The present study was done to confirm the relationship between changes in food patterns and nutrition transition in three South-East Asian countries, namely the Philippines, Malaysia and Indonesia.

This was a cross-sectional study conducted between August 2008 and August 2009 using three methods: interviews, focus group discussions and analyses of government reports.

The study was conducted in rural and urban areas in Manila and Calabanga (Philippines), Selangor and Kuala Selangor (Malaysia), and Padang, Pariaman Tanah Datar and Limapuluh Kota (West Sumatra, Indonesia).

Adults aged 18 to 77 years.

The results showed that Filipinos, Malaysians and Indonesians have retained many aspects of their traditional diets. In fact, most participants in the study considered Western-style and franchise fast foods as snack or recreational foods to be consumed once in a while only. However, a significant difference was noted between urban and rural areas in food varieties consumed. Participants in urban areas consumed more varieties of traditional foods owing to their availability and the participants’ food purchasing power. Although traditional food patterns were maintained by most of the participants, more sugar and vegetable oils were consumed and added to the traditional recipes.

The rapid nutrition transition in this region may be due, instead, to increasing food availability and food purchasing power, rather than to a shift in food preferences towards modern Western foods.

To determine the frequency and content of food-related television (TV) advertisements shown on South African TV.

Four national TV channels were recorded between 15.00 and 21.00 hours (6 h each day, for seven consecutive days, over a 4-week period) to: (i) determine the number of food-related TV advertisements; and (ii) evaluate the content and approach used by advertisers to market their products. The data were viewed by two of the researchers and coded according to time slots, food categories, food products, health claims and presentation.

Of the 1512 recorded TV advertisements, 665 (44 %) were related to food. Of these, 63 % were for food products, 21 % for alcohol, 2 % for multivitamins, 1 % for slimming products and 13 % for supermarket and pharmacy promotions. Nearly 50 % of food advertisements appeared during family viewing time. During this time the most frequent advertisements were for desserts and sweets, fast foods, hot beverages, starchy foods and sweetened drinks. The majority of the alcohol advertisements (ninety-three advertisements, 67 %) fell within the children and family viewing periods and were endorsed by celebrities. Health claims were made in 11 % of the advertisements. The most frequently used benefits claimed were ‘enhances well-being’, ‘improves performance’, ‘boosts energy’, ‘strengthens the immune system’ and ‘is nutritionally balanced’.

The majority of food advertisements shown to both children and adults do not foster good health despite the health claims made. The fact that alcohol advertisements are shown during times when children watch TV needs to be addressed.

To investigate maintenance of changes in food intake and motivation for healthy eating at follow-up 2 data collection after a lifestyle intervention among Pakistani immigrant women.

A culturally adapted lifestyle intervention, aiming at reducing the risk of type 2 diabetes mellitus. Data collection including FFQ and questions on intentions to change dietary behaviour was completed at baseline, right after the 7 ± 1 month intervention (follow-up 1) and 2–3 years after baseline (follow-up 2).

Oslo, Norway.

Pakistani women (n 198), aged 25–60 years, randomized into control and intervention groups.

From follow-up 1 to follow-up 2 there was a shift from action to maintenance stages for intention to reduce fat intake (P < 0·001), change type of fat (P = 0·001), increase vegetable intake (P < 0·001) and reduce sugar intake (P = 0·003) in the intervention group. The reduction in intakes of soft drinks with sugar, fruit drinks with sugar and red meats, and the increase in intakes of vegetables and fish from baseline to follow-up 1 were maintained (significant change from baseline) at follow-up 2 in the intervention group. The intake of vegetables was higher (P = 0·019) and the intake of fruit drinks with sugar lower (P = 0·023) in the intervention group compared with the control group at follow-up 2.

The culturally adapted intervention had the potential of affecting intentions to change food behaviour among Pakistani immigrant women long after completion of the intervention and also of leading to long-term maintenance of beneficial changes in diet.

To assess lunchtime provision of food and drink in English secondary schools and the choices and consumption of food and drink by pupils having school lunches, and to compare provision in 2011 with that in 2004.

Cross-sectional data collected between October 2010 and April 2011. In each school, food and drink provision, including portion weights and number of portions of each item served at lunchtime, were recorded over five consecutive days. Caterers provided recipe information.

England.

A random selection of 5969 pupils having school lunches in a nationally representative sample of eighty secondary schools in England.

