Ethnic differences in BMI among Dutch adolescents: what is the role of screen-viewing, active commuting to school, and consumption of soft drinks and high-caloric snacks?

<p>Abstract</p> <p>Background</p> <p>The threats posed by the rising prevalence of overweight and obesity on public health have been widely acknowledged. Several population groups, which deserve special attention because of their higher prevalence rates, have been identified. These include adolescents and ethnic sub-groups. The aim of the present study was twofold: (1) to assess ethnic differences in body mass index (BMI) and in behaviours that are related to both energy intake and energy expenditure, and (2) to examine whether these behaviours explain the relationship between ethnicity and BMI.</p> <p>Methods</p> <p>We conducted a cross-sectional data analysis among 957 Dutch adolescents (mean age = 12.7 years). Body height and weight were measured using a standardized protocol. Adolescents completed a questionnaire on screen-viewing behaviour, physical activity, consumption of sugar-containing beverages, and consumption of high-caloric snacks.</p> <p>Results</p> <p>In our study sample 121 adolescents (= 13%) were of Non-Western origin. BMI was significantly higher in Non-Western adolescents (boys: 19.9 kg/m², SD = 3.0, girls: 20.9 kg/m², SD = 3.8) compared to Dutch adolescents (boys: 18.4 kg/m², SD = 2.8, girls: 19.0 kg/m², SD = 3.0). Our results show that time spent on television viewing, active commuting to school, and consumption of fruit juices partially mediated the association between BMI and ethnicity.</p> <p>Conclusion</p> <p>Behaviours related to both energy expenditure and energy intake may contribute to the ethnic differences in BMI in adolescents and should be considered when tailoring overweight prevention programs to ethnic subpopulations.</p> <p>Trial registration</p> <p>International Standard Randomised Controlled Trial Number ISRCTN87127361</p

Changes in skinfold thickness and waist circumference after 12 and 24 months resulting from the NHF-NRG In Balance-project

<p>Abstract</p> <p>Background</p> <p>More knowledge is needed regarding the effectiveness of weight gain prevention programmes. The present study tested the 12-and 24-month effectiveness of the 'Netherlands Research programme weight Gain prevention' (NHF-NRG)-In Balance-project, a worksite-based intervention aimed at the prevention of weight gain.</p> <p>Methods</p> <p>Twelve worksites (n = 553 participants) were matched and assigned to either intervention or control group. The worksites and employees of the intervention group received individual (i.e. pedometer, computer-tailored advice) and environmental (i.e. changes in worksite canteen) interventions, directed at physical activity and food intake over 1-year. Differences between the intervention and control group in changes in body weight, BMI, skinfold thickness and waist circumference at 12 and 24 months were examined using multilevel linear regression analyses adjusting for various baseline characteristics (age, gender, BMI, marital status, education and smoking status).</p> <p>Results</p> <p>A significant greater reduction in skinfold thickness was found in the intervention group than in the control group, both after 12-and 24 months (Unstandardized regression coefficients (B) = -2.52, 95% C.I. -4.58, -0.45; p = 0.018; B = -4.83, 95% C.I. 6.98, -2.67; p < 0.001 respectively). Significant differences were also observed for changes in waist circumferences both at 12 months (B = -1.50, 95% C.I. -2.35, -0.65; p < 0.001) and at 24 months (B = -1.30, 95% C.I. -2.18, -0.42; p = 0.005). No significant changes were observed for weight and BMI.</p> <p>Conclusions</p> <p>The project was effective with regard to changes in skinfold thickness and waist circumference both at 12 and 24 months. It supports the usefulness of worksite-based prevention, especially regarding maintenance of behavioral changes.</p

Environmental influences on energy balance-related behaviors: A dual-process view

BACKGROUND: Studies on the impact of the 'obesogenic' environment have often used non-theoretical approaches. In this journal's debate and in other papers authors have argued the necessity of formulating conceptual models for differentiating the causal role of environmental influences on behavior. DISCUSSION: The present paper aims to contribute to the debate by presenting a dual-process view on the environment – behavior relationship. This view is conceptualized in the EnRG framework (Environmental Research framework for weight Gain prevention). In the framework, behavior is postulated to be the result of a simultaneous influence of conscious and unconscious processes. Environmental influences are hypothesized to influence behavior both indirectly and directly. The indirect causal mechanism reflects the mediating role of behavior-specific cognitions in the influence of the environment on behavior. A direct influence reflects the automatic, unconscious, influence of the environment on behavior. Specific personal and behavioral factors are postulated to moderate the causal path (i.e., inducing either the automatic or the cognitively mediated environment – behavior relation). In addition, the EnRG framework applies an energy balance-approach, stimulating the integrated study of determinants of diet and physical activity. CONCLUSION: The application of a dual-process view may guide research towards causal mechanisms linking specific environmental features with energy balance-related behaviors in distinct populations. The present paper is hoped to contribute to the evolution of a paradigm that may help to disentangle the role of 'obesogenic' environmental factors

Challenges in lifestyle and community interventions research; a call for innovation

