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This paper aims to identify challenges in current health service approaches to providing optimal care for people who seek treatment for obesity. Type of program or service: Health service management of obesity in Australia Methods: Drawing on lived experience, clinical and academic perspectives, and available evidence, we reflect on the current state of the healthcare system to support people seeking treatment for obesity. We suggest actions to enable effective, acceptable and equitable care for this group of people.Identified challenges include the complexity of care required to adequately manage obesity, existing service capability and capacity, and high out-of-pocket patient costs.To address these challenges, a comprehensive response is required at all levels of the healthcare system. As a starting point, we propose eight areas of action: partner with people living with obesity; eliminate weight stigma; increase healthcare professional education, guidelines and resources; establish clear referral pathways and working partnerships; scale services to meet demand; ensure flexible and accessible service delivery; implement changes to the Medicare Benefits Schedule to increase service provision and pursue opportunities for subsidised medicines.

BACKGROUND As of 2021, 89% of the Australian population are active internet users. Although the internet is widely used, there are concerns about the quality, accuracy, and credibility of health-related websites. A 2015 systematic assessment of infant feeding websites and apps available in Australia found that 61% of websites were of poor quality and readability with minimal coverage of infant feeding topics and lack of author credibility. OBJECTIVE This study aimed to systematically assess quality, interactivity, readability, and comprehensibility of information targeting infant feeding, active play, screen time and sleep behaviours on websites globally; and provide an update of the 2015 systematic assessment. METHODS Similar methods to the 2015 assessment were used. Key words related to infant milk feeding behaviours, solid feeding behaviours, active play, screen time and sleep were used to identify websites targeting infant health behaviours on Safari Google search engine. The websites were evaluated between July 2021 and February 2022 and assessed for information content based on the Australian Infant Feeding Guidelines and National Physical Activity Recommendations. The Suitability Assessment of Materials (SAM), Quality Component Scoring System (QCSS), the Health-Related Website Evaluation Form (HRWEF), and the adherence to the Health on the Net code (HONcode) were used to evaluate the suitability and quality of information respectively. Readability was assessed used three online readability tools. RESULTS Of the 450 websites screened, 66 were included based on the selection criteria and evaluated. Overall, the quality of websites was mostly adequate. Media- related sources, Non-Governmental Organisations, hospital, and privately owned websites had the highest median quality scores while university websites received the lowest median score (35%). The information covered within the websites was predominantly poor: 91% of the websites received an overall score of ≤74% (mean 53%). Suitability of health information was mostly rated adequate for literacy demand, layout, and learning and motivation of readers. The median readability score for the websites was grade 8.5 which is higher than the Government recommendations (< grade 8). Overall, 74% of websites obtained a poor rating for interactivity measuring active control, two-way communication, and synchronicity. The most common features found on websites were social media links (92%), frequently asked questions (73%), and videos (67%). Only 14% of websites presented information that addressed culture in texts or images. CONCLUSIONS Quality, content, readability, and interactivity of websites promoting health behaviours during infancy ranged between poor to adequate. Since the 2015 systematic assessment, there was a slight improvement in quality of websites but no difference in the SAM rating and readability of information. There is a need for researchers and healthcare providers to leverage innovative web-based platforms to provide culturally competent evidence-based information based on Government guidelines that are accessible to those with limited English proficiency.

Although early childhood obesity prevention has become an important issue internationally, little evidence exists regarding longer term effects (i.e., sustainability) of early interventions.To determine whether intervention benefits at 2 years of age were sustained at 3.5 and 5 years.Follow-up of the Early Prevention of Obesity in Children (EPOCH) individual participant data prospective meta-analysis of four randomized controlled trials including 2196 mother-child dyads at baseline. Interventions were home- or community-based, commenced within 6 months of birth, ended by 2 years of age, and comprised multiple sessions. Controls received standard care. BMI z-score (primary outcome), other anthropometric measures and weight-related behaviours were initially measured at 1.5-2 years and followed up at 3.5 and 5 years.Positive intervention effects on BMI z-scores at 1.5-2 years of age were not apparent by 3.5 years (-0.04 adjusted mean difference; 95% CI:-0.14, 0.06; p = 0.424), and 5 years (0.03; 95% CI: -0.08, 0.14; p = 0.60). While prolonged intervention benefits were detected for a few, but not the majority of, weight-related behaviours at 3.5 years, these effects diminished over time.This meta-analysis found that initial positive effects of childhood obesity interventions faded out after interventions ended, pointing toward the importance of a suite of interventions implemented at multiple stages across childhood.

