Childhood Obesity

Childhood Obesity
Childhood Obesity

Thinkstock, 134812517  

Prepared by: Dr Ralph Richards, Senior Research Consultant, Clearinghouse for Sport, Australian Sports Commission
Topic Expert: Professor Tom Cochrane, Centre for Research and Action in Public Health, University of Canberra (February 2016) 
Reviewed by network: Australian Sport Information Network (AUSPIN)
Last updated by: Ralph Richards (1 May 2017) 

Please refer to the Clearinghouse for Sport disclaimer page for more information concerning this content.

 



Introduction

Obesity has been identified by leading health authorities as a major risk factor contributing to the onset of type-two diabetes and cardiovascular disease.

Obesity among children and adolescents is linked to an increased risk of long-term health problems and may also diminish the quality of life in the short-term. The World Health Organization (WHO) acknowledges that childhood obesity is a complex issue having many interrelated factors, both within and outside of the health sector; including levels of physical activity, dietary habits, environment, education, cultural and socioeconomic status.

The high rate of childhood obesity in Australia is a major health concern for State and Federal Governments. Comparisons with other advanced economies internationally shows that Australia has one of the highest rates of obesity in the world.

  • Australia’s Health 2016, Australian Institute of Health and Welfare, Catalogue Number AUS 199 (2016). Every two years the Australian Institute of Health and Welfare (AIHW) compiles a national report card on the health of Australians. A comprehensive range of health metrics are reported, including population statistics on bodyweight (e.g. underweight, normal, overweight and obese) and compliance with physical activity guidelines. In 2014-15 just over one-quarter of Australian children aged 5 to 14 years were classified as overweight (19%) or obese (7%). Slightly less than one-quarter (23%) of children did not meet the recommended national physical activity guidelines. Among young adults, age 18 to 24, the rate of overweight persons increased to 22% and obese to 15%. Also, 52% of young adults did not meet the recommended physical activity guidelines.

Key Messages

  1. Childhood obesity is linked to increased risk of adverse long-term health outcomes.
  2. Australia has one of the highest rates of childhood obesity among developed countries.
  3. The short and long-term impacts of childhood obesity have significant economic implications.
  4. Regular physical activity during childhood and adolescence helps to regulate body weight and establish health promoting lifestyle behaviours that reduce risk factors associated with obesity and chronic diseases.
  5. Because of the complex interaction of factors influencing childhood obesity, multi-component intervention strategies appear to be the most effective in moderating or reducing adiposity (that is, severe or morbid overweight) in children and adolescents.


Government Reports

The problems arising from a population that is overweight, and the high incidence of obesity among Australia's children and adolescents, have been recognised by Australian Governments (State/Territory and Federal), as well as private sector health organisations.

Identifying the problem

Australia: the Healthiest Country by 2020 (PDF  - 835 KB), Discussion paper prepared by the National Preventative Health Taskforce (2008). This document identifies key issues that will shape the Federal Government’s health strategy. It is estimated that the total cost of obesity in Australia in 2008, not including persons who are overweight, was $8.3 billion annually. Obesity and cardiovascular disease present two health risks that can be reduced by certain lifestyle changes, including an increase in daily physical activity.

Causes of Overweight and Obesity, Australian Institute of Health and Welfare. While many factors may influence an individual's weight, overweight and obesity are due mainly to an imbalance of energy intake from the diet and energy expenditure through physical activities. Genetic and environmental factors play a role, but attention to diet and physical activity is important not only for preventing weight gain, but also for weight loss and subsequent maintenance.

Childhood Obesity: An economic perspective (PDF  - 1.4 MB), Crowle J and Turner E, Australian Government, Productivity Commission, staff working paper (2010). Being overweight or obese as a child has implications for that child’s health now and as an adult. It is a policy concern in Australia, and for governments internationally, that the rate of childhood obesity is too high. Preventive health policies aim to manage risk factors so that the effect of future health problems are reduced. Current preventive health expenditure needs to be justified in terms of its effectiveness and value for public money. Programs to prevent and reduce childhood obesity can be difficult to design and implement successfully, particularly given the complexity of the obesity problem and the multitude of different determinants of obesity. This paper analyses the issue of childhood obesity within an economic policy framework. It also reviews the evidence of trends in obesity in children and provides an overview of recent and planned childhood obesity preventive health programs.

Future prevalence of overweight and obesity in Australian children and adolescents, 2005-2025 (PDF  - 910 KB), Government of Victoria, Department of Human Services (2008). Modelling techniques have been applied to predict current and future prevalence of overweight and/or obesity in Australian children and adults based on sex, age and year of birth cohort. These analyses have confirmed that, based on past trends and no effective interventions, body mass index is predicted to continue to increase for both males and females and across the age span. This would result in around one-third of 5-19 year olds being overweight and/or obese by 2025 as well as 83% of males and 75% of females aged 20 years and over. For Australia, this would represent 16.9 million people. The increase in projected health care costs of type 2 diabetes, largely due to increases in obesity, would be $5.6 billion.

Healthcare in Australia 2012-13: Five years of performance (PDF  - 413 KB), Council of Australian Governments (COAG), Reform Council (2014). Chapter Two covers ‘chronic disease’ and includes statistical information on the rate of type-2 diabetes and obesity in Australia’s adults and children.

Physical activity and sedentary behaviour: Evidence summary (PDF  - 869 KB), VicHealth (2016). Regular physical activity contributes to good health across all life stages, whereas inactivity is one of the most significant risk factors contributing to the global burden of disease. This evidence summary builds upon previous work and includes publications between 2009 and 2014. This report also includes physical activity statistics and trends for Victoria and Australia. 

A Picture of Australia’s Children 2012 (PDF  - 5.8 MB), Australian Institute of Health and Welfare (2012). This report provides current information on how Australia's children are faring according to key indicators of child health, development, and wellbeing; Chapter 16 – Overweight and Obesity.

Risk factor trends: age patterns in key health risk factors over time (PDF  - 1.5 MB), Australian Institute of Health and Welfare (2012). This report presents comparisons over time for different age groups for key health risk factors, including overweight and obesity, physical inactivity, poor diet, smoking and excessive alcohol consumption. Changes over time in the percentage of Australians who display sedentary behaviours are also broken-down by age and gender.

Focus on prevention

Australia, the Healthiest Country by 2020, Technical Report 1 – Obesity in Australia: a need for urgent action, Preventive Health Taskforce (2009). The prevalence of overweight and obesity has been steadily increasing in Australia over the last 30 years. Obesity is particularly prevalent among persons in the most disadvantaged socio-economic groups, people without post-school qualifications, Indigenous Australians, and among many people born overseas. Tackling obesity is about reshaping behaviours for positive outcomes in an environment of nutritional abundance, where technology often eliminates or reduces the need for physical activity. Achieving long-term, sustainable change is difficult, resource-intensive and time-consuming. In order to halt and reverse the rise in overweight and obesity in Australia, a number of initiatives are likely to be required; these include:
• encourage more physical activity;
• reshape the food supply towards lower risk products;
• protect children and others from inappropriate marketing of unhealthy foods and beverages;
• improve public education and information about the risk factors of overweight and obesity;
• reshape urban environments towards healthy options;
• close the gap for disadvantaged communities; and
• build the evidence base, monitor and evaluate the effectiveness of intervention programs.

Clinical Practice Guidelines for the management of overweight and obesity in adults, adolescents and children in Australia (PDF  - 2.1 MB), Australian Government, National Health and Medical Research Council, Department of Health and Ageing (2013). Most children and adolescents who are overweight or obese are identified through primary health care.  Multi component lifestyle interventions are usually indicated, involving reduced energy intake, increased physical activity and less ‘screen time’, and other measures to support behavioural change.  Lifestyle interventions should engage the parents, carers and family and frequent contact with a healthcare professional is beneficial.

Evidence update on obesity prevention across the life-course (PDF  - 1.1 MB), Hector D, King L, Hardy L, St George A, Hebden L Espinel P and Rissel C, University of Sydney, prepared for the NSW Ministry of Health, Physical Activity Nutrition Obesity Research Group (2012).  This report identifies the most promising approaches for action based on the range of evidence across age groups within the key settings of: childcare, schools, workplaces, home and family, primary health care, and community.  Programs are assessed under five criteria: rationale, policy and program content, evidence of effectiveness, areas for further investigation, and promising approaches.

Taking Preventative Action: A response to: ‘Australia the Healthiest Country by 2020’ (PDF  - 1.2 MB), Australian Government, National Preventative Health Taskforce report (2010). This report outlines the Government’s strategy for preventative health action to tackle public health risk factors; those actions targeting obesity include:
• establishing a national agency to guide investments in prevention;
• reducing the impact of diabetes;
• providing funding for social marketing campaigns;
• helping Australians to participate more in sport and active recreation; and
• delivering the most ambitious study of Australia’s health ever conducted. 

Taking Preventative Action identifies the Government’s current position (at the time of publication) as a 'whole of Government' approach, embedding preventative health within primary care settings through the Council of Australian Governments (COAG) agreed policy frameworks on: (1) the National Health and Hospitals Network; (2) Medicare; (3) the National Sport and Active Recreation Policy Framework, and; (4) the National Partnership Agreement on Preventive Health. The reduction and prevention of obesity forms an important part of the Government's proposed preventive health strategy.


Other Australian research

Active Healthy Kids Australia (AHKA) is a collaboration of physical activity researchers from across Australia working toward a common interest – increasing the physical activity levels of all young Australians. The vehicle used to help increase awareness and drive this need for change is the Report Card on Physical Activity for Children and Young People. The Report Card synthesises the best available Australian evidence in order to assign grades to physical activity indicators, and provides a national snapshot of the current levels of physical activity in Australian children and young people. AHKA released its first Report Card in 2014 as part of a ‘Global Matrix’ of grades comparing 14 countries from around the world. The first Report Card asked the question, “Is Sport Enough?” to counteract the rising rate of physical inactivity among Australian children. The second Report Card (2015) suggested that the decline of ‘Active Transport’ among young Australians may contribute to Australia’s poor record of physical activity. The third Report Card (2016) suggests that Australian children may not have sufficient 'tools' to support increased physical activity and that 'Physical Literacy' among our children and youth should take on a higher priority.

More information can be found in the Clearinghouse for Sport under the topics, Physical Literacy and Sport and Active Transport.

  • Active Healthy Kids: Is Sport Enough? (PDF  - 5.3 MB), The Active Healthy Kids Australia Report Card on Physical Activity for Children and Young People (2014). The Physical Activity Report Card initiative was first developed and produced by Active Healthy Kids Canada in 2005, with an updated Report Card released annually for the past decade. This is Australia’s first Physical Activity Report Card and it has been modelled on the Canadian reports. This report serves to inform and update the Australian community on the physical activity and sedentary behaviours of its children and young people. It is anticipated that the Australian Report Card initiative will be at the forefront of physical activity advocacy; to inform policy changes and environmental decision-making in health services, physical activity participation, and highlight research needs. Australia is a sporting nation and large numbers of children are involved in some type of organised sport, but this report clearly shows the need to look at further ways to keep kids active when they are not on the sports field. Behaviours such as walking to school and playing outside must increase, while turning off televisions and computers and reducing sedentary time will also contribute to overall health. Among the 12 grades assigned in the Report Card, key grades include:

‘D’ for Overall Physical Activity Levels;
‘B’ for Organised Sport and Physical Activity Participation;
‘D’for Active Transportation (such as riding or walking to school), and;
‘D’ for Sedentary Behaviours (screen time).    

