Angela M. Craigie

Tracking of obesity-related behaviours from childhood to adulthood: A systematic review

Obesity in childhood carries a wide range of physical, psychological and social disbenefits and also increases the risk of adult obesity with its well-recognised, enhanced risk of several common complex diseases as well as adverse socioeconomic and psychosocial sequelae. Understanding the tracking of the two key modifiable behaviours, food consumption and physical activity, between childhood and adulthood may illuminate the childhood determinants of adult obesity and contribute to the development of effective interventions. We performed a systematic review of the available literature on tracking of both physical activity and of dietary intake between childhood and adulthood by searching MEDLINE, EMBASE, CINAHL, PSYCInfo, Google and Google Scholar. For inclusion, studies had to report baseline measurements when the children were less than, or equal to, 18 years and to report follow-up for at least 5 years to any age over 18 years. After removal of duplicates, 9625 search hits were screened by title and/or abstract and 79 potentially relevant papers were identified and full papers obtained. In total 39 papers were included in this analysis. Of these, 11 papers (from 5 studies) reported data on tracking of diet from childhood to adulthood and 28 papers (from 16 studies) reported data on tracking of physical activity or inactivity. Despite the diversity of study design and measurement methodology, we found evidence of tracking of both physical activity and of diet between childhood and adulthood with estimates of strength of tracking of a similar order for both behaviours. Because of the inherent methodological difficulties in quantifying habitual behaviour, it is likely that the reported estimates of strength of tracking under-estimate the true degree of tracking. The evidence of tracking reported here may give greater impetus to the development of interventions aimed to prevent the persistence of obesity from childhood into adulthood and its attendant adverse socioeconomic, psychosocial and health sequelae.

The impact of a bodyweight and physical activity intervention (BeWEL) initiated through a national colorectal cancer screening programme: randomised controlled trial

Objective To evaluate the impact of a diet and physical activity intervention (BeWEL) on weight change in people with a body mass index >25 weight (kg)/height (m)2 at increased risk of colorectal cancer and other obesity related comorbidities. Design Multicentre, parallel group, randomised controlled trial. Setting Four Scottish National Health Service health boards. Participants 329 overweight or obese adults (aged 50 to 74 years) who had undergone colonoscopy after a positive faecal occult blood test result, as part of the national bowel screening programme, and had a diagnosis of adenoma confirmed by histopathology. 163 were randomised to intervention and 166 to control. Intervention Participants were randomised to a control group (weight loss booklet only) or 12 month intervention group (three face to face visits with a lifestyle counsellor plus monthly 15 minute telephone calls). A goal of 7% reduction in body weight was set and participants received a personalised energy prescription (2508 kJ (600 kcal) below that required for weight maintenance) and bodyweight scales. Motivational interviewing techniques explored self assessed confidence, ambivalence, and personal values concerning weight. Behavioural strategies included goal setting, identifying intentions of implementation, self monitoring of body weight, and counsellor feedback about reported diet, physical activity, and weight change. Main outcome measures The primary outcome was weight change over 12 months. Secondary outcomes included changes in waist circumference, blood pressure, fasting cardiovascular biomarkers, and glucose metabolism variables, physical activity, diet, and alcohol consumption. Results At 12 months, data on the primary outcome were available for 148 (91%) participants in the intervention group and 157 (95%) in the control group. Mean weight loss was 3.50 kg (SD 4.91) (95% confidence interval 2.70 to 4.30) in the intervention group compared with 0.78 kg (SD 3.77) (0.19 to 1.38) in the control group. The group difference was 2.69 kg (95% confidence interval 1.70 to 3.67). Differences between groups were significant for waist circumference, body mass index, blood pressure, blood glucose level, diet, and physical activity. No reported adverse events were considered to be related to trial participation. Conclusions Significant weight loss can be achieved by a diet and physical activity intervention initiated within a national colorectal cancer screening programme, offering considerable potential for risk reduction of disease in older adults. Trial registration Current Controlled Trials ISRCTN53033856.

