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Background: While healthy and sustainable diets benefit human and planetary health, their monetary cost has a direct impact on consumer food choices. This study aimed to identify the cost and environmental impact of the current Brazilian diet (CBD) and compare it with healthy and sustainable diets., Methods: Data from the Brazilian Household Budget Survey 2017/18 and the Footprints of Foods and Culinary Preparations Consumed in Brazil database were used for a modeling study comparing the cost of healthy and sustainable diets (based on the Brazilian Dietary Guidelines (BDG) diet and the EAT-Lancet diet) versus the CBD. The DIETCOST program generated multiple food baskets for each scenario (Montecarlo simulations). Nutritional quality, cost, and environmental impact measures (carbon footprint (CF) and water footprint (WF)) were estimated for all diets and compared by ANOVA. Simple linear regressions used standardized environmental impacts measures to estimate differentials in costs and environmental impacts among diets scenarios., Results: We observed significant differences in costs/1000 kcal. The BDG diet was cheaper (BRL$4.9 (95%IC:4.8;4.9) ≈ USD$1.5) than the CBD (BRL$5.6 (95%IC:5.6;5.7) ≈ USD$1.8) and the EAT-Lancet diet (BRL$6.1 (95%IC:6.0;6.1) ≈ USD$1.9). Ultra-processed foods (UPF) and red meat contributed the most to the CBD cost/1000 kcal, while fruits and vegetables made the lowest contribution to CBD. Red meat, sugary drinks, and UPF were the main contributors to the environmental impacts of the CBD. The environmental impact/1000 kcal of the CBD was nearly double (CF:3.1 kg(95%IC: 3.0;3.1); WF:2,705 L 95%IC:2,671;2,739)) the cost of the BDG diet (CF:1.4 kg (95%IC:1.4;1.4); WF:1,542 L (95%IC:1,524;1,561)) and EAT-Lancet diet (CF:1.1 kg (95%IC:1.0;1.1); WF:1,448 L (95%IC:1,428;1,469)). A one standard deviation increase in standardized CF corresponded to an increase of BRL$0.48 in the cost of the CBD, similar to standardized WF (BRL$0.56). A similar relationship between the environmental impact and the cost of the BDG (CF: BRL$0.20; WF: BRL$0.33) and EAT-Lancet (CF: BRL$0.04; WF: BRL$0.18) was found, but with a less pronounced effect., Conclusions: The BDG diet was cost-effective, while the EAT-Lancet diet was slightly pricier than the CBD. The CBD presented almost double the CF and WF compared to the BDG and EAT-Lancet diets. The lower cost in each diet was associated with lower environmental impact, particularly for the BDG and EAT-Lancet diets. Multisectoral public policies must be applied to guide individuals and societies towards healthier and more sustainable eating patterns., (© 2024. The Author(s).)

Four years after the EAT-Lancet landmark report, worldwide movements call for action to reorient food systems to healthy diets that respect planetary boundaries. Since dietary habits are inherently local and personal, any shift toward healthy and sustainable diets going against this identity will have an uphill road. Therefore, research should address the tension between the local and global nature of the biophysical (health, environment) and social dimensions (culture, economy). Advancing the food system transformation to healthy, sustainable diets transcends the personal control of engaging consumers. The challenge for science is to scale-up, to become more interdisciplinary, and to engage with policymakers and food system actors. This will provide the evidential basis to shift from the current narrative of price, convenience, and taste to one of health, sustainability, and equity. The breaches of planetary boundaries and the environmental and health costs of the food system can no longer be considered externalities. However, conflicting interests and traditions frustrate effective changes in the human-made food system. Public and private stakeholders must embrace social inclusiveness and include the role and accountability of all food system actors from the microlevel to the macrolevel. To achieve this food transformation, a new "social contract," led by governments, is needed to redefine the economic and regulatory power balance between consumers and (inter)national food system actors.

Context: Food Balance Sheets (FBSs) are constructed by the Food and Agricultural Organization (FAO) and portray the food supply and utilization pattern of a country over time., Objective: To examine and analyse the uses of FAO-FBS data in international studies of health and nutrition, and to identify the reported strengths, limitations and reliability of FBS., Data Sources: PubMed, SCOPUS, EMBASE, Food Science and Technology Abstracts (FSTA) and Google Scholar., Data Extraction: Data extracted were author, year of publication, country/countries of the study, aim, study design, analysis, data collected, data sources and outcomes. Additional relevant information (e.g. strengths and limitations of the FBS), were also included. The bibliographies of all included studies were further searched, and any potentially relevant studies retrieved and assessed., Data Analysis: 119 eligible studies (all study designs) published from the earliest available to the end of April, 2016 were collated into five categories of use: within-country analysis of food availability, nutrient availability and/or dietary trends (n = 17); inter-country, regional or global comparison of food groups, nutrient availability and/or dietary trends (n = 45); comparison of FBS with other national sources of dietary data (n = 7); association between FBS dietary factors and mortality or health outcomes (n = 45); and modelling studies (n = 5)., Conclusion: Studies indicate that FBS are useful for international comparison and analysis of trends over time, as they are standardized and updated regularly. FBS data are more reliable when averaged over several years; when results are reported as nutrient densities, trends, and percentage of energy or ratios, rather than absolute values. Also, users should be aware that the quality of FBS data depends on the reliability of national input data. The FBS is a vital source of global food composition data and is valuable for epidemiological studies when reported and analysed appropriately., (© The Author(s) 2020. Published by Oxford University Press on behalf of the International Life Sciences Institute. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)

Group model building (GMB) is a qualitative method aimed at engaging stakeholders to collectively consider the causes of complex problems. Tackling inequities in community nutrition is one such complex problem, as the causes are driven by a variety of interactions between individual factors, social structures, local environments and the global food system. This methods paper describes a GMB process that utilises three system mapping tools in a study with members of a multicultural, low-income community to explore declining fruit and vegetable intake in children. The tools were: 1) graphs over time, which captures the community's understanding of an issue; 2) cognitive mapping, which enables participants to think systemically about the causes and consequences of the issue; 3) causal loop diagrams, which describe feedback loops that reinforce the issue and identify potential actions. Cognitive mapping, a tool not usually associated with GMB, was added to the research process to support the gradual development of participants' thinking and develops the skills needed to tackle an issue from a systems perspective. We evaluate the benefits and impact of these three tools, particularly in engaging participants and increasing understanding of systems thinking in order to develop and mobilise action. The tools could be adapted for use in other community-based research projects. Key learnings were the value of genuine partnership with a local organisation for longevity of the project, recruitment of key decisionmakers from the community early in the process, and allowing time to create sustainable change., Competing Interests: The authors declare no conflict of interest. The funder had no role in the design of the study, in the collection, analyses, or interpretation of data, in the writing of the manuscript, or in the decision to publish the results.

