Prioritizing research into nutrition and obesity

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Prioritizing research into nutrition and obesity

• Dr Rachael Taylor
• Human Nutrition
• University of Otago

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Obes Rev 20045(Suppl 1)4
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Current NZ research

• Community-based obesity prevention projects
• APPLE - 500 primary school aged children in
  Otago
• Energise - 3000 primary school aged children in
  Waikato
• OPIC - 3500 secondary school aged youth in
  Auckland
• Counties-Manukau Lets Beat Diabetes

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Short-term goals

• Utilize existing datasets to determine potential
  effect of nutrition interventions

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NZ kids eat too much fat and not enough calcium
Boys Girls
CNS2002
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Type of milk consumed by NZ children
CNS2002
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Nutrient content of green-top vs blue-top milk
(250ml)
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Short-term goals

• Utilize existing datasets to determine potential
  effect of nutrition interventions
• What barriers to healthy living exist for
  different age and socio-demographic groups
• Determine how policy influences food behaviour in
  different settings
• Undertake studies investigating effect of
  modifying portion size on energy balance (more
  than 1 more or over time)

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Portion size (g or ml) when first introduced
compared with 2002 (USA)
JADA 2003103231
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Energy intake in a restaurant meal according to
entrée portion size
kJ
Obes Res 200412562
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Short-term goals

• How rapidly can intervention produce an effect?
• Use existing interventions
• Design new trials appropriately
• Further work regarding how pricing, taxation,
  availability and promotion of food interact to
  affect food purchases

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A ledger of human eating

• Unhealthy foods
• Highly accessible
• Convenient
• Promoted heavily
• Good tasting
• Cheap

• Healthy foods
• Less accessible
• Less convenient
• Barely promoted
• Less tasty
• More expensive

Obesity Prevention and Public Health 2005
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The CHIPS study

• Testing effect of signage and pricing of low and
  high-fat snack options in school vending machines
• 4 different pricing structures
• Equal, 10, 25 and 50 less
• 3 different promotions
• Nothing, labelled as low-fat, labelled plus sign
  promoting low fat foods
• So 12 different conditions for 1 month each over
  12 month intervention

AJPH 200191112
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Low-fat snacks as total snacks sold according
to price reduction
of snacks sold that were low-fat
d
c
b
a
Price reduction
AJPH 200191112
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of low-fat snacks sold according to signage
Plt0.05 compared with no labelling

of snacks solds that were low-fat
Price reduction
AJPH 200191112
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Intermediate-term goals

• Undertake obesity prevention trials in groups or
  environments where research is lacking
• Preschoolers
• Home environment - role of parents

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Number of studies in each setting (Flynn et al
2006)
Obes Rev 20067(Suppl 1)7-66
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Policies and the Media eg. advertising school
policies
Family Demographics eg. income ethnicity
Knowledge about healthy behaviours
Modeling of healthy behaviours
Accessibility of healthy options
PARENTING
Community Characteristics eg. access to healthy
foods Neigbourhood walkability
Child Characteristics eg.athletic competence age
Shaping childrens eating/ activity behaviours
by use of rewards/punishments
Organizational Characteristics eg. advertising
Obesity prevention and public health 2005
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Intermediate-term goals

• Undertake obesity prevention trials in groups or
  environments where research is lacking
• Preschoolers
• Home environment
• Lower socioeconomic groups

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Prevalence of obesity in men and women in
relation to SES

NZDep01
NNS1997
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Prevalence of obesity in boys and girls in
relation to SES

NZDep01
CNS2002
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Intermediate-term goals

• Undertake obesity prevention trials in groups or
  environments where research is lacking
• Preschoolers
• Home environment
• Lower socioeconomic groups
• Gender specific interventions?

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Females higher prevalence of obesity in children
and adults
Females
Males

NNS1997
CNS2002
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Intermediate-term goals

• Explore why some people are able to maintain
  behaviour changes which promote effective weight
  management
• Incorporate economic assessment into
  interventions to determine cost-benefit of
  different approaches
• Ensure interventions include appropriate process
  evaluation to assist the development and
  implementation of future interventions

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Intermediate-term goals

• Trial effectiveness of alternative methods of
  delivery eg. internet and television?
• Determine effect of built environment on energy
  and nutrient intakes - GPS

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Fast food contains much more energy per gram than
is ideal
kJ/100g
Obes Rev 20034187
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Weight gain over 15 years according to fast food
intake
Weight gain (kg)
Change in intake (times per week)
Baseline intake (times per week)
Lancet 200536536
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Density of fast-food outlets in relation to SES
Population per fast-food outlet
1.0
0.65
0.55
0.40
Health and Place 20028141
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Intermediate-term goals

• Trial effectiveness of alternative methods of
  delivery eg. internet and television?
• Determine effect of built environment on energy
  and nutrient intakes - GPS
• Macronutrient composition and energy density -
  are they important?

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Covert experiments show high fat diets promote
passive overconsumption
AJCN 199562316-329
60 40 20
Energy balance (MJ)
Time (days)
1 2 3 4 5 6
7
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Proc Nutr Soc 200564217
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Long-term goals

• Test different strategies for effective long-term
  (5 years) weight maintenance
• New birth cohort/longitudinal study?
• Maximize research measurement tools for diet,
  activity - cost, time, accuracy
• Effective monitoring of upstream initiatives -
  how do we monitor environmental change?

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Opportunities for influencing the environment
Obes Rev 20045(Suppl 1)4
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How do we harness and maximize research capacity?

• More funding for research only academic
  positions?
• Effective collaboration?
• Who should research - maintenance of research
  quality?

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Maori and Pacific issues

• Intentionally not covered as the topic of
  yesterdays Hui

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Impacting on inequalities

• SES, ethnicity, gender, age, extreme obesity
• Prioritize research to these groups?

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