From Bristol City to Mexico City: New challenges for obesity research

In this blog, Simon Sebire from the Centre for Exercise, Nutrition & Health Sciences and three PhD students reflect on new avenues of research into childhood physical activity and obesity in Low and Middle Income Countries and the opportunities and challenges this work presents.

New ideas emerge in the least likely places. As I listened to Professor Andy Gouldson present his research to the School for Policy Studies in spring 2014, I was inspired to sketch connections between some of Andy’s concepts (economic development and environmental issues) and my own (the psychology of motivating people to adopt healthy behaviours like being physically active). After the talk, I shared my scribbles with my colleague Prof. Russ Jago, only to find that he had an almost identical set.

Our thoughts had independently been transported from Bristol to Mexico and musings about the potential associations of urban development and rural-urban migration on the lifestyle behaviours of children and their families. This international perspective is not something either of us had previously pursued is but clearly had prompted some scribbling! The Mexico connection was inspired by three CONACyT-funded students, from Mexico, who at the time were studying our MSc in Nutrition, Physical Activity and Public Health and were considering PhDs.

Nearly 1 year on the three students (Ana Ortega Avila, Maria Hermosillo Gallardo and Nadia Rodriguez Ceron) are now PhD students in the School for Policy Studies Centre for Exercise, Nutrition and Health Sciences supervised by Prof. Russ Jago, Dr Angeliki Papadaki and I. They secured further funding from CONACyT to pursue their programme of research to study how various social, psychological and environmental factors might be related to physical activity and nutrition behaviours in children adolescents and their families in Mexico.

The causes of and response to increasing levels of obesity in low and middle income countries have been the focus of a recent Guardian Global Development Podcast. The podcast draws on the experiences of children, families, health practitioners and campaigners from South Africa and Mexico. In Mexico 73% of men, 69% of women and approximately 35% of adolescents are obese or overweight which is higher than in the USA. It is clear that there is much to be done to both treat those who are already overweight and prevent the development of obesity in young people. However, extrapolating our existing research and knowledge of what we think drives obesogenic behaviours in places like Bristol to the context of people’s lives in Mexico presents a number of challenges.

Ana, Maria and Nadia have a wealth of experience from previously working in Mexico as nutritionists or within the food industry, so I asked them to listen to the podcast and share their insider’s view of the challenges ahead:

Maria referred to the potentially damaging effects of families in Mexico aspiring to an American lifestyle dominated by unhealthy foods and sedentary behaviour:

The blog says that processed foods and junk food are one of the main causes of overweight and obesity increasing in Mexico, which is partially true, but I think it has to do a little bit more with what I call “junk behaviours”. For example, how mums from rural areas prefer to give their children processed foods instead of home-made meals because they heard somewhere that people from USA consumed them, and because Americans always choose right (at least that’s the belief in some parts of Mexico); junk food and processed foods are the way to go for feeding their children.

Ana suggested that this influence may be strongest in regions closest to America and highlighted the broader problems associated with researching an issue which is geographically diverse:

Mexico is among the largest countries in the world geographically and demographically (118 million people); where differences in dietary pattern exist between rural and urban areas or between north, central and south regions.I have always lived in the northwest and the influence of the U.S.A. is visible in a lot of aspects in our life compared to the centre or south of the country. Our dietary patterns are based on American food choices and less on the Mexican traditional diet.

Ana, Maria and Nadia all added that the potential mismatch between perceptions of wealth and health may be making being overweight an aspiration:

Ana: In my experience as a nutritionist there are a number of cultural misconceptions among population when it comes to healthy nutrition. For example, being a little overweight still means you are healthy and well-nourished whereas being thin means you are unhealthy or sick. People don’t see overweight as a problem, on the contrary, they see it as something normal.

Nadia suggested that such perceptions may prevent parents from identifying obesity as a potential health problem in their children:

I think the healthy body image is distorted as family, friends or in the streets, the most common thing is to see someone obese; and that is really concerning because how will they do something to improve their health if they don’t even think there’s a problem. 

Ana, Maria and Nadia reflected on the challenges of applying our physical activity and nutrition research findings which are largely based on evidence from developed countries such as the UK or USA to the context of middle income countries such as Mexico. A good example is parents’ perceptions of safety when letting their children play outside of the home. In UK research, including some in Bristol by my ENHS colleagues, we tend to focus attention on the presence of traffic or children’s risk of injury while unsupervised. In contrast, perceptions of safety in Mexico are measured nationally with questions including those related to the risk of kidnap, existence of violent gangs in the neighbourhood, armed robbery and frequency of firearms shootings. 73.3% of the participants in the 2014 National Survey on Victimization and Perception of Public Safety (ENVIPE) in Mexico reported not feeling safe in their local areas. In addition to the safety implications of conducting research in this context, it is clear that current measures of parents’ perceptions of their child’s safety to be active outside the home will not be sufficient and Nadia has plans to develop a new tool.

