Obesity Prevention Activities Research Articles

Effectiveness of school-based obesity prevention programme among elementary school children in Jakarta

Introduction: Prevention and treatment of overweight and obesity are easier in children than in adults. This study was conducted to evaluate the Smart Eating and Healthy Activity (SEHAT) programme, an intervention programme involving parents, teachers, and students in Indonesia to prevent obesity at schools. The intervention was conducted in the form of seminars and leaflets distribution to parents, training of teachers, training of student health cadres, training of students by trained teachers, health promotion to school canteen vendors, and promoting healthy home food weekly. Methods: This non-randomised controlled trial study was conducted from January to May 2016 in North Jakarta. The primary outcome was body mass index (BMI) changes measured with SECA® digital scale for weight and microtoise for height measurements. The secondary outcomes were changes in children’s knowledge, self-efficacy and behaviours, measured using self-made questionnaires, and physical activity using the Physical Activity Questionnaire for Older Children (PAQ-C). A total of 278 fourth and fifth-grade elementary school students aged 9 to 11 years old were recruited and grouped into intervention group (121 students) and control group (157 students). Results: The study reported a significant change between intervention and control groups on knowledge (1.28 vs 0.31), attitude (1.85 vs 0.06), physical activity (0.14 vs -0.32), eating fruits and vegetables (0.02 vs -0.78), and BMI (0.33 vs 0.71). Conclusion: The five-month SEHAT intervention programme effectively promoted knowledge on healthy eating and physical activity for obesity prevention by increasing physical activity, eating fruits and vegetables, and maintaining students’ BMI.

Enzymatic Preparation of Low-Molecular-Weight Laminaria japonica Polysaccharides and Evaluation of Its Effect on Modulating Intestinal Microbiota in High-Fat-Diet-Fed Mice.

Recent studies have shown that seaweed polysaccharides can ameliorate high-fat-diet (HFD)-induced metabolic syndromes associated with the regulatory function of gut microbiota. However, kelp, a natural source of seaweed polysaccharides, is highly viscous, making it difficult to prepare dietary fiber by simple degradation. Therefore, we developed a novel method of preparing low-molecular-weight polysaccharides from Laminaria japonica by combining high-pressure pretreatment and composite enzymatic degradation and evaluated the obesity prevention activity of these polysaccharides. Seaweed L. japonica polysaccharides (SJP) were rapidly utilized by the human fecal microbiota in vitro, resulting in the generation of short-chain fatty acids (SCFAs), specifically acetate and propionate. The in vivo effects of SJP on the intestinal microbiota were also investigated using HFD-fed C57BL/6J mice. SJP reduced weight gain and fat deposition in HFD-fed mice and increased the concentration of total SCFAs, including acetate, propionate, and butyrate in the feces. SJP ameliorated HFD-induced gut microbiota dysbiosis, resulting in increased abundance of Faecalibaculum, Romboutsia, and Clostridium sensu stricto 1 and decreased abundance of Blautia and Lactobacillus. Further, SJP enhanced the abundance of Akkermansia muciniphila in mice provided with HFD and normal chow. Single-strain culture experiments also revealed that SJP promoted the growth of A. muciniphila. This study highlights the potential use of SJP, prepared using composite enzymatic degradation (cellulase and recombinant alginate lyase), in preventing obesity and restoring intestinal homeostasis in obese individuals.

Understanding Prevention Networks in a Local Government Area: Insights From a Social Network Analysis Among Western Australian Nutrition, Physical Activity, and Obesity Prevention Programs.

This study aimed to use systems thinking tools to understand network relationships to inform discussions, policy, and practice to improve nutrition, physical activity, and overweight/obesity prevention activities in a Western Australian local government area. An audit of nutrition, physical activity, and obesity prevention activities was conducted, and identified organizations were invited to participate in an organizational network survey. Social network analysis (SNA) determined the extent to which organizations shared information, knowledge, and resources; engaged in joint program planning; applied for and shared funding; and identified operational barriers and contributors. SNA data were mapped and analyzed using UCINET 6 and Netdraw software. Five organizations within the network were identified as core; the remainder were periphery. The strongest networks were sharing information, and the weakest was funding. The connections were centralized to one organization, enabling them to readily influence other organizations and network operations. Remaining organizations indicated limited partnership across the networks. Strengthened collaborations and partnerships are essential to health promotion, as they extend reach and organizational capabilities. This study provides a process for undertaking network analysis, identifying leverage points to facilitate communication and information sharing, and reorienting of collaborations and partnerships to consolidate scarce resources and act strategically within a bounded area. There is a need for stronger relationships between organizations and a reorientation of partnerships to facilitate resource sharing within the local government area, to improve nutrition, physical activity, and obesity prevention practices. SNA can assist in understanding organizational prevention networks within a bounded area to support future planning of practices and policy.

