Introduction to the Active Living Research Reference List 2007


BUILT AND POLICY ENVIRONMENT – DIET & OBESITY

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BUILT AND POLICY ENVIRONMENT – DIET & OBESITY

(2007). Dance it off (The introduction of dance in Chinese schools to combat childhood obesity). Dance Magazine.

(2007). Neighborhood watch fights weight gain. Future Lipidology.
(2007). Reversing the obesity epidemic: policy strategies for health funders. Issue brief (Grantmakers Health).

As part of its continuing mission to serve trustees and staff of health foundations and corporate giving programs, Grantmakers In Health (GIH) convened a group of health funders and policy experts on November 3, 2006 to discuss policy strategies to reverse the obesity epidemic. This report, drawing upon a background paper prepared for the Issue Dialogue and discussion at that meeting, provides an overview of the costs and consequences of the obesity epidemic; presents the rationale for using policy approaches to change food and physical activity environments; and highlights the efforts of health funders supporting policy change in schools, food systems and sustainable agriculture, the built environment, and across communities. It also briefly examines trends and opportunities in health systems, workplaces, and state programs, and concludes with a discussion of challenges and opportunities for moving forward.

K. Ackroff, K. Bonacchi, M. Magee, Y. M. Yiin, J. V. Graves and A. Sclafani. (2007). Obesity by choice revisited: Effects of food availability, flavor variety and nutrient composition on energy intake. Physiology & Behavior.

Recent work suggested that the energy intake and weight gain of rats maintained on chow and 32% sucrose solution could be increased by simply offering more sources of sucrose [Tordoff M.G. Obesity by choice: the powerful influence of nutrient availability on nutrient intake. Am J Physiol 2002;282:R1536-R1539.1. In Experiment I this procedure was replicated but the effect was not: rats given one bottle of sucrose and five bottles of water consumed as much sucrose as those given five bottles of sucrose and one of water. Adding different flavors to the sucroSEid not increase intakes further in Experiment 2. The relative potency of sucrose and other optional foods was studied in Experiment 3. Sucrose solution stimulated more overeating and weight gain than fat (vegetable shortening), and offering both sucrose and shortening did not generate further increases in energy intake. Finally, foods commonly used to produce overeating and weight gain were compared. Sucrose was less effective than a high-fat milk diet, and offering cookies in addition to the milk did not increase energy intake further. The nature of optional foods (nutrient composition and physical form) was markedly more important than the number of food sources available to the animals, and is a better contender as the reason for "obesity by choice". (c) 2007 Elsevier Inc. All rights reserved.

J. Alderman, J. A. Smith, E. J. Fried and R. A. Daynard. (2007). Application of law to the childhood obesity epidemic. Journal of Law, Medicine & Ethics.

Childhood obesity is in important respects a result of legal policies that influence both dietary intake and physical activity. The law must shift focus away from individual risk factors alone and seek instead to promote situational and environmental influences that create an atmosphere conducive to health. To attain this goal, advocates should embrace a population-wide model of public health, and policymakers must critically examine the fashionable rhetoric of consumer choice.


E. Alkon and H. Goldstein. (2007). A California advocacy model for policies to address the obesogenic environment, 1999-2007. European Journal Of Public Health.
J. D. Ard. (2007). Unique perspectives on the obesogenic environment. Journal of General Internal Medicine.
A. Asfaw. (2007). Do government food price policies affect the prevalence of obesity? Empirical evidence from Egypt. World Development.

Obesity has become one of the most serious but neglected global public health problems especially in developing countries. I examine the impact of the Egyptian food subsidy program on mothers' weight. It is hypothesized that the program causes a wide disparity in per calorie costs between energy-dense and energy-dilute foods and thus aggravating the obesity problem. The estimated elasticities reveal that, mothers' BMI is inversely related to the price of subsidized, energy-dense food and directly to the price of a high diet quality but expensive food items suggesting that the program aggravates obesity by lowering the direct costs of becoming obese. (c) 2006 Elsevier Ltd. All rights reserved.

