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OBESITY

ANDREYEVA, T and MICHAUD, P C and others. Obesity and health in Europeans aged 50 years and older. Public Health Vol 121, No 7 - July 2007: 497-509
Abstract: Background: Obesity is increasing globally across all population groups. Limited data are available on how obesity patterns differ across countries. Objective: To document the prevalence of obesity and related health conditions for Europeans aged 50 years and older, and to estimate the association between obesity and health outcomes across 10 European countries. Methods: Data were obtained from the 2004 Survey of Health, Ageing and Retirement in Europe, a cross-national survey of 22 777 Continental Europeans over the age of 50 years. The health outcomes included self-reported health, disability, doctor-diagnosed chronic health conditions and depression. Multivariate regression analysis was used to predict health outcomes across weight classes (defined by body mass index [BMI] from self-reported weight and height) in the pooled sample and individually in each country. Results: The prevalence of obesity (BMI 30) ranged from 12.8% in Sweden to 20.2% in Spain for men and from 12.3% in Switzerland to 25.6% in Spain for women. Adjusting for compositional differences across countries changed little in the observed large heterogeneity in obesity rates throughout Europe. Compared with normal weight individuals, men and women with greater BMI had significantly higher risks for all chronic health conditions examined except heart disease in overweight men. Depression was linked to obesity in women only. Particularly pronounced risks of impaired health and chronic health conditions were found among severely obese people. The effects of obesity on health did not vary significantly across countries. Conclusions: Cross-country differences in the prevalence of obesity in older Europeans are substantial and exceed socio-demographic differentials in excessive body weight. Obesity is associated with significantly poorer health outcomes among Europeans aged 50 years and over, with effects similar across countries. Large heterogeneity in obesity throughout Europe should be investigated further to identify areas for effective public policy.

CONNELLY, J B and DUASO, M J and others. A systematic review of controlled trials of interventions to prevent childhood obesity and overweight: a realistic synthesis of the evidence. Public Health Vol 121, No 7 - July 2007: 510-517
Abstract: Background: Preventing childhood overweight and obesity has become a major public health issue in developed and developing countries. Systematic reviews of this topic have not provided practice-relevant guidance because of the generally low quality of research and the heterogeneity of reported effectiveness. Aim: To present practice-relevant guidance on interventions to reduce at least one measure of adiposity in child populations that do or do not contain overweight or obese children. Design: Systematic review of eligible randomized, controlled trials or controlled trials using a novel approach to synthesizing the trial results through application of descriptive epidemiological and realistic evaluation concepts. Eligible trials involved at least 30 participants, lasted at least 12 weeks and involved non-clinical child populations. Results: Twenty-eight eligible trials were identified to 30 April 2006. Eleven trials were effective and 17 were ineffective in reducing adiposity. Blind to outcome, the main factor distinguishing effective from ineffective trials was the provision of moderate to vigorous aerobic physical activity in the former on a relatively 'compulsory' rather than 'voluntary' basis. Conclusions: By using a novel approach to synthesizing trials, a decisive role for the 'compulsory' provision of aerobic physical activity has been demonstrated. Further research is required to identify how such activity can be sustained and transformed into a personally chosen behaviour by children and over the life course.

DAVIDSON, Fiona. Childhood obesity prevention and physical activity in schools. Health Education Vol 107, No 4 - 2007: 377-395
Abstract: Purpose: The aim of this literature review is to summarise and synthesise the research base concerning childhood obesity and physical activity, particularly in relation to teachers and schools and within a policy context of the UK. The review investigates childhood obesity, physical activity, physical education, the role of teachers, the role of schools and physical activity in the classroom. Design/methodology/approach: A literature review was undertaken involving selection of primary research and other systematic reviews. A computer search was performed using a combination of keywords including: obesity, prevention, intervention, preventive, teachers, schools, healthy schools, role models, physical activity, physical education, active school, active classroom. The review also includes samples of media coverage of the issue. Findings: This review highlights the complex and ambiguous nature of the evidence in relation to this important contemporary issue. Originality/value: A limited understanding of childhood obesity is evident from the review and this precludes definitive conclusions in relation to almost all aspects of the agenda. More quality research is needed in almost all areas of the topic, including areas such as the engagement of schools and teachers.

EPSTEIN, Leonard H and PALUCH, Rocco A and others. Family-based obesity treatment, then and now: twenty-five years of pediatric obesity treatment. Health Psychology Vol 26, No 4 - July 2007: 381-391
Abstract: Objective: Family-based treatments for pediatric obesity were developed over 25 years ago. Over that time, youth have become more obese and the environment more obesiogenic, which may influence efficacy of pediatric weight control. Mixed-effects regression models were used to compare the efficacy of programs initiated 20 to 25 years ago to current programs through 24-month follow-up, as well as to reanalyze 10-year outcomes of previous research using contemporary measures and analytic strategies. Main outcome measures: z-BMI and percent overweight. Results: Results showed significant reductions over time, with no differences in z-BMI change for older versus contemporary studies. Age was a predictor of z-BMI up to 24 months, with younger children showing larger change. Mixed-effects regression models replicated previous long-term effects of family-based interventions. Gender was a predictor of long-term z-BMI change, with girls benefiting more over time than did boys. Conclusion: The efficacy of the family-based behavioral approach to treating pediatric obesity replicates over a 25-year period. Challenges in evaluating treatment effects over time are discussed. Ideas for studying choice of treatments that vary in effect size and for strengthening family-based behavioral treatments are noted.

