Addressing schoolteacher food and nutrition-related health and wellbeing: a scoping review of the food and nutrition constructs used across current research

BACKGROUND

Teachers form a large and essential workforce globally. Their wellbeing impacts personal health-related outcomes with flow on effects for the health, and wellbeing of their students. However, food and nutrition (FN) interventions that include teachers, typically neglect the impact of personal FN factors on a teachers' ability to achieve optimal nutrition-related health and wellbeing, and successfully fulfil their professional FN roles as health promoters, gate keepers, educators', and role models. The aim of this review was to scope FN constructs that have been studied internationally regarding teacher FN-related health and wellbeing.

METHODS

Six databases were searched, and papers extracted in June/July 2021. Eligibility criteria guided by the population, concept, context mnemonic included studies published after 2000, in English language, with an aspect of personal FN-related health and wellbeing, among in-service (practising) and pre-service (training), primary, and secondary teachers. Screening studies for inclusion was completed by two independent researchers with data extraction piloted with the same reviewers and completed by lead author, along with complete descriptive and thematic analysis.

RESULTS

Ten thousand six hundred seventy-seven unique articles were identified with 368 eligible for full text review and 105 included in final extraction and analysis. Sixty-nine descriptive studies were included, followed by 35 intervention studies, with the main data collection method used to assess both personal and professional FN constructs being questionnaires (n = 99 papers), with nutrition knowledge and dietary assessment among the most commonly assessed.

CONCLUSION

FN constructs are used within interventions and studies that include teachers, with diversity in constructs included and how these terms are defined. The evidence from this scoping review can be used to inform data collection and evaluation in future epidemiological and interventional research that addresses teacher FN-related health and wellbeing.

Impact and evaluation of an online culinary nutrition course for health, education and industry professionals to promote vegetable knowledge and consumption

BACKGROUND

Poor diet, including inadequate vegetable intake, is a leading risk factor for noncommunicable disease. Culinary and nutrition education provided to trainee and practising health and education professionals is an emerging strategy to promote improved dietary intake, including vegetable consumption. We evaluated the impact and feasibility of an online culinary medicine and nutrition (CM/CN) short course for health, education and vegetable industry professionals. The course aimed to improve participants' skills and confidence to prepare vegetables, knowledge of evidence-based nutrition information and recommendations for improving vegetable consumption and diet quality.

METHODS

A pre-post study consisting of two separate groups participating in two course rounds recruited practising professionals (n = 30) working in health; community, adult and/or culinary education; and the vegetable industry. Evaluation assessed diet quality, vegetable consumption barriers, cooking and food skill confidence, nutrition knowledge and process measures.

RESULTS

Seventeen participants (68%) completed the programme. Pre- to postintervention statistically significant increases in vegetables (M 1.3, SD 2.2), fruit (M 1.6, SD 3.1), and breads and cereal (M 1.1, SD 1.7) intakes were observed. Statistically significant increases and large effect sizes for mean food skill confidence scores (M 8.9, SD 15.4, Cohen's d 0.56) and nutrition knowledge scores (M 6.2, SD 15.4, Cohen's d 0.83) were also observed pre- to postintervention.

CONCLUSIONS

The short online course was feasible and improved diet quality, food skill confidence and nutrition knowledge. Online CM/CN education for practising professionals represents a promising area of research. Future research involving a larger study sample and a more rigorous study design such as a randomised control trial is warranted.

Facilitators and barriers to providing culinary nutrition, culinary medicine and behaviour change support: An online cross-sectional survey of Australian health and education professionals

BACKGROUND

An Australia wide cross-sectional online survey examined facilitators and barriers of health and education professionals to providing culinary nutrition (CN) and culinary medicine (CM) education and behaviour change support in usual practice, in addition to identifying continuing professional development (CPD) needs in this domain.

METHODS

Survey items included socio-demographic characteristics, cooking and food skills confidence, nutrition knowledge (PKB-7), fruit and vegetable intake (FAVVA) and CPD needs. Data were summarised descriptively.

RESULTS

Of 277 participants, 65% were likely/somewhat likely to participate in CN CPD. Mean (SD) cooking and food skill confidence scores were 73 (17.5) and 107.2 (24), out of 98 and 147, respectively. Mean PKB-7 score was 3.7 (1.4), out of 7. Mean FAVVA score was 98 (29), out of 190.

CONCLUSIONS

Gaps in knowledge and limited time were the greatest modifiable barriers to providing CM/CN education and behaviour change support in practice. Health and education professionals are interested in CPD conducted by dietitians and culinary professionals to enhance their knowledge of CM/CN and behaviour change support.

Development of the Cook-EdTM Matrix to Guide Food and Cooking Skill Selection in Culinary Education Programs That Target Diet Quality and Health

Culinary education programs are generally designed to improve participants’ food and cooking skills, with or without consideration to influencing diet quality or health. No published methods exist to guide food and cooking skills’ content priorities within culinary education programs that target improved diet quality and health. To address this gap, an international team of cooking and nutrition education experts developed the Cooking Education (Cook-Ed^TM) matrix. International food-based dietary guidelines were reviewed to determine common food groups. A six-section matrix was drafted including skill focus points for: (1) Kitchen safety, (2) Food safety, (3) General food skills, (4) Food group specific food skills, (5) General cooking skills, (6) Food group specific cooking skills. A modified e-Delphi method with three consultation rounds was used to reach consensus on the Cook-Ed^TM matrix structure, skill focus points included, and their order. The final Cook-Ed^TM matrix includes 117 skill focus points. The matrix guides program providers in selecting the most suitable skills to consider for their programs to improve dietary and health outcomes, while considering available resources, participant needs, and sustainable nutrition principles. Users can adapt the Cook-Ed^TM matrix to regional food-based dietary guidelines and food cultures.

