Interventions for preventing obesity in children (review)

Background

Prevention of childhood obesity is an international public health priority given the significant impact of obesity on acute and chronic diseases, general health, development and well-being. The international evidence base for strategies that governments, communities and families can implement to prevent obesity, and promote health, has been accumulating but remains unclear.
Objectives

This review primarily aims to update the previous Cochrane review of childhood obesity prevention research and determine the effectiveness of evaluated interventions intended to prevent obesity in children, assessed by change in Body Mass Index (BMI). Secondary aims were to examine the characteristics of the programs and strategies to answer the questions "What works for whom, why and for what cost?"
Search methods

The searches were re-run in CENTRAL, MEDLINE, EMBASE, PsychINFO and CINAHL in March 2010 and searched relevant websites. Non-English language papers were included and experts were contacted.
Selection criteria

The review includes data from childhood obesity prevention studies that used a controlled study design (with or without randomisation). Studies were included if they evaluated interventions, policies or programs in place for twelve weeks or more. If studies were randomised at a cluster level, 6 clusters were required.
Data collection and analysis

Two review authors independently extracted data and assessed the risk of bias of included studies. Data was extracted on intervention implementation, cost, equity and outcomes. Outcome measures were grouped according to whether they measured adiposity, physical activity (PA)-related behaviours or diet-related behaviours. Adverse outcomes were recorded. A meta-analysis was conducted using available BMI or standardised BMI (zBMI) score data with subgroup analysis by age group (0-5, 6-12, 13-18 years, corresponding to stages of developmental and childhood settings).
Main results

This review includes 55 studies (an additional 36 studies found for this update). The majority of studies targeted children aged 6-12 years. The meta-analysis included 37 studies of 27,946 children and demonstrated that programmes were effective at reducing adiposity, although not all individual interventions were effective, and there was a high level of observed heterogeneity (I2=82%). Overall, children in the intervention group had a standardised mean difference in adiposity (measured as BMI or zBMI) of -0.15kg/m2 (95% confidence interval (CI): -0.21 to -0.09). Intervention effects by age subgroups were -0.26kg/m2 (95% CI:-0.53 to 0.00) (0-5 years), -0.15kg/m2 (95% CI -0.23 to -0.08) (6-12 years), and -0.09kg/m2 (95% CI -0.20 to 0.03) (13-18 years). Heterogeneity was apparent in all three age groups and could not explained by randomisation status or the type, duration or setting of the intervention. Only eight studies reported on adverse effects and no evidence of adverse outcomes such as unhealthy dieting practices, increased prevalence of underweight or body image sensitivities was found. Interventions did not appear to increase health inequalities although this was examined in fewer studies.
Authors' conclusions

We found strong evidence to support beneficial effects of child obesity prevention programmes on BMI, particularly for programmes targeted to children aged six to 12 years. However, given the unexplained heterogeneity and the likelihood of small study bias, these findings must be interpreted cautiously. A broad range of programme components were used in these studies and whilst it is not possible to distinguish which of these components contributed most to the beneficial effects observed, our synthesis indicates the following to be promising policies and strategies:

· school curriculum that includes healthy eating, physical activity and body image

· increased sessions for physical activity and the development of fundamental movement skills throughout the school week

· improvements in nutritional quality of the food supply in schools

· environments and cultural practices that support children eating healthier foods and being active throughout each day

· support for teachers and other staff to implement health promotion strategies and activities (e.g. professional development, capacity building activities)

· parent support and home activities that encourage children to be more active, eat more nutritious foods and spend less time in screen based activities

However, study and evaluation designs need to be strengthened, and reporting extended to capture process and implementation factors, outcomes in relation to measures of equity, longer term outcomes, potential harms and costs.

Childhood obesity prevention research must now move towards identifying how effective intervention components can be embedded within health, education and care systems and achieve long term sustainable impacts.

Covariation in life-history traits : differential effects of diet on condition, hormones, behavior, and reproduction in genetic finch morphs