Fruit and vegetable (FV) intake is declining in New Zealand, and over half of New Zealand's children do not meet the recommendation of two serves of fruit and three serves of vegetables daily (with even lower adherence among children in high-deprivation neighbourhoods). The aim of this study was to map the potential causal pathways explaining this decline and possible actions to reverse it. Semi-structured interviews were held in April-May 2018 with 22 national actors from the produce industry, food distribution and retail sector, government, and NGO health organisations. The qualitative systems dynamics method of cognitive mapping was used to explore causal relationships within the food system that result in low FV intake among children. Barriers and solutions identified by participants were analysed using thematic analysis and according to a public health intervention framework. Participants were in agreement with the goal of improving FV intake for health and economic outcomes, and that health promotion strategies had been ineffectual to date due to multiple systemic barriers. Common barriers discussed were poverty, high food prices, low skills/knowledge, unhealthy food environments, climate change, and urbanization. Solutions with the strongest evidence of efficacy identified by the participants were subsidizing FVs and early childhood interventions to improve FV exposure., Competing Interests: The authors declare no conflict of interest. The funder had no role in the design of the study, in the collection, analyses, or interpretation of data, in the writing of the manuscript, or in the decision to publish the results.

The affordability of diets modelled on the current (less healthy) diet compared to a healthy diet based on Dietary Guidelines was calculated for population groups in New Zealand. Diets using common foods were developed for a household of four for the total population, Māori and Pacific groups. Māori and Pacific nutrition expert panels ensured the diets were appropriate. Each current (less healthy) diet was based on eating patterns identified from national nutrition surveys. Food prices were collected from retail outlets. Only the current diets contained alcohol, takeaways and discretionary foods. The modelled healthy diet was cheaper than the current diet for the total population (3.5% difference) and Pacific households (4.5% difference) and similar in cost for Māori households (0.57% difference). When the diets were equivalent in energy, the healthy diet was more expensive than the current diet for all population groups (by 8.5% to 15.6%). For households on the minimum wage, the diets required 27% to 34% of household income, and if receiving income support, required 41⁻52% of household income. Expert panels were invaluable in guiding the process for specific populations. Both the modelled healthy and current diets are unaffordable for some households as a considerable portion of income was required to purchase either diet. Policies are required to improve food security by lowering the cost of healthy food or improving household income.

Background: Evidence on whether healthy diets are more expensive than current diets is mixed due to lack of robust methodology. The aim of this study was to develop a novel methodology to model the cost differential between healthy and current diets and apply it in New Zealand., Methods: Prices of common foods were collected from 15 supermarkets, 15 fruit/vegetable stores and from the Food Price Index. The distribution of the cost of two-weekly healthy and current household diets was modelled using a list of commonly consumed foods, a set of min and max quantity/serves constraints for each, and food group and nutrient intakes based on dietary guidelines (healthy diets) or nutrition survey data (current diets). The cost differential between healthy and current diets was modelled for several diet, prices and policy scenarios. Acceptability of resulting meal plans was validated., Results: The average cost of healthy household diets was $27 more expensive than the average cost of current diets, but 25.8% of healthy diets were cheaper than the average cost of current diets. This cost differential could be reduced if fruits and vegetables became exempt from Goods and Services Tax. Healthy diets were cheaper with an allowance for discretionary foods and more expensive when including takeaway meals. For Māori and Pacific households, healthy diets were on average $40 and $60 cheaper than current diets due to large energy intakes. Discretionary foods and takeaway meals contributed 30-40% to the average cost of current diets., Conclusion: Healthy New Zealand diets were on average more expensive than current diets, but one-quarter of healthy diets were cheaper than the average cost of current diets. The impact of diet composition, types of prices and policies on the cost differential was substantial. The methodology can be used in other countries to monitor the cost differential between healthy and current household diets.

Background: Monitoring the degree of implementation of widely recommended food environment policies by national governments is an important part of stimulating progress towards better population nutritional health., Methods: The Healthy Food Environment Policy Index (Food-EPI) was applied for the second time in New Zealand in 2017 (initially applied in 2014) to measure progress on implementation of widely recommended food environment policies. A national panel of 71 independent (n = 48) and government (n = 23) public health experts rated the extent of implementation of 47 policy and infrastructure support good practice indicators by the Government against international best practice, using an extensive evidence document verified by government officials. Experts proposed and prioritised concrete actions needed to address the critical implementation gaps identified., Results: Inter-rater reliability was good (Gwet's AC2 > 0.8). Approximately half (47%) of the indicators were rated as having 'low' or 'very little, if any' implementation compared to international benchmarks, a decrease since 2014 (60%). A lower proportion of infrastructure support (29%) compared to policy (70%) indicators were rated as having 'low' or 'very little, if any' implementation. The experts recommended 53 actions, prioritising nine for immediate implementation; three of those prioritised actions were the same as in 2014. The vast majority of experts agreed that the Food-EPI is likely to contribute to beneficial policy change and increased their knowledge about food environments and policies., Conclusion: The Food-EPI has the potential to increase accountability of governments to implement widely recommended food environment policies and reduce the burden of obesity and diet-related diseases.

Background: Recent population dietary studies indicate that diets rich in ultra-processed foods, increasingly frequent worldwide, are grossly nutritionally unbalanced, suggesting that the dietary contribution of these foods largely determines the overall nutritional quality of contemporaneous diets. Yet, these studies have focused on individual nutrients (one at a time) rather than the overall nutritional quality of the diets. Here we investigate the relationship between the energy contribution of ultra-processed foods in the US diet and its content of critical nutrients, individually and overall., Methods: We evaluated dietary intakes of 9,317 participants from 2009 to 2010 NHANES aged 1+ years. Food items were classified into unprocessed or minimally processed foods, processed culinary ingredients, processed foods, and ultra-processed foods. First, we examined the average dietary content of macronutrients, micronutrients, and fiber across quintiles of the energy contribution of ultra-processed foods. Then, we used Principal Component Analysis (PCA) to identify a nutrient-balanced dietary pattern to enable the assessment of the overall nutritional quality of the diet. Linear regression was used to explore the association between the dietary share of ultra-processed foods and the balanced-pattern PCA factor score. The scores were thereafter categorized into tertiles, and their distribution was examined across ultra-processed food quintiles. All models incorporated survey sample weights and were adjusted for age, sex, race/ethnicity, family income, and educational attainment., Results: The average content of protein, fiber, vitamins A, C, D, and E, zinc, potassium, phosphorus, magnesium, and calcium in the US diet decreased significantly across quintiles of the energy contribution of ultra-processed foods, while carbohydrate, added sugar, and saturated fat contents increased. An inverse dose-response association was found between ultra-processed food quintiles and overall dietary quality measured through a nutrient-balanced-pattern PCA-derived factor score characterized by being richer in fiber, potassium, magnesium and vitamin C, and having less saturated fat and added sugars., Conclusions: This study suggests that decreasing the dietary share of ultra-processed foods is a rational and effective way to improve the nutritional quality of US diets.

