UKCO Abstracts
The abstract poster display will be available in the exhibition space in Conference Room 1 from 08:45 hours on Thursday until the end of the congress.
Displaying 51 - 75 of 115 abstractsZeynep Nas1, Moritz Herle2, Alice R. Kininmonth1, Andrea D. Smith3, Alison Fildes4 & Clare H. Llewellyn1
1 Department of Behavioural Science and Health, University College London, London, UK
2 Social, Genetic & Developmental Psychiatry Centre, Institute of Psychiatry, Psychology, and Neuroscience, King’s College London, London, UK
3 MRC Epidemiology Unit, University of Cambridge, Cambridge, UK
4 School of Psychology, University of Leeds, Leeds, UK
📌 Allocation: Poster (Board No. 59)
Behavioural Susceptibility Theory hypothesises that inherited variation in appetite plays a causal role in the development of obesity from early life. However, to date, there have been few twin studies of the heritability of appetite in childhood, and none examining the developmental trajectory of genetic and environmental influences on appetite over key developmental stages during the lifecourse. This study therefore examined genetic and environmental contributions to variation in appetite over ten years, from infancy to early adolescence. Participants were from Gemini, a population-based cohort of n=2402 pairs of British twins born in 2007, established to examine genetic and environmental influence on early growth. Parents reported on four core aspects of their children’s appetite (food responsiveness [FR], slowness in eating [SE], satiety responsiveness [SR] and enjoyment of food [EF]), measured using the Baby/Child Eating Behaviour Questionnaire at 8 months, 16 months, 5, 7 and 13 years of age. Longitudinal twin models quantified genetic and environmental influences on variation in each appetite trait at the 5 time-points. Individual differences in all appetite traits were under significant moderate-to-high genetic influence across all stages of development (FR: 41-61%; EF: 59-77%; SR: 46-77%; SE: 43-83%), with the lowest genetic influence observed during toddlerhood for FR, EF and SR. For these three traits there was also significant influence from environmental factors shared completely by twin pairs, at younger ages, which was was highest during toddlerhood (FR: 51%; 95%CI:45-46%; EF: 31%;24-37%; SR: 43%;37-49%), but diminished as children matured into early childhood, with no significant influence on EF or SR by early adolescence. Environmental factors influencing SE at all ages were solely those that were unique to each individual twin (i.e. not shared with their co-twin). This study contributes to a burgeoning research base implicating appetite as a neurobehavioural mediator of genetic susceptibility to obesity, with strong triangulation of evidence now spanning behavioural genetics and a range of other study designs. However, the environment also shapes appetite importantly during the early years; toddlerhood, in particular, appears to offer a key window of opportunity for interventions targeting FR, EF and SR.
Conflicts of interest: None
Funding: The Gemini study was originally funded by a grant from Cancer Research UK (C1418/A7974), and is currently supported by funding from MQ Mental Health Research (MQF17/4) and the Rosetrees Trust (M749). All sources of support had no involvement or restrictions regarding the current study.
Francis M Finucane (1,2,3), Kate Westgate (1), Stephen J Sharp (1), Simon J Griffin (1), Martin J O’Donnell (2,3), Cyrus Cooper (4), Nick J Wareham (1), Soren Brage (1).
(1) MRC Epidemiology Unit, University of Cambridge School of Clinical Medicine, Cambridge, CB20QQ, UK.
(2) Department of Medicine, College of Medicine, Nursing and Health Sciences, University of Galway, Ireland.
(3) Cúram, University of Galway, H91 W2TY, Ireland.
(4) MRC Lifecourse Epidemiology Unit, Southampton, SO16 6YD, UK.
📌 Allocation: Poster (Board No. 60)
We aimed to determine the influence of a supervised, structured exercise programme on physical activity in healthy older adults, within the Hertfordshire Physical Activity Trial (ISRCTN 60986572). The setting was a community-based gymnasium in the UK. Participants included 100 healthy older adults (44% female, age range 67 – 76 years, without prevalent diabetes, cardiovascular disease or poor mobility) born and still living in Hertfordshire, UK with 96% follow-up. Half were randomised to the control group and received no intervention while the other half were randomised to the exercise group and received 36 supervised, moderate intensity, one-hour sessions on a cycle ergometer over 12 weeks. The main outcome measures for this post-hoc analysis was physical activity energy expenditure (PAEE) and its underlying intensity distribution over seven days. This was measured before, during and immediately after the exercise intervention with individually calibrated combined heart rate and movement sensing. Midway through the 12-week intervention, neither overall PAEE nor its underlying activity intensity distribution were different between groups. However, on the three days of the week that the structured exercise programme was delivered (Monday, Wednesday, Friday), the exercise group had a 9.1 kJ/ kg/ day ([2.5, 15.7], p=0.007) increase in PAEE, a reduction in the proportion of time spent under 1.5 metabolic equivalents (METs) and an increase in time spent between 1.5 and 3 METs and above 3 METs, compared to the control group. In the week following the intervention, there was no difference in PAEE between the groups, but the exercise group spent more time between 1.5 and 3 METs, compared to controls. In conclusion, three one-hour bouts per week of structured aerobic exercise increased daily physical activity on the days they occurred, but did not change the overall level of physical activity across the whole week. Future studies should focus on optimising the frequency, duration and intensity of exercise to support active living in this population.
Conflicts of interest: None of the authors has any financial relationships with any organisations that might have an interest in the submitted work in the previous three years. There are no other relationships or activities that could appear to have influenced the submitted work.
Funding: This study was funded by the Medical Research Council. Prof. Finucane is funded by a Clinical Research Career Development Award (grant number N/A) from the Saolta University Healthcare Group in the Health Service Executive (The Irish National Health Service) and by a Science Foundation Ireland CURAM project grant (grant number 13/RC/2073-P2). The University of Cambridge has received salary support in respect of Prof Griffin from the NHS in the East of England through the Clinical Academic Reserve.
Amaal Abdullahi 1, Olivia Williams 1 2, Anjali Zalin 1,2
1. Obesity Service, Barts Health NHS Trust
2. Tier 3 and Tier 4, Bedfordshire Hospitals NHS Foundation Trust
📌 Allocation: Poster (Board No. 61)
Digital interventions to support obesity care hold promise but also need to integrate within care pathways to make an impact. Especially where engagement and accountability are key. The services described were successful in obtaining two grants from NHSx (now transformation) for the implementation of digital pathways within the clinical system. Here we describe two novel human roles -exercise practitioner and digital navigator created to support the integration of the digital workstream into the care pathway. The roles included:
1. Raising awareness to staff and patients as to the benefit of the digital interventions
2. Using a variety of strategies to support digital recruitment and retention
3. Maintaining an overview of the care pathway and spacing digital and physical appointments
3. Monitoring progress using real-time data and self-reported data on the dashboard
4. Contacting patients as needed to support and promote self-empowerment
5. Using platform's analytics dashboard to provide patients with targeted support and guidance
4. Ensure integration of digital and clinical data
5. Creation of monthly reports, allowing for the evaluation of the project, and ensuring continuous reflection and improvement.
