Victoria L. Farmer

Economic evaluation of a community-based obesity prevention program in children: the APPLE project.

Effective strategies are urgently required to reduce the prevalence of obesity during growth. Determining which strategies are most successful should also include analysis of their relative costs. To date, few obesity prevention studies in children have reported data concerning cost‐effectiveness. The aim of this study was to assess the costs and health benefits of implementing the APPLE (A Pilot Program for Lifestyle and Exercise) project, a 2‐year controlled community‐based obesity prevention initiative utilizing activity coordinators (ACs) in schools and nutrition promotion in New Zealand children (5–12 years). The marginal costs of the project in 2006 prices were estimated and compared with the kilograms (kg) of weight‐gain prevented for children in the intervention relative to the control arm. The childrens health‐related quality of life (HRQoL) was also measured using the Health Utilities Index (HUI). The total project cost was NZ

Determining optimal approaches for weight maintenance: a randomized controlled trial

357,490, or NZ

School playgrounds and physical activity policies as predictors of school and home time activity

1,281 per intervention child for 2 years (NZ

Changes in Physical Activity over Time in Young Children: A Longitudinal Study Using Accelerometers

1 = US

Do More Active Children Sleep More? A Repeated Cross-Sectional Analysis Using Accelerometry

0.67 = UK£0.35 = EUR €0.52). Weight z‐score was reduced by 0.18 (0.13, 0.22) units at 2 years and 0.17 (0.11, 0.23) units at 4 years in intervention relative to control children. Mean HUI values did not differ between intervention and control participants. The reduction in weight z‐score observed is equivalent to 2.0 kg of weight‐gain prevented at 15 years of age. The relatively simple intervention approach employed by the APPLE project was successful in significantly reducing the rate of excessive weight gain in children, with implementation costs of NZ

The Stability of Sleep Patterns in Children 3 to 7 Years of Age

664–1,708 per kg of weight‐gain prevented over 4 years.

Change of School Playground Environment on Bullying: A Randomized Controlled Trial

Background: Weight regain often occurs after weight loss in overweight individuals. We aimed to compare the effectiveness of 2 support programs and 2 diets of different macronutrient compositions intended to facilitate long-term weight maintenance. Methods: Using a 2 × 2 factorial design, we randomly assigned 200 women who had lost 5% or more of their initial body weight to an intensive support program (implemented by nutrition and activity specialists) or to an inexpensive nurse-led program (involving “weigh-ins” and encouragement) that included advice about high-carbohydrate diets or relatively high-monounsaturated-fat diets. Results: In total, 174 (87%) participants were followed-up for 2 years. The average weight loss (about 2 kg) did not differ between those in the support programs (0.1 kg, 95% confidence interval [CI] −1.8 to 1.9, p = 0.95) or diets (0.7 kg, 95% CI −1.1 to 2.4, p = 0.46). Total and low-density lipoprotein (LDL) cholesterol levels were significantly higher among those on the high-monounsaturated-fat diet (total cholesterol: 0.17 mmol/L, 95% CI 0.01 to 0.33; p = 0.040; LDL cholesterol: 0.16 mmol/L, 95% CI 0.01 to 0.31; p = 0.039) than among those on the high-carbohydrate diet. Those on the high-monounsaturated-fat diet also had significantly higher intakes of total fat (5% total energy, 95% CI 3% to 6%, p < 0.001) and saturated fat (2% total energy, 95% CI 1% to 2%, p < 0.001). All of the other clinical and laboratory measures were similar among those in the support programs and diets. Interpretation: A relatively inexpensive program involving nurse support is as effective as a more resource-intensive program for weight maintenance over a 2-year period. Diets of different macronutrient composition produced comparable beneficial effects in terms of weight loss maintenance. ClinicalTrials.gov trial register no. NCT00128336.

