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WHO Collaborating Centre for Obesity Prevention
Steven Allender
Best bets – what to do?
Professor of Population Health
Co-Director
WHO Collaborating Centre for Obesity
Prevention
Deakin University
Australia
Senior Researcher
Coronary Heart Disease Statistics
Department of Public Health
University of Oxford
Port Fairy Yacht Club September 3rd & 4th 2012
WHO Collaborating Centre for Obesity Prevention
What works for children?
WHO Collaborating Centre for Obesity Prevention
There is lots of evidence
WHO Collaborating Centre for Obesity Prevention 2011
WHO Collaborating Centre for Obesity Prevention
Review summary
Aims
This review primarily aims to... determine the effectiveness of evaluated interventions intended to
prevent obesity in children, assessed by change in BodyMass Index (BMI).
Secondary aims were to examine the characteristics of the programs and strategies to answer the
questions “What works for whom, why and for what cost?”
Search methods
The searches were re-run in CENTRAL, MEDLINE, EMBASE, PsychINFO and CINAHL in March
2010 and searched relevant websites. Non-English language papers were included and experts
were contacted.
Selection criteria
The review includes data from childhood obesity prevention studies that used a controlled study
design (with or without randomisation). Studies were included if they evaluated interventions,
policies or programs in place for twelve weeks or more.
WHO Collaborating Centre for Obesity Prevention
Review results
55 studies (36 more than 2009)
Majority children aged 6- 12 years
Some evidence that programmes were effective at reducing adiposity.
Strong evidence of child obesity prevention programmes reducing on BMI
Promising policies and strategies:
· school curriculum that includes healthy eating, physical activity and body image
· increased sessions for physical activity and the development of fundamental
movement skills throughout the school week
· improvements in nutritional quality of the food supply in schools
WHO Collaborating Centre for Obesity Prevention
Review results
Promising policies and strategies:
· environments and cultural practices that support children eating
healthier foods and being active throughout each day
· support for teachers and other staff to implement health promotion
strategies and activities (e.g. professional development,
capacity building activities)
· parent support and home activities that encourage children to be more
active, eat more nutritious foods and spend less time in
screen based activities
WHO Collaborating Centre for Obesity Prevention
Prioritisation
WHO Collaborating Centre for Obesity Prevention
Prioritisation!!!
WHO Collaborating Centre for Obesity Prevention Geelong
Overview – Sentinel Site for Obesity
Prevention
• Three demonstration projects in
community-based obesity prevention
• Aim: To build the programs, skills and
evidence necessary to prevent obesity
among children and adolescents
• WHO Collaborating Centre for obesity
prevention, Deakin University
• Barwon South-west region
WHO Collaborating Centre for Obesity Prevention
SSOP Projects - Objectives
Three standard objectives in all three projects:
1. To increase the capacity of relevant Geelong
organisations to promote healthy eating and
physical activity
2. To increase the awareness of the project’s key
messages in homes and early childhood settings
3. To evaluate the process, impact and outcomes
of the project
WHO Collaborating Centre for Obesity Prevention
Sentinel Site for Obesity Prevention
• Features and innovation: – Focusing resources into a defined
geographical area
– Community capacity building
– Multi-strategy, multi-setting intervention
programs
– Monitoring
– Evaluation
WHO Collaborating Centre for Obesity Prevention
Barwon-South Western region
Geelong
Regional
population
~300,000
Geelong
population
~200,000
WHO Collaborating Centre for Obesity Prevention
Logic model for OPIC interventions
1 Intervention dose is either 1 or 0 (intervention, control) or $$ (economic input – all schools)2 Capacity is leadership, skills/knowledge, structures, resources3 Relevant environments are schools, homes, neighbourhoods, churches4 Weight, BMI, BMI-z, waist, waist:height, %fat, prevalence of o/w+obesity
Intervention
Dose1
Δ Community
capacity2
Δ Environments3
Δ Knowledge,