Childhood fitness reduces the long-term cardiometabolic risks associated with childhood obesity (abstract), Schmidt M, Magnussen C, Rees E, Dwyer T and Venn A, International Journal of Obesity, Volume 40 (2016). This study examined whether childhood cardiorespiratory fitness attenuates or modifies the long-term cardiometabolic risks associated with childhood obesity. The study consisted of a 20-year follow-up of subjects (N=1792) who participated in the 1985 Australian Schools Health and Fitness Survey when they were 7–15 years of age. The data showed that both high waist circumference and low cardiorespiratory fitness in childhood were significant independent predictors of metabolic syndrome (MetS) in early adulthood. Higher levels of childhood fitness were also associated with lower risks of adult MetS. Participants who had both high waist circumference and low cardiorespiratory fitness in childhood were 8.5 times more likely to have MetS in adulthood than those who had low waist circumference and high cardiorespiratory fitness in childhood. This study concluded that high cardiorespiratory fitness in childhood is strongly associated with cardiometabolic health in later life, even among those with higher than average abdominal circumference in childhood.        

Childhood obesity and its physical and psychological co-morbidities: A systematic review of Australian children and adolescents, Sanders R, Han A, Baker J and Cobley S, European Journal of Pediatrics, Volume 174, Number 6 (2015). This systematic review of literature evaluates the associations between childhood obesity and physical and psychological health among Australian children and adolescents (0 to 18 years of age). Forty-seven studies fulfilled selection criteria. Evidence suggests that overweight/obese Australian children and adolescents, compared to normal-weight peers, had more cardio-metabolic risk factors and higher risk factors of disease. Overweight/obese children also experience more negative psychological outcomes (e.g. depression, low self-esteem, lower health-related quality of life). Other health consequences have either not been investigated in Australia or the evidence base is not sufficiently robust. Understanding the range of individual, social, and environmental mechanisms driving obesity may help identify interventions and strategies to slow or reverse population trends. 

Children’s body mass index: cohort, age and socio-economic influences, Wake M and Maguire B, Australian Institute of Family Studies (2011).  Australian and international policy-makers recognise the childhood obesity epidemic to be one of the most serious threats to the future health of the population and the viability of the health care system. This report highlights the adverse affect of having a high childhood body mass index (BMI) that increases both cardiovascular risk in children and cardiovascular events in these children when they reach adulthood.

Effects of a ‘school-based’ physical activity intervention on adiposity in adolescents from economically disadvantaged communities: secondary outcomes of the ‘Physical Activity 4 Everyone’ RCT, Hollis J, Sutherland R, Campbell L, et.al., International Journal of Obesity, Volume 40, Issue 10 (2016). The ‘Physical Activity 4 Everyone’ (PA4E1) study tested a multi-component physical activity intervention in 10 secondary schools from socio-economically disadvantaged communities in New South Wales. A cluster randomised controlled trial was conducted; the school-based intervention included seven physical activity strategies: (1) curriculum (i.e. strategies to maximise physical activity in physical education; (2) student physical activity plans; (3) enhanced school sport program; (4) school environment (i.e. physical activity during school breaks); (5) modification of school policy; (6) parents and the community engagement, and (7) links with community physical activity providers. This paper reports on the secondary outcomes of the study, to determine whether the intervention impacted on student adiposity (weight and body mass index) and whether any effect was moderated by gender, baseline BMI, or baseline physical activity level over 12 and 24 months. A total of 1150 students (mean age 12 years) took part in this study. Analysis of results indicated the PA4E1 school-based intervention program achieved moderate reductions in adiposity over 24 months. Therefore, a multi-component intervention that focuses on increasing adolescents’ moderate-to-vigorous physical activity can assist in preventing weight gain among adolescents from socio-economically disadvantaged communities.  

Estimates of the energy deficit required to reverse the trend in childhood obesity in Australian schoolchildren (PDF  - 1.1 MB), Cochrane T, Davey R and de Castella R, Australia and New Zealand Journal of Public Health, published online (11 November 2015). The objective of this study was to estimate the daily energy deficit required to reduce body weight in overweight children to within a normal range, and estimate the time required to reach normal weight. This study found that if an energy deficit of 0.42 MJ/day could be achieved, 60% of overweight children would reach normal weight within about 15 months. A small daily decrease in energy intake, combined with a small increase in energy expenditure (e.g. an additional 15 minutes of moderate-to-vigorous physical activity) can, over time, have an impact on body weight. 

Influence of school community and fitness on prevalence of overweight in Australian school children, Cochrane T, Davey R and de Castella R, Preventive Medicine, Volume 81 (2015). This study sought to determine the variation in prevalence of overweight between school communities and to evaluate the relationship between cardiorespiratory fitness and the probability of being overweight among different school communities. It also tested whether this relationship varies between school communities. Ninety-one schools located across five Australian states and territories were included, data from 31,424 students (16,126 boys and 15,298 girls) included objective assessments of body composition and physical performance. In total, 24.6% of the children were overweight and 69% were of low fitness. The probability of being overweight was negatively associated with increasing cardiorespiratory fitness. The relationship was steepest at low fitness levels and varied markedly between school communities. Children of low fitness had probabilities of being overweight ranging between 26% and 75%, depending on school community; whereas those of high fitness had probabilities of less than 2%. The findings suggest that the greatest gains, from a public health perspective, would occur by focusing physical activity intervention programs on the least fit children from the worst-performing communities.

Influencing children’s health: Critical windows for intervention (PDF  - 834 KB), VicHealth (2015). This research summary is based on the work of Associate Professor Anna Timperio, at the Centre for Physical Activity and Nutrition Research, Deakin University. The findings in this report are based on research that shows associations between a child’s physical activity and eating behaviour, rather than claiming causation. Children who are obese are more likely than others to carry their excess weight into adulthood, thus placing them at increased risk of many life-limiting chronic conditions and diseases. Three key behavioural factors are evident among overweight and obese Australian children: (1) fruit and vegetable intake is below recommended levels; (2) daily physical activity is below recommended guidelines for both intensity and duration, and; (3) daily sedentary activity time exceeds the recommended level. Genetics, individual attitudes, family influence, neighbourhood environments, socioeconomic status and other factors all play a role in influencing the attainment of recommended nutrition, physical activity and behavioural practices. Important childhood transitions present challenges, but also offer opportunities for changing behaviour. This report makes a number of recommendations regarding interventions that local governments, schools, health professionals, and community sector organisations (including sport and recreation) can make to promote and facilitate healthier lifestyles for Australian children and adolescents.

Lifestyle of our Kids, Telford D, Australian National University. The Lifestyle Of Our Kids (LOOK) study is a longitudinal project with primary school children that studies physical and psychological health over a four-year period from Grade 2 to Grade 6. Special attention is applied to the relationship of health and development with physical activity, incorporating a design so that the research may continue into later life.

Local government obesity prevention: An evidence resource, Clark R, Armstrong R and Waters E, CO-OPS Secretariat, Deakin University, Geelong (2010). Local government has long had a pivotal role to play in public health and those working in health promotion roles should make decisions informed by the best research evidence available. Research evidence exists in various forms: (1) data or observational research may be used to identify a problem; (2) research that assists in understanding 'what works', such as a systematic review,  and (3) research that helps to understand who programs and policies work for, under what circumstances, and why they have the desired effect. Each type of research can be used to support decisions at different stages in the decision making process. Prevention of obesity is now a public health priority. However,  the causes of obesity are highly complex; involve a wide range of individual, behavioural, social, environmental and political factors; and there are a multitude of interactions between factors. Understanding effective ways to influence behavioural and environmental determinants, and using this information to inform decision making, are vital steps in slowing the obesity epidemic.

Obesity in Australia: financial impacts and cost benefits of intervention (PDF  - 91 KB), KPMG Econtech report prepared for Medibank Private Ltd. (2010). The economic modelling used in this research attempts to capture both direct and indirect costs associated with population obesity and obesity-related illnesses, as well as the benefits of obesity intervention programs. One of the key finding in this report is that research demonstrates many strategies aimed at reducing obesity in Australia could bring significant benefits to the Australian economy and to community health. Obesity interventions come from three main sources, that include: (1) lifestyle changes (i.e. diet and physical activity), having an 11% success rate; (2) pharmacology (i.e. weight reduction drugs) having an 8% success rate, and (3) medical procedures (i.e. bariatric surgery), having a 28% success rate. However, the efficacy of each type of intervention must be considered against the cost of the intervention and the estimated benefits. Lifestyle interventions had the best cost/benefit ratio. This report notes that the majority of obesity intervention research does not consider the mental and emotional impact of obesity, having an implied ‘cost’ to personal wellbeing. 

Obesity prevention programs and policies: Practitioner and policy‐maker perceptions of feasibility and effectiveness (PDF  - 200 KB), Cleland V, McNeilly B, Crawford D and Ball K, Centre for Physical Activity and Nutrition Research, Deakin University, published in Obesity, Volume 21, Number 9 (2013). This study maps obesity prevention programs implemented by government and non-government organisations in Australia to determine the preferred settings for these strategies. The majority of programs focused on education and improving healthy eating and physical activity patterns. The most effective settings appear to be school curriculum-based initiatives and family-based programs where social support was provided.

Overweight and obesity among Indigenous children: individual and social determinants (PDF  - 380 KB), Thurber K, Boxall A and Partel K, Deeble Institute, Issues Brief, Number 3 (March 2014). Obesity rates are higher among Indigenous, compared to non-Indigenous Australians, and this problem begins in early childhood. If this trend of increasing obesity among Indigenous children continues, there will be a corresponding negative impact on health and the gap in life expectancy will widen, not close. Childhood obesity prevention programs have predominantly targeted individual behaviours, such as physical inactivity and unhealthy diet, but these programs have been unsuccessful to date. The approach needs to shift to addressing social and economic factors, rather than individual behaviours in isolation. Economic disadvantage, maternal education, housing stability, urbanisation and neighbourhood disadvantage are all important factors affecting Indigenous children’s lifestyle and behaviours. Although limited empirical evidence exists, sport and recreation programs appear to offer a promising avenue for obesity prevention in Indigenous communities. Successful sporting programs that encourage physical activity in a fun, culturally relevant, community-based way, can also be linked to other services such as health checks or educational development. Sustainable programs may require investment in sporting infrastructure, as well as improved community safety. The primary aims of these programs may vary, but all programs should encourage health behaviours (physical activity and healthy diet) which promote healthy childhood weight while addressing broader social factors. Because the range of social and economic factors is not confined to the health portfolio (which includes sport), policy development should occur across portfolios and include housing, education, employment, social welfare and community development.

