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The effectiveness of interventions during the first 1,000 days to improve energy balance-related behaviors or prevent overweight/obesity in children from socio-economically disadvantaged families of high-income countries: a systematic review.
Lioret, S, Harrar, F, Boccia, D, Hesketh, KD, Kuswara, K, Van Baaren, C, Maritano, S, Charles, MA, Heude, B, Laws, R
Obesity reviews : an official journal of the International Association for the Study of Obesity. 2023;24(1):e13524
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The first 1,000 days is an opportune time to support parents, as primary caregivers and role model, to promote a healthy lifestyle and prevent obesity for their children. The aim of this study was to update the current evidence on the effectiveness of family-based interventions implemented during pregnancy and up to 2 years of age to improve energy balance-related behaviours and growth, or prevent overweight (OW)/ obesity (OB), in children growing up in families experiencing socio-economic disadvantage. This study is a systematic review of thirty-three studies which corresponded to 24 distinct interventions. Of the 24 interventions, nearly all were (cluster) randomised controlled trials; three had a quasi-experimental design. Results show that there is some effectiveness on behavioural and anthropometric outcomes in young children when programmes target and are tailored to families experiencing socioeconomic disadvantage. Authors conclude that a holistic, multilevel and proportionate interventions are likely to more effective and sustainably address the issue of social inequalities and inequities. Additionally, more thorough process evaluation of such complex interventions using mixed methods is needed to better understand why interventions worked or not, by which mechanisms of action (if any), for whom and in which context.
Abstract
This narrative systematic review examined effectiveness of interventions during pregnancy and up to 2 years of age in improving energy balance-related behaviors or prevent overweight/obesity in children from families experiencing socio-economic disadvantage. We identified 24 interventions, from 33 articles, since 1990. Overall, despite their heterogeneity and variability in internal and external validity, there was some evidence of beneficial impact of interventions on obesity risk (4/15), and associated behaviors, e.g.: breastfeeding (9/18), responsive feeding (11/16), diet (7/8), sedentary (1/3) and movement (4/7) behaviors, and sleep (1/2). The most effective interventions aimed at promoting breastfeeding commenced antenatally; this was similar for the prevention of obesity, provided the intervention continued for at least 2 years postnatally and was multi-behavioral. Effective interventions were more likely to target first-time mothers and involve professional delivery agents, multidisciplinary teams and peer groups. Among ethnic/racial minorities, interventions delivered by lay agents had some impact on dietary behavior but not weight outcomes. Co-creation with stakeholders, including parents, and adherence to theoretical frameworks were additional ingredients for more pragmatic, inclusive, non-judgmental, and effective programs. The growing body of evidence on obesity prevention interventions targeting families experiencing socio-economic disadvantage is promising for reducing early inequalities in obesity risk.
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Prenatal exposure to phthalate and decreased body mass index of children: a systematic review and meta-analysis.
Lee, DW, Lim, HM, Lee, JY, Min, KB, Shin, CH, Lee, YA, Hong, YC
Scientific reports. 2022;12(1):8961
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Phthalates are widely used chemicals to improve the utility of plastics and personal care products. Phthalates can be classified as high-molecular-weight phthalates and low-molecular-weight phthalates. The aim of this study was to clarify whether prenatal and postnatal exposures to phthalates are associated with physical growth as measured by body composition indices in children. This study is a systematic literature review and meta-analysis of 39 studies about the association of phthalates with body composition indices among children. Results showed that prenatal exposure to phthalates is significantly associated with low body mass index in children, but not with body fat mass. In addition, prenatal phthalate exposure may affect the disturbance of normal growth of children rather than act as an obesogen. Authors conclude that it is necessary to administer stricter and broader regulations on phthalates in living environments.
