Thursday, May 24, 2007

The NHS-NRG project on obesity prevention: promising outcomes, applicable recommendations, but the Dutch government fails to meet its obligations

On May 24 the closing symposium of the Netherlands Heart Foundation NRG (NHS-NRG) project was held. NHS-NRG is a unique multi-stage and multi disciplinary project in which nutritionists, movement scientists, epidemiologists, public and occupational health experts, and behavioural scientists worked together to carefully develop, plan, implement and evaluate different projects for prevention of weight gain.

This NRG project recognised three different primary target groups: adolescents, young adults (20-40 years of age), and recently retired people, since these population groups are at high risk for unnecessary weight gain, are in a phase of the life course where important unhealthy lifestyle changes easily occur, and can be reached at settings that allow intervention activities with a high reach and sustainability, i.e. schools, work places and retirement preparation meetings.

The project included studies to identify specific risk behaviours for unnecessary weight gain, to identify important and modifiable behavioural determinants, and to implement and evaluate the intervention programs.

During this final symposium a summary was given of the most important results and conclusions. Professor Daan Kormhout, the consortium leader for this project, gave a brief overview, followed by an excellent state-of-the-art overview by professor Jaap Seidell. The two postdoc researchers of the NRG project, Drs. Tommy Visscher and Stef Kremers subsequently presented the overview of the results of the project.

The study results confirm the importance of identifying specific obesogenic behaviours and obesogenic environments to develop better targeted intervention programs. The studies also indicate that such well-planned and targeted interventions can initiate and help to sustain important changes in obesogenic behaviours and/or indicators of overweight and obesity.

Based on the project’s results recommendations for overweight prevention programs were provided. In summary, these recommendations state that prevention for overweight should focus on specific energy-balance related behaviours, should include strategies to improve motivation, abilities and environmental opportunities, and should be combined with long-term monitoring to further study the effects and learn for future initiatives. These recommendations are in line with earlier statements, but are now based on better evidence.

In the second part of the symposium, representatives of four organisations responsible for policy and implementation related to prevention of overweight (the Netherlands ministry of Health, the Netherlands Nutrition Foundation, the Netherlands Organisation for Promotion of Physical Activity, and the Netherlands Heart Foundation gave their reactions to the recommendations presented. These reactions were discussed with the audience of scientists, policy makers, and public health professionals.

The NRG recommendations were well received among the three implementation organisations. However, more negative news was heard from the representative of the Ministry of Health. She stated that the budget for prevention in general and obesity prevention in particular will most probably be further cut, and that collaboration with other ministries with important tasks related to providing opportunities for an energy-balanced lifestyle (e.g. Infrastructure, Food and Agriculture) was hindered by lack of willingness to seriously collaborate. This despite the fact that obesity rates in the Netherlands still grow to further unacceptable levels in all age groups and social classes, and despite the fact that the Dutch government has signed the European Charter for counteracting obesity. Signing this charter obligates countries to intensify their activities to prevent obesity (

Tuesday, May 22, 2007

The impact of computer-tailored health education

Recently some new and exciting papers on the impact of computer-tailored health education were published. Computer-tailored health education is a way to use ICT to mimic personal health behaviour counselling. Computer-tailoring programs use (electronic) questionnaires to assess respondents' health behaviours and behavioural determinants and provide tailored, personalised and individualised feedback and advice. Computer-tailoring was originally applied with paper-and-pen questionnaires and print feedback, and a systematic review of the literature clearly indicates that this form of health education is superior to more traditional, generic forms of health education (see Kroeze, Werkman & Brug, Ann Beh Med 2007;31:205-223). More recently studies have been conducted and reported that applied web-based tailoring (see for example Brug et al. Eur J Clin Nutr 2005;59:S130-S137) and applied computer-tailoring among various target populations, such as children and adolesents. Leen Haerens of Ghent University recently published one of the first papers to test school-based computer-tailored nutrition education among adolescents. Her study published in Public Health Nutrition (2007;10:443-449) indicates that computer-tailored education alone is not enough.

Corneel Vandelanotte published a paper in Annals of Behavioral Medicine (2007;33:213-219) that for the first time reports a study on the longer-term (2 year follow-up) of his diet and physical activity computer-tailored intervention. His study indicates that effects of computer-tailoring can be sustained. (see for a Dutch example of a web-based computer-tailored life style intervention for diabetes prevention).