(An item from the ISHN Member information service) Public health nutritionists were asked to describe the elements of system and organizational capacity in an article in Issue #10, 2015 of Public Health Nutrition. " A Delphi study involving three iterations of email-delivered questionnaires testing a range of capacity determinants derived from the literature. Consensus was set at >50 % of panellists ranking items as ‘very important’ on a five-point Likert scale across three survey rounds. A total of thirty expert panellists (68 % of an initial panel of forty-four participants) completed all three rounds of Delphi questionnaires. Consensus identified determinants of capacity building in practice including partnerships, resourcing, community development, leadership, workforce development, intelligence and quality of project management." Note: This article reflects the definition of capacity and capacity building developed and used by ISHN as part of its Wikipedia style web site. Read more>>
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(From the ISHN Member information service) An article in the March 2015 issue of Public Health Nutrition suggests that calorie focused thinking in regards to obesity "may mislead and harm public health". Prevailing thinking about obesity holds that quantifying calories should be a principal target for intervention. Part of this thinking is that consumed calories – regardless of their sources – are equivalent; . The article discusses various problems with the idea that ‘a calorie is a calorie’ and with a primarily quantitative focus on food calories. The authors argue for a greater qualitative focus on types of foods) and on the metabolic changes that result from consuming foods of different types. In particular, the authors consider how calorie-focused thinking is inherently biased against high-fat foods, many of which may be protective against obesity and related diseases, and supportive of starchy and sugary replacements, which are likely detrimental. Shifting the focus to qualitative food distinctions, a central argument of the paper is that obesity and related diseases are problems due largely to food-induced physiology (e.g. neurohormonal pathways) not addressable through arithmetic dieting (i.e. calorie counting). The paper considers potential harms of public health initiatives framed around calorie balance sheets – targeting ‘calories in’ and/or ‘calories out’ – that reinforce messages of overeating and inactivity as underlying causes, rather than intermediate effects, of obesity. Finally, the paper concludes that public health should work primarily to support the consumption of whole foods that help protect against obesity-promoting energy imbalance and metabolic dysfunction and not continue to promote calorie-directed messages that may create and blame victims and exacerbate epidemics of obesity and related diseases." Read more>>
(From the ISHN Member information service) An article in the February 2015 Issue of the International Journal of Obesity questions recent reports and reviewws that claim progress is being made in reducing childhood obesity rates. The authors report that "before concluding that the obesity epidemic is not increasing anymore, the validity of the presented data should be discussed more thoroughly. We had a closer look into the literature presented in recent reviews to address the major potential biases and distortions, and to develop insights about how to interpret the presented suggestions for a potential break in the obesity epidemic. Decreasing participation rates, the use of reported rather than measured data and small sample sizes, or lack of representativeness, did not seem to explain presented breaks in the obesity epidemic. Further, available evidence does not suggest that stabilization of obesity rates is seen in higher socioeconomic groups only, or that urbanization could explain a potential break in the obesity epidemic. However, follow-ups of short duration may, in part, explain the apparent break or decrease in the obesity epidemic. On the other hand, a single focus on body mass index (BMI) greater than or equal to25 or greater than or equal to30 kg m−2 is likely to mask a real increase in the obesity epidemic. And, in both children and adults, trends in waist circumferences were generally suggesting an increase, and were stronger than those reported for trends in BMI." Read more>>
(From the ISHN Member information service) Three articles in the August 2014 issue of the American Journal of Clinical Nutrition question the value of eating breakfast. The first, an RCT, suggests that eating or skipping breakfast had no effect on weight loss. The second, an RCT, reported no difference in resting metabolism rates. The third, a systematic review, found only equivocal evidence that eating breakfast had a positive impact on student academic performance. Another systematic review reported that consuming fruits and vegetables without cutting back on total caloric intake will not result in weight loss and another RCT study found little impact from switching to whole grains. Read more>>
(From the ISHN Member information service) In our extensive monitoring of the research, we find that the now-popular "ecological approach" is more often actually applied in the "analysis" stage, identifying the complex, multiple and multi-level influences on behaviour and practice, rather than being actually used in the "action" stage, where the approach is used to organize and deliver a planned variety of interventions to affect the multiple influences. We are pleased to read the article in the August 2014 issue of International Journal of Behavioral Nutrition & Physical Activity, which reports on a superb application of the ecological approach in 15 elementary schools in Mexico. The authors report that "Thirty-two distinct intervention strategies were implemented in one setting (i.e., school) to engage four different target-groups (students, parents, school representatives, government) across two domains (Nutrition and Physical Activity). Overall, 47.5% of the strategies targeted the school infrastructure and/or personnel; 37.5% of strategies targeted a key political actor, the Public Education Secretariat while fewer strategies targeted parents (12.5%) and children (3%). More strategies were implemented in the Nutrition domain (69%) than Physical Activity (31%). The most frequently used SCT construct within both intervention domains was Reciprocal Determinism (e.g., where changes to the environment influence changes in behavior and these behavioral changes influence further changes to the environment); no significant differences were observed in the use of SCT constructs across domains. Findings provide insight into a promising combination of strategies and theoretical constructs that can be used to implement a school-based obesity prevention program. Strategies emphasized school-level infrastructure/personnel change and strong political engagement." The complete text of the article is available. A full report on the project is also available here.
