- 1 A comprehensive, multi-sectoral approach
- 2 Public education
- 3 Settings based interventions
- 4 The physical environment
- 5 National Food and Nutrition Framework
- 6 Food labelling
- 7 Health claims
- 8 Food marketing to children
- 9 Food reformulation
- 10 The role of primary care
- 11 Special groups
- 12 Economic interventions
- 13 Research, monitoring and evaluation
- 14 References
The comprehensive obesity control strategy recommended by the National Preventative Health Taskforce in 2009 was based on the best available evidence for effective public health measures to address obesity. This chapter focuses on some of the key evidence-based interventions for the prevention of overweight and obesity recommended by the Taskforce.
A comprehensive, multi-sectoral approach
The health behaviours which contribute to overweight and obesity are underpinned by a complex range of social, economic, educational and environmental factors. The evidence has demonstrated that strategies targeting individual behaviours relating to diet, energy intake and physical activity without changing the many determinants of these behaviours have not achieved significant or sustained outcomes.
As such, interventions addressing overweight and obesity, physical inactivity, and poor nutrition require an approach that is broad in scope and integrated with an overarching strategy. Central to this approach is the need to change a range of environmental elements to support individuals to make healthier choices. This approach requires action from all levels of society, including individuals and families, industry, schools, workplaces, communities, and health and other professionals, with a steering role for governments.
Consequently the National Preventative Health Taskforce has recommended a long-term, comprehensive and integrated multi-sectoral approach to improving physical activity levels and nutrition aimed at reducing overweight and obesity at the population level in Australia.
Public education campaigns utilise commercial marketing principles and mass media to distribute and promote public health messages. Increasingly, social marketing has been used as a public education strategy. The value of social marketing as a public education tool – as seen in tobacco control – is in its role in influencing attitudes and shifting cultural norms with regard to health behaviours. The National Preventative Health Taskforce in 2009 has highlighted public education using social marketing as a key action area for improving healthy eating and physical activity.
Evidence increasingly shows that well designed and executed social marketing campaigns on health issues can be effective in changing health knowledge, beliefs, attitudes and behaviours across large populations. While the bulk of current evidence relates to tobacco control, social marketing interventions have also been shown to be effective in increasing physical activity and improving nutrition. Limited evidence has demonstrated some success of social marketing interventions in targeting rising rates of obesity in regional Australia.
In a public health setting, public education mass media campaigns are often supported by complementary messaging through other channels including healthcare providers and community programs. This allows for integrated universal and targeted approaches, such that approaches such as social marketing are supplemented and supported by local level initiatives tailored to the needs of specific communities.
The effectiveness of social marketing interventions is improved when they are one component of a comprehensive approach targeting population health behaviours; outcomes of these interventions are generally better when they are supported by complementary policies and programs to support behavioural change and competing marketing messages are restricted. See below for more information on restricting competing health messages through marketing to children.
Settings based interventions
Structured settings in which individuals spend large amounts of their time have the capacity to heavily influence health behaviours. Further, such settings provide an opportunity for public health interventions to target specific populations. Settings based interventions targeting schools, workplaces and communities have demonstrated some success with regard to improving rates of overweight and obesity, levels of physical activity, and nutrition.
Schools, childcare and out of school hours care
Childhood is an important time during which children develop the knowledge, behaviours and skills which can influence their health throughout their lives. Consequently, schools, and increasingly childcare and out-of-school-hours care services, are an important setting for health promotion which can influence both children and their families.
Evidence suggests that school-based approaches targeting overweight and obesity, physical inactivity and poor nutrition are most effective when a whole-of-school approach is taken. This approach involves the integration of supportive school policies (e.g. healthy canteens, walk to school days), curriculum (e.g. nutrition and physical education) and environment (e.g. availability of recreational space), supported by contact with families.
In Australia, school based programs have shown some success in slowing the rise of obesity levels. The Eat Well Be Active project comprising canteen menu changes and healthy breakfast days in schools, walk to school programs, and improved access to sports equipment and coaching resulted in significantly lower increases in body weight amongst children exposed to the program.
There is little published evidence relating to childcare and out of school hours care, but the available evidence indicates that programs involving parents are the most effective.
Workplace health promotion presents enormous potential to access large numbers of people and to improve the health and productivity of the workforce.
There is strong evidence that workplace interventions targeting overweight and obesity, physical inactivity and poor nutrition are effective. Settings based interventions implemented through the workplace have demonstrated modest improvements in physical activity and nutrition, reduction in weight and other chronic disease risk factors, and reductions in medical and absenteeism costs in the workplace.
Effective workplace based strategies include the use of prompts to increase stair use, improved opportunities for physical activity, providing healthy food and beverages, education, and the involvement of employees in program development and implementation.
