Introduction to the Active Living Research Reference List 2007

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C. Knai, M. Suhrcke and T. Lobstein. (2007). Obesity in Eastern Europe: an overview of its health and economic implications. Economics & Human Biology.

AIMS: To assess the evolution and patterns of obesity in countries of the WHO European Region with a particular focus on the Eastern European countries, and to discuss the health and economic implications of obesity for those countries. METHODS: The available data on overweight and obesity in children and adults for the countries of the WHO European countries were collated from the International Obesity TaskForce database and considered in the light of estimates for the costs of obesity-related ill health. RESULTS: Overweight and obesity in most countries of Europe show rising secular trends, and are predicted to continue rising if not addressed. Estimates of the costs to the health services and to economic productivity indicate that some countries may find it hard to cope with the burden of obesity: up to 6% of total health care costs and as much in indirect costs of lost productivity could be attributed to obesity and its associated illnesses. CONCLUSIONS: Transition, despite the many benefits it has undoubtedly conferred to the population living in the Region, has also entailed the collateral damage of a fast growing obesity challenge. Policy-makers in the new and candidate EU countries as well as other countries of the European Region can learn from the negative Western European and global experience, act now to stem the obesity epidemic from further developing and in so doing, reduce the substantial economic losses associated with obesity. Local, national and international strategies will be needed to combat the problem.

A. Kouris-Blazos and M. L. Wahlqvist. (2007). Health economics of weight management: evidence and cost. Asia Pacific Journal of Clinical Nutrition.

The World Health Organization estimates that around one billion people throughout the world are overweight and that over 300 million of these are obese and if current trends continue, the number of overweight persons will increase to 1.5 billion by 2015. The number of obese adults in Australia is estimated to have risen from 2.0 million in 1992/93 to 3.1 million in 2005. The prevalence of obesity has been increasing due to a convergence of factors--the rise of TV viewing, our preference for takeaway and pre-prepared foods, the trend towards more computer-bound sedentary jobs, and fewer opportunities for sport and physical exercise. Obesity is not only linked to lack of self esteem, social and work discrimination, but also to illnesses such as the metabolic syndrome and hyperinsulinaemia (which increases the risk of developing heart disease, diabetes, hypertension, fatty liver), cancer, asthma, dementia, arthritis and kidney disease. It has been estimated that the cost of obesity in Australia in 2005 was $1,721 million. Of this amount, $1,084 million were direct health costs, and $637 million indirect health costs (due to lost work productivity, absenteeism and unemployment). The prevalence cost per year for each obese adult has been estimated at $554 and the value of an obesity cure is about $6,903 per obese person. Government efforts at reducing the burden remain inadequate and a more radical approach is needed. The Australian government, for example, has made changes to Medicare so that GPs can refer people with chronic illness due to obesity to an exercise physiologist and dietitian and receive a Medicare rebate, but so far these measures are having no perceptible effect on obesity levels. There is a growing recognition that both Public Health and Clinical approaches, and Private and Public resources, need to be brought to this growing problem. Australian health economist, Paul Gross, from the Institute of Health Economics and Technology Assessment claims there is too much reliance on health workers to treat the problem, especially doctors, who have not been given additional resources to manage obesity outside a typical doctor's consultation. Gross has recommended that further changes should be made to Medicare, private health insurance, and workplace and tax legislation to give people financial incentives to change their behaviour because obesity should not just be treated by governments as a public health problem but also as a barrier to productivity and a drain on resources. A Special Report of the WMCACA (Weight Management Code Administration Council of Australia) ( on the "Health Economics of Weight Management" has been published in the Asia Pacific Journal of Clinical Nutrition in September 2006. This report explores the cost benefit analysis of weight management in greater detail.

S. P. Kremers, G. J. de Bruijn, M. Droomers, F. van Lenthe and J. Brug. (2007). Moderators of environmental intervention effects on diet and activity in youth. American Journal Of Preventive Medicine.

BACKGROUND: The complexity of the relationship between environmental factors on the one hand and dietary behavior and physical activity on the other necessitates the search for moderators of environmental influences. The current evidence base is reviewed regarding potential moderating factors in the effectiveness of environmental interventions aimed at diet and/or physical activity of children and adolescents. METHODS: The following databases were used: (1) Medline, (2) PubMed, (3) PsychInfo, (4) Web of Science, and (5) ERIC. Additionally, all potentially relevant references in recent reviews were checked. RESULTS: Of the 41 studies included in the review, only seven studies (17%) were identified that reported tests of potential moderators of intervention effects. Gender proved to be the most frequently studied potential moderator. Additionally, race, age, and site have been studied regarding their potential role in modifying the effect of environmental interventions. DISCUSSION: The small number of studies identified in this review prohibited us from attempting to formulate a conclusion on differential environment-behavior relationships in distinct subgroups. Rather than being an exception, it is argued that tests of effect modifiers should become common practice in behavioral nutrition and physical activity research to increase our understanding of mechanisms of behavior change and to optimize interventions.

M. Y. Kubik, M. Story and G. Rieland. (2007). Developing school-based BMI screening and parent notification programs: Findings from focus groups with parents of elementary school students. Health Education & Behavior.

School-based body mass index (BMI) screening and parent notification programs have been advanced as an obesity prevention strategy. However, little is known about how to develop and implement programs. This qualitative study explored the opinions and beliefs of parents of elementary school students concerning school-based BMI screening programs, notification methods, message content, and health information needs related to promoting healthy weight for school-aged children. Ten focus groups were conducted with 71 participants. Parents were generally supportive of school-based BMI screening. However, they wanted assurance that student privacy and respect would be maintained during measurement and that BMI results would be provided to parents in a neutral manner that avoided weight labeling. They also believed that aggregate results should be disseminated to the larger school community to support healthy change in the nutrition and physical activity environments of schools. Implications for practitioners and researchers are discussed.

M. Y. Kubik, M. Story and C. Davey. (2007). Obesity prevention in schools: current role and future practice of school nurses. Preventive Medicine.

OBJECTIVE: To determine responsibilities of school nurses in delivering obesity prevention services, assess opinions and beliefs about school-based obesity prevention and determine factors associated with school nurses supporting and providing obesity prevention services. METHOD: In fall 2005, a self-administered survey was mailed to 275 school nurses in Minnesota; 221 were returned (response rate=80%). RESULTS: Most (76%) school nurses supported the use of school health services (SHS) for obesity prevention. The likelihood of nurses supporting SHS for obesity prevention (p=0.009), as well as performing more child- (p=0.016) and school-level (p = < 0.001) obesity prevention tasks increased as perceived support for school-based obesity prevention from health care providers and school administrators, teachers and foodservice staff increased. Nurses supportive of school-based height, weight and BMI screening and parent notification were twice as likely to perform child-level obesity prevention tasks (p=0.021) and more than three times as likely to support using SHS for obesity prevention (p=0.005). CONCLUSION: Our study suggests considerable support among school nurses for school-based obesity prevention efforts and a growing interest in providing primary and secondary preventive care services in the school setting. Study findings also speak to the need for preparation, time and support from the school and health provider community.

T. Lang and G. Rayner. (2007). Overcoming policy cacophony on obesity: an ecological public health framework for policymakers. Obesity Reviews.

W. P. Lee, J. Lingard and M. Bermingham. (2007). Change in diet and body mass index in Taiwanese women with length of residence in Australia. Asia Pacific Journal of Clinical Nutrition.

The purpose of this cross-sectional study was to examine and compare anthropometric measurements and dietary intake of Taiwanese Chinese females living in Taiwan and Australia, including any effect of length of Australian residence. Height, weight, waist and hip circumference and percent total body fat were measured and dietary intake estimated using a 7-day record. Participants were Taiwanese females without systemic disease (100 from Sydney metropolitan area, Australia, 97 from Ping-Tung County, Taiwan). Subjects in Australia had similar body mass index (weight-kg/height-m(2)) and percent total body fat but higher waist and hip circumference than those in Taiwan (22.9+/-3.0 vs. 22.8+/-3.1 kg/m(2), p >0.05; 31.4+/-5.8 vs. 31.0+/-6.2 %, p >0.05; 76.2+/-7.5 vs. 72.1+/-7.3 cm, p =0.0001; 97.3+/-6.2 vs. 93.3+/-6.2 cm, p =0.0001, respectively), significance unaffected by age adjustment. Total energy intake was higher in Australia (2367+/-574 vs. 1878+/-575 Kcal) as was the caloric adjusted intake of carbohydrate and saturated fat, measured as grams (342.8+/-91.5 vs. 264.9+/-91.0 g; 30.7+/-9.1 vs. 23.0+/-9.1 g) or as percentage of caloric adjusted intake (57.3+/-1.4 vs. 55.6+/-2.3 %; 12.1+/-0.7 vs. 11.2+/-1.1 %), all p<0.001, respectively. There was a trend for anthropometric measures to increase in subjects who had lived in Australia greater than 5 years, and they also have 14 times the odds of having a waist circumference greater than 80 cm compared to those living in Australia less than 5 years (95% CI, 1.84, 112.0). The increase in waist circumference and higher energy and saturated fat intake associated with length of residence in Australia for Taiwanese females suggests an increased risk of cardiovascular disease and diabetes.

