Two articles in the Journal of Nutrition Education & Behaviour mark the re-emergence of multi-intervention approaches to promoting healthy eating and nutrition. frameworks to guide the development of such multi-intervention programs in schools have existed for many years but the renewed interest is welcome. As is often the case, the terminology is re-invented but the meaning and value remains much the same. One article describes a "Policy, Systems, and Environmental Approach" for nutrition education. (go to: https://www.jneb.org/article/S1499-4046(18)30108-8/fulltext). The second article is a statement from the US position of the Academy of Nutrition and Dietetics, School Nutrition Association, and Society for Nutrition Education and Behavior. They recommend "specific strategies in the following key areas: food and nutrition services available throughout the school campus; nutrition initiatives such as farm to school and school gardens; wellness policies; nutrition education and promotion; food and beverage marketing at school; and consideration of roles and responsibilities."   Read more...
(This item is among the 5-10 highlights posted for ISHN members each week from the ISHN Member information service. Click on the web link to join this service and to support ISHN)

A news story in the New York Times reports on how big business got Brazil hooked on Junk Food. As growth slows in wealthy countries, Western food companies are aggressively expanding in developing nations, contributing to obesity and health problems. "Nestlé’s direct-sales army in Brazil is part of a broader transformation of the food system that is delivering Western-style processed food and sugary drinks to the most isolated pockets of Latin America, Africa and Asia. As their growth slows in the wealthiest countries, multinational food companies like Nestlé, PepsiCo and General Mills have been aggressively expanding their presence in developing nations, unleashing a marketing juggernaut that is upending traditional diets from Brazil to Ghana to India."  Read more...
(This item is among the 5-10 highlights posted for ISHN members each week from the ISHN Member information service. Click on the web link to join this service and to support ISHN)

A review of data from the Health Behaviours of School-Age Children (HBSC) surveys between 2002 and 2014 hase been published by the WHO Regional Office. "This report presents the latest trends in obesity, eating behaviours, physical activity and sedentary behaviour from the HBSC study and highlights gender and socioeconomic inequalities across the WHO European Region. Trends have previously been reported separately, but this report brings together for the first time HBSC data on obesity and obesity-related behaviours." The report notes that "Obesity continues to increase in all but a very few countries and regions, with disparities within and between them being marked. Trend data on dietary and physical activity behaviours are more mixed, but show some improvements for some age groups in some countries. Overall, however, the indicators show that adolescents’ dietary behaviours remain far from optimal, with too many sugary products and not enough fruit and vegetables consumed. At the same time, physical activity as part of daily life has been reduced to the bare minimum: adolescents spend most of their time sedentary. This paints a rather bleak picture that requires ambitious policy action." The report shows that some mixed progress has been made in eating habits, physical activity and sedentary time.

• Daily consumption of fruit and vegetables increased slightly between 2002 and 2014, but overall prevalence remains low.
• Daily consumption of sugary soft drinks and sweets decreased noticeably between 2002 and 2014, but consumption remains high: almost one in five adolescents drinks sugary soft drinks daily and one in four eats sweets every day.
• Overall, moderate-to-vigorous-intensity physical activity (MVPA) levels are low and decline with age during the adolescent years.MVPA levels have not changed substantially over time.
• Participation in vigorous-intensity physical activity (VPA) is reasonably high across Europe and appears to have remained stable between 2002 and 2014, with a slight positive trend in girls.
• TV-viewing is decreasing across Europe.Computer use for gaming and non-gaming purposes increased sharply between 2002 and 2014 and offset the TV-viewing decrease.

Despite this leveling off of mixed progress in child and youth behaviours, the report notes that "While levels of obesity have stabilized in some countries and regions,prevalence has increased in over half of those involved in HBSC surveys since 2002. The most marked increases have been observed in eastern European countries, where levels of obesity were relatively low in 2002. Only 13-year-old boys in Norway and 11-year-old girls in Spain experienced a significant decrease in obesity prevalence"
Although the HBSC survey reports only on behaviours and there is no mechanism to correlate or track the introduction of healthy school food policies and increases in physical activity time within the school day, we can safely assume that these HBSC data trends have coincided with increased efforts by schools to prevent obesity. Consequently, we need to question if these school-based efforts alone are sufficient to truly make a difference over the long term. A similar analysis of Canadian efforts (McCall, 2013), reported that similar little progress had been made after two decades of obesity prevention and heart healthy programs in that country.
In our view, this HBSC report requires us to ask some essential but possibly inconvenient questions:

1. If progress seems to be happening with young people in more affluent countries and communities but the overall averages are stagnant or deteriorating, should we shift our focus away from the middle class towards the working class students?
   
2. If schools are now doing their part, should we now focus on other environments such as the media, social media, recreation, sports and even families and introduce much stronger policies such as advertising limits, mandatory restrictions on sugars and other such measures?
3. Given that research and exposure of the activities of food companies has shown that physical activity, while beneficial in many ways, does not significantly affect obesity/overweight, should we focus more on other factors such as mental health, loneliness, boredom, stating at home after school without adult supervision, stressed parents with no time to prepare or even purchase healthy food?

