Amanda Avery

A systematic review investigating interventions that can help reduce consumption of sugar-sweetened beverages in children leading to changes in body fatness

Background Both the prevalence of childhood obesity and the consumption of sugar-sweetened beverages (SSBs) have increased globally. The present review describes interventions that reduce the consumption of SSBs in children and determines whether this leads to subsequent changes in body fatness. Methods Three databases were searched from 2000 to August 2013. Only intervention control trials, ≥6 months in duration, which aimed to reduce the consumption of SSBs in >100 children aged 2–18 years, and reporting changes in body fatness, were included. The quality of selected papers was assessed. Results Eight studies met inclusion criteria. Six interventions achieved significant (P < 0.05) reductions in SSB intake, although this was not always sustained. In the two interventions providing replacement drinks, significant differences in body mass index (12- or 18-month follow-up) were reported (P = 0.001 and 0.045). The risk of being overweight/obesity was reduced (P < 0.05) in three of the five education programmes but in one programme only for girls who were overweight at baseline and in one programme only for pupils perceived to be at greater risk at baseline. In the one study that included both provision of water and education, the risk of being overweight was reduced by 31% (P = 0.04) in the intervention group. Conclusions The evidence suggests that school-based education programmes focusing on reducing SSB consumption, but including follow-up modules, offer opportunities for implementing effective, sustainable interventions. Peer support and changing the school environment (e.g. providing water or replacement drinks) to support educational programmes could improve their effectiveness. Home delivery of more suitable drinks has a big impact on reducing SSB consumption, with associated reductions in body weight.

Weight outcomes audit for 34,271 adults referred to a primary care/commercial weight management partnership scheme

Objective: This project audited rate and extent of weight loss in a primary care/commercial weight management organisation partnership scheme. Methods: 34,271 patients were referred to Slimming World for 12 weekly sessions. Data were analysed using individual weekly weight records. Results: Average (SD) BMI change was –1.5 kg/m2 (1.3), weight change –4.0 kg (3.7), percent weight change –4.0% (3.6), rate of weight change –0.3 kg/week, and number of sessions attended 8.9 (3.6) of 12. For patients attending at least 10 of 12 sessions (n = 19,907 or 58.1%), average (SD) BMI change was –2.0 kg/m2 (1.3), weight change –5.5 kg (3.8), percent weight change –5.5% (3.5), rate of weight change –0.4 kg/week, and average number of sessions attended was 11.5 (0.7) (p < 0.001, compared to all patients). Weight loss was greater in men (n = 3,651) than in women (n = 30,620) (p < 0.001). 35.8% of all patients enrolled and 54.7% in patients attending 10 or more sessions achieved at least 5% weight loss. Weight gain was prevented in 92.1% of all patients referred. Attendance explained 29.6% and percent weight lost in week 1 explained 18.4% of the variance in weight loss. Conclusions: Referral to a commercial organisation is a practical option for National Health Service (NHS) weight management strategies, which achieves clinically safe and effective weight loss.

Healthy weight management during pregnancy: what advice and information is being provided

BACKGROUND Being overweight or obese during pregnancy increases the risk of maternal morbidity and mortality attributed to pregnancy-related complications and also poses risks to the baby. The present study explores the information and advice given to pregnant women of different prepregnancy body mass index (BMI) classifications. METHODS Women with singleton pregnancies and members of the National Childbirth Trust were invited to take part in the study via either National Childbirth Trust antenatal classes or e-mail invitation. A questionnaire was developed to collect quantitative and qualitative data. The number of times that women from different BMI groups were weighed, whether weight gain, diet or exercise advice was received, as well as knowledge of weight gain recommendations was compared using Mann-Whitney U-tests and chi-squared tests. Qualitative data were analysed by thematic content analysis. RESULTS Sixty women took part in the study with complete data set available for 59 of them. The majority of participants (84.1%) were weighed at least once during pregnancy; overweight/obese women were weighed significantly more times than those who were underweight/normal weight (P = 0.014). Only 25.4% of women received weight gain advice; 64.3% received diet/exercise advice from a healthcare source. No significant difference was found with respect to whether advice was received or not when comparing BMI groups. Underweight/normal weight women tended to underestimate, whereas those who were overweight or obese overestimated weight gain recommendations. Themes derived from the qualitative data were: weight gain advice wanted, diet and exercise advice wanted, lack of advice and support, and anxiety. CONCLUSIONS Advice women receive antenatally on weight gain, diet and exercise is brief and generally not related to weight management. Clearer, more detailed and personalised advice is wanted, particularly on weight gain. A lack of advice and support from healthcare professionals leads women to seek information for themselves from potentially un-regulated sources, and also to feelings of anxiety in some cases.

