Current Projects and Activities

DIETARY BEHAVIOURS, CHRONIC DISEASE AND THE PREVENTION OF OBESITY

Support is provided on an ongoing basis to the planning, implementation and evaluation of the “Good for Kids, Good For Life” childhood obesity prevention project in the Hunter New England area.

“Good for Kids, Good for Life” (2006 – 2010)

“Good for Kids, Good for Life” is a large program promoting healthy eating and physical activity for kids up to aged 15 years in the Hunter, New England and Lower Mid North Coast region. It is a pilot program run by Hunter New England Area Health Service as part of the NSW Government’s Live Life Well campaign, and will run until 2010. The program aims to bring together a variety of agencies, community groups and industry to provide practical information, as well as new programs and systems, to help children, parents, carers and the wider community, know more about healthy weight, nutrition and physical activity; with a specific focus on Aboriginal children in the region.

“Good for Kids” plans to re-create home, preschool, school, health service, community and media environments through a variety of interventions. http://www.goodforkids.nsw.gov.au

The evaluation is being conducted through collaboration between NSW Health, Hunter New England Health Service, and the Sydney University Prevention Research Collaboration (PANORG, CPHN and CPAH).
The overall evaluation approach is described in: 'Evaluation at a Glance' [PDF]

Building solutions for preventing childhood obesity – A series of modules

The Cluster has been involved in a collaborative project with the other two Prevention Research Collaborations (Physical Activity Nutrition and Obesity Research Group and the Cluster for Physical Activity and Health) in the development of a set of resources that provide up-to-date and solution-oriented information to guide the development and implementation of child obesity prevention strategies in NSW. This series of modules synthesises recent evidence of the effectiveness of interventions for preventing weight gain and promoting healthy weight among children and adolescents. The modules have been designed to meet the needs of relevant policy-makers, government agencies, area health service workers, non-government and community organisations, and health practitioners.

The dietary behaviour modules, collectively named ‘Building solutions for preventing childhood obesity’ are as follows:

There are also modules on the following topics:

Module 5: Interventions to promote physical activity in children (aged 5 to 12 years)
Module 6: Interventions to increase physical activity in adolescents
Module 7: Interventions to reduce sedentary behaviours

PDF versions of modules 5, 6 and 7 can be found on the NSW Centre for Overweight and Obesity website.

Sugar-sweetened drinks/soft drinks

Soft drinks and other sweetened beverages are the most commonly consumed beverages by Australia children. They are also one of the major sources of non-core food energy. There is some indication that soft drinks are particularly powerful agents of weight gain and that strategies to reduce soft drink may contribute substantially to programs of action to reduce childhood obesity. CPHN has already published several papers in relation to this issue. An upcoming publication will summarise the evidence for the relationship between sugar-sweetened drinks consumption and weight status, the very limited evidence-base on how to intervene, and potentially effective, but as yet untested, intervention ideas.

Gill T, Rangan A, Webb K. The weight of evidence suggests that soft drinks are a major issue in childhood and adolescent obesity. Med J Aust. 2006; 184 (6): 263-264.

Portion Sizes

Increasing portion sizes has been cited as one of the contributors to the obesity pandemic. Several projects assessing portion sizes consumed by the Australian population are in progress; (a) typical portion sizes consumed by age and gender sub-group of commonly consumed foods using the NNS 1995 (b) changes in typical portion sizes consumed over time, using national nutrition surveys and (c) changes in sizes of packaged foods over time.

Consumption of ‘extra foods’ by children and adults

A number of projects examining the consumption of ‘extra’ or energy-dense, nutrient-poor foods have been undertaken by CPHN. These include the classification of ‘extra’ foods, as well as examining the types and quantities of ‘extra’ foods consumed among toddlers, children and adults.

Data collected from 3007 children aged 2-18 years in the 1995 National Nutrition Survey showed that ‘extra’ foods contributed over 40% of daily energy intake, more than double the acceptable limits of 5-20%. Such high intakes have the potential to lead to overweight and obesity, as well as replace more nutritious foods in the diet.

The types of ‘extra’ foods consumed were found to vary with age. Younger children were more likely to consume cordials, fruit drinks, sweet and savoury biscuits, muesli and fruit bars, lollies, and sweet spreads than older children. In contrast, older children and adolescents were more likely to consume sugar-sweetened soft drinks, fried potatoes, meat pies and savoury pastries, sweet pastries, hamburgers and pizza, than younger children. Overall, the types of ‘extra’ foods that contributed most to
total energy intake included sugar-sweetened drinks (soft drinks, cordials and fruit drinks), fried potatoes, and ice cream.

Three publications have resulted from this work:

Rangan A, Randall D, Hector D, Gill T, Webb K. Consumption of ‘extra’ foods by Australian children: types, quantities and contribution to energy and nutrient intakes. Eur J Clin Nutr 2008; 62(3):356-64.

Rangan A, Hector D, Randall D, Gill T, Webb K. Monitoring consumption of 'extra foods' in the Australian diet: comparing two sets of criteria for classifying foods as 'extras'. Nutr Diet 2007; 64(4):261–267.

