A prospective study of overweight, physical activity and depressive symptoms in young women

This study examined the prospective associations of BMI, physical activity (PA), changes in BMI, and changes in PA, with depressive symptoms. Self-reported data on height, weight, PA, selected sociodemographic and health variables and depressive symptoms (CESD-10) were provided in 2000 and 2003 by 6,67 young adult women (22–27 years in 2000) participating in the Australian Longitudinal Study on Women's Health (ALSWH). Results of logistic regression analyses showed that the odds of developing depressive symptoms at follow-up (2003) were higher in women who were overweight or obese in 2000 than in healthy weight women, and lower in women who were active in 2000 than in sedentary women. Changes in BMI were significantly associated with increased odds of depressive symptoms at follow-up. Sedentary women who increased their activity had lower odds of depressive symptoms at follow-up than those who remained sedentary. Increases in activity among initially sedentary young women were protective against depressive symptoms even after adjusting for BMI changes. These findings indicate that overweight and obese young women are at risk of developing depressive symptoms. PA appears to be protective against the development of depressive symptoms, but does not attenuate the depressive symptoms associated with weight gain. However, among initially sedentary young women, even small increases in PA over time may reduce the odds of depressive symptoms, regardless of weight status.

Dose-response associations between screen time and overweight among youth

Objective. To examine dose-response associations between screen time and overweight, independent of physical activity and dietary intake.

Methods. Participants were 580 Dutch youth (13 years; 48% boys). Body mass index, waist circumference and skinfold thickness at four sites determined weight status. Questionnaires examined television viewing and computer use, participation in organized sport and high caloric snack and sugar-containing beverage consumption.

Results. There were no significant associations among boys. Compared with girls spending less than two hours/day in screen time, those who spent three to four hours/day were more likely to be classified as overweight by waist circumference (odds ratio [OR]=3.4; 95% confidence intervals [CI]=1.1-10.7; p=0.03), and this likelihood increased substantially among those spending more than four hours/day (OR=5.5; 95% CI=2.1-14.1; p≤0.0001).

Conclusions. Girls who spend three or more hours/day in screen time are at increased risk of being classified as overweight by waist circumference.

Colac's Be Active Eat Well program outcomes

The high baseline prevalence of overweight highlighted the pressing need for interventions like Be Active Eat Well (BAEW). The mid-intervention survey found that change was underway. The impact on weight status, behaviours and environments is presented.

Scaling up community-based obesity prevention in Australia : background and evaluation design of the health promoting communities : being active eating well initiative

Background : There is only limited evidence available on how best to prevent childhood obesity and community-based interventions hold promise, as several successful interventions have now been published. The Victorian Government has recently funded six disadvantaged communities across Victoria, Australia for three years to promote healthy eating and physical activity for children, families, and adults in a community-based participatory manner. Five of these intervention communities are situated in Primary Care Partnerships and are the subject of this paper. The interventions will comprise a mixture of capacity-building, environmental, and whole-of-community approaches with targeted and population-level interventions. The specific intervention activities will be determined locally within each community through stakeholder and community consultation. Implementation of the interventions will occur through funded positions in primary care and local government. This paper describes the design of the evaluation of the five primary care partnership-based initiatives in the 'Go for your life' Health Promoting Communities: Being Active Eating Well (HPC:BAEW) initiative.

Methods/Design : A mixed method and multi-level evaluation of the HPC:BAEW initiative will capture process, impact and outcome data and involve both local and state-wide evaluators. There will be a combined analysis across the five community intervention projects with outcomes compared to a comparison group using a cross-sectional, quasi-experimental design. The evaluation will capture process, weight status, socio-demographic, obesity-related behavioral and environmental data in intervention and comparison areas. This will be achieved using document analysis, paper-based questionnaires, interviews and direct measures of weight, height and waist circumference from participants (children, adolescents and adults).

Discussion : This study will add significant evidence on how to prevent obesity at a population level in disadvantaged and ethnically diverse communities. The outcomes will have direct influence on policy and practice and guide the development and implementation of future obesity prevention efforts in Australia and internationally.