This systematic review explored the feasibility, acceptability and effect on health outcomes of weight-neutral interventions in health improvement-seeking young people with overweight/obesity.Six databases were searched to March 2021 for health, but not weight, focused interventions (PROSPERO, CRD42020152671). Eligible studies recruited young people (10-24 years) with overweight/obesity. The studies were described using narrative synthesis, with numerical results summarised. The quality of included studies was assessed using the Joanna Briggs Institute critical appraisal tools.Six articles were included, representing three pilot studies. Study 1 (n = 37, 14-17 years) compared a 6-week mindful eating program with single-session lifestyle education; Study 2 (n = 35, 14-17 years) compared 12-week weight-neutral lifestyle education focused on intuitive eating and carbohydrate quality, with/without guided imagery; and Study 3 (n = 33, 12-17 years) compared a 6-week mindfulness intervention with cognitive behavioural therapy in adolescents with depressive symptoms at risk of type 2 diabetes. All interventions explored feasibility (intervention group retention 57%-88%, attendance80%) and reported interventions were acceptable. Studies 1 and 3 reported no change in mindfulness. Study 2 reported an increase (p 0.05) in intuitive eating following weight-neutral plus guided imagery (0.32 ± 0.36, Hawks' Scale, score 1-4), compared with weight-neutral alone (0.15 ± 0.29). Study 1 reported decreased body mass index (p 0.001) following mindful eating (-1.1 kg/mWeight-neutral interventions may be feasible and acceptable in adolescents with overweight/obesity in the short term (≤12 weeks), but data are limited.

BACKGROUND The prevalence of childhood obesity is increasing in China, and the effect of mobile phone short message service (SMS) interventions to prevent early childhood obesity needs to be evaluated. OBJECTIVE The objective of this study was to assess the effect of an SMS intervention on the prevention of obesity in young children. METHODS A quasi-experimental design SMS intervention was carried out in 4 community health centers (CHCs) in Shanghai, China. A total of 2 CHCs were assigned to the intervention group, and 2 CHCs were assigned to the control group. Mothers in the intervention group received weekly SMS messages on breastfeeding and infant feeding from the third trimester to 12 months postpartum. The primary outcomes were children’s body mass index (BMI), BMI z-score, and weight-for-length z-score at 12 and 24 months. Factors associated with higher BMI and weight-for-length z-score at 24 months were also assessed. RESULTS A total of 582 expectant mothers were recruited at the beginning of the third gestational trimester. 477 (82.0%) and 467 (80.2%) mothers and their children were followed up to 12 and 24 months postpartum, respectively. There were no significant differences in children’s BMI, BMI z-score, and weight-for-length z-score at 12 and 24 months between the 2 groups. Factors associated with higher BMI, BMI z-score, and weight-for-length z-score at 24 months included higher birth weight, introduction of solid foods before 4 months, and taking a bottle to bed at 12 months. CONCLUSIONS The SMS intervention did not show a significant effect on children’s BMI, BMI z-score, or weight-for-length z-score at 12 and 24 months. Introduction of solid foods before 4 months and taking a bottle to bed at 12 months were significantly and positively correlated with a higher BMI, BMI z-score, and weight-for-length z-score at 24 months. Further studies with more rigorous design are needed to evaluate the effect of SMS interventions on preventing early childhood obesity.

Children and adolescents with overweight and obesity are a global health concern. This is an integrative overview of six Cochrane systematic reviews, providing an up-to-date synthesis of the evidence examining interventions for the treatment of children and adolescents with overweight or obesity. The data extraction and quality assessments for each review were conducted by one author and checked by a second. The six high quality reviews provide evidence on the effectiveness of behaviour changing interventions conducted in children6 years (7 trials), 6-11 years (70 trials), adolescents 12-17 years (44 trials) and interventions that target only parents of children aged 5-11 years (20 trials); in addition to interventions examining surgery (1 trial) and drugs (21 trials). Most of the evidence was derived from high-income countries and published in the last two decades. Collectively, the evidence suggests that multi-component behaviour changing interventions may be beneficial in achieving small reductions in body weight status in children of all ages, with low adverse event occurrence were reported. More research is required to understand which specific intervention components are most effective and in whom, and how best to maintain intervention effects. Evidence from surgical and drug interventions was too limited to make inferences about use and safety, and adverse events were a serious consideration.

