Associations of physical activity with body weight and fat in men and women

OBJECTIVE: Increasing physical activity is strongly advocated as a key public health strategy for weight gain prevention. We investigated associations of leisure-time physical activity (LTPA) and occupational/domestic physical activity with body mass index (BMI) and a skinfold-derived index of body fat (sum of six skinfolds), among normal-weight and overweight men and women.

DESIGN: Analyses of cross-sectional self-report and measured anthropometric data.

SUBJECTS: A total of 1302 men and women, aged 18-78 y, who were part of a randomly selected sample and who agreed to participate in a physical health assessment.

MEASUREMENTS: Self-report measures of physical activity, measured height and weight, and a skinfold-derived index of body fatness.

RESULTS: Higher levels of LTPA were positively associated with the likelihood of being in the normal BMI and lower body fat range for women, but few or no associations were found for men. No associations were found between measures of occupational/domestic activity and BMI or body fat for men or women.

CONCLUSION: By using a skinfold sum as a more direct measure of adiposity, this study extends and confirms the previous research that has shown an association between BMI and LTPA. Our results suggest gender differences in the relationship of leisure-time physical activity with body fatness. These findings, in conjunction with a better understanding of the causes of such differences, will have important public health implications for the development and targeting of weight gain prevention strategies.

Relationship between body mass index and the use of healthcare services in Australia

Objective: To examine the relationship between body mass index (BMI) and the use of medical and preventive health services. Research Methods and Procedures: This study involved secondary analysis of weighted data from the Australian 1995 National Health Survey. The study was a population survey designed to obtain national benchmark information about a range of health-related issues. Data were available from 17,033 men and 17,174 women, 20 years or age. BMI, based on self-reported weight and height, was analyzed in relation to the use of medical services and preventive health services. Results: A positive relationship was found between BMI and medical service use, such as medication use, visits to hospital accident and emergency departments (for women only); doctor visits, visits to a hospital outpatient clinics; and visits to other health professionals (for women only). A negative relationship was found in women between BMI and preventive health services. Underweight women were found to be significantly less likely to have Papanicolaou smear tests, breast examinations, and mammograms. Discussion: This research shows that people who fall outside the healthy weight range are more likely to use a range of medical services. Given that the BMI of industrialized populations appears to be increasing, this has important ramifications for health service planning and reinforces the need for obesity prevention strategies at a population level.

Reducing sedentary behaviour and increasing physical activity among 10-year-old children: overview and process evaluation of the 'Switch-Play' intervention

Overweight and obesity has doubled among children in Australia. There is an urgent need to develop primary prevention strategies to prevent current and future unhealthy weight gain. The aims of this paper are to describe a randomized controlled trial (‘Switch-Play’) developed to prevent unhealthy weight gain among 10-year-old children and to report the findings of the process evaluation. Children from three government primary schools were randomized by class to one of four conditions: a behavioural modification group (BM; n = 69); a fundamental motor skills group (FMS; n = 73); a combined BM and FMS group (n = 90); or a control (usual classroom lessons) group (n = 61). Children in the BM group participated in 19 sessions that encouraged them to reduce screen-based behaviours, and identified physical activity alternatives. The FMS group participated in 19 lessons that focused on mastery of six skills: run, throw, dodge, strike, vertical jump and kick. The combined group participated in all the BM and FMS activities. The intervention specialist teacher reported that the children showed high enjoyment and engagement (88% lessons attended) in most aspects of the programme. At-home tasks were completed by 57–62% of the children, and 92% completed the in-class tasks. Two-thirds of the children in the BM group participated in the behavioural contracting to switch off the TV. Most of the children reported high enjoyment of the programmes, and only a small proportion (7–17%) reported difficulties in switching off their nominated TV shows. More than half the children reported reducing their TV viewing; however, less than half reported increasing their physical activity. It was found that most aspects of the intervention arms of the programme were successfully delivered to the majority of children participating in ‘Switch-Play’; that the programmes were delivered as intended; and that the programmes were favourably evaluated by participating children and their parents.

Family food environment and dietary behaviors likely to promote fatness in 5-6 year-old children

Background: The family food environment (FFE) is likely to exert important influences on young children's eating. Examination of multiple aspects of the FFE may provide useful insights regarding which of these might most effectively be targeted to prevent childhood obesity.

Objective: To assess the associations between the FFE and a range of obesity-promoting dietary behaviors in 5–6-year-old children.

Design: Cross-sectional study.

