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Dental caries, a non-communicable disease, is one of the most prevalent diseases globally and share common modifiable risk factors with obesity such as excess sugar intake. However, prioritization by governments to improve population oral health has been limited and is typically excluded from the discourse of public health policy development. Therefore, interventions that target dental caries can have other co-benefits including obesity prevention. In Victoria, Australia, local government authorities have a regulatory requirement to develop their Municipal Health and Wellbeing Plans. The aim of this paper is to identify whether prioritization for oral health by local government authorities in Victoria has changed through the subsequent renewal of the Victorian Public Health and Wellbeing Plans 2011–2015 and 2019–2023. Three desktop audits for all publicly available Municipal Health and Wellbeing Plans by local government authorities in Victoria were conducted between 2014 and 2022. Key terms related to oral health was searched within these policy documents and categorized into six indicators: (i) included oral health as a priority, (ii) linked healthy eating and oral health, (iii) supported the Achievement Program, (iv) included the Smiles 4 Miles program, (v) advocated for fluoridated drinking water, and (vi) included other strategies related to oral health. Overall, there was statistically significant reduction in five of the six indicators, with the exception for prioritization of other strategies related to oral health such as targeting excess sugar intake and smoking. A multi-sectoral approach, that includes oral health would be advantageous to address the growing burden of non-communicable diseases. [ABSTRACT FROM AUTHOR]

Background: Calls for the adoption of a systems approach to chronic disease prevention date back at least ten years because of the potential to empower communities to identify and address the complex causes of overnutrition, undernutrition and climate change. Australia, like many countries, has high levels of obesity and extreme climate events. The Reflexive Evidence and Systems interventions to Prevent Obesity and Non-communicable Disease (RESPOND) trial aims to prevent unhealthy weight gain in children in 10 intervention and two pilot communities in north-east Victoria, Australia using community-based participatory approaches informed by systems science. Intervention activities co-designed in 2019 were disrupted by COVID-19 and bushfires. This paper explores the impacts of these 'shocks' on the local prevention workforce to implement actions within communities. Methods: A case study design involving one-hour online focus groups and an on-line survey (November 2021-February 2022). Purposive sampling was used to achieve diverse representation from RESPOND stakeholders including local council, health services, primary care partnerships and department of health. The focus group interview schedule and survey questions were based on Durlak and DuPre's implementation factors. Results: Twenty-nine participants from seven different communities participated in at least one of nine focus groups to discuss the impacts of COVID-19 and bushfires on localised implementation. Twenty-eight participants (97% of focus group sample) also completed the on-line survey. Implementation of RESPOND stalled or stopped in most communities due to bushfires and/or COVID-19. These shocks resulted in organisational priorities changing, loss of momentum for implementation, redeployment of human resources, culminating in fatigue and exhaustion. Participants reported adaptation of RESPOND, but implementation was slowed due to limited resources. Conclusion: Further research is needed to advance risk management strategies and protect resources within health promotion. System shocks such as bushfires and COVID-19 are inevitable, and despite multiple adaptation opportunities, this intervention approach was not 'shock proof'. [ABSTRACT FROM AUTHOR]

Background Childhood obesity is associated with physical and psychological complications thus the prevention of excess weight gain in childhood is an important health goal. Relevant to the prevention of childhood obesity, Australian general practice-specific, preventive care guidelines recommend General Practitioners (GPs) conduct growth monitoring and promote a number of healthy behaviours. However, challenges to providing preventive care in general practice may impact implementation. In October and November, 2022, a series of three workshops focusing on the prevention of childhood obesity were held with a group of Australian GPs and academics. The objective of the workshops was to determine practical ways that GPs can be supported to address barriers to the incorporation of obesity-related prevention activities into their clinical practice, for children with a healthy weight. Methods This paper describes workshop proceedings, specifically the outcomes of co-ideation activities that included idea generation, expansion of the ideas to possible interventions, and the preliminary assessment of these concepts. The ecological levels of the individual, interpersonal, and organisation were considered. Results Possible opportunities to support childhood obesity prevention were identified at multiple ecological levels within the clinic. The preliminary list of proposed interventions to facilitate action included GP education and training, clinical audit facilitation, readily accessible clinical guidelines with linked resources, a repository of resources, and provision of adequate growth monitoring tools in general practice. Conclusions Co-ideation with GPs resulted in a number of proposed interventions, informed by day-to-day practicalities, to support both guideline implementation and childhood obesity prevention in general practice. [ABSTRACT FROM AUTHOR]

From 2012 to 2014, we developed and subsequently evaluated the Healthy Eating, Active Living (HEAL) intervention—an obesity prevention and healthy lifestyle program designed for young people living in residential out-of-home care (OoHC). Based on quantitative (i.e., a randomised trial) and qualitative (i.e., semi-structured interviews) data and an iterative process of redevelopment, the program has evolved from taking a behavioural obesity prevention approach to now being underpinned by a trauma-informed care approach at a systems level. In this paper we outline the theoretical and empirical foundations of the HEALing Matters intervention that is currently being implemented at scale. In addition, we outline how our knowledge translation framework informed the iterative improvement of our intervention with a focus on stakeholder and end-user engagement, partnership, and codesign along the way. IMPLICATIONS There is a strong need for trauma-responsive health-focused programs and interventions within OoHC contexts. HEALing Matters addresses the need for trauma-informed approaches that encourage health behaviour change in young people living in OoHC. Policy, standards, and recommendations must not only acknowledge, but prioritise, the impact of trauma on health-related lifestyle behaviours in order to identify strategies to help address this impact. [ABSTRACT FROM AUTHOR]

Purpose -- The Australian Dietary Guidelines support good health and disease prevention. Children with healthy eating habits established early in life have been shown to continue these habits into adulthood compared with those children who have poor eating habits in their younger years. The nutritional intake of many Australian children is not in accordance with the national guidelines. The reasons children make the food choices they do are unclear from the literature. The paper aims to discuss these issues. Design/methodology/approach - This study used participatory action research methods to explore why primary school-aged children make the food choices that they do. A non-government primary school requested assistance in encouraging their children to make healthier choices from the school canteen menu. The authors gathered opinions from the children in two different ways; a group discussion during class and a "discovery day" that involved four class grades. The authors identified children's food preferences and food availability in canteens. The authors explored how the children perceived healthy foods, the importance of a healthy food environment and what criteria children use to decide what foods to buy. Findings - Children's food preferences were mostly for unhealthy foods, and these were readily available in the canteen. The perception about what foods were healthy was limited. Despite being asked to develop a "healthy" menu, the majority of choices made by the children were not healthy. Children described unhealthy choices as preferable because of taste of the food, if it was sugary, if it was quick to eat, available and cheap, the relationship of food and weather, the connection to health conditions and peer dominance. Practical implications -- This study suggests that children make their food choices based on simple concepts. The challenge lies around producing healthy options in collaboration with the school community that match the children's food choice criteria. Originality/value -- This paper provides a modern and inspiring whole school approach based on equity and empowerment of the children. Discovering why children make food choices from the children's perspective will help to present healthy options that will be more appealing for children. The methodology used to uncover why children make their food choices has also provided valuable insight into a study design that could be used to address other childhood research questions. The methodology offers an educative experience while gathering rich information directly from the children. This information can be used by the school to support children to have more control over their health and to develop behaviours to increase their health for the rest of their lives. [ABSTRACT FROM AUTHOR]

Background: Evidence-based decision-making is an important foundation for health policy and service planning decisions, yet there remain challenges in ensuring that the many forms of available evidence are considered when decisions are being made. Mobilising knowledge for policy and practice is an emergent process, and one that is highly relational, often messy and profoundly context dependent. Systems approaches, such as dynamic simulation modelling can be used to examine both complex health issues and the context in which they are embedded, and to develop decision support tools.Objective: This paper reports on the novel use of participatory simulation modelling as a knowledge mobilisation tool in Australian real-world policy settings. We describe how this approach combined systems science methodology and some of the core elements of knowledge mobilisation best practice. We describe the strategies adopted in three case studies to address both technical and socio-political issues, and compile the experiential lessons derived. Finally, we consider the implications of these knowledge mobilisation case studies and provide evidence for the feasibility of this approach in policy development settings.Conclusion: Participatory dynamic simulation modelling builds on contemporary knowledge mobilisation approaches for health stakeholders to collaborate and explore policy and health service scenarios for priority public health topics. The participatory methods place the decision-maker at the centre of the process and embed deliberative methods and co-production of knowledge. The simulation models function as health policy and programme dynamic decision support tools that integrate diverse forms of evidence, including research evidence, expert knowledge and localised contextual information. Further research is underway to determine the impact of these methods on health service decision-making. [ABSTRACT FROM AUTHOR]

