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This Position Statement examines the evidence for physical activity in weight and adiposity loss, prevention of weight and adiposity gain, and in weight regain in adults, and provides guidance on implications for exercise practitioners. Research evidence indicates that >150 min but preferably 300 min per week of aerobic activity of at least moderate intensity is required to prevent weight and adiposity gain, and at least the upper end of this range of activity to prevent weight regain after weight loss. For meaningful weight and total adiposity loss, a minimum of 300-420 min per week of aerobic activity of at least moderate intensity is required. The evidence around the volume of aerobic physical activity required to reduce central adiposity is emerging, and research suggests that it may be substantially less than that required for weight loss. The impact of high-intensity physical activity and resistance exercise for weight management is uncertain. During consultations for weight management, exercise practitioners should advise that metabolic and cardiovascular health benefits can be achieved with physical activity at any weight, and irrespective of weight change., (Copyright © 2021. Published by Elsevier Ltd.)

Improving the walkability of built environments to promote healthy lifestyles and reduce high body mass is increasingly considered in regional development plans. Walkability indexes have the potential to inform, benchmark and monitor these plans if they are associated with variation in body mass outcomes at spatial scales used for health and urban planning. We assessed relationships between area-level walkability and prevalence and geographic variation in overweight and obesity using an Australian population-based cohort comprising 92,157 Sydney respondents to the 45 and Up Study baseline survey between January 2006 and April 2009. Individual-level data on overweight and obesity were aggregated to 2006 Australian postal areas and analysed as a function of area-level Sydney Walkability Index quartiles using conditional auto regression spatial models adjusted for demographic, social, economic, health and socioeconomic factors. Both overweight and obesity were highly clustered with higher-than-expected prevalence concentrated in the urban sprawl region of western Sydney, and lower-than-expected prevalence in central and eastern Sydney. In fully adjusted spatial models, prevalence of overweight and obesity was 6% and 11% lower in medium-high versus low, and 10% and 15% lower in high versus low walkability postcodes, respectively. Postal area walkability explained approximately 20% and 9% of the excess spatial variation in overweight and obesity that remained after accounting for other individual- and area-level factors. These findings provide support for the potential of area-level walkability indexes to inform, benchmark and monitor regional plans aimed at targeted approaches to reducing population-levels of high body mass through environmental interventions. Future research should consider potential confounding due to neighbourhood self-selection on area-level walkability relations.

Background: Most studies of physical activity (PA) epidemiology use behaviour measured at a single time-point. We examined whether 'PA patterns' (consistently low, consistently high or inconsistent PA levels over time) showed different epidemiological relationships for anthropometric and mortality outcomes, compared to single time-point measure of PA., Methods: Data were the Danish MONICA (MONItoring Trends and Determinants in CArdiovascular Disease) study over three waves 1982-3 (time 1), 1987-8 (time 2) and 1993-4 (time 3). Associations between leisure time single time-point PA levels at time 1 and time 3, and sport and active travel at times 1 and 2 with BMI, waist, hip circumference and mortality (death from coronary heart disease (CHD) and cardiovascular disease (CVD)) were compared to 'PA patterns' spanning multiple time points. PA pattern classified participants' PA as either 1) inactive or low PA at both time points; 2) moderate level PA at time 1 and high activity at time 3; or 3) a 'mixed PA pattern' indicating a varying levels of activity over time. Similarly, sport and active travel were also classified as indicating stable low, stable high and mixed patterns., Results: The moderately and highly active groups for PA at times 1 and 3 had up to 1.7 cm lower increase in waist circumference compared with the inactive/low active group. Across 'PA patterns', 'active maintainers' had a 2.0 cm lower waist circumference than 'inactive/low maintainers'. Waist circumference was inversely related to sport but not active travel. CHD risk did not vary by activity levels at time 1, but was reduced significantly by 43% for high PA at time 3 (vs 'inactive' group) and among 'active maintainers' (vs 'inactive/low maintainers') by 62%. 'Sport pattern' showed stronger reductions in mortality for cardiovascular disease and CHD deaths among sport maintainers, than the single time point measures., Conclusions: PA patterns demonstrated a stronger association with a number of anthropometric and mortality outcomes than the single time-point measures. Operationalising PA as a sustained behavioural pattern may address some of the known under-estimation of risk for poor health in PA self-report measurements and better reflect exposure for epidemiological analysis of risk of health outcomes.

