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Aim: We aimed to explore the future roles of nutrition and dietetics professionals, and what capabilities the workforce would need to fulfil these roles. Method: A qualitative interpretive approach was employed. We conducted individual interviews with nutrition and non-nutrition thought leaders external to the profession. In addition, we conducted focus groups with experts within the nutrition and dietetics profession, academic dietetics educators and students/recent nutrition and dietetics graduates (total sample n = 68). Key nutrition-related issues and challenges, drivers for change and potential future roles of the profession were explored. Data were analysed using a team-based thematic analysis approach. Results: Future roles of nutrition and dietetics professionals were described as food aficionados, diet optimisers, knowledge translators, equity champions, systems navigators and food systems activists, change makers, activists and disruptors. In addition, science was identified as a uniting framework underpinning the professions. An additional 16 critical capabilities were considered to underpin practice. Conclusion: The results demonstrated that the current and future needs for workforce education and development need to address the impact of climate change, growing inequities, the democratisation of knowledge and the disruption of health and food systems. Education providers, regulators, professional associations and citizens need to work together to realise roles that will deliver on better health for all.

During the phase of life from 0-2 years of age (infancy), growth and development is rapid and includes substantial changes in the foods and drinks consumed. Infants transition from consuming solely breast milk or formula to ‘table foods’. Infancy is increasingly recognised as an important phase of life for the development of eating habits and health status which can track over the life course. The value of focusing on infancy for the prevention of diet-related chronic disease and risk factors including overweight, obesity and dental decay over the life-course is becoming increasingly evident. Nonetheless evidence regarding food choices and influences on food choices made for infants is limited. In Australia, infrequent national nutrition surveys only measure diet in children aged two years or older. Evidence from smaller studies suggests some poor food and drink choices are evident in early childhood. Social gradients in diet quality have been reported in populations of adults and older children. Evidence on the extent and nature of social gradients in infant diet quality is also building. Public Health Nutrition (PHN) policy has the potential to equitably improve food and eating environments; food and drink choices made for infants; and consequently infant diet. There is a significant research and evaluation gap regarding the type and the role of strategies at a policy and population level. Whether or how policy addresses potential determinants or inequities in infant diet quality is not known. This type of information could make a difference to the establishment of environments conducive to healthy food and drink choices, and consequently infant diet and health, particularly considering any social inequalities contributing to diet quality. This PhD study therefore addresses the following research question: What are the influences and opportunities for promoting healthy diets for Australian infants? Its overall aim is to contribute a better understanding of infant

ABSTRACT Background The consumption of sweetened beverages is a known common risk factor for the development of obesity and dental caries in children and children consume sweet drinks frequently and in large volumes from an early age. The aim of this study was to examine factors that influence mothers when choosing drinks for their children. Method Semi-structured interviews (n = 32) were conducted with a purposive sample of mothers of young children from Victoria’s Barwon South Western Region (selected from a larger cohort study to include families consuming different types of water, and different socioeconomic status and size). Inductive thematic analysis was conducted on transcribed interviews. Results Several themes emerged as influencing child drink choice. Child age: Water was the main beverage for the youngest child however it was seen as more acceptable to give older children sweetened beverages. Child preference and temperament: influencing when and if sweet drinks were given; Family influences such as grandparents increased children’s consumption of sweet drinks, often providing children drinks such as fruit juice and soft drinks regardless of maternal disapproval. The Setting: children were more likely to be offered sweetened drinks either as a reward or treat for good behaviour or when out shopping, out for dinner or at parties. Conclusions Limiting intake of sweet drinks is considered an important step for child general and oral health. However, the choice of drinks for children has influences from social, environmental and behavioural domains, indicating that a multi-strategy approach is required to bring about this change.

