Stef Kremers. Determinants of diet and physical activity: frameworks, models and considerations

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1 Determinants of diet and physical activity: frameworks, models and considerations Stef Kremers Professor Prevention of Obesity Department of Health Promotion Maastricht University

Conclusions. > 15.000 records reviewed., potentially important pieces of the determinants puzzle., but:. limited evidence for role of specific determinants.

2 Conclusions. > records reviewed., potentially important pieces of the determinants puzzle., but:. limited evidence for role of specific determinants. suggestive but weak correlations.. mixed results across different settings,, and target groups.. More studies., better designs,. needed. Thanks for your attention!

3 Study towards determinants of diet and physical activity 3

4 What are you sinking about? Attitudes Subjective norms Self-efficacy expectations Risk perception Socio-cognitive models

5 Theory of Planned Behaviour Ajzen, I: Attitudes, Personality, and Behavior. Milton Keynes: Open University Press; 1988.

6 Habit as a moderator of cognition behavior relationships

7 Motivational regulation: Self-Determination Theory 7

9 Social Ecological Model Booth et al., Nutr Rev 2001, 59:S21-S39.

10 Framework of Determinants of Physical Activity and Eating Behavior Booth et al., Nutr Rev 2001, 59:S21-S39.

11 ANGELO framework ANalysis Grid of Environments Linked to Obesity Micro (settings) Homes Workplaces Schools Neighborhoods Physical Economic Political Sociocultural Macro (sectors) Health system Food production Urban/rural development Transport system Swinburn B, et al. Prev Med 1999, 29:

12 EnRG framework Environmental Research framework for weight Gain prevention Kremers, S.P.J., De Bruijn, G.J., Visscher, T.L.S., Van Mechelen, W., De Vries, N.K., Brug, J. Environmental influences on energy balance-related behaviors: A dual-process view. Int J Behav Nutr Phys Act 2006; 3: 9.

13 13 Spence & Lee, 2003

14 Foresight report Tackling Obesities, 2007

15 Determinants of dietary behavior and physical activity Determining processes involve combinations of factors at multiple levels of influence Higher-level (upstream) factors play a contextual or risk regulating role Small changes in 1 or more key factors may have large influences The influences are potentially (or typically) nonlinear vs Systems-oriented approaches

16 Systems-oriented approaches

17 Determinants of dietary behavior and physical activity Determining processes involve combinations of factors at multiple levels of influence Higher-level (upstream) factors play a contextual or risk regulating role Small changes in 1 or more key factors may have large influences The influences are potentially (or typically) nonlinear vs Systems-oriented approaches

18 Systems-oriented multilevel framework Glass TA, McAtee MJ. Soc Sci Med 2006;62(7):

19 A Systems approach may contrast the traditional pieces of the puzzle approaches A system is a complex of interacting elements Not a flat and stable puzzle Operation of any one element depends on the existence and operation of other elements in the system Impact of determinants cannot be interpreted in isolation from important (contextual) factors Impact is more than just the sum of the individual parts Putting the separate pieces together in a chain of causation puzzle does not adequately reflect the potential contextual role of higher level determinants

20 but it may prevent this final slide at the Dedipac closing ceremony. > records reviewed., potentially important pieces of the determinants puzzle., but:. limited evidence for role of specific determinants. suggestive but weak correlations.. mixed results across different settings,, and target groups.. More studies., better designs,. needed. Thanks for your attention!

21 Dynamic Systems (2) Systems prefer a particular type of organization that will become relatively stable, even when there are perturbations to the system Attractor landscape Bifurcation points

22 Attractor Landscape

23 Rutten GM, Savelberg HH, Biddle SJH, Kremers SPJ. Interrupting long periods of sitting: Good STUFF. International Journal of Behavioral Nutrition and Physical Activity 2013: 10, 1.

Deakin Research Online

Deakin Research Online This is the published version: Brug, Johannes, Kremers, Stef P., van Lenthe, Frank, Ball, Kylie and Crawford, David 2008, Environmental determinants of healthy eating: in need of