Community coalition efforts to prevent childhood obesity: two-year results of the Shape Up Under 5 study.

BACKGROUND: Cross-sector collaborations and coalitions are promising approaches for childhood obesity prevention, yet there is little empirical evidence about how they affect change. We hypothesized that changes in knowledge of, and engagement with, childhood obesity prevention among coalition members can diffuse through social networks to influence policies, systems, and environments. METHODS: We studied a community coalition (N = 16, Shape Up Under 5 "SUU5 Committee") focused on early childhood obesity prevention in Somerville, MA from 2015-17. Knowledge, engagement, and social network data were collected from Committee members and their network contacts (n = 193) at five timepoints over two years. Policy, systems, and environment data were collected from the SUU5 Committee. Data were collected via the validated COMPACT Stakeholder-driven Community Diffusion survey and analyzed using regression models and social network analysis. RESULTS: Over 2 years, knowledge of (p = 0.0002), and engagement with (p = 0.03), childhood obesity prevention increased significantly among the SUU5 Committee. Knowledge increased among the Committee's social network (p = 0.001). Significant changes in policies, systems, and environments that support childhood obesity prevention were seen from baseline to 24 months (p = 0.003). CONCLUSION: SUU5 had positive effects on "upstream" drivers of early childhood obesity by increasing knowledge and engagement. These changes partially diffused through networks and may have changed "midstream" community policies, systems, and environments.

Child and adolescent obesity: part of a bigger picture.

The prevalence of childhood overweight and obesity has risen substantially worldwide in less than one generation. In the USA, the average weight of a child has risen by more than 5 kg within three decades, to a point where a third of the country's children are overweight or obese. Some low-income and middle-income countries have reported similar or more rapid rises in child obesity, despite continuing high levels of undernutrition. Nutrition policies to tackle child obesity need to promote healthy growth and household nutrition security and protect children from inducements to be inactive or to overconsume foods of poor nutritional quality. The promotion of energy-rich and nutrient-poor products will encourage rapid weight gain in early childhood and exacerbate risk factors for chronic disease in all children, especially those showing poor linear growth. Whereas much public health effort has been expended to restrict the adverse marketing of breastmilk substitutes, similar effort now needs to be expanded and strengthened to protect older children from increasingly sophisticated marketing of sedentary activities and energy-dense, nutrient-poor foods and beverages. To meet this challenge, the governance of food supply and food markets should be improved and commercial activities subordinated to protect and promote children's health.

Progress achieved in restricting the marketing of high-fat, sugary and salty food and beverage products to children.

In May 2010, 192 Member States endorsed Resolution WHA63.14 to restrict the marketing of food and non-alcoholic beverage products high in saturated fats, trans fatty acids, free sugars and/or salt to children and adolescents globally. We examined the actions taken between 2010 and early 2016 - by civil society groups, the World Health Organization (WHO) and its regional offices, other United Nations (UN) organizations, philanthropic institutions and transnational industries - to help decrease the prevalence of obesity and diet-related noncommunicable diseases among young people. By providing relevant technical and policy guidance and tools to Member States, WHO and other UN organizations have helped protect young people from the marketing of branded food and beverage products that are high in fat, sugar and/or salt. The progress achieved by the other actors we investigated appears variable and generally less robust. We suggest that the progress being made towards the full implementation of Resolution WHA63.14 would be accelerated by further restrictions on the marketing of unhealthy food and beverage products and by investing in the promotion of nutrient-dense products. This should help young people meet government-recommended dietary targets. Any effective strategies and actions should align with the goal of WHO to reduce premature mortality from noncommunicable diseases by 25% by 2025 and the aim of the UN to ensure healthy lives for all by 2030.

