# Exercise as it relates to Disease/Exercise and Children: Fat future or fit future?

This is an analysis of the journal article " 'Improving weight status in childhood: results from the eat well be active community programs' " by Tahna Petman (2013)

### What is the background to this research?

Obesity has become one of the most prevalent issues in today's children, with a clear need for effective prevention and intervention strategies. In Australia and New Zealand (ANZ), intervention strategies have been implemented to counteract the issue, although, most of these interventions are a short-term strategy thus making it ineffective.
So how can ANZ rebuild a healthy lifestyle in these children in order for a brighter and healthier future?
A study in the journal, 'International Journal of Public Health" examined the effects a community-based, capacity-building approach, this program was called the Eat Well be Active program (ewba). The goal was to increase healthy eating and physical activity in children and young people (0-18 years old), by working hand in hand with the community to address the behaviour of the children/adolescent and the factors that influence the environment. As a result, the program aimed to decrease obesity in ANZ from 2006 to 2010.

### Where is the research from?

This study was conducted by Tahna Pettman, Anthea Magarey, Nadia Mastersson, Annabelle Wilson and James Dollman. Held in Morphett Vale and in Murray Bridge, both situated in South Australia. These areas were selected based on total population size (~41,000 between both), higher than state average prevalence of overweight individuals, high proportion of indigenous people relative to the state average and networks relevant to the ewba intervention.

### Study Design

This research was a quantitative study utilising self-reported surveys (pre and post intervention) with intervention communities (INT) and non-randomised comparison communities (COMP). COMP was selected to correlate with INT in terms of population, socio-economic disadvantages and similar indigenous population. There were 2 “litmus groups” that were used for evaluation purposes: primary school children aged 10-12 and pre-school children aged 4-5.
The number of pre-school participants are not available as the data was obtained through a state-wide growth monitoring service, although, it is estimated that this study reached at least 75% of the pre-school students state wide. Available data of pre-school students are as followed: 1005 (2006) and 1244 (2009). Data for the primary school students are in relation to 1626 students in 2006 and 1198 in 2009. Anthropometric measurements of height, weight and waist circumference were measured in the primary school students, and anthropometric data for the pre-school students were sourced from the Children, Youth and Women’s Health Service (CYWHS). The hypotheses of this study was that BMI and weight of the children would go down and children will overall be healthier. Settings of intervention included: schools, child day-cares, youth homes, indigenous agencies and community centres.
An action intervention was implemented for each community involved. These were developed through community agreements, sourced from available evidence, expert knowledge and program principles. The basis of these interventions were multi-strategies in various settings. Strategy types included workforce development and peer education, policy, infrastructure improvements, programs and resources, promotion/local marketing, and community development. An example of these interventions include: mentoring programs for students, healthy policies implemented into youth services and environmental improvements for outdoor play spaces. All strategies may be found in detail elsewhere.
A limitation is that BMI doesn't cater for different kinds of body types and for this study to be successful, it relies on a decrease in BMI. Data used for pre-school students weren't from the participants, thus, making the results slightly inaccurate. Furthermore, surveys were self-reported, allowing for false data if the participant wasn't happy with their answer.

### Results

Table 1: Results for Pre-School Students pre and post intervention
| n | Baseline (2006) | | Follow up(2009) | | Change (follow up - baseline) | |
| | INT (n=464) | COMP (n=541) | INT (n=455) | COMP (n=789) | INT | COMP |
| Age | 4.8 ± 0.24 | 4.8 ± 0.23 | 4.8 ± 0.28 | 4.7 ± 0.25 | 0 | 0.1 |
| Mean weight (kg) | 19.5 ± 3.0 | 19.1 ± 2.8 | 19.2 ± 2.8 | 19.3 ± 2.9 | 0.3 | -0.2 |
| BMI (kg/m^2) | 16.64 ± 1.76 | 16.41 ± 1.62 | 16.33 ± 1.61 | 16.22 ± 1.68 | -0.31 | -0.19 |
| BMI z-score | 0.64 ± 1.07 | 0.50 ± 1.02 | 0.44 ± 1.07 | 0.35 ± 1.10 | -0.20 | -0.15 |
Table 2: Results for Primary School Students pre and post intervention
| n | Baseline (2006) | | Follow up(2009) | | Change (follow up - baseline) | |
| | INT (n=836) | COMP (n=790) | INT (n=590) | COMP (n=608) | INT | COMP |
| Age | 11.80 ± 0.88 | 11.73 ± 0.88 | 11.83 ± 0.90 | 11.88 ± 0.85 | 0.03 | 0.15 |
| Mean weight (kg) | 45.05 ± 11.42 | 44.61 ± 10.87 | 45.01 ± 10.94 | 44.99 ± 10.68 | -0.04 | 0.38 |
| Mean waist circumference (cm) | 66.34 ± 9.36 | 66.21 ± 8.47 | 65.05 ± 8.12 | 65.93 ± 8.35 | -1.29 | 0.28 |
| BMI (kg/m^2) | 19.76 ± 3.70 | 19.65 ± 3.39 | 19.74 ± 3.59 | 19.66 ± 3.52 | -0.02 | 0.01 |
| BMI z-score | 0.596 ± 1.127 | 0.598 ± 1.115 | 0.595 ± 1.108 | 0.548 ± 1.131 | -0.001 | -0.050 |
Pre-School: There was an overall reduction in weight and BMI. Though these reductions weren't significant, it is still encouraging to see.
Primary School: Among these children, waist circumference (WC) was decreased by 1.1cm. WC was decreased in both INT and COMP groups, although, only the improvements to the INT group were statistically significant. WC may be the focal point of these results as WC is highly correlated with body fatness in pubescent children rather than BMI. Furthermore, there was no difference seen in BMI, this may be due to a stabilisation of weight which can occur over a few years during early adolescence.
The hypothesis that BMI would go down, showed to be proven as overall BMI z-scores were decreased.

