Table 2 Analysis of GAP actions according to IOTF recommended actions and principles

1. Address both dietary habits and physical activity patterns of the population.

Overall, actions cover both physical activity and nutrition, but tend to be identified and implemented separately, in different settings and jurisdictions and different target groups. Information-dissemination actions were the only actions that addressed physical activity and food consumption in an integrated way.

2. Address both societal and individual level factors.

The GAP contains a mix, with the majority of actions directed at social and environmental factors in specific settings (e.g. school canteens).

3. Address both immediate and distant causes

Focus is on behaviours in everyday settings, rather than social, cultural factors

4. Address multiple focal points and levels of intervention (i.e. national, regional, community and individual levels)

While there is a mix of local and state level action, in many cases the local projects are limited to a small number of sites and unlikely to achieve widespread reach or population effect, unless they were implemented on a major scale across the state, or there is a clear process for staged dissemination and statewide implementation.

5. Build links between sectors that may be otherwise viewed as independent.

The Action Plan brings together programs across key portfolios and creates a significant cross-sectoral agenda and basis for collaboration. However, there are a number of factors that are not addressed, including transport, safety, media and food supply.

6 . Include both policies and programmes.

The GAP is weighted more towards program implementation, rather than policy development. Only three actions relate to changing policy. However, some of the programs have a basis in existing policy, such as earlier commitments to build off-road cycleways.

IOTF PRINCIPLES (1 to 10)

Principle 1. Education alone is not sufficient to change weight-related behaviours. Environmental and social interventions are also required to promote and support behavioural change.

While the majority of actions include environmental interventions, many are small scale and local.

Principle 2. Action must be taken to integrate physical activity into daily life, not just to increase leisure time exercise.

Seven actions within the Plan fit this principle.

Principle 3. Sustainability of programmes is crucial to enable positive change in diet, activity and obesity levels over time.

The GAP is primarily concerned with initiating discrete actions, and does not emphasise structural changes or sustainability.

Principle 4. Political support, intersectoral collaboration and community participation are essential for success.

GAP was initiated with the significant political support and community participation associated with the 2002 Childhood Obesity Summit

Principle 5. Acting locally, even in national initiatives, allows programmes to be tailored to meet real needs, expectations and opportunities.

Many of the GAP's actions support local initiatives. While this approach can support appropriate and tailored approaches, it is important to note that many areas and communities will not be recipients of local initiatives, as actions have only been implemented in selected locations and not universally across NSW

Principle 6. All parts of the community must be reached – not just the motivated healthy.

Many GAP actions adhere to this principle through adopting a targeted or local approach. However, as this occurred in the context of small projects, they did not reach wide sections of the population.

Principle 7. Programmes must be adequately resourced.

While NSW Treasury did not directly allocate additional resources, NSW Health allocated additional funding, totalling $12 million over three years (2004/5 to 2006/7). These funds were concentrated on two new initiatives, the Healthy Schools Canteen Strategy and the establishment of the Centre for Overweight and Obesity. The recent investment of $7.5 million over 5 years by NSW Health and Hunter New England Area Health Service for a large Area-wide, intensive demonstration project (Hunter New England child obesity prevention program), represents a major investment by NSW Government.

Principle 8. Where appropriate, programmes should be integrated into existing initiatives.

This principle is central to the GAP's design, as 50% of actions were identified as core actions for existing agencies.

Principle 9. Programmes should build on existing theory and evidence.

GAP's actions are based on best available evidence, as well as health promotion theory. Note that there was limited evidence regarding effective interventions.

Principle 10. Programmes should be properly monitored, evaluated and documented. This is important for dissemination and transfer of experiences.

The GAP did not specify any impact (e.g. children's eating and physical activity behaviours) or outcome (e.g. population weight status) indicators for reporting and monitoring purposes. The complexity of multiple determinants influencing children's weight status makes it difficult to measure and attribute the direct impact of the actions listed in the Plan. This is particularly true for analysing the contribution of actions that have obesity as a secondary objective.