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M E: Intervention implementation Diet PA EMGO Institute - Care - PDF document

Feb 01, 2024 •412 likes •506 views

Important things first Prevention of weight gain should be given greater Environmental attention determinants of nutrition This requires relatively small changes in lifestyle behaviors that also contribute to improved population

  1. Important things first… • Prevention of weight gain should be given greater Environmental attention determinants of nutrition • This requires relatively small changes in lifestyle behaviors that also contribute to improved population and physical activity health independent of obesity prevention • Such changes in nutrition, physical activity and sedentary behaviours require motivation, ability & opportunity theory, evidence and implications for practice Lifestyle, Overweight and Diabetes • Health education is not enough; environmental change is needed to make the healthy choice the default choice EMGO Institute for Health and Care Research • This means a shift in focus from health promotion to Johannes Brug, Portugese Obesity health protection strategies Conference, 2009 Three important categories of determinants (Based on Outlline Rothshield, 1999; Van Trijp et al., 2006; Brug et al., 2006) • Why focus on environmental opportunities? � Motivation • How im portant is the environm ent for nutrition Interaction and mediation � Ability and PA behaviours? � Opportunity – What environm ent? – Which specific nutrition and PA behaviors? To know ≠ – What measure of environment? To be able to To want – Direct or indirect associations/ effects? ≠ ≠ To be able to To want Planned Promotion of Promotion of Population Population Health Health (Brug et al. Am J Planned Energy balance… . (Brug et al. Am J Clin Clin Nutr 2003; Int J Nutr 2003; Int J Beh Beh Nutr Nutr Phys Phys Act 2005; Act 2005; A: Analysis of health and quality of life B: Analysis of personal and environmental risk factors E E v v a a l l u u C: Analysis of determinants of exposure to risk factors a a t t i i o o D: Intervention development n n M E: Intervention implementation Diet PA EMGO Institute - Care and Prevention

  2. Planned Planned Promotion of Promotion of Population Population Health Health (Brug et al. Am J Positive energy im balance… . (Brug et al. Am J Clin Clin Nutr 2003; Int J Nutr 2003; Int J Beh Beh Nutr Nutr Phys Phys Act 2005; Act 2005; A: Analysis of health and quality of life B: Analysis of personal and environmental risk factors E E v v a a l l C: Analysis of determinants of exposure to risk factors D u u i e t a a t t i i o o M D: Intervention development n n P A E: Intervention implementation Free choice II: people act sensibly Free choice II: people act sensibly Evolution of a theory… (1): People change when you scare them? THREAT = Energy Perceived intake Preventive susceptibility action X High cognitive effort (motivation) Perceived severity Little cognitive effort Energy expenditure Based on Hill, 2002 THREAT = Perceived Preventive Beliefs X evaluations Attitudes Behaviour susceptibility action X Perceived - There is m ore than risks and health… severity - Beliefs are not knowledge… - Affective rather than cognitive? THREAT = 100 Change in Unhealthful eating puts 90 diet 80 ME 70 at risk for weight gain Attitudes to prevent weight gain 60 Important X (Wammes et al. 50 Unpleasant Int J Beh Nutr Phys Act, 2005.) Weight gain is 40 30 very bad 20 10 0 EMGO Institute - Care and Prevention

  3. … or: Theory of planned behavior (Ajzen, 1981). - W e are not alone • Precaution adoption process model - W e are not alw ays in control Attitudes • Social cognitive theory • Health belief m odel Subjective Behaviour • Et cetera Intention norms 20-50% variance Perceived behavior explained control Changes in campaign awareness and message recall during the Mass media campaign ‘ Maak je niet dik ! ’ campaign weeks Campaign 1 Campaign 2 Campaign 3 Campaign 4 Campaign 5 Campaign 6 • Ultimate aim: prevention of 100 campaign awareness overweight 90 message recall 80 70 • Focused on: establishing a neutral familiar with one of the 60 campaign activities energy balance % familiar with 50 the radio commercial 40 • Target group: special attention to young familiar with the TV 30 adults (25 ‐ 35 years of age) with healthy BMI commercial 20 familiar with (18 ‐ 25) the brochure 10 familiar with advertisement 0 in newspapers 0 10 20 30 40 50 60 70 80 90 100 110 120 130 • Period: 2002 ‐ 2007 week Wammes et al., Public Health Nutr, 2005; Wammes et al. Obesity, 2008 Individually-tailored health education; web-based Changes in psychosocial variables during the campaign weeks Campaign 1 Campaign 2 Campaign 3 Campaign 4 Campaign 5 Campaign 6 100 awareness: 90 realistic about * personal body weight 80 attitude 70 60 low self efficacy expectations % 50 40 social support * 30 20 motivatie 10 0 0 10 20 30 40 50 60 70 80 90 100 110 120 130 week EMGO Institute - Care and Prevention