### Conclusion

Results show that an intervention of improving the lifestyle of children through physical activity, nutrition, mentoring and creating a supportive environment improves the general health of children. Though some of the data did not have a significant improvement, it should be known that the age groups that are targeted are still growing and therefore, still gaining weight/height which influences BMI.
Other studies such as Be Active Eat Well (Sanigorski et al. 2008), Romp & Chomp (de Silva-Sanigorski etal. 2010), Fun n Healthyin Moreland! (Mooreand Gibbs 2010), and Project APPLE (Taylor et al. 2007) all showed similar results that an improvement can be seen through a community-based obesity prevention intervention.

### Practical advice

This study and the other research that backs this up, has proved the hypothesis that BMI is decreased with a community-based obesity prevention intervention. Implementing a healthy lifestyle while these children are still young may have a domino effect for further generations. Thus making it important that we take action in today's youth considering that obesity rates in ANZ have significantly increased by an astounding 80% over the past 33 years, which has become the largest increase in a survey of ~200 countries.
Furthermore, a long-term follow up should be implemented in these communities in hope to see that they have kept this healthy lifestyle.

### Further Readings

For further information on the issue of obesity, interventions and extras, check out:
The contribution of organised sports to physical activity in Australia: Results and directions from the Active Healthy Kids Australia 2014 Report Card on physical activity for children and young people - http://www.sciencedirect.com/science/article/pii/S1440244015000936
Early childhood obesity: Association with healthcare expenditure in Australia - http://onlinelibrary.wiley.com/doi/10.1002/oby.21544/full
Prevalence of Overweight and Obesity Among US Children, Adolescents, and Adults, 1999-2002 - http://jamanetwork.com/journals/jama/fullarticle/198912
Australia's Physical Activity and Sedentary Behaviour Guidelines - http://www.health.gov.au/internet/main/publishing.nsf/content/health-pubhlth-strateg-phys-act-guidelines

### References

* 1 2 3 4 Tahna, P. et al. (2013) 'Improving weight status in childhood: results from the eat well be active community programs'. International Journal of Public Health, 02/2014, Volume 59, Issue 1
* 1 2 Australian Bureau of Statistics (2006) Socio-economic indexes for areas (SEIFA). Technical Paper Australian Bureau of Statistics, Canberra
* ↑ Australian Bureau of Statistics (2010) Health and socioeconomic disadvantage. 4102.0—Australian Social Trends. Australian Bureau of Statistics, Canberra
* ↑ Magarey AM, Daniels LA, Golley RK, Perry RA (2011) Promoting healthy eating for children and families: practical approaches of three Australian intervention trials for prevention and management of overweight, vol 31. Advances in medicine and biology. Nova Science Publishers, Inc., New York
* ↑ Pettman T, McAllister M, Verity F, Magarey A, Dollman J, Tripptree M, Stanley S, Wilson A, Mastersson N (2010) Eat Well Be Active Community Programs ﬁnal report. SA Health, Adelaide
* ↑ Watts K, Bell LM, Byrne SM, Jones TW, Davis EA (2008) Waist circumference predicts cardiovascular risk in young Australian children. J Paediatr Child Health 44(12):709–715.
* ↑ Olds TS, Tomkinson GR, Ferrar KE, Maher CA (2009) Trends in the prevalence of childhood overweight and obesity in Australia between 1985 and 2008. Int J Obes 34(1):57–66
* ↑ Sanigorski AM, Bell AC, Kremer PJ, Cuttler R, Swinburn BA (2008a) Reducing unhealthy weight gain in children through community capacity-building: results of a quasi-experimental intervention program, Be Active Eat Well. Int J Obes 32(7):1060–1067
* ↑ de Silva-Sanigorski AM, Bell AC, Kremer P, Nichols M, Crellin M, Smith M, Sharp S, de Groot F, Carpenter L, Boak R, Robertson N, Swinburn BA (2010b) Reducing obesity in early childhood: results from Romp & Chomp, an Australian community-wide intervention program. Am J Clin Nutr 91(4):831–840
* ↑ Moore L, Gibbs L (2010) Evaluation of community-based obesity interventions. In: Preventing childhood obesity. Wiley, New York, pp 157–166
* ↑ Taylor RW, McAuley KA, Barbezat W, Strong A, Williams SM, Mann JI (2007) APPLE Project: 2-y ﬁndings of a communitybased obesity prevention program in primary school-age children. Am J Clin Nutr 86(3):735–742
* ↑ Lucy Carroll (2014) Australia the 'fat country', world obesity ranks reveal: Health. Sydney Morning Herald