Motivation for physical activity in the Jordanian military: Possible determinants of physical activity in male and female recruits.

Given the obligatory nature of physical fitness training in the military and in order to guide intervention development, our study assessed possible motivational determinants as suggested by self-determination theory in addition to other possible determinants. A cross-sectional study was conducted among 218 military recruits during their basic training in Jordan. Physical activity and lifestyle behaviors were measured using the Arab Teens Lifestyle Study (ATLS). Psychosocial variables were assessed using the Exercise Self-Efficacy Scale (ESE), Behavioral Regulation Exercise Scale (BREQ-2) and Exercise Benefits/Barriers Scale (EBBS). Bivariate correlation analysis revealed that identified self-regulation, introjected regulation and exercise self-efficacy scores were positively associated with higher Metabolic Equivalent of Task (METs) and minutes per week of physical activity among male recruits and the overall sample respectively. Among females, only external regulation was positively associated with the total METs/week. Being a male was significantly associated with higher minutes of physical activity among the overall sample. Multivariate regression analyses showed that identified regulation was significantly and positively associated with higher minutes of physical activity among the overall sample and male recruits in addition to higher METs per week among the male recruits. Also, the amotivation score was significantly and positively associated with higher minutes of physical activity among the overall sample and male recruits. A multivariate regression analysis for female recruits showed no significant associations. Intervention developers are advised to increase autonomous forms of motivation through structured enjoyable physical fitness programs in order to enhance intrinsic motivation in the long term.

Fake meat or meat with benefits? How Dutch consumers perceive health and nutritional value of plant-based meat alternatives.

Animal agriculture has a large impact on the environment. Hence, there is an increasing demand for meat alternatives - more sustainably produced plant-based products that replace meat as meal component. Demands for meat alternatives also seem to be fuelled by consumers' belief that meat alternatives are healthier than meat products. In an online questionnaire study, we examined whether consumers indeed perceived meat alternatives to be healthier, to what degree consumers adequately estimated the nutritional value of meat (alternatives), and whether a nutrition claim could misguide consumers. In a panel of 120 Dutch consumers, it was found that meat alternatives were generally perceived as being healthier than meat products. According to supermarket data, meat alternatives contained less protein and saturated fat, higher levels of fibre and salt compared to meat. Consumers were found to overestimate the protein content of meat alternatives relative to meat products, especially when meat alternatives carry a 'high in protein' claim. The current beliefs about the healthiness and nutritional content of meat and meat alternatives are precarious and a fair, transparent, and understandable environment should be created for the conscious consumer.

The ENCOMPASS framework: a practical guide for the evaluation of public health programmes in complex adaptive systems.

BACKGROUND: Systems thinking embraces the complexity of public health problems, including childhood overweight and obesity. It aids in understanding how factors are interrelated, and it can be targeted to produce favourable changes in a system. There is a growing call for systems approaches in public health research, yet limited practical guidance is available on how to evaluate public health programmes within complex adaptive systems. The aim of this paper is to present an evaluation framework that supports researchers in designing systems evaluations in a comprehensive and practical way. METHODS: We searched the literature for existing public health systems evaluation studies. Key characteristics on how to conduct a systems evaluation were extracted and compared across studies. Next, we overlaid the identified characteristics to the context of the Lifestyle Innovations Based on Youth Knowledge and Experience (LIKE) programme evaluation and analyzed which characteristics were essential to carry out the LIKE evaluation. This resulted in the Evaluation of Programmes in Complex Adaptive Systems (ENCOMPASS) framework. RESULTS: The ENCOMPASS framework includes five iterative stages: (1) adopting a system dynamics perspective on the overall evaluation design; (2) defining the system boundaries; (3) understanding the pre-existing system to inform system changes; (4) monitoring dynamic programme output at different system levels; and (5) measuring programme outcome and impact in terms of system changes. CONCLUSIONS: The value of ENCOMPASS lies in the integration of key characteristics from existing systems evaluation studies, as well as in its practical, applied focus. It can be employed in evaluating public health programmes in complex adaptive systems. Furthermore, ENCOMPASS provides guidance for the entire evaluation process, all the way from understanding the system to developing actions to change it and to measuring system changes. By the nature of systems thinking, the ENCOMPASS framework will likely evolve further over time, as the field expands with more completed studies.