The relative contribution of genetic and environmental factors in determining variation in life-history traits is of central interest to evolutionary biologists, but the physiological mechanisms underlying these traits are still poorly understood. Here we experimentally demonstrate opposing effects of nutritional stress on immune function, endocrine physiology, parental care, and reproduction between red and black head-color morphs of the Gouldian finch (Erythrura gouldiae). Although the body condition of black morphs was largely unaffected by diet manipulation, red birds were highly sensitive to dietary changes, exhibiting considerable within-individual changes in condition and immune function. Consequently, nutritionally stressed red birds delayed breeding, produced smaller broods, and reared fewer and lower-quality foster offspring than black morphs. Differences in offspring quality were largely due to morph-specific differences in parental effort: red morphs reduced parental provisioning, whereas black morphs adaptively elevated their provisioning effort to meet the increased nutritional demands of their foster brood. Nutritionally stressed genetic morphs also exhibited divergent glucocorticoid responses. Black morphs showed reduced corticosterone-binding globulin (CBG) concentrations and increased levels of free corticosterone, whereas red morphs exhibited reduced free corticosterone levels and elevated CBG concentrations. These opposing glucocorticoid responses highlight intrinsic differences in endocrine sensitivities and plasticity between genetic morphs, which may underlie the morph-specific differences in condition, behavior, and reproduction and thus ultimately contribute to the evolution and maintenance of color polymorphism.

Mothers adjust offspring sex to match the quality of the rearing environment

Theory predicts that mothers should adjust offspring sex ratios when the expected fitness gains or rearing costs differ between sons and daughters. Recent empirical work has linked biased offspring sex ratios to environmental quality via changes in relative maternal condition. It is unclear, however, whether females can manipulate offspring sex ratios in response to environmental quality alone (i.e. independent of maternal condition). We used a balanced within-female experimental design (i.e. females bred on both low- and high-quality diets) to show that female parrot finches (Erythrura trichroa) manipulate primary offspring sex ratios to the quality of the rearing environment, and not to their own body condition and health. Individual females produced an unbiased sex ratio on high-quality diets, but over-produced sons in poor dietary conditions, even though they maintained similar condition between diet treatments. Despite the lack of sexual size dimorphism, such sex ratio adjustment is in line with predictions from sex allocation theory because nutritionally stressed foster sons were healthier, grew faster and were more likely to survive than daughters. These findings suggest that mothers may adaptively adjust offspring sex ratios to optimally match their offspring to the expected quality of the rearing environment.

The health-related quality of life burden of co-morbid cardiovascular disease and major depressive disorder in Australia : findings from a population-based, cross-sectional study

Purpose Health-related quality of life (HRQOL) can be significantly impaired by the presence of chronic conditions such as cardiovascular disease (CVD) and major depressive disorder (MDD). The aim of this paper was to (1) identify differences in HRQOL between individuals with CVD, MDD, or both, compared to a healthy reference group, (2) establish whether the influence of co-morbid MDD and CVD on HRQOL is additive or synergistic and (3) determine the way in which depression severity interacts with CVD to influence overall HRQOL.

Methods Population-based data from the 2007 Australian National Survey of Mental Health and Well-being (NSMHWB) (n = 8841) were used to compare HRQOL of individuals with MDD and CVD, MDD but not CVD, CVD but not MDD, with a healthy reference group. HRQOL was measured using the Assessment of Quality of Life (AQOL). MDD was identified using the Composite International Diagnostic Interview (CIDI 3.0).

Results Of all four groups, individuals with co-morbid CVD and depression reported the greatest deficits in AQOL utility scores (Coef: −0.32, 95% CI: −0.40, −0.23), after adjusting for covariates. Those with MDD only (Coef: −0.27, 95% CI: −0.30, −0.24) and CVD only (Coef: −0.08, 95% CI: −0.11, −0.05) also reported reduced AQOL utility scores. Second, the influence of MDD and CVD on HRQOL was shown to be additive, rather than synergistic. Third, a significant dose–response relationship was observed between depression severity and HRQOL. However, CVD and depression severity appeared to act independently of each other in impacting HRQOL.

Conclusions HRQOL is greatly impaired in individuals with co-morbid MDD and CVD; these conditions appear to influence HRQOL in an additive fashion. HRQOL alters with depression severity, therefore treating depression and improving HRQOL is of clinical importance.

Impact of depression treatment on mental and physical health-related quality of life of cardiac patients : a meta-analysis

PURPOSE: To conduct a meta-analysis evaluating the effectiveness of depression treatment on mental and physical health-related quality of life (HRQOL) of cardiac patients.

METHODS: Studies were identified using medical, health, psychiatry, psychology, and social sciences databases. Inclusion criteria were (1) 1 or more control conditions, (2) random assignment to condition after admission for myocardial infarction (MI)/acute coronary syndrome, after recording positive results on a depression screener, (3) documentation of depression symptoms at baseline, (4) depression management as a component of the rehabilitation/intervention, (5) validated measure of HRQOL as an outcome, at minimum 6-month followup. For meta-analysis, mental and physical HRQOL were the end points studied, using standardized mean differences for continuous outcome measures, with 95% confidence intervals. Heterogeneity was explored by calculating I2 statistic.

