Snowballing obesity: Australians will get run over if they just sit there

The role of foodbanks in the context of food insecurity: Experiences and eating behaviours amongst users

The study aim was to investigate the role of foodbanks in the context of food insecurity and explore food choices and eating behaviours amongst users. Food insecurity is associated with poor diet quality and obesity; however, the dimensions that influence food choices and eating behaviour remain unclear. Face-to-face interviews were conducted with individuals who had visited a faith-based foodbank in Perth, Western Australia. Participants were thirty-three service users who had collected a food hamper from the foodbank. Interview transcripts were analyzed using thematic analysis. Four main themes emerged: Ties you over until pay day; Food hamper supporting meals and fruit and vegetable consumption; Food choices supplementing hamper; Household gatekeeping and food control. Participants were complimentary about the content of the food hamper received which included a variety of fresh produce. A key new finding was the frequent purchase and consumption of meat and processed meat to supplement the food hamper provision. Future work and interventions to improve eating behaviour and reduce food-related financial pressure for those vulnerable to food insecurity include further exploration of the dimensions influencing food choices (i.e., cultural norms, habits, symbols); exposure to healthy and tasty plant-based meals, (i.e., tasting low-cost and tasty vegetable-based meals); parenting training focused on handling child/partner food choice influences, and, enforcing household rules governing food.

Strengthening complex systems for chronic disease prevention: a systematic review

BACKGROUND

While frameworks exist for strengthening health care systems and public health systems, there are no practical frameworks to describe, assess and strengthen systems for chronic disease prevention (CDP) using complex systems approaches.

METHODS

A systematic and integrative review of peer reviewed literature was conducted to answer the following questions: How can systems for CDP be defined? What are key attributes of effective systems? How are complex systems approaches discussed? Search terms were identified and the Medline, SCOPUS, and Global Health databases were searched December 2017 and January 2018. Reference lists and selected journals were hand searched. A working definition for a system for CDP was developed to provide a guideline for inclusion. Key exclusion criteria were literature did not address the research questions or working definition; was published in a language other than English and before 2000; focused on specific chronic diseases and/or risk factors and not CDP broadly; concentrated on the health care sector and clinical services and/or health status and surveillance data; and described evaluations of setting specific actions such as policies, programs, interventions, approaches, projects, laws, or regulations. Selected literature (n = 141) was coded in terms of the extent to which the research questions and the working definition of systems for CDP were addressed. Data was then analysed and synthesized to determine key themes.

RESULTS

A revised definition of systems for CDP and seven attributes of effective systems for CDP are reported (collaborative capacity, health equity paradigm, leadership and governance, resources, implementation of desired actions, information and complex systems paradigm). A framework was developed to provide a foundation for describing, assessing and strengthening systems for CDP.

CONCLUSIONS

The results of this literature review provide a strong foundation for a framework to help strengthen systems for CDP. The framework consolidates not only well-established attributes of effective CDP but also highlights theoretical and practical insights from complex systems perspectives.

Food Choice and Nutrition: A Social Psychological Perspective

In this Special Issue, entitled "Food choice and Nutrition: A Social Psychological Perspective", three broad themes have been identified: (1) social and environmental influences on food choice; (2) psychological influences on eating behaviour; and (3) eating behaviour profiling.The studies that addressed the social and environmental influences indicated that further research would do well to promote positive food choices rather than reduce negative food choices; promote the reading and interpretation of food labels and find ways to effectively market healthy food choices through accessibility, availability and presentation. The studies on psychological influences found that intentions, perceived behavioural control, and confidence were predictors of healthy eating. Given the importance of psychological factors, such as perceived behavioural control and self-efficacy, healthy eating interventions should reduce barriers to healthy eating and foster perceptions of confidence to consume a healthy diet. The final theme focused on the clustering of individuals according to eating behaviour. Some "types" of individuals reported more frequent consumption of fast foods, ready meals or convenience meals or greater levels of disinhibitiona nd less control over food cravings. Intervention designs which make use of multi-level strategies as advocated by the Ecological Model of Behaviour change that proposes multi-level (combining psychological, social and environmental) strategies are likely to be more effective in reaching and engaging individuals susceptible to unhealthy eating habits than interventions operating on a single level.

Influences underlying family food choices in mothers from an economically disadvantaged community

PURPOSE

The purpose of this qualitative study was to explore the perceptions and attitudes that underlie food choices, and, the impact of a school-based healthy eating intervention in mothers from an economically-disadvantaged community. The aim of the intervention was to educate children to act as 'health messengers' to their families.