Enacting community health: Obesity prevention policies as situated caring

Drawing on Critical Policy Studies and feminist STS, this article conceptualizes obesity prevention activities as ongoing and precarious practices of relating – rather than as means for ‘getting results’ or vehicles through which normative discourses are instilled. It focuses on ‘community approaches’ within public health, whose aim is to stimulate healthy initiatives from what policy makers term ‘bottom-up’, emerging from the situations, concerns and abilities within neighbourhoods. Drawing on ethnographic research on the ‘Amsterdam Healthy Weight Programme’, I demonstrate that different practices of relating enact particular versions of health and community. I warn that reliance on statistics-based problem definitions, dietary advice and professional hierarchies preconfigures health promotion as a matter of ‘reaching out’ to particular ‘problem populations’ defined around class and ethnicity. I show, however, that community approaches may also foster spaces for ‘situated caring’, where health emerges in the negotiation of heterogeneous goods, including neighbourhood revival, togetherness and fun. Situated caring has effects that cannot be captured by obesity prevalence statistics. The study of health promotion policies as practices of relating highlights that policy is not a monolithic structure of plans and commitments but is continuously done and redone. The article, then, introduces a new evaluative field that critically articulates the diverse ways in which ideals such as engagement and health are enacted in practices.

The associations of specific school- and individual-level characteristics with obesity among primary school children in Beijing, China.

We aimed to investigate the associations between school-level characteristics and obesity among Chinese primary school children with consideration of individual-level characteristics. This cross-sectional study was conducted in 2015/2016. School-level characteristics were assessed using an interviewer-administered school questionnaire, and a 'school-based obesity prevention index' was further developed. Individual-level characteristics were collected by self-administered questionnaires. Objectively measured height and weight of students were collected, and obesity status was classified according to the International Obesity Task Force criteria for Asian children. Generalised linear mixed models were used to estimate the associations among the school- and individual-level characteristics and obesity of students. Thirty-seven primary schools from an urban and a rural district of Beijing, China. School staffs, 2201 students and their parents. The school-based obesity prevention index involved the number of health professionals, availability of students' health records, monitoring students' nutrition status, frequency of health education activities, reporting achievements of obesity prevention activities to parents, duration of physical activity during school time and availability of playground equipment. The prevalence of obesity was lower in schools with the higher index value compared with that in schools with the lower index value (OR 0·56; 95 % CI 0·40, 0·79). Some individual-level characteristics were negatively associated with childhood obesity: liking sports, duration of screen time ≤2 h/d, perceived lower eating speed, parental non-overweight/obesity. Irrespective of individual-level characteristics, the specific school-level characteristics had a cumulative effect on obesity among Chinese primary school children. Further school-based obesity intervention should consider these characteristics simultaneously.

Community Coalitions for Change and the Policy, Systems, and Environment Model: A Community-Based Participatory Approach to Addressing Obesity in Rural Tennessee.

Four rural counties in Tennessee adopted the policy, systems, and environment (PSE) approach to address the obesity epidemic in their communities. The community-based participatory initiative, Community Coalitions for Change (C3), was embraced by 67,400 community members and 67 organizations. During year 1, coalition members discussed a need to return to long-held traditions of collective community engagement and action to address rural obesity rates. In response, C3 established 25 community gardens and supported 10 existing gardens, resulting in 8,300 community members who received garden produce. Sites began with an average number of 11 physical activity resources, which increased by year 3 to an average of 13 resources as a result of C3 activities. Overall, 61% (248 of 405) of survey respondents participating in direct education programs reported being more physically active as a result of participating in the programs, 59% (117 of 199) reported eating more fruit, and 66% (131 of 199) reported eating more vegetables. Implications for public health include timing and aligning obesity prevention activities with ongoing initiatives that are working toward similar goals.

Effect of Accelerometer Cut-Off Points on the Recommended Level of Physical Activity for Obesity Prevention in Children.