Objective: To examine the relationship between diet quality and depressive symptomology amongst a community-based sample of Fijian adolescents., Methods: Participants included 7,237 adolescents (52.6% girls; mean age 15.6 years) at baseline (2005) and 2,948 (56% girls; mean age 17.4 years) at follow-up (2007/2008), from the Pacific Obesity Prevention in Communities Project. Intervention schools (n = 7) were selected from Nasinu, near Suva on the main Fijian island Viti Levu, and comparison schools (n = 11) were chosen from towns on the opposite, west side of the island. A dietary questionnaire was used to measure diet quality. Factor analysis clustered dietary variables into two unique and independent factors, referred to as healthy diet quality and unhealthy diet quality. Depressive symptomology was assessed via the emotional subscale of the Paediatric Quality of Life Inventory. Both measures were self-reported and self-administered. Multiple linear regression was used to test cross-sectional associations (at baseline and follow-up) between diet quality and depressive symptomology. Variables controlled for included gender, age, ethnicity, study condition, BMI-z scores, and physical activity., Findings: Strong, positive dose-response associations between healthy diet and high emotional scores (lower depressive symptomology) were found in cross-sectional analyses at baseline and follow-up, among boys and girls. No association was found between emotional health and unhealthy diet., Conclusions: This study suggests that cross-sectional relationships exist between a high quality diet during adolescence and less depressive symptoms, however more evidence is required to determine if these two variables are linked causally. Trial population health strategies that use dietary interventions as a mechanism for mental health promotion provide an opportunity to further test these associations. If this is indeed a true relationship, these forms of interventions have the potential to be inexpensive and have substantial reach, especially in Low and Middle Income Countries., Trial Registration: Australian New Zealand Clinical Trials Registry ACTRN12608000345381., Competing Interests: The authors of this manuscript have the following competing interests: L Millar, S Allender, W Snowdon, B Swinburn, M Moodie and G Waqa’s institutions have received grants from National Health and Medical Research Council. Support was provided to cover the cost of travel to Investigator meetings. The authors were employed by Deakin University. G Waqa’s institution has received grants, and support to cover the cost of travel to Investigator meetings, from Wellcome Trust. G Waqa’s institution also received support in kind such as writing, provision of medicine or equipment, or administrative support, from Secretariat of the Pacific Community grants for school-based interventions. This does not alter our adherence to PLOS ONE policies on sharing data and materials.

Background: Poor diets are a leading cause of disease burden worldwide. In Australia, the Federal Government established the Food and Health Dialogue (the Dialogue) in 2009 to address this issue, primarily through food reformulation. We evaluated the Dialogue's performance over its 6 years of operation and used these findings to develop recommendations for the success of the new Healthy Food Partnership., Methods: We used information from the Dialogue website, media releases, communiqués, e-newsletters, materials released under freedom-of-information, and Parliamentary Hansard to evaluate the Dialogue's achievements from October 2013 to November 2015, using the RE-AIM (reach, efficacy, adoption, implementation and maintenance) framework. We also engaged closely with two former Dialogue members. Our findings update a prior assessment done in October 2013., Results: Little data is available to evaluate the Dialogue's recent achievements, with no information about progress against milestones released since October 2013. In the last 2 years, only one additional set of sodium reduction targets (cheese) was agreed and Quick Service Restaurant foods were added as an area for action. Some activity was identified in 12 of a possible 137 (9 %) areas of action within the Dialogue's mandate. Independent evaluation found targets were partially achieved in some food categories, with substantial variation in success between companies. No effects on the knowledge, behaviours or nutrient intake of the Australian population or evidence of impact on diet-related disease could be identified., Conclusions: The new Healthy Food Partnership has similar goals to the Dialogue. While highly laudable and recognised globally as cost-effective, the mechanism for delivery in Australia has been woefully inadequate. Strong government leadership, adequate funding, clear targets and timelines, management of conflict of interest, comprehensive monitoring and evaluation, and a plan for responsive regulation in the event of missed milestones will be required if the new Healthy Food Partnership is to achieve its urgent public health goals.

Background: Non-communicable diseases (NCDs) are the leading cause of mortality in Fiji, a middle-income country in the Pacific. Some food products processed sold and marketed by the food industry are major contributors to the NCD epidemic, and the food industry is widely identified as having strong economic and political power. However, little research has been undertaken on the attempts by the food industry to influence public health-related policies and programs in its favour. The "corporate political activity" (CPA) of the food industry includes six strategies (information and messaging; financial incentives; constituency building; legal strategies; policy substitution; opposition fragmentation and destabilisation). For this study, we aimed to gain a detailed understanding of the CPA strategies and practices of major food industry actors in Fiji, interpreted through a public health lens., Methods and Results: We implemented a systematic approach to monitor the CPA of the food industry in Fiji for three months. It consisted of document analysis of relevant publicly available information. In parallel, we conducted semi-structured interviews with 10 stakeholders involved in diet- and/or public health-related issues in Fiji. Both components of the study were thematically analysed. We found evidence that the food industry adopted a diverse range of strategies in an attempt to influence public policy in Fiji, with all six CPA strategies identified. Participants identified that there is a substantial risk that the widespread CPA of the food industry could undermine efforts to address NCDs in Fiji., Conclusions: Despite limited public disclosure of information, such as data related to food industry donations to political parties and lobbying, we were able to identify many CPA practices used by the food industry in Fiji. Greater transparency from the food industry and the government would help strengthen efforts to increase their accountability and support NCD prevention. In other low- and middle-income countries, it is likely that a systematic document analysis approach would also need to be supplemented with key informant interviews to gain insight into this important influence on NCD prevention.

Background/objectives: To examine the relationship between diet quality and mental health in an ethnically diverse adolescent population in New Zealand., Subjects/methods: Cross-sectional, population-based study design. Data were available at baseline for 4249 students. Responses from self-reported dietary questionnaires were used to assess diet quality; healthy eating and unhealthy eating were assessed as two separate scales. Mental health was assessed by the emotional subscale of the PedsQL instrument., Results: Eating a healthy diet was significantly associated with better emotional health (P<0.001) and eating an unhealthy diet was significantly associated with greater emotional distress (P<0.001), after controlling for age, ethnicity and gender. The healthy and unhealthy eating scales were independently related to mental health scores., Conclusions: These findings contribute to a growing body of literature that diet quality is associated with mental health in adolescents. Further research is warranted to determine whether improvements to the diets of adolescents can have meaningful improvements to mental well-being.

Objective: To evaluate the immediate and sustained effectiveness of the first Jamie's Ministry of Food Program in Australia on individuals' cooking confidence and positive cooking/eating behaviours., Methods: A quasi- experimental repeated measures design was used incorporating a wait-list control group. A questionnaire was developed and administered at baseline (T1), immediately post program (T2) and 6 months post completion (T3) for participants allocated to the intervention group, while wait -list controls completed it 10 weeks prior to program commencement (T1) and just before program commencement (T2). The questionnaire measured: participants' confidence to cook, the frequency of cooking from basic ingredients, and consumption of vegetables, vegetables with the main meal, fruit, ready-made meals and takeaway. Analysis used a linear mixed model approach for repeated measures using all available data to determine mean differences within and between groups over time., Subjects: All adult participants (≥18 years) who registered and subsequently participated in the program in Ipswich, Queensland, between late November 2011- December 2013, were invited to participate., Results: In the intervention group: 694 completed T1, 383 completed T1 and T2 and 214 completed T1, T2 and T3 assessments. In the wait-list group: 237 completed T1 and 149 completed T1 and T2 assessments. Statistically significant increases within the intervention group (P<0.001) and significant group*time interaction effects (P<0.001) were found in all cooking confidence measures between T1 and T2 as well as cooking from basic ingredients, frequency of eating vegetables with the main meal and daily vegetable intake (0.52 serves/day increase). Statistically significant increases at T2 were sustained at 6 months post program in the intervention group., Conclusions: Jamie's Ministry of Food Program, Australia improved individuals' cooking confidence and cooking/eating behaviours contributing to a healthier diet and is a promising community-based strategy to influence diet quality.