Abstract
Phthalates are well-known endocrine-disrupting chemicals. Many detrimental health effects of phthalates were investigated, but studies on the association of phthalates with obesity in children showed inconsistent results. Thus, this systematic review and meta-analysis were performed to clarify whether prenatal and postnatal exposures to phthalates are associated with physical growth disturbances in children. We performed the systematic review and meta-analysis following the PRISMA 2020 statement guidelines, and found 39 studies that met our inclusion criteria, including 22 longitudinal and 17 cross-sectional studies. We observed a significant negative association between the prenatal exposure to DEHP and the body mass index (BMI) z-score of the offspring (β = - 0.05; 95% CI: - 0.10, - 0.001) in the meta-analysis, while no significant association between the prenatal exposure to DEHP and the body fat percentage of the offspring was observed (β = 0.01; 95% CI: - 0.41, 0.44). In the systematic review, studies on the association between phthalates exposure in childhood and obesity were inconsistent. Prenatal exposure to phthalates was found to be associated with decreased BMI z-score in children, but not associated with body fat percentage. Our findings suggest that phthalates disturb the normal muscle growth of children, rather than induce obesity, as previous studies have hypothesized.
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A systematic review and meta-analysis of school-based interventions with health education to reduce body mass index in adolescents aged 10 to 19 years.
Jacob, CM, Hardy-Johnson, PL, Inskip, HM, Morris, T, Parsons, CM, Barrett, M, Hanson, M, Woods-Townsend, K, Baird, J
The international journal of behavioral nutrition and physical activity. 2021;18(1):1
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Obesity in childhood and adolescence is associated with an increased risk of non-communicable diseases such as Type 2 diabetes, cardiovascular disease, chronic obstructive lung disease and some forms of cancer. The aim of this study was to investigate the effectiveness of health education interventions delivered in school settings to prevent overweight and obesity and/ or reduce BMI in adolescents, and to explore the key features of effectiveness. This study is a systematic review and meta-analysis of 39 publications based on 33 studies. Six studies recruited adolescent girls only, one adolescent boys only and one study included parent-student dyad. Results show that: - Most of the effective interventions were delivered by teachers who were trained prior to the intervention. - School-based interventions are often delivered through school-staff, however, appropriate training/ CPD prior to the intervention could be a crucial component to support the provision and uptake of the intervention. - Many of the effective interventions included parental involvement and modifications to the school environment. - Interventions should target the biological, psychosocial, environmental, and behavioural influences on diet and physical activity. Authors conclude that school-based health education interventions could potentially help in improving BMI outcomes in the adolescent age group.
Abstract
BACKGROUND Adolescents are increasingly susceptible to obesity, and thus at risk of later non-communicable diseases, due to changes in food choices, physical activity levels and exposure to an obesogenic environment. This review aimed to synthesize the literature investigating the effectiveness of health education interventions delivered in school settings to prevent overweight and obesity and/ or reduce BMI in adolescents, and to explore the key features of effectiveness. METHODS A systematic search of electronic databases including MEDLINE, CINAHL, PsychINFO and ERIC for papers published from Jan 2006 was carried out in 2020, following PRISMA guidelines. Studies that evaluated health education interventions in 10-19-year-olds delivered in schools in high-income countries, with a control group and reported BMI/BMI z-score were selected. Three researchers screened titles and abstracts, conducted data extraction and assessed quality of the full text publications. A third of the papers from each set were cross-checked by another reviewer. A meta-analysis of a sub-set of studies was conducted for BMI z-score. RESULTS Thirty-three interventions based on 39 publications were included in the review. Most studies evaluated multi-component interventions using health education to improve behaviours related to diet, physical activity and body composition measures. Fourteen interventions were associated with reduced BMI/BMI z-score. Most interventions (n = 22) were delivered by teachers in classroom settings, 19 of which trained teachers before the intervention. The multi-component interventions (n = 26) included strategies such as environment modifications (n = 10), digital interventions (n = 15) and parent involvement (n = 16). Fourteen studies had a low risk of bias, followed by 10 with medium and nine with a high risk of bias. Fourteen studies were included in a random-effects meta-analysis for BMI z-score. The pooled estimate of this meta-analysis showed a small difference between intervention and control in change in BMI z-score (- 0.06 [95% CI -0.10, - 0.03]). A funnel plot indicated that some degree of publication bias was operating, and hence the effect size might be inflated. CONCLUSIONS Findings from our review suggest that school-based health education interventions have the public health potential to lower BMI towards a healthier range in adolescents. Multi-component interventions involving key stakeholders such as teachers and parents and digital components are a promising strategy.