R. E. Lee, A. Greiner, S. Hall, W. Born, K. S. Kimminau, A. Allison and J. S. Ahluwalia. (2007). Ecologic correlates of obesity in rural obese adults. Journal Of The American College Of Nutrition.

Objective: We examined relationships of individual and environmental factors with obesity and trying to lose weight in rural residents. Methods: The joint contributions of individual and environmental factors on obesity status (obese vs. morbidly obese) and trying to lose weight (yes vs. no) were evaluated using generalized estimating equations. Patients at 29 clinics in rural areas (N = 414, M age 55.0 years (SD = 15.4), 66.3% female) completed anthropometric assessments of weight and height along with survey assessments of individual sociodemographics and trying to lose weight. Rural environments were assessed on aggregated physician access, and sociodemographic context. Results: Most participants (70%, M BMI = 38.3) were obese and 30% morbidly obese. A majority (73%, n = 302) of the sample was trying to lose weight. Compared to obese, morbidly obese participants were more likely to be younger, disproportionately female, not have private insurance, have more comorbid conditions, and rate themselves in worse health in comparison to their obese peers. Compared to not trying to lose weight, trying to lose weight participants were more likely to be younger, disproportionately female, have fewer comorbid conditions, and have attempted to lose weight more times through exercise. Few relationships were seen between environmental variables and obesity or trying to lose weight. Conclusions: There was no consistent pattern of relationships between environment factors and obesity or trying to lose weight was seen. Unique aspects of rural living may not be captured by traditionally available neighborhood measures.

K. K. Lewis and L. H. Man. (2007). Overweight and obesity in Massachusetts: epidemic, hype or policy opportunity? Issue Brief (Mass Health Policy Forum).

In 2005, more than 56 percent of Massachusetts adults were overweight, a 40 percent increase from rates reported in 1990. Overall, nearly 21 percent of Massachusetts adults are obese. Both Blacks and Hispanics in the state are more likely than whites to be both overweight and obese, whereas Asians are the least likely to be overweight or obese. Nationally, rates of overweight and obesity are even higher. Obesity is a risk factor for multiple serious health problems in adults, including heart disease, hardening of the arteries, high cholesterol, high blood pressure, certain types of cancer, stroke, diabetes, muscle and bone disorders and gallbladder disease. In Massachusetts, it is estimated that direct costs for obesity-related medical expenditures came to a total of $1.8 billion (4.7% of total medical expenditures) in 2003. Medical expenditures for obese people are estimated to be 25-27% higher than normal weight people, and 44% higher among people who are very obese. Costs are largely attributed to higher rates of coronary heart disease, hypertension and diabetes, and longer hospital stays. Indirect costs associated with obesity approached $3.9 billion in 1995 reflecting 39.2 million lost workdays, 239 million restricted activity days, 89.5 million hospital bed-days, and 62.6 million physician visits. Causes of obesity include the wide availability of unhealthy foods, increased consumption, changing eating habits, high-calorie beverages, advertising and lack of physical activity. Although a number federal, state and local programs, policies and initiatives aimed at curbing the obesity epidemic have been implemented, more needs to be done. What is the responsibility of government in curbing the obesity epidemic, and how much of the burden should be left up to the individual? These important questions will be discussed at the Massachusetts Health Policy Forum on January 23, 2007. Overweight and obesity continue to climb steadily in the United States among both adults and children, increasing the risk for a host of physical, psychosocial and economic problems. This paper details the issues associated with being overweight or obese, with a focus on Massachusetts. The discussion begins with a general description and definition of this public health epidemic. Next, an examination of factors that contribute to overweight and obesity and associated costs to individuals, families and society is given, followed by a discussion of programs and policy options, both nationally and in the Commonwealth that are aimed at addressing this crisis.

G. Lin, S. Spann, D. Hyman and V. Pavlik. (2007). Climate amenity and BMI. Obesity (Silver Spring).

OBJECTIVES: Our goal was to examine the relationship between BMI and climate amenable for physical activity at the county level in the U.S. RESEARCH METHODS AND PROCEDURES: Using Geographic Information Systems tools and 6-year National Oceanic and Atmospheric Administration station hourly weather records, an index of amenable climate was derived for all U.S. counties. This index was linked to individual BMI in a multi-level analysis that accounted for other individual characteristics from the 2002 survey of the Behavioral Risk Factor Surveillance System. RESULTS: There was an inverse relationship between climate amenable to physical activity and BMI at the county level after controlling for individual risk factors, county road density, and median household income and unemployment rate. Residents in high climate-amenity counties tended to have a lower BMI. DISCUSSION: The contribution of less amenable climate to overweight and obesity in the U.S. is likely to be substantial because it cuts across wide geographic areas. Health promotion strategies that promote mixed land use or other urban design conducive to walking and other physical activities should consider broader environmental disamenities to mitigate their influence. Strategies for outdoor physical activity should also be tailored for people of different racial groups and educational backgrounds due to observed differences in their response to climate amenity.

G. C. Liu, J. S. Wilson, R. Qi and J. Ying. (2007). Green neighborhoods, food retail and childhood overweight: differences by population density. American Journal of Health Promotion.

PURPOSE: This study examines relationships between overweight in children and two environmentalfactors--amount of vegetation surrounding a child's place of residence and proximity of the child's residence to various types of food retail locations. We hypothesize that living in greener neighborhoods, farther from fast food restaurants, and closer to supermarkets would be associated with lower risk of overweight. DESIGN: Cross-sectional study. SETTING: Network of primary care pediatric clinics in Marion County, Indiana. SUBJECTS: We acquired data for 7334 subjects, ages 3 to 18 years, presenting for routine well-child care. MEASURES: Neighborhood vegetation and proximity to food retail were calculated using geographic information systems for each subject using circular and network buffers. Child weight status was defined using body mass index percentiles. Analysis. We used cumulative logit models to examine associations between an index of overweight, neighborhood vegetation, and food retail environment. RESULTS: After controlling for individual socio-demographics and neighborhood socioeconomic status, measures of vegetation and food retail significantly predicted overweight in children. Increased neighborhood vegetation was associated with decreased risk for overweight, but only for subjects residing in higher population density regions. Increased distance between a subject's residence and the nearest large brand name supermarkets was associated with increased risk of overweight, but only for subjects residing in lower population density regions. CONCLUSIONS: This research suggests that aspects of the built environment are determinants of child weight status, ostensibly by influencing physical activity and dietary behaviors.

F. Lobo. (2007). Public policies for the promotion of healthy feeding and the prevention of obesity. Revista Espanola De Salud Publica.
R. P. Lopez. (2007). Neighborhood risk factors for obesity. Obesity.

Objective: The goal of this study was to explore neighborhood environmental factors associated with obesity in a sample of adults living in a major U.S. metropolitan area. Research Methods and Procedures: This was a multi-level study combining data from the U.S. Behavioral Risk Factor Surveillance System with data from the U.S. Census. A total of 15,358 subjects living in 327 zip code tabulation areas were surveyed between 1998 and 2002. The outcome was obesity (BMI > 30), and independent variables assessed included individual level variables (age, education, income, smoking status. sex, black race, and Hispanic ethnicity), and zip code level variables (percentage black, percentage Hispanic, percentage with more than a high school education, retail density, establishment density, employment density, population density, the presence of a supermarket, intersection density, median household income, and density of fast food outlets). Results: After controlling for individual level factors, median household income [relative risk (RR) = 0.992; 95% confidence interval (CI) = 0.990, 0.994], population density (RR 0.98: 95% CI = 0.972, 0.990), employment density (RR 1.004: 95% C1 = 1.001, 1.009), establishment density (RR = 0.981 95% CI 0.964, 0.999), and the presence of a supermarket (RR 0.893; 95% CI = 0.815, 0.978) were associated with obesity risk. Fast food establishment density was poorly associated with obesity risk. Discussion: Where one lives may affect obesity status. Given the influence of the presence of a supermarket on obesity risk, efforts to address food access might be a priority for reducing obesity.

