A new chair in epidemiology of common mental disorders

On Friday October 5, Professor Brenda Penninx gave her inaugural address for her new position as professor of epidemiology of common mental disorders. Professor Penninx coordinates the Netherlands Study of Depression and Anxiety disorders, a large-scale and unique longitudinal study primarily focussed on two of the most common mental disorders: depression and anxiety disorders. During her address, Brenda Penninx provided a clear overview of some recent results from this ongoing study and her plans for further research in the years to come. She touched upon her research showing the associations between these mental disorders and other important burdens of disease, such as cardiovascular conditions, as well as with lifestyle determinants such as nutrition, physical activity and smoking habits. A few years ago she received a VIDI grant for her work from the Netherlands organisation for Scientific Research, NWO, one of the most prestigious grants available (see http://www.nesda.nl/pdf/artikel%20ad%20valvas.pdf) and se is also a member of the ‘Young Academy of the Netherlands Academy of the Royal Dutch Academy of Arts and Sciences (see http://www.knaw.nl/english/index.html and http://www.knaw.nl/cfdata/nieuws/nieuws_detail.cfm?nieuws__id=392). Professor Penninx work is part of the Common Mental Disorders program of the EMGO Institute, and her work illustrates very nicely the fruitful interdisciplinary and interfaculty collaboration within our institute. She works with colleagues from the Psychiatry, Clinical Psychology and General Practitioners departments in mapping causes and effects of common mental disorders, and in exploring and evaluating ways for prevention and early treatment.

A new website to facilitate healthy lifestyle promotion in primary schools in the Netherlands

Last Wednesday the Netherlands Heart Foundation, the Netherlands Nutrition Foundation and the Netherlands Dairy Foundation launched a new web portal to help policy makers, school boards, teachers and parents to make sense out of the great variety of instruments, interventions and educational materials that are meant to contribute to school-based health promotion (see http://www.gezonderwijs.nl/; ‘gezonderwijs’ is Dutch for healthy and smart) .
A symposium with parents, teachers, schoolchildren, policy makers and scientists was held to describe and illustrate why such a portal is useful, and to discuss different avenues for promoting healthful nutrition and physical activity habits among primary schoolchildren. I was one of the speakers. I congratulated the organisers with their initiative but also argued that a web portal with health education possibilities will not be enough to ensure healthy behaviours among our youth; environmental changes are needed. One of the teachers showed a very nice example. The picture shows the school playing ground that was transformed into a multiple sports arena.
Another interesting thing was that the Netherlands Dairy Foundation was one of the initiators. Is this a good public-private partnership to promote health, or another illustration of how ‘objective’ health education and food marketing are intertwined?

Watching TV, using computers, body weight and promotion of healthy lifestyles

More and more studies point out that watching TV, using your computer and other sedentary behaviors are associated with being overweight or obese (see http://www.ijbnpa.org/content/4/1/44 and http://www.ijbnpa.org/content/4/1/41 for some recent examples). The strongest evidence is for TV screen time. Apart from being physically inactive while watching TV, TV and snacking go well together, and watching TV also mean being exposed to junk food advertising. Although the evidence for an association between computer screen time and overweight is less consistent, similar arguments are now valid for computer use. Personal computers used intensively for chatting, surfing the internet etc., which also comes with more and more on-screen marketing, and can easily be combined with snacking.
On the other hand, computer-tailored, and web-based personalised health education has been recognised as a promising means to promote healthy lifestyle behaviors (see http://www.ijbnpa.org/content/4/1/39 for a recent open access paper on this topic). With computer-tailoring, respondents get personalised feedback on the behaviour and behavioural determinants and an individualized behaviour change advice. However, such computer-tailored health education may also increase their screen time…

Three compulsory physical education lessons per week in schools across Europe?

The Culture and Education Committee of the European Parliament adopted by an overwhelming majority a report by the Hungarian member of parliament Pal Schmitt. This report concluded that physical education should be compulsory in primary and secondary schools and that children should at least have three physical education lessons per week. The report also calls for a better integration between sports and academic subjects in schools.

The recommendations are of great importance given the growing rates of overweight and obesity among European youth. Despite this obesity epidemic, the time allocated to physical education in schools has gone down from an average of 121 minutes per week to 109 since 2002.

The report is scheduled to be put to a plenary vote in November in Strasbourg.