Background: Jamie's Ministry of Food (JMoF) Australia is a 10-week community-based cooking skills program which is primarily aimed at increasing cooking skills and confidence and the promotion of eating a more nutritious diet. However, it is likely that the program influences many pathways to behaviour change. This paper explores whether JMoF impacted on known precursors to healthy cooking and eating (such as attitudes, knowledge, beliefs, cooking enjoyment and satisfaction and food purchasing behaviour) and whether there are additional social and health benefits which arise from program participation., Methods: A mixed method, quasi-experimental longitudinal evaluation with a wait-list control was conducted. Intervention participants were measured using repeated questionnaires at three time points; before and after the program and at six-month follow-up. Control participants completed the questionnaire 10 weeks before their program and at program commencement. Quantitative analysis used a linear mixed model approach and generalised linear models for repeated measures using all available data. Qualitative methods involved 30-minute repeated semi-structured interviews with a purposively selected sample, analysed thematically., Results: Statistically significant differences between groups and over time were found for a reduction of take away/fast food weekly purchasing (P = 0.004), and increases in eating meals at the dinner table (P = 0.01), cooking satisfaction (P = 0.01), and the ability to prepare a meal in 30 minutes (P < 0.001) and from basics that was low in cost (P < 0.001). The qualitative findings supported the quantitative results. Repeat qualitative interviews with fifteen participants indicated increased confidence and skills gained from the program to prepare meals from scratch as well as increases in family involvement in cooking and meal times at home., Conclusions: Jamie's Ministry of Food, Australia resulted in improvements in participants' food and cooking attitudes and knowledge, food purchasing behaviours and social interactions within the home environment, which were sustained six months after the program., Trial Registration: Australian and New Zealand Trial registration number: ACTRN12611001209987.

Food marketing is recognized as an important factor influencing children's food preferences and consumption. The purpose of this study was to examine the nature and extent of unhealthy food marketing and non-branded food references in magazines targeted at and popular among children and adolescents 10-17 years old in New Zealand. A content analysis was conducted of all food references (branded and non-branded) found in the five magazines with the highest readership among 10-17 year olds, and the three magazines (of which two were already included among the five most popular magazines) targeted to 10-17 year olds. For each of the six magazines, one issue per month (n = 72 issues in total) over a one-year period (December 2012-January 2014) was included. All foods referenced were classified into healthy/unhealthy according to the food-based Ministry of Health classification system. Branded food references (30% of total) were more frequent for unhealthy (43%) compared to healthy (25%) foods. Magazines specifically targeted to children and adolescents contained a significantly higher proportion of unhealthy branded food references (n = 51/71, 72%) compared to the most popular magazines among children and adolescents (n = 133/317, 42%), of which most were targeted to women. 'Snack items' such as chocolates and ice creams were marketed most frequently (n = 104; 36%), while 'vegetables and fruits' were marketed the least frequently (n = 9; 3%). Direct advertisements accounted for 27% of branded food references and 25% of those featured health or nutrition claims. Both branded and non-branded food references were common within magazines targeted at and popular among children and adolescents, and skewed toward unhealthy foods. This raises concerns about the effectiveness of self-regulation in marketing and emphasizes that government regulations are needed in order to curb children's current potential high exposures to unhealthy food marketing. In addition, magazine editors could take socially responsible editorial positions in regard to healthy eating., (Copyright © 2014 Elsevier Ltd. All rights reserved.)

Background/objectives: The most recent New Zealand Adult Nutrition Survey 2008/09 (ANS 08/9) revealed a decrease in reported energy intakes (EIs) compared with the previous 1997 National Nutrition Survey (NNS97). Conversely, measured body weights increased over the same period. We conducted an analysis on the ANS 08/9 data sets to evaluate reported EIs., Subjects/methods: Analysis was conducted on data from 3919 (1715 men and 2204 women aged > or = 15 years) survey participants who completed the 24-h dietary recall in the ANS 08/9. Under-reporting was assessed using the ratio of reported EI to estimated resting metabolic rate (EI:RMRest), and a cutoff limit of <0.9 (EI:RMRest) was used to identify low energy reporters (LERs). Results were examined by gender, body size, age and ethnicity., Results: The mean EI:RMRest (s.e.m.) was 1.34 (0.02) for men, and 1.23 (0.02) for women. Overall, 21% of men and 25% of women were classified as LERs. There was a greater prevalence of LERs among people with overweight (25%), or obesity (30%) than people with normal body weight (16%, P<0.001). The oldest age group (> or =65 years) had a greater prevalence of LERs (33%) compared with all other age groups (19-24%, P<0.001). Pacific people had a greater prevalence of LERs (33%) compared with Maori (26%, P=0.007) and European (23%, P<0.001). Compared with the NNS97, a substantial increase in the prevalence of LERs was evident in most subgroups., Conclusions: Under-reporting of EI will continue to be a major limitation of nutrition surveys without technological innovation. Care should be taken when interpreting EI data.

The International Network for Food and Obesity/non-communicable diseases Research, Monitoring and Action Support (INFORMAS) proposes to collect performance indicators on food policies, actions and environments related to obesity and non-communicable diseases. This paper reviews existing communications strategies used for performance indicators and proposes the approach to be taken for INFORMAS. Twenty-seven scoring and rating tools were identified in various fields of public health including alcohol, tobacco, physical activity, infant feeding and food environments. These were compared based on the types of indicators used and how they were quantified, scoring methods, presentation and the communication and reporting strategies used. There are several implications of these analyses for INFORMAS: the ratings/benchmarking approach is very commonly used, presumably because it is an effective way to communicate progress and stimulate action, although this has not been formally evaluated; the tools used must be trustworthy, pragmatic and policy-relevant; multiple channels of communication will be needed; communications need to be tailored and targeted to decision-makers; data and methods should be freely accessible. The proposed communications strategy for INFORMAS has been built around these lessons to ensure that INFORMAS's outputs have the greatest chance of being used to improve food environments., (© 2013 The Authors. Obesity Reviews published by John Wiley & Sons Ltd on behalf of the International Association for the Study of Obesity.)

Non-communicable diseases (NCDs) dominate disease burdens globally and poor nutrition increasingly contributes to this global burden. Comprehensive monitoring of food environments, and evaluation of the impact of public and private sector policies on food environments is needed to strengthen accountability systems to reduce NCDs. The International Network for Food and Obesity/NCDs Research, Monitoring and Action Support (INFORMAS) is a global network of public-interest organizations and researchers that aims to monitor, benchmark and support public and private sector actions to create healthy food environments and reduce obesity, NCDs and their related inequalities. The INFORMAS framework includes two 'process' modules, that monitor the policies and actions of the public and private sectors, seven 'impact' modules that monitor the key characteristics of food environments and three 'outcome' modules that monitor dietary quality, risk factors and NCD morbidity and mortality. Monitoring frameworks and indicators have been developed for 10 modules to provide consistency, but allowing for stepwise approaches ('minimal', 'expanded', 'optimal') to data collection and analysis. INFORMAS data will enable benchmarking of food environments between countries, and monitoring of progress over time within countries. Through monitoring and benchmarking, INFORMAS will strengthen the accountability systems needed to help reduce the burden of obesity, NCDs and their related inequalities., (© 2013 The Authors. Obesity Reviews published by John Wiley & Sons Ltd on behalf of the International Association for the Study of Obesity.)