Reliability and validity of the system for observing children's activity and relationships during play (SOCARP)

Background: Children frequently engage in diverse activities that are broadly defined as play, but little research has documented children’s activity levels during play and how they are influenced by social contexts. Assessing potentially modifiable conditions that influence play behavior is needed to design optimal physical activity interventions.

Methods: System for Observing Children’s Activity and Relationships during Play (SOCARP) was developed to simultaneously assess children’s physical activity, social group sizes, activity type, and social behavior during play. One hundred and fourteen children (48 boys, 66 girls; 42% overweight) from 8 elementary schools were observed during recess over 24 days, with 12 days videotaped for reliability purposes. Ninety-nine children wore a uni-axial accelerometer during their observation period.

Results: Estimated energy expenditure rates from SOCARP observations and mean accelerometer counts were significantly correlated (r = .67; P < .01), and interobserver reliabilities (ie, percentage agreement) for activity level (89%), group size (88%), activity type (90%) and interactions (88%) met acceptable criteria. Both physical activity and social interactions were influenced by group size, activity type, and child gender and body weight status.

Conclusions: SOCARP is a valid and reliable observation system for assessing physical activity and play behavior in a recess context.

Fundamental movement skills in children and adolescents : review of associated health benefits

The mastery of fundamental movement skills (FMS) has been purported as contributing to children's physical, cognitive and social development and is thought to provide the foundation for an active lifestyle. Commonly developed in childhood and subsequently refined into context- and sport-specific skills, they include locomotor (e.g. running and hopping), manipulative or object control (e.g. catching and throwing) and stability (e.g. balancing and twisting) skills. The rationale for promoting the development of FMS in childhood relies on the existence of evidence on the current or future benefits associated with the acquisition of FMS proficiency. The objective of this systematic review was to examine the relationship between FMS competency and potential health benefits in children and adolescents. Benefits were defined in terms of psychological, physiological and behavioural outcomes that can impact public health. A systematic search of six electronic databases (EMBASE, OVID MEDLINE, PsycINFO, PubMed, Scopus and SportDiscus) was conducted on 22 June 2009. Included studies were cross-sectional, longitudinal or experimental studies involving healthy children or adolescents (aged 3–18 years) that quantitatively analysed the relationship between FMS competency and potential benefits. The search identified 21 articles examining the relationship between FMS competency and eight potential benefits (i.e. global self-concept, perceived physical competence, cardio-respiratory fitness [CRF], muscular fitness, weight status, flexibility, physical activity and reduced sedentary behaviour). We found strong evidence for a positive association between FMS competency and physical activity in children and adolescents. There was also a positive relationship between FMS competency and CRF and an inverse association between FMS competency and weight status. Due to an inadequate number of studies, the relationship between FMS competency and the remaining benefits was classified as uncertain. More longitudinal and intervention research examining the relationship between FMS competency and potential psychological, physiological and behavioural outcomes in children and adolescents is recommended.

Understanding the correlates of adolescents' TV viewing : a social ecological approach

Objective. To examine associations between social ecological factors and Dutch adolescents’ TV viewing. Design. Cross-sectional examination of predictors of adolescents’ TV viewing.

Participants. A total of 338 adolescents, aged 14 years (55% boys).

Measurements. Adolescents self-reported their age, ethnicity and TV viewing (dichotomized at two hours/day) and responded to items from all three social ecological domains; individual (cognitions based on the Theory of Planned Behaviour and TV viewing habit strength, and other behaviours, such as computer use), social (parental rules about TV viewing and parental TV viewing behavior) and physical environmental factors (TV in bedroom, physical activity equipment available). Parents reported demographic factors (e.g., ethnicity, education level), and their own TV viewing (mins/day); adolescents’ weight status (not overweight vs. overweight/obese) was calculated from objective measures of height and weight. Logistic regression analyses examined associations between socio-ecological factors and adolescents’ TV viewing, and whether associations were moderated by adolescents’ sex, parents’ education and ethnicity.