Digital outcomes will be reported separately. It is our conclusion that these novel roles supported the implementation and success of these digital solutions. Also supporting self-efficacy and clinician confidence in the new interventions.
Conflicts of interest: None
Funding: NHSx
Ritwika Mallik 1, Anjali Zalin 2
1 Barts Health NHS Trust
📌 Allocation: Poster (Board No. 62)
Obesity is a major public health challenge which contributes directly and indirectly to co-morbid health conditions, health inequalities and premature death. Evidence indicates that managing these levels of obesity in the population requires a combination of effective public health measures, an informed and engaged patient and an effective, holistic care pathway. Obesity is linked with deprivation and East London boroughs report some of the highest rates of adult obesity in London. There are several weight management services as well as third-sector options but navigating between them and selecting the most appropriate can be challenging. It is observed that attrition rates are high when people are passively referred, and resources are not relevant to them. In response to this, Barts Obesity Service has developed this novel concept for a dynamic, patient support platform. The vision is to provide a personalised solution for weight management which recognises the complex drivers and heterogeneity of obesity. The tool aims to present a reputable and up to date repository of weight management resources to encourage self-management where appropriate. The platform can be downloaded as an app or desktop programme. The platform provides a mechanism for patients to profile their needs through a series of health-related questions, followed by a list of resources which are personalised to that patient based on their profile. Resources offered are localised depending on the patient’s home location and include a range of organisations from the third, business and public sectors who can support patients depending on their personal profile. The platform also offers risk information to patients to demonstrate the impact of their condition on future health. The aim of this bespoke resource app is to avoid inappropriate referrals and address huge waiting lists aggravated by the pandemic. The app is in the pilot phase and this project has been accepted for the Topol Digital Fellowship. If successful, this tool has the potential to facilitate integrated care and patient empowerment. It has the potential to be transformative for obesity care in the region.
Conflicts of interest: None
Funding: North East London Clinical Commissioning Group and Topol Digital Fellowship
Acknowledgments - Res Consortium
Francis M. Finucane (1, 2), Kate Westgate (1), Stephen Sharp (1), Ema De Lucia Rolfe (1), Alison Sleigh (3), Simon Griffin (1), Martin O’Donnell (2), Nick Wareham (1), Soren Brage (1).
(1) MRC Epidemiology Unit, University of Cambridge School of Clinical Medicine, Cambridge, CB20QQ, UK.
(2) CURAM, School of Medicine, University of Galway, University Road, Galway, Ireland.
(3) University of Cambridge Metabolic Research Laboratories, Wellcome Trust-MRC Institute of Metabolic Science, Cambridge, CB20QQ, UK.
📌 Allocation: Poster (Board No. 63)
Physical activity is an important determinant of health, but the relationship between physical activity energy expenditure (PAEE) and anthropometric and metabolic traits, and how changes in PAEE influence these traits over time, have not previously been described in healthy older adults. We conducted a post-hoc cohort analysis of participants in the Hertfordshire Physical Activity Trial (ISRCTN 60986572), in which 100 healthy older adults (aged 67 – 76 years) were randomised to a 12-week supervised, structured aerobic exercise programme or to a control group with no intervention. We examined baseline associations between physical activity energy expenditure (PAEE, measured with individually calibrated combined heart rate and movement sensing) and anthropometric and metabolic characteristics at baseline, and how changes in activity during the intervention were associated with changes in these characteristics at follow-up. Of 100 participants (44% female) without prevalent diabetes or cardiovascular disease recruited to the trial, 93 had PAEE measures available. There were strong and consistent cross-sectional associations between PAEE and several measures of adiposity, insulin sensitivity and cardiometabolic risk, even after adjusting for aerobic fitness, but changes in physical activity were associated with changes in only some of these outcomes at 12 weeks. These findings emphasise the importance of physical activity for improving metabolic health and reducing cardiovascular risk, even in healthy older adults and independent of their level of aerobic fitness. Anticipated anthropometric and metabolic changes associated with increases in physical activity may take longer than 12 weeks to become apparent.
Conflicts of interest: None of the authors has any financial relationships with any organisations that might have an interest in the submitted work in the previous three years. There are no other relationships or activities that could appear to have influenced the submitted work.
Funding: This study was funded by the Medical Research Council. Prof. Finucane is funded by a Clinical Research Career Development Award (grant number N/A) from the Saolta University Healthcare Group in the Health Service Executive (The Irish National Health Service) and by a Science Foundation Ireland CURAM project grant (grant number 13/RC/2073-P2). The University of Cambridge has received salary support in respect of Prof Griffin from the NHS in the East of England through the Clinical Academic Reserve.
Ritwika Mallik 1, Chris Chinn 2, Michele Sandelson 1, Anjali Zalin 1
1 Barts Health NHS Trust, London, UK
2 Bioscientifica
📌 Allocation: Poster (Board No. 64)
Weight stigma refers to the discriminatory acts and ideologies targeted towards individuals because of their weight and size. It can have devastating social, psychological, and physical effects on people living with obesity. Weight stigma experienced in healthcare settings can lead to avoidance of future care, reduced quality of care and worsening of health inequalities. The All-Party Parliamentary Group on Obesity reported that 88% of the participants have been, stigmatised, criticised or abused because of their obesity and more than a third stated that they had not accessed any lifestyle or prevention services. To understand more about the experiences of people living with obesity at our centre, we created an anonymous questionnaire which was optional for patients attending the obesity clinic at Barts Health NHS Trust. Out of the 19 participants, 74% were female, all felt that they had an issue with their current weight. All had intentionally tried to lose weight of which 63% managed to lose weight. At our centre, 68% felt empowered to lose weight, 58% had been treated empathetically, 63% had been treated respectfully, 53% had felt stigmatized, 58% felt judged, and 53% felt discriminated against. They reported feeling judged by family members, at work and even by healthcare professionals. They just want to be seen as another human and are often labelled as lazy, someone who overeats and does not exercise. The uptake of this voluntary survey was sub optimal and is assumed that obesity and weight stigma remain a delicate topic. All individuals including healthcare professionals need to better acknowledge the negative effects of weight stigma throughout an individual’s lifetime and empathise and support solutions. Increased understanding and awareness about the causes of obesity is of paramount importance. In response to the survey, we have started creating content to tackle misinformation including informative videos and interviews with people living with obesity. One of the videos provides a detailed qualitative patient testimonial about the effects of weight stigma. Weight stigma needs to be eradicated to help improve the care provided for people living with obesity.