Background: The current Australia's Physical Activity and Sedentary Behaviour Guidelines recommend that adults engage in regular moderate-to-vigorous-intensity physical activity (MVPA) and strength training (ST), and minimise time spent in sedentary behaviours (SB). However, evidence about the specific individual and concurrent distribution of these behaviours in Australia is scarce. Therefore, the aim of this study was to determine the prevalence and sociodemographic correlates of MVPA, ST and SB in a national-representative sample of Australian adults., Methods: Data were collected using face-to-face interviews, as part of the National Nutrition and Physical Activity Survey 2011-12. The population-weighted proportions meeting the MVPA (≥ 150 min/week), ST (≥ 2 sessions/week) and combined MVPA-ST guidelines, and proportions classified as having 'low levels of SB' (< 480 min/day) were calculated, and their associations with selected sociodemographic and health-related variables were assessed using multiple logistic regression analyses. This was also done for those at potentially 'high-risk', defined as insufficient MVPA-ST and 'high-sedentary' behaviour., Results: Out of 9345 participants (response rate = 77.0 %), aged 18-85 years, 52.6 % (95 % CI: 51.2 %-54.0 %), 18.6 % (95 % CI: 17.5 %-19.7 %) and 15.0 % (95 % CI: 13.9 %-16.1 %) met the MVPA, ST and combined MVPA-ST guidelines, respectively. Female gender, older age, low/medium education, poorer self-rated health, being classified as underweight or obese, and being a current smoker were independently associated with lower odds of meeting the MVPA, ST and combined MVPA-ST guidelines. A total of 78.9 % (95 % CI: 77.9 %-80.0 %) were classified as having low levels of SB. Females, older adults and those with lower education were more likely to report lower levels of SB, whilst those with poor self-rated health and obese individuals were less likely to report lower levels of SB (i.e. SB = ≥ 480 min/day). A total of 8.9 % (95 % CI: 8.1 %-9.6 %) were categorised as individuals at potentially 'high-risk'. Those with poorer self-rated health, obese individuals, those aged 25-44, and current smokers were more likely to be in the 'high risk' group., Conclusions: The large majority of Australian adults do not meet the full physical activity guidelines and/or report excessive SB. Our results call for public health interventions to reduce physical inactivity and SB in Australia, particularly among the subgroups at the highest risk of these unhealthy behaviours.

Background: Obesity campaign evaluations have used campaign awareness to assess impact, yet have not compared unprompted campaign recallers, with prompted recallers and those with no campaign recall. Using data from an Australian mass-media obesity prevention campaign linking waist circumference and chronic disease we examined whether those with different degrees of campaign recall are distinct groups demographically and for subsequent campaign effects., Methods: A national cross-sectional telephone survey of randomly selected adults aged 18 to 65 years was conducted post- campaign (n = 2812) covering campaign recall, self-reported diet and physical activity (PA) and waist-measuring knowledge, behaviours and intentions to make lifestyle changes. Respondents were divided into three groups indicating campaign recall: Unprompted Recallers (n=1154); Prompted Recallers (n=1284); and No Recallers (n=374) and compared on demographic, knowledge, and behavioural risk factors for obesity/chronic disease., Results: Unprompted Recallers were more likely to speak English at home (p<.001), be in the primary campaign target group (25-45 years with children) (p<0.001) than the other two groups and to be university educated and female than the Prompted Recall group only (p=0.001). Unprompted Recallers had better knowledge about recommended waist circumference (p<.001), fruit (p=0.004), vegetable (p<0.001) and PA guidelines (p<0.001) than both the other groups. The No Recall group was less likely than the other two to be overweight/obese (46% vs 55%, p=0.020 and 54%, p=0.037), comparable on meeting fruit consumption and PA guidelines but more likely to meet vegetable intake recommendations (than Unprompted Recallers only)., Conclusions: Unprompted recallers were more knowledgeable about campaign messages; behaviour change and intentions to change were stronger for the two recall groups compared with the No Recall group but not different between them. The current analysis revealed subtle differences in campaign exposure and/or attendance by different demographic subgroups that would not be apparent in a simple aware/unaware dichotomy.

