Promoting healthy weight in primary school children through physical activity and nutrition education: a pragmatic evaluation of the CHANGE! randomised intervention study.

BACKGROUND: This pragmatic evaluation investigated the effectiveness of the Children's Health, Activity and Nutrition: Get Educated! (CHANGE!) Project, a cluster randomised intervention to promote healthy weight using an educational focus on physical activity and healthy eating. METHODS: Participants (n = 318, aged 10-11 years) from 6 Intervention and 6 Comparison schools took part in the 20 weeks intervention between November 2010 and March/April 2011. This consisted of a teacher-led curriculum, learning resources, and homework tasks. Primary outcome measures were waist circumference, body mass index (BMI), and BMI z-scores. Secondary outcomes were objectively-assessed physical activity and sedentary time, and food intake. Outcomes were assessed at baseline, at post-intervention (20 weeks), and at follow-up (30 weeks). Data were analysed using 2-level multi-level modelling (levels: school, student) and adjusted for baseline values of the outcomes and potential confounders. Differences in intervention effect by subgroup (sex, weight status, socio-economic status) were explored using statistical interaction. RESULTS: Significant between-group effects were observed for waist circumference at post-intervention (ß for intervention effect =-1.63 (95% CI = -2.20, -1.07) cm, p<0.001) and for BMI z-score at follow-up (ß=-0.24 (95% CI = -0.48, -0.003), p=0.04). At follow-up there was also a significant intervention effect for light intensity physical activity (ß=25.97 (95% CI = 8.04, 43.89) min, p=0.01). Interaction analyses revealed that the intervention was most effective for overweight/obese participants (waist circumference: ß=-2.82 (95% CI = -4.06, -1.58) cm, p<0.001), girls (BMI: ß=-0.39 (95% CI = -0.81, 0.03) kg/m2, p=0.07), and participants with higher family socioeconomic status (breakfast consumption: ß=8.82 (95% CI = 6.47, 11.16), p=0.07). CONCLUSIONS: The CHANGE! intervention positively influenced body size outcomes and light physical activity, and most effectively influenced body size outcomes among overweight and obese children and girls. The findings add support for the effectiveness of combined school-based physical activity and nutrition interventions. Additional work is required to test intervention fidelity and the sustained effectiveness of this intervention in the medium and long term. TRIAL REGISTRATION: Current Controlled Trials ISRCTN03863885.

Is it time to regulate over-the-counter weight-loss formulations?

Many products claiming to promote weight loss are freely available to purchase over the counter and are used by a substantial proportion of the population in many countries, who are often seeking rapid weight loss without long-term lifestyle changes. While there are multiple outlets for these products, surveys in England and Australia have found that at least 70% of community pharmacies stock these products and they are also available through internet pharmacies. Since the products are formulated as tablets and capsules, consumers may regard them as medicines, particularly when sold from a pharmacy. Manufacturers often make extravagant claims for their products, suggesting they suppress appetite, increase metabolism, block absorption of fat or carbohydrates and/or bring about diuresis, but there is little robust evidence of efficacy. Most products contain a variety of herbal ingredients and are not without adverse effects. Since very few of the hundreds of products sold in pharmacies are licensed medicines, they are not subject to the controls required for over-the-counter medicines, in terms of efficacy, safety, quality or provision of a standardised patient information leaflet. Pharmacists themselves perceive these products to be unsafe, but have little knowledge about them, other than that supplied by manufacturers. The role of community pharmacy in supporting effective weight management is increasingly important, given the rise in obesity. We question the widespread supply through pharmacies of ineffective products with extravagant claims and suggest that tighter regulation of their promotion and supply may be required.

Regular consumption of a cereal breakfast. Effects on mood and body image satisfaction in adult non-obese women.

