Joanne Gale

30-year trends in overweight, obesity and waist-to-height ratio by socioeconomic status in Australian children, 1985 to 2015

Background/Objective:To report 30-year (1985–2015) prevalence trends in overweight, obesity and abdominal obesity among children by school level and socioeconomic status (SES).Subjects/Methods:Five cross-sectional, population child surveys (age 4–18 years; n=27 808) conducted in 1985–1997–2004–2010–2015 in New South Wales, Australia. Outcomes were prevalence of measured overweight, obesity and waist-to-height ratio (WHtR⩾0.5) by sex, school level (children (primary) and adolescents (high)) and SES tertile.Results:In 2015, the prevalences of overweight, obesity and WHtR⩾0.5 in children were 16.4%, 7.0% and 14.6%, respectively, and in adolescents 21.9%, 17.2% and 4.6%, respectively. Obesity prevalence has not significantly changed in children or adolescents since 1997, nor since 2010 (children, P=0.681; adolescents, P=0.21). Overweight has not significantly changed in children since 1997, but has in adolescents since 1985, with a relative increase of 16 percentage points (P<0.001) between 2010 and 2015. WHtR⩾0.5 prevalence has significantly changed since 1985, except in adolescent girls between 2010 and 2015. Between 2010 and 2015 the relative increase in WHtR⩾0.5 was 17 and 40 percentage points in children and adolescent boys, respectively. Significant disparities in prevalence rates between children and adolescents from low and high SES backgrounds began in 2010 for overweight, since 1997 for obesity and since 2004 for WHtR⩾0.5. Differences between SES groups have become larger over the past 18 years.Conclusions:Since 1997, obesity has remained stable, and overweight has stabilized in children, not in adolescents. WHtR⩾0.5 significantly increased between 1985 and 2015, with prevalence rates at each survey around twice the obesity prevalence. Compared with high SES children and adolescents, the risk of overweight, obesity and WHtR⩾0.5 was significantly higher for low SES children and adolescents. The findings are highly relevant to policy makers involved in child obesity prevention interventions and highlight the need for better targeted interventions among children and adolescents from low SES backgrounds, and adolescents in particular.

Sedentary Behavior and Musculoskeletal Discomfort Are Reduced When Office Workers Trial an Activity-Based Work Environment

Objective: The aim of this study was to evaluate the effect of an activity-based work (ABW) office environment on physical activity and sedentary behavior, work ability, and musculoskeletal discomfort. Methods: Eighty-eight office workers trialed ABW for 4 weeks. Accelerometer and self-reported outcomes were measured at baseline, end-intervention, and follow-up. Data were analyzed using linear mixed models. Results: Accelerometry measured sedentary time; sedentary breaks and step count did not significantly change from baseline to end-intervention (P = 0.13, 0.09, 0.18, respectively). Self-reported sitting-time was 14% lower, with standing-time and walking 11% and 3% higher in ABW than baseline (P < 0.01 for all). Low back pain was lower in ABW than baseline (odds ratio 2.0, 95% confidence interval 1.1 to 3.7). Work ability reduced from 8.4 to 7.8 points (P < 0.01) at follow-up. Conclusions: ABW environment appears to reduce self-reported sedentary behavior and low back pain and increase standing time.

Vegetarian diet and all-cause mortality: Evidence from a large population-based Australian cohort - the 45 and Up Study