Population-wide obesity prevention and treatment programs are fundamental to addressing the increasing overweight and obesity rates in socioeconomically disadvantaged populations. Innovative recruitment strategies, including proactive marketing strategies, are needed to ensure such programs have universal reach and target vulnerable populations. This study aimed to determine the success of proactive recruitment to Australia's Get Healthy Information and Coaching Service® (GHS) and to assess whether the recruitment strategy influenced participants' outcomes. Sociodemographic information was collected from all GHS participants who joined the service between February 2009 and August 2013, and anthropometric information regarding behavioural risk factors was collected from all GHS coaching participants at baseline and six months. Data were analysed according to the participants' referral source (self-referral and secondary referral versus proactive recruitment). Participants recruited through proactive marketing were more likely to be male, aged 50 years or older, have high school education, not be in paid employment and be from the lowest three quintiles of socioeconomic advantage. The risk factor profile of coaching participants recruited through proactive marketing did not vary significantly from those recruited via other mechanisms, although they were less likely to be obese and less likely to have a higher 'at risk' waist circumference measurement. Proactively recruited coaching participants reported significant improvements from baseline to six months (consistent with improvements made by participants recruited through other strategies), although they were significantly more likely to withdraw from coaching before they completed the six-month program.Proactive marketing facilitated use of an obesity prevention service; similar services may have greater reach if proactive marketing recruitment strategies are used. These strategies could be encouraged to assist such services to achieve optimal population impact among hard-to-reach populations.

A lifestyle-modification telephone-based service is delivered in New South Wales (NSW; the Get Healthy Information and Coaching Service (GHS)) as an important obesity-prevention, population-wide program. The present study examined referrals from general practitioners (GP) versus self-referral to the GHS in terms of risk profile and effectiveness of outcomes. The study used a pre-post test design to assess changes in outcomes within the setting of a telephone-based lifestyle-support service available to NSW adults (18+ years) who self-referred or were referred by their health practitioner and/or GP, and registered for the GHS between February 2009 and August 2013 (n = 22 183). The GHS has two service components: (1) the provision of an information kit (one off contact) on healthy eating, being physically active and achieving and/or maintaining a healthy weight; and (2) a 6-month coaching program that includes 10 telephone calls aimed at achieving and maintaining lifestyle-related goals. Sociodemographic characteristics, referral source and self-reported anthropometric (height, waist and waist circumference (WC)) and behavioural risk factor (physical activity and nutrition-related behaviours) data were collected at baseline and at 6 months. Analysis revealed that GPs effectively recruited hard-to-reach subtargets, as well as adults who are obese and have an increased WC risk. Participants in the GHS coaching program, irrespective of GHS referral source, reported a mean weight loss of -3.8 kg, a decrease in WC of -5.0 cm and increases in both fruit and vegetable consumption and physical activity. In conclusion, GPs have an important role in GHS uptake (through proactive referral or as an adjunct to practice-based interventions) because they can recruit those most at need and facilitate improvements in their patients' risk factor profiles.

Objective: Evidence on the direction of the association between sitting time and obesity is limited. The prospective associations between baseline total sitting time and subsequent changes in body mass index (BMI), and baseline BMI and subsequent changes in sitting time were examined., Methods: BMI, from self-reported height and weight, and a single-item measure of sitting time were ascertained at two time points (3.4 ± 0.96 years apart) in a prospective questionnaire-based cohort of 31,787 Australians aged 45-65 years without severe physical limitations., Results: In a fully adjusted model, baseline obesity was associated with increased sitting time among all participants (adjusted odds ratio [aOR] = 1.20 [95% CI, 1.11-1.30]; P < 0.001) and in most subgroups. The association was significant among those who were sitting <4 hours/day (aOR = 1.24 [95% CI, 1.07-1.44]; P = 0.004) and 4-8 hours/day at baseline (aOR=1.18 [95% CI, 1.06-1.32]; P = 0.003), but not in the high sitting groups (P = 0.111 and 0.188 for 8-11 and ≥11 sitting hours/day, respectively). Nonsignificant and inconsistent results were observed for the association between baseline sitting time and subsequent change in BMI., Conclusions: Our findings support the hypothesis that obesity may lead to a subsequent increase in total sitting time, but the association in the other direction is unclear., (Copyright © 2014 The Obesity Society.)

