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					                                          ICO2010 Pre Congress Meeting
                       Sociocultural, Behavioral and Economic Factors in Obesity Prevention

                     Organised by the EASO Prevention Task Force and the Karolinska Institute

Date:                   Saturday 10 July 2010.
Location:               Nobel Forum, Karolinska Institute, Stockholm, Sweden.
Local Chairs:           Finn Rasmussen(Sweden), Lauren Lissner (Sweden)

Dear Colleagues

On behalf of the EASO Prevention Task Force, the Karolinska Institute, and the Scientific Advisory Group it is a great
pleasure for us to welcome you to this Pre Congress Meeting in Stockholm. We are very much looking forward to
inspiring presentations, which we hope will contribute to the further development of obesity prevention research.




Finn Rasmussen, Professor
Department of Public Health Sciences
Karolinska Institute, Stockholm and the Swedish Association for the Study of Obesity




Lauren Lissner, Professor
Department of Community Medicine and Public Health
University of Gothenburg and EASO Public Health and Prevention Task Force


About EASO

Established in 1986, EASO aims to promote research into obesity, facilitate contact between individuals and
organisations, and promote action that tackles the epidemic of obesity

EASO is a leading biomedical association in Europe with networks in over 30 countries. It hosts the annual European
Congress on Obesity (ECO), has dynamic and active Task Forces, organises educational activities throughout the region
and plays a major role in EU/WHO projects.

The objects of EASO are:

    •   To promote the preservation and protection of health and relief of sickness for the public benefit in the field
        of obesity and its related disorders

    •   To promote research, the dissemination of the results of such research and exchange of scientific information
        in the field of obesity within Europe

    •   To develop a deeper understanding of how to achieve and maintain a healthy bodyweight, and to manage and
        prevent obesity and its related conditions by those engaged in the study of obesity – healthcare professionals,
        health related organisations, governments and the European community

                                                     www.easo.org
                                                  Programme
0830 – 0900 hrs:    Registration and Coffee

Morning Session

0900 – 0945 hrs:    Emerging insights about constraints and opportunities for food companies to be more effective
                    in supporting obesity control. (40 min presentation + 5 min questions)
                    Derek Yach (US)

0945 – 1030 hrs:    Socio-cultural and economic challenges and opportunities for obesity prevention.
                    (40 min presentation + 5 min questions)
                    Boyd Swinburn (Australia)

1030 – 1100 hrs:    Morning Coffee and Posters

1100 – 1230 hrs:    Free Oral Communications
                    6 presentations selected from submitted abstracts (10 min presentation + 5 min questions)

1100 – 1115 hrs:    Health care costs of obesity in New Zealand.
                    Marj Moodie (Australia)

1115 – 1130 hrs:    Overweight and obesity among 7-9-year-old Swedish schoolchildren: Urban-rural gradient
                    partly explained by area education level.
                    Agneta Sjöberg (Sweden)

11.30 – 1145 hrs:   Targeting a low SES community for obesity prevention – results from Sweden.
                    Maria Magnusson (Sweden)

1145 – 1200 hrs:    Examination of the activitystat as a determinant of physically active and inactive behaviours.
                    June Stevens (US)

1200 - 1215 hrs:    8-year follow up of school-based intervention on childhood overweight – data of the Kiel
                    Obesity Prevention Study (KOPS).
                    Manfred Müller (Germany)

1215 – 1230 hrs:    Socioeconomic differences in obesity: the role of eating-specific and general psychosocial
                    factors.
                    Hanna Konttinen (Finland)

1230 – 1330 hrs:    Lunch
Afternoon Session

1330 – 1415 hrs:    Free Oral Communications
                    3 presentations selected from submitted abstracts (10 min presentation + 5 min questions)

1330 – 1345 hrs:    Reducing unhealthy weight gain in Fijian adolescents: results of the Healthy Youth Healthy
                    Communities project
                    Gade Waqa (Fiji)

1345 – 1400 hrs:    Outcomes of the It’s Your Move! Project – a 3 year, community-based obesity prevention
                    program in Australian adolescents
                    Lynne Miller (Australia)

1400 – 1425 hrs:    Evaluation of the Living 4 Life project: a youth-led, school-based obesity prevention
                    intervention
                    Jennifer Utter (New Zealand)

1415 – 1450 hrs:    Special Oral Session - Bridging the Evidence Gap in Obesity Prevention: A Framework to Inform
                    Decision Making (20 min presentation + 20 min discussion)
                    Shiriki Kumanyika (US) with discussant Thorkild I A Sørensen (Denmark)

1450 – 1520 hrs:    Afternoon Tea and Posters

1520 – 1600 hrs:    Guided Poster Session (4 minute orals)

                    The influence of empathy and self-efficacy on proficiency in motivational interviewing for
                    promoting healthy dietary and physical activity behaviors. The PRIMROSE study.
                    Benjamin Bohman (Sweden)

                    The EPODE Evaluation Framework.
                    Marije Van Koperen (Netherlands)

                    Food and Beverage Marketing on Children’s Television Stations in Canada: Is Self Regulation.
                    Working? Monique Potvin Kent (Canada)

                    A randomised controlled trial investigating self-weighing and obesity prevention in women
                    Catherine Lombard (Australia)

                    The obese among the poor: Is food security an indicator of obesity risk for the urban poor
                    women? Isil Ergin (Turkey)

                    Development and implementation of a European-wide community intervention in the IDEFICS
                    study. Iris Pigeot (Germany)

                    BMI gain between childhood and adolescence: influence of socioeconomic conditions in
                    southern Brazil. Maria Alice De Assis (Brazil

                    Save the World, Prevent Obesity: Social Movements as Stealth Interventions to Control Obesity.
                    Tom Robinson (US)

                    The relationship between financial stress and the allocation of household food expenditure
                    between core and non-core foods in Australian households in 2003/2004.
                    Cate Burns (Australia)

1600 – 1645 hrs:    Could restrained eating play a role in obesity prevention?
                    (40 min presentation + 5 min questions)
                    Jane Wardle (UK)

1645 – 1730 hrs:    Changing our approach to the design of obesity prevention interventions.
                    (40 min presentation + 5 min questions)
                    Tom Baranowski (US)

1730 hrs:           Close
                    Finn Rasmussen (Sweden)

1745 hrs:           Coaches depart to dinner venue
                              Morning Session – Invited Speaker Presentations
Emerging insights about constraints and opportunities for food companies to be more effective in supporting
Obesity control.
Derek Yach (US)

SVP, Global Health Policy
PepsiCo, Inc

The trends and causes of obesity have been well described. However, global consensus has not been reached on the
goals of obesity control, or on quantitative objectives for prevention and treatment based on evidence. This
presentation will highlight current industry proposals and actions to contribute to obesity prevention as well as
indicate constraints hampering more rapid progress.

There has been a recent transition from general commitments by the leading food companies regarding nutrition to
specific commitments to obesity prevention. Many of these have been inspired initially by the work of the UK Foresight
report on Obesity, and more recently by the White House Report on Obesity. Both spell out some actions industry
needs to play within the context of broader efforts required to prevention obesity in children.

Focused actions by the industry to control obesity include: i) Product development aimed at reducing portion size and
energy density through reformulation and replacement, ii) Changes to marketing to make healthy choices the easy
choices (by support of restricted marketing of certain products to kids in classic and new media ; labeling for clarity;
replacing certain products in schools), iii) Investment in industry and partnered research on topics like satiety and
lower calorie-increased nutrient density products, iv) Innovations in business model development and consumer
insights to shift from a volume and super-sizing norm to a greater appreciation of nutrition quality, v) Support for
community models of real change by independent researchers like those underway in Somerville, USA and through
Etude in France, vi) Advocacy for food subsidies to promote healthy and affordable eating; for public research to
support innovations in healthy eating and active living; in physical education in schools and active urban living, and vii)
Workplace leadership extending to families and community impact.

Most importantly, all efforts from food companies need to be supported by metrics and monitored and reported
independently in order to be regarded as credible by consumers, governments and NGOs.


Socio-cultural and economic challenges and opportunities for obesity prevention.
Boyd Swinburn (Australia)

WHO Collaborating Centre for Obesity Prevention, Deakin University, Melbourne

Obesity prevention programs at the community level are showing some successes and are providing the proof of
principle needed to work out ways to translate the emerging evidence to scale. The focus needs to change from
demonstration projects to influencing the systems that operate within communities and settings such as schools,
primary care, local government and so on. Some of the biggest barriers to promoting healthy choices for food and
physical activity are likely to be socio-cultural. For some cultures, positive underlying values such as love, respect,
caring, and status are closely linked with large amounts of food (served and eaten), larger body sizes and a low
engagement in sports and recreation activities. These manifestations or expressions of positive cultural values can be
obesogenic in certain contexts and they are likely to be difficult to overcome because culture is inherently
conservative. Other cultural aspects such as collectivism, strong hierarchies, and predominant authoritarian parenting
styles add further complexity to overcoming these barriers. Community leaders in these cultures need to be supported
to find positive, creative ways forward to maintain positive traditional cultural values but minimise their obesogenic
impacts.

At a higher level, obesity prevention faces severe economic challenges. Evidence is rapidly emerging that the
concurrent rise in obesity in most high income countries which started about three decades ago has been largely due,
at the behavioural level, to increasing energy intake. This passive overconsumption of energy has in turn been driven
by the increasing supply of cheap, tasty, available and heavily marketed foods and beverages. This in turn has arisen
from the economic systems we have created for business over the past half century: a market-based capitalism which
readily allows the externalisation of costs and internalisation of profits; increasing global trade characterised by
reducing barriers to market access by multi-national companies (which often constitute oligopolies); limited
regulations which protect consumer rights (and human rights); and a fetishism for economic growth, long after it has
delivered its optimal benefits for middle and high income countries. Thus obesity shares the same underlying
determinants as other global consequences of ‘market failure’ and overconsumption such as climate change, species
loss, and land degradation. As long as the powerful vested commercial interests of multi-national companies continue
to over-ride the interests of humans and environments, we will continue with business-as-usual. Political leaders
globally need to be supported to find creative ways to maintain the positive, growth-oriented economic systems for
poorer countries and to restructure for post-growth economic systems in wealthier countries.
                                 Morning Session - Free Oral Communications
Health care costs of obesity in New Zealand.
Lal, A1, Moodie, M1, Swinburn, B2

1
    Deakin Health Economics, Deakin University, Melbourne, Australia
2
    WHO Collaborating Centre for Obesity Prevention, Deakin University, Melbourne, Australia

Introduction: To estimate the health care costs attributable to overweight and obesity in New Zealand in 2006.
Methods: The prevalence of overweight and obesity was obtained from the New Zealand Health Survey 2006/7. We
used population attributable fractions (PAFs) to calculate the proportion of each disease attributable to obesity and
overweight based on the relative risks obtained from large cohort studies. The majority of the direct costs of each
disease related to overweight and obesity were obtained from the New Zealand Health Information Service, and the
New Zealand Ministry of Health. Where cost data was not available estimates were made based on Australian data. We
used a prevalence based approach to calculate hospital inpatient costs, hospital outpatients costs, out-of-hospital
medical services, general practitioner costs, residential care costs, pharmaceutical costs and laboratory test costs. For
each disease, the PAF was multiplied by the total direct cost. The total healthcare costs attributable to overweight
and obesity were determined by summing the PAF weighted costs. Sensitivity analyses were performed on the costs
based on Australian estimates.
Results: Health sector costs for obesity in NZ in 2006 are estimated to be $NZ625.2 million. This equates to 4% of New
Zealand’s total health care expenditure.
Conclusion: The health care costs attributable to overweight and obesity in NZ alone are considerable. In addition,
there are indirect and intangible costs, which we did not measure. Policies and interventions to reduce the prevalence
of obesity are urgently needed to decrease these substantial costs.
1. Conflict of Interest:
None Disclosed
2. Funding:
Research relating to this abstract was funded through the International Collaborative Research Grants Scheme by the
Wellcome Trust (UK), National Health and Medical Research Council (AUS), Health Research Council (NZ)

Overweight and obesity among 7-9-year-old Swedish schoolchildren: Urban-rural gradient partly explained by area
 education level.
Sjöberg A1, Yngve A2, 3, Moraeus L1, Poortvliet E2, Al-Ansari U2, Lissner L1

Affiliations:
1
  Sahlgrenska School of Public Health and Community Medicine, University of Gothenburg, Sweden
2
  Unit for Public Health Nutrition, Karolinska Institutet, Sweden
3
  Department for Health, nutrition and management, Akershus University College, Norway

