Physical Activity Interventions for Children Not Successful

September 28th, 2012 No comments »

According to a just published meta-analysis in the British Medical Journal, “Physical activity interventions have little effect on the overall activity levels of children, which may explain, at least in part why such interventions have a limited effect on body mass index or body fat. The outcome of this meta-analysis questions the contribution of physical activity to the prevention of childhood obesity.”

The meta-analysis included 30 studies involving 14,326 participants, 6,153 with accelerometer measurements. The pooled results provided strong evidence that physical activity interventions have only a small effect (approximately 4 minutes more walking or running per day) on children’s overall activity levels, explaining why such interventions have limited success in reducing body mass index or body fat in children. After school activity may simply replace other activities the child would be normally engaging in or the child may compensate for the exercise by eating back many or most of the calories expended. BMJ: Effectiveness of intervention on physical activity of children

 

Time for a reappraisal

September 14th, 2012 No comments »

I have a blog on the STOP Obesity Alliance website on the latest research on the effectiveness of public policy interventions to prevent obesity.

See:  http://www.stopobesityalliance.org/blog/time-for-a-reappraisal-of-public-policy-interventions-on-obesity

 

 

Maternal Employment and Childhood Obesity

August 24th, 2012 No comments »

Of the putative causes of obesity, one of the strongest and most consistent is maternal obesity. But maternal employment has also been implicated in a number of studies over the last few years. While not proving causation, the dramatic increase in childhood obesity since the 1970’s, coincides with an equally dramatic rise in female participation in the workforce who had children under the age of 18. This rate rose from 47.4% to 71.2%.

Are these two phenomenon related? It’s a good question. Putting two graphs next to each other doesn’t prove one affected the other. Recent studies have shows an increased likelihood that children of working mothers are more likely to be overweight than those of non-working mothers. A systemic review of OECD countries found evidence indicating the working mothers were somewhat more likely to have overweight children. PubMed: Maternal Employment Childhood Health Effects in OECD countries. A large study in the United Kingdom found that any maternal employment after birth contributed to the likelihood the child would be overweight. PubMed: Maternal Employment and early childhood obesity UK Millenium Study.

Moms are not likely to be surprised that the evidence shows that Dad’s employment or hours worked do not correlate to a child overweight, presumably because they spend less time in cooking, food preparation, and child care to begin with.

But the question still remained, does maternal employment result in less time spent in activities directly related to a child’s diet and physical activity or a reduction in other activities. So John Cawly and Feng Liu undertook to research this question, utilizing an extensive database, the American Time Use Study (ATUS).

They found that, on average, working mothers spent 277 minutes a day with children; 410 minutes for non-working mothers. Working mothers were less likely to spend any time grocery shopping, cooking, eating with children, child care and supervising children. Among women who spent any time in these activities, the average number of minutes spent was consistently lower for working than for-non-working mothers. According to the authors, “The one exception to this general pattern is that working mothers are significantly more likely to report spending any time purchasing prepared food.” Roughly 20% of both working and non-working women with children spend 0 minutes with children a day.

More specifically, 8 hours of employment is associated with women spending 7 fewer minutes grocery shopping, 23 fewer minutes cooking, 18 fewer minutes eating with children, 14 minutes fewer minutes playing with children, 51 fewer minutes caring for children, and, 5 fewer minutes supervising children. The time deficits are roughly twice as large for women with a husband or partner than for single mothers. There was no significant difference in the time spent with children by husbands whose spouse worked or did not work. Overall, fathers appear to offset less than 15% of the decrease in time that working mothers spend with their children. Even non-working men pick up only about 1/3 of the slack.

Other research in this field indicate that children of working mothers have fewer formal  meals, more food consumed grazing, more prepared foods, more time spent watching television, and more time unsupervised.

Moms are not having a picnic either. The Cawley study found that, compared to non-working mothers, working mothers spent 48 fewer minutes per day watching TV, 31 fewer minutes sleeping, 17 fewer minutes at leisure and 16 fewer minutes socializing.

As I write this, the airwaves have political ads calling for tougher restrictions on welfare payments (which go to mothers with children), specifically more rigorous work requirements. This study may indicate that there are long term consequences for such policies in terms of maternal and child health. Other policies, including those affecting food labeling and school physical activity should be re-evaluated.

Back in the 1970s, there was a lot of debate over whether mothers should work at all. This was seen as some discretionary. We are a long way away from that time. For the vast majority of working mothers, have the additional income is essential to the whole family survival.

