This meta-analysis provides insight into the role of overweight, obesity, and lack of physical activity on three routes of premature exit from paid employment. In order to protect workers against displacement from the labor force, particularly due to disability pension, workplace health prevention programs to reduce overweight and obesity and promote physical activity are urgently required. 233Review Scand J Work Environ Health. 2013;39(3):233-240 doi:10.5271/sjweh.3354 The contribution of overweight, obesity, and lack of physical activity to exit from paid employment: a meta-analysis by Suzan JW Robroek, PhD,1 Kerstin G Reeuwijk, MSc,1 Frances C Hillier, PhD,2 Clare L Bambra, PhD,2 Rogier M van Rijn, PhD, 1 Alex Burdorf PhD 1 Robroek SJW, Reeuwijk KG, Hillier FC, Bambra CL, van Rijn RM, Burdorf A. The contribution of overweight, obesity and lack of physical activity to exit from paid employment: a meta-analysis. Scand J Work Environ Health. 2013;39(3):233-240. doi:10.5271/sjweh.3354 Objectives The objective of this review was to analyze systematically the association between overweight, obesity, and lack of physical activity (PA) and exit from paid employment through disability pension, unemployment, and early retirement. We also aimed to identify the influence of study population and study design on the magnitude of this association. MethodsWe searched PubMed and Embase for English language, longitudinal, quantitative studies that described the relationship between overweight, obesity, or lack of PA and exit from work. A short checklist was used to assess the internal and external validity of the studies. We first estimated the pooled effects using a random effects model and then analyzed the influence of study and population characteristics on associations by stratified meta-analyses. ResultsIn total, 28 out of 1097 publications met the inclusion criteria. Obese [relative risk (RR)=1.53] and, to a lesser extent, overweight (RR=1.16) individuals had an increased likelihood of exit from paid employment through disability pension, but were not at statistically significant increased risk for unemployment or early retirement. Of 17 associations between a lack of PA and disability pension, 8 were statistically significant; this was also the case for 2 of 3 for unemployment. No associations were statistically significant for early retirement. ConclusionsObesity is a risk factor for exit from paid employment through disability pension. There are also indications that a lack of PA is related to an increased risk of disability pension and unemployment. To protect workers against premature exit from paid employment, long-term interventions to prevent overweight and obesity and promote PA in the working population should be considered for implementation.Key terms disability pension; early retirement; systematic review; unemployment. Life expectancy is steadily increasing in developed countries. Governments are seeking to increase the proportion of elderly persons in paid employment by both extending working li...

BackgroundTackling obesity is one of the major contemporary public health policy challenges and is vital in terms of addressing health inequalities.ObjectivesTo systematically review the effectiveness of interventions (individual, community and societal) in reducing socioeconomic inequalities in obesity among (1) children aged 0–18 years (including prenatal) and (2) adults aged ≥18 years, in any setting, in any country, and (3) to establish how such interventions are organised, implemented and delivered.Data sourcesNine electronic databases including MEDLINE, EMBASE, Cumulative Index to Nursing and Allied Health Literature, PsycINFO and NHS Economic Evaluation Database were searched from database start date to 10 October 2011 (child review) and to 11 October 2012 (adult review). We did not exclude papers on the basis of language, country or publication date. We supplemented these searches with website and grey literature searches.Review methodsPreferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were followed. Experimental studies and observational studies with a duration of at least 12 weeks were included. The reviews considered strategies that might reduce existing inequalities in the prevalence of obesity [i.e. effective targeted interventions or universal interventions that work more effectively in low socioeconomic status (SES) groups] as well as those interventions that might prevent the development of inequalities in obesity (i.e. universal interventions that work equally along the SES gradient). Interventions that involved drugs or surgery and laboratory-based studies were excluded from the reviews. The initial screening of titles and abstracts was conducted by one reviewer with a random 10% of the sample checked by a second reviewer. Data extraction was conducted by one reviewer and independently checked by a second reviewer. The methodological quality of the included studies was appraised independently by two reviewers. Meta-analysis and narrative synthesis were conducted focusing on the ‘best-available’ evidence for each intervention type (defined in terms of study design and quality).ResultsOf 56,967 papers of inequalities in obesity in children, 76 studies (85 papers) were included, and of 70,730 papers of inequalities in obesity in adults, 103 studies (103 papers) were included. These studies suggested that interventions that aim to prevent, reduce or manage obesity do not increase inequalities. For children, there was most evidence of effectiveness for targeted school-delivered, environmental and empowerment interventions. For adults, there was most evidence of effectiveness for primary care-delivered tailored weight loss and community-based weight loss interventions, at least in the short term among low-income women. There were few studies of appropriate design that could be included on societal-level interventions, a clear limitation of the evidence base found.LimitationsThe reviews located few evaluations of societal-level interventions and this was probably because they included only experimental study designs. The quality assessment tool, although described as a tool for public health interventions, seemed to favour those that followed a more clinical model. The implementation tool was practical but enabled only a brief summary of implementation factors to be made. Most of the studies synthesised in the reviews were from outside the UK and related to women.ConclusionsThe reviews have found some evidence of interventions with the potential to reduce SES inequalities in obesity and that obesity management interventions do not increase health inequalities. More experimental studies of the effectiveness and cost-effectiveness of interventions (particularly at the societal level) to reduce inequalities in obesity, particularly among adolescents and adult men in the UK, are needed.Study registrationThe studies are registered as PROSPERO CRD42011001740 and CRD42013003612.FundingThe National Institute for Health Research Public Health Research programme.