Conflicts of interest: None
Funding: None
Lou Atkinson 1,2,3, Brendon Stubbs 1,4, Kristina Curtis 1,5
1 EXI, London, UK
2 Aston University, Birmingham, UK
3 University of Warwick, Coventry, UK
4 Kings College London, London, UK
5 University College London, London, UK
📌 Allocation: Poster (Board No. 65)
The benefits of physical activity (PA) for people living with obesity are shown to be significant, regardless of any associated weight loss, including improved cardiovascular health and mental health. However, there are significant barriers to PA behaviour change for people with obesity. These include multiple co-morbidities, pain, fatigue, low self-efficacy and weight stigma. Clinicians supporting patients with weight management will advise patients to increase PA, however few have the specific knowledge needed to create personalised PA plans, and clinical exercise specialists are a limited resource. Digital therapeutics have the potential to provide accessible, scalable PA behaviour change support for people with obesity. EXI is a clinically validated PA prescription app for patients with one or more long term health conditions, including obesity. The app uses the latest evidence and medical guidelines to create a personalised, achievable plan based on the individual’s unique health and activity data. If used as part of a clinical service, EXI also allows health care providers (HCPs) to track and support patients’ progress via a secure data portal. Retrospective analysis of routinely collected data from all EXI users was undertaken. Over 30,000 people have initiated a PA journey using EXI. 8200 users listed obesity as a health condition. 45% of these users were provided EXI as part of a NHS, public health or private health service, including Tier 3&4 obesity services. 91% also listed at least one other health condition. For users with wearable devices who recorded data at week 12, weekly activity minutes increased significantly compared to week one (t= -2.929, p<0.005). The mean increase was 51 minutes (30%). For users who self-reported weight at week 12, there was a significant decrease in weight compared to week one (t= 3.841, p<0.001). The mean decrease was 4.67kgs (4.2%). While there was much variance in the data, mean weekly prescription adherence ranged from 49-59% over 12 weeks. These findings indicate that EXI can support people with obesity to increase their PA and reduce their weight at significant levels, whether alone, or as part of a care pathway. Further development of EXI will seek to improve prescription adherence.
Conflicts of interest: All authors are either employees or contractors of EXI and receive salaries or payments for their work.
Funding: No external funding was received for this research.
Rebecca A. Jones 1*, Julia Mueller 1*, Rebecca Richards 1, Jennifer Woolston 1, Fiona Whittle 1, Andrew J. Hill 2, Carly A. Hughes 1,3, Michelle Chester 1, Carlotta Schwertel 1, Struan Tait 1, Patricia Eustachio Colombo 1, Robbie Duschinsky 4, Stephen J. Sharp 1, Clare E. Boothby 1, Jennifer Bostock 6, Penny Breeze 7, Alan Brennan 7, Francesco Fusco 4,5, Emma Lawlor 1, Stephen Morris 4, Simon J. Griffin 1,4, Amy L. Ahern 1
* Joint first authors
1 MRC Epidemiology Unit, University of Cambridge, Cambridge, UK
2 Division of Psychological and Social Medicine, School of Medicine, University of Leeds, Leeds, UK
3 Fakenham Medical Practice, Fakenham, UK
4 Primary Care Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
5 Broadstreet Health Economics & Outcomes Research, Vancouver, BC Canada
6 Patient and Public Involvement representative, Cambridge, UK
7 School of Health and Related Research, The University of Sheffield, Sheffield, UK
📌 Allocation: Poster (Board No. 66)
Behavioural weight management interventions are effective in reducing weight, however this is typically regained within 3-5 years. Interventions based on Acceptance and Commitment Therapy (ACT) show promise for better long term outcomes, but have yet demonstrated scalability and cost-effectiveness. Digital, guided self-help programmes delivered by non-specialists could reduce cost and increase reach, but the feasibility of delivering ACT-based content in this format is unclear.
In this pragmatic, two-arm feasibility study, we recruited 61 people who recently completed a behavioural weight management intervention and randomised (2:1 allocation) to SWiM or control group. The SWiM programme includes 14 sessions that used ACT-based treatment to support weight loss maintenance; the programme was delivered via web platform with telephone support from trained non-specialist coaches. The control group received a leaflet about weight loss maintenance. At 3- and 6-months (mid- and post-intervention), we conducted semi-structured interviews with intervention (n=18), control (n=10), and withdrawn (n=3) participants. We interviewed SWiM coaches (n=2); coaches also completed a report form after each participant call. We used thematic analysis, guided by the MRC framework for process evaluations, to identify what did and did not work and why.
From baseline to 6-months, SWiM participants lost -2.15 (SD=6.43) kg and control participants gained 2.17 (SD=6.60) kg. In interviews, intervention participants reported learning new and reinforcing existing skills and strategies which supported behavioural changes that may influence weight management. They found SWiM content useful and easy to understand, with the coaches identified as an important component. The web platform had good usability, but participants experienced problems accessing the content from mobile devices. Control participants shared that they engaged with other weight management interventions during the study. Participants withdrew from the intervention for individual-reasons (e.g., stress, commitments) and study-/intervention-reasons (e.g., disliking intervention content, measurement pack too lengthy). The coaches felt well prepared and found the training and ongoing support to be comprehensive; they suggested including more content on ACT and Motivational Interviewing.
The SWiM programme appears acceptable and demonstrated potential to improve weight loss maintenance. We are refining the intervention based on the findings and developing a protocol for a definitive trial of cost-effectiveness.
Conflicts of interest: AJH has consulted for Slimming World. CAH reports payment or honoraria from Ethicon, Novo Nordisk and International Medical Press for lectures, presentations, speakers bureaus, manuscript writing or educational events. JM is a Trustee for the Association of the Study of Obesity (unpaid role). ALA and SJG are chief investigators on two publicly funded trials where the intervention is provided by WW at no cost outside the submitted work. ALA is a member of the Scientific Advisory Board for WW.
Funding: This research was funded by the National Institute for Health Research (NIHR) under its Programme Grants for Applied Research Programme (Reference Number RP-PG-0216-20010).
Grace Shiplee 1, Sophie Edwards 2, Ranjana Babber 3, Paul Gately 4
Leeds Beckett University
MoreLife UK Ltd
📌 Allocation: Poster (Board No. 67)
Excess weight in pregnancy is an increasing public health concern, growing in line with the global obesity pandemic. Having a BMI of >30 significantly increases the likelihood of a miscarriage from a 1 in 5 chance to a 1 in 4. The prevalence of obesity during pregnancy also is associated with multiple adverse short- and long-term negative health outcomes for both mother and baby. Existing provision in the UK to support women to reduce and manage excess weight in pregnancy is very limited, even though the issue is a widely acknowledged concern within maternity services and Integrated Care Boards. This service evaluation looks at the outcomes of a T3 weight management service delivering a care pathway providing healthy lifestyle support to pregnant women in Greater Manchester. Evaluation is based on service referrals, patient engagement, participation retention and patient reported health outcomes.
Patients were referred to the service by a local midwife based on an inclusion criteria of being pregnant and living with a BMI >35. Eligible patients were triaged and offered the programme. The programme includes 6 flexible one-to-one sessions with a nutritionist with additional input of a multi-disciplinary team of clinicians including, dieticians and psychologists. Programme topics included mental health and wellbeing, balanced diet, physical activity and tackling myths as per NICE guidance.
Between 01.03.22 and 31.01.23, 77 referrals were made to the MoreLife service (31% of women referred were non-white); 47 (61%) women engaged with the antenatal service delivered through comprehensive sessions. 93% of women who started the study completed on average 4 sessions of the intervention, while 23% of participants attended 100% of the support available. All the participants reported a change to their diet which includes adherence to 5 A day, reducing sugar intake and 89% of participants reported improvements in self-reported health outcomes, such as management of gestational diabetes and hypertension. The programme outcomes demonstrate strong levels of engagement from women with the programme, resulting in changed behavior and improved health.