There is no general consensus regarding which accelerometer cut-off point (CoP) is most acceptable to estimate the time spent in moderate-to-vigorous physical activity (MVPA) in children and choice of an appropriate CoP primarily remains a subjective decision. Therefore, this study aimed to analyze the influence of CoP selection on the mean MVPA and to define the optimal thresholds of MVPA derived from different accelerometer CoPs to avoid overweight/obesity and adiposity in children aged 7 to 12 years. Three hundred six children participated. Physical activity (PA) was monitored for seven consecutive days using an ActiGraph accelerometer (model GT3X) and the intensity of PA was estimated using the five most frequently published CoPs. Body adiposity was assessed using a multi-frequency bioelectrical impedance analysis. There was found a wide range of mean levels of MVPA that ranged from 27 (Puyau CoP) to 231 min∙d–1 (Freedson 2005 CoP). A receiver operating characteristic curve analysis indicated that the optimal thresholds for counts per minute (cpm) and MVPA derived from the Puyau CoP was the most useful in classifying children according to their body mass index (BMI) and fat mass percentage (FM%). In the total sample, the optimal thresholds of the MVPA derived from the Puyau CoP were 22 and 23 min∙d–1 when the categories based on BMI and FM%, respectively, were used. The children who did not meet these optimal thresholds had a significantly increased risk of being overweight/obese (OR = 2.88, P < 0.01) and risk of having excess fat mass (OR = 2.41, P < 0.01). In conclusion, the decision of selecting among various CoPs significantly influences the optimal levels of MVPA. The Puyau CoP of 3 200 cmp seems to be the most useful for defining the optimal level of PA for pediatric obesity prevention.

Effectiveness of an intervention to facilitate the implementation of healthy eating and physical activity policies and practices in childcare services: a randomised controlled trial.

BackgroundThe primary aim of this study was to evaluate the effectiveness of an intervention to increase the implementation of healthy eating and physical activity policies and practices by centre-based childcare services. The study also sought to determine if the intervention was effective in improving child dietary intake and increasing child physical activity levels while attending childcare.MethodsA parallel group, randomised controlled trial was conducted in a sample of 128 childcare services. Intervention strategies included provision of implementation support staff, securing executive support, staff training, consensus processes, academic detailing visits, tools and resources, performance monitoring and feedback and a communications strategy. The primary outcome of the trial was the proportion of services implementing all seven healthy eating and physical activity policies and practices targeted by the intervention. Outcome data were collected via telephone surveys with nominated supervisors and room leaders at baseline and immediately post-intervention. Secondary trial outcomes included the differences between groups in the number of serves consumed by children for each food group within the Australian Guide to Healthy Eating and in the proportion of children engaged in sedentary, walking or very active physical activity assessed via observation in a random subsample of 36 services at follow-up.ResultsThere was no significant difference between groups for the primary trial outcome (p = 0.44). Relative to the control group, a significantly larger proportion of intervention group services reported having a written nutrition and physical activity policy (p = 0.05) and providing adult-guided activities to develop fundamental movement skills (p = 0.01). There were no significant differences between groups at follow-up on measures of child dietary intake or physical activity.ConclusionsThe findings of the trial were equivocal. While there was no significant difference between groups for the primary trial outcome, the intervention did significantly increase the proportion of intervention group services implementing two of the seven healthy eating and physical activity policies and practices. High levels of implementation of a number of policies and practices at baseline, significant obesity prevention activity in the study region and higher than previously reported intra-class correlation of child behaviours may, in part, explain the trial findings.Trial registrationAustralian Clinical Trials Registry (reference ACTRN12612000927820).

Can Nutrition Education Support Academic Achievement? Evidence Supporting Integration of Food &amp; Nutrition Education into Intermediate Curricula

Several nutrition education (NE) curricula use integrative approaches, however few studies have investigated its impact on academic achievement. Demonstration that NE instruction can improve achievement in science and mathematics is necessary for improving teacher engagement in obesity prevention activities. The purpose of this study was to explore associations between science (SK), mathematics (MK), and nutrition knowledge (NK) to provide evidence that integrating food/nutrition education in the curriculum supports academic achievement. A secondary analysis of a quasi‐experimental study was conducted using 33 fourth‐grade classrooms across North Carolina and Ohio. Researchers analyzed data using multiple linear regression. Post‐test‐NK score served as the dependent variable, baseline‐NK, post‐test SK and MK served as the independent, or predictor variables. Results revealed that the hypothesized model predicted post‐NK for full sample (F (437)=149.4, p&lt;.001; Adjusted R2=.51), and intervention [F(268)=111.1; p&lt;.001] and comparison groups [F(169)=39.1; p&lt;.001]. For the three domains, SK and MK were predictive of NK with students exposed to the food‐based curriculum demonstrating stronger associations among the domains of knowledge. Using an integrative food‐based curriculum can significantly improve SK and MK among fourth‐graders and may help teachers meet multiple academic content standards, while efficiently using limited classroom time and increasing the amount of NE provided in the classroom.