Secular trends in the prevalence of childhood overweight and obesity across Australian states: A meta-analysis, Ho N, Olds T, Schranz N and Maher C, Journal of Science and Medicine in Sport, published online ahead of print (30 September 2016). A systematic search was conducted to identify all sources that objectively measured the height and weight of Australian children (aged 2–18 years) in studies having a sample size of at least 300. 73 studies met the inclusion criteria and were analysed after statistically adjusting for age and gender, using sample-weighted non-linear regressions. Overall, there has been an increase in prevalence of combined overweight and obesity among children in Australia (i.e. all states and territories) over the monitoring period, from 1967 to 2012. When boys and girls were analysed separately, the rate of overweight or obesity among boys (20.5%) was higher than for girls (17.9%). Taken together, the results confirm that the prevalence of overweight and obesity has increased for all Australian states and territories over the past five decades. Three distinctive time trends were apparent: (1) a near-linear increase in three states – Western Australia, South Australia and Tasmania; (2) an increase, followed by an apparent plateau in recent years in New South Wales and the Australian Capital Territory, and; (3) an increase, followed by a plateau and then a decline in recent years in Victoria, Queensland and the Northern Territory. In general, NT and TAS reported the highest prevalence of overweight and obesity compared to other states and territories from 1985 to 2012, whilst ACT, VIC and WA had the lowest. 

“Stop eating lollies and do lots of sports”: a prospective qualitative study of the development of children’s awareness of dietary restraint and exercise to lose weight, Rodgers R, Wertheim E, Damiano S, Gregg K and Paxton S, International Journal of Behavioral Nutrition and Physical Activity, Volume 12 (2015). Many children as young as 5 years of age have already developed beliefs surrounding diet and physical activity as a means of influencing body size. The aim of this study was to explore the attitudes and beliefs of young (aged 3- to 5-years old) children about dietary restriction and physical activity. A sample of 259 children (116 boys and 143 girls), recruited from Melbourne childcare centres, participated in this study; interviews were conducted at age 3, 4 and 5-years. Responses indicated that 15% of children (by age 5) were aware of stigmatising attitudes towards overweight individuals. Only 4.2 % of 3 year-olds demonstrated dieting awareness, this proportion rose to almost 28 % by age 5 (a statistically significant difference). Similarly, the proportion of children aware of exercise as a body change strategy rose from 2.3% to 16.3 % (also a significant change). About a quarter of all 5-year-olds mentioned general physical activity as a strategy for weight maintenance or loss; there were no gender differences. 

Weighing the cost of obesity: A study of the additional costs of obesity and benefits of intervention in Australia (PDF  - 1.8 MB), Price Waterhouse Coopers and Obesity Australia (2015). Obesity leads to higher health care costs and quality of life risks for individuals, and a major economic burden to society. A number of previous reports have shown that the costs of obesity are considerable to Australia. This report adds to this evidence base by, for the first time, taking a bottom up approach to a cost-benefit analysis that shows how the costs vary among three classes of obesity. The classes of obesity are determined by body mass index (BMI) and are: Class I, BMI 30-34.9; Class II, BMI 35-39.9 and; Class III, BMI 40+. This report suggests that implementing a bundle of well-designed interventions would lead to an economic benefit to society in a relatively short timeframe. However, obesity is a complex issue that goes beyond a simple lack of self-control in diet or sedentary behaviour. One of the key findings from the report is that, although the bundle of interventions identified would be cost effective, they may not be enough to halt the growing rate of obesity. Therefore, additional research on obesity is needed. It is estimated that if the World Health Organization targets could be achieved in Australia, it would result in a $10.3 billion benefit over the next 10 years. Interventions that combine these factors may have the best chance of success: (1) personal (weight loss management programs and GP consultation); (2) education (parental education and school curriculum); (3) environment (food product reform, labelling requirements, and increased tax on unhealthy foods); (4) medical (surgery and pharmaceuticals).  


International practice

World Health Organization (WHO)

Consideration of the evidence on childhood obesity for the Commission on Ending Childhood Obesity (PDF  - 3.5 MB), World Health Organization (2016). This report was published by the WHO’s ad hoc working group on science and evidence for ending childhood obesity. The results, conclusions and recommendations in this report have been endorsed by the International Olympic Committee (IOC). The prevalence of childhood obesity is increasing globally, with the most rapid rise in low and middle-income countries. Currently the majority of overweight or obese children live in developed countries. Children who are overweight or obese are at greater risk of asthma, cognitive impairment in childhood, obesity, diabetes, heart disease, some cancers, respiratory disease, mental health problems, and reproductive disorders later in life. The causes of childhood obesity are complex, but we know that behavioural patterns established early in life impact on both physical activity and dietary habits. Wider societal factors are also significant: socioeconomic considerations; nutritional literacy within families; availability and affordability of healthy foods; inappropriate marketing of foods and beverages to children and families; lack of education; and reduced opportunity for physical activity through healthy play and recreation. Life-course studies suggest that interventions early in life are likely to have the greatest effect.

Interim report of the Commission on Ending Childhood Obesity (PDF  - 617 KB), World Health Organization (WHO), (2015). Among the non-communicable disease risk factors, obesity is particularly concerning in children and adolescents, as it is associated with a wide range of health complications and an increased risk of premature onset of illnesses, including diabetes and heart disease. Childhood obesity is complex and the effectiveness of interventions, to date, indicate that novel approaches are required. A combination of community partnerships, government support and scientific research is necessary in order to develop the best recommendations and implement them worldwide. In this interim report, the Commission discusses key issues and outlines potential policy options. The Commission also recognises that childhood obesity is a complex issue that is influenced by various sectors outside of the health sector, including the built environment, education, agriculture, trade, food and nutrition, sport and recreation, and finance. Governments have primary responsibility for establishing good governance and supporting measures through appropriate regulatory, statutory and policy frameworks. Childhood obesity must also be considered in the context of psychosocial and broader societal determinants. Parental, family or caregiver health knowledge and ability to act on this knowledge, responses to environmental influences, socioeconomic factors and cultural norms about diet, physical activity (or inactivity) and body image all contribute to the development of childhood obesity. The Commission recommends five overarching policy considerations:

  1. Governments have the essential role in coordinating and addressing the challenge of childhood obesity and providing an appropriate regulatory and statutory framework.
  2. Consistent and coordinated multi-sectoral and multi-stake-holder approaches are required to address childhood obesity.
  3. New approaches to addressing the challenge will require constructive, transparent and accountable relationships between government, the private sector and civil society.
  4. Policy implementation requires consideration of different contexts not only between regions and countries but also within countries, taking into account issues of gender and equity.
  5. A monitoring and accountability framework will be required at a national level to ensure effective policy implementation and action. 

Population-based approaches to childhood obesity prevention (PDF  - 1.4 MB), World Health Organisation (WHO), (2012). As part of its global commitment, the World Health Organisation (WHO) has issued a ‘Global Strategy on Diet, Physical Activity and Health’. Population-based approaches to childhood obesity prevention aim to provide Member States with an overview of the types of childhood obesity prevention interventions that can be undertaken at national, sub-national and local levels; and where relevant, indicate which prevention measures are likely to be the most effective. A comprehensive childhood obesity prevention strategy will incorporate aspects of each of these key components: 

  1. a mixture of “top-down” and community-based actions in plans and programs;
  2. a mixture of policy instruments, including legislative and financial tools, to ensure availability and affordability of healthy foods and physical activity opportunities;
  3. the integration of policies into existing structures as a measure to ensure sustainability of action;
  4. interventions across a range of settings, including early childcare, schools, and community organisations;
  5. a multi-sectoral approach to childhood obesity prevention.

Young and physically active: a blueprint for making physical activity appealing to youth (PDF  - 3.3 MB), Kelly P, Matthews A, and Foster C, World Health Organisation (WHO), (2012). Scientific evidence shows that physical inactivity is a leading risk factor for ill health, contributing to the overall increase in overweight and obesity. Over the past few years the promotion of physical activity has increasingly been recognised in Europe as a priority for public health, and many countries have responded by developing policies and interventions.  This report is intended to be a resource for physical-activity promoters, with a focus on supportive urban environments and settings where children and young people live, study and play.

Finland curbs childhood obesity by integrating health in all policies, World Health Organisation (WHO), published online (February 2015). Six years ago, almost 1 in 5 five-year-olds in the Finnish city of Seinäjoki was overweight or obese. Since then, alignment of policies among the departments of urban planning, recreation, education, social services, and health have resulted in a 50% reduction in the incidence of obesity among children. Recognising that most of the factors that influence child and adolescent health lie outside the health sector, Finland is taking an ‘all policies’ approach to incorporate health outcomes into all decision-making areas. The Finnish Ministry of Social Affairs and Health, is helping municipalities implement national policies and track their progress against national benchmarks, share best practices, and receive training on how to implement legislation through a ‘Health In All Policies’ approach.

Other International Sources

EU Action Plan on Childhood Obesity 2014-2020 (PDF  - 333 KB), European Union (2014). This Action Plan demonstrates the EU Member States’ commitment to address the health and welfare issues associated with childhood obesity. Despite action at the European level to reverse the rising trend in overweight and obesity, the proportion of the population who are overweight or obese remains worryingly high, particularly among young people. The implications of overweight and obesity in the Europe are stark: the prevalence of obesity has more than tripled in many European countries since the 1980s and with this increase comes a concomitant increase in rates of associated non-communicable disease. Physical activity patterns play an important role in reducing the incidence of overweight and obesity. It is therefore a concern that in 2012 only 1 in 5 children in the EU reported taking part in regular moderate-to-vigorous intensity exercise. There is increasing evidence to show that preventative interventions targeting children and young people can pay off, with a return on investment of 6–10% expected from interventions implemented in early life. In order to implement this Strategy, a range of policies have been proposed, or are currently being developed, at the EU-level. These policies aim to improve the nutritional content of food; improve access to healthy foods; and increase physical activity levels to prevent overweight and obesity. Areas so far considered include: food labeling, nutrition and health claims, the Common Agricultural Policy; active transport; urban planning; the education and culture sectors, physical activity and sport; as well as additional research. This Strategy also encourages more action-oriented partnerships across the EU involving key stakeholders (e.g. Member States, civil society, and the corporate sector). 

Global, regional, and national prevalence of overweight and obesity in children and adults during 1980—2013: a systematic analysis for the Global Burden of Disease Study 2013, Ng M, et.al., The Lancet, Volume 384, Number 9945 (2014). In 2010, overweight and obesity were estimated to cause 3.4 million deaths, 3.9% of years-of-life lost, and 3.8% of disability-adjusted life-years (DALYs) worldwide. The rise in obesity has led to widespread calls for regular monitoring of changes in overweight and obesity prevalence in all populations. This research obtained data on the prevalence of obesity and overweight by age, sex, country, and year to estimate the prevalence of obesity worldwide.  