Conflicts of interest: All Authors work for MoreLife UK Ltd
Funding: Independent evaluation of an ICB funded service
Sarah Aldukair (1-2), Prof. Jayne Woodside (1), Prof. Khalid Almutairi (3), Dr. Laura McGowan (1)
(1) Centre for Public Health, School of Medicine, Dentistry and Biomedical Sciences, Queen’s University Belfast, Belfast, UK
(2) Department of Health Sciences, College of Health and Rehabilitation Sciences, Princess Nourah Bint Abdulrahman University, Riyadh, Saudi Arabia
(3) Department of Community Health, College of Applied Medical Sciences, King Saud University, Riyadh, Saudi Arabia
📌 Allocation: Poster (Board No. 70)
In the Kingdom of Saudi Arabia (KSA), adolescent health is suboptimal; findings from the KSA World Health Survey in 2019 indicated that, among those aged 15-29 years, 79% had insufficient physical activity and 30% were living with overweight or obesity. Regulations to improve physical activity and health for females were introduced in 2019. While schools are regarded as potential channels to improve public health, many fail to deliver obesity prevention strategies effectively. The aim of this study was to explore barriers to and enablers of implementing obesity prevention school-based interventions through conducting focus group discussions (FGDs) in the female school setting with different stakeholders. A total of n=9 qualitative FGDs were undertaken across three female public high schools in Riyadh with differing levels of economic deprivation; n=6 FGDs took place with students (aged 17) and n=3 FGDs were conducted with school stakeholders (principals and teachers). This abstract reports on the principals and teachers’ FGDs. A semi-structured topic guide was generated using the COM-B model exploring the capabilities, opportunities and motivations of teachers and principals regarding implementation of obesity prevention school-based interventions. A framework analysis was undertaken to explore barriers and enablers. FGDs were analyzed by examining COM-B constructs of capability, opportunity, and motivation. Factors relating to capability were consistent across different schools, with lack of trained staff as a prominent barrier; there was less consistency regarding enablers. Factors relating to opportunity were consistent across different schools; with the built school environment as a prominent barrier, and the newly introduced physical education curriculum as an enabler. The majority of stakeholders discussed the barriers to physical activity and healthy eating related to the opportunity of physical environment. Factors relating to motivation were also consistent across schools and were mainly around the importance of obesity prevention as an enabler, and lack of student motivation as a barrier. Principals and teachers in Saudi high schools across the socio-economic spectrum reported consistent barriers across the COM-B constructs. Enablers across opportunity and motivation constructs were also consistent. However, enablers in terms of capability were less consistent. These findings will help support school-based obesity prevention intervention development.
Conflicts of interest: None
Funding: The research is funded by Princess Nourah bint Abdulrahman University.
Julia Mueller1,*
Penny Breeze2, *
Simon J Griffin1,
Alan Brennan2
Andrew J Hill3
Stephen Morris1,
Carly A Hughes1,
Jenny Woolston1,
Emma Lachassseigne1,
Marie Stubbings1,
Stephen J Sharp1,
Fiona Whittle1,
Katharine Pidd2,
Rebecca A Jones1,
Robbie Duschinsky1,
Clare Boothby1,
Jennifer Bostock4,
Nazrul Islam5,
Amy L Ahern1
* Joint first authors
1 University of Cambridge, Cambridge, UK
2 University of Sheffield, Sheffield, UK
3 University of Leeds, Leeds, UK
4 Patient and Public Involvement representative, Cambridge, UK
5 University of Southampton, Southampton, UK
📌 Allocation: Poster (Board No. 71)
Background: People with type 2 diabetes (T2D) who lose weight could potentially reduce their use of medication and risk of cardiovascular disease, and can even achieve T2D remission. We aimed to evaluate the clinical and cost-effectiveness of a tailored diabetes education and behavioural weight management programme compared with standard care in helping people with overweight or obesity and a recent T2D diagnosis to lower their blood glucose, lose weight and improve cardiovascular risk.
Methods: In this pragmatic, randomised, single-blind, parallel two-group trial, adults (≥18 years) with overweight or obesity (BMI ≥25kg/m2) newly diagnosed with T2D (≤ 3 years) were randomised to a tailored diabetes education and behavioural weight management programme (DEW; delivered by WW) or to current standard care diabetes education (DE; the DESMOND programme). Participants completed assessments at 0, 6, and 12 months. The primary outcome was 12-month change from baseline in HbA1c. We also assessed bodyweight, other biochemical outcomes, behavioural measures (physical activity, food intake), and psychosocial measures (eating behaviour, quality of life). The intervention effect on change in outcomes was estimated from random intercepts linear regression models or logistic regression models. A microsimulation model estimated incremental lifetime costs and QALYs. Trial registration: ISRCTN18399564.
Results: 577 participants were randomised (DEW: 289, DE: 288); 398 (69%) completed 12-month follow-up. We found no evidence for an intervention effect on change in HbA1c from baseline to 12 months (adjusted difference: -1.08 [95% CI: -3.32, 1.15] mmol/mol, p=0.34) or 6 months (-1.88 [-4.19, 0.42] mmol/mol). We found intervention effects on weight at 6 (-1.97kg [-3.11, -0.83]) and 12 months (-1.46kg (-2.69, -0.23]). Participants in DEW had higher odds of achieving remission than participants in DE (6 months: OR=2.17 [1.03, 4.74]; 12 months: OR=2.71 [1.35, 5.72]). DEW is likely to be more cost-effective than usual care at a £20,000 cost-per-QALY threshold.
Conclusions: Including a commercial behavioural weight management programme combined with remote dietary counselling after diagnosis of T2D could help more patients with overweight/obesity to achieve weight loss and remission and be more cost-effective compared with current standard NHS care.
Conflicts of interest: ALA and SJG are the chief investigators on two publicly funded (MRC, NIHR) trials where the intervention is provided by WW (formerly Weight Watchers) at no cost outside the submitted work. ALA is a member of the Scientific Advisory Board for WW. AJH has consulted for Slimming World. CAH reports payment or honoraria from Ethicon, NovoNordisk and International Medical Press for lectures, presentations, speakers bureaus, manuscript writing or educational events. JM is a Trustee for the Association of the Study of Obesity (unpaid role). All other authors report no conflicts of interest.
Funding: This study is funded by the National Institute for Health Research (NIHR) Programme Grants for Applied Research Programme (Reference Number RP-PG- 0216-20010). The views expressed are those of the author(s) and not necessarily those of the NIHR or the Department of Health and Social Care. The tailored diabetes education and behavioural weight management programme (Live Well With Diabetes) is provided by WW (formerly Weight Watchers) free of charge for the purposes of this trial. ALA, SS and SJG are supported by the Medical Research Council (grant MC_UU_00006/6). The University of Cambridge has received salary support in respect of SJG from the NHS in the East of England through the Clinical Academic Reserve. This is an investigator-led trial.