Community-wide interventions have demonstrated some effectiveness in improving physical activity and nutrition, and slowing the increase of obesity rates. However, a recent review of 25 studies of community based interventions designed to increase physical activity levels found research in this area generally of poor quality and yielding inconsistent results.
Internationally, a number of community based nutrition and lifestyle interventions have shown success in stabilising obesity rates and decreasing chronic disease mortality, including cancer mortality. Typically, these interventions integrate multiple strategies, utilising a number of community channels including health care professionals, food retailers, and voluntary organisations, together with the media.
The physical environment
The body of evidence suggests that 'walkable' environments are associated with decreased obesity and higher levels of physical activity. Key characteristics of a walkable environment include mixed land use, higher residential density, street connectivity and design, availability of footpaths, attractive surrounds and perceptions that the environment is safe. One study found that each kilometre walked per day was associated with a 4.8% decrease in the risk of obesity.
Physical environments designed to facilitate active transport such as cycling, walking and public transport are associated with increased physical activity. Infrastructure enabling active transport between residential, commercial and business areas, and access to recreational facilities and sporting infrastructure are key components of such environments. An Australian study found that individuals who drove to work were less likely to achieve recommended levels of physical activity and were 13% more likely to be overweight or obese than non-car users.
There is some evidence that the physical environment can influence diet - improved access to healthy foods may increase their consumption. There is a body of evidence from the US to suggest that neighbourhoods with better access to supermarkets and fewer fast food outlets tend to have healthier diets and lower levels of obesity. However, evidence of a link between proximity to fast food restaurants, and diet and obesity, from outside the US is mixed.
National Food and Nutrition Framework
To support healthier and less energy dense diets, and a safe and sustainable food supply, the National Preventative Health Taskforce recommended the implementation of a National Food and Nutrition Framework. The Framework is designed to drive change in food policy to ensure that all Australians have access to affordable, healthy, fresh and good quality foods, with a focus on disadvantaged groups, and rural and remote communities.
The Australian Government is currently developing a National Food Plan to provide an overarching approach to food policy. The scope of the plan includes food safety and security, health and nutrition, supporting a competitive, productive and efficient food industry, trade opportunities, and sustainability. An appropriate emphasis on public health and nutrition is important in the development of this plan.
Front-of-pack nutrition information has the potential to improve dietary behaviours by assisting consumers to identify healthier food choices at the point of sale. There is evidence that front-of-pack food labelling may provide incentive for the food industry to increase the availability of healthier products through product reformulation and innovation.
A number of front-of-pack labelling formats are in use globally, with different levels of effectiveness. Systems with an interpretive element to indicate the healthiness of a product generally perform better in assisting consumers to identify healthier foods. The evidence suggests that the traffic light system is most effective at conveying clear health information to consumers. Traffic light labelling ranks a product's total fat, saturated fat, sugar and salt/sodium levels as high (red), medium (amber) or low (green). The 2011 report of the review of food labelling law and policy in Australia recommended the voluntary introduction of multiple traffic light labelling on processed foods and on menus at chain food outlets.
The voluntary percentage daily intake guide introduced in 2006 by the Australian Food and Grocery Council lacks an interpretive element. This system displays the percentage of recommended daily requirements of the major nutrients in food products. Evidence suggests that monochrome systems such as the percentage daily intake guide can be difficult for consumers to interpret, particularly for disadvantaged groups where obesity is more prevalent, and perform less well in assisting consumers to correctly identify healthier food products.
For more information, see Position statement: Front-of-pack food labelling.
Several studies have demonstrated that health claims on food products influence consumers' perceptions of the healthiness of the product and their willingness to buy that product. Health claims are often misinterpreted, and can lead to an increased perception of healthiness and willingness to buy.
Recent evidence suggests that foods making specific health claims often do not satisfy the criteria of nutrient profiling models to identify healthy food products. Total fat, saturated fatty acid, sugar and/or sodium levels of products making health claims are often too high to be considered healthy.
Food marketing to children
Children in Australia are exposed to a high volume of unhealthy food advertisements on television and through non-broadcast media. Between 54% and 82% of food advertising during television programs popular with children are for unhealthy foods and beverages high in fat, salt and sugar.
Restricting unhealthy food marketing to children is a key area for action in obesity prevention. Evidence indicates that food marketing to children generates positive beliefs about the advertised products, and influences food preferences, purchasing requests and consumption, as well as dietary habits and health statuses. Further, the high level of unhealthy food advertising may limit the effectiveness of social marketing campaigns for healthy foods and lifestyles.