RESULTS: Five randomized controlled trials included in the analysis represented 2105 participants (1058 intervention vs 1047 comparator). Compared with a comparator group at 6 months, a test for overall effect demonstrated statistically significant improvements in mental HRQOL in favor of the intervention (standardized mean differences = −0.29 [−0.38 to −0.20], [P < .00001]; I2 = 0%). Depression treatment had a modest yet significant impact on physical HRQOL (standardized mean differences = −0.14 [−0.24 to −0.04] [P = .009]; I2 = 15%).

CONCLUSION: While the impact of post-MI depression interventions on physical HRQOL is modest, treatment can improve mental HRQOL in a significant way. Future research is required to develop and evaluate a program that can achieve vital improvements in overall HRQOL, and potentially cardiovascular outcomes, of cardiac patients.

Does agricultural food provide a good alternative to a natural diet for body store deposition in geese?

Over the past decades most goose populations have become increasingly dependent on agricultural crops during wintering and migration periods. The suitability of agricultural crops to support all nutritional requirements of migratory geese for the deposition of body stores has been questioned; feeding on agricultural crops may yield higher rates of fat deposition at the cost of reduced protein accretion due to an unbalanced diet. We compared amino-acid composition of forage, and investigated food-habitat use and dynamics and composition of body stores deposited by barnacle geese feeding on agricultural pasture and in natural salt marsh during spring migratory preparation. Overall content and composition of amino acids was similar among forage from both habitats and appeared equally suitable for protein accretion. There was no relationship between body composition of geese and their preferred food habitat. Fat and wet protein contributed with 67% and 33%, respectively, to body stores gained at a rate of 11 g/d throughout the one-month study period. We found no evidence of impaired protein accretion in geese using agricultural grassland compared to natural salt marsh. Our study supports the hypothesis that the expansion of feeding habitat by including agricultural grassland has played an important role in the recent growth of the East Atlantic flyway population of barnacle geese and other herbivorous waterbirds. Feeding refuges of improved grassland provide geese with an adequate diet for the deposition of body stores crucial for spring migration and subsequent reproduction, thereby alleviating the conflict with agriculture.

Understanding determinants of nutrition, physical activity and quality of life among older adults : the Wellbeing, Eating and Exercise for a Long Life (WELL) study

Background : Nutrition and physical activity are major determinants of health and quality of life; however, there exists little research focusing on determinants of these behaviours in older adults. This is important, since just as these behaviours vary according to subpopulation, it is likely that the determinants also vary. An understanding of the modifiable determinants of nutrition and physical activity behaviours among older adults to take into account the specific life-stage context is required in order to develop effective interventions to promote health and well-being and prevent chronic disease and improve quality of life.

Methods : The aim of this work is to identify how intrapersonal, social and environmental factors influence nutrition and physical activity behaviours among older adults living in urban and rural areas. This study is a cohort study of adults aged 55-65 years across urban and rural Victoria, Australia. Participants completed questionnaires at baseline in 2010 and will complete follow-up questionnaires in 2012 and 2014. Self-report questionnaires will be used to assess outcomes such as food intake, physical activity and sedentary behaviours, anthropometry and quality of life. Explanatory variables include socioeconomic position, and measures of the three levels of influence on older adults' nutrition and physical activity behaviours (intrapersonal, social and perceived environmental influences).

Discussion : Obesity and its determinant behaviours, physical inactivity and poor diet are major public health concerns and are significant determinants of the quality of life among the ageing population. There is a critical need for a better understanding of the determinants of nutrition and physical activity in this important target group. This research will provide evidence for the development of effective policies and programs to promote and support increased physical activity and healthy eating behaviours among older adults.

Complementary medicine, exercise, meditation, diet, and lifestyle modification for anxiety disorders : a review of current evidence

Use of complementary medicines and therapies (CAM) and modification of lifestyle factors such as physical activity and exercise, and diet are being increasingly considered as potential therapeutic options for anxiety disorders. The objective of this metareview was to examine evidence across a broad range of CAM and lifestyle interventions in the treatment of anxiety disorders. In early 2012 we conducted a literature search of PubMed, Scopus, CINAHL, Web of Science, PsycInfo, and the Cochrane Library, for key studies, systematic reviews, and metaanalyses in the area. Our review found that in respect to treatment of generalized anxiety or specific anxiety disorders, CAM evidence revealed support for the herbal medicine Kava. One isolated study shows benefit for naturopathic medicine, whereas acupuncture, yoga, and Tai chi have tentative supportive evidence, which is hampered by overall poor methodology. The breadth of evidence does not support homeopathy for treating anxiety. Strong support exists for lifestyle modifications including adoption of moderate exercise and mindfulness meditation, whereas dietary improvement, avoidance of caffeine, alcohol, and nicotine offer encouraging preliminary data. In conclusion, certain lifestyle modifications and some CAMs may provide a beneficial role in the management of anxiety disorders.

