Body fatness or anthropometry for assessment of unhealthy weight status? Comparison between methods in South African children and adolescents

A variety of methods are available for defining undernutrition (thinness/underweight/under-fat) and overnutrition (overweight/obesity/over-fat). The extent to which these definitions agree is unclear. The present cross-sectional study aimed to assess agreement between widely used methods of assessing nutritional status in children and adolescents, and to examine the benefit of body composition estimates. The main objective of the cross-sectional study was to assess underweight, overweight and obesity using four methods: (i) BMI-for-age using WHO (2007) reference data; (ii) BMI-for-age using Cole et al. and International Obesity Taskforce cut-offs; (iii) weight-for-age using the National Centre for Health Statistics/WHO growth reference 1977; and (iv) body fat percentage estimated by bio-impedance (body fat reference curves for children of McCarthy et al., 2006). Comparisons were made between methods using weighted kappa analyses. Subjects Individuals (n 1519) in three age groups (school grade 1, mean age 7 years; grade 5, mean age 11 years; grade 9, mean age 15 years). Results In boys, prevalence of unhealthy weight status (both under- and overnutrition) was much higher at all ages with body fatness measures than with simple anthropometric proxies for body fatness; agreement between fatness and weight-based measures was fair or slight using Landis and Koch categories. In girls, prevalence of unhealthy weight status was also higher with body fatness than with proxies, although agreement between measures ranged from fair to substantial. Methods for defining under- and overnutrition should not be considered equivalent. Weight-based measures provide highly conservative estimates of unhealthy weight status, possibly more conservative in boys. Simple body composition measures may be more informative than anthropometry for nutritional surveillance of children and adolescents

KEY OUTCOMES FOR CHILDREN: NEW EVIDENCE FROM GROWING UP IN IRELAND. ESRI Research Bulletin 2010/1/1

The welfare of children is a key concern of Irish society and of government policy. A major new project, Growing Up in Ireland, aims to describe the lives of a large scale representative sample of Irish children, and to analyse the factors associated with positive and negative outcomes in terms of such areas as health and education. Such evidence is of critical importance in guiding policy choices affecting children. The study is a longitudinal one, i.e. it will follow two groups or “cohorts” of children over time: a cohort of 11,000 infants (nine months old) and cohort of 8,500 nine-year olds. A recently published report† based on initial data gathered on the nine-year old group already provides a great deal of interesting evidence on several domains of child outcomes including: • physical health and well-being, • educational achievement and intellectual development, • social, emotional and behavioural well-being

Negative growth: the future of obesity in Australia

This publication makes recommendations for a collaborative, coordinated and multi-level approach to tackle the urgent, complex and worsening problem of obesity in Australia. Introduction Much progress has been made by all levels of government in Australia in acknowledging the obesity epidemic and committing to action. However, to maintain a healthy weight, Australians are fighting against a tide of environmental factors that are driving the population towards ever-increasing obesity and the associated health risks. By 2025, more than three-quarters of Australian adults will be overweight or obese. This publication makes recommendations for a collaborative, coordinated and multi-level approach to tackle the urgent, complex and worsening problem of obesity in Australia. It is based largely on the work of Associate Professor Anna Peeters, whose research provides insight into what is happening to the weight of our population, what it means for our community, and how to improve the health of our population

