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.

Longitudinal study of Consumer Price Index (CPI) trends in core and non-core foods in Australia

Objective: This study examined trends in the price of healthy and less-healthy foods from 1989 to 2007 using the Australian Consumer Price Index (CPI).

Methods: CPI food expenditure classes were classified as 'core' or 'non-core'. Trends in the CPI were analysed to examine the rise in prices of core compared with non-core foods.

Results: On average, the CPI for core foods has risen at a slightly higher, though not statistically significant, rate than non-core foods. Furthermore, selected groupings reveal interesting patterns. 'Bread' has risen in price significantly more than 'cakes and biscuits', and 'milk' has risen in price significantly more than 'soft drinks, waters and juices'.

Conclusions and implications: This investigation of food price trends reveals notable differences between core and non-core foods. This should be investigated further to determine the extent to which this contributes to the higher prevalence of diet-related diseases in low socio-economic groups.

The infant feeding activity and nutrition trial (INFANT) an early intervention to prevent childhood obesity : cluster-randomised controlled trial

Background : Multiple factors combine to support a compelling case for interventions that target the development of obesity-promoting behaviours (poor diet, low physical activity and high sedentary behaviour) from their inception. These factors include the rapidly increasing prevalence of fatness throughout childhood, the instigation of obesity-promoting behaviours in infancy, and the tracking of these behaviours from childhood through to adolescence and adulthood. The Infant Feeding Activity and Nutrition Trial (INFANT) aims to determine the effectiveness of an early childhood obesity prevention intervention delivered to first-time parents. The intervention, conducted with parents over the infant's first 18 months of life, will use existing social networks (first-time parent's groups) and an anticipatory guidance framework focusing on parenting skills which support the development of positive diet and physical activity behaviours, and reduced sedentary behaviours in infancy.

Methods/Design : This cluster-randomised controlled trial, with first-time parent groups as the unit of randomisation, will be conducted with a sample of 600 first-time parents and their newborn children who attend the first-time parents' group at Maternal and Child Health Centres. Using a two-stage sampling process, local government areas in Victoria, Australia will be randomly selected at the first stage. At the second stage, a proportional sample of first-time parent groups within selected local government areas will be randomly selected and invited to participate. Informed consent will be obtained and groups will then be randomly allocated to the intervention or control group.

Discussion : The early years hold promise as a time in which obesity prevention may be most effective. To our knowledge this will be the first randomised trial internationally to demonstrate whether an early health promotion program delivered to first-time parents in their existing social groups promotes healthy eating, physical activity and reduced sedentary behaviours. If proven to be effective, INFANT may protect children from the development of obesity and its associated social and economic costs.

Minimising colonic fermentation of high fructan foods : using food processing techniques to reduce levels of fructans in onion and garlic

Background: Irritable Bowel Syndrome (IBS) is a chronic functional disorder of the bowel, affecting up to 15% of Australian adults. Dietary triggers need to be identified and controlled. Researchers have shown that short chain carbohydrates, fructans (high in onion and garlic) play a major role in triggering IBS symptoms. Current dietary management aims to limit the intake of fructans in the diet. Another approach may be to use simple food processing to reduce fructans in foods.

Objective: To investigate if pickling will reduce fructan levels in garlic and shallots, and if pickled garlic and shallots reduce colonic fermentation, and  abdominal symptoms in human volunteers.

Design: Fructan levels of the garlic and shallots were measured using the Megazyme fructan assay. 18 volunteers (13 healthy and 5 IBS) participated in a single blinded, randomised cross over study. Subjects were randomly assigned to receive a breakfast (potato and salmon patty) that was either high (unprocessed) or low (processed/pickled) in garlic and shallots. Breath hydrogen was measured every hour over a ten hour period, and abdominal symptoms were assessed using validated questionnaires.

Outcomes: Pickling over a 12 day period significantly reduced fructan levels in both garlic (p=.0.00) and shallots (p=0.00). Consumption of the low fructan breakfast resulted in significantly lower breath hydrogen (p=0.05), abdominal pain (p=0.032), and wind (p=0.04).

Conclusion: Pickling results in significantly lowered fructan levels in problem foods- shallots and garlic, and lowered colonic fermentation and abdominal symptoms in both healthy and IBS volunteers. This study provides another dietary strategy for dietetic counselling of patients with IBS.

Assessment of mathematical development in early childhood : some views of preschool practitioners in regional and rural Australia

As part of the project Mathematical Thinking of Preschool Children in Rural and Regional Australia: Research and Practice directors, teachers, and assistants in prior-to-school settings from regional and rural eastern Australia were interviewed to ascertain their beliefs and practices concerning early childhood mathematics. This paper reports the responses to  uestions about their assessment of children’s mathematical activity and development. The practitioners provided examples of both incidental and planned assessment activities, the different forms these took, methods of recording, and how the results were used.

Parental status and childhood obesity in Australia

The overall aim of this study was to examine obesogenic factors in children from single and dual parent families. Data from the Longitudinal Study of Australian Children (LSAC) (8,717 children) were analyzed to examine the differences in children ’ s activity levels, dietary intake and BMI according to parental status and determine the likelihood of childhood overweight and obesity in a single-parent household. There were higher rates of overweight and obesity in girls aged four to nine whose parents were single (OR 1:60). Children in single-parent households watched more television, ate more food high in fat and sugar and less fresh fruit and vegetables than children from dual-parent households. The findings suggested that an additive effect of dietary and activity variables may contribute to the higher rates of overweight and obesity in Australian children, and that girls from single-parent households may be particularly at risk.