INFORMAS (International Network for Food and Obesity/non-communicable diseases Research, Monitoring and Action Support) aims to monitor and benchmark the healthiness of food environments globally. In order to assess the impact of food environments on population diets, it is necessary to monitor population diet quality between countries and over time. This paper reviews existing data sources suitable for monitoring population diet quality, and assesses their strengths and limitations. A step-wise framework is then proposed for monitoring population diet quality. Food balance sheets (FBaS), household budget and expenditure surveys (HBES) and food intake surveys are all suitable methods for assessing population diet quality. In the proposed 'minimal' approach, national trends of food and energy availability can be explored using FBaS. In the 'expanded' and 'optimal' approaches, the dietary share of ultra-processed products is measured as an indicator of energy-dense, nutrient-poor diets using HBES and food intake surveys, respectively. In addition, it is proposed that pre-defined diet quality indices are used to score diets, and some of those have been designed for application within all three monitoring approaches. However, in order to enhance the value of global efforts to monitor diet quality, data collection methods and diet quality indicators need further development work., (© 2013 The Authors. Obesity Reviews published by John Wiley & Sons Ltd on behalf of the International Association for the Study of Obesity.)

Background: Obesity has been increasing in adolescents in Fiji and obesogenic dietary patterns need to be assessed to inform health promotion. The objective of this study was to identify the dietary patterns of adolescents in peri-urban Fiji and determine their relationships with standardized body mass index (BMI-z)., Methods: This study analysed baseline measurements from the Pacific Obesity Prevention In Communities (OPIC) Project. The sample comprised 6,871 adolescents aged 13-18 years from 18 secondary schools on the main island of Viti Levu, Fiji. Adolescents completed a questionnaire that included diet-related variables; height and weight were measured. Descriptive statistics and regression analyses were conducted to examine the associations between dietary patterns and BMI-z, while controlling for confounders and cluster effect by school., Results: Of the total sample, 24% of adolescents were overweight or obese, with a higher prevalence among Indigenous Fijians and females. Almost all adolescents reported frequent consumption of sugar sweetened beverages (SSB) (90%) and low intake of fruit and vegetables (74%). Over 25% of participants were frequent consumers of takeaways for dinner, and either high fat/salt snacks, or confectionery after school. Nearly one quarter reported irregular breakfast (24%) and lunch (24%) consumption on school days, while fewer adolescents (13%) ate fried foods after school. IndoFijians were more likely than Indigenous Fijians to regularly consume breakfast, but had a high unhealthy SSB and snack consumption.Regular breakfast (p<0.05), morning snack (p<0.05) and lunch (p<0.05) consumption were significantly associated with lower BMI-z. Consumption of high fat/salt snacks, fried foods and confectionery was lower among participants with higher BMI-z., Conclusions: This study provides important information about Fijian adolescents' dietary patterns and associations with BMI-z. Health promotion should target reducing SSB, increasing fruit and vegetables consumption, and increasing regularity of meals among adolescents. Future research is needed to investigate moderator(s) of inverse associations found between BMI-z and consumption of snacks, fried foods and confectionery to assess for potential reverse causality.

Background: The Be Active Eat Well (BAEW) community-based child obesity prevention intervention was successful in modestly reducing unhealthy weight gain in primary school children using a multi-strategy and multi-setting approach., Objective: To (1) examine the relationship between changes in obesity-related individual, household and school factors and changes in standardised child body mass index (zBMI), and (2) determine if the BAEW intervention moderated these effects., Methods: The longitudinal relationships between changes in individual, household and school variables and changes in zBMI were explored using multilevel modelling, with measurement time (baseline and follow-up) at level 1, individual (behaviours, n = 1812) at level 2 and households (n = 1318) and schools (n = 18) as higher levels (environments). The effect of the intervention was tested while controlling for child age, gender and maternal education level., Results: This study confirmed that the BAEW intervention lowered child zBMI compared with the comparison group (-0.085 units, P = 0.03). The variation between household environments was found to be a large contributor to the percentage of unexplained change in child zBMI (59%), compared with contributions from the individual (23%) and school levels (1%). Across both groups, screen time (P = 0.03), sweet drink consumption (P = 0.03) and lack of household rules for television (TV) viewing (P = 0.05) were associated with increased zBMI, whereas there was a non-significant association with the frequency the TV was on during evening meals (P = 0.07). The moderating effect of the intervention was only evident for the relationship between the frequency of TV on during meals and zBMI, however, this effect was modest (P = 0.04)., Conclusions: The development of childhood obesity involves multi-factorial and multi-level influences, some of which are amenable to change. Obesity prevention strategies should not only target individual behaviours but also the household environment and family practices. Although zBMI changes were modest, these findings are encouraging as small reductions can have population level impacts on childhood obesity levels.

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 also critical to strengthening the evidence base on the effectiveness of such public health approaches to obesity prevention.

We assessed intergenerational differences in food, physical activity, and body size perceptions among refugees and migrants from the Horn of Africa living in Victoria, Australia. We used a qualitative design and obtained data from 48 participants (18 individual interviews; 3 semistructured focus groups). Three major themes emerged: (a) food and physical activity, (b) preference of body size and social expectations, and (c) perceived consequences of various body sizes. For parents, large body size was perceived to equate with being beautiful and wealthy; slimness was associated with chronic illness and poverty. Parents adopted strategies that promoted weight gain in children. These included tailored food practices and restricting children's involvement in physical activity. For young people, slimness was the ideal body size endorsed by their peers, and they adopted strategies to resist parental pressure to gain weight. Obesity-prevention programs in this subpopulation need to adopt a multigenerational approach.

The objective is to identify and test regulatory options for creating supportive environments for physical activity and healthy eating among local governments in Victoria, Australia. A literature review identified nine potential areas for policy intervention at local government level, including the walking environment and food policy. Discussion documents were drafted which summarized the public health evidence and legal framework for change in each area. Levels of support for particular interventions were identified through semi-structured interviews conducted with key informants from local government. We conducted 11 key informant interviews and found support for policy intervention to create environments supportive of physical activity but little support for policy changes to promote healthy eating. Participants reported lack of relevance and competing priorities as reasons for not supporting particular interventions. Promoting healthy eating environments was not considered a priority for local government above food safety. There is a real opportunity for action to prevent obesity at local government level (e.g. mandate the promotion of healthy eating environments). For local government to have a role in the promotion of healthy food environments, regulatory change and suitable funding are required.