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Sociodemographic and lifestyle-related risk factors for identifying vulnerable groups for type 2 diabetes: a narrative review with emphasis on data from Europe.
Kyrou, I, Tsigos, C, Mavrogianni, C, Cardon, G, Van Stappen, V, Latomme, J, Kivelä, J, Wikström, K, Tsochev, K, Nanasi, A, et al
BMC endocrine disorders. 2020;20(Suppl 1):134
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Type 2 diabetes mellitus (T2DM) results from progressive loss of insulin secretion, which is typically combined with various degrees of insulin resistance. The aim of this study is to provide a comprehensive overview of key sociodemographic and lifestyle-related risk factors for identifying vulnerable groups for T2DM with emphasis on data from Europe. This study is a narrative review which includes 101 publications. Literature shows that prevention of T2DM should be a collaborative effort which mobilizes multiple partners/ stakeholders at a national and international (e.g. European) level. In addition, a holistic approach is becoming increasingly essential in order to put into effect multidimensional public health programs and integrated interventions for effective T2DM prevention which will take into account both traditional and socioeconomic/socioecological factors. Authors conclude that a multidimensional approach for the prevention of T2DM may have a broader impact against the current diabesity epidemic within and across countries in Europe.
Abstract
BACKGROUND Type 2 diabetes mellitus (T2DM) comprises the vast majority of all diabetes cases in adults, with alarmingly increasing prevalence over the past few decades worldwide. A particularly heavy healthcare burden of diabetes is noted in Europe, where 8.8% of the population aged 20-79 years is estimated to have diabetes according to the International Diabetes Federation. Multiple risk factors are implicated in the pathogenesis of T2DM with complex underlying interplay and intricate gene-environment interactions. Thus, intense research has been focused on studying the role of T2DM risk factors and on identifying vulnerable groups for T2DM in the general population which can then be targeted for prevention interventions. METHODS For this narrative review, we conducted a comprehensive search of the existing literature on T2DM risk factors, focusing on studies in adult cohorts from European countries which were published in English after January 2000. RESULTS Multiple lifestyle-related and sociodemographic factors were identified as related to high T2DM risk, including age, ethnicity, family history, low socioeconomic status, obesity, metabolic syndrome and each of its components, as well as certain unhealthy lifestyle behaviors. As Europe has an increasingly aging population, multiple migrant and ethnic minority groups and significant socioeconomic diversity both within and across different countries, this review focuses not only on modifiable T2DM risk factors, but also on the impact of pertinent demographic and socioeconomic factors. CONCLUSION In addition to other T2DM risk factors, low socioeconomic status can significantly increase the risk for prediabetes and T2DM, but is often overlooked. In multinational and multicultural regions such as Europe, a holistic approach, which will take into account both traditional and socioeconomic/socioecological factors, is becoming increasingly crucial in order to implement multidimensional public health programs and integrated community-based interventions for effective T2DM prevention.
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Associations of Meal Timing and Frequency with Obesity and Metabolic Syndrome among Korean Adults.
Ha, K, Song, Y
Nutrients. 2019;11(10)
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The timing of food intake appears to affect the robustness of circadian rhythms in metabolic organs, and circadian rhythm disruption is emerging as a new risk factor for cardiovascular disease. As major risk factors for cardiovascular diseases, obesity and metabolic syndrome are critical worldwide issues. In Korea, 3 in 10 adults have obesity or the metabolic syndrome. The aim of this study was to explore meal timing and frequency using various variables, including nightly fasting duration and specific time periods such as morning and night, and to examine their associations with obesity and metabolic syndrome in Korean adults using national survey data. The study used data from the 2013–2017 Korea National Health and Nutrition Examination Survey (KNHANES), which is a continuous annual survey conducted by the Korea Centers for Disease Control and Prevention Results indicated that a greater number of eating episodes was associated with lower prevalence of metabolic abnormalities in men. Furthermore, the prevalence of metabolic syndrome was inversely associated with morning eating in both men and women, whereas it was positively associated with night eating in men. Authors conclude that having desirable eating patterns, including eating in the morning and avoiding eating after 21:00, and an appropriate sleep schedule may be helpful for reducing the risks of obesity and metabolic syndrome, independently of fasting duration.