HILBERT, Anja and RIEF, Winfried and others. What determines public support of obesity prevention? Journal of Epidemiology and Community Health Vol 61, No 7 - July 2007: 585-590
Abstract: Objective: To determine public support of obesity prevention. Design: Representative population-based survey. Setting: Random digit dialling telephone survey of non-institutionalised individuals aged 14 years in Germany. Participants: Representative sample of 1000 individuals. Main outcome measures: Interview-based assessment of prevention support, problem identification, causal attributions and responsibility beliefs regarding obesity. Results: Support for obesity prevention with a focus on behavioural change in children (89.7%) and provision of information in adults (82.2%) was substantial, but regulations were less supported (42.2%). Predictors of prevention support were attributing causes of obesity to the food environment and lack of physical activity, greater problem identification, societal responsibility beliefs and sociodemographic characteristics including female gender and higher age. An information deficit concerning the definition, prevalence, and environmental and genetic risk factors was identified. Conclusion: Results show a high public readiness for obesity prevention with a focus on individual behavioural change, but not for regulations. Addressing specific information deficits regarding the definition, prevalence and causes of obesity could further enhance the public’s understanding of obesity and help to establish obesity prevention measures.

KIMBRO, Rachel Tolbert and BROOKS-GUNN, Jeanne and others. Racial and ethnic differentials in overweight and obesity among 3-year-old children. American Journal of Public Health Vol 97, No 2 - February 2007: 298-305
Abstract: Objectives. We estimated racial/ethnic differences in overweight and obesity in a national sample of 3-year-olds from urban, low-income families and assessed possible determinants of differences. Methods. Survey, in-home observation, and interview data were collected at birth, 1 year, and 3 years. We used logistic regression analyses and adjusted for a range of covariates in examining overweight and obesity differentials according to race/ethnicity. Results. Thirty-five percent of the study children were overweight or obese. Hispanic children were twice as likely as either Black or White children to be overweight or obese. Although we controlled for a wide variety of characteristics, we were unable to explain either White-Hispanic or Black-Hispanic differences in overweight and obesity. However, birthweight, taking a bottle to bed, and mother's weight status were important predictors of children's overweight or obesity at age 3 years. Conclusions. Children's problems with overweight and obesity begin as early as age 3, and Hispanic children and those with obese mothers are especially at risk.

LUSZCZYNSKA, Aleksandra and SOBCZYK, Anna and others. Planning to lose weight: randomized controlled trial of an implementation intention prompt to enhance weight reduction among overweight and obese women. Health Psychology Vol 26, No 4 - July 2007: 507-512
Abstract: Objective: The trial investigates the effects of augmenting an established weight-reduction intervention with implementation intention prompts. Design: Fifty-five overweight or obese women (ages 18 to 76 years; body mass index from 25.28 to 48.33) enrolled in a commercial weight reduction program were randomly assigned to either an implementation intention prompt or a control condition. Data were collected twice, with a time gap of 2 months. Main Outcome Measures: The primary outcome was participants' change in weight and body mass index from preintervention to follow-up. Results: Repeated measures analysis of variance revealed a significant Time x Condition interaction: On average, implementation intention prompt participants lost 4.2 kg (95% confidence interval = 3.19, 5.07), whereas control participants lost 2.1 kg (95% confidence interval = 1.11, 3.09). The change in frequency of planning mediated the effects of the intervention on weight and body mass index change. Conclusion: Among obese or overweight women participating in a commercial weight loss program, those who learn to form implementation intentions can achieve greater weight reduction. Planning facilitation is a key mechanism explaining enhanced weight loss generated by implementation intention formation.

MILNE, Elizabeth and SIMPSON, Julie A and others. Time spent outdoors at midday and children's body mass index. American Journal of Public Health Vol 97, No 2 - February 2007: 306-310
Abstract: Objectives. We investigated whether the Kidskin sun protection intervention increased children's body mass index by reducing the time spent outdoors at midday. Methods. The Kidskin sun protection intervention involved 1614 Australian school children assigned to 1 of 3 groups: a control group, a moderate-intervention group, or a high-intervention group. Schools in the control group received the standard health curriculum and schools in the intervention groups received a multicomponent intervention. Outcomes included time spent outdoors and nevus development (a marker of melanoma risk). Height and weight were measured at 3 time points. Body mass index was transformed into age- and gender-specific z scores; z scores at each age were modeled simultaneously. Time spent outdoors at ages 10 and 12 years was analyzed using a linear mixed effects modeling. Results. The proportion of children who were overweight or obese increased with age. The moderate-intervention and control groups had a minimal increase in z score over time, and the z score for the high-intervention group decreased over time. There were no differences among groups with respect to total time outdoors at any age. Conclusions. It is possible to reduce the time children spend outdoors when ultraviolet radiation is high without producing an unfavorable effect on the children's body mass index.

MOON, Graham and QUARENDON, Gemma and others. Fat nation: deciphering the distinctive geographies of obesity in England. Social Science and Medicine Vol 65, No 1 - July 2007: 20-31
Abstract: Much attention is focused on obesity by both the media and by public health. As a health risk, obesity is recognised as a contributing factor to numerous health problems. Recent evidence points to a growth in levels of obesity in many countries and particular attention is usually given to rising levels of obesity among younger people. England is no exception to these generalisations with recent studies revealing a clear geography to what has been termed an 'obesity epidemic.' This paper examines the complexities inherent in the geography of adult obesity in England. Existing knowledge about the sub-national geography of obesity is examined and assessed. Multilevel synthetic estimation is then used to construct an age-sex-ethnicity disaggregated geography of obesity. These differing geographies are compared and contrasted with pre-existing findings and explored at multiple scales. A complex picture of the geography of obesity in England is revealed.

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