Setting population targets for measuring successful obesity prevention

Social acceptability of standard and behavioral economic inspired policies designed to reduce and prevent obesity

The obesity epidemic is a significant public policy issue facing the international community, resulting in substantial costs to individuals and society. Various policies have been suggested to reduce and prevent obesity, including those informed by standard economics (a key feature of which is the assumption that individuals are rational) and behavioral economics (which identifies and harness deviations from rationality). It is not known which policy interventions taxpayers find acceptable and would prefer to fund via taxation. We provide evidence from a discrete choice experiment on an Australian sample of 996 individuals to investigate social acceptability of eight policies: mass media campaign; traffic light nutritional labeling; taxing sugar sweetened beverages; prepaid cards to purchase healthy food; financial incentives to exercise; improved built environment for physical activity; bans on advertising unhealthy food and drink to children; and improved nutritional quality of food sold in public institutions. Latent class analysis revealed three classes differing in preferences and key respondent characteristics including capacity to benefit. Social acceptability of the eight policies at realistic levels of tax increases was explored using post-estimation analysis. Overall, 78% of the sample were predicted to choose a new policy, varying from 99% in those most likely to benefit from obesity interventions to 19% of those least likely to benefit. A policy informed by standard economics, traffic light labeling was the most popular policy, followed by policies involving regulation: bans on junk food advertising to children and improvement of food quality in public institutions. The least popular policies were behaviorally informed: prepaid cards for the purchase of only healthy foods, and financial incentives to exercise.

Euiiyin-tang in the treatment of obesity: study protocol for a randomised controlled trial

Background

Obesity is a public health concern in many countries due to its increasing prevalence. Euiiyin-tang is an herbal medicine formula often used as a clinical treatment for obesity. It acts to eliminate humidity and purify the blood, the causes of obesity identified by the theoretical framework of Korean medicine. The purpose of this study is to evaluate the efficacy and safety of Euiiyin-tang in treating obesity.

Methods/design

This study is a randomised, double-blinded and placebo-controlled, multicentre trial. It has two parallel arms: the Euiiyin-tang group and the placebo group. A total of 160 obese adult women will be enrolled in the trial. The participants will be randomly divided at a 1:1 ratio at visit 2 (baseline). The participants will be administered Euiiyin-tang or placebo for 12 weeks. The primary endpoint is the change in weight occurring between baseline and post-treatment. The secondary outcomes include average weight reduction, changes in body fat, waist and hip circumferences, body mass index, and lipid profile, and the results of questionnaires such as the Korean version of Obesity-related Quality of Life, the Korean version of Eating Attitudes Test, the Social Readjustment Rating Scale, and the Stress Reaction Inventory.

Discussion

The present study will provide research methodologies for evaluating the efficacy and safety of Euiiyin-tang in patients with obesity. In addition, it will provide evidence of correlation between obesity and Sasang constitutional medicine.

Trial registration

ClinicalTrials.gov, NCT01724099. Registered on 2 November 2012.

Electronic supplementary material

The online version of this article (doi:10.1186/s13063-017-2039-8) contains supplementary material, which is available to authorized users.

Cancers in Australia in 2010 attributable to overweight and obesity

OBJECTIVES

To estimate the proportion and number of cancers occurring in Australia in 2010 attributable to overweight/obesity.

METHODS

We estimated the population attributable fraction (PAF) and number of cancers causally associated with overweight/obesity. We used standard formulae incorporating Australian prevalence data for body mass index (BMI), relative risks associated with BMI and cancer. We also estimated the proportion change in cancer incidence (potential impact fraction [PIF]) that may have occurred assuming that the prevalence of overweight/obesity had remained at 1990 levels.

RESULTS

An estimated 3,917 cancer cases (3.4% of all cancers) diagnosed in 2010 were attributable to overweight/obesity, including 1,101 colon cancers, 971 female post-menopausal breast cancers and 595 endometrial cancers (PAFs of 10%, 8% and 26%, respectively). Highest PAFs were observed for oesophageal adenocarcinoma (31%), endometrial cancer (26%) and kidney cancer (19%). If the prevalence of overweight/obesity in Australia had remained at levels prevailing in 1990, we estimate there would have been 820 fewer cancers diagnosed in 2010 (PIF 2%).

CONCLUSIONS

Overweight/obesity causes a substantial number of cancers in Australia.

IMPLICATIONS

Public health strategies to reduce the prevalence of overweight and obesity will reduce the incidence of cancer, particularly of the colon, breast and endometrium.

Shape Up Somerville: change in parent body mass indexes during a child-targeted, community-based environmental change intervention

OBJECTIVES

We investigated the body mass index (BMI; weight in pounds/[height in inches](2) × 703) of parents whose children participated in Shape Up Somerville (SUS), a community-based participatory research study that altered household, school, and community environments to prevent and reduce childhood obesity.

