Community nutrition and physical activity (CoNPA)
Dietary habits and physical activity are among the most important determinants of health and well-being. An unhealthy diet and a sedentary lifestyle greatly increase the risk for chronic diseases like cardiovascular diseases, obesity, type 2 diabetes, cancer and premature death. Improving dietary habits and physical activity can contribute to achievement of the Sustainable Development Goals.
The main aim of the group’s research is to contribute to equality in health through high quality studies regarding dietary habits and physical activity. The research covers multilevel and mixed-methods health promotion research regarding dietary habits and physical activity with a universal or targeted approach. It is carried out in settings such as child health care, preschools, schools and in residences for adults with disabilities.
The group is conducting research in the following areas:
- Epidemiological studies of dietary habits and physical activity and their determinants, in relation to health outcomes.
- Multidisciplinary research on the development, implementation and evaluation of interventions to promote healthy and sustainable eating habits, physical activity and prevent obesity and chronic diseases.
- Commissioned assignments from external partners within the groups research competence.
Education and teaching
The group members participate in third-level education at undergraduate, graduate and doctoral level in the areas of public health nutrition and physical activity, theory and practice of intervention and implementation research.
Collaboration and knowledge exchange with society
Our research group collaborates with the Public Health Agency of Sweden, the National Food Agency, the National Board of Health and Welfare, the Swedish Association for Local Authorities and Regions, Stockholm County Council, non-governmental organisations, municipalities and other research groups in Sweden and abroad.
We participate in knowledge exchange within the European Union and the World Health Organization.
Several of our research group members have a dual affiliation with the Center of Epidemiology and Community Medicine, Stockholm County Council, which facilitates the translation of research to practice.
A Healthy School Start Plus for children and parents in disadvantaged areas – health promotion and obesity prevention
This three-year project is a further development of our Healthy School Start intervention and runs from 2017-2019, funded by the Swedish Research Council Forte and the Kamprad Family Foundation.
A high-quality evaluation of a programme to promote healthy dietary habits and physical activity and prevent obesity and chronic diseases in children starting school and their parents in disadvantaged areas with great health needs.
The programme is based on Social Cognitive Theory and includes four components:
- A health information brochure to parents
- Motivational Interviewing with the parents concerning their child
- Teacher-led classroom activities with the children with home assignments for the family
- A test of type 2 diabetes risk by parents with follow-up in primary health care, if needed
- Dietary habits
- Physical activity, sedentary behaviour, body weight,height, and waist of children
Quantitative and qualitative methods are used to identify barriers and facilitators of implementation, fidelity, dose, reach, and acceptance of the programme components.
A cluster-randomised controlled trial with 17 schools and 352 families in disadvantaged areas in the Mälardalen region (mid-Sweden).
Föräldrastöd för att främja mat- och rörelsevanor. Nordisk Nutrition nr 4, 2018.
Elinder LS, Patterson E, Andermo S, Nyberg G, Kjellenberg K, Malek M, Moberg M, Norman Å.
A Healthy School Start Plus for prevention of childhood overweight and obesity in disadvantaged areas through parental support in the school setting - study protocol for a parallel group cluster randomised trial.
Elinder LS, Patterson E, Nyberg G, Norman Å
BMC Public Health 2018 04;18(1):459
Publications from previous parental support interventions in the school context:
Parental strategies for influencing the diet of their children - A qualitative study from disadvantaged areas.
Norman Å, Nyberg G, Elinder LS, Berlin A
Appetite 2018 06;125():502-511
Effectiveness of a universal parental support programme to promote health behaviours and prevent overweight and obesity in 6-year-old children in disadvantaged areas, the Healthy School Start Study II, a cluster-randomised controlled trial.
Nyberg G, Norman Å, Sundblom E, Zeebari Z, Elinder LS
Int J Behav Nutr Phys Act 2016 Jan;13():4
Psychometric Properties of a Scale to Assess Parental Self-Efficacy for Influencing Children's Dietary, Physical Activity, Sedentary, and Screen Time Behaviors in Disadvantaged Areas.
Norman Å, Bohman B, Nyberg G, Schäfer Elinder L
Health Educ Behav 2018 02;45(1):132-140
Factors influencing the implementation of a school-based parental support programme to promote health-related behaviours--interviews with teachers and parents.
Bergström H, Haggård U, Norman Å, Sundblom E, Schäfer Elinder L, Nyberg G
BMC Public Health 2015 Jun;15():541
Effectiveness of a universal parental support programme to promote healthy dietary habits and physical activity and to prevent overweight and obesity in 6-year-old children: the Healthy School Start Study, a cluster-randomised controlled trial.
