Tara Boelsen-Robinson

Letter to the Editor: Incidence of childhood obesity in the United States

To the Editor: Cunningham et al. (Jan. 30 issue)1 do not provide important information about weight change from kindergarten through eighth grade. It is obvious that children who have the highest body-mass index in kindergarten or at birth would be at highest risk for the subsequent development of obesity by eighth grade. They would have to gain the same or even less weight between kindergarten and eighth grade to cross the arbitrary threshold for obesity. Thus, if every child gained the same amount of weight from kindergarten onward or, for that matter, from birth onward, those who had the highest weights at birth or in kindergarten would ultimately have the highest risk of being overweight or obese. Over time, however, if children who were not overweight in kindergarten gained more weight per year, they would catch up and would have a similar or higher prevalence of obesity.2-5 Studies of obesity in children must include measures of velocity of weight change over time. It is likely that the velocity of weight change may be a more important determinant of health than body-mass index at earlier ages.

A systematic review of the effectiveness of whole-of-community interventions by socioeconomic position

Whole‐of‐community (WOC) interventions have led to modest reductions in population weight gain. Whether they exhibit differential effectiveness by socioeconomic position (SEP) remains unknown. We aimed to summarize evidence of differential effectiveness of WOC interventions by SEP. Electronic databases and grey literature were searched to identify studies that evaluated the effectiveness of a WOC intervention on behavioural change measures, energy balance behaviours and/or anthropometric outcomes according to any measure of SEP. Interventions were assessed for the following characteristics: structural changes to the environment, number of settings the intervention acted in, presence of community engagement and whether equity was considered in its design. Ten studies were included. Nine reported a greater or equal effect among low SEP groups compared with high SEP groups. These studies commonly featured interventions that incorporated structural changes to the environment, acted across more than three settings and/or employed community engagement. Conclusions did not change when excluding low‐quality studies (n = 4). WOC interventions represent an effective and equitable approach for the reduction of population weight. Structural components, a larger number of settings and community engagement were common in equitable WOC interventions and should be considered in the design of future WOC interventions.

Digital marketing of unhealthy foods to Australian children and adolescents

The emergence of new media-including branded websites, social media and mobile applications-has created additional touch points for unhealthy food and beverage companies to target children and adolescents. The aim of this study was to perform an audit of new media for three top selling food and beverage brands in Australia. The top selling brand in three of the most advertised food and beverage categories was identified. Facebook, websites and mobile phone applications from these three brands were assessed using a combination of descriptive analyses and structured data collection during June and July 2013. Information on target audience, main focus of the activity, marketing strategies employed and connectivity were collected. Promotional activities were assessed against industry self-regulatory codes. McDonalds, Coca-Cola and Cadbury Dairy Milk were audited, with 21 promotional activities identified. These promotional activities appeared to use a number of marketing strategies, with frequent use of indirect product association, engagement techniques and branding. We identified strategic targeting of both children and adolescents. We found that while all promotional activities technically met self-regulatory codes (usually due to media-specific age restrictions) a number appeared to employ unhealthy food or beverage marketing directed to children. Brands are using engaging content via new media aimed at children and adolescents to promote unhealthy food and beverages. Given the limitations of self-regulatory codes in the context of new media, strategies need to be developed to reduce exposure of children and adolescents to marketing of unhealthy food and beverage products via these avenues.

Does intentional weight loss improve daytime sleepiness? A systematic review and meta-analysis

