Matthew Fuller-Tyszkiewicz

Interventions designed to limit gestational weight gain: a systematic review of theory and meta-analysis of intervention components.

Limiting gestational weight gain (GWG) to recommended levels is important to optimize health outcomes for mother and baby. Surprisingly, a recent review revealed that theory‐based interventions to limit GWG were less effective than interventions that did not report a theory‐base; however, strict criteria were used to identify theory‐informed studies. We extended this review and others by systematically evaluating the theories of behaviour change informing GWG interventions using a generalized health psychology perspective, and meta‐analysing behaviour change techniques reported in the interventions. Interventions designed to limit GWG were searched for using health, nursing and psychology databases. Papers reporting an underpinning theory were identified and the CALO‐RE taxonomy was used to determine individual behaviour change techniques. Nineteen studies were identified for inclusion. Eight studies were informed by a behaviour change theory; six reported favourable effects on GWG. Overall, studies based on theory were as effective as non–theory‐based studies at limiting GWG. Furthermore, the provision of information, motivational interviewing, behavioural self‐monitoring and providing rewards contingent on successful behaviour appear to be key strategies when intervening in GWG. Combining these behaviour change techniques with dietary interventions may be most effective. Future research should focus on determining the exact combination of behaviour change techniques, or which underpinning theories, are most useful for limiting GWG.

Associations between obesogenic risk factors and depression among adolescents: a systematic review

Adolescence is a transitional life phase that is associated with heightened risk for two major health conditions – obesity and mental health problems. Given the established comorbidity of obesity and depression, one avenue that warrants further exploration is the association between obesogenic risk and obesity in the expression and maintenance of depressive symptoms. The aim of the current systematic review was to identify and evaluate the empirical literature reporting the relationships between obesogenic risk factors (physical activity, sedentary behaviour, diet and weight status) and depression in adolescents. A search of five databases for studies published over the last decade found 24 studies eligible for review. Relationships were found between lack of physical exercise, heightened sedentary behaviour, poor diet quality, obese or overweight and depression in adolescence. However, the finding that obesogenic risk factors are associated with poor adolescent mental health should be interpreted with caution as data typically come from non‐representative samples with less than optimal study design and methodology.

The associations between TV viewing, food intake, and BMI. A prospective analysis of data from the Longitudinal Study of Australian Children

OBJECTIVE Despite cross-sectional evidence of a link between TV viewing and BMI in early childhood, there has been limited longitudinal exploration of this relationship. The aim of the present study was to explore the potential bi-directionality of the relationship between TV viewing and child BMI. A secondary aim was to evaluate whether this relationship is mediated by dietary intake. STUDY DESIGN Parents of 9064 children (4724 recruited at birth, 4340 recruited at age 4) from the Longitudinal Study of Australian Children (LSAC) completed measures of their childs dietary intake and TV viewing habits at three equidistant time points, separated by 2years. Objective measures of height and weight were also obtained at each time point to calculate BMI. Cross-lagged panel analyses were conducted to evaluate potential bi-directional associations between TV viewing and child BMI, and to evaluate mediation effects of dietary intake for this relationship. RESULTS Our longitudinal findings suggest that the relationship between TV viewing and BMI is bi-directional: Individuals who watch TV are more likely to gain weight, and individuals who are heavier are also more likely to watch TV. Interestingly, dietary intake mediated the BMI-TV viewing relationship for the older children, but not for the birth cohort. CONCLUSIONS Present findings suggest that sedentary behaviours, particularly when coupled with unhealthy dietary habits, constitute a significant risk factor for excessive weight gain in early childhood. Interventions targeted at helping parents to develop healthy TV viewing and eating habits in their young children are clearly warranted.

