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National policies to prevent obesity in early childhood: Using policy mapping to compare policy lessons for Australia with six developed countries.
Esdaile, E, Thow, AM, Gill, T, Sacks, G, Golley, R, Love, P, Wen, LM, Rissel, C
Obesity reviews : an official journal of the International Association for the Study of Obesity. 2019;(11):1542-1556
Abstract
Interventions for obesity prevention in early childhood (first 5 years of life) are likely to have a significant preventive health impact. This mapping review identified recommended policy options for the Australian Federal Government (AFG) by comparing countries with similar population, income, and language to Australia. Policies were mapped in six countries using two matrices. The first matrix examined policy context, describing obesity prevention governance. The second matrix examined policy content, compared with global recommendations. Policies were grouped into downstream (healthcare), midstream (lifestyle and settings), and upstream (determinants of health, including food and built environments). Results identified variance in obesity governance across the six countries including policy coherence, leadership, institutional drivers, and overlapping responsibility across different levels of government. While countries tended to have more downstream or midstream policies, upstream policies were more likely when countries had invested in system-wide approaches to obesity such as developing a national obesity strategy, having separate food/nutrition and physical activity plans, and a dedicated preventive health agency. This study recommends a range of initiatives for the AFG to strengthen policies for the prevention of obesity in early childhood, including prioritising the development of a national food/nutrition strategy.
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Potential interventions targeting adolescent nutrition in Indonesia: a literature review.
Oddo, VM, Roshita, A, Rah, JH
Public health nutrition. 2019;(1):15-27
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OBJECTIVE The present study aimed to take stock of nutrition interventions that warrant consideration as a minimum package of interventions in Indonesia to improve four key nutrition indicators for adolescents: stunting, thinness, overweight and anaemia. DESIGN We conducted a review of the peer-reviewed literature published between 1995 and 2017 on nutrition-specific and nutrition-sensitive interventions that target adolescents in Indonesia. The search to identify studies was conducted in PubMed, Google Scholar and EMBASE, using key search terms. We also explored programmatic and policy documents from the grey literature as they related to adolescents and/or Indonesia. Our search yielded thirty-five peer-reviewed articles and programmatic documents. SETTING Indonesia. SUBJECTS Adolescent girls and boys. RESULTS There is very limited evidence on the impact of interventions specifically among adolescents in Indonesia. Nevertheless, findings from our review suggest the minimum package of interventions in Indonesia could include the following nutrition-specifc interventions: (i) iron-folic acid supplements, paired with antihelminths delivered at scale via school-based platforms and through health centres; and (ii) diet counselling and nutrition education provided through school-based platforms, adolescent youth centres/peer education and technology-based platforms. The minimum package could also include the following nutrition-sensitive interventions: (i) improving access to reproductive health services; and (ii) increasing the coverage of interventions designed to increase school attendance. CONCLUSIONS Programmes and policies targeting adolescent nutrition are relatively new and coverage is low. To improve the nutritional status of this vulnerable population, additional evaluations of adolescent programming and surveillance data on adolescents are needed.
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School Health Program: Impacting Physical Activity Behaviors Among Disadvantaged Students.
Dai, CL
The Journal of school health. 2019;(6):468-475
Abstract
BACKGROUND Children from disadvantaged backgrounds are more apt to experience lower availability of nutritious foods, lack opportunities to exercise, and lack access to recreational facilities, and thus, are more likely to be obese and at greater risk for developing chronic diseases. We review school health education programs' impact on physical activity behaviors among disadvantaged students. METHODS The inclusion criteria of the study were articles: published in English with full text between 2011 and 2017; focused on school health education programs for disadvantaged school-aged students; assessed programs including a physical activity component; examined school-aged children and adolescents' physical activity behaviors; and assessed programs with comparison groups. RESULTS There were 13 studies matching inclusion criteria in this review. The results of this review indicated that school-based health education programs which included culturally appropriate physical activity, parent involvement, and enhanced student motivation and choice of activities appeared to increase physical activity levels among disadvantaged school-aged students. Health education programs should also emphasize behavioral change skills, such as goal setting and self-motivation, to positively impact on students' physical activity behaviors. CONCLUSIONS School-based health education programs may help increase access to physical activity among disadvantaged populations.
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Addressing Obesity in Aging Patients.
Batsis, JA, Zagaria, AB
The Medical clinics of North America. 2018;(1):65-85
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Obesity in older adults affects not only morbidity and mortality but, importantly, quality of life and the risk of institutionalization. Weight loss interventions can effectively lead to improved physical function. Diet-alone interventions can detrimentally affect muscle and bone physiology and, without interventions to affect these elements, can lead to adverse outcomes. Understanding social and nutritional issues facing older adults is of utmost importance to primary care providers. This article will also discuss the insufficient evidence related to pharmacotherapy as well as providing an overview of using physiologic rather than chronologic age for identifying suitable candidates for bariatric surgery.
