Preventing Childhood Obesity - Evidence Policy and Practice.pdf

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Childhood obesity prevention overview Modifiable determinants Underlying factors Nutrition related susceptibility (life-course exposure) Community empowerment demand for: safe and healthy foods, active lives Public and private sector response to people’s health demands Government response in protection of public interest International and National framework policies: health, education, agriculture, economic, urbanization, recreation, transport, trade Legislative framework: to promote, support and protect right to safe and nutritious foods. Access to safe and healthy foods (quantity and quality) Balancing energy intake and expenditure Factors affecting food and PA supply chain Policies affecting marketing, advertisement, subsidies Urban space and facilities for active lives (household school and workplace) Psycho-social determinants of food intake and PA Energy-balance Energy-dense diets (fat and sugar) Physical Activity Appetite and food intake control Pre and postnatal growth Macronutrient quality Micronutrient balance Hormonal response to diet Epigenetic Receptors Adipocyte Cell Growth genes Hormones OBESITY Genetic Monogenic Polygenic potential for future effectiveness present efforts Figure 3.1 The hierarchy of determinants of childhood obesity from basic societal determinants (which have the greatest potential for prevention efforts) to individual and genetic predisposition (which is where the greatest efforts are currently based). A l ife - c ourse a pproach to o besity p revention The concept that obesity should be prevented using a life - course approach is relatively new. The old concept that children would outgrow overweight and obesity has been abandoned based on the currently available data which show that as obesity prevalence rises the tracking of increased adiposity into adulthood becomes stronger and more clearly defined. 6 The evidence indicates that the time to consider obesity and chronic disease prevention is from early life and continues throughout every stage of the life course, Figure 3.2 offers a graphic depiction of this concept. Preconception This is an important time to ensure, if possible, that maternal body mass index ( BMI ) is normal (i.e., between18.5 and 25 kg/m 2 ) and that micronutrient status is normal (i.e., any anemia is corrected and folate intake is adequate through adequate diet, fortified foods or supplements). Monitoring maternal weight gain is important to reduce the risk of low birth weight ( < 2.5 kg) as well as macrosomia (birth weight > 4.0 kg). The relationship between birth weight and obesity is that of an open J - shaped curved: that is, both low birth weight and high birth weight are associated with a higher risk of later obesity. While the mechanisms by which intrauterine undernutrition or overnutrition predisposes to later unhealthy weight gain are beginning to be elucidated, 7 the key message is that we should change what is considered good nutrition during infancy, from a focus on weight gain to one where linear growth and the proportionality of weight relative to length are truly important. Infants and young children The main preventive strategies for these groups are to: promote and support the practice of exclusive breastfeeding for the first six months of life as the preferred mode of feeding; avoiding the use of added sugars and starches when feeding 23
Chapter 3 Obesity prevention:a life-course approach Fetal life Infancy and childhood Adolescence Adult life Development of obesity SES Mother’s Nutrition Smoking Growth Birth weight Breastfeeding SES Infection PEM Micronutrients Growth rate Stature Physical Activity Food behavior Obesity Sendentarism Inactivity Smoking Established adult risky behaviors Diet/Physical activity, Tobacco, Alcohol Biological risks Socio-economic status Environmental conditions Accumulated risk Genetic susceptibility to Obesity Age Figure 3.2 The life - course approach to obesity prevention considers age specific actions at each stage of the life course, the objective of these actions is to ameliorate the burden of obesity that is preventable by diet and physical activity interventions. artificial formula, considering that flow of milk from the bottle is faster than from the breast, so it is easier to provide excess energy; instructing mothers to accept their child ’ s ability to regulate energy intake rather than feeding until the plate is empty; and assuring the appropriate micronutrient intake needed to promote optimal linear growth. Older children and adolescents The main preventive strategies in these age groups are to: promote an active lifestyle, limit television viewing, promote the intake of fruits and vegetables; restrict the intake of energy - dense, micronutrient - poor foods (e.g., packaged snacks); restrict the intake of sugar - sweetened soft drinks. Additional measures to support these behavioral approaches include: modifying the environment to enhance physical activity in schools and communities; creating more opportunities for family interaction (e.g., eating family meals); limiting the exposure to aggressive marketing practices of energy - dense, micronutrient - poor foods; and providing the necessary information and skills to make better food choices. In lower income countries, special attention should be given to avoidance of overfeeding stunted population groups. Nutrition programmes designed to control or prevent undernutrition need to assess stature in combination with weight to prevent providing excess energy to children of low weight - for - age but normal weight-for-height.8,9 In countries undergoing rapid growth and demographic transition, and as populations become more sedentary and able to access energy - dense foods, there is a need to maintain the healthy components of traditional diets (e.g., high intake of vegetables, fruits and non - starch polysaccharides).10 Education provided to parents from disadvantaged communities that are food insecure should stress that overweight and obesity do not represent good health. Low - income groups globally and populations in countries in economic transition often replace traditional micronutrient - rich foods by heavily marketed, sugar - sweetened beverages (such as soft drinks) and energy - dense fatty, salty and sugary foods. 10 These trends, coupled with reduced physical activity, are associated with the rising prevalence of obesity. 24
Page 2: Preventing Childhood Obesity Eviden
Page 6 and 7: Preventing Childhood Obesity Eviden
Page 8 and 9: Contents Foreword, vii Contributors
Page 10: Foreword Obesity became a major hea
Page 13 and 14: Contributors Rob Carter PhD Head, H
Page 15 and 16: Contributors Shiriki Kumanyika PhD,
Page 18: Preface If we had all the evidence,
Page 22 and 23: CHAPTER 1 The c hildhood o besity e
Page 24 and 25: Childhood obesity epidemic Table 1.