Compared with 2004, significantly more schools in 2011 provided main dishes, vegetables and salads, water, fruit juice and other drinks on 4 or 5 d/week (P < 0·005). The number of schools offering items not permitted under the food-based standards for school food on 4 or 5 d/week fell significantly over time (P < 0·005), while the number not offering these items on any day increased significantly (P < 0·005). Meals eaten by pupils were well-balanced in relation to macronutrients.

Lunchtime food provision and consumption in secondary schools have improved considerably since 2004, following the introduction of new compulsory standards for school food in 2009. To maximise their energy and nutrient intake at lunchtime, pupils should be encouraged to select a full meal, and to take and eat more fruit and vegetables. Schools also need continued support to increase the micronutrient content of menus and recipes.

To evaluate long-term patterns of weight change and progression to overweight and obesity during adulthood.

Prospective study. Changes in mean BMI, waist circumference (WC) and weight were assessed over a mean 26-year follow-up (1971–1975 to 1998–2001). Mean BMI (95 % CI) and mean WC (95 % CI) of men and women in BMI and age groups were computed. Mean weight change in BMI and age categories was compared using analysis of covariance.

Framingham Heart Study Offspring/Spouse Nutrition Study.

Men and women (n 2394) aged 20–63 years.

During follow-up, increases in BMI (men: 2·2 kg/m2; women: 3·7 kg/m2) and WC (men: 5·7 cm; women: 15·1 cm) were larger in women than men. BMI gains were greatest in younger adults (20–39 years) and smallest in obese older adults (50–69 years). The prevalence of obesity doubled in men (to 33·2 %) and tripled in women (to 26·6 %). Among normal-weight individuals, abdominal obesity developed in women only. The prevalence of abdominal obesity increased 1·8-fold in men (to 53·0 %) and 2·4-fold in women (to 71·2 %). Weight gain was greatest in the youngest adults (20–29 years), particularly women. Gains continued into the fifth decade among men and then declined in the sixth decade; in women gains continued into the sixth decade.

Patterns of weight change and progression to obesity during adulthood differ in men and women. Preventive intervention strategies for overweight and obesity need to consider age- and sex-specific patterns of changes in anthropometric measures.

The goal of the current study was to examine if the completeness of programme implementation and the completeness of implementation of specific programme elements of the Dutch school-based healthy diet promotion programme Krachtvoer are related to short- and longer-term changes in students’ fruit, sweets and breakfast intakes.

Data on students’ dietary intakes were collected 1–4 weeks and 6 months after programme implementation. Teachers filled in a logbook on programme implementation after each lesson. The relationships between changes in students’ dietary intakes and completeness of implementation of the programme and of specific programme elements were tested using mixed linear regression analyses.

Thirteen Dutch prevocational schools.

Eight hundred and seventy-six of the 1117 participating students and eighteen of the twenty-two participating teachers.

Completeness of programme implementation was positively related to an increase in fruit consumption in the short term. Completeness of implementation of food exposure activities and a practical lesson on advertisements were related to an increase in fruit consumption in the short as well as the longer term. No such relationships were found for sweets and breakfast consumption.

Our results indicate that efforts should be made to help teachers implement the programme as fully as possible.

To assess whether nutritional deficiency increases susceptibility to arsenic-related health effects.

Assessment of nutrition was based on a 24 h recall method of all dietary constituents.

Epidemiological cross-sectional study was conducted in an arsenic-endemic area of West Bengal with groundwater arsenic contamination.

The study was composed of two groups – Group 1 (cases, n 108) exhibiting skin lesions and Group 2 (exposed controls, n 100) not exhibiting skin lesions – age- and sex-matched and having similar arsenic exposure through drinking water and arsenic levels in urine and hair.

Both groups belonged to low socio-economic strata (Group 1 significantly poorer, P < 0·01) and had low BMI (prevalence of BMI < 18·5 kg/m2: in 38 % in Group 1 and 27 % in Group 2). Energy intake was below the Recommended Daily Allowance (set by the Indian Council of Medical Research) in males and females in both groups. Increased risk of arsenical skin lesions was found for those in the lowest quintile of protein intake (v. highest quintile: OR = 4·60, 95 % CI 1·36, 15·50 in males; OR = 5·62, 95 % CI 1·19, 34·57 in females). Significantly lower intakes of energy, protein, thiamin, niacin, Mg, Zn and choline were observed in both males and females of Group 1 compared with Group 2. Significantly lower intakes of carbohydrate, riboflavin, niacin and Cu were also observed in female cases with skin lesions compared with non-cases.

