Tommy L. S. Visscher

The prevention of overweight and obesity in children and adolescents : a review of interventions and programmes

Overweight and obesity are serious, large‐scale, global, public health concerns requiring population‐based childhood overweight and obesity prevention. The overall objective of this review is to identify aspects of successful childhood overweight prevention programmes. This objective will be met by assessing existing interventions quantitatively as well as qualitatively, identifying efficacy, effectiveness and implementation, and evaluating potential adverse effects of previous studies. This review was limited to school‐based studies with a quantitative evaluation using anthropometric outcomes and that intervene on diet or activity‐related behaviours. Quantitative and qualitative approaches are used to identify factors related to successful interventions as well as adverse consequences. Sixty‐eight per cent of the interventions, or 17 of the 25, were ‘effective’ based on a statistically significant reduction in body mass index (BMI) or skin‐folds for the intervention group. Four interventions were effective by BMI as well as skin‐fold measures. Of these, two targeted reductions in television viewing. The remaining two studies targeted direct physical activity intervention through the physical education programme combined with nutrition education. Of the interventions reported here, one was effective in reducing childhood overweight but was also associated with an increase in underweight prevalence. Few other studies reported outcomes for underweight. The majority of overweight/obesity prevention programmes included in this review were effective. Physical education in schools and reducing television viewing are two examples of interventions that have been successful. Because few studies report on underweight prevalence, this review recommends giving more attention to preventing adverse outcomes by reporting the intervention impact on the frequency distribution for both BMI and adiposity measures.

Prevalence of overweight and obesity in the Netherlands.

This paper shows the trends in the prevalence of overweight (body mass index [BMI] ≥ 25 kg m−2) and obesity (BMI ≥ 30 kg m−2) in the Netherlands. Overweight (obesity) prevalence in adult males increased from 37% (4%) in 1981 to 51% (10%) in 2004, and in adult females from 30% (6%) in 1981 to 42% (12%) in 2004, according to self‐reported data. In boys and girls, obesity prevalence doubled or even tripled from 1980 to 1997, and again from 1997 to 2002–2004 a two‐ or threefold increase was seen for almost all ages. According to the most recent data, overweight (obesity) prevalence figures range, depending on age, from 9.2% to 17.3% (2.5–4.3%) in boys, and from 14.6% to 24.6% (2.3–6.5%) in girls. There is a lack of data on the national prevalence of overweight and obesity based on measured height and weight and on prevalences in different subgroups of the population. Regular national representative health examination surveys that measure height and weight are needed to assess the prevalence of overweight and obesity and its distribution over subgroups in the population, and to properly direct and evaluate prevention activities.

Long-term and recent time trends in the prevalence of obesity among Dutch men and women.

OBJECTIVE: To describe long-term and recent time trends in the prevalence of obesity by age and educational level.DESIGN: Repeated cross-sectional population based monitoring studies.SETTING: Consultation Bureau Heart Project 1976–1980, Monitoring Project on Cardiovascular Diseases 1987–1991 and Monitoring project on risk factors for chronic diseases (MORGEN-) project 1993–1997.SUBJECTS: A total of 29 141 men and women aged 37–43 y (1976–1997); and 21 926 men and women aged 20–59 y (1993–1997).MEASUREMENTS: Body mass index, ie weight divided by height squared.RESULTS: Between 1976 and 1997 the prevalence of obesity increased from 4.9 to 8.5% among men and from 6.2 to 9.3% among women aged 37–43 y. Between 1993 and 1997, the prevalence of obesity among men aged 20–59 y was 8.5% and increased by 0.54 percentage points per year (P<0.01). The prevalence of obesity among women was 9.6% and increased by 0.35 percentage points per year (P=0.07). The increase in the prevalence of obesity in the period 1993–1997 was strongest in men with a relatively low educational level and in women with a high educational level.CONCLUSIONS: There has been a steady increase in the prevalence of obesity in the last quarter of the 20th century. Also, a recent increase in the prevalence of obesity has been seen. To stop the increase in the prevalence of obesity, effective strategies for the management and prevention of obesity need to be developed.

Underreporting of BMI in adults and its effect on obesity prevalence estimations in the period 1998 to 2001

Objective: To identify the determinants of underreporting BMI and to evaluate the possibilities of using self‐reported data for valid obesity prevalence rate estimations.