There is global interest in using multisectoral policy approaches to improve diets, and reduce obesity and non-communicable disease. However, there has been ad hoc implementation, which in some sectors such as the economic sector has been very limited, because of the lack of quality evidence on potential costs and impacts, and the inherent challenges associated with cross-sectoral policy development and implementation. The Pacific Obesity Prevention in Communities food policy project aimed to inform relevant policy development and implementation in Pacific Island countries. The project developed an innovative participatory approach to identifying and assessing potential policy options in terms of their effectiveness and feasibility. It also used policy analysis methodology to assess three policy initiatives to reduce fatty meat availability and four soft drink taxes in the region, in order to identify strategies for supporting effective policy implementation., (© 2011 The Authors. obesity reviews © 2011 International Association for the Study of Obesity.)

The purpose of this mixed methods study was to examine the sources of food and dietary patterns of Tongan adolescents (n = 2084) and their perceptions of sociocultural influences. The study incorporated anthropometric measurements, a behavioral survey, and qualitative interviews. More adolescent Tongan females (82.5%) than males (74.3%) reported sourcing morning tea and/or lunch (females 81.9%, males 72.6%) from school canteens or nearby food outlets. More females than males reported consuming obesity-promoting foods such as packaged snack foods (females 38.2%, males 21.3%), chocolates (females 24.7%, males 15.0%), and soft drinks (females 55.3%, males 50.4%). Food purchased for consumption at schools was predominantly energy dense and nutrient poor. Ensuring that students have access to foods of high nutritional quality sourced from school or home, and restricting access to local food outlets that supply unhealthy products would improve the nutrition status of adolescents in Tonga. Furthermore, it is important that obesity prevention interventions are informed by culture-specific influences to optimize uptake of healthy diets.

Objective: To assess the effect of food taxes and subsidies on diet, body weight and health through a systematic review of the literature., Methods: We searched the English-language published and grey literature for empirical and modelling studies on the effects of monetary subsidies or taxes levied on specific food products on consumption habits, body weight and chronic conditions. Empirical studies were dealing with an actual tax, while modelling studies predicted outcomes based on a hypothetical tax or subsidy., Findings: Twenty-four studies met the inclusion criteria: 13 were from the peer-reviewed literature and 11 were published on line. There were 8 empirical and 16 modelling studies. Nine studies assessed the impact of taxes on food consumption only, 5 on consumption and body weight, 4 on consumption and disease and 6 on body weight only. In general, taxes and subsidies influenced consumption in the desired direction, with larger taxes being associated with more significant changes in consumption, body weight and disease incidence. However, studies that focused on a single target food or nutrient may have overestimated the impact of taxes by failing to take into account shifts in consumption to other foods. The quality of the evidence was generally low. Almost all studies were conducted in high-income countries., Conclusion: Food taxes and subsidies have the potential to contribute to healthy consumption patterns at the population level. However, current evidence is generally of low quality and the empirical evaluation of existing taxes is a research priority, along with research into the effectiveness and differential impact of food taxes in developing countries.

Objective: To implement a systematic evidence-informed process to enable Fiji and Tonga to identify the most feasible and targeted policy interventions which would have most impact on diet-related non-communicable diseases., Design: A multisectoral stakeholder group of policy advisers was formed in each country. They used participatory approaches to identify the problem policies and gaps contributing to an unhealthy food environment. Potential solutions to these problems were then identified, and were assessed by them for feasibility, effectiveness, cost-effectiveness and side-effects. Data were gathered on the food and policy environment to support the assessments. A shortlist of preferred policy interventions for action was then developed., Results: Sixty to eighty policy problems were identified in each country, affecting areas such as trade, agriculture, fisheries and pricing. Up to 100 specific potential policy solutions were then developed in each country. Assessment of the policies highlighted relevant problem areas including poor feasibility, limited effectiveness or cost-effectiveness and serious side-effects. A shortlist of twenty to twenty-three preferred new policy options for action in each country was identified., Conclusions: Policy environments in these two countries were not conducive to supporting healthy eating. Substantial areas of potential action are possible, but some represent better choices. It is important for countries to consider the impact of non-health policies on diets.

Policies from non-health sectors have considerable impacts on the food environment and in turn on population nutrition. Health impact assessment (HIA) methods have been developed to identify the potential health effects of non-health policies; however, they are underused both within and outside the health sector. HIA and other assessment methods and tools can be used more extensively in health promotion to assist with the identification of the best policy options to pursue to improve and protect health. A participatory process is presented in this paper which combines HIAs with feasibility and effectiveness assessments. The intention is to enable health promoters to more accurately identify which policy change options would be most likely to improve diets, considering both impact and likelihood of implementation. The process was successfully used in Fiji and Tonga and provided a more systematic way of understanding which policy interventions showed the most promise.

Community-based interventions are an important component of obesity prevention efforts. The literature provides little guidance on priority-setting for obesity prevention in communities, especially for socially and culturally diverse populations. This paper reports on the process of developing prioritized, community-participatory action plans for obesity prevention projects in children and adolescents using the ANGELO (Analysis Grid for Elements Linked to Obesity) Framework. We combined stakeholder engagement processes, the ANGELO Framework (scans for environmental barriers, targeted behaviours, gaps in skills and knowledge) and workshops with key stakeholders to create action plans for six diverse obesity prevention projects in Australia (n = 3), New Zealand, Fiji and Tonga from 2002 to 2005. Some sites included sociocultural contextual analyses in the environmental scans. Target groups were under-5-year-olds (Australia), 4-12-year-olds (Australia) and 13-18-year-olds (all four countries). Over 120 potential behavioural, knowledge, skill and environmental elements were identified for prioritization leading into each 2-day workshop. Many elements were common across the diverse cultural communities; however, several unique sociocultural elements emerged in some cultural groups which informed their action plans. Youth were actively engaged in adolescent projects, allowing their needs to be incorporated into the action plans initiating the process of ownership. A common structure for the action plan promoted efficiencies in the process while allowing for community creativity and innovation. The ANGELO is a flexible and efficient way of achieving an agreed plan for obesity prevention with diverse communities. It is responsive to community needs, combines local and international knowledge and creates stakeholder ownership of the action plan.

Population nutrition problems have a diversity of contributory factors and, ideally, multi-sectoral solutions should be developed by the relevant stakeholders, based on a common understanding of these factors. The problem and solution tree approach is a participatory process of working through the layers of determinants and then developing potential interventions for a specific issue, using the available data and expertise. We tailored this approach for non-communicable disease-related nutrition problems in Pacific Islands and applied it in several countries. The process led to the identification of a considerable range of determinants of unhealthy diets and potential interventions to improve the situation. This practical approach also offered the additional benefit of developing stakeholder awareness in the issues. Problem trees are a relatively simple tool to implement, easy to adapt to differing needs, can generate a wealth of information and can be more widely used.

There are limited practical tools to help clinicians or public health workers manage obesity in their patients. We have previously developed a scanning technique for diagnosing environments leading to obesity (Analysis Grid for Environments/Elements Leading to Obesity). Here we describe the development of a tool for identifying behaviours in an individual most likely to lead to obesity. A questionnaire battery of five tests called the DAB-Q (Diet, Activity and Behaviour Questionnaire) was developed, piloted and internally validated with overweight women from a commercial weight loss programme. Outcome from the tests, which are available free on the Internet, provides clinicians with a simple, effective and time-saving tool for ranking foods, drinks and activities likely to be most effectively targeted for weight loss in an individual. This is based on total scores derived from measures of frequency, potential for change and potency of each item as a potential contributor to overweight.