Page 26 and 27: Childhood obesity epidemic explain
Page 28 and 29: Childhood obesity epidemic Table 1.
Page 30 and 31: Childhood obesity epidemic hepatiti
Page 32 and 33: Childhood obesity epidemic 15 Shiel
Page 34 and 35: CHAPTER 2 Lessons from the c ontrol
Page 36 and 37: Lessons from the control of other e
Page 44 and 45: Childhood obesity prevention overvi
Page 50 and 51: CHAPTER 4 No c ountry for f at c hi
Page 52 and 53: No country for fat children? Ethica
Page 60 and 61: A human rights approach to childhoo
Page 62 and 63: A human rights approach to childhoo
Page 64: A human rights approach to childhoo
Page 67 and 68: Part 2 community and government age
Page 69 and 70: Chapter 6 Questions Evidence needed
Page 71 and 72: Chapter 6 ioral determinants rather
Page 73 and 74: Chapter 6 These issues are particul
Page 75 and 76: Chapter 6 15 Carrel AL , Bernhardt
Page 77 and 78: Chapter 7 at the state level to app
Page 79 and 80: Chapter 7 prevention efforts, parti
Page 81 and 82: Chapter 7 interventions. This appro
Page 83 and 84: CHAPTER 8 Evidence of the i nfl uen
Page 85 and 86: Chapter 8 choices in adolescence, 1
Page 87 and 88: Chapter 8 itself is unlikely to res
Page 89 and 90: Chapter 8 20 Cullen K , Baranowski
Page 91 and 92: Chapter 9 meal frequency, decreased
Page 93 and 94:
Chapter 9 were behavioral (parent -
Page 95 and 96:
Chapter 9 changes regarding partici
Page 97 and 98:
Chapter 9 36 Campbell KJ , Hesketh
Page 99 and 100:
Chapter 10 condition obesity in chi
Page 101 and 102:
Chapter 10 the release of energy an
Page 103 and 104:
Chapter 10 whereas Flynn et al 25 a
Page 105 and 106:
Chapter 10 11 Baranowski T : Advanc
Page 107 and 108:
CHAPTER 11 Obesity p revention in s
Page 109 and 110:
Chapter 11 translation (see Chapter
Page 111 and 112:
Chapter 11 overweight and obesity r
Page 113 and 114:
CHAPTER 12 The p revention of c hil
Page 115 and 116:
Chapter 12 Selective prevention pro
Page 117 and 118:
Chapter 12 Table 12.1 Recommendatio
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Chapter 12 Table 12.1 Continued Gui
Page 121 and 122:
Chapter 12 short - and long - term
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Chapter 12 33 Woo KS , Chook P , Yu
Page 125 and 126:
Chapter 13 There is a relatively sm
Page 127 and 128:
Chapter 13 Modifying the b uilt e n
Page 129 and 130:
Chapter 13 capacity to support chil
Page 131 and 132:
Chapter 13 45 Staunton C , Hubsmith
Page 133 and 134:
Chapter 14 Changes in the food envi
Page 135 and 136:
Chapter 14 Promising interventions
Page 137 and 138:
Chapter 14 10 USDA - ERS : Food CPI
Page 139 and 140:
CHAPTER 15 Food and b everage m ark
Page 141 and 142:
Chapter 15 Box 15.1 The findings of
Page 143 and 144:
Chapter 15 Food, however, is not to
Page 145 and 146:
Chapter 15 competitive analysis eac
Page 147 and 148:
Chapter 15 behaviour: exploring the
Page 149 and 150:
Chapter 16 pawn or sell possessions
Page 151 and 152:
Chapter 16 obesity and that this ma
Page 153 and 154:
Chapter 16 impact of this deprivati
Page 155 and 156:
Chapter 16 10 Marin - Leon L , Sega
Page 157 and 158:
CHAPTER 17 Socio - c ultural i ssue
Page 159 and 160:
Chapter 17 The s ocio - c ultural e
Page 161 and 162:
Chapter 17 with limited access and/
Page 163 and 164:
Chapter 17 What else can be done to
Page 165 and 166:
Chapter 17 55 Grier S , Kumanyika S
Page 167 and 168:
Chapter 18 Ironically, these countr
Page 169 and 170:
Chapter 18 key environmental factor
Page 171 and 172:
Chapter 18 countries precludes the
Page 173 and 174:
Chapter 18 7 Jafar TH , Qadri Z , I
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CHAPTER 19 Evaluation of c ommunity
Page 178 and 179:
Evaluation of community-based obesi
Page 180 and 181:
Page 182 and 183:
