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Monasta L.,Institute for Maternal and Child Health IRCCS Burlo Garofolo | Lobstein T.,International Association for the Study of Obesity | Cole T.J.,University College London | Vignerova J.,National Institute of Public Health | Cattaneo A.,Institute for Maternal and Child Health IRCCS Burlo Garofolo
Obesity Reviews | Year: 2011

Two international datasets are used to define overweight and obesity in pre-school children: the International Obesity Task Force (IOTF) reference and the WHO standard. This study compares the performance of the two datasets in defining overweight and obesity in 24-60 months old children. This was done by plotting the IOTF cut-offs against WHO curves and by comparing the prevalence of overweight and obesity, as defined by the IOTF reference and by the WHO standard, using 2001 data from the Czech Republic. The IOTF cut-off for overweight in 24-60 months old children goes from 1.7 to 1.1 z-scores on the WHO chart, and for obesity it shifts with age from 2.7 to 2.2 z-scores. As a consequence, at 5 years of age the prevalence of overweight in Czech girls is 3.4% using the WHO and 15.3% using the IOTF definition. These discrepancies are due to the choice of cut-offs and to the different criteria used to select the sample for the IOTF reference and the WHO standard. Research is urgently needed to identify, for the WHO standard, BMI cut-offs associated with an increased risk of overweight and obesity, and associated health outcomes later in life. © 2010 The Authors. obesity reviews © 2010 International Association for the Study of Obesity.


Lhachimi S.K.,Erasmus Medical Center | Lhachimi S.K.,Heinrich Heine University Düsseldorf | Nusselder W.J.,Erasmus Medical Center | Lobstein T.J.,International Association for the Study of Obesity | And 7 more authors.
Obesity Reviews | Year: 2013

Summary: A common policy response to the rise in obesity prevalence is to undertake interventions in childhood, but it is an open question whether this is more effective than reducing the risk of becoming obese during adulthood. In this paper, we model the effect on health outcomes of (i) reducing the prevalence of obesity when entering adulthood; (ii) reducing the risk of becoming obese throughout adult life; and (iii) combinations of both approaches. We found that, while all approaches reduce the prevalence of chronic diseases and improve life expectancy, a given percentage reduction in obesity prevalence achieved during childhood had a smaller effect than the same percentage reduction in the risk of becoming obese applied throughout adulthood. A small increase in the probability of becoming obese during adulthood offsets a substantial reduction in prevalence of overweight/obesity achieved during childhood, with the gains from a 50% reduction in child obesity prevalence offset by a 10% increase in the probability of becoming obese in adulthood. We conclude that both policy approaches can improve the health profile throughout the life course of a cohort, but they are not equivalent, and a large reduction in child obesity prevalence may be reversed by a small increase in the risk of becoming overweight or obese in adulthood. © 2013 International Association for the Study of Obesity.


De Bourdeaudhuij I.,Ghent University | Van Cauwenberghe E.,Ghent University | Spittaels H.,Ghent University | Oppert J.-M.,Pitie Salpetriere Hospital AP HP | And 5 more authors.
Obesity Reviews | Year: 2011

It is the purpose of this study to systematically review the evidence of school-based interventions targeting dietary and physical activity behaviour in primary (6-12 years old) and secondary school (12-18 years old) children in Europe. Eleven studies (reported in 27 articles) met the inclusion criteria, six in primary school and five in secondary school children. Interventions were evaluated in terms of behavioural determinants, behaviour (diet and physical activity) and weight-related outcomes (body mass index [BMI] or other indicators of obesity). The results suggest that combining educational and environmental components that focus on both sides of the energy balance give better and more relevant effects. Furthermore, computer-tailored personalized education in the classroom showed better results than a generic classroom curriculum. Environmental interventions might include organized physical activities during breaks, or before and after school; improved availability of physical activity opportunities in and around the school environment; increased physical education lesson time; improved availability or accessibility of healthy food options; and restricted availability and accessibility of unhealthy food options. More high-quality studies are needed to assess obesity-related interventions in Europe. © 2010 The Authors obesity reviews © 2010 International Association for the Study of Obesity.