M. N. Lutfiyya, M. S. Lipsky, J. Wisdom-Behounek and M. Inpanbutr-Martinkus. (2007). Is rural residency a risk factor for overweight and obesity for US children? Obesity.

Objective: Despite studies suggesting that there is a higher prevalence of overweight or obese children in rural areas in the U.S., there are no national studies comparing the prevalence levels of overweight or obese rural to metropolitan children. The objective of this research was to examine the hypothesis that living in a rural area is a risk factor for children being overweight or obese. Research Methods and Procedures: Using the National Survey of Children's Heath, the prevalence of overweight and/or obese rural children was compared with that of children in metropolitan settings. Multivariate analyses were performed on the data to detect if differences varied by health services use factors or demographic factors, such as household income, gender, and race. Results: Multivariate analysis revealed that overweight or obese children >= 5 years of age were more likely to live in rural rather than metropolitan areas (odds ratio = 1.252; 95% confidence interval, 1.248, 1.256). Rural overweight U.S. children >= 5 years of age of age were more likely than their metropolitan counterparts to: be white, live in households <= 200% of the federal poverty level, have no health insurance, have not received preventive health care in the past 12 months, be female, use a computer for non-school work >3 hours a day, and watch television for >3 hours a day. In addition, they were more likely to have comorbidities. Discussion: Living in rural areas is a risk factor for children being overweight or obese.

Y. Manios, V. Costarelli, M. Kolotourou, K. Kondakis, C. Tzavara and G. Moschonis. (2007). Prevalence of obesity in preschool Greek children, in relation to parental characteristics and region of residence. Bmc Public Health.

Background: The aim of this retrospective cohort study was to record the prevalence of overweight and obesity in relation to parental education level, parental body mass index and region of residence, in preschool children in Greece. Methods: A total of 2374 children (1218 males and 1156 females) aged 1-5 years, stratified by parental educational level (Census 1999), were examined from 105 nurseries in five counties, from April 2003 to July 2004, Weight (kg) and height (cm) were obtained and BMI (kg/m(2)) was calculated. Both the US Centers for Disease Control (CDC) and the International Obesity Task Force (IOTF) methods were used to classify each child as "normal", "at risk of overweight" and "overweight". Parental demographic characteristics, such as age and educational level and parental anthropometrical data, such as stature and body weight, were also recorded with the use of a specifically designed questionnaire. Results: The overall estimates of at risk of overweight and overweight using the CDC method was 31.9%, 10.6 percentage points higher than the IOTF estimate of 21.3% and this difference was significant (p < 0.001). Children with one obese parent had 91% greater odds for being overweight compared to those with no obese parent, while the likelihood for being overweight was 2.38 times greater for children with two obese parents in the multivariate model. Conclusion: Both methods used to assess prevalence of obesity have demonstarted that a high percentage of the preschool children in our sample were overweight. Parental body mass index was also shown to be an obesity risk factor in very young children.

C. G. Mascie-Taylor and R. Goto. (2007). Human variation and body mass index: a review of the universality of BMI cut-offs, gender and urban-rural differences, and secular changes. Journal of physiological anthropology.

Use of BMI as a surrogate for body fat percentage is debatable and universal BMI cut-off points do not seem appropriate; lower cut-off points than currently recommended by WHO should be used in some populations, especially in Asia. The adult WHO BMI database indicates that, on average, women are more obese than men, while men are more likely to be pre-obese than women. Urban rates of overweight and obesity are generally higher than rural rates in both sexes. The trend in pre-obesity and obesity over time is generally upward, with very marked increases in the USA and UK in both sexes over the last 10 years.

F. I. Matheson, R. Moineddin and R. H. Glazier. (2008). The weight of place: A multilevel analysis of gender, neighborhood material deprivation, and body mass index among Canadian adults. Social Science & Medicine.

This study examined the impact of neighborhood material deprivation on gender differences in body mass index (BMI) for urban Canadians. Data from a national health survey of adults (Canadian Community Health Survey Cycles 1.1/2.1) were combined with census tract-level neighborhood data from the 2001 census. Using multilevel analysis we found that living in neighborhoods with higher material deprivation was associated with higher BMI. Compared to women living in the most affluent neighborhoods, women living in the most deprived neighborhoods had a BMI score 1.8 points higher. For women 1.65m in height (5'4'' inches), this translated into a 4.8kg or 11lb difference. For men, living in affluent neighborhoods was associated with higher BMI (7lb) relative to men living in deprived neighborhoods. The relative disadvantage for men living in pockets of affluence and women living in pockets of poverty persisted after adjusting for age, married and visible minority status, educational level, self-perceived stress, sense of belonging, and lifestyle factors, including smoking, exercise, diet, and chronic health conditions. The implication of theSEisparate findings for men and women is that interventions that lead to healthy weight control may need to be gender responsive. Our findings also suggest that what we traditionally have thought to be triggering factors for weight gain and maintenance of unhealthy BMI-lifestyle and behavioral factors-are not sufficient explanations. Indeed, these factors account for only a portion of the explanation of why neighborhood stress is associated with BMI. Cultural attitudes about the body that pressure women to meet the thin ideal which can lead to an unhealthy cycle of dieting and, subsequent weight gain, and the general acceptability of the heavier male need to be challenged. Education and intervention within a public health framework remain important targets for producing healthy weight.

A. E. Matthews. (2008). 'Children and obesity: a pan-European project examining the role of food marketing'. European Journal of Public Health.

BACKGROUND: Rising levels of obesity in school-age children across Europe are causing increasing concern. The 'Children, Obesity and associated avoidable Chronic Diseases' project sought to examine the effects of promotion within food marketing, given the influential role it plays in children's diets. METHOD: A questionnaire and data-collection protocol was designed for the national co-ordinators, facilitating standardized responses. Co-ordinators collected data from within 20 European Union countries relating to food promotion to children. RESULTS: Results showed that unhealthy foods such as savoury snacks and confectionary were the most commonly marketed and consumed by children across all countries. Television was found to be the prime promotional medium, with in-school and internet marketing seen as growth areas. Media literacy programmes designed specifically to counterbalance the effects of food marketing to children were reported by only a few of the 20 countries. An ineffective and incoherent pattern of regulation was observed across the countries as few governments imposed tough restrictions with most preferring to persuade industry to voluntarily act with responsibly. Most health, consumer and public interest groups supported food marketing restrictions whilst industry and media groups advocated self-regulation. CONCLUSION: Recommendations include the amendment of the European Union's Television Without Frontiers Directive to ban all TV advertising of unhealthy food to children, the adoption of a commonly agreed European Union definition of an 'unhealthy' food, and the establishment of a mechanism for pan-European monitoring of the nature and extent of food marketing to children and its regulation.

R. Miles, L. B. Panton, M. Jang and E. M. Haymes. (2008). Residential context, walking and obesity: Two African-American neighborhoods compared. Health & Place.

We compare walking and obesity rates in two African-American neighborhoods that are similar in urban form but different in level of neighborhood disadvantage. We find higher rates of utilitarian walking in the neighborhood with higher density and disadvantage and more destinations within walking distance. However levels of leisure walking and physical activity were not higher, and rates of obesity were not lower in the non-poor neighborhood with better maintenance, more sidewalks and recreational facilities. Different types of barriers to physical activity reported in the two neighborhoods and the high rates of overweight and obesity in both may explain the findings.

E. Millstone and T. Lobstein. (2007). Policy options for tackling obesity: what do stakeholders want? Obesity Reviews.

L. Mohebati, T. Lobstein, E. Millstone and M. Jacobs. (2007). Policy options for responding to the growing challenge from obesity in the United Kingdom. Obesity Reviews.