Background: Over a quarter of children aged 2–17 years living in Australia are overweight or obese, with a higher prevalence reported in regional and remote communities. Systems thinking approaches that seek to support communities to generate and implement locally appropriate solutions targeting intertwined environmental, political, sociocultural, and individual determinants of obesity have the potential to ameliorate this. There have however been reported challenges with implementation of such initiatives, which may be strengthened by incorporating implementation science methods. Methods: This pilot randomised controlled trial protocol outlines the development and proposed evaluation of a multicomponent implementation strategy (Action-RESPOND). to increase the implementation of community-based systems thinking child obesity prevention initiatives The target of this intervention is ten rural and regional communities (or local government areas as the unit of allocation) within Northeast Victoria who were participants in a whole-of-systems intervention (RESPOND). Action-RESPOND builds on this intervention by assessing the impact of offering additional implementation strategies to five communities relative to usual care. The development of the multicomponent implementation strategy was informed by the Promoting Action on Research Implementation in Health Services (PARIHS) framework and consists of seven implementation strategies primarily delivered via 'facilitation' methods. Implementation strategies aimed to ensure initiatives implemented are i) evidence-based, ii) address community's specific needs and iii) are suitable for local context. Strategies also aimed to increase the community's capacity to implement, through iv) improving the health promotion team's implementation knowledge and skills, fostering v) leadership, vi) physical resources and vii) community culture to drive implementation. The feasibility, acceptability, potential impact, and cost of the strategy will be assessed at baseline and follow up using surveys administered to key representatives within the community and internal records maintained by the research team. Discussion: By leveraging an existing community-based whole-of-systems intervention, Action-RESPOND offers a unique opportunity to collect pilot feasibility and early empirical data on how to apply implementation and systems science approaches to support obesity prevention in rural and regional communities in Victoria. [ABSTRACT FROM AUTHOR]

There are few short, validated tools to assess young children's obesity‐related dietary behaviours, limiting the rapid screening of dietary behaviours in research and practice‐based early obesity prevention. This study aimed to develop and assess the reliability and validity of a caregiver‐reported short dietary questionnaire to rapidly assess obesity‐related dietary behaviours in children aged 6 months to 5 years. The Early Prevention of Obesity in Childhood Dietary Questionnaire (EPOCH‐DQ) was developed using a rigorous process to determine content and structural validity. Three age‐appropriate versions were developed for (1) infants, aged 6–12 months, (2) toddlers, aged 1–2.9 years and (3) pre‐schoolers, aged 3–5 years. The questionnaire (7–15 items) measures dietary behaviours, including diet risk from non‐core food and beverage intake, diet quality from vegetable frequency, bread type and infant feeding practices. Test–retest reliability was assessed from repeated administrations 1 week apart (n = 126). Internal consistency, concurrent validity (against a comparison questionnaire, the InFANT Food Frequency Questionnaire), construct validity and interpretability were assessed (n = 209). Most scores were highly correlated and significantly associated (p < 0.05) for validity (rs: 0.45–0.89, percentage agreement 68%–100%) and reliability (intraclass correlation coefficient: 0.61–0.99) for diet risk, diet quality and feeding practice items. The EPOCH‐DQ shows acceptable validity and reliability for screening of obesity‐related behaviours of children under 5 years of age. The short length and, thus, low participant burden of the EPOCH‐DQ allows for potential applications in various settings. Future testing of the EPOCH‐DQ should evaluate culturally and socio‐economically diverse populations and establish the predictive validity and sensitivity to detect change. Key messages: Accurate measurement of obesity‐related dietary behaviours is essential for the evaluation of early obesity prevention programmes and monitoring population trends.The 7–15 item Early Prevention of Obesity in Childhood Dietary Questionnaire (EPOCH‐DQ) was shown to have acceptable validity and reliability for assessing obesity‐related behaviours of children aged 6 months to 5 years of age.The short length and thus low participant burden of the EPOCH‐DQ allows for potential applications in various settings, including research, population health monitoring and use by health professionals.Future testing of the EPOCH‐DQ should include evaluation across culturally and socio‐economically diverse populations and determine the predictive validity and sensitivity to detect change of the EPOCH‐DQ. [ABSTRACT FROM AUTHOR]

Aims The study aims to examine whether patterns of health behaviours (based on sleep duration, physical activity, screen time and diet) were associated with obesity in Australian children. Methods This paper included 1833 children aged 6-7 years (51.6% male) recruited in 2006 as part of the Longitudinal Study of Australian Children. Latent class analysis was performed to identify the presence of distinct behavioural profiles on the basis of sleep duration, physical activity, screen time and eating habits. Logistic regression was performed to examine the association between the behavioural profiles and obesity assessed at baseline and 2-year follow-up. Results Three behavioural profiles, healthy (27.7%), sedentary (24.8%) and short sleepers/unhealthy eaters (47.5%), were identified. Compared with the healthy profile, the sedentary profile (odds ratio = 1.59, 95% confidence interval (1.06-2.38)) and short sleepers/unhealthy eaters (odds ratio = 1.47 (1.03-2.13)) had elevated odds of obesity at 2-year follow-up. Conclusions The present study identified distinct profiles of health behaviours in this sample of Australian children. These findings add to existing findings that many health behaviours co-occur and that obesity interventions should target patterns of behaviours in children. [ABSTRACT FROM AUTHOR]

This paper investigates the ways in which ‘the child’ is positioned in obesity debates and, in doing so, examines the discursive relations between childhood obesity, mothering and child neglect. Using legal cases of parental neglect and an analysis of representations of obesity in Australian print media, we argue that a particular constellation of ‘child politics’ in which children are represented as innocent victims of poor parenting is at play. Parenting, however, is a code for mothers and it is their gendered responsibility for food and families for which they are now being held legally culpable in cases of neglect. The relationship between children and mothers has become the focus of moral discourses around childhood obesity, containing contradictory elements of innocence and risk, responsibility and danger. The intersection of child politics, mothering and individualized responsibility not only illuminates the ways in which gender is absent yet centrally implicated in obesity debates and policy, but also highlights how models of neoliberal governance encompass both State and decentralized forms of power in their attempt to regulate excess bodies. [ABSTRACT FROM PUBLISHER]

Obesity is a significant problem for most industrialised nations and an emerging one for developing nations (Organisation for Economic Co-operation and Development 2005). Childhood obesity is of particular concern. This paper, using systematic review procedures, has analysed the intervention strategies used to fight the obesity battle over the past twenty years. For a number of reasons the effectiveness of many intervention strategies was found wanting whilst a minority of cases studied were sound. These cases were analysed and a set of principles developed that could deliver improved processes and outcomes to the problems encountered by planners in the complex obesogenic environment. [ABSTRACT FROM AUTHOR]