A detailed description of the impact of intervention during its two year implementation is provided here. (Note: the results after two years are modest, with small changes in eating habits and some types of physical activity reported. In our view, this reflects the reality that complex, multi-intervention programs need several years in order to be embedded in the school culture as well as to interact with the local neighbourhood and parents/families. Larger, community, media and societal influences are also important. The study did not report any changes to obesity levels. This is consistent with other studies, not only of school programs, that obesity is a problem that is far more challenging than what can be affected by a single setting within the community. For schools, we should adjust our expectations of the impact of even well-delivered multiple interventions such that students are truly supported by healthy factors while in school and that they graduate with the knowledge, skills, selected attitudes, beliefs and intentions that can be reasonably expected. If an entire society is obsengenic, then we should recognize the limits of the school's influence. The authors capture our above assessment of current efforts to implement ecological approaches as follows: " The premise underlying ecological programming is that a multilevel program is likely to be more effective than an individually focused program because it affords the opportunity to encounter the same behavioral prompts (e.g., to be more physically active) from a variety of sources (parents, teachers, coaches) in a variety of settings (home, school, community) [13]-[16]. Therefore, an intervention program that contains diverse strategies to engage several different stakeholders across a range of settings might address the health behavior in a more comprehensive way and thus yield better results than a simpler program (i.e., fewer targets, less settings). Despite its intuitive appeal and an increase in the use of ecological principles for programming to prevent childhood obesity in developed countries [17], optimal (i.e., effective, easy to implement at low cost) combinations of intervention activities to promote healthy lifestyles have yet to be identified. In addition to determining optimal combinations of intervention activities, health promotion practitioners striving to integrate ecological principles into their programs must also strive to develop programs that are theoretically informed. Challenges to theoretical integration include practitioner difficulties in operationalizing and assessing theoretical constructs [18]. The purpose of this study was to assess the integration of ecological principles and theoretical constructs in a school-based obesity prevention program that was successful in creating a supportive environment for healthy behaviors." The conclusion to the paper notes that "The aim of this paper was to assess the integration of ecological principles and theoretical constructs involved in a successful school-based obesity prevention program in Mexico City. We sought to unpack the intervention program along intervention domains in order to develop a map of the successful intervention program. If we compare our ecological map with recommendations in the literature [15],[17],[20], we can ascertain that this intervention program was a genuine ecological effort within a single setting since it delivered a diversity of intervention strategies involving multiple targets (POL, ORG, INT, IND), across both intervention domains. The ecological mapping showed that several different targets (PE teachers, school teachers, food vendors, parents, children and the school environment) were engaged, and that these efforts are consistent with those recommended to promote behavior change and to prevent obesity in children [7],[9],[23],[37]-[39]. Overall, our findings are consistent with existing evidence that policy intervention strategies can impact different ecological levels of influence [42]. This may be especially the case for hierarchical institutions such as school systems, where decisions are made at more than one level." The reflections offered by the researchers are also interesting. "To our knowledge, this is the first research to document the integration of ecological principles and theoretical constructs in a school-based obesity prevention program in Mexico. The deconstruction of a successful intervention program that has documented environmental and student behavior improvements provides novel information for the implementation of multifactorial interventions in school-based health promotion programs. Although there may be a variety of successful combinations of ecological strategies and theoretical constructs, our findings provide one version that can be used as a starting point to develop even more effective combinations. Within the school setting, this ecological combination of strategies emphasizes school and political targets. Moreover, the strategies in both the Nutrition and Physical Activity domains are most commonly underpinned by the theoretical construct of Reciprocal Determinism. In a context where the school environment is considered “obesogenic” and there is compelling evidence that this environment can shape children's eating and PA patterns, the current findings provide valuable insight about the types of strategies that can be leveraged to optimal effects. It is expected that these findings will be especially meaningful to inform obesity prevention programs in Mexico and in low-middle income countries where childhood obesity is an emerging problem." Read more>> (From the ISHN Member information service) A study reported in Volume 107, 2014 of Social Science & Medicine examined whether "Mothers' work hours are likely to affect their time allocation towards activities related to children's diet, activity and well-being. The researchers examined the suggestion that mothers who work more may be more reliant on processed foods, foods prepared away from home and school meal programs