Introduction to the Active Living Research Reference List 2007


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W. Gunathilake, N. M. W. de Alwis, K. V. C. Janaka, C. A. Idampitiya, A. Dissanayake and D. J. S. Fernando. (2007). Increasing prevalence of obesity in Sri Lanka: narrowing the urban rural gap. Diabetic Medicine.
J. Haines, D. Neumark-Sztainer, M. Wall and M. Story. (2007). Personal, behavioral, and environmental risk and protective factors for adolescent overweight. Obesity (Silver Spring).

OBJECTIVE: The objective was to examine a breadth of personal, behavioral, and socio-environmental factors as potential risk and protective factors of overweight among male and female adolescents. RESEARCH METHODS AND PROCEDURES: A longitudinal study was conducted with an ethnically and socio-economically diverse sample of 2516 adolescents who completed surveys at both Time 1 (1998 to 1999) and Time 2 (2003 to 2004) of the Project Eating Among Teens (EAT) study. RESULTS: In 1998 to 1999, 335 (25.7%) girls and 282 (26.4%) boys met the age-adjusted criteria for overweight. During the 5-year study period, 236 (70.5%) of the overweight girls and 185 (65.7%) of the overweight boys remained overweight and 115 (12.0%) girls and 77 (9.9%) boys originally not overweight became overweight. Although differences by sex were found, a number of personal, behavioral, and socio-environmental factors were associated with overweight among both male and female adolescents. Body dissatisfaction and weight concerns at Time 1 predicted overweight at Time 2 for both male and female adolescents. Dieting and use of unhealthy weight control behaviors at Time 1 also predicted overweight at Time 2. Greater frequency of breakfast consumption at Time 1 was protective against overweight. Higher levels of weight-related teasing and parental weight-related concerns and behaviors at Time 1 were positively associated with Time 2 overweight. DISCUSSION: Body dissatisfaction, weight concerns, use of unhealthy weight control behaviors, weight-related stigmatization, and parental concern about the child's weight may increase risk for adolescent overweight. Interventions that enhance adolescents' body satisfaction while providing them with skills to avoid dieting and to engage in more effective weight-control behaviors should be developed and tested.

J. C. Halford, E. J. Boyland, G. M. Hughes, L. Stacey, S. McKean and T. M. Dovey. (2007). Beyond-brand effect of television food advertisements on food choice in children: the effects of weight status. Public Health Nutrition.

OBJECTIVE: To investigate the effect of television food advertising on children's food intake, specifically whether childhood obesity is related to a greater susceptibility to food promotion. DESIGN: The study was a within-subject, counterbalanced design. The children were tested on two occasions separated by two weeks. One condition involved the children viewing food advertisements followed by a cartoon, in the other condition the children viewed non-food adverts followed by the same cartoon. Following the cartoon, their food intake and choice was assessed in a standard paradigm. SETTING: The study was conducted in Liverpool, UK. SUBJECTS: Fifty-nine children (32 male, 27 female) aged 9-11 years were recruited from a UK school to participate in the study. Thirty-three children were normal-weight (NW), 15 overweight (OW) and 11 obese (OB). RESULTS: Exposure to food adverts produced substantial and significant increases in energy intake in all children (P < 0.001). The increase in intake was largest in the obese children (P = 0.04). All children increased their consumption of high-fat and/or sweet energy-dense snacks in response to the adverts (P < 0.001). In the food advert condition, total intake and the intake of these specific snack items correlated with the children's modified age- and gender-specific body mass index score. CONCLUSIONS: TheSEata suggest that obese and overweight children are indeed more responsive to food promotion, which specifically stimulates the intake of energy-dense snacks.

J. C. Halford, E. J. Boyland, G. D. Cooper, T. M. Dovey, C. J. Smith, N. Williams, C. L. Lawton and J. E. Blundell. (2007). Children's food preferences: Effects of weight status, food type, branding and television food advertisements (commercials). International Journal of Pediatric Obesity.

