Socioeconomic position in childhood and adulthood and associations with weight status

People who are less well-off in terms of income, education or job positions are more likely to be overweight or obese, at least in industrialized countries. Such socioeconomic inequalities in body weight have been demonstrated in numerous cross-sectional studies. With Katrina Giskes from the School of Public Health/Centre for Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Queensland, Australia (http://www.hlth.qut.edu.au/) as first author we have now investigated such inequalities from a life course and longitudinal perspective. We examined the association between child- and adulthood socioeconomic position (SEP) and body mass index BMI and overweight/obesity in 1991 and changes in BMI and the prevalence of overweight and obesity between 1991 and 2004. The findings indicated that among women, childhood SEP was more important for body weight than SEP in adulthood: at baseline, women from disadvantaged backgrounds in childhood had a higher BMI and were more likely to be overweight or obese, and they gained significantly more weight between baseline and follow-up. In contrast, adult SEP had a greater impact than childhood circumstances on men's body weight: those from disadvantaged households had a higher mean BMI and were more likely to be overweight or obese at baseline, and they gained significantly more weight between 1991 and 2004. The findings suggest that exposure to disadvantaged circumstances at critically important periods of the life course is associated with body weight and weight gain in adulthood. Importantly, these etiologically relevant periods differ for men and women, suggesting gender-specific pathways to socioeconomic inequalities in body weight in adulthood.

See http://www.ncbi.nlm.nih.gov/pubmed/18356832?ordinalpos=1&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_RVDocSum

Regionally defined diets for health, the environment and cultural diversity in food habits

Last week I spent my days cross country skiing on Hardangervidda in Norway. We went from hut to hut. Some of these huts, Rauhelleren (http://www.turistforeningen.no/turplanlegger/cabin.php?x=5&y=6&v=3&ca_id=134, see the picture next to this message) in particular, serve so-called ‘lokal mat’: regionally grown or raised food. We ate salmon, wild trout, preserved berries of different kinds, some marinated elk, cauliflower soup, and the Norwegian brown cheese.

During the evenings there was plenty of time for reading. I brought Michael Pollan’s new book, In Defence of Food. Pollan argues in this book in favour of focussing on real foods and meals in stead of on nutrients and processed foods, including the so-called functional foods that claim various health benefits. Pollan builds a strong case in a book that is a very good read.

This same week a paper that I co-authored with my Norwegian colleague Elling Bere appeared in electronic pre-publication in Public Health Nutrition (http://www.ncbi.nlm.nih.gov/pubmed/18339225?ordinalpos=1&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_RVDocSum). This paper, entitled ‘Towards health promoting and environmental-friendly regionally defined diets: A Nordic example’ argues for a similar case as Pollan does in his book. We present a Nordic ‘diet’ with foods and ingredients that are and have been appropriate and abundant in the Nordic countries, for which scientific evidence supports health enhancing effects. The best knows health promoting total diet is the so-called Mediterranean diet, but we claim that diets with similar health enhancing properties can be based on regionally appropriate foods. Such an approach will help to protect cultural diversity in eating habits, bio-diversity and the environment.

Exploring the possibilities of further developing midwifery research in the Netherlands

On Friday February 29, Royal Dutch Organisation for midwifes (KNOV, see http://www.verloskundigeninnederland.nl/home/) installed its Scientific Committee. I was asked to chair this committee that needs to explore and promote the possibilities for midwifery research in the Netherlands. The members of the committee are mentioned in one of the attached pictures.
The call for a stronger scientific development and underpinning of the profession comes from the professionals and the schools for midwifes, based on a need for evidence-based practice and further innovations in the field. The Scientific Committee has been specifically asked to propose a research agenda, to explore funding possibilities for midwifery research, and to help to establish a scientific network for midwifery research in the Netherlands, that links to international developments in the field.

Obesity prevention : A systematic review of the evidence regarding efficacy of obesity prevention interventions among adults

This week the journal Obesity Reviews published in e-pub a systematic review of obesity prevention interventions aimed at adults, that I co-authored. Valery Lemmens is first author on this paper ( Obes Rev. 2008 Feb 19 [Epub ahead of print]).

See http://www.ncbi.nlm.nih.gov/pubmed/18298429?ordinalpos=1&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_RVDocSum

Interventions aimed at reducing obesity have mainly focussed on weight loss among overweight and obese adults. Such weight loss intervention have little long-term effects. A stronger focus on obesity prevention is needed. Our review included scientific papers published on this topic from 1996 up to 2006. The results indicate that systematic interventions aiming to prevent weight gain and obesity are scarce and the current evidence of efficacy of obesity prevention interventions is thus based on a small number of studies. Some studies showed a positive impact on body mass index or weight status, but there was too much heterogeneity in terms of study design, theoretical underpinning and target population to draw firm conclusions about which intervention approaches are more effective than others. More research is urgently needed to extend the body of evidence.

