Addressing the elephant in the room: economic growth and the nation's poor health - changing the economy's goal for a healthier future

This opinion piece focuses on how in order to improve the nation's poor health, the government needs to place more value on social justice and wellbeing as well as the use of regulation to positively change culture and health behaviour.

To what extent do unhealthy behaviour indicators explain the neighbourhood deprivation gradient in overweight among 11-year-old English children?

Aims

This study examined associations between neighbourhood deprivation, school commuting behaviour, a range of unhealthy behaviour indicators and overweight/obesity among 11-year-old English children.

Methods

Data are from wave five of the UK Millennium Cohort Study, collected in 2012. Subjects consisted of 7262 (3637 boys) 11-year-old English children. Children were classified as normal weight or overweight/obese. School commute mode (active/passive) and health behaviour indicators were parent-reported. Health behaviour indicator scores below the mean of the lower half of the distribution were classified as unhealthy on this indicator. Neighbourhood deprivation was defined using the 2004 English Indices of Multiple Deprivation. Odds ratios (ORs) for being overweight/obese according to neighbourhood deprivation were estimated. A range of unhealthy behaviour indicators were explored to assess the extent to which they attenuated associations between neighbourhood deprivation and overweight/obesity.

Results

Children living in the most deprived neighbourhoods in England were more likely to be overweight/obese, commute to and from school actively and participate in all unhealthy behaviour indicators compared to children living in the least deprived neighbourhoods. Adjusting for confounders and significant unhealthy behaviour indicators reduced the OR for overweight/obese from 1.81 (95% CI 1.54 to 2.13) to 1.56 (95% CI 1.30 to 1.88) in the highest neighbourhood deprivation group compared to the lowest.

Conclusion

Active school commuting alone is unlikely to be enough to prevent and reduce the prevalence of overweight/obesity in the most deprived English neighbourhoods. Childhood overweight/obesity-related interventions should focus on promoting participation in a range of health behaviours.

Is there a deprivation and maternal education gradient to child obesity and moderate-to-vigorous physical activity? Findings from the Millennium Cohort Study

OBJECTIVE

The primary aim was to examine associations between individual-level and area-level measures of socioeconomic status (SES) and different measures of overweight/obesity in 7-year-old English children. A secondary aim was to examine associations between individual-level and area-level measures of SES and moderate-to-vigorous intensity physical activity (MVPA).

METHODS

Data were from wave four of the Millennium Cohort Study. Children were classified as normal weight, overweight/obese and centrally obese. MVPA was accelerometer derived. Individual-level and area-level SES were defined using self-reported maternal education and the 2004 English Indices of Multiple Deprivation, respectively. Adjusted linear and multinomial logistic regressions were conducted.

RESULTS

Three thousand seven hundred seventeen children (1890 girls) had complete data. Children in the lowest maternal education group and highest deprivation decile were at greatest risk of overweight and central obesity. MVPA was inversely associated with deprivation, and the most deprived children were most likely to achieve 60 min of daily MVPA.

CONCLUSIONS

Individual-level and area-level SES were independently related to overweight and central obesity. Higher rates of overweight and central obesity among deprived children are not due to physical inactivity. Further research examining the concurrent effect of diet and MVPA on child weight status by deprivation is warranted.

Moving Forward with Backward Compatibility: Translating Wrist Accelerometer Data

PURPOSE

This study aimed to provide a means for calibrating raw acceleration data from wrist-worn accelerometers in relation to past estimates of children's moderate-to-vigorous physical activity (MVPA) from a range of cut points applied to hip-worn ActiGraph data.

METHODS

This is a secondary analysis of three studies with concurrent 7-d accelerometer wear at the wrist (GENEActiv) and hip (ActiGraph) in 238 children age 9-12 yr. The time spent above acceleration (ENMO) thresholds of 100, 150, 200, 250, 300, 350, and 400 mg from wrist acceleration data (≤5-s epoch) was calculated for comparison with MVPA estimated from widely used children's hip-worn ActiGraph MVPA cut points (Freedson/Trost, 1100 counts per minute; Pate, 1680 counts per minute; Evenson, 2296 counts per minute; Puyau, 3200 counts per minute) with epochs of ≤5, 15, and 60 s.

RESULTS

The optimal ENMO thresholds for alignment with MVPA estimates from ActiGraph cut points determined from 70% of the sample and cross validated with the remaining 30% were as follows: Freedson/Trost = ENMO 150+ mg, irrespective of ActiGraph epoch (intraclass correlation [ICC] ≥ 0.65); Pate = ENMO 200+ mg, irrespective of ActiGraph epoch (ICC ≥ 0.67); Evenson = ENMO 250+ mg for ≤5- and 15-s epochs (ICC ≥ 0.69) and ENMO 300+ mg for 60-s epochs (ICC = 0.73); Puyau = ENMO 300+ mg for ≤5-s epochs (ICC = 0.73), ENMO 350+ mg for 15-s epochs (ICC = 0.73), and ENMO 400+ mg for 60-s epochs (ICC = 0.65). Agreement was robust with cross-validation ICC = 0.62-0.71 and means within ∣7.8∣% ± 4.9% of MVPA estimates from ActiGraph cut points, except Puyau 60-s epochs (ICC = 0.42).

CONCLUSION

Incremental ENMO thresholds enable children's acceleration data measured at the wrist to be simply and directly compared, at a group level, with past estimates of MVPA from hip-worn ActiGraphs across a range of cut points.