In addition, the political landscape challenges us to consider different ways in which our research may be best able to impact on health policy:

Ana: The political context in Mexico is complex, the government is dealing with high levels of insecurity and corruption, events that prevent the government from focusing on other matters such as the implementation of new health policies.

Maria believes that more is needed to be done to educate policy makers in addition to the public: There is a huge educational barrier, both governmental and individual, which makes difficult to take seriously the obesity and overweight problem.

Nadia: All those factors are completely different to high-income countries, and makes the context a complex matter to understand when almost all the research has developed in a completely different contexts with a wider range of opportunities to change or create policies that have a real impact in the population’s health. 

In summary, over the last year or so, I have been transported from Bristol city to Mexico City thanks to a fortuitous combination of research daydreaming and inspiring MSc (now PhD) students.  As a supervisor, my initial conversations with our new students has forced me out of my research comfort zone, an experience which has been echoed and reported by researchers in the International Physical Activity and the Environment Network in Latin America. Undoubtedly, our success in co-producing research which could have international impact will require us to work together to combine our collective knowledge to understand the context and key drivers of obesity-related behaviour change in Mexico.

Thanks to Ana Avila Ortega, Maria Hermosillo Gallardo and Nadia Rodriguez Ceron for their contributions.

  • Ana’s PhD focusses on the development of a social media intervention to reduce consumption of sugar-sweetened beverages in  Mexican older adolescents
  • Maria is studying the associations between urbanicity in Mexico and lifestyle behaviours and the influence of the rural urban transition on family health.
  • Nadia’s PhD focusses on the environmental and social correlates of physical activity in children in Mexico City.

Dr Simon Sebire is Lecturer in Physical Activity & Exercise Psychology in the Centre for Exercise, Nutrition & Health Sciences (ENHS) in the School for Policy Studies.The results of the 2014 Research Excellence Framework (REF) confirm the Centre’s international reputation for research excellence within the field of physical activity, nutrition and health. ENHS was rated 1st overall in the UK.

 

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Progress on the FAB kids outreach project

FAB1Mark Edwards, Active7 Trial Manager in the School for Policy Studies, reflects on the first term of delivering the FAB Kids outreach workshop in schools. Mark previously blogged on this project here

It’s been a busy term. Aside from their full-time jobs, Exercise, Nutrition and Health Sciences (ENHS) staff and students have worked hard to get the FAB (Food, Activity, and Bodies) Kids project up and running in schools. Taking the workshop from drawing board to school hall has been an arduous task, but seeing the children (and teachers) learn from and enjoy the workshop activities makes the efforts worthwhile. It has been a rewarding process for FAB staff; going into schools and being in dialogue with small groups of children, learning from them and hearing their stories (sometimes fascinating, other times bizarre), and quickly(!) getting to grips with controlling groups of over-excited children.

Between May and early July, 13 staff and student volunteers have delivered the FAB workshop to 355 children. Workshops have been delivered in 8 mainstream primaries, one Special Educational Needs school, and one fee paying school. We’ve also taken FAB to the Big Bang (Cirencester) and Bridgwater Science Festivals.

What has been the impact?

FAB2

So what have the children learnt? At the end of each workshop we ask them just this question. As you’d expect (or hope) from a health-focused workshop, lots of children came away with the message that they should ‘always keep healthy and fit and drink what’s right for you’.  Many took away messages they can use in their day-to-day lives, such as ‘some drinks that appear to be healthy have a lot of added sugar’ and the ‘more you exercise the less likely you are going to have heart problems’. Others memorised interesting snippets  such as ‘Diet Coke contains an ingredient that is in fireworks’, ‘there are over 600 muscles in your body’ and ‘the average heart rate for children is 70-100 beats per minute’. One child was simply speechless (or ironic beyond his years); ‘Absolutely epic! I can’t get any of it out of my head because I learnt so much!’ Whilst most were more conservative in their comments, we hope and think that all children have taken something – however little – from the workshop that may help them to improve their lifestyle.

What did the teachers think?

School staff provide more formal evaluation of the workshop. The three individual workshop activities and the workshop overall (separate questions) were rated ‘very good’ by all teachers. It was interesting to see how teachers engaged with the workshop, with some using it as a way to develop their own knowledge, and experimenting with props and asking questions as if they themselves were participants. The qualitative feedback they provided is testament to the enthusiasm of the staff delivering the workshop. Comments from teachers include:

‘A perfect morning’s learning where the children enjoyed themselves! They loved learning the new facts. All brilliant, staff energetic and formed great relationships with children.’

‘All interactivity was brilliant! Children really enjoy learning in a different way with various approaches.’

‘All the activities were interactive, stimulating and fun for the children. They were enthusiastic and engaged throughout and certainly enjoyed what they were doing.’

FAB3

‘Really loved the jigsaw/children very engaged. Children liked the booklets and enjoyed all the activities.’

‘All members of the team had a lovely manner with children and quickly established a positive rapport. Not always easy! The resources were all well organised, interesting and engaging.’

