Community-based obesity prevention initiatives in aboriginal communities: the experience of the eat well be active community programs in South Australia

Childhood obesity is a growing concern world-wide, and obesity rates are higher in certain groups in the developed world, including Australian Aboriginal people. Community-based obesity prevention interventions (CBOPI) can help to address obesity, however the approach of such programs to reach diverse groups, including Aboriginal people, must be considered. This paper considers one mainstream1 CBOPI, the eat well be active (ewba) Community Programs in South Australia, which was delivered in two communities and sought to reach Aboriginal people as part of the overall program. This paper considers how well this approach was received by the Aboriginal people living and working in those communities. Semi-structured interviews were conducted with nine Aboriginal workers who had some connection to the ewba program, and seven ewba project staff. Qualitative data analysis was performed and factors found to affect how well the program was received by Aboriginal people include relationships, approach and project target group, including geographical area. A different response was observed in the two communities, with a more positive response being observed in the community where more relationships were developed between ewba and Aboriginal staff. For any CBOPI seeking to work with Aboriginal (or other Indigenous) communities, it is vital to consider and plan how the program will meet the needs and preferences of Aboriginal people in all stages of the project, in order to reach this group

The challenges of quantitative evaluation of a multi-setting, multi-strategy community-based childhood obesity prevention programme: lessons learnt from the eat well be active Community Programs in South Australia

Objective To describe the rationale, development and implementation of the quantitative component of evaluation of a multi-setting, multi-strategy, community-based childhood obesity prevention project (the eat well be active (ewba) Community Programs) and the challenges associated with this process and some potential solutions. Design ewba has a quasi-experimental design with intervention and comparison communities. Baseline data were collected in 2006 and post-intervention measures will be taken from a non-matched cohort in 2009. Schoolchildren aged 10–12 years were chosen as one litmus group for evaluation purposes. Setting Thirty-nine primary schools in two metropolitan and two rural communities in South Australia. Subjects A total of 1732 10–12-year-old school students completed a nutrition and/or a physical activity questionnaire and 1637 had anthropometric measures taken; 983 parents, 286 teachers, thirty-six principals, twenty-six canteen and thirteen out-of-school-hours care (OSHC) workers completed Program-specific questionnaires developed for each of these target groups. Results The overall child response rate for the study was 49 %. Sixty-five per cent, 43 %, 90 %, 90 % and 68 % of parent, teachers, principals, canteen and OSHC workers respectively, completed and returned questionnaires. A number of practical, logistical and methodological challenges were experienced when undertaking this data collection. Conclusions Learnings from the process of quantitative baseline data collection for the ewba Community Programs can provide insights for other researchers planning similar studies with similar methods, particularly those evaluating multi-strategy programmes across multiple settings

Attitudes and characteristics of health professionals working in Aboriginal health

There is an unacceptable gap in health status between Aboriginal and non-Aboriginal people in Australia. Linked to social inequalities in health and political and historical marginalisation, this health gap must be urgently addressed. It is important that health professionals, the majority of whom in Australia are non-Aboriginal, are confident and equipped to work in Aboriginal health in order to contribute towards closing the health gap. The purpose of this study was to explore the attitudes and characteristics of non-Aboriginal health professionals working in Aboriginal health. Methods: The research was guided and informed by a social constructionist epistemology and a critical theoretical approach. It was set within a larger healthy eating and physical activity program delivered in one rural and one metropolitan community in South Australia from 2005 to 2010. Non-Aboriginal staff working in the health services where the program was delivered and who had some experience or an interest working in Aboriginal health were invited to participate in a semi-structured interview. Dietitians working across South Australia (rural and metropolitan locations) were also invited to participate in an interview. Data were coded into themes that recurred throughout the interview and this process was guided by critical social research. Results: Thirty-five non-Aboriginal health professionals participated in a semi-structured interview about their experiences working in Aboriginal health. The general attitudes and characteristics of non-Aboriginal health professionals were classified using four main groupings, ranging from a lack of practical knowledge (‘don’t know how’), a fear of practice (‘too scared’), the area of Aboriginal health perceived as too difficult (‘too hard’) and learning to practice regardless (‘barrier breaker’). Workers in each group had different characteristics including various levels of willingness to work in the area; various understandings of Australia’s historical relationship with Aboriginal peoples; varying awareness of their own cultural identity and influence on working with Aboriginal people; and different levels of (dis)comfort expressed in discussions about social, political and intercultural issues that impact on the healthcare encounter. Conclusions: These groupings can be used to assist non-Aboriginal health professionals to reflect on their own levels of confidence, attitudes, characteristics, experiences, approaches and assumptions to Aboriginal health, as an important precursor to further practice and development in Aboriginal health. By encouraging self-reflection of non-Aboriginal health professionals about where their experiences, characteristics and confidence lie, the groupings presented in this paper can be used to encourage non-Aboriginal health professionals, rather than Aboriginal clients or workers, to be the focus for change and deliver health care that is more acceptable to patients and clients, hence influencing health service delivery. The groupings presented can also begin to enable discussions between all health professionals about working together in Aboriginal health