Adherence to the Mediterranean diet among adults in Mediterranean countries: a systematic literature review.

BACKGROUND AND AIM: While the Mediterranean diet (MD) is promoted in non-Mediterranean countries, inhabitants of Mediterranean countries seem to be shifting away from this healthy diet. The aim of this study is to provide an overview of MD adherence in the general adult population of Mediterranean countries. METHODS: A systematic review was conducted following the PRISMA 2020 (Preferred Reporting Items for Systematic Review and Meta-Analysis) guidelines and registered in the Prospero database (CRD42020189337). Literature was searched in PubMed, Web of Science and PsycINFO databases for studies published from 2010 up to and including 2021. The following inclusion criteria were used: age 18 years and older, sample size > 1000 participants, and using a validated MD adherence score. Studies that only included participants with nutrition-related or other severe chronic disorders, as well as studies that only included specific subpopulations (e.g., pregnant women), were excluded in order to focus on the general adult population. A quality analysis of the included studies was done using the NCCMT scale. RESULTS: A total of 50 studies were included. The number of participants in the included studies ranged between 1013 and 94,113. Most of the included studies pertained to the European Mediterranean countries, with fewer studies from the Middle Eastern and North African Mediterranean countries. The vast majority of the included studies reported low or moderate MD adherence, both based on the mean adherence as well as the low or moderate adherence category often being the most prevalent. There were no clear differences noted between sex and age groups. The quality assessment generally showed weak or moderate scores. CONCLUSIONS: Mediterranean populations have been showing moderate adherence to MD in the past 10 years, indicating room for improving adherence to the MD in countries of its origin.

Influence of obesity prevalence on social norms and weight control motivation: a cross-sectional comparison of the Netherlands and the UK.

This cross-sectional survey study explored associations between perceived bodyweight norms, psychological need satisfaction and motivation for weight control among 500 adult residents of two countries with different overweight/obesity prevalence: the UK (63% prevalence) and the Netherlands (50%). A hypothesised model of the effects of descriptive norms (i.e. perceptions of what is typical for most people) and injunctive norms (i.e. perceptions of what is typically approved by others) on autonomous motivation, mediated through basic psychological need satisfaction, was analysed using structural equation modelling. Descriptive norms did not differ between countries, yet UK adults reported a lower-weight injunctive norm. Perceiving higher bodyweights to be normal negatively predicted motivation to manage one's bodyweight mediated through an undermining effect on psychological need satisfaction. Perceiving higher bodyweights to be normal may have the potential to reduce individual motivation for weight control, but the sensitivity of people's perceptions to objective differences in overweight prevalence appears limited.

Tunneling a crosstown highway: a natural experiment testing the longitudinal effect on physical activity and active transport.

BACKGROUND: In the city of Maastricht in the Netherlands, a highway crossing several deprived neighborhoods was tunneled in 2016. The vacant space on top of this tunnel was redesigned and prioritized for pedestrians and cyclists. The aim of this study was to evaluate the effect of this major infrastructural change, named the Green Carpet, on total and transport-based physical activity (PA) levels. METHODS: Participants (≥18 years) were part of one of three area-based exposure groups. The maximal exposure group lived in neighborhoods directly bordering the Green Carpet. The minimal exposure group consisted of individuals living at the other side of the city, and the no exposure group consisted of individuals living in a nearby city. Actual use of the new infrastructure was incorporated as a second measure of exposure. Data were collected before and 3-15 months after the opening of the Green Carpet. Device-based measurements were conducted to obtain PA levels and collect location data. Changes in PA over time and intervention effects were determined using linear mixed models. RESULTS: PA levels in the Green Carpet area increased for the maximal and minimal exposure groups, but did not lead to an increase in total or transport-based PA. For the no exposure group, transport-based MVPA decreased and transport-based SB increased. The significant interaction (time x exposure) for transport-based SB, indicated differences in trends between the no exposure and maximal exposure group (B=-3.59, 95% CI - 7.15; -0.02) and minimal exposure group (B= -4.02, 95% CI -7.85, -0.19). Trends in the results based on analyses focusing on actual use and non-use of the new infrastructure were similar to those of the area-based analyses. CONCLUSIONS: Results suggest that the Green Carpet led to more PA in this specific area, but did not increase the total volume of PA. The area-based differences might reflect the differences between users and non-users, but we should be careful when interpreting these results, due to possible interference of selective mobility bias. This paper reflects that the relationship between infrastructure and PA is not unambiguous. TRIAL REGISTRATION: This research was retrospectively registered at the Netherlands Trial Register ( NL8108 ).

