A PhD thesis that sheds more light on computer-tailored nutrition education

Last Thursday, Dr. Willemieke Kroeze defended her thesis “Insights in the efficacy of computer-tailored nutrition education” at a public ceremony in Rotterdam, the Netherlands. The studies for her thesis indicate that computer-tailored nutrition education is more effective than generic nutrition education, as long as it incorporates personal, normative and behaviour change feedback. No differences in effectiveness were found between print-delivered and web-based computer-tailored nutrition education, but the print-delivered version was somewhat better appreciated. These effects were, however, based on self-report fat intake measures, and could not be confirmed based on objective measures, i.e. blood lipids.

The studies for this thesis have been published in international scientific journals:
http://www.ncbi.nlm.nih.gov/pubmed/18565463?ordinalpos=1&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_RVDocSum
http://www.ncbi.nlm.nih.gov/pubmed/18487136?ordinalpos=2&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_RVDocSum
http://www.ncbi.nlm.nih.gov/pubmed/18063650?ordinalpos=4&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_RVDocSum
http://www.ncbi.nlm.nih.gov/pubmed/16700634?ordinalpos=7&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_RVDocSum
http://www.ncbi.nlm.nih.gov/pubmed/18471932?ordinalpos=3&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_RVDocSum

EMGO seminar: visiting professor David Crawford

On September 1, professor David Crawford from the Center of Physical Activity and Nutrition Research (http://www.deakin.edu.au/hmnbs/cpan/) gave a research seminar on environmental drivers of the obesity epidemic. His excellent presentation covered the obesity and overweight prevalence down under among children, adolescents and adults, and the potential physical and social environmental determinants of obesogenic behaviors and unnecessary weight gain. His presentation made clear that the available evidence for environmental drivers of obesogenic behaviors is not that strong. His presentation ended with 4 categories of clear recommendations to bring this research field further. One of his issues was that we may be focussing too much on environmental determinants of obesity while forgetting about more personal factors of importance, and that we need to do more in investigating mediation and interaction between personal and environmental factors as potential determinants of obesogenic behaviors and weight gain.
Dr. Frank van Lenthe from the department of Public Health at Erasmus University Medical Center in Rotterdam (http://www.erasmusmc.nl/MAGE/), the Netherlands provided a first reaction to David Crawford’s presentation. He claimed that we need to focus even more on environmental factors, because good quality research in this field is still lacking.

The VUmc Department of Epidemiology and Biostatistics

On September 1, the new department of Epidemiology & Biostatistics of the VU University Medical Centre will be officially launched. Last week the personnel of the department held an introductory meeting in which the organisation and leadership of the department was presented. This new department is the result of a merger between the departments of Extramural Medicine, with its strong focus on epidemiology in the extramural setting, and the department of Clinical Epidemiology and Biostatistics, with its strong focus on supporting research of the VUmc in clinical settings. With the new department, most expertise on research methodology and statistics within the VUmc is now concentrated within one department. The mission of the new department of E&B is to initiate, conduct and support excellent research in support of the five research themes of the VU University Medical Center (http://www.english.vumc.nl/research/). The department of E&B has three sections: extramural epidemiology, clinical epidemiology and biostatistics, and four main tasks: research, education, methodology development, and methodological and biostatistical support. The logo and the organisation of the new department is presented in the attached pictures.

A ban on new fast food outlets?

To help to fight the obesity epidemic new policies are considered to promote healthier eating. In Los Angeles, California, city officials are considering a two year moratorium on new fast food outlets in South LA, a lower socio-economic status part of the city with very high obesity prevalence (http://articles.latimes.com/2007/sep/10/local/me-fastfood10).

The Netherlands Nutrition Centre declared in a press release that the Netherlands should follow the LA initiative, especially restricting access to fast food outlets in school areas http://www.voedingscentrum.nl/Voedingscentrum/Nieuws/2008/Fastfoodbeleid.htm).

However, professor Sally McIntyre, from the MRC Social and Public Health Sciences Unit, Glasgow University, provided evidence that it is certainly not always true that poorer neighbourhoods have poorer access to healthy nutrition (http://www.ijbnpa.org/content/4/1/32). And although eating at fast food places has indeed been found to be associated with a higher body weight, higher fat intake and lower fruit and vegetable consumption, a study conducted by professor Robert Jeffery and others from the Division of Epidemiology & Community Health, University of Minnesota School of Public Health, also showed that proximity of fast food outlets was not associated with eating ate those places or with a higher body mass index (http://www.ijbnpa.org/content/3/1/2).

Furthermore, a recent study by professor David Crawford and colleagues from the Centre of Physical Activity and Nutrition Research (http://www.deakin.edu.au/hmnbs/cpan/) from Deakin University in Melbourne, Australia, found an inversre relation between proximity of fast food outlets and body mass index: having a fast food place close to the home was associated with lower BMI (http://www.ncbi.nlm.nih.gov/pubmed/18608630?ordinalpos=3&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_RVDocSum).