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Dietary Management of Obesity: Cornerstones of Healthy Eating Patterns.
Smethers, AD, Rolls, BJ
The Medical clinics of North America. 2018;(1):107-124
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Several dietary patterns, both macronutrient and food based, can lead to weight loss. A key strategy for weight management that can be applied across dietary patterns is to reduce energy density. Clinical trials show that reducing energy density is effective for weight loss and weight loss maintenance. A variety of practical strategies and tools can help facilitate successful weight management by reducing energy density, providing portion control, and improving diet quality. The flexibility of energy density gives patients options to tailor and personalize their dietary pattern to reduce energy intake for sustainable weight loss.
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Obesity intervention programs among adolescents using social cognitive theory: a systematic literature review.
Bagherniya, M, Taghipour, A, Sharma, M, Sahebkar, A, Contento, IR, Keshavarz, SA, Mostafavi Darani, F, Safarian, M
Health education research. 2018;(1):26-39
Abstract
Social cognitive theory (SCT) is a well-known theory for designing nutrition education and physical activity programs for adolescents. This systematic review aimed to evaluate the efficacy of intervention studies based on SCT in reducing or preventing overweight and obesity in adolescents. An electronic literature search in PubMed-Medline, Web of Science and Scopus was performed to identify intervention studies based on SCT aiming at preventing or reducing obesity in adolescents. All the articles published up to July 2016 were included. Only studies reporting body mass index (BMI) or its variant as one of the outcome measures were included. From 240 initially identified studies, 12 met the eligibility criteria. Seven had moderate or strong study quality. Two of the eight randomized controlled trials (RCT) and two of the four quasi-experimental studies showed significant reduction in BMI among intervened participants compared to control. Impacts on diet and physical activity were mixed, but were mostly not significant. The current systematic review found only weak evidence for the efficacy of SCT-based interventions in treating and preventing obesity in adolescents. Further studies systematically using effective behavior change strategies or techniques, larger population sizes, better measurement tools and more robust designs are warranted for a conclusive judgment.
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Impact of school policies on non-communicable disease risk factors - a systematic review.
Singh, A, Bassi, S, Nazar, GP, Saluja, K, Park, M, Kinra, S, Arora, M
BMC public health. 2017;(1):292
Abstract
BACKGROUND Globally, non-communicable diseases (NCDs) are identified as one of the leading causes of mortality. NCDs have several modifiable risk factors including unhealthy diet, physical inactivity, tobacco use and alcohol abuse. Schools provide ideal settings for health promotion, but the effectiveness of school policies in the reduction of risk factors for NCD is not clear. This study reviewed the literature on the impact of school policies on major NCD risk factors. METHODS A systematic review was conducted to identify, collate and synthesize evidence on the effectiveness of school policies on reduction of NCD risk factors. A search strategy was developed to identify the relevant studies on effectiveness of NCD policies in schools for children between the age of 6 to 18 years in Ovid Medline, EMBASE, and Web of Science. Data extraction was conducted using pre-piloted forms. Studies included in the review were assessed for methodological quality using the Effective Public Health Practice Project (EPHPP) quality assessment tool. A narrative synthesis according to the types of outcomes was conducted to present the evidence on the effectiveness of school policies. RESULTS Overall, 27 out of 2633 identified studies were included in the review. School policies were comparatively more effective in reducing unhealthy diet, tobacco use, physical inactivity and inflammatory biomarkers as opposed to anthropometric measures, overweight/obesity, and alcohol use. In total, for 103 outcomes independently evaluated within these studies, 48 outcomes (46%) had significant desirable changes when exposed to the school policies. Based on the quality assessment, 18 studies were categorized as weak, six as moderate and three as having strong methodological quality. CONCLUSION Mixed findings were observed concerning effectiveness of school policies in reducing NCD risk factors. The findings demonstrate that schools can be a good setting for initiating positive changes in reducing NCD risk factors, but more research is required with long-term follow up to study the sustainability of such changes.
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[Interdisciplinarity as a strategy for the prevention of systemic arterial hypertension in children: a systematic review].