METHODS

SUS was a nonrandomized controlled trial with 30 participating elementary schools in 3 Massachusetts communities that occurred from 2002 to 2005. It included first-, second-, and third-grade children. We used an inverse probability weighting estimator adjusted for clustering effects to isolate the influence of SUS on parent (n=478) BMI. The model's dependent variable was the change in pre- and postintervention parent BMI.

RESULTS

SUS was significantly associated with decreases in parent BMIs. SUS decreased treatment parents' BMIs by 0.411 points (95% confidence interval=-0.725, -0.097) relative to control parents.

CONCLUSIONS

The benefits of a community-based environmental change childhood obesity intervention can spill over to parents, resulting in decreased parental BMI. Further research is warranted to examine the effects of this type of intervention on parental health behaviors and health outcomes.

Initiating and continuing behaviour change within a weight gain prevention trial: a qualitative investigation

BACKGROUND

Preventing obesity is an international health priority. In Australia, young women who live in rural communities are at high risk of unhealthy weight gain. Interventions which engage young women and support sustainable behaviour change are needed and comprehensive evaluation of such interventions generates knowledge for population scale-up. This qualitative sub-study aims to identify enablers and barriers to behaviour change initiation and continuation within a community weight gain prevention program.

METHODS

In-depth semi-structured interviews were conducted with program participants 6 months after baseline. All interviews were audio-taped and transcribed verbatim. Transcripts were analysed independently by two investigators via thematic analysis.

PARTICIPANTS

A total of 28 women with a mean age of 39.9±6.2years and a BMI of 28.6±5.2kg/m2 were purposively recruited from the larger cohort (n = 649) that participated in the prevention trial.

RESULTS

Four behaviour change groups emerged were identified from participant interviews: (i) no change, (ii) relapse, (iii) intermittent and (iv) continued change. Factors influencing behaviour change initiation and continuation included realistic program expectations and the participant's ability to apply the core program elements including: setting small, achievable behaviour change goals, problem solving and using self-management techniques. Personal knowledge, skills, motivation, self-efficacy, accountability and perceived social and environmental barriers also affected behaviour change. Satisfaction with personal program progress and the perceived amount of program supports required to achieve ongoing behaviour change varied amongst participants. Women who relapsed expressed a desire for more intensive and regular support from health professionals, identified more barriers unrelated to the program, anticipated significant weight loss and had lower satisfaction with their progress.

CONCLUSION

Initiating and continuing behaviour change is a complex process. Our findings elucidate that initiation and continuation of behaviour change in women undertaking a weight gain prevention program may be facilitated by accurate and realistic understanding of program expectation, the ability to apply the core program messages, higher internal motivation, self-efficacy and minimal social and environmental barriers.

TRIAL REGISTRATION

Australia & New Zealand Clinical Trial Registry ACTRN12612000115831 www.anzctr.org.au.

Diffusing obesity myths

Misinformation or myths about obesity can lead to weight bias and obesity stigma. Counteracting myths with facts and evidence has been shown to be effective educational tools to increase an individuals' knowledge about a certain condition and to reduce stigma.The purpose of this study was to identify common obesity myths within the healthcare and public domains and to develop evidence-based counterarguments to diffuse them. An online search of grey literature, media and public health information sources was conducted to identify common obesity myths. A list of 10 obesity myths was developed and reviewed by obesity experts and key opinion leaders. Counterarguments were developed using current research evidence and validated by obesity experts. A survey of obesity experts and health professionals was conducted to determine the usability and potential effectiveness of the myth-fact messages to reduce weight bias. A total of 754 individuals responded to the request to complete the survey. Of those who responded, 464 (61.5%) completed the survey. All 10 obesity myths were identified to be deeply pervasive within Canadian healthcare and public domains. Although the myth-fact messages were endorsed, respondents also indicated that they would likely not be sufficient to reduce weight bias. Diffusing deeply pervasive obesity myths will require multilevel approaches.

Assessing self-efficacy and self-help methods in women with and without Polycystic Ovary Syndrome

Polycystic Ovary Syndrome (PCOS) is a common endocrine disorder in women strongly associated with obesity and psychological dysfunction. It is crucial to assess the contributions of psychological parameters to obesity and weight management. This survey based cross-sectional study assessed self-efficacy, health attitudes and beliefs, response to illness and adult health history in women with (n = 74) and without PCOS (n = 90). There were no significant differences in self-efficacy, health attitudes and beliefs between groups. Women with PCOS reported less engagement in self-help methods compared to women without (p = 0.003). Women with PCOS reported poorer overall (p < 0.001) and recent health history (p = 0.02), greater prevalence (p < 0.001) and impact of a chronic illness (p < 0.001). It is crucial that women recognize that PCOS is a chronic condition requiring on-going lifestyle management; to encourage active engagement in their management, enhance participation in screening for complications and uptake of lifestyle recommendations.

The role and status of evidence and innovation in the healthy towns programme in England: a qualitative stakeholder interview study

BACKGROUND

In 2008, the Healthy Community Challenge Fund commissioned nine 'healthy towns' in England to implement and evaluate community-based environmental interventions to prevent obesity. This paper examines the role of evidence in informing intervention development, innovation and the potential for programmes to contribute to the evidence base on the effectiveness of interventions that tackle population obesity.