Deficiencies of Zn, Mg and Cu, in addition to protein, B vitamins and choline, are found to be associated with arsenical skin lesions in West Bengal.

To evaluate the prevalence of vitamin D deficiency in pregnant women and their newborns in Beijing, China and the influence of vitamin D deficiency on birth size.

A cross-sectional study.

Data were collected from pregnant women who delivered during April to May 2010 at 306 Hospital of PLA in Beijing, China.

Participants in the study were seventy healthy nulliparous pregnant women with singleton pregnancies who delivered healthy babies at full term and their newborns.

Severe vitamin D deficiency (25-hydroxyvitamin D (25(OH)D) < 25 nmol/l) was detected in 54·5 % of mothers and 46·6 % of newborns. Neither mothers nor newborns had serum 25(OH)D concentrations that reached the normal level (>75 nmol/l). The concentration of 25(OH)D in mothers was positively correlated with that in cord blood (r = 0·89, P < 0·001). Newborns of mothers with severe vitamin D deficiency had lower birth length and birth weight. The head circumference and birth weight were lower in vitamin D-deficient newborns.

The study indicates that pregnant women and neonates residing in Beijing are at high risk of vitamin D deficiency. Neonatal 25(OH)D concentrations are dependently related to maternal 25(OH)D levels. Maternal and neonatal vitamin D status influences newborn size.

To evaluate self-assessed knowledge about diabetes mellitus, to assess determinants of health knowledge and to evaluate consequences of health knowledge on appraisal about consequences of the disease.

Population-based computer-assisted web interview survey, supplemented with a paper-and-pencil survey via post.

Representative sample of the general Austrian population aged 15 years and older.

Men (n 1935) and women (n 2065) with and without diabetes mellitus.

Some 20·5 % of men and 17·7 % of women with diabetes, and 46·2 % of men and 36·7 % of women without diabetes, rated their knowledge about diabetes mellitus to be ‘very bad’ or ‘rather bad’. Individuals with diabetes and individuals with a family member with diabetes rated their information level more often as ‘very good’ or ‘rather good’, with adjusted OR (95 % CI) of 1·7 (1·1, 2·8) and 2·1 (1·6, 2·7), respectively, in men and 2·7 (1·5, 4·8) and 2·7 (2·1, 3·5), respectively, in women. Additional significant influencing factors on diabetes knowledge were age and educational level in both sexes, and city size in men. Independent of personal diabetes status, diabetes knowledge was associated with a lower perception of restrictions on daily life of diabetes patients and with a lower probability of underestimating health consequences of diabetes.

Health knowledge is associated with fewer misconceptions and less underestimation of health consequences in individuals both with and without diabetes mellitus. Thus health information about diabetes is important on the individual level towards disease management as well as on the public health level towards disease prevention.

The current study prospectively examines the intra-uterine hypothesis by comparing maternal, paternal and grandparental lineage influences on children's diet and also maternal–child aggregation patterns during pregnancy and early childhood.

Prenatal dietary information was available for expectant mothers, fathers and up to four grandparents through a detailed validated semi-quantitative FFQ. At 6-year follow-up, when children averaged 5 years of age, dietary information was re-collected for mothers and a subset of maternal grandmothers using the same FFQ. Child's FFQ version was used for children. Anthropometric and sociodemographic variables were also collected.

Three-generation familial cohort representative of the contemporary Irish national population.

Children aged 5 years (n 567) and their parents and grandparents.

Associations for energy, macronutrient and fibre intakes were compared using Pearson's correlations, intra-class correlations (ICC) and linear regression models, adjusted for energy and potential confounders. Significant, moderate-strength positive correlations were observed for nutrient intakes in children's nuclear families (ICC (range) = 0·22–0·28). The father–child associations (r (range) = 0·13–0·20) were weaker than the mother–child associations (r (range) = 0·14–0·33). In general, associations were stronger for maternal postnatal intake–child intake than for maternal prenatal intake–child intake, except for percentage of energy from fat (adjusted β = 0·16, 95 % CI 0·05, 0·26; P = 0·004), which was stronger for maternal prenatal intake, specifically in non-breast-fed children (adjusted β = 0·28, 95 % CI 0·12, 0·44; P = 0·001). Among all grandparents, correlations were significant only for maternal grandmother–mother pairs (r (range) = 0·10–0·36). Significant positive ICC were observed for nutrient intakes of maternal grandmother–mother–child triads (ICC (range) = 0·12–0·27), not found in paternal lines.

