centre for physical activity and nutrition obesity prevention – implications for physical activity...
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Centre for Physical Activity and Nutrition
Obesity prevention – implications for physical activity
promotionProfessor Boyd Swinburn
Centre for Physical Activity and Nutrition School of Health Sciences
Deakin UniversityMelbourne
Centre for Physical Activity and Nutrition
Increasing obesity in all countries
0
5
10
15
20
25
30
35
1980 1983 1989 1995 2000
%O
bese (
BM
I>3
0)
AustraliaNZUSANetherlandsFinland
Centre for Physical Activity and Nutrition
Increasing childhood overweight and obesity
• Overweight + obesity (1995), boys 19.5%, girls 21%
• Adult diabetes now seen in adolescents
• NO monitoring of the situation
0
5
10
15
20
25
30
7-11 12-15 7-11 12-15
1985* 1995* 2000#
Boys Girls
%
y
*Daniels et al 2001 - national data#Goodman et al 2002 – single NSW school
Centre for Physical Activity and Nutrition
Australian children versus England and USA
0
5
10
15
20
25
30
Boys Girls Boys Girls Boys Girls
Obese
Overweight
England Australia USA1994 4-11y/o 1995 7-11y/o 1991 6-11y/o
Definitions by Cole et alLihui & Bell (in press)
Centre for Physical Activity and Nutrition
What do decision-makers need to know
about obesity?• What is the size of the problem?– Increasing prevalence rates, burden of disease, cost
of illness, comparative risk assessment etc
• What are the causes?– Simple but complex– Reviews, WHO Technical Report #916
• What can be done about it?– Bits and pieces of evidence– No evidence on a comprehensive program– No success at obesity prevention in whole populations
Centre for Physical Activity and Nutrition
Burden (‘costs’) of childhood overweight
and obesityChildho
odAdultho
od
Direct costs (govt, personal) o c o cIndirect(lost productivity, early death) o c o cIntangible(loss of quality of life) o c o c
O = overweight/obesity C = complications of obesity
Centre for Physical Activity and Nutrition
Causes of obesity – convincing evidence
WHO Technical Report #916 (www.who.int)
• Regular physical activity (protective)• Sedentary lifestyle (causative)• Diet high in fibre (protective) • High intake of energy-dense foods
(causative) – ED foods are mainly high in fat and/or
sugar– High fat, vegetable-based foods may not
be very energy dense
Centre for Physical Activity and Nutrition
Target groups for prevention
• Adults– Substantial treatment component– Fewer options and issues about free choice
• High risk adults– Probably cost effective
• Children and adolescents– More potential interventions – Greater influence of environments– Greater appeal to public and politicians– Need to be aware of communication dangers
Centre for Physical Activity and Nutrition
How much PA is needed to prevent unhealthy weight gain in adults?
• We don’t know• For post-obese
– About 90 minutes per day
• For adults in sedentary occupations – Almost certainly more than 30 minutes
moderate intensity PA on most days– More like 45-60 minutes per day
Centre for Physical Activity and Nutrition
Prevention of childhood obesity
• Childhood obesity increasing everywhere• No country has a comprehensive program• Evidence on interventions ranges from
thin to non-existent to impossible-to-get• Urgent needs
– Policy leadership – Serious funding– Public advocacy– Evidence
Centre for Physical Activity and Nutrition
Lessons from obesity prevention research to
date• Education (esp curriculum) alone has little impact
• Reducing TV viewing has significant effect on decreasing BMI
• School studies cannot usually get a high enough dose of intervention
• Long duration is needed to see effects
• ?role of RCTs in prevention trials
Centre for Physical Activity and Nutrition
Best Investments to Address Childhood
Obesity• Project funded by Commonwealth
Department of Health and Ageing• 3 components
– Develop appropriate structure for a comprehensive approach
– Estimating effectiveness of interventions– Estimating health care costs and therefore
the warranted investment in prevention
Centre for Physical Activity and Nutrition
Proposed structure(structure/content developed with ~50
Australian experts)• Essential elements
– Communication and education – Whole-of-community demonstration areas– Co-ordination and capacity building– Monitoring and research
• Settings– (Homes), schools*, pre-schools*, neighbourhoods, fast
food outlets, primary care, ante/post natal care
• Sectors– Food supply, food marketing*, (transport, urban
planning)
* = high priority
Centre for Physical Activity and Nutrition
prevalence of childhood overweight & obesity
TV viewing
Fast food outlets
Active neighbour-hoods
Interventions (examples)
Estimated effectiveness
Warranted investment