The aim of this study was to map and analyse how key stakeholders evaluated options for dealing with the rising incidence of obesity in the UK, as part of a wider cross-national study in nine European countries. Multi-criteria mapping was used to capture the ways in which different policy options were evaluated by a variety of key stakeholders. 'Positive societal benefits' was among the criteria most often selected by participants to assess the options and was generally considered more important than costs. Of the seven pre-defined options that all participants appraised, those related to increasing opportunities for physical activity received the highest rankings, and fiscal measures the lowest. Educational measures fared best among the remaining 13 discretionary options while technological measures performed poorly. No one option, or group of options, was considered sufficient to address the obesity problem. Rather, a general consensus was evident in support of mutually reinforcing measures related to education, information, healthier food and physical activity. Although obesity policies are currently emerging in theSEifferent areas in the UK, there is a need for them to be better coordinated, and for improved surveillance to estimate their effectiveness in reversing the trend in obesity.

G. Moon, G. Quarendon, S. Barnard, L. Twigg and B. Blyth. (2007). Fat nation: deciphering the distinctive geographies of obesity in England. Social Science & Medicine.

Much attention is focused on obesity by both the media and by public health. As a health risk, obesity is recognised as a contributing factor to numerous health problems. Recent evidence points to a growth in levels of obesity in many countries and particular attention is usually given to rising levels of obesity among younger people. England is no exception to these generalisations with recent studies revealing a clear geography to what has been termed an 'obesity epidemic.' This paper examines the complexities inherent in the geography of adult obesity in England. Existing knowledge about the sub-national geography of obesity is examined and assessed. Multilevel synthetic estimation is then used to construct an age-sex-ethnicity disaggregated geography of obesity. TheSEiffering geographies are compared and contrasted with pre-existing findings and explored at multiple scales. A complex picture of the geography of obesity in England is revealed.

L. Murkowski. (2007). Preventing obesity in children - The time is right for policy action. American Journal Of Preventive Medicine.

B. Newell, K. Proust, R. Dyball and P. McManus. (2007). Seeing obesity as a systems problem. N S W Public Health Bull.

Obesity has reached epidemic proportions in many countries and persists despite continuing efforts to find solutions. Such 'stubborn problems' often signal the influence of 'feedback systems'. In the case of the obesity epidemic, this possibility can be investigated using available system analysis tools. The investigation must begin with a study of the interplay between the full range of human and environmental factors. This paper outlines the nature of feedback and briefly discusses some of its management implications. A practical way to initiate a 'systems approach' to the obesity problem is suggested and four principles to guide the management of complex human- environment systems are presented.

N. L. Nollen, C. A. Befort, P. Snow, C. M. Daley, E. F. Ellerbeck and J. S. Ahluwalia. (2007). The school food environment and adolescent obesity: qualitative insights from high school principals and food service personnel. International Journal of Behavioral Nutrition and Physical Activity.

OBJECTIVES: To examine high school personnel's perceptions of the school environment, its impact on obesity, and the potential impact of legislation regulating schools' food/beverage offerings. METHODS: Semi-structured interviews were conducted with the principal (n = 8) and dietitian/food service manager (n = 7) at 8 schools (4 rural, 4 suburban) participating in a larger study examining the relationship between the school environment and adolescent health behavior patterns. RESULTS: Principal themes included: 1) Obesity is a problem in general, but not at their school, 2) Schools have been unfairly targeted above more salient factors (e.g., community and home environment), 3) Attempts at change should start before high school, 4) Student health is one priority area among multiple competing demands; academic achievement is the top priority, 5) Legislation should be informed by educators and better incorporate the school's perspective. Food service themes included: 1) Obesity is not a problem at their school; school food service is not the cause, 2) Food offerings are based largely on the importance of preparing students for the real world by providing choice and the need to maintain high participation rates; both healthy and unhealthy options are available, 3) A la carte keeps lunch participation high and prices low but should be used as a supplement, not a replacement, to the main meal, 4) Vending provides school's additional revenue; vending is not part of food service and is appropriate if it does not interfere with the lunch program. CONCLUSION: Discrepancies exist between government/public health officials and school personnel that may inhibit collaborative efforts to address obesity through modifications to the school environment. Future policy initiatives may be enhanced by seeking the input of school personnel, providing recommendations firmly grounded in evidence-based practice, framing initiatives in terms of their potential impact on the issues of most concern to schools (e.g., academic achievement, finances/revenue), and minimizing barriers by providing schools adequate resources to carry out and evaluate the effectiveness of their efforts.

C. Oberlinner, S. Lang, C. Germann, B. Trauth, F. Eberle, R. Pluto, S. Neumann and A. Zober. (2007). Prevention of overweight and obesity in the workplace. Gesundheitswesen.

Background: The rise in the prevalence of overweight and obesity and their associated diseases is leading to substantial health and socioeconomic problems in industrialized countries. The Commission of the European Community indicates that workplaces are a setting that has a strong potential for health promotion and disease prevention. Against this background the department of occupational medicine and health protection of the BASF Aktiengesellschaft initiated a health promotion campaign "Trim down the pounds - Losing weight without losing your mind" on the prevention of overweight and obesity at the workplace. Subjects and Methods: The target group included all overweight and obese employees among the 34,000 employees at the BASF site in Ludwigshafen. Overweight and obese employees should reduce weight (either in lowering their body mass index (BMI) by 2 points or by reducing their BMI to less than 25 kg/m(2)) over a period of nine months assisted by a health promotion programme and normal-weight colleagues (weight-loss helpers). All participants were monitored by occupational physicians, this was also to detect obesity-related diseases. A prize money of C 10,000 for successful participants and their weight-loss helpers was drawn by lot. Results: A total of 2,062 employees took part in the health promotion campaign (1,313 overweight and obese employees and 749 weight-loss helpers). 708 overweight participants attended the weight-control measurement after nine months, 658 people had succeeded in reducing their body weight, 440 of them had lowered their BMI by more than 2 points. 83% of those attending the weight-control measurement had a weight-loss helper. Medical benefits were shown by improvement of laboratory parameters and detection of obesity-related diseases. Conclusion: The health promotion campaign "Trim down the pounds" demonstrated that the workplace is a promising focal point for conducting prevention programmes based on the proximity of occupational medical services to the employee. Prevention of overweight and obesity in the workplace is possible by promoting healthy diets in workplace-canteens and physical activity programs like "walking in the lunch break". These programs are substantially strengthened by occupational medical activities in detecting obesity-related diseases. Health promotion at the workplace can be viewed as a benefit to employee and employer alike with employers benefiting from a reduction of lost productivity costs.

P. M. O'Malley, L. D. Johnston, J. Delva, J. G. Bachman and J. E. Schulenberg. (2007). Variation in obesity among American secondary school students by school and school characteristics. American Journal Of Preventive Medicine.

Background: Body mass index (BMI) is known to vary by individual characteristics, but little is known about whether BMI varies by school and by school characteristics. Methods: Nationally representative samples of United States schools and students are used to determine the extent to which BMI and percent of students at or above the 85th percentile of BMI vary by school and by school characteristics. Data from the 1991-2004 Monitoring the Future (MTF) study were analyzed in 2006 and 2007. Results: A relatively small proportion of variance in BMI lies between schools; intraclass correlations are on the order of 3%. Still, this is sufficient variation to provide very different environments for students attending schools that are low versus high in average BMI. There is some modest variation by school type (public, Catholic private, non-Catholic private); school size (number of students in the sampled grade); region of the country; and population density. There is more variation as a function of school socioeconomic status (SES) and racial/ethnic composition of the school. School SES in particular was negatively associated with BMI levels, even after controlling individual-level SES and racial/ethnic status. Conclusions: The residual differences in BMI by school suggest that some characteristic of the school and/or community environment-perhaps cultural factors or peer role modeling or differences in school food, beverage, or physical education policies-facilitate obesity in schools with a high concentration of lower socioeconomic students, beyond individual-level factors.

M. A. Papas, A. J. Alberg, R. Ewing, K. J. Helzlsouer, T. L. Gary and A. C. Klassen. (2007). The built environment and obesity. Epidemiologic Reviews.