Where next?

Although we are delighted with this term’s progress, we are not complacent and have identified several areas for improvement (which will be made over the summer). In September, MSc students will be invited to assist with the delivery of the workshop. As such, we will be designing training sessions and delivery manuals over the next few months. The plan is to allow trained MSc students to deliver the workshop, giving some supervisory roles, and gradually reducing the hands-on involvement of ENHS staff. In September we will begin to book in more schools to receive the workshop.

FAB_team

If you would like any further information on the FAB Kids workshop please visit www.fab-kids.org or email fab-kids@bristol.ac.uk.

FAB team members: Bethan Baker Williams, Rachael Pound (MSc student), Mark Edwards, Laura Pool, Kate Banfield, Byron Tibbitts, Jo Kesten and Sarah Harding.

ENHS is a research centre in the School for Policy Studies. Staff work on a variety of projects focusing on physical activity and nutrition, and their associations with health across the life course. Much research in ENHS is conducted with children in local schools.

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Children, parents and screen-viewing: New evidence from the School for Policy Studies

jago

Russ Jago from the Centre for Exercise, Nutrition & Health Sciences discusses a recent paper in the International Journal of Behavioural Nutrition and Physical Activity on parent and child screen-viewing and its implications.

A body of evidence has shown that screen-viewing (watching TV, using the internet, playing games consoles) is associated with adverse health effects such as increased risk of heart disease, type 2 diabetes and obesity among adults. Recent research has also shown that screen-viewing is associated with adverse health effects among children and adolescents such as increased risk of obesity, higher cholesterol levels and poorer mental well-being. Collectively these findings indicate that there is a need to understand children and adolescent’s levels and patterns of screen-viewing among children and adolescents and identify ways in which the screen-viewing levels of children can be reduced. To date the bulk of this work has focussed on older-aged primary school aged children and adolescents with a lack of information about the screen-viewing patterns of younger children. This gap is important because previous work has shown that screen-viewing patterns are established in early life and then track through childhood into adulthood. Thus, there is a need to examine levels of screen-viewing among children at the start of primary school and the key factors that are associated with these patterns.

A relatively under-explored area of research is how patterns of screen-viewing may be shared between children and their parents. It seems logical that children who live in homes in which the parents engage in high levels of screen-viewing may be more likely to spend more time screen-viewing. Previous work has suggested that associations may exist between parent and child screen-viewing but again current research has been dominated by studies that have included older children and restricted to assessments of mothers’ TV viewing. These studies have not provided information on other forms of screen-viewing such as computer use or the roles of dads. These gaps are important as our previous work has shown that TV viewing is becoming a less dominant form of screen-viewing with other types of viewing such as tablet and smart-phones becoming more dominant.

In our current paper we attempted to look at these issues by examining the screen-viewing patterns of 1078 Year 1 (5-6 year old) children and their parents. These data are from the British Heart Foundation funded B-Proact1V project which was conducted in 63 primary schools in the greater Bristol area. We asked the parents to complete a survey reporting their own screen-viewing patterns and those of their child. In households in which there were 2 adults we asked the second parent to also report on his or her screen-viewing behaviour. We then examined levels of screen-viewing for the children and the parents and associations between parent and child screen-viewing. We found that 12 per cent of boys and eight per cent of girls in this age group watched more than two hours of TV on a weekday, with 30 per cent of parents exceeding this threshold. Figures were much higher at weekends, with 45 per cent of boys, 42 per cent of girls, 57 per cent of fathers and 53 per cent of mothers watching more than two hours of TV each day.

When we examined the associations between parent and child screen-viewing we found that children were at least 3.4 times more likely to spend more than two hours per day watching TV if their parents watched two or more hours of TV, compared to children whose parents watch less than two hours of TV. There were, however, different patterns for parents’ computer use in which daughters were 3.5 times more likely to use a computer at the weekends if their fathers spent more than 30 minutes a day doing so. There was, however, no evidence that sons were similarly influenced.

What do the results mean?

The results support our hypothesis that parents are strong influences on children’s screen-viewing behaviours and also show that it is not just mums but also dads who have important influences. These findings therefore imply that strategies which focus on reducing the screen-viewing habits of the entire family are likely to be important. Moreover, the results suggest that future behaviour change strategies need to focus on a broad range of screen-viewing behaviours and look at the factors that lead to screen-viewing and if they differ for weekdays versus weekend days. Over the next few months we will be analysing further data from this project to try and answer some of these more specific questions on how these behaviours are formed and how they might be changed.

Paper: ‘Cross-sectional associations between the screen-time of parents and young children: differences by parent and child gender and day of the week’ by R. Jago, J. Thompson, S. Sebire, L. Wood, L. Pool, J.Zahra and D. Lawlor in the International Journal of Behavioral Nutrition and Physical Activity, 2014, 11:54, doi:10.1186/1479-5868-11-54

 

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