Background: Overweight and obesity in Australia has risen at an alarming rate over the last 20 years as in other industrialised countries around the world, yet the policy response, locally and globally, has been limited. Using a childhood obesity summit held in Australia in 2002 as a case study, this paper examines how evidence was used in setting the agenda, influencing the Summit debate and shaping the policy responses which emerged. The study used multiple methods of data collection including documentary analysis, key informant interviews, a focus group discussion and media analysis. The resulting data were content analysed to examine the types of evidence used in the Summit and how the state of the evidence base contributed to policy-making. Results: Empirical research evidence concerning the magnitude of the problem was widely reported and largely uncontested in the media and in the Summit debates. In contrast, the evidence base for action was mostly opinion and ideas as empirical data was lacking. Opinions and ideas were generally found to be an acceptable basis for agreeing policy action coupled with thorough evaluation. However, the analysis revealed that the evidence was fiercely contested around food advertising to children and action agreed was therefore limited. Conclusion: The Summit demonstrated that policy action will move forward in the absence of strong research evidence. Where powerful and competing groups contest possible policy options, however, the evidence base required for action needs to be substantial. As with tobacco control, obesity control efforts are likely to face ongoing challenges around the nature of the evidence and interventions proposed to tackle the problem. Overcoming the challenges in controlling obesity will be more likely if researchers and public health advocates enhance their understanding of the policy process, including the role different types of evidence can play in influencing public debate and policy decisions, the interests and tactics of the different stakeholders involved and the part that can be played by time-limited yet high profile events such as Summits. [ABSTRACT FROM AUTHOR]

Background: Insufficient sleep is potentially an important modifiable risk factor for obesity and poor physical activity and sedentary behaviours among children. However, inconsistencies across studies highlight the need for more objective measures. This paper examines the relationship between sleep duration and objectively measured physical activity, sedentary time and weight status, among a sample of Victorian Primary School children.Methods: A sub-sample of 298 grades four (n = 157) and six (n = 132) Victorian primary school children (aged 9.2-13.2 years) with complete accelerometry and anthropometry data, from 39 schools, were taken from a pilot study of a larger state based cluster randomized control trial in 2013. Data comprised: researcher measured height and weight; accelerometry derived physical activity and sedentary time; and self-reported sleep duration and hypothesised confounding factors (e.g. age, gender and environmental factors).Results: Compared with sufficient sleepers (67 %), those with insufficient sleep (<10 hrs/day) were significantly more likely to be overweight (OR 1.97, 95 % CI:1.11-3.48) or obese (OR 2.43, 95 % CI:1.26-4.71). No association between sleep and objectively measured physical activity levels or sedentary time was found.Conclusion: The strong positive relationship between weight status and sleep deprivation merits further research though PA and sedentary time do not seem to be involved in the relationship. Strategies to improve sleep duration may help obesity prevention initiatives in the future. [ABSTRACT FROM AUTHOR]

Efforts to combat childhood obesity in Australia are hampered by the lack of quality epidemiological data to routinely monitor the prevalence and distribution of the condition. This paper summarises the literature on issues relevant to childhood obesity monitoring and makes recommendations for implementing a school-based childhood obesity monitoring program in Australia. The primary purpose of such a program would be to collect population-level health data to inform both policy and the development and evaluation of community-based obesity prevention interventions. Recommendations are made for the types of data to be collected, data collection procedures and program management and evaluation. Data from an obesity monitoring program are crucial for directing and informing policies, practices and services, identifying subgroups at greatest risk of obesity and evaluating progress towards meeting obesity-related targets. Such data would also increase the community awareness necessary to foster change. [ABSTRACT FROM AUTHOR]

Aim: The aim of this paper was to investigate the relationship between circulating 25-hydroxyvitamin D (25(OH)D) and cardio-metabolic risk factors in a large cohort of obese youth attending tertiary paediatric obesity services.Methods: We conducted a retrospective cross-sectional study. Data were retrospectively collected from all new consultations of children and adolescents attending obesity outpatient clinics between 2008 and 2011 at the two major paediatric hospitals in Melbourne, Australia. Information collected included demographics, anthropometry, blood pressure, pubertal staging, body composition and fasting serum levels of 25(OH)D, glucose, insulin, cholesterol, triglyceride, high-density lipoprotein, liver function, calcium and phosphate.Results: 25(OH)D data were available in 229 patients (age 3-18 years; 116 men; mean (standard deviation) body mass index ( BMI) Z-score 2.5 (0.5) ). One hundred four (45%) participants were 25(OH)D deficient (<50 nmol/L). Lower serum 25(OH)D levels were associated with higher BMI Z-score (P-trend = 0.001), total fat mass (P-trend = 0.009), systolic (P-trend = 0.03) and diastolic blood pressures(P-trend = 0.009). In multivariable-adjusted regression analysis, 25(OH)D was significantly lower in those with elevated blood pressure after adjustment for BMI(P-trend = 0.004) or total fat mass (P-trend = 0.01).Conclusion: Overweight and obese youth attending specialist obesity services have a high prevalence of vitamin D deficiency. In this population, lower levels of vitamin D were seen in those with greater adiposity, and independent of this, in those who had higher blood pressure. [ABSTRACT FROM AUTHOR]

Background: Childhood obesity is a serious public health concern worldwide. Community-based obesity prevention interventions offer promise due to their focus on the broader social, cultural and environmental contexts rather than individual behaviour change and their potential for sustainability and scalability. This paper aims to determine the effectiveness of a South Australian community-based, multi-setting, multi-strategy intervention, OPAL (Obesity Prevention and Lifestyle), in increasing healthy weight prevalence in 9 to 11-year-olds.Methods: A quasi-experimental repeated cross-sectional design was employed. This paper reports on the anthropometric, health-related quality of life (HRQoL) and behaviour outcomes of primary school children (9-11 years) after 2-3 years of intervention delivery. Consenting children from primary schools (20 intervention communities, INT; 20 matched comparison communities, COMP) completed self-report questionnaires on diet, activity and screen time behaviours. HRQoL was measured using the Child Health Utility 9D. Body Mass Index (BMI) z-score and weight status were determined from children's measured height and weight. A multilevel mixed-effects model, accounting for clustering in schools, was implemented to determine intervention effect. Sequential Bonferroni adjustment was used to allow for multiple comparisons of the secondary outcomes.Results: At baseline and final, respectively, 2611 and 1873 children completed questionnaires and 2353 and 1760 had anthropometric measures taken. The prevalence of children with healthy weight did not significantly change over time in INT (OR 1.11, 95%CI 0.92-1.35, p = 0.27) or COMP (OR 0.85, 95%CI 0.68-1.06, p = 0.14). Although changes in the likelihood of obesity, BMI z-score and HRQoL favoured the INT group, the differences were not significant after Bonferroni adjustment. There were also no significant differences between groups at final for behavioural outcomes.Conclusions: OPAL did not have a significant impact on the proportion of 9 to 11-year-olds in the healthy weight range, nor children's BMI z-score, HRQoL and behaviours. Long-term, flexible community-based program evaluation approaches are required .Trial Registration: ACTRN12616000477426 (12th April 2016, retrospectively registered). [ABSTRACT FROM AUTHOR]

Aim The aims of this paper are to describe the growth of urban Australian Aboriginal infants from birth to 24 months of age and to identify the proportion of these infants experiencing rapid weight gain ( RWG) and overweight/obesity. Methods The Gudaga Study is a longitudinal birth cohort of 159 Australian Aboriginal children born on the urban fringe of Sydney. Birthweight and length were extracted from hospital data. Children with a birthweight >1500 grams were included in the analysis ( n = 157). Weight, length and head circumference were measured at 2-3 weeks and then six-monthly until 24 months of age. Age- and gender-specific Z-scores were determined from the Centers for Disease Control (CDC) 2000 growth charts for weight, length, head circumference and body mass index ( BMI). The proportion of children experiencing RWG (an increase in weight-for-age Z-scores ≥0.67 between birth and 12 months) was calculated. The association between RWG and ≥85th CDC percentile for BMI at 24 months was tested using Pearson's χ2. Results The mean weight of Gudaga infants was less than the CDC mean length-for-age at birth and 2-3 weeks of age but greater than CDC mean length-for-age and weight-for-age at 18 and 24 months of age. Overall, 42 infants (34.4%) experienced RWG, and 45 infants (36.9%) were overweight/obese at 24 months of age. A greater proportion of those who experienced RWG (61.9%) were overweight/obese at 24 months than those who did not experience RWG (23.8%). Conclusion Our study suggests a concerning proportion of urban Indigenous infants experience RWG and overweight/obesity in early childhood. [ABSTRACT FROM AUTHOR]