Obesity results from a complex interaction between diet, physical activity, and the environment. The built environment encompasses a range of physical and social elements that make up the structure of a community and may influence obesity. This review summarizes existing empirical research relating the built environment to obesity. The Medline, PsychInfo, and Web of Science databases were searched using the keywords "obesity" or "overweight" and "neighborhood" or "built environment" or "environment." The search was restricted to English-language articles conducted in human populations between 1966 and 2007. To meet inclusion criteria, articles had to 1) have a direct measure of body weight and 2) have an objective measure of the built environment. A total of 1,506 abstracts were obtained, and 20 articles met the inclusion criteria. Most articles (84%) reported a statistically significant positive association between some aspect of the built environment and obesity. Several methodological issues were of concern, including the inconsistency of measurements of the built environment across studies, the cross-sectional design of most investigations, and the focus on aspects of either diet or physical activity but not both. Given the importance of the physical and social contexts of individual behavior and the limited success of individual-based interventions in long-term obesity prevention, more research on the impact of the built environment on obesity is needed.

R. Pendola and S. Gen. (2007). BMI, auto use, and the urban environment in San Francisco. Health & Place.

The epidemic of overweight and obesity has sparked interest in urban planning circles. Many believe the built environment directly influences physical health, and recent empirical evidence supports this notion. Cross-sectional survey data was collected from a sample of San Francisco residents (n = 670) in the summer of 2005. Body mass index (BMI) served as the dependent variable. Independent variables included population density and auto use. Results indicate an inverse relationship between density and auto use as well as higher BMI scores for respondents reporting high levels of auto use for the work/school commute and trips to the grocery store. (c) 2006 Elsevier Ltd. All rights reserved.

I. Peytremann-Bridevaux, D. Faeh and B. Santos-Eggimann. (2007). Prevalence of overweight and obesity in rural and urban settings of 10 European countries. Preventive Medicine.

Objectives. First to explore differences in prevalence of overweight and obesity between rural and urban areas of 10 European countries, then to determine whether body mass index varies with the countries' gross domestic product. Methods. We used baseline data (2004) from countries participating in the Study of Health, Ageing and Retirement in Europe, which included 16,695 non-institutionalized individuals aged 50-79 years with body mass index >= 18.5 kg/m(2). Height and weight were self-reported and body mass index categorized as normal weight (18.5-24.9 k g/m(2)), overweight (25.0-29.9 kg/m(2)) and obesity (>= 30 kg/m(2)). Weighted prevalences of overweight and obesity in rural and urban areas were estimated, and logistic regressions performed to investigate the association between rural residence and body mass index, adjusting for age, sex, household income and education. Spearman's correlation examined the relationship between body mass index and gross domestic product. Results. We found no differences in the prevalence of over-weight and obesity between rural and urban areas. Separate analysis by gender, age, education or income level did not reveal additional rural-urban variations. Body mass index was slightly higher when gross domestic product was lower. Conclusions. Programs aimed at preventing or managing overweight and obesity in the 50-79 years age range should be addressed to residents of both rural and urban areas, but tailored to their specific characteristics. (C) 2006 Elsevier Inc. All rights reserved.

A. J. Plantinga and S. Bernell. (2007). The association between urban sprawl and obesity: Is it a two-way street? Journal Of Regional Science.

We empirically examine the relationship between obesity and urban development patterns where individuals reside. Previous analyses treat urban form as exogenous to weight, and find higher body mass indices (BMI) among residents of areas with sprawl patterns of development. Using samples of recent movers, we find that the causality runs in both directions. Individuals who move to denser locations lose weight. As well, BMI is a determinant of the choice of a dense or sprawling location. In sum, while moving to a dense area results in weight loss, such locations are unlikely to be selected by individuals with high BMI.

A. J. Plantinga and S. Bernell. (2007). Can urban planning reduce obesity? The role of self-selection in explaining the link between weight and urban sprawl. Review Of Agricultural Economics.

L. M. Powell, M. C. Auld, F. J. Chaloupka, P. M. O'Malley and L. D. Johnston. (2007). Associations between access to food stores and adolescent body mass index. American Journal Of Preventive Medicine.

Background: Environmental factors such as the availability of local-area food stores may be important contributors to the increasing rate of obesity among U.S. adolescents. Methods: Repeated cross-sections of individual-level data on adolescents drawn from the Monitoring the Future surveys linked by geocode identifiers to data on food store availability were used to examine associations between adolescent weight and the availability of four types of grocery food stores that include chain supermarkets, nonchain supermarkets, convenience stores, and other grocery stores, holding constant a variety of other individual- and neighborhood-level influences. Results: Increased availability of chain supermarkets was statistically significantly associated with lower adolescent Body Mass Index (BMI) and overweight and that greater availability of convenience stores was statistically significantly associated with higher BMI and overweight. The association between supermarket availability and weight was larger for African-American students compared to white or Hispanic students and larger for students in households in which the mother worked full time. Conclusions: Economic and urban planning land use policies which increase the availability of chain supermarkets may have beneficial effects on youths' weight outcomes.

C. A. Pratt, S. C. Lemon, I. D. Fernandez, R. Goetzel, S. A. Beresford, S. A. French, V. J. Stevens, T. M. Vogt and L. S. Webber. (2007). Design characteristics of worksite environmental interventions for obesity prevention. Obesity.

Objective: This paper describes the design characteristics of the National Heart, Lung, and Blood Institute (NHLBI)-funded studies that are testing innovative environmental interventions for weight control and obesity prevention at worksites. Research Methods and Procedures: Seven separate studies that have a total of 114 worksites (similar to 48,000 employees) across studies are being conducted. The worksite settings include hotels, hospitals, manufacturing facilities, businesses, schools, and bus garages located across the U.S. Each study uses its own conceptual model drawn from the literature and includes the socio-ecological model for health promotion, the epidemiological triad, and those integrating organizational and social contexts. The interventions, which are offered to all employees, include environmental- and individual-level approaches to improve physical activity and promote healthful eating practices. Environmental strategies include reducing portion sizes, modifying cafeteria recipes to lower their fat contents, and increasing the accessibility of fitness equipment at the workplace. Across all seven studies about 48% (N = 23,000) of the population is randomly selected for measurements. The primary outcome measure is change in BMI or body weight after two years of intervention. Secondary measures include waist circumference, objective, and self-report measures of physical activity, dietary intake, changes in vending machines and cafeteria food offerings, work productivity, healthcare use, and return on investment. Discussion: The results of these studies could have important implications for the design and implementation of worksite overweight and obesity control programs.

B. A. Rabin, T. K. Boehmer and R. C. Brownson. (2007). Cross-national comparison of environmental and policy correlates of obesity in Europe. European Journal Of Public Health.

Background: Despite the growing agreement that modern environments fuel increased food consumption and decreased physical activity, few studies have addressed environmental and policy correlates of obesity. This study describes obesity patterns across Europe and identifies macroenvironmental factors associated with obesity prevalence at a national level. Methods: Data on obesity prevalence and indicators of the physical, economic, and policy environment were assembled from international databases for 24 European countries. Coefficient estimates between overall, male, and female obesity prevalence and each independent variable were calculated using linear regression. Results: The obesity prevalence varied widely across countries and between genders with higher values in Central and Eastern European countries and lower values in France, Italy, and some Scandinavian countries. Statistically significant inverse associations were observed between overall and female obesity prevalence and variables from the following domains: economic (real domestic product), food (available fat), urbanization (urban population), transport (passenger cars, price of gasoline, motorways), and policy (governance indicators). There was also a negative association between overall obesity and available fruits/vegetables, and between female obesity and single-member households. Male obesity was inversely associated with available fruits/vegetables and density of motorways. The magnitude of the coefficient estimates suggests stronger associations for female obesity than for male obesity in all cases. Conclusions: This exploratory study suggests a need to conduct additional research examining the role of obesogenic environments in European countries, with a special focus on policy-related variables, and to further study gender-specific differences in obesity and its correlates.

K. Reynolds, D. Gu, P. K. Whelton, X. Wu, X. Duan, J. Mo and J. He. (2007). Prevalence and risk factors of overweight and obesity in China. Obesity (Silver Spring).

