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Rapid Responses: Rapid Responses published:
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A Model Town?
- Rohit PT Narayan, Sukhpal S Gill, Bilal H Chaudhry, Noreen Mahmood (16 August 2008)
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Community approach to obesity
- John Pemberton (16 August 2008)
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Beating the bulge
- Jason R Beck (18 August 2008)
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obesity in australian town
- John Pemberton (19 August 2008)
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Victorian Parliament should investigate health issue
- Colin F Clarke (20 August 2008)
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Rohit PT Narayan, Medical Student School of Medicine, University of Birmingham, Birmingham B15 2TT, Sukhpal S Gill, Bilal H Chaudhry, Noreen Mahmood
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It was refreshing to read about the active measures that are being taken by parents and the local health, housing, and government authorities in Colac to tackle childhood obesity.(1) However, we think the interventions employed by the ‘Be Active Eat Well’ campaign are unrealistic in addressing the problems of; large, urban, and ethnically diverse populations, that are dependent on a state funded system such as the NHS. The study acknowledged that its sample was not representative of ethnically diverse populations found in many other larger cities.(2) As a result the idea of sub communities of ethnic groups within local community was not encountered. One cannot simply apply a universal intervention programme broadly across an entire community, without considering the different beliefs and cultural practices that exist within it. Other intervention programmes and government initiatives recognise the need to tailor programmes to sub communities with appropriate regard to cultural differences.(3)(4) The original study reveals $AUD 100 000 (per year) and the 6789 person-hours to carry out the intervention programme. These resources were used for the ~ 2000 children and the programme lasted 3 years, yet the analysis included less than half of the original sample. It is interesting to note that such a high intensity programme, which relied on both government and non-governmental resources, was unsuccessful in halting the rising obesity in a small rural town. The issue of cost-effectiveness clearly needs to be evaluated using a larger, more ethnically diverse study. Rohit PT Narayan, Medical Student(1), Sukhpal S Gill, Medical Student(1), Bilal H Chaudhry, Medical Student(1), Noreen Mahmood, GP(2) 1 School of Medicine, University of Birmingham, Birmingham B15 2TT, 2 Hall Green Health Centre, 979 Stratford Road, Birmingham, B28 8BG Correspondence to: rpn462@bham.ac.uk References: 1. Moynihan R. Small Australian town is model for community campaigns against obesity. BMJ 2008;337:a1238 2. Sanigorski AM et al. Reducing unhealthy weight gain in children through community capacity-building: results of a quasi-experimental intervention program, Be Active Eat Well. International Journal of Obesity (2008) 32, 1060–1067 3. Kumar BN et al. Ethnic differences in obesity among immigrants from developing countries, in Oslo, Norway. International Journal of Obesity (2006) 30, 684–690 4. Parliamentary Office of Science and Technology. Ethnicity and health. Jan 2007 Number 276. http://www.parliament.uk/documents/upload/postpn276.pdf - accessed 15/08/2008 Competing interests: None declared |
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John Pemberton, retired iona cannonfields hathersage hope valley s32 1ag
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This approach in an Australian town was directed to children and had a significant effect in reducing obesity.. Until now t he treatment of individuals with overweight or obesity with special diets,drugs and major surgery has failed to halt the rapid increase in these conditions and the population approach should now be attempted. Every adult over 18 should be advised to discover his or her Body Mass Index. [BMI] This can be easily done on the internet by entering "obesity chart ". Providing the enquirer knows his or her weight in lbs or kilograms and their height in metres or inches they can then read off their BMI which will tell them whether they are underweight,healthy weight,overweight or obese. The most important group is the 80% , whose weight is healthy because they can keep an eye on their BMI and can take early sreps to avoid getting overweight. Thse who are overweight may be pursuaded to make a greater effort to lose weight/. For the obese it may be too late. Competing interests: None declared |
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Jason R Beck, Radiation Therapist Radiation Oncology Victoria, Australia. 3806