Health at a Glance 2013, OECD indicators (PDF  - 3.6 MB), Organisation for Economic Cooperation and Development (2013). Children who are overweight or obese are at greater risk of poor health in adolescence, as well as in adulthood. Excess weight problems in childhood are associated with an increased risk of being an obese adult, at which point cardiovascular disease, diabetes, certain forms of cancer, osteoarthritis, a reduced quality of life and premature death become health concerns. While studies show that obesity rates in some developed countries like the US have begun to level off, Australia's are still on the rise. Australia is now fourth in the rate of obesity in the OECD's ranking of advanced nations with 28.3% of its citizens being obese, behind the US, Mexico and New Zealand.

Canada

Active Healthy Kids Canada: Is Canada in the Running? (PDF  - 23.5 MB), Report Card on Physical Activity for Children and Youth – how Canada stacks up against 14 other countries on physical activity for children and youth (2014). Why are Canadian children sitting more and moving less? The answer requires a hard look at the culture of convenience; for most Canadians the socially acceptable walking distance to school is less than 1.6 km and distance between home and school is the single most reported reason why kids do not walk or bike to get there. Our country values efficiency – doing more in less time – which may be at direct odds with promoting children’s health. We have engineered opportunities for spontaneous movement (such as getting to places on foot and playing outdoors) out of our kids’ daily lives and have tried to compensate with organised activities such as sports leagues and physical education classes. Canada is among the leading developed nations in its policies, places and programs, earning a B+ in Community and Built Environments. Canada also earns a C+ in School Physical Education and a C+ in Organised Sport Participation. However, Sedentary Behaviours earn an F and the number of obese Canadian children remains high. This highlights the complexity of the problem. Short Report (PDF  - 1.3 MB), Active Healthy Kids Canada – Is Canada in the Running?

A Sport Parent’s Guide (PDF  - 1.7 MB), Canadian Sport for Life (2007).  Medical and sport research shows that Canadian children are increasingly at risk for obesity and disease due to low levels of activity and poor nutritional habits.  Some experts have also suggested that Canada is producing declining performances in international competition due to a lack of physical activity and sport development during childhood years.

Obesity in Canada (PDF  - 1.7 MB), Public Health Agency of Canada and the Canadian Institute for Health Information (2011). This report highlights the prevalence, determinants, and impact of obesity in Canada among adults, children and youth, and Aboriginal Peoples. Research has identified a number of determinants associated with obesity, including physical activity, diet, socioeconomic status, ethnicity, immigration and environmental factors.  A population health approach to understanding obesity examines both the long-term and more immediate factors linked to obesity. However, these patterns are complex and determinants are interconnected; furthermore some factors, such as income and education, tend to give rise to different risk factors for men and women.

New Zealand

Obesity key facts and statistics, New Zealand Government, Ministry of Health. This page provides introductory statistics about obesity in New Zealand as it affects children and adults.

New Zealand Health Survey: Annual update of key results 2014/15 (PDF  - 900 KB), Murphy B, Weerasekera D, Cox S, Turley M, Fawcett J and Pittams G, Ministry of Health (2015). Obesity rates among children and adults continues to rise. One in nine children, aged 2 – 14 years, is obese. Obesity rates are strongly linked to socioeconomic deprivation; the obesity rate for children living in the most deprived neighbourhoods is five times that of those living in the least deprived neighbourhoods. For adults the rate-ratio is 1.7 times, after adjusting for age, sex and ethnic differences. Physical inactivity rates are also increasing for adults; 14% of the adult population is inactive, reporting less than 30 minutes of physical activity per week.

Evolving approach to combating child obesity (PDF  - 152 KB), New Zealand Government, Auditor-General’s Report (2013). Child obesity is a multifaceted problem to which there is no single or universally accepted solution. The many factors that contribute to obesity and obesity-related health issues are complex and include broader social issues, such as poverty, housing conditions, food security, and the cost of healthy food. Evidence suggests that obese and overweight children generally come from the most deprived neighbourhoods in New Zealand. The prevalence of being overweight and obese in Māori and Pasifika children and young people is higher than in the total population. Obesity in childhood and adolescence has a range of serious adverse health consequences, both in the short term (for the obese child) and long term (for the adult who was obese as a child). Children who are obese are more likely to become obese adults, and this likelihood increases the more obese a child is. Obesity in adults is known to lead to both chronic and severe medical problems, such as heart disease, cancer, type-2 diabetes, and high blood pressure; and these diseases can affect a person’s life expectancy. The Auditor General’s report also found that the Ministry of Education and Sport New Zealand no longer focus on obesity to the extent they had in the past. The Ministry of Health was continuing with a range of existing interventions while testing and evaluating new ideas and approaches to identify the most effective focus for New Zealand’s efforts to combat obesity.

United Kingdom

Effectiveness of intervention on physical activity of children: systematic review and meta-analysis of controlled trials with objectively measured outcomes (abstract), Metcalf B, Henley W, and Wilkin T, British Journal of Sports Medicine, Volume 47, Number 4 (2013). This high quality meta-analysis examined the effects of physical activity interventions on overall activity levels of children, finding only small and clinically insignificant changes. These findings indicate how researchers and practitioners still have a huge challenge ahead in developing effective interventions to promote physical activity, a behaviour for which there is clear evidence of health benefits in all age and population groups.

Childhood obesity – brave and bold action (PDF  - 683 KB), Parliament of the United Kingdom, House of Commons Health Committee, Report HC 465 (30 November 2015). This report concludes that the scale and consequences of childhood obesity demand bold and urgent action from Government. One fifth of children are overweight or obese when they begin school, and this figure increases to one third by the time they leave primary school. Furthermore, the most disadvantaged children are twice as likely to be obese. Obesity is not only a serious and growing problem for individual children and the wider population, it is also a significant contributor to health inequality. Few effective interventions are in place to help those children identified as overweight or obese, making it all the more important to focus on prevention. The recommendations made by this Committee have a strong focus on changing the food environment. Although it is recognised that physical activity has enormous benefits, regardless of body weight, encouraging people to increase their physical activity levels alone is not enough. This Committee endorses the recommendations made on increasing children’s physical activity levels in the previous report ‘The Impact of Diet and Physical Activity on Health’. The Committee calls on the Government to increase provision for physical activity in childhood and considers this an important part of a comprehensive strategy to tackle obesity. However, the Government should not lose sight of the clear evidence that measures to improve the food environment to reduce calorie intake must lie at the heart of a successful strategy. Overall, the Committee’s recommendations are intended to reduce sugar in people’s diets through a number of possible government controls on unhealthy food and drink, including price (taxation), labeling requirements; education and information campaigns; food standards; and marketing/advertising restrictions. This report endorses Public Health England’s many recommendations regarding broader and deeper controls on advertising and marketing to children, including sponsorship of children’s sports and sporting events, of foods and beverages containing high amounts of sugar, salt and fat.

Obesity Knowledge and Intelligence.  Public Health England provides a single point of contact containing wide-ranging authoritative information on obesity; data, evaluation, evidence and research related to weight status and its determinants.  This information is available to a wide range of organisations and provides support to policy makers and practitioners involved in obesity and related issues.

Statistics on obesity, physical activity and diet – England 2016, Government of the United Kingdom, Health & Social Care Information Centre (20 April 2016). In 2014/15, more than 1 in 5 children enrolled in pre-school, and 1 in 3 children in Year 6 were measured as obese or overweight. Children from the most socioeconomically deprived areas are twice as likely to be obese than children in least deprived areas. The proportion of children (age 5 to 15 years) who met the weekly physical activity guidelines fell among boys (28% to 21%) and girls (19% to 16%) during the period 2008 to 2012. 

Tipping the Scales: Why preventing obesity makes economic sense (PDF  - 14.9 MB), Bhimjiyani A, Knuchel-Takano A and Hunt D, Cancer Research UK (2016). This report provides new evidence on trends in overweight and obesity. In the United Kingdom over the next 20 years rising levels of obesity will lead to an additional 670,000 cases of cancer and £2.5 billion in National Health Service and social care costs. This report examines the potential merits of different policy options in helping to achieve small, consistent reductions in overweight and obesity. Based upon current evidence, the most effective policies would include: (1) introduction of a 6am to 9pm ban on television advertising of unhealthy foods and beverage products; (2) restricting online marketing of unhealthy foods and beverages and other product placement; (3) introducing additional tax on sugar-sweetened beverages; (4) examining the case for further tax (or other fiscal measures) to limit sugar, salt, and fat content of foods and beverages; (5) strengthening food standards in all publically funded institutions; (6) changing labelling laws for foods and beverages and instituting awareness campaigns; (7) increasing the access to recreational facilities and open spaces, particularly to disadvantages groups; (8) promoting walking and cycling as modes of public transport; (9) developing a new accountability framework for the food and beverage industry.

United States

An in-depth look at the lifetime economic cost of obesity (PDF  - 300 KB), Kasman M, Hammond R, Werman A, Mack-Crane A and McKinnon R, Brookings Institute (May 2015). Along with the detrimental health impacts of obesity, there are also economic implications, some more easily quantifiable than others. This report looks at the lifetime economic impact of obesity borne by society. The economic modelling compared net present value of lifetime costs of two hypothetical 1000-person, demographically matched cohorts – one obese and one normal weight. Using the assumptions of this economic model, on average, the lifetime societal costs of each obese person in the United States was estimated at more than $92,000 (in 2013 US dollar value). The estimated societal costs for the current obese population exceed $1.1 trillion.

Accelerating Progress in Obesity Prevention, National Academy of Sciences, Committee on Accelerating Progress in Obesity Prevention; Food and Nutrition Board (2012). The United States continues to experience an epidemic of overweight and obesity. This national health condition constitutes a startling setback to major improvements achieved in other areas of health during the past century. The substantial and long-term human and societal costs of obesity, the great difficulty of treating this problem once it has developed, and the relatively slow progress made thus far in turning the national obesity numbers around underline the urgent need to develop a plan for accelerating progress in obesity prevention. The committee identified close to 800 previously published recommendations and associated strategies and actions related to obesity prevention and assessed the potential of each to help achieve this goal. A nine-point strategy was proposed by the committee: 

  1. Bold, widespread, and sustained action will be necessary to accelerate progress in obesity prevention.
  2. Priority and targeted actions must drive cultural and societal changes to improve environments that influence physical activity and food intake options.
  3. Cultural and societal changes are needed to address obesity, and a systems approach must be taken when formulating obesity prevention recommendations so as to address the problem from all possible dimensions.
  4. Solutions to the obesity epidemic must come from multiple sources, involve multiple levels and sectors, and take into account the synergy of multiple strategies.
  5. Obesity prevention recommendations should be based on the best available scientific evidence as outlined in the Locate Evidence, Evaluate Evidence, Assemble Evidence, Inform Decisions (L.E.A.D.) framework.
  6. The cost, feasibility, and practicality of implementing prior and further recommendations must be considered.
  7. Unintended consequences of obesity prevention efforts must be considered.
  8. Obesity prevention recommendations should incorporate ongoing evaluation of progress toward achieving benchmarks and of the need for any course corrections.
  9. Recommendations to accelerate progress in obesity prevention must include an assessment of the potential for high impact, the reach and scope of potential effects, the timeliness of effects, the ability to reduce disparities and promote equity, and clearly measureable outcomes.

