Challenges in lifestyle and community interventions research

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

Perceived health status: is obesity perceived as a risk factor and disease?

One might expect that a perception of obesity being a risk factor and disease, contributes to effective obesity prevention and management strategies. However, obesity rates continue to increase worldwide. The question arises whether obesity is truly perceived as a risk factor and a disease. This paper aims at describing perception of obesity as risk factor and disease among individuals seeking care, individuals not seeking care, the society, and different professionals having a role in the field of obesity. The paper is a reflection of the lecture on the topic that was given at the EASO's New Investigators United's Summer School 2016 in Portugal and the discussion with the new investigators and other senior speakers. Individual obese patients seeking help are very much aware of obesity being a risk factor and disease, but perceptions regarding obesity seem to be flawed among those who do not seek help for obesity. Also, misperceptions regarding obesity play a role at different levels, including society, different political levels, the fields of health care and social work, prevention organizations, and the food and marketing industry. The food and marketing industry has an enormous role in changing perceptions by the society and policy makers. Obesity rates will continue to increase as long as individuals, the society, and professionals at different levels have false interpretations of the severity of obesity. Severe action is needed against those who are playing a role in maintaining false perceptions of obesity as a risk factor and disease.- (undefined

Associations between Safety from Crime, Cycling, and Obesity in a Dutch Elderly Population: Results from the Longitudinal Aging Study Amsterdam

The objective of this cross-sectional study was to investigate differences in associations between crime rates, cycling, and weight status between people living in low and high socioeconomic status (SES) neighbourhoods. In total, 470 participants in the Longitudinal Aging Study Amsterdam were included (age: 63–70 y). Body height and weight were measured using a stadiometer and calibrated weight scale, respectively. Cycling behaviour was assessed in a face-to-face interview, and neighbourhood crime rates were assessed using data from police reports. Men residing in high SES neighbourhoods cycled more than males residing in low SES neighbourhoods. Cycling was negatively related to crime rates among both men and women living in low SES neighbourhoods. Among men living in low SES neighbourhoods, more cycling was associated with lower BMI. Interventions aiming to prevent obesity in older people may consider aiming at increasing bicycle use in lower SES neighbourhoods, but neighbourhood safety issues should be considered

Effect in zijn context: Evaluatie van Jongeren op Gezond Gewicht (JOGG)

‘Hoeveel effect heeft die interventie?’ Een logische vraag die de wethouder stelde. Hij moet immers de uitgaven in zijn beleid kunnen onderbouwen. Waarschijnlijk geldt de vraag voor veel van de keuzen die hij dagelijks moet maken. Het betrof in dit geval echter een educatief programma dat zou worden ingezet in het kader van de integrale aanpak van obesitas onder de jeugd in zijn gemeente. We zullen in dit artikel laten zien waarom de vraag van de wethouder de verkeerde is. Een betere is: ‘Kan ik deze interventie in mijn gemeente laten bijdragen aan de preventie van obesitas onder jongeren?’ We beargumenteren in dit artikel niet alleen waarom deze vraag beter past bij integrale obesitaspreventie, maar ook dat voor het beantwoorden ervan niet zozeer naar de interventie-elementen moet worden gekeken, als wel vooral naar de aard van de context waarin de interventie moet worden ingepast

Opportunities for intervention strategies for weight management: global actions on fluid intake patterns

Water is an essential nutrient for all physiological functions and particularly important for thermoregulation. About 60% of our body weight is made of water. Under standard conditions (18-20 °C and moderate activity), water balance is regulated within 0.2 % of body weight over a 24-hour period. Water requirement varies between individuals and according to environmental conditions. Concerning considerations related to obesity, the health impact of fluid intake is commonly overlooked. Fluid intake advices are missing in most of food pyramids offered to the public, and water requirements and hydration challenges remain often neglected. The purpose of this paper is to emphasize and discuss the role of water consumption in the context of other important public health measures for weight management. Attention will be focused on fluid intake patterns and hydration-related questions in the context of global interventions and/or physical activity programs settled in weight management protocols

Behavioural and socio-demographic characteristics of Dutch neighbourhoods with high prevalence of childhood obesity