Abstract
Emerging studies indicate that meal timing is linked to cardiometabolic risks by deterioration of circadian rhythms, however limited evidence is available in humans. This large-scale cross-sectional study explored the associations of meal timing and frequency with obesity and metabolic syndrome among Korean adults. Meal timing was defined as nightly fasting duration and morning, evening, and night eating, and meal frequency was estimated as the number of daily eating episodes using a single-day 24-hour dietary recall method. Meal frequency was inversely associated with prevalence of abdominal obesity, elevated blood pressure, and elevated triglycerides in men only. Independent of the nightly fasting duration and eating episodes, morning eating was associated with a lower prevalence of metabolic syndrome (odds ratio (OR), 0.73; 95% confidence interval (CI), 0.57-0.93 for men and OR, 0.69; 95% CI, 0.54-0.89 for women) than no morning eating, whereas night eating was associated with a 48% higher prevalence of metabolic syndrome (OR, 1.48; 95% CI, 1.15-1.90) than no night eating in men only. Longer fasting duration and less sleep were associated with obesity and metabolic syndrome. These findings suggest that overall eating patterns, including energy distribution across the day, eating frequency, and sleep duration, rather than fasting duration alone, are related to cardiometabolic risks in free-living Korean adults.
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How and why weight stigma drives the obesity 'epidemic' and harms health.
Tomiyama, AJ, Carr, D, Granberg, EM, Major, B, Robinson, E, Sutin, AR, Brewis, A
BMC medicine. 2018;16(1):123
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Weight stigma is defined as the social rejection and devaluation that accrues to those who do not comply with prevailing social norms of adequate body weight and shape. In this opinion-based study, authors discuss that: • Latest literature indicates that weight stigma can trigger physiological and behavioural changes linked to poor metabolic health and increased weight gain. • Healthcare is a setting in which weight stigma is particularly pervasive, with significant consequences for the health of higher-weight patients. This stigma has direct and observable consequences for the quality and nature of services provided to those with obesity. • Stigma may be an unintended consequence of anti-obesity efforts, undermining their intended effect. Moreover, focusing solely on obesity treatment runs the risk of missing other diagnoses. • The science of weight stigma crystallizes a key point for future success – to tackle the obesity ‘epidemic’ we must tackle the parallel epidemic of weight stigma. • Public service messages are needed to educate people about the stigma, discrimination, and challenges facing higher-weight individuals. Authors conclude that to advance as an equal society, healthcare providers should lead the way for weight stigma eradication.
Abstract
BACKGROUND In an era when obesity prevalence is high throughout much of the world, there is a correspondingly pervasive and strong culture of weight stigma. For example, representative studies show that some forms of weight discrimination are more prevalent even than discrimination based on race or ethnicity. DISCUSSION In this Opinion article, we review compelling evidence that weight stigma is harmful to health, over and above objective body mass index. Weight stigma is prospectively related to heightened mortality and other chronic diseases and conditions. Most ironically, it actually begets heightened risk of obesity through multiple obesogenic pathways. Weight stigma is particularly prevalent and detrimental in healthcare settings, with documented high levels of 'anti-fat' bias in healthcare providers, patients with obesity receiving poorer care and having worse outcomes, and medical students with obesity reporting high levels of alcohol and substance use to cope with internalized weight stigma. In terms of solutions, the most effective and ethical approaches should be aimed at changing the behaviors and attitudes of those who stigmatize, rather than towards the targets of weight stigma. Medical training must address weight bias, training healthcare professionals about how it is perpetuated and on its potentially harmful effects on their patients. CONCLUSION Weight stigma is likely to drive weight gain and poor health and thus should be eradicated. This effort can begin by training compassionate and knowledgeable healthcare providers who will deliver better care and ultimately lessen the negative effects of weight stigma.
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Predictors of weight stigma experienced by middle-older aged, general-practice patients with obesity in disadvantaged areas of Australia: a cross-sectional study.