Results. Compared with others, overweight/obese adolescents (odds ratio (OR)=3.0; p≤0.001), those with high computer use (OR=2.3; p≤0.0001), with high TV viewing habit strength (OR=1.3; p≤0.0001), and those whose parents had high levels of TV viewing (OR=2.4; p≤0.01) were more likely to exceed two hours of TV viewing per day. The association with habit strength was moderated by gender, and the association with parents’ TV viewing was moderated by parents’ education and ethnicity.

Conclusions. Interventions should target parents’ TV viewing behaviors and aim to amend habitual, ‘mindless’ TV viewing among adolescents.

Why do some socioeconomically disadvantaged women eat better than others? An investigation of the personal, social and environmental correlates of fruit and vegetable consumption

The purpose of this paper was to examine the contribution of individual, social and environmental factors to predicting fruit and vegetable consumption among women of low socioeconomic position (SEP). An Australian community sample of 355 women of low SEP provided survey data on sociodemographic information, diet (fruit and vegetable consumption), and various cognitive, behavioural, social and perceived environmental influences on healthy eating. Information on the availability and accessibility of major chain supermarkets and fruit and vegetable stores from participant's residence was collected through objective audits. Women who were older, dieting to lose weight, had a greater taste preference for fruit and perceived the cost of fruit to be lower were more likely to be high fruit consumers. Women who had a high BMI were more likely to be high vegetable consumers. Women who perceived a greater availability of healthy foods in their neighbourhoods were more likely to be high fruit and vegetable consumers. Strategies aimed at increasing fruit and vegetable consumption among low SEP women should focus on modifying perceptions about the cost, availability and taste of fruits and vegetables. Tailoring nutrition interventions to accommodate differences in age, weight-control practices and weight status may also prove beneficial.

Characteristics of energy under-reporting in children and adolescents

Under-reporting (UR) of food intake is an issue of concern, as it may distort the relationships studied between diet and health. This topic has been scarcely addressed in children. The objective of the study was to assess the extent of UR in French children and investigate associated covariates. A total of 1455 children aged 3–17 years were taken from the nationally representative cross-sectional French étude Individuelle Nationale des Consommations Alimentaires (INCA2) dietary survey (2006–7). Food intake was reported in a 7 d diet record. Socio-economic status, sedentary behaviour, weight perception variables and food habits were collected by questionnaires. Weight and height were measured. Under-reporters were identified according to the Goldberg criterion adapted to children. Multivariate logistic regressions investigated the associations between UR and covariates. Rates of under-reporters were 4·9 and 26·0 % in children aged 3–10 and 11–17 years, respectively (P < 0·0001), without significant differences between boys and girls. Overall, UR was positively associated with a lower socio-economic status, overweight, skipping breakfast and dinner, a higher contribution of proteins to energy intake (EI), and a lower contribution of simple carbohydrates to EI. Under-reporters aged 3–10 years also had a higher sedentary behaviour and a lower snack-eating frequency. In adolescents, UR was also associated with a less-frequent school canteen attendance, a perception of being overweight, a wish to weigh less, and current and past restrictive diets. In conclusion, under-reporters differ from plausible reporters in several characteristics related to diet, lifestyle, weight status and socio-economic status. Therefore, it is important to consider this differential UR bias when investigating diet–disease associations in children.

The health-related quality of life of overweight and obese adolescents - a study measuring body mass index and adolescent-reported perceptions

Objective. To determine whether the health-related quality of life (HRQOL) of overweight and obese adolescents is significantly lower than that of their healthy weight counterparts, and if so, whether any demographic trends exist and the relative contribution of each HRQOL dimension.

Methods. Cross-sectional analysis of 2,890 students participating in the Pacific Obesity Prevention in Communities Project, Australia. HRQOL was measured using the Pediatric Quality of Life Inventory (PedsQL) adolescent module. Adolescent height and weight were measured by trained field workers and weight categories assigned according to the International Obesity Task Force BMI cut-off points for adolescents. Multivariate linear regression analyses were undertaken to estimate the mean differences in HRQOL scores between (i) overweight and healthy weight, and (ii) obese and healthy weight adolescents, whilst adjusting for gender, age and socioeconomic status quartile.