Objective. To investigate the effects of weight status, food type and exposure to food and non-food advertisements on children's preference for branded and non-branded foods. Design. A within-subjects, counterbalanced design with control (toy advertisement) and experimental (food advertisement) conditions. Subjects. A total of 37 school students (age: 11-13 years; weight status: 24 lean, 10 overweight, 3 obese). Measurements. Advertisement recall list, two food preference measures; the Leeds Food Preference Measure (LFPM), the Adapted Food Preference Measure (AFPM) and a food choice measure; the Leeds Forced-choice Test (LFCT). Results. Normal weight children selected more branded and non-branded food items after exposure to food advertisements than in the control (toy advertisement) condition. Obese and overweight children showed a greater preference for branded foods than normal weight children per se, and also in this group only, there was a significant correlation between food advertisement recall and the total number of food items chosen in the experimental (food advertisement) condition. Conclusion. Exposure to food advertisements increased the preference for branded food items in the normal weight children. This suggests that television food advertisement exposure can produce the same 'obesigenic' food preference response found in overweight and obese children in their normal weight counterparts.

T. Harkin. (2007). Preventing childhood obesity - The power of policy and political will. American Journal Of Preventive Medicine.
C. Hawkes. (2007). Promoting healthy diets and tackling obesity and diet-related chronic diseases: What are the agricultural policy levers? Food And Nutrition Bulletin.

Background. Diet-related chronic diseases are now a serious global public health problem. Public health groups are calling for the agricultural sector to play a greater role in tackling the threat. Objective. To identify potential points of policy intervention in the agricultural sector that could be leveraged to promote healthy diets and tackle obesity and diet-related chronic diseases. Methods. A review of the literature on the dietary implications of agriculture, a conceptual analysis of the issues, and the identification of relevant examples. Results. There are two main potential points of intervention in the agricultural sector that could be leveraged to promote healthy diets: agricultural policies and agricultural production practices. Agricultural policies and practices affect diet through their influence on food availability, price, and nutrient quality, which in turn affects food choices available to consumers. Agricultural policies amenable to intervention include input, production, and trade policies, agricultural production practices amenable to intervention include crop breeding, crop fertilization practices, livestock-feeding practices, and crop systems diversity. Conclusions. It is well-known that agricultural policies and production practices influence what farmers choose to grow. Agricultural policies and production practices could also play a role in influencing what consumers choose to eat. To identify how agricultural policies and practices can usefully contribute toward promoting healthy diets and tackling obesity and diet-related chronic diseases, health policyrnakers need to examine whether current agricultural policies and production practices are contributing to-or detracting from-efforts to attain dietary goals; where and how could agricultural intervention help achieve dietary goals; and whether there are trade-offs between these interventions and other important concerns, such as undernutrition and the livelihoods of agricultural producers. Given the potential of agriculture to contribute to large-scale, population-level dietary improvements, these questions warrant closer attention from health policymakers.

K. C. Heesch, Han, J.L. (2007). Associations Between Demographic, Perceptual, and Behavioral Factors and Support for Policies Encouraging Active Transport. Journal of Physical Activity and Health.

BACKGROUND: Policies that encourage physical activity are recommended to increase physical activity rates. Few studies have examined public support for such policies. The aim of this study was to assess support for policies that may increase active transport and correlates of this support. METHODS: A telephone survey was administered to 460 Oklahoma residents. RESULTS: Most respondents supported policies that may encourage walking and bicycling for transport. Most favored the improvement of public transportation over building new roads to address transportation concerns. In multivariate models, a positive attitude toward walking was the only variable significantly associated with support for most policy outcomes (p < 0.05). Participation in active commuting and a positive attitude toward bicycling were correlates of strong support for the creation of bike ways (p < 0.05). CONCLUSIONS: Experience with active commuting and positive attitudes toward walking and bicycling are associated with support for policies that may encourage walking and bicycling for transport.

J. Herrin, T. Kennedy, G. Topham, M. Page, L. Hubbs-Tait and A. Harrist. (2007). School environment and child weight. Faseb Journal.

A. Hilbert, W. Rief and E. Braehler. (2007). What determines public support of obesity prevention? Journal of Epidemiology and Community Health.