METHOD

Sixteen semi-structured phone interviews were conducted with mothers with four receiving a second interview. Interviews were conducted following their child's participation in a six-week after school healthy cooking intervention.

RESULTS

Thematic content analysis revealed four main themes: Cost and budget influence on food choices, diversity in household rules controlling food, role of socialisation on diet, and improved cooking skills and confidence to make homemade meals. The interview findings demonstrated the positive influence of the after-school cooking intervention on children and their families in cooking skills, promoting healthier cooking methods and increasing confidence to prepare homemade meals.

CONCLUSIONS

The findings demonstrated the wider economic and social influences on food choices and eating practices. Socialisation into, and strong cultural norms around, eating habits were significant influences on family diet and on parental decisions underpinning food choices and attitudes towards the control of food within the family. The intervention was perceived to be successful in terms of improving nutritional knowledge, cooking skills and increasing confidence to make healthy and tasty homemade meals. The study demonstrates the importance of parental involvement in school-based interventions if improvements in healthy eating are to be evidenced at the family level and maintained.

Synthetic versus plaster of Paris casts in the treatment of fractures of the forearm in children

Fractures of the forearm (radius or ulna or both) in children have traditionally been immobilised in plaster of Paris (POP) but synthetic cast materials are becoming more popular. There have been no randomised studies comparing the efficacy of these two materials. The aim of this study was to investigate which cast material is superior for the management of these fractures. We undertook a single-centre prospective randomised trial involving 199 patients with acute fractures of the forearm requiring general anaesthesia for reduction. Patients were randomised by sealed envelope into either a POP or synthetic group and then underwent routine closed reduction and immobilisation in a cast. The patients were reviewed at one and six weeks. A satisfaction questionnaire was completed following the removal of the cast. All clinical complications were recorded and the cast indices were calculated. There was an increase in complications in the POP group. These complications included soft areas of POP requiring revision and loss of reduction with some requiring re-manipulation. There was an increased mean padding index in the fractures that lost reduction. Synthetic casts were preferred by the patients.

This study indicates that the clinical outcomes and patient satisfaction are superior using synthetic casts with no reduction in safety.

Cite this article: Bone Joint J 2013;95-B:1285–9.

Economic burden of obesity in primary total knee arthroplasty

OBJECTIVE

To compare the hospital inpatient costs between nonobese and obese patients and estimate the economic burden of obesity in primary total knee arthroplasty (TKA).

METHODS

A cost identification study was conducted in a consecutive cohort of 530 patients who underwent TKA between 2006 and 2007 at a university-affiliated tertiary referral center in Melbourne, Australia. Total hospital inpatient costs incurred at the study institution associated with the index surgery and subsequent related emergency presentations and readmissions during the episode of care were captured. Predictor variables of interest were obesity and body mass index (BMI), and the outcomes of interest were total hospital inpatient costs for the index surgery and episode of care, defined as the first 12 months following TKA. Multivariate linear regression techniques were used to examine the association between the predictors of interest and hospital costs, adjusting for clinically relevant variables.

RESULTS

Economic data were analyzed in 521 patients, of which 317 (60.8%) were obese. Obesity was associated with higher inpatient index surgery costs (+$1,226.89 [95% confidence interval (95% CI) $82.25, $2,371.52]; P = 0.036) and episode of care costs (+$1,821.36 [95% CI $244.93, $3,397.79]; P = 0.024). Each unit increase in BMI was also associated with higher inpatient index surgery costs ($128.91 [95% CI $34.53, $223.28]; P = 0.008) and total episode of care costs ($158.79 [95% CI $28.54, $289.05]; P = 0.017).

CONCLUSION

The estimated significant additional annual obesity-related expenditure reported in this study establishes a rationale to trial and evaluate interventions that target weight loss in obese patients undergoing TKA from both a quality of life and economic perspective.

Slipped capital femoral epiphysis: rising rates with obesity and aboriginality in South Australia

We analysed the incidence of slipped capital femoral epiphysis (SCFE) in South Australia, investigating possible associations between an increased incidence of SCFE, the local indigenous population and the Australian obesity epidemic during the last 20 years. Data including race, age and gender were collected to obtain a profile of the South Australian SCFE patient, and were then compared with epidemiological data for South Australian adolescents. We concluded that the incidence of both obesity and SCFE is increasing. We also noted that the median weight of SCFE patients has increased and the mean age at diagnosis has decreased. Despite weight profiles comparable with those of the general population, we noted that an indigenous child was three times more likely to develop SCFE than a non-indigenous child. As far as we know there is no published literature on the predisposition of Aboriginal Australians to SCFE.

