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Multilevel governance, public health and the regulation of food: is tobacco control policy a model? J Public Health Policy 2019; 40:147-165. [PMID: 30824824 DOI: 10.1057/s41271-019-00165-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Campaigns against risk factors for non-communicable diseases (NCDs) caused by smoking and obesity have become increasingly common on multiple levels of government, from the local to the international. Non-governmental actors have cooperated with government bodies to make policies. By analysing the policies of the World Trade Organization, the World Health Organization, the European Union, and the United Kingdom and United States governments, we identify how the struggles between public health advocates and commercial interests reached the global level, and how the relatively successful fight to 'denormalize' tobacco consumption has become a model for anti-obesity advocates. It highlights three factors important in policy change: framing the policy problem, the policymaking environment and 'windows of opportunity'-to analyse the struggle between 'harm regulation' and 'neoprohibition' approaches to an international obesity prevention regime.
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Gittelsohn J, Novotny R, Trude ACB, Butel J, Mikkelsen BE. Challenges and Lessons Learned from Multi-Level Multi-Component Interventions to Prevent and Reduce Childhood Obesity. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2018; 16:ijerph16010030. [PMID: 30586845 PMCID: PMC6339209 DOI: 10.3390/ijerph16010030] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/09/2018] [Revised: 12/10/2018] [Accepted: 12/20/2018] [Indexed: 12/12/2022]
Abstract
Multi-level multi-component (MLMC) strategies have been recommended to prevent and reduce childhood obesity, but results of such trials have been mixed. The present work discusses lessons learned from three recently completed MLMC interventions to inform future research and policy addressing childhood obesity. B’more Healthy Communities for Kids (BHCK), Children’s Healthy Living (CHL), and Health and Local Community (SoL) trials had distinct cultural contexts, global regions, and study designs, but intervened at multiple levels of the socioecological model with strategies that address multiple components of complex food and physical activity environments to prevent childhood obesity. We discuss four common themes: (i) How to engage with community partners and involve them in development of intervention and study design; (ii) build and maintain intervention intensity by creating mutual promotion and reinforcement of the intervention activities across the multiple levels and components; (iii) conduct process evaluation for monitoring, midcourse corrections, and to engage stakeholder groups; and (iv) sustaining MLMC interventions and its effect by developing enduring and systems focused collaborations. The paper expands on each of these themes with specific lessons learned and presents future directions for MLMC trials.
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Affiliation(s)
- Joel Gittelsohn
- Center for Human Nutrition, International Health Department, Johns Hopkins Bloomberg School of Public Health, 615 N Wolfe St, Baltimore, MD 21205, USA.
| | - Rachel Novotny
- Children's Healthy Living Center of Excellence, College of Tropical Agriculture and Human Resources ⁻ University of Hawai'i at Mānoa, Honolulu, HI 96822, USA.
| | - Angela Cristina Bizzotto Trude
- Center for Human Nutrition, International Health Department, Johns Hopkins Bloomberg School of Public Health, 615 N Wolfe St, Baltimore, MD 21205, USA.
| | - Jean Butel
- Children's Healthy Living Center of Excellence, College of Tropical Agriculture and Human Resources ⁻ University of Hawai'i at Mānoa, Honolulu, HI 96822, USA.
| | - Bent Egberg Mikkelsen
- Department of Learning & Philosophy, Aalborg University, A.C. Meyers Vænge 15, DK-2450 Copenhagen SV, Denmark.
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Effective advocacy strategies for influencing government nutrition policy: a conceptual model. Int J Behav Nutr Phys Act 2018; 15:83. [PMID: 30170610 PMCID: PMC6119246 DOI: 10.1186/s12966-018-0716-y] [Citation(s) in RCA: 59] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2018] [Accepted: 08/19/2018] [Indexed: 01/11/2023] Open
Abstract
Influencing public policy change can be difficult and complex, particularly for those with limited power and resources. For any one issue there may be several groups, including the commercial sector and public health advocates advocating from different policy perspectives. However, much of the public health advocacy literature and tools available for those wanting to improve their practice is based on research from one specific perspective of an issue. This approach deprives advocates of potential insight into the most effective levers for this complex and difficult process. To provide a more comprehensive insight into effective levers for influencing public health policy change, a conceptual model for poorly-resourced advocates was developed. The model was developed through the integration and synthesis of policy process and network theories with the results from three studies conducted previously by the authors: a systematic literature review; a social network analysis of influential actors in Australian nutrition policy; plus in-depth interviews with a sample of these actors who had diverse perspectives on influencing nutrition policy. Through understanding the key steps in this model advocates will be better equipped to increase political and public will, and affect positive policy change.
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Divaris K, Bhaskar V, McGraw KA. Pediatric obesity-related curricular content and training in dental schools and dental hygiene programs: systematic review and recommendations. J Public Health Dent 2017; 77 Suppl 1:S96-S103. [PMID: 28708273 DOI: 10.1111/jphd.12236] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2017] [Accepted: 06/14/2017] [Indexed: 11/30/2022]
Abstract
OBJECTIVES The authors conducted a systematic review to determine: a) What dental schools and dental hygiene programs are doing to promote knowledge and skills related to addressing childhood obesity and to reduce consumption of sugar-sweetened beverages (SSBs) and b) What else these schools and programs could do to better equip future oral health professionals to address childhood obesity and reduce consumption of SSBs. METHODS The authors searched PubMed, Scopus, Education Full Text (EBSCOHost), and ERIC (EBSCOHost) to identify peer-reviewed publications reporting on obesity or dietetic-related curricula in dental and dental hygiene education within the last 20 years. Three studies met inclusion and exclusion criteria. Outcomes of the identified studies were abstracted and summarized independently by two investigators. RESULTS The first study describes a 2009 survey of pediatric dentistry residents. Approximately, half had received formal training yet they lacked essential knowledge or skills for managing children who were obese. The second study describes nutrition-related coursework offered in the second year of a predoctoral dental school curriculum in Saudi Arabia, and the third study reports on the development of an "oral health rotation" dietetic internship in a pediatric dentistry clinic, in the context of interprofessional education (IPE). CONCLUSIONS Evidence of dental schools' and dental hygiene programs' efforts to address obesity and SSB consumption in children in their curricula is scant, while Commission on Dental Accreditation standards make sporadic mentions of diet and nutrition. Opportunities exist to leverage existing resources and innovative, experiential approaches, including IPE, to formally, and effectively address this important issue in predoctoral oral health education.