Do parenting practices moderate the association between the physical neighbourhood environment and changes in children's time spent at various physical activity levels? An exploratory longitudinal study.

BACKGROUND: As many children do not meet the recommended daily physical activity (PA) levels, more research is needed towards environmental determinants of children's PA levels. The aims of this longitudinal study were to investigate whether the physical environment and parenting practices have an impact on changes in children's weekday time spent at various PA levels and whether associations between physical neighbourhood environment and changes in children's PA are moderated by parenting practices. METHODS: We performed a secondary data analysis of longitudinal data collected at three timepoints (baseline, 6, and 18 months) from 10 control schools of the Active Living study, a quasi-experimental study, which took place in South Limburg, the Netherlands. In total, 240 children aged 8-12 years were included in the analyses. PA levels were measured using accelerometry (ActiGraph GT3X+). The physical environment was assessed at baseline through neighbourhood audits of the school environment, and PA parenting practices were measured at baseline via validated parental questionnaires. Multivariate multilevel regression analyses were conducted to determine the main effects of the physical environment and parenting practices on changes in children's time spent in sedentary behaviour (SB), light PA and moderate-to-vigorous PA (MVPA) over 18 months. Additionally, moderation of the association between the physical environment and children's PA levels by parenting practices was examined by adding interacting terms to the regression equations. RESULTS: Walkability of the physical environmental was associated with a decrease in SB at 18 months (B = -5.45, p < .05). In addition, the parenting practice logistic support was associated with an increase in MVPA (at all time points, B = .68, B = .73 and B = 1.02, respectively, all p < .05) and a decrease in SB (at 18 months, B = -1.71, p < .05). Stratified analyses (based on significant interaction terms) showed that the effect of specific physical environmental features (e.g., sports facilities) on children's improvements in PA levels were strengthened by favourable parenting practices. DISCUSSION: Besides the main effects of walkability and logistic support, there were indications that several parenting practices moderate the association between the physical environment and changes in children's time in various PA levels. The current findings are exploratory, and need to be confirmed in further research.

Lifestyle coaches as a central professional in the health care network? Dynamic changes over time using a network analysis.

BACKGROUND: Overweight and obesity are problems that are increasing globally in both children as well as adults, and may be prevented by adopting a healthier lifestyle. Lifestyle coaches counsel overweight and obese children (and their parents) as well as adults in initiating and maintaining healthier lifestyle behaviours. It is currently unclear whether this novel professional in the Dutch health care system functions as a linchpin in networks that evolve around lifestyle-related health problems. The aim of the present study is to investigate the formation and development of networks of lifestyle coaches and their positions within these networks. METHODS: In this longitudinal study, key professionals and professionals within relevant organisations in the Coaching on Lifestyle (CooL) care networks were asked to fill in three online questionnaires. Respondents were asked to indicate whether they collaborated with each of the specified professionals in the context of CooL. The overall network structures and the central role of the lifestyle coaches were examined by using network analysis. RESULTS: The results showed that the networks in three out of four regions were relatively centralised, but that none of the networks were dense, and that the professionals seemed to collaborate less with others over time. Half of the lifestyle coaches had a high number of collaborations and a central position within their networks, which also increased over time. In half of the regions, the lifestyle coaches had increased their role as consultants, while their role as gatekeeper and liaison decreased over time. In most regions, the sector of lifestyle coaches had a central position in their networks in just one measurement. Other central sectors were the local sports organisation, public health services, youth health care and the municipal government. CONCLUSIONS: Overall, we cannot conclude that more central and denser networks were formed during the study period. In addition, the lifestyle coaches were not often positioned as a central sector within these networks. Entrepreneurial, network and brokering competences are required for lifestyle coaches to build up denser networks. TRIAL REGISTRATION: NTR6208 ; date registered: 13-01-2017; retrospectively registered; Netherlands Trial Register.