Healthy eating and obesity prevention for preschoolers: a randomised controlled trial

Background

Developing effective prevention and intervention programs for the formative preschool years is seen as an essential step in combating the obesity epidemic across the lifespan. The overall goal of the current project is to measure the effectiveness of a healthy eating and childhood obesity prevention intervention, the MEND (Mind Exercise Nutrition Do It!) program that is delivered to parents of children aged 2-4 years.

Methods/Design

This randomised controlled trial will be conducted with 200 parents and their 2-4 year old children who attend the MEND 2-4 program in metropolitan and regional Victoria. Parent-child dyads will attend ten 90-minute group workshops. These workshops focus on general nutrition, as well as physical activity and behaviours. They are typically held at community or maternal and child health centres and run by a MEND 2-4 trained program leader. Child eating habits, physical activity levels and parental behaviours and cognitions pertaining to nutrition and physical activity will be assessed at baseline, the end of the intervention, and at 6 and 12 months post the intervention. Informed consent will be obtained from all parents, who will then be randomly allocated to the intervention or wait-list control group.

Discussion

Our study is the first RCT of a healthy eating and childhood obesity prevention intervention targeted specifically to Australian parents and their preschool children aged 2-4 years. It responds to the call by experts in the area of childhood obesity and child health that prevention of overweight in the formative preschool years should focus on parents, given that parental beliefs, attitudes, perceptions and behaviours appear to impact significantly on the development of early overweight. This is 'solution-oriented' rather than 'problem-oriented' research, with its focus being on prevention rather than intervention. If this is a positive trial, the MEND2-4 program can be implemented as a national program.

Trial Registration

Australian New Zealand Clinical Trials Registry ACTRN12610000200088

The liver and the waistline: Fifty years of growth

Fifty years of the Gastroenterological Society of Australia have witnessed the changing appearance of Australians. Asian immigration has transformed the dominant urban culture from European to Eurasian, with some unique Australian attributes. Meanwhile, global conditions have altered body shape, and our sports-proud country is now fat! Thus, as in North America, Europe, China, and affluent Asia-Pacific countries, prosperity and lifestyle, cheap processed foods coupled with reduced physical activity have created an epidemic of over-nutrition resulting in overweight/obesity. Additional genetic factors are at the core of the apple shape (central obesity) that typifies over-nourished persons with metabolic syndrome. Indigenous Australians, once the leanest and fittest humans, now have exceedingly high rates of obesity and type 2 diabetes, contributing to shorter life expectancy; Asian Australians are also at higher risk. Like non-steroidal anti-inflammatory drugs (NSAIDs) and cigarette smoking, obesity now contributes much to gastrointestinal morbidity and mortality (gastroesophageal reflux disease, cancers, gallstones, endoscopy complications). This review focuses on Australian research about fatty liver, particularly roles of central obesity/insulin resistance in non-alcoholic fatty liver disease/steatohepatitis (NAFLD/NASH). The outputs include many highly cited original articles and reviews and the first book on NAFLD. Studies have identified community prevalence, clinical outcomes, association with insulin resistance, metabolic syndrome and hypoadiponectinemia, developed and explored animal models for mechanisms of inflammation and fibrosis, conceptualized etiopathogenesis, and demonstrated that NASH can be reversed by lowering body weight and increasing physical activity. The findings have led to development of regional guidelines on NAFLD, the first internationally, and should now inform daily practice of gastroenterologists.

Developing an award program for children's settings to support healthy eating and physical activity and reduce the risk of overweight and obesity

BACKGROUND

This paper aimed to identify the best way to engage, motivate and support early childhood services (ECS) and primary schools (PS) to create policy and practise changes to promote healthy eating and physical activity. This information would be used to develop a suitable program to implement within these children's settings to reduce the risk of childhood overweight and obesity.

METHODS

The Medical Research Council's (UK) framework for the design and evaluation of complex interventions was used to guide the development of the healthy eating and physical activity program suitable for ECS and PS. Within this framework a range of evaluation methods, including stakeholder planning, in-depth interviews with ECS and PS staff and acceptability and feasibility trials in one local government area, were used to ascertain the best way to engage and support positive changes in these children's settings.

RESULTS

Both ECS and PS identified that they had a role to play to improve children's healthy eating and physical activity. ECS identified their role in promoting healthy eating and physical activity as important for children's health, and instilling healthy habits for life. PS felt that these were health issues, rather than educational issues; however, schools saw the link between healthy eating and physical activity and student learning outcomes. These settings identified that a program that provides a simple guide that recognises good practise in these settings, such as an award scheme using a health promoting schools approach, as a feasible and acceptable way for them to support children's healthy eating and physical activity.