OBJECTIVE: To examine the prevalence and risk factors of overweight and obesity in China. RESEARCH METHODS AND PROCEDURES: A cross-sectional survey was conducted in a nationally representative sample of 15,540 Chinese adults in 2000-2001. Body weight, height, and waist circumference were measured by trained observers. Overweight and obesity were defined according to the World Health Organization classification. Central obesity was defined according to guidelines of the International Diabetes Federation. RESULTS: Mean BMI and waist circumference were 23.1 kg/m2 and 79.6 cm, respectively, for men and 23.5 kg/m2 and 77.2 cm, respectively, for women. The prevalences of overweight and obesity were 24.1% and 2.8% in men and 26.1% and 5.0% in women, respectively. The prevalence of central obesity was 16.1% in men and 37.6% in women. The prevalences of overweight, obesity, and central obesity were higher among residents in northern China compared with their counterparts in southern China and among those in urban areas compared with those in rural areas. Lifestyle factors were the most important risk factors to explain the differences in overweight and central obesity between northern and southern residents. Among women, lifestyle and diet were the most important risk factors to explain the differences between urban and rural residents, whereas socioeconomic status, lifestyle, and diet were all important among men. DISCUSSION: Our study indicates that overweight and obesity have become important public health problems in China. Environmental risk factors may be the main reason for regional differences in the prevalence of overweight and obesity in China.

A. Rito and J. Breda. (2007). Childhood obesity prevention policies: from rhetoric to practice. A Portuguese case study. International Journal Of Obesity.

N. A. Ross, S. Tremblay, S. Khan, D. Crouse, M. Tremblay and J. M. Berthelot. (2007). Body mass index in urban Canada: neighborhood and metropolitan area effects. American Journal of Public Health.

OBJECTIVES: We investigated the influence of neighborhood and metropolitan area characteristics on body mass index (BMI) in urban Canada in 2001. METHODS: We conducted a multilevel analysis with data collected from a cross-sectional survey of men and women nested in neighborhoods and metropolitan areas in urban Canada during 2001. RESULTS: After we controlled for individual sociodemographic characteristics and behaviors, the average BMIs of residents of neighborhoods in which a large proportion of individuals had less than a high school education were higher than those BMIs of residents in neighborhoods with small proportions of such individuals (P<.01). Living in a neighborhood with a high proportion of recent immigrants was associated with lower BMI for men (P<.01), but not for women. Neighborhood dwelling density was not associated with BMI for either gender. Metropolitan sprawl was associated with higher BMI for men (P=.02), but the effect was not significant for women (P=.09). CONCLUSIONS: BMI is strongly patterned by an individual's social position in urban Canada. A neighborhood's social condition has an incremental influence on the average BMI of its residents. However, BMI is not influenced by dwelling density. Metropolitan sprawl is associated with higher BMI for Canadian men, which supports recent evidence of this same association among American men. Individuals and their environments collectively influence BMI in urban Canada.

A. Rundle, A. V. D. Roux, L. M. Freeman, D. Miller, K. M. Neckerman and C. C. Weiss. (2007). The urban built environment and obesity in New York City: A multilevel analysis. American Journal Of Health Promotion.

Purpose. To examine whether urban form is associated with body size within a densely-settled city. Design. Cross-sectional analysis using multilevel modeling to relate body mass index (BMI) to built environment resources. Setting. Census tracts (n = 1989) within the five boroughs of New York City. Subjects. Adult volunteers (n = 13,102) from the five boroughs of New York City recruited between January 2000 and December 2002. Measures. The dependent variable was objectively-measured BMI. Independent variables included land use mix; bus and subway stop density; population density; and intersection density. Covariates included age, gender, race, education, and census tract-level poverty and race/ethnicity. Analysis. Cross-sectional multilevel analyses. Results. Mixed land use (Beta = -. 55, p <. 01), density of bus stops (Beta = 01, p < 01) and subway stops (Beta = -. 06, p <. 01), and population density (Beta = 25, p < 001), but not intersection density (Beta = -. 002) were significantly inversely associated with BMI after adjustment for individual- and neighborhood-level sociodemographic characteristics. Comparing the 90th to the 10th percentile of each built environment variable, the predicted adjusted difference in BMI with increased mixed land use was -.41 units, with bus stop density was -.33 units, with subway stop density was -.34 units, and with population density was -.86 units. Conclusion. BMI is associated with built environment characteristics in New York City.

C. F. Runge. (2007). Economic consequences of the obese. Diabetes.

The private and social costs of obesity have many causes, and their consequences can be grimly predicted with only rough accuracy. Among the most devastating is the increased incidence of diabetes, of which 60% can be directly attributed to weight gain. There are now about one billion people worldwide who are overweight or obese, compared with 850 million who are chronically underweight. It is estimated that the number of people worldwide with diabetes will increase from 175 million in 2000 to 353 million in 2030, with India and China together accounting for 24% of the total in 2050. Obesity and its economic costs are borne on three levels. At an individual level, obesity imposes costs by limiting personal opportunity in many ways, only some of which can be quantified. In the workplace (assuming the obese are employed, which they may not be, due in part to their condition), costs are borne by employers due to lost productivity, absences, underperformance, and higher insurance premia, which in the aggregate are quite large. Finally, obesity affects expenditures by local, state, and national governments, where programs compensate for or cover some of the private and workforce costs of illness and unemployment.

S. C. Savva, M. Chadjioannou and M. J. Tornaritis. (2007). Policy options for responding to the growing challenge from obesity: Cyprus national findings. Obesity Reviews.

A multifaceted public health policy approach is required for reversing the current obesity epidemic. The Policy Options for Responding to the Growing Challenge of Obesity Research Project aimed to explore the consistency and/or variability of the perspectives of key stakeholders towards a range of different options to respond to the growing challenge of obesity among nine participating European member states. The multi-criteria mapping technique was used. Cyprus national data, when analysed in the public health and public policy context of Cyprus, collectively indicate that no single policy option appears to be unique in combating obesity, but rather need to be combined with other policy options. Specifically, measures are needed to improve levels of knowledge and understanding regarding food, diet, health and fitness beginning from early childhood with health professionals having an important role in this regard. These measures should be coupled with informational initiatives emphasizing the improvement of nutritional information labelling system, and the control of food and drink advertising. There was also a consensus regarding the need for modifying the supply of and demand for foodstuffs, but not via economic instruments. Practical feasibility, social acceptability, efficacy and social benefits but not the economic costs of the options were deemed the most important criteria for a successful implementation.

K. Seiders and R. D. Petty. (2007). Taming the obesity beast: Children, marketing, and public policy considerations. Journal Of Public Policy & Marketing.

This essay explores the policy implications of the findings in this special section for potential remedies and opportunities for further research in the critical area of obesity. Children are an important focus here both because of the dramatic increase in childhood obesity in recent decades and because they lack the cognitive development and social experience to process marketing communications with the sophistication of adults. In addition, children's food purchaSEecisions are substantially influenced by their parents. Although packaged food marketers are setting their own voluntary restrictions on products to be marketed during entertainment content targeted at children, the impact of such restrictions is limited because children are substantial viewers of general entertainment content. This essay suggests that more prominent nutrition disclosure oriented toward obesity concerns for both packaged foods and fast-food restaurants should be more fully considered. It further suggests that increased marketing research is needed to better understand children as consumers, the role of parents as gatekeepers, and the differences between ethnic population segments. Marketing research also can contribute to the assessment of the effectiveness of different regulatory approaches adopted by various countries and the viability of mass educational approaches versus individual encouragement by parents, doctors, and others. The authors note that because obesity is a long-term health problem, a longitudinal tracking study would be useful in studying both health effects over time and the effectiveness of various policy interventions.

J. P. Sekhobo and B. Berney. (2007). Community occupational structure and neighborhood obesity in New York city. American Journal Of Epidemiology.

J. Smith. (2007). The contribution of infant food marketing to the obesogenic environment in Australia. Breastfeeding review.

Obesity has been growing rapidly among both children and adult Australians in recent decades, raising concern at the associated chronic disease burden, and generating debate over the extent of individual versus government responsibility. This paper briefly reviews recent scientific evidence on links between poor early life nutrition and obesity in later life, which suggests that artificial baby milk rather than breastfeeding in infancy is associated with a 30-50% higher likelihood of later life obesity. It then presents data on long-term trends in breastfeeding in Australia and on consumption of infant milk products since 1939. Evidence is also presented of increased marketing and promotion of breastmilk substitutes from the mid 1950s, including through the healthcare system, associated with the emergence of increased competition in the Australian infant food industry. This collaborative marketing effort by industry and health professionals in turn contributed importantly to the sharp decline in breastfeeding from the mid 1950s. As a consequence, most Australians born since 1955 were exposed to artificial baby milk in early infancy. A substantial proportion of Australian infants are still partially fed with artificial baby milk in the first 12 months of life. The example of infant food highlights that the healthcare system and the food industry, and not just individual mothers' choices, have contributed to poor infant nutrition and obesity trends in Australia. Redressing healthcare system and industry practices to restore a supportive environment for breastfeeding is thus argued to be a necessary element of the public health response to the current obesity problem.