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Affiliation(s)
- Kimon Divaris
- Department of Pediatric Dentistry, School of Dentistry, University of North Carolina at Chapel Hill, NC, USA.,Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, NC, USA
| | - Vaishnavi Bhaskar
- ITDP program, School of Dentistry, University of Michigan, Ann Arbor, MI, USA
| | - Kathleen A McGraw
- User Services & School of Dentistry Liaison, Health Sciences Library, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
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Khayatzadeh-Mahani A, Ruckert A, Labonté R. Obesity prevention: co-framing for intersectoral ‘buy-in’. CRITICAL PUBLIC HEALTH 2017. [DOI: 10.1080/09581596.2017.1282604] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Akram Khayatzadeh-Mahani
- School of Public Policy, University of Calgary, Calgary, Canada
- Health Services Management Research Center, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
- School of Epidemiology, Public Health and Preventive Medicine, University of Ottawa, Ottawa, Canada
| | - Arne Ruckert
- School of Epidemiology, Public Health and Preventive Medicine, University of Ottawa, Ottawa, Canada
| | - Ronald Labonté
- School of Epidemiology, Public Health and Preventive Medicine, University of Ottawa, Ottawa, Canada
- Canada Research Chair, Globalization and Health Equity Research Unit, University of Ottawa, Ottawa, Canada
- Faculty of Health Sciences, Flinders University of South Australia, Adelaide, Australia
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Hillier TA, Pedula KL, Vesco KK, Oshiro CES, Ogasawara KK. Impact of Maternal Glucose and Gestational Weight Gain on Child Obesity over the First Decade of Life in Normal Birth Weight Infants. Matern Child Health J 2016; 20:1559-68. [PMID: 27154523 PMCID: PMC9870031 DOI: 10.1007/s10995-016-1955-7] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
Objective To determine, among children with normal birth weight, if maternal hyperglycemia and weight gain independently increase childhood obesity risk in a very large diverse population. Methods Study population was 24,141 individuals (mothers and their normal birth weight offspring, born 1995-2003) among a diverse population with universal GDM screening [50-g glucose-challenge test (GCT); 3 h. 100 g oral glucose tolerance test (OGTT) if GCT+]. Among the 13,037 full-term offspring with normal birth weight (2500-4000 g), annual measured height/weight was ascertained between ages 2 and 10 years to calculate gender-specific BMI-for-age percentiles using USA norms (1960-1995 standard). Results Among children who began life with normal birth weight, we found a significant trend for developing both childhood overweight (>85 %ile) and obesity (>95 %ile) during the first decade of life with both maternal hyperglycemia (normal GCT, GCT+ but no GDM, GDM) and excessive gestational weight gain [>40 pounds (18.1 kg)]; p < 0.0001 for both trends. These maternal glucose and/or weight gain effects to imprint for childhood obesity in the first decade remained after adjustment for potential confounders including maternal age, parity, as well as pre-pregnancy BMI. The attributable risk (%) for childhood obesity was 28.5 % (95 % CI 15.9-41.1) for GDM and 16.4 % (95 % CI 9.4-23.2) for excessive gestational weight gain. Conclusions for Practice Both maternal hyperglycemia and excessive weight gain have independent effects to increase childhood obesity risk. Future research should focus on prevention efforts during pregnancy as a potential window of opportunity to reduce childhood obesity.
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Affiliation(s)
- Teresa A Hillier
- Center for Health Research, Kaiser Permanente Northwest, 3800 N. Interstate Ave., Portland, OR, 97227, USA.
- Center for Health Research, Kaiser Permanente Hawaii, Honolulu, HI, USA.
| | - Kathryn L Pedula
- Center for Health Research, Kaiser Permanente Northwest, 3800 N. Interstate Ave., Portland, OR, 97227, USA
| | - Kimberly K Vesco
- Center for Health Research, Kaiser Permanente Northwest, 3800 N. Interstate Ave., Portland, OR, 97227, USA
| | - Caryn E S Oshiro
- Center for Health Research, Kaiser Permanente Hawaii, Honolulu, HI, USA
| | - Keith K Ogasawara
- Department of Obstetrics and Gynecology, Kaiser Permanente Hawaii, Honolulu, HI, USA
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Millstein RA, Woodruff SI, Linton LS, Edwards CC, Sallis JF. Development of measures to evaluate youth advocacy for obesity prevention. Int J Behav Nutr Phys Act 2016; 13:84. [PMID: 27461189 PMCID: PMC4962448 DOI: 10.1186/s12966-016-0410-x] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2015] [Accepted: 07/19/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Youth advocacy has been successfully used in substance use prevention but is a novel strategy in obesity prevention. As a precondition for building an evidence base for youth advocacy for obesity prevention, the present study aimed to develop and evaluate measures of youth advocacy mediator, process, and outcome variables. METHODS The Youth Engagement and Action for Health (YEAH!) program (San Diego County, CA) engaged youth and adult group leaders in advocacy for school and neighborhood improvements to nutrition and physical activity environments. Based on a model of youth advocacy, scales were developed to assess mediators, intervention processes, and proximal outcomes of youth advocacy for obesity prevention. Youth (baseline n = 136) and adult group leaders (baseline n = 47) completed surveys before and after advocacy projects. With baseline data, we created youth advocacy and adult leadership subscales using confirmatory factor analysis (CFA) and described their psychometric properties. RESULTS Youth came from 21 groups, were ages 9-22, and most were female. Most youth were non-White, and the largest ethnic group was Hispanic/Latino (35.6%). The proposed factor structure held for most (14/20 youth and 1/2 adult) subscales. Modifications were necessary for 6 of the originally proposed 20 youth and 1 of the 2 adult multi-item subscales, which involved splitting larger subscales into two components and dropping low-performing items. CONCLUSIONS Internally consistent scales to assess mediators, intervention processes, and proximal outcomes of youth advocacy for obesity prevention were developed. The resulting scales can be used in future studies to evaluate youth advocacy programs.