The vegetarian diet is thought to have health benefits including reductions in type 2 diabetes, hypertension, and obesity. Evidence to date suggests that vegetarians tend to have lower mortality rates when compared with non-vegetarians, but most studies are not population-based and other healthy lifestyle factors may have confounded apparent protective effects. The aim of this study was to evaluate the association between categories of vegetarian diet (including complete, semi and pesco-vegetarian) and all-cause mortality in a large population-based Australian cohort. The 45 and Up Study is a cohort study of 267,180 men and women aged ≥45years in New South Wales (NSW), Australia. Vegetarian diet status was assessed by baseline questionnaire and participants were categorized into complete vegetarians, semi-vegetarians (eat meat≤once/week), pesco-vegetarians and regular meat eaters. All-cause mortality was determined by linked registry data to mid-2014. Cox proportional hazards models quantified the association between vegetarian diet and all-cause mortality adjusting for a range of potential confounding factors. Among 243,096 participants (mean age: 62.3years, 46.7% men) there were 16,836 deaths over a mean 6.1years of follow-up. Following extensive adjustment for potential confounding factors there was no significant difference in all-cause mortality for vegetarians versus non-vegetarians [HR=1.16 (95% CI 0.93-1.45)]. There was also no significant difference in mortality risk between pesco-vegetarians [HR=0.79 (95% CI 0.59-1.06)] or semi-vegetarians [HR=1.12 (95% CI 0.96-1.31)] versus regular meat eaters. We found no evidence that following a vegetarian diet, semi-vegetarian diet or a pesco-vegetarian diet has an independent protective effect on all-cause mortality.

Who is at risk of chronic disease? Associations between risk profiles of physical activity, sitting and cardio‐metabolic disease in Australian adults

Objective: To examine the associations of physical activity (PA) and sitting time (sit) with cardio‐metabolic diseases.

Impact of the Make Healthy Normal mass media campaign (Phase 1) on knowledge, attitudes and behaviours: a cohort study

Objective: To determine the impact of the first phase of the Make Healthy Normal mass media campaign on NSW adults’ active living and healthy eating knowledge, attitudes, intentions and behaviour.

Associations between multiple indicators of socio-economic status and muscle-strengthening activity participation in a nationally representative population sample of Australian adults

BACKGROUND Muscle-strengthening activity (MSA) (e.g. weight training), confers unique health benefits. While socioeconomic status (SES) correlates with leisure time physical activity, little is known about its relation with MSA. METHODS Cross-sectional study of a representative sample of 8993 Australian adults (>18years) who participated in the National Nutrition and Physical Activity Survey 2011-12. Information was collected on SES (income, education, socio-economic disadvantage and remoteness) and MSA participation. RESULTS 17.9% (CI: 16.8-19.0) met the national guidelines for MSA (≥2 sessions/week). Men and younger adults (<35years) met MSA guidelines more than females (19.7%; CI: 18.3-21.1% vs 16.1%; CI: 14.6-17.6%; p<0.001) and older adults respectively (25.0%; CI: 22.4-27.7% vs 10.4%; CI: 8.9-11.8%; p<0.001). All SES indicators were associated with meeting the guidelines in unadjusted analyses. When adjusting for total physical activity and mutually adjusting for each socioeconomic indicator only remoteness (OR for city vs rural=1.65; CI: 1.17-2.32; p<0.001) was associated with MSA participation (education OR=1.09 for high vs low; CI: 0.80-1.47, p=0.748; income OR=1.31 for Q5 vs Q1, CI: 0.93-1.85, p=0.328; social disadvantage OR=1.04 for v.high vs v.low, CI: 0.76-1.43, p=0.855). These associations were further attenuated when adjusting for BMI, smoking status and self-rated health. CONCLUSION Remoteness, and to a lesser degree, education, income and social disadvantage, were independently associated with MSA participation. Public health interventions should improve access to strength training facilities, and/or increase home-based muscle-strengthening activity in remote areas.

Prevalence of elevated alanine transaminase in Australia and its relationship to metabolic risk factors: A cross‐sectional study of 9,447 people

Elevated alanine transaminase (ALT) is a strong predictor of metabolic syndrome, but there are few data from the Australian population. We aimed to determine the prevalence of elevated ALT and association with metabolic risk factors.