Effects of the KEIGAAF intervention on the BMI z-score and energy balance-related behaviors of primary school-aged children.

The aim of the current study was to evaluate the one- and two-year effectiveness of the KEIGAAF intervention, a school-based mutual adaptation intervention, on the BMI z-score (primary outcome), and energy balance-related behaviors (secondary outcomes) of children aged 7-10 years.A quasi-experimental study was conducted including eight intervention schools and three control schools located in low socioeconomic neighborhoods in the Netherlands. Baseline measurements were conducted in March and April 2017 and repeated after one and 2 years. Data were collected on children's BMI z-score, sedentary behavior (SB), physical activity (PA) behavior, and nutrition behavior through the use of anthropometric measurements, accelerometers, and questionnaires, respectively. All data were supplemented with demographics, and weather conditions data was added to the PA data. Based on the comprehensiveness of implemented physical activities, intervention schools were divided into schools having a comprehensive PA approach and schools having a less comprehensive approach. Intervention effects on continuous outcomes were analyzed using multiple linear mixed models and on binary outcome measures using generalized estimating equations. Intervention and control schools were compared, as well as comprehensive PA schools, less comprehensive PA schools, and control schools. Effect sizes (Cohen's d) were calculated.In total, 523 children participated. Children were on average 8.5 years old and 54% were girls. After 2 years, intervention children's BMI z-score decreased (B = -0.05, 95% CI -0.11;0.01) significantly compared to the control group (B = 0.20, 95% CI 0.09;0.31). Additionally, the intervention prevented an age-related decline in moderate-to-vigorous PA (MVPA) (%MVPA: B = 0.95, 95% CI 0.13;1.76). Negative intervention effects were seen on sugar-sweetened beverages and water consumption at school, due to larger favorable changes in the control group compared to the intervention group. After 2 years, the comprehensive PA schools showed more favorable effects on BMI z-score, SB, and MVPA compared to the other two conditions.This study shows that the KEIGAAF intervention is effective in improving children's MVPA during school days and BMI z-score, especially in vulnerable children. Additionally, we advocate the implementation of a comprehensive approach to promote a healthy weight status, to stimulate children's PA levels, and to prevent children from spending excessive time on sedentary behaviors.Trial registrationNetherlands Trial Register, NTR6716 ( NL6528 ), Registered 27 June 2017 - retrospectively registered.

The coaching on lifestyle (CooL) intervention for obesity, a study protocol for an action-oriented mixed-methods study.

BACKGROUND: Combined lifestyle interventions (CLIs) have proved to be effective in changing and maintaining behavioural lifestyle changes and reducing overweight and obesity, in clinical and real-world settings. In this CLI, lifestyle coaches are expected to promote lifestyle changes of participants regarding physical activity and diet. In the Coaching on Lifestyle (CooL) intervention, which takes a period of 8 to 10 months, lifestyle coaches counsel adults and children aged 4 years and older (and their parents) who are obese or are overweight with an increased risk of developing cardiovascular diseases or type II diabetes. In group and individual sessions, themes such as physical activity, dietary behaviours, sleep and stress are addressed. The aim of the present study is to monitor the implementation process of the CooL intervention and to examine how the lifestyle coaches contribute to a healthier lifestyle of the participants. METHODS: This action-oriented study involves monitoring the implementation process of the CooL intervention and examining the lifestyle changes achieved by participants over time, in a one-group pre-post design using mixed methods. Methods include semi-structured interviews, observations, document analysis, biomedical parameters and questionnaires. DISCUSSION: The added value of the CooL study lies in its action-oriented approach and the use of mixed methods, including both qualitative and quantitative research methods. The long-term coaching used in the CooL intervention is expected to have beneficial effects on sustained lifestyle changes. TRIAL REGISTRATION: NTR6208 ; date registered: 13-01-2017.

Study protocol of the quasi-experimental evaluation of "KEIGAAF": a context-based physical activity and nutrition intervention for primary school children.