Making sense of adolescent-targeted social media food marketing: A qualitative study of expert views on key definitions, priorities and challenges

Traditional food marketing stimulates adolescents' consumption of energy-dense, nutrient-poor foods. These dietary behaviours may track into adulthood and lead to weight gain, obesity and related non-communicable diseases. While social media use in adolescents has proliferated, little is known about the content of food marketing within these platforms, and how this impacts adolescents' dietary behaviours. This paper aimed to obtain expert insights on factors involved in the association between social media food marketing (SMFM) and adolescent dietary behaviours, and to explore their views on key priorities, challenges and strategies for future SMFM research and policies. One-on-one semi-structured interviews (n = 17) were conducted with experts from Western Europe, Australia and North America, in the fields of public health (policy), nutrition science, social media marketing, adolescent medicine, clinical psychology, behavioural sciences, communication, food industry, social influencing, and social marketing. The experts' collective responses identified that the line between food content posted by social media users and food companies is blurred. Adolescents' processing of SMFM may be mostly implicit, involving social comparison, emotional engagement, and attaching symbolic meanings to foods. Mediating factors and adolescent-specific and SMFM-specific moderating factors potentially influencing adolescents' response to SMFM were summarized in a Social Ecological model. Experts agreed that there is limited scientific evidence on adolescent-targeted SMFM and there are no strict regulations in place to protect adolescents from unhealthy SMFM, while adolescents are active social media users who are cognitively vulnerable to implicit marketing tactics. Adolescent-targeted SMFM should be controlled by encouraging healthy food marketing or limiting junk food marketing. Also, prioritizing both quantitative research on SMFM exposure and its impact, and qualitative research to obtain adolescents' perspectives, is crucial to advocate for regulatory changes regarding adolescent-targeted SMFM content.

Culinary medicine and culinary nutrition education for individuals with the capacity to influence health related behaviour change: A scoping review

BACKGROUND

Culinary medicine (CM) or culinary nutrition (CN) education provided to professionals with the capacity to influence behaviour change is an emerging strategy to promote diet quality and reduce the burden of diet related chronic disease in adults. The purpose of this scoping review was to synthesise current research describing CM/CN education provided to or by health, education and culinary professionals, or students of these disciplines.

METHODS

Preferred Reporting Items for Systematic reviews and Meta-Analysis extension for Scoping Reviews (PRISMA-ScR) was used. Eleven electronic databases were searched in March 2019. Included studies were: (i) nutrition, health or lifestyle programs with a CM/CN component; (ii) study participants or programs facilitated by people working or training in health, community and/or adult education, or culinary roles where facilitator training was described; (iii) reported in the English language; and (iv) published from 2003.

RESULTS

In total, 33 studies were included. Nineteen studies delivered programs to general population groups and were facilitated by health professionals and/or health university students. Fourteen studies delivered CM/CN training to health professionals or students. Studies reported changes in participants' culinary skill and nutrition knowledge (n = 18), changes in dietary intake (n = 13), attitudes and behaviour change in healthy eating and cooking (n = 4), and competency in nutrition counselling and knowledge (n = 7).

CONCLUSIONS

Further research examining the effectiveness of CM/CN programs, and that describes optimal content, format and timing of the programs, is needed. Research evaluating the impact of training in CM/CN to education and culinary professionals on healthy cooking behaviours of their patients/clients is warranted.

A Qualitative Study of Motivators, Strategies, Barriers, and Learning Needs Related to Healthy Cooking during Pregnancy

Nutrition during pregnancy has lifelong impacts on the health of mother and child. However, this life stage presents unique challenges to healthy cooking and eating. Cooking interventions show promising results, but often lack theoretical basis and rigorous evaluation. The objective of this formative, qualitative study was to explore motivators, strategies, and barriers related to healthy cooking during pregnancy. Pregnant individuals’ preferences for a cooking education program were also explored. We conducted five focus groups with pregnant individuals (n = 20) in Southeast Michigan in 2019. Focus groups were audio-recorded and transcribed verbatim, then double coded by two members of the research team. Mean gestational age was 18.3 ± 9.6 weeks. Common motivators included feeding other children, avoiding pregnancy complications, promoting fetal growth, and avoiding foodborne illness. Challenges included pregnancy symptoms, navigating nutrition recommendations, mental energy of meal planning, family preferences, and time constraints. Strategies employed were meal planning and including a variety of foods. Participants identified organizational strategies, recipes, nutrition information, and peer support as important components of a cooking intervention during pregnancy. This study characterized multiple challenges to healthy home cooking during pregnancy, providing novel insight to inform the development of cooking skills education programs during this important life stage.

Process Evaluation of the 'No Money No Time' Healthy Eating Website Promoted Using Social Marketing Principles. A Case Study

Background: Reaching and engaging individuals, especially young adults, in web-based prevention programs is challenging. ‘No Money No Time’ (NMNT) is a purpose built, healthy eating website with content and a social marketing strategy designed to reach and engage a young adult (18–34 year olds) target group. The aim of the current study was to conduct a process evaluation of the 12-month social marketing strategy to acquire and engage NMNT users, particularly young adults. Methods: a process evaluation framework for complex interventions was applied to investigate the implementation of the social marketing strategy component, mechanisms of impact and contextual factors. Google Analytics data for the first 12 months of operation (17 July 2019 to 17 July 2020) was evaluated. Results: in year one, 42,413 users from 150+ countries accessed NMNT, with 47.6% aged 18–34 years. The most successful channel for acquiring total users, young adults and return users was via organic search, demonstrating success of our marketing strategies that included a Search Engine Optimisation audit, a content strategy, a backlink strategy and regular promotional activities. For engagement, there was a mean of 4.46 pages viewed per session and mean session duration of 3 min, 35 s. Users clicked a ‘call-to-action’ button to commence the embedded diet quality tool in 25.1% of sessions. The most common device used to access NMNT (63.9%) was smartphone/mobile. Engagement with ‘quick, cheap and healthy recipes’ had the highest page views. Conclusions: findings can inform online nutrition programs, particularly for young adults, and can apply to other digital health programs.

Impact of preconception, pregnancy, and postpartum culinary nutrition education interventions: a systematic review

CONTEXT

Frequent consumption of home-prepared meals is associated with higher diet quality in children and adults. Therefore, increasing the culinary skills of women and couples during their childbearing years may be an effective strategy for the prevention of overweight and obesity.

OBJECTIVE

To determine the impact of culinary nutrition-education interventions for women with or without their partners during preconception, pregnancy, or postpartum (PPP) on parental cooking skills, nutrition knowledge, parent/child diet quality, or health outcomes.

DATA SOURCES

Eligibility criteria were defined using a PICOS framework. A systematic search strategy was developed to identify eligible studies and was implemented in 11 electronic databases. Reference lists of selected systematic reviews were manually searched for additional studies.

DATA EXTRACTION

Study characteristics and outcomes were extracted from eligible studies by 1 reviewer and checked by a second reviewer.

DATA ANALYSIS

A narrative synthesis of the findings of eligible studies was prepared including descriptive statistics. Reporting was guided by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement and Synthesis Without Meta-Analysis in systematic reviews reporting guideline.