Obesity prevention: the young and the old

Obesity prevention efforts are mostly aimed at young people. More and more initiatives are trying to encourage ‘ obesopreventive’ behaviours among children and adolescents not only through health education but also, for example, by introducing extra physical education and activity hours in the school curriculum, changing what is for sale in the school canteen, or otherwise trying to make the school a more health behaviour friendly environment (see for some Dutch projects example http://www.rotterdamlekkerfit.nl/, http://www.onderzoekinformatie.nl/nl/oi/nod/onderzoek/OND1293890/). The rationale behind a focus on youth is that children’s lifestyle habits may not be as firmly established and may be easier to modify and that overweight in childhood and adolescence is a strong determinant of life-long overweight.
Younger adults are another important target group for obesity prevention. Young adults in the age group of 25-35 or 40 years of age, go through important life course phases that often lead to lower physical activity levels and changes in eating habits. This group is also responsible for razing the next generation and is therefore of utmost importance for obesity prevention among children. The national prevention-of-overweight campaign of the Netherlands Nutrition Center is primarily aimed at this target group (http://www.voedingscentrum.nl/voedingscentrum/Public/Statisch/English+summary/).
However, the group with the highest prevalence of overweight and obesity is the elderly. On Thursday professor Marjolein Visser gave her inaugural address as professor of Nutrition and Health and she addressed this issue in a crystal clear manner. Professor Visser is head of the Department of Nutrition and Health (http://www.falw.vu.nl/Onderzoeksinstituten/index.cfm/home_subsection.cfm/subsectionid/6E313033-1279-D040-8BFBBC0F92E88FA1) and her chair is established at the institute of Health Sciences ate the VU University and at the EMGO Institute of the VU University Medical Center (see http://www.emgo.nl/) The evidence she provided showed that Dutch elderly today are much less physically active than a decade ago, and that the prevalence of obesity has doubled in that period among some groups of elderly people (see http://www.ncbi.nlm.nih.gov/sites/entrez?Db=pubmed&Cmd=ShowDetailView&TermToSearch=16425851&ordinalpos=12&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_RVDocSum). A study reported by Slingerlandt and others also indicated that Dutch elderly change their physical activity patterns when they retire (http://aje.oxfordjournals.org/cgi/content/full/165/12/1356). It is clear that obesity prevention should not be restricted to one age group, but deserves a true life course perspective with interventions specifically tailored to the different key age groups.

Obesity prevention: From health promotion to health protection.

Friday 7 September the Dutch federation of university medical centers (NFU, see http://www.nfu.nl/) organized a meeting on how to fight the obesity epidemic. After a general introduction on the obesity trends and consequences by professor Jaap Seidel, VU University, Professor Liesbeth Mathus, Amsterdam University Medical Center, gave an overview of medical treatment possibilities, showing that the most promising treatment approach, with long-term follow-up and intensity, is often unavailable in the Netherlands.
Next, the meeting focused on lifestyle interventions to promote prevention of overweight and obesity. Professor Boyd Swinburn from Deakin University, Melbourne (Aus), see http://www.deakin.edu.au/hmnbs/ens/staff/index.php?username=swinburn, has argued that obesity is a normal reaction to an abnormal environment. This environment that provides opportunities and promotes eating energy dense foods almost anytime, anywhere, and enables avoidance of almost any physical activity, is regarded as the driving force behind the obesity epidemic. Swinburn depicts the obesity epidemic as a ‘runaway weight train’ with the obesogenic environment as the down hill track (see http://www.bmj.com/cgi/content/full/329/7468/736). Although most people have freedom of choice where foods and physical activities are concerned, they have to choose in an environment in which unhealthy food choices and lack of physical activity are the easy and intensively marketed choices.
The great accomplishments in public health in countries like the Netherlands, such as the eradication of a number of infectious diseases, improvements in traffic and food safety, and also the reduction in smoking prevalence have all been accomplished by means of an integral approach in which health protection measures, i.e. regulations and environmental change measures, such as building sewage systems, establishing and enforcing traffic laws, or taxing tobacco and creating smoke-free environments, were of key importance. However, despite the environmental causes for the obesity epidemic, obesity prevention efforts are still mostly based on health education and health promotion activities. Such health education is not strong enough to help slow down the weight train. I argued that we need a health protection approach to obesity prevention to finally make a difference. Such a health protection approach should include ‘safe’ food and physical activity environments in, for example, (pre) schools and worksites, a ban on food marketing to children and on unproven direct as well as indirect health claims for foods, and taking ‘protection’ of physical activity into account in all infrastructure projects so that physical activity will again become a necessary and routine part of daily living.

European Research Funding for obesity prevention among youth?

Late last week we had our first web-based conference call for the HOPE project (Health promotion through Obesity Prevention in Europe, http://www.hopeproject.eu/), to discuss the project’s progress. Colleagues from IOTF (http://www.iotf.org/), Erasmus University Medical Centre’s department of Public Health (http://www2.eur.nl/fgg/mgz/), University of Oslo’s department of Nutrition (http://www.med.uio.no/imb/nutri/english/index.html), University of Ghent University’s department of Movement and Sports Sciences (http://www.lo-bsw.ugent.be/), Unit for Health Services Research and International Health –IRCCS Burlo, in Trieste, Institut National de la Santé et de la Recherche Médicale –INSERM, In Paris, the Karolinska Institute in Stockholm, and from the EMGO-Institute of the VU University Medical Centre (http://www.emgo.nl/) were all in front of the pc with their headsets to talk about the progress in subsequent workpackages of the EU funded project.

The HOPE project aims to further explore determinants of overweight across Europe, and to identify effective strategies for obesity prevention, based on existing data and networks.
An important extension to the HOPE project would be to use and further enrich this information to develop and test new intervention schemes for prevention of unnecessary weight gain. One of the calls for proposals within the EU 7th framework program (see http://cordis.europa.eu/fp7/home_en.html) indeed asks for such research specifically aimed at children and adolescents, and we are now in the final stages of preparing exactly such a proposal together with partners from different countries across Europe. Next week the proposal will need to be in Brussels...