Are physical education-related state policies and schools' physical education requirement related to children's physical activity and obesity (abstract), Kim J, Journal of School Health, Volume 82, Number 6 (2012).  This study from the United States examined the relationship between the physical education requirements of schools and children’s physical activity and obesity. The study concluded that gaps exist between state physical education related policies and their implementation in schools.  Physical education requirements seem to improve children's physical activity, with some gender variation. However, the association between school physical education requirements and children's weight was less clear.

Childhood obesity prevention strategies for rural communities (PDF  - 4.4 MB), Corbett A, Gratale D, Ellis W, Revere C and Chang D, The Nemours Foundation (2014). Over the past 30 years, childhood obesity rates in the U.S. have tripled. Also, children living in rural areas are 25% more likely than those in metropolitan areas to be overweight or obese. Certain characteristics of rural communities contribute to the problem of childhood obesity, including barriers such as higher poverty levels, less access to opportunities for physical activity and healthy eating, and limited resources to provide physical education in schools. However, one of the greatest assets of a rural environment is the sense of community, the amazing spirit for volunteerism, and the network of caring individuals. This toolkit provides a range of strategies, interventions and ideas that communities can use to counter the increase in obesity among rural populations.

Creating Equal Opportunities for a Healthy Weight, Workshop Summary, Breiner H, Parker L, and Olson S, National Academy of Sciences (2013). The Standing Committee on Childhood Obesity Prevention was formed in 2008 to serve as a focal point for national and state-level policy discussions about obesity prevention. It comprised national leaders in public health, public policy, medicine, nutrition, physical activity, pediatrics, obesity prevention, the social and behavioral sciences, biostatistics, and epidemiology. This workshop was the last formal activity of the standing committee and a new phase of obesity work was initiated with the formation of the Roundtable on Obesity Solutions. It covered the following six areas: (1) physical activity, (2) foods and beverages, (3) workplaces, (4) health care, (5) messaging, and (6) schools. 

Designed to Move: A physical activity action agenda (PDF  - 3.4 MB), American College of Sports Medicine, International Council of Sport Science and Physical Education, and Nike Inc. (2012). Today nearly one in three American children are overweight or obese. This epidemic has coincided with a rise in obesity-related health issues, such as type-2 diabetes and heart disease that drive up the cost of health care and threaten to make this generation the first to live shorter lives than their parents. Designed to Move is a strategy document that outlines the problem and proposes a physical activity action plan.

Early Childhood Obesity Prevention Policies, Birch L, Parker L, and Burns A, National Academy of Sciences, Committee on Obesity Prevention Policies for Young Children (2011). Efforts to prevent childhood obesity to date have focused largely on school-aged children, with relatively little attention to children under age 5. However, there is a growing awareness that efforts to prevent childhood obesity must begin before children ever enter the school system. This report is one of a series of publications dedicated to providing succinct information on childhood obesity prevention specifically for policy makers. A number of key factors influence the risk for obesity in an infant or young child, including prenatal influences, eating patterns, physical activity and sedentary behavior, sleep patterns, and marketing and screen time. Young children are dependent on parents, caregivers, and others to provide environments that can help shape these factors in positive ways by, for example, supporting the development of lifestyle behaviors that promote growth and development, making healthy foods available in appropriate amounts, and providing safe places for active play. Moreover, all of these factors come into play in the policy environment that surrounds and influences parents and children and must be addressed in a coordinated manner if progress is to be made against the early onset of childhood obesity. 

F as in FAT: how obesity threatens America’s future (PDF  - 5.3 MB), Levi J, Segal L, Laurent R, Lang A, and Rayburn J, Trust for America’s Health, Robert Wood Johnson Foundation (2012).  This is the ninth annual edition of the report How obesity threatens America’s future. This new analysis provides a picture of two possible futures for the health of Americans over the next 20 years. If obesity rates continue to increase along their current trend, 44% of American adults could be obese and the rate could be higher in some States.  The number of new cases of type-2 diabetes, coronary heart disease and stroke, hypertension, and arthritis could increase 10 times between 2010 and 2020, and then double again by 2030.  Obesity-related health care costs could increase by more than 10 percent nationally and by more than 20 percent in some States. As an alternative, the report states that by lowering obesity trends by only 5 percent in each state, millions of Americans could avoid serious health problems and billions of dollars in health spending could be saved.

Physical Activity: Moving toward obesity solutions workshop summary, Pray L, Food and Nutrition Board, Institute of Medicine of the National Academies, National Academy Press (2015). In 2008, the U.S. federal government issued physical activity guidelines for the first time. The Institute of Medicine’s Roundtable on Obesity Solutions was held to explore the state of the science regarding the impact of physical activity in the prevention and treatment of overweight and obesity, and to highlight innovative strategies for promoting physical activity across different segments of the population. This report summarises the presentations and discussions from this workshop.