En mai 2010, 192 États membres ont ratifié la Résolution WHA63.14 pour restreindre, à l'échelle internationale, la commercialisation des produits alimentaires et boissons non alcoolisées riches en graisses saturées, en acides gras trans, en sucres libres et/ou en sel, destinés aux enfants et aux adolescents. Nous avons étudié des initiatives d'organisations de la société civile, de l'Organisation mondiale de la Santé (OMS) et de ses bureaux régionaux, d'autres agences de l'Organisation des Nations unies (ONU), d'institutions philanthropiques et de groupes industriels internationaux, menées entre 2010 et début 2016 en vue d'aider à réduire la prévalence de l'obésité et des maladies non transmissibles liées à l'alimentation chez les jeunes. En fournissant aux États membres des outils et des conseils utiles en matière technique et pour l'adoption de mesures politiques, l'OMS et d'autres agences de l'ONU ont contribué à protéger les jeunes face à la commercialisation d'aliments et de boissons de marques, riches en graisses, en sucre et/ou en sel. Les résultats obtenus grâce aux initiatives des autres acteurs étudiés semblent variables et généralement moins solides. Nous suggérons d'accélérer les progrès accomplis vers la mise en œuvre complète de la Résolution WHA63.14, en restreignant davantage la commercialisation des aliments et boissons mauvais pour la santé et en investissant dans la promotion de produits denses sur le plan nutritionnel. Cela permettrait d'aider les jeunes à atteindre les objectifs nutritionnels recommandés par les gouvernements. Pour être efficaces, les stratégies et mesures adoptées doivent être cohérentes avec l'objectif de l'OMS visant à réduire la mortalité prématurée due aux maladies non transmissibles de 25% d'ici 2025 et avec l'objectif de l'ONU visant à permettre à tous de vivre en bonne santé d'ici 2030.

En mayo de 2010, 192 Estados Miembros aprobaron la Resolución WHA63.14 para limitar la promoción de alimentos y bebidas no alcohólicas con elevadas cantidades de grasas saturadas, ácidos grasos trans, azúcares libres y/o sal dirigida a los niños y adolescentes de todo el mundo. Se examinaron las medidas tomadas entre 2010 y principios de 2016 por parte de grupos de la sociedad civil, la Organización Mundial de la Salud (OMS) y sus sedes regionales, otras organizaciones de las Naciones Unidas, instituciones filantrópicas e industrias transnacionales para contribuir a la reducción de la prevalencia de la obesidad y enfermedades no contagiosas relacionadas con la alimentación entre los jóvenes. Mediante las directrices y herramientas políticas y técnicas correspondientes ofrecidas a los Estados Miembros, la OMS y otras organizaciones de las Naciones Unidas han ayudado a proteger a los jóvenes de la promoción de productos alimentarios y bebidas de marca con elevadas cantidades de grasa, azúcar y/o sal. Los progresos realizados por los otros participantes investigados parecen ser desiguales y, en general, menos sólidos. Nuestra sugerencia es que el progreso hacia la implementación completa de la Resolución WHA63.14 se acelere limitando aún más la promoción de productos alimentarios y bebidas insanos y se invierta en la promoción de productos altamente nutritivos. Esto debería ayudar a los jóvenes a alcanzar los objetivos nutricionales recomendados por los gobiernos. Todas las estrategias y medidas eficaces deberían ajustarse a la meta de la OMS de reducir la mortalidad prematura provocada por enfermedades no contagiosas en un 25% en 2015 y el objetivo de las Naciones Unidas de garantizar una vida sana para todos en 2030.

Lifestyle factors and adolescent depressive symptomatology: Associations and effect sizes of diet, physical activity and sedentary behaviour.

OBJECTIVE: Depression affects many Australian adolescents. Research points to the potential of lifestyle improvement for the population-level prevention of mental disorders. However, most studies examine single relationships without considering the combined contribution of lifestyle factors to variance in depression. This study examined associations between adolescent diet, physical activity and screen time behaviours and depressive symptomatology. METHODS: A cross-sectional sample of year 8 and 10 students was recruited from 23 participating schools in 18 Victorian communities. Students were recruited using opt-out consent, resulting in 3295 participants from 4680 registered school enrolments (Participation Rate: 70.4%). Participants completed a supervised self-report questionnaire comprising Moods and Feelings Questionnaire-Short Form, an assessment of physical activity and sedentary behaviours during and outside school, and weekly food intake. Surveyed covariates included hours of sleep per night, age, socio-economic status and measured anthropometry. A hierarchical regression stratified by gender was conducted, with dichotomised Moods and Feelings Questionnaire-Short Form score as the outcome, and screen time, physical activity and dietary patterns as predictors. Nested regression analyses were then conducted to ascertain the variance in Moods and Feelings Questionnaire-Short Form score attributable to each significant predictor from the initial regression. RESULTS: Increased scores on an unhealthy dietary pattern (odds ratio = 1.18; 95% confidence interval = [1.07, 1.32]) and physical activity guideline attainment (0.91; [0.85, 0.97]) were associated with depressive symptomatology in males, while screen time guideline attainment (0.95; [0.91, 0.98]) was associated with depression in females. No association was observed between healthy diet pattern and Moods and Feelings Questionnaire-Short Form. Overall, effect sizes were generally small, and the regression model accounted for 5.22% of Moods and Feelings Questionnaire-Short Form variance. CONCLUSION: Gender-specific associations were observed between physical activity and both sedentary and dietary behaviours and depressive symptomatology among adolescents, although reverse causality cannot be refuted at this stage. Lifestyle behaviours may represent a modifiable target for the prevention of depressive symptomatology in adolescents.

