No effects of tailored feedback and face to face counseling on health behaviors in hypercholesterolemia patients

In a paper just published in the journal PLOS ONE, with Karen Broekhuizen, who will defend her thesis this Friday and become Dr. Karen Broekhuizen- as first author, we describe the evaluation of an individualised tailored lifestyle intervention on physical activity, dietary intake, smoking and compliance to statin therapy in people with Familial Hypercholesterolemia (FH).
Adults with FH (n = 340) were randomly assigned to a usual care control group or an intervention group. The intervention consisted of web-based tailored lifestyle advice and face-to-face counselling. Physical activity, fat, fruit and vegetable intake, smoking and compliance to statin therapy were self-reported at baseline and after 12 months.
Individually tailored feedback did not prove to be superior to no intervention regarding changes in multiple lifestyle behaviours in people with FH. Earlier studies on computer-tailoring did show very promising effects. In the present study actual exposure to the intervention was also suboptimal, and a higher received dose of computer-tailored interventions should be achieved counsellor training should be more extensive.

Television in the bedroom and increased body weight

Kids who spent more time watching TV are more likely to be overweight. This may be because if kids watch a lot of TV they sit too much, they may snack while watching TV, and/or they more exposed to marketing of unhealthy foods. It has been suggested that in order to reduce TV time, the opportunities for watching TV should be diminished: TV should become less accessible and available. In another study just published in the journal Pediatric Obesity, with Dr. Adrian Cameron as first author, we studied if 10-12 year old schoolchildren across Europe who have a TV in their bedroom are more likely to watch more TV, be overweight, and drink more soft drinks. This study was part of the ENERGY project. We found that almost 40% of schoolchildren had a bedroom television, with the highest percentage among Hungarian children (65%) and lowest for Belgian, Slovenian and Spanish children (all ≈28%). A television in the bedroom was positively associated with time spent watching television, soft drink consumption and overweight and obesity. The relationship between a television in the bedroom and measures of body size was partly mediated by total television viewing time but not by sleep duration, physical activity time or soft drink consumption.

Sedentary time, physical activity, and overweight in European schoolchildren

As we published recently in the journal PLOS ONE, more than 20% of 10-12 year old schoolchildren across Europe is overweight or obese. In some countries these rates are much higher, with more than 40% of Greek children being overweight of obese. When kids eat more calories than they use, the gain weight. Preventing overweight and obesity thus means maintaining a good energy balance. At least one hour of medium to high intensity physical activity is recommended for children for fitness and energy-balance. Next to diet and physical activity, too much sedentary behavior, i.e. activities that children do while sitting -watching TV, playing computer games, reading, doing homework et cetera- may be a separate risk behavior for metabolic health; even when children are physically active enough, if they sit most of the rest of the day, they may still be more likely to be overweight and obese. The evidence to support this is mixed at best, however. In our PLOS ONE study we showed that children spend more than two hours per day in front of the TV or computer screen. In separate studies we also showed that such screen time was only a minor part of total sedentary time, and that children who sat most had higher body mass index and waist circumference, but we found no evidence for other negative metabolic health indicators. In a new study just published in Pediatric Obesity, with prof Ilse de Bourdeaudhuij from Ghent University as first author, we now find that girls who show low physical activity and high sedentary time are most likely to be overweight, while for boys physical activity seems more than sedentary time.

Overweight and health behaviors in school children: Switzerland is doing good...

Overweight in children and adolescents is a major public health issue. To allow international comparisons, Switzerland joined the ENERGY study's cross sectional survey consortium that investigated the prevalence of overweight and obesity as well as selected dietary, physical and sedentary behaviors of 10--12 years old pupils across seven other countries in Europe. The aim of the study just published in the International Journal of Behavioral Nutrition and Physical Activity was to compare body composition and energy-balance related behaviors of Swiss schoolchildren to those of the seven European ENERGY-countries (i,e, Belgium, Greece, Hungary, the Netherlands, Norway, Slovenia and Spain) and to analyze overweight and energy-balance related behaviors of Swiss children according to socio-demographic factors. The results regarding these ENERGY countries were published in the journal Plos ONE earlier this year.
In Switzerland significantly less children were overweight (13.9%) or obese (2.3%) compared to the average across the ENERGY-countries (23.7% and 4.7%, respectively), and were even somewhat lower than the ENERGY countries with the lowest prevalence, i.e. Norway, Belgium and the Netherlands. Sugar sweetened beverage intakes and breakfast habits of Swiss children did not differ significantly from those of ENERGY. However, the mean time devoted by Swiss children to walking or cycling to school and attending sports activities was significantly higher and screen time significantly lower compared to the other ENERGY-countries. Within the Swiss, sample relatively large and consistent differences were observed between children from native and non-native ethnicity.