Bernardi, L, França, MC, Xavier, AM, Novello, D
Ciencia & saude coletiva. 2017;(12):3987-4000
Abstract
Researches that developed interdisciplinary actions in schools seeking to modify the arteial pressure levels or salt and/or sodium consumption by children were analyzed. Studies available on the PubMed, ScienceDirect and Lilacs databases, associating the keywords: intervention study, nutrition intervention, schoolchildren, school health, blood pressure, sodium and salt were included. The research included articles from the last 15 years, in Portuguese, English and Spanish, which had preschool or school children as participants. With respect to the change of the blood pressure levels, 7 studies with positive and significant results and 6 without variation were identified. In terms of modification of the ingestion of food with high salt and/or sodium content, 4 studies revealed positive and significant results, and only one was unsuccessful. The conclusions drawn are that the interventions that use nutritional education combined with physical activities prevail in the literature. However, these actions proved to be more effective when implemented over a long period of time.
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Impact of educational interventions on primary prevention of cardiovascular disease: A systematic review with a focus on physical activity.
Ramôa Castro, A, Oliveira, NL, Ribeiro, F, Oliveira, J
The European journal of general practice. 2017;(1):59-68
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BACKGROUND Evidence from epidemiological and experimental studies illustrates the beneficial impact of healthy lifestyle behaviours on cardiovascular risk. OBJECTIVES To assess the effectiveness of primary care health education interventions designed to promote healthy lifestyles on physical activity levels and cardiovascular risk. METHODS A computer-aided search on PubMed and Scopus was performed to identify relevant studies published from January 2000 to October 2016. Two authors independently selected studies for inclusion and extracted data, including intervention characteristics and outcome measures, namely physical activity and cardiovascular risk or risk factors. RESULTS Of the 212 identified studies, 15 met the inclusion criteria. The 15 studies enrolled 6727 participants; the sample size varied between 74 and 878 adults. Fourteen studies assessed physical activity by questionnaire and only one study used accelerometry. Eight of the 15 studies showed improvements in the physical activity levels after the intervention, ranging from 5% to 26% in those where significant changes between groups were detected. Most studies reported significant positive effects of the health education interventions on cardiovascular risk factors, mainly on lipid profile, blood pressure and cardiovascular risk score. CONCLUSION The health education interventions, in primary care, seem to improve daily physical activity, cardiovascular risk factors and risk score.
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The Effectiveness and Cost of Lifestyle Interventions Including Nutrition Education for Diabetes Prevention: A Systematic Review and Meta-Analysis.
Sun, Y, You, W, Almeida, F, Estabrooks, P, Davy, B
Journal of the Academy of Nutrition and Dietetics. 2017;(3):404-421.e36
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BACKGROUND Type 2 diabetes is a significant public health concern. With the completion of the Diabetes Prevention Program, there has been a proliferation of studies attempting to translate this evidence base into practice. However, the cost, effectiveness, and cost-effectiveness of these adapted interventions is unknown. OBJECTIVE The purpose of this systematic review was to conduct a comprehensive meta-analysis to synthesize the effectiveness, cost, and cost-effectiveness of lifestyle diabetes prevention interventions and compare effects by intervention delivery agent (dietitian vs non-dietitian) and channel (in-person vs technology-delivered). METHODS English and full-text research articles published up to July 2015 were identified using the Cochrane Library, PubMed, Education Resources Information Center, CAB Direct, Science Direct, and Google Scholar. Sixty-nine studies met inclusion criteria. Most employed both dietary and physical activity intervention components (four of 69 were diet-only interventions). Changes in weight, fasting and 2-hour blood glucose concentration, and hemoglobin A1c were extracted from each article. Heterogeneity was measured by the I2 index, and study-specific effect sizes or mean differences were pooled using a random effects model when heterogeneity was confirmed. RESULTS Participants receiving intervention with nutrition education experienced a reduction of 2.07 kg (95% CI 1.52 to 2.62; P<0.001; I2=90.99%, 95% CI 88.61% to 92.87%) in weight at 12 months with effect sizes over time ranging from small (0.17, 95% CI 0.04 to 0.30; P=0.012; I2= 86.83%, 95% CI 80.42% to 91.14%) to medium (0.65, 95% CI 0.49 to 0.82; P<0.001; I2=98.75%, 95% CI 98.52% to 98.94). Effect sizes for 2-hour blood glucose and hemoglobin A1c level changes ranged from small to medium. The meta-regression analysis revealed a larger relative weight loss in dietitian-delivered interventions than in those delivered by nondietitians (full sample: -1.0 kg; US subsample: -2.4 kg), and did not find statistical evidence that the delivery channel was an important predictor of weight loss. The average cost per kilogram weight loss ranged from $34.06 over 6 months to $1,005.36 over 12 months. The cost of intervention per participant delivered by dietitians was lower than interventions delivered by non-dietitians, although few studies reported costs. CONCLUSIONS Lifestyle interventions are effective in reducing body weight and glucose-related outcomes. Dietitian-delivered interventions, compared with those delivered by other personnel, achieved greater weight reduction. No consistent trend was identified across different delivery channels.