Current food marketing regulations are limited, and only apply to specific children’s programming on television. The highest numbers of children watch commercial television between 6pm and 9pm when the regulations do not apply. Self-regulatory codes are in place, but their effectiveness is limited as they are typically voluntary, permissive, and poorly monitored and enforced.
For more information, see Position statement - Food Marketing to children
Many processed foods are high in salt, sugar, fat and energy and low in overall nutritional quality. Improving the nutritional quality of the food supply through product reformulation and innovation has enormous potential for improving population nutrition and health. Reducing portion sizes of processed foods, which have increased substantially in recent years, also has the potential to decrease energy intake as evidence indicates that people tend to consume more kilojoules when they are presented with larger portions of food and beverages.
Internationally, there has been some success with food reformulation having a positive health impact on reducing negative nutrients such as salt. In Mauritius, a government led change which saw soybean oil replace palm oil as the main cooking oil led to a pronounced reduction in population cholesterol levels, despite an increase in obesity. In the UK, a government-industry partnership to reduce salt levels in processed foods, together with a public awareness campaign saw a 10% reduction in average daily salt consumption.
In Australia, food reformulation has been shown to be a cost-effective preventive health measure. An evaluation of 123 Australian preventive health interventions found that limiting the salt content of three basic foods (bread, cereals and margarine) on a mandatory basis, would have a large impact on population health. This intervention was shown to not only be cost-effective, but cost saving.
Food reformulation in Australia is driven by the Food and Health Dialogue, established in 2009 to enable government, industry and public health groups to work collaboratively on the issue. Under the program voluntary targets have been set for reducing salt and saturated fat levels in a range of foods. At this stage, targets have not been set by the Food and Health Dialogue for reducing energy content (kilojoules), but the food industry have indicated that reducing energy content in food products is a component of the Healthier Australia Commitment.
The role of primary care
Around 86% of Australians visit their GP every year, making primary care an important setting for chronic disease prevention. The Royal Australian College of General Practitioners supports GPs to address overweight and obesity, physical inactivity and poor nutrition with a range of evidence-based guidelines on preventive health and behavioural risk factors. In addition, the Australian Department of Health and Ageing funds the lifestyle prescriptions program, Lifescripts, which provides evidence-based tools to GPs to help patients address lifestyle risk factors for chronic disease such as alcohol misuse.
While limited evidence suggests brief GP interventions can produce short-term increases in physical activity and small changes in dietary behaviour, programs delivered by multidisciplinary teams may be more effective at maintaining weight loss. There is evidence that multidisciplinary teams that can comprise nurses, dieticians, exercise physiologists, behavioural therapists and GPs can deliver effective diet and physical activity interventions.
The capacity to deliver effective physical activity and dietary intervention programs in Australia will require substantial workforce development, and development of effective funding models for preventive interventions in primary care settings. The Australian Government's national health reform agenda seeks to enhance the role of primary care in preventive health through supporting practice nurses to deliver preventive health programs.
Certain population groups have higher rates of obesity and overweight, poor nutrition and physical inactivity and are at higher risk of related chronic disease. In general, these risk factors are more prevalent among Australians in lower socioeconomic groups, people living in rural and remote areas and Indigenous Australians. Issues such as affordable access to healthy foods and opportunities to engage in physical activity are likely to be major contributing factors. The development and implementation of specific interventions targeting the social determinants of health in these groups is key to addressing this clustering of risk factors.
Economic interventions, such as taxation, grants and subsidies can provide incentives and disincentives to help modify health behaviours relating to overweight and obesity, physical activity and nutrition.
In Australia, there are a lack of financial incentives and disincentives to support increased physical activity. The fringe benefits tax for private motor vehicle use promotes the use of private cars rather than active transport (such as walking, cycling and public transport), encouraging inactivity. There is potential for subsidisation of recreational activities to improve physical activity levels.
Economic interventions targeting nutrition include taxation of unhealthy foods include portion size pricing, and subsidy schemes and rewards for food providers, advertisers and consumers. Currently, there is limited evidence of the effectiveness of food taxes and subsidies in reducing overweight and obesity, and improving nutrition. However, the available evidence suggests that taxation and subsidies resulting in non-trivial pricing changes can contribute to healthy consumption patterns, particularly for children and adolescents, and low socio-economic populations.
The ACE-Prevention report identified a 10% tax on unhealthy foods as an effective and cost-effective preventive health intervention for Australia. Criticisms of this model include concerns that taxing unhealthy foods would disproportionately affect lower income earners who spend a higher proportion of their income on food.
Further research and careful modelling of the impact of food taxation and subsidy interventions across population groups is required, particularly with reference to sustained behavioural changes, before widespread implementation.
Research, monitoring and evaluation
Overweight and obesity is a relatively new public health issue. The evidence base regarding effective prevention and management interventions is still developing. As such, further research in this field is required to build the evidence to support public health and policy initiatives.