R Puddick 1, R Carr 1, M Whitman 1, E Allen 2, G Wren 3
1 Second Nature, London, UK, 2 Victoria Surgery, Bury St Edmunds, UK, 3 University of Oxford, Oxford, UK
📌 Allocation: Poster (Board No. 72)
Second Nature offers a variety of digitally-delivered weight management programmes tailored to specific health needs, such as for people living with obesity or type 2 diabetes. This retrospective analysis aimed to examine the effectiveness of Second Nature for people living with obesity, or obesity and type 2 diabetes.
This retrospective analysis of real-world data included NHS-referred patients with a minimum BMI of 35 kg/m2. The 12-month Second Nature programme was divided into a 'Core' phase, to promote initial weight loss, and a 'Sustain' phase, to support participants to maintain long-term behavioural changes. A Multi-Disciplinary Team (MDT) comprising of Second Nature's dietitian or nutritionist health coaches, exercise specialists, and each participant's General Practitioner (GP) or nurse ensured safe and effective care for each participant. This approach enabled the continuous monitoring of clinical measures and adjustment of medications as needed. Weight readings recorded at any point after two years were analysed using a paired t-test, with the null hypothesis being a weight loss of 0%. The sensitivity of the results to missing data were assessed using Last Observation Carried Forward (LOCF), which assumed the last weight reading before the two-year mark was maintained, and Baseline Observation Carried Forward (BOCF), which assumed a 0% weight loss.
The analysis involved 1,194 NHS-referred participants with a mean age of 49.9 (SD 12.0) years, a mean baseline BMI of 46.3 kg/m2 (SD 31.6), and composed of 787 females (66%). Out of these, 281 participants (24%) recorded weight readings after two years, with a mean weight loss of 11.8% (SD 11.9; p <0.001). The LOCF analysis of 971 participants, showed a mean weight loss of 7.0% (SD 10.1; p <0.001). Whilst the BOCF analysis showed a mean weight loss of 2.8% (SD 7.3; p <0.001) across all 1,194 participants.
This analysis provides evidence to support the effectiveness of the Second Nature programme for people living with obesity. Participants who recorded weight readings after two years achieved clinically meaningful weight loss of 11.8%. These findings provide evidence that digitally delivered weight management interventions can effectively support participants with complex requirements when integrated with NHS weight management services.
Conflicts of interest: Robbie Puddick, Rosie Carr, and Michael Whitman are Second Nature employees.
Funding: Internal research conducted by Second Nature, no funding provided
Julia Dunn 1, Axel Haupt 1, Tamer Coskun 1, Zvonko Milicevic 1, Alun Lloyd Davies (Non-author Presenter) 2
1 Eli Lilly and Company, Indianapolis, IN, USA
2 Eli Lilly and Company, Basingstoke, UK
📌 Allocation: Poster (Board No. 73)
Tirzepatide (TZP), a GIP/GLP-1 receptor agonist delivered robust body weight (BW) loss in people with type 2 diabetes (T2D) and obesity in Phase 3 clinical trials. This randomized, double-blind, parallel study compared the effects of TZP 15mg, semaglutide 1mg (SEMA) and placebo on energy intake (assessed by an ad libitum lunch), appetite (visual analog scale) and body composition at baseline and at 28 weeks of treatment. At 28 weeks, reductions in BW from baseline were observed with TZP (-11.2 kg) and SEMA (-6.9 kg), and significantly differed between groups (-4.3 kg; p<0.001). Reductions in fat mass from baseline were also observed with TZP (-9.7 kg) and SEMA (-5.9 kg), and significantly differed between groups (-3.8 kg; p=0.002). Energy intake reductions from baseline observed with TZP (-348.4 kcal) and SEMA (-284.1 kcal) did not differ between groups (-64.3 kcal; p=0.187). TZP and SEMA reduced overall appetite assessment score but did not differ between groups. TZP achieved greater weight loss than SEMA, consistent with results of the larger Phase 3 trial. BW reduction was mostly driven by fat mass loss. Significant and clinically meaningful reductions in appetite and energy intake were observed with both TZP and SEMA. However, these effects could not completely explain the additional weight loss with TZP. As appetite and energy intake reduction were not significantly different between treatments, additional mechanisms might contribute to the weight loss with TZP.
Previously presented at Obesity Week 2022.
Conflicts of interest: JD, AX, TC, ZM are employees and shareholders of Eli Lilly and Company
Funding: Funded by Eli Lilly and Company
Louis J Aronne 1, Ania M Jastreboff 2, Carel W Le Roux 3, Raleigh Malik 4, Nadia Ahmad 4, Bing Liu 4, Mathijs C Bunck 4, Shuyu Zhang 4, Adam Stefanski 4, Sarah Vokes-Tilley (Non-author Presenter) 5
1 Comprehensive Weight Control Center, Weill Cornell Medicine, New York, New York, USA;
2 Section of Endocrinology and Metabolism, Department of Medicine, and the Section of Pediatric Endocrinology, Department of Pediatrics, Yale University School of Medicine, New Haven, Connecticut, USA;
3 Diabetes Complications Research Centre, Conway Institute, School of Medicine, University College Dublin, Dublin, Ireland;
4 Eli Lilly and Company, Indianapolis, Indiana, USA;
5 Eli Lilly and Company, Basingstoke, UK
📌 Allocation: Poster (Board No. 76)
This pre-specified analysis of SURMOUNT-1 trial evaluated the efficacy of tirzepatide (TZP) according to baseline severity of obesity. Adult participants, with obesity, or overweight (OW) with weight-related comorbidities (excluding diabetes), were randomised (1:1:1:1) to once-weekly TZP 5, 10, or 15mg, or placebo (PBO). Percent change from baseline in body weight (BW) and proportion of participants achieving ≥5% BW reduction at week 72 were assessed in participants with BMI ≥27–<30 (OW), ≥30–<35 (Class 1 obesity), ≥35–<40 (Class 2 obesity), and ≥40kg/m2 (Class 3 obesity). On treatment data prior to discontinuation of study drug were used for analysis. 2539 adults were randomised (female=68%, mean age=45 years, BW=104.8kg, BMI=38.0kg/m2). All TZP doses lowered BW vs PBO regardless of baseline BMI category (p<0.001). The estimated treatment difference (95%CI) of TZP 5, 10, and 15mg, respectively, vs PBO for the %BW change from baseline was: -13.6% (-18.0,-9.3), -15.2% (-19.6,-10.8), and -15.2% (-19.6,-10.7) in OW; -13.9% (-15.7,-12.2), -19.3% (-21.1,-17.5), and -18.6% (-20.4,-16.7) in Class 1 obesity; -13.3% (-15.3,-11.2), -20.0% (-22.0,-17.9), and -22.5% (-24.5,-20.4) in Class 2 obesity; and -13.4% (-15.5,-11.3), -18.2% (-20.2,-16.2), and -20.3% (-22.3,-18.3) in Class 3 obesity. The proportion of participants achieving ≥5% BW reduction in each BMI category, respectively, was greater (p<0.001) with TZP (92-100%, 90-98%, 90-98%, and 87-97%) vs PBO (30%, 28%, 25%, and 30%). In adults with obesity, each TZP dose led to significant BW reductions vs PBO irrespective of baseline BMI. The higher TZP doses (10 and 15mg) led to greater BW reductions.
