Laurel Edmunds

Systematic review of long-term lifestyle interventions to prevent weight gain and morbidity in adults

The aim of this article is to determine the effectiveness of long‐term lifestyle interventions for the prevention of weight gain and morbidity in adults. Prevention of weight gain is important in adults who are of normal weight, overweight and obese. A systematic review of controlled trials of lifestyle interventions in adults with a body mass index of less than 35u2003kgu2003m−2 with at least 2 years of follow‐up was carried out. Eleven of 39 comparisons produced significant improvement in weight between groups at 2 years or longer with mean difference weight change ranging from −0.5 to −11.5u2003kg. Effective interventions included a 600u2003kcal/day deficit diet deficit/low‐fat diet (with and without meal replacements), low‐calorie diet, Weight Watchers diet, low‐fat non‐reducing diet, diet with behaviour therapy, diet with exercise, diet with exercise and behaviour therapy. Adding meal replacements to a low‐fat diet (with and without exercise and behaviour therapy) produced significant improvement in weight. Head‐to‐head interventions failed to show significant effect on weight with the exception of a Mediterranean diet with behaviour therapy compared with low‐fat diet. Diet with exercise and/or behaviour therapy demonstrated significant reduction in hypertension and improvement in risk of metabolic syndrome and diabetes compared with no treatment control. Lifestyle interventions demonstrated significant improvement in weight, reduction in hypertension and reduction in risk of type 2 diabetes and the metabolic syndrome.

Evidence based paediatrics: evidence based management of childhood obesity

This is the second in a series of five articles nnThe parents of a 10 year old boy who is very overweight bring him to consult you. He is an only child. His mother is of normal weight but his father is a large man and is overweight. His fathers two brothers are obese. His parents report that the boys behaviour is deteriorating and that he is becoming isolated from his peers. His mother has tried various dieting strategies but these have not halted his increasing gain in weight. His parents are concerned that he will “end up like his two uncles.” The boy says he is unhappy about his size because he gets teased and has trouble making friends. His mother asks whether his health is at risk and how he can be helped.nn#### Summary pointsnnYoung obese children should maintain weight or gain weight slowly rather than lose weightnnInculcating healthy eating habits is better than restricting dietnnSustainable lifestyle activities should be encouragednnPsychosocial problems are important consequences of overweight or obesitynnBehavioural treatments should be individually designednnAll treatments must be acceptable to the familynnIn 1998 the World Health Organization designated obesity as a global epidemic.1 The epidemic, which includes adults and children, is a result of societal and environmental factors that promote weight gain, factors that health professionals cannot expect to change. Results of obesity treatment programmes at obesity clinics have been disappointing, although children do better than adults. Prevention is therefore essential to reduce the health burden of obesity on society. It is vital to treat and prevent obesity in childhood, as lifestyle behaviours that contribute to and sustain obesity in adults are less well established in children and may be more amenable to change. The evidence suggests that the family provides a suitable …

The association between diet and physical activity and subsequent excess weight gain and obesity assessed at 5 years of age or older: a systematic review of the epidemiological evidence