Background Overweight adolescents are more likely to have dysfunctional eating behaviours compared to normal weight adolescents. Little is known about the effects of obesity treatment on the psychological dimensions of eating behavior in this population. Objective To examine the effects of a prescriptive dietary intervention on external eating (eating in response to food cues, regardless of hunger and satiety), emotional eating and dietary restraint and their relation to weight loss. Parental acceptability was also examined. Method This is a secondary study of a 12-month randomized trial, the RESIST study, which examined the effects of two diets on insulin sensitivity. Participants were 109 obese 10- to 17-year-olds with clinical features of insulin resistance. The program commenced with a 3- month dietary intervention using a structured meal plan, with the addition of an exercise intervention in the next 3 months and followed by a 6 month maintenance period.This paper presents changes in eating behaviors measured by the Eating Pattern Inventory for Children and parent rated diet acceptability during the first 6 months of the trial. As there was no difference between the diets on outcome of interest, both diet groups were combined for analyses. Results After 6 months, the proportion of participants who reported consuming more in response to external eating cues decreased from 17% to 5% (P = 0.003), whereas non- emotional eating increased from 48% to 65% (p = 0.014). Dietary restraint and parental pressure to eat remained unchanged. A reduction in external eating (rho = 0.36, P < 0.001) and a reduction in dietary restraint (r = 0.26, P = 0.013) were associated with greater weight loss at 3 and 6 months, respectively. Overall this approach was well accepted by parents with 72% of parents considered that their child would be able to follow the meal plan for the longer term. Conclusions In the short to medium term, a prescriptive dietary intervention approach is a well-accepted and suitable option for obese adolescents with clinical features of insulin resistance. It may reduce external and emotional eating, led to modest weight loss and did not cause any adverse effect on dietary restraint. [ABSTRACT FROM AUTHOR]

Aim: At least one in twenty Australian school children are obese. [1] The causes and consequences of childhood obesity are well documented. This article examines the current literature on obesity management in school-aged, Australian children. Methods: A systematic review was undertaken to examine the efficacy of weight management strategies of obese Australian school-aged children. Search strategies were implemented in Medline and Pubmed databases. The inclusion criteria required original data of Australian origin, school-aged children (4 to 18 years), BMI defined populations and publication within the period of January 2005 to July 2011. Reviews, editorials and publications with inappropriate focus were excluded. Thirteen publications were analysed. Results: Nine of the thirteen papers reviewed focused on general practice (GP) mediated interventions, with the remainder utilising community, school or tertiary hospital management. Limitations identified by GP-led interventions included difficulties recognising obese children, discussing obesity with families, poor financial reward, time constraints, and a lack of proven management strategies. A school-based program was investigated, but was found to be ineffective in reducing obesity. Successful community-based strategies focused on parent-centred dietary modifications or exercise alterations in children. Conclusion: Obesity-specific management programs of children are scarce in Australia. As obesity remains a significant problem in Australia, this topic warrants further focus and investigation. [ABSTRACT FROM AUTHOR]

Contemporary Western societies focus considerable policy and media attention on the 'epidemic of childhood obesity'. In this paper we examine the mobilisation of notions of responsibility and consumption in these discussions, and consider the implications they have for women as mothers. In particular, we are interested to explore the potential conflicts mothers face as care providers and nurturers when responsible care is framed as withholding or managing the food consumption of children. We argue that the competing discursive frameworks around mothers' food provision invite further theorisation that explicitly addresses nourishment and consumption as elements of maternal practice and care. We draw on the work of Neysmith and Reitsma-Street (2005) regarding 'provisioning' to undertake a critical examination of the discourses in the 'childhood obesity' epidemic, with particular attention to Australian media and policy discussions. According to Neysmith and Reitsma-Street, mothers are central to social 'provisioning', that is, the labour that secures the necessities of life. This provisioning framework captures paid market work and unpaid caring labour, policy settings and social locations, allowing for a rich conceptualisation of the conditions mothers negotiate as they provide for their children. Taking up the possibilities of this framework, we argue that, insofar as health risks and responsibilities are largely individualised, mothering is framed as primarily about giving, and childhood obesity is considered a disease of affluence and over-consumption, imperatives for maternal provisioning and nurture are potentially in conflict with critiques of consumption and excess. [ABSTRACT FROM AUTHOR]

Background: Kids--'Go for your life' (K-GFYL) is an award-based health promotion program being implemented across Victoria, Australia. The program aims to reduce the risk of childhood obesity by improving the socio-cultural, policy and physical environments in children's care and educational settings. Membership of the K-GFYL program is open to all primary and pre-schools and early childhood services across the State. Once in the program, member schools and services are centrally supported to undertake the health promotion (intervention) activities. Once the K-GFYL program 'criteria' are reached the school/service is assessed and 'awarded'. This paper describes the design of the evaluation of the statewide K-GFYL intervention program.Methods/design: The evaluation is mixed method and cross sectional and aims to: 1) Determine if K-GFYL award status is associated with more health promoting environments in schools/services compared to those who are members only; 2) Determine if children attending K-GFYL award schools/services have higher levels of healthy eating and physical activity-related behaviors compared to those who are members only; 3) Examine the barriers to implementing and achieving the K-GFYL award; and 4) Determine the economic cost of implementing K-GFYL in primary schools. Parent surveys will capture information about the home environment and child dietary and physical activity-related behaviors. Environmental questionnaires in early childhood settings and schools will capture information on the physical activity and nutrition environment and current health promotion activities. Lunchbox surveys and a set of open-ended questions for kindergarten parents will provide additional data. Resource use associated with the intervention activities will be collected from primary schools for cost analysis.Discussion: The K-GFYL award program is a community-wide intervention that requires a comprehensive, multi-level evaluation. The evaluation design is constrained by the lack of a non-K-GFYL control group, short time frames and delayed funding of this large scale evaluation across all intervention settings. However, despite this, the evaluation will generate valuable evidence about the utility of a community-wide environmental approach to preventing childhood obesity which will inform future public health policies and health promotion programs internationally.Trial Registration: ACTRN12609001075279. [ABSTRACT FROM AUTHOR]

Abstract: Childhood obesity is widely constructed as reaching epidemic proportions with consumption of fast food viewed as a contributing factor. This paper analyses media reporting of the regulation of fast food consumption to children. A media search of five Australian newspapers for the period January 2006 to June 2008 elicited 100 articles relating to the regulation of fast food advertising to children. Content and thematic analysis of the articles reveal conflicting perspectives on the role of the state; the level of accountability of the food and advertising industries; and responsibilities of parents for regulating fast food consumption in children. The Federal Government, food and advertising industries and free to air broadcasters favour industry self-regulation and personal responsibility for fast food consumption while the proponents of government regulation include consumer groups, state government health ministers, nutrition and public health academics and medical and health foundations. The regulation of fast food advertising to children is discussed in relation to ideas about governance and the public health strategies which follow from these ideas. The paper argues that all proposed solutions are indicative of a neoliberal approach to the governance of health insofar as the responsibility for regulation of food marketing is viewed as lying with industry and the regulation of lifestyle risk is viewed as an individual responsibility. [Copyright &y& Elsevier]

Overweight and obesity has doubled among children in Australia. There is an urgent need to develop primary prevention strategies to prevent current and future unhealthy weight gain. The aims of this paper are to describe a randomized controlled trial (‘Switch-Play’) developed to prevent unhealthy weight gain among 10-year-old children and to report the findings of the process evaluation. Children from three government primary schools were randomized by class to one of four conditions: a behavioural modification group (BM;n = 69); a fundamental motor skills group (FMS; n = 73); a combined BM and FMS group (n = 90); or a control (usual classroom lessons) group (n = 61). Children in the BM group participated in 19 sessions that encouraged them to reduce screen-based behaviours, and identified physical activity alternatives. The FMS group participated in 19 lessons that focused on mastery of six skills: run, throw, dodge, strike, vertical jump and kick. The combined group participated in all the BM and FMS activities. The intervention specialist teacher reported that the children showed high enjoyment and engagement (88% lessons attended) in most aspects of the programme. At-home tasks were completed by 57–62% of the children, and 92% completed the in-class tasks. Two-thirds of the children in the BM group participated in the behavioural contracting to switch off the TV. Most of the children reported high enjoyment of the programmes, and only a small proportion (7–17%) reported difficulties in switching off their nominated TV shows. More than half the children reported reducing their TV viewing; however, less than half reported increasing their physical activity. It was found that most aspects of the intervention arms of the programme were successfully delivered to the majority of children participating in ‘Switch-Play’; that the programmes were delivered as intended; and that the programmes were favourably evaluated by participating children and their parents. [ABSTRACT FROM AUTHOR]