Improving weight status in childhood: results from the 'eat well be active' community programs

There is a clear need for effective prevention and treatment interventions to manage the high prevalence of childhood overweight globally. It is well recognised that changes in the social and economic environment in the last three decades have been a major contributor to altered eating and activity patterns resulting in positive energy balance. The most recent update to the Cochrane review of interventions for preventing obesity in children identified that the majority of childhood obesity prevention intervention evaluations were short-term (12 months or less) and largely focussed on individual behaviour change. Also from this review there is now some early evidence that settings-based obesity prevention interventions are effective at reducing body mass index in the short term. However, given the short-term nature of these interventions, sustainability of this change is unclear, and stronger evidence from larger-scale evaluations is needed about what intervention components are feasible to be embedded into children’s settings and systems (e.g. the school environment) to be able to translate and scale up research findings into effective public health approaches. Until recently, effective obesity prevention interventions have largely drawn upon behaviour change theories, which appear to be unlikely to produce sustainable change in outcomes if they do not consider the broader social and environmental context. Models based on ecological theory show the complex interaction between individuals’ behaviour and their broader environments, that influence eating and activity. A community-based, capacity-building approach aims to promote sustainable skill development and increase the ability of individuals to improve environments that promote health outcomes.This presents a promising approach to obesity prevention, and evidence is needed on processes and outcomes of interventions guided by such theories

Minimal change in children’s lifestyle behaviours and adiposity following a home-based obesity intervention: results from a pilot study

This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.Background/Methods: Families of overweight and obese children require support to make sustainable lifestyle changes to improve their child’s diet and activity behaviours and in turn weight status. The aim of this pre-post intervention pilot study was to evaluate the feasibility of an individualised home-based intervention for treatment seeking overweight/obese 4–12 year olds and their caregivers. Baseline measures were used to develop a family-specific intervention to improve the quality of the home environment. The intervention was delivered as individualised written recommendations and resources plus phone call and home visit support. Baseline measures were repeated approximately 6 months later. Results: Complete data for 24 children was available. Parents reported that 43 % of intervention recommendations were implemented ‘very much’. Some descriptive changes were observed in the home environment, most commonly including fruit and vegetables in their child’s lunchbox, not providing food treats, and restricting children’s access to chips/savoury snack biscuits. At the group level, minimal change was detected in children’s diet and activity behaviours or weight status (all p > 0.05). Conclusion: The study findings did not support intervention feasibility in its current form. Future interventions should target the family food and activity environment, but also utilise an approach to address the complex social circumstances which limit parent’s ability to prioritise healthy family lifestyle behaviours. Trial registration: Australian New Zealand Clinical Trials Registry (ANZCTR) 3/12/2014. http://www.ANZCTR.org.au. ACTRN1261400126467

Poor dietary patterns at 1-5 years of age are related to food neophobia and breastfeeding duration but not age of introduction to solids in a relatively advantaged sample

Previous studies have investigated associations between individual foods or food group intake, and breastfeeding duration, age of solid introduction and food neophobia. This study aimed to investigate associations between whole dietary patterns in young children, and breastfeeding duration, age of solid introduction and food neophobia. Parents of children (N = 234) aged 1–5 years completed an online questionnaire. Dietary risk scores were calculated using the Toddler (1–3 years) or Preschool (>3–<5 years) Dietary Questionnaires which evaluates the previous week's food-group intake (scored 0–100; higher score = higher risk of poor dietary quality). Neophobia was measured using the Child Food Neophobia scale (1.0–4.0; higher score = more neophobic). Associations were investigated using multivariable linear regression, adjusting for covariates. Children (54% female, 3.0 ± 1.4 years) were from advantaged families and were breastfed until 11.8 (5.0–16.0) months, started solids at 5.6 ± 1.4 months of age, moderately neophobic (2.1 ± 0.7) and at moderate dietary risk (29.2 ± 9.2). Shorter breastfeeding duration (β = −0.21; p = 0.001) and poorer child food neophobia scores (β = 0.36; p < 0.001) were associated with higher dietary risk scores. Age of introduction to solids showed no association with dietary risk (p = 0.744). These findings suggest that in addition to breastfeeding promotion, supporting parents to manage neophobic behaviour may be important in promoting healthy eating patterns in early childhood

