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Environmental: Healthy influences

Settings-based approaches: sports clubs

Last updated 20-04-2020

Settings-based interventions can create supportive environments for obesity prevention and management. Outlined below is the rationale for policy and practice changes to sports clubs, together with a summary of evidence on strategies shown to be effective and a discussion of some notable trials.

Key Evidence

01

More than 17 million Australians 15+ are engaged in organised sport or physical activity weekly

02

A successful weight loss program developed in Scotland targeted men who were professional football fans

The World Health Organization recommends strategies in community settings to tackle modifiable risk factors for chronic disease including poor diet and physical inactivity.1 Strategies may draw on existing infrastructure in settings such workplaces, healthcare settings, sports clubs and grocery stores to reach large numbers of people.

Sports clubs have the potential to reach large numbers of Australians, with more than 17 million Australians aged 15 years and over engaged in organised sport and physical activity at least weekly2 and many millions watching various professional sporting codes on television3 or attending matches in person.4 While sporting organisations provide an important and logical forum for supporting healthy diets and physical activity, there is a need for more published research to determine the effectiveness of policy interventions in this setting.5

Strategies that can be implemented through sports clubs include targeted physical activity and healthy eating programs, restrictions on marketing of unhealthy food, and availability and promotion of healthy food through food service retail outlets such as canteens. Outlined below are examples of a successful weight management program that targeted fans of professional sport; and changes in food service retail outlets in sport and recreation settings.

Football fans in training

A weight loss and management program targeted at men and delivered through professional football (soccer) clubs in Scotland resulted in sustained weight loss at 3.5 years and significant improvements in clinical, behavioural and psychological outcomes.6 As part of the ‘Football Fans in Training’ program, men aged 35 to 65 years were invited to join a 12-week weight management program delivered free of charge by community coaching staff at professional football clubs. Weekly sessions combined advice on healthy eating and behaviour change tips with a group physical activity session. The 12-week active phase was followed by a weight maintenance phase over the next nine months, including six email prompts from coaches and an invitation to a group reunion. Gender-sensitive features of the program included the football club setting, use of football insignia on program materials and style of delivery focused on participative and peer-supported learning.

A randomised controlled trial found the program to be effective at 12 months, with a mean difference in weight loss of 4.94 kilograms in favour of the intervention group. The intervention group also showed significant improvements in other outcomes including clinical (blood pressure and waist circumference), behavioural (physical activity, diet, alcohol) and psychological (self-esteem) outcomes.7 Follow-up research showed that at 3.5 years, men who had received the intervention sustained a mean weight loss of 2.9 kilograms from baseline and maintained improvements in clinical, behavioural and psychological outcomes.6 Considering the health benefits gained, the program was found to be highly cost-effective, both over 3.5 years and participants’ lifetime.

The success of the model has led to the expansion of the program, which as of 2018 had been delivered to 4500 men in 33 professional football clubs in Scotland6 and picked up by football clubs in England, the Netherlands, Norway and Portugal.8 In Germany, short-term results show that men in the intervention group lost an average 6.24 kilograms compared to men in the control group losing an average 0.5 kilograms after 12 weeks.9 The program has expanded to other sports, such as the Australian Football League (through the Fremantle Dockers and West Coast Eagles football clubs), rugby in New Zealand and ice hockey in Canada.10 A Scottish study has shown that the program demonstrated potential as a weight loss intervention for women.11

Changes in food service retail outlets in sport and recreation settings

In Australia, a multi-component intervention delivered over 2.5 winter seasons at community football clubs in New South Wales improved the availability and promotion of fruit and vegetables and non sugar-sweetened drinks at canteens subject to the intervention, compared to a control group.12 Research staff supported the clubs to implement various strategies as part of the intervention, including improved availability and promotion of healthier options, education for club members on the benefits of healthy eating, and harnessing support for the changes by club coaches and committee members. There was no evidence of reduced club income resulting from the introduction of healthy options.

