Obesity prevention – implications for physical activity promotion

1. Obesity prevention – implications for physical activity promotion Professor Boyd Swinburn Centre for Physical Activity and Nutrition School of Health Sciences Deakin University Melbourne

2. Increasing obesity in all countries

3. % y Boys Girls Increasing childhood overweight and obesity • Overweight + obesity (1995), boys 19.5%, girls 21% • Adult diabetes now seen in adolescents • NO monitoring of the situation *Daniels et al 2001 - national data #Goodman et al 2002 – single NSW school

4. Definitions by Cole et al Lihui & Bell (in press) England Australia USA 1994 4-11y/o 1995 7-11y/o 1991 6-11y/o Australian children versus England and USA

5. 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

6. Burden (‘costs’) of childhood overweight and obesity O = overweight/obesity C = complications of obesity

7. Causes of obesity –convincing evidenceWHO 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

8. 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

9. 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

10. 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

11. 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

12. 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

13. 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

14. Schema for the threshold analysis for reducing childhood obesity Interventions (examples) Estimated effectiveness Warranted investment Economic cost of obesity (O) & its complications (C) Childhood Adulthood TV viewing O C O C  prevalence of childhood overweight & obesity Direct Fast food outlets O C O C Indirect O C O C Intangible Active neighbour-hoods evidence modelling

15. 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

17.  Food ED  Energy intake  Beverage ED • Prevalence overweight/ obesity • Weight  BMI  Sedentariness  Energy output  Physical activity Assumed pathways

18. Modelling assumptions PA • 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%)

19. 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

20. 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

21. Sentinel Site for Obesity Prevention Barwon-South Western Region of Victoria Warrnambool Colac Geelong

22. 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

23. 2002 2003 2004 2005 2006 Increase capacity, training Reach Sustainability Demo area 1 - interventions & evaluation Develop indicators, Pilot testing, monitoring design Activities Demo area 2 – interventions & evaluation Demo area 3 – interventions & evaluation Develop and support interventions Sentinel Site: Proposed schema for action Time Regular 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.

24. 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

25. 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

26. Action plan • ANGELO process – scan environments, prioritise target behaviours, env actions, communication messages • Comprehensive plan

27. 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