J. F. Bell, G. C. Liu and J. Wilson. (2007). Associations between neighborhood greenness, residential density and two-year changes in children's body mass index. Pediatric Research.

W. Bemelmans, P. van Baal, W. Wendel-Vos, J. Schuit, E. Feskens, A. Ament and R. Hoogenveen. (2008). The costs, effects and cost-effectiveness of counteracting overweight on a population level. A scientific base for policy targets for the Dutch national plan for action. Preventive Medicine.

OBJECTIVES: To gain insight in realistic policy targets for overweight at a population level and the accompanying costs. Therefore, the effect on overweight prevalence was estimated of large scale implementation of a community intervention (applied to 90% of general population) and an intensive lifestyle program (applied to 10% of overweight adults), and costs and cost-effectiveness were assessed. METHODS: Costs and effects were based on two Dutch projects and verified by similar international projects. A markov-type simulation model estimated long-term health benefits, health care costs and cost-effectiveness. RESULTS: Combined implementation of the interventions - at the above mentioned scale - reduces prevalence rates of overweight by approximately 3 percentage points and of physical inactivity by 2 percentage points after 5 years, at a cost of 7 euros per adult capita per year. The cost-effectiveness ratio of combined implementation amounts to euro6000 per life-year gained and euro5700 per QALY gained (including costs of unrelated diseases in life years gained). Sensitivity analyses showed that these ratios are quite robust. CONCLUSIONS: A realistic policy target is a decrease in overweight prevalence of three percentage points, compared to a situation with no interventions. In reality, large scale implementation of the interventions may not counteract the expected upward trends in The Netherlands completely. Nonetheless, implementation of the interventions is cost-effective.

T. K. Boehmer, R. C. Brownson, D. Haire-Joshu and M. L. Dreisinger. (2007). Patterns of childhood obesity prevention legislation in the United States. Preventing Chronic Disease.

INTRODUCTION: Because of the public's growing awareness of the childhood obesity epidemic, health policies that address obesogenic environments by encouraging healthy eating and increased physical activity are gaining more attention. However, there has been little systematic examination of state policy efforts. This study identified and described state-level childhood obesity prevention legislation introduced and adopted from 2003 through 2005 and attempted to identify regional geographic patterns of introduced legislation. METHODS: A scan of legislation from all 50 states identified 717 bills and 134 resolutions that met study inclusion criteria. Analyses examined patterns in the introduction and adoption of legislation by time, topic area, and geography. RESULTS: Overall, 17% of bills and 53% of resolutions were adopted. The amount of legislation introduced and adopted increased from 2003 through 2005. The topic areas with the most introduced legislation were school nutrition standards and vending machines (n = 238); physical education and physical activity (n = 191); and studies, councils, or task forces (n = 110). Community-related topic areas of walking and biking paths (37%), farmers' markets (36%), and statewide initiatives (30%) had the highest proportion of bills adopted, followed by model school policies (29%) and safe routes to school (28%). Some regional geographic patterns in the introduction of legislation were observed. There was no statistical association between state-level adult obesity prevalence and introduction of legislation. CONCLUSION: Public health and health policy practitioners can use this information to improve advocacy efforts and strengthen the political climate for establishing childhood obesity prevention legislation within state governments. Expanded surveillance (including standardized identification and cataloging) of introduced and adopted legislation will enhance the ability to assess progress and identify effective approaches. Future policy research should examine determinants, implementation, and effectiveness of legislation to prevent childhood obesity.


T. K. Boehmer, C. M. Hoehner, A. D. Deshpande, L. K. B. Ramirez and R. C. Brownson. (2007). Perceived and observed neighborhood indicators of obesity among urban adults. International Journal Of Obesity.