M. Stafford, S. Cummins, A. Ellaway, A. Sacker, R. D. Wiggins and S. Macintyre. (2007). Pathways to obesity: identifying local, modifiable determinants of physical activity and diet. Social Science & Medicine.

Many studies document small area inequalities in morbidity and mortality and show associations between area deprivation and health. However, few studies unpack the "black box" of area deprivation to show which specific local social and physical environmental characteristics impact upon health, and might be amenable to modification. We theorised a model of the potential causal pathways to obesity and employed path analysis using a rich data set from national studies in England and Scotland to test the model empirically. Significant associations between obesity and neighbourhood disorder and access to local high street facilities (local shops, financial services and health-related stores found in a typical small UK town) were found. There was a tendency for lower levels of obesity in areas with more swimming pools and supermarkets. In turn, policing levels, physical dereliction and recorded violent crime were associated with neighbourhood disorder. The analysis identifies several factors that are associated with (and are probably determinants of) obesity and which are outside the standard remit of the healthcare sector. They highlight the role that public and private sector organisations have in promoting the nation's health. Public health professionals should seek to work alongside or within these organisations to capitalise on opportunities to improve health.

S. D. Sugarman and N. Sandman. (2007). Fighting childhood obesity through performance-based regulation of the food industry. Duke Law Journal.

That childhood obesity is an alarming public health problem is clear and widely appreciated. What is altogether unclear is what our society should do about it. Some people think the solution lies in using tort law to sue McDonald's, Coca-Cola, and other corporations. We reject that notion. Others believe that government should order specific changes in the behavior of food companies and school officials--and yet, there is little reason for confidence that these "command and control" strategies will make a difference. Instead, we propose "performance-based regulation" of the food industry. This is analogous to the approach our country is now taking with respect to elementary and secondary education (most prominently in the No Child Left Behind legislation). Schools are not told how to achieve better educational results, but better outcomes are demanded of them. This strategy has also been used in the environmental context to reduce harmful power plant emissions, and it has been briefly proposed as a way of regulating cigarette companies. In this Article, we propose that large firms selling food and drink that is high in sugar or fat will be assigned the responsibility of reducing obesity rates in a specific pool of children. A firm's share of the overall responsibility will be based on its share of the "bad' food market, and the children assigned to it will be organized by geographically proximate schools where obesity rates are currently above the plan's nationwide target rate of 8 percent (the actual childhood obesity rate today is approximately 16 percent). Firms that fail to achieve their goals will be subject to serious financial penalties.

E. Svensson, D. L. Reas, I. Sandanger and J. F. Nygard. (2007). Urban-rural differences in BMI, overweight and obesity in Norway (1990 and 2001). Scandinavian Journal Of Public Health.

Aim: The aim of this study was to examine body mass index and the prevalence of overweight and obesity in 1990 and 2001 in Oslo and Lofoten, Norway. Methods: A randomly selected study population of 1,924 individuals (OsLof) underwent a structured personal interview in 1990. In 2001, 1,629 individuals underwent the same interview. These samples were analysed as two cross-sectional datasets. Results: Overall mean BMI in 1990 was 24.7 for men and 22.9 for women, increasing significantly in 2001 to 26.1 and 24.6, respectively. In 1990, 37% of men and 20% of women were overweight, while 5% of men and 4% of women were obese. The corresponding figures for 2001 were 48% and 27% for overweight, and 12% and 11% for obesity, respectively. Discussion: The greatest increases in average BMI occurred for the youngest (18-34 years) for both genders and geographic regions. In 1990, urban-rural differences existed for mean BMI and proportion overweight for both genders, although geographic differences persisted only for women 10 years later.

L. Szponar, J. Ciok, A. Dolna and M. Oltarzewski. (2007). Policy options for responding to the growing challenge from obesity (PorGrow) in Poland. Obesity Reviews.

To explore the perspectives of stakeholders towards a range of policy options to respond to obesity in Poland, a multi-criteria mapping method was used. During structured interviews, stakeholders were invited to appraise policy options by reference to criteria of their own choosing. They also provided relative weightings to their criteria, generating overall rankings of the policy options in relation to each other. Efficacy, feasibility and societal benefits were the groups of criteria deemed most important. There was most consensus in favour of options related to health education, particularly in schools, compared with options that aimed at modifying the environment to prevent obesity, i.e. options around physical activity, modifying the supply and demand for food products, and information-related options. There was little support for technological solutions or institutional reforms. There was broad consensus that to reverse the rising trend in the incidence of obesity, it will be necessary to implement a portfolio of measures, but options related to behaviour change through education are most highly regarded. It will also be necessary to invest in improved surveillance and monitoring of Polish dietary practices, levels of physical activity and obesity in terms of data on height, weight and body mass indexes.

C. Tudor-Locke, J. J. Kronenfeld, S. S. Kim, M. Benin and M. Kuby. (2007). A geographical comparison of prevalence of overweight school-aged children: the National Survey of Children's Health 2003. Pediatrics.

OBJECTIVES: This study presents a geographical comparison of state-specific prevalence estimates of children who are at risk of overweight and/or overweight using the 2003 National Survey of Children's Health. METHODS: Using the 2003 National Survey of Children's Health, we computed prevalence estimates of children who are at risk of overweight and/or overweight among a nationally representative sample of 69,000 children between 5 and 17 years old. RESULTS: Overall, 36.4% of the children (39.8% of the boys and 32% of the girls) in the sample were in the combined category of at risk of overweight or overweight, representing an estimated 17 million US children. We found geographic variation at the state and the regional levels. The southeastern states, especially those west of the Appalachians and in the lower Mississippi region, had the highest prevalence of children who are at risk of overweight and/or overweight. The central Rocky Mountain states of Colorado, Utah, and Wyoming had the lowest prevalence, followed by the northwestern quadrant of the lower 48 states and New England. CONCLUSIONS: These National Survey of Children's Health data provide clinicians and public health professionals with useful data required for policy and planning related to childhood obesity at state levels. TheSEata also serve as important baseline indicators and can be used to track changes over time.

S. J. Ulijaszek. (2007). Frameworks of population obesity and the use of cultural consensus modeling in the study of environments contributing to obesity. Economics & Human Biology.

Obesity in Eastern Europe has been linked to privilege and status prior to the collapse of communism, and to exposure to free-market economics after it. Neither formulation is a complete explanation, and it is useful to examine the potential value of other models of population obesity for the understanding of this phenomenon. These include those of: thrifty genotypes; obesogenic behaviour; obesogenic environments; nutrition transition; obesogenic culture; and biocultural interactions of genetics, environment, behaviour and culture. At the broadest level, obesity emerges from the interaction of thrifty genotype with obesogenic environment. However, defining obesogenic environments remains problematic, especially in relation to sociocultural factors. Furthermore, since different identity groups may share different values concerning the obesogenicity of the environment, a priori assumptions about group homogeneity may lead to flawed interpretations of the importance of sociocultural factors in obesogenic environments. A new way to identify cultural coherence of groups and populations in relation to environments contributing to obesity is put forward here, that of cultural consensus modeling. (c) 2007 Elsevier B.V. All rights reserved.

K. van der Horst, A. Oenema, I. Ferreira, W. Wendel-Vos, K. Giskes, F. van Lenthe and J. Brug. (2007). A systematic review of environmental correlates of obesity-related dietary behaviors in youth. Health Education Research.

There is increasing interest in the role the environment plays in shaping the dietary behavior of youth, particularly in the context of obesity prevention. An overview of environmental factors associated with obesity-related dietary behaviors among youth is needed to inform the development of interventions. A systematic review of observational studies on environmental correlates of energy, fat, fruit/vegetable, snack/fast food and soft drink intakes in children (4-12 years) and adolescents (13-18 years) was conducted. The results were summarized using the analysis grid for environments linked to obesity. The 58 papers reviewed mostly focused on sociocultural and economical-environmental factors at the household level. The most consistent associations were found between parental intake and children's fat, fruit/vegetable intakes, parent and sibling intake with adolescent's energy and fat intakes and parental education with adolescent's fruit/vegetable intake. A less consistent but positive association was found for availability and accessibility on children's fruit/vegetable intake. Environmental factors are predominantly studied at the household level and focus on sociocultural and economic aspects. Most consistent associations were found for parental influences (parental intake and education). More studies examining environmental factors using longitudinal study designs and validated measures are needed for solid evidence to inform interventions.

