Lack of effectiveness of YouRAction, an Intervention to Promote Adolescent Physical Activity Using Personal and Environmental Feedback

YouRAction (targeting individual level determinants) and YouRAction+e (targeting in addition perceived environmental determinants) are two versions of a computer-tailored web-based interventions aiming to promote physical activity among adolescents. In a study just published in PLOS ONE with Rick Prins as first author, the one and six months effects of these computer-tailored interventions on compliance with the guideline to engage in at least one hour of moderate-to-vigorous physical activity (MVPA) per day are examined. Both tailored interventions were compared to web-based generich health education regarding physical activity.
Unfortunatley, there were no statistically significant intervention effects on compliance with the MVPA guideline, nor on overweight or waist circumference. Furthermore, the youngsters who were offered the YouRAction interventins were significantly less likely to have accessed the intervention on line compared to the generic health education.
This study could thus not demonstrate that the YouRAction and YouRAction+e interventions were effective and insufficient use and exposure to the intervention content may be an explanation for the lack of effects. These results differ from the larger evidence-base regarding computer-tailored health education. recent reviews of the literature suggest that computer-tailored health education is in general more effective than generic information.

The SPOTLIGHT project kick off meeting

Today the official start of the Sustainable Prevention of Obesity Through Integrated Strategies (SPOTLIGHT) project officially started with a meeting at the VU University medical center's EMGO+ institute. SPOTLIGHT is a cross European research project funded within the European Commission's 7th Framework program.
The SPOTLIGHT project aims to contribute to fighting the obesity epidemic. The prevalence of overweight and obesity in Europe is high and contribute to mortality and the burden of many chronic diseases, especially within groups of lower social-economic status. Obesity is largely determined by modifiable lifestyle dependent risk factors such as reduced physical activity, sedentary behaviour and an unhealthy diet. There is growing evidence that influences on individuals and their lifestyle should not only be addressed in single-level interventions that focus on a distinct individual, social or environmental aspect, but rather in community based multi-level intervention approaches (MIAs) that integrate individual, community, organisational, and societal systems.
SPOTLIGHT aims to increase and combine knowledge on the wide  ange of determinants of obesity in a systematic way, and to identify MIAs that are strong in terms of Reach, Efficacy, Adoption, Implementation and Maintenance (RE-AIM). A further aim is to identify factors for successful implementation of MIAs into health promotion practice.
By combining published research and collected cross-European data with expert and target-group perspectives, effective, sustainable and implementable MIAs that counteract obesogenic behaviours in adults will be defined. We will provide an evidence-based model for effective MIAs in health promotion practice applicable across Europe, and disseminate our findings by policy makers and the scientific community. We will develop a handbook with evidence- and practice-based instructions as well as practical recommendations for policies and interventions, suggestions and reference to best practice that serve as a major dissemination tool.

A roadmap to an obesity research agenda for Europe

With the Horizon 2020 program of the European Commission in its final stages of development, it is of crucial importance to showcase the most important health issues to the European decision makers and influencers. See http://ec.europa.eu/research/horizon2020/index_en.cfm for more information regarding Horizon 2020. Obesity is certainly one of them. Obesity is one of the most important determinants of avoidable burden of disease.
Today a meeting organised by the European Association of the Study of Obesity was held in Brussels to communicate and help define the research agenda for the Horizon 2020 era regarding obesity prevention and treatment. A trans disciplinary team of researchers from across Europe with their specialities in for example, animal models, medical treatment of obesity, behavioral sciences, public health et cetera presented and discussed what they believe to be the main priorities for further obesity research in the years to come.

The ENERGY project; a writing retreat and gourmet Nordic food

Last week we had a 3-day meeting at Agder University in Kristiansand, Norway, to analyse and prepare scientific reports of the results of the EuropeaN Energy balance Research to prevent excessive weight Gain among Youth” (ENERGY)-project. ENERGY is the development and formative evaluation of a theory-informed and evidence-based multi-component school-based and family-involved intervention program ready to be implemented and evaluated for effectiveness across Europe. This project consisting of a conceptual framework, systematic reviews and secondary data analyses, validation studies, as well as a cross sectional study and an intervention study across different countries in Europe, finalizes this summer. The reporting on the firts pases of the project is well underway, and we are now in the process of analysing the evaluation of the intervention, called UP4FUN.

