Family average income and body mass index above the healthy weight range among urban and rural resicents in regional Mainland China

Objective: To explore the relationship between family average income (FAI; an index of socio-economic status) and body mass index (BMI; a widely used, inexpensive indicator of weight status) above the healthy weight range in a region of Mainland China. Design: Population-based cross-sectional study, conducted between October 1999 and March 2000 on a sample of regular local residents aged 35 years or older who were selected by random cluster sampling. Setting: Forty-five administrative villages selected from three urban districts and two rural counties of Nanjing municipality, Mainland China, with a regional population of 5.6 million. Subjects: In total, 29 340 subjects participated; 67.7% from urban and 32.3% from rural areas; 49.8% male and 50.2% female. The response rate among eligible participants was 90.1%. Results: The proportion of participants classified as overweight was 30.5%, while 7.8% were identified as obese. After adjusting for possible confounding variables (age, gender, area of residence, educational level, occupational and leisure-time physical activity, daily vegetable consumption and frequency of red meat intake), urban participants were more likely to be overweight or obese relative to their rural counterparts, more women than men were obese, and participants in the lowest FAI tertile were the least likely to be above the healthy weight range. Conclusions: The proportion of adults with BMI above the healthy weight range was positively related to having a higher socio-economic status (indexed by FAI) in a regional Chinese population.

Physical activity and healthy weight maintenance from childhood to adulthood

The objective of this study was to determine whether change in physical activity was associated with maintaining a healthy weight from childhood to adulthood. This prospective cohort study examined 1,594 young Australian adults (48.9% female) aged 27–36 years who were first examined at age 9–15 years as part of a national health and fitness survey. BMI was calculated from measured height and weight, and physical activity was self-reported at both time points; pedometers were also used at follow-up. Change in physical activity was characterized by calculating the difference between baseline and follow-up z-scores. Change scores were categorized as decreasing (large, moderate), stable, or increasing (large, moderate). Healthy weight was defined in childhood as a BMI less than international overweight cutoff points, and in adulthood as BMI<25 kg/m2. Healthy weight maintainers were healthy weight at both time points. Compared with those who demonstrated large relative decreases in physical activity, females in all other groups were 25–37% more likely to be healthy weight maintainers, although associations differed according to the physical activity measure used at follow-up and few reached statistical significance. Although younger males whose relative physical activity moderately or largely increased were 27–34% more likely to be healthy weight maintainers than those whose relative physical activity largely decreased, differences were not statistically significant. In conclusion, relatively increasing and stable physical activity from childhood to adulthood was only weakly associated with healthy weight maintenance. Examining personal, social, and environmental factors associated with healthy weight maintenance will be an important next step in understanding why some groups avoid becoming overweight.

Personal, social and environmental correlates of healthy weight status amongst mothers from socioeconomically disadvantaged neighborhoods : findings from the READI study

Background

Socioeconomically disadvantaged mothers are at high risk of obesity, yet the aetiology of obesity in this group remains poorly understood. The aim of this study was to examine the perceived personal, social and physical environmental factors associated with resilience to obesity among mothers from socioeconomically disadvantaged neighbourhoods.
Methods

Survey data were provided by a cohort of 1840 women aged 18-46 years with dependent children (aged 0-18 years) from 40 urban and 40 rural socioeconomically disadvantaged neighbourhoods across Victoria, Australia. Mothers responded to a number of questions relating to personal, social and environmental influences on their physical activity and eating habits. Mothers' weight status was classified as healthy weight (BMI: 18.5-24.99), overweight (BMI: 25-29.99) or obese (BMI: 30+).
Results

Mothers' weight status was bivariably associated with factors from all three domains (personal, social and physical environmental). In a multivariable model, mothers' perceived ability to make time for healthy eating (OR = 1.34) and physical activity (OR = 1.11) despite family commitments, and the frequency with which families ate healthy low-fat foods with mothers (OR = 1.28) remained significantly positively associated with healthy weight status. The frequency with which families encouraged eating healthy low-fat foods remained negatively associated (OR = 0.81) with weight status; ie greater encouragement was associated with less healthy weight status.
Conclusions

Drawing on the characteristics of mothers resilient to obesity might assist in developing intervention strategies to help other mothers in socioeconomically disadvantaged neighbourhoods to manage their weight. Such strategies might focus on planning for and prioritising time for healthy eating and physical activity behaviours, and including family members in and encouraging family mealtimes.