Subjects: Five hundred and sixty families sampled from three socio-economically distinct areas.

Measurements: Predictors included parental perceptions of their child's diet, food availability, child feeding practices, parental modeling of eating and food preparation and television (TV) exposure. Dietary outcomes included energy intake, vegetable, sweet snack, savory snack and high-energy (non-dairy) fluid consumption.

Results: Multiple linear regression analyses, adjusted for all other predictor variables and maternal education, showed that several aspects of the FFE were associated with dietary outcomes likely to promote fatness in 5–6-year-old children. For example, increased TV viewing time was associated with increased index of energy intake, increased sweet snack and high-energy drink consumption, and deceased vegetable intake. In addition, parent's increased confidence in the adequacy of their child's diet was associated with increased consumption of sweet and savory snacks and decreased vegetable consumption. 

Conclusion:  This study substantially extends previous research in the area, providing important insights with which to guide family-based obesity prevention strategies.

Interventions for preventing obesity in childhood. A systematic review

Background The prevalence of obesity and overweight is increasing worldwide. Obesity in children impacts on their health in both short- and long-term. Obesity prevention strategies are poorly understood.

Objective To assess the effectiveness of interventions designed to prevent obesity in childhood.

Search strategy Electronic databases were searched from January 1985 to October 1999.

Selection criteria Data from randomized control trials and non-randomized trials with concurrent control group were included. A priori, studies with follow up of 1 year minimum were selected however, this was subsequently amended to include studies with a minimum follow up of three months.

Data collection & analysis Two reviewers independently extracted data and assessed study quality.

Main results Seven studies were included, three long-term (>1 years) and four short-term (>3 months and <1 years). The studies included were diverse in terms of study design and quality, target population, theoretical underpinning of intervention approach, and outcome measures. As such, it was not appropriate to combine study findings using statistical methods.

Conclusions Two of the long-term studies (one focused on dietary education and physical activity vs. control, and the other only on dietary education vs. control), resulted in a reduction in the prevalence on obesity, but the third, which focused on dietary education and physical activity, found no effect. Of the four short-term studies, three focused simply on physical activity/reduction of sedentary behavious vs. control. Two of these studies resulted in a reduction in the prevalence of obesity in intervention groups compared with control groups, and another study found a non-significant reduction. The fourth study focused on dietary education and physical activity, and did not find an effect on obesity, but did report a reduction in fat intake. Overall, the findings of the review suggest that currently there is limited quality data on the effectiveness of obesity prevention programmes and as such no generalizable conclusions can be drawn. The need for well-designed studies that examine a range of interventions remains a priority.

Puberty and the onset of substance use and abuse

Objective: Substance abuse remains one of the major threats to adolescent health in Western cultures. The study aim was to ascertain the extent of association between pubertal development and early adolescent substance use.

Methods: The design was a cross-sectional survey of 10- to 15-year-old subjects in the states of Washington, United States, and Victoria, Australia. Participants were 5769 students in grades 5, 7, and 9, drawn as a 2-stage cluster sample in each state, and the questionnaire was completed in the school classrooms. The main outcomes of the study were lifetime substance use (tobacco use, having been drunk, or cannabis use), recent substance use (tobacco, alcohol, or cannabis use in the previous month), and substance abuse (daily smoking, any binge drinking, drinking at least weekly, or cannabis use at least weekly).

Results: The odds of lifetime substance use were almost twofold higher (odds ratio [OR]: 1.7; 95% confidence interval [CI]: 1.4–2.1) in midpuberty (Tanner stage III) and were threefold higher (OR: 3.1; 95% CI: 2.4–4.2) in late puberty (Tanner stage IV/V), after adjustment for age and school grade level. Recent substance use was moderately higher (OR: 1.4; 95% CI: 1.0–1.9) in midpuberty and more than twofold higher (OR: 2.3; 95% CI: 1.7–3.3) in late puberty. The odds of substance abuse were twofold higher (OR: 2.0; 95% CI: 1.2–3.2) in midpuberty and more than threefold higher (OR: 3.5; 95% CI: 2.2–5.4) in late puberty. Reporting most friends as substance users was more likely in the later stages of pubertal development, a relationship that accounted in part for the association found between later pubertal stage and substance abuse.

Conclusions: Pubertal stage was associated with higher rates of substance use and abuse independent of age and school grade level. Early maturers had higher levels of substance use because they entered the risk period at an earlier point than did late maturers. The study findings support prevention strategies and policies that decrease recreational substance use within the peer social group in the early teens.