Breakfast has psychological and nutritional benefits due to physiological mechanisms and expectations about health impact. Beliefs people hold about calories in food can adversely affect mood and body-image satisfaction and such adverse reactions can be predicted by body mass index. The objectives were to test the effect of consuming isocaloric breakfasts, appearing different in calorie content, on appetite, mood and body-image satisfaction, and to assess impact on daily nutrient intake. One-hundred-and-twenty-three women were randomly assigned to eat a cereal or muffin breakfast which "appeared" different in calorie content while unaware they were isocaloric. Participants estimated calories of breakfast, appetite, mood, and body-image satisfaction on a daily basis for seven-days. The cereal breakfast was perceived to be lower in calories, made participants fuller, happier, relaxed, and more satisfied about weight and body compared to the muffin breakfast. Differences in estimated daily fibre and micronutrient intake were compatible with the design. Breakfasts were isocaloric yet the cereal breakfast was rated lower in calories and produced more positive psychological reactions. This evidence indicates the power of perceptions of foods to influence important attributes of health and well-being which could be valuable in dietary interventions where mood and body image satisfaction affect outcome.

Associations between children's socioeconomic status, weight status, and sex, with screen-based sedentary behaviours and sport participation.

OBJECTIVE: The objective was to study associations between socioeconomic status (SES), weight status, and sex, with children's participation in sedentary behaviours and sport. METHODS: Children (aged 9-10 years; n = 6,337) completed a questionnaire to establish how long they spent in sedentary behaviours and sport participation during week days and weekend days. Height and weight were measured to calculate body mass index. Associations between dependent and independent variables were investigated using hierarchical loglinear analysis. RESULTS: A significantly greater proportion of boys than girls spent > or = 1 h per weekday and weekend day watching television (TV) (p < 0.001), playing video games (p < 0.001), and participating in sport (p < 0.001). TV viewing and video gaming for > or = 1 h per day were inversely associated with SES (p = 0.001), whilst the greatest proportion of children participating in sport for > or = 1 h were in the highest SES quartile (p < 0.001). Overweight girls were more likely than normal weight girls to use the internet for > or = 1 h per weekend day (p < 0.001). CONCLUSIONS: Relatively more lower SES children spent time in sedentary behaviours than sport participation. Weight status was not consistently associated with sedentary behaviours. Proportionately more boys than girls watched TV, played video games, and participated in sport, suggesting that boys find time for sedentary behaviours and physical activity. Efforts should be made to address inequalities in the prevalence of sedentary behaviours and sport participation for all children regardless of SES, weight status, or sex.

Changes in BMI and prevalence of obesity and overweight in children in Liverpool, 1998-2006.

AIMS: To investigate changes in mean body mass index (BMI) and prevalence of obesity between 1998 and 2006 in annual cohorts of 9-10-year-old Liverpool schoolchildren. METHODS: Stature and body mass data collected at the Liverpool SportsLinx project's fitness testing sessions were available on 26,782 (n = 13,637 boys, 13,145 girls) participants. BMI was calculated from these data. RESULTS: BMI z-score increased over time (p < 0.01) in both boys (z-score range = -0.22-0.14) and girls (z-score range = -0.2-0.16), with all years showing significantly higher BMI values in comparison to the first two years of the project (p < 0.01). There were no significant differences between the most recent three years of data in boys and girls. Prevalence of obesity, and obesity plus overweight increased over time. However a 'levelling off' in prevalence was observed in the most recent three years of data (2003-2006). CONCLUSIONS: A substantial number of Liverpool schoolchildren are at risk of obesity-related illness and disease. However the most recent three cohorts' data (2003-2006) suggest that the increasing prevalence of obesity may have slowed; a positive step towards meeting the partnership agreement to halt the year-on-year increase in obesity by 2010.

The prevalence of underweight in 9-10-year-old schoolchildren in Liverpool: 1998-2006.