Aim: Regulation on food marketing to children is a recommended response to childhood obesity rates. Policy requires country‐relevant criteria to determine which foods are eligible to be advertised. This study aims to compare six nutrition profiling models for use in food marketing regulation in Australia. Methods: Advertisements on the outside of buses in five suburban Sydney transport hubs were photographed. Food and beverages advertised were analysed using the Health Star Rating; three models developed for food marketing regulation: the Australian Health Council guide and two World Health Organization models; the NOVA system; and the Nutrient Profiling Scoring Criterion used in Australian advertising industry codes. The proportion and types of products advertised on the buses that would be permitted by each of the six models were then analysed. Results: A total of 603 advertisements were identified. Of those, over a quarter of the advertisements were for foods and beverages (n = 157, 26%) and 2.3% (n = 14) for alcohol. Among the food and non‐alcoholic beverage advertisements, 84% were for unhealthy foods according to the Health Council guide. The Health Council guide would permit 31% unique foods to be advertised. The NOVA system would permit the least proportion of foods to be advertised (16%), while the Health Star Rating (40%), and Nutrient Profiling Scoring Criterion (38%) would permit the most. Conclusion: The Australian Health Council guide is the recommended model for food marketing regulation because it aligns with dietary guidelines by excluding discretionary foods from advertising. Australian governments can use the Health Council guide to develop policy in the National Obesity Strategy to protect children from marketing of unhealthy food. [ABSTRACT FROM AUTHOR]

Background: Despite advancements in the use of body mass index (BMI) to categorize obesity severity in pediatrics, its utility in guiding individual clinical decision making remains limited. The Edmonton Obesity Staging System for Pediatrics (EOSS‐P) provides a way to categorize the medical and functional impacts of obesity according to the severity of impairment. The aim of this study was to describe the severity of obesity among a sample of multicultural Australian children using both BMI and EOSS‐P tools. Methods: This cross‐sectional study included children aged 2–17 years receiving obesity treatment through the Growing Health Kids (GHK) multi‐disciplinary weight management service in Australia between January to December 2021. BMI severity was determined using the 95th percentile for BMI on age and gender standardized Centre for Disease Control and Prevention (CDC) growth charts. The EOSS‐P staging system was applied across the four health domains (metabolic, mechanical, mental health and social milieu) using clinical information. Results: Complete data was obtained for 338 children (age 10.0 ± 3.66 years), of whom 69.5% were affected by severe obesity. An EOSS‐P stage 3 (most severe) was assigned to 49.7% of children, the remaining 48.5% were assigned stage 2 and 1.5% were assigned stage 1 (least severe). BMI predicted health risk as defined by EOSS‐P overall score. BMI class did not predict poor mental health. Conclusion: Used in combination, BMI and EOSS‐P provide improved risk stratification of pediatric obesity. This additional tool can help focus resources and develop comprehensive multidisciplinary treatment plans. [ABSTRACT FROM AUTHOR]

Summary: Background: E‐health, defined as the use of information and communication technologies to improve healthcare delivery and health outcomes, has been promoted as a cost‐effective strategy to treat adolescent overweight and obesity. However, evidence supporting this claim is lacking. Objectives: Assess the potential cost‐effectiveness of a hypothetical e‐health intervention for adolescents with overweight and obesity. Methods: The costs and effect size (BMI reduction) of the hypothetical intervention were sourced from recent systematic reviews. Using a micro‐simulation model with a lifetime time horizon, we conducted a modelled cost‐utility analysis of the intervention compared to a 'do‐nothing' approach. To explore uncertainty, we conducted bootstrapping on individual‐level costs and quality‐adjusted life years (QALYs) and performed multiple one‐way sensitivity analyses. Results: The incremental cost‐effectiveness ratio (ICER) for the e‐health intervention was dominant (cheaper and more effective), with a 96% probability of being cost‐effective at a willingness‐to‐pay (WTP) of $50 000/QALY. The ICER remained dominant in all sensitivity analyses except when using the lower bounds of the hypothetical intervention effect size, which reduced the probability of cost‐effectiveness at a WTP of $50 000/QALY to 51%. Conclusion: E‐health interventions for treatment of adolescent overweight and obesity demonstrate very good cost‐effectiveness potential and should be considered by healthcare decision makers. However, further research on the efficacy of such interventions is warranted to strengthen the case for investment. [ABSTRACT FROM AUTHOR]

Summary: Background: Evidence for longitudinal associations between childhood weight status and academic achievement remains unclear due to considerable heterogeneity in study design, measures of academic achievement and appropriate categorization of weight status. Objective: To examine longitudinal associations between childhood weight status (underweight, healthy weight, overweight/obese) and academic achievement in the transition from preschool to primary (elementary) school among Australian school children. Methods: Data were from the Healthy Active Preschool and Primary Years study. Height and weight, for calculating BMI were measured at baseline (preschool age 3–5 years; 2008/9) and follow‐up (primary school age 6–8 years; 2011/12). Academic achievement was measured at age 9 years. Results: No associations between BMI z‐score or weight category in the preschool years and later NAPLAN scores were found for boys. For girls, having a higher BMI z‐score (B = −13.68, 95%CI: −26.61, −0.76) and being affected by overweight (B = −33.57, 95%CI: −61.50, −5.24) in preschool was associated with lower language scores. Remaining affected by overweight from preschool to primary school was associated with lower numeracy (B = −25.03, 95%CI: −49.74, −0.33), spelling (B = −33.5, 95%CI: −63.43, −3.58), language (B = −37.89, 95%CI: −72.75, −3.03) and total achievement scores (B = −24.24, 95%CI: −44.85, −3.63) among girls. For boys, becoming affected by overweight was associated with lower spelling (B = −38.76, 95%CI: −73.59, −3.93) and total achievement scores (B = −27.70, 95%CI: −54.81, −0.58). Conclusions: Associations between being affected by overweight/obesity and poorer academic achievement were more pronounced in girls than boys, indicating potentially inequitable impacts of excess weight and highlighting the greater need for intervention among girls. However, stronger study designs are needed to confirm our findings. [ABSTRACT FROM AUTHOR]

Background: Community-based interventions have shown promise in addressing the childhood obesity epidemic. Such efforts rely on the knowledge of key community members and their engagement with the drivers of obesity in their community. This paper presents the protocol for the measurement and evaluation of knowledge and engagement among community leaders within a whole-of-community systems intervention across 10 large intervention communities in Australia.Methods: We will investigate the role of stakeholder knowledge and engagement in the implementation and effectiveness of the stepped wedge cluster randomised trial in ten communities in Victoria, Australia. Data will be collected using the Stakeholder-driven Community Diffusion Survey (SDCD) to measure levels of knowledge and engagement prior to commencement (2019), across the three separate levels of governance within the intervention at five time points. Primary outcomes will be baseline overall knowledge and engagement scores across the three levels of governance and change in overall knowledge and engagement over time.Discussion: We hypothesise there will be heterogeneity between intervention sites on levels of knowledge and engagement and that these differences will be associated with variability in implementation success.Trial Registration: Australian New Zealand Clinical Trials Registry ACTRN12618001986268 . Registered on 11 December 2018. [ABSTRACT FROM AUTHOR]

The article provides discussions regarding further evidences of childhood obesity being an epidemic in Australia. It speculates the prevalence of various papers published to acknowledge the complexity of the causes of overweight and obesity including the publications of World Health Organization and National Health and Medical Research Council. It provides further discussions on the topic including surveys conducted for identifying the progress of the projects and actions for the problem.