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Affiliation(s)
- Rachel A. Millstein
- San Diego State University/University of California, San Diego Joint Doctoral Program in Clinical Psychology, San Diego, CA 92103 USA
- Present Address: Department of Psychiatry, Massachusetts General Hospital, Boston, MA 02114 USA
| | - Susan I. Woodruff
- San Diego State University, School of Social Work, San Diego, CA 92182 USA
| | | | | | - James F. Sallis
- Department of Family Medicine and Public Health, University of California, San Diego, CA 92013 USA
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Ortiz SE, Zimmerman FJ, Adler GJ. Increasing public support for food-industry related, obesity prevention policies: The role of a taste-engineering frame and contextualized values. Soc Sci Med 2016; 156:142-53. [PMID: 27038322 DOI: 10.1016/j.socscimed.2016.02.042] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2015] [Revised: 02/24/2016] [Accepted: 02/28/2016] [Indexed: 11/28/2022]
Abstract
BACKGROUND Support for policies to combat obesity is often undermined by a public sense that obesity is largely a matter of personal responsibility. Industry rhetoric is a major contributor to this perception, as the soda/fast food/big food companies emphasize choice and individual agency in their efforts to neutralize policies that are burdensome. Yet obesity experts recognize that environmental forces play a major role in obesity. We investigate whether exposure to a taste-engineering frame increases support for food and beverage policies that address obesity. A taste-engineering frame details strategies used by the food industry to engineer preferences and increase the over-consumption of processed foods and sugary beverages. We also examine the effects of exposure to two contextualized values that have recently been promoted in expert discourse-consumer knowledge and consumer safety - on public support of policies. Our research shows how causal frames and contextualized values may effectively produce support for new obesity policies. METHODS We use an online survey experiment to test the effects of exposure to a taste-engineering frame (TEF), the value of consumer knowledge (CK), or the value of consumer safety (CS), on level of support for a range of policies. A random sample of adults, age 18 + living in the United States was included in the study (N = 2580). Ordered logistic regression was used to measure the effects of treatment exposure. The primary outcome was level-of-support for four (4) food-industry related, obesity prevention policies (aka food and beverage policies): 1) require food-manufacturers to disclose the amount of additives in food products on food packaging; 2) require food-manufacturers to advertise food products in accordance with their actual nutritional value; 3) prohibit all high-fat, high-sugar food advertising on television programming watched primarily by children; and 4) increase healthy food availability in work sites, schools, and hospitals. FINDINGS These data suggest that a taste-engineering frame and contextualized values significantly increase public support for many of the food and beverage policies tested. CONCLUSIONS Applying a taste-engineering frame and/or contextualized values to address obesity advances a population-based policy agenda to counteract the effects of food-industry strategies.
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Affiliation(s)
- Selena E Ortiz
- Department of Health Policy and Administration, College of Health and Human Development, The Pennsylvania State University, 601L Ford Building, University Park, PA 16802, USA.
| | - Frederick J Zimmerman
- Department of Health Policy and Management, UCLA Fielding School of Public Health, UCLA, BOX 951772, 31-236B CHS, Los Angeles, CA 90095, USA.
| | - Gary J Adler
- Department of Sociology and Criminology, College of the Liberal Arts, The Pennsylvania State University, 514 Oswald Tower, University Park, PA 16802, USA.
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Rogers EA, Fine SC, Handley MA, Davis HB, Kass J, Schillinger D. Engaging Minority Youth in Diabetes Prevention Efforts Through a Participatory, Spoken-Word Social Marketing Campaign. Am J Health Promot 2016; 31:336-339. [PMID: 26730553 DOI: 10.4278/ajhp.141215-arb-624] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE To examine the reach, efficacy, and adoption of The Bigger Picture, a type 2 diabetes (T2DM) social marketing campaign that uses spoken-word public service announcements (PSAs) to teach youth about socioenvironmental conditions influencing T2DM risk. DESIGN A nonexperimental pilot dissemination evaluation through high school assemblies and a Web-based platform were used. SETTING The study took place in San Francisco Bay Area high schools during 2013. SUBJECTS In the study, 885 students were sampled from 13 high schools. INTERVENTION A 1-hour assembly provided data, poet performances, video PSAs, and Web-based platform information. A Web-based platform featured the campaign Web site and social media. MEASURES Student surveys preassembly and postassembly (knowledge, attitudes), assembly observations, school demographics, counts of Web-based utilization, and adoption were measured. ANALYSIS Descriptive statistics, McNemar's χ2 test, and mixed modeling accounting for clustering were used to analyze data. RESULTS The campaign included 23 youth poet-created PSAs. It reached >2400 students (93% self-identified non-white) through school assemblies and has garnered >1,000,000 views of Web-based video PSAs. School participants demonstrated increased short-term knowledge of T2DM as preventable, with risk driven by socioenvironmental factors (34% preassembly identified environmental causes as influencing T2DM risk compared to 83% postassembly), and perceived greater personal salience of T2DM risk reduction (p < .001 for all). The campaign has been adopted by regional public health departments. CONCLUSION The Bigger Picture campaign showed its potential for reaching and engaging diverse youth. Campaign messaging is being adopted by stakeholders.
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Key Words
- Health focus: prevention and health literacy
- Outcome measure: cognitive, descriptive
- Research purpose: program evaluation
- Setting: Web-based platform, school
- Strategy: education
- Study design: nonexperimental
- Target population age: youth
- Target population circumstances: income level, geographic location, race/ethnicity
- Type 2 Diabetes Mellitus, Prevention, Adolescent, Social Marketing, Health Campaigns, Health Literacy, Prevention Research. Manuscript format: research
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Affiliation(s)
- Elizabeth A Rogers
- 1 Departments of Internal Medicine and Pediatrics, and the Department of Medicine's Applied Clinical Research Program, University of Minnesota, Minneapolis, Minnesota.,2 Departments of Internal Medicine and Pediatrics, University of California, San Francisco, California
| | - Sarah C Fine
- 3 Division of General Internal Medicine and Center for Vulnerable Populations at San Francisco General Hospital, University of California, San Francisco, California
| | - Margaret A Handley
- 4 Department of Epidemiology and Biostatistics and Center for Vulnerable Populations at San Francisco General Hospital, University of California, San Francisco, San Francisco General Hospital and Trauma Center, San Francisco, California
| | | | - James Kass
- 5 Youth Speaks, San Francisco, California
| | - Dean Schillinger
- 3 Division of General Internal Medicine and Center for Vulnerable Populations at San Francisco General Hospital, University of California, San Francisco, California
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Evaluating Industry Self-Regulation of Food Marketing to Children. Am J Prev Med 2015; 49:181-7. [PMID: 25960392 DOI: 10.1016/j.amepre.2015.01.027] [Citation(s) in RCA: 56] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2014] [Revised: 01/29/2015] [Accepted: 03/02/2015] [Indexed: 11/20/2022]
Abstract
INTRODUCTION Concern has grown about the role of televised food advertising as a contributor to childhood obesity. In response, the food industry adopted a program of self-regulation, with participating companies pledging to limit child-targeted advertising to healthier products. The implicit promise of the industry initiative is a significant improvement in the overall nutritional quality of foods marketed to children, thereby negating the need for governmental regulation to accomplish that objective. This study assesses the efficacy of industry self-regulation by comparing advertising content on children's TV programs before and after self-regulation was implemented. METHODS A systematic content analysis of food advertisements (n=625 in 2007, n=354 in 2013) appearing in children's TV programs on the most popular cable and broadcast channels was conducted. RESULTS All analyses were conducted in 2014. Findings indicated that no significant improvement in the overall nutritional quality of foods marketed to children has been achieved since industry self-regulation was adopted. In 2013, 80.5% of all foods advertised to children on TV were for products in the poorest nutritional category, and thus pose high risk for contributing to obesity. CONCLUSIONS The lack of significant improvement in the nutritional quality of food marketed to children is likely a result of the weak nutritional standards for defining healthy foods employed by industry, and because a substantial proportion of child-oriented food marketers do not participate in self-regulation. The lack of success achieved by self-regulation indicates that other policy actions are needed to effectively reduce children's exposure to obesogenic food advertising.