Service quality in a higher education context : an integrated model

Purpose – The aim of this study is to develop and empirically test an integrated model incorporating the antecedents and consequences of service quality in a higher education context.

Design/methodology/approach – This research employed both qualitative and quantitative research methods. The data from three focus groups, conducted at the Central Queensland University (CQU), Rockhampton, Australia, generated key themes and their interrelationships. The theoretical model was then tested using structural equation modelling technique on a sample of 528 university students.

Findings – The findings show that information (marketing communications) is more statistically significant than past experience as the antecedents of service quality. The consequences of service quality are composed of trust, satisfaction, and image. Overall, the results suggest a good validity of the theoretical model and the key paths in the model are found statistically significant, except past experience affecting service quality.

Originality/value – The model provides a good explanation of a university brand image, and perceived service quality was found playing an important role in this model. Universities intending to enhance their image are encouraged to consider focusing their efforts on marketing communication information, service quality, student satisfaction and trust.

Conducting field research in a primary school setting : methodological considerations for maximizing response rates, data quality and quantity

Background: Schools are an ideal setting in which to involve children in research. Yet for investigators wishing to work in these settings, there are few method papers providing insights into working efficiently in this setting.

Objective: The aim of this paper is to describe the five strategies used to increase response rates, data quality and quantity in the TRansport Environment and Kids (TREK) project.

Setting: The TREK project examined the association between neighbourhood urban design and active transport in Grade 5–7 school children (n = 1480) attending 25 primary schools in metropolitan Perth, Western Australia during 2007.

Method: Children completed several survey components during school time (i.e. questionnaire, mapping activity, travel diary and anthropometric measurements) and at home (i.e. pedometer study, parent questionnaire).

Results: Overall, 69.4% of schools and 56.6% of children agreed to participate in the study and, of these, 89.9% returned a completed travel diary, 97.8% returned their pedometer and 88.8% of parents returned their questionnaire. These return rates are superior to similar studies. Five strategies appeared important: (1) building positive relationships with key school personnel; (2) child-centred approaches to survey development; (3) comprehensive classroom management techniques to standardize and optimize group sessions; (4) extensive follow-up procedures for collecting survey items; and (5) a specially designed data management/monitoring system.

Conclusion: Sharing methodological approaches for obtaining high-quality data will ensure research opportunities within schools are maximized. These methodological issues have implications for planning, budgeting and implementing future research.

The quality of dietary intake methodology and reporting in child and adolescent obesity intervention trials : a systematic review

Assessing dietary intake is important in evaluating childhood obesity intervention effectiveness. The purpose of this review was to evaluate the dietary intake methods and reporting in intervention studies that included a dietary component to treat overweight or obese children. A systematic review of studies published in the English language, between 1985 and August 2010 in health databases. The search identified 2,295 papers, of which 335 were retrieved and 31 met the inclusion criteria. Twenty-three studies reported energy intake as an outcome measure, 20 reported macronutrient intakes and 10 studies reported food intake outcomes. The most common dietary method employed was the food diary (n = 13), followed by 24-h recall (n = 5), food frequency questionnaire (FFQ) (n = 4) and dietary questionnaire (n = 4). The quality of the dietary intake methods reporting was rated as ‘poor’ in 15 studies (52%) and only 3 were rated as ‘excellent’. The reporting quality of FFQs tended to be higher than food diaries/recalls. Deficiencies in the quality of dietary intake methods reporting in child obesity studies were identified. Use of a dietary intake methods reporting checklist is recommended. This will enable the quality of dietary intake results to be evaluated, and an increased ability to replicate study methodology by other researchers.

Leading the evaluation of institutional online learning environments for quality enhancement in times of change

This paper reports on findings from a nationally funded project which aims to design and implement a quality management framework for online learning environments (OLEs). Evaluation is a key component of any quality management system and it is this aspect of the framework that is the focus of this paper. In developing the framework initial focus groups were conducted at the five participating institutions. These revealed that, although regarded as important, there did not appear to be a shared understanding of the nature and purpose of evaluation. A second series of focus groups revealed there were multiple perspectives arising from those with a vested interest in online learning. These perspectives will be outlined. Overall, how evaluation was undertaken was highly variable within and across the five institutions reflecting where they were at in relation to the development of their OLE.