Knai C.,London School of Hygiene and Tropical Medicine | Lobstein T.,International Association for the Study of Obesity | Darmon N.,Aix - Marseille University | Rutter H.,London School of Hygiene and Tropical Medicine | McKee M.,London School of Hygiene and Tropical Medicine
International Journal of Environmental Research and Public Health | Year: 2012

There is growing evidence of social disparities in overweight among European children. This paper examines whether there is an association between socioeconomic inequality and prevalence of child overweight in European countries, and if socioeconomic disparities in child overweight are increasing. We analyse cross-country comparisons of household inequality and child overweight prevalence in Europe and review within-country variations over time of childhood overweight by social grouping, drawn from a review of the literature. Data from 22 European countries suggest that greater inequality in household income is positively associated with both self-reported and measured child overweight prevalence. Moreover, seven studies from four countries reported on the influence of socioeconomic factors on the distribution of child overweight over time. Four out of seven reported widening social disparities in childhood overweight, a fifth found statistically significant disparities only in a small sub-group, one found non-statistically significant disparities, and a lack of social gradient was reported in the last study. Where there is evidence of a widening social gradient in child overweight, it is likely that the changes in lifestyles and dietary habits involved in the increase in the prevalence of overweight have had a less favourable impact in low socio-economic status groups than in the rest of the population. More profound structural changes, based on population-wide social and environmental interventions are needed to halt the increasing social gradient in child overweight in current and future generations. © 2012 by the authors; licensee MDPI, Basel, Switzerland.


Hawkes C.,Consulting Services | Lobstein T.,International Association for the Study of Obesity
International Journal of Pediatric Obesity | Year: 2011

Objectives. To describe the global regulatory environment around food marketing to children in 2009 and to identify changes in this environment since 2006. Methods. Informants able to provide information on national controls on marketing to children were identified and sent a standardised template for data collection, developed and refined through iterative use with informants. Responses were encouraged by sending draft versions of completed templates to informants for their approval. Results. The policy environment was described in the 27 member states of the European Union, and in a further 32 countries. Of these 59 countries, 26 have made explicit statements on food marketing to children in strategy documents, and 20 have, or are developing, explicit policies in the form of statutory measures, official guidelines or approved forms of self-regulation. These figures reflect a change in the policy environment since 2006. Although there is still resistance to change, there has been significant movement towards greater restriction on promotional marketing to children, achieved through a variety of means. Government-approved forms of self-regulation have been the dominant response, but statutory measures are increasingly being adopted. The nature and degree of the restrictions differ considerably, with significant implications for policy impact. In many cases the policy objectives remain poorly articulated, resulting in difficulty in formulating indicators to monitor and assess impact. Conclusion. To address food marketing to children, governments need to develop clearer statements of the objectives to be achieved, define the indicators that can demonstrate this achievement, and require the relevant stakeholders to account for the progress being made. © 2011 Informa Healthcare.


Hawkes C.,City University London | Friel S.,Australian National University | Lobstein T.,International Association for the Study of Obesity | Lang T.,City University London
Food Policy | Year: 2012

In light of the shift in policy paradigm in agriculture from state intervention to market liberalisation and globalisation, this paper develops a series of hypotheses on the relationship between agricultural policies and consumer diets. The first hypothesis is that the paradigm shift has led to greater specialisation of production, so changing the ability and incentive for producers to supply certain foods relative to others. Second, the shift has affected farmgate prices (both up and down), so creating opportunities for the industries which purchase farm commodities (the food consuming industries - FCIs) to substitute lower priced ingredients, thereby influencing the nutritional quality and content of foods available in the marketplace. Third, it has increased the ability of the FCIs to " add value" through product innovation and marketing, creating a market characterised by highly differentiated products targeted to individualised preferences, thus increasing the acceptability of a wider variety and quantity of food products.The changing agricultural policy paradigm has therefore altered the environment in which consumers make their food choices, in the form of food availability, affordability and acceptability. Nevertheless, the paper finds no clear pattern when it comes to health; the changes have affected both " unhealthy" and " healthy" foods and ingredients. The key process of importance for health, then, is not whether the " ingredients" produced by agriculture are healthy or not, but how they are substituted, transformed, distributed and marketed through the supply chain (e.g. vegetable oils into transfats).This leads to an important implication: that policies to intervene directly in agricultural production to promote healthy eating are unlikely to be effective or efficient if they do not take into account how foods are processed, distributed and marketed through the supply chain. In practice, this means that the potential for policy interventions in agriculture to improve diets is limited - but nevertheless potentially important where it exists given the upstream nature of the change. Incentives could be created for the FCIs to substitute " healthier" ingredients in their products, and/or to sell more of them, in instances where these changes can be passed all the way to the consumer. Greater investment could also be made in fruit and vegetable production for local markets.Along with testing the hypotheses established in this paper, the research priority should to identify the incentives that influence the products produced by the FCIs, with the objective of finding those most amenable to leveraging the supply chain towards healthier eating. © 2012 Elsevier Ltd.