RESULTS

A total of 6951 articles were identified from the search strategy and 31 studies during pregnancy or postpartum were included. By category, the number of studies with a favorable outcome per total number of studies measuring outcome were as follows: parental food/cooking skills (n = 5 of 5), nutrition knowledge (n = 6 of 11), parent/child diet quality (n = 10 of 19), infant feeding (n = 6 of 11), eating behavior (n = 2 of 5), maternal (n = 2 of 5) and child anthropometry (n = 6 of 10), mental health and development n = (2 of 3), and clinical indictors (n = 1 of 1).

CONCLUSIONS

Culinary nutrition-education interventions during pregnancy and the postpartum period show promise in improving cooking skills, diet quality, and a variety of health-related outcomes. The precise effect of these interventions during PPP is limited by the quality and heterogeneity of study designs to date.

SYSTEMATIC REVIEW REGISTRATION

PROSPERO registration number: CRD42020154966.

Be Healthe for Your Heart: A Pilot Randomized Controlled Trial Evaluating a Web-Based Behavioral Intervention to Improve the Cardiovascular Health of Women with a History of Preeclampsia

This pilot randomized controlled trial (RCT) aimed to determine the acceptability and preliminary efficacy of a web-based cardiovascular disease (CVD) prevention intervention for women following preeclampsia. Australian women with a recent history (≤4 years post diagnosis) of preeclampsia were randomized into two study arms: (1) Be Healthe for your Heart, a web-based behavioral intervention or; (2) Control, access to the National Heart Foundation website. Assessments were conducted at baseline, and after three months. Intervention acceptability and impact on absolute CVD 30-year risk score, CVD risk markers and health behaviors were assessed. Twenty-four of 31 (77.4%) women completed the three-month assessment. Eleven out of 13 intervention participants (84.6%) agreed/strongly agreed they were satisfied with the program, with a mean score of 4.2 ± 0.9 (maximum of five). There were no significant between or within group differences in absolute CVD risk, CVD risk markers or health behaviors from baseline to three months. Women with a history of preeclampsia were successfully recruited and retained and they reported high levels of acceptability with the Be Healthe for your Heart program. Further research is therefore needed from powered trials to determine the impact of web-based lifestyle interventions on CVD risk in this at-risk group.

Cook-EdTM: A Model for Planning, Implementing and Evaluating Cooking Programs to Improve Diet and Health

Domestic cooking education programs are typically designed to improve an individual’s food and cooking skills, although not necessarily diet quality. Currently, there are no comprehensive models to guide the planning, implementation and evaluation of domestic cooking education programs that focus on improving diet and health. Our aim was to address this through development of the Cooking Education (“Cook-Ed^TM”) model, using the PRECEDE-PROCEED model as the underlying Cook-Ed^TM framework. A review of the food and cooking skills education literature informed the content of the Cook-Ed^TM model. Cook-Ed^TM was critiqued by experts in consumer behaviour, cooking and nutrition education research and education until consensus on model content and format was reached. Cook-Ed^TM leads cooking program developers through eight distinct stages, engaging key stakeholders in a co-design process from the outset to tailor programs to address the need of individuals and inform the development of program content, program delivery, and evaluation. A Cook-Ed^TM scenario applied in practice is described. The proposed Cook-Ed^TM model has potential to be adapted for use in domestic cooking education programs delivered in clinical, community, school or research settings. Further research will establish Cook-Ed^TM’s utility in enhancing program development and in improving food and cooking skills, dietary patterns and health outcomes.

Development of the Home Cooking EnviRonment and Equipment Inventory Observation form (Home-CookERITM): An Assessment of Content Validity, Face Validity, and Inter-Rater Agreement

Introduction: Quantifying Home Cooking EnviRonments has applications in nutrition epidemiology, health promotion, and nutrition interventions. This study aimed to develop a tool to quantify household cooking environments and establish its content validity, face validity, and inter-rater agreement. Methods: The Home Cooking EnviRonment and equipment Inventory observation form (Home-CookERI™) was developed as a 24-question (91-item) online survey. Items included domestic spaces and resources for storage, disposal, preparation, and cooking of food or non-alcoholic beverages. Home-CookERI^TM was piloted to assess content validity, face validity, and usability with six Australian experts (i.e., dietitians, nutrition researchers, chefs, a food technology teacher, and a kitchen designer) and 13 laypersons. Pilot participants provided feedback in a 10 min telephone interview. Home-CookERI™ was modified to an 89-item survey in line with the pilot findings. Inter-rater agreement was examined between two trained raters in 33 unique Australian households. Raters were required to observe each item before recording a response. Home occupants were instructed to only assist with locating items if asked. Raters were blinded to each other’s responses. Inter-rater agreement was calculated by Cohen’s Kappa coefficient (κ) for each item. To optimize κ, similar items were grouped together reducing the number of items to 81. Results: Home-CookERI^TM had excellent content and face validity with responding participants; all 24 questions were both clear and relevant (X² (1, n = 19; 19.0, p = 0.392)). Inter-rater agreement for the modified 81-item Home-CookERI™ was almost-perfect to perfect for 46% of kitchen items (n = 37 items, κ = 0.81–1), moderate to substantial for 28% (n = 23, κ = 0.51–0.8), slight to fair for 15% (n = 12, κ = 0.01–0.5), and chance or worse for 11% of items (n = 9, κ ≤ 0.0). Home-CookERI^TM was further optimized by reduction to a 77-item version, which is now available to researchers. Conclusion: Home-CookERI™ is a comprehensive tool for quantifying Australian household cooking environments. It has excellent face and content validity and moderate to perfect inter-rater agreement for almost three-quarters of included kitchen items. To expand Home-CookERI™ applications, a home occupant self-completion version is planned for validation.

Children's Intake of Food from Non-Fast-Food Outlets and Child-Specific Menus: A Survey of Parents

Eating out-of-home is associated with higher energy intakes in children. The continued high prevalence of childhood obesity requires a greater understanding of child menu options and eating out frequency to inform appropriate regulatory initiatives. The majority of studies to date have focused on menus from fast-food outlets with few focused on non-fast-food outlets. This study aimed to describe parents’ reports of their child(ren)’s (aged up to 6 years) frequency of consuming foods at non-fast-food outlets, observations of child menus at these outlets, and their purchasing behaviours and future preferences regarding these menus; and if their responses were influenced by sociodemographic characteristics. Ninety-five parents completed a 15-item cross-sectional survey. Overall, children from 54% of families consumed food from non-fast-food outlets at least monthly. Of the 87 parents who reported that their child eats at a non-fast-food restaurant, 71 had children who ordered from child menus every time (7%, n = 5), often (29%, n = 22), sometimes (42%, n = 32) or rarely (16%, n = 12), with a further 7% (n = 5) never ordering from these menus. All parents indicated that they would like to see a higher proportion of healthy child menu items than is currently offered. Parents’ responses were not influenced by sociodemographic characteristics. Parents’ views support implementation of initiatives to increase availability of healthy options on child menus at non-fast-food outlets.