The aim of the present review was to perform a systematic in-depth review of the best evidence from controlled trial studies that have investigated the effects of nutrition, diet and dietary change on learning, education and performance in school-aged children (4 -18 years) from the UK and other developed countries. The twenty-nine studies identified for the review examined the effects of breakfast consumption, sugar intake, fish oil and vitamin supplementation and 'good diets'. In summary, the studies included in the present review suggest there is insufficient evidence to identify any effect of nutrition, diet and dietary change on learning, education or performance of school-aged children from the developed world. However, there is emerging evidence for the effects of certain fatty acids which appear to be a function of dose and time. Further research is required in settings of relevance to the UK and must be of high quality, representative of all populations, undertaken for longer durations and use universal validated measures of educational attainment. However, challenges in terms of interpreting the results of such studies within the context of factors such as family and community context, poverty, disease and the rate of individual maturation and neurodevelopment will remain. Whilst the importance of diet in educational attainment remains under investigation, the evidence for promotion of lower-fat, -salt and -sugar diets, high in fruits, vegetables and complex carbohydrates, as well as promotion of physical activity remains unequivocal in terms of health outcomes for all schoolchildren.

Objective: To assess the effectiveness of a brief face-to-face health promotion intervention which included a 'pledge' using brief negotiation techniques, compared with standard advice-giving techniques, delivered in a community setting. Design: A parallel group pre-post design using randomised matched groups. Lifestyle helpers delivered the intervention (one consultation per participant). Diet, physical activity and anthropometric measurements were collected at baseline, 6 months and 12 months. Qualitative data were also collected. Setting: Middlesbrough (UK). Subjects: Adults living in low socio-economic areas. Results: Recruitment and engagement of lifestyle helpers was difficult, and initial expectations that local health authority staff working in the community and community champions would act as lifestyle helpers were not realised. As a consequence, recruitment of participants was lower than anticipated. One hundred and twenty-eight adults were recruited and the retention rate was 48 % at 12 months. Barriers to participation included poor health and competing commitments. No significant differences in change in diet or physical activity behaviours, or BMI, between the intervention and control groups were observed. The control group had a significantly greater decrease in waist circumference at 12 months compared with the intervention group. Conclusions: This exploratory trial provides important insights in terms of recruiting lifestyle helpers for community-based health promotion interventions, specifically (i) the priorities and limitations in terms of time (regardless of their general enthusiasm) for staff employed by the local health authority, and (ii) the willingness of potential community champions to serve their local community in areas where community identity and 'spirit' are seen as lacking. Keywords Public health Behaviour change Food ExerciseThe increasing prevalence of obesity in the UK general population is a major public health concern. By 2050 we might expect 60 % of men and 50 % of women to be clinically obese, with obesity-related diseases costing a predicted extra £45?5 billion per year (1) . Lifestyle behavioural factors play a key role in the development of obesity as well as serious health conditions such as diabetes, coronary disease and cancer. As a result, there is a growing acknowledgment that the emphasis should shift from curative approaches to preventive strategies that target lifestyle behaviours such as diet and physical activity.Many conventional health promotion interventions targeting unhealthy diets and low levels of physical activity continue to be based upon traditional advicegiving approaches (i.e. provision of unsolicited advice and direct persuasion). This approach can be appropriate for the management of many medical conditions, but may not be effective in public health preventive programmes (2) . The often frustratingly small percentage of people who respond positively to advice on behaviour change, and the tendency for clinicians to label patients as 'res...

SNAP was developed to be a simple, quick and engaging method of assessing energy balance-related behaviours at a group or population level and succeeded because it can collect a whole day's recall (dietary intake and physical activities) in less than 25 min to a reasonable and acceptable degree of accuracy.

