prevention research? - the university of sydney

Prevention Research Collaboration

Physical Activity Nutrition Obesity Research GroupCluster for Physical Activity and Health

Cluster for Public Health Nutrition

News on physical activity, nutrition and obesity prevention

Funded by the NSW Health Department and supported by The University of Sydney

Set to improve through Munch and Move?As outlined in the last edition of this newsletter, Munch and Move is a state-wide program involving NSW Department of Health, Area Health Services, ECTARC, an early childhood training organisation, and the Prevention Research Collaboration at the University of Sydney,

Munch and Move supports preschools to incorporate fundamental movement skills and structured play in children’s activities, as well as encourage healthy food and drinks as part of their daily routine. Area Health Services recruit pre-schools to participate in Munch and Move, and provide them with ongoing support. In 2008 over 550 preschool staff from more than 300 preschools attended a training session and 25 more workshops are planned for 2009.

The teachers who attended a training workshop have provided glowing feedback on the content of the day. One teacher said “It was excellent and one of the best I have attended for a while in its relevance and ability to pass on information.” Another comment was that “kids love it, and the teachers just love it” she said.

Munch and Move provides an excellent opportunity for the PRC to undertake c o m m u n i t y - b a s e d intervention research. The evaluation of Munch and Move will examine changes fundamental movement skills and lunchbox contents as well as preschool practices. Keep an eye out for these results in future editions of this newsletter.

For more information please contact Sarah Howlett.

THIS ISSUE

Page 2From the editor•

Introducing PANORG•

Page 3Sit but fit: Does screen • time affect kids’ fitness?

Page 4Traffic light labeling – will • it get the green light?

Page 5Adults across NSW are • walking more

Page 6Are sugary drinks smart•

Evaluating the SDPP•

Page 7Do you really need • that ‘extra’ piece of chocolate?

Building links between • prevention, clinical medicine and science:

Introducing the Institute • of Obesity, Nutrition and Exercise (IONE)

Page 8Meet and greet • Katherine Jukic

Congratulations to • PH Phongsavan

Contact Us•

May 2009

what’s new in prevention research?

“We’ve been hearing great

stories about kids going

back to their parents and

saying ‘No, I can’t have

that in my lunch box’.”

Emily Beattie practises her striking skills

News on nutrition, physical

activity and weight research

2 PRC News


activity and weight researchIntroducing PANORG Established in late 2008, the Physical Activity Nutrition Obesity Research Group (PANORG) is funded by NSW Health to undertake policy-relevant research in these topic areas, and enable fast-track dissemination into NSW policy and practice.

It builds on the substantial work conducted for NSW Health over the last 5 to 10 years by the NSW Centre for Overweight and Obesity (COO), NSW Centre for Physical Activity and Health (CPAH) and NSW Centre for Public Health Nutrition (CPHN).

PANORG recently convened a strategic planning forum on 18th March, 2009. With over 40 participants, this forum involved open discussion between experts working in research, policy and practice on policy-relevant research priorities in physical activity, nutrition and obesity prevention.

PANORG’s work program will encompass: evaluation of interventions, determinants research and monitoring of physical activity, nutrition and weight status. It will also involve collaborating with health promotion professionals across Area Health Services and non-government organisations, as well as staff from the Centre for Health Advancement in NSW Health. PANORG is a relatively small group with about 6 positions supporting this work.

PANORG’s role in pursuing policy-relevant research and actively applying this to support current policy and practice is quite distinctive. Interestingly, an article on the roles of university-based health promotion research centres established by the Canadian federal government has been published recently.1 The roles of these centres, particularly in knowledge translation, training and mentoring, as well as the specific challenges they face working in health promotion research, are similar to PANORG’s.

Reference: Langille L, Crowell S, Lyons R. Six essential role of health

promotion research centres: the Atlantic Canada experience. /Health

Promotion International /2009,24(1), 78-87.

For more information please contact Lesley King.

From the editor

Welcome to the ‘new look’ news magazine of the Prevention Research Collaboration! This edition, the first since December 2007, highlights the importance of research into issues related to weight, healthy eating and physical activity across the lifespan. This edition spans research on preschool age children, older children, adolescents and adults. We are pleased to provide updates on a number of projects that have been mentioned in earlier editions, including Munch and Move and Traffic Light Food Labelling. There is also new research into sedentariness and fitness in ch ildren as well as patterns of sugary drinks consumption in young adults. Don’t forget to read the “Introduction to PANORG” piece which describes the new NSW Health funded research program.

