Exploring network structure and the role of key stakeholders to understand the obesity prevention system in an Australian metropolitan health service: Study protocol

Introduction: Little progress has been made to address the increasing obesity prevalence over the past few decades, and there is growing concern about the far-reaching consequences for health and well-being related to obesity on a global scale. Systems thinking is emerging as a suitable approach for obesity prevention, as it allows health researchers, practitioners and policy-makers to systematically synthesise existing data, expose gaps, inform priority setting and identify leverage points in the system. The aim of this study is to trial a systems thinking approach to better understand the local obesity prevention system, and identify gaps and viable opportunities for health promotion activities to strengthen obesity prevention efforts in an Australian metropolitan health service. Methods and analysis: A mixed methods design will be undertaken in a metropolitan health service area in Perth, Western Australia in 2019-2020. A systems inventory audit will be used to identify physical activity, nutrition and overweight/obesity prevention activities taking place in the study area. An organisational network survey will be administered, and a social network analysis undertaken to examine relationships between organisations in the network. The relationships and interactions will compare the level and type of interactions each organisation has within the network. Parameters including density, centrality and betweenness will be computed using UCINET and Netdraw. Ethics and dissemination: Ethics approval has been obtained from the Curtin University Human Research Ethics Committee (approval number HRE2017-0862). Results will be reviewed with members of the advisory group, submitted to relevant journals and presented at relevant conferences to health promotion practitioners and policy-makers. The area health service, as co-producers of the research, will use findings to inform policy and strategy across the study area

Improving Nutrition and Activity Behaviors Using Digital Technology and Tailored Feedback: Protocol for the LiveLighter Tailored Diet and Activity (ToDAy) Randomized Controlled Trial

Background: Excess weight is a major risk factor for chronic diseases. In Australia, over 60% of adults are overweight or obese. The overconsumption of energy-dense nutrient-poor (EDNP) foods and low physical activity (PA) levels are key factors contributing to population obesity. New cost-effective approaches to improve population diet and PA behaviors are needed. Objective: This 1-year randomized controlled trial (6-month intervention and 6-month follow-up) aims to investigate whether a tailored intervention using mobile technology can improve diet and PA behaviors leading to weight loss in adults (aged 18-65 years) who are overweight or obese and recruited through a social marketing campaign (LiveLighter). Methods: All eligible participants will provide data on demographics and lifestyle behaviors online at baseline, 6 months, and 12 months. Using two-stage randomization, participants will be allocated into one of three conditions (n=200 per group): tailored feedback delivered via email at seven time points, informed by objective dietary (mobile food record app) and activity (wearable activity monitor) assessment; active control receiving no tailored feedback, but undergoing the same objective assessments as tailored feedback; and online control receiving no tailored feedback or objective assessments. Primary outcome measures at 6 and 12 months are changes in body mass, EDNP food and beverage consumption, and daily moderate-to-vigorous PA (measured via accelerometry). Secondary outcomes include change in fruit and vegetable consumption, daily sedentary behaviors, and cost effectiveness. Results: Enrolment commenced in August 2017. Primary outcomes at 12 months will be available for analysis from September 2019. Conclusions: Tailored email feedback provided to individuals may deliver a cost-effective strategy to overcome existing barriers to improving diet and PA. If found to be successful and cost effective, upscaling this intervention for inclusion in larger-scale interventions is highly feasible. Trial Registration: Australian New Zealand Clinical Trials Registry ACTRN12617000554369; https://www.anzctr.org.au /Trial/Registration/TrialReview.aspx?id=371325&isReview=true. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/12782