Obesity, Diet, Physical Activity, Sedentary Habits in European Youth 2002-14

9/10/2017

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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)
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Nutrition, Activity & Technology Lessons May Reduce BMI

11/2/2015

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A locally developed instructional program that was started by a teacher, helped by crowd-sourced funding and then evaluated by the Johnson Foundation and North Carolina has reported reductions in BMI after one year in a small scale quasi-experimental study published in the October 2015 issue of the Journal of School Health. "Motivating Adolescents with Technology to CHOOSE Health™ (MATCH) is an educational and behavioral intervention in seventh grade. Teachers in 2 schools delivered the MATCH curriculum, with 1 control school. Using a quasi-experimental design, outcome measures included lessons completed, body mass index (BMI), BMI z-score (zBMI), BMI percentile, weight category, and self-reported lifestyle behaviors. We used multiple regression models to compare group results. For the MATCH group (N = 189), teachers provided lessons over 14 weeks; the control group (N = 173) received usual curriculum. Post-intervention, the MATCH group had significant decreases in BMI measures compared with the control. In combined overweight and obese participants, the mean (95% confidence interval) zBMI change was −0.05 (−0.07, −0.03) in MATCH and −0.01 (−0.04, 0.02) in control, p = .034 between groups. After 1 year, improvements are sustained: for the overweight subgroup, the mean zBMI decreased from 1.34 to 1.26 post-MATCH, then to 1.26 after 1 year; for the obese subgroup, mean zBMI = 2.16, to 2.13 post-MATCH to 2.08 after 1 year. Self-reported lifestyle behaviors showed no differences."  Read more>>   (An item from the ISHN Member information service)
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Fitness & Fatness: Different Constructs, Different Measures

9/8/2015

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(An item from the ISHN Member information service)  A letter/article in Issue #11, 2015 of Public Health Nutrition makes a good point in response to an earlier article suggesting that BMI should be replaced as a measure of obesity by the time it takes a child to run 500 meters. The argument is made well by differentiating "fitness" from "fatness". The physical fitness to run that distance is quite a different construct than a simplistic height/weight ration such as BMI. Further, there are more sophisticated measures of body fat (waist circumference, waist to to height ratio and abdominal fat etc) that can replace BMI if needed. However it is this simple clarification of fitness and fatness that may be even more important to consider, especially in the light of increasing evidence that physical activity alone has little impact on body weight. Increasingly, researchers are turning to diet/healthy eating and accompanying mental states (boredom, loneliness,k stress) as the dominant factors. Read more>>
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Procedural Rigour in Selecting Evidence-Informed Interventions: Check Assumptions, Real-World Conditions & Systems Priorities Before Deciding