Lowering of oxidative stress improves endothelial function in healthy subjects with habitually low intake of fruit and vegetables: A randomized controlled trial of antioxidant- and polyphenol-rich blackcurrant juice

Inadequate intake of the recommended five-a-day fruit and vegetable portions might contribute to increased cardiovascular disease risk. We assessed the effects of dietary intake of a blackcurrant juice drink, rich in vitamin C and polyphenols, on oxidative stress and vascular function. This was a double-blind, placebo-controlled, parallel group study of 66 healthy adults who habitually consume <2 portions of fruit and vegetables per day. Participants were randomly allocated to consume 250ml of placebo (flavored water) or low or high blackcurrant juice drink four times a day for 6 weeks. Flow-mediated dilation (FMD) and plasma concentrations of F2-isoprostanes and vitamin C were measured. In the high blackcurrant juice drink group FMD increased significantly (5.8±3.1 to 6.9±3.1%, P=0.022) compared with the placebo group (6.0±2.2 to 5.1±2.4%). Plasma vitamin C concentration increased significantly in the low (38.6±17.6 to 49.4±21.0µmol/L, P<0.001) and high (34.6±20.4 to 73.8±23.3µmol/L, P<0.001) blackcurrant juice drink groups compared with the placebo group (38.1±21.0 to 29.0±17.6µmol/L). F2-isoprostane concentrations were significantly lower in the high blackcurrant juice drink group (225±64pg/ml) compared with the low blackcurrant juice drink (257±69pg/ml, P=0.002) and placebo group (254±59pg/ml, P=0.003). At follow-up, changes in plasma vitamin C correlated significantly with changes in FMD (r=0.308, P=0.044). Consumption of blackcurrant juice drink high in vitamin C and polyphenols can decrease oxidative stress and improve vascular health in individuals with habitually low dietary fruit and vegetable intake.

Tracking of Dietary Intake and Factors Associated with Dietary Change from Early Adolescence to Adulthood: The ASH30 Study

Objective: This paper describes the tracking of food intake from adolescence to adulthood according to location as an adult (at the time of the follow-up study) and gender. Additionally this paper explores factors associated with change in food intake. Method: Two 3-day food diaries, demographic and socio-economic information were collected in 1980 and 2000 from the same 198 participants (81 male, 117 female). Foods consumed were assigned to the five categories in The Balance of Good Health (BGH) food model. The tracking of food intake was assessed using Pearson correlation analyses. In 2000 two questionnaires were completed. Demographic and key attributional factors, derived from closed and open-ended responses to the questionnaire, were compared with measured change using regression analysis. Results: There was significant tracking of intake by food group from adolescence to adulthood according to location as an adult and gender. Eight combinations of descriptive variables and questionnaire factors were associated with change in intake of four of the five BGH food groups. Conclusion: Between adolescence and adulthood, dietary tracking is influenced by variables including gender and location. Attributions for change in food intake were associated with measured changes in food intake. In order to support healthier eating habits, it is important to be aware of factors contributing to changes in food intake, such as parental influences and perceived influences of time and work.

Raised adolescent body mass index predicts the development of adiposity and a central distribution of body fat in adulthood: a longitudinal study