Objective: In light of the increasing prevalence of obesity in children and the potential of schools as a setting for intervention, we aimed to identify the main foods and beverages consumed at primary school and to determine differences in consumption patterns between children who used the school canteen and those who did not., Design: Cross-sectional survey of school foods in 1681 5-12 y old children, 2003-2004., Setting: Barwon South-Western region of Victoria, Australia., Results: The school food provided an average (+/-s.e.m.) of 3087+/-26 kJ. Bread was the most frequently consumed food and contributed 20% of total energy at school, biscuits 13%, fruit 10%, muesli/fruit bars 8%, packaged snacks 7%, and fruit juice/cordial 6%. About 10% of children used the school canteen and these children obtained more total energy and more energy from cakes, fast foods and soft drink than noncanteen users (P<0.001). In all, 68% of children had fruit in their lunchboxes, however, over 90% of children had energy-dense, micronutrient-poor snacks ('junk food')., Conclusions: Fruit intake in primary schools seems reasonably high but could be targeted for further increase as part of promoting a healthy diet. Of concern, however, are the excessive amounts of energy-dense foods in school lunchboxes. These should be considered a priority for health promotion efforts along with reducing the consumption of sweetened drinks. These measures are urgently needed to improve the school-based diets of Australian children and attempt to curb the increasing prevalence of childhood obesity.

Objectives: To review the evidence on the diet and nutrition causes of obesity and to recommend strategies to reduce obesity prevalence., Design: The evidence for potential aetiological factors and strategies to reduce obesity prevalence was reviewed, and recommendations for public health action, population nutrition goals and further research were made., Results: Protective factors against obesity were considered to be: regular physical activity (convincing); a high intake of dietary non-starch polysaccharides (NSP)/fibre (convincing); supportive home and school environments for children (probable); and breastfeeding (probable). Risk factors for obesity were considered to be sedentary lifestyles (convincing); a high intake of energy-dense, micronutrient-poor foods (convincing); heavy marketing of energy-dense foods and fast food outlets (probable); sugar-sweetened soft drinks and fruit juices (probable); adverse social and economic conditions-developed countries, especially in women (probable). A broad range of strategies were recommended to reduce obesity prevalence including: influencing the food supply to make healthy choices easier; reducing the marketing of energy dense foods and beverages to children; influencing urban environments and transport systems to promote physical activity; developing community-wide programmes in multiple settings; increased communications about healthy eating and physical activity; and improved health services to promote breastfeeding and manage currently overweight or obese people., Conclusions: The increasing prevalence of obesity is a major health threat in both low- and high income countries. Comprehensive programmes will be needed to turn the epidemic around.

Background and Aim: Coronary heart disease (CHD) is common in New Zealand. Risk factors for CHD are modifiable or non-modifiable. Modifiable risk factor levels of CHD survivors were compared with those without such a history (non-CHD)., Methods and Results: Participants were from a cross-sectional survey of 5,656 workers aged > or = 40. CHD survivors were 73 general practitioner (GP)-confirmed participants with a history of hospitalisation for CHD. There were no significant differences in mean blood pressure levels between CHD survivors and non-CHD workers after adjusting for age, gender and ethnicity, but current use of antihypertensive medications was higher in CHD survivors (34.2%) than non-CHD workers (8.1%); p < 0.001. CHD survivors had higher, similarly adjusted, mean serum total cholesterol, triglyceride and lower HDL-cholesterol levels, and their reported carbohydrate, fibre, polyunsaturated fat intakes and ratio of polyunsaturated to saturated fat intakes were higher and total fat, saturated fat and monounsaturated fat intakes were lower. CHD survivors ate fewer servings of red meats per month and more servings of fruit, and cereal, and number of cups of milk. Salt added to meals was lower and margarine use higher in CHD survivors. There were no significant differences in the proportions of those who exercised regularly, or were current cigarette smokers. However, more CHD survivors (57.5%) than non-CHD workers (33.1%) were ex-smokers p < 0.001, who had stopped smoking at a higher mean (se) age (41.1 (1.36) vs 37.6 (0.20) years respectively; p = 0.012)., Conclusions: A large proportion of CHD survivors were dyslipidaemic, despite consuming a lower fat, higher fibre and carbohydrate diet. More than 50% of CHD survivors were ex-cigarette smokers, who had given up smoking at a later age than non-CHD workers. These high-risk CHD survivors would benefit from more aggressive measures aimed at correcting their dyslipidaemias.

The objective of this study was to describe the food and nutrient intakes of adults in three Samoan church communities located in Auckland, New Zealand. The study had a cross-sectional design and measured usual dietary intake in 437 participants, aged 20 years and over, using a self-completed, 89-item quantitative food frequency questionnaire. Median daily energy and nutrient intakes were calculated and compared by gender and age groups. Men obtained a significantly (p < 0.05) lower proportion of their energy from breads and cereals, fruits and vegetables and fats and oils than women. Compared to those aged 40+ years, those aged < 40 obtained a significantly (p < 0.01) lower proportion of their energy from meat, pulses and eggs, fruit and vegetables, and starchy staples. A significantly (p < 0.01) higher proportion of their energy intake came from takeaways, soft drinks, snacks and dairy products. Nutrient analysis revealed that those aged < 40 years obtained significantly (p < 0.001) more energy from fat and sugar, and less energy from protein (p < 0.001) than the older group. They also had significantly lower intakes, per 1000 kilocalories, of a wide selection of vitamins and minerals. A dietary transition has occurred for New Zealand Samoans, reflecting a shift from traditional to modern dietary patterns and a decline in the nutritional quality of the diet.

Objective: To examine changes in the Pima Indian diet composition that may have played a role in the dramatic rise in the incidence of NIDDM among Pima Indians over the last century., Research Design and Methods: We investigated the composition of the foods comparable to those available to the Pima approximately 100 yr ago, with the aim of reproducing this traditional diet as faithfully as possible for a dietary intervention study. An approximation of the traditional diet was ascertained from the ethnohistoric literature and traditional recipes., Results: We estimated that the traditional Pima diet, although seasonably variable, was approximately 70-80% carbohydrate, 8-12% fat, and 12-18% protein. A diet analogous to the traditional Pima diet is largely reproducible with the foods available today. Many native foods are available locally and many commercial products can be substituted when native foods are unavailable., Conclusions: The Pima Indian diet of the last century was much higher in carbohydrate and lower in fat compared with the modern-day Pima diet. Any changes that this diabetes-prone population can make toward their traditional diet may help to decrease their incidence of diabetes.