4/10/2015

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(From the ISHN Member information service)  An excellent illustration of a procedure to select evidence-based interventions to promote health is described in Issue #1, 2015 of Environmental Health Review. ISHN recommends the use of this type of planning tool but also suggests that, despite the rigour within this procedure used to select relevant research on better practices, other steps need to be taken to test our underlying assumptions before we begin as well as use our common sense in assessing the fit between the planned intervention and our local context, especially in regards to likely barriers that may be prevalent in our local communities, states or countries.
The illustration used in the journal article is focused on an urban setting, wherein the public health practitioners are looking for urban planning interventions to increase physical activity among children and adults in the community in response to rising obesity rates. The article takes the reader through several planning steps to identify such urban planning tools, eventually pointing to a credible research review published by the CDC in the United States that suggest that "Community-scale urban design and land-use regulations, policies, and practices" such as zoning regulations and building codes, and environmental changes brought about by government policies or builders’ practices. The latter include policies encouraging transit-oriented development, and policies addressing street layouts, the density of development, the location of more stores, jobs and schools within walking distance of where people live as well as "street-scale urban design and land use approaches"  in small geographic areas, generally limited to a few blocks, such as improved street lighting or infrastructure projects that increase the ease and safety of street crossing, ensure sidewalk continuity, introduce or enhance traffic calming such as center islands or raised crosswalks, or enhance the aesthetics of the street area, such as landscaping can improve levels of physical activity. Once these two types of interventions are identified in the procedure, the remaining steps suggest the involvement of stakeholders, program development and building in evaluation and feedback mechanisms. One section of the procedure suggests "Assessing Applicability and Transferability of Evidence" but the focus in that section is on how the knowledge about the intervention can be transferred successfully to policy-makers and practitioners and mentions real-barriers related to feasibility such as costs, resources and other practical factors only briefly.
We suggest here that this excellent illustration of a procedure to select an intervention to address a problem needs to be accompanied by at least three other processes. The first of these is to test our assumptions about the type of outcome we are seeking. The illustration in this article, where the fictional planners decide in advance that increased physical activity can prevent or reduce obesity and overweight is actually reflective of many real-life planners, who have done the same. The trouble is that there is increasing evidence, including from sources such as the CDC and the centre which has published this guide to selecting interventions, that increased physical activity alone, will have little impact on body weight unless it is very intense, well beyond the scope of the average person. The second process we suggest is a real hard look at the resources available in the community or organization. The research reviews identified in the article did note these barriers in their study. The barriers to community scale interventions include "1) changing how cities are built given that the urban landscape changes relatively slowly, 2) zoning regulations that preclude mixed-use neighborhoods, 3) cost of remodeling/retrofitting existing communities, 4) lack of effective communication between different professional groups (i.e., urban planners, architects, transportation engineers, public health professionals, etc.), and 5) changing behavioral norms directed towards urban design, lifestyle, and physical activity patterns" The real world barriers to street scale changes include: "the expense of changing existing streetscapes. In addition, street-scale urban design an land use policies require careful planning and coordination between urban planners, architects, engineers, developers, and public health professionals. Success is greatly enhanced by community buy-in, which can take time and effort to achieve. Inadequate resources and lack of incentives for improving pedestrian-friendliness may affect how completely and appropriately interventions are implemented and evaluated". The article suggests that the local context is an established urban setting. In most established cities, it is very difficult to make major changes in existing neighbourhoods, especially in these days where priority concerns might very well be crime, traffic and aging infrastructure. This real world observation leads us to the third major consideration that should be used in conjunction with this procedure to select evidence-based interventions. The third consideration needs to be an in-depth understanding of the core mandates, constraints and current concerns of the system that will carry the major part of the burden in implementing the intervention. In this case, it is the municipality. There are lots of examples of how such systems analysis can be done, but we close this ISHN Commentary with an appropriate example, also found by the same centre that has created this procedure for identifying evidence-based interventions. This systems planning guide that they suggest is from the province of Alberta, which suggests that program planners consider the characterisitcs of the system that will will host the intervention. These include the leadership, organization "slack" in committed vs available resources, staffing, time for implementation and more.
In school health promotion, ISHN is pleased to be pat of a global dialogue being led by educators in regards to how health and social programs can be better integrated within education systems. We suggest that before we select an intervention from the research, we seek to truly understand the system that will carry the intervention over the long term. We also suggest we look closely ar practical barriers and that we check our assumptions. Read more>>
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Calorie-Focused Thinking May Prevent Progress in Reducing Obesity

4/6/2015

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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>>
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Questionable Progress in Reducing Childhood Obesity

3/31/2015

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(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>>
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Progress in US Childhood Obesity Limited to Early Years

3/30/2015

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(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>>
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Mothers Working Affects their Children's Diet, Physical Activity

7/2/2014

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(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>>
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Academy of Nutrition and Dietetics Position on Childhood Obesity

3/11/2014

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(An item from the ISHN Member information service) An article in the February 2014 issue of Infant, Child, Adolescent Nutrition summarizes the recent position adopted by the Academy of Nutrition and Dietetics on pediatric obesity. The authors recommended a multisystem approach to effectively address pediatric obesity. They identified the following 6 key recommendations: (1) Integrate education with supportive environmental change. (2) Include both nutrition education and physical education.(3) Build in parent engagement for younger children. (4) Promote community engagement in schools and child care. (5) Policies that limit food availability show promise. (6) Dose and continuity is important. Read more>>
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