Further Resources and Reading

Research  

  • Are sleep duration and sleep quality associated with diet quality, physical activity, and body weight status? A population-based study of Canadian children (abstract), Khan M, Chu Y, Kirk S and Veugelers P, Canadian Journal of Public Health, Volume 106, Number 5 (2015). Approximately half of the surveyed parents reported that their children were not getting adequate sleep at night. Longer sleep duration was statistically significantly associated with decreased risk for overweight and obesity independent of other sleep characteristics. Longer sleep duration was also associated with better diet quality and higher levels of physical activity. These findings indicate a need for health promotion strategies to encourage adequate sleep and to promote healthy sleep environments among children. Given the links between sleep, body weight, physical activity and other lifestyle behaviours, these messages should be included in public health interventions aimed at promoting health among children.
  • Childhood obesity prevention programs: Comparative effectiveness review and meta-analysis (PDF  - 13.7 MB), Wang Y, et.al., United States Government, Department of Health and Human Services, Agency for Healthcare Research and Quality, Comparative Effectiveness Review Number 115, AHRQ Publication Number 13-EHC081-EF (June 2013). Childhood obesity is a serious health problem in the United States and worldwide, with more than 30 percent of American children and adolescents being overweight or obese. This review compared the effects of interventions on weight-related outcomes (e.g., body mass index, waist circumference, percent body fat, skinfold thickness, prevalence of obesity and overweight); intermediate outcomes (e.g., diet and physical activity); and obesity-related clinical outcomes (e.g., blood pressure and blood lipids). The overall evidence is moderate about the effectiveness of school-based interventions for childhood obesity prevention. Physical activity interventions in a school-based setting with a family component or diet and physical activity interventions in a school-based setting with home and community components have the most evidence for effectiveness. More research is needed to test the strength of interventions in other settings; such as policy, environmental, and consumer health informatics.
  • Comprehensive sector-wide strategies to prevent and control obesity: what are the potential health and broader societal benefits? A case study from Australia, Kite J, Hector D, St George A, Pedisic Z, Phongsavan P, Bauman A, Mitchell J and Bellew B, Public Health Research & Practice, Volume 25, Issue 4 (2015). Several countries have established multi-stakeholder strategies to prevent or control overweight and obesity in the population. This study looked at the sector-wide benefits and impacts likely to accrue from implementing a comprehensive obesity prevention strategy in New South Wales. Evidence reviews and epidemiological models were used to show potential benefits from meeting selected targets and objectives specified in the strategy. Data models were premised on hypothetically achievable targets – namely, 5% reduction in obesity, 5% reduction in overweight, 15% relative reduction in insufficient physical activity, 25% relative reduction in sedentary behaviour, 25% relative reduction in sugar-sweetened beverage consumption, 25% reduction in insufficient fruit consumption and 10% reduction in insufficient vegetable consumption. The modeling showed that for children and adolescents, improved health outcomes potentially include a significant reduction in metabolic risk factors and cardiovascular disease, depression, rates of mortality in hospitalised children, and bullying. Estimating the cost-benefit of such a strategy was beyond the scope of this study. Quantifying the health and social benefits that are likely to accrue if comprehensive sector-wide obesity prevention strategies are established will help strengthen advocacy for their implementation.
  • Diet quality and physical activity in relation to childhood obesity (abstract), An R, International Journal of Adolescent Medicine and Health, published online ahead of print (15 August 2015). Population-level studies on the relationship between lifestyles and childhood obesity typically focus on either physical activity or diet but seldom both. This study examined physical activity and diet quality in relation to obesity in a nationally representative sample of U.S. children and adolescents. Data from the National Health and Nutrition Examination Survey 2003–2006 was used. Participants engaging in at least 60 minutes of moderate-to-vigorous physical activity daily (measured by accelerometer) were classified as being physically active. Using the healthy diet & physically active group as a baseline, the increased risk of obesity was estimated for children in one of the three remaining groups: (1) unhealthy diet & physically inactive (UD-PI), 16-19% increased risk; (2) healthy diet & physically inactive (HD-PI), 14-17% increased risk, and (3) unhealthy diet & physically active (UD-PA), about 3% increased risk. It appears that regular moderate-to-vigorous physical activity attenuated the risk of obesity to a greater extent than improved diet.
  • Do youth sports prevent pediatric obesity? A systematic review and commentary (PDF  - 331 KB), Nelson T, Stovitz S, Thomas M, LaVio N, Bauer K and Neumark-Sztainer D, Current Sports Medicine Reports, Volume 10, Number 6 (2011). Sport may be a promising setting for obesity prevention among youth. This review of research compared sport participants with non-participants on weight status, physical activity and diet. Nineteen studies were included in the review. No clear pattern of association between body weight and sport participation was found. A number of studies examined the relationship between sport participation and diet and found that sport participation is associated with eating more fruit, vegetables and consumption of dairy products, but also more fast food and sugar sweetened beverage consumption. It is unclear from these results whether sports programs, as currently offered, protect youth from becoming overweight or obese. Additional research is necessary to understand how sport, and youth sport settings, can help promote energy balance and healthy body weight.
  • Early childhood obesity prevention policies, Birch L, Parker L and Burns A (editors), Institute of Medicine of the National Academies of Science, National Academy Press, Washington D.C. (2011). Environmental factors can profoundly affect children’s development and obesity risk in the first years of life, when patterns of eating, physical activity, and sleep are developing. Accordingly, this report offers policy recommendations designed to prevent obesity in infancy and early childhood by promoting healthy early-childhood environments in settings outside the home (i.e. such as child care settings) where young children spend a substantial amount of time.
  • Effect of school-based interventions on physical activity and fitness in children and adolescents: A review of reviews and systematic updateBritish Journal of Sports Medicine, Volume 45, Number 11 (2011). School-based interventions are thought to be the most universally applicable and effective way to counteract low physical activity (PA) and fitness although there is some disagreement about the optimal intervention strategy. This review summarise other reviews of physical activity studies or intervention studies. This review looked at controlled and randomised controlled school-based trials conducted from 2007 through 2010 that had a PA or fitness outcome measure, a duration in excess of 12 weeks, and a sufficiently healthy (non-clinical) population aged 6-18 years. In these reviews, 47 to 65% of trials were found to be effective. The effect was mostly seen in school-related PA, while effects outside school were often not observed or assessed. The school-based application of multi-component intervention strategies was the most consistent and promising intervention strategy. There was disagreement regarding the effectiveness of family involvement and the duration and intensity of the intervention.
  • Estimated energy expenditures for school-based policies and active living (PDF  - 149 KB), Bassett D, et.al., American Journal of Preventive Medicine, Volume 44, Number 2 (2013). Despite overwhelming evidence of the health benefıts of physical activity, most American youth are not meeting the 60 minutes per day recommendation for moderate-to- vigorous intensity physical activity (MVPA). Policy changes have the potential to bring about substantial increases in physical activity in youth within school and community settings. This paper summarises the results of over 300 published studies between 1995 and 2011. Within school settings, the average minutes of MVPA gained per school day (in addition to any physical education instruction) for each of these intervention categories were: mandatory physical education class - 23 minutes; classroom activity breaks - 19 minutes; after-school activity programs - 10 minutes; standardised physical education curricula - 6 minutes; modifıed playgrounds - 6 minutes,and; and modifıed recess (5 minutes more than traditional recess). Within community settings, signifıcant MVPA was associated with active commuting (16 minutes) and park renovations (12 minutes), but proximity to parks had a small effect (1 minute). No conclusions could be drawn regarding joint-use agreements, because of a lack of studies quantifying their impact on energy expenditure. Within community settings, signifıcant MVPA increases were associated with active commuting - 16 minutes; park renovations and design - 12 minutes, but proximity to parks had only a small effect (1 minute). No conclusions were drawn regarding joint-use programs (school and community) because of a lack of studies quantifying their impact on energy expenditure.
  • Evidence for prospective associations among depression and obesity in population-based studies (PDF  - 135 KB), Faith M, Butryn M, Wadden T, Fabricatore A, Nguyen A and Heymsfield S, Obesity Reviews, Volume 12, Issue 5 (2011). Obesity may lead to depression or be one of its consequences. This review included 25 studies, of which 10 tested ‘obesity-to-depression’ pathways, and 15 tested ‘depression-to-obesity’ pathways. Eighty per cent of the studies reported significant obesity-to-depression associations, while 53% of the studies reported significant depression-to-obesity associations. Thus, there was good evidence that obesity is prospectively associated with increased depression.
  • Examining a developmental approach to childhood obesity: The fetal and early childhood years: Workshop Summary, Pray L, National Academy Press (2015). Recent scientific evidence has examined the origins of childhood obesity as an outcome of the dynamic interplay of genetic, behavioural, and environmental factors. A body of evidence suggests that both maternal and paternal nutritional practices can affect a child’s risk of later obesity. The field of epigenetics has led researchers to speculate that many of the observed associations between early developmental exposures and later risk of childhood obesity are linked and that many risk factors can be mediated by interventions targeting family attitudes and practices about nutrition, physical activity, and lifestyle choices. The National Research Council Board on Children, Youth, and Families in the United States convened a workshop of experts to explore the evidence on the interaction of biology, environment, and developmental stage on the risk of childhood obesity. This report is primarily focused on nutritional practices, however, one of the conclusions offered by the workshop group was that the “most bang for the buck” obesity prevention intervention will likely come from a whole-of-community approach, one that focuses not only on families and individuals, but also on the environment and public policy.
  • Exploring service providers' perspectives in improving childhood obesity prevention among CALD communities in Victoria, Australia, Cyril S, Green J, Nicholson J, Agho K and Renzaho A, PLOS One, published online (13 October 2016). Childhood obesity rates have been increasing disproportionately among disadvantaged communities in Australia, including culturally and linguistically diverse (CaLD) migrant groups, due to their poor participation in the available obesity prevention initiatives that target children. This research looks at the perceptions of service providers, and what is needed to improve the participation of CaLD communities. Analysis of interviews with service providers showed three major themes presenting barriers to CaLD engagement: (1) integrating obesity prevention messages within other programs; (2) coordination between prevention and treatment services, and; (3) establishment of a childhood obesity surveillance system. Collaborative approaches between health systems, immigrant services, child services, and community programs are needed to address obesity-related disparities in CaLD communities.
  • Genome-wide physical activity interactions in adiposity ― A meta-analysis of 200,452 adults, Graff M, Scott R, Justice A, et.al., PLOS Genetics, published online (27 April 2017). Physical activity may modify the genetic effects that give rise to increased risk of obesity. To identify adiposity loci whose effects are modified by physical activity, the research team performed genome-wide interaction meta-analyses of body mass index (BMI) and BMI-adjusted waist circumference and waist-hip ratio. Data from 200,452 adults, 180,423 of European and 20,029 of other ancestry were used; 23% of participants were categorised as inactive and 77% as physically active. In the strongest known obesity-risk gene, FTO, the effect of the gene is attenuated by approximately 30% in physically active individuals compared to inactive individuals. The analyses indicate that other similar gene-physical activity interactions may exist, but better measurement of physical activity and improved analytical methods will be required to identify them.
  • The impact of physical education on obesity among elementary school children (Abstract), Cawley J, Frisvold D and Meyerhoefer C, Journal of Health Economics, Volume 32, Issue 4 (2013). In response to the dramatic rise in childhood obesity in the United States, the Centers for Disease Control (CDC) and other organisations have advocated increasing the amount of time that elementary school children spend in physical education (PE) classes. However, not enough is known about the effect of PE on children’s weight. This study uses data from the Early Childhood Longitudinal Study, Kindergarten Cohort for 1998–2004. Results indicate that PE lowers body mass index score and reduces the probability of obesity by the time the children entered fifth grade. This effect is more concentrated among boys, as PE is a complement to other types of physical activity; whereas PE serves as a substitutes for other physical activity among girls. This represents some of the first evidence of a causal effect of PE on youth obesity, and thus offers support for the assumptions behind the CDC recommendations. This study found no evidence that increased PE time crowds out time in academic courses or has any negative affect on academic achievement test scores.