for their children's meals. A greater number of work hours may also lead to more unsupervised time for children that may, in turn, allow for an increase in unhealthy behaviors among their children such as snacking and sedentary activities such as TV watching. the study confirmed that hypothesis, even more so for higher income families. "Using data on a national cohort of children, we examine the relationship between mothers' average weekly work hours during their children's school years on children's dietary and activity behaviors, BMI and obesity in 5th and 8th grade. Our results are consistent with findings from the literature that maternal work hours are positively associated with children's BMI and obesity especially among children with higher socioeconomic status. Unlike previous papers, our detailed data on children's behaviors allow us to speak directly to affected behaviors that may contribute to the increased BMI. We show that children whose mothers work more consume more unhealthy foods (e.g. soda, fast food) and less healthy foods (e.g. fruits, vegetables, milk) and watch more television. Although they report being slightly more physically active, likely due to organized physical activities, the BMI and obesity results suggest that the deterioration in diet and increase in sedentary behaviors dominate." Read more>>
(From the ISHN Member information service) An article in Issue #3, 2014 of Health Promotion Practice illustrates the challenges of working in loosely-coupled education and health systems. This Canadian study examined policy documents on school nutrition and education in Canada at the federal, provincial and regional or local authority levels. The researchers note that "Results reveal distinct differences across federal, provincial, and regional levels. The availability of nutritious food in schools and having nutrition education as part of the curriculum were key components of the physical environment across federal and provincial levels. Federal and provincial priorities are guided by a health promotion framework and adopting a partnership approach to policy implementation. Gaps in regional-level policy include incorporating nutrition education in the curriculum and making the link between nutrition and obesity." Read more>>
(From Politico) First lady Michelle Obama and school lunch ladies used to be on the same team, but now they’re locked in a political war against each other. For the first three years of Obama’s Let’s Move! campaign, the School Nutrition Association, a powerful group that represents 55,000 cafeteria professionals, was a close ally in the White House push to get kids to eat healthier. Fast-forward to today: SNA is standing shoulder to shoulder with House Republicans, pushing to grant schools waivers from the requirements if they are losing money and aiming to relax the standards when the law is reauthorized next year. The story behind the school lunch flip-flop is a complicated web of lobbying change-ups, industry influence and partisan posturing inside the Beltway. It also casts a spotlight on how difficult it is to make the economics of school meals work — and just how much resistance there can be to Washington directing nationwide change. Read more
(From the ISHN Member information service) The nutrition related data from the US School Health Policies & Practices Survey (2012 Results shows that over 80% of school districts requited instruction about nutrition at all grade levels, 80.8% of districts required all schools to offer breakfast to students and 96.6% of districts required all schools to offer lunch to students. The percentage of districts that made information available to students on the nutrition and caloric content of foods available to them increased from 46.0% in 2000 to 68.2% in 2012. 72.5% of states evaluated the implementation of local wellness policies at the district or school level. 35.5% of districts had no single individual responsible for ensuring compliance with the district’s wellness policy. 73.5% of states provided funding for professional development or offered professional development to those who teach health education on nutrition and dietary behavior. The percentage of districts that provided funding for professional development or
offered professional development to those who teach health education on nutrition and dietary behavior increased from 43.3% in 2000 to 62.9% in 2012. Read more>> (An item from the ISHN Member information service) An article in the February 2014 issue of Public Health Nutrition reports on the use of the RE-AIM implementation model was used to monitorreach, effect, implementation and maintenance of two different streams of an elementary school nutrition education program. Most noteworthy is that "Thirty-seven per cent of third-grade teachers in the dissemination sample reordered SMC materials during the subsequent school year thereby reporting on the likely maintenance of the program after the trial. The authors also noted that "Results In the evaluation sample, differences between the control and intervention groups were observed for nutrition knowledge, self-efficacy, outcome expectancies, and intakes of vegetables, fruit (girls only), soda, and low-nutrient high-energy foods from pre- to post-survey. Group differences in change in knowledge, outcome expectancies and vegetable intake were sustained through the 3-month follow-up (efficacy). One hundred per cent of intervention teachers in the evaluation sample implemented all of the lessons (implementation). The dissemination sample represented 42 % of third-grade students (reach) and 39 % of third-grade classrooms in public elementary schools in California during 2010–2011 (adoption)." The value of this RE-AIM framework is that it provides an indication of likely ongoing uptake of this program without any specific funding or technical support. Consequently, the authors conclude that the program demonstrates a moderate to high potential impact. Read more>>
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