Summary: Background: There is a paucity of studies evaluating targeted obesity prevention interventions in pre‐school children. Objectives: We conducted a randomized controlled trial to evaluate the efficacy of a parent‐based obesity prevention intervention for pre‐schoolers – MEND (Mind, Exercise, Nutrition … Do It!) 2–4 on child diet, eating habits, physical activity/sedentary behaviours, and body mass index (BMI). Methods: Parent–child dyads attended 10 weekly 90‐min workshops relating to nutrition, physical activity and behaviours, including guided active play and healthy snack time. Assessments were conducted at baseline, immediately post‐intervention, and 6 and 12 months post‐intervention; child intake of vegetables, fruit, beverages, processed snack foods, fussiness, satiety responsiveness, physical activity, sedentary behaviour and neophobia were assessed via parent proxy report. Parent and child height and weight were measured. Results: Two hundred one parent–child dyads were randomized to intervention (n = 104) and control (n = 97). Baseline mean child age was 2.7 (standard deviation [SD] 0.6) years, and child BMI‐for‐age z‐score (World Health Organization) was 0.66 (SD 0.88). We found significant positive group effects for vegetable (P = 0.01) and snack food (P = 0.03) intake, and satiety responsiveness (P = 0.047) immediately post‐intervention. At 12 months follow‐up, intervention children exhibited less neophobia (P = 0.03) than controls. Conclusion: Future research should focus on additional strategies to support parents to continue positive behaviour change. ACTRN12610000200088. [ABSTRACT FROM AUTHOR]

Retail food environments are increasingly considered influential in determining dietary behaviours and health outcomes. We reviewed the available evidence on associations between community (type, availability and accessibility of food outlets) and consumer (product availability, prices, promotions and nutritional quality within stores) food environments and dietary outcomes in order to develop an evidence-based framework for monitoring the availability of healthy and unhealthy foods and non-alcoholic beverages in retail food environments. Current evidence is suggestive of an association between community and consumer food environments and dietary outcomes; however, substantial heterogeneity in study designs, methods and measurement tools makes it difficult to draw firm conclusions. The use of standardized tools to monitor local food environments within and across countries may help to validate this relationship. We propose a step-wise framework to monitor and benchmark community and consumer retail food environments that can be used to assess density of healthy and unhealthy food outlets; measure proximity of healthy and unhealthy food outlets to homes/schools; evaluate availability of healthy and unhealthy foods in-store; compare food environments over time and between regions and countries; evaluate compliance with local policies, guidelines or voluntary codes of practice; and determine the impact of changes to retail food environments on health outcomes, such as obesity. [ABSTRACT FROM AUTHOR]

Simulation models (SMs) combine information from a variety of sources to provide a useful tool for examining how the effects of obesity unfold over time and impact population health. SMs can aid in the understanding of the complex interaction of the drivers of diet and activity and their relation to health outcomes. As emphasized in a recently released report of the Institute or Medicine, SMs can be especially useful for considering the potential impact of an array of policies that will be required to tackle the obesity problem. The purpose of this paper is to present an overview of existing SMs for obesity. First, a background section introduces the different types of models, explains how models are constructed, shows the utility of SMs and discusses their strengths and weaknesses. Using these typologies, we then briefly review extant obesity SMs. We categorize these models according to their focus: health and economic outcomes, trends in obesity as a function of past trends, physiologically based behavioural models, environmental contributors to obesity and policy interventions. Finally, we suggest directions for future research. [ABSTRACT FROM AUTHOR]

A comprehensive policy approach is needed to control the growing obesity epidemic. This paper proposes the Obesity Policy Action (OPA) framework, modified from the World Health Organization framework for the implementation of the Global Strategy on Diet, Physical Activity and Health, to provide specific guidance for governments to systematically identify areas for obesity policy action. The proposed framework incorporates three different public health approaches to addressing obesity: (i) ‘upstream’ policies influence either the broad social and economic conditions of society (e.g. taxation, education, social security) or the food and physical activity environments to make healthy eating and physical activity choices easier; (ii) ‘midstream’ policies are aimed at directly influencing population behaviours; and (iii) ‘downstream’ policies support health services and clinical interventions. A set of grids for analysing potential policies to support obesity prevention and management is presented. The general pattern that emerges from populating the analysis grids as they relate to the Australian context is that all sectors and levels of government, non-governmental organizations and private businesses have multiple opportunities to contribute to reducing obesity. The proposed framework and analysis grids provide a comprehensive approach to mapping the policy environment related to obesity, and a tool for identifying policy gaps, barriers and opportunities. [ABSTRACT FROM AUTHOR]

OBJECTIVES:: The Australian Guide to Healthy Eating is based on five core food groups and water. Foods or beverages that do not fit into these groups are considered extra or‘noncore’. We tested the hypotheses that noncore foods and beverages make a greater proportional contribution to mean daily energy intakes of: (1) children, compared with other age groups; and (2) overweight and obese children, compared with healthy weight children. DESIGN, SETTING AND SUBJECTS:: We used data from 13?858 participants aged 2 to 80+?y who had 24-h dietary recall data collected in the 1995 cross-sectional Australian National Nutrition Survey. ANOVA was used to compare the percentage of energy provided by noncore foods and beverages by age and weight status. RESULTS:: Children (5 to 12?y) and adolescents (13 to 18?y) obtained significantly more (P<0.001) of their daily food energy from noncore foods (41.5 and 43.4%, respectively) than all other age groups. These age groups also obtained significantly more (P<0.001) of their daily beverage energy from noncore beverages (30.7 and 36.9%, respectively). Results were not consistent with weight status, although very young (2-4?y) obese children obtained significantly more energy (P<0.05) from noncore beverages than children in a healthy weight range. Younger children may also have consumed a greater quantity of foods and beverages. Under-reporting may have obscured similar results for older children. CONCLUSIONS:: By definition, noncore foods and beverages are surplus to the requirements of a healthy diet. We found that Australian children consume these foods and beverages in excess.European Journal of Clinical Nutrition (2005) 59, 639-645. doi:10.1038/sj.ejcn.1602091 Published online 16 February 2005 [ABSTRACT FROM AUTHOR]

OBJECTIVES:: The energy density (ED) of the diet is considered an important determinant of total energy intake and thus energy balance and weight change. We aimed to compare relationships between ED and macronutrient content in individual food and beverage items as well as population diet in a typical Western country. DESIGN:: Nutrient data for 3673 food items and 247 beverage items came from the Australian Food and Nutrient database (AusNut). Food and beverage intake data came from the 1995 Australian National Nutrition Survey (a 24-h dietary recall survey in 13?858 people over the age of 2). Relationships between ED and macronutrient and water content were analysed by linear regression with 95%prediction bands. RESULTS:: For both individual food items and population food intake, there was a positive relationship between ED and percent energy as fat and negative relationships between ED and percent energy as carbohydrate and percent water by weight. In all cases, there was close agreement between the slopes of the regression lines between food items and dietary intake. There were no clear relationships between ED and macronutrient content for beverage items. Carbohydrate (mostly sucrose) contributed 91, 47, and 25%of total energy for sugar-based, fat-based, and alcohol-based beverages respectively. CONCLUSIONS:: The relationship between ED and fat content of foods holds true across both population diets and individual food items available in the food supply in a typical Western country such as Australia. As high-fat diets are associated with a high BMI, population measures with an overall aim of reducing the ED of diets may be effective in mediating the growing problem of overweight and obesity. SPONSORSHIP:: NoneEuropean Journal of Clinical Nutrition (2004) 58, 1485-1491. doi:10.1038/sj.ejcn.1601994 Published online 2 June 2004 [ABSTRACT FROM AUTHOR]