Assessment of dietary sodium intake using a food frequency questionnaire and 24-hour urinary sodium excretion: a systematic literature review

BackgroundPrevious work has suggested that the number of permanent play facilities in school playgrounds and school-based policies on physical activity can influence physical activity in children. However, few comparable studies have used objective measures of physical activity or have had little adjustment for multiple confounders.MethodsPhysical activity was measured by accelerometry over 5 recess periods and 3 full school days in 441 children from 16 primary schools in Dunedin, New Zealand. The number of permanent play facilities (swing, fort, slide, obstacle course, climbing wall etc) in each school playground was counted on three occasions by three researchers following a standardized protocol. Information on school policies pertaining to physical activity and participation in organized sport was collected by questionnaire.ResultsMeasurement of school playgrounds proved to be reliable (ICC 0.89) and consistent over time. Boys were significantly more active than girls (P < 0.001), but little time overall was spent in moderate-vigorous physical activity (MVPA). Boys engaged in MVPA for 32 (SD 17) minutes each day of which 17 (10) took place at school compared with 23 (14) and 11 (7) minutes respectively in girls. Each additional 10-unit increase in play facilities was associated with 3.2% (95% CI 0.0-6.4%) more total activity and 8.3% (0.8-16.3%) more MVPA during recess. By contrast, school policy score was not associated with physical activity in children.ConclusionThe number of permanent play facilities in school playgrounds is associated with higher physical activity in children, whereas no relationship was observed for school policies relating to physical activity. Increasing the number of permanent play facilities may offer a cost-effective long-term approach to increasing activity levels in children.

The effect of increasing risk and challenge in the school playground on physical activity and weight in children: a cluster randomised controlled trial (PLAY)

Previous research has suggested that marked declines in physical activity occur during the preschool years, and across the transition into school. However, longitudinal studies using objective measures of activity have been limited by sample size and length of follow-up. The aims of this study were to determine how overall activity and time in different intensities of activity change in children followed from 3 to 7 years. Children (n = 242) wore Actical accelerometers at 3, 4, 5, 5.5, 6.5 and 7 years of age during all waking and sleeping hours for a minimum of 5 days. Time in sedentary (S), light (L), moderate (M), and vigorous (V) physical activity was determined using available cut points. Data were analyzed using a mixed model and expressed as counts per minute (cpm, overall activity) and the ratio of active time to sedentary time (LMV:S), adjusted for multiple confounders including sex, age, time worn, and weather. At 5 years, physical activity had declined substantially to around half that observed at 3 years. Although starting school was associated with a further short-term (6-month) decline in activity (cpm) in both boys (difference; 95% CI: -98; -149, -46) and girls (-124; -174, -74, both P<0.001), this proved to be relatively transient; activity levels were similar at 6-7 years as they were just prior to starting school. Boys were more physically active than girls as indicated by an overall 12% (95% CI: 2, 22%) higher ratio of active to sedentary time (P = 0.014), but the pattern of this difference did not change from 3 to 7 years. Time worn and weather variables were significant predictors of activity. In conclusion, both boys and girls show a marked decline in activity from 3 to 4 years of age, a decrease that is essentially maintained through to 7 years of age. Factors driving this marked decrease need to be determined to enable the development of targeted interventions.

What did schools experience from participating in a randomised controlled study (PLAY) that prioritised risk and challenge in active play for children while at school

Aim To determine whether levels of daytime physical activity are associated with sleep duration and night waking in children assessed using accelerometry, and if these associations change over time. Methods 24-hour accelerometry data were obtained from 234 children at 3, 5 and 7 years of age for at least 5 days at each time. Sleep duration was estimated using the Sadeh algorithm. Time spent in sedentary, light and moderate-vigorous (MVPA) activity was established using published cut-points. Appropriate statistical techniques were utilised to account for the closed nature of the data (24-hour periods). Results Time spent asleep was related more to sedentary or light activity and not to MVPA. The most active (95th percentile) children spent 55–84 fewer minutes asleep and 16–19 more minutes awake at night compared to the least active (5th percentile) children. Children with later bedtimes slept less at night (30–40 minutes) and undertook more sedentary (10–15 minutes) but also more light (18–23 minutes) activity during the day. However, no differences in MVPA were apparent according to bedtime. Children slept slightly less on weekend nights (11 minutes) compared with week-nights, but only at 3 years of age. Most relationships were broadly similar at 3, 5 and 7 years of age. Conclusion Children who are more physically active during the day have shorter total sleep time and are more awake at night than less active children. The protective effect of sleep on obesity does not appear to be mediated by increased physical activity.