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Introduction Health related quality of life is a multi-dimensional construct of particular interest in determining the consequences of illness and disease. This study aimed to determine the relationships between overweight/obesity, and associated obesogenic risk behaviours with health related quality of life and physical, social, emotional and school sub-domains, among a large cohort of Australian primary school children. Methods The data were derived from the Goulburn Valley Health Behaviours Monitoring study whereby a census-styled school recruitment process and high participatory opt-out (passive) procedure was employed. All primary schools in three Local Government Areas were invited to participate between July-September 2016 with 39/62 (62%) of schools participating and 1606/2034 (79%) students in Grade 2 (aged approx. 7-8 years), Grade 4 (aged approx. 9-10 years) and Grade 6 (aged approx. 11-12 years) participating. Measured height and weight were collected among participating students and older children (Grade 4 and 6) who also completed a self-report behavioural questionnaire, including the paediatric quality of life inventory. Results Among 809 children aged 9 to 12 years, there were 219 (27.1%) classified as overweight/obese. Male children classified as overweight/obese reported significantly lower health related quality of life in the physical functioning and global functioning scores, compared to normal weight males. Significantly higher quality of life scores were observed among all children who met the physical activity recommendations on five out of the seven previous days. Significantly higher scores were observed among males adhering to the daily screen time recommendations, and among those meeting daily recommendations for fruit consumption. Among male school children, soft drink consumption was associated to lower health related quality of life. Conclusion Although cross-sectional, these findings highlight children with overweight/obesity and some underlying lifestyle behavioural risk factors, had significantly lower healthy-related quality of life, although this was observed most consistently among male school children. These findings have not previously been identified in young children and highlights the need to consider mental and emotional health in public health efforts to prevent obesity. Trial Registration ANZCTR Trial Registry: ACTRN12616000980437 retrospectively registered 26 July 2016

Background Healthy Together Victoria (HTV) was a Victorian Government initiative that sought to reduce the prevalence of overweight and obesity through targeting chronic disease risk factors including physical activity, poor diet quality, smoking, and harmful alcohol use. The intervention involved a boosted workforce of > 170 local-level staff in 12 communities; employed to deliver system activation around health and wellbeing for individuals, families and communities. A cluster randomised trial (CRT) of a systems thinking approach to obesity prevention was embedded within HTV. We present the two-year changes in overweight and obesity and associated behaviours among secondary school students across Victoria, Australia. Methods Twenty-three geographically bounded areas were randomised to intervention (12 communities) or comparison (11 communities). Randomly selected secondary schools within each community were invited to participate in the trial in 2014 and 2016. Students in Grade 8 (aged approximately 13–15 years) and Grade 10 (aged approximately 15–16 years) at participating schools were recruited using an opt-out approach across July–September 2014 and 2016. Primary outcomes were body mass index (BMI) and waist circumference. Secondary outcomes were physical activity, sedentary behaviour, diet quality, health-related quality of life, and depressive symptoms. Linear mixed models were fit to estimate the intervention effect adjusting for child/school characteristics. Results There were 4242 intervention children and 2999 control children in the final analysis. For boys, the two-year change showed improvement in intervention versus control for waist circumference (difference in change: − 2.5 cm; 95% confidence interval [CI]: − 4.6, − 0.5) and consumption of sugar-sweetened beverages per day (< 1 serve: 8.5 percentage points; 95% CI: 0.6, 16.5). For girls, there were no statistically significant differences between conditions. Conclusions HTV seemed to produce favourable changes in waist circumference and sugar-sweetened beverage consumption for boys, however, no effect on BMI was observed. Although the HTV intervention was cut short, and the period between data collection points was relatively short, the changes observed in HTV contribute to the growing evidence of whole-of-community interventions targeting childhood obesity. Trial registration This trial is unregistered. The intervention itself was a policy setting delivered by government and our role was the collection of data to evaluate the effect of this natural experiment. That is, this study was not a trial from the classical point of view and we were not responsible for the intervention.