As part of our new look, PRC News will have a series of guest editors, so there will be a new editor for each edition. I am lucky enough to be the inaugural guest editor and would like to acknowledge the work of Nick Evershed, who has conducted interviews and written drafts of the articles included in this edition. We hope you enjoy reading about our latest research and projects.

We are planning to produce three editions of PRC News over this year, and welcome feedback from readers. If you would like to be on our mailing list to receive hard copy versions please email us on: [email protected].

Louise Farrell

Delegates in discussion at the PANORG Planning Day





PRC News 3

Sit but Fit: Does screen time affect kids’ fitness?

Researchers from the Centre for Overweight and Obesity have determined that children who spend more than two hours on small screen recreation such as watching television or playing on computers are significantly less fit than children who spend less than two hours in front of screens.

The group of researchers, led by Dr. Louise Hardy, examined trends in sedentary behaviour using data from the 2004 NSW Schools Physical Activity and Nutrition Survey. The survey assessed the cardiovascular fitness, small-screen recreation time (SSR), and total sedentary behaviour for 2,750 students in Grades 6, 8 and 10.

Dr Hardy said one of the main aims of the study was to test the paediatric media guidelines issued by both the American Academy of Pediatrics, and Australia’s College of Pediatrics, which suggest that children spend no longer than 2 hours a day on small-screen recreation.

Dr Hardy said that “The recommendations were based on prudence, rather than developed against a direct health outcome such as fitness” .

“If you’re going to make a recommendation it needs to be benchmarked against a health outcome – and prior to this study that had not been established for small screen recreation in children” she said. “The key finding of this study was that it confirmed the 2 hours/day limit is a good guideline as children’s fitness declines beyond this point.”

“We examined the threshold for small screen recreation against fitness using statistical methods which gave us a better indication of the point at which their fitness starts to change. And interestingly enough, it was about the two-hour mark. So the guidelines which were developed in prudence were basically spot-on” she said.

In addition to examining SSR, the study set out to analyse total sedentary behaviour, which includes other activities such as passive transport (car bus journeys),time spent on hobbies, crafts or just ‘sitting around hanging out’. Dr Hardy said one of the problems with many studies is that they do not examine sedentary behaviour in its entirety,

saying “We know there are lots of other activities kids engage in aside from SSR which are sitting activities.”

Dr Hardy said that, overall, the kids who did more sitting were a lot less fit, and the effect was greater amongst girls and Grade 8 boys.

According to Dr Hardy, sedentary behaviour is an important factor in overall health, and one that has been somewhat neglected in comparison to other factors such

as diet and physical activity. She said it can also cause specific health problems, saying: “Sedentariness isn’t just about not having any contribution to your energy balance, it’s also about its effect on mental health and bone growth and development, particularly with kids.”

When asked how the two-hour rule should be implemented now that it has been confirmed, Dr Hardy stressed the need for education: “It’s not a very palatable message to get out there and I think there’s also issues when you say that the limit of SSR is 2 hours per day, which almost endorses that you can sit in front of the screen for 2 hours. No screen days is better. The first step is to raise people’s awareness that there is a guideline, because we know that awareness of that guideline is very low. This is the first step towards changing screen time behaviour.”

The research was published in the February edition of the American Journal for Preventative Medicine, and funded by NSW Department of Health.

Reference: Hardy L, Dobbins T, Denney-Wilson E, Okely A and Booth

M. Sedentariness, Small-Screen Recreation and Fitness in Youth.

American Journal of Preventive Medicine, 2009,36: 120 120-125.

For more information please contact Lou Hardy.

“If you’re going to make

a recommendation it

needs to be benchmarked

against a health outcome

– and prior to this study

that had not been

established for small

screen recreation in

children” she said. “The

key finding of this study

was that it confirmed

the 2 hours/day limit

is a good guideline as

children’s fitness declines

beyond this point.”



4 PRC News


activity and weight researchTraffic light labelling – will it get the green light?

This newsletter has previously informed readers of the discussion about potentially introducing a nutrient profiling system as part of front of package labelling in Australia (Dec 2007). While no decisions have been made on whether this will

occur, or the final system that will be adopted, the debate and discussion continues to gain momentum.

