Lauren Williams

Preventing weight gain: a population cohort study of the nature and effectiveness of mid-age women's weight control practices

Objective:To examine womens weight control practices and their effectiveness in preventing weight gain.Design:Retrospective cohort study of weight control practices and 2-year weight change among mid-age women participating in the Australian Longitudinal Study on Womens Health (ALSWH).Subjects:11 589 Australian women (aged 47–52 years).Measurements:The prevalence and types of self-reported weight control practices used were assessed by a nine-item instrument. Two-year weight change was self-reported and adjusted for baseline body mass index (BMI) and other potential confounders.Results:Seventy-four per cent of the cohort (N=8556) reported actively trying to control their weight. Dietary modification was used more frequently than exercise. Two-thirds of the weight-controlling women used a combination of practices, the two most common being ‘decreased food quantity, cut down on fats/sugars and exercise’ (32%, baseline BMI 25.87(0.10)), and ‘decreased food quantity and cut down on fats/sugars without exercise’ (15.6%, baseline BMI 27.04(0.14)). Potentially health-damaging practices (smoking, laxatives, fasting) were relatively uncommon, at 7.9%. Only one combination of practices (decreased food quantity, cut down on fats/sugars, use of a commercial weight loss programme and exercise) prevented mean weight gain (−0.03 kg), whereas the mean (s.d.) weight of the cohort increased (+1.19(4.78)) over the 2-year period.Conclusions:The majority of mid-age women attempting weight control used practices consistent with public health messages. Despite their efforts, the group was mostly unsuccessful in preventing weight gain. Public health authorities and health practitioners may need to make more quantitative recommendations and emphasize the importance of balancing physical activity with dietary intake to achieve successful weight control for women at this life stage.

Weight gained in two years by a population of mid-aged women: how much is too much?

Objective:To establish the prevalence of weight change in mid-aged women over a 2-year period, and to assess the relationship between weight change and physical and mental well-being (SF36) in order to begin debate about the need for quantified standards of weight gain.Design:Prospective study of weight change and well-being over a 2-year period among mid-aged women participating in a large national survey.Subjects:Seven thousand two hundred and seventy women without surgical menopause aged between 45 and 50 years (termed mid-aged), enrolled in the Australian Longitudinal Study on Womens Health.Measurements:Weight change (self-reported weight at two time points) and physical and mental well-being (SF-36) explored using linear regression, while adjusting for potential confounders.Results:Only half the women maintained their weight within 2.25 kg, and one-third gained more than this amount in a 2-year period. While weight gain (⩾2.25 kg) was negatively associated with physical well-being, both weight loss and weight gain were associated with poorer mental well-being.Conclusion:This is the first prospective study using a large, population-based cohort to demonstrate that small changes in weight are associated with changes in well-being in mid-aged Australian women. It provides further evidence of the need for public health messages to specify the actual amount that constitutes weight gain, but further research is needed to establish these standards for the entire population.

The sexual division of dieting: women's voices

This article reports the findings of focus group research on Australian women who have engaged in dieting practices to lose weight. There have been few qualitative sociological studies on dieting, despite it being a common practice among western women. From the empirical data in this study three distinct themes emerged: women participate in the perpetuation and reinforcement of the thin ideal; women clearly trade-off health in the pursuit of dieting to lose weight; and the dominant discourse of the thin ideal is not only mediated in various ways, but is also contested by a reverse discourse of size acceptance. A sociology of food and the body enables the discourses in the area of dieting women to be deconstructed, offering an insight into the gendered context of food, which has implications for the sociology of health and illness.

Development and Pilot Testing of the Eating4two Mobile Phone App to Monitor Gestational Weight Gain

Background The number of pregnant women with a body mass index (BMI) of 30kg/m2 or more is increasing, which has important implications for antenatal care. Various resource-intensive interventions have attempted to assist women in managing their weight gain during pregnancy with limited success. A mobile phone app has been proposed as a convenient and cost-effective alternative to face-to-face interventions. Objective This paper describes the process of developing and pilot testing the Eating4Two app, which aims to provide women with a simple gestational weight gain (GWG) calculator, general dietary information, and the motivation to achieve a healthy weight gain during pregnancy. Methods The project involved the development of app components, including a graphing function that allows the user to record their weight throughout the pregnancy and to receive real-time feedback on weight gain progress and general information on antenatal nutrition. Stakeholder consultation was used to inform development. The app was pilot tested with 10 pregnant women using a mixed method approach via an online survey, 2 focus groups, and 1 individual interview. Results The Eating4Two app took 7 months to develop and evaluate. It involved several disciplines--including nutrition and dietetics, midwifery, public health, and information technology--at the University of Canberra. Participants found the Eating4Two app to be a motivational tool but would have liked scales or other markers on the graph that demonstrated exact weight gain. They also liked the nutrition information; however, many felt it should be formatted in a more user friendly way. Conclusions The Eating4Two app was viewed by participants in our study as an innovative support system to help motivate healthy behaviors during pregnancy and as a credible resource for accessing nutrition-focused information. The feedback provided by participants will assist with refining the current prototype for use in a clinical intervention trial.