attitudes, beliefs,
perceptions etc
Δ Behaviours Δ Anthropometry4
INPUTS
POPULATION
MEDIATORS
INDIVIDUAL
MEDIATORSOUTCOMES
MODERATORS
Ethnicity, socio-cultural
factors, gender, age, SES
Δ QoL
Δ QALYs gained
Δ Policy
= Measured = Modelled
Logic model
WHO Collaborating Centre for Obesity Prevention
<5 y/o
WHO Collaborating Centre for Obesity Prevention
Romp & Chomp specific objectives –
developed through ANGELO process
• Increase:
– Consumption of
water and milk
– Consumption of fruit
and vegetables
– Active play at home
– Structured active
play in early
childhood settings
• Decrease:
– Consumption of high
sugar drinks
– Consumption of
energy dense snacks
– TV viewing time
WHO Collaborating Centre for Obesity Prevention
Romp & Chomp - outcomes
WHO Collaborating Centre for Obesity Prevention
4-12 y/o
WHO Collaborating Centre for Obesity Prevention
BAEW specific objectives
• Increase
– The proportion of
primary school
children who
walk/cycle to school
– The amount of active
play in the after-
school time and on
weekends
– Consumption of fruit
• Decrease
– Time spent watching
TV & playing on
computers or
electronic games
– Consumption of high
sugar drinks
– Consumption of
packaged, energy
dense snacks
WHO Collaborating Centre for Obesity Prevention
BAEW – Physical activity
interventions Physical activity strategies • After-school activities program
• Be Active Arts program
• Walking school buses and walk to school days
• Promotional materials (for example, balloons, stickers)
• Sporting club coach training and equipment
• Sets of pedometers
Screen time • TV power-down week, including a 2-week curriculum
• Interactive, glossy, children’s newsletters (5 x 1600, distributed through schools)
• Teacher fliers (linking to children’s newsletters)
WHO Collaborating Centre for Obesity Prevention
Less weight and waist gain in intervention group
over 3y
-3.5
-3
-2.5
-2
-1.5
-1
-0.5
0BMI (kg/m2) z-BMI Weight (kg) Waist (cm)
Un
its
of
Ch
ange
(In
t ve
rsu
s C
om
p)
p = 0.056
p = 0.017
p = 0.014
p = 0.000
Adjusted for confounders: age, gender, height, duration of follow up Sanigorski et al Int J Obesity 2008
WHO Collaborating Centre for Obesity Prevention
Preventing unhealthy weight gain
adolescents
It’s Your Move! An adolescent obesity prevention project conducted in the Barwon-South Western Region of Victoria
WHO Collaborating Centre for Obesity Prevention
It’s Your Move!
• Community-based, 3-year obesity prevention program in 5 secondary schools in Geelong
• 1 of 4 sites in the Pacific OPIC
Project (Obesity Prevention
In Communities)
• Funded by DHS, NHMRC,
VicHealth, DoHA
Geelong
WHO Collaborating Centre for Obesity Prevention
Evaluation
• Outcome and impact evaluation
– Before and after measurements
• Intervention area (E Geelong/Bellarine) versus
comparison area (rest of Barwon-SW region)
– 3,075 high school students participating in evaluation
– Outcome measures
• Body composition, body mass index, waist
circumference
– Impact measures
• Behaviours, knowledge, attitudes, quality of life
• Process evaluation
WHO Collaborating Centre for Obesity Prevention
Evaluation
• School Environmental Surveys
– 3 part survey
• Part 1 completed by principal [25 questions]
• Part 2 completed by canteen manager [12 questions Part 2 ]
• Part 3 completed by 3 teachers [individually, 27 questions]
• Socio-cultural studies
– Qualitative and quantitative studies
– S-C influences on food, PA, body size perception
• Quality of Life
– 2 Quality of Life questionnaires validated for adolescents
WHO Collaborating Centre for Obesity Prevention
Measurements and surveys
WHO Collaborating Centre for Obesity Prevention
It’s Your Move! Intervention
Three standard objectives
- Building Capacity
- Social Marketing
- Evaluation
Four nutrition objectives
- Water versus sweet drinks
- Breakfast
- Fruit and vegetables
- Food @ School
Two physical activity objectives
- Walking and cycling
- Getting active
One innovative objective
- Healthy body weight, shape and size
WHO Collaborating Centre for Obesity Prevention
Water versus Sweet Drinks
• Water bottle – teacher and booklist
• Vending machine changes
• DVD presentation developed by Ambassadors
• Curriculum: Sweet drink display
• Water fountains
• Water Policy
• School Newsletters
• Postcard for classrooms
• Water Bottle Rules
• Social Marketing • ‘H2O, way to go!’