Earlier this year the BMC portfolio was enriched by a new journal BMC Obesity. Here, we present the aims and objectives of the section on Lifestyle and Community Interventions. Innovative research is needed. Preventing or managing obesity requires addressing different determinants across multiple levels where diverse levers and stakeholders can play a critical role. Interactions of these determinants within and between systems need to be studied. How to leverage, manage and measure this complexity underlies the innovation that is needed in the next generation of obesity interventions. The ambition of the Lifestyle and Community Interventions section is to provide a space for innovative research, including research that falls outside the traditional comfort zone. We welcome studies of heterogeneous designs, including those of qualitative, quantitative, mixed and systems methodologies. Studies of interest include not only outcomes research of interventions but also process evaluation, cost-effectiveness or cost-benefit analysis, and implementation and dissemination research. Innovations that integrate diverse intervention levers or combine primary and secondary levels of prevention are particularly encouraged. The general aim of BMC Obesity’s Lifestyle and Community Interventions section is to advance our ability to decide on what combinations of approaches will be required to effectively and equitably prevent obesity

Children’s sedentary behaviour: descriptive epidemiology and associations with objectively-measured sedentary time

Background: Little is known regarding the patterning and socio-demographic distribution of multiple sedentary behaviours in children. The aims of this study were to: 1) describe the leisure-time sedentary behaviour of 9-10 year old British children, and 2) establish associations with objectively-measured sedentary time. Methods: Cross-sectional analysis in the SPEEDY study (Sport, Physical activity and Eating behaviour: Environmental Determinants in Young people) (N=1513, 44.3% boys). Twelve leisure-time sedentary behaviours were assessed by questionnaire. Objectively-measured leisure-time sedentary time (Actigraph GT1M, <100 counts/minute) was assessed over 7 days. Differences by sex and socioeconomic status (SES) in self-reported sedentary behaviours were tested using Kruskal-Wallis tests. The association between objectively-measured sedentary time and the separate sedentary behaviours (continuous (minutes) and categorised into 'none' 'low' or 'high' participation) was assessed using multi-level linear regression. Results: Sex differences were observed for time spent in most sedentary behaviours (all p ≤ 0.02), except computer use. Girls spent more time in combined non-screen sedentary behaviour (median, interquartile range: girls: 770.0 minutes, 390.0-1230.0; boys: 725.0, 365.0 - 1182.5; p = 0.003), whereas boys spent more time in screen-based behaviours (girls: 540.0, 273.0 - 1050.0; boys: 885.0, 502.5 - 1665.0; p < 0.001). Time spent in five non-screen behaviours differed by SES, with higher values in those of higher SES (all p ≤ 0.001). Regression analyses with continuous exposures indicated that reading (β = 0.1, p < 0.001) and watching television (β = 0.04, p < 0.01) were positively associated with objectively-measured sedentary time, whilst playing board games (β = -0.12, p < 0.05) was negatively associated. Analysed in categorical form, sitting and talking (vs. none: 'low' β = 26.1,ns; 'high' 30.9, p < 0.05), playing video games (vs. none: 'low' β = 49.1, p < 0.01; 'high' 60.2, p < 0.01) and watching television (vs. lowest tertile: middle β = 22.2,ns; highest β = 31.9, p < 0.05) were positively associated with objectively-measured sedentary time whereas talking on the phone (vs. none: 'low' β = -38.5, p < 0.01; 'high' -60.2, p < 0.01) and using a computer/internet (vs. none: 'low' β = -30.7, p < 0.05; 'high' -4.2,ns) were negatively associated. Conclusions: Boys and girls and children of different socioeconomic backgrounds engage in different leisure-time sedentary behaviours. Whilst a number of behaviours may be predictive of total sedentary time, collectively they explain little overall variance. Future studies should consider a wide range of sedentary behaviours and incorporate objective measures to quantify sedentary time where possible

Inequities in energy-balance related behaviours and family environmental determinants in European children : baseline results of the prospective EPHE evaluation study

Background: Tackling inequalities in overweight, obesity and related determinants has become a top priority for the European research and policy agendas. Although it has been established that such inequalities accumulate from early childhood onward, they have not been studied extensively in children. The current article discusses the results of an explorative analysis for the identification of inequalities in behaviours and their determinants between groups with high and low socio-economic status. Methods: This study is part of the Epode for the Promotion of Health Equity (EPHE) evaluation study, the overall aim of which is to assess the impact and sustainability of EPODE methodology to diminish inequalities in childhood obesity and overweight. Seven community-based programmes from different European countries (Belgium, Bulgaria, France, Greece, Portugal, Romania, The Netherlands) participate in the EPHE study. In each of the communities, children aged 6-8 years participated, resulting in a total sample of 1266 children and their families. A parental self-administrated questionnaire was disseminated in order to assess the socio-economic status of the household, selected energy balance-related behaviours (1. fruit and vegetable consumption; 2. soft drink/fruit juices and water consumption; 3. screen time and 4. sleep duration) of the children and associated family environmental determinants. The Mann-Whitney U test and Pearson's chi-square test were used to test differences between the low and high education groups. The country-specific median was chosen as the cut-off point to determine the educational level, given the different average educational level in every country. Results: Children with mothers of relatively high educational level consumed fruits and vegetables more frequently than their peers of low socio-economic status. The latter group of children had a higher intake of fruit juices and/or soft drinks and had higher screen time. Parental rules and home availability were consistently different between the two socio-economic groups in our study in all countries. However we did not find a common pattern for all behaviours and the variability across the countries was large. Conclusions: Our findings are indicative of socio-economic inequalities in our samples, although the variability across the countries was large. The effectiveness of interventions aimed at chancing parental rules and behaviour on health inequalities should be studied