Adolescent television viewing and unhealthy snack food consumption: the mediating role of home availability of unhealthy snack foods

OBJECTIVE To examine whether home availability of energy-dense snack foods mediates the association between television (TV) viewing and energy-dense snack consumption among adolescents. DESIGN Cross-sectional. SETTING Secondary schools in Victoria, Australia. SUBJECTS Adolescents (n 2984) from Years 7 and 9 of secondary school completed a web-based survey, between September 2004 and July 2005, assessing their energy-dense snack food consumption, school-day and weekend-day TV viewing and home availability of energy-dense snack foods. RESULTS School-day and weekend-day TV viewing were positively associated with energy-dense snack consumption among adolescent boys (β = 0·003, P < 0·001) and girls (β = 0·03, P < 0·001). Furthermore, TV viewing (school day and weekend day) were positively associated with home availability of energy-dense snack foods among adolescent boys and girls and home availability of energy-dense snack foods was positively associated with energy-dense snack food consumption among boys (β = 0·26, P < 0·001) and girls (β = 0·28, P < 0·001). Home availability partly mediated the association between TV viewing and energy-dense snack consumption. CONCLUSIONS The results of the present study suggest that TV viewing has a significant role to play in adolescent unhealthy eating behaviours. Future research should assess the efficacy of methods to reduce adolescent energy-dense snack food consumption by targeting parents to reduce home availability of energy-dense foods and by reducing TV viewing behaviours of adolescents.

Portrayal of the Slow Food movement in the Australian print media: Conviviality, localism and romanticism

The Slow Food movement promotes itself as supporting ethical modes of food production and consumption. This article reports on research that investigated the representations of the movement in the Australian print media, exploring the discourses relating to Slow Food and examining whether the media exposure is positively or negatively framed. A content and discourse analysis was undertaken of articles on Slow Food over a three-month period. The analysis aimed to provide a contextual basis for how Slow Food is perceived, the messages it conveys, and the activities it undertakes. Major themes arising from the data were ‘conviviality’ (social pleasures of sharing ‘good food’), ‘localism’ (social, health and environmental benefits of local produce), and ‘romanticism’ (of idyllic rural lifestyles as an antidote to the time-poverty of urban life). The findings shed light on the role played by the print media in reproducing and creating public understandings of the Slow Food movement.

The effect of social class on mid-age women's weight control practices and weight gain ☆

The prevalence of obesity and weight gain is higher in the working class, but we know little about class differences in practices used to control weight. This study examined associations between self-reported measures of social class (upper, middle, or working class), weight control practices, and weight among a cohort of 11,589 mid-aged women (aged 47-52) participating in the Australian Longitudinal Study on Womens Health (ALSWH). A multivariate model tested whether mean weight change over a two-year period differed by social class after adjusting for area of residence, age, education, baseline BMI, and smoking. Working-class women gained significantly more weight at 1.27 (0.07) kg (95% CI: 1.12-1.42) over 2 years, compared with middle/upper-class women at 1.01 (0.07) kg (95% CI: 0.88-1.15). They were significantly more likely to use potentially harmful weight control practices than middle/upper-class women (8.9%) (Chi-squared test=30.65, p<0.0001), and less likely to meet physical activity recommendations. The study provides longitudinal evidence from a nationally representative sample of women that social class is related to weight gain, and to certain weight control practices. The findings have implications for the development of weight gain prevention programs for socially disadvantaged groups.

The views and attitudes of health professionals providing antenatal care to women with a high BMI: a qualitative research study

BACKGROUND The prevalence of overweight and obesity is increasing amongst women of child bearing age. The objective of this study was to investigate the views and attitudes of providers of antenatal care for women who have a body mass index (BMI) of 30 kg/m(2) and over. METHODS A qualitative study using focus groups was undertaken within the department of obstetrics and gynaecology at a large teaching hospital in south-eastern Australia. Three focus group discussions were held. One with hospital midwives (n=10), one with continuity of care midwives (n=18) and one with obstetricians (n=5). Data were analysed using Interpretative Phenomenological Analysis (IPA). FINDINGS Six dominant themes emerged: (1) obesity puts the health of mothers, babies and health professionals at risk; (2) overweight and obesity has become the norm; (3) weighing women and advising about weight gain is out of fashion; (4) weight is a sensitive topic to discuss; (5) there are significant barriers to weight control in pregnancy; and (6) health professionals and women need to deal with maternal obesity. These themes are drawn together to form a model representing current health care issues for these women. CONCLUSION Health professionals, who have a high BMI, can find it difficult to discuss obesity during antenatal visits with obese women. Specialist dietary interventions and evidence based guidelines for working with child-bearing women is seen as a public health priority by health care professionals.