Introduction: Sweden could from an international perspective be regarded as an egalitarian country. However, Swedish
children experience different health conditions depending on dwelling place and socio-economic status (SES). Overweight
and obesity has been reported to be more prevalent in smaller towns and in the countryside compared to the metropolitan
areas. Here we present urban-rural differences in prevalence of overweight and obesity based on a nationally representative
sample of 7-9-year-old Swedish schoolchildren. This survey was part of the WHO Childhood Obesity Surveillance Initiative
(COSI).
Methods: In spring 2008, 4538 children in 94 primary schools underwent anthropometric examinations. Trained field teams
measured weight, height and waist circumference with standardised methods. Overweight, pre-obesity and obesity were
defined using the IOTF classification, and waist to height ratio >0.5 was used as an alternative indicator. School areas were
classified to be urban, semi-urban or rural based on population density as defined by the European Commission, and as low,
medium and high SES based on proportion of the population with university degree. General linear regression models were
used to calculate odds ratios (OR) with 95% confidence intervals (95%-CI) for overweight, obesity and high waist-height ratio.
Results: Overweight was found in 17% of the children, including 14% pre-obesity and 3% obesity. For overweight, OR (95%-CI)
was 1.33 (0.92; 4.88) and 1.61 (1.25; 2.07) in semi-urban and rural areas, respectively, relative to urban areas.
Corresponding values for obesity were 1.72 (0.87; 3.40) and 2.25 (1.27; 3.98), and for high waist-height ratio 1.42 (0.88;
2.31) and 1.76 (1.20; 2.56), respectively. After adjusting for SES, differences by level of urbanisation levelled out. OR for
overweight was 0.97 (0.67; 1.42) and 1.14 (0.84; 1.54) in semi-urban and rural areas, compared to urban. For obesity
corresponding figures were 1.08 (0.48; 2.43) and 1.34 (0.63; 2.82) and for high waist-height ratio 0.90 (0.54; 1.49) and 1.02
(0.64; 1.61), respectively. We also found gender differences for obesity prevalence. Among girls alone, no significant urban-
rural differences were observed.
Conclusion: The urban-rural gradient in prevalence of overweight and obesity may have its origin in differences in living
conditions at the community level and could partly be explained by educational differences. Deeper studies of children’s and
families’ lifestyle in different areas are required to find out why overweight and obesity varies with level of urbanisation.
Conflict of interest: None Disclosed. Funding: The Swedish Council for Working Life and Social Research (#2006-1506, #2006-
1624), The Swedish Research Council (#2006-7777).
Targeting a low SES community for obesity prevention – results from Sweden.
Magnusson, MB¹ ², Kjellgren KI ³, Sjöberg A¹, Lissner L

1
  Department of Public Health and Community Medicine, Public Health Epidemiology Unit, The Sahlgrenska Academy at
the University of Gothenburg, Sweden
²Primary Health Care Clinic Angered, Gothenburg, Sweden
³Institute of Health and Care Sciences, the Sahlgrenska Academy at the University of Gothenburg, Sweden

Objective: The aim was to assess recent trends in obesity, health beliefs, food-related behaviours and markers of physical
activity in Swedish schoolchildren aged 11-12 years with a focus on socioeconomic disparities.
Methods: The study was conducted in two residential areas in Gothenburg, Sweden with high and low socioeconomic
status (SES), the latter with a high percentage of immigrants. All pupils in fifth and sixth grades (n=228) were invited. A
questionnaire on habitual diet, physical activity and health beliefs was used. Overweight, obesity and BMI z-score were
calculated from measured weight and height. Comparisons were made between (i) in the low SES school, 2008 versus
2003, when a similar study was conducted and (ii) the low and high SES school (2008).
Results: In the low SES school, there was a shift downwards in BMI z-score, significant in girls only. The prevalence of
obesity decreased non-significantly from 13 % to 7 %. In the high SES school, the corresponding prevalence was
significantly lower (less than 1 %). Numerous life-style habits differed between the schools, all in favour of the high SES-
school. In 2008 compared to 2003, significantly more children in the low SES school believed that their lifestyle could
affect their health. There was an improvement in some dietary variables but a decrease in physical activity.
Conclusion: In the last five years we observed a shift downwards in the BMI z-score for the girls in the low SES school,
in combination with a decrease in intake of calorically sweetened drinks and confectionary. The positive changes are
suggested to be a result of health promotion work and prevention efforts and may be connected to an increased belief
in the ability to affect one’s health. Our results underscore the importance of continuing preventive gender-sensitive
efforts to promote healthy habits and slow the childhood obesity epidemic. In this context, low SES-areas need to be
prioritized and actions should be tailored for the population. The difference in prevalence of obesity and many
lifestyle variables between children in residential areas of different SES are substantial, which calls for targeted
intervention efforts. A deeper understanding of the socio-cultural context of obesity in high risk areas, as well as of
gender-specific and psycho-social aspects, is urgently needed.

Grant support from the Region Västra Götaland, Sweden and from the Swedish Council of Working Life and Social
Research (FAS) is gratefully acknowledged.
Conflict of interest: We declare no conflict of interest

Examination of the activitystat as a determinant of physically active and inactive behaviours.
Stevens, J1,2, Baggett, C2
1
    Department of Nutrition, University of North Carolina, Chapel Hill, USA
2
    Department of Epidemiology, University of North Carolina, Chapel Hill, USA

Introduction: Although not a uniform finding, some studies have shown that increases in physically active behaviors
promoted by an intervention were accompanied by declines in other active behaviors resulting in total activity
remaining constant. These findings have lead to the “activitystat” hypothesis of physical activity compensation that
suggests total physical activity is regulated within a narrow range that is specific to individuals. The purpose of this
study was to determine if such compensation could be identified in an observational study. To our knowledge this is
the first study to examine this issue using repeated measures analysis and objective assessments of physical activity
and inactivity.
 Methods: Participants were 6,916, eighth grade girls participating in the Trial of Activity for Adolescent Girls (TAAG)
in the United States. Inactivity and physical activity were measured over 6- consecutive days using accelerometry (MTI
Actigraph). A within-girl, repeated measures design was used to assess the associations between intensities of physical
activity, inactivity and total activity using general linear mixed models. Evidence was sought within one day and over 2
day periods. Results: Within a given day, a 1-minute increase in MVPA was associated with a decline in inactivity of
1.85 minutes on the same day (95% confidence interval: -1.89, -1.82). A 1 MET-minute increase in inactivity was
associated with a decrease of 3.18 MET-minutes (95% confidence interval: -3.19, -3.17) of total physical activity
(activity > 2 METS) on the same day. Associations were similar when we examined if the activity levels on a given day
affected levels on the following day.
Conclusion: Our findings indicated that increases in MVPA resulted in a decline in inactivity and decreases in inactivity
resulted in increases in total physical activity. These results suggest that physically active episodes resulting from
behavioral interventions are unlikely to unintentionally cause increases in inactivity and that total physical activity
levels in individuals are not maintained within a narrow range as suggested by the activitystat hypothesis.

Funding: NIH/NHLBI (#U01HL-066845, HL-66852, HL-066853, HL-066855, HL-066856, HL-066857, and HL-066858)
8-year follow up of school-based intervention on childhood overweight – data of the Kiel Obesity Prevention Study
 (KOPS).
Plachta-Danielzik, S1, Landsberg, B1, Lange, D1, Seiberl, J1, Müller, MJ1
1
    Christian-Albrechts-University of Kiel, Kiel, Germany

Introduction: 4-year follow up data of school-based intervention of KOPS showed effects on prevalence, incidence and
remission of overweight in children of high SES (according to education) and normal weight mothers (Plachta-Danielzik
et al., obesity 2007).
Objective: To evaluate 8-year outcome of school-based health promotion on weight status, lifestyle factors and blood
pressure as part of KOPS.
Methods: Within a quasi-randomized controlled trial 240 intervention (I) and 952 non-intervention (NI) students at age
6 and 14 years were assessed between 1996 and 2008 in schools of Kiel, Germany. 6 nutrition units followed by 20
minutes running games were performed within the first year at school. Primary outcome was 8-year change in BMI-SDS
(according to German reference percentiles of Kromeyer-Hauschild et al., 2001). Successful intervention was tested
using multilevel linear regression analysis.
Results: 8-year changes in BMI-SDS were +0.18 and +0.22 with increases in prevalence of overweight from 8.3 to 10.4%
and 7.0 to 11.2% in I and NI students, respectively. Cumulative 8-year-incidence of overweight was 5.9% and 7.1% in I
and NI students. An effect of the intervention on 8-year changes in BMI-SDS was significant in students of high SES
families (-0.17 and +0.17 in I and NI; p<0.01) only. Intervention had no measurable effects on lifestyle habits and blood
pressure.
Conclusion: School-based health promotion has some favourable and sustained effects on 8-year changes in BMI-SDS
being most pronounced in students of high SES families. The data argue in favour of further preventive (including
environmental and political) measures.


1. Conflict of interest: None disclosed.
2. Funding: This work was supported by DFG Mu 5.1-5, WCRF and the „Kompetenznetz Adipositas (Competence
Network on Obesity)“ funded by the Federal Ministry of Education and Research (FKZ: 01GI0821).


Socioeconomic differences in obesity: the role of eating-specific and general psychosocial factors.
Konttinen, H1, Silventoinen, K1, Sarlio-Lähteenkorva, S1, Männistö, S2, Haukkala, A1

Affiliations:
1
  University of Helsinki, Helsinki, Finland
2
  National Institute for Health and Welfare, Helsinki, Finland

Introduction: Socioeconomic status (SES) differences in obesity and dietary patterns are well-established with those
having lower status being more obese and consuming unhealthier diets. However, the mechanisms explaining these
differences are less clear. At the individual level, motives underlying the food choice could contribute to the SES
gradient in obesity. Higher psychosocial distress among individuals with lower SES has also been one suggested
mechanism. The present study aimed to investigate whether eating-specific and general psychosocial factors explain
the SES differences in obesity in the general population.
Methods: Cross-sectional data from the FINRISK 2007 Study (Dilgom substudy) of 25-74-year-old Finnish men (n=2325)
and women (n=2699) were analyzed with multivariate regression analyses. Psychosocial factors measured included food
choice motives (Food Choice Questionnaire), psychological eating behaviours (TFEQ-R18), depressive symptoms (CES-D)
and general self-control (Self-Control Scale). Participants’ body mass index (BMI) and waist circumference (WC) were
measured in a health examination. Self-reported total years of education and household income were used to assess
participants’ SES.
Results: Education and income were inversely related to BMI and WC in both genders, except that income had non-
significant associations among men. From the nine food choice motives, price and familiarity of the food most clearly
differentiated between the SES groups: those having lower status considered familiarity and price more important.
Restrained, uncontrolled and emotional eating were unrelated to SES, while higher levels of education and income
were related to lower depressive symptoms and higher self-control. Uncontrolled eating (r=0.30 – 0.34), emotional
eating (r=0.25 – 0.32) and self-control (r=-0.16 – -0.23) were the strongest psychosocial correlates of BMI and WC in
both genders. Among women, adjusting for food choice motives and self-control attenuated the associations of
education with BMI and WC, but among men adjustments did not change the associations.
Conclusion: There was some indication that psychological food choice motives and general self-control contribute to
educational differences in obesity among women, but clearly also other factors are relevant including sociocultural and
environmental factors. More research is needed to better understand the mechanisms underlying the SES gradient in
obesity and to reduce these inequalities.