METHOD

Twenty qualitative interviews with local programme stakeholders and national policy actors were conducted. Interview transcripts were coded and thematically analysed. Initial analyses were guided by research questions regarding the nature and role of evidence in the development and implementation of the healthy towns programme and the capacity for evidence generation to inform future intervention design, policy and practice.

FINDINGS

Stakeholders relied on local anecdotal and observational evidence to guide programme development. While the programme was considered an opportunity to trial new and innovative approaches, the requirement to predict likely health impacts and adopt evidence-based practice was viewed contradictory to this aim. Stakeholders believed there were missed opportunities to add to the existing empirical evidence base due to a lack of clarity and planning, particularly around timing, in local and national evaluations.

CONCLUSIONS

A strong emphasis on relying on existing evidence-based practice and producing positive impacts and outcomes may have impeded the opportunity to implement truly innovative programmes because of fear of failure. Building more time for development, implementation and evaluation into future initiatives would maximise the use and generation of robust and relevant evidence for public health policy and practice.

Projected socioeconomic disparities in the prevalence of obesity among Australian adults

OBJECTIVE

To project prevalence of normal weight, overweight and obesity by educational attainment, assuming a continuation of the observed individual weight change in the 5-year follow-up of the national population survey, the Australian Diabetes, Obesity and Lifestyle study (AusDiab; 2000-2005).

METHODS

Age-specific transition probabilities between BMI categories, estimated using logistic regression, were entered into education-level-specific, incidence-based, multi-state life tables. Assuming a continuation of the weight change observed in AusDiab, these life tables estimate the prevalence of normal weight, overweight and obesity for Australian adults with low (secondary), medium (diploma) and high (degree) levels of education between 2005 and 2025.

RESULTS

The prevalence of obesity among individuals with secondary level educational attainment is estimated to increase from 23% in 2000 to 44% in 2025. Among individuals with a degree qualification or higher, it will increase from 14% to 30%. If all current educational inequalities in weight change could be eliminated, the projected difference in the prevalence of obesity by 2025 between the highest and lowest educated categories would only be reduced by half (to a 6 percentage point difference from 14 percentage points).

CONCLUSION

We predict that almost half of Australian adults with low educational status will be obese by 2025. Current trends in obesity have the potential to drive an increase in the absolute difference in obesity prevalence between educational categories in future years.

IMPLICATIONS

Unless obesity prevention and management strategies focus specifically on narrowing social inequalities in obesity, inequalities in health are likely to widen.

Projected progression of the prevalence of obesity in Australia

Several country-specific and global projections of the future obesity prevalence have been conducted. However, these projections are obtained by extrapolating past prevalence of obesity or distributions of body weight. More accurate would be to base estimates on the most recent measures of weight change. Using measures of overweight and obesity incidence from a national, longitudinal study, we estimated the future obesity prevalence in Australian adults. Participants were adults aged ≥25 years in 2000 participating in the Australian Diabetes, Obesity, and Lifestyle (AusDiab) study (baseline 2000, follow-up 2005). In this population, approximately one-fifth of those with normal weight or overweight progressed to a higher weight category within 5 years. Between 2000 and 2025, the adult prevalence of normal weight was estimated to decrease from 40.6 to 28.1% and the prevalence of obesity to increase from 20.5 to 33.9%. By the time, those people aged 25-29 in 2000 reach 60-64 years, 22.1% will be normal weight, and 42.4% will be obese. On average, normal-weight females aged 25-29 years in 2000 will live another 56.2 years: 26.6 years with normal weight, 15.6 years with overweight, and 14.0 years with obesity. Normal-weight males aged 25-29 years in 2000 will live another 51.5 years: 21.6 years with normal weight, 21.1 years with overweight, and 8.8 years with obesity. If the rates of weight gain observed in the first 5 years of this decade are maintained, our findings suggest that normal-weight adults will constitute less than a third of the population by 2025, and the obesity prevalence will have increased by 65%.

Public health campaigns and obesity - a critique

BACKGROUND

Controlling obesity has become one of the highest priorities for public health practitioners in developed countries. In the absence of safe, effective and widely accessible high-risk approaches (e.g. drugs and surgery) attention has focussed on community-based approaches and social marketing campaigns as the most appropriate form of intervention. However there is limited evidence in support of substantial effectiveness of such interventions.

DISCUSSION

To date there is little evidence that community-based interventions and social marketing campaigns specifically targeting obesity provide substantial or lasting benefit. Concerns have been raised about potential negative effects created by a focus of these interventions on body shape and size, and of the associated media targeting of obesity.

SUMMARY

A more appropriate strategy would be to enact high-level policy and legislative changes to alter the obesogenic environments in which we live by providing incentives for healthy eating and increased levels of physical activity. Research is also needed to improve treatments available for individuals already obese.