A cross-sectional prevalence study of ethnically targeted and general audience outdoor obesity-related advertising

Advancing public health obesity policy through state attorneys general

Obesity in the United States exacts a heavy health and financial toll, requiring new approaches to address this public health crisis. State attorneys general have been underutilized in efforts to formulate and implement food and obesity policy solutions. Their authority lies at the intersection of law and public policy, creating unique opportunities unavailable to other officials and government entities. Attorneys general have a broad range of authority over matters specifically relevant to obesity and nutrition policy, including parens patriae (parent of the country) authority, protecting consumer interests, enacting and supporting rules and regulations, working together across states, engaging in consumer education, and drafting opinions and amicus briefs. Significant room exists for greater attorney general involvement in formulating and championing solutions to public health problems such as obesity.

The Memphis Girls' health Enrichment Multi-site Studies (GEMS): an evaluation of the efficacy of a 2-year obesity prevention program in African American girls

OBJECTIVE

To determine the efficacy of a 2-year obesity prevention program in African American girls.

DESIGN

Memphis GEMS (Girls' health Enrichment Multi-site Studies) was a controlled trial in which girls were randomly assigned to an obesity prevention program or alternative intervention.

SETTING

Local community centers and YWCAs (Young Women's Christian Associations) in Memphis, Tennessee.

PARTICIPANTS

Girls aged 8 to 10 years (N = 303) who were identified by a parent or guardian as African American and who had a body mass index (BMI) at or higher than the 25th percentile for age or 1 parent with a BMI of 25 or higher.

INTERVENTIONS

Group behavioral counseling to promote healthy eating and increased physical activity (obesity prevention program) or self-esteem and social efficacy (alternative intervention).

MAIN OUTCOME MEASURE

The BMI at 2 years.

RESULTS

The BMI increased in all girls with no treatment effect (obesity prevention minus alternative intervention) at 2 years (mean, 0.09; 95% confidence interval [CI], -0.40 to 0.58). Two-year treatment effects in the expected direction were observed for servings per day of sweetened beverages (mean, -0.19; 95% CI, -0.39 to 0.09), water (mean, 0.21; 95% CI, 0.03 to 0.40), and vegetables (mean, 0.15; 95% CI,-0.02 to 0.30), but there were no effects on physical activity. Post hoc analyses suggested a treatment effect in younger girls (P for interaction = .08). The mean BMI difference at 2 years was -2.41 (95% CI, -4.83 to 0.02) in girls initially aged 8 years and -1.02 (95% CI, -2.31 to 0.27) in those initially aged 10 years.

CONCLUSIONS

The lack of significant BMI change at 2 years indicates that this intervention alone is insufficient for obesity prevention. Effectiveness may require more explicit behavior change goals and a stronger physical activity component as well as supportive changes in environmental contexts.

The California Endowment's Healthy Eating, Active Communities program: a midpoint review

OBJECTIVES

We conducted a midpoint review of The California Endowment's Healthy Eating, Active Communities (HEAC) program, which works in 6 low-income California communities to prevent childhood obesity by changing children's environments. The HEAC program conducts interventions in 5 key childhood environments: schools, after-school programs, neighborhoods, health care, and marketing and advertising.

METHODS

We measured changes in foods and beverages sold at schools and in neighborhoods in HEAC sites; changes in school and after-school physical activity programming and equipment; individual-level changes in children's attitudes and behaviors related to food and physical activity; and HEAC-related awareness and engagement on the part of community members, stakeholders, and policymakers.

RESULTS

Children's environments changed to promote healthier lifestyles across a wide range of domains in all 5 key childhood environments for all 6 HEAC communities. Children in HEAC communities are also engaging in more healthy behaviors than they were before the program's implementation.

CONCLUSIONS

HEAC sites successfully changed children's food and physical activity environments, making a healthy lifestyle a more viable option for low-income children and their families.

Disparities in peaks, plateaus, and declines in prevalence of high BMI among adolescents

OBJECTIVES

The objective of this study was to investigate trends in prevalence of high BMI from 2001 to 2008 and examine racial/ethnic disparities.

METHODS

Records for a total of 8 283 718 fifth-, seventh-, and ninth-grade students who underwent California's school-based BMI screening between 2001 and 2008 were included. Logistic regression identified trends in prevalence of high BMI (>or=85th, >or=95th, >or=97th, and >or=99th percentiles).