  • A multinational examination of weight bias: Predictors of anti-fat attitudes across four countries, Puhl R, Latner J, O’Brien K, Luedicke J, Danielsdottir S and Forhan M, International Journal of Obesity, Volume 39 (2015). Along with the increased rate of obesity in many countries, there is also an increase in the bias and prejudice directed toward persons with high body weight (known as 'weight bias'). Data was gathered from 2866 persons from four countries; Australia, Canada, Iceland, and the United States. The extent of weight bias was consistent across all four countries, and in each nation, obesity predicted stronger weight bias. There was a belief that obesity is attributable to lack of willpower and personal responsibility. The magnitude of weight bias was stronger among males than females, and among individuals without family members who were themselves overweight. The findings suggest that sociocultural factors may contribute to weight bias and overweight persons become targets of stigma, making weight reduction efforts more difficult.
  • Obesity in the early childhood years: State of the science and implementation of promising solutions (Workshop Summary), Olson S, National Academy of Sciences, Food and Nutrition Board, USA (2016). The prevalence of obesity among US children aged 2-5 years is approximately 8.4% of this population (2012 statistics). To explore what is known about the causes and prevention of early childhood obesity, the National Academy of Sciences held a roundtable workshop, this report presents their findings. The experts commented that the evidence linking motor behaviours in infancy and adiposity is limited, perhaps due to difficulties in measurement. Risk factors for infant and early childhood obesity were: (1) gestational weight gain; (2) maternal health (smoking behaviour) during pregnancy; (3) accelerated infant weight gain; (4) breastfeeding behaviour; (5) insufficient sleep duration and poor quality sleep; (6) screen viewing time; (7) parental responses to infant hunger and satiety cues; (8) parental feeding practices (portion size); (9) intake of high sugar and fat foods (i.e. fast food and sugar sweetened beverages), (10) physical inactivity, and (11) socio-cultural factors. Dietary, physical activity, sedentary behaviour and sleep guidelines for infants (0 to 2 years of age) and early childhood (to age 4) are being reviewed by the US Department of Agriculture and should be revised in the next two years. The workshop participants noted that interventions targeting community organisations (i.e. child care settings) and parental behaviours have been effective in promoting healthy eating and regular physical activity as a means of reducing infant and early childhood obesity.
  • Physical activity and obesity: What we know and what we need to know, Chin S, Kahathuduwa C and Binks M, Obesity Reviews, published online (14 October 2016). This analysis of systematic reviews and meta-analyses also includes the conclusions from high-quality clinical trials. The researchers have eliminated studies that were methodologically flawed in an attempt to reduce the ambiguity in the literature related to the role of physical activity in weight loss and maintenance, as a treatment for obesity. This analysis further sought to isolate the effects of various types of exercise, independent of dietary interventions, to further clarify their contribution. Finally, several gaps in knowledge are identified that will inform future research.
  • Process and impact evaluation of the Romp & Chomp obesity prevention intervention in early childhood settings: Lessons learned from implementation in preschools and long day care settings (PDF  - 1.6 MB), de Silva-Sanigorski A, Bell A, Kremer P, et.al., Childhood Obesity, Volume 8, Number 3 (2012). The Romp & Chomp controlled trial, which aimed to prevent obesity in preschool Australian children, was found to reduce the prevalence of childhood overweight and obesity and improve children’s dietary patterns. The intervention focused on capacity building and policy implementation within various early childhood settings. This paper reports on the process and impact evaluation of this trial and the lessons learned from this complex community intervention. The environmental audits demonstrated positive impacts in both settings on policy, nutrition, physical activity opportunities, and staff capacity and practices, although results varied across settings and were more substantial in the preschool settings. These results provide confidence that obesity prevention interventions in children’s settings can be effective; however, significant efforts must be directed toward developing context-specific strategies that invest in policies, capacity building, staff support, and parent engagement.
  • Proportion of children meeting recommendations for 24-hour movement guidelines and associations with adiposity in a 12-country study, Roman-Vinas B, Chaput J, Katzmarzyk P, et.al., International Journal of Behavioral Nutrition and Physical Activity, Volume 13, published online (25 November 2016). This study evaluated the adherence of 6128 children, aged 9 to 11 years, on the three main variables (physical activity, sedentary behaviour, and sleep) of the Canadian 24-hour movement guidelines and the relationship with body mass index (BMI). Data were taken from the ISCOLE study, a multinational study designed to determine the relationships between lifestyle behaviours and obesity; participating countries include: Australia (N=451 subjects from Adelaide), Brazil, Canada, China, Colombia, Finland, India, Kenya, Portugal, South Africa, the United Kingdom and the United States. The results showed that only 15% of Australian children in this study met the recommendations on all three variables. However, children who did meet all three criteria had significantly lower BMI and their odds ratio for obesity was significantly lower. Subjects from China and Brazil had the highest obesity rates (24.5% and 21.5%, respectively) and subjects from Finland and Colombia had the lowest (5.4% and 5.6% respectively). This study concluded that further efforts should aim to find ways to collectively increase daily physical activity, reduce screen time, and ensure an adequate night’s sleep in children.
  • The role of youth sports in promoting children's physical activity and preventing pediatric obesity: A systematic review, Lee J, Pope Z and Gao Z, Behavioral Medicine, published online ahead of print ( 23 June 2016). This review looked at 44 published studies concerning youth sport participation, overall physical activity (PA) and obesity status. Inclusion criteria included comparison of sport participants with non-participants having various levels of PA. The results indicated that participation in youth sport was positively associated with children's physical activity levels, and youth participating in sports were more likely to persist in their PA. However, the relationship between youth sport participation and obesity status was inconclusive.
  • Secular differences in the association between caloric intake, macronutrient intake, and physical activity with obesity, Brown R, Sharma A, Ardern C, Mirdamadi P, Mirdamadi P and Kuk J, Obesity Research & Clinical Practice, published online (14 September 2015). This study looked at whether the relationship between caloric intake, macronutrient intake, and physical activity with obesity has changed over time. Dietary data from 36,377 U.S. adults from the National Health and Nutrition Survey (NHANES) between 1971 and 2008 was used. Physical activity frequency data was only available in 14,419 adults between 1988 and 2006. Generalised linear models were used to examine if the association between total caloric intake, percent dietary macronutrient intake and physical activity with body mass index (BMI) was different over time. Between 1971 and 2008, BMI, total caloric intake and carbohydrate intake increased 10—14%, and fat and protein intake decreased 5—9%. Between 1988 and 2006, frequency of leisure time physical activity increased. However, for a given amount of caloric intake, macronutrient intake or leisure time physical activity, the predicted BMI was higher in 2006 that in 1988, the difference being statistically significant (P < 0.05). The authors conclude that factors other than diet and physical activity may be contributing to the increase in BMI over generations. Further research is necessary to identify these factors and to determine the mechanisms through which they affect body weight.
  • Time with friends and physical activity as mechanisms linking obesity and television viewing among youth, Vandewater E, Park S, Hebert E and Cummings H, International Journal of Behavioral Nutrition and Physical Activity, Volume 12, Supplement 1 (2015). Despite recent reports suggesting that childhood obesity rates in the U.S. may be leveling off, obesity among children and youth continues to be one of the most persistent public health problems in the United States. This study looked at the bivariate relationships between childhood obesity and physical activity, friendships and television viewing time among children (n=1545, mean age 13.8 years). This study found strong evidence of a positive relationship between time spent with friends and physical activity. Both physical activity and friendships are important mediators of links between overweight/obesity and television viewing in youth. The social world of overweight and obese youth tends to be solitary, rejecting and negative; compared to normal-weight youth. Obese children are often perceived negatively and are less likely to develop multiple friendships. There is consistent evidence that overweight youth have fewer friends, are less likely to have mutual or reciprocated friendships, and are alone more frequently than normal-weight youth; this may lead to excessive screen time and food consumption. The study also found that time spent with friends was positively related to moderate-to-vigorous physical activity.
  • Weight loss interventions for overweight and obese adolescents: a systematic review, Boff R, Liboni R, Batista I. de Souza L and Oliveira M, Eating and Weight Disorders – Studies on Anorexia, Bulimia and Obesity, abstract published online ahead of print (19 August 2016). This review of literature looked at the efficacy of non-drug treatments to promote weight loss in overweight and obese adolescents. Studies published between 2004 and 2014 were examined, 115 from over 12,000 publications met the review criteria. All the effective interventions were multifactorial, with components such as nutrition education, physical activity, family support and psychological therapy. The number of contacts between facilitators and subjects during the course of an intervention was also a predictor of treatment efficacy. This review concluded that multidisciplinary interventions including family support and guided behaviour modification appear to be effective methods of reducing body mass in overweight and obese adolescents.
  • What Role Can eHealth Play in Preventing Childhood Obesity? (PDF  - 519 KB), Jablow P, Robert Wood Johnson Foundation (2009). Childhood overweight and obesity are epidemic in the United States and throughout the world. Researchers at the Health-e Technologies Initiative at Brigham & Women's Hospital in Boston sought to determine what role electronic technologies can play in preventing and reducing childhood obesity, especially in low-income and culturally diverse communities. From 2005 to 2007, project staff reviewed published research and commentary about technology and childhood obesity, convened an interdisciplinary panel of experts to explore perspectives and in 2009 issued a report, Childhood Obesity Prevention and Reduction: Role of eHealth. This report addresses the potential role that evidence-based eHealth can play in reducing the incidence and prevalence of childhood obesity for at-risk children and families, especially those from low socioeconomic status (SES) and culturally diverse neighbourhoods and communities. There is a concern, often expressed in public discourse, that the omnipresent role of technology in the lives of our youth promotes a sedentary lifestyle and may be a major causal factor in the rise of overweight and obesity in our society. Key findings in this report:
    • 'Screen time' is often identified as a primary cause of childhood obesity. However, some uses of technology are more passive than others so the relationship needs to be more clearly delineated.
    • The ubiquity of technology in the lives of today's youth means interventions to prevent and treat childhood obesity need to be adapted to their unique learning and information-seeking styles. Interventions that are designed to prevent and treat obesity should be adapted to the preferred styles of these frequent technology users.
    • Interventions that do not integrate seamlessly into the daily ecology of children’s lives are not likely to succeed.
    • Partnerships between the entertainment industry and software developers could play a key role in the battle against childhood obesity. Program developers must be culturally aware and consider cultural issues and challenges when creating eHealth interventions.
    • More qualitative and quantitative research is necessary to better understand the use of eHealth applications to address childhood obesity.
    • eHealth interventions can require substantial up-front costs, both in the development of computing hardware and sophisticated software applications. However, the cost of technologies used for eHealth inevitably decrease over time, posing less of a barrier to scalability and access for traditionally underserved populations.
  • Why are poorer children at higher risk of obesity and overweight? A UK cohort study, Goisis A, Sacker A and Kelly Y, The European Journal of Public Health, Volume 26, Issue 1 (2016), first published online (10 December 2015). Data from the Millennium Cohort Study (United Kingdom) was used to assess overweight at age 5 and again at age 11 years (N=11,965). Socioeconomic conditions, parental health, the children’s physical activity and sedentary behaviours were also assessed. The analysis revealed that income disadvantage was the greatest risk factor to childhood obesity at both ages. Among the bottom family income quintile, children at age 5 were twice as likely to be obese and at age 11 three times more likely, compared to children from the top quintile. Physical activity and diet were particularly important in explaining inequalities.