The National Preventative Health Taskforce recommend a 'learning by doing' approach to balance the need for better evidence with the urgency of the obesity problem. This approach involves the integration of program implementation with close monitoring and evaluation, requiring enhanced health risk surveillance at the population level and an expanded preventive health research agenda.
Expanding the evidence for translation and dissemination through integrating and implementing evaluation frameworks at the beginning of dissemination of an intervention will allow the establishment of an evidence base for the efficacy of interventions and of their being scaled up to include more settings and populations.
- National Preventative Health Taskforce. Australia: the healthiest country by 2020. National preventative health strategy – the roadmap for action. Canberra: Commonwealth of Australia; 2009 Jun 30 Available from: http://www.preventativehealth.org.au/internet/preventativehealth/publishing.nsf/Content/nphs-roadmap/$File/nphs-roadmap.pdf.
- Butland B, Jebb S, Kopelman P, McPherson K, Thomas S, Mardell J, et al. Foresight. tackling obesities: future choices - project report. Second edition. UK: Government Office for Science; 2007 Available from: http://www.bis.gov.uk/assets/foresight/docs/obesity/17.pdf.
- World Cancer Research Fund, American Institute for Cancer Research. Policy and action for cancer prevention. Food, nutrition, and physical activity: a global perspective. Washington DC: AICR; 2009 Available from: http://www.dietandcancerreport.org/cancer_resource_center/downloads/chapters/pr/Introductory%20pages.pdf.
- World Health Organization. Global strategy on diet, physical activity and health. Geneva: WHO; 2004 Available from: http://www.who.int/nmh/wha/59/dpas/en/.
- Abroms LC, Maibach EW. The effectiveness of mass communication to change public behavior. Annu Rev Public Health 2008;29:219-34 Abstract available at http://www.ncbi.nlm.nih.gov/pubmed/18173391.
- Noar SM. A 10-year retrospective of research in health mass media campaigns: where do we go from here? J Health Commun 2006;11(1):21-42 Abstract available at http://www.ncbi.nlm.nih.gov/pubmed/16546917.
- Wakefield MA, Loken B, Hornik RC. Use of mass media campaigns to change health behaviour. Lancet 2010 Oct 9;376(9748):1261-71 Abstract available at http://www.ncbi.nlm.nih.gov/pubmed/20933263.
- Gordon R, McDermott L, Stead M, Angus K. The effectiveness of social marketing interventions for health improvement: what's the evidence? Public Health 2006 Dec;120(12):1133-9 Abstract available at http://www.ncbi.nlm.nih.gov/pubmed/17095026.
- Huhman ME, Potter LD, Duke JC, Judkins DR, Heitzler CD, Wong FL. Evaluation of a national physical activity intervention for children: VERB campaign, 2002-2004. Am J Prev Med 2007 Jan;32(1):38-43 Abstract available at http://www.ncbi.nlm.nih.gov/pubmed/17218189.
- Pomerleau J, Lock K, Knai C, McKee M. Interventions designed to increase adult fruit and vegetable intake can be effective: a systematic review of the literature. J Nutr 2005 Oct;135(10):2486-95 Abstract available at http://www.ncbi.nlm.nih.gov/pubmed/16177217.
- Sanigorski AM, Bell AC, Kremer PJ, Cuttler R, Swinburn BA. Reducing unhealthy weight gain in children through community capacity-building: results of a quasi-experimental intervention program, Be Active Eat Well. Int J Obes (Lond) 2008 Jul;32(7):1060-7 Abstract available at http://www.ncbi.nlm.nih.gov/pubmed/18542082.
- Evans WD. How social marketing works in health care. BMJ 2006 May 20;332(7551):1207-10 Abstract available at http://www.ncbi.nlm.nih.gov/pubmed/16710002.
- International Union for Health Promotion and Education. Promoting health in schools: from evidence to action. France: IUHPE; 2010 Available from: http://www.iuhpe.org/uploaded/Activities/Scientific_Affairs/CDC/School%20Health/PHiS_EtA_EN_WEB.pdf.
- National Institute for Health and Clinical Excellence. Guidance on the prevention, identification, assessment and management of overweight and obesity in adults and children. Quick reference guide 1. For local authorities, schools and early years providers, workplaces and the public. London: NICE; 2006 Dec. Report No.: CG43. Available from: http://www.nice.org.uk/nicemedia/live/11000/30363/30363.pdf.
- Timperio A, Salmon J, Ball K. Evidence-based strategies to promote physical activity among children, adolescents and young adults: review and update. J Sci Med Sport 2004 Apr;7(1 Suppl):20-9 Abstract available at http://www.ncbi.nlm.nih.gov/pubmed/15214598.