Page 184 and 185:
Page 186 and 187:
CHAPTER 20 Economic e valuation of
Page 188 and 189:
Economic evaluation of obesity inte
Page 190 and 191:
Page 192 and 193:
Page 194 and 195:
CHAPTER 21 Monitoring of c hildhood
Page 196 and 197:
Monitoring of childhood obesity Non
Page 198 and 199:
Monitoring of childhood obesity Noo
Page 200 and 201:
Monitoring of childhood obesity Tab
Page 202 and 203:
Monitoring of childhood obesity 11
Page 204 and 205:
Knowledge translation and exchange
Page 206 and 207:
Page 208 and 209:
Page 210 and 211:
Page 212 and 213:
The role of advocacy Why d o w e n
Page 214 and 215:
The role of advocacy mate long - te
Page 216 and 217:
The role of advocacy position put o
Page 218:
The role of advocacy 6 Yach D , Haw
Page 221 and 222:
Part 4 infrastructure, funding or r
Page 223 and 224:
Chapter 24 by examining why policy
Page 225 and 226:
Chapter 24 has privileged the manuf
Page 227 and 228:
Chapter 24 case study is an analysi
Page 229 and 230:
Chapter 24 by being highly visible
Page 231 and 232:
CHAPTER 25 Developing the political
Page 233 and 234:
Chapter 25 Involuntary: all society
Page 235 and 236:
Chapter 25 Shiriki Kumanyika and co
Page 237 and 238:
Chapter 25 The next steps Given the
Page 239 and 240:
CHAPTER 26 Community i nterventions
Page 241 and 242:
Chapter 26 Table 26.1 The health pr
Page 243 and 244:
Chapter 26 consider and build on th
Page 245 and 246:
Chapter 26 programs and messages be
Page 247 and 248:
Chapter 26 Victoria, Australia. The
Page 249 and 250:
Chapter 26 participants for appropr
Page 251 and 252:
CHAPTER 27 Community c apacity b ui
Page 253 and 254:
Chapter 27 level and macro - change
Page 255 and 256:
Chapter 27 & Chomp ” where the co
Page 257 and 258:
Chapter 27 Box 27.4 Excerpt from Go
Page 259 and 260:
Chapter 27 Table 27.1 Capacity buil
Page 261 and 262:
Chapter 27 38 Borys Jean - Michel :
Page 263 and 264:
Chapter 28 Box 28.1 The EPODE progr
Page 265 and 266:
Chapter 28 Figure 28.1 For parents:
Page 267 and 268:
Chapter 28 Figure 28.2 Promoting ph
Page 269 and 270:
Chapter 28 marketing, there is ofte
Page 271 and 272:
Chapter 28 social problems. The art
Page 273 and 274:
Chapter 29 length gain observed in
Page 275 and 276:
Chapter 29 tissue deposition relate
Page 277 and 278:
Chapter 29 A study in the USA found
Page 279 and 280:
Chapter 29 7 Cole TJ , Bellizzi MC
Page 281 and 282:
Chapter 29 environmental approaches
Page 283 and 284:
Chapter 30 it all on their own, sin
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Chapter 30 Forty - three countries
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Chapter 30 Box 30.2 Elements of the
Page 289 and 290:
Chapter 31 childhood obesity rates
Page 291 and 292:
Chapter 31 became inactive or was t
Page 293 and 294:
Chapter 31 healthy diets and portio
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CHAPTER 32 Working with m inority g
Page 297 and 298:
Chapter 32 and reflect the circumst
Page 299 and 300:
Chapter 32 inclusion and exclusion
Page 301 and 302:
Chapter 32 3 Mercer SL , Vinney JD
Page 303 and 304:
Chapter 33 % of total DALYs lost 2
Page 305 and 306:
Chapter 33 Finally, within a given
Page 307 and 308:
Chapter 33 urbanized and have aband
Page 309 and 310:
Chapter 33 Box 33.1 Recommendations
Page 311 and 312:
CHAPTER 34 Preventing c hildhood o
Page 313 and 314:
Chapter 34 with a plateau in cigare
Page 315 and 316:
Chapter 34 segments of the populati
Page 317 and 318:
Index academic performance 11, 264
Page 319 and 320:
Index evidence-based and evidence-i
Page 321 and 322:
Index community-based 33, 58, 151,
Page 323 and 324:
Index parental support 67 PE 25, 81
Page 325:
Index Minnesota Heart Heath Project
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