OBJECTIVE: To determine public support of obesity prevention. DESIGN: Representative population-based survey. SETTING: Random digit dialling telephone survey of non-institutionalised individuals aged >/=14 years in Germany. PARTICIPANTS: Representative sample of 1000 individuals. MAIN OUTCOME MEASURES: Interview-based assessment of prevention support, problem identification, causal attributions and responsibility beliefs regarding obesity. RESULTS: Support for obesity prevention with a focus on behavioural change in children (89.7%) and provision of information in adults (82.2%) was substantial, but regulations were less supported (42.2%). Predictors of prevention support were attributing causes of obesity to the food environment and lack of physical activity, greater problem identification, societal responsibility beliefs and sociodemographic characteristics including female gender and higher age. An information deficit concerning the definition, prevalence, and environmental and genetic risk factors was identified. CONCLUSION: Results show a high public readiness for obesity prevention with a focus on individual behavioural change, but not for regulations. Addressing specific information deficits regarding the definition, prevalence and causes of obesity could further enhance the public's understanding of obesity and help to establish obesity prevention measures.

J. O. Hill, J. C. Peters and H. R. Wyatt. (2007). The role of public policy in treating the epidemic of global obesity. Clinical pharmacology and therapeutics.

Given the powerful forces promoting population weight gain, the obesity epidemic cannot be reversed solely by promoting individual behavior change. Policy initiatives might lessen the impact of the biological and economical forces promoting weight gain or provide motivation to resist these forces. Unfortunately, there is little information to adequately evaluate the many policies that have been suggested. The intent of this review is to discuss the potential use of policy to stem the global epidemic of obesity.

M. Holdsworth, Y. Kameli and F. Delpeuch. (2007). Stakeholder views on policy options for responding to the growing challenge from obesity in France: findings from the PorGrow project. Obesity Review.

To explore the perspectives of key stakeholders towards a range of policy options to prevent obesity in France, a multi-criteria mapping method was used to gather quantitative and qualitative data from 21 types of stakeholder groups. During structured interviews, stakeholders appraised a set of pre-defined options by reference to criteria of their own choosing and provided relative weights to their criteria, and overall rankings of the policy options. Efficacy, feasibility and societal benefits were the groups of criteria given most importance by stakeholders. There was most consensus and preference for options related to health education, particularly in schools, compared with options that aimed at changing the environment to prevent obesity, i.e. options around physical activity; options that modified food supply and demand; and information-related options. There was little support for technological solutions or institutional reforms. While there was broad interest in a range of different options, those related to behaviour change through education were the most valued by stakeholders. Raising awareness among policymakers about the convincing scientific evidence for the effectiveness of environmental level policy options will be a crucial first step.

C. Homer and L. A. Simpson. (2007). Childhood obesity: what's health care policy got to do with it? Health Affairs (Millwood).

The health care industry must acknowledge its critical role in addressing childhood obesity. All components of the industry--payers, plans, and providers--must act based on the best available evidence. This evidence now points to promoting breastfeeding and increased physical activity, decreased television time, and decreased consumption of sugar-sweetened beverages; the use of more-effective counseling techniques; and linking practice and community-based strategies around a common message. Policies in support of these changes include reimbursement for counseling and community efforts; training; incentives; and support for traditional and pragmatic research, the latter including sharing outcomes using common metrics across programs.

Z. Horvath, M. G. Pankotai and I. Szabolcs. (2007). Stakeholder appraisal of policy options for responding to obesity in Hungary. Obesity Review.

Overweight and obesity increases risks for many diseases, while treating them is expensive. Trends in the prevalence of overweight and obesity over the last two decades indicate the need for urgent interventions. Several different kinds of interventions could modify the obesogenic environment. The aim of this study was to map which policy options will be acceptable and effective in Hungary. Interviews were conducted with 21 stakeholders representing a wide range of viewpoints to evaluate seven core and 13 discretionary policy options under different criteria. The 21 Hungarian participants used 92 appraisal criteria covering a wide range of issues. Efficacy, practical feasibility, social acceptability and societal benefits were widely judged more important than the costs of measures. Significant additional social and health benefits were anticipated from changes in transport and planning policies, but the cost to the public sector was considered high and the implementation difficult. There was broad support for changes in patterns of food consumption and levels of physical activity. There was a consensus that without developing the attitudes of individuals to be more responsible for their health, environmental changes alone would not be enough to reverse the trend of the growing prevalence of obesity.

S. Inagami, D. A. Cohen and S. M. Asch. (2007). Neighborhood fast food concentration, location of grocery stores and body mass index. American Journal Of Epidemiology.
S. J. Jones and E. A. Frongillo. (2007). Intervention testing the effectiveness of local engagement in policy as a means to prevent child obesity. Faseb Journal.