WHO Collaborating Centre for Obesity Prevention
Lessons learnt
• To present two intervention strategies which
worked well:
– Student Ambassador Model
– Food @ School framework
And one which did not work well:
– School lunchtime activities
• To understand the critical success factors for
intervention strategies
WHO Collaborating Centre for Obesity Prevention
Student Ambassador Model
• Selection of students
– Dependent on the school: School Project
Officer selection, interview, or application
• Formal training: Certificate II Sport and Event
Management
– Included: planning retreats to provide skills,
knowledge, leadership, and positive peer
feedback
WHO Collaborating Centre for Obesity Prevention
Role of Student Ambassadors
• For the project
– Planning (action plan and annual plans)
– Leadership and spokespeople
• For the schools
– Peer-led interventions, advocacy for change,
leadership
• For themselves
– Leadership training and practice
WHO Collaborating Centre for Obesity Prevention
Student Ambassadors
WHO Collaborating Centre for Obesity Prevention
Student Ambassadors: Key Learnings
• Vital component to ensure that the
school interventions were peer-led
while building the students’ own
capacity
• Highly valued and accepted role by
the students (considered positive &
cool)
• Program required high
Project Co-ordinator input
WHO Collaborating Centre for Obesity Prevention
Food @ School Framework
• A whole school approach to food
– Including several action plan strategies:
• Curriculum materials
• Supportive school environments
• Healthy eating messages
• Policies and support materials for breakfast,
camps, excursions and sport days, catering,
fundraising, canteens, vending machines, water,
and occupational health and safety and rewarding
students in the classroom
WHO Collaborating Centre for Obesity Prevention
Food @ School: Implementation
• ‘Bottom-up’ approach
– Project coordinators working with staff and
students through to the school governance
systems
– Evolved from practice to policy
• Combined the multiple food and healthy
eating strategies together
• Long process (up to 3 years) to ratify
WHO Collaborating Centre for Obesity Prevention
Food @ School Framework: Key Learnings
• A staged, ‘bottom up’ approach allows time for gaining buy-in and flexibility but makes it a long process
• Elements were tailored to each school’s context so that the final policy differed significantly across the five schools
• Value in combining nutrition objectives
• Significant input by the project team
WHO Collaborating Centre for Obesity Prevention
Lunchtime Activities
• Lunchtime activities at schools such as:
– Physical Activity: yoga, walking groups, dance, 3 on 3
basketball, soccer tournaments
– Food: soup, sushi, salad wraps, juice
• Tended to start with great enthusiasm but were
relatively short lived
WHO Collaborating Centre for Obesity Prevention
Lunchtime Activities: Key Learnings
• Lunchtime activities and one off events (e.g. physical activity or healthy eating promotional days)
– Initially positive & good for raising awareness
– More readily implemented than policy or environmental changes
– Required high School Project Officer input
• High project staff input
– Took their time and attention away from the more sustainable activities
WHO Collaborating Centre for Obesity Prevention
Conclusions: Intervention
• School-based interventions need to focus on structures and policies more than activities
• Work through the existing school structures,
– this may take several years in the case of comprehensive food policies.
• Student Ambassador program does require coordination resources but has multiple student and program benefits
WHO Collaborating Centre for Obesity Prevention
What is the intervention in CBIs?