Background The geographical or natural conditions of a country affect the manner in which economic growth takes place. Overcoming natural impediments and making use of geographical and natural advantages is the duty of economic experts and researchers. In order to overcome geographical and natural hardships, investments above international norm are needed and, on the contrary, by the optimal use of natural and regional advantages of a given area, less investment is needed for economic growth. In spite of all defeats and victories, ups and downs, the inhabitants of this land have relatively always played a determining role in West Asia and have greatly influenced and being influenced by the neighboring events and nation. The Iranian territory is located inside the desert belt of the Northern Hemisphere and is geographically placed in a belt line, the same as the plains in North Africa, Tibet and Turkistan. The country of Iran is about 1648195 square kilometers. From the total 1648195 square kilometers of the Country nearly 509442 square kilometers are used in agriculture and the rest is uncultivable areas or covered by cities, villages, lakes and roads. From 31% cultivable land in Iran; the two Northern provinces on the Caspian Sea coasts with an area of 5.5% of the overall area of Iran form more than 20% of the cultivable lands. 11 Introduction nObesity arises from a complex interplay between genetic susceptibility and behaviour, primarily relating to dietary habits and physical activity (Foresight, 2007). Evidence for specific behavioural factors that promote or protect against excess weight gain have been usefully reviewed (Wareham, 2007); (Jebb, 2007), and is more limited in children compared with adults (Rennie et al., 2005). A number of behavioural risk factors have been postulated, including TV viewing, diets with a high energy density, and fast foods. Most evidence is derived from cross sectional studies which can frequently produce conflicting results. Prospective studies with accurate measure of diet and physical activity exposures, and outcomes in terms of body fatness, are deemed to provide the more robust evidence on which to base interventions to achieve long-term behavioural change and prevent excess weight gain. n nThe question to be answered by this comprehensive systematic review of the epidemiological evidence was ‘What is the association between food, food groups, nutrition and physical activity and subsequent excess weight gain and obesity in humans?’ Relevant exposures include patterns of diet; breastfeeding; food and drink; food preparation; dietary constituents; physical activity and inactivity; energy intake; energy density of diet; energy expenditure. Outcomes in adulthood and childhood have reported separately. Outcomes of interest included markers of weight gain; overweight; obesity; markers of body composition; markers of distribution of fat. n nThe results of this review will provide evidence of association, but not causes, of subsequent excess weight gain and obesity. There is a degree of uncertainty inherent in epidemiological evidence, given that it is impossible to determine if there are uncontrolled variables, including genetic variations. The well known association between relatively high non caloric sweetner usage and subsequent weight gain is a useful reminder that, whilst an evidence based approach is critical to the process of scientific enquiry, consideration of evidence from other types of studies (mechanistic studies, intervention studies) and understanding the context of the evidence reviewed is essential if we are to provide policy makers, industry, service providers and the public with sensible recommendations.

A systematic review and meta-analysis of randomized controlled trials of endovascular thrombectomy compared with best medical treatment for acute ischemic stroke.

Background Acute ischemic strokes involving occlusion of large vessels usually recanalize poorly following treatment with intravenous thrombolysis. Recent studies have shown higher recanalization and higher good outcome rates with endovascular therapy compared with best medical management alone. A systematic review and meta-analysis investigating the benefits of all randomized controlled trials of endovascular thrombectomy where at least 25% of patients were treated with a thrombectomy device for the treatment of acute ischemic stroke compared with best medical treatment have yet to be performed. Aim To perform a systematic review and a meta-analysis evaluating the effectiveness of endovascular thrombectomy compared with best medical care for treatment of acute ischemic stroke. Summary of review Our search identified 437 publications, from which eight studies (totaling 2423 patients) matched the inclusion criteria. Overall, endovascular thrombectomy was associated with improved functional outcomes (modified Rankin Scale 0–2) [odds ratio 1·56 (1·32–1·85), P < 0·00001]. There was a tendency toward decreased mortality [odds ratio 0·84 (0·67–1·05), P = 0·12], and symptomatic intracerebral hemorrhage was not increased [odds ratio 1·03 (0·71–1·49), P = 0·88] compared with best medical management alone. The odds ratio for a favorable functional outcome increased to 2·23 (1·77–2·81, P < 0·00001) when newer generation thrombectomy devices were used in greater than 50% of the cases in each trial. Conclusions There is clear evidence for improvement in functional independence with endovascular thrombectomy compared with standard medical care, suggesting that endovascular thrombectomy should be considered the standard effective treatment alongside thombolysis in eligible patients.