M. B. Justus, K. W. Ryan, J. Rockenbach, C. Katterapalli and P. Card-Higginson. (2007). Lessons learned while implementing a legislated school policy: body mass index assessments among Arkansas's public school students. Journal of School Health.

BACKGROUND: To comprehensively address the childhood and adolescent obesity epidemic, Arkansas enacted Act 1220 of 2003. Among a series of community- and school-based interventions, the Act requires each public school student to have his/her body mass index (BMI) assessed and reported annually to parents. The process of implementing this policy on a statewide level and lessons learned are described in this article. METHODS: A confidential, standardized protocol to measure student BMIs and report results to parents was developed. Affordable, reliable, and durable equipment was selected and school personnel who conducted BMI assessments were trained to ensure standardization. To enhance the efficiency and ease of the measurement and reporting process and promote long-term and locally based sustainability, during the first 3 years of implementation, a transition from a paper-based system to a Web-based system was made. Confidential, individualized Child Health Reports have provided students' parents with information about the health of their children. RESULTS: Participation by schools and students has been high as a result of collaboration between the health and education communities and the students and their families. Childhood obesity has not increased since Act 1220 was passed into law. CONCLUSIONS: Parents, schools, school districts, and the state are able to better understand the obesity epidemic and track progress using detailed annual data. Providing a standardized measurement protocol, equipment, and efficient data entry and report generation options has enabled Arkansas to institutionalize the BMI assessment process in public schools.

S. Kamarzaman and N. Bruce. (2007). Causes of childhood obesity in Malaysia: Potential interaction of food availability, children's lifestyle choices and eating behaviour. Homo-Journal Of Comparative Human Biology.
C. Karakos, V. Karanasiou, N. Kavouras, I. Kalantzis, K. Stamatiou, C. Chlopsios, F. Lebren, E. Skoumbourdis and E. Damianaki. (2007). Prevalence of adolescent overweight in urban and rural areas of Greece. International Journal Of Obesity.
S. H. Kim and L. A. Willis. (2007). Talking about obesity: news framing of who is responsible for causing and fixing the problem. Journal of health communication.

Analyzing newspaper articles and television news, we explore how American news media have framed the issue of obesity. More specifically, we analyze the way the media present the question of who is responsible for causing and fixing the problem. Our data reveal that over the last 10 years, mentions of personal causes and solutions significantly have outnumbered societal attributions of responsibility. Recently, however, a balance was established between individualistic and societal attributions of responsibility. Mentions of societal causes and solutions have increased considerably, whereas decreasing numbers of personal solutions have appeared in the media. Findings also indicate that television news is more likely than newspapers to mention personal solutions, but less likely to attribute the responsibility to society.

L. King, C. Turnour and M. Wise. (2007). Analysing NSW state policy for child obesity prevention: strategic policy versus practical action. Australia and New Zealand Health Policy.

ABSTRACT: BACKGROUND: There is increasing worldwide recognition of the need for government policies to address the recent increases in the incidence and prevalence of childhood obesity. The complexity and inter-relatedness of the determinants of obesity pose a genuine policy challenge, both scientifically and politically. This study examines the characteristics of one of the early policy responses, the NSW Government's Prevention of Obesity in Children and Young People: NSW Government Action Plan 2003-2007 (GAP), as a case study, assessing it in terms of its content and capacity for implementation. RESULTS: This policy was designed as an initial set of practical actions spanning five government sectors. Most of the policy actions fitted with existing implementation systems within NSW government, and reflected an incremental approach to policy formulation and implementation. CONCLUSION: As a case study, the NSW Government Action Plan illustrates that childhood obesity policy development and implementation are at an early stage. This policy, while limited, may have built sufficient commitment and support to create momentum for more strategic policy in the future. A more sophisticated, comprehensive and strategic policy which can also be widely implemented and evaluated should now be built on this base.

M. D. Kipke, E. Iverson, D. Moore, C. Booker, V. Ruelas, A. L. Peters and F. Kaufman. (2007). Food and park environments: neighborhood-level risks for childhood obesity in east Los Angeles. Journal of Adolescent Health.