Effective interventions to prevent obesity in children have never been more necessary. There have been over 30 published reviews and meta-analyses on such interventions (randomized and controlled trials) since 2008. In summary, interventions which involve the whole community (community-based) in complex interventions (promoting healthy eating, reduction in sedentary behaviours and increase in physical activity) that target environments and upstream determinants appear to be more effective. In this article the strengths and weaknesses of community-based complex interventions which aim to prevent obesity in children will be discussed and a selection of recent and ongoing interventions that are shaping the evidence-base in this field will be highlighted (beyond those reported in other papers in this supplement: KOPS, CHILT, TigerKids, IDEFICS and TrinkFit). This paper reviews the challenges and opportunities associated with designing and evaluating community-based complex interventions and initiatives. These include a) design issues (strengths and weaknesses of different types of evidence), b) measurement of (effectiveness) outcomes, c) development of interventions (pilot work, planning frameworks and underpinning theories), d) partnership working and community engagement and e) health inequalities.

BackgroundSocioeconomic inequalities in obesity and associated risk factors for obesity are widening throughout developed countries worldwide. Tackling obesity is high on the public health agenda both in the United Kingdom and internationally. However, what works in terms of interventions that are able to reduce inequalities in obesity is lacking.Methods/DesignThe review will examine public health interventions at the individual, community and societal level that might reduce inequalities in obesity among adults aged 18 years and over, in any setting and in any country. The following electronic databases will be searched: MEDLINE, EMBASE, CINAHL, PsycINFO, Social Science Citation Index, ASSIA, IBSS, Sociological Abstracts, and the NHS Economic Evaluation Database. Database searches will be supplemented with website and gray literature searches. No studies will be excluded based on language, country or publication date. Randomized and non-randomized controlled trials, prospective and retrospective cohort studies (with/without control groups) and prospective repeat cross-sectional studies (with/without control groups) that have a primary outcome that is a proxy for body fatness and have examined differential effects with regard to socioeconomic status (education, income, occupation, social class, deprivation, poverty) or where the intervention has been targeted specifically at disadvantaged groups or deprived areas will be included. Study inclusion, data extraction and quality appraisal will be conducted by two reviewers. Meta-analysis and narrative synthesis will be conducted. The main analysis will examine the effects of 1) individual, 2) community and 3) societal level public health interventions on socioeconomic inequalities in adult obesity. Interventions will be characterized by their level of action and their approach to tackling inequalities. Contextual information on how such public health interventions are organized, implemented and delivered will also be examined.DiscussionThe review will provide evidence, and reveal any gaps in the evidence base, of public health strategies which reduce and prevent inequalities in the prevalence of obesity in adults and provide information on the organization, implementation and delivery of such interventions.Trial registrationPROSPERO registration number: CRD42013003612

BackgroundThere is growing evidence of the impact of overweight and obesity on short- and long-term functioning, health and well-being. Internationally, childhood obesity rates continue to rise in some countries (for example, Mexico, India, China and Canada), although there is emerging evidence of a slowing of this increase or a plateauing in some age groups. In most European countries, the United States and Australia, however, socioeconomic inequalities in relation to obesity and risk factors for obesity are widening. Addressing inequalities in obesity, therefore, has a very high profile on the public health and health services agendas. However, there is a lack of accessible policy-ready evidence on what works in terms of interventions to reduce inequalities in obesity.Methods and designThis article describes the protocol for a National Health Service Trust (NHS) National Institute for Health Research-funded systematic review of public health interventions at the individual, community and societal levels which might reduce socioeconomic inequalities in relation to obesity amongst children ages 0 to 18 years. The studies will be selected only if (1) they included a primary outcome that is a proxy for body fatness and (2) examined differential effects with regard to socioeconomic status (education, income, occupation, social class, deprivation and poverty) or the intervention was targeted specifically at disadvantaged groups (for example, children of the unemployed, lone parents, low income and so on) or at people who live in deprived areas. A rigorous and inclusive international literature search will be conducted for randomised and nonrandomised controlled trials, prospective and retrospective cohort studies (with and/or without control groups) and prospective repeat cross-sectional studies (with and/or without control groups). The following electronic databases will be searched: MEDLINE, Embase, CINAHL, PsycINFO, Social Science Citation Index, ASSIA, IBSS, Sociological Abstracts and the NHS Economic Evaluation Database. Database searches will be supplemented with website and grey literature searches. No studies will be excluded on the basis of language, country of origin or publication date. Study inclusion, data extraction and quality appraisal will be conducted by two reviewers. Meta-analysis and narrative synthesis will be conducted. The main analysis will examine the effects of (1) individual, (2) community and (3) societal level public health interventions on socioeconomic inequalities in childhood obesity. Interventions will be characterised by their level of action and their approach to tackling inequalities. Contextual information on how such public health interventions are organised, implemented and delivered will also be examined.DiscussionIn this review, we consider public health strategies which reduce and prevent inequalities in the prevalence of childhood obesity, highlight any gaps in the evidence base and seek to establish how such public health interventions are organised, implemented and deliv...