Catherine Hankey

The prevalence and determinants of obesity in adults with intellectual disabilities.

People with intellectual disabilities experience significant health inequalities compared with the general population, including a shorter life expectancy and high levels of unmet health needs. Another accepted measure of health inequalities, the prevalence of obesity, has been shown to be higher in adults with intellectual disabilities than in the general population. While the factors contributing to the increased prevalence among adults with intellectual disabilities are not well understood, the high rates of obesity among younger adults highlight the need for further research involving children and adolescents with intellectual disabilities. To take forward the priorities for research and the development of effective, accessible services, there is a need for collaboration between professionals working in the fields of intellectual disabilities and obesity.

Relationships between cigarette smoking, body size and body shape

OBJECTIVE:To define relationships between smoking status, body mass index (BMI), waist and hip circumferences (WC, HC) and waist to hip ratio (WHR).DESIGN:Further analysis of the cross-sectional Scottish Health Survey 1998 data.SUBJECTS:Nationally representative sample of 9047 adults aged 16–74 y.RESULTS:Body mass index (BMI) was lower in current smokers and higher in exsmokers (P<0.001) when compared with nonsmokers in the survey population as a whole. After adjustment for confounding factors (age, social class, physical activity and alcohol intake), these differences still remained. However, examination of age categories showed no such differences in BMI between current smokers and nonsmokers in men aged 16–24 y or women aged below 55 y. In the age category 16–24 y, prevalence of cigarette smoking was highest at 51% (men) and 43% (women) in obese subjects and lowest at 35% (men) and 33% (women) in people with BMI of 25–30 kg/m2. For women current smokers, mean WC and WHR were higher and HC was lower compared with nonsmokers (P<0.001). In men, only HC was lower in current smokers compared with nonsmokers for the entire sample (P<0.001).CONCLUSION:Cigarette smoking is associated with a lower BMI in adults over 24 y particularly in men, but not in younger people. In women, smoking is linked to the development of central adiposity. The gender-related central adiposity of men is not further increased by smoking, but a lower HC could suggest a reduction in muscle mass.

Dietary vitamin K influences intra-individual variability in anticoagulant response to warfarin

The relationship between dietary intake of vitamin K, fat, plasma vitamin K concentrations and anticoagulation response to warfarin within individuals, as well as the contribution of dietary vitamin K to differences in warfarin dose requirements between individuals were investigated in 53 patients on warfarin therapy who had stably controlled anticoagulation. Each patient completed a dietary record of all foods consumed on a daily basis for 4 weeks. Each week a blood sample was taken for measurement of the international normalized ratio (INR), plasma vitamin K, triglycerides and warfarin enantiomer concentrations. The patients’ genotype for CYP2C9 was also determined. Regression analysis of the data showed that, for each increase of 100 μg in the daily dietary intake of vitamin K averaged over 4 d, the INR was reduced by 0·2. There was no correlation between warfarin daily dose and average daily dietary vitamin K intake when calculated over 28 d. The regression model for warfarin dose showed that, while dietary vitamin K had no effect, CYP2C9 genotype (P = 2%) and age (P < 1%) significantly contributed to inter‐patient variability in warfarin dose requirements. A consistent intake of vitamin K could reduce intrapatient variability in anticoagulation response and thus improve the safety of warfarin therapy.

A review of weight loss interventions for adults with intellectual disabilities

Obesity is more prevalent in adults with intellectual disabilities than in the general population, and has been shown to contribute to their reduced life expectancy, and increased health needs. Relatively few studies have examined the effectiveness of weight loss interventions for adults with intellectual disabilities. However, there is evidence to support interventions that take account of the context of the lives of adults with intellectual disabilities, including carer involvement in interventions. To reduce the health inequalities experienced by adults with intellectual disabilities, there is a clear need to develop accessible, evidence‐based clinical weight management services.

Eating habits, beliefs, attitudes and knowledge among health professionals regarding the links between obesity, nutrition and health

OBJECTIVE To document knowledge, attitudes, beliefs and eating habits of health professionals with respect to obesity, nutrition and weight management. DESIGN A self-complete questionnaire postal survey. SETTING Primary care and dietetic practice in Scotland. SUBJECTS A systematic stratified sample of 2290 subjects incorporated general practitioners (n=1400), practice nurses (n=613) and all practising dietitians (n=360) who were members of the British Dietetic Association. RESULTS The overall response rate was 65%. All professionals showed a clear understanding of nutrition and health. Understanding of obesity as a disease and of the effectiveness of weight management using low-energy diets was limited. Below 10% had carried out audit to determine the incidence of obesity and overweight, and most were uncertain about their own effectiveness in delivering weight management advice. CONCLUSION This study confirms that health professionals have some knowledge of nutrition and weight management but are unclear how to deliver effective weight management advice. Further training is justified to ensure the effective provision of nutritional advice to patients.