Accounting for fluctuations in body dissatisfaction

The present study evaluated whether the strength of relationship between contextual cues (presence of company and mood) and state body dissatisfaction varied as a function of individual differences in key trait measures (body shame, body surveillance tendencies, internalization of appearance standards, and trait affect) which have been linked to trait body dissatisfaction. Fifty-five undergraduate women completed a questionnaire containing the trait-based measures and then carried a Personal Digital Assistant (PDA) for a 7-day period. The PDA prompted participants six times daily to self-report their current mood and state body dissatisfaction. Multi-level modeling revealed that individual differences in body shame predicted inter-individual variability in the strength of the relationships between presence of company and state body dissatisfaction, and positive mood and state body dissatisfaction. Trait positive affect also explained variance in the positive mood state-body dissatisfaction relationship. The implications of the findings for prevention of body image disturbances are discussed.

The role of psychosocial factors in exclusive breastfeeding to six months postpartum

OBJECTIVE to investigate the psychosocial variables associated with the ability to exclusively breastfeed to six months postpartum. Additionally, to evaluate a conceptual model of psychosocial correlates of exclusive breastfeeding duration. DESIGN online, retrospective questionnaire. SETTING the questionnaire was placed online and participants accessed it through social networking sites including groups relating to breastfeeding, motherhood and parenting. Participants were also able to share the link with their own networks. This online setting facilitated recruitment of a wide range of Australian and international participants. PARTICIPANTS 174 women aged 18 years and older who had given birth between six months to two years prior. Participants completed an online questionnaire, which asked them to report on three time points: pre-pregnancy, during pregnancy and during the first six months postpartum. Data were collected from June to December 2011. MEASUREMENTS psychometrically validated tools such as the breastfeeding Self-Efficacy Scale, Body Attitude Questionnaire, Depression Anxiety and Stress Scale, Fetal Health Locus of Control Scale, and the brief COPE scale were used to measure psychosocial variables. Additional scales were developed by the researchers and met scale reliability criteria. FINDINGS correlation analyses, t-tests and path analysis were used to statistically analyse the data. Results showed that women who exclusively breast fed to six months postpartum exhibited higher intention to exclusively breastfeed, breastfeeding self-efficacy, comfort breastfeeding in public, perceived physical strength and reported less perceived breastfeeding difficulties. Path analyses indicated that breastfeeding self-efficacy was a strong significant predictor of both exclusive breastfeeding intention and duration. Maternal attitude towards pregnancy (both during pregnancy and postpartum), psychological adjustment and early breastfeeding difficulties were also found to be significant predictors of exclusive breastfeeding intention and duration. KEY CONCLUSIONS psychosocial factors are likely to play a significant role in the maintenance of exclusive breastfeeding for six months post-birth. Future research should adopt a prospective study design to examine the influence of psychosocial factors systematically and rigorously. IMPLICATIONS FOR PRACTICE longitudinal, prospective studies are needed to further examine the role of psychosocial factors on exclusive breastfeeding outcomes. Interventions, which involve improving psychosocial factors such as breastfeeding self-efficacy, may improve exclusive breastfeeding outcomes.

Body dissatisfaction during pregnancy: a systematic review of cross-sectional and prospective correlates

This article systematically reviews the literature pertaining to correlates of body dissatisfaction during pregnancy. A total of 8 electronic databases were searched and 251 papers identified, 56 of which met inclusion criteria. Full text scrutiny of these papers reduced the final list of reviewed papers to 22. Results of the review highlight that psychological factors were associated with body dissatisfaction during pregnancy, and noted the surfeit of studies examining the relationship was between body dissatisfaction and depression. It is concluded that the prevention of heightened body dissatisfaction during the reproductive phase will only be effective when models of risk factors have been examined systematically and rigorously.

Physical Activity in Young Children: A Systematic Review of Parental Influences.