BACKGROUND: The environment affects children's energy balance-related behaviors to a considerable extent. A context-based physical activity and nutrition school- and family-based intervention, named KEIGAAF, is being implemented in low socio-economic neighborhoods in Eindhoven, The Netherlands. The aim of this study was to investigate: 1) the effectiveness of the KEIGAAF intervention on BMI z-score, waist circumference, physical activity, sedentary behavior, nutrition behavior, and physical fitness of primary school children, and 2) the process related to the implementation of the intervention. METHODS: A quasi-experimental, controlled study with eight intervention schools and three control schools was conducted. The KEIGAAF intervention consists of a combined top-down and bottom-up school intervention: a steering committee developed the general KEIGAAF principles (top-down), and in accordance with these principles, KEIGAAF working groups subsequently develop and implement the intervention in their local context (bottom-up). Parents are also invited to participate in a family-based parenting program, i.e., Triple P Lifestyle. Children aged 7 to 10 years old (grades 4 to 6 in the Netherlands) are included in the study. Effect evaluation data is collected at baseline, after one year, and after two years by using a child questionnaire, accelerometers, anthropometry, a physical fitness test, and a parent questionnaire. A mixed methods approach is applied for the process evaluation: quantitative (checklists, questionnaires) and qualitative methods (observations, interviews) are used. To analyze intervention effectiveness, multilevel regression analyses will be conducted. Content analyses will be conducted on the qualitative process data. DISCUSSION: Two important environmental settings, the school environment and the family environment, are simultaneously targeted in the KEIGAAF intervention. The combined top-down and bottom-up approach is expected to make the intervention an effective and sustainable version of the Health Promoting Schools framework. An elaborate process evaluation will be conducted alongside an effect evaluation in which multiple data collection sources (both qualitative and quantitative) are used. TRIAL REGISTRATION: Dutch Trial Register NTR6716 (registration date 27/06/2017, retrospectively registered), METC163027, NL58554.068.16, Fonds NutsOhra project number 101.253.

How to bridge the intention-behavior gap in food parenting: Automatic constructs and underlying techniques.

Although parents often report positive intentions to promote and create a healthy food environment for their children (e.g., setting limits to snacks offered), they also experience difficulties in translating these intentions into actual behaviors. In this position paper, we argue that automatic processes explain an important part of the gap between parents' intentions and their actual food parenting behaviors. We provide a conceptual framework in which we hypothesize that automatic effects on food parenting occur through two key interrelated constructs: habits (key outcome construct) and volitional regulation behaviors (key mediating construct). Moreover, we discuss potentially important impulse-focused techniques that may directly change habits (e.g., nudging; inhibitory control training) or indirectly through volitional regulation behaviors (e.g., implementation intentions; mental contrasting). We make use of the literature on the role of intention-behavior discordance in general health behaviors and discuss implications for food parenting practices. Our framework provides a dual process view towards food parenting and may help to explain when and why parents are likely to engage in (un)healthy food parenting behaviors. In addition, this framework may hopefully stimulate research on (combinations of old and) new techniques to promote good food parenting behaviors.

Bidirectional associations between activity-related parenting practices, and child physical activity, sedentary screen-based behavior and body mass index: a longitudinal analysis.

BACKGROUND: It has been generally assumed that activity-related parenting practices influence children's activity behavior and weight status. However, vice versa parents may also change their parenting behaviors in response to their perceptions of their child's activity behavior and weight status. This study examined the bidirectional relationships between activity-related parenting practices, and physical activity, sedentary screen-based behavior, and body mass index (BMI) between children's age of 5 and 7 years. METHODS: Three scales of the Activity-related Parenting Questionnaire (i.e. 'restriction of sedentary behavior', 'stimulation of physical activity', and 'monitoring of physical activity') were completed by 1694 parents of the Dutch KOALA Birth Cohort Study at the child's age of around 5 and again around age 7. Physical activity, sedentary screen-based behavior and BMI were measured at both ages as well. Linear regression models were used to estimate the bidirectional associations between each parenting practice and the child's physical activity levels, sedentary screen-based behavior and BMI z-scores. RESULTS: Several parenting practices at age 5 predicted child physical activity, sedentary screen-based behavior, and BMI z-scores at age 7. Restriction of sedentary behavior positively predicted child BMI and sedentary screen-based behavior, whereas this practice negatively predicted child physical activity. In addition, stimulation of physical activity at age 5 was significantly associated with higher levels of child physical activity at age 7. The following child factors at age 5 predicted parenting practices at age 7: Child physical activity positively predicted parental stimulation of physical activity and monitoring activities. Sedentary screen-based behavior was associated with lower parental stimulation to be active. CONCLUSIONS: Findings generally revealed that parents and children mutually influence each other's behavior. A reinforcing feedback loop was present between parental stimulation of physical activity and child physical activity. Bidirectional parent-child interaction should be considered in future research in order to properly inform parenting-related intervention programs aimed at preventing or treating childhood overweight or obesity. System dynamic methods to explore the existence of reinforcing or balancing loops are needed in this regard.

