Errata pasted onto back page. Bibliography: leaves 193-228.

Errata pasted onto back page. / Bibliography: leaves 193-228. / xv, 228 leaves : ill. (chiefly col.) ; 30 cm. / Title page, contents and abstract only. The complete thesis in print form is available from the University Library. / Thesis (Ph.D.)--University of Adelaide, Dept. of Physiology, 2001

Although increasing stair use among adults with sedentary occupations can provide an accessible means of integrating moderate physical activity within daily work routines, there is little evidence-based information available to guide architects on how to design buildings that promote stair use. This study examined the relationship between stair use and a broad range of features of the physical environment within 10 buildings. Based on a review of the literature, a thematic framework (Appeal, Convenience, Comfort, Legibility and Safety) was developed for identifying the features of buildings that may influence stair use. Three methods of investigation were used to examine the relationship between stair use and variables of the five themes and their constructs. Buildings users were surveyed for their reasons for both single and multi-level route choice. The results indicated that reasons associated with convenience and legibility of route had greater influence on route choice than appeal, comfort or safety. Stair and elevator use were measured in the ten buildings along with variables that operationalized the thematic framework. Regression analysis was utilized to examine the relationship between stair use and the operationalized variables of the thematic framework. The results of regression analysis indicated that stair use was associated with 8 key spatial variables of convenience and legibility (travel distances from stair to nearest entrance and to the elevator; percentage of total building area or total occupant load attributed to each stair; physical accessibility of each stair; area of stair isovist; number of turns from the stair to closest entrance and to the most integrated path). Most local environmental features of stairs such as lighting levels and views were not statistically influential. Multivariate regression analysis indicated that three variables (effective area of each stair, area of stair isovist, and number of turns required between the stair and the most integrated path) explained 53% of stair use. A graphic analysis of the arrangement of the 8 key spatial variables within the ten buildings indicated that buildings with high overall levels of stair use optimized the key spatial variables in respect to the location of stair(s) within the building floor plan.

Objective: Assess the effectiveness of an ecological approach to promote healthy food choices in early childhood education through an educational workshop series. Design: Utilizing play-based learning, the workshops emphasized an ecological approach to health and food choice by letting children explore and experience healthy foods through various play-based and experiential activities. Data were collected and analyzed using grounded theory of semi-structured interviews with children, parents, and early childhood educators (ECEs), thematic analysis of children’s drawings, and quantitative food preference and food categorization surveys conducted with the children. Setting: The work was undertaken in three YMCA child care centres located in the Greater Toronto Area: Newcastle, Unionville, and inner-city Toronto. Participants: Participants comprised of 19 children, 5 parents, and 9 ECEs. Conclusions: The ecological approach to the promotion of healthy food choices in early childhood education was demonstrated to be an effective health promotion strategy for children aged 3 to 5.

Background Overweight and obesity are considerable public health issues internationally as well as in Sweden. On a global level, the obesity prevalence has nearly doubled over the last 30 years. Currently in Sweden, more than one third of all women, and slightly more than half of all men, are either overweight or obese. The long-term results of obesity treatment programs are modest as reported by other studies. The importance of extending the focus to not only obesity treatment, but also prevention of weight gain, has therefore been emphasized. Aim The overall aim of this thesis is to explore the concept of primary weight maintenance (PWM) and to increase the knowledge of the attitudes, behaviours, strategies and surrounding circumstances that are important for PWM in a Swedish middle-aged population. Material and methods All study participants were recruited based on their previous participation in a health survey in their home setting; The Västerbotten Intervention Programme (VIP) in Västerbotten Sweden (paperI-IV), or the Upstate Health and Wellness Study in Upstate New York (IV), USA. All subjects had participated twice, with a time period of ten years between health surveys. The prevalence of obesity between the years 1990-2004 was calculated for VIP participants (paper I). Ten-year non-gain (lost weight or maintained body weight within 3% of baseline weight) or weightgain (≥3%) was calculated for individuals aged 30, 40, or 50 years at baseline. A multivariate logistic regression model was built to predict weight non-gain. In-depth interviews were conducted with 23 maintainers and four slight gainers in Sweden and analysed using Grounded Theory (paper II). A questionnaire study was conducted including 2138 Swedish and 2134 US participants (paper III and IV). Analysis of variance (ANOVA), correlation, and linear regression were performed to identify attitudes, strategies, and behaviours that are predictive of PWM in different age, sex and BMI subgroups in Sweden (paper III). Further, the pattern of ten-year weightchange (% and kg) in 1999-2009 was calculated for Swedish and US women within different subgroups (paper IV). ANOVA, correlation and chi-squaretests were conducted to contrast eating and exercise habits between the two countries that may explain the differences in weight change. Results The prevalence of obesity (BMI ≥30) in Västerbotten increased from 9.4% in 1990 to 17.5% in 2004 (I). Older age, being female, being overweight at baseline, later survey year, baseline diagnosis of diabetes, and lack of snuff use increased the chances of not gaining weight. Based on the in-depth interviews, describing attitudes, behaviours and strategies of importance for PWM, a model was constructed (II). Weight maintenance was characterized as “a tightrope walk” and four strategies of significance for PWM were described as “to rely on heritage”, “to find the joy”, “to find the routine” and “to be in control”. The questionnaire study aimed at identifying predictors of PWM in different age, sex and BMI groups (III). The pattern of significant predictors was widely disparate between different subgroups. Of 166 predictors tested, 152 (91.6%) were predictive of PWM in at least one subgroup. However, only 4.6% of these were significant in half of the subgroups or more. The mean percent weight changes (in all cases weightgain), between 1999-2009 for Swedish and US women, were 4.9% (SD=5.8) and 9.1% (SD=13.7) respectively (p for t-test˂0.001) (IV). For the US women, the largest weight change occurred among the 30 year olds for all three BMI strata. For the Swedish, it was seen among overweight and obese 30 year old women. The largest difference in ten-year weight change between the two countries for any two matched subgroups was seen in normal weight 30 year olds. Significantly more of the women in this Swedish subgroup stated having more of healthy behaviours. However, there was a tendency for unhealthy behaviours to be strongly associated with greater weight gain in the US, but much less so in Sweden. Conclusion: Younger individuals, those of normal body weight, and those without health conditions (e.g. diabetes type 2) and cardiovascular riskfactors – were the least likely to maintain their weight over the 10 year period (I). Educational efforts on the prevention of overweight and obesity should therefore be broadened to include those individuals. The in-depth interview study showed great variety with regard to attitudes, strategies and behaviours important for PWM (II). The results from this study informs health personnel about the need to tailor advice related to body weight, not only to different sub-groups of individuals trying to lose weight but also to subgroups of primary weight maintainers who are trying to maintain weight. This statement was also supported by the questionnaire data, where the large disparity in the pattern of significant variables between subgroups suggests that these interventions should be tailored to the person’s demographic (age,sex and BMI) (III). Paper IV showed that even though the prevalence of obesity among Swedish women has increased substantially during these ten years, it has not kept pace with the increase in the US. One explanation for this may be that normal 30 year old Swedish women have more healthy behaviours than do US women. However, the insensitivity of the Swedish women to weight gain for healthy versus unhealthy alternatives may also be a factor. If the exact reason behind this phenomenon can be identified this may contribute to a deeper understanding of PWM both in Sweden and the US.