Objective: The global obesity epidemic has been partially attributed to modern environments that encourage inactivity and overeating, yet few studies have examined specific features of the physical neighborhood environment that influence obesity. Using two different measurement methods, this study sought to identify and compare perceived and observed neighborhood indicators of obesity and a high-risk profile of being obese and inactive. Design: Cross-sectional telephone surveys (perceived) and street-scale environmental audits (observed) were conducted concurrently in two diverse US cities to assess recreational facility access, land use, transportation infrastructure and aesthetics. Subjects: A total of 1032 randomly selected urban residents (20% obese, 32% black, 65% female). Analysis: Bivariate and multivariate logistic regression analyses were conducted to estimate the association (adjusted prevalence odds ratio (aOR)) between the primary outcome (obese vs normal weight) and perceived and observed environmental indicators, controlling for demographic variables. Results: Being obese was significantly associated with perceived indicators of no nearby nonresidential destinations (aOR=2.2), absence of sidewalks (aOR=2.2), unpleasant community (aOR=3.1) and lack of interesting sites (aOR=4.8) and observed indicators of poor sidewalk quality (aOR=2.1), physical disorder (aOR=4.0) and presence of garbage (aOR=3.7). Perceived and observed indicators of land use and aesthetics were the most robust neighborhood correlates of obesity in multivariate analyses. Conclusions: The findings contribute substantially to the growing evidence base of community-level correlates of obesity and suggest salient environmental and policy intervention strategies that may reduce population- level obesity prevalence. Continued use of both measurement methods is recommended to clarify inconsistent associations across perceived and observed indicators within the same domain.

P. Borg and M. Fogelholm. (2007). Stakeholder appraisal of policy options for responding to obesity in Finland. Obesity Reviews.

The aim of the Finnish Policy Options for Responding to the Growing Challenge of Obesity Research Project study was to use a multi-criteria mapping method to assess stakeholder opinions on policies that might have relevance when planning policies targeting obesity prevention. When evaluating policies, criteria relating to 'Positive societal benefits' and 'Additional health benefits' were often considered important, along with the more obvious 'Efficacy in addressing obesity'. Other criteria (like economic factors) were of less importance. All policy options targeting at 'Educational and Research Initiatives' were highly ranked in the analysis by all stakeholders. Policies aimed at improving 'Food-Related Informational Initiatives' were also ranked well on average, although more variation between stakeholders existed. Policies targeting increased physical activity and easier access/provision to healthy foods received also relatively good rankings but with wide variation and doubts in the appraisals. Policies encouraging new technological innovations and institutional reforms were mostly ranked poorly and were not seen as solutions to obesity problem. Irrespective of the stakeholder group, it seems that while traditional educational policies were most highly ranked, several other policies are also viable options in the policy portfolio of obesity prevention.


L. Botterill. (2007). Obesity, business and public policy. Australian Journal Of Political Science.

R. V. Brown, A. K. Yancey, J. Williams, B. Cole, W. McCarthy, S. A. Grier and A. Hillier. (2007). Association between outdoor adverstisements and weight-related disparities in New York City. Journal Of General Internal Medicine.
J. Brug. (2007). The European charter for counteracting obesity: a late but important step towards action. Observations on the WHO-Europe ministerial conference, Istanbul, November 15-17, 2006. International Journal of Behavioral Nutrition and Physical Activity.

BACKGROUND: On November 15-17, 2006 the World Health Organization Regional Office for Europe organised a ministerial conference on counteracting obesity in the European region. Delegations from 48 countries met in Istanbul, Turkey. Observed by relevant nongovernmental organisations and expert temporary advisors, the European ministers adopted a charter on counteracting obesity. This charter states that countries within the European region should be able to show results in slowing down and stopping the obesity epidemic within the next 4-5 years, especially among children, and that the obesity prevalence trends should be reversed before 2015. To achieve this, the charter explicitly calls for action beyond health education: changes in the physical, political, informational and social environments are needed to facilitate a healthy energy balanced lifestyle. DISCUSSION: The fact that all member states of WHO-Europe have now explicitly agreed on an ecological approach to fighting the obesity epidemic with a timeline for visible results is important. However, the charter does not explicate specific enough and measurable objectives for improvement, nor the means needed to reach these. SUMMARY: The fact that all WHO-Europe member states have agreed on a charter that recognizes that counteracting obesity requires a multidisciplinary and ecological approach, with a timeline for improvements, is a late but important step forward for public health policy and practice across Europe. However, more specific tangible goals should now be set, the required means should be allocated, coordinated and immediate action should be implemented, and research to identify effective strategies should be encouraged and facilitated.