A debate on public radio: nutrition education or environmental change to promote health behaviour?

http://nl.wikipedia.org/wiki/Joop_Atsma) of the Christian Democratic Party on Dutch public radio. I argued that rules and regulations will be necessary for effective obesity prevention policy in order to change the present ‘obesogenic’ environment into a more ‘obesopreventive’ environment. Mister Atsma claimed that health education is the way to go forward. Our research indicates that a health education approach will be insufficient to change people’s nutrition and physical activity behaviours for obesity prevention. Environmental changes are needed to better facilitate healthful nutrition and physical activity behaviours, and to make un-healthful choices less available and accessible. This is also what has been advocated by WHO Europe in their policy to curb the obesity epidemic (see http://www.euro.who.int/obesity/conference2006). Please visit http://omroep.vara.nl/De_VARA_op_Radio_1.2681.0.html and link to ‘Radio Kassa 26 Februari to listen to the radio debate.

How to get people to actually visit efficacious tailored health education websites, and what is needed for such education to be effective?

Last month a paper appeared in the journal Health Education that I co-authored, based on as study by Rick Crutzen, from Maastricht University. Rick and Wendy Brouwers from Erasmus University Medical Centre both work on their PhD’s based on research into why people do or do not visit, access, and stay long enough to complete e-health promotion interventions on the web. Research has indicated that so-called computer-tailored health education is more likely to result in health behaviour change than generic health education. In computer-tailoring people receive personalized feedback and advice, based on a personal assessment of the health behaviour and behavioural determinants. The web is regarded as a very promising channel to distribute such tailored advice, but studies comparing web-based and print computer-tailored intervention indicate that print-delivered versions may be more effective. One reason is that people do not visit the relevant website, or do not stay long enough to really go through the diagnosis and advice. Rick and Wendy’s studies explore why that is the case and what might make people more attentive to web-based tailored interventions.

The purpose of Rick Crutzen’s paper was to gain first insight into factors which might be associated with exposure to internet-delivered interventions. He conducted semi-structured focus group interviews with five groups of Dutch adolescents, aged 12-17 years. Several aspects of exposure, e.g. a first visit, staying long enough actually to use and process the information; and revisiting the intervention, were explored. The results indicate that word-of-mouth ‘marketing’, social comparison information, and regular reminders may help to increase exposure to web-based e-health interventions among adolescents. Further research will be conducted to test these and other issues to improve exposure.

Willemieke Kroeze recently published a paper in Health Education Research (http://her.oxfordjournals.org/) looking into what is needed for computer-tailored nutrition education to be effective. She compared three different versions of the education. A first version provided respondents with feedback about their behaviour compared to recommended intake levels, a second version provided additional feedback about the respondent’s intake compared to that of peers, and the third version also gave so-called action feedback: practical tailored information on how to make dietary changes. The results showed that the most extensive feedback was the only version that was better than non-tailored, generic nutrition information.

For abstracts of relevant papers, please see
· http://www.ncbi.nlm.nih.gov/pubmed/18209115?ordinalpos=1&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_RVDocSum
· http://www.ncbi.nlm.nih.gov/pubmed/16700634?ordinalpos=4&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_RVDocSum
· http://www.ncbi.nlm.nih.gov/pubmed/18063650?ordinalpos=1&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_RVDocSum

A three-country meeting on behavioural nutrition and physical activity

On Tuesday February 19 researchers from Cambridge, Ghent and the EMGO Institute came together in Amsterdam for a one-day meeting. This has grown into a yearly event, and this week was the fourth time these research groups met.

The three groups are interested in and have research programs on behavioural nutrition and physical activity research. The annual meetings were organised because of great similarities in research interests and ongoing studies.

During the morning program presentations by Sanne de Vries and Nannah Tak from the EMGO Institute, Kirstin Corder from Cambridge, and Leen Haerens and Benedicte Deforche from Ghent gave presentations on ongoing research on compliance to physical activity recommendations among youth and effects of school-based interventions to promote healthful behaviours among children and adolescents.

In the afternoon, research leaders from the three groups, Nick Wareham, Willem van Mechelen and Ilse de Bourdeaudhuij provided short introductions to inform discussions in smaller groups about future collaborations in research on measurement of physical activity, dietary behaviours and potential determinants, environmental determinants of physical activity and diet, computer-tailored health promotion.

One of the photos showes some good intentions that were made for further collaboration.