Centre for Physical Activity and Nutrition Obesity prevention – implications for physical activity...
-
Upload
helen-morrison -
Category
Documents
-
view
222 -
download
2
Transcript of Centre for Physical Activity and Nutrition Obesity prevention – implications for physical activity...
![Page 1: Centre for Physical Activity and Nutrition Obesity prevention – implications for physical activity promotion Professor Boyd Swinburn Centre for Physical.](https://reader035.fdocuments.net/reader035/viewer/2022062515/56649d1b5503460f949f165c/html5/thumbnails/1.jpg)
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
![Page 2: Centre for Physical Activity and Nutrition Obesity prevention – implications for physical activity promotion Professor Boyd Swinburn Centre for Physical.](https://reader035.fdocuments.net/reader035/viewer/2022062515/56649d1b5503460f949f165c/html5/thumbnails/2.jpg)
Centre for Physical Activity and Nutrition
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
![Page 3: Centre for Physical Activity and Nutrition Obesity prevention – implications for physical activity promotion Professor Boyd Swinburn Centre for Physical.](https://reader035.fdocuments.net/reader035/viewer/2022062515/56649d1b5503460f949f165c/html5/thumbnails/3.jpg)
Centre for Physical Activity and Nutrition
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
![Page 4: Centre for Physical Activity and Nutrition Obesity prevention – implications for physical activity promotion Professor Boyd Swinburn Centre for Physical.](https://reader035.fdocuments.net/reader035/viewer/2022062515/56649d1b5503460f949f165c/html5/thumbnails/4.jpg)
Centre for Physical Activity and Nutrition
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)
![Page 5: Centre for Physical Activity and Nutrition Obesity prevention – implications for physical activity promotion Professor Boyd Swinburn Centre for Physical.](https://reader035.fdocuments.net/reader035/viewer/2022062515/56649d1b5503460f949f165c/html5/thumbnails/5.jpg)
Centre for Physical Activity and Nutrition
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
![Page 6: Centre for Physical Activity and Nutrition Obesity prevention – implications for physical activity promotion Professor Boyd Swinburn Centre for Physical.](https://reader035.fdocuments.net/reader035/viewer/2022062515/56649d1b5503460f949f165c/html5/thumbnails/6.jpg)
Centre for Physical Activity and Nutrition
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
![Page 7: Centre for Physical Activity and Nutrition Obesity prevention – implications for physical activity promotion Professor Boyd Swinburn Centre for Physical.](https://reader035.fdocuments.net/reader035/viewer/2022062515/56649d1b5503460f949f165c/html5/thumbnails/7.jpg)
Centre for Physical Activity and Nutrition
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
![Page 8: Centre for Physical Activity and Nutrition Obesity prevention – implications for physical activity promotion Professor Boyd Swinburn Centre for Physical.](https://reader035.fdocuments.net/reader035/viewer/2022062515/56649d1b5503460f949f165c/html5/thumbnails/8.jpg)
Centre for Physical Activity and Nutrition
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
![Page 9: Centre for Physical Activity and Nutrition Obesity prevention – implications for physical activity promotion Professor Boyd Swinburn Centre for Physical.](https://reader035.fdocuments.net/reader035/viewer/2022062515/56649d1b5503460f949f165c/html5/thumbnails/9.jpg)
Centre for Physical Activity and Nutrition
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
![Page 10: Centre for Physical Activity and Nutrition Obesity prevention – implications for physical activity promotion Professor Boyd Swinburn Centre for Physical.](https://reader035.fdocuments.net/reader035/viewer/2022062515/56649d1b5503460f949f165c/html5/thumbnails/10.jpg)
Centre for Physical Activity and Nutrition
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
![Page 11: Centre for Physical Activity and Nutrition Obesity prevention – implications for physical activity promotion Professor Boyd Swinburn Centre for Physical.](https://reader035.fdocuments.net/reader035/viewer/2022062515/56649d1b5503460f949f165c/html5/thumbnails/11.jpg)
Centre for Physical Activity and Nutrition
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
![Page 12: Centre for Physical Activity and Nutrition Obesity prevention – implications for physical activity promotion Professor Boyd Swinburn Centre for Physical.](https://reader035.fdocuments.net/reader035/viewer/2022062515/56649d1b5503460f949f165c/html5/thumbnails/12.jpg)
Centre for Physical Activity and Nutrition
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
![Page 13: Centre for Physical Activity and Nutrition Obesity prevention – implications for physical activity promotion Professor Boyd Swinburn Centre for Physical.](https://reader035.fdocuments.net/reader035/viewer/2022062515/56649d1b5503460f949f165c/html5/thumbnails/13.jpg)
Centre for Physical Activity and Nutrition
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
![Page 14: Centre for Physical Activity and Nutrition Obesity prevention – implications for physical activity promotion Professor Boyd Swinburn Centre for Physical.](https://reader035.fdocuments.net/reader035/viewer/2022062515/56649d1b5503460f949f165c/html5/thumbnails/14.jpg)