The Get Healthy Information and Coaching Service® (GHS), a free government-funded telephone-delivered information and coaching service was launched in February 2009 by the Australian New South Wales state government. It represents the translation of research evidence applied in the real world (T4 or Phase 4 translation), aimed at addressing the modifiable risk factors associated with the overweight and obesity. In controlled settings, it has been established that telephone-based lifestyle counseling programs are efficacious in reducing anthropometric and behavioral risk factors. This article presents the GHS case study as a population-wide intervention and describes the quasi-experimental evaluation framework used to evaluate both the process (statewide implementation) and impact (effectiveness) of the GHS in a real-world environment. It details the data collection, measures, and statistical analysis required in assessing the process of implementation-reach and recruitment, marketing and promotion, service satisfaction, intervention fidelity, and GHS setting up and operations costs-and in assessing the impact of GHS-increasing physical activity, improving dietary practices, and reducing body weight and waist circumference. The comprehensive evaluation framework designed for the GHS provides a method for building effectiveness evidence of a rare translation of efficacy trial evidence into population-wide practice.

Aim: To examine associations between occupational and leisure-time sitting, physical activity and obesity in working adults., Methods: We analyzed data from workers from the 2007-08 Australian National Health Survey (n=10,785). Participants reported their activity at work (mostly sitting, standing, walking, or heavy labor), transport-related walking, leisure-time sitting and physical activity. Body mass index was objectively measured. Adjusted Cox proportional hazard regression models examined associations between occupational activity category, leisure-time sitting, physical activity and obesity risk., Results: Substantial proportions of men (42%) and women (47%) mostly sit at work. Workers with sitting jobs were significantly more likely to be sufficiently active during leisure-time than workers with mostly standing, walking or heavy labor jobs (RR=0.88, 0.80, 0.86 respectively). Workers with mostly sitting jobs had significantly higher overweight/obesity risk than workers with mostly standing jobs (RR=0.88, 95% CI: 0.82-0.95) independent of physical activity and leisure-time sitting. Workers with leisure-time sitting of less than four hours per day had significantly lower obesity risk than workers with four or more hours per day of leisure-time sitting (RR=0.77, 95%CI: 0.69-0.87) independent of physical activity and occupational activity., Conclusions: Sitting time and physical activity are independently associated with obesity. Leisure-time sitting may have a stronger association with obesity risk than occupational sitting., (Copyright © 2011 Elsevier Inc. All rights reserved.)

Issue Addressed: Introducing a new and free population-wide telephone service to assist adults to be more active, eat healthier and achieve a healthy weight requires large-scale marketing.The challenge is to understand the pattern of advertising that is effective at generating public awareness and interest in using the new service., Methods: A mass media campaign, consisting mainly of television advertising, was launched in March 2009 to promote the NSW Get Healthy Information and Coaching Service (GHS).This included GHS-specific and re-badged National 'Measure Up' campaign television advertisements.The number of calls and website visits to the GHS were monitored during the first 10 months of the initiative. GHS participants were also asked where they heard about the service., Results: Paid television advertising shows a dose-response relationship with contacts to the GHS.The 30-second GHS-specific advertising was significantly more effective at generating contacts compared to 'Measure Up' advertising, and compared to GHS advertising that involved the 15-second advertising. Participants were significantly more likely to report television advertising as their referral source during periods of GHS advertising when compared to 'Measure up' advertising., Conclusions: On-going marketing of state-wide prevention initiatives is necessary to achieve population-wide engagement. On the whole, specific GHS-promoting messages were more effective in recruiting participants than the re-badged national 'Measure Up' Campaign advertising.The relevance of the creative execution, the call to action and the length of time a viewer is exposed to the GHS details have an impact on the numbers of calls to the GHS.

Recent reports have suggested that the problem of childhood and adolescent obesity has been exaggerated in Australia, and that community-wide obesity prevention initiatives are not warranted; we argue that this is not an accurate reflection of the situation. Available data indicate that obesity affects 6%-8% of Australian schoolchildren, and that the proportion has continued to increase in recent years. Childhood and adolescent obesity is associated with a wide range of immediate health concerns, as well as increasing the risk of disease in adulthood. Some weight-related health problems are also found in overweight children. A range of strategies, including whole-of-community obesity prevention programs, will be required to tackle this problem. Concerns about disordered eating in children and adolescents should not preclude appropriate action on childhood obesity.