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Johnson AR, Makowski L. Nutrition and metabolic correlates of obesity and inflammation: clinical considerations. J Nutr 2015; 145:1131S-1136S. [PMID: 25833891 PMCID: PMC4410497 DOI: 10.3945/jn.114.200758] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2014] [Accepted: 12/08/2014] [Indexed: 11/14/2022] Open
Abstract
Since 1980, the global prevalence of obesity has doubled; in the United States, it has almost tripled. Billions of people are overweight and obese; the WHO reports that >65% of the world's population die of diseases related to overweight rather than underweight. Obesity is a complex disease that can be studied from "metropolis to metabolite"—that is, beginning at the policy and the population level through epidemiology and intervention studies; to bench work including preclinical models, tissue, and cell culture studies; to biochemical assays; and to metabolomics. Metabolomics is the next research frontier because it provides a real-time snapshot of biochemical building blocks and products of cellular processes. This report comments on practical considerations when conducting metabolomics research. The pros and cons and important study design concerns are addressed to aid in increasing metabolomics research in the United States. The link between metabolism and inflammation is an understudied phenomenon that has great potential to transform our understanding of immunometabolism in obesity, diabetes, cancer, and other diseases; metabolomics promises to be an important tool in understanding the complex relations between factors contributing to such diseases.
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Affiliation(s)
- Amy R Johnson
- Department of Nutrition, Gillings School of Global Public Health, and
| | - Liza Makowski
- Department of Nutrition, Gillings School of Global Public Health, and School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC
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Ortiz SE, Zimmerman FJ, Gilliam FD. Weighing in: the taste-engineering frame in obesity expert discourse. Am J Public Health 2015; 105:554-9. [PMID: 25602888 DOI: 10.2105/ajph.2014.302273] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVES We sought expert opinion on the problems with 2 dominant obesity-prevention discourse frames-personal responsibility and the environment-and examined alternative frames for understanding and addressing obesity. METHODS We conducted 60-minute, semistructured interviews with 15 US-based obesity experts. We manually coded and entered interview transcripts into software, generating themes and subthematic areas that captured the debate's essence. RESULTS Although the environmental frame is the dominant model used in communications with the public and policymakers, several experts found that communicating key messages within this frame was difficult because of the enormity of the obesity problem. A subframe of the environmental frame--the taste-engineering frame--identifies food industry strategies to influence the overconsumption of certain foods and beverages. This emerging frame deconstructs the environmental frame so that causal attributes and responsible agents are more easily identifiable and proposed policies and public health interventions more salient. CONCLUSIONS Expert interviews are an invaluable resource for understanding how experts use frames in discussing their work and in conversations with the public and policymakers. Future empirical studies testing the effectiveness of the taste-engineering frame on public opinion and support for structural-level health policies are needed.
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Affiliation(s)
- Selena E Ortiz
- At the time of the study, Selena E. Ortiz was a PhD candidate at the Fielding School of Public Health, University of California Los Angeles (UCLA), and a Robert Wood Johnson Health and Society Scholar at Harvard University, Cambridge, MA. Frederick J. Zimmerman is with the Department of Health Policy and Management, Fielding School of Public Health, UCLA. Franklin D. Gilliam Jr is with the Luskin School of Public Affairs, UCLA
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Televised obesity-prevention advertising across US media markets: exposure and content, 2010-2011. Public Health Nutr 2014; 18:983-93. [PMID: 25076385 DOI: 10.1017/s1368980014001335] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
OBJECTIVE To examine levels of exposure and content characteristics for recent televised obesity-prevention campaigns sponsored by state and community health departments, federal agencies, non-profit organizations and television stations in the USA. DESIGN Nielsen television ratings for obesity-prevention advertising were collected for the top seventy-five US media markets and were used to calculate household exposure levels for 2010 and 2011. Governmental advertisements were coded for content. SETTING United States. RESULTS Average household exposure to obesity-prevention campaigns was 2·6 advertisements per month. Exposure increased by 31 % between 2010 and 2011, largely driven by increases in federal advertisements. In 2011, the federal government accounted for 62 % of obesity-prevention exposure, non-profit organizations for 9 %, community departments for 8 %, state departments for 3 %, and television station-sponsored public-service announcements for 17 %. The greatest percentage increase between 2010 and 2011 was in community advertising, reflecting efforts funded by the Communities Putting Prevention to Work (CPPW) programme. Among thirty-four state and community campaigns, the majority advocated both healthy eating and physical activity (53 %). Campaigns typically had positive or neutral emotional valence (94 %). Obesity or overweight was mentioned in 47 % of campaigns, but only 9 % specifically advocated weight loss. CONCLUSIONS Exposure to televised obesity-prevention advertising increased from 2010 to 2011 and was higher than previously found in 1999-2003, apart from in 2003 during the federal VERB campaign. Nevertheless, exposure remains low relative to advertising for unhealthy foods. New federal campaigns have increased exposure to obesity-prevention advertising nationally, while CPPW grants have increased exposure for targeted areas.