Jimmy Louie and other researchers from Sydney University recommended that a “traffic light” food-labelling system be introduced to make it easier for consumers to make decisions based on the nutritional quality of food. This recommendation, which has been made to the Food Regulations Standing Committee, is based on a review of current research on front-of-package labelling. The review compared two types of sign-posting, the percentage daily intake system, and the coloured traffic light system.

Jimmy said “Signposting is about making labels easier to read and understand. A successful signposting system should be one that consumers can easily use, and not one that just benefits the industry.” He added “Traffic light food-labelling is a simple way of expressing the nutritional quality of a food and clearly shows consumers which food choices are healthier and which are less healthy.”

The traffic-light system makes use of red, yellow and green “traffic light” labels for a number of potentially unhealthy components, such as total fat, saturated fat, sugars and salt. If a product is low in total fat, for example, it will have a green light for that category. “With the traffic light system, you could probably tell within five seconds which food is better” Jimmy said. “We think the traffic light system would be more suitable to tackle the obesity problem.”

The percentage daily intake system is an extension of the nutrition information panel seen on current food packaging, and calculates recommended daily intakes of different nutrients which can be difficult

for consumers to interpret. “The percentage daily intake values are based on an average 70 kilogram adult diet” he said. “So if you are heavier or lighter your energy requirements and other nutrient requirements will change, and the percentage daily intake listed will not be appropriate for use.” Jimmy added “Because percentage daily intake is based on serving sizes, this system requires consumers to make calculations in the supermarket, which is unlikely.”

Mr Louie said that in the UK, where traffic light labelling is voluntary, sales of food carrying green lights increased, while food carrying more red lights decreased. “That shows its affecting consumer behaviour” he said.

For more information please contact Jimmy Louie.

Jimmy said “Signposting

is about making labels

easier to read and

understand. A successful

signposting system should

be one that consumers

can easily use, and not

one that just benefits the

industry.”

Potential examples of traffic light labelling





PRC News 5

A new study shows Australians are walking more than ever, with the divide in physical activity between different areas of the population shrinking.

University of Sydney Research Fellow Dr Dafna Merom said that from 1998 to 2006 there has been an increase in both the number of people walking, and the number of people walking at a health-enhancing rate, which may result in the population getting fitter overall.

“The outcome [of the study] is that there has not only been an increase in the number of people participating in this activity, but also an increase in the number of people who undertook regular walking at a health-enhancing level” said Dr Merom. She said walking activity increased across all age groups and weight groups as well as urban and rural areas. Also, the disparity in walking activity between different socio-economic groups seen in previous years has disappeared, meaning disadvantaged and advantaged groups are walking at an equal amount. These results strengthen the idea that walking is an ideal form of exercise, no matter what your background.

Dr Merom explained that: “There is accumulated evidence that if you only walk but do it daily for at least thirty minutes you get the minimum health benefits. It may not be exactly the amount you need to prevent weight gain, you may need more, but for overall cardio-vascular benefits and metabolic benefits you need at a minimum to accumulate one hundred and fifty minutes per week.”

“It is important to promote walking because it has the potential to minimise health inequality, or physical activity inequality in the population, because it’s easily adopted and maintained” said Dr Merom, “It’s also very appropriate to a wide range of the population because it involves very little barriers - people from low SES can engage in this behaviour with no economic barriers, because you don’t have to pay for it.” Pedometer programs such as Step by Step have been shown to increase walking.

Dr Merom said the strength of the study lies in capturing all purposes of walking, and the use of consistent, global measurements of walking over a long time period.

“Assessment of walking has generally been limited to walking as a form of exercise and recreation, and there hasn’t been a good measure that also captures lifestyle walking - the one that you use for errands, to get to places,” she said, “The Centre for

Epidemiology and Research in the NSW Department of Health have implemented a global measure of walking that includes all purposes - this is a very strong public health tool, to inform us about the future health of the population, and also whether we follow the right track in policy and intervention efforts.”

Dr. Merom said the next step in her research was to investigate factors that might be driving trends seen in walking, such as increase in transport related walking and environmental factors.

The study was a collaborative effort between the Centre for Epidemiology and Research NSW Department of Health and researchers in the Cluster for Physical Activity and Health School of Public Health, University of Sydney. It will be published in the Journal of Preventive Medicine, and is now available on-line at http://dx.doi.org/10.1016/j.ypmed.2009.02.010

For more information please contact Dafna Merom.