Previously presented at Obesity Week 2022.
Conflicts of interest: CW Le Roux reports grants from Irish Research Council, Health Research Board, Science Foundation Ireland and Anabio, consulting fees from Novo Nordisk, Eli Lilly, Johnson & Johnson, Boerhinger Ingelheim and GI Dynamics, honoraria for lectures/speaker bureau for Novo Nordisk, Herbalife and Johnson & Johnson, travel support for attending meetings from Novo Nordisk, Herbalife and Johnson & Johnson. R Malik, N Ahmad, B Liu, MC Bunck, S Zhang and, and A Stefanski are employees and shareholders of Eli Lilly and Company.
Funding: Funded by Eli Lilly and Company
Hannah Bithell 1, Tamara Brown 2, Kenneth Clare 3, Rhiannon Day 2, Kathryn Denvir 1,3, Louisa Ells 2, Paul Gately 2, Halima Iqbal 4, Karina Kinsella 2, Jordan Marwood 2, Maryam Mirza 1, James Stubbs 5
1 Patient and Public Representative, UK
2 Leeds Beckett University, Leeds, UK
3 Obesity UK, Kent, UK
4 University of Bradford, Bradford, UK
5 University of Leeds, Leeds, UK
📌 Allocation: Poster (Board No. 77)
Obesity UK is the UK’s largest charity representing the voice of people living with obesity and runs bi-weekly support groups providing much needed peer-led support. However, lesbian, gay, bi, transgender (including non-binary), queer or associated identities (LGBTQ+), and diverse ethnic communities are underrepresented. LGBTQ+ people and South Asian Muslim women are more likely to live with obesity, but less likely engage with existing weight management services. Our primary aim is to improve equality, diversity, and inclusion, by providing support for, and enhancing the voice of, currently least heard and underserved communities at high risk of obesity and associated co-morbidities. This research is truly innovative: every aspect of this research has been or will be developed by people with lived experience of obesity. It is led by Obesity UK; with co-investigators who are patient and public representatives; and facilitated by researchers in the Obesity Institute alongside, University of Bradford, Leeds City Council, West Yorkshire Integrated Care Board, and local LGBTQ+ and South Asian communities across West Yorkshire. We will co-develop tailored peer-led support groups with these two communities and train community peers to facilitate. We will learn how to co-develop these support groups and evaluate whether the new groups are successful and achieve what they set out to do, according to co-produced core values and principles. We will learn how to create a sustainable model for developing other peer-led support groups tailored to the needs of other underserved communities across the UK and roll out using a co-developed implementation toolkit. Preparatory coproduction work with people with lived experience from both communities has already highlighted key learning points such as the need for a safe and supportive space free from stigma and using person first language in all support groups. The two diverse communities also have distinctive needs, women from the South Asian Muslim community prefer in-person support group meetings, and people from the LGBTQ+ community prefer online support groups. This co-produced research will underpin a substantive programme grant to develop a new wellbeing registry which will represent the needs of all people living with obesity and inform person-centred weight management care.
Conflicts of interest: None of the team members have any conflicts of interest to declare.
Funding: National Institute for Health and Care Research Programme Development Grant (NIHR205214) £143,688 January 2023-June 2024. Host Organisation: NHS West Yorkshire Integrated Care Board. Other collaborators include Leeds City Council and Mid Yorkshire Hospitals NHS Trust.
Sarah E Moore 1, Clare B Kelly 1, Julia McClelland 1, Laura McGowan 1, Dunla Gallagher 1, Rebecca J Beeken 2, Chris R Cardwell 1, Helen Croker 3, Kelly-Ann Eastwood 4, Caroline McGirr 1, Roisin O’Neill 1, Jayne V Woodside 1 and Michelle C McKinley 1
1 Centre for Public Health, School of Medicine, Dentistry and Biomedical Sciences, Queen’s University Belfast, Belfast, BT12 6BA; 2 Leeds Institute of Health Sciences, School of Medicine, University of Leeds, Leeds, LS2 9JT; 3 World Cancer Research Fund, London, N1 9FW; 4 St Michael’s Hospital, University Hospitals Bristol and Weston NHS Foundation Trust, Southwell Street, Bristol, BS2 8EG
📌 Allocation: Poster (Board No. 78)
There is limited weight management support available to pregnant women with overweight and obesity. Evidence-based gestational weight management interventions that are acceptable and feasible to deliver are needed. This abstract reports the acceptability of the ‘Healthy Habits in Pregnancy and Beyond (HHIPBe)’ behavioural intervention delivered to pregnant women (BMI between 25-38 kg/m2) during routine antenatal care at a maternity care site in the Republic of Ireland. HHIPBe was adapted from the ‘Ten Top Tips for a Healthy Weight (10TT)’ intervention and encouraged development of ten diet, physical activity and weight management habitual behaviours. The intervention was a brief (15-20 minute) 1:1 intervention session delivered by a midwife in early pregnancy and supported by a leaflet, logbook and app. Due to the COVID-19 pandemic, sessions were delivered remotely or in person where feasible. Acceptability was assessed through semi-structured online interviews with women postpartum and healthcare professionals involved in study oversight, recruitment and intervention delivery. Data were analysed thematically. Twenty-one women were recruited at this site over 4 months (Age: 33.67±4.44 years; BMI: 29.23±3.37 kg/m2); 12 received the intervention. Participant interviews (n=6) indicated that women found the brief 1:1 intervention session encouraging and non-judgemental, the tips achievable and materials useful. A sensitivity surrounding weight being discussed was apparent, however, it was also clear that women found the intervention very acceptable. Several women discussed the value of the intervention in terms of positive changes to diet, activity, weight management and wider family impacts. Some women would have valued the intervention earlier in pregnancy to start forming habits and managing their weight gain sooner. Healthcare professional interviews (n=4) indicated that delivery of the brief 1:1 intervention was straightforward and that the bespoke training provided by the research team was helpful. The main barrier identified to integrating the intervention within existing care was staff availability to deliver it. This brief habit-based behavioural intervention to facilitate healthy eating and physical activity and aid appropriate gestational weight management was acceptable to pregnant women with overweight and obesity, has potential to be integrated into routine antenatal care and warrants further investigation in a full trial.
Conflicts of interest: None.
Funding: This research was funded by CHITIN (CHI/5434/2018). CHITIN has received €10.6m (or million) funding from the European Union’s INTERREG VA Programme, managed by the Special EU Programmes Body (SEUPB) with match funding from the Departments of Health in NI and ROI.