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Levy MD, Loy L, Zatz LY. Policy approach to nutrition and physical activity education in health care professional training. Am J Clin Nutr 2014; 99:1194S-201S. [PMID: 24646822 PMCID: PMC3985221 DOI: 10.3945/ajcn.113.073544] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Nutrition and physical activity are key risk factors for a host of today's most prevalent and costly chronic conditions, such as obesity and diabetes; yet, health care providers are not adequately trained to educate patients on the components of a healthy lifestyle. The purpose of this article is to underscore the need for improved nutrition and physical activity training among health care professionals and to explore opportunities for how policy can help support a shift in training. We first identify key barriers to sufficient training in nutrition and physical activity. Then, we provide an overview of how recent changes in the government and institutional policy environment are supporting a shift toward prevention in our health care system and creating an even greater need for improved training of health care professionals in nutrition and physical activity. Last, we outline recommendations for additional policy changes that could drive enhanced training for health care professionals and recommend future directions in research.
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Affiliation(s)
- Matthew D Levy
- Division of Community Pediatrics, Department of Pediatrics, Medstar Georgetown University Hospital, Washington, DC (MDL), and the Bipartisan Policy Center, Washington, DC (LL and LYZ)
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McBeth MK, Clemons RS, Husmann MA, Kusko E, Gaarden A. The Social Construction of a Crisis: Policy Narratives and Contemporary U.S. Obesity Policy. ACTA ACUST UNITED AC 2014. [DOI: 10.1002/rhc3.12042] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Linton LS, Edwards CC, Woodruff SI, Millstein RA, Moder C. Youth advocacy as a tool for environmental and policy changes that support physical activity and nutrition: an evaluation study in San Diego County. Prev Chronic Dis 2014; 11:E46. [PMID: 24674636 PMCID: PMC3970770 DOI: 10.5888/pcd11.130321] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND As evidence grows about the benefits of policy and environmental changes to support active living and healthy eating, effective tools for implementing change must be developed. Youth advocacy, a successful strategy in the field of tobacco control, should be evaluated for its potential in the field of obesity prevention. COMMUNITY CONTEXT San Diego State University collaborated with the San Diego County Childhood Obesity Initiative to evaluate Youth Engagement and Action for Health! (YEAH!), a youth advocacy project to engage youth and adult mentors in advocating for neighborhood improvements in physical activity and healthy eating opportunities. Study objectives included documenting group process and success of groups in engaging in community advocacy with decision makers. METHODS In 2011 and 2012, YEAH! group leaders were recruited from the San Diego County Childhood Obesity Initiative's half-day train-the-trainer seminars for adult leaders. Evaluators collected baseline and postproject survey data from youth participants and adult group leaders and interviewed decision makers. OUTCOMES Of the 21 groups formed, 20 completed the evaluation, conducted community assessments, and advocated with decision makers. Various types of decision makers were engaged, including school principals, food service personnel, city council members, and parks and recreation officials. Eleven groups reported change(s) implemented as a result of their advocacy, 4 groups reported changes pending, and 5 groups reported no change as a result of their efforts. INTERPRETATION Even a brief training session, paired with a practical manual, technical assistance, and commitment of adult leaders and youth may successfully engage decision makers and, ultimately, bring about change.
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Affiliation(s)
- Leslie S Linton
- Health Policy Consulting Group, 4486 Vereda Mar De Ponderosa, San Diego, CA 92130. E-mail:
| | | | - Susan I Woodruff
- San Diego State University School of Social Work, San Diego, California
| | - Rachel A Millstein
- San Diego State University/University of California at San Diego Joint Doctoral Program in Clinical Psychology, San Diego, California
| | - Cheryl Moder
- Community Health Improvement Partners, San Diego County Childhood Obesity Initiative
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17
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Rogers EA, Fine S, Handley MA, Davis H, Kass J, Schillinger D. Development and early implementation of the bigger picture, a youth-targeted public health literacy campaign to prevent type 2 diabetes. JOURNAL OF HEALTH COMMUNICATION 2014; 19 Suppl 2:144-160. [PMID: 25315590 PMCID: PMC4217646 DOI: 10.1080/10810730.2014.940476] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
The prevalence of type 2 diabetes is rapidly rising, especially among minority and low-income youth. There is an unmet need to engage youth in identifying solutions to reverse this trajectory. Social marketing campaigns and entertainment education are effective forms of health communication for engaging populations in health-promoting behaviors. Critical to curbing the epidemic is moving the diabetes conversation away from individual behavior alone and toward a socioecologic perspective using a public health literacy framework. The authors developed an academic-community partnership to develop, implement, and evaluate a type 2 diabetes prevention campaign targeting minority and low-income youth. The Bigger Picture campaign uses hard-hitting, youth-generated spoken-word messages around key environmental and social drivers of the type 2 diabetes epidemic. Campaign goals included promoting health capacity and civic engagement. This article focuses on the development and implementation of the campaign, including (a) rationale and theoretical underpinnings, (b) steps in campaign creation, (c) testing the campaign messaging, and (d) campaign dissemination and evaluation planning. A youth-created health communication campaign using a public health literacy framework with targeted, relevant, and compelling messaging appears to be a promising vehicle for reaching at-risk youth to increase knowledge of and attitudes about preventing type 2 diabetes, change social norms, and motivate participation in health-promoting initiatives.
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Affiliation(s)
- Elizabeth A Rogers
- a Applied Clinical Research Program , University of Minnesota School of Medicine , Minneapolis , Minnesota , USA
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18
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Sundaram S, Johnson AR, Makowski L. Obesity, metabolism and the microenvironment: Links to cancer. J Carcinog 2013; 12:19. [PMID: 24227994 PMCID: PMC3816318 DOI: 10.4103/1477-3163.119606] [Citation(s) in RCA: 72] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2013] [Accepted: 08/06/2013] [Indexed: 02/06/2023] Open
Abstract
Historically, cancer research has focused on identifying mutations or amplification of genes within the tumor, which informed the development of targeted therapies against affected pathways. This work often considers tumor cells in isolation; however, it is becoming increasingly apparent that the microenvironment surrounding tumor cells strongly influences tumor onset and progression. This is the so-called “seed and soil” hypothesis wherein the seed (cancer cell) is fed and molded by the metabolites, growth factors, modifications of the extracellular matrix or angiogenic factors provided by the soil (or stroma). Currently, 65% of the US population is obese or overweight; similarly staggering figures are reported in US children and globally. Obesity mediates and can exacerbate, both normal and tumor microenvironment dysfunction. Many obesity-associated endocrine, metabolic and inflammatory mediators are suspected to play a role in oncogenesis by modifying systemic nutrient metabolism and the nutrient substrates available locally in the stroma. It is vitally important to understand the biological processes linking obesity and cancer to develop better intervention strategies aimed at curbing the carcinogenic events associated with obesity. In this review, obesity-driven changes in both the normal and tumor microenvironment, alterations in metabolism, and release of signaling molecules such as endocrine, growth, and inflammatory mediators will be highlighted. In addition, we will discuss the effects of the timing of obesity onset or particular “windows of susceptibility,” with a focus on breast cancer etiology.