State Practitioner Insights Into Local Public Health Challenges and Opportunities in Obesity Prevention: a Qualitative Study

IntroductionThe extent of obesity prevention activities conducted by local health departments (LHDs) varies widely. The purpose of this qualitative study was to characterize how state obesity prevention program directors perceived the role of LHDs in obesity prevention and factors that impact LHDs’ success in obesity prevention.MethodsFrom June 2011 through August 2011, we conducted 28 semistructured interviews with directors of federally funded obesity prevention programs at 22 state and regional health departments. Interviews were transcribed verbatim, coded, and analyzed to identify recurring themes and key quotations.ResultsMain themes focused on the roles of LHDs in local policy and environmental change and on the barriers and facilitators to LHD success. The role LHDs play in obesity prevention varied across states but generally reflected governance structure (decentralized vs centralized). Barriers to local prevention efforts included competing priorities, lack of local capacity, siloed public health structures, and a lack of local engagement in policy and environmental change. Structures and processes that facilitated prevention were having state support (eg, resources, technical assistance), dedicated staff, strong communication networks, and a robust community health assessment and planning process.ConclusionsThese findings provide insight into successful strategies state and local practitioners are using to implement innovative (and evidence-informed) community-based interventions. The change in the nature of obesity prevention requires a rethinking of the state–local relationship, especially in centralized states.

Child Care Providers’ Perceptions of Children’s Lifestyles and Risk Factors for Obesity: A Focus Group Study

Objective: This study attempts to understand child care providers’ perceptions of remarkable children’s lifestyles and discusses potentially successful strategies of cooperation among child care providers, parents, and health professionals for health promotion and the prevention of obesity in preschool children. Methods: We conducted 6 focus group discussions consisting of 34 child care providers employed by private and public child care centers, and a public kindergarten in Yamanashi Prefecture, Japan. Systematic thematic analysis was conducted to generate themes to address the study questions. Results: What the focus group participants discussed with felt mainly into the 3 different kinds of points: “Concerns of Child Care Providers Regarding Parental Attitudes about Nutrition and Nurture,” “Tensions between Parents and Child Care Providers,” and “Current Obesity Prevention Activities and the Role of Child Care Professionals.” Conclusions: Childcare providers had many concerns that fell into 5 main issues of the possible detrimental effects on children’s health due to parents’ nurturing methods and lifestyles. Participants described possible strategies for the prevention of childhood obesity in childcare settings as well as barriers to effective intervention. Childcare providers felt that a system to demand helps from public health nurses in guiding parents would be effective in preventing childhood obesity.

Relationship between raised BMI and sugar sweetened beverage and high fat food consumption among children

Longitudinal evidence of relationships between unhealthy diets and BMI in children is crucial for appropriately targeting obesity prevention activities. The objective was to determine the relationship between frequency of consumption of sugar sweetened beverages (SSBs) and high fat foods (HFFs) and body weight in Australian children aged from 4 to 10 years. Data from 4,164 children participating in four waves (wave 1, 2004; wave 2, 2006; wave 3, 2008; and wave 4, 2010) of the Longitudinal Study of Australian Children were analyzed. A multi-level growth model tested relationships between consumption of SSB and HFF and BMI z-scores. BMI z-scores were associated with daily consumption of HFF, SSB and maternal BMI independent of BMI z-scores at wave 1 (baseline); with each additional occurrence of SSB and HFF consumption intake per day, BMI z-score increased by 0.015 U (P < 0.01) and 0.014 U (P < 0.001), respectively. With each additional maternal BMI unit, BMI z-score increased by 0.032 (P < 0.001). Higher BMI z-scores were strongly associated with the consumption of SSBs and HFFs. Future efforts to prevent obesity should consider urgent action to address the impact of the consumption of SSBs and HFFs in childhood.

