Promoting healthy eating and physical activity in adolescents

The purpose of this article is to provide an update on promoting healthy dietary and physical activity behaviors in adolescents. In the first part of the article the authors discuss the importance of healthy eating and physical activity during adolescence, present national recommendations and guidelines for diet and activity, and briefly review major nutrition and physical activity concerns of adolescents today. The second part presents a review of diet- and activity-related health promotion and risk reduction factors in a variety of settings and provides recommendations for practitioners. Future research needs are also addressed.     

Correlates of physical activity among Australian Indigenous and non‐Indigenous adolescents

Objective: Physical inactivity is an important modifiable cause of the excess burden of disease among Indigenous Australians. We describe physical activity patterns and influencing factors, comparing Indigenous and non‐Indigenous adolescents. Methods: Indigenous (n=359) and non‐Indigenous (n=637) adolescents aged 13–17 years from disadvantaged New South Wales regions completed a health and lifestyle survey. Socio‐demographic, social, psychosocial and health correlates of out of school physical activity (high vs. low) among the whole sample, and stratified by Indigenous status were examined. Results: Only 21% of Indigenous and 28% of non‐Indigenous adolescents achieved higher levels of physical activity. Overall, higher levels were associated with being male; sports team membership; lower levels of TV viewing time and having an employed mother. Indigenous girls were less active than boys (OR=0.36; 85%CI=0.24–0.54), as were those whose mothers were unemployed (OR=0.66; 95%CI=0.40–1.09). Among non‐Indigenous adolescents, high levels of physical activity were associated with sports team membership (OR=2.28; 95%CI=1.39–3.74) and community involvement (OR=1.46; 95%CI=1.04–2.06). Conclusions: Physical activity levels were similarly low among disadvantaged Indigenous and non‐Indigenous adolescents. Some influencing factors existed across the whole sample; others in stratification by Indigenous status. Implications for public health: Early and targeted, supportive approaches are necessary. Some apply to disadvantaged adolescents broadly; others are Indigenous or non‐Indigenous specific.     

Promoting healthy eating and physical activity short-term effects of a mass media campaign

BACKGROUND: Soaring obesity levels present a severe health risk in the United States, especially in low-income minority populations. INTERVENTION: High-frequency paid television and radio advertising, as well as bus and streetcar signage. SETTING/PARTICIPANTS: A mass media campaign in New Orleans to promote walking and fruit and vegetable consumption in a low-income, predominantly African-American urban population. Messages tailored with consideration of the African-American majority. DESIGN: Random-digit-dial telephone surveys using cross-sectional representative samples at baseline in 2004 and following the onset of the campaign in 2005. MEASURES: Survey items on campaign message recall; attitudes toward walking, snack food avoidance, and fruit and vegetable consumption; and behaviors related to fruit and vegetable consumption, snack food consumption, and utilitarian and leisure walking. RESULTS: From baseline, there were significant increases in message recall measures, positive attitudes toward fruit and vegetable consumption, and positive attitudes toward walking. Behaviors did not change significantly. In 2005, message recall measures were associated with positive levels of each of the outcome variables. CONCLUSIONS: Over 5 months, the media campaign appeared to have stimulated improvements in attitudes toward healthy diet and walking behaviors addressed by the campaign. These findings encourage the continuation of the media campaign, with future evaluation to consider whether the behavioral measures change.     

Promoting physical activity and healthy eating: Convergence in framing the role of industry

This commentary addresses a little explored aspect of prevention, namely, how public health practitioners conceptualize the roles of industries whose business interests may be at odds with physical activity and eating nutrient-rich foods. Taking their cues from successful campaigns in tobacco control, many public health advocates have framed obesity as a battle with the food industry. Such framing presents problems when it exacerbates existing tensions between practitioners in nutrition and physical activity, and alienates potential fitness industry partners. Creating healthy environments requires reframing expectations of all industries that influence physical activity and inactivity. A broader view of the influence of corporate practices on physical and social environments will help both physical activity and nutrition advocates identify what they can do together, and in partnership with the business sector, to create environments that promote activity and nutritious eating.     