Background: Scalable interventions that improve the nutritional quality of foods in children's lunchboxes have considerable potential to improve child public health nutrition. This study assessed the potential efficacy, feasibility and acceptability of an m-health intervention, 'SWAP IT', to improve the energy and nutritional quality of foods packed in children's lunchboxes. Methods: The study employed a 2X2 factorial cluster randomized-controlled trial design. Twelve primary schools in New South Wales, Australia were randomly allocated to one of four groups: (i) no intervention;(ii) physical activity intervention only;(iii) lunchbox intervention only; or(iv) physical activity and lunchbox intervention combined. The two intervention strategies were evaluated separately. This paper focuses on the effects of the lunchbox intervention only. The lunchbox intervention comprised four strategies: 1) school nutrition guidelines; 2) lunchbox lessons; 3) information pushed to parents via a school-communication app and 4) parent resources addressing barriers to packing healthy lunchboxes. Outcome measures were taken at baseline and immediately post-intervention (10 weeks) and included measures of effectiveness (mean energy (kJ) packed in lunchboxes, total energy and percentage energy from recommended foods consistent with Australian Dietary Guidelines), feasibility (of delivering intervention to schools, parent app engagement and behaviour change) and acceptability to school staff and parents. Linear mixed models were used to assess intervention efficacy. Results: Of the 1915 lunchbox observations, at follow-up there was no significant differences between intervention and control group in mean energy of foods packed within lunchboxes (− 118.39 kJ, CI = -307.08, 70.30, p = 0.22). There was a significant increase favouring the intervention in the secondary outcome of mean lunchbox energy from recommended foods (79.21 kJ, CI = 1.99, 156.43, p = 0.04), and a non-significant increase in percentage of lunchbox energy from recommended foods in intervention schools (4.57%, CI = -0.52, 9.66, p = 0.08). The views of the messages pushed via the app ranged from 387 to 1550 views per week (mean views =1025 per week). A large proportion (71%) of parents reported awareness of the intervention, making healthier swaps in the lunchbox (55%), and pushed content was helpful (84%). Conclusion: The study is the first RCT to assess the potential of a multi-component m-health lunchbox intervention. The intervention was feasible, acceptable and potentially effective in improving the nutritional quality of foods packed within children's lunchboxes. Trial registration: Australian Clinical Trials Registry ACTRN: ACTRN12616001228471. [ABSTRACT FROM AUTHOR]

Background: In Australia, childhood obesity follows a socioeconomic gradient whereby children with lower socioeconomic position are disproportionately burdened. To reduce these inequalities in childhood obesity requires a multi-component policy-driven response. Action to address health issues is underpinned by the ways in which they are represented as 'problems' in public policy. This study critically examines representations of inequalities in childhood obesity within Australian health policy documents published between 2000-2019. Methods: Australia's federal, state and territory government health department websites were searched for health policy documents including healthy weight, obesity, healthy eating, food and nutrition strategies; child and youth health strategies; and broader health and wellbeing, prevention and health promotion policies that proposed objectives or strategies for childhood obesity prevention. Thematic analysis of eligible documents was guided by a theoretical framework informed by problematization theory, ecological systems theory, and theoretical principles for equity in health policy. Results: Eighteen policy documents were eligible for inclusion. The dominant representation of inequalities in childhood obesity was one of individual responsibility. The social determinants of inequalities in childhood obesity were acknowledged, yet policy actions predominantly focused on individual determinants. Equity was positioned as a principle of policy documents but was seldom mentioned in policy actions. Conclusion: Current representations of inequalities in childhood obesity in Australian health policy documents do not adequately address the underlying causes of health inequities. In order to reduce inequalities in childhood obesity future policies will need greater focus on health equity and the social determinants of health (SDoH). [ABSTRACT FROM AUTHOR]

Summary: Background: Given the high prevalence of early childhood overweight and obesity, more evidence is required to better understand the cost‐effectiveness of community‐wide interventions targeting obesity prevention in children aged 0–5 years. Objectives: To assess the cost‐effectiveness of the Romp & Chomp community‐wide early childhood obesity prevention intervention if delivered across Australia in 2018 from a funder perspective, against a no‐intervention comparator. Methods: Intervention costs were estimated in 2018 Australian dollars. The annual Early Prevention of Obesity in Childhood micro‐simulation model estimated body mass index (BMI) trajectories to age 15 years, based on end of trial data at age 3.5 years. Results from modelled cost‐effectiveness analyses were presented as incremental cost‐effectiveness ratios (ICERs): cost per BMI unit avoided, and cost per quality‐adjusted life year (QALY) gained at age 15 years. Results: All Australian children aged 0–5 years (n = 1 906 075) would receive the intervention. Total estimated intervention cost and annual cost per participant were AUD178 million and AUD93, respectively, if implemented nationally. The ICERs were AUD1 126 per BMI unit avoided and AUD26 399 per QALY gained (64% probability of being cost‐effective measured against a AUD50 000 per QALY threshold). Conclusions: Romp & Chomp has a fair probability of being cost‐effective if delivered at scale. [ABSTRACT FROM AUTHOR]

Background: Early childhood (from conception to five years) is a key life stage for interventions to prevent obesity. In the Australian Federation, policy responsibility for obesity prevention sits across all levels of government and several intergovernmental institutions, rendering a complicated policy space. There is a gap in our understanding of the role of intergovernmentalism in developing obesity prevention policy in Australia. Given the complexity of intergovernmental structures and initiatives influencing childhood obesity prevention policy, it is important to understand the perspectives of senior health officials within the bureaucracy of government who through their roles may be able to influence processes or new strategies. Methods: Document analysis relating to obesity prevention in the intergovernmental context provided material support to the study. This analysis informed the interview guides for nine interviews with ten senior health department officials (one interview per jurisdiction). Findings: Several opportunities exist to support nutrition and obesity prevention in early childhood including marketing regulation (discretionary choices, breastmilk substitutes, commercial complementary foods and 'toddler milks') and supporting the early childhood education and care sector. This study found a widening structural gap to support national obesity policy in Australia. New public management strategies limit the ability of intergovernmental institutions to support coordination within and between governments to address complex issues such as obesity. Subnational informants perceived a gap in national leadership for obesity prevention, while a Commonwealth informant noted the commitment of the national government to partner with industry under a self-regulation model. In this gap, subnational leaders have pursued nationally consistent action to address obesity, including the development of a national obesity strategy as a bipartisan endeavour across jurisdictions. Public officials calculate the strategic possibilities of pursuing opportunities within state agendas but note the limited chances of structural change in the absence of national leadership and funding. [ABSTRACT FROM AUTHOR]

The article presents abstracts of articles related to healthcare in Australia including "Overweight and obesity among Indigenous children: individual and social determinants," by K. Thurber and colleagues, "Population health improvement: a community health business model that engages partners in all sectors," by D. A. Kindig and colleagues, and "Health workforce planning in OECD countries: a review of 26 projection models from 18 countries," by T. Ono.