Generating better evidence to engage local food outlets in obesity prevention research

Participation from the business community is critical to effectively addressing the problem of obesity. This commentary builds on the recent Institute of Medicine report – Accelerating Progress in Obesity Prevention – which calls for participation from the business community, particularly food outlets, to effectively address the problem of obesity. This commentary specifically discusses the importance of collecting information on fiscal-related outcomes (e.g., revenue) in order to better engage local food outlets in obesity prevention activities in the community. The routine collection of fiscal indicators in obesity prevention studies is critical so that the argument for more involvement from local food outlets, particularly for those interventions which are revenue positive or revenue neutral, can be more persuasively made.

Obesity prevention programs and policies: Practitioner and policy‐maker perceptions of feasibility and effectiveness

The aims of this study were to map obesity prevention activity being implemented by government, non-government, and community-based organizations; to determine practitioner and policy-maker perceptions of the feasibility and effectiveness of a range of evidence-based obesity prevention strategies; and to determine practitioner and policy-maker perceptions of preferred settings for obesity prevention strategies. This study involved a cross-sectional survey of 304 public health practitioners and policy-makers from government, non-government, and community organizations across Victoria, Australia. Participants reported their organizations' current obesity prevention programs and policies, their own perceptions of the feasibility and effectiveness of strategies to prevent obesity and their preferred settings for obesity prevention. Thirty-nine percent had an obesity prevention policy, and 92% were implementing obesity prevention programs. The most common programs focused on education, skill-building, and increasing access to healthy eating/physical activity opportunities. School curriculum-based initiatives, social support for physical activity, and family-based programs were considered the most effective strategies, whereas curriculum-based initiatives, active after-school programs, and providing access to and information about physical activity facilities were deemed the most feasible strategies. Schools were generally perceived as the most preferred setting for obesity prevention. Many organizations had obesity prevention programs, but far fewer had obesity prevention policies. Current strategies and those considered feasible and effective are often mismatched with the empirical literature. Systems to ensure better alignment between researchers, practitioners, and policy-makers, and identifying effective methods of translating empirical evidence into practice and policy are required.

Where is obesity prevention on the map?: distribution and predictors of local health department prevention activities in relation to county-level obesity prevalence in the United States.

The system of local health departments (LHDs) in the United States has the potential to advance a locally oriented public health response in obesity control and reduce geographic disparities. However, the extent to which obesity prevention programs correspond to local obesity levels is unknown. This study examines the extent to which LHDs across the United States have responded to local levels of obesity by examining the association between jurisdiction-level obesity prevalence and the existence of obesity prevention programs. Data on LHD organizational characteristics from the Profile Study of Local Health Departments and county-level estimates of obesity from the Behavioral Risk Factor Surveillance System were analyzed (n = 2300). Since local public health systems are nested within state infrastructure, multilevel models were used to examine the relationship between county-level obesity prevalence and LHD obesity prevention programming and to assess the impact of state-level clustering. Two thousand three hundred local health department jurisdictions defined with respect to county boundaries. Practitioners in local health departments who responded to the 2005 Profile Study of Local Health Departments. Likelihood of having obesity prevention activities and association with area-level obesity prevalence. The existence of obesity prevention activities was not associated with the prevalence of obesity in the jurisdiction. A substantial portion of the variance in LHD activities was explained by state-level clustering. This article identified a gap in the local public health response to the obesity epidemic and underscores the importance of multilevel modeling in examining predictors of LHD performance.

Establishing the Baseline Height and Weight Status of New Hampshire Head Start Children, 2007–2008

We report on a standardized survey of height and weight status of children attending the New Hampshire Head Start Program during the 2007–2008 school year. Baseline prevalence estimates of overweight and obesity are needed for obesity prevention activities and intervention. We selected a random one-stage cluster sample and screened 629 children ages 3–5 years attending 27 of 45 Head Start sites. Survey participants underwent standardized height and weight measurements. We recorded sex and date of birth and calculated body mass index (BMI). For each participating site, we determined rural or urban status. We assessed prevalence of overweight and obesity for the survey sample and the statistical significance of differences between subgroups. Prevalence of overweight (BMI ≥ 85th and < 95th percentile) was 18.4% (95% confidence interval [CI]: 16.5%–20.4%), and prevalence of obesity (BMI ≥ 95th percentile) was 18.1% (95% CI: 16.1%–20.2%). No statistically significant differences were noted by age or sex. Children attending urban sites were found to be significantly more likely obese when compared with children attending rural sites. Children enrolled in New Hampshire Head Start demonstrate an increased prevalence of overweight and obesity compared with the general population. There are marked differences in the prevalence of obesity by urban/rural sites. Specific interventions for Head Start children are warranted.