Increased food energy supply as a major driver of the obesity epidemic: a global analysis.

OBJECTIVE: We investigated associations between changes in national food energy supply and in average population body weight. METHODS: We collected data from 24 high-, 27 middle- and 18 low-income countries on the average measured body weight from global databases, national health and nutrition survey reports and peer-reviewed papers. Changes in average body weight were derived from study pairs that were at least four years apart (various years, 1971-2010). Selected study pairs were considered to be representative of an adolescent or adult population, at national or subnational scale. Food energy supply data were retrieved from the Food and Agriculture Organization of the United Nations food balance sheets. We estimated the population energy requirements at survey time points using Institute of Medicine equations. Finally, we estimated the change in energy intake that could theoretically account for the observed change in average body weight using an experimentally-validated model. FINDINGS: In 56 countries, an increase in food energy supply was associated with an increase in average body weight. In 45 countries, the increase in food energy supply was higher than the model-predicted increase in energy intake. The association between change in food energy supply and change in body weight was statistically significant overall and for high-income countries (P < 0.001). CONCLUSION: The findings suggest that increases in food energy supply are sufficient to explain increases in average population body weight, especially in high-income countries. Policy efforts are needed to improve the healthiness of food systems and environments to reduce global obesity.

Caffeine increases sugar-sweetened beverage consumption in a free-living population: a randomised controlled trial.

Excessive sugar-sweetened beverage (SSB) consumption has been associated with overweight and obesity. Caffeine is a common additive to SSB, and through dependence effects, it has the potential to promote the consumption of caffeine-containing foods. The objective of the present study was to assess the influence that caffeine has on the consumption of SSB. Participants (n 99) were blindly assigned to either a caffeinated SSB (C-SSB) or a non-caffeinated SSB (NC-SSB) group. Following randomisation, all participants completed a 9 d flavour-conditioning paradigm. They then completed a 28 d ad libitum intake intervention where they consumed as much or as little of C-SSB or NC-SSB as desired. The amount consumed (ml) was recorded daily, 4 d diet diaries were collected and liking of SSB was assessed at the start and end of the intervention. Participants (n 50) consuming the C-SSB had a daily SSB intake of 419 (sd 298) ml (785 (sd 559) kJ/d) over the 28 d intervention, significantly more than participants (n 49) consuming the NC-SSB (273 (sd 278) ml/d, 512 (sd 521) kJ/d) (P=0.05). However, participants who consumed the C-SSB liked the SSB more than those who consumed the NC-SSB (6.3 v. 6.0 on a nine-point hedonic scale, P= 0.022). The addition of low concentrations of caffeine to the SSB significantly increases the consumption of the SSB. Regulating caffeine as a food additive may be an effective strategy to decrease the consumption of nutrient-poor high-energy foods and beverages.

Critical design features for establishing a childhood obesity monitoring program in Australia.

Efforts to combat childhood obesity in Australia are hampered by the lack of quality epidemiological data to routinely monitor the prevalence and distribution of the condition. This paper summarises the literature on issues relevant to childhood obesity monitoring and makes recommendations for implementing a school-based childhood obesity monitoring program in Australia. The primary purpose of such a program would be to collect population-level health data to inform both policy and the development and evaluation of community-based obesity prevention interventions. Recommendations are made for the types of data to be collected, data collection procedures and program management and evaluation. Data from an obesity monitoring program are crucial for directing and informing policies, practices and services, identifying subgroups at greatest risk of obesity and evaluating progress towards meeting obesity-related targets. Such data would also increase the community awareness necessary to foster change.

