Louisa J Ells

Trends in maternal obesity incidence rates, demographic predictors, and health inequalities in 36 821 women over a 15‐year period

Objective  The aim of this study was to identify trends in maternal obesity incidence over time and to identify those women most at risk and potential‐associated health inequalities.

Obesity and disability – a short review

The prevalence of both obesity and disability is increasing globally and there is now growing evidence to suggest that these two health priorities may be linked. This paper explores the evidence linking obesity to muscular‐skeletal conditions, mental health disorders and learning disabilities in both adult and child populations. The impact of obesity on the four most prevalent disabling conditions in the UK (arthritis, mental health disorders, learning disabilities and back ailments) has been examined through novel data analysis of the 2001 Health Survey for England and UK Back Exercise And Manipulation trial data. Together these analyses strongly suggest that whether the cause or result of disability, obesity is undeniably implicated, thus presenting a serious public health priority. Future research efforts are required to strengthen the evidence base examining obesity in back disorders, mental health and learning disabilities, in order to improve current clinical management.

eHealth interventions for the prevention and treatment of overweight and obesity in adults: a systematic review with meta-analysis

A systematic review of randomized controlled trials was conducted to evaluate the effectiveness of eHealth interventions for the prevention and treatment of overweight and obesity in adults. Eight databases were searched for studies published in English from 1995 to 17 September 2014. Eighty‐four studies were included, with 183 intervention arms, of which 76% (n = 139) included an eHealth component. Sixty‐one studies had the primary aim of weight loss, 10 weight loss maintenance, eight weight gain prevention, and five weight loss and maintenance. eHealth interventions were predominantly delivered using the Internet, but also email, text messages, monitoring devices, mobile applications, computer programs, podcasts and personal digital assistants. Forty percent (n = 55) of interventions used more than one type of technology, and 43.2% (n = 60) were delivered solely using eHealth technologies. Meta‐analyses demonstrated significantly greater weight loss (kg) in eHealth weight loss interventions compared with control (MD −2.70 [−3.33,−2.08], P < 0.001) or minimal interventions (MD −1.40 [−1.98,−0.82], P < 0.001), and in eHealth weight loss interventions with extra components or technologies (MD 1.46 [0.80, 2.13], P < 0.001) compared with standard eHealth programmes. The findings support the use of eHealth interventions as a treatment option for obesity, but there is insufficient evidence for the effectiveness of eHealth interventions for weight loss maintenance or weight gain prevention.

The development and evaluation of a novel computer program to assess previous-day dietary and physical activity behaviours in school children: The Synchronised Nutrition and Activity Program TM (SNAP TM )

Self-report recall questionnaires used to measure physical activity and dietary intake in children can be labour intensive and monotonous and tend to focus on either dietary intake or physical activity. The web-based software, Synchronised Nutrition and Activity Program TM (SNAP TM ), was developed to produce a novel, simple, quick and engaging method of assessing energy balance-related behaviours at a population level, combining principles from new and existing 24 h recall methodologies, set within a user-friendly interface. Dietary intake was measured using counts for twenty-one food groups and physical activity levels were measured in min of moderate to vigorous physical activity (MVPA). A combination of the mean difference between methods, type II regression and non-parametric limits of agreement techniques were used to examine the accuracy and precision of SNAP TM . Method comparison analyses demonstrated a good agreement for both dietary intake and physical activity behaviours. For dietary variables, accuracy of SNAP TM (mean difference) was within ^ 1 count for the majority of food groups. The proportion of the sample with between-method agreement within ^1 count ranged from 0·40 to 0·99. For min of MVPA, there was no substantial fixed or proportional bias, and a mean difference between methods (SNAP TM – accelerometry) of 29 min. SNAP TM provides a quick, accurate, low-burden, cost-effective and engaging method of assessing energy balance behaviours at a population level. Tools such as SNAP TM , which exploit the popularity, privacy and engagement of the computer interface, and linkages with other datasets, could make a substantial contribution to future public health monitoring and research.

