Family environmental factors do not explain differences in the behavioral effect of a healthy diet promotion program in lower vocational schools among

In a paper in American Journal of Health Promotion, Martens et al assess whether family environmental factors affected changes in fruit and snack consumption among 12- to 14-year-old adolescents participating in a Dutch healthy diet promotion program. Data from an intervention study in 10 schools were analysed. The participants (students and one parent) were recruited from lower vocational schools in the southern and central parts of The Netherlands. The authors were able to get 502 matched student and parent questionnaires. The results indicated that there were no significant family environmental predictors of program-induced changes in either fruit or snack intakes aof adolescents. So despite the fact that family-environments are regarded as of crucial importance for child and adolescent nutrition behaviours, in this study no evidence was found that such family factors influence the effectiveness of a school-based healthful nutrition promotion program. The study suggests that there were subgroups of adolescents who profited less from the program because of family environmental factors.

Dutch youth health care promotes four so-called energy-balance
behaviours for the prevention of obesity: increasing physical activity, reducing
sedentary behaviour and sugar-containing drinks, and eating breakfast. However,
data on the prevalence of these behaviours and intentions to engage in
them among primary schoolchildren is limited, especially for multi-ethnic,
inner-city populations. In a paper by Jansen et al. in Journal of Human Nutrition and Dietetics explorative evidence on these energy-balance behaviours is presented for adolescents in the Rotterdam area, a city with approximately 50% adolescents from ethnic minorities. Jansen is senior researcher at the municipal health service in the Rotterdam area.
The prevalence of being overweight was 30.4%, including 9.0% obesity.
Engagement in energy-balance behaviours varied from 58.6% for outdoor play
(>1 h previous day) to 85.9% for active transportation to school.
The highest positive intentions were reported for taking part in sports
(83.9%), and lowest for reducing computer time (41.3%). Only very small differences in behaviours and intentions according to socio-demographic characteristics including ethnic background were found. The results confirm that the prevalence of being overweight among Dutch inner-city schoolchildren is high. The small differences between ethnic groups suggest that a general rather than a differentiated approach is needed to improve engagement in energy-balance behaviours among inner-city schoolchildren.

Combining education with school environment changes appears effective for healthy diet promotion in school-aged children

A recent systematic review publiced by Eveline de Cauwenberghe and colleagues in British Journal of Nutrition clearly indicates that nutrition education only or only modifying the school environment (e.g. by making healthy oprion better available or accessible) may have some effects on more healthful eating among the children, but the evidence for an effect of a combination of both strategies was much stronger, especially for promotion of fruit and vegetable intakes.

Twenty-nine studies conducted in countries of the European Union among children were identified that met the inclusion criteria. Strong evidence of effect was found for multicomponent interventions on fruit and vegetable intakes, while limited evidence of effect was found for educational interventions on behaviour, and for environmental interventions on fruit and vegetable intakes. Interventions that specifically targeted children from lower socio-economic status groups showed limited evidence of effect on behaviour. Effects on anthropometrics were often not measured, and therefore evidence was lacking whether the intervention also influenced body size or composition.

Fewer studies among adolescents were identified, and the evidence for that important target group was less clear.

This review study is part of the Health promotion through Obesity Prevention across Europe (HOPE) project.