Read more....
(This item is among the 5-10 highlights posted for ISHN members each week from the ISHN Member information service. Click on the web link to join this service and to support ISHN)

(An item from the ISHN Member information service)  Readers of this blog will know that we have been tracking the relationship (or lack thereof) between physical activity and overweight/obesity. Two Articles in July 2015 Issue of International Journal of Obesity continue the discussion. One article suggests that self-reporting of eating and activity behaviours are not sufficiently accurate and objective measurement is required. Another article reports on a study that "identified an unhealthy cluster of TV viewing with ED food/drink consumption, which predicted overweight/obesity in a small longitudinal sample of Australian children. Cluster stability was fair to moderate over 3 years and is a novel finding. A third behaviour examined in the study, physical activity was apparently not as significant as the eating/TV watching behaviours. This finding continues our growing realization that eating and activity may be independent factors/behaviours rather than linked and that it may be wiser to focus on eating, especially when combined with television viewing. Read more>>

(An item from the ISHN Member information service)  An article in Issue #6, 2015 of Journal of Health Psychology reports on a small study of tThe impact of a school-based gardening intervention on intentions and behaviour related to fruit and vegetable consumption in children. The results of this singke school study are positive but the explanation of the result is equally interesting. The Theory of Planned Behaviour was used to explain the results. "Measures of the Theory of Planned Behaviour and fruit and vegetable consumption were taken pre- and post-intervention. Repeated measures analysis of variance and hierarchical regression analysis indicated that the intervention group increased daily consumption of fruits and vegetables and increased intentions, attitudes, norms, and perceived behavioural control related to fruit and vegetable consumption. Attitudes, norms and perceived behavioural control significantly predicted changes in fruit and vegetable consumption." It is this combination knowledge, practical experience, changes in attitudes, intentions, percveptions of control/health beliefs and the other aspects listed in the article that we need to consider more often. Read more>>

(From the ISHN Member information service) An article in the March 2015 issue of Pediatrics reports on progress being made in reducing childhood obesity in the US. The 2 national surveys that have provided the most valid and reliable data are the National Health and Nutrition Examination Survey (NHANES) and the Pediatric Nutrition Surveillance System (PedNSS). The authors report that" Inspection of prevalence rates over time show that after a consistent increase which began after 1980, the prevalence of obesity in 2- to 5-year-old children began to plateau between 2003 and 2004 (Fig 1). Data between 2003–2004 and 2009–2010 showed no statistically significant change in childhood obesity rates, whereas a decrease of 3.7% occurred between 2009–2010 and 2011–2012 in 2- to 5-year old children. No significant changes were observed in the prevalence of obesity among children and adolescents in other age groups. " These results are similar to an extensive analysis that ISHN did on Canadian efforts over the past two decades to reduce obesity levels among school-age children. The results in both countries suggest that a re-consideration of the current focus on calories and physical activity as primary intervention is warranted. Read More>>

(From the ISHN Member information service)  The WHO fact sheet describing the response of health ministries to prevent and control NCDs indicates the collective, global intentions and strategies. The ideas and actions not mentioned on the page and in the action plan are as important as the ones that are highlighted. WHO summarizes the actions needed as follows:
" To lessen the impact of NCDs on individuals and society, a comprehensive approach is needed that requires all sectors, including health, finance, foreign affairs, education, agriculture, planning and others, to work together to reduce the risks associated with NCDs, as well as promote the interventions to prevent and control them. An important way to reduce NCDs is to focus on lessening the risk factors associated with these diseases. Low-cost solutions exist to reduce the common modifiable risk factors (mainly tobacco use, unhealthy diet and physical inactivity, and the harmful use of alcohol) and map the epidemic of NCDs and their risk factors. Other ways to reduce NCDs are high impact essential NCD interventions that can be delivered through a primary health-care approach to strengthen early detection and timely treatment. Evidence shows that such interventions are excellent economic investments because. The greatest impact can be achieved by creating healthy public policies that promote NCD prevention and control and reorienting health systems. Lower-income countries generally have lower capacity for prevention and control. Countries with inadequate health insurance coverage are unlikely to provide universal access to essential NCD interventions". Our initial comments: (1) The WHO is clearly medical, focused on health services rather than health promotion. (2) The absence of disease is the goal rather than overall health. (3) Other sectors are expected to be partners but a settings-based approach, essential to these partnerships, is neglected and forgotten. Read more>>

(From the ISHN Member information service)  The release of the WHO status report/global action plan this week represents the efforts of health ministries to address a cluster of physical health diseases. The key facts are not new: "(1) NCD's kill 38 million people each year. (2) Almost 3/4 of deaths (28 million) occur in low- and middle-income countries.(3) Sixteen million deaths occur before the age of 70; 82% of these "premature" deaths occur in low/middle-income countries. (4) Cardiovascular diseases account for most deaths, (17.5 million), followed by cancers (8.2 million), respiratory diseases (4 million), and diabetes (1.5 million). These 4 groups of diseases account for 82% of all NCD deaths. Tobacco use, physical inactivity, unhealthy diet and the harmful use of alcohol increase the risk of NCDs. Tobacco accounts for around 6 million deaths every year and is projected to increase to 8 million by 2030. About 3.2 million deaths annually can be attributed to insufficient physical activity. More than half of the 3.3 million annual deaths from harmful drinking are from NCDs In 2010, 1.7 million annual deaths from cardiovascular causes have been attributed to excess salt/s. To lessen the impact of NCDs on individuals and society, a comprehensive approach is needed that requires all sectors, including health, finance, foreign affairs, education, agriculture, planning and others, to work together to reduce the risks associated with NCDs, as well as promote the interventions to prevent and control them.odium intake.More than 190 countries agreed in 2011 to reduce the avoidable NCD burden in a Global action plan. This plan aims to reduce the number of premature deaths from NCDs by 25% by 2025. In 2015, countries will begin to set national targets and measure progress on the 2010 baselines. The UN General Assembly will convene a third high-level meeting on NCDs in 2018 to take stock of national progress. 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)  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