Medium chain triglycerides (MCT) have long been advocated as potential weight-lowering agents or potential tools in the treatment and prevention of human obesity. These statements have been made after findings from human and animal trials that consumption of MCT increases energy expenditure and fat oxidation compared to long chain triglycerides (LCT). In addition, animal studies have resulted in lower body weight gain and smaller fat depots when animals were fed MCT compared to those fed LCT. However, long-term controlled trials studying the effects of consumption of MCT in humans have not been conducted and the longest trial to date, 14 d of duration, has shown that the effect of MCT on energy expenditure may be transient. Therefore, we aimed to determine whether, in controlled feeding conditions, consumption of MCT for 4 wk would lead to differences in energy expenditure and substrate oxidation versus consumption of an isocaloric diet rich in LCT. Furthermore, our aim was to establish whether consumption of MCT for 4 wk would lead to greater changes in body composition than would LCT consumption. We conducted two randomized, controlled, crossover feeding trials involving overweight women and men to test our objectives. A secondary objective was to examine the potential satiating effect of MCT, and this was tested in men. Finally, a third objective was to determine whether, when combined with phytosterols and flaxseed oil, MCT consumption would result in different blood lipid profile compared to LCT. Nineteen healthy overweight women and 24 healthy overweight men participated in two separate randomized controlled trials to test these objectives. Energy expenditure and body composition were assessed at the beginning and end of each experimental phases, which differed only in the type of fat included in the controlled diets. Blood samples were also taken at baseline and endpoint of each phase to determine plasma lipid concentrations. Result

acase@tulane.edu

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Pink and Dude Chefs: A nutrition and culinary intervention for middle school students Tianna Sheehan The prevalence of obesity in US adolescents has more than tripled in the past 35 years, and the greatest impact has been among low-income and minority racial/ethnic populations. Adolescents report inadequate fruit and vegetable intake, an overconsumption of sweetened beverages, and a high reliance on fast food locations for meals or snacks; increasing the risk of adolescent obesity. Building knowledge and skills through culinary interventions may empower middle school students to create and also choose healthful foods. Pink and Dude Chefs, a six-week nutrition and culinary intervention, aims to improve healthy eating behaviors by increasing nutrition knowledge and culinary ability. Trained research assistants from California Polytechnic State University (Cal Poly) led middle school boys and girls in lessons ranging on topics including macronutrients, real-world application of USDA MyPlate guidelines, and meal planning and budgeting. Cal Poly research assistants supported middle school participants in cooking recipes that were specifically chosen to highlight themes covered in the nutrition lesson and to progress in difficulty throughout the program. The program consisted of 12 lessons that were each divided into 1 hour of classroom nutrition instruction and 1 hour of hands-on cooking practicum. The program took place in two locations, at Mesa Middle School in Arroyo Grande, California and Carpinteria Middle School in Carpinteria, California with 15-20 middle school volunteer participants who enrolled in each program. Questionnaires were used to measure fruit and vegetable preferences, dietary behavior, and barriers to healthy eating, culinary skill, culinary confidence, and basic nutrition knowledge pre- and post-intervention. Participants’ responses indicated an improved dietary profile as indicated by fruit and vegetable preferences, and fruit and vegetable intake. Responses also indicated increased culinary confidence and improved nutrition knowledge. More research is needed to test the long-term impact of participation in nutrition and culinary interventions.

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