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]

Introduction. The success of family-based community programs for childhood obesity may be increased by promoting social-cognitive factors that influence motivation and participant engagement. Incentivizing behavior can potentially enhance engagement and encourage behavior change. This research investigated motivators to engagement with a multicomponent incentive-based strategy to improve attendance and health-related behavior change in a family community-based weight management program for overweight and obese children. Method. Qualitative analysis combining; demographic data (n = 512), survey of parents (n = 273), and stakeholder (n = 10) and family interviews (n = 24). Participants were selected from program providers and families participating in an Australian community weight management program during a randomized controlled trial (n = 512 children). Maximum variation sampling (demographics and group characteristics) and inductive thematic analysis were used. Results/Conclusion. Four factors influencing engagement were (1) personal value, (2) achievement, (3) support, and (4) overwhelm. These themes corroborated with social-cognitive factors, fostered by a combination of behavior change components in the program that increased participant accountability and intrinsic motivation. Focusing on autonomous goal planning with parental involvement, tracking of goals, and reviewing of goals may complement existing strategies in child-focused treatment programs. Low-value noncash incentives linked to goal setting for encouraging healthy eating and physical activity were well accepted and may enhance family engagement and attendance. [ABSTRACT FROM AUTHOR]

Some 30 years ago, Australia introduced the Children's Television Standards (CTS) with the twin goals of providing children with high-quality local programs and offering some protection from the perceived harms of television. The most recent review of the CTS occurred in the context of a decade of increasing international concern at rising levels of overweight and obesity, especially in very young children. Overlapping regulatory jurisdictions and co-regulatory frameworks complicate the process of addressing pressing issues of child health, while rapid changes to the media ecology have both extended the amount of programming for children and increased the economic challenges for producers. Our article begins with an overview of the conceptual shifts in priorities articulated in the CTS over time. Using the 2007-09 Review of the CTS as a case study, it then examines the role of research and stakeholder discourses in the CTS review process and critiques the effectiveness of existing regulatory regimes, both in providing access to dedicated children's content and in addressing the problem of escalating obesity levels in the population. [ABSTRACT FROM AUTHOR]

Alarm about the increasing prevalence of childhood obesity has focussed attention on individual lifestyle behaviours that may contribute to unhealthy weight. Television viewing is often a focus of the obesity debate. Not only is it sedentary, it also has the potential to influence other lifestyle behaviours either by displacing physical activities or through the consumption of high energy snack foods while watching TV. The research reported here uses data from 2,143 Australian 6-7 year children to examine the lifestyle behaviours associated with excess weight. These children spent 90 min each day watching television, 100 min each day in physical activity, and 39% consumed high levels of snack foods. Nearly one in five (18%) were overweight or obese. After adjustment for family and child characteristics, more time spent watching television was associated with more snacking and less physical activity. However, television viewing was associated with children's weight status, but snacking and physical activities were not. These findings confirm the existence from a young age, of a cluster of lifestyle behaviours that are associated with unhealthy weight status. [ABSTRACT FROM AUTHOR]

Objectives. To determine rates and persistence of obesity in nationally representative samples of young Australian children with and without intellectual impairment and to examine the relationship between obesity and socioeconomic disadvantage. Study design. Secondary analysis of data extracted from Waves 1 and 2 of the Longitudinal Study of Australian Children. Results. Significantly higher rates of obesity were observed among six to seven-year-old children with intellectual impairment when compared with their ‘typically developing’ peers (8.5% vs. 5.4%, OR=1.61, 95% CI 1.19–2.17). Between-group differences in obesity rates increased linearly across early childhood. By age six to seven, 23% of all obese children had intellectual impairment. Between-group differences in obesity rates were partially accounted for by increased exposure to socioeconomic disadvantage among children with intellectual impairment. Conclusions. Increased risk for obesity is apparent in young children with intellectual impairment. Prevention and early intervention strategies for obesity will need to ensure that they are contextualised to be fit for purpose with this high-risk group of children. [ABSTRACT FROM AUTHOR]

Background: Early childhood is a critical window for preventing obesity and chronic disease. Yet, 1 in 4 Australian children aged 5 years and under are affected by overweight or obesity; and significant proportions of children under 5 years fail to meet guidelines for diet quality, physical activity (PA), screen time, and sleep. Consequently, effective interventions to promote healthy lifestyle behaviors and prevent obesity during early childhood are needed. Community playgroups provide an opportunity for parents, carers, and children to meet in a safe and relaxed environment to play and share information. The structure, low cost and reach of playgroups provide a unique platform to engage parents in a scalable program to promote healthful lifestyle behaviors and prevent childhood obesity. However, the evidence base for the effectiveness of health promotion programs delivered in community playgroup settings is limited and lacking credible evidence from rigorously conducted randomized controlled trials.Methods: The Healthy Conversations @ Playgroup randomized controlled trial (RCT) aims to address the underlying behavioral risk factors for obesity by helping parents take effective steps to improve their child's dietary, PA, screen time, and sleep behaviors. The intervention program comprises 10 "healthy conversations" led by a trained peer facilitator, designed to increase parents' behavioral capability and self-efficacy to implement autonomy-supportive parenting practices. The program will be delivered biweekly during regularly scheduled playgroup sessions over 10-weeks. Effectiveness will be tested in a 2-arm cluster RCT involving 60 community playgroups in three states across Australia. After baseline assessments, participating playgroups will be randomly allocated to either intervention or wait-list control conditions. Primary outcomes (vegetable intake, discretionary foods, daily PA, screen time, sleep duration, and body mass index [BMI] z-score) will be assessed at baseline, immediately post-intervention (10-weeks; T2) and 6-months post-intervention (T3). Outcomes will be assessed for differential change at T2 and T3.Discussion: The Healthy Conversations @ Playgroup trial will rigorously evaluate a novel peer-led intervention program to promote healthful lifestyle behaviors and prevent obesity in children and families attending community playgroups. If effective, the program could be immediately scaled-up and delivered in community playgroups across Australia.Trial Registration: Trial registered 22nd January 2021 with the Australian and New Zealand Clinical Trials Registry ( ACTRN12621000055808 ). [ABSTRACT FROM AUTHOR]

Aim: To identify multi‐disciplinary paediatric weight management services currently available in Australia and determine gaps in service provision for children and adolescents with obesity. Methods: Surveys were distributed to 17 identified Australian multi‐disciplinary paediatric weight management services. A representative from each service was asked to complete an online survey regarding service and patient characteristics, assessment and management practices, and professional development approaches. Results: Representatives from 16 multi‐disciplinary paediatric weight management services completed the survey. Fourteen services were based in major metropolitan cities and two in regional areas. Fourteen services provided care to pre‐school aged children (0–4 years old), 15 to primary school aged children (5–12 years old) and 13 to high school aged children (13–18 years old). The number of patients seen per year per service ranged from 20 to 250 and duration of waiting lists ranged from 2 months to more than 12 months. Conclusions: The current availability and accessibility of multi‐disciplinary paediatric weight management services is inadequate to service Australian children and adolescents with obesity, particularly those with severe obesity and those in rural and remote communities. To better address the issue of paediatric obesity, establishment of additional multi‐disciplinary services, training for health‐care professionals and monitoring of the provision of evidence‐based care is urgently needed. [ABSTRACT FROM AUTHOR]

Introduction: Healthy Beginnings is an established nurse-led early childhood obesity prevention program that promotes healthy infant feeding practices and active play in the early years of life. To improve engagement with culturally and linguistically diverse populations, the Healthy Beginnings program delivered by telephone was culturally adapted and implemented with Arabic- and Chinese-speaking mothers in Sydney, Australia. The cultural adaptation process has been published separately. In this article, we aimed to evaluate the feasibility of the culturally adapted program.Methods: In 2018-2019, the culturally adapted Healthy Beginnings program was implemented with Arabic- and Chinese-speaking women recruited from antenatal clinics in Sydney. At four staged timepoints (from third trimester until 6 months of age), mothers were sent culturally adapted health promotion booklets and text messages and offered four support calls from bi-cultural child and family health nurses in Arabic and Chinese. A mixed methods evaluation included a) baseline and 6-month telephone surveys, followed by b) semi-structured follow-up interviews with a subset of participating mothers and program delivery staff. Main outcomes of this feasibility study were reach (recruitment and retention), intervention dose delivered (number of nurse support calls completed) and acceptability (appropriateness based on cognitive and emotional responses).Results: At recruitment, 176 mothers were eligible and consented to participate. Of 163 mothers who completed the baseline survey, 95% completed the program (n = 8 withdrew) and 83% completed the 6-month survey (n = 70 Arabic- and n = 65 Chinese-speaking mothers). Most mothers (n = 127, 78%) completed at least one nurse support call. The qualitative analysis of follow-up interviews with 42 mothers (22 Arabic- and 20 Chinese-speaking mothers) and 10 program delivery staff highlighted the perceived value of the program and the positive role of bi-cultural nurses and in-language resources. Mothers who completed more nurse support calls generally expressed greater acceptability.Conclusions: The culturally adapted Healthy Beginnings program was feasible to deliver and acceptable to Arabic- and Chinese-speaking mothers. Our results highlight the importance of in-language resources and individualised bi-cultural nurse support by telephone for supporting culturally and linguistically diverse migrant families with infant feeding and active play. These findings support the potential for program refinements and progression to an effectiveness trial. [ABSTRACT FROM AUTHOR]