C. M. Burns and A. D. Inglis. (2007). Measuring food access in Melbourne: Access to healthy and fast foods by car, bus and foot in an urban municipality in Melbourne. Health & Place.

Access to healthy food can be an important determinant of a healthy diet. This paper describes the assessment of access to healthy and unhealthy foods using a GIS accessibility programme in a large outer municipality of Melbourne. Access to a major supermarket was used as a proxy for access to a healthy diet and fast food outlet as proxy for access to unhealthy food. Our results indicated that most (>80%) residents lived within an 8-10 min car journey of a major supermarket i.e. have good access to a healthy diet. However, more advantaged areas had closer access to supermarkets, conversely less advantaged areas had closer access to fast food outlets. These findings have application for urban planners, public health practitioners and policy makers. (C) 2007 Elsevier Ltd. All rights reserved.

T. Byers and R. L. Sedjo. (2007). Public health response to the obesity epidemic: too soon or too late? The Journal of Nutrition.

Public health actions in response to new threats are often taken despite uncertainty about the efficacy of the action. The challenge, then, is to make ongoing judgments about whether actions are taken too soon, before a sufficient understanding of the efficacy of interventions is known, or too late, after much of the prevention potential is lost. The ongoing obesity epidemic presents exactly this type of challenge. General lessons learned from the AIDS and tobacco epidemics as well as others can be useful now as we contemplate options for reversing the ongoing epidemic of obesity in the United States. In this article we briefly review current evidence regarding the efficacy of obesity interventions in both clinical and community settings. We conclude that although little direct evidence is available on the efficacy of interventions for the obesity epidemic, there are some reasonable options derived from experience with other public health epidemics that can contribute to the solution of the obesity problem.


K. J. Campbell, D. A. Crawford, J. Salmon, A. Carver, S. P. Garnett and L. A. Baur. (2007). Associations between the home food environment and obesity-promoting eating behaviors in adolescence. Obesity (Silver Spring).

OBJECTIVE: This study examines relationships between multiple aspects of the home food environment and obesity-promoting characteristics of 12- to 13-year-old adolescents' diets, specifically frequency of consumption of high-energy fluids, sweet snacks, savory snacks, and take-out foods. RESEARCH METHODS: This was a cross-sectional study including 347 adolescents 12 to 13 years of age and their parents. Data were collected via self-completed surveys. The adolescents' diets were assessed using a Food Frequency Questionnaire derived from existing age-appropriate National Nutrition Survey data. An extensive range of domains within the home food environment were assessed. Bivariate linear regression analyses were run split by gender. Forced entry multiple linear regression analyses (adjusting for all variables significant in bivariate analyses as well as for maternal education) were also performed, stratified by the sex of the child. RESULTS: The influence of mothers, either as models for eating behaviors or as the providers of food, was pervasive. Mothers' intake of high-energy fluids (p = 0.003), sweet snacks (p = 0.010), savory snacks (p = 0.008), and take-out food (p = 0.007) was positively associated with boys' intake of all these foods. In addition, mothers' intake of high-energy fluids was positively associated with daughters' consumption of theSErinks (p = 0.025). Furthermore, availability of unhealthy foods at home was positively associated with girls' sweet snack (p = 0.001), girls' savory snack (p < 0.001), boys' savory snack (p = 0.002), and, in the bivariate analyses, girls' high-energy fluid consumption (p = 0.002). DISCUSSION: This study of home food environment influences on adolescent diet highlights the pervasive influence of mothers in determining adolescents' obesity-promoting eating, providing direction for obesity prevention strategies and future research.

G. M. Catlin. (2007). A more palatable solution? Comparing the viability of smart growth statutes to other legislative methods of controlling the obesity epidemic. Wisconsin Law Review.
R. L. Chambers, L. W. Turner and S. B. Hunt. (2007). Application of ecological models to risks related to being overweight among nurses. Psychol Report.