Building effective school-university partnerships for a quality teacher workforce : a Victorian led initiative

‘Building effective school-university partnerships for a quality teacher workforce: A Victorian led initiative’ project, (‘BESUP’), funded by the Department of Education and Early Childhood Development from 2010 – 2011, was conducted by the research team from the School of Education, Deakin University in collaboration with key personnel in two ‘clusters’ of schools located in the Maroondah Education Coalition and in Keysborough/Noble Park.

The overall aim of this project was to examine a pilot model of effective school-university partnership that engages pre-service and in-service teachers and researchers in the co-production of professional knowledge and practice. The model of a university-school partnership that was investigated in the research project was developed as part of the Master of Teaching, a 16 credit pre-service postgraduate course in the School of Education that had the first intake of pre-service teachers in March, 2010. In the design and implementation of the Master of Teaching course, the School of Education set out to create a new relationship between key stakeholders in the preparation of the next generation of teachers. A commitment to doing the professional experience component differently was central to the conceptualization of the new course. To this end, three new professional experience curriculum units were designed with the placements ‘embedded’ into the units themselves.

The research questions that shaped the BESUP research project are:
• What are the design features of an effective school-university partnership model?
• What are the features of cross-generational (pre-service, in-service) models of quality supervision, mentoring and support in a school-university partnership model?
• What are the conditions for an effective professional development program for teachers and academic staff to support professional experience within school-university partnerships?

That the Department of Education and Early Childhood Development funded this research is evidence of the system’s awareness of and concern for investigating ways forward that will provide the next generation of teachers with strong links between the learning experiences undertaken in the university component of their pre-service teacher education and the professional experience component located in schools. The report suggests the significance of ongoing professional conversations and new ways of engaging in professional learning among all of the partners.

Impact of medical Qigong on quality of life, fatigue, mood and inflammation in cancer patients : a randomized controlled trial

Background: Substantial numbers of cancer patients use complementary medicine therapies, even without a supportive evidence base. This study aimed to evaluate in a randomized controlled trial, the use of Medical Qigong (MQ) compared with usual care to improve the quality of life (QOL) of cancer patients. Patients and methods: One hundred and sixty-two patients with a range of cancers were recruited. QOL and fatigue were measured by Functional Assessment of Cancer Therapy—General and Functional Assessment of Cancer Therapy—Fatigue, respectively, and mood status by Profile of Mood State. The inflammatory marker serum C-reactive protein (CRP) was monitored serially. Results: Regression analysis indicated that the MQ group significantly improved overall QOL (t144 = −5.761, P < 0.001), fatigue (t153 = −5.621, P < 0.001), mood disturbance (t122 =2.346, P = 0.021) and inflammation (CRP) (t99 = 2.042, P < 0.044) compared with usual care after controlling for baseline variables. Conclusions: This study indicates that MQ can improve cancer patients’ overall QOL and mood status and reduce specific side-effects of treatment. It may also produce physical benefits in the long term through reduced inflammation.

Rural living and health-related quality of life in Australians with Parkinson's disease

Introduction: The motor and non-motor symptoms associated with idiopathic Parkinson’s disease (PD) may compromise the health-related quality of life (HRQOL) of some individuals living with this debilitating condition. Although growing evidence suggests that PD may be more prevalent in rural communities, there is little information about the life quality of these individuals. This study examines whether HRQOL ratings vary in relation to rural and metropolitan life settings.
Methods: An analytic cross-sectional study was conducted to compare the HRQOL of two separate samples of people with PD living in metropolitan Melbourne and rural Victoria. The metropolitan sample consisted of 210 individuals who had participated in the baseline assessment for an existing clinical trial. The rural sample comprised 24 participants who attended community-based rehabilitation programs and support groups in rural Victoria. Health-related quality of life was quantified using the Parkinson’s Disease Questionnaire-39 (PDQ-39).
Results: The HRQOL of participants in rural Australia differed from individuals living in a large metropolitan city (p=0.025). Participants in rural Australia reported worse overall HRQOL, after controlling for differences in disease duration. Their overall HRQOL was lower than for city dwellers. Rural living was also found to be a significant negative predictor of HRQOL (β=0.14; 95% CI -1.27 to -0.08; _p=0.027).
Conclusion: The findings of this study suggest that some people with PD living in rural Victoria perceive their HRQOL to be relatively poor. In order to minimise the debilitating consequences of this disease, further studies examining the factors that may contribute to the HRQOL of individuals living in rural and remote areas are required.