These findings suggest that maternal-environment programming influences dietary intake.

To review evidence on the associations between vitamin B12 intake and its biomarkers, vitamin B12 intake and its functional health outcomes, and vitamin B12 biomarkers and functional health outcomes.

A systematic review was conducted by searching electronic databases, until January 2012, using a standardized strategy developed in the EURRECA network. Relevant articles were screened and sorted based on title and abstract, then based on full text, and finally included if they met inclusion criteria. A total of sixteen articles were included in the review.

Articles covered four continents: America (n 4), Europe (n 8), Africa (n 1) and Asia (n 3).

Population groups included healthy infants, children and adolescents, and pregnant and lactating women.

From the total number of 5815 papers retrieved from the initial search, only sixteen were eligible according to the inclusion criteria: five for infants, five for children and adolescents, and six for pregnant and lactating women.

Only one main conclusion could be extracted from this scarce number of references: a positive association between vitamin B12 intake and serum vitamin B12 in the infant group. Other associations were not reported in the eligible papers or the results were not provided in a consistent manner. The low number of papers that could be included in our systematic review is probably due to the attention that is currently given to research on vitamin B12 in elderly people. Our observations in the current systematic review justify the idea of performing well-designed studies on vitamin B12 in young populations.

Food cost is an important factor influencing the consumption of nutritious foods and subsequent chronic disease risk. The present study compared the cost of branded food products with their generic equivalents across a range of food categories.

The survey was conducted within two major supermarket chains across six locations in Sydney, Australia (n 12).

Price differences were calculated for ‘core’ (nutrient dense and low in energy) and ‘extra’ (high in undesirable nutrients and/or energy) packaged foods (n 22) between generic and branded items.

A cost saving of 44 % was found by purchasing generic over branded products across all food categories. The most significant savings were for core foods, such as bread and cereals, and the smallest cost savings were seen for fruit products. There was little variation in cost saving between branded and generic products by socio-economic status of the supermarket location.

The large price differential between branded and generic food products implies that consumers, particularly those on lower incomes, could benefit financially from purchasing generic items. The promotion of core generic products may be an effective strategy to assist people on lower incomes to meet dietary guidelines.

(i) To map how US adults value ‘choice’ in the context of obesity policy and (ii) to discuss implications for obesity prevention in children.

Semi-structured interviews (n 105) were conducted between 2006 and 2009 about causes of and solutions to childhood obesity. Quotes captured in field notes from community meetings (n 6) on childhood obesity prevention were also analysed. Each use of the word ‘choice’ and its variants was identified in these texts. Content and discourse were analysed to identify the implied values and meaning in each use.

North-eastern USA.

One hundred and five adults, some involved in childhood obesity prevention initiatives.

Three distinct frames of ‘choice’ emerged: (i) having choices (choice as freedom), (ii) making choices (choice as responsibility) and (iii) influencing choices (contextual constraints and impacts on choice). Many speakers used more than one frame over the course of an interview. Most people using the third frame seemed to share the values behind the first two frames, but focused on conditions required to enable people to be accountable for their choices and to make truly free choices. A small subset thought outside the frame of individual choice, valuing, as one person put it, a ‘social contract’.

Public debate in the USA about responsibility for and solutions to rising obesity rates often hinges on notions of ‘choice’. These frames, and the values underlying them, are not mutually exclusive. Respecting the values behind each ‘choice’ frame when crafting obesity prevention policy and employing all three in public communications about such policy may facilitate greater consensus on prevention measures.

To assess the prevalence and geographic distribution of major cardiovascular risk factors in a large community-wide sample of the Italian population.

A cross-sectional survey. Standardized methods were used to collect and measure cardiovascular risk factors. Data were adjusted for survey weightings. Qualitative and quantitative variables were compared with parametric and non-parametric tests, as appropriate.

Towns (n 193) across different Italian regions.

Unselected adults (n 24 213; 12 626 men; 11 587 women) aged 18–98 years (mean age 56·9 (sd 15·3) years), who volunteered to participate in a community-wide screening programme over a 2 d period in 2007.