Labour and economic development: emerging issues in developing Asia

Contents:
Child labour and economic development : emerging issues in developing Asia /​ Gamini Herath and Kishor Sharma
Child labour in developing countries : review of theoretical and : empirical issues /​ Gamini Herath
Cumulative causation as explanation and policy base for child labour /​ G. Bamberry
Child labour : an integrated approach /​ Manohar Pawar
Trade, growth and child labour practices in South Asia /​ Kishor Sharma
An overview of child labour laws, prevention strategies and assessment of their effectiveness in Bangladesh /​ Jesmul Hasan
An overview of child labour in India /​ Subhashini Subbaraman and Harald von Witzke
Child labour in India : a critical evaluation of four issues /​ Anna Pinto
Prevention of child labour in Nepal : an overview of strategy and effectiveness
Chiranjibi nepal
Prevention of child labour in Pakistan : analysis of strategy and effectiveness /​ Shafqat Munir and Hassan Mangi
Issues relating to prevention of child labour in Sri Lanka /​ Nisha Arunatilake and Roshani de Silva.

Child labour in developing countries: review of theoretical and empirical issues

Contents:Child labour and economic development : emerging issues in developing Asia /​ Gamini Herath and Kishor Sharma
Child labour in developing countries : review of theoretical and : empirical issues /​ Gamini Herath
Cumulative causation as explanation and policy base for child labour /​ G. Bamberry
Child labour : an integrated approach /​ Manohar Pawar
Trade, growth and child labour practices in South Asia /​ Kishor Sharma
An overview of child labour laws, prevention strategies and assessment of their effectiveness in Bangladesh /​ Jesmul Hasan
An overview of child labour in India /​ Subhashini Subbaraman and Harald von Witzke
Child labour in India : a critical evaluation of four issues /​ Anna Pinto
Prevention of child labour in Nepal : an overview of strategy and effectiveness
Chiranjibi nepal
Prevention of child labour in Pakistan : analysis of strategy and effectiveness /​ Shafqat Munir and Hassan Mangi
Issues relating to prevention of child labour in Sri Lanka /​ Nisha Arunatilake and Roshani de Silva.

Prevalence of psychological distress, anxiety and depression in rural communities in Australia

Objective: To describe the prevalence of psychological distress, depression and anxiety in three Australian rural settings and to identify the levels of risk by gender and age.

Design and setting: Three cross-sectional surveys in the Greater Green Triangle area covering the south-east of South Australia (Limestone Coast), and south-west (Corangamite Shire) and north-west (Wimmera) of Victoria.

Participants: A total of 1563 people, aged 25–74 years, randomly selected from the electoral roll.

Main outcome measures: Psychological distress assessed by the Kessler 10, and anxiety and depression assessed by the Hospital Anxiety and Depression Scale.

Results: The prevalence of psychological distress was 31% for both men and women with two-thirds reporting moderate and one-third high levels of psychological distress. The prevalence of depression and anxiety was approximately 10%. The highest rate of psychological distress, anxiety and depression occurred in the 45–54 years age group. There were no consistent gender or area differences in the prevalence of psychological distress, depression or anxiety.

Conclusions: A third of the rural population reported psychological distress, with the highest prevalence observed in middle-aged men and women. Thus, health professionals should attend not only to physical health, but also to mental health status in this age group. It is also important to target prevention strategies at the 20% who reported moderate levels of psychological distress in order to prevent the development of more serious conditions.

Associations between the home food environment and obesity-promoting eating behaviors in adolescence

Objective: This study examines relationships between multiple aspects of the home food environment and obesity-promoting characteristics of 12- to 13-year-old adolescents' diets, specifically frequency of consumption of high-energy fluids, sweet snacks, savory snacks, and take-out foods.

Research Methods: This was a cross-sectional study including 347 adolescents 12 to 13 years of age and their parents. Data were collected via self-completed surveys. The adolescents' diets were assessed using a Food Frequency Questionnaire derived from existing age-appropriate National Nutrition Survey data. An extensive range of domains within the home food environment were assessed. Bivariate linear regression analyses were run split by gender. Forced entry multiple linear regression analyses (adjusting for all variables significant in bivariate analyses as well as for maternal education) were also performed, stratified by the sex of the child.