Why lose weight? Reasons for seeking weight loss by overweight but otherwise healthy men.

Objective: To identify the reasons for seeking weight loss in overweight or obese but otherwise healthy men.Design: Interviews, prior to intervention, with subjects who had volunteered to participate in a work-site-based weight loss study.Subjects: Ninety-one overweight/obese male workers. Mean age 41, range 18–55 y, mean body mass index (BMI) 31.0, range 26.2–41.6 kg/m2.Measurements: Anthropometric measurements; body weight and height. Body mass index calculated. A short interview using open questions to determine the individuals reason for seeking weight loss.Results: The message that weight loss is beneficial to health for the overweight was recognized by all subjects regardless of BMI, and was reported as the main factor for attempting weight loss. Improved fitness and effects on appearance and well-being were reported half as often as the primary reason for weight loss.Conclusion: Overweight lay members of the public have accepted the health education message that weight loss can improve health. Overweight but otherwise healthy men who responded, of their own accord, to an electronic mail message offering help to lose weight did not regard obesity and overweight as primarily a cosmetic issue. This is still, however, important, especially to younger people.

Weight management: a comparison of existing dietary approaches in a work-site setting

OBJECTIVES: (1) To compare the effectiveness a 2512 kJ (600 kcal) daily energy deficit diet (ED) with a 6279 kJ (1500 kcal) generalized low-calorie diet (GLC) over a 24 week period (12 weeks weight loss plus 12 weeks weight maintenance). (2) To determine if the inclusion of lean red meat at least five times per week as part of a slimming diet is compatible with weight loss in comparison with a diet that excludes lean red meat.DESIGN: Randomized controlled trial.SETTING: Large petrochemical work-site.PARTICIPANTS: One-hundred and twenty-two men aged between 18 and 55 y.MAIN OUTCOME MEASURES: Weight loss and maintenance of weight loss.INTERVENTION: Eligible volunteers were randomized to one of the four diet/meat combinations (ED meat, ED no meat, GLC meat, GLC no meat). One-third of subjects in each diet/meat combination were randomized to an initial control period prior to receiving dietary advice. All subjects attended for review every 2 weeks during the weight loss period. For the 12 week structured weight maintenance phase, individualized energy prescriptions were re-calculated for the ED group as 1.4 (activity factor) × basal metabolic rate. Healthy eating advice was reviewed with subjects in the GLC group. All subjects were contacted by electronic mail at 2 week intervals and anthropometric and dietary information requested.RESULTS: No difference was evident between diet groups in mean weight loss at 12 weeks (4.3 (s.d. 3.4) kg ED group vs 5.0 (s.d. 3.5) kg GLC group, P=0.34). Mean weight loss was closer to the intended weight loss in the 2512 kJ (600 kcal) ED group. The dropout rate was also lower than the GLC group. The inclusion of lean red meat in the diet on at least five occasions per week did not impair weight loss. Mean weight gain following 12 weeks weight maintenance was +1.1 (s.d. 1.8) kg, P<0.0001. No differences were found between groups.CONCLUSIONS: This study has shown that the individualized 2512 kJ (600 kcal) ED approach was no more effective in terms of weight loss than the 6279 kJ (1500 kcal) GLC approach. However the ED approach might be considered preferable as compliance was better with this less demanding prescription. In terms of weight loss the elimination of red meat from the diet is unnecessary. The weight maintenance intervention was designed as a low-input approach, however weight regain was significant and weight maintenance strategies require further development.