Results. The sample had a mean age of 14.6 years (range 11–18), 56.2% boys, 20.2% overweight and 6.3% obese. Higher weight status categories were associated with lower HRQOL scores (mean PedsQL scores: healthy weight: 79.1, overweight: 77.7 and obese: 73.7). Relative to the healthy weight group, and after adjustments, overweight and obese adolescents reported 1.44 (p = 0.005) and 5.55 (p < 0.001) lower HRQOL summary scores, respectively. Overweight adolescents reported significantly lower scores in physical and social functioning, whilst obese adolescents reported significantly lower scores in the same dimensions plus emotional functioning. Girls and younger (< 15 years) adolescents reported greater mean negative HRQOL differences associated with excess weight.

Conclusions. Overweight and obesity in adolescents are associated with significantly lower HRQOL scores.

Utility-based quality of life of overweight and obese adolescents

Objective : To explore the relationship between overweight/obesity and utility in adolescents.

Methods : Data were collected from 2890 adolescents attending 13 secondary schools in the state of Victoria, Australia. The Assessment of Quality of Life 6-Dimension (AQoL-6D) questionnaire was used to measure individual utility. Adolescent's height and weight were measured and weight status categories assigned according to the World Health Organization adolescent growth standards. Multivariate linear regression analyses were undertaken for the whole population and subpopulations of boys and girls to estimate the mean differences in utility scores between 1) overweight and healthy weight and 2) obese and healthy weight adolescents, while controlling for demographic and socioeconomic status variables.

Results : The mean age of adolescents was 14.6 years, 56.2% were boys, 22.2% were overweight, and 9.4% were obese. The mean utility of healthy weight adolescents was 0.860. After adjustments, the overweight and obese groups reported significantly lower mean utility scores (differences: −0.018 and −0.059, respectively, relative to the healthy weight group). This can be interpreted as equivalent to a stated willingness to sacrifice 1.8% and 5.9% of a life in perfect health or 2.3% and 6.8% of a life at healthy weight. A significant utility difference associated with overweight was only experienced by girls (−0.039, P = 0.003). Both sexes experienced significant utility differences associated with obesity, but the magnitude was double for girls (−0.084, P < 0.001) relative to boys (−0.041, P = 0.022).

Conclusion : Utility is lower among overweight and more so among obese adolescents.

Socio-demographic characteristics of children experiencing socioeconomic disadvantage who meet physical activity and screen-time recommendations : the READI study

Objective - To identify socio-demographic characteristics of children from socioeconomically disadvantaged neighbourhoods who meet physical activity and screen recommendations.
Method - Children aged 5–12 years (n = 373; 45% boys) were recruited in 2007 from socioeconomically disadvantaged urban and rural areas of Victoria, Australia. Children's physical activity, height and weight were objectively measured. Mothers reported their highest level of education, and proxy-reported their child's usual screen-time. Odds ratios (OR) and 95% confidence intervals (95% CI) examined odds of meeting physical activity (> 60 minutes/day) and screen (≤ 120 minutes/day) recommendations according to socio-demographic characteristics.
Results - Approximately 84% of children met physical activity and 43% met screen recommendations. Age was inversely associated with odds of meeting physical activity and screen recommendations, and overweight/obese status was associated with lower odds of meeting screen recommendations (boys: OR = 0.39, 95%CI = 0.16–0.95; girls: OR = 0.47, 95%CI = 0.26–0.83). Among boys, living in a rural area was positively associated with meeting screen recommendations (OR = 3.08, 95%CI = 1.42–6.64). Among girls, high levels of maternal education were positively associated with meeting screen recommendations (OR = 2.76, 95%CI = 1.33–5.75).
Conclusion - Specific socio-demographic characteristics were associated with odds of meeting physical activity and screen recommendations. Identifying factors associated with such ‘resilience’ among this group may provide important learnings to inform future physical activity promotion initiatives.

