Study on reliability and validity of the ENERGY questionnaire published

The ENERGY-project is a European Commission funded cross-European project to gain more insight

in Energy Balance Related Behaviors (EBRB, i.e. specific eating, physical activity and sedentary behaviors that contribute to risk for overweight and obesity) and their potential behavioural determinants, and to inform and test a school-based and family-involved obesity prevention intervention scheme. As part of the ENERGY-project a crosssectional survey among more than 7000 children, their parents, and schools was conducted in seven countries representing different regions of Europe. This survey used questionnaires among children, parents, and school staff, as well as observations in the school and school environments. However, for the survey no established valid and reliable measures that could be administered in large populations of schoolchildren in different countries across Europe were available. Therefore, we developed a child and parent questionnaire to assess a range of EBRBs and potential individual and environmental behavioural determinants, and examined the test-retest reliability and construct validity of these two main questionnaires used in the ENERGY cross-sectional survey. The reliability study among children is now published in the International Journal of Behavioral Nutrition and Physical Activity, with Dr. Amika Singh as the first author.

Self-care is an important aspect of heart failure (HF) management. Information on possible determinants of selfcare is needed for the development of self-care promotion interventions. HF self-care includes self-care management, self-care maintenance, sodium, fluid and alcohol intake restriction, physical activity, smoking cessation, monitoring signs and symptoms and keeping follow-up appointments. To assess the evidence regarding presumed determinants of HF self-care in order to make recommendations for interventions to promote self-care behavior among HF patients, a systematic literature review was conducted. This review is now published in the journal Heart Failure Reviews, with Rony Oosterum-Calo as first author. Twenty-six original scientific articles were included in the review. Results showed that  patients’ who were diagnosis with HF longer agi, i.e. with more experience with the disease, were more likley to performe self-care maintenance. Moreover, it was found that HF patients’ perceived benefits and barriers are related to their restriction of sodium intake, and that patients with type-D personality are less likely to consult medical professionals. All other evidence was inconsistent, mainly due to insufficient evidence or lack of studies. Interventions that aim to increase the performance of self-care maintenance can teach newly diagnosed patients the skills that are usually attained with experience acquired as a result of living with HF for a longer time. Perceived benefits and barriers of restricting sodium intake could be targeted in interventions for sodium intake reduction among HF patients. Finally, interventions for the promotion of adequate consulting of medical professionals can specifically target HF patients with a type-D personality.

Trying to explain educational differences in consumption of sugary drinks

One of the possibly most important correlates and determinants of nutrition behaviour is socio-economic background. Again and again it is found that people from lower socio-economic status, as indicated by level of education, income, job status or other factors, are, for example, more likely to be overweight and eat poorer diets. Such differences are already found among children and adolescents. In a recent paper published in Public Health Nutrition, we explored mediators of gender and educational differences in sugarsweetened soft drinks consumption (SDC) and we investigated whether gender and level of future education moderate the associations of accessibility, modelling, attitudes and preferences with SDC. We were able to use data from 2870 children in 9th and 10th grade from more than thirty secondary schools in Norway.

As expected, girls and pupils planning higher education reported to drink SDC less often than boys and pupils going to higher levels of education. The differences according to future education plans were mediated by accessibility and modelling: thus children who were planning to go to higher education had lower accesibility to sugary drinks and were less likely to be exposed to peer models that drank lots of sugary drinks.

The joint Australian-New Zealand Nutrion Societies meeting

Last week I presented the results of the ENERGY study on childhood overweight and obesity and prevention of childhood overweight and obesity across Europe, at the annual meeting of the Australian and New Zealand nutrition societies. The meeting's theme was 'Lean and Green' with a focus on obesity as well as on sustainable food and nutrition. My keynote presentation was linked to the 'Lean' theme, while Prof. Tim Lang talked about the link with sustainability - via a web-video presentation. The meeting was much like similar meetings in the Netherlands or elsewhere in Europe, with similar presentations, studies and discussions, and even sponsors (e.g. similar to such events in the Netherlands, the Dairy industry was the main sponsor of the meeting).

Visiting the School of Population Health, University of Auckland

On my way to the joint annual meeting of the Australian and New Zealand Nutrition Societies in Quesnstown, New Zealand, together with Professor Kylie Ball from Deakin University, I visited the clinical trial research unit of the School of Population Health of the University of Auckland. We had meetings with the behavioral nutrition and physical activity research leaders of the unit, i.e. Cliona Ni Mhurchu and Ralph Madison, as well as a number of research fellows and PhD students. Kylie and I provided a joint symposium at lunch time.

Visiting C-PAN at Deakin University, Melbourne

This week I am visiting the Center for Phyiscal Activity and Nutrition Research (C-PAN) at Deaking University, Melbourne, Australia. C-PAN is one of the internationally leading groups in (behavioral) nutrition and physical activity research. Their focus is very similar to parts of the EMGO Institute for Health and Care Research (EMGO+), our Lifestyle, Overweight & Diabetes and Musculoskeletal Health programs in particular. The close collaboration with C-PAN has resulted in a number of joined projects, including involvement of C-PAN staff in the EMGO+ European Commission funded ENERGY project on obesity prevention in school-age children across Europe, and involvement of EMGO+ staff in C-PAN's READY project on resilience to obesity among women from lower socio-economic backgrounds, and a growing number of joint scientific publications. The accompanying photo shows (except for myself and C-PAN's director David Crawford's son Alex) the C-PAN staff that visited EMGO+ in the last couple of years, as well as another regular visitor of C-PAN, Prof. Bob Jeffery from the epidemiology unit of the University of Minnesota, USA. (Notice C-PAN in chocolate letters, in anticipation of the Dutch Sinterklaas festivities....)http://en.wikipedia.org/wiki/Sinterklaas

Health education is not enough to promote healthy diets and physical activity

Today two PhD candidates from the EMGO Institute for Health and Care Research defended there theses at the VU University here in Amsterdam. In his thesis 'Efforts to prevent diabetes and cardiovascular disease in primary care' Jeroen Lakerveld explored the effects of a health education program based on motivational interviewing and problem solving treatment to motivate and enable people with high risk to adopt health behaviors that contribute to diabetes prevention (e.g. healthy eating and physical activity). The effect study showed generally no effects of this health education approach.  Dr. Lakerveld states that the approach taken may have been too limited, and that for interventions to be effective changes in the environment, i.e. the availablity of and social support for health choices may be needed.

Willemijn Vermeer studied the role of portion sizes of foods and the development and evaluation of interventions to motivate or enable people to take smaller portion sizes. Earlier research shows that portion sizes have increase quite abit over the years, e.g. coke, candy bars, fast food entrees are sold in much bigger portion sizes nowadays than a few decades ago. Additional research strongly suggests that these increases contribute to overeating and to overweight and obesity. Dr. Vermeer research shows that policies to actually reduce portion sizes are not acceptable for the general public or for food catering organisation, while interventions that are regarded as acceptable, i.e. better labels to explain portion sizes or more choice between different portion sizes, appear to be ineffective.

Both studies suggest that health education is not enough and that people need to be nudged toward healthier behavior - that the healthy choice should be made the easy and default choice. The present Dutch government disregards this and earlier (and even stronger) evidence. Theb Dutch policy is that people are ablle and will make informed choices about their health behavior and that freedom of choice and autonomy should be promoted. In an environment that promotes supersizing and lack of physical activity, that freedom of choice appears to be quite relative.