The obesity epidemic appears set to worsen the morbidity and mortality from leading causes of death in Australia - ischaemic heart disease, stroke and obesity-related cancers. The aim of this study was to compare hospital separations, deaths and direct health costs for middle-aged adults (45 to 54 years) in 2004/05 with those attaining age 45 to 54 years in 2024/25 who were born into an obesogenic environment. Using data from National Health Surveys, prevalence of obesity in 2004/05 was calculated for those born in 1950/51-59/60 and four scenarios were considered to project rates in 2024/25 for those born in 1970/71-79/80: an age-cohort model; a linear trend model; a steady state where rates increase to equal those of the older birth cohort at the same age; and a best case where rates remain at 2004/05 levels. Population attributable fractions were calculated by gender and disease using relative risks of disease from the literature, and applied to hospital separations, deaths, and direct health system costs data to estimate the proportion of each attributable to obesity. In 2024/25 the projected number of hospitalizations of 45 to 54 year olds due to the diseases of interest could be more than halved, over 200 lives rescued and $51.5 million (in 2004/05 dollars) saved if further gains in obesity in the younger birth cohort are halted. Instead, if the worst case scenario is realized there will be a more than doubling in costs (in 2004/05 dollars) compared with those born in 1950/51-59/60.

Objective: To determine the prevalence and factors associated with overweight/obesity among adults in Ho Chi Minh City (HCMC) using Caucasian and Asian cut-offs., Study Design: A cross-sectional survey., Methods: In 2005, 1,971 adults aged 25-64 years in HCMC were randomly selected using a proportional to population size sampling method to estimate the prevalence of overweight and obesity, measured by body mass index (BMI) and waist circumference. Multivariable logistic models were used to examine associations between overweight/obesity and socioeconomic status, health-related behaviors, and biochemical indices of chronic disease risk., Results: The prevalence of overweight and obesity using the Caucasian BMI cut-offs were 13.9% and 1.8% respectively, and those with the Asian BMI cut-offs were 27.5% and 5.7%, respectively. The abdominal adiposity rates were higher than the BMI overweight and obesity rates in women, but not in men. Increasing age, low education, high household wealth index, high levels of sitting and reclining time, cholesterol and high blood pressure were significantly associated with overweight and obesity. Current smoking and sedentary leisure time was significantly negatively associated with this status in men., Conclusion: Associations between overweight/obesity and metabolic disorders were evident using both cut-offs. Asian cut-offs identified more risk factors and therefore could be considered for defining at-risk groups. The results highlight the importance of intervention programs to prevent overweight/obesity in young adults.

Objective: To discuss appropriate endpoints for research designed to prevent obesity. Research investigating practical solutions to the complex multi-factorial global obesity epidemic may be stalled by undue emphasis on reduced body weight as the only acceptable endpoint., Approach: Considering prevention research in cardiovascular disease and tobacco control, we contend that investigations of intermediate endpoints make an important contribution to the multi-faceted approach needed to combat the complex problem of obesity., Conclusion: Intermediate endpoints are respected in other public health areas: reductions in risk factors such as high blood cholesterol or smoking are acceptable study endpoints for research aimed at reducing heart disease or lung cancer. Likewise, practical endpoints can be valuable in studies investigating interventions to reduce identified and potential intermediate risk factors for obesity, such as soft drink consumption., Implications: Reduced obesity is the global aim but obesity is not caused by one exposure and will not be solved by a single modality intervention. A wider debate about endpoint selection may assist research which identifies individual building blocks of obesity prevention in the same way as individual gene mapping contributed to the Human Genome Project.

To address increasing rates of overweight and obesity, a population-based telephone intervention was introduced in New South Wales, Australia. The Get Healthy Information and Coaching Service[R] (GHS) offered participants a 6-month coaching program or detailed self-help information. Determining the population reach of GHS is of public health importance to ensure that the program reaches disadvantaged groups. This paper describes the socio-demographic and risk profile of participants (n = 4828) in the first 18 months of operations, determines how representative they are of the population, assesses changes in participants' socio-demographic profile and compares "information-only" and "coaching" participants. The results show that GHS users are representative of the adult population in relation to education, employment status, Aboriginal status, fruit and vegetable consumption and alcohol use. However, more female, middle-aged, English-speaking, rural and socially disadvantaged adults participated in GHS. Coaching Participants were more likely to be overweight and to be ex-smokers than the general population. There was substantial variability in GHS recruitment, when mass-reach television advertising was used, participants enrolled from a major city and from more disadvantaged communities. The GHS has broader population reach than many local interventions, but further efforts are needed to increase reach by Aboriginal communities, other minorities and men.