There has been a decline in the proportion of clinical academics compared with full-time clinicians, since 2004. A Working Party was established to help develop and implement a model for the training of clinical academics. After a highly successful first summit in 2014 that summarised the challenges faced by clinical academics in Australia and New Zealand, a second summit was convened late in 2015 to report on progress and to identify key areas for further action. The second summit provided survey results that identified the varied training pathways currently offered to clinical academics and the institutions willing to be involved in developing improved pathways. A literature review also described the contributions that clinical academics make to the health sector and the challenges faced by this workforce sector. Current training pathways created for clinical academics by Australasian institutions were presented as examples of what can be done. The perspectives of government and research organisations presented at the summit helped define how key stakeholders can contribute. Following the summit, there was a strong commitment to continue to work towards developing a sustainable and defined training pathway for clinical academics. The need for a coordinated and integrated approach was highlighted. Some key objectives were agreed upon for the next phase, including identifying and engaging key advocates within government and leading institutions; publishing and profiling the contributions of successful clinical academics to healthcare outcomes; defining the stages of a clinical academic training pathway; and establishing a mentoring programme for training clinical academics.

To determine whether overweight or obesity among children (aged 2 to ≤5 years) is associated with direct healthcare costs, after adjusting for child, household, and socioeconomic characteristics.A longitudinal cohort analysis was performed in 350 children aged 2 years assessed over 3 years of follow-up. Child weight status was determined from mean BMI z-scores at 2, 3.5, and 5 years, and healthcare utilization including medicines, nonhospital, hospital, and emergency care was determined by data linkage. Using adjusted multivariable regression analyses, the relationship between total 3-year healthcare costs and weight status was examined. Observations took place in Sydney, Australia, between 2011 and 2014.After adjustment for significant maternal and sociodemographic characteristics, healthcare costs of children with obesity (BMI z-score2SD) were 1.62 (95% CI 1.12-2.34, P = 0.01) times those of children with healthy weight. However, costs of overweight children were similar to those of healthy weight (P = 0.96). The additional 3-year costs of healthcare for a child with obesity compared with healthy weight were $AUD 825 (95% CI $135-$2,117) for general patients and $AUD 1332 (95% CI $174-$4,280) for concession card holders.Prevention of obesity in early childhood may have concurrent benefits in reducing healthcare expenditure.

Young adults are a highly desirable target population for energy-dense, nutrient-poor (EDNP) food and beverage marketing. But little research, resources, advocacy and policy action have been directed at this age group, despite the fact that young adults are gaining weight faster than previous generations and other population groups. Factors such as identity development and shifting interpersonal influences differentiate young adulthood from other life stages and influence the adoption of both healthy and unhealthy eating behaviours. EDNP food and beverage marketing campaigns use techniques to normalize brands within young adult culture, in particular through online social media. Young adults must be a priority population in future obesity prevention efforts. Stronger policies to protect young adults from EDNP food and beverage marketing may also increase the effectiveness of policies that are meant to protect younger children. Restrictions on EDNP food and beverage marketing should be extended to include Internet-based advertising and also aim to protect vulnerable young adults.

Department of Nutrition and Food Science (I.L.), University of the Basque Country, 01006 Vitoria, Spain; GENUD (Growth, Exercise, Nutrition, and Development) Research Group (I.L., G.R., L.A.M.), Faculty of Medicine and Department of Pediatrics (G.R.), Instituto Aragones de Ciencias de la Salud (G.R.), and University School of Health Sciences (L.A.M.), University of Zaragoza, 50009 Zaragoza, Spain; Department of Physical Education (J.R.R.), School of Physical Education and Sport Sciences, University of Granada, 18071 Granada, Spain; Unit for Preventive Nutrition (J.R.R., F.O.P.), Department of Biosciences and Nutrition at NOVUM, Karolinska Institutet, SE-17177 Huddinge, Sweden; Department of Public Health (I.H., S.D., K.E.V.), Faculty of Medicine, Ghent University, and Department of Nutrition and Dietetics (K.E.V.), Faculty of Health Care Vesalius, University College Ghent, 9000 Ghent, Belgium; Department of Medical Physiology (F.B.O., D.J.-P.), School of Medicine, University of Granada, 18014 Granada, Spain; Department of Nutrition and Food Science (C.B.), University of Bonn, D-53117 Bonn, Germany; National Research Institute on Food and Nutrition (L.C.), 00178 Roma, Italy; Department of Pediatrics (D.M.), University of Pecs, H-7623, Pecs-Jozsef A 7, Hungary; Division of Nutrition and Metabolism (K.W.), Department of Pediatrics, Medical University of Vienna, A-1090 Vienna, Austria; University of Crete School of Medicine (A.K., M.P.), GR-71033 Crete, Greece; Immunonutrition Research Group (L.E.D., A.M.), Department of Metabolism and Nutrition, Spanish Council for Scientific Research, Madrid, Spain; Institut National de la Sante et de la Recherche Medicale Unite 995 (F.G.), IFR 114, Faculty of Medicine, University of Lille 2, 59044 Lille, France; and Department of Pediatrics (F.G.), Jeanne de Flandre Children’s University Hospital, 59037 Lille, France