As I have reported here before, there is certainly evidence suggesting that availability and accessibility of healthy and less healthy foods are associated with nutrition behaviours. The studies by Jeffery and Crawford indicate that these associations are, however, not as straightforward as we maybe would like them to be.

ENDORSE: ENvironmental Determinants of Obesity related behaviours in Rotterdam School ChildrEn; recent results.

Obesity prevalence is high and rising among children and adolescents in most developed countries. For obesity prevention, it is of utmost importance to identify the behavioural and environmental determinants of obesity among youth. The ENDORSE study was specifically designed to gain further insight in which family, school and neighbourhood characteristics predict obesity-related nutrition and physical activity behaviours among adolescents. ENDORSE is a longitudinal study with baseline measurements of BMI, waist circumference, a range of potential obesogenic behaviours, and questionnaire assessments as well as audits and observations of home, school and neighbourhood environments (for a full description of the study design and measurements, please see http://www.biomedcentral.com/1471-2458/8/142).

Recently two papers based on the baseline measurements of ENDORSE were published by Elling Bere et al. (http://www.ncbi.nlm.nih.gov/pubmed/18657568?ordinalpos=1&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_RVDocSum) and by Klazine van der Horst et al. (http://www.ncbi.nlm.nih.gov/pubmed/18617354?ordinalpos=3&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_RVDocSum).

Bere and colleagues explored differences in active commuting to school according to ethnicity and distance to school. Almost 50% of the adolescents reported to actively commute to school on most school days, and mode of commuting was associated with ethnicity and distance. Adolescents from Dutch ethnicity were 5 times as likely to be active commuters to school than youth from foreign ethnicity, and they were especially more likely to cycle to school. Walking to school was common up to a distance of 3k one way, while cycling was common up to a distance of 10k.
Van der Horst et al. explored associations between school environmental factors with soft drinks and snack consumption. Their study indicates that personal factors such as motivation and attitudes are more important for adolescents’ soft drink and snack intakes than availability and accessibility of these foods in the school environment.
These studies again show that different environments may have very different effects for very different energy-balance related behaviours.

The hundred mile diet or Prehistoric cooking?

We have been bombarded by a variety of diets over the last decades, mostly promising to help us loose weight. Concerns about the obesity epidemic are met and maybe even surpassed by concerns about global warming and other environmental issues. Agriculture and how and what we eat contributes strongly to green house gasses globally, and the CO2 ‘foot print’ of especially meat and other animal products is impressive.
The growth of the organic movement and the dissemination of organic produce in main stream supermarkets show that many people are willing to make changes in their food choices to contribute to a more sustainable way of feeding ourselves. However, now that organic foods and produce have become mainstream, the production has increased enormously, and a big challenge is to remain true to the real basis of ecological farming and production. Many organic product travel thousand of miles before they reach your supermarket, grocer or butcher, making their true contribution to a more sustainable environment rather doubtful. This issue is very nicely described and discussed in Paul Roberts (see http://the-end-of-oil.com/) book, ‘The end of food’.

Another interesting way to try to contribute to a more sustainable way of eating is to eat locally, and thus to reduce the transport-related CO2 fingerprint of the foods we eat. In Michael Pollan’s (http://www.michaelpollan.com/) books ‘The omnivore’s Dilemma’ and ‘In defence of food’ he very clearly illustrates the possible ecological differences between foods that may carry the organic label, and locally produced foods, and a case is build for buying locally. The growth in so-called farmers markets is a sign that buying locally is getting more and more popular.

The so-called ‘hundred mile diet’ (see http://100milediet.org/) is a way to strive to eating more locally. This ‘diet’ is based on the experiences of Alisa Smith and James MacKinnon (http://100milediet.org/contact-us/) who realised that the average food they ate had travelled at least 1500 miles. They decided to try to eat only foods that were produced within a hundred mile radius from their apartment in Vancouver, British Colombia. Since then, many other have decided to try similarly.

A very different way of eating, but that links to local food production, that has received attention here in the Netherlands is the ‘Oerdis’ (see http://www.innovatienetwerk.org/nl/concepten/view/16/Oerdis.html/ for a description in Dutch) which is prehistoric cooking (see http://www.channel4.com/history/microsites/T/timeteam/snapshot_cooking.html and ) and eating. Oerdis reconstructs the way of eating and cooking of our prehistoric ancestors based on archaeological, anthropological and historical research. Some research indicates that our hunting and gathering prehistoric ancestors had similar height as we do today and may have enjoyed long and healthy lives, suggesting that such prehistoric eating habits, with, for example, more animal protein from wild omega-3 fatty-acid rich animals and fish, and less carbohydrates, contributed to a healthy diet.

Cycling in the Alps

The past week I have been cycling the Alps together with my wife and two friends, and my mother in law as the team director. With, among others, the Joux Plane, the Colombiere, The Iseran, the Telegraph, the Galibier, the Sarenne, Glandon and Madeleine on the program we burned between 2500 and 4500 kcal on our bikes. Rather difficult to keep a neutral energy balance on such days...