Association between TV viewing, computer use and overweight, determinants and competing activities of screen time in 4- to 13-year-old children

Objective:TV viewing and computer use is associated with childhood overweight, but it remains unclear as to how these behaviours could best be targeted. The aim of this study was to determine to what extent the association between TV viewing, computer use and overweight is explained by other determinants of overweight, to find determinants of TV viewing and computer use in the home environment and to investigate competing activities.Method:A cross-sectional study was carried out among 4072 children aged 4–13 years in the city of Zwolle, the Netherlands. Data collection consisted of measured height, weight and waist circumference, and a parental questionnaire on socio-demographic characteristics, childs nutrition, physical activity (PA) and sedentary behaviour. Associations were studied with logistic regression analyses, for older and younger children, boys and girls separately.Results:The odds ratio (OR) of being overweight was 1.70 (95% confidence interval (CI): 1.07–2.72) for viewing TV >1.5 h among 4- to 8-year-old children adjusted for all potential confounders. Computer use was not significantly associated with overweight. Determinants of TV viewing were as follows: having >2 TVs in the household (OR: 2.38; 95% CI: 1.66–3.41), a TV in the childs bedroom and not having rules on TV viewing. TV viewing and computer use were both associated with shorter sleep duration and not with less PA.Conclusion:Association between TV viewing and overweight is not explained by socio-demographic variables, drinking sugared drinks and eating snacks. Factors in the home environment influence childrens TV viewing. Parents have a central role as they determine the number of TVs, rules and also their childrens bedtime. Therefore, interventions to reduce screen time should support parents in making home environmental changes, especially when the children are young.

Design of the Dutch Obesity Intervention in Teenagers (NRG-DOiT): systematic development, implementation and evaluation of a school-based intervention aimed at the prevention of excessive weight gain in adolescents

BackgroundOnly limited data are available on the development, implementation, and evaluation processes of weight gain prevention programs in adolescents. To be able to learn from successes and failures of such interventions, integral written and published reports are needed.MethodsApplying the Intervention Mapping (IM) protocol, this paper describes the development, implementation, and evaluation of the Dutch Obesity Intervention in Teenagers (DOiT), a school-based intervention program aimed at the prevention of excessive weight gain.The intervention focussed on the following health behaviours: (1) reduction of the consumption of sugar-sweetened beverages, (2) reduction of energy intake derived from snacks, (3) decrease of levels of sedentary behaviour, and (4) increase of levels of physical activity (i.e. active transport behaviour and sports participation).The intervention program consisted of an individual classroom-based component (i.e. an educational program, covering 11 lessons of both biology and physical education classes), and an environmental component (i.e. encouraging and supporting changes at the school canteens, as well as offering additional physical education classes).We evaluated the effectiveness of the intervention program using a randomised controlled trial design. We assessed the effects of the intervention on body composition (primary outcome measure), as well as on behaviour, behavioural determinants, and aerobic fitness (secondary outcome measures). Furthermore, we conducted a process evaluation.DiscussionThe development of the DOiT-intervention resulted in a comprehensive school-based weight gain prevention program, tailored to the needs of Dutch adolescents from low socio-economic background.

Effects of retirement on lifestyle in relation to changes in weight and waist circumference in Dutch men: a prospective study.

OBJECTIVE To study changes in lifestyle in relation to changes in body weight and waist circumference associated with occupational retirement in men. DESIGN A prospective cohort study with 5 years of follow-up. At baseline and at follow-up, questionnaires were completed and body weight and waist circumference were measured. SETTING The Doetinchem Cohort Study, consisting of inhabitants of Doetinchem, a town in a rural area of The Netherlands. SUBJECTS In total 288 healthy men aged 50-65 years at baseline, who either remained employed or retired over follow-up. RESULTS The effect of retirement on changes in weight and waist circumference was dependent on type of former occupation. Increase in body weight and waist circumference was higher among men who retired from active jobs (0.42 kg year(-1) and 0.77 cm year(-1), respectively) than among men who retired from sedentary jobs (0.08 kg year(-1) and 0.23 cm year(-1), respectively). Weight gain and increase in waist circumference were associated with a decrease in fruit consumption and fibre density of the diet, with an increase in frequency of eating breakfast, and with a decrease in several physical activities, such as household activities, bicycling, walking and doing odd jobs. CONCLUSION Retirement was associated with an increase in weight and waist circumference among those with former active jobs, but not among those with former sedentary jobs. Retirement may bring opportunities for healthy changes in diet and physical activity, which could be used in health promotion programmes.