Food parenting practices for 5 to 12 year old children: a concept map analysis of parenting and nutrition experts input.

BACKGROUND: Parents are an important influence on children's dietary intake and eating behaviors. However, the lack of a conceptual framework and inconsistent assessment of food parenting practices limits our understanding of which food parenting practices are most influential on children. The aim of this study was to develop a food parenting practice conceptual framework using systematic approaches of literature reviews and expert input. METHOD: A previously completed systematic review of food parenting practice instruments and a qualitative study of parents informed the development of a food parenting practice item bank consisting of 3632 food parenting practice items. The original item bank was further reduced to 110 key food parenting concepts using binning and winnowing techniques. A panel of 32 experts in parenting and nutrition were invited to sort the food parenting practice concepts into categories that reflected their perceptions of a food parenting practice conceptual framework. Multi-dimensional scaling produced a point map of the sorted concepts and hierarchical cluster analysis identified potential solutions. Subjective modifications were used to identify two potential solutions, with additional feedback from the expert panel requested. RESULTS: The experts came from 8 countries and 25 participated in the sorting and 23 provided additional feedback. A parsimonious and a comprehensive concept map were developed based on the clustering of the food parenting practice constructs. The parsimonious concept map contained 7 constructs, while the comprehensive concept map contained 17 constructs and was informed by a previously published content map for food parenting practices. Most of the experts (52%) preferred the comprehensive concept map, while 35% preferred to present both solutions. CONCLUSION: The comprehensive food parenting practice conceptual map will provide the basis for developing a calibrated Item Response Modeling (IRM) item bank that can be used with computerized adaptive testing. Such an item bank will allow for more consistency in measuring food parenting practices across studies to better assess the impact of food parenting practices on child outcomes and the effect of interventions that target parents as agents of change.

Psychological and personality factors in type 2 diabetes mellitus, presenting the rationale and exploratory results from The Maastricht Study, a population-based cohort study.

BACKGROUND: Strong longitudinal evidence exists that psychological distress is associated with a high morbidity and mortality risk in type 2 diabetes. Little is known about the biological and behavioral mechanisms that may explain this association. Moreover, the role of personality traits in these associations is still unclear. In this paper, we first describe the design of the psychological part of The Maastricht Study that aims to elucidate these mechanisms. Next, we present exploratory results on the prevalence of depression, anxiety and personality traits in type 2 diabetes. Finally, we briefly discuss the importance of these findings for clinical research and practice. METHODS: We measured psychological distress and depression using the MINI diagnostic interview, the PHQ-9 and GAD-7 questionnaires in the first 864 participants of The Maastricht Study, a large, population-based cohort study. Personality traits were measured by the DS14 and Big Five personality questionnaires. Type 2 diabetes was assessed by an oral glucose tolerance test. Logistic regression analyses were used to estimate the associations of depression, anxiety and personality with type 2 diabetes, adjusted for age, sex and education level. RESULTS: Individuals with type 2 diabetes had higher levels of depressive and anxiety symptoms, odds ratios (95 % CI) were 3.15 (1.49; 6.67), 1.73 (0.83-3.60), 1.50 (0.72-3.12), for PHQ-9 ≥ 10, current depressive disorder and GAD-7 ≥ 10, respectively. Type D personality, social inhibition and negative affectivity were more prevalent in type 2 diabetes, odds ratios were 1.95 (1.23-3.10), 1.35 (0.93-1.94) and 1.70 (1.14-2.51), respectively. Individuals with type 2 diabetes were less extraverted, less conscientious, less agreeable and less emotionally stable, and similar in openness to individuals without type 2 diabetes, although effect sizes were small. CONCLUSIONS: Individuals with type 2 diabetes experience more psychological distress and have different personality traits compared to individuals without type 2 diabetes. Future longitudinal analyses within The Maastricht Study will increase our understanding of biological and behavioral mechanisms that link psychological distress to morbidity and mortality in type 2 diabetes.

