Lana Hebden

Development of Smartphone Applications for Nutrition and Physical Activity Behavior Change

Background Young adults (aged 18 to 35) are a population group at high risk for weight gain, yet we know little about how to intervene in this group. Easy access to treatment and support with self-monitoring of their behaviors may be important. Smartphones are gaining in popularity with this population group and software applications (“apps”) used on these mobile devices are a novel technology that can be used to deliver brief health behavior change interventions directly to individuals en masse, with potentially favorable cost-utility. However, existing apps for modifying nutrition or physical activity behaviors may not always reflect best practice guidelines for weight management. Objective This paper describes the process of developing four apps aimed at modifying key lifestyle behaviors associated with weight gain during young adulthood, including physical activity, and consumption of take-out foods (fast food), fruit and vegetables, and sugar-sweetened drinks. Methods The development process involved: (1) deciding on the behavior change strategies, relevant guidelines, graphic design, and potential data collection; (2) selecting the platform (Web-based versus native); (3) creating the design, which required decisions about the user interface, architecture of the relational database, and programming code; and (4) testing the prototype versions with the target audience (young adults aged 18 to 35). Results The four apps took 18 months to develop, involving the fields of marketing, nutrition and dietetics, physical activity, and information technology. Ten subjects provided qualitative feedback about using the apps. The slow running speed of the apps (due to a reliance on an active Internet connection) was the primary issue identified by this group, as well as the requirement to log in to the apps. Conclusions Smartphone apps may be an innovative medium for delivering individual health behavior change intervention en masse, but researchers must give consideration to the target population, available technologies, existing commercial apps, and the possibility that their use will be irregular and short-lived.

Lifestyle intervention for preventing weight gain in young adults: a systematic review and meta‐analysis of RCTs

Younger generations of Australians are gaining weight faster than their parents. Associated health consequences are likely to ensue unless weight gains are prevented; however, it is unclear how to effectively intervene in this population. Electronic databases for health sciences were searched from April to the end of August 2011. Nine studies were included in the review, eight in the meta‐analysis, from 771 abstracts reviewed for eligibility criteria: randomized controlled trials of lifestyle interventions, published in English (1980 onward), aimed at preventing weight gain among healthy subjects 18–35 years. Mean body weight change was the primary outcome. The combined weighted mean change in intervention participants was −0.87 kg (95% CI −1.56, −0.18) and in control participants 0.86 kg (95% CI 0.14, 1.57). Post hoc meta‐regression analyses revealed evidence‐based interventions of 4 months or longer duration were significantly associated with greater weight loss (−1.62 [95% CI −3.21, −0.04], P = 0.045). The small number, short duration and large heterogeneity of trials means the effectiveness of lifestyle intervention for preventing young adult weight gain remains unclear. Future trials conducted over longer periods with larger samples are urgently required to develop effective programmes that will protect against weight gains in future generations.

Industry self regulation of television food advertising: responsible or responsive?

INTRODUCTION This study evaluated the impact of the Australian Food and Grocery Council (AFGC) self-regulatory initiative on unhealthy food marketing to children, introduced in January 2009. The study compared patterns of food advertising by AFGC and non-AFGC signatory companies in 2009, 2007 and 2006 on three Sydney commercial free-to-air television channels. METHODS Data were collected across seven days in May 2006 and 2007, and four days in May 2009. Advertised foods were coded as core, non-core and miscellaneous. Regression for counts analyses was used to examine change in rates of advertisements across the sampled periods and differential change between AFGC-signatory or non-signatory companies between 2007 and 2009. RESULTS Of 36 food companies that advertised during the 2009 sample period, 14 were AFGC signatories. The average number of food advertisements decreased significantly from 7.0 per hour in 2007 to 5.9 in 2009. There was a significant reduction in non-core food advertising from 2007 to 2009 by AFGC signatories compared with non-signatory companies overall and during peak times, when the largest numbers of children were viewing. There was no reduction in the rate of non-core food advertisements by all companies, and these advertisements continue to comprise the majority during peak viewing times. DISCUSSION While some companies have responded to pressures to reduce unhealthy food advertising on television, the impact of the self-regulatory code is limited by the extent of uptake by food companies. The continued advertising of unhealthy foods indicates that this self-regulatory code does not adequately protect children.