• Community capacity building approach
– Leadership and commitment
– Funding and resources
– Organisational relationships and structures
– Knowledge and skills
• Multiple settings and participatory process
– The approach and process need to be robust
– Content is determined and specified by the
community players Bell et al Health Prom Int 2008
WHO Collaborating Centre for Obesity Prevention
Community Readiness to Change
Level of readiness to change
(y axis)
9. High level of community
ownership
8. Confirmation/ expansion
7. Stabilization
6. Initiation
5. Preparation
4. Pre-planning
3. Vague awareness
2. Denial/Resistance
1. No awareness
0
1
2
3
4
5
6
7
8
9
Intervention schools Comparison schools
WHO Collaborating Centre for Obesity Prevention
IYM: Individual school changes
Percentage point change in overweight/obesity prevalence
Millar et al Obesity Rev 2011 12(suppl 2): 20-28
-8.1
8.9
4.3
1.8
0.0
3.8
-1.4
0.0 -0.3
-4.7 -5.6
-8.0
-20.0
-15.0
-10.0
-5.0
0.0
5.0
10.0
15.0
20.0
% c
han
ge
ove
rwe
igh
t/ o
bes
e b
as
eli
ne t
o f
ollo
w-u
p
Unit change (shaded) in Community Readiness to Change from baseline to follow-up
No change +1 increase +2 increase +3 increase
Millar et al., forthcoming
WHO Collaborating Centre for Obesity Prevention
7 Community Demonstration Projects:
Capacity Building Pyramid
PROJECTS
Fun ‘n’ Healthy in Moreland (FHM)
Colac Be Active Eat Well (BAEW)
Geelong Romp & Champ (R&C)
E Geelong It’s Your Move! (IYM)
Fiji Healthy Youth
Healthy Community (HYHC)
Tonga Ma’alahi Youth (MY)
Mangere Living for Life (LFL)
PI – 4
Co-Inv – 16
Staff, RFs, HDR – 64 FHM 13; BAEW, R&C, IYM 24;
HYHC 11; MY 8; LFL 8
Partner organisations ~ 102 (eg schools, LGAs, health orgs, community orgs,
peak bodies, govt agencies, commercial entities)
FHM 28; BAEW, R&C, IYM 40, HYHC 17; MY 14; LFL 17
Other Stakeholders ~ 283 (eg funders, other settings, linked organisations)
FHM 55; BAEW, R&C, IYM 85, HYHC 78; MY 35; LFL 30
Children & adolescents* ~ 31,500 FHM 3,000; BAEW, R&C, IYM 17,000, HYHC 6,000; MY 1500; LFL 4000
* Children in intervention
communities. Families
and others influenced by
the interventions are
additional to this. This
number again are in the
comparison communities.
Response rates 35-70%
Research
Practice
Policy
WHO Collaborating Centre for Obesity Prevention
What could be done directly? (1)
• Policies (ie school rules)
– Access to school grounds, equipment etc
– Need to make sure that policies are not unduly
preventing informal PA
– Can only apply where schools have jurisdiction
– Policies are important because they set the
boundaries and reflect the culture
• Curriculum
– More ‘Active’ curriculum – moving (or even
standing) embedded into learning
– Content area of learning about PA & fitness
WHO Collaborating Centre for Obesity Prevention
What could be done directly? (2)
• Social marketing
– Developing messages and materials
– What are the motivators (fun, social, alert and awake, cool) and
aware of ‘costs’
– Usually done as ‘campaign’ (sustainability?)
• Programs
– Supporting informal PA (esp for those less active, non competitive)
– Often need leaders because not formalised
• Events or other initiatives
– Can be good (awareness, something new, launch etc)
– One-offs take a lot of effort and can distract from influencing
systems and embedding change
WHO Collaborating Centre for Obesity Prevention
What could done with the systems? (1)
• Leadership support and role modelling
– Who are the champions for any policy changes needed to
have school rules (and culture) promoting informal PA?
– Policy often requires ‘bottom-up’ pressure and top level
stewardship through the system
– Staff and student leaders as role models
• Information systems
– What’s happening? How do you let people know?
• Financing
– Equipment
– Supervision
WHO Collaborating Centre for Obesity Prevention
What could done with the systems? (2)
• Partnerships/networks
– Links with community opportunities (more often
formal and organised sport or activities)
– Promotion within the school (reciprocal visits,
information flows, meeting people etc)
• Workforce development
– Does the existing workforce training for teachers
and staff need to be strengthened in this area?