Culture and healthy lifestyles: a qualitative exploration of the role of food and physical activity in three urban Australian Indigenous communities

Objective: 1) To explore the links between Indigenous Australian children's perspectives on culture, and healthy lifestyle behaviours. 2) To provide insight into how to approach the development of a health intervention targeting lifestyle behaviours in Australian Indigenous children. Methods: Seven semi‐structured focus groups sessions were conducted with Australian Indigenous children aged 5–12 years living on the South Coast of New South Wales. Audio‐recordings were transcribed and thematic analyses were conducted and related to principles of grounded theory. Results: Participants had connections to aspects of Australian Indigenous culture that were embedded in their everyday lives. Healthy lifestyle behaviours (such as healthy eating and physical activity) were found to be interconnected with Australian Indigenous culture and positive emotional wellbeing was identified as an important outcome of connecting Australian Indigenous children to cultural practices. Conclusion: Understanding the importance of culture and its role in healthy lifestyles is critical in the development of health interventions for Indigenous populations. Implication: Health interventions embedded with Australian Indigenous culture may have potential to improve physical and emotional health within Australian Indigenous communities. However, it is unlikely that a ‘one size fits all’ approach to health interventions can be taken.     

Is healthy behavior contagious: associations of social norms with physical activity and healthy eating

Background  

Social norms are theoretically hypothesized to influence health-related behaviors such as physical activity and eating behaviors. However, empirical evidence relating social norms to these behaviors, independently of other more commonly-investigated social constructs such as social support, is scarce and findings equivocal, perhaps due to limitations in the ways in which social norms have been conceptualized and assessed. This study investigated associations between clearly-defined social norms and a range of physical activity and eating behaviors amongst women, adjusting for the effects of social support.     

Promoting physical activity and a healthful diet among children: results of a school-based intervention study.

BACKGROUND: National health objectives call for improved diet and more regular physical activity among children. We tested the effects of a school-based program to improve students' diet and physical activity behavior at school. METHODS: Two of the four elementary schools in one Texas school district were assigned to intervention and two to control conditions. The three intervention components were classroom health education, vigorous physical education, and lower fat, lower sodium school lunches. Nutrients from school lunches and the total day and the amount of physical activity students obtained during physical education were assessed as outcome. RESULTS: Analysis of school lunches showed declines from base line to posttest in the two intervention schools of 15.5% and 10.4% for total fat, 31.7% and 18.8% for saturated fat, and 40.2% and 53.6% for sodium; posttest values were lower in the intervention schools. Observation of physical activity during physical education classes indicated an increase in the intervention schools from baseline to posttest in the percent of time children engaged in moderate-to-vigorous physical activity from less than 10% of class time at baseline to about 40% of class time at posttest; posttest values were higher in the intervention schools than in the control schools. CONCLUSIONS: This efficacy study demonstrates the feasibility of substantially modifying school lunches and school physical education to improve children's diet and physical activity behavior at school.     

School health guidelines to promote healthy eating and physical activity

During the last 3 decades, the prevalence of obesity has tripled among persons aged 6--19 years. Multiple chronic disease risk factors, such as high blood pressure, high cholesterol levels, and high blood glucose levels are related to obesity. Schools have a responsibility to help prevent obesity and promote physical activity and healthy eating through policies, practices, and supportive environments. This report describes school health guidelines for promoting healthy eating and physical activity, including coordination of school policies and practices; supportive environments; school nutrition services; physical education and physical activity programs; health education; health, mental health, and social services; family and community involvement; school employee wellness; and professional development for school staff members. These guidelines, developed in collaboration with specialists from universities and from national, federal, state, local, and voluntary agencies and organizations, are based on an in-depth review of research, theory, and best practices in healthy eating and physical activity promotion in school health, public health, and education. Because every guideline might not be appropriate or feasible for every school to implement, individual schools should determine which guidelines have the highest priority based on the needs of the school and available resources.     

Facilitators of and barriers to healthy eating and physical activity for Black women: a focus group study in Florida,USA

Black women’s experiences of, perceptions of, and attitudes to healthy eating and physical activity have been suggested as contributors to their high rates of obesity. This paper uses data from four focus groups with Black women aged 18–45?years in Broward County, Florida, to explore their views. Findings suggest that participants were aware of the importance of healthy eating and physical activity, and motivated by wanting to model healthy behaviors for their families, but that ‘healthy’ behavior was perceived as requiring considerable ‘pre-planning’ and commitment. Programs addressing Black women that incorporate their perceptions and work with them to overcome challenges are needed.     

Barriers to healthy eating amongst men: a qualitative analysis

Currently, little is known about the meanings men attach to food or to the links between food and health. The burgeoning literature on men's health highlights forms of masculinity (e.g. risk-taking, invulnerability) as a factor (negatively) influencing men's health practices. The aim of this study was to provide an analysis of men's accounts of food and health using concepts pertaining to masculinity. We report on a qualitative analysis of a dataset comprising 24 interviews with UK men from a range of age and social class groups. Our findings suggest two principal barriers to healthy eating in men: cynicism about government health messages and a rejection of healthy food on grounds of poor taste and inability to satisfy. These findings are discussed in relation to masculine ideals such as rationality, autonomy and strength. The implications of our analysis for future research and men's health promotion policy are discussed.     