Potential determinants of sugar sweetened beverage consumption

Sugar-sweetened beverage (SSB) consumption may increase risk for unnecessary weight gain. At least there is quite some evidence from observational studies that indicates that higher intakes of SBB is associated with higher risk for overweight and obesity. To develop interventions discouraging consumption, more insight is needed about possible behavioural determinants that drive SBB consumption. In a recent publication in the British Journal of Nutrition Nicole Ezendam and colleagues describe a study on cognitive and environmental predictors of reducing SSB consumption. The paper describes the relationship between potential cognitive determinants of change (attitudes, subjective norms, perceived behavioural control and intentions) and perceived environmental factors (family food rule regarding SBB consumption and home availability of SSB) with changes in SSB consumption between baseline and 4-month follow-up among 12-13 year olds in the city of Rotterdam, the Netherlands. The study also explored whether the relationships between the environmental factors and SSB consumption are mediated by the cognitive determinants. The results show that a high perceived behavioural control to lower intake was associated with a decrease in consumption of SSB. Low home availability and a stricter family food rule were also associated with a decrease in consumption between baseline and follow-up. The association between home availability and decreased intake was mediated by perceived behavioural control to drink less. The results indicate that interventions to decrease SSB intake should focus on improving attitudes and perceived behavioural control to reduce intake, and on limiting home availability and stimulating stricter family food rules regarding SSB consumption.

Denying obesity

In the last issue of the European Journal of Public Health Arnaud Chiolero and Fred Paccaud ask if the obesity, epidemic is a booga booga, i.e. a 'religious ritual', a 'frightening, imaginary creature', a 'way to scare the living piss out of someone in a comedic fashion', or a 'noise that people use to scare each other’. In the same issue Professor Tim Lobstein of the International Association for the Study of Obesity, and Professor David Crawford and myself were asked to write short commentaries to the paper by Chiolero and Paccaud.
As Lobstein rightly argues that "with any social crisis, someone will want to challenge the accepted science and provoke a defence from the scientists". The similarities with the global warming sceptics are obvious.
With rising and very high prevalence rates worldwide, and overwhelming evidence that obesity is indeed a major public health crisis, there is no doubt that an obesity pandemic is among us in the sense that it is ‘occurring over a wide geographic area and affecting an exceptional high proportion of the population’ (Meriam Webster online Dictionary). Please access the paper by Chiolero and Paccaud as well as the two commentaries at the European Journal of Public Health website.

The annual meeting of the Portuguese Society of the Study of Obesity

Last Friday I gave a keynote lecture at the annual meeting of the Portuguese Society of the Study of Obesity (congresso portugues de obesidad). Together with one other keynote speaker, Geoffrey Williams of the University of Rochester, we were the only ones presenting in English. Because my Portuguese is complete non existent, I did not get much off the other presentations, but I understood that the conference was mainly clinically oriented, aiming to share information on obesity treatment from a primarily clinical perspective. Professor Williams and myself were also two of very few who talked on a behavioural perspective of obesity treatment and prevention.
Professor Williams, an expert on Self Determination Theory (SDT) and on interventions using that theory for a range of health behaviour changes, including obesity treatment, gave a very nice and complete overview of the evidence for SDT-based interventions. He presented great mediation analyses that indicated that the cornerstones of SDT, autonomy and control, indeed mediate the effects of SDT-based interventions.
I provided an overview of the rationale and evidence for obesogenic social, physical and economical environments, informed by results of a number of studies I was and am involved in, such as the Health Promotion through Obesity Prevention in Europe (HOPE) project and the EuropeaN Energy balance Research to prevent excessive weight Gain among Youth (ENERGY) project. Click here for a handout of my presentation.

EMGO Institute for Health and Care Research 2009 policy day

Last Friday the program directors, department and committee chairs and a number of senior researchers from the EMGO Institute for Health and Care Research met at ‘The Tides’ in Overveen. Based on SWOT analyses of EMGO+ and its research programs, with this day we were aiming to finalize the 2010 policy plans for the four EMGO+ research programs, and to discuss EMGO’s performance and ambitions in a perspective of further internationalization of research related to EMGO’s mission. The internationalization topic was introduced by Professor Jaap Seidell who argued, based on analyses of the times higher education world university rankings and the academic ranking of world universities (‘Shanghai University Ranking’) that the VU University and the VU University Medical Center do not do very good in these rankings, despite good publication and citation indexes, and that lack of true internationalization, indicated by international staff, students, and established and formal collaborations with universities/research centers in other countries is an important determinant of our lower ranking. The policy plans that will importantly aim at further internationalization will be finalized in the next few weeks and then published on the EMGO+ website.