Obesity prevention – implications for physical activity promotion

Centre for Physical Activity and Nutrition

Obesity prevention – implications for physical activity

promotionProfessor Boyd Swinburn

Centre for Physical Activity and Nutrition School of Health Sciences

Deakin UniversityMelbourne


Increasing obesity in all countries

0

5

10

15

20

25

30

35

1980 1983 1989 1995 2000

%O

bese (

BM

I>3

0)

AustraliaNZUSANetherlandsFinland


Increasing childhood overweight and obesity

• Overweight + obesity (1995), boys 19.5%, girls 21%

• Adult diabetes now seen in adolescents

• NO monitoring of the situation

0

5

10

15

20

25

30

7-11 12-15 7-11 12-15

1985* 1995* 2000#

Boys Girls

%

y

*Daniels et al 2001 - national data#Goodman et al 2002 – single NSW school


Australian children versus England and USA

0

5

10

15

20

25

30

Boys Girls Boys Girls Boys Girls

Obese

Overweight

England Australia USA1994 4-11y/o 1995 7-11y/o 1991 6-11y/o

Definitions by Cole et alLihui & Bell (in press)


What do decision-makers need to know

about obesity?• What is the size of the problem?– Increasing prevalence rates, burden of disease, cost

of illness, comparative risk assessment etc

• What are the causes?– Simple but complex– Reviews, WHO Technical Report #916

• What can be done about it?– Bits and pieces of evidence– No evidence on a comprehensive program– No success at obesity prevention in whole populations


Burden (‘costs’) of childhood overweight

and obesityChildho

odAdultho

od

Direct costs (govt, personal) o c o cIndirect(lost productivity, early death) o c o cIntangible(loss of quality of life) o c o c

O = overweight/obesity C = complications of obesity


Causes of obesity – convincing evidence

WHO Technical Report #916 (www.who.int)

• Regular physical activity (protective)• Sedentary lifestyle (causative)• Diet high in fibre (protective) • High intake of energy-dense foods

(causative) – ED foods are mainly high in fat and/or

sugar– High fat, vegetable-based foods may not

be very energy dense


Target groups for prevention

• Adults– Substantial treatment component– Fewer options and issues about free choice

• High risk adults– Probably cost effective

• Children and adolescents– More potential interventions – Greater influence of environments– Greater appeal to public and politicians– Need to be aware of communication dangers


How much PA is needed to prevent unhealthy weight gain in adults?

• We don’t know• For post-obese

– About 90 minutes per day

• For adults in sedentary occupations – Almost certainly more than 30 minutes

moderate intensity PA on most days– More like 45-60 minutes per day


Prevention of childhood obesity

• Childhood obesity increasing everywhere• No country has a comprehensive program• Evidence on interventions ranges from

thin to non-existent to impossible-to-get• Urgent needs

– Policy leadership – Serious funding– Public advocacy– Evidence


Lessons from obesity prevention research to

date• Education (esp curriculum) alone has little impact

• Reducing TV viewing has significant effect on decreasing BMI

• School studies cannot usually get a high enough dose of intervention

• Long duration is needed to see effects

• ?role of RCTs in prevention trials


Best Investments to Address Childhood

Obesity• Project funded by Commonwealth

Department of Health and Ageing• 3 components

– Develop appropriate structure for a comprehensive approach

– Estimating effectiveness of interventions– Estimating health care costs and therefore

the warranted investment in prevention


Proposed structure(structure/content developed with ~50

Australian experts)• Essential elements

– Communication and education – Whole-of-community demonstration areas– Co-ordination and capacity building– Monitoring and research

• Settings– (Homes), schools*, pre-schools*, neighbourhoods, fast

food outlets, primary care, ante/post natal care

• Sectors– Food supply, food marketing*, (transport, urban

planning)

* = high priority


prevalence of childhood overweight & obesity

TV viewing

Fast food outlets

Active neighbour-hoods

Interventions (examples)

Estimated effectiveness

Warranted investment

Economic cost of obesity (O) & its complications (C)