Intake of energy-dense snack foods and drinks among Dutch children aged 7-12 years: how many, how much, when, where and which?

OBJECTIVE: To describe the energy-dense snack food (EDSF) and energy-dense drink (EDD) consumption of children in the Netherlands and investigate subgroup differences. The amounts consumed, eating occasions, places of consumption and consumed types are reported. DESIGN: Twenty-four hour dietary recall data were used to describe the EDSF and EDD consumption. Subgroup differences concerning these intakes were identified with ANCOVA. SETTING: Dutch National Food Consumption Survey 2007-2010. SUBJECTS: Children (n 860) aged 7-12 years. RESULTS: The mean number of EDSF events was 3·3 (sd 1·6) per day, yielding 1569·7 (sd 928·7) kJ. Average EDD consumption was 594·2 (sd 342·3) ml/d, yielding 737·2 (sd 495·9) kJ. Over 90 % of the children consumed more energy from non-core foods per day than recommended. Differences in EDSF and EDD consumption were found between several subgroups. Most importantly, we found higher intakes among older children and children with low educated mothers. Almost half of the EDSF events took place in the afternoon and at home. Cookies and sweets were consumed during half of the EDSF events. Almost one-third of the EDD were consumed in the afternoon. The majority of these drinks were consumed at home and most were soft drinks. CONCLUSIONS: The results demonstrate that snack food and drink consumption is highly prevalent among Dutch children. Health promotion efforts addressing these behaviours are warranted and the present study could accelerate these initiatives. Focusing on children with low educated parents and on snacking at home after school offers the greatest potential to reduce snack food and drink intakes.

Context matters! The relationship between mother-reported family nutrition climate, general parenting, food parenting practices and children's BMI.

BACKGROUND: Efforts to explain children's nutrition behavior or weight often involve investigating the parent-child relationship, typically studying the associations between food parenting practices (FPPs) and child outcomes. However, these behaviors are embedded in a broader system: general parenting (GP, the general emotional climate at home), and the family health climate (an aspect of the broader family system in the context of health). In the current study, we combined the parent-child measures of parenting (FPPs and GP) and the nutritional dimension of the family health climate (family nutrition climate, FNC) to get a broader view of how these concepts are interrelated. The current study had two aims: predicting FPPs using GP and FNC as predictor variables, and investigating the relationship between FPPs and children's weight in different groups of parents, based on low and high GP and FNC scores. METHODS: We collected cross-sectional data via an online survey panel. Mothers of 267 children aged 5-12 years filled out a questionnaire assessing demographics (e.g., children's weight and height), GP, FPPs, and FNC. Bivariate correlation coefficients were calculated between all constructs. Structural equation modeling was performed to test the hypothesized relationships between GP, FNC and FPPs. Hereafter, different groups of parents were identified, using median split, based on a low or high score on GP or a low or high score on FNC. Bivariate correlation coefficients were calculated between FPPs and children's BMI z-score for these different groups. RESULTS: GP and FNC were consistently positively correlated (all r's ≥.177), and both concepts were positively associated with healthy FPPs (all r's ≥.214). In families with a positive context (i.e. scoring high on GP and on FNC), healthy FPPs were associated with lower BMI z-scores of the children (r -.229). This association was not found for children with a more negative family context. CONCLUSIONS: FNC and GP are valuable additional concepts to investigate relationships between FPPs and child outcomes. We recommend that more studies, next to investigating the parent-child system, include a measure of the broader family system, in order to get a broader view of the mechanisms explaining child health behaviors and weight status.

Determinants of dietary behavior and physical activity among Canadian Inuit: a systematic review.