Obesity is associated with excessive daytime sleepiness, but its causality remains unclear. We aimed to assess the extent to which intentional weight loss affects daytime sleepiness. Electronic databases were searched through 24 October 2016. Studies involving overweight or obese adults, a weight loss intervention and repeated valid measures of daytime sleepiness were included in the review. Two independent reviewers extracted data on study characteristics, main outcome (change in daytime sleepiness score standardized by standard deviation of baseline sleepiness scores), potential mediators (e.g. amount of weight loss and change in apnoea–hypopnoea index) and other co‐factors (e.g. baseline demographics). Forty‐two studies were included in the review. Fifteen before‐and‐after studies on surgical weight loss interventions showed large improvements in daytime sleepiness, with a standardized effect size of −0.97 (95% confidence interval [CI] −1.21 to −0.72). Twenty‐seven studies on non‐surgical weight loss interventions showed small‐to‐moderate improvement in daytime sleepiness, with a standardized effect size of −0.40 (95%CI −0.52 to −0.27), with no difference between controlled and before‐and‐after studies. We found a nonlinear association between amount of weight loss and change in daytime sleepiness. This review suggests that weight loss interventions improve daytime sleepiness, with a clear dose–response relationship. This supports the previously hypothesized causal effect of obesity on daytime sleepiness. It is important to assess and manage daytime sleepiness in obese patients.

The effect of a change to healthy vending in a major Australian health service on sales of healthy and unhealthy food and beverages

Vending machines predominantly offer discretionary, packaged foods and beverages, high in sugar, saturated fat and/or sodium (Byrd-Bredbenner et al., 2012), and contribute to 4% of sugarsweetened beverage (SSB) intake in US adults (An & Maurer, 2016). Excessive consumption of these types of items has been shown to contribute to weight gain, obesity, cardiovascular disease, diabetes, some cancers, and in the case of SSBs, dental caries (National Health and Medical Research Council and Food for Health Dietary Guidelines for Australian Adults, 2003). Vending machines are consequently recognised as a potential point of intervention to shift the population towards healthier food choices

Incidence of childhood obesity in the United States.

To the Editor: Cunningham et al. (Jan. 30 issue)1 do not provide important information about weight change from kindergarten through eighth grade. It is obvious that children who have the highest body-mass index in kindergarten or at birth would be at highest risk for the subsequent development of obesity by eighth grade. They would have to gain the same or even less weight between kindergarten and eighth grade to cross the arbitrary threshold for obesity. Thus, if every child gained the same amount of weight from kindergarten onward or, for that matter, from birth onward, those who had the highest weights at birth or in kindergarten would ultimately have the highest risk of being overweight or obese. Over time, however, if children who were not overweight in kindergarten gained more weight per year, they would catch up and would have a similar or higher prevalence of obesity.2-5 Studies of obesity in children must include measures of velocity of weight change over time. It is likely that the velocity of weight change may be a more important determinant of health than body-mass index at earlier ages.

Examining the nutritional quality of food and beverage consumed at Melbourne aquatic and recreation centres

Objective: Examine the nutritional quality of food and beverages consumed across a sample of community aquatic and recreation centres in metropolitan Melbourne, Australia.

The role of new media in marketing unhealthy food and beverages to children and adolescents

theoretical framework that will enable organisation of current and future universal obesity prevention interventions into their likely impact on the socioeconomic gradient of population weight gain. Methods: We partitioned the framework into two scales; the environment where action is taken (micro and macro environments) and the degree to which an intervention targets individual agency or embedded structures to influence behaviour change (characterised by three predominant policy types: agentic, agento-structural and structural). Results: Agentic interventions, which are heavily reliant on individual agency, are more likely to increase socioeconomic inequalities in population weight. Examples of these types of interventions include social marketing, school nutrition education programs and signage to encourage healthy behaviours. Structural interventions generally describe an equal or greater benefit for lower socioeconomic groups and include food procurement policies, restricting the availability of unhealthy foods in schools and a mandatory increase in school physical education time. Agento-structural interventions are mindful of the environment in which health behaviours take place, but individual agency is nonetheless important. Agento-structural interventions include work place design to encourage incidental exercise and mandatory nutrition labelling. There is a lack of empirical evidence and theoretical clarity regarding the socioeconomic impact of agento-structural interventions, however we hypothesise that those aimed at the macroenvironmental context are more likely to have an equitable impact. Conclusions: Examination of the socioeconomic health impact of obesity prevention interventions is crucial. This is especially true for agentostructural interventions, which show great promise for obesity prevention, but where the greatest uncertainty regarding the socioeconomic health impact remains. Failure to do so runs the risk of widening the socioeconomic gradient in health as we strive to prevent obesity.