Nyberg G, Sundblom E, Norman Å, Bohman B, Hagberg J, Elinder LS
PLoS ONE 2015 ;10(2):e0116876
One size does not fit all-qualitative process evaluation of the Healthy School Start parental support programme to prevent overweight and obesity among children in disadvantaged areas in Sweden.
Norman Å, Nyberg G, Elinder LS, Berlin A
BMC Public Health 2016 Jan;16():37
Low socio-economic status associated with unhealthy weight in six-year-old Swedish children despite higher levels of physical activity.
Beckvid Henriksson G, Franzén S, Elinder LS, Nyberg G
Acta Paediatr. 2016 Oct;105(10):1204-10
The intake of selected foods by six-year-old Swedish children differs according to parental education and migration status.
Säfsten E, Nyberg G, Elinder LS, Norman Å, Patterson E
Acta Paediatr. 2016 Apr;105(4):421-6
Effectiveness of universal parental support interventions addressing children's dietary habits, physical activity and bodyweight: A systematic review.
Kader M, Sundblom E, Elinder LS
Prev Med 2015 Aug;77():52-67
Aspects influencing the implementation of a parental support programme to promote health-related behaviours in a school setting according to teachers and parents. Bergström H, Haggård U, Norman Å, Sundblom E, Elinder LS, Nyberg G. BMC Public Health 2015, 15:541.
Stuck in a vicious circle of stress. Parental concerns and barriers to changing children's dietary and physical activity habits.
Norman Å, Berlin A, Sundblom E, Elinder LS, Nyberg G
Appetite 2015 Apr;87():137-42
Longitudinal changes in health behaviours and body weight among Swedish school children--associations with age, gender and parental education--the SCIP school cohort.
Elinder LS, Heinemans N, Zeebari Z, Patterson E
BMC Public Health 2014 Jun;14():640
Validity and Reliability of a Parental Self-Efficacy Instrument in the Healthy School Start Prevention Trial of Childhood Obesity.
Bohman B, Nyberg G, Sundblom E, Elinder LS
Health Educ Behav 2014 Aug;41(4):392-6
A participatory and capacity-building approach to healthy eating and physical activity- SCIP-school: a 2-year controlled trial.
Elinder LS, Heinemans N, Hagberg J, Quetel AK, Hagströmer M
Int J Behav Nutr Phys Act 2012 Dec;9():145
A healthy school start - parental support to promote healthy dietary habits and physical activity in children: design and evaluation of a cluster-randomised intervention.
Nyberg G, Sundblom E, Norman A, Elinder LS
BMC Public Health 2011 Mar;11():185
Project contact person:
School Food Sweden (SkolmatSverige)
School meals are provided free of cost for all children aged 6-16 years in Sweden and since 2011 the law states that school meals should also be “nutritious”.
A novel web-based system called SkolmatSverige (School food Sweden) was launched in 2012. It is currently used by almost half of all primary schools in Sweden, and it allows continuous evaluation of school meal quality as well as research relating school meal quality to health and educational outcomes.
SkolmatSverige consists of an instrument to be completed by the school, usually by the head of catering. The instrument covers six different domains. In addition, the school can choose to administer two questionnaires to pupils and staff at the school.
The six domains are:
- Food choice and provision
- Nutritional adequacy
- Safe and hygienic food
- Service and the pedagogic lunch
- Environmental impact
- Organisation and policy
Automatic feedback to the school showing their strengths and weaknesses in the different areas is provided. This feedback, plus encouragement to create an action plan is intended to help them improve their school meal quality.
Results and further work
Two years after the new law was introduced small but significant improvements were seen. Preliminary analysis suggests that repeated use of the instrument is helping schools to improve their school meal quality.
The data gathered makes it possible to conduct research on potential systematic differences in school meal quality in the country and on the health and educational effects of school meals. See www.skolmatsverige.se for more results in Swedish.
SkolmatSverige – verktyget som bidrar till utveckling av skolmåltidens kvalitet.
Patterson E, Elinder LS. Nordisk Nutrition nr 1, 2016.
Improvements in school meal quality in Sweden after the introduction of new legislation-a 2-year follow-up.
Patterson E, Elinder LS
Eur J Public Health 2015 Aug;25(4):655-60
Design, testing and validation of an innovative web-based instrument to evaluate school meal quality.
Patterson E, Quetel AK, Lilja K, Simma M, Olsson L, Elinder LS
Public Health Nutr 2013 Jun;16(6):1028-36
Project contact person:
The Swedish school meal scheme offers a unique opportunity to foster healthy and sustainable dietary habits among the young generation. This four-year research project running from 2016 - 2019 is financed by the Swedish Research Council Formas.