- Task Force on Community Preventive Services, Anderson LM, Quinn TA, Glanz K, Ramirez G, Kahwati LC, et al. The effectiveness of worksite nutrition and physical activity interventions for controlling employee overweight and obesity: a systematic review. Am J Prev Med 2009 Oct;37(4):340-57 Abstract available at http://www.ncbi.nlm.nih.gov/pubmed/19765507.
- Chau J. Evidence module: workplace physical activity and nutrition interventions. Sydney: Physical Activity Nutrition and Obesity Research Group, University of Sydney; 2009 Available from: http://sydney.edu.au/medicine/public-health/panorg/pdfs/Evidence_module_Workplace.pdf.
- World Health Organization, World Economic Forum. Preventing noncommunicable diseases in the workplace through diet and physical activity: WHO/World Economic Forum report of a joint event. Geneva: WHO/WEF; 2008 Available from: http://whqlibdoc.who.int/publications/2008/9789241596329_eng.pdf.
- American Institute for Preventive Medicine. The health and economic implications of worksite wellness programs. Wellness white paper. Michigan, US: AIPM; 2008.
- Baker PR, Francis DP, Soares J, Weightman AL, Foster C. Community wide interventions for increasing physical activity. Cochrane Database Syst Rev 2011 Apr 13;(4):CD008366 Abstract available at http://www.ncbi.nlm.nih.gov/pubmed/21491409.
- Westley H. Thin living. BMJ 2007 Dec 15;335(7632):1236-7 Abstract available at http://www.ncbi.nlm.nih.gov/pubmed/18079544.
- Puska P. Successful prevention of non-communicable diseases: 25 year experiences with North Karelia Project in Finland. Public Health Medicine 2011;4(1):5-7.
- Raine K, Spence JC, Church J, Boule N, Slater L, Marko J, et al. State of the evidence review on urban health and healthy weights. Canadian Institute for Health Information: Ottawa; 2008 Available from: https://secure.cihi.ca/free_products/Urban%20Health%20and%20Healthy%20Weights.pdf.
- Frank LD, Andresen MA, Schmid TL. Obesity relationships with community design, physical activity, and time spent in cars. Am J Prev Med 2004 Aug;27(2):87-96 Abstract available at http://www.ncbi.nlm.nih.gov/pubmed/15261894.
- Giles-Corti B, Macintyre S, Clarkson JP, Pikora T, Donovan RJ. Environmental and lifestyle factors associated with overweight and obesity in Perth, Australia. Am J Health Promot 2003 Sep;18(1):93-102 Abstract available at http://www.ncbi.nlm.nih.gov/pubmed/13677967.
- Schoeppe S, Braubach M. Tackling obesity by creating healthy residential environments. Copenhagen: World Health Organization Regional Office for Europe; 2007 Available from: http://www.euro.who.int/__data/assets/pdf_file/0012/98697/E90593.pdf.
- Australian Institute of Health and Welfare. Health and the environment: a compilation of evidence. Canberra: AIHW; 2011 Mar. Report No.: PHE 136. Available from: https://www.aihw.gov.au/WorkArea/DownloadAsset.aspx?id=10737418532&libID=10737418531.
- Gebel K, King L, Bauman A, Vita P, Gill T, Rigby A, et al. Creating healthy environments: a review of links between the physical environment, physical activity and obesity. Sydney: NSW Health Department and NSW Centre for Overweight and Obesity; 2005 Available from: http://sydney.edu.au/medicine/public-health/coo/pdf/2005_creating_healthy_environments.pdf.
- Wen LM, Orr N, Millett C, Rissel C. Driving to work and overweight and obesity: findings from the 2003 New South Wales Health Survey, Australia. Int J Obes (Lond) 2006 May;30(5):782-6 Abstract available at http://www.ncbi.nlm.nih.gov/pubmed/16404406.
- Larson NI, Story MT, Nelson MC. Neighborhood environments: disparities in access to healthy foods in the U.S. Am J Prev Med 2009 Jan;36(1):74-81 Abstract available at http://www.ncbi.nlm.nih.gov/pubmed/18977112.
- Morland K, Diez Roux AV, Wing S. Supermarkets, other food stores, and obesity: the atherosclerosis risk in communities study. Am J Prev Med 2006 Apr;30(4):333-9 Abstract available at http://www.ncbi.nlm.nih.gov/pubmed/16530621.
- Department of Agriculture, Fisheries and Forestry. Issues paper to inform development of a national food plan. Canberra: DAFF; 2011 Available from: http://www.daff.gov.au/__data/assets/pdf_file/0009/1926315/nfp_-_final.pdf.
