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.

Research areas

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.

Research projects

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:

  1. A health information brochure to parents
  2. Motivational Interviewing with the parents concerning their child
  3. Teacher-led classroom activities with the children with home assignments for the family
  4. A test of type 2 diabetes risk by parents with follow-up in primary health care, if needed

Outcomes:

  • Dietary habits
  • Physical activity, sedentary behaviour, body weight,height, and waist of children

Process evaluation:

Quantitative and qualitative methods are used to identify barriers and facilitators of implementation, fidelity, dose, reach, and acceptance of the programme components.

Study design

A cluster-randomised controlled trial with 17 schools and 352 families in disadvantaged areas in the Mälardalen region (mid-Sweden). 

Publications

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 L, Patterson E, Nyberg G, Norman
BMC Public Health 2018 Apr;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 , Nyberg G, Elinder L, Berlin A
Appetite 2018 Jun;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 , Sundblom E, Zeebari Z, Elinder L
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 , Bohman B, Nyberg G, Schäfer Elinder L
Health Educ Behav 2018 Feb;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 , 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 , Bohman B, Hagberg J, Elinder L
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 , Nyberg G, Elinder L, 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 L, 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 L, Norman , 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 L
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 , Berlin A, Sundblom E, Elinder L, 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 L, 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 L
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 L, Heinemans N, Hagberg J, Quetel A, 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 L
BMC Public Health 2011 Mar;11():185

Project contact person: 

Postdoc

Åsa Norman

Organizational unit: Social Medicin
E-mail: asa.norman@ki.se

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”.

Aim

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.

Web-based system

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.

Publications

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 L
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 A, Lilja K, Simma M, Olsson L, Elinder L
Public Health Nutr 2013 Jun;16(6):1028-36

Project contact person

Associated

Emma Patterson

Phone: +46-(0)8-123 371 85
Organizational unit: Social Medicin
E-mail: Emma.Patterson@ki.se

OPTIMAT Sweden

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.

Aim

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.

Ongoing studies

  • 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

Planned studies

  • 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

Publications

Fostering sustainable dietary habits through optimized school meals in Sweden – OPTIMAT.
Eustachio Colombo P, Elinder LS, Parlesak A, Lindroos AK, Patterson E. Public Health Panorama. 2017; 557-560.

Project contact person

Associated

Emma Patterson

Phone: +46-(0)8-123 371 85
Organizational unit: Social Medicin
E-mail: Emma.Patterson@ki.se

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.

Aim

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:

  1. 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?
  2. What characterises interventions that are effective regarding the content and the implementation?
  3. What are the age, sex, family structure, socioeconomic status, country of birth or geographic location moderators of intervention effects?

Review registration

Project contact person

Lecturer

Susanne Andermo

Phone: +46-(0)8-524 839 02
Organizational unit: Division of Nursing- Nursing 2
E-mail: Susanne.Andermo@ki.se

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.

Aim

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

The programme  includes four intervention components:

  1. Activity sessions
  2. Healthy meals
  3. Health information
  4. Parental support group sessions

Primary outcome:

  • Physical activity and sedentary time

Secondary outcomes:

  • Physical activity habits
  • Sedentary behaviour
  • Anthopometry
  • Metabolic risk factors
  • Quality of life

Process evaluation

Fidelity to the intervention, barriers and facilitators to continue being physically active and participate in local organisations after the intervention.

Ongoing studies

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:

  1. A controlled intervention study to evaluate physical activity, sedentary behaviour, cardiovascular risk, quality of life and a qualitative interview study examining psychosocial health
  2. Qualitative interview studies to examine facilitating factors for the participating families to continue being physically active after the intervention
  3. Health economic assessment of the programme

Project contact person

Research coordinator

Gisela Nyberg

Organizational unit: Social Medicin
E-mail: Gisela.Nyberg@ki.se

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

Research coordinator

Gisela Nyberg

Organizational unit: Social Medicin
E-mail: Gisela.Nyberg@ki.se

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.

Aim 

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 programme

The twelve-month programme includes three components:

  1. Appointment of a health ambassador among staff
  2. A study circle for staff - where they discuss health promotion work routines and practices
  3. A health course for the residents

Outcomes: 

  • 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

Process evaluation:
Interviews are conducted with managers and health ambassadors to assess barriers and facilitators of implementation, and fidelity to the program components is monitored. 

Implementation

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.

Publications

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.

Effect and Process Evaluation of a Structural Health Intervention in Community Residences for Adults with Intellectual Disabilities. 
Elinder LS, Sundblom E, Zeebari Z, Bergström H. Journal of Policy and Practice in Intellectual Disabilities. DOI:10.1111/jppi.12262

Understanding the Implementation Process of a Multi-Component Health Promotion Intervention for Adults with Intellectual Disabilities in Sweden.
Sundblom E, Bergström H, Ellinder L
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 L, 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 L
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 L
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 L, 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 L, Bergström H, Hagberg J, Wihlman U, Hagströmer M
BMC Public Health 2010 Dec;10():761

Project contact person

Adjunct professor

Liselotte Schäfer Elinder

Phone: +46-(0)72-526 69 91
Organizational unit: Social Medicin
E-mail: Liselotte.Schafer-Elinder@ki.se

Doctoral Students

  • 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 (from 1 of August, 2018): 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.

Scientific Publications

Please see under relevant project above.

Other Publications

Publication Author

 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

Group members

Susanne AndermoPostdoc

Susanne.Andermo@ki.se

08-524 839 02

Patricia Eustachio ColomboPhD student, Graduate Student

patricia.eustachio.colombo@ki.se

Karin KjellenbergResearch assistant

karin.kjellenberg@ki.se

Mahnoush MalekPhD student

mahnoush.malek@ki.se

Marianna MobergPhD student, Graduate Student

marianna.moberg@ki.se

Åsa NormanPostdoc

asa.norman@ki.se

Gisela NybergResearch coordinator

Gisela.Nyberg@ki.se

Emma PattersonAssociated

Emma.Patterson@ki.se

08-123 371 85

Liselotte Schäfer ElinderAdjunct professor

Liselotte.Schafer-Elinder@ki.se

072-526 69 91

Contact

Research group leader

Adjunct professor

Liselotte Schäfer Elinder

Phone: +46-(0)72-526 69 91
Organizational unit: Social Medicin
E-mail: Liselotte.Schafer-Elinder@ki.se

NutritionPhysical activityPublic HealthSocial MedicineSustainable development