1. Conflict of Interest:
None Disclosed
2. Funding:
Research relating to this abstract was funded by the Academy of Finland (215450 and 118065, Research Programme on
Nutrition, Food and Health, ELVIRA)
                                   Afternoon Session - Free Oral Communications
Reducing unhealthy weight gain in Fijian adolescents: results of the Healthy Youth Healthy Communities project
Kremer, P1, Vanualailai, N2, Roberts, G2, Schultz, J3, Waqa, G2, Moodie, M4, Malakellis, M1, Pryor, J2, Swinburn, B4
1
    Deakin University, Geelong, Australia
2
    Fiji National University, Suva, Fiji
3
    National Food and Nutrition Centre, Suva, Fiji
4
    Deakin University, Melbourne, Australia

Introduction: Obesity prevalence is very high among Pacific populations. Adolescence is a critical period for obesity prevention
programs because of the rapid age-related weight gain in early adulthood. This paper reports on the outcomes of a 3-year
community-based project, Healthy Youth Healthy Communities (HYHC), undertaken with Fijian adolescents on the island of Viti
Levu. HYHC was part of the Pacific OPIC (Obesity Prevention In Communities) Project.
Methods: The HYHC intervention was developed with schools and comprised social marketing, capacity building, and nutrition and
physical activity initiatives designed to reduce unhealthy weight gain in adolescents. The evaluation of HYHC incorporated a quasi-
experimental, longitudinal design. Anthropometric, quality of life (QoL), behavioural and demographic data were collected on
adolescents from seven intervention secondary schools in the peri-urban area of Suva at baseline (2005/2006, n=2670, response
rate: 75%) and follow-up (2007/2008, n=874, follow-up rate: 33%). The comparison group was a matched sample of eleven secondary
schools from three towns from western Viti Levu with a baseline response rate of 73%(n=4567) and follow-up rate of 45% (n=2062).
Results: Adolescents from the HYHC intervention group had significantly lower percentage body fat (mean: -1.17%, 95% CI: -1.73 - -
1.10) after adjusting for baseline measure, relevant covariates and clustering by school, than comparison group adolescents. There
were no group differences for weight, body mass index, standardized body mass index, or proportion of overweight. Similar results
were obtained for separate Indigenous Fijian and Indo-Fijiian sub-samples. Results for behaviours indicated improvements towards
healthy patterns on most measures, however there were few significant group differences. Significantly lower increases were seen
in the intervention group for one measure of QoL (PedsQL) but not the other (AQoL).
Conclusion: A health promotion program focused on community capacity building did not significantly reduce unhealthy weight gain
or influence obesity promoting behaviours among a sample of Fijian adolescents. Despite strengthening evidence supporting the
efficacy of health promoting approaches to reduce obesity among younger children, it appears that this approach may be ineffective
for adolescents or in other contexts where significant economic, physical and social-cultural barriers may exist. Consequently, more
‘top-down’ or other innovative approaches may be needed in addition to community-based programs to reduce obesity among
adolescents from the Pacific region.

1. Conflict of Interest: None disclosed
2. Funding: Research relating to this abstract was funded by Wellcome Trust (UK), National Health and Medical Research Council
(Australia), and Health Research Council (NZ)

Outcomes of the It’s Your Move! Project – a 3 year, community-based obesity prevention program in Australian
adolescents
Millar, L1, Malakellis, M2, Kremer, P2, Mathews, L2, de Silva-Sanigorski, A2, Swinburn, B1, Moodie M1
1
    Deakin University, Melbourne, Australia
2
    Deakin University, Geelong, Australia

Introduction: Effective, long-term community-based intervention programs are needed for obesity prevention and adolescents are
an important, but unrepresented target group. It’s Your Move! (IYM) was a 3-year intervention project based in 5 secondary schools
in the Geelong/Bellarine region of Victoria, Australia and was part of the Pacific OPIC (Obesity Prevention In Communities) Project.
This paper reports results for the IYM intervention measured against a regionally-representative comparison group for body mass
index (BMI), BMI-z score and obesity-related behaviours.
Methods: IYM developed a 10 point action plan in collaboration with schools and implemented initiatives around social marketing,
capacity building, nutrition and physical activity through school project officers and student ambassadors. Objectives focused on
influencing key behaviours and environments to increase healthy eating and physical activity and improve the capacity of families,
schools and the community for promoting healthy behaviours. The evaluation had a longitudinal design with measured height,
weight, behavioural (diet & physical activity) and quality of life (QoL) collected pre- and post-intervention by trained staff. BMI-z
score was calculated using WHO criteria.
Results: Pre- and post-intervention response rates were 53% (n = 1852) and 69% (n = 1276) for the intervention group and 47% (n =
1188) and 66% (n = 778) for the comparison group respectively. Differences in post-intervention BMI and BMI-z scores between the
intervention and comparison groups were -0.12 (95%CI -0.36 - 0.10) and -0.05 (95%CI -0.11 - 0.02) adjusted for baseline variable,
age and height at follow-up, gender, duration between measurements, and clustering by school. Effects for girls and older students
approached significance (p values 0.02 - 0.05) with -0.10 difference in BMI-z score for older students, p<0.01 (95%CI -0.17 - -0.04).
Analysis of diet, physical activity, and QoL variables showed mixed results with no overall pattern of positive changes for the
intervention group.
Conclusion: The IYM program showed limited overall success in improving behavioural and anthropometric measures, however,
older students and girls may have responded more favourably. This limited effectiveness may be related to a combination of: the
general difficulty of changing established behaviours; the low receptivity of adolescents to health promotion efforts; the types
interventions and an insufficient ‘dose’ achieved over 3 years; and the relatively low level of government policy support for obesity
prevention action in adolescents at that time. Obesity prevention in adolescents is a challenge that necessitates innovative
approaches that require a mix of top down and bottom up health promotion efforts.

1. Conflict of Interest: None to declare
2. Funding: Research relating to this abstract was supported by the Victorian Government Department of Health, the National
Health and Medical Research Council, and VicHealth.
Evaluation of the Living 4 Life project: a youth-led, school-based obesity prevention intervention
Utter, J1, Scragg, R1, Faeamani, G1, Robinson, E1

Affiliations:
1
 School of Population Health, University of Auckland, New Zealand

Introduction: The Living 4 Life study was a three year, school-based intervention to improve nutrition, increase
activity and reduce obesity among an ethnically diverse population of adolescents. The study was part of the wider
Pacific Obesity Prevention In Communities (OPIC) study. The intervention activities were developed along positive
youth development principles by Student Health Councils within each school and included interventions like breakfast
clubs, physical activities at school, health promotions, and improvements to the quality of school foods.
Methods: The study design was quasi-experimental, with four high schools in the intervention and two high schools
with similar demographics of students as control schools. Student survey data and physical measurements of all older
students within each school (ages 15 to 18 years) were collected at baseline and at the end of the third intervention
year. Response rates for students were 66% (n=1634) and 66% (n=1612) for baseline and follow-up, respectively, and
were similar in intervention and control schools. To determine the effectiveness of the interventions, a random-effects
mixed model was used to test for changes in primary outcomes (e.g. body size measurements).
Results: There were no significant differences in changes in body size measurements or nutrition and activity
behaviours between the intervention and control schools. The prevalence of obesity in intervention schools was 32% at
baseline and 35% at follow-up; in control schools the estimates were 29% and 30%, respectively. Within school
improvements in nutrition and activity behaviours (reductions in television, soft drink consumption and breakfast
skipping) were observed in three of the four intervention schools and one control school. In these same schools, a
higher proportion of students at follow-up than baseline reported that their school encouraged healthy eating and
physical activity. One intervention school had a number of negative changes in student behaviours and perceptions
over the study period. Fidelity to the interventions varied between schools and was closely related to senior
administrative support. Contextual factors affecting study fidelity and outcomes will be discussed.
Conclusion: Our study did not demonstrate significant improvements to BMI; this may reflect that the intervention was
not intensive enough or that by adolescence, changes in BMI and related behaviours are difficult to achieve. School-
based nutrition and physical activity interventions that actively involve young people in the design of interventions
may result in improvements in student eating and activity behaviours, but active support from senior management and
adults within the school is required.

1. Conflict of Interest: None to disclose.
2. Funding: Research related to this abstract was funded by the Health Research Council of New Zealand.

Special Oral Session - Bridging the Evidence Gap in Obesity Prevention: A Framework to Inform Decision Making
Kumanyika, S. K.1, the Committee on an Evidence Framework for Obesity Prevention Decision Making, Lynn Parker2,
and Leslie Sim2

Affiliations:
1
  University of Pennsylvania School of Medicine, Philadelphia, PA, United States of America
2
  Institute of Medicine of the National Academies, Washington, DC, United States of America

Introduction: The obesity epidemic poses major challenges for policy makers, public health professionals, and other
decision makers. When decisive action is taken to address this epidemic they need evidence to explain why the actions
are needed and to help them determine what actions to take and how to go about them.
Methods: The Institute of Medicine of the National Academies will release a report in April 2010 on a framework for
evidence-informed decision making in obesity prevention efforts focused on approaches for assessing policy,
environmental, and community interventions designed to influence diet and physical activity.
Results: The result of an 18-month study by a committee of experts, including researchers and decision makers, the
report will provide an overview of the nature of the evidence base for obesity prevention as it is currently construed
and identify the challenges associated with integrating scientific evidence with broader influences on policy and
programmatic considerations. The report will provide a practical framework for how to select, implement, and
evaluate obesity prevention efforts and identify ways in which existing or new tools and methods can be used to build
a useful and timely evidence base appropriate to the challenges presented by the epidemic.
Conclusion: This speaker, the chair of the study committee, will review key policy and research findings and
recommendations from the Institute of Medicine report, including a focus on the utilization and support of this
framework as well as building a resource base to inform future decisions.

1. Conflict of Interest:
Committees assembled by the Institute of Medicine of the National Academies who write consensus reports undergo an
extensive selection process. Committee members serve as individuals without conflict of interest and with biases
minimized and balanced. None disclosed.

2. Funding: This report was funded by Kaiser Permanente; The Centers for Disease Control and Prevention; and The
Robert Wood Johnson Foundation.
                                      Afternoon Session - Oral Poster Session
The influence of empathy and self-efficacy on proficiency in motivational interviewing for promoting healthy
dietary and physical activity behaviors. The PRIMROSE study.
Bohman, B1, Forsberg, L1,2, Ghaderi, A1,3, & Rasmussen, F1

Affiliations:
1
  Department of Public Health Sciences, Karolinska Institutet, Sweden
2
  Department of Clinical Neuroscience, Karolinska Institutet, Sweden
3
  Department of Psychology, Uppsala University, Sweden

Introduction: Motivational interviewing (MI) is a brief psychotherapy that has proven effective in motivating clients to
accomplish behavior change. Training research suggests that proficiency in MI requires extensive practice with feedback
and supervision over time. However, the determinants of MI proficiency are not well known. Studies indicate that clinician
empathy and self-efficacy may function as predictors. The purpose of this study was to investigate whether pre-training
empathy and self-efficacy predicted proficiency in MI after training and supervision among nurses at child health centers
(CHCs).

Methods: PRIMROSE is a primary preventative randomized controlled study of childhood obesity conducted at CHCs in
Sweden. In this substudy, nurses (N=49) in the intervention group responded to self-report questionnaires measuring
empathy and self-efficacy, i.e., nurses’ beliefs in their ability to influence parents to promote healthy dietary and physical
activity behaviors in their children. Empathy was measured by the Helpful Responses Questionnaire, and self-efficacy by
a new instrument developed by our team. MI training consisted of a 4-day workshop, with the last 2 days focusing on
guided exercises and role-play. Nurses recorded sessions with parents and their children at CHCs. Sessions were coded
for MI proficiency using the Motivational Interviewing Integrity Code (MITI) and then supervised on 4 consecutive
occasions. Data were analyzed using multiple regression modeling. Predictor variables were pre-workshop empathy and
self-efficacy, expressed in standard deviations (z-scores). Outcome variables were MI proficiency indices according to the
MITI after workshop and supervision. Adjustments were made for time since workshop and number of years in profession.

Results: Pre-workshop empathy and self-efficacy did not significantly predict proficiency in MI among nurses at CHCs,
neither after workshop nor after 4 occasions of supervision. Regression coefficients per 1 standard deviation increase in
predictors ranged from 0.08 to -0.19 (p-values .98-.07).

Conclusions: Empathy and self-efficacy did not predict proficiency in MI among nurses at CHCs. Presumably, due to the
complexity of the phenomenon, to be able to predict MI proficiency several interpersonal and technical skills must be
taken into account.  


The EPODE Evaluation Framework.
                     1           2              3             4
Van Koperen, TM , Seidell, JC , Visscher, TLS , Greaux, KM

1,2,4
        VU University, Dept. of Health Sciences, Amsterdam, The Netherlands
3
    Hogeschool Windesheim, Zwolle, The Netherlands

Introduction: The objective of the effective EPODE program is to foster healthier lifestyles and to reduce childhood
overweight. It is a community based intervention (CBI) using multisectoral collaboration, political commitment, private
partners and social marketing principles. To give insight in the EPODE process and support European implementation, a
framework is needed to guide monitoring and evaluation of the program. This research is carried out for the EPODE
European Network (EEN).
Methods: First a program theory was composed by data retrieved from the EPODE National Coordination Team, EPODE
documents and literature on the evaluation of CBI. According to this program theory, semi-structured interviews with
EPODE local project managers and international experts on CBI and evaluation were conducted. The retrieved
information led to the construction of a logic intervention model. After the processindicators were added the initial
evaluation framework was build. The framework and indicators were then again discussed in expert workgroups and
finalized.
Results: The final EPODE evaluation framework follows an iterative process of input, activities, results and output on
four different levels: national, local, community and individual (the child). Within these levels indicators for the
process evaluation of the CBI EPODE can be found.
Conclusion: The evaluation of CBI’s as EPODE is challenging because many significant factors play a role in achieving
the desired health outcome. Stating a causal relation between these factors is impossible, but aforementioned
evaluation framework could be an aid in setting up the evaluation of EPODE similar CBI’s and to compare these on
methodology and outcome.