– Volunteer training systems
WHO Collaborating Centre for Obesity Prevention
Food at school
• Includes: food sold in canteens; vending
machines; food at events; food for fundraising;
food as rewards; role modelling etc
• While food at school does not include a large
amount of a student’s annual energy intake, it
has an enormous ‘Lighthouse Effect’
• Tough but most important area with many
stakeholders
• Needs to in all school’s action plans
WHO Collaborating Centre for Obesity Prevention
School Environment – Canteen Menu
NONE of the primary schools measured in Victoria met the Healthy
Canteen Guidelines
WHO Collaborating Centre for Obesity Prevention
Specific food issues
• Sugar-sweetened beverages including fruit juices
– A priority to reduce, closely linked with weight gain
and poor oral health
• Foods high in fat, salt and sugar
– Often cheap, tasty, easy to prepare, long shelf life,
higher profit margins, promoted, in demand etc
• Fruit
– Quite high consumption at school, easy to promote
• Vegetables
– V few meet guidelines, harder to promote at school
WHO Collaborating Centre for Obesity Prevention
What could be done directly? (1)
• Policies (ie school rules)
– Comprehensive school food policy – developed,
promoted, implemented, monitored
– Takes a lot of effort and needs high level champions
– Reflection of school values versus realities (student
well being vs profit, healthy ideal vs current habits)
• Curriculum
– Substantial scope within curriculum (health and
other area)
– Linking what is taught with what is practised
WHO Collaborating Centre for Obesity Prevention
What could be done directly? (2)
• Social marketing
– Developing messages & materials (especially linked to new policy)
– What are the motivators and what are the ‘costs’
– Who is the audience (students, teachers, parents, school board)
• Programs
– Growing, cooking, eating, cuisines etc etc
– Embedded in ongoing school activities
• Events or other initiatives
– Many options (but events are a lot of work)
– Good for launching new initiatives
– Structural options eg gardens
WHO Collaborating Centre for Obesity Prevention
What could done with the systems? (1)
• Leadership support and role modelling
– Leadership is absolutely critical for getting healthy school
food policies through the system – many stakeholders
– Staff and student leaders as role models
• Information systems
– Communication systems are vital – keeping everyone in
the loop, up-coming, positive feedback etc
– Monitoring and feedback on progress of school canteen
• Financing
– Profits from canteen, food fundraisers etc
– Altered profit margins, more preparation of fresh food
WHO Collaborating Centre for Obesity Prevention
What could done with the systems? (2)
• Partnerships/networks
– Many food-related potential partners in the
community (farm to plate)
– Links with schools who have made the transition
to healthy food schools
• Workforce development
– Does the existing workforce training for canteen
managers and teachers need to be strengthened
in this area?
– Volunteer training systems
WHO Collaborating Centre for Obesity Prevention
33% of students were trying to lose
weight
Other IYM findings of note
WHO Collaborating Centre for Obesity Prevention
Project plans
• Name?
• Overall aim – reducing unhealthy weight gain
and improving well being in adolescents
• Objectives (SMART - what will be achieved?)
– Comprehensive food at school policy
– Active transport (Melrose), informal PA
(Deakin), mental health (Calwell)
• Strategies (how will the objective be achieved)
• Actions (who will do what by when)
WHO Collaborating Centre for Obesity Prevention
Project plans
• Living documents (version control)
• Focus of the management meetings
• Augmented by GANTT charts
• Used for the evaluation of
– Process
– Embedding in systems
– Modifying systems
WHO Collaborating Centre for Obesity Prevention
‘In’ the system – Food at school
• To develop, ratify, implement and monitor a
comprehensive school food policy
• Strategies
– Governance and leadership eg school food steering
committee with mandate and timelines
– Information systems on progress with feedback eg canteen
sales, student satisfaction
– Resources to get to full implementation (project $$), ongoing
business model
– Partnerships (eg NA), networks (eg other schools), contracts
(eg with providers)
– Workforce development eg canteen manager training
– Social marketing targeting decision-makers
WHO Collaborating Centre for Obesity Prevention
‘In’ the system – Active transport
• To increase the proportion of students (living within 30
minutes walking radius of school) using AT regularly to/from
school by x%
• Strategies
– Supportive environments eg bike sheds, cycle
lanes, crossing safety, safe routes
– Social marketing
– Training programs for cycling
– Partnerships with council
– Information systems on transport to school
WHO Collaborating Centre for Obesity Prevention
‘On’ the system – leadership
• Leadership and governance (for improving
environments and behaviours related to healthy eating and PA)
– To optimise the school’s existing leadership
and governance systems, and include new
structures and processes for identifying and
supporting diverse champions
• Seeding question for actions
– What needs to happen (or is happening) to
achieve the above optimised and enhanced
leadership and governance systems?
WHO Collaborating Centre for Obesity Prevention
On the system – information
• Information and communications (for improving
environments and behaviours related to healthy eating and PA)
– To optimise the school’s existing information
and communications systems and include new
intelligence loops such that information is
gathered and effectively communicated to the
right audiences
• Seeding question for actions
– What needs to happen to achieve the above
optimised and enhanced information systems?