To develop a holistic model for a health-promoting, affordable, and socially acceptable school meal plan optimized for environmental sustainability (greenhouse gas emissions). The project constitutes collaboration between Karolinska Institute, the National Food Agency Sweden, and the University College Copenhagen.
- Optimizing Swedish school food supply: integrating environmental, health, economic, and cultural dimensions of dietary sustainability with linear programming
- School lunches, their contribution to overall dietary intake and relation to school meal quality - a cross sectional study
- Implementation of a new and sustainable menu plan in schools, effects on food consumption and waste
- Implementation of the new and sustainable menu plan - a qualitative process evaluation
Project contact person:
School-based physical activity interventions and mental health in children and adolescents: a systematic review
A systematic review commissioned by The Public Health Agency of Sweden to be delivered December 2018.
To review the effects of school-based interventions aiming to increase physical activity or decrease sedentary behaviour on mental health in children and adolescents.
Specific questions are:
- What are the effects of school-based interventions to increase physical activity or decrease sedentary behaviour on the prevalence of positive mental health or introverted psychological disorders in normal populations of children and adolescents?
- What characterises interventions that are effective regarding the content and the implementation?
- What are the age, sex, family structure, socioeconomic status, country of birth or geographic location moderators of intervention effects?
Project contact person
A Healthy Generation
A Healthy Generation aims to to increase physical activity and encourage a healthy lifestyle in families in disadvantaged areas in Sweden. Participants were 8 to 9-year-old children (n=67) and their parents (n=94). Four schools were included in this controlled study (2 intervention/2 control).
The nine-month programme is run by a foundation A Healthy Generation in close cooperation with municipalities and local organisations. Families are invited to activities twice a week, such as soccer, basketball, dance, boxing, outdoor activities and ice-skating.
The aim of this study is to evaluate, quantitatively and qualitatively, the effects of the programme A Healthy Generation in children aged 8-9 years old and their families in areas with low socio-economic status.
The programme includes four intervention components:
- Activity sessions
- Healthy meals
- Health information
- Parental support group sessions
- Physical activity and sedentary time
- Physical activity habits
- Sedentary behaviour
- Metabolic risk factors
- Quality of life
Fidelity to the intervention, barriers and facilitators to continue being physically active and participate in local organisations after the intervention.
The evaluation of the program is performed as a controlled intervention study in collaboration with researchers at the Department of Medicine, Karolinska Institutet.
This research project will be conducted in three studies:
- A controlled intervention study to evaluate physical activity, sedentary behaviour, cardiovascular risk, quality of life and a qualitative interview study examining psychosocial health
- Qualitative interview studies to examine facilitating factors for the participating families to continue being physically active after the intervention
- Health economic assessment of the programme
Project contact person
Riksmaten Ungdom – physical activity
A national survey of physical activity and sedentary behaviour in Swedish children and adolescents – Riksmaten Ungdom
This cross-sectional study performed by the Swedish Food Agency aims to generate national data on diet, physical activity, sedentary behaviour and the significance of participating in organised sports among different ages, sex and socio-economic groups. Our research group is responsible for the data on physical activity.
Girls and boys in grade 5, grade 8 and grade 2 in high school were included in this study between August 2016 and June 2017 (N=3500). Physical activity and sedentary time were measured objectively. Data were collected on participation in organised sports, screen time, height, weight, age, sex and socio-economic background.
The results from this survey will be published in Swedish reports and scientific publications.
Project contact person
Health promotion for adults with intellectual disabilities
Adults with intellectual disabilities have an increased risk of developing physical as well as mental ill-health. This target group on average has poor dietary habits, low physical activity and a higher prevalence of obesity compared to the general population. Effective health programmes for this target group are lacking.
To develop and evaluate a multi-component programme to promote physical activity and healthy diet among adults with intellectual disabilities targeting both residents and staff in community residences.
The twelve-month programme includes three components:
- Appointment of a health ambassador among staff
- A study circle for staff - where they discuss health promotion work routines and practices
- A health course for the residents
- Work routines in residences assessed by questionnaire
- Physical activity of residents measured objectively
- Diet quality of residents assessed by digital photography
- Anthropometry of residents
- Satisfaction with life of residents assessed by structured interview
Interviews are conducted with managers and health ambassadors to assess barriers and facilitators of implementation, and fidelity to the program components is monitored.
The programme has been implemented in 30 community residences in Stockholm County and has been evaluated in a cluster-randomized controlled trial. In another quasi-experimental study including 84 residences in 8 municipalities we have assessed the implementation of the study circle for staff component and its effect on work routines.