The primary aim of this review was to identify and evaluate the strength of associations of the key parental factors measured in studies examining early childhood physical activity (PA). A systematic review of the literature, using databases PsychINFO, Medline, Academic Search Complete, PSYCHinfo, and CINHAL, published between January 1986 and March 2011 was conducted; 20 papers were relevant for the current review. While 12 parenting variables were identified, only 5 of these had been investigated sufficiently to provide conclusive findings. There were inconsistencies in the findings involving the social learning variable parental enjoyment and variables involving parental behaviours such as maternal depression and self-efficacy, and rules for sedentary behaviour, and parental perceptions, which included perceived importance of PA, fear of safety, and perception of childs motor competence. Given these inconsistencies, a meta-analysis was conducted to determine whether the method of measuring PA (objective or subjective) influenced the strength of associations between the parental factors and young childrens PA. There was no difference in the strength of associations in the studies that used objective or subjective measurement (via parent self-report). Further investigation is needed to clarify and understand the specific parental influences and behaviours that are associated with PA in young children. In particular, longitudinal research is needed to better understand how parental influences and PA levels of children during the formative preschool and early elementary school years are associated.

Body satisfaction among adolescents in eight different countries

The current study examined body satisfaction and the value of body size among adolescents in Australia, Fiji, Malaysia, Tonga, Tongans in New Zealand, China, Chile and Greece. In total, 2489 adolescent females and 2152 males participated in the study. The results demonstrated that males were more satisfied with their body than females. Males generally had a lower BMI than females, except for males in China and Malaysia. Attitudes towards large bodies for males and females varied by cultural group. These results demonstrate the strong cultural similarities in body satisfaction, but the differences that occur in relation to a large body.

The meaning of body image experiences during the perinatal period: A systematic review of the qualitative literature.

Literature reporting body image disturbances across the perinatal period has produced inconsistent findings, owing to the complexity of body image experiences during pregnancy and the first year postpartum. Existing qualitative data might provide potential avenues to advance understanding of pregnancy-related body image experiences and guide future quantitative research. The present systematic review synthesised the findings of 10 qualitative studies exploring the body image experiences of women through the perinatal period, albeit the majority focused only on pregnancy. Themes emerging included malleability of body image ideals across pregnancy (including the shift from aesthetic to functional concerns about ones appearance), the salience of stomach and breasts for self-rated body satisfaction, and perceived pressure to limit weight gain across pregnancy in order to return quickly to pre-pregnancy figure following birth. These qualitative findings suggest greater complexity of body image experiences during perinatal period than can be captured by typically used self-report measures.

Body image during pregnancy: an evaluation of the suitability of the body attitudes questionnaire

BackgroundAvailable data suggest that body dissatisfaction is common during pregnancy and may even be a precursor to post-natal depression. However, in order to accurately identify at-risk women, it is essential to first establish that body image measures function appropriately in pregnant populations. Our study examines the suitability of the Body Attitudes Questionnaire (BAQ) for measuring body dissatisfaction among pregnant women by comparing the psychometric functioning of the BAQ: (1) across key phases of pregnancy, and (2) between pregnant and non-pregnant women.MethodsA total of 176 pregnant women from Melbourne, Victoria filled out a questionnaire battery containing demographic questions and the Body Attitudes Questionnaire at 16, 24, and 32 weeks during pregnancy. A comparison group of 148 non-pregnant women also completed the questionnaire battery at Time 1. Evaluations of the psychometric properties of the BAQ consisted of a series of measurement invariance tests conducted within a structural equation modelling framework.ResultsAlthough the internal consistency and factorial validity of the subscales of the BAQ were established across time and also in comparisons between pregnant and non-pregnant women, measurement invariance tests showed non-invariant item intercepts across pregnancy and also in comparison with the non-pregnant subgroup. Inspection of modification indices revealed a complex, non-uniform pattern of differences in item intercepts across groups.ConclusionsCollectively, our findings suggest that comparisons of body dissatisfaction between pregnant and non-pregnant women (at least based on the BAQ) are likely to be conflated by differential measurement biases that serve to undermine attempts to accurately assess level of body dissatisfaction. Researchers should be cautious in assessments of body dissatisfaction among pregnant women until a suitable measure has been established for use in this population. Given the fact that body dissatisfaction is often associated with maladaptive behaviours, such as unhealthy eating and extreme weight loss behaviours, and with ante-and post-natal depression, that have serious negative implications for women’s health and well-being, and potentially also for the unborn foetus during pregnancy, developing a suitable body image screening tool, specific to the perinatal period is clearly warranted.