Can a relatively low-intensity intervention by health professionals prevent weight gain in mid-age women? 12-Month outcomes of the 40-Something randomised controlled trial

Background:Weight gain in perimenopausal women results in increased visceral adipose tissue, leading to metabolic syndrome and associated comorbidities. Despite a high prevalence of weight gain at this life stage, interventions to prevent menopausal obesity are lacking.Aim:To test the effectiveness of an intervention delivered by health professionals using a motivational interviewing (MI) counselling style in preventing weight gain in non-obese (body mass index (BMI) 18.5 and 29.9 kg m−2) women in late premenopause.Methods:In a randomised controlled trial, 54 women (mean (s.d.) age 47.3 (1.8) years; BMI 25.1 (2.4) kg m−2) who had menstruated within the preceding 3 months were randomly assigned to an MI intervention (n=28) (five health professional MI counselling sessions) or a self-directed intervention (SDI) (print materials only) (n=26). The primary outcome, body weight (kg) and secondary outcomes (blood lipids, glucose, body fat %, lean mass % and waist circumference) were measured at baseline and postintervention (12 months), and intention-to-treat analysis was conducted.Results:Forty women completed all measures and adhered to all protocols. The weight at 12 months for the MI group of 65.6 kg (95% CI: 64.5; 66.8) was significantly different (P=0.034) from the SDI group of 67.4 kg (95% CI: 66.2; 68.6). When stratified by baseline BMI category, the MI group lost significantly more weight (−2.6 kg; 95% CI: −3.9; −1.2) than the SDI group (−0.1 kg; 95% CI: −1.2; 1.0, P=0.002) for the healthy weight women. The overweight women lost weight regardless of the intervention group, with no between-group difference (−3.5 kg; 95% CI: −6.1, −1.0 and −2.3; 95% CI: −4.1, −0.5, P=0.467).Conclusion:This relatively low-intensity intervention, incorporating MI into health professional counselling, not only effectively prevented weight gain but also achieved significant weight loss and decreased diastolic blood pressure. Further refinements are required to optimise outcomes for overweight women.

Effectiveness of Dietetic Consultations in Primary Health Care: A Systematic Review of Randomized Controlled Trials

BACKGROUND A dietetic consultation is a structured process aimed at supporting individual patients to modify their dietary behaviors to improve health outcomes. The body of evidence on the effectiveness of nutrition care provided by dietitians in primary health care settings has not previously been synthesized. This information is important to inform the role of dietitians in primary health care service delivery. OBJECTIVE The aim of this systematic review was to evaluate the evidence of the effectiveness of individual consultations provided exclusively by dietitians in primary care to support adult patients to modify dietary intake and improve health outcomes. STUDY DESIGN ProQuest Family Health, Scopus, PubMed Central, Medline, the Cumulative Index to Nursing and Allied Health Literature, and Cochrane databases were searched for English language systematic reviews or randomized controlled trials published before October 2016. The key terms used identified the provision of nutrition care exclusively by a dietitian in a primary health care setting aimed at supporting adult patients to modify dietary behaviors and/or improve biomarkers of health. Interventions delivered to patients aged younger than 18 years, in hospital, via telephone only, in a group or lecture setting, or by a multidisciplinary team were excluded. The methodologic quality of each study was appraised using the Cochrane Risk of Bias tool and the body of evidence was assessed using the Academy of Nutrition and Dietetics Evidence Analysis Manual. MAIN OUTCOME MEASURES Outcomes included the effectiveness of dietetic interventions in terms of anthropometry, clinical indicators, and dietary intake. A statistically significant between-group difference was used to indicate intervention effectiveness (P<0.05). RESULTS Twenty-six randomized controlled studies met eligibility criteria, representing 5,500 adults receiving dietetic consultations in a primary care setting. Eighteen of 26 included studies showed statistically significant differences in dietary, anthropometric, or clinical indicators between intervention and comparator groups. When focusing specifically on each studys stated aim, significant improvements favoring the intervention compared with control were found for the following management areas: glycemic control (four out of four studies), dietary change (four out of four studies), anthropometry (four out of seven studies), cholesterol (two out of eight studies), triglycerides (one out of five), and blood pressure (zero out of three) studies. CONCLUSIONS Dietetic consultations for adults in primary care settings appear to be effective for improvement in diet quality, diabetes outcomes (including blood glucose and glycated haemoglobin values), and weight loss outcomes (eg, changes in weight and waist circumference) and to limit gestational weight gain (Grade II: Fair evidence). Research evaluated in this review does not provide consistent support for the effectiveness of direct dietetic counseling alone in achieving outcomes relating to plasma lipid levels and blood pressure (Grade III: Limited evidence). Therefore, to more effectively control these cardiovascular disease risk factors, future research might explore novel nutrition counseling approaches as well as dietitians functioning as part of multidisciplinary teams.