Sociocultural factors relating to Tongans' and Indigenous Fijians' patterns of eating, physical activity and body size

This paper reviews literature between 1974 and 2007 that addresses the impact of sociocultural factors on reported patterns of eating, physical activity (activity) and body size of Tongans and indigenous Fijians (Fijians) in their countries of origin. There have been changes in diet (more imported and fewer traditional foods), activity (reduced, especially in urban settings), residence (rural-urban shift) and body size (increased obesity and at a younger age). The prevalence of overweight/obesity in Tongans and Fijians has increased rapidly over the last two decades and remains among the highest in the world (>80% in Tonga; >40% in Fiji), with more females reported to be obese than males. The few studies that investigated sociocultural influences on patterns of eating, activity and/or body size in this population have examined the impact of hierarchical organisation, rank and status (sex, seniority), values (respect, care, co-operation) and/or role expectations. It is important to examine how sociocultural factors influence eating, activity and body size in order to i) establish factors that promote or protect against obesity, ii) inform culturally-appropriate interventions to promote healthy lifestyles and body size, and iii) halt the obesity epidemic, especially in cultural groups with a high prevalence of obesity. There is an urgent need for more systematic investigations of key sociocultural factors, whilst taking into account the complex interplay between sociocultural factors, behaviours and other influences (historical; socioeconomic; policy; external global influences; physical environment).     

The power of policy: a case study of healthy eating among children

We used a case study approach to examine the nutritional effect of a policy to increase fruit and vegetable consumption in the Students Today Achieving Results for Tomorrow after-school program. The snack menu was changed in 44 after-school programs serving 8000 low-income and ethnically diverse elementary-school students. A comparison of previous and current snack menus identified a significant increase in fruit servings (83%) and no change in vegetable servings. We discuss the unintended consequences resulting from the menu changes.     

Evaluation of a 2-year physical activity and healthy eating intervention in middle school children

The aim of the present study was to evaluate the effects of a middle school physical activity and healthy eating intervention, including an environmental and computer-tailored component, and to investigate the effects of parental involvement. A random sample of 15 schools with seventh and eight graders was randomly assigned to one of three conditions: (i) intervention with parental involvement, (ii) intervention alone and (iii) control group. In 10 schools, an intervention, combining environmental changes with computer-tailored feedback, was implemented over 2 school years. In five intervention schools, increased parental support was added. Physical activity was measured with questionnaires in the total sample and with accelerometers in a sub-sample of children. Fat intake, fruit, water and soft drink consumption were measured using food-frequency questionnaires. Results showed significant positive intervention effects on physical activity in both genders and on fat intake in girls. Parental involvement did not increase intervention effects. It can be concluded that physical activity and eating behaviours of middle school children can be improved by school-based strategies combining environmental and personal interventions. The use of personalized computer-tailored interventions seems to be a promising tool for targeting adolescents but needs to be further explored.     

Promoting healthy lifestyles in children: a pilot program of be a fit kid

Be a Fit Kid is a 12-week program aimed at improving physical activity and nutritional habits in children. The physical activity component of the program emphasized cardiovascular fitness, flexibility, muscular strength, and bone development through running, yoga, jumping, and strength exercises. All activities were individualized and noncompetitive. The nutrition component focused on current dietary guidelines that emphasize a diet rich in vegetables, fruits, unsaturated fats, and whole grains, and low in saturated fat and sugar. Following the 12-week intervention, significant improvements were observed in body composition, fitness, nutrition knowledge, dietary habits, and in those who participated 75% of the time, significant reductions in total cholesterol and triglyceride levels were observed. Findings from the pilot trial suggest that health promotion programs can be well received by children and may favorably alter overweight and the development of adult lifestyle-related diseases.     

Individual, social, environmental, and physical environmental correlates with physical activity among Canadians: a cross-sectional study

Background  

The identification of various individual, social and physical environmental factors affecting physical activity (PA) behavior in Canada can help in the development of more tailored intervention strategies for promoting higher PA levels in Canada. This study examined the influences of various individual, social and physical environmental factors on PA participation by gender, age and socioeconomic status, using data from the 2002 nationwide survey of the Physical Activity Monitor.