WHO Collaborating Centre for Obesity Prevention
‘On’ the system – resources
• Finances and resources (for improving environments
and behaviours related to healthy eating and PA)
– To mobilise from existing and new sources,
sufficient resources to sustain effective actions
• Seeding question for actions
– What needs to happen to achieve the above
optimised and enhanced finances/resource
systems?
WHO Collaborating Centre for Obesity Prevention
‘On’ the system – partnerships
• Partnerships, networks and organisational
relationships (for improving environments and behaviours
related to healthy eating and PA)
– To optimise existing relationships and create
new relationships to enhance actions
• Seeding question for actions
– What needs to happen to achieve the above
optimised and enhanced partnership and
relationships?
WHO Collaborating Centre for Obesity Prevention
‘On’ the system – workforce
• Workforce development (for improving environments
and behaviours related to healthy eating and PA)
– To enhance existing WF development
systems and identify new opportunities for
staff, students and volunteers to increase their
skills and confidence to promote healthy
eating and PA
• Seeding question for actions
– What needs to happen to achieve the above
optimised and enhanced workforce
development systems?
WHO Collaborating Centre for Obesity Prevention
Steven Allender
Best bets – what to do?
Professor of Population Health
Co-Director
WHO Collaborating Centre for Obesity
Prevention
Deakin University
Australia
Senior Researcher
Coronary Heart Disease Statistics
Department of Public Health
University of Oxford
Port Fairy Yacht Club September 3rd & 4th 2012
WHO Collaborating Centre for Obesity Prevention
Actions Description Leadership Information Financing Partnerships Workforce
Policy That at least 50%
of food at school
is ‘green’
Principal and school
leadership to develop and
drive policy
Parent committee,
teacher/s, school
leadership team
Student representative
committee
Canteen sales data
Student surveys of
choice
Audit of whether
policy is followed
Release
mandate to
make profit for 3
months to
assess viability
Find ways to
reduce cost of
healthy food
Nutrition Australia
ACT Health
ACT Education
Canteen provider
IYM Geelong
IYM School Co-
ordinator
Training of
canteen manager
and staff
Role modeling of
school teachers
Curriculum Kids learn how to
traffic light label
foods and apply
this to canteen
School curriculum
committee
Lead teachers in nutrition
subjects
Canteen management
Provided in class to
students
Canteen menu
Teacher time to
develop
curriculum
National curriculum
authority
Nutrition Australia
Key teachers in
each subject
Canteen
management
Social
marketing
Newsletters and
posters
supporting the
‘green food’
school
IYM Co-ordinator
Student Rep Council
Change in attitudes
to green food
% green foods
posted on school
web site
Support for
printing posters
Web site
support
Other IYM schools
Other ACT schools
Student/s or staff
to produce
article/flyer/s
School web
admin
Programs Food at school
program teaching
healthy cooking
and reading of
food labels
Teacher/s to coordinate
programs
Number provided
and attendance
Equipment
Teacher/
facilitator time
Church food
provision
Local s/markets
Students,
volunteers, clubs,
teachers,
associations
Events Healthy school
challenge
Nude food days
IYM Co-ordinator
Student Rep Committee
Parent and community
committee
Amount of
packaging used
Nutrition Australia
etc.
High % red food intake
Kids choose red foods
Used as rewards in
class Sold at special events
Sold in canteen
Green foods available
at school
Red foods available
from surrounding shops
Red foods available
from home
Red foods are available
Principal wants better
NAPLAN results
High demand for red
foods
Canteen provider is a
business
Need to be profitable
Cross subsidize other
activities
School management
Red foods common at
home
Staff role model red
foods
Red foods are normal
Red foods are cheap
Red foods are cool
Principal wants good
student behavior
Aim to meet national
curriculum Obesity prevention a
key focus
School food >50%
green
Canteen manager
Canteen cross
subsidizes other
activities
Canteen sales data
IYM COORDINATOR
WHO Collaborating Centre for Obesity Prevention
Investment in nutrition and PA activities
WHO Collaborating Centre for Obesity Prevention
What causes obesity?
Positive energy balance
• More energy is taken in than is spent, causing
an excess of energy which is converted into fat
WHO Collaborating Centre for Obesity Prevention
What causes obesity?