Rangan A, Randall D, Hector D, Gill T, Webb K. Consumption of ‘extra’ foods by Australian adults: types, quantities and contribution to energy and nutrient intakes. Eur J Clin Nutr 2008. published online 29 October 2008

Download Table 1 - The criteria used to classify 'extra' foods.
Download Table 2 - A detailed list of core and 'extra' foods.
Download Table 3 - The criteria used to classify 'extra' foods using two different monitoring systems.

Details of a study examining the consumption of extra foods among toddlers can be found in the following publication:

Webb K, Lahti-Koski M, Rutishauser I, Hector D, Knezcevic N, Gill T, Peat JK, Leeder SR. (2006) Consumption of extra foods (energy-dense, nutrient-poor) among Australian children aged 16-24 months from western Sydney, Australia. Public Health Nutr. 9(8): 1035-1044.

Conceptualisation, measurement and intervening to modify the food environment for nutrition/weight status improvement

It is now widely accepted that the environment in which we live has a profound effect on our ability to achieve energy balance and control our weight. However our understanding or definition of the food environment and its relationship to the development of obesity has not been clearly defined.

Interest in making “healthy choices easy choices” was high among public health practitioners in the early 1990s. Recognition was growing that aspects of the food supply (price, availability, advertising, regulation, etc.), locally and nationally, often undermines healthy eating and population nutrition objectives. Tim Gill will review previous work/literature to provide an overview of different concepts of ‘food environments’, methods used to measure aspects of the food environment in various settings, gaps in these methods, and highlight priorities for further clarification and description of food environments.

Webb K, Leeder SR. New Year’s resolution: let’s get rid of excessive food prices in remote Australia. Med J Aust. 2007; 186 (1): 7-8. (editorial)

Food and nutrition factors related to health outcomes

All members of staff are involved in one or more collaborative projects with other groups to define, measure, and analyse the food and nutrition exposure variables (including breastfeeding) for epidemiological studies, including the Childhood Asthma Prevention Study and the Blue Mountains Eye Study, both cohort studies funded by NHMRC. A series of publications has resulted from both studies and more are planned, with Centre staff as first authors or co-authors on several of these.

Webb K, Lahti-Koski M, Rutishauser I, Hector D, Knezcevic N, Gill T, Peat JK, Leeder SR. (2006) Consumption of extra foods (energy-dense, nutrient-poor) among Australian children aged 16-24 months from western Sydney, Australia. Public Health Nutr. 9(8): 1035-1044

Survey questions to monitor food habits of children

In collaboration with PANORG, we are assessing the repeatability and validity of short nutrition questions in preschool children.

A report with recommended core survey questions for on-going use in the NSW Child Health Survey, and in other state health surveys of children, was prepared for NSW Health in 2005. Published validation studies of the short questions informed the selection of these for inclusion in the NSW Health Survey. A number of related projects have been/are being undertaken to study the validity of survey questions, and response categories, and will inform future refinements of the questions.

Business cases for a national food and nutrition monitoring and surveillance system

Karen Webb worked with a team of consultants from several universities on a tender funded by the Commonwealth Department of Health and Aging on developing a case and recommendations for a ‘least cost’ food and nutrition monitoring system for Australia. The Nexus report, as it is called, was published by the Commonwealth Department of Health and Aging in 2006, and is in the process of implementing recommendations from the report. The report, based on international as well as Australia experience, and wide consultation with stakeholders, presents a compelling case for funding a system of routine data collection on the food and nutrition situation in Australia, and to house this activity within Australia’s premier data collection and analysis agencies, the Australian Bureau of Statistics and the Australian Institute of Health and Welfare. While the nutrition field is dependent on such an information system for the rational development of policies and interventions, the health bureaucracy requires a ‘business case’ to allocate continued and adequate funding.

Television Food advertising: estimating children's exposure

In collaboration with PANORG and CPAH, the Cluster has participated in the TV advertising project, which investigated the proportion of food advertisements during children’s TV viewing hours and the content of the food advertisements. We taped and analysed the food advertising of commercial channels in Sydney during one week in 2006. We have described the extent and exposure of children to high fat/ high sugar advertisements and have modelled the effect on quantity and type of advertising with possible regulatory policies of TV advertising. TV advertising patterns were compared between 2002 and 2006 and significant changes identified.

Kelly B, Smith B, King L, Flood V, Bauman A. Television food advertising to children: the extent and nature of exposure. Public Health Nutr. 2007 [Epub ahead of print] 1-7.

Kelly B, Smith B, King L, Flood V, Bauman A. Food advertising on Sydney television: the extent of children’s exposure. Report Australian Centre for Health Promotion and joint Prevention Research Centres, for NSW Health, 2006.

View report [PDF]

An e-communication intervention to decrease soft drink consumption in young adults: the SENT study (pilot study 2007- 2008)

This study aims to investigate the effectiveness of an intervention to reduce soft drink consumption in young adults. The proposed intervention uses process-tailored messages based on the transtheoretical behavioural model, delivered through e-communication technologies, including websites, email and SMS.

Predictors of weight status in 5-year olds (2006-)

Using data from the Child Asthma Prevention Study (CAPS) birth cohort, we are analysing predictors of BMI and weight gain. Data on the childrens' dietary patterns at 18 months, as well as weights, heights, and childcare attendance; and baseline data on parental education, ethnicity, socioeconomic indicators and smoking habits will be used to select models to explain BMI at five years.