Background: Understanding why research is conducted may help address the under-utilisation of research. This study examined the reasons for childhood obesity prevention knowledge production in New South Wales (NSW), Australia, and the factors influencing research choices from the perspective of the researchers and health policy agencies contributing to the research.Methods: A literature search of SCOPUS and ISI Web of Knowledge (affiliation and key word searches) was conducted to compile a database of NSW childhood obesity research outputs, published between 2000 and 2015 (n = 543). Descriptive statistics were used to quantify outputs by research type, differentiating measurement, descriptive, and intervention research, systematic reviews and other publications. Interviews were conducted with a sample of researchers drawn from the database (n = 13) and decision makers from health policy agencies who funded and contributed to childhood obesity research in NSW (n = 15). Researcher interviews examined views about societal impacts, why and under what circumstances the research was conducted. Decision-maker interviews examined policy agency research investment and how research was used in decision making. Content analysis and a thematic approach was used to analyse the interview transcripts.Results: The research in this case was conducted for mix of reasons including those traditionally associated with academic inquiry, as well as intentions to influence policy and practice. Differences in funding mechanisms, administrative and employment arrangements, and 'who' initiated the research, created differing incentives and perspectives for knowledge production. Factors associated with the characteristics and experience of the individuals involved also influenced goals, as did the type of research conducted. Policy agencies played a role in directing research to address policy needs.Conclusions: The findings of this study confirm that researchers are strongly influenced by their working environment. Funding schemes and other incentives to support policy relevant knowledge production are important. Contextual factors such as policy priorities, policy-driven research funding and the embedded nature or strong connections between some researchers and the policy agencies involved, are likely to have influenced the extent to which policy goals were reported in this study. [ABSTRACT FROM AUTHOR]

This study examined the pattern of activity energy expenditure (AEE) among New South Wales (NSW) high school students in relation to age, sex, socioeconomic status (SES), place of residence, cultural background, season, participation in moderate- and vigorous-intensity and in organized and non-organized physical activity. Methods: Cross-sectional survey of a randomly-selected sample (N = 2026). Respondents self-reported their physical activity participation during a usual week in summer and winter. Results: Boys reported greater AEE than girls and, whereas APE was greater among grade 10 than grade 8 boys, the reverse was true for girls. Boys reported the same APE for summer and winter, but girls reported less APE during winter Both boys and girls reported spending the same proportion of their APE in vigorous-intensity (72%) compared with moderate-intensity activity (28%) and in non-organized (60%) compared with organized activity. There was no clear association between urban/rural place of residence and APE. Although APE tended to be positively associated with SES among girls, there was no association among boys. Girls from Asian cultural backgrounds reported much lower AEE than girls from other cultural backgrounds. Conclusion: Patterns of energy expenditure among adolescent boys and girls should be considered in developing interventions to ensure needs are adequately met. [ABSTRACT FROM AUTHOR]

Background: Despite emerging research about the role of the family and home environment on early childhood obesity, little is known on how weight-related behaviors, parent practices and the home environment influence overweight/obesity in older children and adolescents.Methods: This analysis used data from a cross-sectional, representative population survey of Australian children age 5-16 years conducted in 2015. Data included measured anthropometry to calculate body mass index (BMI; kg/m2) and waist-to-height ratio (WHtR; waist circumference/height). Information on home-based weight-related behaviors (individual eating and screen time behaviors, parent influences including rules and home environment factors) were measured using established short questions, with parental proxy reporting for children in up to grade 4, and self-report for students in grades 6, 8 and 10. Logistic regression models were used to examine associations between weight status and home-based weight-related behaviors.Results: Both children and adolescents who did not consume breakfast daily were more likely to be overweight/obese OR (95% CI) = 1.39 (1.07-1.81) p = 0.015, OR (95% CI) =1.42 (1.16-1.74) p = 0.001, respectively, adjusted for age, gender, socio-economic status, rural/urban residence and physical activity. There was also a significant positive association with higher waist-to-height ratio in both children and adolescents. Among children, having a TV in the bedroom was also associated with overweight and obesity OR (95% CI) = 1.54 (1.13-2.09) p = 0.006 and higher waist-to-height ratio. For adolescents, parenting practices such as having no rules on screen-time, OR (95% CI) = 1.29 (1.07-1.55) p = 0.008, and rewarding good behavior with sweets, OR (95% CI) = 2.18 (1.05-4.52) p = 0.036, were significant factors associated with overweight and obesity. The prevalence of these obesogenic behaviors were higher in certain sub-groups of children and adolescents, specifically those from social disadvantage and non-English-speaking backgrounds.Conclusions: Interventions to reduce the prevalence of obesity and overweight should include promoting daily breakfast, reducing screen-time, and encouraging health-promoting parenting practices. Interventions should particularly focus on those at some social disadvantage and from non-English-speaking backgrounds. [ABSTRACT FROM AUTHOR]