The habitual meal and snacking patterns of university students in two countries and their use of vending machines

BACKGROUND Dietary patterns and food choices in western and northern European countries can differ from those in countries that surround the Mediterranean basin. However, irregular meal patterns and the consumption of high-energy snacks tend to become common in most countries and their association with the prevalence of obesity has been examined in many studies. The first aim of the present study was to describe the habitual meal and snack intakes, including the use of vending machines, for two groups of first-year university students in two countries of different cultural backgrounds. The second aim was to explore the relationships between body mass index (BMI) and snacking for these two groups. METHODS One hundred and sixty first-year undergraduate university students from two defined universities in Greece (n = 80) and Scotland (n = 80) volunteered to complete a food frequency questionnaire (FFQ). The FFQ comprised 16 questions assessing their meal and snacking habits. Self-assessed height and weight data were collected. RESULTS The majority of the 160 students reported a BMI in the healthy range (<25 kg m(-2)). Overall, 26% of the students reported never consuming breakfast. More Scottish students (74%) used vending machines (P < 0.05). More Scottish students consumed chocolate bars and crisps than Greek students (41% and 34% versus 37.5% and 20%, respectively). Only the choice of chocolate bars from vending machines and the consumption of crisps and low fat yogurts were related to BMI (P < 0.05) for both groups. CONCLUSIONS University students living in different countries report similar dietary patterns but differ in their snacking habits. No relationships were found between BMI and snacking. There is a need to carry out research to further our understanding of this relationship.

The associations between current recommendation for physical activity and cardiovascular risks associated with obesity

Objective:To examine associations between current recommended physical activity levels and body mass index (BMI) with some cardiovascular disease (CVD) risk factors (total cholesterol, high-density lipoprotein cholesterol (HDL-C), non-HDL-cholesterol (non-HDL-C), C-reactive protein (CRP), fibrinogen, and blood pressure), general health score (GHQ12) and predicted coronary heart disease (CHD) risk.Design:Further analysis of the cross-sectional Scottish Health Survey 1998 data.Subjects:Five thousand four hundred and sixty adults 16–74 years of age.Results:After controlling for some confounding factors, obesity was significantly associated with higher odds ratio (OR) for elevated cholesterol, CRP, systolic blood pressure, non-HDL-C and lower HDL-C (P<0.001), and with greater predicted CHD risk compared to BMI <25 kg/m2. Regular self-reported physical activity was associated with smaller OR of lower HDL-C and higher CRP, and average predicted 10-year CHD risk in obese subjects, but did not eliminate the higher risk of the measured CVD risk factors in this group. The OR of these two risk factors were still high 4.39 and 2.67, respectively, when compared with those who were inactive with BMI <25 kg/m2 (P<0.001). Those who reported being physically active had better GHQ scores in all BMI categories (P<0.001).Conclusion:Reporting achievement of recommended physical activity levels may reduce some CVD risk factors, predicted CHD risk and improve psychosocial health, but may not eliminate the extra risk imposed by overweight/obesity. Therefore, increasing physical activity and reducing body weight should be considered to tackle CVD risk factors.

Weight changes in young adults: a mixed-methods study

Objective:In both the United States and United Kingdom, countries with high prevalence of obesity, weight gain is particularly rapid in young adulthood and especially identified among first-year students.Design:A triangulation protocol was used, incorporating quantitative and qualitative research methods. A 27-question online survey was sent to all first-year undergraduates twice, with a 9-month interval. An online focus group was conducted at the end of the year, analysed by content and thematically. Self-reported weights and heights were validated against objectively measured data.Results:From a total of 3010 first-year students, 1440 (female=734) responded at baseline mean (s.d.) age 20 (3.6) years, body mass index 22.3 (4.6) kg m−2, 17% smokers and 80% alcohol drinkers. At follow-up, 1275 students reported a mean weight change of 1.8 (s.d. 2.6) kg over the 9-month period. Self-reported data correlated strongly with measured weights (r=0.999, P<0.001) and heights (r=0.998, P<0.001). Predictors of weight gain were baseline weight (P<0.001). Dairy products consumption was associated with less weight gain (P<0.001). Fruit and vegetable consumption, and time spent on physical activity or sleeping were associated with neither weight gain nor weight loss. Focus group content analysis revealed weight gain as a major concern, reported by half the participants, and increased alcohol consumption was considered the most common lifestyle change behind weight gain. Thematic analysis identified three main themes as barriers to or facilitators of healthy lifestyles and weight; budget, peer influence and time management.Conclusions:Rapid weight gain is of concern to young adults. Students living away from home are at particular risk, owing to specific obesogenic behaviours. Consumption of fruit and vegetables, and physical activity, despite popular beliefs, were not associated with protection against weight gain.