Results: The influence of mothers, either as models for eating behaviors or as the providers of food, was pervasive. Mothers' intake of high-energy fluids (p = 0.003), sweet snacks (p = 0.010), savory snacks (p = 0.008), and take-out food (p = 0.007) was positively associated with boys' intake of all these foods. In addition, mothers' intake of high-energy fluids was positively associated with daughters' consumption of these drinks (p = 0.025). Furthermore, availability of unhealthy foods at home was positively associated with girls' sweet snack (p = 0.001), girls' savory snack (p < 0.001), boys' savory snack (p = 0.002), and, in the bivariate analyses, girls' high-energy fluid consumption (p = 0.002).

Discussion: This study of home food environment influences on adolescent diet highlights the pervasive influence of mothers in determining adolescents' obesity-promoting eating, providing direction for obesity prevention strategies and future research.

Are squash players protecting their eyes?

Methods: A survey of 303 players (aged ≥18 years) was conducted at three squash venues in Melbourne, Australia over a three week period in June 2000 to obtain information about protective eyewear use.

Results: Of 303 participants the response rate was 98.1%; 66.1% were males, with a mean age of 40.5 years. The majority (68.4%) had played squash for 10 years or more. Although 18.8% of players reported using protective eyewear, only 8.9% reported wearing approved eyewear. Both age group (p<0.05) and years of squash experience (p<0.01) were significantly associated with any eyewear use. The two main influences were personal experience of eye injuries (50.0%) and knowledge of eye injury risk (33.9%). A commonly reported barrier was restriction of vision (34.2%).

Conclusion: These findings demonstrate a low prevalence of voluntary use of appropriate protective eyewear. Future prevention strategies incorporating education campaigns should focus on increasing players' knowledge of risks. The barriers to use and misconceptions about which types of eyewear is most protective need to be addressed as a priority.

Stability of body mass index in Australian children: a prospective cohort study across the middle childhood years

Objective: To investigate the prevalence and incidence of overweight and obesity, the frequency of overweight resolution and the influence of parental adiposity during middle childhood.

Design: As part of a prospective cohort study, height and weight were measured in 1997 and 2000/2001. Children were classified as non-overweight, overweight or obese based on standard international definitions. Body mass index (BMI) was transformed into age- and gender-specific Z-scores employing the LMS method and 2000 growth chart data of the Centers for Disease Control and Prevention. Parents self-reported height and weight, and were classified as underweight, healthy weight, overweight or obese based on World Health Organization definitions.

Setting: Primary schools in Victoria, Australia.

Subjects: In total, 1438 children aged 5–10 years at baseline.

Results: The prevalence of overweight and obesity increased between baseline (15.0 and 4.3%, respectively) and follow-up (19.7 and 4.8%, respectively; P < 0.001 for increase in overweight and obesity combined). There were 140 incident cases of overweight (9.7% of the cohort) and 24 of obesity (1.7% of the cohort); only 3.8% of the cohort (19.8% of overweight/obese children) resolved to a healthy weight. The stability of child adiposity as measured by BMI category (84.8% remained in the same category) and BMI Z-score (r = 0.84; mean change = −0.05) was extremely high. Mean change in BMI Z-score decreased with age (linear trend β = 0.03, 95% confidence interval 0.01–0.05). The influence of parental adiposity largely disappeared when children's baseline BMI was adjusted for.

Conclusions: During middle childhood, the incidence of overweight/obesity exceeds the proportion of children resolving to non-overweight. However, for most children adiposity remains stable, and stability appears to increase with age. Prevention strategies targeting children in early childhood are required.

Interventions for preventing obesity in children (Review)

Background
Obesity prevention is an international public health priority. The prevalence of obesity and overweight is increasing in child populations throughout the world, impacting on short and long-term health. Obesity prevention strategies for children can change behaviour but efficacy in terms of preventing obesity remains poorly understood.

Objectives
To assess the effectiveness of interventions designed to prevent obesity in childhood through diet, physical activity and/or lifestyle and social support.

Search strategy
MEDLINE, PsycINFO, EMBASE, CINAHL and CENTRAL were searched from 1990 to February 2005. Non-English language papers were included and experts contacted.

Selection criteria
Randomised controlled trials and controlled clinical trials with minimum duration twelve weeks.

Data collection and analysis
Two reviewers independently extracted data and assessed study quality.

Main results
Twenty-two studies were included; ten long-term (at least 12 months) and twelve short-term (12 weeks to 12 months). Nineteen were school/preschool-based interventions, one was a community-based intervention targeting low-income families, and two were family-based interventions targeting non-obese children of obese or overweight parents.