Monitoring the impacts of trade agreements on food environments

The liberalization of international trade and foreign direct investment through multilateral, regional and bilateral agreements has had profound implications for the structure and nature of food systems, and therefore, for the availability, nutritional quality, accessibility, price and promotion of foods in different locations. Public health attention has only relatively recently turned to the links between trade and investment agreements, diets and health, and there is currently no systematic monitoring of this area. This paper reviews the available evidence on the links between trade agreements, food environments and diets from an obesity and non-communicable disease (NCD) perspective. Based on the key issues identified through the review, the paper outlines an approach for monitoring the potential impact of trade agreements on food environments and obesity/NCD risks. The proposed monitoring approach encompasses a set of guiding principles, recommended procedures for data collection and analysis, and quantifiable ‘minimal’, ‘expanded’ and ‘optimal’ measurement indicators to be tailored to national priorities, capacity and resources. Formal risk assessment processes of existing and evolving trade and investment agreements, which focus on their impacts on food environments will help inform the development of healthy trade policy, strengthen domestic nutrition and health policy space and ultimately protect population nutrition.The following organizations provided funding support for the travel of participants to Italy for this meeting and the preparation of background research papers: The Rockefeller Foundation, International Obesity Taskforce (IOTF), University of Auckland, Deakin University, The George Institute, University of Sydney, Queensland University of Technology, University of Oxford, University of Pennsylvania Perelman School of Medicine, World Cancer Research Fund International, University of Toronto, and The Australian National University. The Faculty of Health at Deakin University kindly supported the costs for open access availability of this paper, and the Australian National Health and Medical Research Council Centre for Research Excellence in Obesity Policy and Food Systems (APP1041020) supported the coordination and finalizing of INFORMAS manuscripts

An ecological systems approach to examining risk factors for early childhood overweight: findings from the UK Millennium Cohort Study

Objective: To use an ecological systems approach to examine individual-, family-, community- and area-level risk factors for overweight (including obesity) in 3-year-old children. Methods: A prospective nationally representative cohort study conducted in England, Wales, Scotland, Northern Ireland. Participants included 13 188 singleton children aged 3 years in the Millennium Cohort Study, born between 2000 and 2002, who had complete height/weight data. The main outcome measure was childhood overweight (including obesity) defined by the International Obesity TaskForce cut-offs for body mass index. Results: 23.0% of 3-year-old children were overweight or obese. In the fully adjusted model, primarily individual- and family-level factors were associated with early childhood overweight: birthweight z-score (adjusted odds ratio, 1.36, 95% CI 1.30 to 1.42), black ethnicity (1.41, 1.11 to 1.80) (compared with white), introduction to solid foods or =21 hours/week (1.23, 1.10 to 1.37) (compared with never worked). Breastfeeding > or =4 months (0.86, 0.76 to 0.97) (compared with none) and Indian ethnicity (0.63, 0.42 to 0.94) were associated with a decreased risk of early childhood overweight. Children from Wales were also more likely to be overweight than children from England. Conclusions: Most risk factors for early childhood overweight are modifiable or would allow at-risk groups to be identified. Policies and interventions should focus on parents and providing them with an environment to support healthy behaviours for themselves and their children

Regional differences in overweight: an effect of people or place?

Objective: To examine UK country and English regional differences in childhood overweight (including obesity) at 3 years and determine whether any differences persist after adjustment for individual risk factors. Design: Nationally representative prospective study. Setting: England, Wales, Scotland and Northern Ireland. Participants: 13 194 singleton children from the UK Millennium Cohort Study with height and weight data at age 3 years. Main outcome measure: Overweight (including obesity) was defined according to the International Obesity TaskForce cut-offs for body mass index, which are age and sex specific. Results: At 3 years of age, 23% (3102) of children were overweight or obese. In univariable analyses, children from Northern Ireland (odds ratio 1.30, 95% confidence interval 1.14 to 1.48) and Wales (1.26, 1.11 to 1.44) were more likely to be overweight than children from England. There were no differences in overweight between children from Scotland and England. Within England, children from the East (0.71, 0.57 to 0.88) and South East regions (0.82, 0.68 to 0.99) were less likely to be overweight than children from London. There were no differences in overweight between children from other English regions and children from London. These differences were maintained after adjustment for individual socio-demographic characteristics and other risk factors for overweight. Conclusions: UK country and English regional differences in early childhood overweight are independent of individual risk factors. This suggests a role for policies to support environmental changes that remove barriers to physical activity or healthy eating in young children

The biggest vested interest of all: how government lobbies to restrict individual rights and freedom