Sizing the association between lifestyle behaviours and fatness in a large, heterogeneous sample of youth of multiple ethnicities from 4 countries.

BACKGROUND: The magnitude of the relationship between lifestyle risk factors for obesity and adiposity is not clear. The aim of this study was to clarify this in order to determine the level of importance of lifestyle factors in obesity aetiology. METHODS: A cross-sectional analysis was carried out on data on youth who were not trying to change weight (n = 5714), aged 12 to 22 years and from 8 ethnic groups living in New Zealand, Australia, Fiji and Tonga. Demographic and lifestyle data were measured by questionnaires. Fatness was measured by body mass index (BMI), BMI z-score and bioimpedance analysis, which was used to estimate percent body fat and total fat mass (TFM). Associations between lifestyle and body composition variables were examined using linear regression and forest plots. RESULTS: TV watching was positively related to fatness in a dose-dependent manner. Strong, dose-dependent associations were observed between fatness and soft drink consumption (positive relationship), breakfast consumption (inverse relationship) and after-school physical activity (inverse relationship). Breakfast consumption-fatness associations varied in size across ethnic groups. Lifestyle risk factors for obesity were associated with percentage differences in body composition variables that were greatest for TFM and smallest for BMI. CONCLUSIONS: Lifestyle factors were most strongly related to TFM, which suggests that studies that use BMI alone to quantify fatness underestimate the full effect of lifestyle on adiposity. This study clarifies the size of lifestyle-fatness relationships observed in previous studies.

Community-based efforts to prevent obesity: Australia-wide survey of projects.

ISSUES ADDRESSED: Community-based programs that affect healthy environments and policies have emerged as an effective response to high obesity levels in populations. Apart from limited individual reports, little is currently known about these programs, limiting the potential to provide effective support, to promote effective practice, prevent adverse outcomes and disseminate intervention results and experience. The aim of the present study was to identify the size and reach of current community-based obesity prevention projects in Australia and to examine their characteristics, program features (e.g. intervention setting), capacity and approach to obesity prevention. METHODS: Detailed survey completed by representatives from community-based obesity prevention initiatives in Australia. RESULTS: There was wide variation in funding, capacity and approach to obesity prevention among the 78 participating projects. Median annual funding was Au$94900 (range Au$2500-$4.46 million). The most common intervention settings were schools (39%). Forty per cent of programs focused on a population group of ≥50000 people. A large proportion of respondents felt that they did not have sufficient resources or staff training to achieve project objectives. CONCLUSION: Community-based projects currently represent a very large investment by both government and non-government sectors for the prevention of obesity. Existing projects are diverse in size and scope, and reach large segments of the population. Further work is needed to identify the full extent of existing community actions and to monitor their reach and future 'scale up' to ensure that future activities aim for effective integration into systems, policies and environments. SO WHAT? Community-based programs make a substantial contribution to the prevention of obesity and promotion of healthy lifestyles in Australia. A risk of the current intervention landscape is that effective approaches may go unrecognised due to lack of effective evaluations or limitations in program design, duration or size. Policy makers and researchers must recognise the potential contribution of these initiatives, to both public health and knowledge generation, and provide support for strong evaluation and sustainable intervention designs.

New insights in the mechanisms of weight-loss maintenance: Summary from a Pennington symposium.

Obesity is a chronic disease that affects more than 650 million adults worldwide. Obesity not only is a significant health concern on its own, but predisposes to cardiometabolic comorbidities, including coronary heart disease, dyslipidemia, hypertension, type 2 diabetes, and some cancers. Lifestyle interventions effectively promote weight loss of 5% to 10%, and pharmacological and surgical interventions even more, with some novel approved drugs inducing up to an average of 25% weight loss. Yet, maintaining weight loss over the long-term remains extremely challenging, and subsequent weight gain is typical. The mechanisms underlying weight regain remain to be fully elucidated. The purpose of this Pennington Biomedical Scientific Symposium was to review and highlight the complex interplay between the physiological, behavioral, and environmental systems controlling energy intake and expenditure. Each of these contributions were further discussed in the context of weight-loss maintenance, and systems-level viewpoints were highlighted to interpret gaps in current approaches. The invited speakers built upon the science of obesity and weight loss to collectively propose future research directions that will aid in revealing the complicated mechanisms involved in the weight-reduced state.