Why do women choose or reject careers in academic medicine? A narrative review of empirical evidence

Women are under-represented in academic medicine. We reviewed the empirical evidence focusing on the reasons for womens choice or rejection of careers in academic medicine. Using a systematic search, we identified 52 studies published between 1985, and 2015. More than half had methodological limitations and most were from North America. Eight main themes were explored in these studies. There was consistent evidence for four of these themes: women are interested in teaching more than in research; participation in research can encourage women into academic medicine; women lack adequate mentors and role models; and women experience gender discrimination and bias. The evidence was conflicting on four themes: women are less interested in research than men; women lose commitment to research as their education and training progress; women are deterred from academic careers by financial considerations; and women are deterred by concerns about work-life balance. Inconsistency of findings across studies suggests significant opportunities to overcome barriers by providing a more enabling environment. We identified substantial gaps in the scientific literature that could form the focus of future research, including shifting the focus from individuals career choices to the societal and organisational contexts and cultures within which those choices are made; extending the evidence base to include a wider range of countries and settings; and testing the efficacy of interventions.

A global call for action to include gender in research impact assessment

Global investment in biomedical research has grown significantly over the last decades, reaching approximately a quarter of a trillion US dollars in 2010. However, not all of this investment is distributed evenly by gender. It follows, arguably, that scarce research resources may not be optimally invested (by either not supporting the best science or by failing to investigate topics that benefit women and men equitably). Women across the world tend to be significantly underrepresented in research both as researchers and research participants, receive less research funding, and appear less frequently than men as authors on research publications. There is also some evidence that women are relatively disadvantaged as the beneficiaries of research, in terms of its health, societal and economic impacts. Historical gender biases may have created a path dependency that means that the research system and the impacts of research are biased towards male researchers and male beneficiaries, making it inherently difficult (though not impossible) to eliminate gender bias. In this commentary, we – a group of scholars and practitioners from Africa, America, Asia and Europe – argue that gender-sensitive research impact assessment could become a force for good in moving science policy and practice towards gender equity. Research impact assessment is the multidisciplinary field of scientific inquiry that examines the research process to maximise scientific, societal and economic returns on investment in research. It encompasses many theoretical and methodological approaches that can be used to investigate gender bias and recommend actions for change to maximise research impact. We offer a set of recommendations to research funders, research institutions and research evaluators who conduct impact assessment on how to include and strengthen analysis of gender equity in research impact assessment and issue a global call for action.

Advancing gender equality through the Athena SWAN Charter for Women in Science: An exploratory study of women's and men's perceptions

BackgroundWhile in the United Kingdom, Ireland, and Australia, higher education and research institutions are widely engaged with the Athena SWAN Charter for Women in Science to advance gender equality, empirical research on this process and its impact is rare. This study combined two data sets (free- text comments from a survey and qualitative interviews) to explore the range of experiences and perceptions of participation in Athena SWAN in medical science departments of a research-intensive university in Oxford, United Kingdom.MethodsThe study is based on the secondary analysis of data from two projects: 59 respondents to an anonymous online survey (42 women, 17 men) provided relevant free-text comments and, separately, 37 women participated in face-to-face narrative interviews. Free-text survey comments and narrative interviews were analysed thematically using constant comparison.ResultsBoth women and men said that participation in Athena SWAN had brought about important structural and cultural changes, including increased support for women’s careers, greater appreciation of caring responsibilities, and efforts to challenge discrimination and bias. Many said that these positive changes would not have happened without linkage of Athena SWAN to government research funding, while others thought there were unintended consequences. Concerns about the programme design and implementation included a perception that Athena SWAN has limited ability to address longstanding and entrenched power and pay imbalances, persisting lack of work-life balance in academic medicine, questions about the sustainability of positive changes, belief that achieving the award could become an end in itself, resentment about perceived positive discrimination, and perceptions that further structural and cultural changes were needed in the university and wider society.ConclusionsThe findings from this study suggest that Athena SWAN has a positive impact in advancing gender equality, but there may be limits to how much it can improve gender equality without wider institutional and societal changes. To address the fundamental causes of gender inequality would require cultural change and welfare state policies incentivising men to increase their participation in unpaid workxa0in the family, which is beyond the scope of higher education and research policy.