Screen media, parenting practices, and the family environment in Australia: a longitudinal study of young children’s media use, lifestyles, and outcomes for healthy weight

Few studies of media use and adiposity explore the influence of parenting on children’s lifestyle behaviors. Screen media access, bedroom television, lack of physical activity, and snacking on energy-dense foods have long been implicated in child overweight. This research used data from the first three waves of the Longitudinal Study of Australian Children to investigate, prospectively, the associations between parental practices in early to middle childhood and children’s behaviors and weight in late childhood. A path model was used to investigate whether consistent parentingpredicted setting of boundaries for access to and use of media, and was indirectly associated with children’s lifestyle behaviors that increase the likelihood of healthy weight maintenance. The findings demonstrated that children’s lifestyles pertinent to weight maintenance and media use cluster together and involve both old and newer screen media, but are also predicted by parenting practices and the family environment.

Healthy weight regulation and eating disorder prevention in high school students: a universal and targeted web-based intervention

Background: Given the rising rates of obesity in children and adolescents, developing evidence-based weight loss or weight maintenance interventions that can be widely disseminated, well implemented, and are highly scalable is a public health necessity. Such interventions should ensure that adolescents establish healthy weight regulation practices while also reducing eating disorder risk.

Objective: This study describes an online program, StayingFit, which has two tracks for universal and targeted delivery and was designed to enhance healthy living skills, encourage healthy weight regulation, and improve weight/shape concerns among high school adolescents.

Methods: Ninth grade students in two high schools in the San Francisco Bay area and in St Louis were invited to participate. Students who were overweight (body mass index [BMI] >85th percentile) were offered the weight management track of StayingFit; students who were normal weight were offered the healthy habits track. The 12-session program included a monitored discussion group and interactive self-monitoring logs. Measures completed pre- and post-intervention included self-report height and weight, used to calculate BMI percentile for age and sex and standardized BMI (zBMI), Youth Risk Behavior Survey (YRBS) nutrition data, the Weight Concerns Scale, and the Center for Epidemiological Studies Depression Scale.

Results: A total of 336 students provided informed consent and were included in the analyses. The racial breakdown of the sample was as follows: 46.7% (157/336) multiracial/other, 31.0% (104/336) Caucasian, 16.7% (56/336) African American, and 5.7% (19/336) did not specify; 43.5% (146/336) of students identified as Hispanic/Latino. BMI percentile and zBMI significantly decreased among students in the weight management track. BMI percentile and zBMI did not significantly change among students in the healthy habits track, demonstrating that these students maintained their weight. Weight/shape concerns significantly decreased among participants in both tracks who had elevated weight/shape concerns at baseline. Fruit and vegetable consumption increased for both tracks. Physical activity increased among participants in the weight management track, while soda consumption and television time decreased.

Conclusions: Results suggest that an Internet-based, universally delivered, targeted intervention may support healthy weight regulation, improve weight/shape concerns among participants with eating disorders risk, and increase physical activity in high school students. Tailored content and interactive features to encourage behavior change may lead to sustainable improvements in adolescent health.

Effectiveness of interventions targeting physical activity, nutrition and healthy weight for university and college students: a systematic review and meta-analysis

To examine the effectiveness of interventions aimed at improving physical activity, diet, and/or weight-related behaviors amongst university/college students. Five online databases were searched (January 1970 to April 2014). Experimental study designs were eligible for inclusion. Data extraction was performed by one reviewer using a standardized form developed by the researchers and checked by a second reviewer. Data were described in a narrative synthesis and meta-analyses were conducted when appropriate. Study quality was also established. Forty-one studies were included; of these, 34 reported significant improvements in one of the key outcomes. Of the studies examining physical activity 18/29 yielded significant results, with meta-analysis demonstrating significant increases in moderate physical activity in intervention groups compared to control. Of the studies examining nutrition, 12/24 reported significantly improved outcomes; only 4/12 assessing weight loss outcomes found significant weight reduction. This appears to be the first systematic review of physical activity, diet and weight loss interventions targeting university and college students. Tertiary institutions are appropriate settings for implementing and evaluating lifestyle interventions, however more research is needed to improve such strategies.

Women's work. Maintaining a healthy body weight

This study describes women's perceptions of the supports and barriers to maintaining a healthy weight among currently healthy weight women from urban and rural socio-economically disadvantaged areas. Using focus groups and interviews, we asked women about their experiences of maintaining a healthy weight. Overwhelmingly, women described their healthy weight practices in terms of concepts related to work and management. The theme of ‘managing health’ comprised issues of managing multiple responsibilities, time, and emotions associated with healthy practices. Rural women faced particular difficulties in accessing supports at a practical level (for example, lack of childcare) and due to the gendered roles they enacted in caring for others. Family background (in particular, mothers’ attitudes to food and weight) also appeared to influence perceptions about healthy weight maintenance. In the context of global increases in the prevalence of obesity, the value of initiatives aimed at supporting healthy weight women to maintain their weight should not be under-estimated. Such initiatives need to work within the social and personal constraints that women face in maintaining good health.