Objective: To test the hypothesis that adolescent body mass index (BMI) tracks into adulthood and can be used as a predictor of obesity and/or central adiposity in adulthood. Method: A prospective cohort study following up 111 female and 84 male subjects who participated in dietary and anthropometric surveys when aged 12 years (in 1979–1981) and 33 years (in 2000–2001). At both time points, height and weight were measured and BMI calculated. At 33 years, waist circumference (WC) and hip circumference were also measured and waist-to-hip ratio (WHR) calculated. Results: In the male and female participants, BMI at 12 years was associated significantly with BMI at 33 years (R = 0.58 and 0.53, respectively, both p < 0.01) and WC at 33 years (R = 0.58 and 0.53, both p < 0.01). The probability of being an obese adult increased with rising adolescent BMI: normal weight male (BMI < 20.89 kg/m2) and female subjects (BMI < 21.20 kg/m2) at 12 years had a 20% and a 7% chance of being obese at 33 years, respectively; the probabilities for obese male (BMI ≥25.58kg/m2) and female subjects (BMI ≥26.05kg/m2) were 83 and 64%. The corresponding probability of becoming centrally obese (measured by WC) increased from 17 and 16% in male and female subjects of a normal weight to 58 and 59% in those being obese. Conclusions: Adolescent BMI is a good predictor of adult BMI and WC and the likelihood of becoming obese and/or centrally obese in adulthood.

Supporting postpartum weight loss in women living in deprived communities: design implications for a randomised control trial

Background/Objectives:Pregnancy is a life stage where excess weight gain may occur and the postpartum period is often characterised by weight retention. The aim of the current study was to evaluate the feasibility of undertaking a randomised controlled trial of a weight loss intervention (WeighWell) in postpartum women living in areas of social disadvantage.Subjects/Methods:The study aimed to recruit 60 women who were not pregnant, 6–18 months postpartum with a body mass index >25 kg/m2 living in areas of deprivation within Tayside, UK. Recruitment strategies focused on visits to community groups; writing directly to postpartum women living in areas of deprivation and primary care teams who covered the most deprived 15% of the population and advertising in community settings. The 12-week intervention used motivational interviewing techniques to promote an energy deficit diet and increased physical activity, delivered by three face-to-face consultations plus three structured telephone calls.Results:Of 142 women screened, 63 were eligible and 52 (83%) were recruited and randomised to an intervention (n=29) or comparison group (n=23). Over the 12-week intervention, body weight changed significantly by −1.6±2.0 kg in the intervention group compared with +0.2±2.2 kg in the comparison group, indicating the potential efficacy of the intervention. Loss to follow-up was 24% in the intervention group and 39% for the comparison group.Conclusions:The findings support the development of a definitive trial that embraces personalised recruitment strategies and the development of approaches to improve retention over a clinically relevant intervention period.

Study protocol for BeWEL: The impact of a BodyWEight and physicaL activity intervention on adults at risk of developing colorectal adenomas

BackgroundColorectal cancer (CRC) is the third most commonly diagnosed cancer and the second highest cause of cancer death in the UK. Most cases occur in people over 50 years and CRC often co-exists with other lifestyle related disorders including obesity, type 2 diabetes mellitus (T2DM) and cardiovascular disease (CVD). These diseases share risk factors related to the metabolic syndrome including large body size, abnormal lipids and markers of insulin resistance indicating common aetiological pathways.Methods/DesignThis 3 year study will be a two-arm, multicentre, randomised controlled trial comparing the BeWEL lifestyle (diet, physical activity and behaviour change) programme against usual care. The pre-trial development will take 6 months and participants will be recruited over a 12 month period and undertake the intervention and follow up for 12 months (total 24 months recruitment and intervention implementation) with a further 6 months for data collection, analysis and interpretation.Four hundred and fifty two participants who have had a colorectal adenoma detected and removed (through the national colorectal screening programme) will provide 80% power to detect a weight loss of 7% over 12 months.Primary outcomes are changes in body weight and waist circumference. Secondary outcomes will include cardiovascular risk factors, psycho-social measures and intervention costs.DiscussionThe results from this study will enhance the evidence base for lifestyle change in patients at higher risk of chronic disease including obesity related cancers.International Standard Randomised Controlled Trials No: ISRCTN53033856

Understanding the potential and challenges of adenoma treatment as a prevention opportunity: insights from the BeWEL formative study