Be Healthe for Your Heart: Protocol for a Pilot Randomized Controlled Trial Evaluating a Web-Based Behavioral Intervention to Improve the Cardiovascular Health of Women With a History of Preeclampsia

Background: Women with a history of preeclampsia are at greater risk of cardiovascular disease (CVD) related morbidity. Despite this knowledge, there is a lack of interventions available for women with a history of preeclampsia for the prevention of CVD. The aim of this pilot randomized controlled trial (RCT) is to determine the acceptability and preliminary efficacy of a web-based behavioral intervention targeted to women with a history of preeclampsia (Be Healthe for your Heart).

Method: Australian women aged 18–45 years, with a recent history (≤4 years post diagnosis) of preeclampsia will be recruited for a 3-months, 2-arm parallel group pilot RCT. Participants will be randomized into 2 study arms: (1) Be Healthe for your Heart or; (2) Control, with assessments conducted at baseline, and after 3-months. Be Healthe for your Heart is an intervention delivered online via the program website, with weekly emails to support changes in modifiable CVD risk factors (excess body weight, physical inactivity, poor diet, and stress), using behavior change techniques (e.g., self-monitoring, goal setting). Intervention acceptability (satisfaction, usability, appropriateness, and usage) and impact on absolute full CVD 30-years risk score, CVD risk markers, and modifiable risk factors will be assessed.

Discussion: No studies to date have evaluated acceptability and preliminary efficacy of a web-based intervention for the prevention of CVD in this high-risk population with preeclampsia. This pilot trial will inform development of a fully powered RCT if acceptability and preliminary efficacy are demonstrated.

Issues in Measuring and Interpreting Diet and Its Contribution to Obesity

PURPOSE OF REVIEW

This review summarises the issues related to the measurement and interpretation of dietary intake in individuals with overweight and obesity, as well as identifies future research priorities.

RECENT FINDINGS

Some aspects of the assessment of dietary intake have improved through the application of technology-based methods and the use of dietary biomarkers. In populations with overweight and obesity, misreporting bias related to social desirability is a prominent issue. Future efforts should focus on combining technology-based dietary methods with the use of dietary biomarkers to help reduce and account for the impact of these biases. Future research will be important in terms of strengthening methods used in the assessment and interpretation of dietary intake data in the context of overweight and obesity.

WITHDRAWN: Interventions for treating obesity in children

BACKGROUND

Child and adolescent obesity is increasingly prevalent, and can be associated with significant short- and long-term health consequences.

OBJECTIVES

To assess the efficacy of lifestyle, drug and surgical interventions for treating obesity in childhood.

SEARCH METHODS

We searched CENTRAL on The Cochrane Library Issue 2 2008, MEDLINE, EMBASE, CINAHL, PsycINFO, ISI Web of Science, DARE and NHS EED. Searches were undertaken from 1985 to May 2008. References were checked. No language restrictions were applied.

SELECTION CRITERIA

We selected randomised controlled trials (RCTs) of lifestyle (i.e. dietary, physical activity and/or behavioural therapy), drug and surgical interventions for treating obesity in children (mean age under 18 years) with or without the support of family members, with a minimum of six months follow up (three months for actual drug therapy). Interventions that specifically dealt with the treatment of eating disorders or type 2 diabetes, or included participants with a secondary or syndromic cause of obesity were excluded.

DATA COLLECTION AND ANALYSIS

Two reviewers independently assessed trial quality and extracted data following the Cochrane Handbook. Where necessary authors were contacted for additional information.

MAIN RESULTS

We included 64 RCTs (5230 participants). Lifestyle interventions focused on physical activity and sedentary behaviour in 12 studies, diet in 6 studies, and 36 concentrated on behaviorally orientated treatment programs. Three types of drug interventions (metformin, orlistat and sibutramine) were found in 10 studies. No surgical intervention was eligible for inclusion. The studies included varied greatly in intervention design, outcome measurements and methodological quality.Meta-analyses indicated a reduction in overweight at 6 and 12 months follow up in: i) lifestyle interventions involving children; and ii) lifestyle interventions in adolescents with or without the addition of orlistat or sibutramine. A range of adverse effects was noted in drug RCTs.

AUTHORS' CONCLUSIONS

While there is limited quality data to recommend one treatment program to be favoured over another, this review shows that combined behavioural lifestyle interventions compared to standard care or self-help can produce a significant and clinically meaningful reduction in overweight in children and adolescents. In obese adolescents, consideration should be given to the use of either orlistat or sibutramine, as an adjunct to lifestyle interventions, although this approach needs to be carefully weighed up against the potential for adverse effects. Furthermore, high quality research that considers psychosocial determinants for behaviour change, strategies to improve clinician-family interaction, and cost-effective programs for primary and community care is required.

School-Level Socioeconomic Status Influences Adolescents' Health-Related Lifestyle Behaviors and Intentions

BACKGROUND

School-level socioeconomic status (SES) influences on adolescents' lifestyle behaviors is understudied. We examined how school-level SES and sex influence adolescents' health-related lifestyle behaviors and intentions.

METHODS

Grade 8 students aged 13-14 years completed an online questionnaire regarding their sociodemographic characteristics, dietary behaviors, physical activity participation and recreational screen-time, and intentions regarding these behaviors. School-level SES, based on an Index of Community Socio-Educational Advantage (ICSEA), was categorized as low or high. Generalized estimating equations estimated individual-level summary statistics, adjusted for clustering.

RESULTS

Students (N = 2538; response rate = 79%) from 23 high schools (low ICSEA = 16) participated. Compared with low ICSEA students, high ICSEA students were more likely to report eating breakfast daily (OR 1.9 [95% CI 1.5, 2.4]), not drinking sugar-sweetened beverages (SSBs) daily (2.9 [1.9, 4.3]), and were more likely to have intentions to eat breakfast (1.8 [1.3, 2.3]) and ≥ 5 vegetable serves (1.2 [1.0, 1.5]) daily. Boys were more likely than girls to meet recommendations for breakfast eating, vegetable intake, moderate-to-vigorous physical activity and screen-time, but boys were less likely to meet recommendations regarding SSB intake.

CONCLUSIONS

Students from low ICSEA schools would benefit from additional support to improve dietary-related behaviors and intentions. More research is required to identify what targeted approaches will address sex differences in adolescents' lifestyle behaviors.

