The utility of serving size in the measurement of soft drink consumption.

BACKGROUND: Many studies examining population differences in soft drink consumption or the association it has with fatness have not included serving size in its assessment. It is not clear what effect this has on their findings and our study aimed to investigate this by comparing the relationships that days (serving size unaccounted for) and cans/day (serving size accounted for) of consumption have with ethnicity/country and fatness. METHODS: Daily nutrient intakes were calculated from a self-administered food frequency questionnaire from a cross-sectional health screening study. Participants were Pacific (n=954) and New Zealand European (n=1745) people aged 35 to 74 years. RESULTS: Compared to Australian youth, NZ Pacific youth consumed soft drinks more frequently but a larger difference was observed for cans/day. In a dose-dependent manner, FMI was positively associated with days (P=0.015) and cans/day (P=0.024) of consumption. However, cans/day showed a stronger relationship, with a standardised regression coefficient of 0.066, compared to 0.033 for days of consumption. CONCLUSIONS: It is useful to include serving size in the assessment of soft drink consumption. Excluding it leads to underestimation of both ethnic/country differences in daily volume of intake and associations with fatness.

The Pacific Obesity Prevention in Communities project: project overview and methods.

Obesity is increasing worldwide with the Pacific region having the highest prevalence among adults. The most common precursor of adult obesity is adolescent obesity making this a critical period for prevention. The Pacific Obesity Prevention in Communities project was a four-country project (Fiji, Tonga, New Zealand and Australia) designed to prevent adolescent obesity. This paper overviews the project and the methods common to the four countries. Each country implemented a community-based intervention programme promoting healthy eating, physical activity and healthy weight in adolescents. A community capacity-building approach was used, with common processes employed but with contextualized interventions within each country. Changes in anthropometric, behavioural and perception outcomes were evaluated at the individual level and school environments and community capacity at the settings level. The evaluation tools common to each are described. Additional analytical studies included economic, socio-cultural and policy studies. The project pioneered many areas of obesity prevention research: using multi-country collaboration to build research capacity; testing a capacity-building approach in ethnic groups with very high obesity prevalence; costing complex, long-term community intervention programmes; systematically studying the powerful socio-cultural influences on weight gain; and undertaking a participatory, national, priority-setting process for policy interventions using simulation modelling of cost-effectiveness of interventions.

Outcome results for the Ma'alahi Youth Project, a Tongan community-based obesity prevention programme for adolescents.

Tonga has a very high prevalence of obesity with steep increases during youth, making adolescence a critical time for obesity prevention. The Ma'alahi Youth Project, the Tongan arm of the Pacific Obesity Prevention in Communities project, was a 3-year, quasi-experimental study of community-based interventions among adolescents in three districts on Tonga's main island (Tongatapu) compared to the island of Vava'u. Interventions focused mainly on capacity building, social marketing, education and activities promoting physical activity and local fruit and vegetables. The evaluation used a longitudinal design (mean follow-up duration 2.4 years). Both intervention and comparison groups showed similar large increases in overweight and obesity prevalence (10.1% points, n = 815; 12.6% points, n = 897 respectively). Apart from a small relative decrease in percentage body fat in the intervention group (-1.5%, P < 0.0001), there were no differences in outcomes for any anthropometric variables between groups and behavioural changes did not follow a clear positive pattern. In conclusion, the Ma'alahi Youth Project had no impact on the large increase in prevalence of overweight and obesity among Tongan adolescents. Community-based interventions in such populations with high obesity prevalence may require more intensive or longer interventions, as well as specific strategies targeting the substantial socio-cultural barriers to achieving a healthy weight.

Socio-cultural agents and their impact on body image and body change strategies among adolescents in Fiji, Tonga, Tongans in New Zealand and Australia.

This paper reports on the findings of studies that were conducted as part of the Pacific Obesity Prevention in Communities project. The studies evaluated the types of messages that adolescents received in relation to body image, physical activity and eating. The participants were male and female adolescents from Fiji (two cultural groups), Tonga, New Zealand (Tongans) and Australia (European Australians). Three studies were conducted: interviews with 48 adolescents (24 male, 24 female) from each cultural group, questionnaires with 600 adolescents (300 male, 300 female) from each cultural group and the perceptual distortion study with 100 adolescents (50 male, 50 female) from the two cultural groups in Fiji and European Australians. The results demonstrate that parents, peers, the media, as well as religious influences impact on the type of body valued by adolescents in each of the cultural groups, as well as their levels of body satisfaction. These influences also shape the type and volume of food consumed, and the type and frequency of physical activity. The results of these studies highlight the major role played by the broader societal values in shaping the nature of the messages that adolescents receive in relation to their body size, eating and physical activity.