Validation testing of a short food‐group‐based questionnaire to assess dietary risk in preschoolers aged 3–5 years

This article may be used for non-commercial purposes in accordance with Wiley Terms and Conditions for self-archiving'. Copyright (2018) Dietitians Association of Australia. All rights reserved. This author accepted manuscript is made available following 12 month embargo from date of publication (February 2018) in accordance with the publisher’s archiving policy.Background: Short questionnaire-style dietary assessment methods are useful for monitoring compliance with dietary guidelines. A reliable and valid short food-based questionnaire for assessing dietary risk in toddlers aged 1-3 years was recently adapted for use in pre-schoolers. This study aimed to determine the reliability and validity of this 19-item Preschooler Dietary Questionnaire (PDQ) that assesses dietary risk of 3-5 year-olds. Methods: Primary caregivers of preschoolers completed a two-stage online survey: 1) a demographic questionnaire and the PDQ; 2) a second PDQ and a validated 54-item semi-quantitative food frequency questionnaire (FFQ). Dietary risk scores (0-100; higher score=higher risk) derived from the two PDQ administrations (2.1±1.0 weeks apart) were compared and average scores assessed against the FFQ. Cross-classification into dietary risk categories (low, 0-24; moderate, 25-49; high, 50-74; very high, 75- 100) was determined. The relationship of dietary risk scores with BMI z-score was assessed using standard linear regression. Results: Preschoolers’ (n=74) risk scores were highly correlated yet statistically different for reliability (ICC=0.87; mean bias 1.51, 95% CI 0.07, 2.95, p=0.040) and validity (r=0.85; mean bias -1.64, 95% CI -2.86, -0.43, p=0.009). There was no systematic bias between the two tools. All participants were classified into the same (80%) or adjacent (20%) category upon administration of each tool. Risk scores were not associated with BMIz scores (β -0.09, 95%CI -0.02,-0.04, p=0.512). Conclusion: The PDQ is a novel and useful screening instrument to rapidly identify preschooler dietary, but not obesity, risk. The tool could facilitate referral to appropriate health professionals for detailed assessment and intervention

Is higher formula intake and limited dietary diversity in Australian children at 14 months of age associated with dietary quality at 24 months?

© 2017 Elsevier. This manuscript version is made available under the CC-BY-NC-ND 4.0 license http://creativecommons.org/licenses/by-nc-nd/4.0/ This author accepted manuscript is made available following 24 month embargo from date of publication (Sept 2017) in accordance with the publisher’s archiving policyA varied and diverse diet in childhood supports optimum long-term preferences and growth. Previous analysis from 14-month-old Australian children in the NOURISH and South Australian Infants Dietary Intake (SAIDI) studies found higher formula intake was associated with lower dietary diversity. This analysis investigated whether formula intake and dietary diversity at 14 months of age is associated with dietary quality at 24 months. This is a secondary analysis of intake data from NOURISH and SAIDI cohorts. Scores for dietary diversity, fruit variety, vegetable variety and meat/alternative variety were combined using structural equation modelling to form the latent variable ‘Dietary quality’ (DQ) at age 24 months. A longitudinal model examined influence of formula (grams), cow's milk (grams) and dietary diversity at 14 months and covariates, on DQ. At age 24 months (n = 337) 27% of children obtained a maximum dietary diversity score (5/5). Variety scores were relatively low – with mean variety scores (and possible range) being four for fruit (0–30); five for vegetables (0–36); and three for meat/alternatives (0–8). Dietary diversity at 14 months (β = 0.19, p = 0.001), maternal age (β = 0.24, p < 0.001) and education (β = 0.22, p < 0.001) predicted DQ at 24 months while Child Food Neophobia Score was negatively associated with DQ (β = −0.30, p < 0.001). Formula intake was negatively associated with diversity at 14 months, but not DQ at 24. Diversity and variety were limited despite sociodemographic advantage of the sample. Diversity at 14 months, degree of neophobia and sociodemographic factors predicted DQ at 24 months. There is an ongoing need to emphasise the importance of repeated early exposure to healthy foods, such that children have the opportunity to learn to like a range of tastes and texture, thereby maximising dietary diversity and quality in infancy and early toddlerhood

Evaluation of micronutrient intakes of children and adolescents: National Nutrition Survey 1995 and comparison with 1985 data

Canberra, AC

Contemporary assessment of child dietary intake in the context of the obesity epidemic

New Yor