Thank you for inviting me to speak today.
I'm going to present research findings drawn from systematic reviews of the international literature about the effects of interventions that aim to promote children's and young people's physical activity and healthy eating, and from complementary systematic reviews of children's and young people's views about these topics.
The age ranges we studied were children 4 to 10 and young people from 11 to 16. These were all studies addressing children and young people generally, rather than children or young people who were obese.
The studies of children's and young people's views were all conducted in the United Kingdom, so I can't tell you how accurately they might reflect the views of Canadian children and young people. However, when I describe the findings, you will be able to judge for yourselves to what extent they ring true, considering what you know about the children and young people in your own country.
I shall describe each of the reviews in turn, starting with young people and physical activity. This review was published in 2001, with the latest included study published in 2000. The findings are based on 12 evaluations of the effects of interventions and on 16 studies of young people's views addressing aspects of the community or wider society that help or hinder young people's physical activity.
We found that multi-component school-based interventions had a little success in some circumstances. There was some improvement in knowledge, and young British women said the interventions influenced their behaviour.
Most young people saw physical activity as beneficial for both health and social reasons. Young women particularly valued the role of physical activity in maintaining weight and a toned figure, but unlike young men, they found that physical activity did not fit in well with their leisure time.
Ideas for promoting physical activity included increasing or modifying practical and material resources, such as creating more cycle lanes; making activities more affordable; increasing access to clubs for dancing and combining sports with leisure facilities; and more innovative choices in school physical education, such as dancing, cycling, and aerobics. This means that interventions are needed that increase the range of free activities, improve school facilities, provide more choice of activities in school, and emphasize the fun and social aspects of sport.
There are major gaps for research and development, particularly in the areas of parental constraints and the interaction with mental health.
At the same time as searching for these studies, we also sought studies about young people and healthy eating. The findings are based on seven evaluations from around the world that studied aspects of the community or wider society that help or hinder healthy eating and eight studies of young people's views in the U.K. We found a small number of well-designed evaluations that showed mixed evidence on effectiveness. All studies detected at least some positive effects on healthy eating. Interventions were multi-component, complementing classroom activities with school-wide initiatives and changes to the young people's environment, such as facilities for physical activity. The interventions also involved parents. There was stronger evidence for effectiveness among young women compared to young men.
Young people had clear views on healthy eating. Barriers to healthy eating included the cost and poor availability of healthy foods and the association of these foods with adults and parents. In contrast, fast foods were widely available, tastier, and were associated with pleasure, friendship, and being able to exercise choice. Ideas for promoting nutrition included the provision of information on the nutritional content of school meals--for young women particularly--and better food labelling.
Evaluated interventions often neglected the views of young people, especially in terms of their concerns about the taste, cost, and availability of healthy foods. This means that promising interventions are those that address concerns such as the high cost of healthy foods, a taste preference for fast foods or lack of will power to avoid fast foods, and food labelling.
Interventions, and their evaluations, also need to consider issues of gender, inequalities in health, and the interrelationships between healthy eating, physical activity, and mental health.
We followed these reviews, but there are few on children and physical activity outside of school published in 2003, with the latest included study published in 2002. It's based on five evaluations of the effects of interventions, all undertaken in the U.S.A., and five studies of children's and parents' views. We found that there are few evaluated health promotion interventions that address physical activity beyond school-based physical education, and even fewer have been rigorously evaluated.
Interventions shown to be effective include education and provision of equipment for monitoring TV or video game use, engaging parents in supporting and encouraging their children's physical activity, and multi-component, multi-site interventions using a combination of school-based physical education and home-based activities.
Approaches that appear to take into account the views of children in the U.K. but that require further evaluation and development include those that provide children with a diverse range of physical activities to choose from, emphasize the aspects of participating in physical activity that children value, such as opportunities to spend time with friends, provide free or low-cost transport and reduce costs, and aim to provide a safer local environment in which children can actively travel and play.
The findings mean it's not yet clear whether these types of interventions will always result in positive behavioural changes, which components are essential for success, or the extent to which they are appropriate for children in a particular context.
At the same time as searching for studies of children and physical activity, we sought studies about children and healthy eating, in particular, eating fruit and vegetables. The findings are based on 19 evaluations of the effects of health promotion interventions and eight studies of children's and parents' views. We found that interventions were largely school-based and often combined learning about the health benefits of fruit and vegetables with hands-on experience in the form of food preparation and taste testing. The majority also involved parents alongside teachers and health promotion practitioners. Some included changes to the foods provided at school and some targeted more physical activity as well as healthy eating.
The results of our analysis reveal that these kinds of interventions have a small but statistically significant positive effect. Bigger effects are associated with targeted interventions for parents with risk factors for cardiovascular disease. There was no evidence of the effectiveness of single component interventions such as classroom lessons alone or providing fruit-only tuck shops.
Six main issues emerged from the studies of children's views: one, children don't see it as their role to be interested in health; two, children don't see messages about future health as personally relevant or credible; three, fruit, vegetables, and confectionery have very different meanings for children; four, children actively seek ways to exercise their own choices with regard to food; five, children value eating as a social occasion; six, children see the contradiction between what is promoted in theory and what adults provide in practice.
The studies of children's views suggest that the interventions should treat fruit and vegetables in different ways and should not focus on health warnings. Interventions that were in line with these suggestions tended to be more effective than those that were not. This means that promoting healthy eating can be an integral and acceptable component of the school curriculum; effective intervention in schools requires skills, time, and support from a wide range of people; it's easier to increase children's consumption of fruit than vegetables; simple strategies may be branding fruit and vegetables as tasty rather than healthy or may be promoting fruit and vegetables in different ways; and more challenging strategies may be making health messages relevant and credible to children and creating situations for children to have ownership over their food choices.
For all four of these reviews, conclusions about effectiveness remain tentative because of the small numbers of rigorous evaluations found. Most of the research did not look at socially excluded young people or those who seldom go to school.
All four reviews found that although children and young people often have clear views on what helps or hinders their healthy behaviour, their views are rarely taken into account in the development of interventions. We recommend developing and rigorously evaluating interventions that take the views of children or young people as a starting point.
Thank you.