Obesity interventions

With statistics showing that around one third of young New Zealanders are overweight, research programmes are looking at ways to modify both the eating and activity patterns of our babies and children.

We live in a world that promotes over-eating and a sedentary lifestyle, and high obesity levels show we're paying the price.

The challenge for New Zealand – and the rest of the Western world, therefore – is to modify both the environment and human behaviour to stem the global obesity epidemic, employing education and intervention techniques.

A third of New Zealand children up to 14 years are heavier than they should be. Around eight per cent are obese and a further 21 per cent are overweight, even those as young as two to four years.

Clearly, there's no magic bullet solution, but some of the research by the Dunedin School of Medicine has focused on obesity prevention at an early age.

Associate Professor Rachael Taylor explains that many behavioural patterns are thought to be formed early in life, including eating and sleeping. "Prevention is better than a cure. We believe the earlier humans are able to form good eating habits, the more likely they are to last a lifetime.

"Education alone doesn't influence behaviour. We know that people need to know how to make changes, rather than just understanding why it's necessary. We also know that a range of strategies are required to manage the problem, including increasing activity at work, school and leisure time, changing what we eat and how we use food, and getting enough sleep as well as managing environmental factors such as food advertising. Finger-pointing at one specific issue isn't the answer."

"The challenges are that we live in a world where high-energy food is too accessible and labour-saving devices and technology mean we move less. We can't change that, but we do have to learn to do things differently."

Taylor specialises in developing interventions and, along with University, national and international colleagues, has been working on a range of studies with children and babies aimed at modifying eating and activity behaviours. The aim is to trial interventions to get quality evidence of an effect and confirm success of the delivery mechanisms before introducing national programmes.

One study started more than a decade ago, known as "Apple", provided an activity co-ordinator to encourage play and, in particular, to help overcome barriers of not having many people in a small rural community able to coach sports teams. The intervention proved successful – the Body Mass Index (BMI) of those measured dropped compared to the control group, but the trial didn't just change body composition, it changed attitudes as well.

"We're finding that the benefits are continuing when we return to monitor progress; we're seeing people continuing with their new habits."

Other activity interventions include looking at the philosophy of play, including structure and rules at schools, to encourage children into more active play and to promote exploration. This meant a return to activities like bull-rush and tree-climbing, but with appropriate risk management strategies to keep it safe.

An interest in early intervention led to a new study, the Prevention of Overweight in Infancy (POI), looking at a series of interventions for infants on food, activity and sleep which are known to influence health and obesity.

"We have good child health systems in New Zealand, but here we have been offering parents specific guidance on managing and promoting good behaviours and supporting appropriate choices at a very early age. The aim is to begin a life of eating with good habits."

Another two-year-long study, Baby-led Introduction to Solids (BLISS), studies the importance of self-regulation in weight management and involves 200 infants. This study is investigating an alternative way of introducing babies to complementary foods where the babies feed themselves whole foods right from the start of solids' introduction.

"New babies feed whenever they need to from day one, but that control of food intake lessens when caregivers take over feeding solid food. We know self-regulation is important in weight control and this study looks at whether babies can continue to regulate their food intake, to recognise hunger and to stop when they are satisfied. We want to see if this self-regulation can lead to better control of food intake and eating habits as they age.

"The challenges are that we live in a world where high-energy food is too accessible and labour-saving devices and technology mean we move less. We can't change that, but we do have to learn to do things differently. With education, support and changes to the environment, we can help individuals modify behaviour, without that change being a personal imposition."