The global obesity pandemic: shaped by global drivers and local environments.

The simultaneous increases in obesity in almost all countries seem to be driven mainly by changes in the global food system, which is producing more processed, affordable, and effectively marketed food than ever before. This passive overconsumption of energy leading to obesity is a predictable outcome of market economies predicated on consumption-based growth. The global food system drivers interact with local environmental factors to create a wide variation in obesity prevalence between populations. Within populations, the interactions between environmental and individual factors, including genetic makeup, explain variability in body size between individuals. However, even with this individual variation, the epidemic has predictable patterns in subpopulations. In low-income countries, obesity mostly affects middle-aged adults (especially women) from wealthy, urban environments; whereas in high-income countries it affects both sexes and all ages, but is disproportionately greater in disadvantaged groups. Unlike other major causes of preventable death and disability, such as tobacco use, injuries, and infectious diseases, there are no exemplar populations in which the obesity epidemic has been reversed by public health measures. This absence increases the urgency for evidence-creating policy action, with a priority on reduction of the supply-side drivers.

Quantification of the effect of energy imbalance on bodyweight.

Obesity interventions can result in weight loss, but accurate prediction of the bodyweight time course requires properly accounting for dynamic energy imbalances. In this report, we describe a mathematical modelling approach to adult human metabolism that simulates energy expenditure adaptations during weight loss. We also present a web-based simulator for prediction of weight change dynamics. We show that the bodyweight response to a change of energy intake is slow, with half times of about 1 year. Furthermore, adults with greater adiposity have a larger expected weight loss for the same change of energy intake, and to reach their steady-state weight will take longer than it would for those with less initial body fat. Using a population-averaged model, we calculated the energy-balance dynamics corresponding to the development of the US adult obesity epidemic. A small persistent average daily energy imbalance gap between intake and expenditure of about 30 kJ per day underlies the observed average weight gain. However, energy intake must have risen to keep pace with increased expenditure associated with increased weight. The average increase of energy intake needed to sustain the increased weight (the maintenance energy gap) has amounted to about 0·9 MJ per day and quantifies the public health challenge to reverse the obesity epidemic.

Changing the future of obesity: science, policy, and action.

The global obesity epidemic has been escalating for four decades, yet sustained prevention efforts have barely begun. An emerging science that uses quantitative models has provided key insights into the dynamics of this epidemic, and enabled researchers to combine evidence and to calculate the effect of behaviours, interventions, and policies at several levels--from individual to population. Forecasts suggest that high rates of obesity will affect future population health and economics. Energy gap models have quantified the association of changes in energy intake and expenditure with weight change, and have documented the effect of higher intake on obesity prevalence. Empirical evidence that shows interventions are effective is limited but expanding. We identify several cost-effective policies that governments should prioritise for implementation. Systems science provides a framework for organising the complexity of forces driving the obesity epidemic and has important implications for policy makers. Many parties (such as governments, international organisations, the private sector, and civil society) need to contribute complementary actions in a coordinated approach. Priority actions include policies to improve the food and built environments, cross-cutting actions (such as leadership, healthy public policies, and monitoring), and much greater funding for prevention programmes. Increased investment in population obesity monitoring would improve the accuracy of forecasts and evaluations. The integration of actions within existing systems into both health and non-health sectors (trade, agriculture, transport, urban planning, and development) can greatly increase the influence and sustainability of policies. We call for a sustained worldwide effort to monitor, prevent, and control obesity.

Screen time and physical activity behaviours are associated with health-related quality of life in Australian adolescents.

