From the editor.

With so much happening in the area of childhood obesity today, it is timely that the September issue bears this theme. We have a commendable range of articles from across Australia, including surveys of primary school communities in New South Wales, Victoria and Queensland, and a letter describing a parenting program in South Australia. The focus is on discussing the problem and describing related research and intervention programs. One of the features common to all contributions is the search for a comprehensive and novel approach. This is seen through questioning common assumptions, addressing the need to collect and analyse hard data, and examining the broader context from which childhood obesity has emerged.

The issue opens with the Editorial by the President of the Dietitians Association of Australia, Professor Sandra Capra, acknowledging the need for a concerted effort from organisations, professionals and individuals across the whole community. Professor Capra outlines the position of DAA and reminds us of the complexity of the problem and its possible solutions. She also refers to DAA's services to members including access to peer-reviewed innovative programs for weight management.

We are privileged to have the leading article on childhood obesity by Professor Louise Baur, a world expert in the field and a member of a number of significant international groups working on the problem. Professor Baur reiterates that paediatric obesity is not a benign condition in itself. Apart from the risk of future ill health, it can carry concurrent burdens related to psychosocial orthopaedic, respiratory, gastrointestinal, sleep and metabolic health problems. School-based programs are one of many approaches to addressing the problem, but all may not be as it seems, as the referent articles show. Sutherland and co-authors acknowledge the pressure placed on schools to address a range of health and social issues in addition to ensuring basic literacy and numeracy. In their survey of parents, teachers, healthcare workers and pupils in a NSW central coast primary school, they show that attitudes varied regarding the significance of the school environment in preventing obesity, with healthcare workers as the most keen and teachers the least. Schools can make a contribution, but the issues go beyond school, and we do well to keep that perspective. In the survey by Cleland et al. of children, parents and teachers from 12 primary schools in Victoria, the importance parents placed on the role of the canteen in developing eating patterns was equivocal, and only 9.5% of boys and 5.8% of girls reported using the canteen on most days. This put canteen strategies in perspective too, but of real interest were the novel ideas from interviewees for using the canteen as a health-promoting tool. These bore a marketing flavour, with suggestions for decreased cost of healthy alternatives, increased availability and publicity.

The need to test assumptions about school breakfast programs was the focus of the next paper by Radcliffe and colleagues who surveyed 832 primary students in 14 urban and rural schools in southern Queensland. They found only 3% of respondents skipped breakfast, suggesting a breakfast program may not be a useful strategy, but they found the quality of food consumed by children for breakfast has room for improvement. Using the Australian Guide to Healthy Eating as a benchmark for scoring dietary patterns, they argued that both parents and children need to be targeted to achieve improvements in dietary intake. Back in New South Wales, the situation in out-of-school hours care would be different. In one of the first published studies of nutrition in this context, Sangster and colleagues found in the 41 services studied that 44% offered vegetables or fruit to children and 34% has policies on nutrition. In this professional Insight paper they noted the need to work within this context, particularly given the differences from long-day care facilities where there is more regulation as well as facilities and qualified staff.

The theme of childhood obesity--new ideas and challenges, continues in the Letters to the Editor. David Crawford's group posits hard data against the notion that children of dual career families are at greater risk of obesity through inactivity, and argues out-of-school hours care is a potentially important location for activity. Further, they argue that long-term, multiple-setting, community interventions require serious government commitment. In another letter Magarey's team describe their Healthy Eating and Lifestyle through Positive Parenting program, which is currently being implemented as the nutrition component in the Parenting Eating and Activity for Child Health (PEACH) program, an NHMRC-funded intervention trial in overweight five- to nine-year-olds in Adelaide and Sydney. They also argue that this program should sit in a nest of community interventions including the school and the wider community environments.

Moving from childhood obesity, but nevertheless focusing on new ways of doing things, the first paper in the education section addresses the utility of the curriculum in raising awareness about a broader range of foods, in this case legumes, among nutrition students. This paper by Lacey also moves the issue beyond Australia--a very welcome article from Pennsylvania, USA. An article by Hughes accompanies this, on the public health nutrition workforce, raising issues about the size of the workforce, stability, the number of advanced practitioners and the need for continued monitoring of the workforce. Gillen provides the continuing education section, on Gestational Diabetes Mellitus, a very significant area to consider for dietary intervention. Finally, it is very pleasing to see a letter from Professor Stewart Truswell supporting the commentary in the June issue on building our links with New Zealand. The valuable contributions by our New Zealand colleagues were clearly demonstrated in that issue. It sets a good example of the active involvement in the journal we would like to see from dietitians and nutritionists from both countries and well beyond.

Professor Linda Tapsell APD 

Editor