The Get Healthy Information and Coaching Service® (GHS), a free government-funded telephone-delivered information and coaching service was launched in February 2009 by the Australian New South Wales state government. It represents the translation of research evidence applied in the real world (T4 or Phase 4 translation), aimed at addressing the modifiable risk factors associated with the overweight and obesity. In controlled settings, it has been established that telephone-based lifestyle counseling programs are efficacious in reducing anthropometric and behavioral risk factors. This article presents the GHS case study as a population-wide intervention and describes the quasi-experimental evaluation framework used to evaluate both the process (statewide implementation) and impact (effectiveness) of the GHS in a real-world environment. It details the data collection, measures, and statistical analysis required in assessing the process of implementation—reach and recruitment, marketing and promotion, service satisfaction, intervention fidelity, and GHS setting up and operations costs—and in assessing the impact of GHS—increasing physical activity, improving dietary practices, and reducing body weight and waist circumference. The comprehensive evaluation framework designed for the GHS provides a method for building effectiveness evidence of a rare translation of efficacy trial evidence into population-wide practice. [ABSTRACT FROM PUBLISHER]

Issue addressed: Women with previous gestational diabetes mellitus (GDM) are at increased risk of developing type 2 diabetes; this risk is higher in non-Caucasian women. This study explored the beliefs, attitudes, social support, environmental influences and other factors related to diabetes risk behaviours among Arabic, Cantonese/Mandarin, and English speaking women with recent GDM. Methods: Women living in the Sydney metropolitan area (Australia) who had GDM 6-36 months previously were included. In-depth semi-structured telephone interviews on women's experiences and perceptions of GDM and the lifestyle risk factors for developing type 2 diabetes were conducted in the language participants spoke at home (n=20 Arabic, 20 Cantonese/Mandarin, 17 English). Data were analysed for underlying themes using NVivo software. Results: Mental distress, role perceptions, social support and cultural expectations were major issues related to women's struggles to find the right balance between the large proportion of household and child care responsibilities and leading a healthy lifestyle. Conclusion: Women's ability to follow a healthy lifestyle is embedded in their psychological wellbeing and the social and cultural context of their lives. The study highlights the need for a holistic approach that ensures personal support and access to services as well as lifestyle specific programs. [ABSTRACT FROM AUTHOR]

Background: Adults spend about one third of their day at work and occupation may be a risk factor for obesity because of associated socioeconomic and behavioral factors such as physical activity and sedentary time. The aim of this study was to examine body mass index (BMI) and prevalence of overweight and obesity by occupation and explore the contributions of socioeconomic factors and lifestyle behaviors (including leisure time and commuting physical activity, diet, smoking, and alcohol) to occupational risk. Methods: Secondary analyses of the National Health Survey in Australia (2005) were conducted for working age adults (20 to 64 years). Linear and logistic regression models using BMI as either dichotomous or continuous response were computed for occupation type. Model 1 was age-adjusted, Model 2 adjusted for age and socioeconomic variables and Model 3 adjusted for age, socioeconomic variables and lifestyle behaviours. All models were stratified by gender. Results: Age-adjusted data indicated that men in associate professional (OR 1.34, 95% CI 1.10-1.63) and intermediate production and transport (OR 1.24 95% CI 1.03-1.50) occupations had a higher risk of BMI = 25 kg/m2 than those without occupation, and women in professional (OR 0.71, 95% CI 0.61-0.82), management (OR 0.72, 95% CI 0.56-0.92) and advanced clerical and service occupations (OR 0.73 95% CI 0.58-0.93) had a lower risk. After adjustment for socioeconomic factors no occupational group had an increased risk but for males, professionals, tradesmen, laborers and elementary clerical workers had a lower risk as did female associate professionals and intermediate clerical workers. Adjustment for lifestyle factors explained the lower risk in the female professional and associate professionals but failed to account for the lower odds ratios in the other occupations. Conclusions: The pattern of overweight and obesity among occupations differs by gender. Healthy lifestyle behaviors appear to protect females in professional and associate professional occupations from overweight. For high-risk occupations lifestyle modification could be included in workplace health promotion programs. Further investigation of gender-specific occupational behaviors and additional lifestyle behaviors to those assessed in the current Australian Health Survey, is indicated. [ABSTRACT FROM AUTHOR]