CONCLUSION

Through the process of design and evaluation a program - Kids - 'Go for your life', was developed to promote and support children's healthy eating and physical activity and reduce the risk of childhood overweight and obesity. Kids - 'Go for your life' used an award program, based on a health promoting schools approach, which was demonstrated to be a suitable model to engage ECS and PS and was acceptable and feasible to create policy and practise changes to support healthy eating and physical activity for children.

Being 'fat' in today's world: a qualitative study of the lived experiences of people with obesity in Australia

OBJECTIVE

To develop an in-depth picture of both lived experience of obesity and the impact of socio-cultural factors on people living with obesity.

DESIGN

Qualitative methodology, utilizing in-depth semi-structured interviews with a community sample of obese adults (body mass index >or=30). Community sampling methods were supplemented with purposive sampling techniques to ensure a diverse range of individuals were included.

RESULTS

Seventy-six individuals (aged 16-72) were interviewed. Most had struggled with their weight for most of their lives (n=45). Almost all had experienced stigma and discrimination in childhood (n=36), as adolescents (n=41) or as adults (n=72). About half stated that they had been humiliated by health professionals because of their weight. Participants felt an individual responsibility to lose weight, and many tried extreme forms of dieting to do so. Participants described an increasing culture of 'blame' against people living with obesity perpetuated by media and public health messages. Eighty percent said that they hated or disliked the word obesity and would rather be called fat or overweight.

DISCUSSION AND CONCLUSION

There are four key conclusions: (i) the experiences of obesity are diverse, but there are common themes, (ii) people living with obesity have heard the messages but find it difficult to act upon them, (iii) interventions should be tailored to address both individual and community needs and (iv) we need to rethink how to approach obesity interventions to ensure that avoid recapitulating damaging social stereotypes and exacerbating social inequalities.

Review of evidence to guide primary health care policy and practice to prevent childhood obesity

OBJECTIVES

To identify key barriers to effective engagement of primary health care (PHC) providers and families in promoting healthy weight among children aged 2-6 years, and to examine promising interventions to identify policy goals to overcome these barriers.

METHODS

We conducted a literature review of published and unpublished articles from January 1990 to February 2006 using keywords relating to childhood obesity, risk factors, prevention, populations and primary care provider interventions, constraints and models. We identified barriers to engagement by PHC providers. Appraisal of "promise" was based on best available evidence and consideration of strengths and weaknesses of interventions in specific contexts and settings.

RESULTS

Of 982 interventions aimed at the primary prevention of overweight and obesity among children, few related to 2-6-year-olds, with only 45 interventions meeting the inclusion criteria and 11 ranking highly on key criteria. Areas of weakness were low-level engagement by PHC providers, focus on single risk factors rather than a multidimensional approach, and lack of a population focus. A range of administrative, attitudinal, knowledge, skills and training issues were identified as barriers to effective engagement of different PHC providers with parents and other early childhood service providers.

CONCLUSIONS

Engagement of PHC providers in prevention of childhood obesity requires a systematic approach involving practice protocols, assessment tools, client support material and referral pathways, as well as adequate training and sufficient staff for implementation. A more comprehensive approach could be promoted by increased collaboration, agreed role delineation, consistent public health messages and better coordination between PHC providers and other service providers, facilitated at service policy and administration level.

What's law got to do with it part 1: A framework for obesity prevention

This article provides a conceptual framework for thinking about the role of law in responding to population weight gain in Australia. Part 1 focuses on two core questions. Firstly, in pursuing the aim of weight reduction at the population level, what should law be trying to influence? The challenge here is to identify a model of the determinants of obesity that is adequate for legal purposes and that illustrates the entry points where law could best be used as an instrument of public health policy. Secondly, what kinds of strategies and tools can law offer to obesity prevention? The challenge here is to identify a model of law that captures the variety of contributions law is capable of making, at different levels of government, and across different legal systems.In Part 1 of the article, I argue that although law can intervene at a number of levels, the most important opportunities lie in seeking to influence the social, economic and environmental influences that shape patterns of eating and nutrition across the population as a whole. Only policies that impact broadly across the population can be expected to influence the weight distribution curve that has shifted relentlessly to the right in recent decades. Part 2 of the article builds on this analysis by offering a critical review of selected legal strategies for healthier nutrition and obesity prevention.