Evaluation of the ‘Mealtime Magic’ brief leaflet-based intervention in general practice

AimTo assess current primary care childhood obesity prevention activity and experiences of general practitioners (GPs) and practice nurses in delivering the ‘Mealtime Magic’ brief intervention. To determine the acceptability of the brief intervention and reported impact upon confidence and behaviour of parents.BackgroundA gap persists in the evidence base regarding brief childhood obesity prevention interventions in primary care, where good opportunities for primary prevention work lie.MethodsA quantitative and qualitative evaluation design, without control group, with post-intervention evaluation of parental outcomes and ‘before and after’ evaluation of healthcare professional perspectives was employed, using questionnaires. Five primary care practices in Worcestershire, England took part: six GPs, seven practice nurses (11 females and two males). 110 of 223 parents receiving the intervention completed follow-up measures (107 females, two males and one gender unknown; 106 White British). The intervention involved providing the ‘Mealtime Magic’ leaflet regarding childhood healthy eating behaviours, with verbal reinforcement of three main messages, to all parents with children aged five years and younger presenting to primary care over a six-week period. Staff received a 30-minute training session.FindingsTwelve of 13 health professionals ranked childhood obesity of importance relative to other priorities. Secondary prevention activities were undertaken more frequently than primary prevention. All professionals found the intervention easy to deliver; 12 of 13 stated they would use the leaflet in the future. Reported professional confidence in knowledge of evidence-based healthy eating behaviour messages increased following intervention delivery. Resource barriers and perceived parental sensitivity with subject were reported. Ninety two percent (100/109) of parents stated the leaflet was helpful. Up to 52% (57/110) of parents reported more confidence regarding leaflet suggestions and up to 47% (49/105) reported positive behaviour changes. Evaluation of brief intervention approaches may help address perceived barriers to undertaking childhood obesity prevention work in primary care in the UK.

Estimating health-adjusted life expectancy conditional on risk factors: results for smoking and obesity

BackgroundSmoking and obesity are risk factors causing a large burden of disease. To help formulate and prioritize among smoking and obesity prevention activities, estimations of health-adjusted life expectancy (HALE) for cohorts that differ solely in their lifestyle (e.g. smoking vs. non smoking) can provide valuable information. Furthermore, in combination with estimates of life expectancy (LE), it can be tested whether prevention of obesity and smoking results in compression of morbidity.MethodsUsing a dynamic population model that calculates the incidence of chronic disease conditional on epidemiological risk factors, we estimated LE and HALE at age 20 for a cohort of smokers with a normal weight (BMI < 25), a cohort of non-smoking obese people (BMI>30) and a cohort of 'healthy living' people (i.e. non smoking with a BMI < 25). Health state valuations for the different cohorts were calculated using the estimated disease prevalence rates in combination with data from the Dutch Burden of Disease study. Health state valuations are multiplied with life years to estimate HALE. Absolute compression of morbidity is defined as a reduction in unhealthy life expectancy (LE-HALE) and relative compression as a reduction in the proportion of life lived in good health (LE-HALE)/LE.ResultsEstimates of HALE are highest for a 'healthy living' cohort (54.8 years for men and 55.4 years for women at age 20). Differences in HALE compared to 'healthy living' men at age 20 are 7.8 and 4.6 for respectively smoking and obese men. Differences in HALE compared to 'healthy living' women at age 20 are 6.0 and 4.5 for respectively smoking and obese women. Unhealthy life expectancy is about equal for all cohorts, meaning that successful prevention would not result in absolute compression of morbidity. Sensitivity analyses demonstrate that although estimates of LE and HALE are sensitive to changes in disease epidemiology, differences in LE and HALE between the different cohorts are fairly robust. In most cases, elimination of smoking or obesity does not result in absolute compression of morbidity but slightly increases the part of life lived in good health.ConclusionDifferences in HALE between smoking, obese and 'healthy living' cohorts are substantial and similar to differences in LE. However, our results do not indicate that substantial compression of morbidity is to be expected as a result of successful smoking or obesity prevention.