1. Conflict of Interest: None
2. Funding
1. Grant: Directorate General for Health and Consumers (European Commission)
2. EEN Project associated partners: Free University of Amsterdam (The Netherlands), Gent University (Belgium), Lille 2
University (France), Zaragoza University (Spain), Proteines (France), Fleurbaix Laventie Ville Santé NGO (France)
3. EEN private partners: Ferrero, Mars, Nestlé, Orangina-Schweppes
Food and Beverage Marketing on Children’s Television Stations in Canada: Is Self Regulation. Working?
Potvin Kent, M1, Dubois, L1, Wanless, A1

Affiliations: 1University of Ottawa, Ottawa, ON, Canada

Objective: To examine the differences in food and beverage marketing between 16 corporations participating in a self
regulatory advertising initiative designed to limit or improve the marketing of foods/beverages to children (CAI) and
those not participating in this initiatve (non-CAI) on two children’s television stations in Canada.

Methods: A content analysis of 41.5 hours of television on two children’s preferred stations was undertaken. All
promotions including advertisements, contests and sponsorship announcements and their nutritional content were
coded.

Results: While 7 corporations participating in the CAI did not advertise to children in our television sample, the
remaining 9 corporations in the CAI group were responsible for significantly more food/beverage promotions than the
16 corporations in the non-CAI group. The food category most frequently promoted by both CAI and non-CAI groups was
candy and snacks although the CAI group promoted significantly more candy and snacks than the non-CAI group. The
CAI group did not promote any beverages during our sample. Nutritionally, the CAI group promoted food products that
were significantly higher in fat and sodium although similar in fibre and sugar content than the non-CAI group.

Conclusion: Although the CAI and non-CAI groups may represent different types of corporations, with the exception of
the 7 corporations that did not market to children at all, commitments that have been made in the Children’s Food
and Beverage Advertising Initiative do not appear to be having a measurable influence on the food and beverage
promotions viewed by children in Canada.

1.   Conflict of interest: none disclosed.
2.   Funding: This research was funded by the Canadian Institutes of Health Research.


A randomised controlled trial investigating self-weighing and obesity prevention in women
Lombard C 1, Teede H.1

Affiliations: 1The Jean Hailes Foundation for Women’s Health, School of Public Health and Preventive Medicine,
Monash University, Melbourne, Australia

Introduction: Self-weighing is emerging as a potentially important strategy in weight management. In prospective
cohort and observational studies regular self-weighing has been associated with greater weight loss and improved
weight maintenance following weight loss, but few trials have reported self-weighing in the context of a randomised
controlled trial. This study investigated the influence of self-weighing on weight change as part of a randomised
controlled trial to prevent weight gain in community based women.
Methods: 250 mothers of young children (mean age 40 years ± 4.5, mean BMI 27.9kg/m2 ± 5.6) were recruited from 12
primary schools and randomized as clusters to intervention (n=127) or control (n= 125). The self-management lifestyle
intervention (HeLP-her) consisted of 4 group sessions and mobile phone text support over 1 year. Regular self -
weighing was emphasised as one of the key behavioral strategies. The control group received generic population diet
and physical activity guidelines in a single group session with no instruction to self-weigh. Measures included measured
weight, frequency of self-weighing, physical activity and food intake.
Results: At 4 months the intervention women who regularly self-weighed lost weight (-1.66 kg) compared to those
who rarely self-weighed (+0.07kg), a difference of -1.73kg (95% CI; -3.35 to -0.11 p=0.04). At 12 months regular self–
weighing was associated with weight loss in intervention participants (-1.11kg, SD 3.96) but not in control participants
who gained weight (+0.88kg, SD 4.66) a difference between groups of -1.99kg (95%CI, -3.75 to -0.23, p=0.03). Women
in both intervention and control groups who did not self weigh gained weight at 12 months (0.62kg and 0.78kg
respectively) with no difference between groups (-0.16; 95% CI,-1.23 to 0.90, p=0.74). Baseline BMI was similar in both
the regular weighers and the non-regular weighers (mean BMI 27.8 kg/m2 and 27.6 kg/m2 respectively).
Conclusion: Self-weighing when paired with a simple self-management intervention to prevent weight gain has a
significant impact on weight change in the short term and longer term.

Conflict None
Funding Research relating to this abstract was funded by the William Buckland Foundation Australia, VicHealth, and
NH&MRC.
The obese among the poor: Is food security an indicator of obesity risk for the urban poor women?
Ergin, I1, Turk, M2

Affiliations: 1 Ege University, Department of Public Health, Izmir, Turkey

Introduction: The adaptive mechanisms in food scarcity, lack of free choice for nutritious food and the role of food
insecurity has been key to describing the relation between poverty and obesity. Food insecurity in urban poor women
has been related with obesity. This study aimed to determine prevalence of obesity and food insecurity and their
relationship among urban poor women
Methods: Cross-sectional study was conducted among 20-64 year-old women in Naldoken, an urban poor area of Izmir
city, Turkey in 2005. The target population were urban poor women (1578) living in the area served by the Naldoken
Primary Care Center. The random sample (n=265) stratified by age, had face-to-face interviews and anthropometric
measurements with a 90.9% response rate. Body mass index was used for obesity classification. The state of food
insecurity and poverty was evaluated.
Results: Among the women, 56.8% lived in absolute poverty and only 34% had food security. Obesity prevalence was
46.1%. Obesity risk doubled at households with food security. Food security was more achievable for nuclear families,
where households had steadier jobs with less experience of unemployment and those above absolute poverty level.
Obesity predominates in this “in-between” socioeconomic stage where people are “relatively poor” but food “secure”.
Conclusion: The food secure group among the urban poor presents a doubtful “security” considering their increased
risk for obesity. The content of their diets and the achieved success in supplying food and becoming food secure should
be thoroughly examined in the context of obesity.

1. Conflict of ınterest: None disclosed
2. Funding: No funding

Development and implementation of a European-wide community intervention in the IDEFICS study.
Keimer, KM1, de Henauw, S², Hebestreit, A1, Marild, S³, Molnár, D4, Moreno, L5, Siani, A6, Tornaritis, M7, Veidebaum,
T8, Verbestel, V², Pigeot, I1 on behalf of the IDEFICS Consortium
1
 University of Bremen, Bremen Institute for Prevention Research and Social Medicine, Bremen, Germany
²Ghent University, Faculty of Medicine and Health Sciences, Department of Public Health/ Department of Movement and Sport
Sciences, Ghent, Belgium
³Göteburg University, Queen Silvia Children's Hospital, Department of Pediatrics, Göteburg, Sweden
4
 University of Pécs, Medical Faculty, Department of Paediatrics, Pécs, Hungary
5
 University of Zaragoza, Zaragoza, Spain
6
 National Research Council, Institute of Food Sciences, Unit of Epidemiology & Population Genetics, Avellino, Italy
7
 Research & Education Institute of Child Health, Strovolos, Cyprus
8
 National Institute for Health Development, Tallinn, Estonia

Introduction: The IDEFICS community intervention was implemented in eight European countries (Belgium, Germany,
Estonia, Italy, Sweden, Spain, Hungary, Cyprus) over the duration of one year (08.2008- 07.2009). It aims at
behavioural as well as structural changes in the areas of diet, physical activity (PA) and stress coping.
Methods: The IDEFICS community intervention was developed with the help of “intervention mapping” (Bartholomew
et al. 2004) and focus groups (with parents, pedagogues and children aged 6 to 8 years). Three steps were necessary
for the development: 1. Definition of intervention goals; 2. Selection of appropriate theoretical strategies and
practical methods; 3. Design of an intervention plan. Subsequently ten intervention modules on four levels
(community, settings school and kindergarten, families, individuals) were designed.
Results: Key messages are: eat more vegetables and fruits, consume more water, increase PA, reduce television
viewing, adequate sleep duration and spend more (family) time together. The developed intervention modules were
translated and locally adapted to each country. These modules are: 1. Involvement of community partners; 2. Long-
term media campaign and public relation strategy; 3. Lobbying for community environmental and policy interventions;
4. Building partnerships/ Involvement of school representatives; 5. Education of children/ healthy weeks; 6.
Environmental changes related to physical activity ; 7. Health related physical education curricula; 8. Environmental
changes and school policy related to water consumption; 9. Environmental changes and school policy related to fruit
and vegetables; 10. Education of parents. The modules were presented and handed over to the participating schools
and kindergartens in the form of a handbook. International examples on the implementation of these modules will be
presented. Lessons learned and ideas for improvement will be given.
Conclusion: Adaptation of modules to individual country specifics was partly difficult. Barriers in the cooperation with
stakeholders had to be overcome during the intervention. Many stakeholders were reluctant to actively take part in
the intervention and to undertake the necessary structural changes. Despite these difficulties several modules were
successfully implemented and first (structural) changes in the intervention regions are visible.

Bartholomew, KL, Parcel GS, Kok G, Gotlieb NH (2004) Intervention Mapping: a protocol for applying health psychology theory to
prevention programmes. J. Health Psych., 9, 85-89
1. Conflict of Interest: None Disclosed.
2. Funding: Worked out within the IDEFICS Project (www.idefics.eu); Funded by the EC, FP 6, Contract No. 016181 (FOOD).
BMI gain between childhood and adolescence: influence of socioeconomic conditions in southern Brazil.
De Assis, MAA1, González, DA2, Costa, FF1

Affiliations: 1 Federal University of Santa Catarina, Florianopolis, SC, Brazil.
2
  Federal University of Pelotas, Pelotas, RS, Brazil.

Introduction: Obesity is an increasing problem around the world and is associated with socioeconomic position.
Evidences suggest that among females from middle income countries a socioeconomic inversion of obesity occurs in
adolescence, and poorest women become more obese than wealthiest.
Objective: To assess the association between socioeconomic predictors and body mass index (BMI) change from
childhood (7-10 years) to early adolescence (11-14 years).
Methods: School-based prospective study conducted in Florianopolis (southern Brazil). In 2002 a systematic sample of
school age children had their weight and height measured. Information on socioeconomic variables (monthly family
income, number of children, persons per sleeping room and type of school: private or public) were collected. Measures
were repeated again in 2007. Outcomes variables were generated based on WHO growth standards: BMI for age z-
scores (BAZ) in 2002 and 2007, and the difference in BAZ between the two periods. Multivariate linear regression
analyses were performed to assess the contribution of each potential socioeconomic predictor on the outcomes, based
on a hierarchical model. Baseline BAZ was included as a covariate for BMI z-score change analysis to correct for
regression to the mean.
Results: 586 children were included in the analysis (58% girls). In 2002 and 2007, mean BAZ was higher among males
(boys 0.56 and 0.47; girls 0.24 and 0.08, respectively). The reduction in BAZ between 2002 and 2007 was significant
only among girls (β=-0.16 95%CI -0.25;-0.18).
For boys, BAZ was positively associated with family income and persons/room in 2002 and 2007, even after adjustment
for confounding (mean differences among extreme categories between 0.4 to 0.8). For girls, in 2002 BAZ was only
associated with the number of persons/room (direct trend). On the other hand, family income which was not
associated with BAZ in 2002, showed an inverse association in 2007 (mean difference between extreme categories -
0.46, P=0.003). BAZ change between 2002 and 2007 showed a reduction among boys who had a greater number of
siblings. Among girls BAZ reduction was higher among wealthiest (higher family income and with lower number of
persons/room), even after adjustment for confounders.
Conclusion: Among males there is a direct association between socioeconomic position and BAZ, which begin early in
childhood and persist in adolescence. Among girls, an inverse association became apparent in adolescence as a
consequence of decrease in BAZ among wealthiest and slightly increase in poorer. This highlights the importance of
intervention in different periods for males and females.

Save the World, Prevent Obesity: Social Movements as Stealth Interventions to Control Obesity.
Robinson, TN

Affiliations:
Division of General Pediatrics and Stanford Prevention Research Center, Stanford University School of Medicine
Stanford, California, U.S.A.