Overall, the prevalence of major cardiovascular risk factors was: obesity, 22·7 % (women 18·9 %, men 26·1 %); overweight, 44·7 % (women 31·6 %, men 56·7 %); hypertension, 59·6 % (women 48·3 %, men 70·0 %); dyslipidaemia, 59·1 % (women 57·7 %, men 60·3 %); diabetes, 15·3 % (women 11·2 %, men 19·0 %) and smoking, 19·8 % (women 14·0 %, men 25·2 %). We found a high prevalence of unhealthy eating habits; fruit and vegetable consumption was below the recommended range in 60 % of the study population. Ninety per cent of the study population had more than one cardiovascular risk factor and 84 % had between two and five cardiovascular risk factors. There were differences among Italian macro-areas mainly for obesity, hypertension, dyslipidaemia and diabetes.

The study provides alarming evidence on current prevalence data for major cardiovascular risk factors in a large sample of the Italian population. Particularly, obesity and hypertension represent a relevant public health problem. There is a pressing need for effective preventive health measures which must also take into account the differences among Italian macro-areas.

To assess the adequacy of milk and alternatives, Ca and vitamin D intakes in First Nations (FN) youth in Ontario, Canada. Intakes were compared with the general population and dietary standards. Variation in intakes by community (proxy for remoteness) and BMI was examined.

Data were collected by 24 h recall between November 2003 and June 2010. Intakes were analysed descriptively. Variation in intakes, by community and BMI category, was assessed using ANOVA.

Five remote FN communities of the Mushkegowuk Territory (northern Ontario, Canada) and two less-remote southern Ontario FN communities.

Schoolchildren (n 457) in grades 6 to 12.

Compared with Canada's Food Guide recommendations, 72·6 to 84·7 % had an inadequate intake of milk and alternatives depending on age and sex group; 86·2 % of individuals fell below the RDA for Ca; 96·4 % fell below the RDA for vitamin D. Community variation in intakes was detected, although in all cases Fort Albany had higher intakes, even when it was the more northern (remote) community. A BMI × sex interaction was found for intake of milk and alternatives (P = 0·041): an inverse relationship between intake and BMI was seen in females; in males, those who were overweight had the highest intake, followed by normal-weight and obese youth.

The nutritional inadequacies parallel the results of other Canadian studies of Aboriginal populations. Population health interventions to improve intakes are warranted. Moreover, community variation in intakes exists among FN youth in the present study (Fort Albany pairs only), but results were not as expected.

Although previous research has shown that the Food Dudes programme increases children's fruit and vegetable consumption at school, there has been limited evaluation of the extent to which changes are maintained in the long term. Furthermore, despite knowledge that the nutritional content of home-supplied meals is lower than that of school-supplied meals, little consideration has been given to the programme's impact on meals provided from home. The present study therefore assessed the long-term effectiveness of the Food Dudes programme for both school- and home-supplied lunches.

Two cohorts of children participated, one receiving the Food Dudes intervention and a matched control group who did not receive any intervention. Consumption of fruit and vegetables was assessed pre-intervention, then at 3 and 12 months post-intervention. Consumption was measured across five consecutive days in each school using weighed intake (school-provided meals) and digital photography (home-provided meals).

Fifteen primary schools, six intervention (n 1282) and seven control schools (n 1151).

Participants were children aged 4–11 years.

A significant increase in the consumption of fruit and vegetables was found at 3 months for children in the intervention schools, but only for those eating school-supplied lunches. However, increases were not maintained at 12 months.

The Food Dudes programme has a limited effect in producing even short-term changes in children's fruit and vegetable consumption at lunchtime. Further development work is required to ensure the short- and long-term effectiveness of interventions promoting fruit and vegetable consumption in children such as the Food Dudes programme.

The predominance of marketing of products high in fat, sugar and/or salt to children has been well documented and implicated in the incidence of obesity. The present study aimed to determine whether foods marketed to children in UK supermarkets are nutritionally similar to the non-children's equivalent, focusing on food categories that may be viewed as healthier options.

Nutritional data were collected on yoghurts (n 147), cereal bars (n 145) and ready meals (n 144) from seven major UK supermarkets and categorised as children's or non-children's products based on the characteristics, promotional nature or information on the product packaging. Fat, sugar and salt content was compared per 100 g and per recommended portion size.

UK.