Thomas Curtis 1, Yvonne McKeown 1, Juliet Finnie 1
Oviva UK, London
📌 Allocation: Poster (Board No. 80)
Tier 3 obesity services are being revolutionised by the arrival of GLP1-RA therapies, such as Saxenda®. These drugs have been shown to be highly effective in promoting weight loss in landmark trials. However, concerns exist that their reach may be limited by the lack of sufficient multidisciplinary Tier 3 services in the UK. The ability to develop a remote service for injectable GLP1-RA initiation and management provides significant scope for overcoming patient access barriers, provided this is safe and acceptable to patients. The authors aimed to deliver and evaluate a digital, remote Tier 3 obesity service that provides patients with the confidence and support required to safely initiate and manage injectable GLP1-RA obesity therapy (Saxenda®). Saxenda® was prescribed as part of a comprehensive 12 month digital and remote tier 3 weight management pathway to eligible participants (n=111). A random sample of these patients (n=47) were invited to provide feedback via a structured telephone survey. Patients were included regardless of treatment continuation status. Thirty-two patients (68%) provided feedback. Adverse event data was systematically collected for all participants on the programme and analysed. Across all ten questions, the proportion of responses that were positive (‘Good’ or ‘very good’) was above 93% (range 93.8%-100%). The proportion reporting their overall experience as positive was 96.9% [95% CI 84.3% , 99.5%], with 90.6% reporting their overall experience as ‘very good’ [95% CI 75.8%, 96.8%]. The proportion confident in initiating treatment following remote consultation was 93.8% [95% CI 79.9 , 98.3%]. No serious adverse events were reported for any GLP1-RA patients on the programme (n=111). The results demonstrate that a remote specialist Tier 3 weight management service was highly effective in providing patients with the confidence and support they need to start and manage injectable GLP1-RA obesity therapy, with no safety concerns identified. Remote services can be a safe and highly acceptable means of overcoming patient access barriers to the emerging injectable obesity therapies.
Conflicts of interest: None
Funding: None
Amanda Avery 1, 2, Josef Toon 2, 3, Sarah E Bennett 2, Laura Holloway 2, Jemma Donovan 2, Carolyn Pallister 2
1 University of Nottingham, UK
2 Slimming World, UK
3 De Montfort University, UK
📌 Allocation: Poster (Board No. 82)
Obesity is a chronic condition and requires on-going or intermittent support over time. Community weight management programmes, such as Slimming World, provide ongoing support for people seeking weight management. Longer-term follow up outcomes of people receiving support from such programmes in self-funded settings is understudied. This study evaluates the most recent weight outcomes of adults who first joined Slimming World in 2016 and also accessed the service at least two years later. This secondary analysis included adults who joined Slimming World during 2016. Most recent electronic weight data for members who attended at least two years after joining were collated using last observation carried forward. Members who had at least one weight recorded between 2018 and 2023 (100,560 adults, 9.2% of people who joined in 2016) were included. Mean age and BMI at baseline were 49.4 (13.8) years and 33.9 (6.83) kg/m2 and 8.5% were male. 93.7% were matched to an IMD decile with 24.2% (n=22,790) in the lowest three and 35.5% (n=33,345) in the highest three deciles.
Mean change in weight and BMI was -11.2 (7.9)% and -3.9 (3.2) kg/m2 respectively with 20.4% at a personal target weight. Changes in weight by year of last reported weight were as follows; in 2018: -10.9 (7.5)% (n=50,332), 2019: -11.2 (7.9)% (n=20,731), 2020: -11.0 (8.3)% (n=14,407), 2021: -11.5 (8.9)% (n=5,343), 2022: -12.0 (8.4)% (n=3,299) and 2023: -13.6 (8.6)% (n=6,448). Year of last reported weight positively correlated with joining age (r=0.19, p<0.001) whilst correlations with joining BMI and IMD were not meaningful (both r<0.001). This evaluation shows successful long-term weight outcomes from two to seven years in adults from a range of socioeconomic backgrounds who received weight management support from Slimming World. Results show that people achieve and/or maintain losses of over 10% with around 20% attending at their personal target weight. Although this data doesn’t explore if continuous or intermittent support was accessed, this analysis highlights the importance of open-ended support as a key factor in successful obesity management.
Conflicts of interest: All authors work full or part-time for Slimming World.
Funding: N/A
Alun Lloyd Davies 1, Kamlesh Khunti 2, Matt Capehorn 3, Esther Artime 4, Erik Spaepen 5, Atif Adam 6, Xiaoyu Lin 6, Mengyuan Shang 6, Sarah Seager 6, Lill-brith von Arx 7
1 Eli Lilly and Company, Basingstoke, UK.
2 University of Leicester, Leicester, UK.
3 Rotherham Institute for Obesity, Rotherham, UK.
4 Eli Lilly and Company, Alcobendas, Spain.
5 HaaPACS GmbH, Schriesheim, Germany.
6 IQVIA, LTD, London, UK.
7 Eli Lilly and Company, Herlev, Denmark.
📌 Allocation: Poster (Board No. 83)
The EpIdeMiology Landscape and PAtient Care paThways of Obesity (IMPACT-O) study is a multi-country retrospective cohort study that reports the rates and impact of overweight/obesity across selected countries in Europe and the Asia-Pacific region. Epidemiological data can be used to help inform public health decision-making. The IMPACT-O study utilises electronic medical records (EMR) and claims databases standardised to the Observed Medical Outcomes Partnership Common Data Model from Australia, China, France, Germany, Italy, Spain, the UK and Japan. Here we report data from the UK IMRD (IQVIA Medical Research Database) THIN (The Health Improvement Network) database for the April 2023 data cut. UK IMRD is a database of anonymised EMR collected at primary care clinics throughout the UK. The total number of adults with overweight/obesity, based on diagnosis codes and/or body mass index (BMI) between 2018–2022, was estimated. For the prevalent cohort, BMI category and comorbidities were described for adults (≥18 years) with ≥1 BMI record of ≥25.0 kg/m2 (for overweight or obesity) and ≥12 months before the index date (highest BMI record). BMI was recorded for 38.9% of active patients in the database (n=4,454,982). Overall, the number of adults identified with overweight or obesity based on BMI (≥25.0 kg/m2) and/or diagnosis codes was 1,110,830, of which only 4.2% had a diagnosis code present. The prevalent cohort consisted of 893,246 individuals; of those, 403,502 (45.2%) had overweight (25≤BMI<30), 271,746 (30.4%) had obesity class I (30≤BMI<35), 128,216 (14.4%) had obesity class II (35≤BMI<40), and 89,782 (10.1%) had obesity class III (BMI≥40). 71.2% of adults with overweight/obesity had ≥1 comorbidity (n=636,044) and 47.8% (n=426 820) had multimorbidity (≥2). Overall, the most common comorbidities were hypertension (50.0%), dyslipidaemia (34.5%), depression (27.5%), and type 2 diabetes (15.7%). Generally, comorbidity rates increased with BMI category. These UK primary care cohort results demonstrated that only a small proportion of people with overweight/obesity had formal documented coded diagnoses in their EMR. Since diagnosis codes and weight/height (BMI) may be poorly recorded in EMR, there may be an underestimation of the number of people with overweight/obesity.