Most efforts to achieve energy balance by directly targeting eating and activity behaviors produce relatively modest
effects lasting for limited periods of time. Elusive have been approaches that result in large, sustained changes.
Accomplishing this goal may require a whole new way of looking at the challenge of altering behaviors to achieve
energy balance. Stealth interventions emphasize the incentive value of the process of behavior change -- rather than
the resulting health-related outcomes. By focusing on process motivators, health-related outcomes become side
effects of the interventions from the perspective of those participating. Applying these principles has proven
successful in screen time reduction, dance, and team sports interventions to prevent and control obesity in children. It
also may be possible to apply the same principles to produce much larger, more sustained, and more widely adopted
behavior changes as parts of broader ideological and social movements. Looking for examples where individuals adopt
and sustain dramatic changes in their behaviors, social and ideological movements stand out. These may act, in part,
via self-, collective- and/or public identity formation and expectations, effects of social interaction and/or support,
associated emotional valence, and avoiding threats to personal failure through collective responsibility, thus enhancing
perceived individual self-efficacy and collective efficacy. Because the goal behaviors of many existing social
movements overlap with obesity-related behaviors, they represent potential stealth interventions for obesity reduction
which are already proving motivating to sizeable segments of the population. Examples include, environmentalism and
climate change, food safety, food justice, community safety, beautification and traffic reduction, human rights/social
justice, anti-globalization, animal protection, political action, anti-consumerism, violence and crime prevention,
cause-related fundraising, energy independence, and national security/anti-terrorism. Allying with these movements
could be the ultimate expression of the stealth intervention approach. If successful, substantial reductions in
population levels of obesity may occur without having to persuade the public to change their eating and activity
behaviors for purposes of attaining and maintaining a healthy weight.

1. Conflict of Interest: None
2. Funding: No Funding
The relationship between financial stress and the allocation of household food expenditure between core and
non-core foods in Australian households in 2003/2004.
Burns, C 1, Gold, L 2

Affiliations: 1 WHO Collaborating Centre for Obesity Prevention, Deakin University, Melbourne, Australia
2
  Health Economics Unit, Deakin University, Melbourne, Australia

Introduction: It is known that those with fewer socio-economic resources are more likely to be overweight or obese.
Socio-economic resources can be measured using income. However,it also possible to quantify socio-economic
resources by looking at how households spend their income and face deprivation. Financial stress can be
conceptualised as a measure of this ‘deprivation’. Similarly it is possible to characterise dietary patterns using
household food expenditure rather than dietary survey data. Expenditure data has the added advantage of indicating
allocation of funds between food types. This study examined the relationship between financial stress and the
allocation of household food expenditure between core (healthy) and non-core (unhealthy) foods.
Methods: A secondary analysis of the Australian Bureau of Statistics (ABS) Household Expenditure Survey 2003-04 was
conducted (n= 6957 households). Financial stress was measured using a validated 6 item questionnaire within the
survey which was summed as a score. The population was grouped; no financial stress, moderate stress and high stress.
Using ABS food codes and the Australian Guide to Healthy Eating, ‘at home’ food purchases were categorised into
aggregate core and non-core food groups, with 5 core subgroups and 7 non-core subgroups. To examine within-
household allocation of food spending, expenditure for each food group was expressed as a proportion of total ‘at
home’ food expenditure. The relationships between these proportions and different levels of financial stress were
analysed using a generalized linear model GLM.
Results: Preliminary analyses indicated the allocation of expenditure to the core subgroup of fruit decreased
significantly with increasing financial stress. However, proportional allocation of food expenditure to the non-core
subgroups of soft drinks and processed meats increased significantly with increasing financial stress.
Conclusions: Differences are evident in the way that households experiencing financial stress allocate food
expenditure between core and non-core foods. Further research is required to identify how financial stress impacts on
the amount and allocation of household food expenditure.
1
 . No conflict of interest 2. Burns is funded by a VicHealth Public Health Fellowship, Gold an NHMRC Capacity Building
Grant
                                   Afternoon Session - Invited Presentations
Could restrained eating play a role in obesity prevention?
Jane Wardle (UK)

Cancer Research UK, Health Behaviour Research Centre Department of Epidemiology and Public Health University
College London, London, UK.


The rise in rates of obesity has highlighted the need for effective weight control strategies at the population level.  
Environmental strategies that make healthy lifestyles easier are an essential component.  Recommendations to the 
public on increasing physical activity and improving dietary quality are also regarded as important.  But whether 
members of the public who are obese or at risk of obesity should be advised to restrict their food intake is more 
controversial.  Even more contentious are issues of weighing and calorie counting: should overweight people be advised 
to keep track of their weight or their calorie intake?  Some authorities see these restrictive practices as self‐evidently 
good, while others regard them as at best useless and at worst likely to lead to eating disorders.   
 
This presentation will briefly review the literature relating restraint to weight control and consider the potential for new 
theoretical and methodological approaches to clarify the circumstances in which restraint can promote effective weight 
control. 

Changing our approach to the design of obesity prevention interventions.
Tom Baranowski, PhD

Professor of Pediatrics (Behavioral Nutrition and Physical Activity)
Baylor College of Medicine
USDA/ARS Children’s Nutrition Research Center
1100 Bates St, Rm 2050
Houston TX 77030-2600
USA

We are at a crossroads in obesity prevention research: do we tweak our current interventions thinking all we need are
minor changes “to get it right!” or do we transform to an exploratory method that builds a foundation to make it right
in each community? Most of the hundreds of obesity prevention interventions have not worked; when they worked they
produced small changes; and there is no apparent pattern between the effective and ineffective programs to guide
future efforts. While it is clear that an elementary energy balance model is inadequate for preventing obesity, and
possible that non-energy-balance biological causes may be partially at play that also need serious investigation, we
need to more carefully examine what we are doing. An analysis applying a conceptual mediating variable model
reveals that our measures of adiposity, behaviors and psychosocial and environmental mediators are inadequate; what
behaviors are causing elevated adiposity are not known; strong causal influences on the behaviors have not been
identified; and there is no literature on effective procedures for manipulating the mediating variables. An alternative
approach builds a foundation for intervention in specific targeted groups by conducting sequential exploratory studies:
1) identify the behaviors causing obesity in the targeted population; 2) identify the psychosocial and ecological causes
of the offending behaviors; 3) test the procedures that change those causes enough to change the behaviors; and 4)
pilot test a comprehensive intervention. This alternative offers promise of building interventions on firm empirical
foundations that should lead to effective interventions, but take a longer time.
                                                  Poster Abstracts

Poster 1: Nutrition and Students’ Health at the Medical Faculty Kragujevac
Prof. dr Nela Đjonovic

Affiliations: Medical faculty University of Kragujevac
               Institute for Public Health Kragujevac

Aim: We wanted to explore if students of the Medical faculty in Kragujevac were fed correctly, which dietary habits
had significant relation to BMI, how much they knew principles of energy balance and how they applied them in daily
life.
Material and methods: We have used specially designed questionnaire for gathering data about their health, habits
and nutrition. The research was undertaken at the Medical faculty of Kragujevac during June 2008 and January 2009.
Approximately 150 randomly selected students of the III, IV and V years answered the questionnaire. We used standard
statistical methods to calculate our results, SPSS for Windows ver. 11.0.
Results: The average BMI of students was 21.49±3,08, minimal BMI was 16,30, and maximum was 29,30. Sex had a
significant association with BMI (χ2 =55,81,r<0.05), as did the consumption of soft (soda) drinks (ρ=0.455,r<0.01), high-
fat food (ρ=0.253,r<0.01) and excessive energy intake (ρ=0.362,r<0.01). Body weight and BMI were not related to
consumption of black coffee (ρ=0.091,r>0.05) or by an increased amount of taken food after skipping a meal
(ρ=0.169,r>0.05). Fluctuation of body weight during studies affected the consumption of soft (soda) drinks
(ρ=0.304,r<0.01), high-fat food (ρ=0.246,r<0.01), amount of food by meal (ρ=0.259,r<0.01), but fluctuation of body
weight during the studies was not influenced by sex (χ2=14,4,p>0.05).
Conclusion: Students of the Medical faculty in Kragujevac were in a group of average fed persons for their age.
Nutrition habits were not influenced by sex and age.

Key words: Nutrition, students, habits.

Poster 2: Socioeconomic and lifestyle factors associated with overweight and obesity in young Australian adults.
Allman-Farinelli M, Chey T

Affiliation: University of Sydney, Sydney, Australia

Introduction: We have previously demonstrated that generation is an independent risk factor for overweight and
obesity in the Australian population and are planning prevention programs for young adults. The aim of this study was
to analyse data obtained from 20 to 29 year olds in the National Health Survey (conducted by the Australian Bureau of
Statistics) with respect to socioeconomic and lifestyle behaviours that might predict overweight and obesity to target
interventions appropriately.
Methods: Secondary analyses of the nationally representative data set included descriptive statistics (prevalence) and
logistic regression models with adjustment for all included variables. All analyses were stratified by gender. Variables
included were age group (20-24 and 25-29), country of birth (Australia/other English heritage or other) education (four
categories from nil post school to degree or better), household income (highest to lowest quintile), participation in
leisure time physical activity and/or walking for transport (four categories), smoking (current or not) alcohol
consumption (four categories) and whether they consumed two or more and four or more serves of vegetables daily.
All analyses were with SAS(v9.1 2003 SAS Institute, Cary, NC, USA)
Results: Overall 30.8% of females (F) and 47.6% of males (M) were overweight or obese and the risk was greater for 25-
29 year olds (OR 2.0 95%CI 1.6 to 2.5 M and OR 1.5 95%CI 1.2 to 1.8 F). Subjects born outside Australia were less likely
to be overweight. Income and education were determinants in men only (OR 0.6 95%CI 0.4-0.8 for degree and OR 1.6
95%CI 1.2-2.3 quintile 5 lowest vs. highest for income). Among lifestyle factors smoking and alcohol intake were
significant in women (smoking OR 1.5 95%CI1.1-1.9 and low to moderate alcohol OR 0.8 95%CI 06.-1.0). Participation in
leisure time physical activity or walking for transport was not predictive but only 15% of subjects surveyed reported no
activity. Amount of fruit and vegetables intake showed no difference in risk.
Conclusion: This analytical study of the national survey indicates socioeconomic variables are important risk factors in
young men but less so in young women. More in depth surveys and longitudinal data are indicated to detect risks of
weight gain with behavioural factors.
Poster 3: Physical activity behaviour in children
Bergman P1, Mårild S1

Affiliations: 1University of Gothenburg, Sahlgrenska Akademin, Department of Paediatrics, Gothenburg, Sweden.

Background: Physical activity in children is of great importance, as it is associated with many risk factors for chronic
diseases. The association of physical activity and health depends most likely not only on the total physical activity
during a certain day, but also on the physical activity behaviour i.e. not only the total time being physical active but
also how this time has been accumulated. Despite the large amount of literature on the positive health effects of
physical activity little is known regarding physical activity behaviour and health in children.

In this study we aim to quantify and describe children’s physical activity behaviour.

Methods: An accelerometer assesses physical activity by detecting bodily displacement i.e. acceleration. The
acceleration is represented by an analog voltage created by a piezo-electrical instrument converting the mechanical
energy from acceleration to electrical voltage. The voltage signal is summarised over a user defined time period, an
epoch, into what is called a count. The counts represent the intensity of the physical activity performed during that
specific epoch.

To quantify the physical activity behaviour all epochs within a predefined count interval was summarised to give the
duration of physical activity at a given intensity level. To estimate how the time had been accumulated the number of
occasions it took to accumulate that time was calculated. An occasion is defined as a continuous run of epochs at a
given intensity level. A high accumulation-to-occasion ratio is hypothesized to indicate a spontaneous behaviour while
a low would indicate a more planned behaviour.

In this study 610 children from the IDEFICS-study wore an accelerometer during all time awake for a minimum of two
days. The accelerometers were set to collect data every 15th second.

Results: Boys tended to have accumulated more time than girls at all intensities. There was evidence that a peak in
duration at almost all intensities was apparent for the 4-5 year olds. Boys accumulated their physical activity at more
occasions indicating a more spontaneous behaviour compared to girls. The younger children showed a greater
spontaneity in the lower intensities while the older did in the higher intensities.

Conclusion: The proposed method to quantify physical activity behaviour was able to show differences in physical
activity behaviour depending on gender and age. The decline in physical activity previously thought of as occurring
during the transition from childhood to adolescence may start as early as age 4-5.

Poster 4: Behaviour Problems and Overweight in Adolescence  
Boa-Sorte N, Santos D, Grave L, Feitosa C, Marques L, Amorim T1.