Attendance and weight outcomes in 4754 adults referred over 6 months to a primary care/commercial weight management partnership scheme.

•  There is growing evidence of the effectiveness of commercial weight management programmes in the community. A recent randomized controlled trial has shown commercial providers to be more effective than NHS providers for weight management solutions in primary care. Some commercial weight management providers have established national slimming on referral schemes for weight management, which result on average in weight losses of 4–5% over a 12‐week referral period. A recent randomized controlled trial of a similar scheme over 12 months yielded similar weight loses. Another RCT comparing commercial providers over 6 months showed average weight losses of ∼6.6% across providers.

Influence of Slimming World’s lifestyle programme on diet, activity behaviour and health of participants and their families

BACKGROUND Understanding the impact of commercial weight management programmes on behaviour change is an area that requires greater evidence. The present study investigated the impact of a commercial weight management organisations diet and activity programmes on the lifestyles of those accessing the services and their families. METHODS This survey was based on self-reports from a group of people involved in their own weight control. A questionnaire consisting of multiple choice and open-ended questions regarding diet, activity patterns and health was distributed in a commercial slimming organisations magazine and was available on the website for a 4 week period. Two thousand eight hundred and twelve respondents were analysed, including the organisations members (53%) and nonmembers (47%). RESULTS Those following the dietary programme reported significant changes towards healthier food choices in line with current guidelines (P < 0.01). Over 80% reported an improvement in their own health and over 26% reported an improvement in their partners or familys health (P < 0.01). Respondents reported increasing physical activity after being made aware of the organisations activity programme (P < 0.001). Members were more likely to have become more active than nonmembers (P = 0.011). The longer respondents had been members, the more likely they were to report an increased participation in physical activity (P = 0.02). Half of those reporting increased activity indicated that their partner or whole family had also increased their activity levels. CONCLUSIONS The commercial slimming organisations programme appeared to be having a beneficial impact on the diet and activity behaviours of those accessing the service. Group members were more likely to make positive behaviour changes and health improvements tended to increase with the duration of membership. The improvements observed with respect to both diet and activity levels also reached the wider family network.

Behavioural and Motivational Factors Associated with Weight Loss and Maintenance in a Commercial Weight Management Programme

This survey examined self-reported behaviour changes associated with weight loss and maintenance in a group of 292 members of a commercial weight management organisation (CWMO). Mean (SD) joining weight was 89.0 (20.0) kg, duration of membership was 29.1 (16.2) months and time taken to reach their current weight was 16.3 (13.5) months. Mean (SD) weight change was -15.6 (11.4) kg and BMI change was -5.7 (4.0) kg/m 2 , (both p<0.001), which had been maintained for 11.7 (12.8) months. Primary factors reported by participants as important in achieving their weight loss included not going hungry by satisfying appetite with low energy density food eaten ad libitum, following a flexible diet, peer-group support and tools to cope with small lapses. Several reported eating/activity behaviours significantly correlated with weight loss maintenance (WLM). However in regression analysis, while most individual changes in eating behaviour and activity behaviour were significant predictors of weight change in this group, no variables explained more than a few percent of the variance, after adjusting for age, gender, height and starting weight. A range of eating and activity behaviours was associated with weight loss maintenance. It is important to offer consumers flexible solutions they can adapt to their individual lifestyle needs.

Antenatal weight management: women’s experiences, behaviours, and expectations of weighing in early pregnancy

The current emphasis on obstetric risk management helps to frame gestational weight gain as problematic and encourages intervention by healthcare professionals. However pregnant women have reported confusion, distrust, and negative effects associated with antenatal weight management interactions. The MAGIC study (MAnaging weiGht In pregnanCy) sought to examine womens self-reported experiences of usual-care antenatal weight management in early pregnancy and consider these alongside weight monitoring behaviours and future expectations. 193 women (18 yrs+) were recruited from routine antenatal clinics at the Nottingham University Hospital NHS Trust. Self-reported gestation was 10–27 weeks, with 41.5% (n = 80) between 12 and 14 and 43.0% (n = 83) between 20 and 22 weeks. At recruitment 50.3% of participants (n = 97) could be classified as overweight or obese. 69.4% of highest weight women (≥30 kg/m2) did not report receiving advice about weight, although they were significantly more likely compared to women with BMI < 30 kg/m2. The majority of women (regardless of BMI) did not express any barriers to being weighed and 40.8% reported weighing themselves at home. Women across the BMI categories expressed a desire for more engagement from healthcare professionals on the issue of bodyweight. Women are clearly not being served appropriately in the current situation which simultaneously problematizes and fails to offer constructive dialogue.