PURPOSE: The rapid increase in obesity over the past two decades suggests that behavioral and environmental influences, including poor nutrition and physical inactivity, are fueling what is now widely recognized as a public health crisis. Yet, limited research has been conducted to examine how environmental factors, such as neighborhood-level characteristics, may be associated with increased risk for obesity. METHODS: Community-level risk associated with childhood obesity was examined in East Los Angeles, a community with one of the highest rates of childhood obesity in Los Angeles by triangulating: 1) spatial data for the number and location of food establishments relative to the location of schools; 2) observations regarding the availability and quality of fruits and vegetables in local grocery stores; and 3) observations regarding the quality and utilization of local parks. RESULTS: The findings revealed that there were 190 food outlets in the study community, of which 93 (49%) were fast-food restaurants. Of the fast-food restaurants, 63% were within walking distance of a school. In contrast, there were 62 grocery stores, of which only 18% sold fresh fruits and/or vegetables of good quality. Of the stores that did sell fruits and/or vegetables, only four were within walking distance of a school. Although well maintained, the five parks in this community accounted for only 37.28 acres, or 0.543 acres per 1000 residents. CONCLUSIONS: These findings suggest that children have easy access to fast food, and limited access to both healthy food options and parks in which to engage in physical fitness activities. This was particularly true in areas around schools. The implications for these findings with regards to policy-related prevention and future research are discussed.

T. R. Kirk, A. de Looy, R. Fletcher and C. H. Ruxton. (2007). Nutritionists in industry can play a key role in helping to achieve Health of the Nation targets for nutrition. Journal of human nutrition and dietetics.

Nutritionists working in food manufacturing and retailing are potentially in a more powerful position than any other professional group to contribute towards achieving the national targets for nutrition and the reduction of nutrition-related diseases, set out in The Health of the Nation (DoH, 1992) and in Scotland's Health, A Challenge to Us All (Scottish Office, 1993). The present paper sets out the details of this argument. First, a review is given of the functions and types of activities carried out by nutritionists in industry. Then a number of key practical ways in which nutritionists, through their activities and functions, can help towards achieving national targets for nutrition and nutrition-related diseases are described. Finally, suggestions are made about the knowledge, skills, and personal attributes needed by nutritionists who intend making successful careers in industry and who wish, at the same time, to contribute towards improving the health of the nation.

K. I. Klepp, M. Wind, I. de Bourdeaudhuij, C. P. Rodrigo, P. Due, M. Bjelland and J. Brug. (2007). Television viewing and exposure to food-related commercials among European school children, associations with fruit and vegetable intake: a cross sectional study. International Journal Of Behavioral Nutrition And Physical Activity.

Background: Fruit and vegetable intake is low among European children and exposure to TV is negatively associated with the intake of fruit and vegetables. The aim of the present study was to explore exposure to food commercials on TV in nine European countries. Associations between such exposure and intake of fruit and vegetables and possible mediating effects of attitudes toward and liking of fruit and vegetables were assessed. Methods: A cross-sectional survey was performed in nine European countries, i.e. Austria, Belgium, Denmark, Iceland, the Netherlands, Norway, Portugal, Spain and Sweden, from October-December 2003, as a part of the Pro Children study. Data on usual intake of fruit and vegetables, and related correlates were collected by means of a self-administered questionnaire among 11-year-old school children (mean age 11.4 (sd = 0.48), 50.2% boys). Complete data was available for 13,035 children. Differences in exposure to TV ads between countries, gender and social class were explored by analysis of variance. Multiple linear regression analysis was used to test associations between exposure to TV ads and intake and to assess mediating effects. Results: The large majority of children in all nine countries report recent exposure to a number of TV ads for food, and they were more often exposed to ads for unhealthy food than for fruit and vegetables (mean of 2.2 (sd = 1.0) unhealthy ads vs. mean of 1.7 (sd = 1.0) healthy ads; p < 0.001). Boys reported somewhat higher TV viewing than girls did (2.5 (sd = 1.7) vs. 2.2 (sd = 1.6) hours per day; p < 0.001), and children from lower social classes reported higher TV viewing than higher social class children did (2.4 (sd = 1.7) vs. 2.0 (sd = 1.5); p < 0.001). Across all countries, exposure to TV ads for healthy foods was positively associated (r = 0.09-0.16) with reported fruit and vegetable intake. This association was in part mediated by attitudes toward and liking of fruit and vegetables. Conclusion: Exposure to TV ads for fruit and vegetables appear to be associated with fruit and vegetable consumption among European school children. This relationship is in part mediated through cognitive factors such as attitudes and preferences concerning fruit and vegetables.

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