Affiliations: Public Health Institute – Federal University of Bahia, Salvador, Bahia, Brazil

Introduction: several studies report association between behavioural problems and chronic diseases, and show that
adolescence is a stage of life very sensitive to behavioral changes, with high risk to such problems. Recent studies have
shown increased prevalence of overweight and obesity among brazilian adolescents. These findings can’t be explained
only by genetic aspects and changes in lifestyle. Although it is controversial, there are evidences that behavioural
problems and overweight are associated, so that it is essential to better understand this relationship. Consequently, the
final aim of the present study was to analyze association between behavioural problems and overweight among brazilian
adolescents.
Methods: cross-sectional study with partial analysis of 227 adolescents, aged 11 to 18 years old, living in Monte Gordo
                                                                                                   th
district, Camaçari, Bahia, Brazil. Overweight was defined as BMI/age index greater than 85 (CDC/NCHS 2000).
Behavioural problems were estimated by Youth Self Report questionnaire (YSR), one of the most widely used
standardized instruments for measuring self-reported problems in adolescents aged 11 to 18 years. Instead of placing the
adolescent in one or several diagnostic categories, the reported problems vary on eight narrow-band syndromes and two
broader dimensions (internalizing and externalizing). The youth is asked to rate each item on a three-point scale: 0 = not
true, 1 = somewhat or sometimes true, and 2 = very true or often true. The adolescent was asked to rate the items for
how well they describe him or her now or during the past six months. The 90th percentile was used as the cut-off for
behavioral problems and broader dimensions. Social economic status (SES) was classified on three levels: low, middle
and high, based on familiar percapita income. Prevalence Ratio (PR) was obtained by Poisson regression with robust
variance.
Results: We observed overweight prevalence of 11.9%, and it was higher, but not significantly, among girls (PR: 1.40; CI
95%: 0.59 – 3.32). We identified behavioural problems at 10.2% of subjects; internalising problems were the most
common (22.12% versus 8.41% of externalising problems). Association between behavioural problems and overweight
(PR: 2.52; CI95%:1.13-5.61) remained after gender, age and SES adjustment (adjusted PR: 2.40; CI95%:1.06-5.44), with
the same results for internalising problems (adjusted PR: 2.06; CI95%:1.01-4.20).
Conclusion: Results demonstrate association between behavior disturbance and overweight, suggesting that these
agents are very important in understanding aetiology of overweight and obesity.

1. Conflict of Interest: None Disclosed
2. Funding: Research relating to this abstract was funded by FAPESB (Agency of Promotion of the State of Bahia) 
Poster 5: Nutrients and alcoholic beverages in relation to obesity markers in an adult Swedish population
Brandhagen, M1 , Bertéus Forslund, H1 , Lissner, L2 , Winkvist, A1, Lindroos, AK3, Carlsson, L4, Sjöström, L4,
Larsson, I5 ,

Affiliations: 1 Department of Clinical Nutrition, Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden
 2
   Department of Public Health and Community Medicine, Sahlgrenska Academy at the University of Gothenburg, Gothenburg,
Sweden
3
  MRC Human Nutrition Research, Cambridge, United Kingdom
4
  Department of Molecular and Clinical Medicine, Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden
5
  The Obesity Unit, Sahlgrenska University Hospital, Gothenburg, Sweden.

Introduction: A higher energy density is often associated to a higher total energy intake, which promotes fat
deposition. Alcohol has high energy density and the consumption of different types of alcoholic beverages could be
related to body weight increase and abdominal fat deposition.
Methods: The Swedish Obese Subjects reference study is a population based cross-sectional study in the Gothenburg
area comprising 524 men and 611 women, 37-61 years old and BMI 17.6- 45.4 kg/m2. The participants answered a
retrospective dietary questionnaire on habitual food intake including intake of alcoholic beverages during the last
three months. The participants specified intake frequency from standardized portions of different foods and drinks.
The nutrient intake was calculated from the retrospective food survey. Anthropometry and biochemical risk variables
for cardiovascular disease were measured. Body composition was measured by Dual energy X-ray absorptiometry. The
nutrient intake was analysed in relation to anthropometric measures in multivariate regression analysis, adjusting for
age, all energy contributing nutrients and education. For the analyses of different types of alcohol containing
beverages the model was adjusted for age, energy intake, other types of alcohol containing beverages and education.
Results: In sex specific fully adjusted models a significant positive association between intake of alcohol from spirits
and waist circumference in both men and women were found (men: β: 1.74, p<0.01; women: β: 2.33, p<0.01). In men
a significant positive association between spirits and %body fat was found (β: 0.71, p<0.05). In women sagittal
diameter, SAD (β: 0.58, p< 0.01) and BMI (β: 0.79, p<0.01) were significant positive associated with consumption of
spirits. In men a negative association between fat intake and BMI (β:-0.03, p<0.01), SAD (β: -0.02, p<0.05) and waist
circumference (β: -0.05, p<0.05) were found. In men only protein were positively associated with BMI (β: 0.03, p
0.001), body fat% (β: 0.04, p<0.05), SAD ( β: 0.02, p 0.01) and waist circumference (β: 0.09, p>0.01).
Conclusion: Spirits appears to be a strong risk factor for central and general obesity in both men and women.
Furthermore in men inverse associations between fat intake and BMI, SAD and waist circumference were found. Protein
intake in men was positively associated to both general and central obesity measures. Although the cross- sectional
design of this study does not permit any causal conclusions, the results however underscore the need of more
knowledge about obesogenic diets.

Poster 6: Assessing the role of cultural, social and economic factors in an early childhood obesity prevention
intervention
Thébaud V1 ; Daniels L1; Margarey A2

Affiliations:
1
  School of Public Health, Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Australia.
2
  Nutrition and Dietetics Department, School of Medicine, Flinders University, Adelaide, Australia

Introduction:
Evidence is accumulating that parental feeding practices strongly influence children’s eating patterns, which in turn determine
adult eating habits. Family based interventions are recognised as a promising strategy for obesity prevention. However, most
prevention interventions aimed at reducing the prevalence of obesity in children have focused on school-age children and met with
limited success. Recent reviews have highlighted that guidance to parents to establish positive feeding practices should be provided
at an earlier age when children are particularly receptive, and before adverse habits are established. As in all obesity prevention
interventions, cultural, social and economic factors may moderate the success of such strategies. This communication will present a
doctoral research project aimed at determining how such factors can influence the impact of family interventions on early feeding
practices.
 Methods:
The project will utilise data from participants in the NOURISH Randomized Control Trial (RCT) initiated in 2008, to assess the effects
on early feeding practices of anticipatory guidance to a group of first-time mothers, commencing when the infants were 4-6 months
of age. The communication will present a research plan designed to evaluate the moderating influence of cultural, social and
economic factors on the effectiveness of the intervention, including i) a review-based analysis of the role of these factors in the
efficacy of child obesity prevention interventions; ii) a description of the RCT and main variables available to carry out the analysis,
iii) the key assumptions examined, and iv) the research methods.
Results:
Based on the literature review, key cultural, social and economic factors that potentially influence the outcomes of obesity
prevention studies will be presented and discussed, along with the variables commonly used to measure them. Comparison with the
variables measured in the NOURISH trial define the data set on which the analysis will be based. The methods for the analysis will
also be discussed, based on the literature review.
Conclusion:
The communication will present a review of the role of cultural, social and economic factors and the extent to which these are
considered in evaluating the outcomes of child obesity prevention interventions. A proposed method to assess moderation by these
factors in the NOURISH RCT will be included.
1. Conflict of interest none 2. Funding: NOURISH is funded by the National Health and Medical Research Council; research related
to this abstract is supported by an Australian Postgraduate Award.
Poster 7: Involvement of children to change the design of the physical environment of the school yard
Eiben G1, Teimouri, M2, Svennberg M2

Affiliations: 1Sahlgrenska School of Public Health and Community Medicine, University of Gothenburg, Sweden.
               2
                 Department of Arts and Cultural Development, Region Västra Götaland, Gothenburg, Sweden

Introduction: Ecological behavioural models state that the physical environment has a direct association with physical
activity. In other words, merely living in a more supportive neighbourhood will lead to higher levels of physical
activity. This is an important lifestyle factor, contributing to maintain and improve health in all age groups. Especially
in children it is important to establish healthy activity behaviours in order to maintain them throughout life. Younger
children have still a natural drive to be active, which makes it easier to encourage them to be more physically active.
Children are at the same time also more vulnerable and therefore the children’s environments need to be supportive
for physical activity. Small changes to the environment are also believed to target many in the society i.e. making
changes to the school yard environment will affect all children at that school.
Methods: Politicians, representatives from the municipality, children and adolescence, teachers, pedagogues, property
manager, and the IDEFICS-study in Sweden collaborated together with architecture pedagogues from the region in
order to create an inspiring school yard. The architecture pedagogue had regular meetings together with school
children at all age groups. They discussed how the school yard is being used so far and new ideas how to change the
school yard environment.
Results: After three month of work, the children together with the architecture pedagogue had created a list with
proposals, which has been discussed with the collaborating stakeholders. A large diversity of ideas mainly depending
on age and interest were presented. Many of the suggestions were small alterations of the environment, e.g.
exchanging sticky bushes, multicolour playground markings, creating new small spaces for different activities by using
plantation, benches and shelters. To light up the school yard in order to use it in the dark season was another. Other
suggestions required more financial resources, e.g. plastic grass on the football pitch, create space for playing street
football, basket, volleyball and a skateboard vertical. However, not all suggestions were aimed to create more
opportunities for physical activity, some was aimed for creating places were the children can meet, rest and talk.
Conclusion: To involve children in creating their environment results in large engagement with many feasible ideas.
Most of the suggestions were aimed to stimulate and increase physical activity; however some suggestion were made
to create meeting places, which are also important for the children’s wellbeing and health in a social perspective.

Poster 8: Tongan adolescents’ perceptions of relationships between diet, body weight and health: Implications for
obesity-prevention.
Fotu, K1, Mavoa, H2

                1
Affiliations:       Fiji School of Medicine, Suva, Fiji
                2
                    WHO Collaborating Centre for Obesity Prevention, Deakin University, Melbourne, Victoria, Australia

Introduction: The prevalence of obesity in Tonga is among the highest in the world and little is known about
sociocultural factors that influence patterns of eating, physical activity and body size. This study explored the
perceptions and beliefs of 12-18 year old Tongans about relationships between current eating patterns, health and
body weight, as well as predictions about these relationships when participants leave school.
Methods: Tongan interviewers conducted semi-structured interviews with 48 Tongan adolescents. Interviews focused
on everyday eating patterns and perceived relationships between food, health and body weight. Data were analyzed
collaboratively by Tongan and European researchers.
Results: : Most adolescents reported consuming energy-dense, nutrient-poor foods and sweet drinks at home and at
school. There was a high awareness of the health benefits of local foods, including fruit and vegetables, however,
fruit and vegetable consumption was very low. While participants recognized that energy-dense nutrient-poor foods
were both unhealthy and obesogenic, weekday consumption was high. Participants recognized that local (traditional)
foods were healthier than imported foods and snacks. Primarily, females associated sweet drinks with obesity and poor
health. The primary behavioural consequences of obesity identified by participants were being unhealthy, and lazy,
lethargic and short of breath while walking, running and doing chores. Both female and males predicted that both
their intake of energy-dense, nutrient-poor foods, sweet drinks and body weight would increase after they left school.
Half of the participants expected to eat more regularly than currently once they left school because they expected
more ready access to food and more opportunities for eating breakfast and/or lunch. The consumption of more food as
school leavers was also related to having more control over food choices, with more unsupervised time at home.
Conclusion: While these adolescents were aware of healthy and unhealthy foods and drinks, their reported diets did
not reflect their health knowledge. Further, adolescents predicted increases in both food consumption and body
weight as school leavers. They also predicted increases in consumption of more energy-dense food and sweet drinks as
adults. These results have implications for targeting current and future dietary behavior, given that there is a marked
increase in the prevalence of obesity in early adulthood.
Poster 9: Access to bariatric surgery – an example of gender linked health inequality
Gill J, Hartland AJ, Khan A, Elshaw A, Heitmann M

Walsall Manor Hospital, Walsall, UK

Introduction: Observation of patients referred to a tertiary referral centre for bariatric surgery suggested a health
inequality with not only a large female:male ratio, but males having more obesity related co-morbidites at referral.

Methods: Audit of 226 randomly selected patients referred for to a tertiary referral centre bariatric surgery over a 6
year period (2004-2009).

