Peter Kremer

Reducing unhealthy weight gain in children through community capacity-building: results of a quasi-experimental intervention program, Be Active Eat Well.

Background:Be Active Eat Well (BAEW) was a multifaceted community capacity-building program promoting healthy eating and physical activity for children (aged 4–12 years) in the Australian town of Colac.Objective:To evaluate the effects of BAEW on reducing childrens unhealthy weight gain.Methods:BAEW had a quasi-experimental, longitudinal design with anthropometric and demographic data collected on Colac children in four preschools and six primary schools at baseline (2003, n=1001, response rate: 58%) and follow-up (2006, n=839, follow-up rate: 84%). The comparison sample was a stratified random selection of preschools (n=4) and primary schools (n=12) from the rest of the Barwon South Western region of Victoria, with baseline assessment in 2003–2004 (n=1183, response rate: 44%) and follow-up in 2006 (n=979, follow-up rate: 83%).Results:Colac children had significantly lower increases in body weight (mean: −0.92 kg, 95% CI: −1.74 to −0.11), waist (−3.14 cm, −5.07 to −1.22), waist/height (−0.02, −0.03 to −0.004), and body mass index z-score (−0.11, −0.21 to −0.01) than comparison children, adjusted for baseline variable, age, height, gender, duration between measurements and clustering by school. In Colac, the anthropometric changes were not related to four indicators of socioeconomic status (SES), whereas in the comparison group 19/20 such analyses showed significantly greater gains in anthropometry in children from lower SES families. Changes in underweight and attempted weight loss were no different between the groups.Conclusions:Building community capacity to promote healthy eating and physical activity appears to be a safe and effective way to reduce unhealthy weight gain in children without increasing health inequalities.

Reducing obesity in early childhood: results from Romp & Chomp, an Australian community-wide intervention program

BACKGROUND There is growing evidence that community-based interventions can reduce childhood obesity in older children. OBJECTIVE We aimed to determine the effectiveness of the Romp & Chomp intervention in reducing obesity and promoting healthy eating and active play in children aged 0-5 y. DESIGN Romp & Chomp was a community-wide, multisetting, multistrategy intervention conducted in Australia from 2004 to 2008. The intervention occurred in a large regional city (Geelong) with a target group of 12,000 children and focused on community capacity building and environmental (political, sociocultural, and physical) changes to increase healthy eating and active play in early-childhood care and educational settings. The evaluation was repeat cross-sectional with a quasiexperimental design and comparison sample. Main outcome measures were body mass index (BMI), standardized BMI (zBMI; according to the Centers for Disease Control and Prevention 2000 reference charts), and prevalence of overweight/obesity and obesity-related behaviors in children aged 2 and 3.5 y. RESULTS After the intervention there was a significantly lower mean weight, BMI, and zBMI in the 3.5-y-old subsample and a significantly lower prevalence of overweight/obesity in both the 2- and 3.5-y-old subsamples (by 2.5 and 3.4 percentage points, respectively) than in the comparison sample (a difference of 0.7 percentage points; P < 0.05) compared with baseline values. Intervention child-behavioral data showed a significantly lower intake of packaged snacks (by 0.23 serving), fruit juice (0.52 serving), and cordial (0.43 serving) than that in the comparison sample (all P < 0.05). CONCLUSION A community-wide multisetting, multistrategy intervention in early-childhood settings can reduce childhood obesity and improve young childrens diets. This trial was registered with the Australian Clinical Trials Registry at anzctr.org.au as ACTRN12607000374460.

A Prospective Study of Diet Quality and Mental Health in Adolescents

Objectives A number of cross-sectional and prospective studies have now been published demonstrating inverse relationships between diet quality and the common mental disorders in adults. However, there are no existing prospective studies of this association in adolescents, the onset period of most disorders, limiting inferences regarding possible causal relationships. Methods In this study, 3040 Australian adolescents, aged 11–18 years at baseline, were measured in 2005–6 and 2007–8. Information on diet and mental health was collected by self-report and anthropometric data by trained researchers. Results There were cross-sectional, dose response relationships identified between measures of both healthy (positive) and unhealthy (inverse) diets and scores on the emotional subscale of the Pediatric Quality of Life Inventory (PedsQL), where higher scores mean better mental health, before and after adjustments for age, gender, socio-economic status, dieting behaviours, body mass index and physical activity. Higher healthy diet scores at baseline also predicted higher PedsQL scores at follow-up, while higher unhealthy diet scores at baseline predicted lower PedsQL scores at follow-up. Improvements in diet quality were mirrored by improvements in mental health over the follow-up period, while deteriorating diet quality was associated with poorer psychological functioning. Finally, results did not support the reverse causality hypothesis. Conclusion This study highlights the importance of diet in adolescence and its potential role in modifying mental health over the life course. Given that the majority of common mental health problems first manifest in adolescence, intervention studies are now required to test the effectiveness of preventing the common mental disorders through dietary modification.