Centre for Physical Activity and Nutrition
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
![Page 15: Centre for Physical Activity and Nutrition Obesity prevention – implications for physical activity promotion Professor Boyd Swinburn Centre for Physical.](https://reader035.fdocuments.net/reader035/viewer/2022062515/56649d1b5503460f949f165c/html5/thumbnails/15.jpg)
Centre for Physical Activity and Nutrition
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
![Page 16: Centre for Physical Activity and Nutrition Obesity prevention – implications for physical activity promotion Professor Boyd Swinburn Centre for Physical.](https://reader035.fdocuments.net/reader035/viewer/2022062515/56649d1b5503460f949f165c/html5/thumbnails/16.jpg)
Centre for Physical Activity and Nutrition
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
![Page 17: Centre for Physical Activity and Nutrition Obesity prevention – implications for physical activity promotion Professor Boyd Swinburn Centre for Physical.](https://reader035.fdocuments.net/reader035/viewer/2022062515/56649d1b5503460f949f165c/html5/thumbnails/17.jpg)
Centre for Physical Activity and Nutrition
Assumed pathways
Sedentariness
Physical activity
Prevalence overweight/
obesity
Food ED
Beverage ED Energy
intake
Energy output
Weight BMI
![Page 18: Centre for Physical Activity and Nutrition Obesity prevention – implications for physical activity promotion Professor Boyd Swinburn Centre for Physical.](https://reader035.fdocuments.net/reader035/viewer/2022062515/56649d1b5503460f949f165c/html5/thumbnails/18.jpg)
Centre for Physical Activity and Nutrition
• 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
![Page 19: Centre for Physical Activity and Nutrition Obesity prevention – implications for physical activity promotion Professor Boyd Swinburn Centre for Physical.](https://reader035.fdocuments.net/reader035/viewer/2022062515/56649d1b5503460f949f165c/html5/thumbnails/19.jpg)
Centre for Physical Activity and Nutrition
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
![Page 20: Centre for Physical Activity and Nutrition Obesity prevention – implications for physical activity promotion Professor Boyd Swinburn Centre for Physical.](https://reader035.fdocuments.net/reader035/viewer/2022062515/56649d1b5503460f949f165c/html5/thumbnails/20.jpg)
Centre for Physical Activity and Nutrition
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
![Page 21: Centre for Physical Activity and Nutrition Obesity prevention – implications for physical activity promotion Professor Boyd Swinburn Centre for Physical.](https://reader035.fdocuments.net/reader035/viewer/2022062515/56649d1b5503460f949f165c/html5/thumbnails/21.jpg)
Centre for Physical Activity and Nutrition
Sentinel Site for Obesity Prevention
Barwon-South Western Region of Victoria
Warrnambool Colac Geelong
![Page 22: Centre for Physical Activity and Nutrition Obesity prevention – implications for physical activity promotion Professor Boyd Swinburn Centre for Physical.](https://reader035.fdocuments.net/reader035/viewer/2022062515/56649d1b5503460f949f165c/html5/thumbnails/22.jpg)
Centre for Physical Activity and Nutrition
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
![Page 23: Centre for Physical Activity and Nutrition Obesity prevention – implications for physical activity promotion Professor Boyd Swinburn Centre for Physical.](https://reader035.fdocuments.net/reader035/viewer/2022062515/56649d1b5503460f949f165c/html5/thumbnails/23.jpg)
Centre for Physical Activity and Nutrition
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
![Page 24: Centre for Physical Activity and Nutrition Obesity prevention – implications for physical activity promotion Professor Boyd Swinburn Centre for Physical.](https://reader035.fdocuments.net/reader035/viewer/2022062515/56649d1b5503460f949f165c/html5/thumbnails/24.jpg)
Centre for Physical Activity and Nutrition
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
![Page 25: Centre for Physical Activity and Nutrition Obesity prevention – implications for physical activity promotion Professor Boyd Swinburn Centre for Physical.](https://reader035.fdocuments.net/reader035/viewer/2022062515/56649d1b5503460f949f165c/html5/thumbnails/25.jpg)
Centre for Physical Activity and Nutrition
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
![Page 26: Centre for Physical Activity and Nutrition Obesity prevention – implications for physical activity promotion Professor Boyd Swinburn Centre for Physical.](https://reader035.fdocuments.net/reader035/viewer/2022062515/56649d1b5503460f949f165c/html5/thumbnails/26.jpg)
Centre for Physical Activity and Nutrition
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
![Page 27: Centre for Physical Activity and Nutrition Obesity prevention – implications for physical activity promotion Professor Boyd Swinburn Centre for Physical.](https://reader035.fdocuments.net/reader035/viewer/2022062515/56649d1b5503460f949f165c/html5/thumbnails/27.jpg)
Centre for Physical Activity and Nutrition
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