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Affiliation(s)
- Sneha Sundaram
- Department of Nutrition, Nutrition Obesity Research Center, and Lineberger Comprehensive Cancer Center, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, 135 Dauer Drive, CB #7461, Chapel Hill, NC, 27599, USA
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19
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Remuzzi G, Benigni A, Finkelstein FO, Grunfeld JP, Joly D, Katz I, Liu ZH, Miyata T, Perico N, Rodriguez-Iturbe B, Antiga L, Schaefer F, Schieppati A, Schrier RW, Tonelli M. Kidney failure: aims for the next 10 years and barriers to success. Lancet 2013; 382:353-62. [PMID: 23727164 DOI: 10.1016/s0140-6736(13)60438-9] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Although in some parts of the world acute and chronic kidney diseases are preventable or treatable disorders, in many other regions these diseases are left without any care. The nephrology community needs to commit itself to reduction of this divide between high-income and low-income regions. Moreover, new and exciting developments in fields such as pharmacology, genetic, or bioengineering, can give a boost, in the next decade, to a new era of diagnosis and treatment of kidney diseases, which should be made available to more patients.
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Affiliation(s)
- Giuseppe Remuzzi
- IRCCS-Istituto di Ricerche Farmacologiche Mario Negri, Bergamo, Italy.
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20
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Hebert JR, Allison DB, Archer E, Lavie CJ, Blair SN. Scientific decision making, policy decisions, and the obesity pandemic. Mayo Clin Proc 2013; 88:593-604. [PMID: 23726399 PMCID: PMC3759398 DOI: 10.1016/j.mayocp.2013.04.005] [Citation(s) in RCA: 59] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2013] [Revised: 03/26/2013] [Accepted: 04/01/2013] [Indexed: 01/02/2023]
Abstract
Rising and epidemic rates of obesity in many parts of the world are leading to increased suffering and economic stress from diverting health care resources to treating a variety of serious, but preventable, chronic diseases etiologically linked to obesity, particularly type 2 diabetes mellitus and cardiovascular diseases. Despite decades of research into the causes of the obesity pandemic, we seem to be no nearer to a solution now than when the rise in body weights was first chronicled decades ago. The case is made that impediments to a clear understanding of the nature of the problem occur at many levels. These obstacles begin with defining obesity and include lax application of scientific standards of review, tenuous assumption making, flawed measurement and other methods, constrained discourse limiting examination of alternative explanations of cause, and policies that determine funding priorities. These issues constrain creativity and stifle expansive thinking that could otherwise advance the field in preventing and treating obesity and its complications. Suggestions are made to create a climate of open exchange of ideas and redirection of policies that can remove the barriers that prevent us from making material progress in solving a pressing major public health problem of the early 21st century.
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Affiliation(s)
- James R Hebert
- South Carolina Statewide Cancer Prevention and Control Program, University of South Carolina, Columbia, SC 29208, USA.
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21
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Lyn R, Aytur S, Davis TA, Eyler AA, Evenson KR, Chriqui JF, Cradock AL, Goins KV, Litt J, Brownson RC. Policy, systems, and environmental approaches for obesity prevention: a framework to inform local and state action. JOURNAL OF PUBLIC HEALTH MANAGEMENT AND PRACTICE 2013; 19:S23-33. [PMID: 23529052 PMCID: PMC4943076 DOI: 10.1097/phh.0b013e3182841709] [Citation(s) in RCA: 50] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The public health literature has not fully explored the complexities of the policy process as they relate to public health practice and obesity prevention. We conducted a review of the literature across the policy science and public health fields, distilled key theories of policy making, and developed a framework to inform policy, systems, and environmental change efforts on obesity prevention. Beginning with a conceptual description, we focus on understanding three domains of the policy process: the problem domain, the policy domain, and the political domain. We identify key activities in the policy process including the following: (a) assessing the social and political environment; (b) engaging, educating and collaborating with key individuals and groups; (c) identifying and framing the problem; (d) utilizing available evidence; (e) identifying policy solutions; and (f) building public support and political will. The article provides policy change resources and case studies to guide and support local and state efforts around obesity prevention.
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Affiliation(s)
- Rodney Lyn
- Division of Health Management and Policy, Institute of Public Health, Georgia State University, Atlanta, Georgia 30302, USA.
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22
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Hendriks AM, Kremers SPJ, Gubbels JS, Raat H, de Vries NK, Jansen MWJ. Towards health in all policies for childhood obesity prevention. J Obes 2013; 2013:632540. [PMID: 24490059 PMCID: PMC3893738 DOI: 10.1155/2013/632540] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2012] [Accepted: 03/21/2013] [Indexed: 11/17/2022] Open
Abstract
The childhood obesity epidemic can be best tackled by means of an integrated approach, which is enabled by integrated public health policies, or Health in All Policies. Integrated policies are developed through intersectoral collaboration between local government policy makers from health and nonhealth sectors. Such intersectoral collaboration has been proved to be difficult. In this study, we investigated which resources influence intersectoral collaboration. The behavior change wheel framework was used to categorize motivation-, capability-, and opportunity-related resources for intersectoral collaboration. In-depth interviews were held with eight officials representing 10 non-health policy sectors within a local government. Results showed that health and non-health policy sectors did not share policy goals, which decreased motivation for intersectoral collaboration. Awareness of the linkage between health and nonhealth policy sectors was limited, and management was not involved in creating such awareness, which reduced the capability for intersectoral collaboration. Insufficient organizational resources and structures reduced opportunities for intersectoral collaboration. To stimulate intersectoral collaboration to prevent childhood obesity, we recommend that public health professionals should reframe health goals in the terminology of nonhealth policy sectors, that municipal department managers should increase awareness of public health in non-health policy sectors, and that flatter organizational structures should be established.