Update of the best practice dietetic management of overweight and obese children and adolescents: a systematic review protocol

REVIEW QUESTION/OBJECTIVE

To update an existing systematic review series of randomized controlled trials (RCT) that include a dietary intervention for the management of overweight or obesity in children or adolescents.Specifically, the review questions are: In randomized controlled trials of interventions which include a dietary intervention for the management of overweight or obesity in children or adolescents.

A pilot randomized controlled trial of a post-discharge program to support emerging adults with type 1 diabetes mellitus transition from pediatric to adult care

AIMS

There is a paucity of randomized controlled trials (RCT) examining transition from pediatric to adult care in type 1 diabetes mellitus (T1DM). This study aimed to determine if transition in T1DM is more effective with a comprehensive transition program (CTP) compared with standard clinical practice (SCP).

METHODS

This RCT recruited as young people left pediatric diabetes services. The trial co-ordinator provided CTP participants with standardized telephone communication support at week 1, and 3, 6, and 12 months post-discharge from pediatric care. SCP participants were briefly contacted at 6 and 12 months post-discharge to confirm transfer status; they received no other post-discharge contact as per usual practice. At 12 months, the primary outcomes were engagement and retention in the adult service and secondary outcomes included hemoglobin A1c (HbA1c), diabetes-related hospitalizations, microvascular complication appearance, and global self-worth.

RESULTS

Most CTP participants (11/14) and all SCP (12/12) participants (P = 0.2) transferred to an adult diabetes service; the median time to transfer was 14-15 wk. Overall, participants' frequency of adult diabetes service visits was sub-optimal but their retention in adult care was high. The only group difference was a higher HbA1c at baseline and follow-up in the CTP group. However, a general linear model found that follow-up HbA1c increased by 1.2% for each percentage increase in baseline HbA1c [95% confidence interval (0.4, 1.9; P = 0.01)], independent of treatment group.

CONCLUSIONS

Despite the challenges in recruiting adequate numbers, these findings provide valuable insights for future T1DM transition RCTs that are needed to build a more solid evidence-base in this field.

A process evaluation of an adolescent weight management intervention: findings and recommendations

Process evaluation is valuable in guiding development of effective intervention programmes but rare in adolescent weight management. This paper presents a process evaluation of the Loozit(®) randomized controlled trial, a community-based behavioural lifestyle intervention for obese 13-16 year olds. Adolescents were randomized to receive the two-phase Loozit(®) group programme, with (n = 73) or without (n = 78), additional therapeutic contact (telephone coaching, short message service and/or emails) in Phase 2. Quantitative and qualitative process data were collected. Facilitators used a standardized evaluation form to document participant attendance, and comment on lesson adherence and process delivery. Adolescents and parents completed satisfaction questionnaires at 2-, 12- and 24-month follow-ups. Following the intervention, 14 adolescents who provided informed written consent were interviewed about their experience with additional therapeutic contact. Data were analysed using descriptive statistics, parametric and non-parametric tests to compare group means, and thematic analyses. Group attendance rates averaged 85 and 47% during Phases 1 (0-2 months) and 2 (3-24 months), respectively. Facilitators frequently noted that participants reported making healthy lifestyle changes. Elements enjoyed in the sessions included practical activities, fun active games, resistance training and forming new friendships. Adolescents struggled with setting specific, measurable, achievable, realistic and timely (SMART) goals. Overall, participants were satisfied with the help received including the telephone and electronic contact. More than 80% of participants found the programme changed adolescents' eating and physical activity habits, and 89% of parents reported changing parenting strategies. Future adolescent group-based programmes may enhance participant engagement and programme effectiveness by including more interactive and frequent telephone and electronic contact.

Transition to adult care in adolescent obesity: a systematic review and why it is a neglected topic

Transition in pediatric health care involves the purposeful, planned movement of patients from pediatric to adult services. Following the significant increases in long-term survival of chronic childhood diseases in the 1980s, transition has taken on an increasing importance in the management of these chronic diseases. In Australia, there is a conspicuous lack of programs/guidelines for transitioning adolescents with obesity. The authors sought to determine if this is an international phenomenon that should be addressed. This study aimed to identify what formal transition services or guidelines exist internationally for adolescents with overweight/obesity. Two systematic reviews of the published and 'gray' literature were implemented via searches of relevant databases, search engines and websites. The primary review eligibility criteria were documents published between 1982 and 2012 including any aspect of transitioning adolescents with overweight/obesity from pediatric to adult weight management services. The secondary review included current clinical practice guidelines/statements on pediatric obesity management published between 1992 and 2012, and transition recommendations contained within. Non-English language documents were excluded. Relevant text from eligible documents was systematically identified and extracted, and a qualitative synthesis of the data was prepared. Overall, 2272 unique records were identified from the literature searches. Three eligible articles were identified by the primary review. The secondary review identified 24 eligible guidelines/statements. In total, six of the identified documents contained information on transition in adolescent obesity-the most detailed documents provided only a brief statement recommending that transition from pediatric to adult weight management services should take place. In conclusion, internationally there is an absence of published intervention programs/policies, and brevity of clinical guidance and expert opinion, on the transition of adolescents with obesity making this a priority research area. Consideration is given to the reasons why transition in adolescent obesity is a neglected topic.

Maternal misconceptions of weight status among Nepean adolescents

Adolescence is characterized by rapid physical growth and sexual maturation. These changes may alter parents' beliefs about their adolescent's weight status. This study aimed to examine the changes between early and mid-adolescence in: (a) the accuracy of maternal perception regarding her adolescent's weight status, (b) the degree of maternal concern about her adolescent's weight status, and (c) the predictors of maternal misclassification of adolescent overweight as average weight. A secondary analysis of the longitudinal Nepean Study data was conducted. Participants were Australian, free-living 13-year-olds in 2002-2003 (n=347) followed up at age 15 years (n=279) and their mothers. Participants' body mass index (BMI) status (overweight, normal, or underweight) was calculated from measured height and weight. Maternal perceptions and concerns about adolescent's weight status were determined by items adapted from the Child Feeding Questionnaire. Sex-adjusted binary logistic regression models assessed potential predictors of maternal misclassification of adolescent overweight. Data were available on 224 adolescent-mother dyads. Approximately one fourth of mothers misclassified their adolescent's weight status, but this varied across groups (age 13 years [%]; age 15 years [%], respectively) underweight (75%; 70%), overweight (54%; 59%), and normal weight (12%; 9%). The endpoint data show that between 13 and 15 years of age, maternal concern regarding their adolescent's weight decreased in all weight-status groups. Predictors of maternal misclassification of adolescent overweight were adolescent BMI z score, recent weight-management practices, weight history, sex, and maternal concern regarding her adolescent's weight. These results reinforce the need for strategies in primary care that are implemented throughout adolescence to improve maternal awareness of childhood overweight.

