(An item from the ISHN Member information service) An article in Issue #2, 2015 of Health Education Research reports on a cohort study of the adoption of obesity prevention policies and practices by Australian primary schools: 2006 to 2013. The authors reports that "The prevalence of all four of the healthy eating practices and one physical activity practice significantly increased, while the prevalence of one physical activity practice significantly decreased. The adoption of practices did not differ by school characteristics. Government investment can equitably enhance school adoption of some obesity prevention policies and practices on a jurisdiction-wide basis. Additional and/or different implementation strategies may be required to facilitate greater adoption of physical activity practices. Ongoing monitoring of school adoption of school policies and practices is needed." A slide presentation of tghe results is available here. Read more from the abstract of the article here.
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(An item from the ISHN Member information service) Readers of this blog will know that ISHN has been tracking the changes in overweight/obesity among children and youth to determine if we are making any progress in preventing or reducing childhood obesity. Three articles in Supplementary Issue #2, 2015 of The European Journal of Public Health add to the ongoing observation that little progress is being made. These articles are based on trends analysis of the HBSC data in Western Europe and North America over the past decade. The article on obesity/overweight reported " Overweight prevalence increased among boys in 13 countries and among girls in 12 countries; in 10 countries, predominantly in Eastern Europe, an increase was observed for both boys and girls. Stabilization in overweight rates was noted in the remaining countries; none of the countries exhibited a decrease over the 8-year period examined. In the majority of countries (20/25) there were no age differences in trends in overweight prevalence." The second reported that "Multilevel logistic regression analyses showed an increase in daily fruit and vegetable consumption between 2002 and 2010 in the majority of countries for both genders and all three age groups" The third reported that "There was a slight overall increase in the number of youth reaching at least one hour of physical activity per day between 2002 and 2010 (17.0% and 18.6%, respectively). MVPA increased significantly (P ≤ 0.05) among boys in 16 countries. Conversely, nine countries showed a significant decrease." In our view, these results, despite considerable investments in physical activity programs and changes to school food policies, suggest that we need to reconsider our fundamental approach to address other factors such as structural/life-work circumstances, marketing of unhealthy foods and mental health considerations. Read more>>
(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) A meta-analysis in Volume 56, 2015 of Preventive Medicine concludes that school-based nutrition education can affect the BMI of children. Unlike interventions aimed at single behaviours such as physical activity, the authors of this review suggest that a focus on healthy eating may be the best course for reducing body weight. The authors "conducted a systematic search of 14 databases until May 2010 and cross-reference check in 8 systematic reviews (SRs) for studies published that described randomized controlled trials conducted in schools to reduce or prevent overweight in children and adolescents. An additional search was carried out using PubMed for papers published through May 2012, and no further papers were identified. Body mass index (BMI) was the primary outcome. The title and abstract review and the quality assessment were performed independently by two researchers. From the 4888 references initially retrieved, only 8 met the eligibility criteria for a random-effects meta-analysis. The total population consisted of 8722 children and adolescents. Across the studies, there was an average treatment effect of − 0.33 kg/m2 (− 0.55, − 0.11 95% CI) on BMI, with 84% of this effect explained by the highest quality studies. This systematic review provides evidence that school-based nutrition education interventions are effective in reducing the BMI of children and adolescents" 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>>
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