PURPOSE: To explore the cross-sectional relationships between health-related quality of life (HRQoL) and physical activity (PA) behaviours and screen-based media (SBM) use among a sample of Australian adolescents. METHODS: Data came from baseline measures collected for the It's Your Move! community-based obesity prevention intervention. Questionnaire data on sociodemographics, PA, SBM and HRQoL were collected from 3,040 students (56% boys) aged 11-18 years in grade levels 7-11 in 12 secondary schools. Anthropometric data were measured. RESULTS: The highest level of PA at recess, lunchtime and after school was associated with higher HRQoL scores (boys, by 5.3, 8.1, 6.3 points; girls, by 4.2, 6.1, 8.2 points) compared with not being active during these periods. Exceeding 2 h of SBM use each day was associated with significantly lower HRQoL scores (boys, by 3.2 points; girls, by 4.0 points). Adolescents who were physically active and low SBM users on school days had higher HRQoL scores (boys, by 6.6 points; girls, by 7.8 points) compared with those who were not physically active every school day and high SBM users on school days. CONCLUSIONS: Several of the relationships between low PA and high SBM use and HRQoL were comparable to those previously observed between chronic disease conditions and HRQoL, indicating that these behaviours deserve substantial attention.

Utility-based quality of life of overweight and obese adolescents.

OBJECTIVE: To explore the relationship between overweight/obesity and utility in adolescents. METHODS: Data were collected from 2890 adolescents attending 13 secondary schools in the state of Victoria, Australia. The Assessment of Quality of Life 6-Dimension (AQoL-6D) questionnaire was used to measure individual utility. Adolescent's height and weight were measured and weight status categories assigned according to the World Health Organization adolescent growth standards. Multivariate linear regression analyses were undertaken for the whole population and subpopulations of boys and girls to estimate the mean differences in utility scores between 1) overweight and healthy weight and 2) obese and healthy weight adolescents, while controlling for demographic and socioeconomic status variables. RESULTS: The mean age of adolescents was 14.6 years, 56.2% were boys, 22.2% were overweight, and 9.4% were obese. The mean utility of healthy weight adolescents was 0.860. After adjustments, the overweight and obese groups reported significantly lower mean utility scores (differences: -0.018 and -0.059, respectively, relative to the healthy weight group). This can be interpreted as equivalent to a stated willingness to sacrifice 1.8% and 5.9% of a life in perfect health or 2.3% and 6.8% of a life at healthy weight. A significant utility difference associated with overweight was only experienced by girls (-0.039, P = 0.003). Both sexes experienced significant utility differences associated with obesity, but the magnitude was double for girls (-0.084, P < 0.001) relative to boys (-0.041, P = 0.022). CONCLUSION: Utility is lower among overweight and more so among obese adolescents.

Process evaluation of a community-based adolescent obesity prevention project in Tonga.

BACKGROUND: The rising burden of obesity in Tonga is alarming. The promotion of healthy behaviours and environments requires immediate urgent action and a multi-sectoral approach. A three-year community based study titled the Ma'alahi Youth Project (MYP) conducted in Tonga from 2005-2008 aimed to increase the capacity of the whole community (schools, churches, parents and adolescents) to promote healthy eating and regular physical activity and to reduce the prevalence of overweight and obesity amongst youth and their families. This paper reflects on the process evaluation for MYP, against a set of Best Practice Principles for community-based obesity prevention. METHODS: MYP was managed by the Fiji School of Medicine. A team of five staff in Tonga were committed to planning, implementation and evaluation of a strategic plan, the key planks of which were developed during a two day community workshop. Intervention activities were delivered in villages, churches and schools, on the main island of Tongatapu. Process evaluation data covering the resource utilisation associated with all intervention activities were collected, and analysed by dose, frequency and reach for specific strategies. The action plan included three standard objectives around capacity building, social marketing and evaluation; four nutrition; two physical activity objectives; and one around championing key people as role models. RESULTS: While the interventions included a wide mix of activities straddling across all of these objectives and in both school and village settings, there was a major focus on the social marketing and physical activity objectives. The intervention reach, frequency and dose varied widely across all activities, and showed no consistent patterns. CONCLUSIONS: The adolescent obesity interventions implemented as part of the MYP program comprised a wide range of activities conducted in multiple settings, touched a broad spectrum of the population (wider than the target group), but the dose and frequency of activities were generally insufficient and not sustained. Also the project confirmed that, while the MYP resulted in increased community awareness of healthy behaviours, Tonga is still in its infancy in terms of conducting public health research and lacks research infrastructure and capacity.