Is yoga beneficial for cancer survivors?

Physical activity and exercise have been found to help cancer survivors to improve fitness, reduce fatigue, and is associated with better survival. In a paper published in BMC Cancer, with Dr. Laurien Buffart as first author, we systematically reviewed and meta-analysed the results of existing randomized controlled trial (RCT) testing the effects of yoga on physical and psychosocial outcomes in cancer patients and survivors. Sixteen publications of 13 RCTs met the inclusion criteria, of which one included patients with lymphomas and the others focused on patients with breast cancer.

Of the outcomes studied in more than three studies among patients with breast cancer, we found large reductions in distress, anxiety, and depression, moderate reductions in fatigue, moderate increases in general quality of life, emotional function and social function, and a small increase in functional well-being. Evidence for effects on physical function and sleep was not found. We concluded that yoga appeared to be a feasible intervention and that beneficial effects on self-reported physical and psychosocial wellbeing were found among  patients with breast cancer, but no evidence was found for beneficial effects on physical function.

Micro-level economic factors and incentives in children's obesogenic behaviors

To date, most research on environments that may encourage children to eat too much and move too little, i.e. so-called obesogenic environments, has focused on physical and socio-cultural environments. Such environments determine what foods and physical activity opportunities are available and accessible (physical environment) and what is socially and culturally appropriate, acceptable and encouraged.The role of economic factors has been investigated to a much lesser extent. Our objective was to explore the association of micro-level economic factors and incentives with sports activities and intake of soft drinks and fruit juice in 10-12 year-old school children across Europe, and to explore price sensitivity in children's soft drink consumption and correlates of this price sensitivity. This study that was part of the ENERGY project was just published in the International Journal of Behavioral Nutrition and Physical Activity.
Data for the study originate from a cross-sectional survey undertaken in seven European countries (Belgium, Greece, Hungary, Netherlands, Norway, Slovenia and Spain) in 2010 among more than 7000 10-12 year-old school children and 6000 of their parents
Economic factors were found to be associated with children's sports participation and sugary drink consumption. Parents' financial support was found to be an important correlate of children's sports activities i.e. children whose parents financially supported their sports activities were more likely to engage in sports. Children's pocket money was a strong correlate of soft drink consumption; more pocket money was associated with more soft drinks. The majority of the responding children reported to expect that significantly higher prices of soft drinks would lead them to buy less soft drinks.

Family influences on children's soft drink and juice intakes

With the recently published paper in the New England Journal of Medicine, the evidence that sugary drinks contribute to unnecessary weight gain in children and adolescents is becoming more and more convincing.
The aim of a study we just published in e-pub in the scientific journal Appetite was to investigate associations of family-related factors with children's fruit drink/juice and soft drink consumption. We used the ENERGY study data from >7000 11 year old children and one of their parents from eight countries across Europe. We analyzed if the children's self-reported fruit drink/juice and soft drink intake and a range of family environment and parenting factors were associated. We looked at such factors as parental modeling (i.e. parents' own juice and soft drink intakes), availability of juice and soft drinks at home, whether parents monitored their children's intakes, their self-efficacy, parents' permissiveness, negotiations regarding intakes, communicating health beliefs, et cetera. Three of the 11 family-related factors considered (modeling, availability, and family consumption) were positively associated with children's fruit drink/juice and soft drink intake. Thus, children's intakes were on average higher when their parents had high intakes themselves, when drinks were readily available at home, and when family consumption was higher. Additionally, three other factors (permissiveness, monitoring, and self-efficacy) were solely associated with soft drink intake, i.e. children of parents who were more permissive regarding soft drinks, and who did not monitor children's intakes, and with lower self-efficacy drank more soft drinks. These results contribute to the body of evidence regarding the importance of the home environment for children's soft drink intakes. Most interventions aiming at contributing to the promotion of health behaviors in school-aged children are school-based and fail to involve the family; our study once more points to the importance of family, and especially parent, involvement.