Objectives To explore prevention opportunities presented by colorectal adenoma diagnosis and inform engagement strategies for the BeWEL study (body weight and physical activity lifestyle intervention for colorectal cancer screening participants who have undergone adenoma removal). Methods Qualitative study comprising 4 purposively sampled focus groups conducted in urban and rural areas in Tayside, Scotland, with different deprivation levels. Participants were men and women (n = 17) aged 50-74 with BMI > 25 kg/m2 with removal of adenoma detected by colorectal cancer screening. Results Adenoma diagnosis presents both opportunities and challenges for prevention. Some patients perceived adenoma as minor and not sufficiently motivating to act as a ‘teachable moment’. Patients had low awareness of the relationship between adenoma and lifestyle factors, and received little information on prevention during screening and treatment. Consequently they interpreted post-treatment ‘all clear’ messages as validation of existing lifestyles, and did not see the relevance of prevention advice. Receptiveness increased when the association between lifestyle, adenoma recurrence and other illness was explained. Conclusion The study illustrates the value of exploratory research into patient understanding to improve communications and health services. Without unduly worrying patients, professionals should explain how to reduce risk of adenoma, cancer and other diseases, particularly through diet, physical activity and weight reduction.

Meeting the challenges of recruitment to multicentre, community-based, lifestyle-change trials: a case study of the BeWEL trial

BackgroundRecruiting participants to multicentre, community-based trials is a challenge. This case study describes how this challenge was met for the BeWEL trial, which evaluated the impact of a diet and physical activity intervention on body weight in people who had had pre-cancerous bowel polyps.MethodsThe BeWEL trial was a community-based trial, involving centres linked to the Scottish National Health Service (NHS) colorectal cancer screening programme. BeWEL had a recruitment target of 316 and its primary recruitment route was the colonoscopy clinics of the Scottish Bowel Screening Programme.ResultsBeWEL exceeded its recruitment target but needed a 6-month no-cost extension from the funder to achieve this. The major causes of delay were lower consent rates (49% as opposed to 70% estimated from earlier work), the time taken for NHS research and development department approvals and the inclusion of two additional sites to increase recruitment, for which there were substantial bureaucratic delays. A range of specific interventions to increase recruitment, for example, telephone reminders and a shorter participant information leaflet, helped to increase the proportion of eligible individuals consenting and being randomized.ConclusionsRecruitment to multicentre trials is a challenge but can be successfully achieved with a committed team. In a UK context, NHS research and development approval can be a substantial source of delay. Investigators should be cautious when estimating consent rates. If consent rates are less than expected, qualitative analysis might be beneficial, to try and identify the reason. Finally, investigators should select trial sites on the basis of a formal assessment of a site’s past performance and the likelihood of success in the trial being planned.Trial registrationCurrent Controlled Trials ISRCTN53033856

Awareness of Lifestyle and Colorectal Cancer Risk: Findings from the BeWEL Study.

It is estimated that 47% of colorectal cancers (CRC) could be prevented by appropriate lifestyles. This study aimed to identify awareness of the causes of CRC in patients who had been diagnosed with a colorectal adenoma through the Scottish Bowel Screening Programme and subsequently enrolled in an intervention trial (using diet and physical activity education and behavioural change techniques) (BeWEL). At baseline and 12-month follow-up, participants answered an open-ended question on factors influencing CRC development. Of the 329 participants at baseline, 40 (12%) reported that they did not know any risk factors and 36 (11%) failed to identify specific factors related to diet and activity. From a potential knowledge score of 1 to 6, the mean score was 1.5 (SD 1.1, range 0 to 5) with no difference between intervention and control groups. At follow-up, the intervention group had a significantly greater knowledge score and better weight loss, diet, and physical activity measures than the control group. Awareness of relevant lifestyle factors for CRC remains low in people at increased risk of the disease. Opportunities within routine NHS screening to aid the capability (including knowledge of risk factors) of individuals to make behavioural changes to reduce CRC risk deserve exploration.