An example of best practice guidelines healthy food and drink choices in community sports clubs

On availability, an initiative by YMCA Victoria to remove all sugar-sweetened beverages (SSBs) and increase healthier drink availability over a year at 16 aquatic and recreation centres reduced sales of the unhealthiest ‘red’ (limit intake) drinks.13 The initiative involved the complete removal of some types of ‘red’ SSBs (e.g. non-diet carbonated beverages) and reduced the availability of others (e.g. sports drinks), together with complementary strategies such as promotional posters and placing the healthier drinks at eye level. The initiative led to a substantial decrease in sales of ‘red’ drinks, while sales of the healthiest ‘green’ drinks did not change and sales of all drinks decreased.

On price, a study of YMCA Victoria aquatic and recreation centre managers found pricing interventions to promote healthy food and beverage choices could be feasible and acceptable to retailers, although contextual considerations were likely to be important.14 These included support from organisational leadership and staff, café facilities and/or availability of healthy food suppliers, profitability impacts and customer feedback.

References

1. World Health Organization (2014). Global status report on noncommunicable diseases. Available from: https://www.who.int/nmh/publications/
2. Australian Sports Commission. (2019). AusPlay survey results July 2018-June 2019 Retrieved 10/01/2019, from https://www.clearinghouseforsport.gov.au/
3. Roy Morgan. (2018). Media release - Olympics top TV sport ahead of AFL, Comm. Games & Cricket. Retrieved from http://www.roymorgan.com/findings/7508-top-sport-tv-viewing-december-2017-201803020101
4. Georgakis S. (2018). Why soccer is falling behind footy and rugby in Australia, The Conversation. Retrieved from https://theconversation.com/
5. Priest N, Armstrong R, Doyle J, Waters E (2008). Policy interventions implemented through sporting organisations for promoting healthy behaviour change. Cochrane Database of Systematic Reviews, Issue 3. Art. No.: CD004809.
6. Gray CM, Wyke S, et al. (2018). Long-term weight loss trajectories following participation in a randomised controlled trial of a weight management programme for men delivered through professional football clubs: a longitudinal cohort study and economic evaluation. The International Journal of Behavioral Nutrition and Physical Activity 15(1): 60-60.
7. Hunt K, Wyke S, et al. (2014). A gender-sensitised weight loss and healthy living programme for overweight and obese men delivered by Scottish Premier League football clubs (FFIT): a pragmatic randomised controlled trial. Lancet (London, England) 383(9924): 1211-21.
8. van Nassau F, van der Ploeg HP, et al. (2016). Study protocol of European Fans in Training (EuroFIT): a four-country randomised controlled trial of a lifestyle program for men delivered in elite football clubs. BMC Public Health 16(1): 598.
9. Pietsch B, Weisser B, et al. (2019). Short term effects of a weight loss and healthy lifestyle programme for overweight and obese men delivered by German football clubs. European Journal of Sport Science: 1-10.
10. Curtin University (2018). Media release - Footy fans the new recruits in WA-first project to tackle obesity. Available from: https://news.curtin.edu.au/
11. Bunn C, Donnachie C, et al. (2018). Can professional football clubs deliver a weight management programme for women: a feasibility study. BMC Public Health 18(1): 1330.
12. Wolfenden L, Kingsland M, et al. (2015). Improving availability, promotion and purchase of fruit and vegetable and non sugar-sweetened drink products at community sporting clubs: a randomised trial. International Journal of Behavioral Nutrition and Physical Activity 12(1): 35.
13. Boelsen-Robinson T, Orellana L, Backholer K, Kurzeme A, Jerebine A, Gilham B, Chung A and Peeters A (2020). Change in drink purchases in 16 Australian recreation centres following a sugar-sweetened beverage reduction initiative: an observational study. BMJ Open 10(3): e029492.
14. Huse O, Zorbas C, Jerebine A, Kurzeme A, Blake M, Ferguson M . . . Backholer K. (2019). Recreation centre managers’ perceptions of pricing interventions to promote healthy eating. Health Promotion International.