Prevalence of severe childhood obesity in England: 2006–2013

Background International evidence shows that severe paediatric obesity results in an increased risk of ill health and may require specialised weight management strategies, yet there remains a lack of data on the extent of the problem. Objective To examine the prevalence of severe obesity in children aged 4–5 and 10–11 years, attending English schools between 2006/2007 and 2012/2013. Design A retrospective analysis of National Child Measurement Programme (NCMP) data. Setting Maintained schools in England. Participants All children aged 4–5 and 10–11 years included in the NCMP dataset. Main outcome measures Prevalence of severe childhood obesity, defined using the 99.6th centile of the British 1990 (UK90) growth reference for body mass index (BMI), analysed by sex, geography, ethnic group and deprivation. Results The key findings show that in 2012/2013, severe obesity (BMI ≥UK90 99.6th centile) was found in 1.9% of girls and 2.3% of boys aged 4–5 years, and 2.9% of girls and 3.9% of boys aged 10–11 years. Severe obesity prevalence varies geographically and is more prevalent in children from deprived areas, and among those from black ethnic groups. Conclusions The findings from this study should help to raise awareness of the prevalence of severe obesity and support the provision of adequate treatment and prevention services both to support children who are already severely obese and reduce the prevalence of extreme weight in the future.

Surveillance and monitoring.

Background: The UK Government has identified obesity as a priority area, as it is thought to present a serious public health problem. Although it is a highly complex multifactorial disease, it has been hypothesized that obesity, in particular morbid obesity, may decrease life by up to 9 years and significantly increase the risk of many other important diseases, e.g. diabetes, heart disease and some cancers. Furthermore, it has been estimated that if obesity continues to rise at the current rate, children could die earlier than their parents (1). A joint report from the Audit Commission, the Healthcare Commission and the National Audit Office estimated that the current cost of obesity to the National Health Service (NHS) in England stands at £1 billion, and that the cost to the UK economy is £2.3–2.6 billion in indirect costs. If this present trend continues, by 2010 the annual cost to the economy could be £3.6 billion a year (2). Obesity cannot be considered in isolation from other lifestyle factors, in particular, physical exercise. Strategies for reducing obesity must therefore consider both sides of the energy equation.

The Effectiveness of Sedentary Behaviour Interventions for Reducing Body Mass Index in Children and Adolescents: Systematic Review and Meta-analysis

Intervention studies have been undertaken to reduce sedentary behaviour (SB) and thereby potentially ameliorate unhealthy weight gain in children and adolescents. We synthesised evidence and quantified the effects of SB interventions (single or multiple components) on body mass index (BMI) or BMI z‐score in this population. Publications up to March 2015 were located through electronic searches. Inclusion criteria were interventions targeting SB in children that had a control group and objective measures of weight and height. Mean change in BMI or BMI z‐score from baseline to post‐intervention were quantified for intervention and control groups and meta‐analyzed using a random effects model. The pooled mean reduction in BMI and BMI z‐score was significant but very small (standardized mean difference = −0.060, 95% confidence interval: −0.098 to −0.022). However, the pooled estimate was substantially greater for an overweight or obese population (standardized mean difference = −0.255, 95% confidence interval: −0.400 to −0.109). Multicomponent interventions (SB and other behaviours) delivered to children from 5 to 12 years old in a non‐educational setting appear to favour BMI reduction. In summary, SB interventions are associated with very small improvement in BMI in mixed‐weight populations. However, SB interventions should be part of multicomponent interventions for treating obese children.

Displacing Sedentary Time: Association with Cardiovascular Disease Prevalence.

PURPOSE Isotemporal substitution analysis offers new insights for public health but has only recently been applied to sedentary behavior research. We aimed to quantify associations between the substitution of 10 min of sedentary behavior with 10 min of light physical activity (LPA) or moderate-to-vigorous physical activity (MVPA) and the prevalence of cardiovascular disease (CVD). Age was also explored as a potential effect modifier. METHODS We completed a secondary analysis of data from 1477 adults from the Health Survey for England (2008). Sedentary time, LPA, and MVPA were measured using accelerometry. We applied isotemporal models to quantify the relationship with CVD prevalence of replacing 10 min of sedentary time with equivalent amounts of LPA or MVPA. Prevalence risk ratios (RR) with 95% confidence intervals (CI) are presented, adjusted for covariates. The role of age as an effect modifier was explored via age-MVPA and age-LPA interactions. CVD was defined as per the International Classification of Diseases. RESULTS The prevalence of CVD was 24%. The RR was 0.97 (95% CI, 0.96-0.99) for LPA and 0.88 (0.81-0.96) for MVPA. Substitution of approximately 50 min of LPA would be required for an association equivalent to 10 min of MVPA. The beneficial association of MVPA was attenuated with age, with a decrease in the relative risk reduction of approximately 7% per decade. CONCLUSIONS Isotemporal substitution of sedentary time with LPA was associated with a trivial relative risk reduction for CVD, whereas the equivalent replacement with MVPA had a small beneficial relationship. With respect to CVD prevalence, MVPA might become decreasingly important in older individuals. Prospective studies are needed to investigate causality.

