Many overweight children and their parents underestimate the children’s weight status

A first step to obesity prevention and treatment is that one is aware of one's overweight. In a study across Europe, as part of the ENERGY study, we explored if children and their parents are aware of the children's overweight and obesity. This study was just published in e-pub in Public Health Nutrition.

The study was conducted among 6113 children aged 10–12 years and their parents. Children’s weight and height were objectively measured. Parental anthropometric and sociodemographic data were self-reported. Children and their parents were asked to comment on children’s weight status based on five-point Likert-type scales, ranging from ‘I am much too thin’ to ‘I am much too fat’ (children) and ‘My child’s weight is way too low’ to ‘My child’s weight is way too much’ (parents). These data were combined with children’s actual weight status, in order to assess underestimation of children’s weight status by children themselves and by their parents, respectively. 

43% of overweight/obese children and 28% of parents of overweight/obese children underestimated their and their children’s weight status, respectively. A higher likelihood for this underestimation was observed in Eastern and Southern compared with Central/Northern countries. Overweight or obese parents, parents of boys, and children from overweight/obese or unemployed parents were more likely to underestimate children’s weight status.

Determinants of dietary behavior among youth: an umbrella review

The literature on potential determinants of dietary behavior among youth is extensive and unwieldy. We conducted an umbrella review (or a 'review-of-reviews') to present a comprehensive overview of the current scientific knowledge. This review of reviews was just published in the International Journal of Behavioral Nutrition & Physical Activity.
We included systematic reviews identified in four scientific literature databases (i.e. PubMed, PsycINFO, The Cochrane Library and Web of Science) that summarized determinants of observable child and adolescent dietary behaviors. Data extraction included a judgment of the importance of determinants, strength of evidence and evaluation of the methodological quality of the eligible reviews.
In total, 17 reviews were considered. Whereas social-cognitive determinants were addressed most frequently towards the end of the 20th century, environmental determinants (in particular social and physical environmental factors) have been studied most extensively during the past decade, thereby representing a paradigm shift.With regard to environmental determinants, mixed findings were reported. Sedentary behavior and intention were found to be significant determinants of a wide range of dietary behaviors in most reviews, but these results were based on cross-sectional studies only. Other potential determinants such as automaticity, self-regulation and subjective norm have been studied in relatively few studies, but results suggest that these factors are important.

Good practice characteristics of diet and physical activity interventions and policies

Diet, physical activity and sedentary behaviour are main determinants of avoidable burden of disease. To promote health healthy lifestyles, public policies that promote or endorse such lifestyles are of crucial importance. Within the DEDIPAC (Determinants of Diet and Physical Activity) joint action of the Healthy Diet for a Healthy Life European Joint Programming initiative, we conducted an umbrella review -i.e. a systematic reviews of existing reviews- aimed at eliciting good practice characteristics of interventions and policies aiming at healthy diet, increasing physical activity, and lowering sedentary behaviours. This umbrella review was just published in the journal BMC Public Health.
We applied the World Health Organization’s framework, and sought for 3 types of characteristics, reflecting: (1) main intervention/policy characteristics, referring to the design, targets, and participants, (2) monitoring and evaluation processes, and (3) implementation issues.
We derived a list of 149 potential good practice characteristics, of which 53 were classified as relevant. The main characteristics of intervention/policy fell into 6 categories: the use of intervention theory, participants, target behavior, content development/management, multidimensionality, practitioners/settings. Monitoring and evaluation characteristics were also grouped into 6 categories: costs/funding, outcomes, evaluation of effects, time/effect size, reach, the evaluation of participation and generalizability, active components/underlying processes. Implementation characteristics were grouped into eight categories: participation processes, training for practitioners, the use/integration of existing resources, feasibility, maintenance/sustainability, implementation partnerships, implementation consistency/adaptation processes, transferability.
The use of the proposed list of 53 good practice characteristics may foster further development of health promotion sciences, as it would allow for identification of success vectors in the domains of main characteristics of interventions/policies, their implementation, evaluation and monitoring processes.