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Affiliation(s)
- Anna-Marie Hendriks
- Academic Collaborative Centre for Public Health Limburg, Regional Public Health Service, P.O. Box 2022, 6160 HA, Geleen, The Netherlands
- Caphri, School of Public Health and Primary Care, Maastricht University, P.O. Box 616, 6200 MD Maastricht, The Netherlands
- Faculty of Health, Medicine and Life Sciences, Department of Health Promotion, Maastricht University, P.O. Box 616, 6200 MD Maastricht, The Netherlands
| | - Stef P. J. Kremers
- Faculty of Health, Medicine and Life Sciences, Department of Health Promotion, Maastricht University, P.O. Box 616, 6200 MD Maastricht, The Netherlands
- NUTRIM, School for Nutrition, Toxicology and Metabolism, Maastricht University, P.O. Box 616, 6200 MD Maastricht, The Netherlands
| | - Jessica S. Gubbels
- Faculty of Health, Medicine and Life Sciences, Department of Health Promotion, Maastricht University, P.O. Box 616, 6200 MD Maastricht, The Netherlands
- NUTRIM, School for Nutrition, Toxicology and Metabolism, Maastricht University, P.O. Box 616, 6200 MD Maastricht, The Netherlands
| | - Hein Raat
- Department of Public Health, Erasmus MC University Medical Center Rotterdam, P.O. Box 2040, 3000 CA Rotterdam, The Netherlands
| | - Nanne K. de Vries
- Caphri, School of Public Health and Primary Care, Maastricht University, P.O. Box 616, 6200 MD Maastricht, The Netherlands
- Faculty of Health, Medicine and Life Sciences, Department of Health Promotion, Maastricht University, P.O. Box 616, 6200 MD Maastricht, The Netherlands
- NUTRIM, School for Nutrition, Toxicology and Metabolism, Maastricht University, P.O. Box 616, 6200 MD Maastricht, The Netherlands
| | - Maria W. J. Jansen
- Academic Collaborative Centre for Public Health Limburg, Regional Public Health Service, P.O. Box 2022, 6160 HA, Geleen, The Netherlands
- Caphri, School of Public Health and Primary Care, Maastricht University, P.O. Box 616, 6200 MD Maastricht, The Netherlands
- Faculty of Health, Medicine and Life Sciences, Department of Health Services Research Maastricht University, P.O. Box 616, 6200 MD Maastricht, The Netherlands
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23
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Kalin SR, Fung TT. Comparison of child obesity prevention and control content in mainstream and Spanish-language US parenting magazines. J Acad Nutr Diet 2013; 113:133-40. [PMID: 23260730 DOI: 10.1016/j.jand.2012.09.023] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2011] [Accepted: 09/21/2012] [Indexed: 11/18/2022]
Abstract
Mass media coverage of child obesity is rising, paralleling the child obesity epidemic's growth, and there is evidence that parents seek parenting advice from media sources. Yet little to no research has examined the coverage of child obesity in parenting magazines or Spanish-language media. The purpose of this study was to use qualitative and quantitative content analysis methods to identify, quantify, and compare strategies for child obesity prevention and control presented in mainstream and Spanish-language US parenting magazines. Child obesity-related editorial content in 68 mainstream and 20 Spanish-language magazine issues published over 32 months was gathered. Magazine content was coded with a manual developed by refining themes from the sample and from an evidence-based child obesity prevention action plan. Seventy-three articles related to child obesity prevention and control were identified. Most focused on parental behavior change rather than environmental change, and only 3 in 10 articles referred to the social context in which parental behavior change takes place. Child obesity-focused articles were not given high prominence; only one in four articles in the entire sample referred to child obesity as a growing problem or epidemic. Key differences between genres reflect culturally important Latino themes, including family focus and changing health beliefs around child weight status. Given mass media's potential influence on parenting practices and public perceptions, nutrition communication professionals and registered dietitians need to work to reframe media coverage of childhood obesity as an environmental problem that requires broad-based policy solutions. Spanish-speaking media can be an ally in helping Latina women change cultural health beliefs around child weight status.
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Affiliation(s)
- Sari R Kalin
- Nutrition and Health Promotion, Department of Nutrition, Simmons College, Boston, MA, USA.
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24
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Snelling A. The Obesity Epidemic. AMERICAN JOURNAL OF HEALTH EDUCATION 2013. [DOI: 10.1080/19325037.2012.10599229] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- Anastasia Snelling
- a School of Education, Teaching and Health , American University , Washington , D.C. , 20016
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25
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Bloom T, Sharpe L, Mullan B, Zucker N. A pilot evaluation of appetite-awareness training in the treatment of childhood overweight and obesity: a preliminary investigation. Int J Eat Disord 2013; 46:47-51. [PMID: 22826019 DOI: 10.1002/eat.22041] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/24/2012] [Indexed: 11/11/2022]
Abstract
OBJECTIVE The aim of this study was to conduct a preliminary evaluation of Children's Appetite Awareness Training (CAAT), a treatment for childhood obesity which encourages overweight children to eat in response to internal appetite cues. METHOD Overweight children (ages 6-12 years old) were randomized to either the CAAT treatment group (N = 23), to receive 1-h treatment sessions over 6 weeks, or a wait-list group (N = 24). Weight and height of children and parents in both groups were assessed at pre- and post-treatment (or equivalent time for wait-list control) and at a 6-month follow-up for those in the CAAT group. RESULTS The intervention had a significant, short-term effect on the BMI of children who participated. Although at 6-month follow-up, children's BMI has not increased significantly, the difference between pretreatment and follow-up BMI was no longer significant. DISCUSSION These results are encouraging for the use of CAAT with overweight children. Long-term effectiveness could be enhanced through increasing the duration of the program, adding booster sessions and increased involvement of parents.
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Affiliation(s)
- Taryn Bloom
- School of Psychology, The University of Sydney, New South Wales, Australia
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26
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Hendriks AM, Gubbels JS, De Vries NK, Seidell JC, Kremers SPJ, Jansen MWJ. Interventions to promote an integrated approach to public health problems: an application to childhood obesity. JOURNAL OF ENVIRONMENTAL AND PUBLIC HEALTH 2012; 2012:913236. [PMID: 22792120 PMCID: PMC3390054 DOI: 10.1155/2012/913236] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/05/2012] [Accepted: 05/08/2012] [Indexed: 01/09/2023]
Abstract
Experts stress the need to bring the childhood obesity epidemic under control by means of an integrated approach. The implementation of such an approach requires the development of integrated enabling policies on public health by local governments. A prerequisite for developing such integrated public health policies is intersectoral collaboration. Since the development of integrated policies is still in its early stages, this study aimed to answer the following research question: "What interventions can promote intersectoral collaboration and the development of integrated health policies for the prevention of childhood obesity?" Data were collected through a literature search and observations of and interviews with stakeholders. Based on a theoretical framework, we categorized potential interventions that could optimize an integrated approach regarding children's physical activity and diet. The intervention categories included education, persuasion, incentivization, coercion, training, restriction, environmental restructuring, modeling, and enablement.