Markers of achievement for assessing and monitoring gender equity in translational research organisations: a rationale and study protocol

Introduction Translational research organisations (TROs) are a core component of the UKs expanding research base. Equity of career opportunity is key to ensuring a diverse and internationally competitive workforce. The UK now requires TROs to demonstrate how they are supporting gender equity. Yet, the evidence base for documenting such efforts is sparse. This study is designed to inform the acceleration of womens advancement and leadership in two of the UKs leading TROs—the National Institute for Health Research (NIHR) Biomedical Research Centres (BRCs) in Oxford and London—through the development, application and dissemination of a conceptual framework and measurement tool. Methods and analysis A cross-sectional retrospective evaluation. A conceptual framework with markers of achievement and corresponding candidate metrics has been specifically designed for this study based on an adapted balanced scorecard approach. It will be refined with an online stakeholder consultation and semistructured interviews to test the face validity and explore practices and mechanisms that influence gender equity in the given settings. Data will be collected via the relevant administrative databases. A comparison of two funding periods (2007–2012 and 2012–2017) will be carried out. Ethics and dissemination The University of Oxford Clinical Trials and Research Governance Team and the Research and Development Governance Team of Guys and St Thomas’ National Health Service (NHS) Foundation Trust reviewed the study and deemed it exempt from full ethics review. The results of the study will be used to inform prospective planning and monitoring within the participating NIHR BRCs with a view to accelerating womens advancement and leadership. Both the results of the study and its methodology will be further disseminated to academics and practitioners through the networks of collaborating TROs, relevant conferences and articles in peer-reviewed journals.

Experiences of those Taking Part in the BeeZee Bodies Family- Based Weight Management Intervention: A Qualitative Evaluation

The need for effective community, child weight management interventions continues. The BeeZee Bodies (BZB) family-based child weight management programme for 7-11-year-olds and 12-15–year-olds has been developed iteratively over five years, with quantitative and qualitative evaluations refining the programmes. The aim of this study was to present the experiences and opinions of those taking part in BZB programmes as part of a real world evaluation. Three focus groups, following a semi-structured protocol, were conducted with 20 participants (15 parents, 5 adolescents) 3 months post-intervention. Analyses were thematic, iterative and underpinned by Grounded Theory. Two themes emerged; (1) programme contents, (2) social interactions, with each sub-divided. Parents described increased appreciation of physical activity and dietary components, improvements in parenting and good relationships with personnel. A wide range of positive personal outcomes and changes within the family were perceived by parents and adolescents including: changes in physical activity take-up, eating habits, portion sizes, and an improved understanding of parenting an overweight child. The parenting skills element further enhanced the social cohesion fostered through attendance. There were opportunities to build new friendships for both parents and adolescents, and for parents to interact with their offspring in a different context, all of which supported behaviour change. The BZB programme was viewed by participants as successful and delivered by engaging personnel. Key strengths were social cohesion generated by including parenting sessions and inclusiveness of the physical activities on offer. BZB has been refined in response to qualitative evaluations and reviews and this process continues.

The importance of psycho-social effects in family-based interventions.

The search for effective community-based, child weight management interventions continues and guidelines recommend including a qualitative element in evaluations. The opinions and reflections presented here belong to those taking part in the BeeZee Bodies family-based weight-management programmes for 7–15xa0yr olds in 2010 and 2011. Six focus groups were conducted with 35 participants (24 parents and 11 adolescents) 3 months post intervention. Analyses were thematic and iterative. One of the main themes was social interactions and the role they play in establishing and sustaining behaviour change. Participants reported building new relationships between themselves and the children as being very important – they talked of ”bonding” and “gelling”. For some, these friendships facilitated continued involvement in social and physical activities post-intervention. Apart from the open, accepting and encouraging attitudes of the interventionists, this “bonding” was enhanced for children by the enjoyment of taking part in physical activities where they did not feel judged, unlike the school environment. Parents also found the physical activities significant, both personally and in seeing their children’s pleasure. Another key aspect was the social cohesion generated by the ‘parenting’ element of the intervention, which enabled parents to openly discuss individual challenges in a supportive environment. This also enabled some parents to engage less helpful partners and relatives in in the change process. Encouraging social interactions and building friendships authentically amongst parents and children, and facilitated parental reflection were key drivers for participation and sustaining newly established patterns of behaviour beyond the end of the intervention.