Six of the ten long-term studies combined dietary education and physical activity interventions; five resulted in no difference in overweight status between groups and one resulted in improvements for girls receiving the intervention, but not boys. Two studies focused on physical activity alone. Of these, a multi-media approach appeared to be effective in preventing obesity. Two studies focused on nutrition education alone, but neither were effective in preventing obesity.

Four of the twelve short-term studies focused on interventions to increase physical activity levels, and two of these studies resulted in minor reductions in overweight status in favour of the intervention. The other eight studies combined advice on diet and physical activity, but none had a significant impact.

The studies were heterogeneous in terms of study design, quality, target population, theoretical underpinning, and outcome measures, making it impossible to combine study findings using statistical methods. There was an absence of cost-effectiveness data.

Authors' conclusions
The majority of studies were short-term. Studies that focused on combining dietary and physical activity approaches did not significantly improve BMI, but some studies that focused on dietary or physical activity approaches showed a small but positive impact on BMI status. Nearly all studies included resulted in some improvement in diet or physical activity. Appropriateness of development, design, duration and intensity of interventions to prevent obesity in childhood needs to be reconsidered alongside comprehensive reporting of the intervention scope and process.

Access to a healthy diet and fast foods in the City of Casey

It is known that the consumption of fast food is associated with obesity (Binkley 2000). Relative ease of access to fast foods compared with healthy foods may contribute to the increasing prevalence of obesity. The aim of this study was to determine and compare the access by car to fast foods and a healthy diet. The study was located in the City of Casey, a municipality in South East Melbourne with a population of 220,000. We have previously shown that ease of access to a large chain supermarket ensures access to a basket of healthy foods adequate to meet the nutritional needs of a family of 6 (Burns 2004). The City of Casey council provided location details for major fast food outlets and supermarkets. Fast food was defined as food sourced from an outlet without table service. We included only those major fast food chain outlets which had more than 10 franchises within Australia. We included the 3 major supermarket chains that account for 87% total food retailing in Victoria. Geographic details from the City of Casey were used to map the location of these outlets. Then using these locations and road network a basic cost distance model was created for either the supermarket chains or fast food chains outlets. The cost unit is (time), it was to calculate by giving the roads in the network an average travel speed depending in the type of road (minor, major or highway) and then calculating how long it would take to reach the closest outlet. Access to supermarket and fast food outlets were determined relative to population density.
Our results indicate that in the City of Casey most (> 80%) people live within an 8-10 minute car journey of a major supermarket and a fast food outlet. Fifty percent of the fast food outlets are co-located with a supermarket. We conclude that access to both healthy food and fast food in the City of Casey is good if you own a car. The increasing demand for fast food is easily met in this municipality. Obesity prevention strategies in Casey should concentrate on the food choices available at fast food outlets and town planning to ensure a mix of food outlets to maximize the likelihood of healthy food choices.

Prevalence and cost of musculoskeletal disorders: a population-based, public hospital system healthcare consumption approach.

Objective: To use a population-level, public-hospital approach to compare the prevalence and cost of musculoskeletal diseases (MSD) with other clinical specialties.

Methods: A healthcare utilization survey of 4 million individual records over 4 years, from all major public hospitals in the state of Victoria (estimated population 4.8 million residents in 2000/01) from 1997/98 to 2000/01. Main outcome measures were inpatient episodes of care, bed-days, and outpatient clinic encounters. MSD was defined as the combination of orthopedics and rheumatology.

Results: After obstetrics, MSD was the most frequent outpatient service, with orthopedics accounting for 9.9% of all visits in 2000/01. The proportion of MSD outpatient encounters (on average 11.6% of the total) was constant over the study period. Among 26 medical specialties, MSD had the sixth highest number of inpatient episodes (6.2% in 2000/01), following renal dialysis (14.6%), general surgery (8.2%), obstetrics (7.6%), gastroenterology (7.1%), and general medicine (6.7%). MSD was the fifth highest consumer of bed-days, occupying on average 7.7% of all beds per annum in the period 1997/98 to 2000/01, behind psychiatry (10.1%), respiratory medicine (8.5%), rehabilitation (8.3%), and general medicine (7.8%). MSD was the third most-costly discipline in 2000/01, with total costs of over A dollars 169 million (9.7% of total inpatient costs that year), behind respiratory medicine (11.6%) and general surgery (11.5%).

Conclusion: Compared to other diseases, MSD consumes a substantial proportion of healthcare resources in Victorian public hospitals. These data have important implications for allocation of healthcare resources, clinical care pathways, and prevention strategies.