Associations between diet quality and depressed mood in adolescents : results from the Australian healthy neighbourhoods study

Objective: Adolescence frequently coincides with the onset of psychiatric illness and depression is commonly observed in adolescents. Recent data suggest a role for diet quality in adult depression. Given the importance of adequate nutrition for brain development, it is of interest to examine whether diet quality is also related to depression in adolescents. Methods: The study examined 7114 adolescents, aged 10–14 years, who participated in the Australian Healthy Neighbourhoods Study. Healthy and unhealthy diet quality scores were derived from a dietary questionnaire. The Short Mood and Feelings Questionnaire for adolescents measured depression. Adjustments were made for age, gender, socioeconomic status, parental education, parental work status, family conflict, poor family management, dieting behaviours, body mass index, physical activity, and smoking. Results: Compared to the lowest category of the healthy diet score, the adjusted odds ratios (95% confidence interval) for symptomatic depression across categories (C) was: C2 = 0.61 (0.45–0.84); C3 = 0.58 (0.43–0.79); C4 = 0.47 (0.35–0.64); and C5 = 0.55 (0.40–0.77). Compared to the lowest quintile, the adjusted odds ratios (95% confidence interval) for symptomatic depression across increasing quintiles of the unhealthy diet score were: Q2 = 1.03 (0.87–1.22); Q3 = 1.22 (1.03–1.44); Q4 = 1.29 (1.12–1.50); and Q5 = 1.79 (1.52–2.11). Conclusions: Our results demonstrate an association between diet quality and adolescent depression that exists over and above the influence of socioeconomic, family, and other potential confounding factors.

Contribution of ‘noncore’ foods and beverages to the energy intake and weight status of Australian children

Objectives:The Australian Guide to Healthy Eating is based on five core food groups and water. Foods or beverages that do not fit into these groups are considered extra or ‘noncore’. We tested the hypotheses that noncore foods and beverages make a greater proportional contribution to mean daily energy intakes of: (1) children, compared with other age groups; and (2) overweight and obese children, compared with healthy weight children.Design, setting and subjects:We used data from 13 858 participants aged 2 to 80+ y who had 24-h dietary recall data collected in the 1995 cross-sectional Australian National Nutrition Survey. ANOVA was used to compare the percentage of energy provided by noncore foods and beverages by age and weight status.Results:Children (5 to 12 y) and adolescents (13 to 18 y) obtained significantly more (P<0.001) of their daily food energy from noncore foods (41.5 and 43.4%, respectively) than all other age groups. These age groups also obtained significantly more (P<0.001) of their daily beverage energy from noncore beverages (30.7 and 36.9%, respectively). Results were not consistent with weight status, although very young (2–4 y) obese children obtained significantly more energy (P<0.05) from noncore beverages than children in a healthy weight range. Younger children may also have consumed a greater quantity of foods and beverages. Under-reporting may have obscured similar results for older children.Conclusions:By definition, noncore foods and beverages are surplus to the requirements of a healthy diet. We found that Australian children consume these foods and beverages in excess.

Association between the family environment and television viewing in Australian children.

Aim:  To describe the time children spend watching television (TV) and to assess associations between TV viewing time, the family environment and weight status.

Physical activity, leisure-time screen use and depression among children and young adolescents

OBJECTIVES Adolescent mental disorders remain a relatively neglected area of research, despite evidence that these conditions affect youth disproportionately. We examined associations between physical activity, leisure-time screen use and depressive symptoms among Australian children and adolescents. DESIGN Large cross-sectional observational study. METHODS Self-reported physical activity and leisure-time screen behaviours, and depressive symptoms using the Short Mood and Feeling Questionnaire were assessed in 8256 students aged 10-16 years (mean age=11.5 years, SD=0.8). RESULTS Thirty three percent of the sample reported moderate to high depressive symptoms, with rates higher among females (OR=1.18; 95% CI: 1.02, 1.36; p=0.001). Increased opportunities to be active at school outside class (OR=0.70; 0.58, 0.85; p<0.001), being active in physical education classes (OR=0.77; 0.69, 0.86; p<0.001), greater involvement in sports teams at school (OR=0.77; 0.67, 0.88; p<0.001) and outside of school (OR=0.84; 0.73, 0.96; p=0.01) were all independently associated with lower odds for depressive symptoms. Meeting recommended guidelines for physical activity (OR=0.62; 0.44, 0.88; p=0.007) and, for 12-14 year olds, leisure-time screen use (OR=0.77; 0.59, 0.99; p=0.04) were also independently associated with lower odds for depressive symptoms. CONCLUSIONS Higher levels of physical activity among children and young adolescents, and lower levels of leisure-time screen use among young adolescents, are associated with lower depressive symptoms. Longitudinal studies are needed to understand the causal relationships between these variables.

Lunchbox contents of Australian school children: room for improvement

Objective:In light of the increasing prevalence of obesity in children and the potential of schools as a setting for intervention, we aimed to identify the main foods and beverages consumed at primary school and to determine differences in consumption patterns between children who used the school canteen and those who did not.Design:Cross-sectional survey of school foods in 1681 5–12 y old children, 2003–2004.Setting:Barwon South—Western region of Victoria, Australia.Results:The school food provided an average (±s.e.m.) of 3087±26 kJ. Bread was the most frequently consumed food and contributed 20% of total energy at school, biscuits 13%, fruit 10%, muesli/fruit bars 8%, packaged snacks 7%, and fruit juice/cordial 6%. About 10% of children used the school canteen and these children obtained more total energy and more energy from cakes, fast foods and soft drink than noncanteen users (P<0.001). In all, 68% of children had fruit in their lunchboxes, however, over 90% of children had energy-dense, micronutrient-poor snacks (‘junk food’).Conclusions:Fruit intake in primary schools seems reasonably high but could be targeted for further increase as part of promoting a healthy diet. Of concern, however, are the excessive amounts of energy-dense foods in school lunchboxes. These should be considered a priority for health promotion efforts along with reducing the consumption of sweetened drinks. These measures are urgently needed to improve the school-based diets of Australian children and attempt to curb the increasing prevalence of childhood obesity.

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.

High childhood obesity in an Australian population

Objective: The objective was to determine the prevalences of overweight and obesity in regional Australian children and to examine the association between BMI and indicators of socioeconomic status (SES).