To determine the costs and cost-effectiveness of an early childhood home visiting program delivered to families in socio-economically disadvantaged areas of Sydney, Australia during 2007-2010.Economic evaluation of a randomized controlled trial, the healthy beginnings (HB) trial, from the perspective of the health funder. Intervention resources were determined from local health district records in 2012 $AUD. Health-care resource utilization was determined through patient-level data linkage.The cost of HB intervention in the clinical trial over 2 years was $1309 per child (2012 $AUD). The incremental cost-effectiveness ratio was $4230 per unit BMI avoided and $631 per 0.1 reduction in BMI z-score. It was estimated that the program could be delivered in practice for $709 per child; with incremental cost-effectiveness ratios of $2697 per unit BMI avoided and $376 per 0.1 reduction in BMI z-score.We present the first economic evaluation of an effective obesity prevention initiative in early childhood. HB is a moderately priced intervention with demonstrated effectiveness that offers similar or better value for money than existing obesity prevention or treatment interventions targeted at older children.

ObjectiveTo assess the association between socio-economic position (SEP) and poor eating behaviours in a large representative sample of Australian secondary-school students.DesignCross-sectional survey of students’ vegetable, fruit, sugar-sweetened beverage and fast-food consumption assessed using validated instruments and collected via a web-based self-report format.SettingSecondary schools across all Australian states and territories.SubjectsSecondary-school students (n 12 188; response rate: 54 %) aged 12–17 years participating in the 2009–10 National Secondary Students’ Diet and Activity (NaSSDA) survey.ResultsOverall, 25 % of students reported consuming ≤1 serving of vegetables/d and 29 % reported eating ≤1 serving of fruit/d. Fourteen per cent of students reported drinking at least 1–2 cups of sugar-sweetened beverages/d while 9 % reported eating fast food ≥3 times/week. After adjusting for other demographic factors, students of lower-SEP areas were more likely to report low intake of vegetables (F(4, 231) = 3·61, P = 0·007) and high frequency of consumption of sugar-sweetened beverages (F(4, 231) = 8·41, P < 0·001) and fast food (F(4, 231) = 4·59, P = 0·001) compared with students of high-SEP neighbourhoods. A positive SEP association was found for fruit consumption among female students only (F(4, 231) = 4·20, P = 0·003). Those from lower-SEP areas were also more likely to engage in multiple poor eating behaviours (F(4, 231)=5·80, P < 0·001).ConclusionsResults suggest that socio-economic disparities in Australian adolescents’ eating behaviours do exist, with students residing in lower-SEP neighbourhoods faring less well than those from high-SEP neighbourhoods. Reducing social inequalities in eating behaviours among young people should be a key consideration of future preventive strategies.

Throughout the developed world there is an increasing prevalence of childhood obesity. Because of this increase, and awareness of the risks to long term health that childhood obesity presents, the phenomena is now described by many as a global epidemic. Children, Obesity and Exercise provides sport, exercise and medicine students and professionals with an accessible and practical guide to understanding and managing childhood and adolescent obesity. It covers: overweight, obesity and body composition; physical activity, growth and development; psycho-social aspects of childhood obesity; physical activity behaviours; eating behaviours; measuring childrens behaviour; interventions for prevention and management of childhood obesity. Children, Obesity and Exercise addresses the need for authoritative advice and innovative approaches to the prevention and management of this chronic problem.