- Cowburn G, Stockley L. Consumer understanding and use of nutrition labelling: a systematic review. Public Health Nutr 2005 Feb;8(1):21-8 Abstract available at http://www.ncbi.nlm.nih.gov/pubmed/15705241.
- Gorton D, Ni Mhurchu C, Chen MH, Dixon R. Nutrition labels: a survey of use, understanding and preferences among ethnically diverse shoppers in New Zealand. Public Health Nutr 2009 Sep;12(9):1359-65 Abstract available at http://www.ncbi.nlm.nih.gov/pubmed/19087382.
- Kelly B, Hughes C, Chapman K, Louie JC, Dixon H, Crawford J, et al. Consumer testing of the acceptability and effectiveness of front-of-pack food labelling systems for the Australian grocery market. Health Promot Int 2009 Jun;24(2):120-9 Abstract available at http://www.ncbi.nlm.nih.gov/pubmed/19336501.
- Maubach N, Hoek J. The effect of alternative nutrition information formats on consumers’ evaluations of a children’s breakfast cereal. In: University of Wollongong. Partnerships, proof and practice - International Nonprofit and Social Marketing Conference 2008 Jul 15-16 Wollongong: University of Wollongong; 2008 Available from: http://ro.uow.edu.au/cgi/viewcontent.cgi?article=1000&context=insm08.
- US Food and Drug Administration. Calories count: report of the working group on obesity. [homepage on the internet] USA: US FDA; 2004 Mar 12 [cited 2013 Sep 30; updated 2013 Feb 6]. Available from: http://www.fda.gov/Food/FoodScienceResearch/ConsumerBehaviorResearch/ucm081696.htm.
- Conquest Research. Food labelling study prepared for Which? United Kingdom: Conquest Research; 2006 Jun.
- Malam S, Clegg S, Kirwan S, McGinigal S. Comprehension and use of UK nutrition signpost labelling schemes. UK: Food Standards Agency; 2009 May Available from: http://www.food.gov.uk/multimedia/pdfs/pmpreport.pdf.
- Blewett N, Goddard N, Pettigrew S, Reynolds C, Yeatman H. ‘Labelling logic’ – the final report of the review of food labelling law and policy. Canberra: Commonwealth of Australia; 2011 Available from: http://www.foodlabellingreview.gov.au/internet/foodlabelling/publishing.nsf/content/48C0548D80E715BCCA257825001E5DC0/$File/Labelling%20Logic_2011.pdf.
- Harris JL, Thompson JM, Schwartz MB, Brownell KD. Nutrition-related claims on children's cereals: what do they mean to parents and do they influence willingness to buy? Public Health Nutr 2011 Dec;14(12):2207-12 Abstract available at http://www.ncbi.nlm.nih.gov/pubmed/21806872.
- Lynam AM, McKevitt A, Gibney MJ. Irish consumers' use and perception of nutrition and health claims. Public Health Nutr 2011 Dec;14(12):2213-9 Abstract available at http://www.ncbi.nlm.nih.gov/pubmed/21557863.
- Dixon H, Scully M, Wakefield M, Kelly B, Chapman K, Donovan R. Parent's responses to nutrient claims and sports celebrity endorsements on energy-dense and nutrient-poor foods: an experimental study. Public Health Nutr 2011 Jun;14(6):1071-9 Abstract available at http://www.ncbi.nlm.nih.gov/pubmed/21306666.
- Trichterborn J, Harzer G, Kunz C. Nutrient profiling and food label claims: evaluation of dairy products in three major European countries. Eur J Clin Nutr 2011 Sep;65(9):1032-8 Abstract available at http://www.ncbi.nlm.nih.gov/pubmed/21540877.
- Kelly B, Chapman K, King L, Hebden L. Trends in food advertising to children on free-to-air television in Australia. Aust N Z J Public Health 2011 Apr;35(2):131-4 Abstract available at http://www.ncbi.nlm.nih.gov/pubmed/21463408.
- Hebden L, King L, Chau J, Kelly B. Food advertising on children's popular subscription television channels in Australia. Aust N Z J Public Health 2011 Apr;35(2):127-30 Abstract available at http://www.ncbi.nlm.nih.gov/pubmed/21463407.
- CHOICE. Food advertising to children: who's the biggest loser? CHOICE; 2009 Available from: http://www.choice.com.au/files/f134515.pdf.
- CHOICE. Food marketing: child's play? [homepage on the internet] Australian Consumers Association; 2006 [cited 2006 Sep 18; updated 2006 Sep 18]. Available from: http://www.choice.com.au/viewArticle.aspx?id=105275&catId.
- Jones S, Wiese E, Fabrianesi B. Following the links: food advertising and promotion on children's magazine websites. Journal of Nonprofit & Public Sector Marketing 2008;20 (2).