‘TXT2BFiT’ a mobile phone-based healthy lifestyle program for preventing unhealthy weight gain in young adults: study protocol for a randomized controlled trial

BackgroundDespite international efforts to arrest increasing rates of overweight and obesity, many population strategies have neglected young adults as a target group. Young adults are at high risk for unhealthy weight gain which tends to persist throughout adulthood with associated chronic disease health risks.Methods/designTXT2BFiT is a nine month two-arm parallel-group randomized controlled trial aimed at improving weight management and weight-related dietary and physical activity behaviors among young adults. Participants are recruited via general practice (primary medical care) clinics in Sydney, New South Wales, Australia. All participants receive a mailed resource outlining national physical activity and dietary guidelines and access to the study website. Additional resources accessible to the intervention arm via the study website include Smartphone mobile applications, printable handouts, an interactive healthy weight tracker chart, and a community blog. The study consists of two phases: (1) Intensive phase (weeks 1 to 12): the control arm receives four short message service (SMS) text messages; the intervention arm receives eight SMS messages/week tailored to their baseline stage-of-change, one Email/week, and personalized coaching calls during weeks 0, 2, 5, 8, and 11; and (2) Maintenance phase (weeks 14 to 36): the intervention arm receives one SMS message/month, one Email/month and booster coaching calls during months 5 and 8. A sample of N = 354 (177 per arm) is required to detect differences in primary outcomes: body weight (kg) and body mass index (kg/m2), and secondary outcomes: physical activity, sitting time, intake of specific foods, beverages and nutrients, stage-of-change, self-efficacy and participant well-being, at three and nine months. Program reach, costs, implementation and participant engagement will also be assessed.DiscussionThis mobile phone based program addresses an important gap in obesity prevention efforts to date. The method of intervention delivery is via platforms that are highly accessible and appropriate for this population group. If effective, further translational research will be required to assess how this program might operate in the broader community.Trial registrationAustralian New Zealand Clinical Trials Registry ACTRN12612000924853

Advertising of fast food to children on Australian television: the impact of industry self-regulation.

OBJECTIVE To assess the impact of the quick-service restaurant industry (QSRI) self-regulatory initiative on fast-food advertising to children on Australian commercial television. DESIGN AND SETTING Analysis of advertisements for foods on the three main free-to-air commercial television channels (channels 7, 9 and 10) in Sydney, Australia, over 4 days in both May 2009 and April 2010 in terms of: number of advertisements; types of food (coded core [healthy] foods, non-core [unhealthy] foods, miscellaneous foods; or fast foods); whether advertised meals were intended for children; whether advertisements were broadcast during childrens peak viewing times; and whether the company in question was a signatory to the QSRI initiative. MAIN OUTCOME MEASURES Change in the mean frequency and rate of food advertisements per hour from 2009 to 2010; change in the types of fast-food meals (healthier alternatives [at least one nutrient-dense, low-energy food considered part of a healthy diet for children], non-core [high in undesirable nutrients and not considered part of a healthy diet for children], and other) being advertised; and proportion of childrens energy requirements provided by fast-food meals. RESULTS From 2009 to 2010, the mean frequency of fast-food advertisements increased from 1.1 to 1.5 per hour. While non-core fast foods comprised a lesser share of fast-food advertising in 2010 than 2009, the mean frequency at which they were advertised during times when the largest numbers of children were watching television remained the same (1.3 per hour in both 2009 and 2010). Family meals advertised for childrens consumption in 2010 provided energy far in excess of childrens requirements. CONCLUSIONS Childrens exposure to unhealthy fast-food advertising has not changed following the introduction of self-regulation, and some fast foods advertised for childrens consumption contain excessive energy. The limited impact of self-regulation suggests that governments should define the policy framework for regulating fast-food advertising to children.

Effectiveness of a mHealth Lifestyle Program With Telephone Support (TXT2BFiT) to Prevent Unhealthy Weight Gain in Young Adults: Randomized Controlled Trial

