New conceptual frameworks and ideas that challenge our ways of thinking about problems and issues are important. Public health nutrition is a field of practice and research that has a strong focus on change and change processes. We identify and seek to understand nutrition problems, the determinants and strategy options available, and work towards changing the social, economic, environmental and personal factors that work against optimal nutrition. If only it was that easy. Effectively implementing change is one of our perennial challenges. In this issue, McLachlan and Garrett(Reference McLachlan and Garrett1) present a paper describing a descriptive framework of the orders of change and a change model (Theory U). It should be required reading, if not to change the way we consider and plan for change, then to help categorise and order our approach to change in practice.
Early intervention and upstream focus are consistent features of a preventive approach. This means that pregnancy, infancy and childhood are critical life-stages for public health nutrition intervention, monitoring and research. Hong et al.(Reference Hong, Park, Kim, Lee, Park, Ha, Kong and Park2) present results from a prospective cohort study of Koreans investigating the association of maternal micronutrient status (vitamins A, C and E, folate) and oxidative stress status in pregnancy with infant growth during the first year of life. Their analysis suggests the importance of preventing folate deficiency and supplementing vitamin C during pregnancy.
Kosti et al.(Reference Kosti, Panagiotakos, Zampelas, Mihas, Alevizos, Leonard, Tountas and Mariolis3) present findings from a cross-sectional study of cereal consumption among Greek schoolchildren and explore associations with obesity. Their analysis provides intelligence that may be applicable to further developing obesity prevention and management strategies and guidance.
Clark et al.(Reference Clark, Goyder, Bissell, Blank, Walters and Peters4) present a study that compares parents’ self-reported child-feeding behaviours in two socio-economically contrasting areas in the UK. Not surprisingly, child-feeding behaviours differed between areas within a single city and within a largely white population, reinforcing the evidence for the critical role of socio-economic and educational factors in child nutrition.
The importance of the food supply and other environmental determinants of nutritional status and food choice seems obvious. Research by Walker et al.(Reference Walker, Woods, Rickard and Wong5) in this issue quantifies what many Australian consumers have long experienced and what nutritionists have long lamented: that our food choice environment is biased towards a huge array of choice of products that fail to meet nutritional quality standards (read junk food!).
They suggest that the supply balance needs to be shifted in favour of ‘healthier’ snack foods and beverages by reformulation of many products by the food industry and their presentation in smaller, standardised, portion-size packaging. This somewhat optimistic suggestion brings me back to McLachlan and Garrett’s paper about nutrition change strategies. It is rarely enough to know what needs to change. Effectively achieving change such as that proposed by Walker and colleagues remains the core challenge for public health nutrition as a discipline.