- Kelly B, Bochynska K, Kornman K, Chapman K. Internet food marketing on popular children's websites and food product websites in Australia. Public Health Nutr 2008 Nov;11(11):1180-7 Abstract available at http://www.ncbi.nlm.nih.gov/pubmed/18298882.
- Kelly B, Chapman K. Food references and marketing to children in Australian magazines: a content analysis. Health Promot Int 2007 Dec;22(4):284-91 Abstract available at http://www.ncbi.nlm.nih.gov/pubmed/17923469.
- Jones SC, Gregory P, Kervin L. Branded food references in children's magazines: 'advertisements' are the tip of the iceberg. Pediatr Obes 2012 Jun;7(3):220-9 Abstract available at http://www.ncbi.nlm.nih.gov/pubmed/22434788.
- Chapman K, Nicholas P, Banovic D, Supramaniam R. The extent and nature of food promotion directed to children in Australian supermarkets. Health Promot Int 2006 Dec;21(4):331-9 Abstract available at http://www.ncbi.nlm.nih.gov/pubmed/16885173.
- Hebden L, King L, Kelly B, Chapman K, Innes-Hughes C. A menagerie of promotional characters: promoting food to children through food packaging. J Nutr Educ Behav 2011 Sep;43(5):349-55 Abstract available at http://www.ncbi.nlm.nih.gov/pubmed/21906547.
- World Health Organization, Food and Agriculture Organization. Diet, nutrition and the prevention of chronic diseases. Geneva, Switzerland: WHO; 2003. Report No.: WHO technical report series 916. Available from: http://apps.who.int/iris/bitstream/10665/42665/1/WHO_TRS_916.pdf.
- McGinnis JM, Gootman JA, Kraak VI. Food marketing to children and youth: threat or opportunity? Washington, DC: The National Academies Press; 2005 Available from: http://www.nap.edu/openbook.php?record_id=11514&page=R1.
- Dalmeny K, Hanna E, Lobstein T. Broadcasting bad health: why food marketing to children needs to be controlled. International Association of Consumer Food Organizations; 2003 Jul Available from: http://cspinet.org/reports/codex/foodmarketingreport.pdf.
- Cairns G, Angus K, Hastings G, Caraher M. Systematic reviews of the evidence on the nature, extent and effects of food marketing to children. A retrospective summary. Appetite 2013 Mar;62:209-15 Abstract available at http://www.ncbi.nlm.nih.gov/pubmed/22561190.
- Commonwealth of Australia, Attorney General's Department. Children's television standards 2009. Canberra: Office of Legislative Drafting and Publishing; 2012 Available from: http://www.acma.gov.au/webwr/aba/contentreg/codes/television/documents/childrens_tv_standards_2009.pdf.
- Australian Communications and Media Authority. Children's television standards review. Issues paper. ACMA; 2007 Available from: http://www.acma.gov.au/~/media/Content%20Monitoring%20and%20Review/Report/pdf/cts_review_issues_paper%20pdf.pdf.
- Hebden L, King L, Kelly B, Chapman K, Innes-Hughes C. Industry self-regulation of food marketing to children: reading the fine print. Health Promot J Austr 2010 Dec;21(3):229-35 Abstract available at http://www.ncbi.nlm.nih.gov/pubmed/21118071.
- Hebden LA, King L, Grunseit A, Kelly B, Chapman K. Advertising of fast food to children on Australian television: the impact of industry self-regulation. Med J Aust 2011 Jul 4;195(1):20-4 Abstract available at http://www.ncbi.nlm.nih.gov/pubmed/21728936.
- King L, Hebden L, Grunseit A, Kelly B, Chapman K, Venugopal K. Industry self regulation of television food advertising: responsible or responsive? Int J Pediatr Obes 2011 Jun;6(2-2):e390-8 Abstract available at http://www.ncbi.nlm.nih.gov/pubmed/20858046.
- Dowse GK, Gareeboo H, Alberti KG, Zimmet P, Tuomilehto J, Purran A, et al. Changes in population cholesterol concentrations and other cardiovascular risk factor levels after five years of the non-communicable disease intervention programme in Mauritius. Mauritius Non-communicable Disease Study Group. BMJ 1995 Nov 11;311(7015):1255-9 Abstract available at http://www.ncbi.nlm.nih.gov/pubmed/7496233.
- National Centre for Social Research. An assessment of dietary sodium levels among adults (aged 19-64) in the UK general population in 2008, based on analysis of dietary sodium in 24 hour urine samples. UK: National Centre for Social Research; 2008 Available from: http://www.food.gov.uk/multimedia/pdfs/sodiumreport08.pdf.
