall of food and beverage consumption.Subject/Methods:Thirteen volunteer adults in Oxford, United Kingdom, were recruited. Participants wore the SenseCam for 2 days while continuing their usual daily activities. On day 3, participants’ diets were assessed using an interviewer-administered 24-h recall. SenseCam images were then shown to the participants and any additional dietary information that participants provided after viewing the images was recorded. Energy and macronutrient intakes were compared between the 24-h recall and 24-h recall+SenseCam.Results:Data from 10 participants were included in the final analysis (8 males and 2 females), mean age 33±11 years, mean BMI 25.9±5.1 kg/m2. Viewing the SenseCam images increased self-reported energy intake by approximately 1432±1564 kJ or 12.5% compared with the 24-h recall alone (P=0.02). The increase was predominantly due to reporting of 41 additional foods (241 vs 282 total foods) across a range of food groups. Eight changes in portion size were made, which resulted in a negligible change to energy intake.Conclusions:Wearable cameras are promising method to enhance the accuracy of self-reported dietary assessment methods.

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.