Background Weight gained in young adulthood often persists throughout later life with associated chronic disease risk. Despite this, current population prevention strategies are not specifically designed for young adults. Objective We designed and assessed the efficacy of an mHealth prevention program, TXT2BFiT, in preventing excess weight gain and improving dietary and physical activity behaviors in young adults at increased risk of obesity and unhealthy lifestyle choices. Methods A two-arm, parallel-group randomized controlled trial was conducted. Subjects and analyzing researchers were blinded. A total of 250 18- to 35-year-olds with a high risk of weight gain, a body mass index (BMI) of 23.0 to 24.9 kg/m2 with at least 2 kg of weight gain in the previous 12 months, or a BMI of 25.0 to 31.9 kg/m2 were randomized to the intervention or control group. In the 12-week intervention period, the intervention group received 8 text messages weekly based on the transtheoretical model of behavior change, 1 email weekly, 5 personalized coaching calls, a diet booklet, and access to resources and mobile phone apps on a website. Control group participants received only 4 text messages and printed dietary and physical activity guidelines. Measured body weight and height were collected at baseline and at 12 weeks. Outcomes were assessed via online surveys at baseline and at 12 weeks, including self-reported weight and dietary and physical activity measures. Results A total of 214 participants—110 intervention and 104 control—completed the 12-week intervention period. A total of 10 participants out of 250 (4.0%)—10 intervention and 0 control—dropped out, and 26 participants (10.4%)—5 intervention and 21 control—did not complete postintervention online surveys. Adherence to coaching calls and delivery of text messages was over 90%. At 12 weeks, the intervention group were 2.2 kg (95% CI 0.8-3.6) lighter than controls (P=.005). Intervention participants consumed more vegetables (P=.009), fewer sugary soft drinks (P=.002), and fewer energy-dense takeout meals (P=.001) compared to controls. They also increased their total physical activity by 252.5 MET-minutes (95% CI 1.2-503.8, P=.05) and total physical activity by 1.3 days (95% CI 0.5-2.2, P=.003) compared to controls. Conclusions The TXT2BFiT low-intensity intervention was successful in preventing weight gain with modest weight loss and improvement in lifestyle behaviors among overweight young adults. The short-term success of the 12-week intervention period shows potential. Maintenance of the behavior change will be monitored at 9 months. Trial Registration Trial Registration: The Australian New Zealand Clinical Trials Registry ACTRN12612000924853; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?ACTRN=12612000924853 (Archived by WebCite at http://www.webcitation.org/6Z6w9LlS9).

A Menagerie of Promotional Characters: Promoting Food to Children through Food Packaging

OBJECTIVE To determine the extent to which (1) promotional characters are used on food packaging for healthful and less-healthful food and (2) different companies use this persuasive marketing strategy. DESIGN Cross-sectional supermarket audit of all food and beverages featuring promotional characters on the packaging. SETTING Three Australian supermarket chains. VARIABLES MEASURED Frequency of observed products, package size, nutritional composition. ANALYSIS Frequencies and bivariate analyses was conducted. Nutritional composition (healthful vs less healthful) was analyzed by character type and company type, that is, whether the company was signed to the Australian Food and Grocery Council Responsible Marketing to Children Initiative (RMCI) signatory. RESULTS Products featuring promotional characters on packaging (n = 352) were predominantly less-healthful food and beverages (70%). [corrected]. Nutritional composition varied significantly by character type, with 69% of products with sportspersons, celebrities, or movie tie-ins being healthful, compared with 38% of licensed and 16% [corrected] of company-owned characters. Only 13 of the 75 companies using characters on packaging were RMCI signatory. CONCLUSIONS AND IMPLICATIONS Promotional characters are largely used on food packaging to promote less-healthful food to children. Most of these characters are company-owned characters that are not subject to any form of regulation in Australia. Further efforts to limit this form of marketing to children are required.

Art of persuasion: An analysis of techniques used to market foods to children

Aim:  Persuasive marketing techniques, such as promotional characters, influence childrens food preferences and requests for foods. The aim of this research was to describe the techniques used to market unhealthy foods and beverages to children on Sydney free‐to‐air television.

Building the case for independent monitoring of food advertising on Australian television

OBJECTIVE To provide an independent monitoring report examining the ongoing impact of Australian self-regulatory pledges on food and drink advertising to children on commercial television. DESIGN Analysis of food advertisements across comparable sample time periods in April/May 2006, 2007, 2009, 2010 and 2011. The main outcome measure comprised change in the mean rate of non-core food advertisements from 2006 to 2011. SETTING Sydney free-to-air television channels. SUBJECTS Televised food advertisements. RESULTS In 2011 the rate of non-core food advertisements was not significantly different from that in 2006 or 2010 (3·2/h v. 4·1/h and 3·1/h), although there were variations across the intervening years. The rate of fast-food advertising in 2010 was significantly higher than in 2006 (1·8/h v. 1·1/h, P < 0·001), but the same as that in 2011 (1·5/h). CONCLUSIONS The frequency of non-core food advertising on Sydney television has remained essentially unchanged between 2006 and 2011, despite the implementation of two industry self-regulatory pledges. The current study illustrates the value of independent monitoring as a basic requirement of any responsive regulatory approach.

Trends in food advertising to children on free‐to‐air television in Australia

Objective: The issue of marketing unhealthy food to children and its contribution to childhood obesity has become a highly politicised debate in Australia. The aim of this study was to compare recent television food advertising patterns in 2008 to previously published Australian research on television advertising from 2006 and 2007, to examine any changes following policy debates.