Are motivational signs to increase stair use a thing of the past? A multi‐building study

Issue addressed Only half of Australias adult population is sufficiently physical active. One method thought to increase incidental physical activity at work is the use of stair-promoting interventions. Stairs are readily available and stair climbing is considered vigorous physical activity. Motivational signs have been extensively and effectively trialled to increase stair use, but are they suitable for contemporary populations? Methods Participants were occupants of three selected University of Sydney buildings using the elevators or stairs. Infrared people counters were installed to monitor stair and elevator use for 24 h/day during two baseline weeks, followed by two intervention weeks, where motivational and directional signs were placed at points of choice. Results At baseline there was a large between-building variation in the change in stair to elevator proportion, where we observed a small increase in two buildings (81-84%, odds ratio (OR): 1.16 (1.09, 1.23), and 26-27%, OR: 1.09 (1.03, 1.15)), and a decrease (30-25%, OR: 0.75 (0.72, 0.77) in the third building. Conclusions Differences in stair use among buildings could be due to building design and function. Motivational and directional signs to promote stair use showed small or nil effects. The future of interventions promoting stair use in occupational settings may need more interactive or personalised intervention methods. So what? The implications of this study are that posters to promote stair use might be a thing of the past and this should be considered in future workplace health promotion efforts to increase physical activity. More novel and interactive methods using new media are recommended.

From awareness to behaviour: Testing a hierarchy of effects model on the Australian Make Healthy Normal campaign using mediation analysis

The Make Healthy Normal mass media campaign was a three-year campaign launched in 2015 in New South Wales (NSW), Australia to address community norms around overweight and obesity. It was underpinned by a hierarchy of effects model; a commonly used framework in campaigns but one that has rarely been tested. The campaign evaluation included a cohort study of NSW adults, surveyed three times over 12 months (n = 939 at Wave 3). This study tested the campaigns hierarchy of effects model, which theorized that participants would move from recognition to behaviour change via understanding, knowledge, attitude, social norms, self-efficacy, and intention, using these data. We used the moderation and mediation of effects method proposed by Baron and Kenny, adjusting for age and sex, to test for progression through the hierarchy of effects for two outcomes: physical activity and fast food consumption. We found a clear progression through the theorized model, from recognition through to behaviour change, via the intermediate variables for both outcomes. We also found several effects not predicted by the theorized model, with consistently strong associations between understanding and attitude, understanding and self-efficacy, attitude and self-efficacy, and self-efficacy and behaviour change in both outcome models. Our study provides support for the hierarchy of effects as a conceptual model in campaign planning and evaluation of social marketing campaigns. To our knowledge, this is the first study to compare the hierarchy between two behavioural outcomes and the consistency observed between the models adds to the potential usefulness of the hierarchy of effects.

Weight-Related Goal Setting in a Telephone-Based Preventive Health-Coaching Program Demonstration of Effectiveness

Purpose: This study investigated whether participants in a 6-month telephone-based coaching program, who set physical activity, nutrition, and weight loss goals had better outcomes in these domains. Design: Quasi-experimental design. Setting: The Australian Get Healthy Information and Coaching Service (GHS), a free population-wide telephone health-coaching service that includes goal setting as a key component of its coaching program. Participants: Consenting GHS coaching participants who had completed coaching between February 2009 and December 2012 (n = 4108). Measures: At baseline, participants select a goal for the coaching program, and sociodemographic variables are collected. Self-reported weight, height, waist circumference, physical activity, and nutrition-related behaviors are assessed at baseline and 6 months. Analysis: Descriptive analysis was performed on key sociodemographic variables, and the relationship between goal type and change in health outcomes was assessed using a series of linear mixed models that modeled change from baseline to 6 months. Results: Participants who set goals in relation to weight management and physical activity achieved better results in these areas than those who set alternate goals, losing more than those who set alternate goals (1.5 kg and 0.9 cm in waist circumference) and increasing walking per week (40 minutes), respectively. There was no difference in food-related outcomes for those that set nutrition-related goals. Conclusion: Goal setting for weight management and increasing physical activity in the overweight and obese population, undertaken in a telephone-based coaching program, can be effective.