Summary: Objective: To investigate general practitioners’ (GPs’) knowledge, role perception, confidence and practices of managing adult and childhood overweight and obesity, and to explore the association with GPs’ attendance at Continuing Professional Development (CPD) on overweight and obesity. Methods: In 2007, all GPs in seven Divisions of general practice in New South Wales were sent a questionnaire on GPs perceptions and practices of weight counselling. Results: 646GPs participated (40% response rate). About half of the GPs (47%) believed that only a small percentage of adults could reduce weight and maintain that loss, whereas 33% had a similar belief in relation to children. Most GPs believed that it was their role to manage weight and felt confident to do so with adults, but fewer GPs felt confident in managing children. Nevertheless, just over one-third of GPs reported they counselled more than 10 adult patients, and a similar proportion counselled more than 3 children per week. GPs who felt more confident were more likely to counsel adults (OR=2.69, p =0.001) and children (OR=3.31, p <0.001). Those who received CPD were more likely to feel confident in managing adults (OR=1.56, p =0.031) and children (OR=2.19, p <0.001). Conclusions: Although the majority of GPs believe that weight management is their role, only a small proportion regularly provided counselling. This may partly be the result of GPs confidence in managing patients, especially children. CPD on overweight and obesity may benefit GP confidence, but additional training is needed to improve GP''s counselling behaviour, particularly for children. [Copyright &y& Elsevier]

Purpose. Most public health physical activity guidelines now encourage people to look for opportunities to accumulate physical activity throughout the day. Climbing stairs in lieu of riding escalators is a prime opportunity to make healthier choices that promote active living. The purpose of this investigation was to examine the effects of pedestrian commuter traffic on choices to ride an escalator, walk up an escalator, or walk up adjacent stairs in a busy urban subway station at rush hour. Design. A total of 9766 commuters were observed by two recorders for a 2.5-hour period during the morning rush hour over 8 weeks as to whether the commuters walked up stairs or rode an adjacent escalator in a subway station. The number of observations per 5-minute block was recorded, and an index of commuter traffic was computed. Demographic information and use of escalators/stairs were also. recorded. Setting. An urban subway station with a two-flight staircase adjacent to an escalator. Participants. Adult commuters travelling to work during the morning rush hour. Measures. Physical activity choices were examined in relation to commuter traffic. Demographic information, such as age, race, and weight status, were also considered. Analysis. A χ² analysis was used to examine differences in proportions across variables of interest. Means were compared by using multivari ate analysis of variance, and confidence intervals were computed. Results. During the least-heavy commuter traffic period, only 11.2% of commuters chose to walk up the stairs, whereas significantly more did so during moderate 18. 7% and high 20.8% commuter traffic periods (χ² = 61.8, p <.001). During low-traffic times, significantly more commuters (21.4%) walked up the escalators compared with moderate-traffic (18.0%) or high-traffic (18.3%) periods. African-American commuters passively rode the escalator more (68.2%) than white commuters (56. 7%), and their patterns were less affected by commuter traffic (p <.05). Conclusion. Congestion in public places can have a significant effect on opportunities for choosing active versus passive options in moving through public places. Urban planners should consider this when designing facilities in busy locations. [ABSTRACT FROM AUTHOR]

Abstract: Objective: With increasing rates of non-communicable disease, there is a need for implementing population-wide, evidence-based interventions for improving behavioural risk factors. Telephone-based interventions provide one option. This study reports on the evaluation of the Australia''s Get Healthy Information and Coaching Service®, to improve lifestyle behaviours, amongst a population-wide sample who completed the 6-month coaching programme. Methods: Using a pre-post design, New South Wales participants who completed telephone-based coaching between February 2009 and December 2011 were included. Outcomes comprised self-reported weight, waist circumference, height, physical activity and dietary behaviours. Matched pair analyses and multivariate modelling were performed to assess behavioural changes. Results: Participants (n=1440) reported statistically significant improvements in weight (−3.9kg (5.1)); waist circumference (−5.0cm (6.0)); and Body Mass Index (−1.4 BMI units (1.8)); number of walking and moderate–vigorous physical activity sessions of ≥30min per week; number of vigorous physical activity sessions of ≥20min per week and servings of vegetables; fruit; take-away meals and sweetened drinks (all p<0.001). Improvements in weight, waist, moderate physical activity, fruit and vegetable and take-away meals consumption remained significant after adjusting for socio-demographic characteristics. Conclusions: These results support the effectiveness of replicating an evidence-based intervention in improving population risk factors for chronic disease. [Copyright &y& Elsevier]