Positive energy balance
• More energy is taken in than is spent, causing
an excess of energy which is converted into fat
Energy
in Energy
out
WHO Collaborating Centre for Obesity Prevention
PHYSICAL ACTIVITY FOOD CONSUMPTION
Energy in
Energy out
WHO Collaborating Centre for Obesity Prevention
The Process
-The main question to remember is ‘why’
-The process can continue until the analysis reaches
a point where solutions become apparent, or when a
certain number of levels, commonly three, have
been detailed.
Pacific Research Centre for the Prevention of Obesity and Non-communicable Diseases
Starting problem
Cost Availability Preference
WHO Collaborating Centre for Obesity Prevention
The Process
-The main question to remember is ‘why’
Pacific Research Centre for the Prevention of Obesity and Non-communicable Diseases
LOW INTAKE FRUIT
Cost Availability Preference
Why is cost high
WHO Collaborating Centre for Obesity Prevention
The Process – Activity
-The main question to remember is ‘why’
Pacific Research Centre for the Prevention of Obesity and Non-communicable Diseases
LOW INTAKE FRUIT
Cost Availability Preference
High import
duties
Low levels local
production
WHO Collaborating Centre for Obesity Prevention
Red foods: Foods and drinks categorised as Red are energy dense but have little nutritional value. Most are high in saturated fat, salt and/or sugar.
Green foods: excellent sources of important nutrients and
represent the five food groups needed for optimum
health and wellbeing. They are low in saturated fat, added sugar and salt.
WHO Collaborating Centre for Obesity Prevention High % red food intake
WHO Collaborating Centre for Obesity Prevention High % red food intake
Kids choose red foods
WHO Collaborating Centre for Obesity Prevention High % red food intake
Kids choose red foods
Red foods are available
WHO Collaborating Centre for Obesity Prevention High % red food intake
Kids choose red foods
Red foods available at
school
Red foods available
from surrounding shops
Red foods available
from home
Red foods are available
WHO Collaborating Centre for Obesity Prevention High % red food intake
Kids choose red foods
Red foods available at
school
Red foods available
from surrounding shops
Red foods available
from home
Red foods are available
WHO Collaborating Centre for Obesity Prevention High % red food intake
Kids choose red foods
Used as rewards in
class Sold at special events
Sold in canteen
Red foods available at
school
Red foods available
from surrounding shops
Red foods available
from home
Red foods are available
WHO Collaborating Centre for Obesity Prevention High % red food intake
Kids choose red foods
Used as rewards in
class Sold at special events
Sold in canteen
Red foods available at
school
Red foods available
from surrounding shops
Red foods available
from home
Red foods are available
High demand for red
foods
Cross subsidize other
activities
WHO Collaborating Centre for Obesity Prevention High % red food intake
Kids choose red foods
Used as rewards in
class Sold at special events
Sold in canteen
Red foods available at
school
Red foods available
from surrounding shops
Red foods available
from home
Red foods are available
High demand for red
foods
Cross subsidize other
activities
Red foods are normal
Red foods are cheap
Red foods are cool
WHO Collaborating Centre for Obesity Prevention High % red food intake
Kids choose red foods
Used as rewards in
class Sold at special events
Sold in canteen
Red foods available at
school
Red foods available
from surrounding shops
Red foods available
from home
Red foods are available
Canteen cross
subsidizes other
activities
High demand for red
foods
Canteen provider is a
business
Need to be profitable
Cross subsidize other
activities
Goals of school
management
Red foods common at
home
Staff role model red
foods
Red foods are normal
Red foods are cheap
Red foods are cool
WHO Collaborating Centre for Obesity Prevention High % red food intake
Kids choose red foods
Used as rewards in
class Sold at special events
Sold in canteen
Red foods available at
school
Red foods available
from surrounding shops
Red foods available
from home
Red foods are available
Principal wants better
NAPLAN results
Canteen cross
subsidizes other
activities
High demand for red
foods
Canteen provider is a
business
Need to be profitable
Cross subsidize other
activities
Goals of school
management
Red foods common at
home
Staff role model red
foods
Red foods are normal
Red foods are cheap
Red foods are cool
Principal wants good
student behavior
Aim to meet national
curriculum