Prevention and treatment of infant and childhood vitamin D deficiency in Australia and New Zealand : a consensus statement

• Vitamin D deficiency has re-emerged as a significant paediatric health issue, with complications including hypocalcaemic seizures, rickets, limb pain and fracture.

• A major risk factor for infants is maternal vitamin D deficiency. For older infants and children, risk factors include dark skin colour, cultural practices, prolonged breastfeeding, restricted sun exposure and certain medical conditions.

• To prevent vitamin D deficiency in infants, pregnant women, especially those who are dark-skinned or veiled, should be screened and treated for vitamin D deficiency, and breastfed infants of dark-skinned or veiled women should be supplemented with vitamin D for the first 12 months of life.

• Regular sunlight exposure can prevent vitamin D deficiency, but the safe exposure time for children is unknown.

• To prevent vitamin D deficiency, at-risk children should receive 400 IU vitamin D daily; if compliance is poor, an annual dose of 150 000 IU may be considered.

• Treatment of vitamin D deficiency involves giving ergocalciferol or cholecalciferol for 3 months (1000 IU/day if < 1 month of age; 3000 IU/ day if 1-12 months of age; 5000 IU/day if > 12 months of age).

• High-dose bolus therapy (300 000-500 000 IU) should be considered for children over 12 months of age if compliance or absorption issues are suspected.

Influences on consumption of soft drinks and fast foods in adolescents

Soft drink and fast food are energy dense foodstuffs that are heavily marketed to adolescents, and are likely to be important in terms of risk of obesity. This study sought to examine the influences on soft drink and fast food consumption among adolescents as part of a cross-sectional survey of 2,719 adolescents (aged 11-16) from 93 randomly selected schools in New South Wales, Australia. Students provided information on soft drink and fast food consumption, and responded to statements examining influences over consumption. Over half of the boys and more than one third of the girls reported drinking soft drink daily, and consumption peaked in Grade 8 students. A quarter of students reported choosing soft drinks instead of water or milk, and around 40% agreed that soft drink was usually available in their homes. Availability in the home and drinking soft drinks with meals was most strongly associated with consumption in all age groups. Fast food consumption was higher among boys than girls in all age groups. Convenience and value for money yielded the strongest associations with fast food
consumption in boys, while preferring fast food to meals at home and preferring to “upsize” meals were most strongly associated with consumption in girls. Interventions to reduce consumption of soft drinks should target availability in both the home and school environment by removing soft drinks and replacing them with more nutritive beverages. Fast food outlets should be encouraged to provide a greater range of healthy and competitively priced options in reasonable portions.

Process and impact evaluation of the romp & chomp obesity prevention intervention in early childhood settings : lessons learned from implementation in preschools and long day care settings

Background: The Romp & Chomp controlled trial, which aimed to prevent obesity in preschool Australian children, was recently found to reduce the prevalence of childhood overweight and obesity and improve children’s dietary patterns. The intervention focused on capacity building and policy implementation within various early childhood settings. This paper reports on the process and impact evaluation of this trial and the lessons learned from this complex community intervention.
Methods: Process data was collected throughout and audits capturing nutrition and physical activity-related environments and practices were completed postintervention by directors of Long Day Care (LDC) centers (n = 10) and preschools (n = 41) in intervention and comparison (n = 161 LDC and n = 347 preschool) groups.
Results: The environmental audits demonstrated positive impacts in both settings on policy, nutrition, physical activity opportunities, and staff capacity and practices, although results varied across settings and were more substantial in the preschool settings. Important lessons were learned in relation to implementation of such community-based interventions, including the significant barriers to implementing health-promotion interventions in early childhood settings, lack of engagement of for-profit LDC centers in the evaluation, and an inability to attribute direct intervention impacts when the intervention components were delivered as part of a health-promotion package integrated with other programs.
Conclusions: These results provide confidence that obesity prevention interventions in children’s settings can be effective; however, significant efforts must be directed toward developing context-specific strategies that invest in policies, capacity building, staff support, and parent engagement. Recognition by funders and reviewers of the difficulties involved in implementing and evaluating such complex interventions is also critical to strengthening the evidence base on the effectiveness of such public health approaches to obesity prevention.

Progress on obesity prevention over 20 years in Australia and New Zealand

The lessons learned from over 20 years of obesity prevention efforts in Australia and New Zealand are presented. The obesity epidemic started in the 1980s but poor monitoring systems meant the rise in obesity prevalence initially went undetected. In the 1990s, experts started advocating for government action; however, it was the rapid increase in media reports on obesity in the early 2000s which created the pressure for action. Several, comprehensive reports produced some programme investment but no regulatory policies were implemented. The powerful food industry lobby ensured this lack of policies on front-of-pack food labelling, restrictions on unhealthy food marketing to children, or taxes on unhealthy foods. The New Zealand government even backpedalled by rescinding healthy school food guidelines and withdrawing funding for the comprehensive national obesity strategy. In 2007, Australian Governments started a major long term-investment in preventive health in order to improve economic productivity. Other positive initiatives, especially in Australia, were: the establishment of several advocacy organizations; successful, long-term, whole-of-community projects reducing childhood obesity; a national knowledge exchange system for practitioners; and some innovative programmes and social marketing. However, despite multiple reports and strong advocacy, key recommended regulatory policies remain unimplemented, largely due to the private sector interests dominating public policy development.