Issue addressed: Childhood obesity poses a significant immediate and long-term burden to individuals, societies and health systems. Infrequent and inadequate monitoring has led to uncertainty about trends in childhood obesity prevalence in many countries. High-quality data, collected at regular intervals, over extended timeframes, with high response rates and timely feedback are essential to support prevention efforts. Our aim was to establish a sustainable childhood obesity monitoring system in regional Australia to collect accurate anthropometric and behavioural data, provide timely feedback to communities and build community engagement and capacity. Methods: All schools from six government regions of South-West Victoria were invited to participate. Passive (opt-out) consent was used to collect measured anthropometric and self-reported behavioural data from children in years 2, 4, and 6, aged 7-12 years. Results: We achieved a 70% school participation rate (n = 46) and a 93% student response rate (n = 2198) among government and independent schools. Results were reported within 10 weeks post data collection. Harnessing high levels of community engagement throughout the planning, data collection and reporting phases increased community capacity and data utility. Conclusions: The monitoring system achieved high response rates, community engagement and community capacity building, and delivered results back to the community in a timely manner.

The Australian Capital Territory ‘It's Your Move!’ (ACT‐IYM) was a three‐year (2012–2014) systems intervention to prevent obesity among adolescents. The ACT‐IYM project involved three intervention schools and three comparison schools and targeted secondary students aged 12–16 years. The intervention consisted of multiple initiatives at individual, community, and school policy level to support healthier nutrition and physical activity. Intervention school‐specific objectives related to increasing active transport, increasing time spent physically active at school, and supporting mental wellbeing. Data were collected in 2012 and 2014 from 656 students. Anthropometric data were objectively measured and behavioural data self‐reported. Proportions of overweight or obesity were similar over time within the intervention (24.5% baseline and 22.8% follow‐up) and comparison groups (31.8% baseline and 30.6% follow‐up). Within schools, two of three the intervention schools showed a significant decrease in the prevalence of overweight and obesity (p<0.05). There was some evidence of effectiveness of the systems approach to preventing obesity among adolescents. The incorporation of systems thinking has been touted as the next stage in obesity prevention and public health more broadly. These findings demonstrate that the use of systems methods can be effective on a small scale.

Background Environments within schools including the physical, social-cultural and policy/practice environments have the potential to influence children’s physical activity (PA) behaviours and weight status. This Australian first study comprehensively examined the association(s) of physical, social-cultural and policy/practice environments with PA, active transport (AT) and weight status among regional primary school children. Methods Data were from two childhood obesity monitoring systems in regional Victoria, Australia. Measured height and weight were collected from students in Year 2 (aged approx. 7–8 years), Year 4 (9–10 years), and Year 6 (11–12 years). Self–reported PA behaviour, including AT were collected from students in Year 4 and 6 and a sub-sample wore an ActiGraph (wGT3X-BT) accelerometer for 7-days. A school physical activity environment audit was completed by the school principal and responses were used to calculate school physical activity environment scores (PAES) and active transport environment scores (ATES). Mixed effects logistic regression was used to assess the relationship between the proportion of students meeting the PA guidelines (≥60mins/day of moderate-to-vigorous PA) and PAES tertiles (low, medium, high) and those using AT and school ATES tertiles, controlling for gender, school size/type and socioeconomic composition. Results The analysed sample included 54/146 (37%) schools and 3360/5376 (64%) students. In stratified analysis, girls in schools with a medium PAES score were more likely to meet the objectively measured PA guideline compared to low PAES score (OR 2.3, 95%CI 1.27, 4.16). Similarly, students in schools with a medium or high ATES score had higher odds of self-reported AT (medium OR 3.15, 95%CI 1.67, 5.94; high OR 3.71, 95%CI: 1.80, 7.64). No association between PAES or ATES and weight status were observed. Self-reported AT among boys (OR 1.59, 95%CI 1.19, 2.13) and girls (OR 1.56, 95%CI 1.08, 2.27) was associated with higher odds of meeting self-reported PA guidelines on all 7-days than those who did not report using AT. Conclusions In this study of regional Victorian primary schools, PA environments were only associated with girls’ adherence to PA guidelines. School AT environments were strongly associated with students’ AT behaviours and with increased likelihood of students being physically active.