Per 100 g, children's yoghurts and cereal bars were higher in total sugars, fat and saturated fat than the non-children's; this was significant for all except sugar and total fat in cereal bars. Per portion these differences remained, except for sugars in yoghurts. Conversely children's ready meals were significantly lower in these nutrients per portion than non-children's, but not when expressed per 100 g. Children's yoghurts and ready meals had significantly lower sodium content than non-children's both per portion and per 100 g.

Significant differences between the nutritional composition of children's and non-children's products were observed but varied depending on the unit reference. A significant number of products marketed towards children were higher in fat, sugar and salt than those marketed to the general population.

To examine the association between breakfast consumption and physical activity in a well-characterised sample of English children.

Cross-sectional study using food diaries to record breakfast consumption and accelerometry to assess physical activity.

Norfolk county, England.

Children (n 1697) aged 9–10 years from the SPEEDY (Sport, Physical Activity and Eating behaviour: Environmental Determinants in Young people) study.

Boys who consumed a poor-quality breakfast based on dairy product, cereal and fruit intakes spent approximately 7 min more time in moderate-to-vigorous physical activity (MVPA) during weekday afternoons and evenings compared with those who did not consume breakfast (P < 0·05). On weekend days, boys who consumed a poor- or good-quality breakfast spent approximately 6 and 5 min less time respectively being sedentary during the mornings compared with breakfast non-consumers (P < 0·05). Boys who consumed a good-quality breakfast spent almost 3 min more in MVPA during the morning on weekend days compared with non-consumers, and boys who consumed a poor- or good-quality breakfast were 22 % and 16 % more active overall respectively than breakfast non-consumers (P < 0·05). During the rest of the day, boys who consumed a good-quality breakfast spent about 11 min less time being sedentary (P < 0·05) and 7 min more time in MVPA (P < 0·01).

Although some associations between breakfast consumption and physical activity were detected for boys, the present study does not provide strong evidence that failing to consume breakfast, or having a low energy intake at breakfast time, is detrimental to children's physical activity levels.

To determine parents’ and children's attitudes towards food, beverage and alcohol sponsorship of elite and children's sports and the acceptability of policies and alternative funding models to limit this sponsorship.

Telephone surveys were conducted with parents in February–May 2011. One child from each household was invited to complete an online survey. Surveys assessed parents’ perceptions about the influence of sponsorship on children and support for limiting sponsorship, and children's awareness of and attitudes towards sponsors.

Randomly sampled households in New South Wales, Australia.

Parents (n 825) and children aged 10–16 years (n 243).

Three-quarters of parents supported the introduction of policies to restrict unhealthy food, beverage and alcohol sponsorship of children's and elite sports. More parents (81 %) supported the introduction of alternative funding models to allow these companies to sponsor sport provided there was no visible branding. Two-thirds of children recalled sponsors of their favourite elite sports team/athlete, with 428 sponsors recalled. Of these, 11 % were food/beverage companies and 3 % were alcohol-related. For 39 % of sponsors, children reported feeling better about the company after it had sponsored a team/athlete.

Australian parents support restrictions on unhealthy food, beverage and alcohol sport sponsorship. Children's positive associations regarding sponsors are likely to be linked to brand preferences and usage.

According to the Family Ecological Model (FEM), parenting behaviours are shaped by the contexts in which families are embedded. In the present study, we utilize the FEM to guide a mixed-methods community assessment and summarize the results. Additionally, we discuss the utility of the FEM and outline possible improvements.

Using a cross-sectional design, qualitative and quantitative methods were used to examine the ecologies of parents' cognitions and behaviours specific to children's diet, physical activity and screen-based behaviours. Results were mapped onto constructs outlined in the FEM.

The study took place in five Head Start centres in a small north-eastern city. The community assessment was part of a larger study to develop and evaluate a family-centred obesity prevention programme for low-income families.

Participants included eighty-nine low-income parents/caregivers of children enrolled in Head Start.

Parents reported a broad range of factors affecting their parenting cognitions and behaviours. Intrafamilial factors included educational and cultural backgrounds, family size and a lack of social support from partners. Organizational factors included staff stability at key organizations, a lack of service integration and differing school routines. Community factors included social connectedness to neighbours/friends, shared norms around parenting and the availability of safe public housing and play spaces. Policy- and media-related factors included requirements of public assistance programmes, back-to-work policies and children's exposure to food advertisements.

Based on these findings, the FEM was refined to create an evidence-based, temporally structured logic model to support and guide family-centred research in childhood obesity prevention.