The Federal Treasurer Wayne Swan wrote in The Monthly in March 2012 that : Australia’s fair go is today under threat from a new source."To be blunt, the rising power of vested interests is undermining our equality and threatening our democracy."But not all vested interests are private corporations. This paper draws attention to two statutory agencies of the Commonwealth Government that have an explicit, legislatively - defined function to lobby and advocate for public policy change – the Australian National Preventive Health Agency and the Australian Human Rights Commission.These two agencies are effectively taxpayer funded lobbyists, embedded in the public policy process, enjoying privileged access to the institutions of government.The Australian National Preventative Health Agency (ANPHA) received $57,718,000 in the 2012 - 13 Federal Budget to “driv[e] the national capacity for change and innovation around preventive health policies and programs.”ANPHA publicly advocates and privately lobbies for a wide range of Nanny State restrictions on alcohol, tobacco, and unhealthy food.The Australian Human Rights Commission (AHRC) received$23,133,000 in the 2012 - 13 Federal Budget . One oF its primary tasks is to “promote an understanding and acceptance ... of human rights in Australia ... undertake research and educational programs” and “develop laws, policies and programs” for parliament to enact. ( Unfortunately, the AHRC does not disclose how much it of it s budget it directs towards this task.)However the human rights that the AHRC chooses to promote and advocate are highly selective, favouring certain rights above others.As well as being policy lobbyists in their own right, AHRC and ANPHA are central to a pattern of relationships between the government and non - government sectors. Taxpayer money is being used to lobby for the allocation of more taxpayer money.One - third of the submissions to the Preventative Health Taskforce – which established the Australian National Preventive Health Agency – were from bodies which received large amounts of taxpayer funding

Safe Routes to School Increases Physical Activity and Improves Health

This report indicates how Safe Routes to School is being institutionalized at select schools, and providing a mechanism to improve student and school health. It provides local case studies from Benton County, OR; Eau Claire, WI; Flagstaff, AZ; and Garfield, NJ that detail how SRTS can lead to improved public health

Real-world research and its importance in respiratory medicine

Peer reviewedPublisher PD

A taxing approach to choice: how behavioural taxes deliver perverse outcomes

Executive summary: Behavioural taxes are taxes that are designed to influence behaviour against consumption. The application of behavioural taxes is fundamentally illiberal. They interfere with the rights and freedoms of individuals to make choices about their own consumption. Behavioural taxes generally take the form of excise taxes. Australia has a complicated and inconsistent form of behavioural tax in the form of an alcohol excise tax, with three separate taxing regimes - differing rates of excise, the wine equalization tax and customs. The efficacy of behavioural taxes is also questionable. Research shows that significant behavioural taxes may influence the behaviour of moderate drinkers, but not the heavy drinkers that the policy was designed to influence. Similarly, behavioural taxes for alcohol appear to be less effective with young people who have higher disposable incomes. Not all alcoholic products have seen a decline. There has been a progressive increase in the consumption of wine, with only modest increases in the consumption of spirits and ready-to-drink beverages. The Rudd government’s 2008 alcopops tax prompted a rapid decline in consumption of RTDs. However, the evidence is that consumers substituted RTDs with privately mixed spirits, and potentially white wine and cider. The rising price of alcohol at venues is leading young people to engage in ‘preloading’ by consuming large volumes of cheaper alcohol in private homes before going to a bar or club. Research also identified that there was no reduction in the consequences associated with alcohol, such as alcohol-related hospital admission rates. Academic evidence suggests potential substitution from alcohol to illicit drugs. Similarly, the rising cost of tobacco taxes can similarly prompt consumers to switch from legal products to illegal ‘chop-chop’ or counterfeit tobacco products. The Danish fat tax has been identified as delivering equally perverse outcomes. Some consumers had been crossing national borders to buy products with saturated fat contents from neighbouring countries, while no notable change in consumer behaviour has been identified. International analysis has identified that behavioural taxes are regressive. They explicitly target inelastic goods that make up a proportionally higher share of Australian household incomes, particularly related to food and beverages. The consistency of taxation across all alcohol products is logical as the current taxation arrangements deliver perverse outcomes. However, any change should not be used as justification to increase tax revenue