The process evaluation of It's Your Move!, an Australian adolescent community-based obesity prevention project.

BACKGROUND: Evidence on interventions for preventing unhealthy weight gain in adolescents is urgently needed. The aim of this paper is to describe the process evaluation for a three-year (2005-2008) project conducted in five secondary schools in the East Geelong/Bellarine region of Victoria, Australia. The project, 'It's Your Move!' aimed to reduce unhealthy weight gain by promoting healthy eating patterns, regular physical activity, healthy body weight, and body size perception amongst youth; and improve the capacity of families, schools, and community organisations to sustain the promotion of healthy eating and physical activity in the region. METHODS: The project was supported by Deakin University (training and evaluation), a Reference Committee (strategic direction, budgetary approval and monitoring) and a Project Management Committee (project delivery). A workshop of students, teachers and other stakeholders formulated a 10-point action plan, which was then translated into strategies and initiatives specific to each school by the School Project Officers (staff members released from teaching duties one day per week) and trained Student Ambassadors. Baseline surveys informed intervention development. Process data were collected on all intervention activities and these were collated and enumerated, where possible, into a set of mutually exclusive tables to demonstrate the types of strategies and the dose, frequency and reach of intervention activities. RESULTS: The action plan included three guiding objectives, four on nutrition, two on physical activity and one on body image. The process evaluation data showed that a mix of intervention strategies were implemented, including social marketing, one-off events, lunch time and curriculum programs, improvements in infrastructure, and healthy school food policies. The majority of the interventions were implemented in schools and focused on capacity building and healthy eating strategies as physical activity practices were seen by the teachers as already meeting students' needs. CONCLUSIONS: While substantial health-promoting activities were conducted (especially related to healthy eating), there remain further opportunities for secondary schools to use a whole-of-school approach through the school curriculum, environment, policies and ethos to improve healthy eating, physical activity and healthy body perceptions in youth. To achieve this, significant, sustained leadership will be required within the education sector generally and within schools specifically.

Increasing community capacity to prevent childhood obesity: challenges, lessons learned and results from the Romp & Chomp intervention.

BACKGROUND: Obesity is a major public health issue; however, only limited evidence is available about effective ways to prevent obesity, particularly in early childhood. Romp & Chomp was a community-wide obesity prevention intervention conducted in Geelong Australia with a target group of 12,000 children aged 0-5 years. The intervention had an environmental and capacity building focus and we have recently demonstrated that the prevalence of overweight/obesity was lower in intervention children, post-intervention. Capacity building is defined as the development of knowledge, skills, commitment, structures, systems and leadership to enable effective health promotion and the aim of this study was to determine if the capacity of the Geelong community, represented by key stakeholder organisations, to support healthy eating and physical activity for young children was increased after Romp & Chomp. METHODS: A mixed methods evaluation with three data sources was utilised. 1) Document analysis comprised assessment of the documented formative and intervention activities against a capacity building framework (five domains: Partnerships, Leadership, Resource Allocation, Workforce Development, and Organisational Development); 2) Thematic analysis of key informant interviews (n = 16); and 3) the quantitative Community Capacity Index Survey. RESULTS: Document analysis showed that the majority of the capacity building activities addressed the Partnerships, Resource Allocation and Organisational Development domains of capacity building, with a lack of activity in the Leadership and Workforce Development domains. The thematic analysis revealed the establishment of sustainable partnerships, use of specialist advice, and integration of activities into ongoing formal training for early childhood workers. Complex issues also emerged from the key informant interviews regarding the challenges of limited funding, high staff turnover, changing governance structures, lack of high level leadership and unclear communication strategies. The Community Capacity Index provided further evidence that the project implementation network achieved a moderate level of capacity. CONCLUSIONS: Romp & Chomp increased the capacity of organisations, settings and services in the Geelong community to support healthy eating and physical activity for young children. Despite this success there are important learnings from this mixed methods evaluation that should inform current and future community-based public health and health promotion initiatives. TRIAL REGISTRATION NUMBER: ANZCTRN12607000374460.