Twelve-month outcomes of the loozit randomized controlled trial: a community-based healthy lifestyle program for overweight and obese adolescents

OBJECTIVES

To assess the outcomes of the Loozit adolescent weight management intervention and to evaluate the effect of additional therapeutic contact 12 months into the program.

DESIGN

A 24-month, 2-arm randomized controlled trial. Results at 12 months are presented.

SETTING

Community health center and children's hospital in Sydney, Australia.

PARTICIPANTS

A total of 151 overweight or obese 13- to 16-year-olds.

INTERVENTION

In the first 2 months (phase 1), participants received 7 adolescent and parent weekly sessions focused on lifestyle modification. From 2 to 24 months (phase 2), adolescents attended booster sessions once every 3 months. During phase 2, adolescents randomized to the additional therapeutic contact arm also received telephone coaching and electronic communications once every 2 weeks.

OUTCOME MEASURES

Baseline to 12-month changes in body mass index z score and waist to height ratio (primary outcomes) and changes in metabolic, psychosocial, and behavioral variables.

RESULTS

Of 151 randomized adolescents, 82.1% completed 12-month follow-up. Intent-to-treat analyses showed significant reductions in mean body mass index z score (-0.09; 95% CI, -0.12 to -0.06), waist to height ratio (-0.02; 95% CI, -0.03 to -0.01), total cholesterol level (-4 mg/dL; 95% CI, -8 to 0 mg/dL; to convert to millimoles per liter, multiply by 0.0259), and triglycerides level (geometric mean, -80 mg/dL; 95% CI, -88 to -71 mg/dL; to convert to millimoles per liter, multiply by 0.0113). Most psychosocial outcomes improved, including global self-worth, but there were few dietary, physical activity, or sedentary behavior changes. No difference was found in primary outcomes between participants who did or did not receive additional therapeutic contact.

CONCLUSIONS

The Loozit randomized controlled trial produced a significant but modest reduction in body mass index z score and improved psychosocial outcomes at 12 months. Supplementary telephone and electronic contact provided no additional benefit at 12 months. Trial Registration anzctr.org.au Identifier: 12606000175572.

Recruitment challenges and recommendations for adolescent obesity trials

AIM

To report our experiences with recruiting overweight and obese 13- to 16-year-olds for the Loozit® weight management randomised control trial (RCT) and to identify effective strategies for recruiting adolescents from the community to a treatment trial.

METHODS

The Loozit RCT is a two-arm, community-based, lifestyle intervention that aims to evaluate the effect of additional therapeutic contact provided via telephone coaching and electronic communications as an adjunct to the Loozit group programme. Strategic areas that were targeted to recruit adolescents included media, schools, health professionals and community organisations. The programme aimed to recruit a cohort of 12-16 adolescents (body mass index z-score range 1.0-2.5) aged 13-16 years every 3 months over 3 years. Information regarding recruitment and eligibility to participate was initially assessed during a telephone screen. The relative cost effectiveness of recruitment strategies was determined based on recruitment rates and costs including administrative costs and research assistant time.

RESULTS

Out of 474 enquiries, 32% resulted in an enrollment to the RCT. Newspaper articles and school newsletters accounted for nearly 60% of enquiries and enrollments and were the most cost-effective recruitment strategies. Common reasons for ineligibility for inclusion in the RCT were adolescents being too young (21%) and parents consenting but adolescents refusing to participate (17%).

CONCLUSIONS

The most successful recruitment strategies for the Loozit RCT were local newspapers and school newsletters. Future studies should consider involving a Public Relations department and other potentially cost-effective strategies such as peer recruitment.

The role of parents in pre-adolescent and adolescent overweight and obesity treatment: a systematic review of clinical recommendations

The study aims to describe clinical recommendations (i) on the role of parents in both pre-adolescent and adolescent overweight and obesity treatment; (ii) to health professionals on how to involve parents in paediatric overweight and obesity treatment and (iii) to identify deficiencies in the associated literature. A systematic literature review was conducted in March 2010 to identify clinical practice guidelines, position or consensus statements on clinical management of paediatric overweight or obesity, developed by a national or international health professional association or government agency, and endorsed for current use. Relevant clinical recommendations in these documents were identified via a screen for the words 'parent', 'family' and synonyms. Twenty documents were included. Most documents emphasized the importance of involving parents or the family in paediatric overweight and obesity treatment with approximately a third of documents providing separate recommendations on the role of parents/family for pre-adolescents and adolescents. The documents varied markedly with regard to the presence of recommendations on parent/family involvement in the various components of lifestyle interventions or bariatric surgery. Almost half of the documents contained recommendations to health professionals regarding interactions with parents. High-quality research is needed on age-specific techniques to optimize the involvement of parents and family members in paediatric overweight and obesity treatment.

Short-term outcomes of community-based adolescent weight management: The Loozit® Study

BACKGROUND

The Loozit(®) Study is a randomised controlled trial investigating extended support in a 24 month community-based weight management program for overweight to moderately obese, but otherwise healthy, 13 to 16 year olds.

METHODS

This pre-post study examines the two month outcomes of the initial Loozit(®) group intervention received by both study arms. Adolescents (n = 151; 48% male) and their parents separately attended seven weekly group sessions focused on lifestyle modification. At baseline and two months, adolescents' anthropometry, blood pressure, and fasted blood sample were assessed. Primary outcomes were two month changes in body mass index (BMI) z-score and waist-to-height-ratio (WHtR). Secondary outcomes included changes in metabolic profile, self-reported dietary intake/patterns, physical and sedentary activities, psychological characteristics and social status. Changes in outcome measures were assessed using paired samples t-tests for continuous variables or McNemar's test for dichotomous categorical variables.

RESULTS

Of the 151 adolescents who enrolled, 130 (86%) completed the two month program. Among these 130 adolescents (47% male), there was a statistically significant (P < 0.01) reduction in mean [95% CI] BMI (0.27 kg/m2 [0.41, 0.13]), BMI z-score (0.05 [0.06, 0.03]), WHtR (0.02 [0.03, 0.01]), total cholesterol (0.14 mmol/L [0.24, 0.05]) and low-density lipoprotein cholesterol (0.12 mmol/L [0.21, 0.04]). There were improvements in all psychological measures, the majority of the dietary intake measures, and some physical activities (P < 0.05). Time spent watching TV and participating in non-screen sedentary activities decreased (P < 0.05).