Cole T.J.,University College London | Lobstein T.,International Association for the Study of Obesity
Pediatric Obesity | Year: 2012

Background: The international (International Obesity Task Force; IOTF) body mass index (BMI) cut-offs are widely used to assess the prevalence of child overweight, obesity and thinness. Based on data from six countries fitted by the LMS method, they link BMI values at 18 years (16, 17, 18.5, 25 and 30 kg m-2) to child centiles, which are averaged across the countries. Unlike other BMI references, e.g. The World Health Organization (WHO) standard, these cut-offs cannot be expressed as centiles (e.g. 85th). Methods: To address this, we averaged the previously unpublished L, M and S curves for the six countries, and used them to derive new cut-offs defined in terms of the centiles at 18 years corresponding to each BMI value. These new cut-offs were compared with the originals, and with the WHO standard and reference, by measuring their prevalence rates based on US and Chinese data. Results: The new cut-offs were virtually identical to the originals, giving prevalence rates differing by <0.2% on average. The discrepancies were smaller for overweight and obesity than for thinness. The international and WHO prevalences were systematically different before/after age 5. Conclusions: Defining the international cut-offs in terms of the underlying LMS curves has several benefits. New cut-offs are easy to derive (e.g. BMI 35 for morbid obesity), and they can be expressed as BMI centiles (e.g. boys obesity = 98.9th centile), allowing them to be compared with other BMI references. For WHO, median BMI is relatively low in early life and high at older ages, probably due to its method of construction. © 2012 The Author.


Brinsden H.,International Association for the Study of Obesity | Lobstein T.,International Association for the Study of Obesity
Pediatric Obesity | Year: 2013

Background: The food and beverage industry have made voluntary pledges to reduce children's exposure to the marketing of energy-dense foods and beverages, and in 2012 announced the replacement of company-specific nutrient profiling schemes with uniform sets of criteria from 2013 (in the USA) and 2014 (in the European Union [EU]). Objective: To compare the proposed USA and EU nutrient profiling schemes and three government-led schemes, paying particular attention to the differences in sugar criteria. Method: Food and beverage products permitted to be advertised in the USA under pre-2013 criteria were examined using five nutrient profiling schemes: the forthcoming USA and EU schemes and three government-approved schemes: the US Interagency Working Group (IWG) proposals, the United Kingdom Office of Communications (OfCom) regulations and the Danish Forum co-regulatory Code. Results: Under the new USA and EU nutrient profiling schemes, 88 (49%) and 73 (41%) of a total of 178 products would be permitted to be advertised, respectively. The US IWG permitted 25 (14%) products; the Ofcom regulations permitted 65 (37%) and the Danish Code permitted 13 (7%). Conclusion: Government-led schemes are significantly more restrictive than industry-led schemes, primarily due to their tougher sugar criteria. The Danish Forum (93%) and USA IWG scheme (86%) are the most restrictive of the five examined. Further harmonization of nutrient profiling schemes is needed to reduce children's exposure to the promotion of energy-dense foods. © 2013 The Authors.


Lobstein T.,International Association for the Study of Obesity
Appetite | Year: 2013

A series of meetings on the topic of children's exposure to the marketing of food and beverages was held between researchers and government officials based in Europe and the Americas during 2010-2011. The meetings resulted in a number of outputs, including observations from policy-makers on the types of evidence they needed to strengthen policy-making. Their observations on the definitions of a child, the specification of foods using nutrient profiling schemes, the types of media carrying marketing messages, and the related policy implementation problems, are summarised in this Short Communication. The paper highlights the need for research which can directly support policy-making and which can evaluate its effectiveness. © 2012 Elsevier Ltd.


Lobstein T.,International Association for the Study of Obesity
Proceedings of the Nutrition Society | Year: 2011

The recent rise in the prevalence of obesity in the UK population includes women of reproductive age and children. For both groups there are specific health concerns consequent on excess bodyweight, including obstetric complications, fetal growth abnormalities and a range of obesity co-morbidities seen in children that were rarely found in young people a generation earlier. This paper identifies some of the issues which challenge policy-makers: guidelines for gestational weight gain and for weight loss after pregnancy; inequalities and interventions in pregnancy; interventions to prevent child obesity; and the role of individuals, government and the commercial sector in implementing policies for promoting healthy weight. © 2011 The Author.

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