OBJECTIVE: To identify neighbourhoods with increased prevalence of overweight children and to examine whether the association between neighbourhood and overweight can be explained by demographic characteristics and energy-related behaviours. METHOD: This cross-sectional study was carried out among 4,072 primary schoolchildren in the city of Zwolle, The Netherlands. Data collection consisted of measured height, weight and waist circumference, and a parental questionnaire on socio-demographic characteristics, dietary and (in)activity behaviour of their child. With multivariate logistic regressions, associations between unhealthy behaviours and neighbourhoods (defined by postal code) with high and low prevalence of childhood overweight were investigated. RESULTS: In three neighbourhoods the prevalence of overweight was significantly higher (16.5% vs. 10.6%, p < 0.05). The odds of living in these neighbourhoods were higher among children watching >2 h television/day (OR: 1.57; 95% CI: 1.15-2.14), not eating breakfast daily (OR: 2.86; 95% CI: 1.93-4.23), drinking >3 glasses/day sugared drinks (OR: 1.23; 95% CI: 1.01-1.50) on weekdays and not participating in organized sports (OR: 1.32; 95% CI: 1.09-1.59). This odds was however lower among children eating <2 fruit/day (OR: 0.83; 95% CI: 0.69-1.00) on weekends. The association between neighbourhood and overweight altered slightly after adjustment for socio-demographic and behavioural characteristics during weekdays (OR: 1.42; 95% CI: 1.05-1.92) and weekends (OR: 1.50; 95% CI; 1.11-2.02). CONCLUSION: Three neighbourhoods with higher prevalence of overweight were identified. A small part of the association between overweight and neighbourhood is explained by socio-demographic factors and unhealthy behaviours measured in this study. Neighbourhoods with higher overweight prevalence are a priority setting for targeted interventions to prevent overweight. The association between neighbourhood and overweight needs to be explored further to understand the role the neighbourhood can play in tackling overweight

Obesity and unhealthy life-years in adult Finns: an empirical approach

BACKGROUND: Obesity is more strongly related to morbidity and disability than to mortality. Obese individuals are thus expected to have more unhealthy life-years than normal-weight persons. The objective of the present study was to quantify the number of excess unhealthy life-years in obese individuals. METHODS: A representative cohort of 19 518 Finnish men and women aged 20 to 92 years was followed for 15 years. Participation rate was 83%. Obesity was defined as a body mass index of 30.0 or higher. The number of unhealthy life-years due to premature work disability, hospitalization for coronary heart disease, and need for long-term medication was calculated per category of body mass index. RESULTS: During the follow-up of 15 years, obese men who never smoked aged 20 to 64 years had, on average, 0.63 more years of work disability, 0.36 more years of coronary heart disease, and 1.68 more years of longterm medication use, than normal-weight counterparts. Obese women had, respectively, 0.52, 0.46, and 1.49 more years from these conditions than normal weight women. The excess risks of morbidity and disability due to obesity were highest in the youngest age groups and exceeded those of mortality in all age groups. Obese men and women 65 years and older who never smoked had, respectively, 1.71 and 1.41 excess unhealthy life-years (not statistically significant) due to premature need for long-term medication compared with normal-weight subjects, but no excess unhealthy life-years due to coronary heart disease. CONCLUSIONS: Obesity has a lifetime impact on disability and morbidity. A further increase in obesity will lead to an increase in unhealthy life-years and in direct and indirect health care costs

Agreement between parent and child report of physical activity, sedentary and dietary behaviours in 9-12-year-old children and associations with children’s weight status

Abstract Background To date, population based surveys aimed at gaining insight in health related behaviour of children have often used either child self-reports or parent proxy reports. It remains unclear however, if surveys using different sources of information from either parents or children are comparable. In addition, (over)weight status of children can lead to under- and over reporting by parents and children as a result of social desirability bias. We aimed at gaining insight in the level of agreement between parents and child reports regarding aspects of certain dietary, physical activity and sedentary behaviours, and whether there are differences in agreement between parents and child reports in healthy-weight and overweight children. Methods Weighted kappa was used to determine the level of agreement between child and parent reports on health-related behaviour in 1998 parent-child dyads. We also stratified for weight status of the children. Information on children’s health related behaviours was obtained by parental and children’s questionnaires, and children’s height and weight were measured. Associations between children’s weight status and children reporting less, reporting more and reporting the same amount of health behaviour as their parents were investigated with multinomial logistic regression analysis. Results The Cohen’s kappa coefficients ranged from almost perfect agreement for the variable means of transportation, fair for the variables breakfast consumption and frequency of outside play to slight for the variables duration of outside play, frequency and duration of TV/DVD viewing and family dinner. Overweight children were significantly more likely to report less breakfast consumption (OR = 2.6 (95% CI: 1.3 – 5.1)) and lower frequency of outside play than their parents (OR = 1.8 (95% CI: 1.1 – 2.9)). Conclusion There can be considerable disagreement between the health related behaviours of children as reported by parents or the children themselves. Based on the present study, it cannot be concluded whether parents’ or children’s reports are more accurate. For future studies, social desirability and recall bias would be best demonstrated in a validation study comparing child and parent self-reports with more objective measures of physical activity and food intake