- Vos T, Carter R, Barendregt J, Mihalopoulos C, Veerman JL, Magnus A, et al. ACE–Prevention Team (2010). Assessing cost-effectiveness in prevention (ACE–Prevention): Final report. Brisbane, Melbourne: University of Queensland, Deakin University; 2010 Sep Available from: http://www.deakin.edu.au/strategic-research/population-health/assets/resources/ace-prevention-report.pdf.
- Harris M, Bennett J, Del Mar C, Fasher M, Foreman L, Furler J, et al. Guidelines for preventive activities in general practice. 7th ed. South Melbourne: Royal Australian College of General Practitioners; 2009 Available from: http://healthprofessionals.flyingdoctor.org.au/IgnitionSuite/uploads/docs/RACGP%20Guidelines%20for%20Preventive%20Activities%20in%20General%20Practice.pdf.
- Royal Australian College of General Practitioners. Smoking, nutrition, alcohol and physical activity (SNAP): a population health guide to behavioural risk factors in general practice. South Melbourne: RACGP; 2004 Available from: http://www.racgp.org.au/download/documents/Guidelines/snapguide2004.pdf.
- Royal Australian College of General Practitioners. Putting prevention into practice: guidelines for the implementation of prevention in the general practice setting. 2nd ed. South Melbourne: RACGP; 2006 Available from: http://www.racgp.org.au/download/documents/Guidelines/Greenbook/racgpgreenbook2nd.pdf.
- Smith BJ. Promotion of physical activity in primary health care: update of the evidence on interventions. J Sci Med Sport 2004 Apr;7(1 Suppl):67-73 Abstract available at http://www.ncbi.nlm.nih.gov/pubmed/15214604.
- Pignone MP, Ammerman A, Fernandez L, Orleans CT, Pender N, Woolf S, et al. Counseling to promote a healthy diet in adults: a summary of the evidence for the U.S. Preventive Services Task Force. Am J Prev Med 2003 Jan;24(1):75-92 Abstract available at http://www.ncbi.nlm.nih.gov/pubmed/12554027.
- Kirk SF, Penney TL, McHugh TL, Sharma AM. Effective weight management practice: a review of the lifestyle intervention evidence. Int J Obes (Lond) 2012 Feb;36(2):178-85 Abstract available at http://www.ncbi.nlm.nih.gov/pubmed/21487396.
- IMAGE Study Group, Greaves CJ, Sheppard KE, Abraham C, Hardeman W, Roden M, et al. Systematic review of reviews of intervention components associated with increased effectiveness in dietary and physical activity interventions. BMC Public Health 2011 Feb 18;11:119 Abstract available at http://www.ncbi.nlm.nih.gov/pubmed/21333011.
- Department of Health and Ageing. What is national health reform delivering? [homepage on the internet] Canberra: DoHA; 2017 Nov 18 [cited 2013 Aug 19; updated 2010 Nov 9]. Available from: http://www.yourhealth.gov.au/internet/yourhealth/publishing.nsf/Content/reformQA03#practice%20nurses.
- Australian Bureau of Statistics. National health survey 2007-2008: summary of results. Canberra: ABS; 2009. Report No.: 4364.0. Available from: http://www.abs.gov.au/AUSSTATS/abs@.nsf/mf/4364.0.
- Australian Institute of Health and Welfare. Rural, regional and remote health: indicators of health. Rural health series no. 5. Canberra: AIHW; 2005. Report No.: Cat. no. PHE 59. Available from: http://www.aihw.gov.au/WorkArea/DownloadAsset.aspx?id=6442459626.
- Australian Institute of Health and Welfare. Aboriginal and Torres Strait Islander health performance framework 2008 report: detailed analyses. Canberra: AIHW; 2009 Jan 19. Report No.: Cat. no. IHW 22.. Available from: http://www.aihw.gov.au/publication-detail/?id=6442468199.
- Powell LM, Chaloupka FJ. Food prices and obesity: evidence and policy implications for taxes and subsidies. Milbank Q 2009 Mar;87(1):229-57 Abstract available at http://www.ncbi.nlm.nih.gov/pubmed/19298422.
- Thow AM, Jan S, Leeder S, Swinburn B. The effect of fiscal policy on diet, obesity and chronic disease: a systematic review. Bull World Health Organ 2010 Aug 1;88(8):609-14 Abstract available at http://www.ncbi.nlm.nih.gov/pubmed/20680126.
- Rychetnik L, Bauman A, Laws R, King L, Rissel C, Nutbeam D, et al. Translating research for evidence-based public health: key concepts and future directions. J Epidemiol Community Health 2012 Dec;66(12):1187-92 Abstract available at http://www.ncbi.nlm.nih.gov/pubmed/22569750.