Exploring the evidence base for Tier 3 weight management interventions for adults: a systematic review

Specialist weight management services provide a treatment option for severe obesity. The objective of the study is to review the characteristics, impact and practice implications of specialist weight management services for adults in the UK. Systematic review: EMBASE, MEDLINE and PsycINFO were searched from January 2005 to March 2016 with supplementary searches. Adults with a body mass index of ≥40 kg m−2, or ≥35 kg m−2 with comorbidity or ≥30 kg m−2 with type 2 diabetes and any study of multicomponent interventions, in any UK or Ireland setting, delivered by a specialist multidisciplinary team are the inclusion criteria. Fourteen studies in a variety of settings were included: 1 randomized controlled trial, 3 controlled and 10 observational studies. Mean baseline body mass index and age ranged from 40 to 54 kg m−2 and from 40 to 58 years. The studies were heterogeneous making comparisons of service characteristics difficult. Multidisciplinary team composition and eligibility criteria varied; dropout rates were high (43–62%). Statistically significant reduction in mean body mass index over time ranged from −1.4 to −3.1 kg m−2 and mean weight changes ranged from −2.2 to −12.4 kg. Completers achieving at least 5% reduction of initial body weight ranged from 32 to 51%. There was evidence for improved outcomes in diabetics. Specialist weight management services can demonstrate clinically significant weight loss and have an important role in supporting adults to manage severe and often complex forms of obesity. This review highlights important variations in provision and strongly indicates the need for further research into effective approaches to support severely obese adults.

Parental response to a letter reporting child overweight measured as part of a routine national programme in England: results from interviews with parents

BackgroundRising rates of childhood obesity have become a pressing issue in public health, threatening both the mental and physical well-being of children. Attempts to address this problem are multifaceted, and in England include the National Child Measurement Programme (NCMP) which assesses weight status in English primary school children in reception class (aged 4–5) and in year 6 (aged 10–11), with results being sent out to parents. However the effectiveness and impact of this routine parental feedback has yet to be fully understood. This paper reports one component of a mixed methods study undertaken in North East England, examining the impact of the feedback letters on parents’ understanding and feelings about their child’s weight status and whether or not this seemed likely to lead to behaviour change.MethodsOne-to-one semi-structured interviews (n = 16) were conducted with a sample of parents/guardians after they had received their child’s weight results letter. Eight parents/guardians were sub-sampled from the group whose child had been indicated to be overweight or obese and eight were from the group whose child had been indicated to be of ideal weight status. Interviews were conducted until data saturation was reached for both groups.ResultsThe reactions of parents/guardians whose children were identified as being overweight followed a sequence of behaviours ranging from shock, disgust with the programme, through denial and self-blame to acceptance, worry and intention to seek help. On the other hand, the reaction of parents/guardians whose children were identified as being ideal weight ranged from relief, pleasure and happiness through affirmation and self-congratulation to ‘othering’.ConclusionsWhilst overweight and obesity is often portrayed as a medical condition, parents/guardians see it as deeply rooted in their social lives and not in health terms. Parents believe that the causes of overeating and lack of exercise relate closely to the obesogenic environment, particularly the complex social and cultural milieu and time pressures within which this sample of people live. Associating this problem in feedback letters with dangerous diseases like cancer, and advising parents to visit GPs to resolve child weight issues was perceived as inappropriate by the parents, and caused controversy and anger. Given the likelihood that the NCMP will continue as a monitoring device, it is evident that the management of the process needs to be reviewed, with particular attention being paid to the feedback process. Local health authorities will need to manage parental expectations and ensure linkage with appropriately commissioned remedial weight management interventions.