OBJECTIVE: To estimate the prevalence of underweight between 1998 and 2006 in Liverpool schoolchildren aged 9-10 years using recently published underweight cut-off points. DESIGN AND SETTING: Stature and body mass data collected at the Liverpool SportsLinx project's fitness testing sessions were used to calculate BMI. SUBJECTS: Data were available on 26,782 (n 13,637 boys, 13,145 girls) participants. RESULTS: Overall underweight declined in boys from 10.3% in 1998-1999 to 6.9% in 2005-2006, and all sub-classifications of underweight declined, in particular grade 3 underweight, with the most recent prevalence being 0.1%. In girls, the prevalence of underweight declined from 10.8% in 1998-1999 to 7.5% in 2005-2006. The prevalence of all grades of underweight was higher in girls than in boys. Underweight showed a fluctuating pattern across all grades over time for boys and girls, and overall prevalence in 2005-2006 represents over 200 children across the city. CONCLUSIONS: Underweight may have reduced slightly from baseline, but remains a substantial problem in Liverpool, with the prevalence of overall underweight being relatively similar to the prevalence of obesity. The present study highlights the requirement for policy makers and funders to consider both ends of the body mass spectrum when fixing priorities in child health.

Is air temperature at birth associated with body mass index in 9-10 year-old children?

Several studies suggest that temperature (season) at birth affects body weight and obesity years later. This study related air temperature at birth to body mass index in Liverpool primary school children (n = 11,084). No association was found between body mass index categories and month or season of birth and only weak correlations with month of birth and air temperature at birth. These correlations disappeared when controlled for precise age and an index of deprivation but girls in the third quintile for deprivation had a higher body mass index if born in colder weather.

Is overweight and obesity in 9-10-year-old children in Liverpool related to deprivation and/or electoral ward when based on school attended?

OBJECTIVES: To determine whether weight problems in children (overweight, obesity and overweight or obesity) were related to deprivation indices when attributed only according to electoral ward of the school attended. To determine whether children with weight problems were more likely to be found in some wards rather than others, and to compare the distribution for boys and girls. DESIGN: Retrospective, cross-sectional, observational study. SETTING: One hundred and six primary schools from all parts of Liverpool city. SUBJECTS: Five cohorts of 9-10-year-old children between 1998 and 2003. MAIN OUTCOME MEASURES: Body mass index (BMI) for each child to estimate proportions overweight, obese and overweight or obese according to international criteria. RESULTS: Between January 1998 and March 2003, the heights and weights of 7902 boys and 7514 girls were measured and BMI calculated. The prevalence of boys and girls categorised as overweight or obese was very high (1620, 20.6% and 1909, 25.7%, respectively). Prevalence was not related to deprivation and varied between wards only for the girls; some wards had very different prevalence rates for boys and girls (Picton: 59 boys, 23.4%; 106 girls, 36.6%). The most deprived ward did not have a remarkable prevalence of overweight or obesity (Speke: 32 boys, 15.3%; 40 girls, 19.8%). CONCLUSIONS: Obesity is a major problem and requires urgent action but targeting intervention on the basis of administrative areas may be very wasteful. Different factors seem to lead to obesity in boys and girls, and attention should be paid to the role of the physical environment.

Assessment of malnutrition in mental health clients: nurses' judgement vs. a nutrition risk tool.

BACKGROUND: The existence of malnutrition in general hospitals is well documented. Psychiatric patients are known to have increased risk of malnutrition, yet physical examinations and nutritional assessments rarely take place in psychiatric hospitals. AIM: The purpose of this study was to adapt an established nutrition risk score for use with psychiatric patients, using criteria previously agreed by the care team, and to assess whether the clinical judgement of ward staff alone identified a similar group of patients to be at risk. METHOD: The risk score assessment was compared with a subjective risk assessment made by nursing staff as patients were admitted to the unit. Data were collected for 112 patients. RESULTS: The comparison revealed that nurses did not identify malnutrition in the same patients as the risk score, overlooking 27 (29%) at risk patients. Nurses associated malnutrition with psychotic illness, suggesting that depressed patients are more likely to be overlooked. STUDY LIMITATIONS: Although the risk score was based on a validated tool and its content and face validity were established, it has not itself been validated against criteria of nutritional status (malnutrition). CONCLUSIONS: Implementing routine nutritional screening on such units would assist in identifying at risk patients, enabling referral for dietetic intervention to be made. Providing nutrition education for staff might help to improve knowledge and awareness of malnutrition for this patient group.