Spooner, C, Jayasinghe, UW, Faruqi, N, Stocks, N, Harris, MF
BMC public health. 2018;18(1):640
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People in higher categories of obesity are at substantially increased health risk because mortality increases sharply as body mass index rises above 30. In addition to physical health risks, people with obesity commonly experience weight-related stigma. The aim of this study was to identify predictors of perceived weight stigma among patients with obesity attending general practices in socioeconomically disadvantaged urban areas of Australia. This is a cross-sectional study for which data from telephone interviews with patients with obesity were used. Patients were recruited from 17 general practices in socioeconomically disadvantaged areas of Sydney and Adelaide. Results indicate that one-third of the sample had experienced direct forms of weight discrimination in the week before being interviewed. Furthermore, weight discrimination was more likely to be experienced by patients in higher obesity categories, who were not employed, who spoke a language other than English at home and who had lower scores on the Health Literacy Questionnaire domain (that measures the ability to actively engage with healthcare providers). Authors conclude that weight stigma may compound other forms of social disadvantage. Thus, strategies are needed to address weight stigma at the individual, system and population levels and to educate primary care providers to be more alert to the needs of their patients with obesity.
Abstract
BACKGROUND Rates of obesity have increased globally and weight stigma is commonly experienced by people with obesity. Feeling stigmatised because of one's weight can be a barrier to healthy eating, physical activity and to seeking help for weight management. The aim of this study was to identify predictors of perceived weight among middle-older aged patients with obesity attending general practices in socioeconomically disadvantaged urban areas of Australia. METHODS As part of a randomised clinical trial in Australia, telephone interviews were conducted with 120 patients from 17 general practices in socioeconomically disadvantaged of Sydney and Adelaide. Patients were aged 40-70 years with a BMI ≥ 30 kg/m2. The interviews included questions relating to socio-demographic variables (e.g. gender, language spoken at home), experiences of weight-related discrimination, and the Health Literacy Questionnaire (HLQ). Multi-level logistic regression data analysis was undertaken to examine predictors of recent experiences of weight-related discrimination ("weight stigma"). RESULTS The multi-level model showed that weight stigma was positively associated with obesity category 2 (BMI = 35 to < 40; OR 4.47 (95% CI 1.03 to 19.40)) and obesity category 3 (BMI = ≥ 40; OR 27.06 (95% CI 4.85 to 150.95)), not being employed (OR 7.70 (95% CI 2.17 to 27.25)), non-English speaking backgrounds (OR 5.74 (95% CI 1.35 to 24.45)) and negatively associated with the HLQ domain: ability to actively engage with healthcare providers (OR 0.12 (95% CI 0.05 to 0.28)). There was no association between weight stigma and gender, age, education or the other HLQ domains examined. CONCLUSIONS Weight stigma disproportionately affected the patients with obesity most in need of support to manage their weight: those with more severe obesity, from non-English speaking backgrounds and who were not in employment. Additionally, those who had experienced weight stigma were less able to actively engage with healthcare providers further compounding their disadvantage. This suggests the need for a more proactive approach to identify weight stigma by healthcare providers. Addressing weight stigma at the individual, system and population levels is recommended. TRIAL REGISTRATION The trial was registered with the Australian Clinical Trials Registry ACTRN126400102162 .
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Can Reduced Intake Associated with Downsizing a High Energy Dense Meal Item be Offset by Increased Vegetable Variety in 3⁻5-year-old Children?
Carstairs, SA, Caton, SJ, Blundell-Birtill, P, Rolls, BJ, Hetherington, MM, Cecil, JE
Nutrients. 2018;10(12)
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Large proportions of energy dense foods tend to lead to over-consumption. However, offering smaller portions of energy-dense foods may lead to compensatory consumption of other foods. The aim of this study was to investigate the effects of reducing portion sizes of energy-dense foods, whilst increasing the variety of vegetables offered to pre-school children. The study was an experimental design were 51 participants – 3 to 5-year old pre-school children - were offered a lunch meal which was either a standard (100%) or downsized (60%) portion of a high-energy dense food over a period of 8 weeks. The results showed a significant reduction in intake of the high energy dense meal item and total meal intake in pre-school children. Offering a variety of vegetables as low energy dense sides within the meal increased vegetable intake compared to offering a single vegetable. Authors conclude that downsizing the portion of the high energy dense component of a lunch-time meal can be used as an effective strategy to reduce high energy dense food intake without a compensatory change in intake of other foods in pre-school aged children.