The prevalence of regular walking* by disadvantaged socioeconomic quintiles: NSW 2002 and 2006

32 3228 29 29

37 37 35 37 37

15202530354045

Leastdisadvantaged

Quintile 1

Quintile 2 Quintile 3 Quintile 4 Mostdisadvantaged

Quintile 5

%

2002

2006

* Accumulation ≥150minutes per week over ≥5 occassions

Adults across NSW are walking more



6 PRC News


activity and weight researchAre sugary drinks smart?A new study examining young adults’ attitudes and behaviours towards soft drinks has revealed that most do not consider soft drinks a health concern.

The team of researchers from the Centre for Overweight and Obesity conducted focus groups with university students to glean information about their consumption of different types of sweetened drinks.

Lesley King explained the rationale for the study: “We know that young adults are the biggest consumers of soft drinks and that they are gaining weight more quickly than previous generations did at the same age. So from an obesity prevention point of view, the possibility of reducing overall consumption of soft drink is a potentially powerful intervention.”

The study highlighted the importance of social and environmental cues in determining soft drink consumption, with many participants citing cost, value for money, marketing, and social settings as factors influencing their consumption. Young adults’ awareness of the nutrition and health issues associated with consumption of sweetened drinks was very low. Libby Hattersley conducted the focus groups, and realised that through the group discussion, people became progressively aware of the issue.

Another key finding was that some young adults consume soft drinks as an alternative to alcohol, to moderate their alcohol consumption. As a Public Health Officer on placement with COO, Melissa Irwin was involved in the qualitative data analysis, and highlighted the importance of this result. “Some caution

is required to ensure that messages address both alcohol and soft drink harm reduction aims” she stated.

The results of the study can pave the way for developing programs to increase awareness about reducing consumption of sweetened drinks, including juices as well as soft drinks.

The study was funded by NSW Health, and has been published in the journal Public Health Nutrition.

Reference: Hattersley L, Irwin M, King L, Allman-Farinelli M.

Determinants and patterns of soft drink consumption in young

adults: a qualitative analysis. Public Health Nutrition 2009

For more information please contact Lesley King.

Evaluating the Sydney Diabetes Prevention ProgramA pilot type 2 diabetes prevention program, funded by the NSW Department of Health, is being implemented by Sydney South West Area Health Service and evaluated by the Prevention Research Collaboration at the University of Sydney.

Studies have shown that lifestyle modification can prevent or delay the onset of diabetes. The Sydney Diabetes Prevention Program (SDPP) aims to reduce the risk of developing diabetes by addressing the modifiable risk factors of physical activity and diet. The program implementation and evaluation are being led by a team of academics which includes Professor Stephen Colagiuri (IONE), Professor Adrian Bauman (PRC) and Professor Ian Caterson (IONE).

People at high risk of developing diabetes are eligible for the 12-month lifestyle modification program which supports participants to increase fibre consumption, decrease total fat and saturated fat consumption, increase physical activity and decrease weight. The intervention is being led by Philip Vita and supported by a team of project officers.

The program is being evaluated to determine its feasibility and effectiveness in the real world setting. A comprehensive evaluation is measuring physical activity, dietary habits, health service usage, social support and self-efficacy for physical activity and healthy eating, health related quality of life and an economic analysis is being conducted. The evaluation activities are being led and supported by Louise Farrell and Magnolia Cardona.

For more information please contact Louise Farrell.

“A lot of my friends and girlfriends

have the rationale that if it’s liquid it

doesn’t really count, so the calories

don’t count.” – Female Participant.





PRC News 7

Do you really need that ‘extra’ piece of chocolate?

According to research conducted by the Cluster for Public Health Nutrition (CPHN), Australian adults consume nearly double the recommended amount of non-core or “extra foods”.

Dr Anna Rangan said the new study published in the European Journal of Clinical Nutrition analysed data from the last national nutrition survey to determine the amount of “extra foods” consumed by Australian adults. The survey, conducted by the Australian Bureau of Statistics in 1995, surveyed over ten thousand Australians over the age of 19 and asked them what they’d eaten in the last 24 hours. Dr Rangan’s group then categorised the foods into types, and calculated the average amount consumed per day for each type of food.

“Extra foods are those foods in the diet that are high in energy, fat and/or sugar and low in essential nutrients” she said. “Examples would be biscuits, cakes, soft drinks, ice cream, pies, hot chips and high fat take-away items.”