Just a word about the American Time Use Study: This database, maintained by the Department of Labor, Bureau of Labor Statistics (http://www.bls.gov/tus/) is, in my opinion, underutilized in obesity. Predictably, we hear recommendations that people should just change their lifestyle, spend more time, like 30-60 minutes a day in physical activity, more time buying fresh foods, cooking wholesome foods, turning off the TV to do some activity, etc….Well, the ATUS provides some average time usage by adults. For weekdays: Personal care activity 9.24 hours, eating and drinking 1.19 hours, household activities 1.63 hours,  purchasing goods and services, .69 hours, caring for household members .54, comparing for non-household members .20 hours, working and work related activities 4.49 hours, educational activities .60 hours, organizational, civic and religious activities 0.25 hours, leisure and sports 4.73, telephone calls, email, .16 hours. The point is, when asking people to make changes in their diets and physical activity, we have to ask “where is this time going to come from?” It has come from other activities? Taking care of Grandma? Volunteering at church? What? Just giving ‘good advice’ is not enough when so many Americans are living such stressful lives when free time is in short supply, especially for working moms.

Read Cawley and Liu’s research at PubMed:Maternal Employment and Childhood Obesity

Illustration from www.itsnitelife.com.

USAToday Coverage of IOM Recommendations

May 8th, 2012 1 comment »

Multiple strategies needed to fight obesity, study suggests

By Nanci Hellmich, USA TODAY

Updated 1h 12m ago

WASHINGTON – Taming the obesity epidemic in this country needs an all-hands-on-deck strategy so that schools provide students 60 minutes of physical activity daily, fast-food restaurants offer healthier fare for kids, and communities build recreational spaces that encourage physical activity, says a new report out Tuesday. 

  • A new report recommends kids have 60 minutes of active time per day.By Reed Saxon, APA new report recommends kids have 60 minutes of active time per day.

By Reed Saxon, AP

A new report recommends kids have 60 minutes of active time per day.

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It’s going to take “bold actions” like these and a full-scale effort across all segments of society to reduce the obesity epidemic, says the report from experts convened by theInstitute of Medicine, which provides independent advice on health issues to policy makers, foundations and others.

The goals and some of the strategies were presented here at the Centers for Disease Control and Prevention’s “Weight of the Nation” meeting, where experts are discussing ideas for the prevention and control of obesity.

Currently, two-thirds of adults and a third of children in the USA are overweight or obese, government statistics show. Another study out Monday predicted that as many as 42% of adults may be obese, roughly 30 or more pounds over a healthy weight, by 2030 if actions aren’t taken to reverse the trend.

Extra weight takes a huge toll on health increasing the risk of type 2 diabetes, heart disease, stroke, many types of cancer, sleep apnea and other debilitating and chronic illnesses, and it costs billions of dollars in extra medical expenditures.

The Institute of Medicine committee reviewed more than 800 obesity prevention recommendations to pinpoint the most effective ones.

The report says there is no one answer to this problem, but it’s going to require bringing all the pieces together — the schools, the workplace, health care providers, says Dan Glickman, chairman of the institute committee and former secretary of the U.S. Department of Agriculture. “There are no magic bullets in here, but this report puts it all together.”

The illnesses and costs associated with obesity are spiraling out of control, he says. “If we don’t address this comprehensively, it will basically take us down as a society.”

M. R. C. Greenwood, vice chairwoman of the committee and president of the University of Hawaiisystem, says, “Many people will probably say ‘what’s new’ and what’s new is the clear statement that we must begin to attack this problem collectively on all fronts. It’s a massive problem unlike anything we have ever tackled before.”

Here are the five goals and a some strategies suggested for achieving them:

Make it easier for people to work physical activity into their daily lives. For instance, people need to have safe places to be active including trails, parks, playgrounds and community recreation centers.

Create an environment where healthy food and beverage options are the routine, easy choice.

Fast-food and chain restaurants could revise menus to make sure at least half of their kids’ meals comply with government’s dietary guidelines for moderately active 4- to 8-year-olds, and that those meals are moderately priced.

Businesses, governments and others should adopt policies to reduce the consumption of sugar-sweetened beverages including making clean water available in public places, work sites and recreation areas.

Improve messages about physical activity and nutrition.

The food, beverage, restaurant and media industries should take voluntary action to adopt nutritionally based standards for marketing aimed at children and adolescents, ages 2-17. If those standards aren’t adopted within two years by the majority of companies, then local, state and federal policymakers should consider setting mandatory nutritional standards for marketing to this age group.

Expand the role of health care providers, insurers and employers in obesity prevention.

Employers should provide access to healthy foods at work and offer opportunities for physical activity as part of their wellness/health promotion programs.

All health care providers should adopt standards of practice for preventing, screening, diagnosing and treating people who are overweight or obese.

Make schools a national focal point for obesity prevention.

Students should have nutrition education throughout their school years, and kids in kindergarten through 12th grade should have the chance to engage in a total of 60 minutes of physical activity each school day. This should include participation in quality physical education.

“There’s so much to do, and the country is still doing so little,” says Margo Wootan, director of nutrition policy for the Center for Science in the Public Interest, a Washington-based consumer group. “It seems heartless that we’re abandoning two-thirds of the American population to obesity-related diseases.”

There are lots of ways for students to get an hour of physical activity during the school day including recess, PE, walking and biking to school, classroom activities and after-school sports, Wootan says. “Kids need a chance to run around in order to sit still and learn in the classroom.”