Results: Of 226 patients audited, 181 were female (80.1%), 45 males (19.1%) p<0.01. Average ages: 44 years (male), 42
years (females). Average weight and body mass index was greater in males (117.7 v 136.8 kg, p<0.01, 55.8 v 50.6
kg/m2, p<0.05). The prevalence of hypertension (15.6% v 7.7% p<0.01), type 2 diabetes (6.7% v 3.9% p<0.01) and
dyslipidaemia (13.3% v 5.5% p<0.01) was highest in males. The prevalence of depression (20.4% v 11.1% p<0.01) and
back pain (12.7% v 4.4% p<0.01) was greatest amongst females. There was no significant difference in the male:female
prevalence of Ischaemic heart disease (6.6 v 6.6%) or osteoarthritis (26,7 v 27.8%). By allotting a score of +1 for each
co-morbidity, males had a greater co-morbidity index score at referral (1.0 v 0.79 p<0.05).

Conclusions: Our investigation found that fewer males than females were referred for bariatric surgery. Males referred
had greater morbid obesity and more obesity related co-morbidities than females. This suggests a potentially serious
health inequality. The reasons for this inequality require further investigation. However, our study suggests that the
current healthcare system in the UK may be disadvantageous to males in the acquisition of clinically effective bariatric
surgery.

1.Conflict of Interest:
None
2.Funding:No Funding

Poster 10: Prevalence of overweight and obesity in 7 years old children in the Czech Republic – development in
last 50 years
Kunesová,M 1, Vignerová, J2 Braunerová, R1, , Procházka, B3, Parizková, J1 , Kalousková,P1, Marková, V1, Riedlová, J2,
Zamrazilová, H1, Steflová, A4
1
  Obesity Management Centre, Institute of Endocrinology, Prague, Czech Republic
2
  National Institute of Public Health, Prague, Czech Republic
3
  Paediatric Clinic, Kutná Hora, Czech Republic
4
  WHO, Prague, Czech Republic

Objective: Assessment of time trends in childhood overweight and obesity prevalence is an important tool for
evaluation of strategies in childhood obesity prevention and treatment. The aim of the study was to compare
prevalence of obesity in 7 years old children in the Czech Republic in the last fifty years..
Methods: A total of 1704 children between 6.5 and 7.5 years of age were evaluated in 2008, the data were compared
with the results in 7 years old children examined during the Nationwide Anthropological Surveys in 2001 and with the
data from 1951.
Results: Increasing prevalence of overweight and obesity was shown in 7 years old children from 1951 to 2001.
Enhancement in prevalence of overweight was about two-fold, obesity prevalence increased 4.6times in boys and
3.2times in girls. In period from 2001 to 2008 decrease in obesity prevalence in girls, and decrease in overweight
prevalence in both genders was shown, mild increase was shown only in obesity prevalence in boys.
Conclusion: The results of the long term follow up of overweight and obesity prevalence in 7 years old children suggest
positive trend in last 7 years possibly partly as a result of preventive strategies in the Czech Republic.

Supported by grant NS/9832-4 IGA Ministry of Health, Czech Republic.
Poster 11: Establishing a healthy growth trajectory in formula-fed infants: the BabyMilk trial
Lakshman R1, Griffin S1, Hardeman W2, Ong K1

Affiliations:
1
  MRC Epidemiology Unit, Cambridge, UK
2
  Department of Public Health and Primary Care, Cambridge, UK

Introduction
In 2004, based on new data on energy expenditure, the World Health Organisation lowered the recommended energy
requirements for infants by 15 to 20%. Current formula-feeding instructions in the UK correspond to the earlier 1985
WHO recommendations and this may contribute to the faster weight gain in formula-fed compared to breastfed
infants. BabyMilk is an explanatory randomised controlled trial to evaluate the efficacy and acceptability of a theory-
based, multi-component behavioural intervention to lower formula-milk intake (based on 2004 WHO recommendations)
and prevent excessive infancy weight gain.
Intervention
To develop and optimise the intervention and evaluation tools, we undertook two systematic reviews and performed
qualitative studies with mothers and a range of healthcare professionals. The intervention is based on Social Cognitive
theory and includes a motivational component, a component to help translate motivations into actions, and support for
mothers to cope with difficult infant behaviour. 700 formula-fed infants will be randomized to receive standard advice
or the intervention, which involves three face-to-face contacts and two telephone contacts during the first six months
of life in addition to theory-based leaflets and materials.
Outcomes
The primary outcome will be weight gain from birth to 1 year, conditional on birthweight. Secondary outcomes include
infant anthropometry, milk and dietary intakes, sleeping and other behaviours. Process measures such as psychological
mediators of the intervention will also be measured.
Conclusion
The BabyMilk trial will enhance understanding of the factors related to excessive infant feeding and weight gain and
will inform future strategies for obesity prevention.
1. Conflict of Interest:
None Disclosed
2. Funding:
Medical Research Council, UK

Poster 12: Sociocultural factors underpinning recreational physical activities in adolescent females from four
cultural groups: Implications for obesity prevention
Mavoa, H1, Waqa, G2 , Fifita Fotu, K2 and Swinburn, B1

Affiliations:
    1. WHO Collaborating Centre for Obesity Prevention, Deakin University, Melbourne, Australia
    2. Fiji School of Medicine, Fiji

There is a greater decrease in females’ recreational physical activity (recreational PA) during adolescence than for males.
Sociocultural factors impacting on recreational PA are likely to vary across cultural groups and these variations are likely to
be more pronounced during adolescence than during childhood. This paper draws on interviews with adolescent females from
four cultural groups (Fijians and IndoFijians in Fiji; Tongans in Tonga; Caucasians in Australia). It compares participants’
reports of recreational PA and their perspectives on inhibiting factors.
Methods: Interviewers were from the same sexes and same cultural groups. Semi-structured interviews were conducted with
24 participants aged 12-18 year per cultural group. Interview transcripts were subjected to constant comparative thematic
analysis. Researchers from each cultural group analysed the data independently then together.
Results: There were similarities in all cultural groups in terms of participants reporting that 1) male peers engaged in more
recreational PA than females, and 2) females were less likely to engage in recreational PA because they lacked motivation,
had insufficient skills, lacked muscle strength and/or were unfit Participants in all groups indicated that peer expectations
and peer acceptance were key influences on females’ recreational PA. There were also clear differences between cultural
groups in terms of engagement in recreational PA and perceived inhibiters. In line with survey data, more Australian
Caucasian interviewees reported engaging in physical activities during recreation than Fijians, who were more recreationally
active than either Tongans or IndoFijians. Sociocultural factors that interviewees saw as inhibiting adolescent females
recreational PA included 1) expectations (norms) of appropriate activities for young females (Tongans; Fijians; IndoFijians),
2) parental restrictions (Tongans; Fijians; IndoFijians), 3) safety (Tongans; Fijians; IndoFijians), 4) household responsibilities
(Tongans; Fijians), 5) embarrassment during mixed-sex activities (Tongans; IndoFijians), and 6) dress (Tongans; IndoFijians).
Some cultural groups prioritised study over recreational PA ((Tongans; IndoFijians; Australians).
Conclusion: The culturally-specific barriers identified by participants in Tonga and Fiji highlight the fundamental need to
take into account underlying values and role expectations when developing obesity-prevention programmes. This is especially
important during adolescence when there may be clear and increasing expectations of gender-appropriate activities and
when socio cultural factors contribute to rapid decline in recreational physical activities for females.

1. Conflict of Interest: None
2. Funding:
Welcome Trust (Fiji and Tonga)
National Health and Medical Research Council (Australia).
Poster 13: The use of culture in interventions targeting diet and physical activity: lessons learned from studies
among ethnic minorities.
Nicolaou M, Nierkens V, Vissenberg C, Hosper K, Beune E, Hartman M, van Valkengoed I, Stronks K

Affiliations: Academic Medical Centre, University of Amsterdam, the Netherlands.

Introduction: Overweight and obesity prevalence is often high in ethnic minority groups, making them important
targets for intervention activities. There is a general consensus that interventions aimed to achieve behavioural
change are likely to be more effective when they take the culture of the target group into account. Several reviews
suggest the effectiveness of culturally sensitive interventions compared to ‘standard care’ or ‘no intervention’. Little
is known, however, about the effectiveness of specific cultural elements. Which cultural adaptations increase the
effectiveness of interventions? Insight into the specific cultural elements that facilitate behaviour change in ethnic
minority populations will enrich the evidence base for interventions aimed at these groups. In addition, knowledge
gained from this field of research may inform the development of obesity prevention programmes aimed at the
population as a whole.
Methods: Systematic search in Medline, Psychinfo and Embase. Search terms included 'racial/ethnic groups', 'cultural
sensitivity', ' health promotion', 'nutrition', 'physical activity' and 'weight loss'. Included were studies on ethnic minority
adults 18yrs and older that evaluate specific cultural elements.
Preliminary Results: Studies that evaluate specific cultural components are scarce. We found 10 interventions that
tested specific cultural components: primary outcomes were physical activity only (2), dietary behaviour only (2) and
overweight/obesity (6). The types of cultural adaptations tested were the inclusion of sociocultural values in
intervention materials, use of lay health promoters, incorporation of faith and attention to the ethnic composition of
participants. The different cultural adaptations tested indicated some effect on primary and secondary outcome
measures. Many were not statistically significant.
Discussion: The cultural elements and effects of the studies are very mixed implying that we cannot draw clear
conclusions about the effectiveness of specific cultural elements. Our results indicate that the inclusion cultural
elements in interventions contribute to behavioural change. However more ‘experimental’ studies in which specific
elements are tested are required to further refine the available evidence. Insights from this field of research can
inform the development of interventions aimed at the other target populations such as lower socioeconomic groups in
the majority population.

1. Conflict of Interest: None
2. Funding:
Internal funding from the department of Public Health, AMC, University of Amsterdam

Poster 14: Dietary Patterns and Emerging trends of Childhood Obesity in India and Behavioural Management
           1         2
Nigam,R , Rishi , P
               1
Affiliations: JLN Cancer Hospital,Bhopal,India.
2
    Indian Institute of Forest Management, Bhopal,India

Introduction: The pace for teens and children is fast and getting faster. Added to the pressures from school and
increasing competitiveness to prepare for college or a job, participation in sports and extra activities further changes
the nutritional demand and eating patterns of children. Owing to that, it was planned to study the dietary patterns
and obesity trends of urban school children of middle to higher socioeconomic status using physical growth parameters
of height and weight and bio-chemical parameter of blood cholesterol.
Method: A sample of 156 school aged urban middle and upper class physically and mentally healthy children (5-12
years)was selected from the schools of Bhopal city of India. A comprehensive dietary schedule was used by the
investigator consisting of Demographic Profile, Physical Profile, Biochemical Profile, Dietary Profile and Cognitive
Profile.
Results: The total calorie intake of the sample was found to be below or near the normal , however, calories from fat
and proteins intake were relatively high. 13.8 % of the sample was above 95th percentile indicating the over weight
condition while 10.3 % of the sample was between 85th –95th percentile of B M I for age indicating the children at risk of
being over weight. A major finding of this study revolves around high fat intake and its possible short term and long
term consequences. The dietary fat per day was found to be in the excess of 12-13 gms which is also being depicted in
the bio chemical parameter of serum cholesterol levels of these children. Around 56% of the sample had border line to
high risk levels of serum cholesterol(<170mg%) putting them at high risk of developing hypercholesterolemia later. A
high intake of fat, especially the high percentage of saturated fat in the diet of children may be one of the reasons for
elevated cholesterol levels.
More children were on high junk food diet with a high impact of visual media like TV advertisements and showing
higher levels of serum cholesterol and were overweight or at risk of being over weight. More so, the combination of
excess dietary fat with continuously reducing physical activity levels in urban children makes the situation more grim.
Conclusions: Childhood obesity is a growing problem in India. Since obesity is a known risk factor for many adult
diseases, curtailing childhood obesity is vital to ensuring children grow up to be healthy adults. Recommendations for
excess fat management, life style management and dietary behavioural modification were made.