CONCLUSIONS

The Loozit(®) program may be a promising option for stabilizing overweight and improving various metabolic factors, psychological functioning and lifestyle behaviors in overweight adolescents in a community setting.

TRIAL REGISTRATION

Australian New Zealand Clinical Trials RegistryACTRNO12606000175572.

Electronic therapeutic contact for adolescent weight management: the Loozit study

OBJECTIVE

To examine adolescent and facilitator participation in the first 10 months of an obesity management intervention including electronic contact (e-contact) via e-mail and short message service (SMS) communication.

MATERIALS AND METHODS

Participants (n=49) were overweight and obese (13-16 year olds) and were randomized to receive e-contact in the Loozit trial. Adolescents were sent brief, semipersonalized health messages approximately monthly, from 2 to 12 months. We analyzed adolescents' response patterns, reply content, satisfaction with e-contact intervention, and facilitator responsiveness. Two coding systems described the general attributes and content of adolescent replies and facilitator responses.

RESULTS

Adolescents' overall reply rate was 22%. There was no difference in age, sex, socioeconomic status, body mass index z-score, or initial group program attendance between the 27 adolescents who replied to 0-2 messages and the 22 who replied to >or=3 messages. Adolescent SMS replies had less characters and a quicker response time compared with e-mail replies. Adolescent responses were largely relevant to initial health messages sent (91%), with few using "SMS language" (17%) or emoticons (7%). Most adolescents rated e-contact as "somewhat helpful." Facilitators responded to 93% of adolescent replies, and most responses were personalized (93%), encouraging (88%), and educational (75%).

CONCLUSIONS

Although adolescent engagement was modest, SMS and e-mail communication is a feasible and acceptable adjunct to group lifestyle intervention and telephone coaching in overweight and obese adolescents. Healthy eating messages and those concluding with "please reply" elicited the highest reply rates, and thus these message types should be included in future adolescent e-contact interventions.

Adolescent-parent interactions and communication preferences regarding body weight and weight management: a qualitative study

Background

This study aimed to canvass the nature of adolescent-parent interactions about weight, particularly overweight, and to explore ideas of how to foster supportive discussions regarding weight, both in the home and with family doctors.

Methods

A market research company was contracted to recruit and conduct a series of separate focus groups with adolescents and unrelated parents of adolescents from low-middle socio-economic areas in Sydney and a regional centre, Australia. Group discussions were audio recorded, transcribed, and then a qualitative content analysis of the data was performed.

Results

Nine focus groups were conducted; two were held with girls (n = 13), three with boys (n = 18), and four with parents (20 mothers, 12 fathers). Adolescent and parent descriptions of weight-related interactions could be classified into three distinct approaches: indirect/cautious (i.e. focus on eating or physical activity behaviors without discussing weight specifically); direct/open (i.e. body weight was discussed); and never/rarely discussing the subject. Indirect approaches were described most frequently by both adolescents and parents and were generally preferred over direct approaches. Parents and adolescents were circumspect but generally supportive of the potential role for family doctors to monitor and discuss adolescent weight status.

Conclusions

These findings have implications for developing acceptable messages for adolescent and family overweight prevention and treatment interventions.

Adolescent-parent interactions and attitudes around screen time and sugary drink consumption: a qualitative study

BACKGROUND

Little is known about how adolescents and their parents interact and talk about some of the key lifestyle behaviors that are associated with overweight and obesity, such as screen time (ST) and sugary drink (SD) consumption. This qualitative study aimed to explore adolescents' and parents' perceptions, attitudes, and interactions in regards to these topics.

METHODS

Using an exploratory approach, semi-structured focus groups were conducted separately with adolescents and (unrelated) parents. Participants were recruited from low and middle socio-economic areas in the Sydney metropolitan area and a regional area of New South Wales, Australia. Transcripts were analysed using thematic analysis for each of the four content areas (adolescent-ST, adolescent-SD consumption, parents' views on adolescents' ST and parents' views on adolescents' SD consumption).

RESULTS

Nine focus groups, with a total of 63 participants, were conducted. Broad themes spanned all groups: patterns of behavior; attitudes and concerns; adolescent-parent interactions; strategies for behavior change; and awareness of ST guidelines. While parents and adolescents described similar patterns of behaviour in relation to adolescents' SD consumption and ST, there were marked differences in their attitudes to these two behaviours which were also evident in the adolescent-parent interactions in the home that they described. Parents felt able to limit adolescents' access to SDs, but felt unable to control their adolescents' screen time.

CONCLUSION

This study offers unique insights regarding topics rarely explored with parents or adolescents, yet which are part of everyday family life, are known to be linked to risk of weight gain, and are potentially amenable to change.

A randomised controlled trial of a community-based healthy lifestyle program for overweight and obese adolescents: the Loozit study protocol

BACKGROUND

There is a need to develop sustainable and clinically effective weight management interventions that are suitable for delivery in community settings where the vast majority of overweight and obese adolescents should be treated. This study aims to evaluate the effect of additional therapeutic contact as an adjunct to the Loozit group program -- a community-based, lifestyle intervention for overweight and lower grade obesity in adolescents. The additional therapeutic contact is provided via telephone coaching and either mobile phone Short Message Service or electronic mail, or both.

METHODS AND DESIGN

The study design is a two-arm randomised controlled trial that aims to recruit 168 overweight and obese 13-16 year olds (Body Mass Index z-score 1.0 to 2.5) in Sydney, Australia. Adolescents with secondary causes of obesity or significant medical illness are excluded. Participants are recruited via schools, media coverage, health professionals and several community organisations. Study arm one receives the Loozit group weight management program (G). Study arm two receives the same Loozit group weight management program plus additional therapeutic contact (G+ATC). The 'G' intervention consists of two phases. Phase 1 involves seven weekly group sessions held separately for adolescents and their parents. This is followed by phase 2 that involves a further seven group sessions held regularly, for adolescents only, until two years follow-up. Additional therapeutic contact is provided to adolescents in the 'G+ATC' study arm approximately once per fortnight during phase 2 only. Outcome measurements are assessed at 2, 12 and 24 months post-baseline and include: BMI z-score, waist z-score, metabolic profile indicators, physical activity, sedentary behaviour, eating patterns, and psychosocial well-being.

DISCUSSION

The Loozit study is the first randomised controlled trial of a community-based adolescent weight management intervention to incorporate additional therapeutic contact via a combination of telephone coaching, mobile phone Short Message Service, and electronic mail. If shown to be successful, the Loozit group weight management program with additional therapeutic contact has the potential to be readily translatable to a range of health care settings.