Service evaluation of weight outcomes as a function of initial BMI in 34,271 adults referred to a primary care/commercial weight management partnership scheme

BackgroundIt is not clear if behaviour change programmes are more or less effective for weight management in people with high BMIs than for those who are moderately overweight. An earlier service evaluation reported on the rate and extent of weight loss in a primary care/commercial weight management organisation partnership scheme, in 34,271 patients were referred by their health care professionals to a UK commercial weight management organisation, Slimming World for 12 weekly sessions. This project updated that service evaluation by examining weight loss outcomes as a function of initial BMI in the same 34,271 patients.FindingsPatients referred to the scheme (n = 34,271) were categorised by BMI groups <30 kg/m2, 30-34.9 kg/m2, 35-39.9 kg/m2 and to ≥ 40 kg/m2. Mean weight losses after 12 weekly sessions were 2.9, 3.6, 4.1, and 4.8 kg for each BMI category respectively. Regression analysis showed that after adjusting for age and gender, relative to the <30 kg/m2 group, absolute weight losses were 0.8, 1.4 and 2.4 kg more for the 30-34.9 kg/m2, 35-39.9 kg/m2 and to ≥ 40 kg/m2 groups, respectively (all p<0.001). Percent weight loss was similar in each BMI category: 3.7%, 4.0%, 4.0% and 3.9%, respectively (p<0.001).ConclusionsThis service evaluation demonstrates that 12 week referral to a commercial organisation is as effective for people with high BMIs as for those who are moderately overweight.

An initial evaluation of a family-based approach to weight management in adolescents attending a community weight management group

Background Family-based approaches are recommended for the prevention and management of childhood obesity. Given the large numbers of obese children, scalable practical solutions are required. The present study evaluated a family-based national programme that aimed to empower adolescents to adopt healthier lifestyles. Methods Group facilitators supporting more than six young members (11–15 years) participated in the study. A questionnaire was designed to determine the characteristics of the adult attending with the adolescent, any health professional recommendations given and the young member’s integration within traditional adult weight management groups. Data on measured height and weight [and calculated body mass index (BMI)], sex and attendance were collated from member’s records. Results Questionnaires were completed by 22 facilitators (15% response rate), representing data for 128 young members with complete weight data available for 106. All members had a joining BMI > 91st centile, with 68% >98th centile. The mean (SD) number of weeks attended was 12.5 (8.1), with 19% (20) having attended for more than 20 weeks with 62% still attending. A mean (SD) BMI Z-score change of 2.49 (0.72) to 2.27 (0.74) was achieved (P < 0.001). The relationship of the adult supporter to the young member was varied, with 62% either already members or joining alongside their daughter/son. Limited guidance was provided by health professionals before or during attendance. Facilitators were comfortable about the age mix within groups. Conclusions The community weight management organisation studied takes a family-based approach and successfully supports young members to manage their weight.

Weight, body mass index and behaviour change in a commercially run lifestyle programme for young people.

BACKGROUND   There are few practical, scalable, community-based solutions that provide ongoing support to combat the recent rapid rise in obesity in young people. A commercial weight management organisation (CWMO) has developed a tailored version of its programme for young people. The present study assessed the programmes impact on self-reported body weight, body mass index (BMI; kg m(-2) ) and health-related behaviour changes in participating young people. METHODS   Seventy-nine current young members completed a web-based questionnaire on age, height, weight and self-reported eating and activity behaviours for when they joined the programme and at the time of survey. Inclusion criteria were age 11-15 years old and membership for at least 1 month. Subjects completed the questionnaire online via the CWMO website. This was a retrospective observational study without a control group. All data were self-reported. RESULTS   Mean (SD) age was 13.4 (1.4) years and start weight was 78.5 (16.7) kg; 67% were >99th centile for BMI. Mean (SD) attendance was 23 (19) weeks; weight change was -5.0 (4.5) kg; BMI change was -2.5 (2.0) kg m(-2) ; and BMI Z-score change was -0.5 (0.4) (all P < 0.001). Height increased by 0.01 (0.03) m (P < 0.01); however, height Z-score remained unchanged. Regression analysis showed that BMI Z-score change was related to increased fruit and vegetable intake (P = 0.012), as well as a decrease in avoidance of moderate and intense activity (both P < 0.003). CONCLUSIONS   This programme for overweight and obese young people helped implement behaviour and lifestyle changes that were associated with significant reductions in self-reported weight and BMI Z-score, without compromising growth in height.