Economic cost of obesity (O) & its complications (C)
Direct
Indirect
Intangible
Childhood Adulthood
COCO
COCO
COCO
Schema for the threshold analysis for reducing childhood obesity
evidence modelling
Centre for Physical Activity and Nutrition
Modelling • First pass of modelling economic
costs and intervention effectiveness completed but remains confidential– Many of the modelling methods are new
& assumptions need to be agreed upon– Needs greater consultation, other data
to fill gaps, and peer review– First pass gave politically difficult results – Able to discuss methodology
Centre for Physical Activity and Nutrition
Average number of food advertisements
0 2 4 6 8 10 12 14
Australia
USA
UK
France
Greece
Finland
Germany
Denmark
Netherlands
Belgium Club RTL
Norway TV3
Austria
Sweden TV4
Cou
ntr
y
Average number of food ads per hour
Centre for Physical Activity and Nutrition
Assumed pathways
Sedentariness
Physical activity
Prevalence overweight/
obesity
Food ED
Beverage ED Energy
intake
Energy output
Weight BMI
Centre for Physical Activity and Nutrition
• Sedentary behaviour– Used TV viewing BMI (Robinson,
Gortmaker) – estimate 3pp o/w obesity prevalence per 1hour TV viewing
– No modelling via EE• Physical activity
– Used the added energetic values for PA (eg walking = 0.4kJ/kg/min)
– Uncertainty about compensation (assumed 50%)
Modelling assumptions PA
Centre for Physical Activity and Nutrition
Best Investments
• Childhood O/W & obesity costs a lot of money and the ‘warranted investment’ in prevention is large
• A comprehensive prevention program should substantially reduce prevalence
• Currently being considered by the National Obesity Taskforce
Centre for Physical Activity and Nutrition
Whole-of-community demonstration areas
• Funding is scarce – Need to concentrate to have greatest
effect• Lack of evidence
– Need to closely evaluate interventions• Dose needs to be high
– Multiple strategies in multiple settings• Need intersectoral collaboration
– Better at local level
Centre for Physical Activity and Nutrition
Sentinel Site for Obesity Prevention
Barwon-South Western Region of Victoria
Warrnambool Colac Geelong
Centre for Physical Activity and Nutrition
Aims of the Sentinel Site
• Capacity building– To increase the knowledge and expertise in obesity
prevention and physical activity promotion
• Monitoring– To develop indicators and monitoring systems for
physical activity, nutrition and obesity
• Intervention support– To work with communities and DHS to develop and
implement multi-strategy, multi-setting interventions
• Evaluation– To evaluate the effects of the interventions and
disseminate findings
Centre for Physical Activity and Nutrition
Sentinel Site: Proposed schema for action
TimeRegular monitoring of region: Monitor PAN environments, behaviours, outcomes in a variety of settings. Use for baseline and outcome variables for interventions, assessment of program reach and population impact. Linked to state/national monitoring programs.
Develop indicators,Pilot testing,monitoring design
Demo area 1 - interventions & evaluation
Demo area 2 – interventions & evaluation
Demo area 3 – interventions & evaluation
Act
ivit
ies
Develop and support interventions
Increase capacity, training
2002 2003 2004 2005
ReachSustainability
2006
Centre for Physical Activity and Nutrition
Choosing sites
• Why Barwon-SW?– Strong, existing Deakin-DHS (BSW)
partnerships– Strong, existing nutrition & PA networks– Range of SES and rural/small town/urban
• Which demonstration area?– Good existing infrastructure, relationships,
expertise– Geographical bounds– Needs, SES, community capacity
Centre for Physical Activity and Nutrition
Progress to date
• Funding from DHA, DHS, VicHealth• Colac Y1
– Partnerships & structures, coordinator, planning, training (ANGELO, social marketing, schools, GPs), action plan, baseline measurements
• Monitoring– Outcomes (BMI), behaviours (PA, eating),
determinants (policies, environments etc)– Schools, LGA
• Course development for Obesity Prevention
Centre for Physical Activity and Nutrition
Action plan
• ANGELO process – scan environments, prioritise target behaviours, env actions, communication messages
• Comprehensive planCommunications Capacity building
Monitoring TV viewing
Sugar drinks water ED snacks fruit
Active transport Active play (3-6pm)
Fast food outlets Mgt for o/w children
Centre for Physical Activity and Nutrition
Conclusions
• The rising obesity epidemic is the largest preventable health problem in Australian children
• A comprehensive, multi-strategy, multi-setting approach is needed to reverse it
• Whole-of-community demonstration areas are needed to build the evidence
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