A virtual audit tool to assess obesogenicity of the build environment in neighbourhoods

A lack of physical activity and overconsumption of energy dense food is associated with overweight and obesity. The neighbourhood environment may stimulate or hinder the development and/or maintenance of a healthy lifestyle. To improve research on the obesogenicity of neighbourhood environments, reliable, valid and convenient assessment methods of potential obesogenic characteristics of neighbourhood environments are needed. In a study just published in pre-pub in the International Journal of Health Geographics -as part of the Spotlight project- we examined the reliability and validity of the SPOTLIGHT-Virtual Audit Tool (S- VAT), which uses remote sensing techniques (Street View feature in Google Earth) for desk- based assessment of environmental obesogenicity.
A total of 128 street segments in four Dutch urban neighbourhoods – heterogeneous in socio- economic status and residential density – were assessed using the S-VAT. Environmental characteristics were categorised as walking related items, cycling related items, public transport, aesthetics, land use-mix, grocery stores, food outlets and physical activity facilities. To assess concordance of inter- and intra-observer reliability of the Street View feature in Google Earth, and validity scores with real life audits, percentage agreement and Cohen's Kappa (k) were calculated.

The results suggest that the S-VAT is a reliable and valid remote sensing tool to assess potential obesogenic environmental characteristics.

Implementation evaluation of school-based obesity prevention programmes in youth; how, what and why?

In an ideal world, one combats public health problems with theory- and evidence-based programmes. In the real world, evidence-based programmes are often lacking and programmes that are developed and implemented are mainly practice-based. Furthermore, if evidence-based programs are available, these are often not implemented as intended, making the effectiveness in real life settings often much lower than ideal.
Three important generic implementation research questions in the context of programme evaluation are: (i) how to promote implementation as intended; (ii) what happens during implementation; and (iii) why did my programme (not) work? In an invited commentary just published in the journal Public Health Nutrition we -with soon-to-be Dr. Femke van Nassau as first author- discuss
these three questions, enriched by our experiences with the school-based obesity prevention programme DOiT(Dutch Obesity Intervention in Teenagers).

Parental modelling mediates parental education differences in children's TV time

Children from lower educated parents tend to have less positive health behaviours than kids from higher educated parents. Children's sport participation is a health behaviour, associated with positive health outcomes, while children's TV time -a sedentary behaviour- is associated with higher likelihood for overweight and obesity and lower cardiometabolic health. In a paper just published online in Preventive Medicine, we assessed whether differences in children's sport participation and TV time according to parental education were mediated by parental modelling, i.e. by 'example behaviour' of the parents. In other words: we wanted to explore if lower educated parents are less likely to participate in sports and watch more TV themselves and if these behaviours help explain the less positive health behaviours in their children. We used the data of the cross European ENERGY study. We found evidence that parental modelling was important for differences in children's health behaviours according to the level of education of their parents, especially regarding children's TV time.

DEDIPAC: Determinants of diet and physical activity Knowledge Hub

To address major societal challenges and enhance cooperation in research across Europe, the European Commission has initiated and facilitated ‘joint programming’. Joint programming is a process by which Member States engage in defining, developing and implementing a common strategic research agenda, based on a shared vision of how to address major societal challenges that no Member State is capable of resolving independently. Setting up a Joint Programming Initiative (JPI) should also contribute to avoiding unnecessary overlap and repetition of research, and enable and enhance the development and use of standardised research methods, procedures and data management. The Determinants of Diet and Physical Activity (DEDIPAC) Knowledge Hub (KH) is the first joint action of the European JPI ‘A Healthy Diet for a Healthy Life’. A paper describing the rationale, organisation and potential added value of DEDIPAC was just published in the International Journal of Behavioral Nutrition and Physical Activity. The objective of DEDIPAC is to contribute to improving understanding of the determinants of dietary, physical activity and sedentary behaviours. DEDIPAC KH is a multi-disciplinary consortium of 46 consortia and organisations supported by joint programming grants from 12 countries across Europe. The work is divided into three thematic areas: (I) assessment and harmonisation of methods for future research, surveillance and monitoring, and for evaluation of interventions and policies; (II) determinants of dietary, physical activity and sedentary behaviours across the life course and in vulnerable groups; and (III) evaluation and benchmarking of public health and policy interventions aimed at improving dietary, physical activity and sedentary behaviours. In the first three years, DEDIPAC KH will organise, develop, share and harmonise expertise, methods, measures, data and other infrastructure. This should further European research and improve the broad multi-disciplinary approach needed to study the interactions between multilevel determinants in influencing dietary, physical activity and sedentary behaviours. Insights will be translated into more effective interventions and policies for the promotion of healthier behaviours and more effective monitoring and evaluation of the impacts of such interventions.