Involvement of young Australian adults in meal preparation : cross-sectional associations with abdominal obesity and body mass index

Previous research has shown that involvement in meal preparation is positively associated with better diet quality. However, it is unclear whether there is an association between involvement in meal preparation and being overweight or obese. This study investigated whether the level of involvement in meal preparation was associated with objectively measured weight status in young adults. During 2004-2006, a national sample of 1,996 Australian adults aged 26 to 36 years completed a self-administered questionnaire including questions on sociodemographic characteristics, diet, and physical activity. Participants were asked to report who usually prepared the main meal on working days and responses were categorized as “myself,” “shared,” or “someone else.” Waist circumference, weight, and height were measured by trained staff. Moderate abdominal obesity was defined as waist circumference >94 cm for men and >80 cm for women. Overweight was defined as body mass index (calculated as kg/m2) >25. Prevalence ratios were calculated using log binomial regression. After adjusting for age, education, and leisure time physical activity, men who shared the meal preparation had a slightly lower prevalence of moderate abdominal obesity (prevalence ratio=0.92; 95% confidence interval [CI]: 0.86 to 0.99) than those whose meals were usually prepared by someone else. There was no association with having sole responsibility (prevalence ratio=0.99; 95% CI: 0.92 to 1.06). There were no associations between level of involvement in meal preparation and being overweight (shared responsibility prevalence ratio=0.99; 95% CI: 0.92 to 1.07; sole responsibility prevalence ratio=0.98; 95% CI: 0.91 to 1.05). For women, level of involvement was not associated with moderate abdominal obesity (shared responsibility prevalence ratio=0.93; 95% CI: 0.84 to 1.03; sole responsibility prevalence ratio=0.94; 95% CI: 0.86 to 1.03) or being overweight (shared responsibility prevalence ratio=0.93; 95% CI: 0.84 to 1.02; sole responsibility prevalence ratio=0.93; 95% CI: 0.85 to 1.02). In this sample of young adults, level of involvement in meal preparation was not strongly related to weight status.

Assessing dietary intake in children and adolescents : considerations and recommendations for obesity research

Dietary intake and food habits are important contributors to the obesity epidemic. They are highly modifi able components of energy balance and are usually targeted in both obesity prevention and treatment programs. However, measurement of total diet creates challenges and can convey a large burden in terms of cost, technical expertise, impact on respondents and time. It is not surprising therefore that comprehensive reports of dietary intake in children are uncommon and, when reported, have limitations. The aim of this paper is to guide researchers and practitioners in selecting the most appropriate dietary assessment method for situations involving children and adolescents. This paper presents a summary of the issues to consider when choosing a method, a description of some of the more commonly used dietary assessment methods for young people and a series of case-studies to illustrate the range of circumstances faced when measuring dietary intake. We recommend that researchers consider the specifi c components of dietary intake addressed in their research and practice, and whether diet should be reported comprehensively or as targeted components. Other considerations include age, cognitive ability, weight status, physical activity level, respondent burden, and reliability and validity in the context of program goals and research questions. A checklist for selecting the appropriate dietary methodology is provided. This guide aims to facilitate the reporting of dietary intake and food habits in the context of obesity using valid and reliable measures, thus contributing to the evidence-base for nutrition policies and programs relating to obesity.

The importance of long-term follow-up in child and adolescent obesity prevention interventions

Pediatric overweight and obesity continues to be a major public health concern. Once established it is diffi cult to treat; therefore well-designed and evaluated prevention interventions are vitally important. There is considerable evidence to suggest that obesity prevention initiatives can change children ’ s behaviours and weight status over the short- or mediumterm; however, there is far less evidence on which to judge the impact over the longer term. In response to the rise in short- and medium-term obesity prevention studies for children and adolescents over recent years, the Prevention Stream of the Australasian Child and Adolescent Obesity Research Network highlight fi ve points as to why the dearth of obesity prevention studies with long-term follow-up should be urgently addressed. Furthermore, recommendations to strengthen the evidence base and outline key implications for research design in this area and the support required for long-term follow-up studies are detailed.