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Objective To investigate whether childhood overweight at age 4-5 increases publicly funded health care costs during childhood, and to explore the role of timing and duration of overweight on health costs. Data Sources The Longitudinal Study of Australian Children (2004-2008) and linked records from Medicare, Australia's public health insurance provider (2004-2009). Study Design The influence of overweight status on non-hospital Medicare costs incurred by children over a 5-year period was estimated using two-part models and one-part generalized linear models ( GLM). All models controlled for demographic, socioeconomic, and parental characteristics. Principal Findings Being overweight at age 4-5 is associated with significantly higher pharmaceutical and medical care costs. The results imply that for all children aged 4 and 5 in 2004-2005, those who were overweight had a combined 5-year Medicare bill that was AUD$9.8 million higher than that of normal weight children. Results from dynamic analyses show that costs of childhood overweight occur contemporaneously, and the duration of overweight is positively associated with medical costs for children who became overweight after age 5. Conclusions This study reveals that the financial burden to the public health system of childhood overweight and obesity occurs even during the first 5 years of primary school. [ABSTRACT FROM AUTHOR]

Background: The diets, physical activity and sedentary behavior levels of both children and adults in Australia are suboptimal. The family environment, as the first ecological niche of children, exerts an important influence on the onset of children's habits. Parent modeling is one part of this environment and a logical focus for child obesity prevention initiatives. The focus on parent's own behaviors provides a potential opportunity to decrease obesity risk behaviors in parents as well. Objective: To assess the effect of a parent-focused early childhood obesity prevention intervention on first-time mothers' diets, physical activity and TV viewing time. Methods: The Melbourne InFANT Program is a cluster-randomized controlled trial which involved 542 mothers over their newborn's first 18 months of life. The intervention focused on parenting skills and strategies, including parental modeling, and aimed to promote development of healthy child and parent behaviors from birth, including healthy diet, increased physical activity and reduced TV viewing time. Data regarding mothers' diet (food frequency questionnaire), physical activity and TV viewing times (self-reported questionnaire) were collected using validated tools at both baseline and post-intervention. Four dietary patterns were derived at baseline using principal components analyses including frequencies of 55 food groups. Analysis of covariance was used to measure the impact of the intervention. Results: The scores of both the "High-energy snack and processed foods" and the "High-fat foods" dietary patterns decreased more in the intervention group: -0.22 (-0.42;-0.02) and -0.25 (-0.50;-0.01), respectively. No other significant intervention vs. control effects were observed regarding total physical activity, TV viewing time, and the two other dietary patterns, i.e. "Fruits and vegetables" and "Cereals and sweet foods". Conclusions: These findings suggest that supporting first-time mothers to promote healthy lifestyle behaviors in their infants impacts maternal dietary intakes positively. Further research needs to assess ways in which we might further enhance those lifestyle behaviors not impacted by the InFANT intervention. [ABSTRACT FROM AUTHOR]

Background: Population-level health promotion is often conceived as a tension between "top-down" and "bottom-up" strategy and action. We report behind-the-scenes insights from Australia's largest ever investment in the "top-down" approach, the $45m state-wide scale-up of two childhood obesity programmes. We used Normalisation Process Theory (NPT) as a template to interpret the organisational embedding of the purpose-built software designed to facilitate the initiative. The use of the technology was mandatory for evaluation, i.e. for reporting the proportion of schools and childcare centres which complied with recommended health practices (the implementation targets). Additionally, the software was recommended as a device to guide the implementation process. We set out to study its use in practice.Methods: Short-term, high-intensity ethnography with all 14 programme delivery teams across New South Wales was conducted, cross-sectionally, 4 years after scale-up began. The four key mechanisms of NPT (coherence/sensemaking, cognitive participation/engagement, collective action and reflexive monitoring) were used to describe the ways the technology had normalised (embedded).Results: Some teams and practitioners embraced how the software offered a way of working systematically with sites to encourage uptake of recommended practices, while others rejected it as a form of "mechanisation". Conscious choices had to be made at an individual and team level about the practice style offered by the technology-thus prompting personal sensemaking, re-organisation of work, awareness of choices by others and reflexivity about professional values. Local organisational arrangements allowed technology users to enter data and assist the work of non-users-collective action that legitimised opposite behaviours. Thus, the technology and the programme delivery style it represented were normalised by pathways of adoption and non-adoption. Normalised use and non-use were accepted and different choices made by local programme managers were respected. State-wide, implementation targets are being reported as met.Conclusion: We observed a form of self-organisation where individual practitioners and teams are finding their own place in a new system, consistent with complexity-based understandings of fostering scale-up in health care. Self-organisation could be facilitated with further cross-team interaction to continuously renew and revise sensemaking processes and support diverse adoption choices across different contexts. [ABSTRACT FROM AUTHOR]

Purpose. To examine sedentary behaviours (including television viewing, playing computer games and computer use), diet, exercise and fitness in relation to overweight/obesity in Australian adolescents. Methods. Questionnaires elicited food frequency data, time spent in TV-viewing, using computers, other sedentary occupations and physical activity recall. Weight, height and fitness (laps completed in the Leger test) were measured. Results. Among 281 boys and 321 girls, mean age 12 years (SD 0.9), 56 boys (20.0%) and 70 girls (23.3%) were overweight/obese. Greater fitness was associated with decreased risk of overweight/obesity in boys (Odds ratio [OR] 0.74; 95% CI 0.55, 0.99) and girls (OR 0.93; 95% CI 0.91, 0.99). TV-viewing predicted increased risk in boys (OR 1.04; 95% CI 1.01, 1.06) and decreased risk in girls (OR 0.99; 95% CI 0.96, 0.99). Computer use, video games, and other sedentary behaviours were not significantly related to risk of overweight/obesity. Vegetable intake was associated with lower risk in boys (OR 0.98; 95% CI 0.97, 0.99); greater risk was associated with lower fat intake in boys and girls, lower consumption of energy-dense snacks in boys (OR 0.74; 95% CI 0.62, 0.88) and greater intake of vegetables in girls (OR 1.02; 95% CI 1.00, 1.03), suggesting dieting or knowledge of favourable dietary choices in overweight/obese children. Conclusions. Among these adolescents, fitness was negatively related to risk for overweight/obesity in boys and girls. TV-viewing was a positive predictor in boys and a negative predictor in girls but the effect size was small; other sedentary behaviours did not predict risk. [ABSTRACT FROM AUTHOR]