Our project is aiming to promote health diets and physical activity among school-age children. Most of the researchers in the ENERGY project  try to practice what they preach. In recent years there is a big emphasis in healthy diet promotion on regional, health promoting foods and diets. Such regionally appropriate, gourmet, good-for-health-and environment diets get a strong emphasis in the Nordic countries, and has been labelled the Nordic Diet. The best restaurant of the world -NOMA restaurant in Copenhagen-, as well as other Michelin star restaurants in the Nordic countries, such as Frantzen/Lindeberg in Stockholm, are strong advocates of the Nordic kitchen and have taken the Nordic cooking to top levels. Prof. Elling Bere, one of our hosts at Agder University, and me have published one of the first scientific papers proposing a Nordic diet, and comparing the Nordic diet with maybe the most famous regionally defined healthful diet, i.e. the Mediterranean diet.

Kristiansand has its own proud example of a Gourmet Nordic restaurant, i.e. Maltid restaurant. One of the evening dinners we had at the home of Froydis Nordgard Vik, one of the PhD candidates and crucial collaborators on the ENERGY project, and she had arranged for food delivered by and prepared at her home by Maltid so that were provided the opportunity to practice Nordic health-promoting eating in the best possible way.  

Energy balance-related behaviours associated with overweight and obesity in preschool children

A systematic review just published online in the journal Obesity Reviews aimed to systematically identify dietary, physical activity and sedentary behaviours in preschool children (4-6 years of age) that are prospectively related to overweight or obesity later in childhood. Dr. Saskia te Velde is first author of this paper. Prospective studies published between 1990 and 2010 were selected from electronic data bases of scientific publications and 23 papers reporting on 15 different study samples could be included in the review. Strong evidence was found for an inverse association between total physical activity and overweight, i.e. the more the kids were physically active, the less likely they were overweight. Moderately strong evidence was found for a positive association between television viewing and overweight, thus the more they engaged in TV watching, the more likely they were to be overweight. In the reviewed studies dietary intake was assessed is so many different ways that insufficient evidence was found for an association between dietary intake or specific dietary behaviours and overweight. These results suggest that interventions aiming to prevent overweight among preschool children should focus on promotion of total physical activity and limitation of screen time and that further research is needed to establish whether and which dietary behaviours are important for obesity prevention in this age group. However, we also concluded and recommended that despite the lack of evidence for dietary behaviours from the present review, future interventions may already target specific dietary behaviours that are highly prevalent and for which there a clear rationale as well as preliminary evidence that these behaviours are associated with overweight.

A second paper in that same special issue of Obesity Reviews with Dr. Maartje van Stralen as first author reported on secondary analyses of different studies conducted across Europe on weight status and risk behaviors for overweight and obesity in pre-scholers. This study aimed to gain insight in the prevalence of overweight in European preschoolers (4–7 years), to identify energy balance-related behaviours associated with overweight/obesity; and to explore children at risk for overweight and obesity. Secondary analyses of six European data sets were conducted according to standardized protocols. Based on objectively measured height and weight, prevalence of overweight and obesity across the countries ranged from 8% to 30% and 1% to 13%, respectively, with highest rates in Southern European countries (i.e. Spain and Greece). Kids who spend more time in sedentary activities were more likley to be overweight/obese. We concluded that future obesity prevention interventions in preschoolers should target screen time giving specific attention to children from parents who are themselves overweight/obese and from lower socioeconomic positions.

Ice skating on Spaarne, near Haarlem

For the fourth year in a row, we have a few weeks of good frost, and the ice is nice and thick on many canals and lakes. Is skipped work for a few hours today to enjoy the ice and went for a nice ride on my skates on the Spaarne canal, near Haarlem.
See http://youtu.be/9-JZgCUlxKo for a video impression....

The importance of parental involvement in school-based programs to promote healthy nutrition and physical activity

Parental involvement is often advocated as important for school-based interventions, because parents are a main determinant of children's dietary and physical activity behaviors. We conducted a systematic review of the available scientific literature on this issue to explore the available scientific evidence for this claim. This review thus aimed at determining the impact of parental involvement in school-based obesity prevention interventions in children and adolescents. Our review was conducted as part of the ENERGY project, a European Commission-funded project to improve obesity prevention among school-aged children across Europe. The review was just published in the International Journal of Public Health. Wendy van Lippevelde, a PhD candidate from the University of Ghent was first author.
Akltough some positive effects of parental involvement were found on children's behaviours and behavioural determinants, the evidence was inconclusive. Maybe the most prominebt outcome of our review was that so few studies have been conducted that have explicetely tested the effect of parental involvement, and celarly more studies are needed to address this important issue.  There is a need for more studies comparing school-based interventions with and without a parental component, and dose, strategies and content of parental components of school-based interventions should be better reported in research articles.