  4. Spendings on advertising and Five a day But health education is not enough… campaign in US 2004 … (Nestle, 2006) • Too sweet and friendly… 2 50 • Crushed by marketing 2 00 Pepsi 1 50 Coke Sprite Creme savers 1 00 Sickers 5 a day 50 0 Million US$ Where are we so far… Energy intake, energy expenditure and energy balance • Motivation-based determ inant models do quite well in practice • … but not good enough Energy intake • … especially not among children and adolescents Cognitive effort (motivation, abilities) or environmental control Little cognitive effort Energy expenditure Based on Hill, 2002 The ‘environment’ Environmental opportunities Physical environment Social-cultural environment • Ecological ‘m odel’… – Making healthy choices easy choices – Making healthful nutrition and physical activity: • Easier • Better facilitated Political environment Economical environment • More necessary • Unavoidable EMGO Institute - Care and Prevention

  5. The runaway weight train (Swinburn & Egger BMJ 2007) The runaway weight train (Swinburn & Egger BMJ 2007) Personal Health choice protection; Energy- Health environmental balance train education change Obesopreventive environment What is the evidence? (Obesity Reviews, The overall conclusions from the six systematic reviews - 1 (Brug & Van 2007) Lenthe 2005; Brug et al Am J Prev Med, 2006; Brug et al. Proc Nutr Society 2008) • More evidence for the im portance of social environm ents than for physical environm ents: • Series of reviews: – Social support and m odelling appears to be important for physical activity , in youth as well as in adulthood. – Brug et al. Am J Prev Med, 2006 – Parents have a crucial role in the health behaviour of their children. They should not only provide a good exam ple by eating right and being physically active – Ferreira et al. Obes Rev, 2007 themselves, but also by using parenting practices and styles that encourage and support healthy habits in their offspring. – Giskes et al. Prev Med, 2007 • Availability and accessibility of healthy and less healthy foods are important for nutrition behaviours , in youth and adulthood; schools and worksites offer good opportunities to improve availability of healthful foods. – Kremers et al. Am J Prev Med, 2007 • From the reviews of intervention studies it appeared that increasing physical activity opportunities makes a difference, and schools and w orksites offer good settings to – Van der Horst et al. Health Educ Res, 2007 do that. Especially increasing the amount of hours of physical education/ physical activity in schools can m ake a difference for youth. Improving opportunities for walking can make a difference in adults. – Wendel-Vos et al. Obes Rev, 2007 Children and adolescents from m ore deprived fam ilies are likely to have unhealthier • diets and less physical activity , and lower household income is associated with less – Van Hooijdonk et al. In Preparation healthy diets in adults. The overall conclusions from the six systematic reviews - 2 (Brug & Van Issues Lenthe 2005; Brug et al Am J Prev Med, 2006; Brug et al. Proc Nutr Society 2008) • Physical environment vs. Social environment • Most research is of low quality with w eak research designs , non-validated measurement instruments, lack of • Direct or mediated and moderated influences of adjustment for confounders , non-optim al statistical environment on behaviour; planned or autom atic? m ethods • Solution-oriented research appears to be more fruitful • Objective environment vs. Subjective/ perceived than problem-oriented research environment • Lack of evidence ; because of lack of (good) studies? • Specific nutrition and physical activities Especially for macro-level environment factors • Observational studies vs. Intervention • Lack of studies that look at environm ental and individual level determinants of nutrition and PA behaviours studies/ experimentation/ natural experiments EMGO Institute - Care and Prevention

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