Age standardization in mapping adult overweight and obesity trends in the WHO European Region

This study aims to improve comparability of available data within the World Health Organization (WHO) European Region taking into account differences related to the aging of the population. Surveys were included if they were conducted on adults aged 25–64 years between 1985 and 2010 in the WHO European Region. Overweight/obesity prevalences were adjusted to the European standard population aged 25–64. Data were entered for each of the 5‐year categories between 1981 and 2010. Measured height and weight data were available for males in 16 and females in 24 of the 53 countries. The 50–64‐year‐olds had higher prevalence of overweight and obesity as compared to the 25–49‐year‐olds. This pattern occurs in every country, by male and female, in almost all surveys. Age‐standardized overweight prevalence was higher among males than females in all countries. Trend data showed increases in most countries. Age‐standardized maps were based on self‐reported data because of insufficient availability of measured data. Results showed more countries with available data as well as the higher category of obesity in the later surveys. Measured values are needed and age adjustment is important in documenting emerging overweight and obesity trends, independent of demographic changes, in the WHO European Region.

Age, period and cohort effects on body weight and body mass index in adults: The Doetinchem Cohort Study

OBJECTIVE To study the development of body weight with ageing, in a general adult population, taking into account possible period and cohort effects. DESIGN A prospective cohort study with 11 years of follow-up. At baseline and after 6 and 11 years, body weight and height were measured. SETTING The Doetinchem Cohort Study, consisting of inhabitants of Doetinchem, a town in a rural area of The Netherlands. SUBJECTS In total, 4070 healthy men and women aged 20-59 years at baseline. RESULTS Increase in BMI with ageing was less profound based on cross-sectional data than based on longitudinal data. More recent-born cohorts had a higher BMI at a given age than cohorts who were born earlier. Increase in mean BMI with ageing was observed in all age groups and was similar for groups with a different educational level. Highest increase in BMI over 11 years was observed in the youngest group, aged 20-29 years at baseline (2.2 [95 % CL 2.0, 2.3] kg/m2), and lowest increase in the oldest group, aged 50-59 years at baseline (1.1 [1.0, 1.3] kg/m2). CONCLUSIONS Findings of the present study using longitudinal data suggest that increase in BMI with ageing is underestimated in all age groups by studying cross-sectional data only. Further, weight gain is present in all educational levels and does not stop at middle age.

Cognitive determinants of energy balance-related behaviours : measurement issues

The burden of disease as a result of overweight and obesity calls for in-depth examination of the main causes of behavioural actions responsible for weight gain. Since weight gain is the result of a positive energy balance, these behavioural actions are referred to as ‘energy balance-related behaviours’ (EBRBs). In the broadest sense, there are only two EBRBs: food intake and physical activity. However, both diet and physical activity are complex behavioural categories that involve a variety of actions. This article discusses the potential problems and opportunities related to the assessment of cognitive determinants of energy intake and energy expenditure behaviours.We argue for the necessity of studying determinants of EBRBs within an energy balance approach, i.e. focusing on energy input as well as output, instead of only studying dietary change or physical activity behaviour. As a result, however, theoretically sound questionnaires assessing determinants of EBRBs are likely to annoy respondents. It is especially the measurement of the behaviours and the use of belief-based constructs that cause questionnaires to be long, which may lead to low response rates and invalid data.In this article, we propose a careful and systematic consideration of the inclusion or exclusion of measures of cognitive determinants. First, if studies show that an EBRB is strongly influenced by environmental factors and is not or only to a minor extent under intentional control, measurement of cognitions is of little use. Second, only when we have proof that attitudes, norms and perceived behavioural control predict intentions, should we aim to assess the underlying beliefs. Third, since assessment of beliefs results in similar or better prediction than using belief-valuation combinations, we should not ‘annoy’ respondents with valuation items. Finally, we argue that the traditional paper-and-pencil survey is still the most reliable and practical data collection method. However, pilot studies applying computerised adaptive methods to determinants of EBRBs are encouraged.