1. Conflict of Interest: None
2. Funding: No Funding
Poster 15: The development of a post-graduate multidisciplinary training program for treating childhood
overweight.
Øen, G.1, Stormark, K.M.2

Affiliations:
1
  Haugesund/Stord University College, Stord, Norway
2
  UNI Health, Bergen, Norway

Introduction: There is a demand for increased training of community health workers in treating overweight in
children. This training program aimed primarily at health care nurses is based on a psycho-educative, family-based
empowerment approach to the overweight problem. The main themes in the program is: Understanding overweight,
treatment approaches, establishing therapeutic alliance and motivational interviewing. During one half of the teaching
program the students worked in multi-professional groups, in order to increase the cooperation skills in meeting the
overweight child and his/her family as a coordinated team.
Methods: Forty multidisciplinary students attend the training program. 36 students filled in questionnaires about
knowledge and attitudes about overweight in children, before and after taking part in the training program.
Results: The students reported a pronounced increase in both knowledge and competence in working with overweight
issues in children and their families. Most pronounced was the increase in specific treatment methods and specifically
in motivational interviewing. A clear majority of the students reported a marked increase in security and coping with
overweight issues, and also that quality of the health services they provided had improved due to this training
program.
Conclusion: This training program led to increased knowledge and competence about overweight issues in children and
their families, especially on treatment perspectives and motivational interviewing. The students also reported that
participation in the program was associated with improved services for the overweight child and their family.
Conflict of Interest: None Disclosed.
Funding: Research relating to this abstract was funded by Centre for Child and Adolescent Mental Health, UNI Health,
Bergen

Poster 16: Applying socio-cultural lenses to childhood obesity prevention among African migrants to developed
countries: Lessons learnt from the African Migrant Obesity Study
Renzaho, AMN1, Wilson, A2, Mellor, D3, Green, J, Swinburn, B1, McCabe, M3

Affiliations: 1WHO Collaborating Centre, Deakin University, Australia; 2Cairns Public Health Unit, Australia; 3School of
Psychology, Deakin University, Australia

Introduction: Post-migration, African migrants are at an increased risk of obesity and obesity-related diabetes. The
aim of this study is to identify socio-cultural factors that predispose African migrants to obesity.
Methods: The African Migrant Obesity Study incorporated three complementary qualitative studies that included a
total of 30 semi-structured individual interviews with. 12 adolescents and 18 parents, and 17 focus group discussions
(N=143 i.e. 50 13- to 17-year old children and 93 parents).
Results: Four major themes emerged: 1) New food environment characterised by a) an abundance of cheap and readily
available processed, packaged and labelled food, b) nutrition messages that are complex to gauge due to poor literacy
levels, c) promotion of a slim body size which contradicts pre-existing cultural values surrounding body shape; and d)
Australian food being perceived as full of harmful chemicals; 2) intergenerational acculturation gap; 3) parental
feeding practices; and 4) lifestyle-related adjustments. Wide misunderstanding and scepticism of the Australian food
supply was evident and we found significant intergenerational differences in relation to how the new food environment
is interpreted and negotiated. Whilst parents and adolescents shared views regarding packaged food and chemicals in
food, there were significant intergenerational differences in how nutritional messages were interpreted. Adolescents’
school education and higher language and literacy levels gave them a greater knowledge of nutrition and health.
Intergenerational differences in preferred body size were also apparent and adolescents, influenced by their Australian
peers and Western media sources, demonstrated a preference for a slim body size. Intergenerational conflicts related
to parenting practices, especially in the feeding domain and decision making, impacted negatively on children’s
nutritional and lifestyle choices. Parents spoke of a significant lifestyle change-related stress, from a traditional and
easy-going community-orientated lifestyle to one which was hectic, time-constrained and busy. In contrast, young
people felt that the lifestyle in Australia was much easier than in Africa.
Conclusion: Significant intergenerational differences in relation to beliefs and the new food and health environment
typify life in African migrant families. Community-based obesity prevention programs need to have an understanding
of the cultural and social dimensions that shape the lives of African migrant communities and acknowledge changes in
traditional family roles and values that are occurring post migration. The emphasis should be on the addressing risk
factors associated with cultural transition and values related to parenting, family functioning, and social support, and
most importantly intergenerational acculturation gaps

Conflict of Interest
No conflict of interest
Funding
Andre Renzaho is supported by a NHMRC Capacity Grant. The study was funded by The Victorian Health Promotion
Foundation and the Deakin University Faculty Research Development Grant
Poster 17: Health promotion in community residences for adults with intellectual disabilities
             1                      1
Bergström, H , Schäfer Elinder, L

Affiliations: 1Dept. of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden

Introduction: Adults with intellectual disabilities have a high risk of developing overweight and obesity, leading to ill-
health and chronic diseases. In general, the level of physical activity is low and often diets are poor. The staff in
community residences often has low education, and therefore health promotion should target both residents and staff.
The purpose of this project is to develop and evaluate an intervention promoting physical activity and healthy eating
among people with intellectual disabilities living in community residences.
Methods: The 1-year intervention is directed at both residents and staff and consists of three core components: 1) A
study circle conducted by and for staff and based on a newly developed booklet “Focus health” consisting of 10
themes. 2) A study circle for residents based on a material called “Drivers license of health”, an educational and
practical material developed by “Studieförbundet Vuxenskolan”. 3) Appointed “Health ambassadors” chosen among
staff in each residence, who will receive health education and whose role it is to inspire colleagues and build a
network. Participants are recruited from 32 community residences in Stockholm County with a total of about 160
subjects. The design of the study is a cluster randomized controlled trial with physical activity as the primary outcome
and diet, BMI, waist circumference, and quality of life as secondary outcomes. Physical activity is measured with
pedometers while diet is assessed by a novel method in this target group, namely digital photography. Quality of life is
assessed through a brief interview with residents. Intermediary outcomes are related to opportunities for healthy
eating and physical activity assessed through questionnaires to and interviews with staff. Qualitative methods will also
be used to describe and analyze barriers and opportunities to health promotion in this setting.
Results: Baseline data is currently being collected and results will be presented. The assessment of diet by digital
photography is being validated and will be discussed.
Conclusion: The intervention is well received but there are several challenges working with this target group.

1. Conflict of Interest: None Disclosed
2. Funding: Research relating to this abstract was funded by the Stockholm County Council

Poster 18: Obesity risk factors - education through health and safety at school
Siradze L. MD PhD1 , Saakashvili N. MD PhD2.

Gorgasali st N9 Tbilisi 0105 Georgia
Georgia Development Agency
Science Practical Canter of Rehabilitation and Prevention

Introduction: Rising health risk factors and post-conflict vulnerability & violence have a tremendous affect on the
learning potential of pupils and subsequently on the health of the community, therefore on economic restoration and
growth. An analysis of the existing data of the Georgia National Center for Control of Diseases indicates that there
are higher indicators of obesity - 23%. Despite increased indications of diseases, Georgia does not have a regulation
policy or educational materials for health education in schools (standards, indicators, national policies, strategies,
guidelines, text books or curriculum). On the other hand the state law of education demands that schools provide a
healthy and safe learning environment for pupils and staff. The analysis of the data of disease, its spread and
the requirements of state regulations inspired the "Georgia Development Agency" to found the alliance “Health and
Safe school” (AH&SS) in 2008. Members of AH&SS are private medical professionals, scientific and practical clinics and
the National Center for Control of Disease. AH&SS closely collaborates with the Ministry of Science and Education,
Ministry of Labor, Health and Social Affairs, civil professional unions of teachers and international organizations.

Methods: The Georgia Development Agency with the Unit of Elementology studied the level of micro and macro
elements in the weekly diet of 29 pupils aged 10-12 years. After analysing the results, we developed health eating
modules regarding international indicators, that were adapted with traditional Georgian eating habits. The health
eating modules as a part of civil educational lessons were delivered to pupils in the Public school N24 Tbilisi.

Results and Conclusions: It was agreed to incorporate the of Health Educational learning materials in Healthy
Lifestyles and to include "Health & Safe" Educational knowledge into the subject of “ civil education” (obesity,
smoking, blood pressure…) The Alliance H&S school, with the Georgian Ministries of Education and Health and other
national organizations, assessed and improved their capacity to educate healthy life skills through schools. The civil
initiative of private experts at the nexus with government (Ministries of Health and Education) are the best solution
for promoting health education, the value of health & safety care skills, for the new generation, school staff, parents
and community in Georgia.

1. Conflict of Interest: None Disclosed
2. Funding:
Georgia Development Agency
Science Practical Canter of Rehabilitation and Prevention
To made agreement with Ministries of Health and Education of Georgia.
Poster 19: Abstract Title: The role of sociocultural factors in obesity etiology in Pacific adolescents and their
parents: A mixed-methods study in Auckland, New Zealand
Teevale, T., Thomas, D.R., Scragg, R., Faeamani, G., Nosa, V.

Affiliations: School of Population Health, University of Auckland, Auckland, New Zealand.

Introduction The South Pacific region has the highest rates of obesity in the world. However, of particular concern is
the higher prevalence observed in Pacific population groups in New Zealand. Pacific adults (63.7%) and children
(23.3%) have an almost three-fold higher risk of being obese compared to the general population (26.5% for adults;
8.3% for children).These disparate rates and the lack of empirical data to support the development of preventive and
management actions to address obesity among Pacific populations in New Zealand, is the key motivation behind the
current study. The aim of the study was to explore socio-cultural factors that may promote or prevent obesity in
Pacific communities in New Zealand. Specific objectives were to describe the behaviours, beliefs and values of Pacific
adolescents and their parents, related to food consumption and physical activity and to examine the patterns among
obese and non-obese Pacific adolescents and their parents.
Methods A self-completion questionnaire was administered to 2490 Pacific students who participated in the New
Zealand arm of the Obesity Prevention In Communities (OPIC) project. Sixty-eight people (33 adolescents and 35
parents) from 30 Pacific households were interviewed in the qualitative phase of the study. To meet the comparative
objectives of the study, Pacific households were recruited by obese (n=15) and healthy weight (n=15) status of
adolescents.
Results Household socio-economic position, parental occupational type, health education and experience were
significantly linked to healthy eating and physical activity behaviours. Socio-cultural factors such as values and beliefs
about food and physical activity, which were comparable between obese and non-obese Pacific adolescents and their
parents, showed only small associations with health behaviours. Obese adolescents held the same attitudes, beliefs
and values about food and physical activity as their healthy-weight counterparts, but these factors were not protective
for obesity-risk.
Conclusion This study indicates that social status and environmental factors related to poverty affect the health-
promoting behaviours of Pacific communities in New Zealand. To address obesity in Pacific youth in New Zealand,
specific macro-environmental changes are recommended including food pricing control policies to mitigate healthy
food costs, revising sustained employment hour policies, making changes to school food and physical activity
environments.
Conflict of Interest / Funding: None Disclosed/Applicable

Poster 20: Comparison of the body composition of young people aged 15-17 of different socio-economic status
living in a less-urbanized region of Poland
                 1            2             1
Wadolowska, L , Dlugosz, A , Bieganska, J
1
    University of Warmia and Mazury, Olsztyn, Poland
2
    Nicolaus Copernicus University, Bydgoszcz, Poland

Introduction: Health inequalities and the occurrence of excess weight and obesity are primarily based on social and
economic factors. The results of research concerning the effects of socio-economic stratification of Poles are not
explicit. The aim of the research was to analyse the body composition in relation to socio-economic status (SES) of
young people aged between 15 and 17, living in a less- urbanized region of Poland.
Methods: 250 boys and 252 girls aged 15-17 participated in the research. The teenagers lived in a city (>150,000
inhabitants) or in small towns and villages of a less-urbanized region of north-eastern Poland, with a predominance of
agricultural areas. Body composition was estimated by the use of anthropometric methods. SES characteristics
included: declared economic situation of the family (4 categories), size of the place of residence (3 categories),
parents’ education (3 categories each) and parents’ main sources of income (5 categories each). The SES index was
calculated as the product of numerical values assigned to verbal statements of SES characteristics, and the persons of
low, mean and high SES were determined based on a tertile distribution of the SES index.
Results: Girls with high SES, in comparison to girls with low SES, were most frequently taller (height>2SD; 5% vs. 0%,
respectively) and had a larger waist circumference (by 3.6 cm on average), hip circumference (3.5 cm), arm muscle
circumference (1.0 cm), upper arm muscle area (322 mm2), fat mass percentage (2.2%) and lower biceps skinfold
thickness (3.0 mm). Boys with high SES, as compared to boys with low SES, were most frequently overweight
(weight>2SD; 9% vs. 0%, respectively), BMI>2SD (7% vs. 0%, respectively) and had a larger waist circumference (by 3.1
cm on average), hip circumference (3.2 cm), arm muscle circumference (1.0 cm), fat mass (3.3 kg), fat mass
percentage (3.9%) and lower biceps skinfold thickness (1.6 mm).
Conclusion: In young people living under less-favourable environmental conditions, high SES was conductive to a higher
content of muscle and fat tissue, regardless of the gender, and to a larger body size of girls and a higher body weight
of boys. This suggests that a better socio-economic situation can equalize developmental opportunities of young
people living in a less-urbanized region of Poland.

Funding: Research relating to this abstract was funded by the Polish Ministry of Science and Higher Education.

				
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