Abstract
Large portions of energy dense foods promote overconsumption but offering small portions might lead to compensatory intake of other foods. Offering a variety of vegetables could help promote vegetable intake and offset the effect of reducing the portion size (PS) of a high energy dense (HED) food. Therefore, we tested the effect on intake of reducing the PS of a HED unit lunch item while varying the variety of the accompanying low energy dense (LED) vegetables. In a within-subjects design, 43 3⁻5-year-old pre-schoolers were served a lunch meal in their nursery on 8 occasions. Children were served a standard (100%) or downsized (60%) portion of a HED sandwich with a side of LED vegetables offered as a single (carrot, cherry tomato, cucumber) or variety (all 3 types) item. Reducing the PS of a HED sandwich reduced sandwich (g) (p < 0.001) and total meal intake (kcal) consumption (p = 0.001) without an increased intake of other foods in the meal (LED vegetables (p = 0.169); dessert (p = 0.835)). Offering a variety of vegetables, compared with a single vegetable, increased vegetable intake (g) (p = 0.003) across PS conditions. Downsizing and variety were effective strategies individually for altering pre-schoolers' intakes of HED and LED meal items, however, using variety to offset HED downsizing was not supported in the present study.
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A longitudinal cohort study examining determinants of overweight and obesity in adulthood.
Barakat-Haddad, C, Saeed, U, Elliott, S
Canadian journal of public health = Revue canadienne de sante publique. 2017;108(1):e27-e35
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Adulthood obesity is a global health concern, which has consistently been associated with insulin resistance, type 2 diabetes, cardiovascular diseases, asthma, stroke, osteoarthritis, and various types of cancers. The objectives of this study were: 1) apply the Life Course Health Development (LCHD) model to assess childhood and life course determinants of weight status in adulthood, 2) evaluate associations between adulthood weight status and geographical differences in air quality, and 3) assess gender-specific factors associated with weight status in adulthood. The study is a longitudinal study for which childhood data (n=3202) was acquired from the original research program (1978–1986), which resulted in 315 participants. Results indicate that in childhood, 72% of participants enjoyed a healthy weight; this declined to 33% in adulthood in the same cohort. Male gender and prolonged occupational exposures to harmful contaminants were associated with adulthood overweight and obesity. Authors conclude that adulthood overweight and obesity are associated with childhood and life-course factors, including residential and occupational contaminant exposures, in a gender-specific manner.
Abstract
OBJECTIVES Adulthood overweight and obesity are multifaceted conditions influenced by a combination of biological, environmental and socio-cultural factors across the lifespan. Using a longitudinal study design, we aimed to identify determinants of adulthood overweight and obesity, in relation to: 1) childhood and life course factors, 2) geographical differences in air quality, and 3) gender-specific factors, in a cohort followed from childhood into adulthood. METHODS Childhood data were acquired (1978-1986) from children residing in four distinct Hamilton neighbourhoods (Ontario, Canada), including air-quality assessments. Adulthood data were obtained (2006-2007) from successfully retraced participants (n = 315) using comprehensive self-administered questionnaires. Multivariate logistic regressions were used to evaluate determinants of adulthood overweight (BMI: 25-29.9 kg/m2) and obesity (BMI: ≥30). RESULTS The prevalence of normal weight decreased drastically at follow-up in adulthood, while that of overweight and obesity increased. Both overweight and obesity in adulthood were associated with male gender and occupational exposures to contaminants. Childhood residence in Hamilton neighbourhoods with better air quality was associated with lesser odds of adulthood overweight, whereas adulthood obesity was strongly linked to childhood weight gain (overweight or obesity). Among females, childhood weight status predicted overweight and obesity in adulthood, with always living in Hamilton, lack of additional health insurance, negative self-appraisal and high blood pressure during adulthood identified as other significant predictors. Among males, prolonged occupational exposures to contaminants emerged as a unique determinant of adulthood weight gain. CONCLUSION Adulthood overweight and obesity are associated with childhood and life course determinants, including childhood weight status, residential air quality and occupational contaminant exposures, in a gender-specific manner.