Results and further work
Results have been encouraging regarding physical activity, but further development is needed regarding improvements in diet. A manual (in Swedish) has been produced and the programme is being implemented in several municipalities throughout Sweden.
Effect and Process Evaluation of a Structural Health Intervention in Community Residences for Adults With Intellectual Disabilities.
Elinder, Liselotte S; Sundblom, Elinor; Zeebari, Zangin; Bergstrom, Helena. Journal of Policy and Practice in Intellectual Disabilities, 2018, Vol.15(4), p.319(10)
Manual. Hälsofrämjande gruppbostad. Ett program för att främja bra mat- och rörelsevanor i gruppbostäder och servicebostäder (Manual. Health promotion in community residences. A program to promote healthy dietary habits and physical activity in community residences – a manual).
Centre for Epidemiology and Community Medicine, Stockholm county Council. Stockholm 2014.
Understanding the Implementation Process of a Multi-Component Health Promotion Intervention for Adults with Intellectual Disabilities in Sweden.
Sundblom E, Bergström H, Ellinder LS
J Appl Res Intellect Disabil 2015 Jul;28(4):296-306
Barriers and facilitators in health education for adults with intellectual disabilities--a qualitative study.
Bergström H, Elinder LS, Wihlman U
Health Educ Res 2014 Apr;29(2):259-71
Promoting health of people with intellectual disabilities: Views of professionals working in group homes.
Wahlström L, Bergström H, Marttila A
J Intellect Disabil 2014 Jun;18(2):113-128
A multi-component universal intervention to improve diet and physical activity among adults with intellectual disabilities in community residences: a cluster randomised controlled trial.
Bergström H, Hagströmer M, Hagberg J, Elinder LS
Res Dev Disabil 2013 Nov;34(11):3847-57
Psychometric evaluation of a scale to assess satisfaction with life among people with intellectual disabilities living in community residences.
Bergström H, Hochwälder J, Kottorp A, Elinder LS
J Intellect Disabil Res 2013 Mar;57(3):250-6
The role of staff in health promotion in community residences for people with intellectual disabilities: variation in views among managers and caregivers.
Bergström H, Wihlman U
J Intellect Disabil 2011 Sep;15(3):167-76
Validation of personal digital photography to assess dietary quality among people with intellectual disabilities.
Elinder LS, Brunosson A, Bergström H, Hagströmer M, Patterson E
J Intellect Disabil Res 2012 Feb;56(2):221-6
Promoting a healthy diet and physical activity in adults with intellectual disabilities living in community residences: design and evaluation of a cluster-randomized intervention.
Elinder LS, Bergström H, Hagberg J, Wihlman U, Hagströmer M
BMC Public Health 2010 Dec;10():761
Project contact person:
- Patricia Eustachio Colombo: Fostering sustainable dietary habits through optimzed school meals - OPTIMAT. Dissertation expected 2021.
- Mahnoush Malek: The Healthy School Start Plus study – Parental support to promote health behaviours and to prevent obesity in disadvantaged areas. Dissertation expected 2021.
- Marianna Moberg : Implementation of new work routines for prevention of child overweight and obesity within school health care – focus on the interaction between the school nurse and parents. Dissertation expected 2022.
Please see under relevant project above.
|Evidensbaserat folkhälsoarbete (Studentlitteratur)||Elinder LS, Kwak L (eds)|
|Food and nutrition. In: J. Mackenbach and M. McKee (eds). Successes and failures of health policy in Europe over four decades. Open University Press McGraw Hill - Education; 2013.||Elinder LS, Bollars C|
|”Sverige behöver nationell strategi för nutrition och fysisk aktivitet (Debattartikel i Läkartidningen)”||Elinder LS, Patterson E, Nyberg G, Säfsten E, Sundblom E|
|Hur kan vi jobba mer evidensbaserat med att främja hälsosamma matvanor i framtiden? Nordisk Nutrition nr 1, 2016.||Elinder LS|
|Insatser för att främja hälsosamma matvanor och fysisk aktivitet – en kartläggande översikt över systematiska kunskapsöversikter (Promotion of healthy dietary habits and physical activity – a review of systematic reviews and Nordic primary studies). Karolinska Institutet, 2017.
Bilaga 1 Bilaga 2 Bilaga 3
|Bergström H, Rahman S, Lynch C, Elinder LS|
|Global region of birth is an independent risk factor for type 2 diabetes in Stockholm, Sweden. European Journal of Public Health.||Elinder LS, Hakimi S, Lager A, Patterson E|