TRIAL REGISTRATION

The protocol for this study is registered with the Australian Clinical Trials Registry (ACTRNO12606000175572).

Interventions for treating obesity in children

BACKGROUND

Child and adolescent obesity is increasingly prevalent, and can be associated with significant short- and long-term health consequences.

OBJECTIVES

To assess the efficacy of lifestyle, drug and surgical interventions for treating obesity in childhood.

SEARCH STRATEGY

We searched CENTRAL on The Cochrane Library Issue 2 2008, MEDLINE, EMBASE, CINAHL, PsycINFO, ISI Web of Science, DARE and NHS EED. Searches were undertaken from 1985 to May 2008. References were checked. No language restrictions were applied.

SELECTION CRITERIA

We selected randomised controlled trials (RCTs) of lifestyle (i.e. dietary, physical activity and/or behavioural therapy), drug and surgical interventions for treating obesity in children (mean age under 18 years) with or without the support of family members, with a minimum of six months follow up (three months for actual drug therapy). Interventions that specifically dealt with the treatment of eating disorders or type 2 diabetes, or included participants with a secondary or syndromic cause of obesity were excluded.

DATA COLLECTION AND ANALYSIS

Two reviewers independently assessed trial quality and extracted data following the Cochrane Handbook. Where necessary authors were contacted for additional information.

MAIN RESULTS

We included 64 RCTs (5230 participants). Lifestyle interventions focused on physical activity and sedentary behaviour in 12 studies, diet in 6 studies, and 36 concentrated on behaviorally orientated treatment programs. Three types of drug interventions (metformin, orlistat and sibutramine) were found in 10 studies. No surgical intervention was eligible for inclusion. The studies included varied greatly in intervention design, outcome measurements and methodological quality.Meta-analyses indicated a reduction in overweight at 6 and 12 months follow up in: i) lifestyle interventions involving children; and ii) lifestyle interventions in adolescents with or without the addition of orlistat or sibutramine. A range of adverse effects was noted in drug RCTs.

AUTHORS' CONCLUSIONS

While there is limited quality data to recommend one treatment program to be favoured over another, this review shows that combined behavioural lifestyle interventions compared to standard care or self-help can produce a significant and clinically meaningful reduction in overweight in children and adolescents. In obese adolescents, consideration should be given to the use of either orlistat or sibutramine, as an adjunct to lifestyle interventions, although this approach needs to be carefully weighed up against the potential for adverse effects. Furthermore, high quality research that considers psychosocial determinants for behaviour change, strategies to improve clinician-family interaction, and cost-effective programs for primary and community care is required.

Change in women's body mass index and waist circumference, 1997 to 2002: The Nepean Study

OBJECTIVE

To investigate characteristics associated with body mass index (BMI) and waist circumference stability over a five-year period in women with school-age children.

METHODS

Women with 7-8 year-old children from western Sydney, Australia, had anthropometric measures taken in 1996/97 (n=436) and five years later (n=327). Socio-demographic characteristics examined at baseline included age, socioeconomic status, smoking, and number of children.

RESULTS

Over five years, less than half of the women maintained a stable BMI (38.8%) or waist circumference (31.5%), with the majority gaining in both indicators of adiposity. BMI and socio-demographic characteristics were not predictive of BMI or waist circumference stability or decrease.

CONCLUSIONS AND IMPLICATIONS

Total and abdominal adiposity increased in these Australian women who have children. The results support the need to develop effective weight gain prevention initiatives.

Family and home correlates of television viewing in 12-13 year old adolescents: the Nepean Study

BACKGROUND

Few young people meet television viewing guidelines.

PURPOSE

To determine the association between factors in the family and home environment and watching television, including videos and DVDs, in early adolescence.

METHODS

Cross-sectional, self-report survey of 343 adolescents aged 12-13 years (173 girls), and their parents (338 mothers, 293 fathers). Main measures were factors in the family and home environment potentially associated with adolescents spending >or= 2 hours per day in front of the television. Factors examined included family structure, opportunities to watch television/video/DVDs, perceptions of rules and regulations on television viewing, and television viewing practices.

RESULTS

Two-thirds of adolescents watched >or= 2 hours television per day. Factors in the family and home environment associated with adolescents watching television >or= 2 hours per day include adolescents who have siblings (Adjusted Odds Ratio [95%CI] AOR = 3.0 [1.2, 7.8]); access to pay television (AOR = 2.0 [1.1, 3.7]); ate snacks while watching television (AOR = 3.1 [1.8, 5.4]); co-viewed television with parents (AOR = 2.3 [1.3, 4.2]); and had mothers who watched >or= 2 hours television per day (AOR = 2.4 [1.3, 4.6]).

CONCLUSION

There are factors in the family and home environment that influence the volume of television viewed by 12-13 year olds. Television plays a central role in the family environment, potentially providing a means of recreation among families of young adolescents for little cost. Interventions which target family television viewing practices and those of parents, in particular, are more likely to be effective than interventions which directly target adolescent viewing times.

Increasing central adiposity: the Nepean longitudinal study of young people aged 7–8 to 12–13 y

BACKGROUND

Estimates of the prevalence of overweight and obesity in young people are typically based on body mass index (BMI). However, BMI may not indicate the level of central adiposity. Waist circumference has therefore been recommended to identify young people at risk of morbidity associated with central adiposity.

OBJECTIVE

To investigate (a) change in total and central adiposity between 7-8 and 12-13 y (b) agreement between classifying young people as overweight or obese based on total adiposity and central adiposity, and (c) risk factors associated with the development of total and central adiposity.

DESIGN

Anthropometric measurements were taken on 342 children in 1996/97 and 5 y later. Risk factors examined included birth weight, physical activity, TV viewing, pubertal status, parental adiposity, diet and socio-economic status.

RESULTS

Between 7-8 and 12-13 y indices of central adiposity increased more than total adiposity; waist circumference z-score increased by (mean+/-s.d.) 0.74+/-0.92 and BMI z-score increased by 0.18+/-0.67. At 12-13 y there was moderate agreement between the two measures of adiposity (weighted kappa=0.64). However, waist circumference identified a greater number of young people as overweight or obese compared to BMI (41.2 vs 29.3%, P<0.001). Adiposity status at 7-8 y, maternal obesity, and pubertal stage were the strongest predictors of BMI status at 12-13 y. Risk factors associated with increased central adiposity were similar.

CONCLUSIONS

Overweight and obesity, as measured by waist circumference, is a bigger problem than is currently assessed by BMI. Targeting known risk factors for total adiposity may be an appropriate strategy for preventing increased central adiposity.