Discussing childhood overweight and obesity with parents: a health communication dilemma

Childhood obesity has reached alarming levels and the problem has assumed great significance for health care staff who work with overweight children and their families. Anecdotal accounts of the difficulties that may emerge when health care providers communicate that a child's weight is outside of the normal range, were a key stimulus for this review. A local government health department commissioned a review of literature on communicating with parents about childhood overweight and obesity. Literature concerned with communicating a child's overweight to parents was limited and, as a result, this review draws upon a disparate body of literature to examine what is known and what might be helpful for health care providers when discussing a child's weight with the child and parents. This paper identifies a range of factors influencing communication between health care workers and parents and offers a number of practical approaches and strategies for facilitating successful communication between health practitioners and the parents of children.

Priorities for reducing the burden of injuries in sport: the example of Australian football

The promotion of safe sports participation has become a public health issue due to rising obesity rates and the potential for parental concerns about safety to inhibit sports participation. The safety of Australian football and its elite game, the Australian Football League (AFL), is often the focus of media commentary. Participation in the modified version of the game (Auskick) has been shown to be safer but by the time children reach the under-15 age group, adult rules are in place and the umbrella of safety provided by modified rules is gone. Figures released recently by the AFL suggest that injury rates at the elite-level are at an historical low, but equivalent information for the more than 400,000 non-elite participants is not available. Published literature related to preventing injuries in Australian football highlights a significant knowledge gap with respect to the aetiology of injuries in non-elite participants and only a very small evidence base for prevention of injuries in this sport. Gains in reducing the public health impact of football injuries, and injury-related barriers to Australian football participation, will only come from substantial investment in large-scale trials at the non-elite level, and a co-ordinated and multidisciplinary approach to dealing with safety and injury issues across all levels of play. Active and committed collaboration of key stakeholders such as government health agencies, peak sports bodies, sports administrators, clinicians, researchers, clubs, coaches and the participants themselves will be necessary.

Obesity prevention: necessary and possible. A structured approach for effective planning

Obesity is a serious public health problem that has important social, economic and health consequences. The prevalence of obesity is rising rapidly throughout the world in both rich and poor countries, and it affects all sections of society. There are several important reasons for addressing the prevention of obesity, rather than its treatment or management. The prevention of weight gain (or the reversal of small gains) and the maintenance of a healthy weight are likely to be easier, less expensive and potentially more effective than the treatment of obesity after it has fully developed. A structured planning framework for the identification of potential interventions for the promotion of healthy weight and the prevention of weight gain is clearly required. However, detailed reviews of the scientific literature have revealed that the body of research is too small to provide firm guidance on consistently-effective interventions for adults or children. Ultimately, a broader approach to evidence of effectiveness needs to be adopted. The present paper proposes a structured planning approach that utilises the portfolio model and allows the selection of interventions to be based on the best available evidence, while not excluding untried but promising strategies.

Effect of obesity on early morbidity and mortality following cardiac surgery

BACKGROUND

The prevalence of obesity in most developed nations, including Australia, continues to rise and represent an increasing public health concern. Obesity has been considered a major risk factor in patients undergoing cardiac and other major surgery.

METHODS

We retrospectively analysed prospectively collected data of consecutive patients undergoing cardiac surgery between June 2001 and February 2006 at two Australian public hospitals. Patients were divided into three groups by body mass index (BMI): non-obese (BMI 20-30), obese (BMI>30-40) and morbidly obese (BMI>40). Associations between early mortality and morbidity and obesity were assessed by univariate and multivariate methods.

RESULTS

Out of 4053 patients, 85 were excluded for BMI<20. A total of 2743 patients were defined as non-obese, 1136 obese and 89 morbidly obese. There were no significant differences in operative mortality, stroke, pneumonia, new renal failure, atrial fibrillation, prolonged ventilation, reintubation, readmission to intensive care, prolonged length of hospital stay or readmission within 30 days. The morbidly obese group had increased rates of deep sternal infection by univariate (odds ratio [OR] 6.4, 95% confidence interval [CI] 2.1-19.1, p<0.001) and multivariate (OR 13.1, CI 3.4-50.7, p<0.001) analysis. The obese group had a lower rate of re-operation for bleeding by univariate (OR 0.61, CI 0.41-0.91, p=0.01) and multivariate (OR 0.64, CI 0.42-0.99, p=0.04) analysis.

CONCLUSION

Apart from an increased rate of deep sternal wound infection, obesity is not associated with early mortality or other post-operative complications. The protective effect of obesity on re-operation for bleeding requires further study.

Time for sport and health to be formally linked in a positive way

Preventing sports injury has rarely been cited as an appropriate action to respond to the obesity epidemic, and in fact a recent letter has suggested that those playing sport are as responsible for their predicament as those who are obese. This opinion piece argues that it is time for better prevention and management of sports injury to be seen as part of the complex solution to preventing obesity, rather than being a self-inflicted problem that governments should continue to ignore.