RESULTS

For 3 of 4 BMI cut points, prevalence continued to increase for black and American Indian girls through 2008, Hispanic girls plateaued after 2005, non-Hispanic white girls declined to 2001 prevalence levels after peaking in 2005, and Asian girls showed no increases. Non-Hispanic white boys peaked in 2005, then declined to 2001 prevalence levels for all BMI cut points; Hispanic and Asian boys declined after 2005 (for 3 lowest BMI cut points only) but remained above 2001 levels; and American Indian boys peaked later (2007) and declined only for BMI>or=95th. No girls and few boys showed a decline after peaking in prevalence of BMI>or=99th percentile. In 2008, disparities in prevalence were greatest for BMI>or=99th percentile, with prevalence of 4.9% for American Indian girls and 4.6% for black girls versus 1.3% for non-Hispanic white girls.

CONCLUSIONS

On the basis of statewide California data, prevalence of high BMI is declining for some groups but has not declined for American Indian and black girls. These trends portend greater disparities over time, particularly in severe obesity. Interventions and policies that are tailored to the highest risk groups should be pursued.

Socio-economic differences in eating-related attitudes, behaviours and environments of adolescents

OBJECTIVE

The aim of the present study was to investigate the relationship between area-level socio-economic status and healthy and less healthy eating behaviours among adolescents and to determine whether the relationship between area-level socio-economic status and dietary behaviours was related to the relevant attitudes and environments.

DESIGN

Data were collected as part of Youth'07, a nationally representative survey of the health and well-being of New Zealand youth.

SETTING

New Zealand secondary schools, 2007.

SUBJECTS

A total of 9107 secondary-school students in New Zealand.

RESULTS

Students from more deprived areas perceived more supportive school environments and cared as much about healthy eating as students in more affluent areas. However, these students were significantly more likely to report consuming fast food, soft drinks and chocolates.

CONCLUSIONS

Addressing area-level socio-economic disparities in healthy eating requires addressing the availability, affordability and marketing of unhealthy snack foods, particularly in economically deprived areas.

The Food Marketing Defense Model: Integrating Psychological Research to Protect Youth and Inform Public Policy

Marketing practices that promote calorie-dense, nutrient-poor foods directly to children and adolescents present significant public health risk. Worldwide, calls for government action and industry change to protect young people from the negative effects of food marketing have increased. Current proposals focus on restricting television advertising to children under 12 years old, but current psychological models suggest that much more is required. All forms of marketing pose considerable risk; adolescents are also highly vulnerable; and food marketing may produce far-reaching negative health outcomes. We propose a food marketing defense model that posits four necessary conditions to effectively counter harmful food marketing practices: awareness, understanding, ability and motivation to resist. A new generation of psychological research is needed to examine each of these processes, including the psychological mechanisms through which food marketing affects young people, to identify public policy that will effectively protect them from harmful influence.

Promoting physical activity and healthy eating: convergence in framing the role of industry

This commentary addresses a little explored aspect of prevention, namely, how public health practitioners conceptualize the roles of industries whose business interests may be at odds with physical activity and eating nutrient-rich foods. Taking their cues from successful campaigns in tobacco control, many public health advocates have framed obesity as a battle with the food industry. Such framing presents problems when it exacerbates existing tensions between practitioners in nutrition and physical activity, and alienates potential fitness industry partners. Creating healthy environments requires reframing expectations of all industries that influence physical activity and inactivity. A broader view of the influence of corporate practices on physical and social environments will help both physical activity and nutrition advocates identify what they can do together, and in partnership with the business sector, to create environments that promote activity and nutritious eating.

Food Systems and Public Health Disparities

The United States has set a national goal to eliminate health disparities. This article emphasizes the importance of food systems in generating and exacerbating health disparities in the United States and suggests avenues for reducing them. It presents a conceptual model showing how broad food system conditions interplay with community food environments-and how these relationships are filtered and refracted through prisms of social disparities to generate and exacerbate health disparities. Interactions with demand factors in the social environment are described. The article also highlights the separate food systems pathway to health disparities via environmental and occupational health effects of agriculture.