Reading

  • Bridging the evidence gap in obesity prevention: A framework to inform decision making, Kumanyika S, Parker L and Sim L, Editors, National Academy Press (2010). This report focuses on the challenge of obesity prevention, viewed from a population or public health perspective. It addresses the issues of how to identify, use, and evaluate evidence; and how to generate evidence where it is lacking so that well informed program and policy decisions can be made.
  • Changing the future of obesity: Science, policy, and action, Gortmaker S, Swinburn B, Levy D, Carter R, Mabry P, Finegood D, Huang T, Marsh T and Moodie M, The Lancet, Volume 378, Number 9793, p838-847 (2011). The emerging science on obesity uses quantitative models to provided key insights into the dynamics of this worldwide epidemic, and has enabled researchers to combine evidence and to calculate the effect of behaviours, interventions, and policies at several levels—from individual to population. The changes needed to reverse the epidemic are likely to require many sustained interventions at several levels. Necessary alterations include: individual behaviour change; interventions in schools, homes, and workplaces; and sector change within agriculture, food services, education, transportation, and urban planning. Despite the overwhelming evidence showing the need to reduce obesity, no clear consensus on effective government policy or programmatic strategies has been reached. Most countries do not have sufficient population monitoring data on physical activity, dietary intake, and obesity prevalence to set meaningful goals and assess progress. The number of suggested interventions, plus the contested nature of potential solutions, can create a ‘policy cacophony’. This report reviews key findings from these models; including trends in obesity, health, and economic outcomes, the dynamics of weight gain and loss, and the cost-effectiveness of interventions. It also outlines strategies for the prevention of obesity that build upon the growing science and specifically links evidence for effectiveness and cost with implementation feasibility and other concerns of policy makers. Finally, this report presents a call to action from a systems perspective, with a focus on cost-effective and sustainable strategies.
  • The current state of obesity solutions in the United States: Workshop Summary, Olson S, roundtable on Obesity Solutions, Institute of Medicine, National Academy of Sciences (2014). This report states that many programs, services, and activities that affect nutrition and physical activity are under way in the United States, but the overarching element that unites these efforts is policy. Good policies are: (1) scalable - work that succeeds at the local level can be scaled up to the national level quickly; (2) enforceable - especially when outcomes can be measured, policies can be a mechanism for implementing such changes as physical activity requirements, and (3) meaningful - they can build sustainable momentum for change and create new leaders who can articulate issues in ways that are most relevant to a community. The Physical Activity Guidelines for Americans; the work of the President’s Council on Fitness, Sports, and Nutrition; and the Let’s Move! initiative are all helping to increase physical activity and reduce obesity among children.
  • Evaluating obesity prevention efforts: A plan for measuring progress, Green L, Sim L and Breiner H (editors) National Academy Press, USA (2013).  The report contains: (1) a conceptual evaluation framework to consider when evaluating progress of obesity prevention efforts; (2) broad conclusions and a review of existing evaluation efforts; (3) flexible evaluation plans for national, state, and community stakeholders; (4) indicators of progress and existing data sources for measuring these indicators; (5) recommendations for evaluation changes to encourage and enhance the extent and effectiveness of obesity prevention evaluations; and (6) measurement ideas to determine the impact of The Weight of the Nation campaign.
  • Exercise can help control weight, Harvard School of Public Health, online information on obesity prevention. Despite all the health benefits of physical activity, people worldwide are getting less — at school, at home, at work, and as they travel from place to place. Globally, about one in three people gets little, if any, physical activity; below the level recommended for the maintenance of health. Physical activity levels are declining not only in wealthy countries, such as the U.S., but also in low and middle-income countries, such as China and India. It has become clear that this decline in physical activity is a key contributor to the global obesity epidemic, and in turn, to rising rates of chronic disease. 
  • The fat lie (PDF  - 1.8 MB), Snowdon C, Institute of Economic Affairs, London (2014). The rise in population obesity is believed to be the result of over consumption of food, or an increase in the consumption of energy dense, nutrient poor, food such as sugar and processed foods. Proposed solutions include product regulation (industry self-regulation or government regulation), imposition of tax, and other market based policies. However, some evidence suggests that sugar and salt per capita consumption in Britain has actually declined by 16% since 1992 and overall calorie consumption has also fallen in recent years. Although it’s noted that a reduction in consumption at the population level is no guarantee of a reduction at the individual level. This report looks at the primary cause of obesity as a decline in physical activity in the home and workplace, not a consequence of calorie consumption alone.
  • Interventions for preventing obesity in children (Review) (PDF  - 2.2 MB), Waters E, et. al. Cochrane Database of Systematic Reviews, Issue 12, published online (7 December 2011). This review primarily aims to update previous reviews of childhood obesity prevention research and determine the effectiveness of evaluated interventions intended to prevent obesity in children; to answer the questions “What works for whom, why and at what cost?” This review found strong evidence to support beneficial effects of child obesity prevention programs, particularly for programs targeted to children aged six to 12 years. A broad range of program components were used in these studies and whilst it is not possible to distinguish which of these components contributed most to the beneficial effects observed, the synthesis of evidence indicates the following to be promising policies and strategies: (1) a school curriculum that includes the components of healthy eating, physical activity and body image, (2) increased sessions for physical activity in schools and the development of fundamental movement skills, (3) improvements in nutritional quality of the food supply in schools, (4) creating environments and cultural practices that support children eating healthier foods and being active throughout each day, (5) support for teachers and other staff to implement health promotion strategies and activities in the school curriculum, (6) parent support and home activities that encourage children to be more active, eat more nutritious foods, and spend less time in screen based activities.
  • Leisure education within the context of a childhood obesity intervention programme: Parents’ experiences, Shannon C, World Leisure Journal, Volume 54, Number 1 (2012). As parents became more aware of their children's free time use, interests, and experiences, they developed an understanding of their role as facilitators of their children's leisure time activity.
  • A map of community-based obesity prevention initiatives in Australia following obesity funding 2009-2013, Whelan J, Love P, Romanus A, Pettman T, Bolton K, Smith E, Gill T, Coveney J, Waters E and Allender S, Australian and New Zealand Journal of Public Health, published online (5 January 2015). Public health policies targeting obesity are usually multi-strategy, multi-level community-based initiatives; and some appear to be more promising than others. In Australia, all levels of government have funded and facilitated a range of community-based obesity prevention initiatives (CBIs). Programs are usually heterogeneous in their funding, timing, target audience and structure. This paper presents an overview CBIs operating in Australia, to facilitate knowledge exchange and shared opportunities for learning, and to guide the development of best practice. 
  • Obesity and injury in Australia: A review of the literature (Abstract), Norton L, Harrison J, Pointer S and Lathlean T, Australian Institute of Health and Welfare (2011). Obesity and injury are major health burdens on society and possible relationships have been reported. This report presents summary information from an overview of the existing literature to investigate obesity–injury relationships.
  • Obesity prevention: the case for action (PDF  - 434 KB), Kumanyika S, Jeffery R, Morabia A, Ritenbaugh C and Antipatis V, International Journal of Obesity, Volume 26 (2002). In 1997 the World Health Organization (WHO) set up an expert consultation group on obesity and its threat to the health of populations worldwide. This report provides a case for action, and proposes five broad areas where governments can adopt effective policies and strategies: (1)correcting societal causes of obesity through food intake and physical activity patterns; (2) commitment to action at all levels of government; (3) Links between policies and processes across different settings and sectors, and; (4) strategies for improving individuals’ lifestyles, as well as for the population.  
  • Obesity prevention through physical activity in school-age children and adolescents (PDF  - 1.9 MB), Viuda-Serranto A, Gonzalez-Millan C and Perez-Gonzalez B, Universidad Camilo Jose Cela (2011). The mechanism of obesity development is not fully understood. It is a complex multi-factorial issue, which means that the rising prevalence of obesity can therefore not be explained or addressed by a single factor. However, it is clear that obesity occurs when energy intake exceeds energy expenditure. The ignorance regarding the role of physical activity in the prevention of obesity in children and adolescents is widespread. In addition, a large body of research evidence has shown that once a child has become obese, there is a high probability that this obesity will continue into adulthood. Therefore, there is general acceptance that children should be considered the priority population for intervention strategies aimed at treating or, ideally, preventing the onset of obesity. Physical activity must be a major component of any intervention strategy to address childhood obesity.
  • Obesity Reviews (John Wiley & Sons publisher). The official journal of the International Association for the Study of Obesity, which links over 50 national and international associations.
  • Overweight and Obesity, Australian Institute of Health and Welfare (infographic). Rates of overweight and obesity are continuing to rise in Australia. Collecting information on these trends is important for managing the health problems associated with them.
  • Prevention of childhood obesity by reducing soft drinks (PDF  - 60 KB), James J and Kerr D, International Journal of Obesity, Volume 29 (2005). There are a variety of environmental factors that may be contributing to the increase of childhood obesity. One such factor may be the increased consumption of soft drinks. The association between the consumption of sugar-sweetened drinks and childhood obesity has been established in three separate American studies. It has been found that children who consume these drinks have a higher energy intake and are more likely to become overweight. In the United Kingdom, a school-based intervention focused on reducing the consumption of high sugar drinks has been shown to be effective in preventing a further increase in obesity.
  • Primary prevention of overweight in children and adolescents: A meta-analysis of the effectiveness of interventions aiming to decrease sedentary behaviour, van Grieken A, Ezendam N, Paulis W, van der Wouden J and Raat H, International Journal of Behavioral Nutrition and Physical Activity, Volume 9 (May 2012). This paper provides the results of a meta-analysis of published research on the effects of interventions, implemented in school and general population settings, on excessive sedentary behaviour in children and adolescents and body mass index. Results indicated that interventions targeting a reduction in sedentary behaviour and interventions targeting multiple health behaviours can result in significant decreases in sedentary behaviour.
  • The stigma of obesity: A review and update, Puhl R and Heuer C, Obesity, A Research Journal, published online (May 2009).  Obese individuals are highly stigmatised and face multiple forms of prejudice and discrimination because of their weight. The prevalence of weight discrimination in the United States has increased by 66% over the past decade and is now comparable to the rate of racial discrimination.
  • What works for the prevention and treatment of obesity among children: Lessons from experimental evaluations of programs and interventions (PDF  - 275 KB), Hadley A, Hair, E and Dreisbach N, Child Trends, Fact Sheet, Publication Number 2010-07 (March 2010). This fact sheet synthesises the findings from multiple studies that implemented randomly assigned experimental treatments to subjects to examine the impacts of various intervention strategies on child obesity outcomes and to identify programs that work and isolate the components of programs that contribute to success. While several themes emerge, no single approach, setting, or activity stands out as most effective. Results from the review suggest that programs with narrow goals and those that specifically target obese and/or overweight children are more likely to be effective at impacting at least one obesity-related outcome. Success on some outcomes was linked to participant age; for example, physical activity programs tended to be effective for adolescents 12-17 years of age and weight loss programs tended to be effective for older adolescents 16-19 years of age. Program length played an important role in some cases, as long-term physical activity programs were more successful than short-term programs. A number of intervention strategies were associated with success on particular outcomes – specifically, therapy and counseling were linked to improved nutrition and physical activity. Many approaches are associated with mixed findings, where some programs had impacts while others did not, suggesting the need for further rigorous and targeted evaluations to identify effectiveness.

Other Resources

  • Alliance for a Healthier Generation. The Alliance was founded by the American Heart Association and the Clinton Foundation as a response to the growing rate of childhood obesity in the United States. This website contains information on healthier living through better eating habits and increased physical activity.
  • Better Health Channel (Victorian Government). Obesity increases the risk of many diseases. Chronic conditions and diseases associated with obesity include diabetes, high blood pressure, atherosclerosis, cardiovascular disease, stroke, some cancers and sleep apnoea.  This website provides definitions and explanations of the factors associated with obesity.
  • Exercise is Medicine. A global initiative by the American College of Sports Medicine (ACSM) and the American Medical Association (AMA) designed to help improve the health and well-being patients through a regular physical activity prescription from doctors and other health care providers. Research shows that a low level of physical activity exposes a patient to a greater risk of obesity, hypertension, or high cholesterol; regular physical activity can decrease the risk of these health problems by 40%.
  • Fight the Obesity Epidemic (FOE). FOE is a charitable trust working to reverse or stop the rise of obesity and type-2 diabetes in New Zealand. The website provides a variety of information about obesity and the associated personal and public health issues.
  • Healthdirect Australia. This online resource provides information on a variety of health topics, including childhood obesity.
  • Healthway (Government of Western Australia). Healthway provides sponsorship and support to community organisations to promote healthy messages, facilitate healthy environments, reduce the promotion of unhealthy messages, and increase participation in healthy activities.
  • Heart Foundation Australia. The Heart Foundation advocates to government and offers a range of professional information and resources to create healthier communities that support active lifestyles.
  • Let’s Move Childcare (The Nemours Foundation and the Centres for Disease Control and Prevention). This website provides information and resources about the obesity problem among children age 0-6 years in the United States. Child care and early education providers can be a powerful force in children's lives and can help them learn habits that prevent childhood obesity and lead to a healthier life.
  • Obesity Australia. The mission of Obesity Australia is to drive change in the public perceptions of obesity, its prevalence and its treatment.  The website provides a number of reports and fact sheets that can be downloaded.
  • Steps for Life. This is a not-for-profit organisation founded in 2009 that aims to address the obesity problem in New Zealand through education and programs designed to change eating habits and increase physical activity. 
  • VicHealth. The Victorian Health Promotion Foundation (VicHealth) is a Victorian Government supported health promotion organisation with a primary focus on promoting good health and preventing chronic disease.
  • WHO Collaborating Centre Obesity Prevention, Deakin University. The WHO Collaborating Centre Obesity Prevention Unit is one of the largest research groups dedicated to obesity prevention research in Australia. In addition to a comprehensive research program, the Centre offers education, training and expert consultancy services. The focus is on supporting organisations, services, and alliances to undertake obesity prevention strategies, evaluate their effectiveness, and introduce methodologies to monitor and improve approaches to obesity prevention and the burden of chronic disease.

Videos

(access restrictions explained in the Client Service Model)

  • Let’s Move! keynote: Cities, Towns and Communities, Pfohl S, Executive Director of the President’s Council on Fitness, Sports and Nutrition, USA. Presentation given at the NSW Premier’s Council for Active Living (PCAL), Fit NSW 2016 Conference (March 2016). Topics covered in the FitNSW Conference – childhood obesity, preventive health, and active transport. (available to all Clearinghouse members)
  • Exercise and heart health in overweight childrenHealthDay News (11 August 2015). Exercise can significantly improve the cardiovascular health of overweight and obese children and adolescents.
  • WHO - Healthy People through Sport, Dr Douglas Bettcher, Director, Department for Prevention of Non-communicable Diseases, World Health Organization (WHO) and Dr Godfrey Xuereb, Team Leader for Population-based Prevention in the Prevention of Non-communicable Diseases Department, WHO, Smart Talk Seminar Series, Australian Institute of Sport (2 April 2013). Dr Douglas Bettcher, Director, Department for Prevention of Non-communicable Diseases, World Health Organization (WHO) and Dr Godfrey Xuereb, Team Leader for Population-based Prevention in the Prevention of Non-communicable Diseases Department discuss the role of sport in the prevention of non-communicable disease. (available to all Clearinghouse members)

Related Clearinghouse for Sport portfolios


Is this information complete?

The Clearinghouse for Sport is a sector-wide knowledge sharing initiative, and as such your contributions are encouraged and appreciated. If you would like to suggest a resource, submit a publication, or provide feedback on this topic, please contact us.

Alternatively, if you would like to be kept up to date with research and information published about this topic, please request a research profile setup.