Background In Australia, around 67% of adults and 25% of children (5–17 years) are currently overweight or obese (Australian Bureau of Statistics, 4364.0.55.001 - National Health Survey: First Results, 2017–18, 2018). The Campbelltown – Changing our Future study will translate ‘a whole of system’ approach, previously trialed in rural communities in Victoria and the Australian Capital Territoty, to Campbelltown Local Government Area (LGA), a socioeconomically and ethnically diverse urban community in south western Sydney, NSW. Methods The study intervention will use a five-step approach; 1 – set up a childhood obesity monitoring system by collecting baseline data from children in primary schools across Campbelltown LGA to give a local context to the community when developing the systems map; 2 - key stakeholders develop systems maps which inform the development of the interventions; 3 - key stakeholders and community groups identify priority areas for action and form working groups; 4 - implementation of the interventions; 5 - evaluation of the interventions. The study will adopt a longitudinal pre/post design with repeated measures at baseline, 2 years and 4 years. Both qualitative and quantitative methods will be used to collect and analyse the data. Discussion Addressing childhood overweight and obesity is complex and requires a multifaceted intervention. This approach has the capacity to impact a range of factors that influence childhood overweight and obesity utilising existing capacity of multiple partners with broad community reach. Findings will develop local responses which capture the complexity of obesity at a community level and further our understanding of the interrelationships and relative importance of local factors impacting childhood overweight and obesity. This study aims to provide evidence for systems methods and approaches suitable for adaption and scaling and may provide evidence of successful community intervention elements.

To report the prevalence of healthy weight and related behaviours among Victorian Aboriginal and non‐Aboriginal children and explore associations between these factors and health‐related quality of life (HRQoL). Analysis of cross‐sectional data from two cluster randomised controlled trials using logistic and linear mixed models. The sample included Aboriginal (n=303) and non‐Aboriginal (n=3,026) children aged 8–13 years. More than two‐thirds of Aboriginal children met guidelines for fruit (75.9%), sweetened drinks (66.7%), sleep (73.1%), screen time (67.7%) and objectively measured physical activity (83.6%); and 79.1% reported consuming take‐away foods less than once per week. Aboriginal children were more likely to meet vegetable consumption guidelines (OR=1.42, 95%CI: 1.05, 1.93), but less likely to have a healthy weight (OR=0.66, 95%CI: 0.52, 0.85) than non‐Aboriginal children. Mean HRQoL scores were significantly higher among non‐Aboriginal children and both Aboriginal and non‐Aboriginal children meeting health guidelines. Most Aboriginal children in this study met guidelines for fruit, physical activity, screen time and sleep, and those meeting these guidelines had significantly higher HRQoL. Promoting nutrition, physical activity and sleep is likely to benefit all children. Aboriginal community‐controlled organisations can use these data to design culturally‐specific programs that may improve disparities in healthy weight and HRQoL.

The paper describes one of the first attempts to evaluate an obesity prevention intervention that was informed by systems thinking and deliberately addressed the complexity within each school setting. A quasi‐experimental design was adopted, and the intervention design included the facility for each school to choose and adopt interventions that were specific to their school context and priorities. This, in turn, meant the expectation of differential behavioural effects was part of the initial design and therefore a comparison of outcomes by intervention school was warranted.

(1) Background: Childhood overweight and obesity is a significant and preventable problem worldwide. School environments have been suggested to be plausible targets for interventions seeking to improve the quality of children’s dietary intake. The objective of this study was to determine the extent to which the current characteristics of the school food environment were associated with primary school students’ dietary intake and Body Mass Index (BMI) z scores in a representative sample in regional Victoria. (2) Methods: This study included 53 schools, comprising a sample of 3,496 students in year levels two (aged 7–8 years), four (9–10 years) and six (11–12 years). Year four and six students completed dietary questionnaires. Principals from each school completed a survey on school food environment characteristics. Mixed-effects logistic regression was used to assess the relationship between students’ dietary intake and school food environment scores, controlling for confounders such as socio-economic status, school size and sex. Food environment scores were also analysed against the odds of being healthy weight (defined as normal BMI z score). (3) Results: Mixed associations were found for the relationship between students’ dietary intake and food environment scores. Meeting the guidelines for vegetable intake was not associated with food environment scores, but students were more likely (OR: 1.68 95% CI 1.26, 2.24) to meet the guidelines if they attended a large school (>300 enrolments) and were female (OR: 1.28 95% CI: 1.02, 1.59). Healthy weight was not associated with school food environment scores, but being a healthy weight was significantly associated with less disadvantage (OR: 1.24 95% CI 1.05, 1.45). Conclusion: In this study, the measured characteristics of school food environments did not have strong associations with dietary intakes or BMI among students.