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Affiliation(s)
- Anna-Marie Hendriks
- Academic Collaborative Centre for Public Health Limburg, Regional Public Health Service, Geleen, The Netherlands.
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Abstract
This article assesses the role played by media in contributing to the current epidemic of childhood obesity. Electronic media use, often referred to as screen time, is significantly correlated with child adiposity. Although the causal mechanism that accounts for this relationship is unclear, it is well established that reducing screen time improves weight status. Media advertising for unhealthy foods contributes to obesity by influencing children's food preferences, requests, and diet. Industry efforts have failed to improve the nutritional quality of foods marketed on television to children, leading public health advocates to recommend government restrictions on child-targeted advertisements for unhealthy foods.
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Allen PJ, Batra P, Geiger BM, Wommack T, Gilhooly C, Pothos EN. Rationale and consequences of reclassifying obesity as an addictive disorder: neurobiology, food environment and social policy perspectives. Physiol Behav 2012; 107:126-37. [PMID: 22583861 DOI: 10.1016/j.physbeh.2012.05.005] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2011] [Revised: 04/02/2012] [Accepted: 05/06/2012] [Indexed: 01/13/2023]
Abstract
The rapid increase in the prevalence of obesity is a priority for investigators from across numerous disciplines, including biology, nutritional science, and public health and policy. In this paper, we systematically examine the premise that common dietary obesity is an addictive disorder, based on the criteria for addiction described in the Diagnostic and Statistical Manual (DSM) of Mental Disorders of the American Psychiatric Association, version IV, and consider the consequences of such a reclassification of obesity for public policy. Specifically, we discuss evidence from both human and animal studies investigating the effects of various types and amounts of food and the food environment in obese individuals. Neurobiological studies have shown that the hedonic brain pathways activated by palatable food overlap considerably with those activated by drugs of abuse and suffer significant deficits after chronic exposure to high-energy diets. Furthermore, food as a stimulus can induce the sensitization, compulsion and relapse patterns observed in individuals who are addicted to illicit drugs. The current food environment encourages these addictive-like behaviors where increased exposure through advertisements, proximity and increased portion sizes are routine. Taking lessons from the tobacco experience, it is clear that reclassifying common dietary obesity as an addictive disorder would necessitate policy changes (e.g., regulatory efforts, economic strategies, and educational approaches). These policies could be instrumental in addressing the obesity epidemic, by encouraging the food industry and the political leadership to collaborate with the scientific and medical community in establishing new and more effective therapeutic approaches.
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Affiliation(s)
- Patricia J Allen
- Department of Psychology, Tufts University, Medford, MA 02155, USA
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Millstein RA, Sallis JF. Youth advocacy for obesity prevention: the next wave of social change for health. Transl Behav Med 2011; 1:497-505. [PMID: 24073069 PMCID: PMC3717625 DOI: 10.1007/s13142-011-0060-0] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Recommended obesity prevention interventions target multiple levels. Effective advocacy is needed to influence factors at individual, social, environmental, and policy levels. This paper describes the rationale for engaging youth in obesity prevention advocacy efforts targeting environment and policy changes to improve nutrition and physical activity. Advocacy involves education, skill development, and behavior and attitude changes, with the goal of persuading others or taking action. Youth advocacy has been successfully used in substance use prevention, but it is relatively new in obesity prevention. A model is presented to guide intervention and evaluation in youth advocacy for obesity prevention. With youth advocacy as a central construct, the model outlines inputs and outcomes of advocacy at individual, social environment, built environment, and policy levels. The model can be used and refined in youth advocacy evaluation projects. By involving youth in their communities, advocacy can produce ownership, engagement, and future involvement yielding sustainable changes.
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Affiliation(s)
- Rachel A Millstein
- />SDSU/UCSD Joint Doctoral Program in Clinical Psychology, 3900 Fifth Avenue, Suite 310, San Diego, CA 92103 USA
| | - James F Sallis
- />Department of Psychology, San Diego State University, 3900 Fifth Avenue, Suite 310, San Diego, CA 92103 USA
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30
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Sampey BP, Vanhoose AM, Winfield HM, Freemerman AJ, Muehlbauer MJ, Fueger PT, Newgard CB, Makowski L. Cafeteria diet is a robust model of human metabolic syndrome with liver and adipose inflammation: comparison to high-fat diet. Obesity (Silver Spring) 2011; 19:1109-17. [PMID: 21331068 PMCID: PMC3130193 DOI: 10.1038/oby.2011.18] [Citation(s) in RCA: 417] [Impact Index Per Article: 32.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2010] [Accepted: 01/09/2011] [Indexed: 12/15/2022]
Abstract
Obesity has reached epidemic proportions worldwide and reports estimate that American children consume up to 25% of calories from snacks. Several animal models of obesity exist, but studies are lacking that compare high-fat diets (HFD) traditionally used in rodent models of diet-induced obesity (DIO) to diets consisting of food regularly consumed by humans, including high-salt, high-fat, low-fiber, energy dense foods such as cookies, chips, and processed meats. To investigate the obesogenic and inflammatory consequences of a cafeteria diet (CAF) compared to a lard-based 45% HFD in rodent models, male Wistar rats were fed HFD, CAF or chow control diets for 15 weeks. Body weight increased dramatically and remained significantly elevated in CAF-fed rats compared to all other diets. Glucose- and insulin-tolerance tests revealed that hyperinsulinemia, hyperglycemia, and glucose intolerance were exaggerated in the CAF-fed rats compared to controls and HFD-fed rats. It is well-established that macrophages infiltrate metabolic tissues at the onset of weight gain and directly contribute to inflammation, insulin resistance, and obesity. Although both high fat diets resulted in increased adiposity and hepatosteatosis, CAF-fed rats displayed remarkable inflammation in white fat, brown fat and liver compared to HFD and controls. In sum, the CAF provided a robust model of human metabolic syndrome compared to traditional lard-based HFD, creating a phenotype of exaggerated obesity with glucose intolerance and inflammation. This model provides a unique platform to study the biochemical, genomic and physiological mechanisms of obesity and obesity-related disease states that are pandemic in western civilization today.
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Affiliation(s)
- Brante P Sampey
- Department of Nutrition, Gillings School of Global Public Health, School of Medicine; University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
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