M. C. Wang, C. Cubbin, D. Ahn and M. A. Winkleby. (2007). Changes in neighbourhood food store environment, food behaviour and body mass index, 1981-1990. Public Health Nutrition.

OBJECTIVE: This paper examines trends in the neighbourhood food store environment (defined by the number and geographic density of food stores of each type in a neighbourhood), and in food consumption behaviour and overweight risk of 5779 men and women. DESIGN: The study used data gathered by the Stanford Heart Disease Prevention Program in four cross-sectional surveys conducted from 1981 to 1990. SETTING: Four mid-sized cities in agricultural regions of California. SUBJECTS: In total, 3154 women and 2625 men, aged 25-74 years. RESULTS: From 1981 to 1990, there were large increases in the number and density of neighbourhood stores selling sweets, pizza stores, small grocery stores and fast-food restaurants. During this period, the percentage of women and men who adopted healthy food behaviours increased but so did the percentage who adopted less healthy food behaviours. The percentage who were obese increased by 28% in women and 24% in men.ConclusionFindings point to increases in neighbourhood food stores that generally offer mostly unhealthy foods, and also to the importance of examining other food pattern changes that may have a substantial impact on obesity, such as large increases in portion sizes during the 1980s.

Y. Wang and M. A. Beydoun. (2007). The obesity epidemic in the United States--gender, age, socioeconomic, racial/ethnic, and geographic characteristics: a systematic review and meta-regression analysis. Epidemiologic Reviews.

This review of the obesity epidemic provides a comprehensive description of the current situation, time trends, and disparities across gender, age, socioeconomic status, racial/ethnic groups, and geographic regions in the United States based on national data. The authors searched studies published between 1990 and 2006. Adult overweight and obesity were defined by using body mass index (weight (kg)/height (m)(2)) cutpoints of 25 and 30, respectively; childhood "at risk for overweight" and overweight were defined as the 85th and 95th percentiles of body mass index. Average annual increase in and future projections for prevalence were estimated by using linear regression models. Among adults, obesity prevalence increased from 13% to 32% between the 1960s and 2004. Currently, 66% of adults are overweight or obese; 16% of children and adolescents are overweight and 34% are at risk of overweight. Minority and low-socioeconomic-status groups are disproportionately affected at all ages. Annual increases in prevalence ranged from 0.3 to 0.9 percentage points across groups. By 2015, 75% of adults will be overweight or obese, and 41% will be obese. In conclusion, obesity has increased at an alarming rate in the United States over the past three decades. The associations of obesity with gender, age, ethnicity, and socioeconomic status are complex and dynamic. Related population-based programs and policies are needed.

J. Wardle, N. H. Brodersen and D. Boniface. (2007). School-based physical activity and changes in adiposity. International Journal Of Obesity.

Objective: School-based physical education (PE) is often proposed as a strategy for obesity prevention, but many trials have found non-significant effects on body mass index (BMI). We examined the impact of school PE on adiposity in adolescents, using an ecological analysis to relate the number of PE sessions to changes in BMI and waist circumference. Research methods and procedures: Five-year, longitudinal, school-based study involving 34 secondary schools in London, England. Students were aged 11-12 years at baseline. Twenty-five schools reported one weekly session of PE, seven schools reported two sessions and two boys' schools reported three sessions. Weights, heights and waist circumferences were measured annually, and complete data from the first and fifth years of the study were available on 2727 students. Analyses compared anthropometric changes between students in schools with higher or lower amounts of PE time. In boys, the comparisons were between those receiving 1, 2 or 3 weekly sessions. In girls, comparisons were between those receiving one and two sessions. Results: There were no differences in BMI changes or the percentage of students classified as obese between schools of higher and lower frequency of PE. However, using unadjusted data, there were lower gains in waist circumference in boys and girls from the higher PE schools. Controlling for baseline demographic and anthropometric characteristics, boys in schools providing 3 weekly PE sessions gained on average approximately 3 cm less than boys in schools providing one or two sessions (P<0.001). Differences in girls were in the same direction but not significant. Discussion: Higher levels of school PE were associated with lower gains in adiposity in boys. This strengthens the case for including recommendations on school PE time as part of population strategies to control adolescent obesity.

N. M. Wells, S. P. Ashdown, E. H. S. Davies, F. D. Cowett and Y. Z. Yang. (2007). Environment, design and obesity - Opportunities for interdisciplinary collaborative research. Environment And Behavior.

This article presents a framework for considering the relevance of the physical environment to obesity. The authors adopt the notion that the "environment" constitutes the space outside the person and therefore broaden the common conceptualization of the "environment" to encompass a full spectrum from small-scale design elements to large-scale community infrastructure. An energy balance approach is also adopted. The energy balance perspective recognizes the equilibrium of food consumption and energy expenditure, rather than focusing solely on one or the other side of the equation. The authors consider how environmental characteristics present either barriers (that hinder), or supports (that promote) healthy habits. Thus, they describe a range of obesity-related environmental themes that provide opportunities for innovative collaborative research between environmental psychologists and colleagues in fields ranging from apparel design to landscape architecture. Last, conceptual and methodological considerations are briefly presented.

O. Werder. (2007). Battle of the bulge: an analysis of the obesity prevention campaigns in the United States and Germany. Obesity Review.

Obesity is not a problem exclusive to the United States. The European Union Commission for Health and Consumer Protection admits that obesity is the major emerging threat to public health in Europe. As a recent survey suggested that the prevalence of obese men and women has approximately doubled in both countries within the last 20 years, this study compares the message elements and linguistic tactics used in either campaign of those two countries to highlight differences and similarities. The current US obesity prevention campaign is based on sound research and preparation and disseminates memorable and inspiring messages. The educational, help-for-self-help focus on the individual disseminated through mass media is a trademark of this campaign. The German campaign attempts to interact extensively with the public, local government and the professions, and focuses on public participation in healthy behaviors, generally emphasizing call-to-action activities over educational media messages. This study maintains that obesity communication research should find ways to analyse and evaluate the effectiveness and success rate of efforts taking place in other areas and other countries. In addition, in order to facilitate active thought about health messages in the absence of a perceived need, introduced guidelines relating to presentation of content and linguistic variables that motivate cognitive effort should be considered.

M. White. (2007). Food access and obesity. Obesity Reviews.
N. Wilson, G. Thomson and G. Jenkin. (2007). More evidence for action on New Zealand's obesogenic school environment and food pricing. The New Zealand medical journal.
M. G. Wilson, R. Z. Goetzel, R. J. Ozminkowski, D. M. DeJoy, L. Della, E. C. Roemer, J. Schneider, K. J. Tully, J. M. White and C. M. Baase. (2007). Using formative research to develop environmental and ecological interventions to address overweight and obesity. Obesity (Silver Spring).

OBJECTIVE: This paper presents the formative research phase of a large multi-site intervention study conducted to inform the feasibility of introducing environmental and ecological interventions. RESEARCH METHODS AND PROCEDURES: Using mixed methods that included an environmental assessment, climate survey, leadership focus groups and interviews, and archival data, information was collected on employee health and job factors, the physical environment, social-organizational environment, and current health programs. RESULTS: Results show that 83% of employees at the study sites were overweight or obese. Leadership was very supportive of health initiatives and felt integrating the strategies into organizational operations would increase their likelihood of success. Environmental assessment scores ranged from 47 to 19 on a 100-point scale. Health services personnel tended to view the organizational climate for health more positively than site leadership (mean of 3.6 vs. 3.0, respectively). DISCUSSION: Intervention strategies chosen included increasing healthy food choices in vending, cafeterias, and company meetings, providing a walking path, targeting messages, developing site goals, training leaders, and establishing leaders at the work group level.

K. M. Winther, T. Hejgaard and S. Krarup-Pedersen. (2007). The communities' plan against obesity, 2005-2008. International Journal Of Obesity.

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