When it comes to food marketing to kids, “companies claim to be taking meaningful action, but still the overwhelming majority of food ads aimed at kids are for unhealthy foods,” she says.

“What industry says is healthy to market to kids is not what most parents and health professionals think is healthy.”

Not everyone is convinced that the actions outlined in the report will make a dent in the obesity problem. “The literature in evaluating interventions like these shows weak effectiveness at best,” says Morgan Downey, editor and publisher of the downeyobesityreport.com. “So rather than evaluate the strategies’ effectiveness, they (the committee members) are just shouting them even louder.”

For more information about reprints & permissions, visit our FAQ’s. To report corrections and clarifications, contact Standards Editor Brent Jones. For publication consideration in the newspaper, send comments to letters@usatoday.com. Include name, phone number, city and state for verification. To view our corrections, go to corrections.usatoday.com.

Posted 11h 11m ago | Updated 1h 12m ago

 

Competitive Food Sales in Schools Not Affect Obesity

February 2nd, 2012 No comments »

Most US middle and high schools sell soft drinks, candy and chips to their students. These practices have been widely criticized as contributing to childhood and adolescent obesity. However, a new study followed  approximately 19,450 children from fifth to eight grade. Researchers found the children’s weight gain was not associated with the introduction or the duration of exposure to competitive foods. This did not vary by gender, race/ethnicity or family socioeconomic status. Possible explanations are that children’s food preferences and dietary patterns are firmly established before adolescence. Also, schools are highly structured whereas home life may have more opportunities for snacking. http://www.asanet.org/images/journals/docs/pdf/soe/Jan12SOEFeature.pdf.

Who Would Have Thought?

December 27th, 2011 No comments »

Gee, teen-agers want to eat junk food? Eating advice of experts and parents rejected?

No way, right?

Well, if you were skeptical before about school meal reforms, this article will be right up your alley. It shows the ‘creativity’ of teenagers in frustrating the nutritional advice of adults.  L.A. schools’ healthful school lunches panned by LAUSD students – latimes.com

Schools and Children

September 27th, 2009 No comments »

As concern about childhood obesity has increased, the school environment has received increased attention.

Retooling school food offerings can help. The Somerville MA experiment Retooling food service for early elementary school…[Prev Chronic Dis. 2009] – PubMed Result

A very positive study on the value of nutrition education in the schools Effectiveness of school programs in preventing chi…[Am J Public Health. 2005] – PubMed Result

Effect of the school food environment Association between school food environment and pr…[J Am Diet Assoc. 2009] – PubMed Result

School food environments and practices affect diet…[J Am Diet Assoc. 2009] – PubMed Result

Schools are making progress in addressing obesity. Schools and obesity prevention: creating school en…[Milbank Q. 2009] – PubMed Result

International Journal of Obesity – Abstract of article: Childhood overweight and elementary school outcomes

Overweight affect school performance in girls but not boys. See: http://www.rand.org/pubs/reprints/2008/RAND_RP1315.pdf

Impact of removing low nutrition foods in schools. The Impact of Removing Snacks of Low Nutritional V…[Health Educ Behav. 2009] – PubMed Result

Food use in middle and high school fundraising: do…[J Am Diet Assoc. 2009] – PubMed Result

School Environment gets worse with higher grades. School food environments and policies in US public…[Pediatrics. 2008] – PubMed Result

BMI measurement in schools Body mass index measurement in schools. [J Sch Health. 2007] – PubMed Result

Journal of Public Health Policy – Disparities in Physical Activity and Sedentary Behaviors Among US Children and Adolescents: Prevalence, Correlates, and Intervention Implications

Journal of Public Health Policy – Arkansas Act 1220 of 2003 to Reduce Childhood Obesity: Its Implementation and Impact on Child and Adolescent Body Mass Index

Journal of Public Health Policy – Early Impact of the Federally Mandated Local Wellness Policy on Physical Activity in Rural, Low-Income Elementary Schools in Colorado

Journal of Public Health Policy – Preventing Childhood Obesity through State Policy: Qualitative Assessment of Enablers and Barriers

Journal of Public Health Policy – Correlates of Walking to School and Implications for Public Policies: Survey Results from Parents of Elementary School Children in Austin, Texas

Journal of Public Health Policy – Sociodemographic, Family, and Environmental Factors Associated with Active Commuting to School among US Adolescents

Journal of Public Health Policy – Implementation of Texas Senate Bill 19 to Increase Physical Activity in Elementary Schools

The Built Environment

September 27th, 2009 No comments »

Understanding the Relationship between Activity an…[BMC Public Health. 2009] – PubMed Result

Prevalence, trends and environmental influences on…[Med Sport Sci. 2007] – PubMed Result

Built Environments and Obesity in Disadvantaged Po…[Epidemiol Rev. 2009] – PubMed Result

Neighborhood environments: disparities in access t…[Am J Prev Med. 2009] – PubMed Result

Physical environmental correlates of childhood obe…[Obes Rev. 2009] – PubMed Result