Background: The Romp & Chomp controlled trial, which aimed to prevent obesity in preschool Australian children, was recently 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. Methods: Process data was collected throughout and audits capturing nutrition and physical activity-related environments and practices were completed postintervention by directors of Long Day Care (LDC) centers (n = 10) and preschools (n = 41) in intervention and comparison (n = 161 LDC and n = 347 preschool) groups. Results: 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. Important lessons were learned in relation to implementation of such community-based interventions, including the significant barriers to implementing health-promotion interventions in early childhood settings, lack of engagement of for-profit LDC centers in the evaluation, and an inability to attribute direct intervention impacts when the intervention components were delivered as part of a health-promotion package integrated with other programs. Conclusions: 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. Recognition by funders and reviewers of the difficulties involved in implementing and evaluating such complex interventions is

Background: There is growing evidence that community-based interventions can reduce childhood obesity in older children. Objective: We aimed to determine the effectiveness of the Romp & Chomp intervention in reducing obesity and promoting healthy eating and active play in children aged 0–5 y. Design: Romp & Chomp was a community-wide, multisetting, multistrategy intervention conducted in Australia from 2004 to 2008. The intervention occurred in a large regional city (Geelong) with a target group of 12,000 children and focused on community capacity building and environmental (political, sociocultural, and physical) changes to increase healthy eating and active play in early-childhood care and educational settings. The evaluation was repeat cross-sectional with a quasiexperimental design and comparison sample. Main outcome measures were body mass index (BMI), standardized BMI (zBMI; according to the Centers for Disease Control and Prevention 2000 reference charts), and prevalence of overweight/obesity and obesity-related behaviors in children aged 2 and 3.5 y. Results: After the intervention there was a significantly lower mean weight, BMI, and zBMI in the 3.5-y-old subsample and a significantly lower prevalence of overweight/obesity in both the 2- and 3.5-y-old subsamples (by 2.5 and 3.4 percentage points, respectively) than in the comparison sample (a difference of 0.7 percentage points; P < 0.05) compared with baseline values. Intervention child-behavioral data showed a significantly lower intake of packaged snacks (by 0.23 serving), fruit juice (0.52 serving), and cordial (0.43 serving) than that in the comparison sample (all P < 0.05). Conclusion: A community-wide multisetting, multistrategy intervention in early-childhood settings can reduce childhood obesity and improve young children's diets. This trial was registered with the Australian Clinical Trials Registry at anzctr.org.au as ACTRN12607000374460.

Report for Diabetes Australia Victoria and the Life! Taking Action on Diabetes program

Background The consumption of sweetened beverages is a known common risk factor for the development of obesity and dental caries in children and children consume sweet drinks frequently and in large volumes from an early age. The aim of this study was to examine factors that influence mothers when choosing drinks for their children. Method Semi-structured interviews (n = 32) were conducted with a purposive sample of mothers of young children from Victoria’s Barwon South Western Region (selected from a larger cohort study to include families consuming different types of water, and different socioeconomic status and size). Inductive thematic analysis was conducted on transcribed interviews. Results Several themes emerged as influencing child drink choice. Child age: Water was the main beverage for the youngest child however it was seen as more acceptable to give older children sweetened beverages. Child preference and temperament: influencing when and if sweet drinks were given; Family influences such as grandparents increased children’s consumption of sweet drinks, often providing children drinks such as fruit juice and soft drinks regardless of maternal disapproval. The Setting: children were more likely to be offered sweetened drinks either as a reward or treat for good behaviour or when out shopping, out for dinner or at parties. Conclusions Limiting intake of sweet drinks is considered an important step for child general and oral health. However, the choice of drinks for children has influences from social, environmental and behavioural domains, indicating that a multi-strategy approach is required to bring about this change.

Background Early childhood is an important time to establish eating behaviours and taste preferences, and there is strong evidence of the association between the early introduction of sugar‐sweetened beverages and obesity and dental caries (tooth decay). Dental caries early in life predicts lifetime caries experience, and worldwide expenditure for dental caries is high. Methods Questionnaire data from the Splash! longitudinal birth cohort study of young children in Victoria, Australia was used to examine beverage consumption and parental feeding behaviours of young children, aiming to provide contemporary dietary data and assess consistency with the Australian dietary guidelines. Results From 12 months of age, the proportion of children drinking sugar‐sweetened beverages consistently increased with age (e.g. fruit juice consumed by 21.8% at 12 months and 76.7% at 4 years of age). However, the most common beverages for young children are milk and water, consistent with Australian dietary guidelines. In relation to other risk factors for dental caries, at 6 months of age children were sharing utensils, and at 12 months three quarters of carers tasted the child's food before feeding. Conclusions The increasing consumption of sugar‐sweetened beverages and prevalence of other risk factors for dental caries and obesity through early childhood continues to be a problem despite efforts to raise awareness of these issues with parents.