Opportunities to promote healthy maternal weight during and following pregnancy

 This thesis has identified opportunities for provision of support for women to attain a healthy weight and healthy diet and physical activity behaviours during and following pregnancy. A better understanding of strategies to promote optimal support to women during the postpartum period has been achieved.

Who does not gain weight? Prevalence and predictors of weight maintenance in young women

OBJECTIVE: To investigate the prevalence and predictors of weight maintenance over time in a large sample of young Australian women.

DESIGN: This population study examined baseline and 4 y follow-up data from the cohort of young women participating in the Australian Longitudinal Study on Women's Health.

SUBJECTS: A total of 8726 young women aged 18-23 y at baseline.

MEASURES: Height, weight and body mass index (BMI); physical activity; time spent sitting; selected eating behaviours (eg dieting, disordered eating, takeaway food consumption); cigarette smoking, alcohol consumption; parity; and sociodemographic characteristics.

RESULTS: Only 44% of the women reported their BMI at follow-up to be within 5% of their baseline BMI (maintainers); 41% had gained weight and 15% had lost weight. Weight maintainers were more likely to be in managerial or professional occupations; to have never married; to be currently studying; and not to be mothers. Controlling for sociodemographic factors, weight maintainers were more likely to be in a healthy weight range at baseline, and to report that they spent less time sitting, and consumed less takeaway food, than women who gained weight.

CONCLUSIONS: Fewer than half the young women in this community sample maintained their weight over this 4 y period in their early twenties. Findings of widespread weight gain, particularly among those already overweight, suggest that early adulthood, which is a time of significant life changes for many women, may be an important time for implementing strategies to promote maintenance of healthy weight. Strategies which encourage decreased sitting time and less takeaway food consumption may be effective for encouraging weight maintenance at this life stage.

Patterns and demographic predictors of 5-year weight change in a multi-ethnic cohort of men and women in Australia

Objective: This study investigated 5-year trends in body weight, overweight and obesity and their association with sociodemographic variables in a large, multi-ethnic community sample of Australian adults.  Design: This prospective population study used baseline and 5-year follow-up data from participants in the Melbourne Collaborative Cohort Study (MCCS). Setting: Population study in Melbourne, Australia. Subjects: In total, 12 125 men and 17 674 women aged 35–69 years at baseline. Results: Mean 5-year weight change in this sample was +1.58 (standard deviation (SD) 4.82) kg for men and +2.42 (SD 5.17) kg for women. Younger (35–44 years) men and, in particular, women gained more weight than older adults and were at highest risk of major weight gain ($5 kg) and becoming overweight. Risk of major weight gain and associations between demographic variables and weight change did not vary greatly by ethnicity. Education level showed complex associations with weight outcomes that differed by sex and ethnicity. Multivariate analyses showed that, among men, higher initial body weight was associated with decreased likelihood of major weight gain, whereas among women, those initially overweight or obese were about 20% more likely to experience major weight gain than underweight or healthy weight women. Conclusions: Findings of widespread weight gain across this entire population sample, and particularly among younger women and women who were already overweight, are a cause for alarm. The prevention of weight gain and obesity across the entire population should be an urgent public health priority. Young-to-mid adulthood appears to be a critical time to intervene to prevent future weight gain.

Strategies which aim to positively impact on weight, physical activity, diet and sedentary behaviours in children from zero to five years. A systematic review of the literature

Preventing the development of obesity in children is an international health priority. To assess the effectiveness of interventions designed to prevent obesity, promote healthy eating and/or physical activity and/or to reduce sedentary behaviours in 0–5-year-old children, a systematic review of the literature was performed. Literature searches were limited to articles published between January 1995 and June 2006, printed in English and sampling children aged 0–5-years. Searches excluded literature concerned with breastfeeding, eating disorders, and interventions which were school-based or concerned with obesity treatment. Two reviewers independently extracted data and assessed study strengths and weaknesses. Nine included studies were grouped based on the settings in which they were delivered. Most studies involved multi-approach interventions, were conducted in the USA and varied in study designs and quality. All showed some level of effectiveness on at least one obesity-behaviour in young children. These studies support, at a range of levels, the premise that parents are receptive to and capable of some behavioural changes that may promote healthy weight in their young children. The small quantity of research heralds the need, particularly given the potential for early intervention to have long-lasting impacts on individual and population health, to build in a substantial way upon this evidence base.