This paper provides a discussion of environmental strategies to improve health behaviors of nurses. Behavioral choices, partly due to social and environmental factors, influence risk of chronic disease. Strategies that modify environments are critical components of public health interventions, particularly those concerned with improving diet and physical activity. Nurses' health behaviors may be especially important, due to their influence as models when caring for patients. Modifications in work environments may enable nurses to acquire and maintain healthy behaviors.

S. Chung, B. M. Popkin, M. E. Domino and S. C. Stearns. (2007). Effect of retirement on eating out and weight change: an analysis of gender differences. Obesity (Silver Spring).

OBJECTIVES: The objectives were to understand how the retirement decisions of older Americans influence household food consumption patterns by gender and, in turn, to examine the impact of the change in food consumption on weight. RESEARCH METHODS AND PROCEDURES: This study used five waves of the Health and Retirement Study (1992 to 2002; n=28,117). Participants were 50 to 71 years old during the study period. We used longitudinal regression analyses controlling for health events, spousal factors, socioeconomic factors, and individual fixed effects over time. RESULTS: Retirement of the individual and of his/her spouse reduced the individual's monthly spending on eating out by $10 and $7 on average, respectively, but did not change household spending on food at home. The wife's, but not the husband's, retirement decreased the spouse's spending on eating out by $13/mo. Spending on eating out was a significant but weak (0.003BMI/$) predictor of weight gain. DISCUSSION: The decrease in spending on eating out after retirement, particularly women's, suggests that people eat out less when they have more time for food preparation at home. However, increases in other risks of weight gain with retirement, such as physical inactivity, could counteract the effects of eating out less.

M. A. Clark and P. Gleason. (2007). The national school lunch program, beverage consumption, and child obesity. Faseb Journal.
C. Codrington, K. Sarri and A. Kafatos. (2007). Stakeholder appraisal of policy options for tackling obesity in Greece. Obesity Reviews.

The study aimed to map stakeholders' evaluations of policy options to counter the rising prevalence of obesity in Greece, where the case for action on obesity is only now being made. The multi-criteria mapping method was used to capture and compare stakeholders' appraisals and to provide a policy analysis. Efficacy and practical feasibility were the issues most frequently used by stakeholders to evaluate options and were weighted more highly than cost criteria, which were often defined in terms of governmental costs. There was a broad favourable appraisal for downstream measures offering individuals the skills, information and opportunities to make healthier choices, rather than options to modify the obesogenic environment. Consistently, high rankings were given to educational options, for improving communal facilities and for some information-related options (food labelling, advertising), with particular support for policies targeting the young. There was also significant advocacy by a few for the creation of a new government body charged with intersectoral policy co-ordination. The Policy Options for Responding to the Growing Challenge of Obesity Research Project analyses thus point to support for a portfolio of measures to combat the problem of obesity in Greece as well as an appreciation that political will is an essential prerequisite.

M. A. Colchero and D. Bishai. (2007). Effect of Neighborhood Exposures on Changes in Weight among Women in Cebu, Philippines (1983 2002). American Journal Of Epidemiology.

The authors aimed to identify the contributions of community factors to weight change in a cohort of women from Metropolitan Cebu, Philippines, between 1983 and 2002. The authors created a three-level random-intercept model to see whether mean body mass index (BMI; weight (kg)/height (m)(2)) varied by individual- and cluster-level variables and identified community characteristics associated with changes in BMI among 2,952 nonpregnant women. The average BMI among women living in places with four public amenities (telephones, electricity, mail delivery, and newspapers) was 0.16 kg/m(2) (95% confidence interval: 0.07, 0.26) higher than that of women living in places with fewer than three amenities. An increase in population density of 10,000 persons per km(2) was associated with a BMI increase of 0.09 kg/m(2) (95% confidence interval: 0.05, 0.13). A model with interactions revealed that the effect of population density increased significantly over time. These findings confirm earlier observations that in low-income countries, obesity starts among the wealthiest communities. Secondary and tertiary prevention policies designed to reduce obesity should be implemented in the most economically developed areas first. Primary prevention would be most needed in less developed areas, where the obesity epidemic is just beginning.




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