Study protocol of a cluster randomised controlled trial investigating the effectiveness of a tailored energy balance programme for recent retirees

BACKGROUND: People in transitional life stages, such as occupational retirement, are likely to gain weight and accumulate abdominal fat mass caused by changes in physical activity and diet. Hence, retirees are an important target group for weight gain prevention programmes, as described in the present paper. METHODS/DESIGN: A systematic and stepwise approach (Intervention Mapping) is used to develop a low-intensity energy balance intervention programme for recent retirees. This one-year, low-intensity multifaceted programme aims to prevent accumulation of abdominal fat mass and general weight gain by increasing awareness of energy balance and influencing related behaviours of participants' preference. These behaviours are physical activity, fibre intake, portion size and fat consumption. The effectiveness of the intervention programme is tested in a cluster randomised controlled trial. Measurements of anthropometry, physical activity, energy intake, and related psychosocial determinants are performed at baseline and repeated at 6 months for intermediate effect, at 12 months to evaluate short-term intervention effects and at 24 months to test the sustainability of the effects. DISCUSSION: This intervention programme is unique in its focus on retirees and energy balance. It aims at increasing awareness and takes into account personal preferences of the users by offering several options for behaviour change. Moreover, the intervention programme is evaluated at short-term and long-term and includes consecutive outcome measures (determinants, behaviour and body composition)

Design of the Dutch Obesity Intervention in Teenagers (NRG-DOiT): systematic development, implementation and evaluation of a school-based intervention aimed at the prevention of excessive weight gain in adolescents

BACKGROUND: Only limited data are available on the development, implementation, and evaluation processes of weight gain prevention programs in adolescents. To be able to learn from successes and failures of such interventions, integral written and published reports are needed. METHODS: Applying the Intervention Mapping (IM) protocol, this paper describes the development, implementation, and evaluation of the Dutch Obesity Intervention in Teenagers (DOiT), a school-based intervention program aimed at the prevention of excessive weight gain. The intervention focussed on the following health behaviours: (1) reduction of the consumption of sugar-sweetened beverages, (2) reduction of energy intake derived from snacks, (3) decrease of levels of sedentary behaviour, and (4) increase of levels of physical activity (i.e. active transport behaviour and sports participation). The intervention program consisted of an individual classroom-based component (i.e. an educational program, covering 11 lessons of both biology and physical education classes), and an environmental component (i.e. encouraging and supporting changes at the school canteens, as well as offering additional physical education classes). We evaluated the effectiveness of the intervention program using a randomised controlled trial design. We assessed the effects of the intervention on body composition (primary outcome measure), as well as on behaviour, behavioural determinants, and aerobic fitness (secondary outcome measures). Furthermore, we conducted a process evaluation. DISCUSSION: The development of the DOiT-intervention resulted in a comprehensive school-based weight gain prevention program, tailored to the needs of Dutch adolescents from low socio-economic background

The influence of the macro-environment on physical activity: a multilevel analysis of 38 countries worldwide

<p>Abstract</p> <p>Background</p> <p>As indicated by the ANGELO framework and similar models, various environmental factors influence population levels of physical activity (PA). To date attention has focused on the micro-level environment, while evidence on the macro-level environment remains scarce and mostly limited to high-income countries. This study aims to investigate whether environmental factors at macro-level are associated with PA among a broader range of countries.</p> <p>Methods</p> <p>Data from the World Health Survey (WHS) was used to analyze 177,035 adults from 38 (mostly low and middle income) countries. The International Physical Activity Questionnaire-Short Form (IPAQ-S) was used to measure PA. Respondents were classified as active or inactive for vigorous PA, moderate PA and walking. Multilevel logistic regression was performed to assess associations between macro-level environmental factors and the prevalence of PA, with control for individual-level socioeconomic factors.</p> <p>Results</p> <p>The prevalence of PA varied widely between countries and types of PA (5.0%-93.8%). A negative association was found between gross domestic product and PA, odds ratios for men were 0.76 (95% CI: 0.65-0.89) for moderate PA and 0.79 (95% CI: 0.63-0.98) for walking. A higher temperature was associated with less PA (all types) and higher urbanization was associated with less vigorous and moderate PA. More gender equality was also associated with more walking for women. Governmental functioning and literacy rate were not found to be associated with any type of PA.</p> <p>Conclusions</p> <p>This exploratory study indicates that factors such as climate, economic development and cultural factors are determinants of the level of overall PA at national levels. This underlines the suggestion that the macro-environment should be regarded as an important influence on PA.</p