Objective: This study aimed to test the effectiveness of the Whole of Systems Trial of Prevention Strategies for Childhood Obesity (WHO STOPS Childhood Obesity) for behavioral, health-related quality of life (HRQoL), and BMI outcomes.Methods: This was a cluster randomized trial of 10 communities randomly allocated (1:1) to start intervention in 2015 (step 1) or in 2019 (after 4 years) in South West Victoria, Australia. Data were collected from participating primary schools in April to June of 2015 (73% school participation rate), 2017 (69%), and 2019 (63%). Student participation rates were 80% in 2015 (1,792/2,516 invited), 81% in 2017 (2,411/2,963), and 79% in 2019 (2,177/2,720). Repeat cross-sectional analyses of measured height and weight (grades two, four, and six [aged approximately 7 to 12 years]), self-reported behavior, and HRQoL (grades four and six) were conducted.Results: There was an intervention by time interaction in BMI z scores (P = 0.031) and obesity/overweight prevalence (P = 0.006). BMI z score and overweight/obesity prevalence decreased between 2015 and 2017 and increased between 2017 and 2019 in intervention communities. The intervention significantly reduced takeaway food consumption (P = 0.034) and improved physical (P = 0.019), psychosocial (P = 0.026), and global (P = 0.012) HRQoL. Water consumption increased among girls (P = 0.033) in the intervention communities, as did energy-dense, nutrient-poor snack consumption among boys (P = 0.006).Conclusions: WHO STOPS had a positive impact on takeaway food intake and HRQoL. [ABSTRACT FROM AUTHOR]

Implementing programs at scale has become a vital part of the government response to the continuing childhood obesity epidemic. We are studying the largest ever scale-up of school and child care obesity prevention programs in Australia. Health promotion teams support primary schools and early childhood services in their area to achieve a number of specified, evidence-based practices aimed at organizational changes to improve healthy eating and physical activity. Key performance indicators (KPIs) were devised to track program uptake across different areas—measuring both the proportion of schools and early childhood services reached and the proportion of practices achieved in each setting (i.e. the proportion of sites implementing programs as planned). Using a 'tight–loose–tight' model, all local health districts receive funding and are held accountable to reaching KPI implementation targets. However, local teams have independent discretion over how to best use funds to reach targets. Based on 12 months of ethnographic fieldwork and interviews across all districts, this study examines variations in the decision making and strategizing processes of the health promotion teams. We identified three distinct styles of practice: KPI-driven practice (strategic, focussed on targets); relationship-driven practice (focussed on long-term goals); and equity-driven practice (directing resources to sites most in need). In adapting to KPIs, teams make trade-offs and choices. Some teams struggled to balance a moral imperative to attend to equity issues, with a practical need to meet implementation targets. We discuss how models of program scale-up and tracking could possibly evolve to recognize this complexity. [ABSTRACT FROM AUTHOR]

Summary: Background: In the absence of rigorous evidence of cost‐effectiveness for early childhood obesity prevention interventions, the next‐best option may be for decision‐makers to consider the relevant costs of interventions when allocating resources. Objectives: This study aimed to estimate systematically the cost of five obesity prevention interventions in children aged 0‐2 years, undertaken in research settings in Australia and New Zealand. Methods: A standardised costing protocol informed the costing methodology, ensuring comparability of results across interventions. Micro‐costing was undertaken, with intervention costs defined from the funder perspective and valued in 2018 Australian dollars using unit costs from the trials or market rates. Results: Interventions varied widely in their resource use. The total cost per participant ranged from $80 for the CHAT SMS intervention arm (95% UI $77‐$82) to $1135 for the Healthy Beginnings intervention (95% UI $1059‐$1189). Time costs of personnel delivering interventions contributed >50% of total intervention costs for all included studies. Conclusions: An understanding of the costs associated with intervention delivery modes is important, alongside effectiveness. Telephone delivery may include unexpected costs associated with connection to intervention participants at convenient times. A SMS‐based intervention had the lowest delivery cost in this study. [ABSTRACT FROM AUTHOR]

Aim: To explore sleep patterns in indigenous Australian children and assess the role of sleep timing in longitudinal changes in body mass index (BMI).Methods: Latent profile analysis was conducted with the Australian Longitudinal Study of Indigenous Children (LSIC) cohort data (wave 5), to determine distinct patterns of bed and wake timing, taking account of weekday sleep duration, weekday and weekend bedtimes, and weekday wake times. Multilevel models with a random intercept were used to investigate the role of baseline sleep pattern in predicting longitudinal changes in BMI.Results: Baseline data for 1258 children (50.7% males), mean age 6.32 ± 1.52 years, indicated the presence of five classes of sleep patterns: early/long sleepers (4.5%), normative sleepers (25.5%), late sleepers (49.9%), consistent late sleepers (11.1%) and early risers (9%). Late sleeping was significantly associated with longitudinal gains in BMI. Compared with early sleepers, consistent late sleepers experienced 1.03 unit gain in BMI at follow-up (95% CI: 0.001-2.05, P = .05).Conclusion: This study underscores the importance of looking beyond sleep duration and highlights the positive outcomes of early bedtimes in children. As sleep timing is modifiable, this offers the opportunity for improvement in sleep and protecting against future weight gain in indigenous children. [ABSTRACT FROM AUTHOR]

Background: Obesity and long term health condition (LTHC) are major public health concerns that have an impact on productivity losses at work. Little is known about the longitudinal association between obesity and LTHC with impaired productivity. Objective: This study aims to explore the longitudinal association between obesity and LTHC with presenteeism or working while sick. Design: Longitudinal research design Setting: Australian workplaces Methods: This study pooled individual-level data of 111,086 employees collected in wave 6 through wave 18 from the Household, Income and Labour Dynamics in Australia (HILDA) survey. The study used a Generalized Estimating Equation (GEE) model with logistic link function to estimate the association. Results: The findings suggest that overweight (Odds Ratios [OR]: 1.09, 95% Confidence Interval [CI]: 1.05–1.14), obesity (OR: 1.38, 95% CI: 1.31–1.45), and LTHC (OR: 3.03, 95% CI: 2.90–3.16) are significantly positively associated with presenteeism. Conclusions: The longitudinal association between obesity and LTHC with presenteeism among Australian employees implies that interventions to improve workers' health and well-being will reduce the risk of presenteeism at work. [ABSTRACT FROM AUTHOR]

Objective: Junk-food marketing contributes significantly to childhood obesity, which in turn imposes major health and economic burdens. Despite this, political priority for addressing junk-food marketing has been weak in many countries. Competing interests, worldviews and beliefs of stakeholders involved with the issue contribute to this political inertia. An integral group of actors for driving policy change are parliamentarians, who champion policy and enact legislation. However, how parliamentarians interpret and portray (i.e. frame) the causes and solutions of public health nutrition problems is poorly understood. The present study aimed to understand how Australian parliamentarians from different political parties frame the problem of junk-food marketing.Design: Framing analysis of transcripts from the Australian Government's Parliamentary Hansard, involving development of a theoretical framework, data collection, coding transcripts and thematic synthesis of results.Settings: Australia.Participants: None.Results: Parliamentarian framing generally reflected political party ideology. Liberal parliamentarians called for minimal government regulation and greater personal responsibility, reflecting the party's core values of liberalism and neoliberalism. Greens parliamentarians framed the issue as systemic, highlighting the need for government intervention and reflecting the core party value of social justice. Labor parliamentarians used both frames at varying times.Conclusions: Parliamentarians' framing was generally consistent with their party ideology, though subject to changes over time. This project provides insights into the role of framing and ideology in shaping public health policy responses and may inform communication strategies for nutrition advocates. Advocates might consider using frames that resonate with the ideologies of different political parties and adapting these over time. [ABSTRACT FROM AUTHOR]