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From the Editor
With so much happening
in the area of childhood obesity today, it is timely that the September
issue bears this theme. We have a commendable range of articles from across
Australia, including surveys of primary school communities in New South
Wales, Victoria and Queensland, and a letter describing a parenting program
in South Australia. The focus is on discussing the problem and describing
related research and intervention programs. One of the features common to
all contributions is the search for a comprehensive and novel approach.
This is seen through questioning common assumptions, addressing the need
to collect and analyse hard data, and examining the broader context from
which childhood obesity has emerged.
The issue opens with the Editorial by the President of the Dietitians Association
of Australia, Professor Sandra Capra, acknowledging the need for a concerted
effort from organisations, professionals and individuals across the whole
community. Professor Capra outlines the position
of DAA and reminds us of the complexity of the problem and its possible
solutions. She also refers to DAA’s services to members including
access to peer reviewed innovative programs for weight management.
We are privileged to have the leading article on childhood obesity by
Professor Louise Baur, a world expert in the field and a member of a number
of significant international groups working on the problem. Professor
Baur reiterates that paediatric obesity is not a benign condition
in itself. Apart from the risk of future ill health, it can carry concurrent
burdens related to psychosocial orthopaedic, respiratory, gastrointestinal,
sleep and metabolic health problems. School based programs are one of
many approaches to addressing the problem, but all may not be as it seems,
as the referent articles show. Sutherland and co-authors acknowledge the
pressure placed on schools to address a range of health and social issues
in addition to ensuring basic literacy and numeracy. In their survey of
parents, teachers, healthcare workers and pupils in a NSW
central coast primary school, they show that attitudes varied regarding
the significance of the school environment in preventing obesity, with
healthcare workers as the most keen and teachers the least. Schools can
make a contribution, but the issues go beyond school, and we do well to
keep that perspective. In the survey by Cleland et al. of children, parents
and teachers from 12 primary schools in Victoria, the importance parents
placed on the role of the canteen in developing eating patterns was equivocal,
and only 9.5% of boys and 5.8% of girls reported using the canteen on
most days. This put canteen strategies in perspective too, but of real
interest were the novel ideas from interviewees for using the canteen
as a health promoting tool. These bore a marketing flavour, with suggestions
for decreased cost of healthy alternatives, increased availability and
publicity.
The need to test assumptions about school breakfast programs was the focus
of the next paper by Radcliffe and colleagues who surveyed 832 primary
students in 14 urban and rural schools in southern Queensland. They found
only 3% of respondents skipped breakfast, suggesting
a breakfast program may not be a useful strategy, but they found the quality
of food consumed by children for breakfast has room for improvement. Using
the Australian Guide to Healthy Eating as a benchmark for scoring dietary
patterns, they argued that both parents and children need to be targeted
to achieve improvements in dietary intake. Back in New South Wales, the
situation in out-of-school hours care would be different. In one of the
first published studies of nutrition in this context, Sangster and colleagues
found in the 41 services studied that 44% offered vegetables or fruit
to children and 34% has policies on nutrition. In this professional Insight
paper they noted the need to work within this context, particularly given
the differences from long day care facilities where there is more regulation
as well as facilities and qualified staff.
The theme of childhood obesity—new ideas and challenges, continues
in the Letters to the Editor. David Crawford’s group posits hard
data against the notion that children of dual career families are at greater
risk of obesity through inactivity, and argues out-of-school hours care
is a potentially important location for activity. Further, they argue
that long term, multiple setting, community interventions require serious
government commitment. In another letter Magarey’s team describe
their Healthy Eat-ing and Lifestyle through Positive Parenting program,
which is currently being implemented as the nutrition component in the
Parenting Eating and Activity for Child Health (PEACH) program, an NHMRC-funded
intervention
trial in overweight five to nine-year-olds in Adelaide and Sydney. They
also argue that this program should sit in a nest of community interventions
including the school and the wider community environments.
Moving from childhood
obesity, but nevertheless focusing on new ways of doing things, the first
paper in the education section addresses the utility of the curriculum
in raising awareness about a broader range of foods,
in this case legumes, among nutrition students. This paper by Lacey also
moves the issue beyond Australia—a very welcome article from Pennsylvania,
USA. An article by Hughes accompanies this, on the public health nutrition
workforce, raising issues about the size of the workforce, stability,
the number of advanced practitioners and the need for continued monitoring
of the workforce. Gillen provides the continuing education section, on
Gestational Diabetes Mellitus, a very significant area to consider for
dietary intervention. Finally, it is very pleasing to see a letter from
Professor Stewart Truswell supporting the commentary in the June issue
on building our links with New Zealand. The valuable contributions by
our New Zealand colleagues were clearly demonstrated in that issue. It
sets a good example of the active involvement in the journal we would
like to see from dietitians and nutritionists from both countries and
well beyond.
Professor Linda Tapsell APD
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