BACKGROUND: Increased dependence on Western diets and low physical activity have largely contributed to weight gain and associated chronic diseases in the Canadian Inuit population. The purpose of this study was to systematically review factors influencing dietary and physical activity behaviors to guide health promotion interventions and provide recommendations for future studies. METHOD: We conducted a systematic literature review to identify relevant articles. Searches were conducted between May 2014 and July 2014, and inclusive of articles published up until July 2014. Articles were searched using four databases: PubMed, PsycINFO, SocINDEX, and Psychology and Behavioral Sciences Collection. Eligible studies focused on diet and/or physical activity or determinants of diet and/or physical activity in Canadian Inuit population, and were published in English. RESULTS: A total of 45 articles were included in the analysis. A detailed appraisal of the articles suggested that many Inuit have disconnected from the traditional ways of life, including harvesting and processing of traditional food species and the associated physical activity. In the last two decades there has been a significant shift from consumption of healthy traditional foods to energy-dense store-bought foods particularly among younger Inuit (<50 years of age). Additionally, low socioeconomic status (SES) and high transportation cost affect food accessibility and contribute to poor dietary choices in the population. However, a few articles that described the mediating role of psychosocial factors reported that higher SES, increased healthful food knowledge, and self-efficacy towards healthy dietary behavior, were associated with greater intentions to make healthier food choices and participate in physical activity. CONCLUSION: It is evident that the rapid social, cultural, and environmental changes in the Arctic have altered dietary and physical activity behaviors of Canadian Inuit. However, our understanding is limited on how these behaviours might be influenced in the face of these changes. Prospective studies are needed to advance our knowledge of cognitive and environmental determinants of Inuit energy balance-related behaviours. These studies can inform the development of health promotion interventions in the population.

Determinants of dietary behavior among youth: an umbrella review.

BACKGROUND: The literature on determinants of dietary behavior among youth is extensive and unwieldy. We conducted an umbrella review or review-of-reviews to present a comprehensive overview of the current knowledge. METHODS: Therefore, we included systematic reviews identified in four databases (i.e. PubMed, PsycINFO, The Cochrane Library and Web of Science) that summarized determinants of observable child and adolescent dietary behaviors. Data extraction included a judgment of the importance of determinants, strength of evidence and evaluation of the methodological quality of the eligible reviews. RESULTS: In total, 17 reviews were considered eligible. Whereas social-cognitive determinants were addressed most intensively towards the end of the 20th century, environmental determinants (particularly social and physical environmental) have been studied most extensively during the past decade, thereby representing a paradigm shift. With regard to environmental determinants, mixed findings were reported. Sedentary behavior and intention were found to be significant determinants of a wide range of dietary behaviors in most reviews with limited suggestive evidence due to the cross-sectional study designs. Other potential determinants such as automaticity, self-regulation and subjective norm have been studied in relatively few studies, but results are promising. CONCLUSION: The multitude of studies conducted on potential determinants of dietary behavior provides quite convincing evidence of the importance of several determinants (i.e. quite some variables were significantly related to dietary behavior). However, because of the often used weak research designs in the studies covered in the available reviews, the evidence for true determinants is suggestive at best.

Aerobic and strength exercises for youngsters aged 12 to 15: what do parents think?

BACKGROUND: Although strength exercises evidently have both physiological and psychological health benefits across all ages, they are erroneously considered to adversely affect health status in youngsters. The aim of this study was to examine parental attitudes towards their child's physical activity in general, as well as aerobic and strength exercises in particular. METHODS: In total, 314 parents from an online panel representative of the Dutch population completed an online survey about their own physical activity and that of their child (12-15 years old). The study also explored reasons for non-participation, and attitudes about the parents' own and their child's physical activity level. RESULTS: Parents consistently reported a positive attitude towards aerobic exercises, but a less positive attitude regarding strength exercises. Parents were more likely to indicate that their child was not allowed to participate in strength exercises (29.6 %) than aerobic exercises (4.0 %). They thought that strength exercises could interfere with optimal physical development. CONCLUSIONS: This study consistently shows that parents have a positive attitude towards aerobic exercises, but a less positive attitude regarding strength exercises. We suggest testing interventions to increase parental understanding of the advantages of and possibilities for (e.g., facilities) strength training on their child's health.