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The experiment conducted in Colac gives great incentives to all Australian primary school children, to keep healthy and active. The results of the trial are encouraging in a time when fast foods are replacing home made meals. It is important to note that school lunches in Australia are different to school lunches in Europe. Traditionally in Australia, school lunch boxes may contain a piece of fruit, a vegemite sandwich (Marmite in the UK)and a small treat like a packet of crisps or a biscuit. It is not the norm in Australia for hot lunches to be provided by the school for all the children, as may be the case in many European countries. The aussie "canteen" is more of a treat for children who may order a lunch once a week, if at all. Unfortunately, increasing rates of foods containimng high sugar and fat content, have crept into the lunch boxes of Australian children. The initiative educates children to healthy alternatives and provides a strong foundation for future eating habits. Fruit and veg are the order of the day intead of foods high in sugar and fat. A different program is running in the local primary school (Berwick) where breakfast is provided for children in the first grade, three days per week. This is to educate children on the improtance of having a healthy breakfast. The program was started as many students reported, not having any breakfast before coming to school. The principals are the same, education and better health. The bottom line is educating our children for a better and healthier future. Prevention being the key. The cost benefits for our health system will be enormous and our children will reap the rewards of beating the bulge. Jamie Oliver has campaigned hard to improve the school lunches in the UK. He should be recognised and commended for his contribution, for also trying to beat the bulge. It is only a matter of time before this education package is rolled out across the state and even the county as part of the curriculum. A larger study goup will support the results of the Colac trial and put to rest any doubts. Congratulations to all the staff and children in the Colac study, and keep up the good work. Competing interests: None declared |
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John Pemberton, retired iona cannonfields hathersage hope valley s32 1ag
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The Australian town Colac succeeded in reducing obesity amog children by a community approach.The same approach to all ages should be applied in the UK. The individual approach with, diets, drugs and now major surgery has failed to halt the tide of obesity which now threatens to swamp us. A population approach should include advising every adult to find out their Body Mass Index {BMI}. Providing they know their weight in lbs or kilos and height in inches or metres by clicking on Google "obesity charts" they can read off their BMI and find out whether they are underweight, healthy weight, overweight or obese. Most emphasis should be placed on the 80 % of the population who are a healthy weight because advice to that group on how to stay that way will be easier to achieve than to pursuade those who are overweight or obese to lose weight. To prevent people of healthy weight from becoming overweight by giving them the ability to find out when they are just starting to move into the overweight class would help many people to regulate their diet and exercise in order to maintain a healthy weight. In the long run this would reduce the incidence of obesity. Competing interests: None declared |
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Colin F Clarke, Hon Sec CTC Yorkshire and Humber Region YO41 1BU
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Australia is now the fattest nation in the world, with more than 9 million adults rated as obese or overwieght and children are aslo affected (1). In tackling Australia's worst public health crisis, it is essential that all possible causes be investigated and addressed. The enactment of bicycle helmet laws in Australia in the early 1990s had a major impact on cycle use. Whereas cycle use prior to the laws had been generally increasing, as soon as laws were passed and enforced cycle use fell sharply (2). There were early signs that helmet compulsion might cause some people to give up cycling, such as when many students at schools in Victoria chose to give up cycling when they were required to wear helmets pre-law. It would therefore have been sensible for governments to ensure that the effect of compulsory wearing on numbers of cyclists was monitored accurately. This was not done, but some measurements of numbers were made, most being incidental to surveys of helmet wearing. In 1989 (before the helmet law), there were estimated to be 2.2 million cyclists in Victoria, of whom 1.4 million were in Melbourne. Cycling had been booming for some years – in Melbourne there was an increase of 47 per cent in the number of cyclists from 1986 to 1989. Population growth during the same period was 7.5 per cent. Cycling activity (percentage of trips) in small rural towns such as Colac was generally higher than in Melbourne. The helmet law saw a large downturn in cycling. Total bicycle use by children aged 5-17 decreased by 36 per cent from May/June 1990 to May/June 1991. There were further decreases to May/June 1992 in Melbourne, with teenage cycling showing by then a 46 per cent decrease from pre-law levels. In 1985-6, 3.4 per cent of trips in Melbourne were by bicycle. In 2004 this was only 2.0 per cent, suggesting that cycling was still much reduced compared with before the helmet law. In 2008 Curnow (3) concluded: “Compulsion to wear a bicycle helmet is detrimental to public health in Australia.” The Victorian Government assessment of introducing helmet legislation did not consider the health effects if fewer people cycled, a major failing. The state government should correct this error by providing a detailed health assessment, full social evaluation and accept submissions from the public. Ref 1) Stewart S, Tikellis G, Carrington M, Walker K, O'Dea K. Australia's future 'fat bomb'. Baker Heart and Diabetes Research Institute. 2008 2)'Helmet laws discourage cycling' http://wwwcyclehelmets.org/1194.html, accessed 20.08.08 3)Curnow WJ. Bicycle helmets and public health in Australia. Health Promotion Journal of Australia, 2008 Apr;19(1):10-15. Competing interests: None declared |
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