Direct

Indirect

Intangible

Childhood Adulthood

COCO

COCO

COCO

Schema for the threshold analysis for reducing childhood obesity

evidence modelling


Modelling • First pass of modelling economic

costs and intervention effectiveness completed but remains confidential– Many of the modelling methods are new

& assumptions need to be agreed upon– Needs greater consultation, other data

to fill gaps, and peer review– First pass gave politically difficult results – Able to discuss methodology


Average number of food advertisements

0 2 4 6 8 10 12 14

Australia

USA

UK

France

Greece

Finland

Germany

Denmark

Netherlands

Belgium Club RTL

Norway TV3

Austria

Sweden TV4

Cou

ntr

y

Average number of food ads per hour


Assumed pathways

Sedentariness

Physical activity

Prevalence overweight/

obesity

Food ED

Beverage ED Energy

intake

Energy output

Weight BMI


• Sedentary behaviour– Used TV viewing BMI (Robinson,

Gortmaker) – estimate 3pp o/w obesity prevalence per 1hour TV viewing

– No modelling via EE• Physical activity

– Used the added energetic values for PA (eg walking = 0.4kJ/kg/min)

– Uncertainty about compensation (assumed 50%)

Modelling assumptions PA


Best Investments

• Childhood O/W & obesity costs a lot of money and the ‘warranted investment’ in prevention is large

• A comprehensive prevention program should substantially reduce prevalence

• Currently being considered by the National Obesity Taskforce


Whole-of-community demonstration areas

• Funding is scarce – Need to concentrate to have greatest

effect• Lack of evidence

– Need to closely evaluate interventions• Dose needs to be high

– Multiple strategies in multiple settings• Need intersectoral collaboration

– Better at local level


Sentinel Site for Obesity Prevention

Barwon-South Western Region of Victoria

Warrnambool Colac Geelong


Aims of the Sentinel Site

• Capacity building– To increase the knowledge and expertise in obesity

prevention and physical activity promotion

• Monitoring– To develop indicators and monitoring systems for

physical activity, nutrition and obesity

• Intervention support– To work with communities and DHS to develop and

implement multi-strategy, multi-setting interventions

• Evaluation– To evaluate the effects of the interventions and

disseminate findings


Sentinel Site: Proposed schema for action

TimeRegular monitoring of region: Monitor PAN environments, behaviours, outcomes in a variety of settings. Use for baseline and outcome variables for interventions, assessment of program reach and population impact. Linked to state/national monitoring programs.

Develop indicators,Pilot testing,monitoring design

Demo area 1 - interventions & evaluation

Demo area 2 – interventions & evaluation

Demo area 3 – interventions & evaluation

Act

ivit

ies

Develop and support interventions

Increase capacity, training

2002 2003 2004 2005

ReachSustainability

2006


Choosing sites

• Why Barwon-SW?– Strong, existing Deakin-DHS (BSW)

partnerships– Strong, existing nutrition & PA networks– Range of SES and rural/small town/urban

• Which demonstration area?– Good existing infrastructure, relationships,

expertise– Geographical bounds– Needs, SES, community capacity


Progress to date

• Funding from DHA, DHS, VicHealth• Colac Y1

– Partnerships & structures, coordinator, planning, training (ANGELO, social marketing, schools, GPs), action plan, baseline measurements

• Monitoring– Outcomes (BMI), behaviours (PA, eating),

determinants (policies, environments etc)– Schools, LGA

• Course development for Obesity Prevention


Action plan

• ANGELO process – scan environments, prioritise target behaviours, env actions, communication messages

• Comprehensive planCommunications Capacity building

Monitoring TV viewing

Sugar drinks water ED snacks fruit

Active transport Active play (3-6pm)

Fast food outlets Mgt for o/w children


Conclusions

• The rising obesity epidemic is the largest preventable health problem in Australian children

• A comprehensive, multi-strategy, multi-setting approach is needed to reverse it

• Whole-of-community demonstration areas are needed to build the evidence

Obesity prevention – implications for physical activity promotion

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