The results of the study showed the percentage of energy obtained from extra foods was 38% for men, and 34% for women. The highest contributors to energy intake were hot chips (2.8%), margarine (2.6%), cakes and muffins (2.5%), beer (2.4%), sugar-sweetened soft drinks (2.4%), and meat pies (2.2%). Younger adults were more likely to consume sugar-sweetened soft drinks, hot chips, meat pies and pizza; whereas older adults were more likely to consume sweet and savoury biscuits, cakes and muffins.

Dr Rangan said the high consumption of these foods is problematic, as energy-dense, nutrient-poor foods are associated with weight gain, obesity and other health problems such as diabetes and hypertension. In addition,

these foods can replace more nutritious foods in the diet, leading to marginal intakes of some micronutrients.

Efforts are required to support the entire Australian population to limit their consumption of foods high in energy, fat and sugar. Dr Rangan suggested traffic light labelling, as highlighted by Jimmy Louie on page 4 of this newsletter, as one way of doing this. “Traffic light labelling would help consumers identify foods high in energy, fat and sugar and make informed decisions about ‘extra’ foods in their diet.”

Reference: Rangan A, Schindeler S, Hector D, Gill T, Webb K.

Consumption of ‘extra’ foods by Australian adults: types, quantity

and contribution to energy and nutrient intakes. European Journal of

Clinical Nutrition 2008 Oct 29. [Epub ahead of print].

For more information please contact Anna Rangan.

Building links between prevention, clinical medicine and science: Introducing the Institute of Obesity, Nutrition and Exercise (IONE)

The Institute of Obesity, Nutrition and Exercise (IONE), which was established in July 2007 brings together a wide range of Sydney University researchers involved in obesity, nutrition and exercise. IONE is a collaboration of established groups, seeking to enrich and improve the quality and quantity of research addressing these three topics.

The Prevention Research Collaboration forms one division within IONE. Other groups and programs include human nutrition, exercise science, obesity management, diabetes prevention and physiology of the development of obesity and weight re-gain.

The Director, Professor Ian Caterson, said that the research being undertaken within IONE seeks to have an impact on knowledge and policy at international, national and state levels.

We know that it can be a little complicated for outsiders to make the distinctions between PANORG, PRC and IONE but readers can be reassured that we really do work alongside and with each other, as illustrated in this newsletter.



8 PRC News

Meet and greet Katherine JukicOver 20 people work across the PRC and in this edition of the newsletter we would like to introduce Katherine Jukic who is the Scientific Project Officer with the Australian and New Zealand Obesity Society (ANZOS, formerly known to many of you as ASSO). She also works as an Associate Lecturer and course coordinator within the Discipline of Nutrition and Metabolism at Sydney University.

Katherine’s previous experience includes work as a research dietitian in the field of food allergy as well as a private practice and consultant dietitian in allied health and bariatric surgery environments. In her role at ANZOS, Katherine is working comprehensively on the SCOPE (Specialist Certification of Obesity Professional Education) program as well as other ANZOS projects.

Keep your eye out for more information on ANZOS activities in future editions. In her spare time Katherine unwinds with yoga, reading and eating good food – Mediterranean – yum!

Congratulations to PH PhongsavanCongratulations to the PRC’s own Dr Philayrath Phongsavan, who has been appointed to the position of Senior Lecturer in Disease Prevention and Health Promotion within the School of Public Health at the University of Sydney.

After completing a degree in Psychology and working in this area for a few years, PH found herself wanting to ‘make a difference’ for populations. She completed a Masters of Public Health, focusing on Health Promotion and worked at USYD and UNSW for three years before embarking on a PhD which involved a longitudinal study of factors influencing the health of adolescents.

PH worked in the Pacific Region for 4 years delivering and evaluating health promotion programs across 13 Pacific Islands, with a focus on health and nutrition. In all, PH brings 15 years’ experience of teaching health promotion to this role. She hopes to put in place a strong evidence-based health promotion program which supports students to seek and identify solutions to health-based problems, identify priorities for disease prevention and implement and evaluate high quality programs.

In her spare time PH is an avid reader…her favourite book is To Kill A Mockingbird, written by Harper Lee.

Contact Us

Physical Activity Nutrition Obesity Research Group

Cluster for Physical Activity and Health

Cluster for Public Health Nutrition

PANORG: Phone 9036 3271

CPAH: www.cpah.health.usyd.edu.au

CPHN: www.cphn.mmb.usyd.edu.au

prevention research? - the university of sydney

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