Conflicts of interest: Alun Lloyd Davies, Esther Artime and Lill-brith von Arx are employees and shareholders of Eli Lilly and Company. Erik Spaepen is an external consultant of Eli Lilly and Company. Kamlesh Khunti acted as a consultant, speaker, or received grants for investigator-initiated studies for AstraZeneca, Boehringer Ingelheim, Eli Lilly and Company, Merck Sharp and Dohme, Novartis, Novo Nordisk, Sanofi-Aventis and Servier; consultant and speaker for Abbott, Amgen, Bayer, Napp and Roche; and is the study lead for UK for Applied Therapeutics and Oramed Pharmaceuticals. Matt Capehorn is the Medical Director of Lighterlife; serves as an Ad Hoc Medical Advisor to McDonalds, UK; and has also received honoraria for talks or attendance at meetings from Novo Nordisk, Eli Lilly and Company, and Boehringer Ingelheim. Atif Adam, Xiaoyu Lin, Mengyuan Shang and Sarah Seager have no conflict of interest to declare.
Funding: This work was funded by Eli Lilly and Company.
Suzanne Seery1, Karen Gaynor1, Annette Sheehy2, Nadine Lynch2, Karla Smuts3, Sarah Noone5, Marguerite Corby4, Christine Gurnett4, Ciara Heverin5, Peter Curley6, Nicole Power6
1 HSE, Health and Wellbeing division, National Clinical Programme for Obesity, Dublin, Ireland.
2 HSE, Community Healthcare Organisation 1 (Donegal).
3 HSE, Community Healthcare Organisation 9 (Dublin North central).
4 HSE, Community Healthcare organisation 3 (Limerick).
5 HSE, Community Healthcare Organisation 2 (Galway).
6HSE, Community Healthcare Organisation 7 (Dublin South West).
📌 Allocation: Poster (Board No. 84)
Background: Funding was allocated for the design and implementation of a dietitian led online behavioural weight management programme, as part of the integrated model of care for prevention and management of chronic disease within the Irish healthcare system. Referral criteria for the programme includes adults with a BMI ≥ 30kg/m2 with co-morbidities. The programme includes an initial 1:1 assessment followed by 14 group sessions delivered over 12 months. The aim of this study is to describe the baseline characteristics of participants in the early implementation phase between October 2021 and November 2022 across five sites.
Methods: The majority of recruited participants were sourced from validated waiting lists of patients referred to the dietitian for weight management. Baseline characteristics data was entered via SmartSurvey.co.uk and included socio-demographics, anthropometry, co-morbidity status, and biochemistry relating to cardio-metabolic health (if available). Participants who accepted a place on the programme completed a questionnaire that included rating their confidence (1 = Not at all Confident, 7 = Extremely Confident) in talking to a healthcare professional about their health and in using technology to access a virtual weight management programme. Data analysis was completed using MS excel.
Results: Main source of referral was via GP (59%) and 111 patients completed an initial assessment. The mean age was 55 (± 14) years, majority female (74%) and 24% are living with Type 2 diabetes. Mean weight was 111.3 (± 25.4) kg (range = 75.2 – 223 kg, n= 107). Mean body mass index (BMI) was 40.7 (± 7.4) kg/m2 (range 30 – 61 kg/m2, n= 107). Mean LDL cholesterol was 2.63 (± 1.1) mmol/L (range = 0.8 – 5.5 mmol/L, n = 52). Participant’s median rating of confidence in talking to a healthcare professional about their health was 6 (n = 83) and in using technology to access the programme was 5 (n = 74).
Conclusion: Findings indicate further work is needed to improve engagement with men and younger people. Higher BMI and prevalence of co-morbidities at baseline highlights the need for improving access to specialist obesity services.
Conflicts of interest: Nil conflicts of interest
Funding: The data analysis and evaluation work was completed as part of the lead authors role employed by the Health Service Executive in Ireland.
Letitia Sermin-Reed 1, Mackenzie Fong 1, Gemma Andreae 1, Hannah Mehmood 1, Frances Hillier-Brown 1
1. Newcastle University, Newcastle-upon-Tyne, UK
📌 Allocation: Oral Presentation
Tackling childhood obesity requires a systems approach, including upstream interventions to address and change the obesogenic environment. Approaches suggested within government policy persist to rely on self-regulation that requires a high level of individual agency, potentially due to the evidence base being strongest at this level. The evaluation of upstream interventions that aim to change environments is required to supplement the evidence base. The aim of this systematic review was to evaluate the effectiveness of upstream and low agency environmental approaches to reduce obesity in children. The databases MEDLINE, Embase, and PsychINFO were searched in addition to internet sources, registries, citations and reference lists of included studies. Natural or quasi-experimental studies that investigated low-agency environmental interventions to reduce childhood obesity, which measured childhood obesity-related outcomes and included participants aged <18 years, were included. Risk of bias was assessed using the Effective Public Health Practice Project (EPHPP) tool. Narrative synthesis was conducted for analysis of the results. Of 2,769 articles identified, 24 were eligible for inclusion. Two studies were of weak quality, 12 were of moderate quality and 10 were of strong quality. Fifteen studies examined interventions that targeted the food environment and nine studies examined interventions that targeted physical activity environment. The majority were conducted in school settings (n=17), followed by child day-care settings (n=4) and the community and wider settings (n=3). The majority (n=15) of studies demonstrated some favourable effects of the intervention under investigation on childhood obesity outcomes. Overall, evidence indicates that upstream and low-agency interventions are effective in reducing childhood obesity, especially when delivered in a school setting. The generally long data collection time periods of the studies suggest the long-term effectiveness of such interventions. However, additional higher-quality research is needed for more robust conclusions. Policymakers should also move beyond the school settings for the implementation of such interventions, and additional research using natural or quasi-experimental study designs in such settings is required. Future research should also investigate the effects of such interventions on inequalities in childhood obesity.
Conflicts of interest: None
Funding: None
Lucie Nield 1
Lucie Nield, Advanced Wellbeing Research Centre, Sheffield Hallam University, Olympic Legacy Park, Sheffield, S9 3TU.
📌 Allocation: Oral Presentation
Adolescence is a time of change defined by increased autonomy and acquisition of new skills, including food and health practices. However, adolescence is experienced differently across sociocultural contexts. Understanding drivers of food practice in adolescence is vital as these impact future health outcomes, including obesity, and can drive health inequality. This study investigates drivers of food choice behaviour in adolescents living in a deprived urban area of England, identifies the dominant drivers and their impact on health and wellbeing, and explores how adolescents from low SES groups understand and action autonomy in their food practices. PhotoVoice, a focussed ethnographical methodology where participants reflect on lived experience, was used to address the study aim. Participants (n=21) were secondary school pupils aged 14-15 years, recruited from a school situated in an area of deprivation. Four overarching themes were developed from the qualitative data framework analysis: 1) Food preference and other determinants of food choice; 2) Concept, understanding and importance of health; 3) Developing autonomy, skills, and independence and 4) Role of community, friends, and family in food practices. The adolescents were developing autonomy in relation to their food practices, whilst navigating a complex web of factors which were, in part, determined by their social class location. Weight management was their key health focus, with participants describing a preference to eat less, rather than choose more nutritious foods. Participants found the main barriers to healthy eating were the perceived ‘effort’ of being healthy and additional time for preparing healthier food. Parents and schools highly influence food choices, with adolescents preferring a broad palate of takeaway and convenience foods.
Conflicts of interest: There are no conflicts of interest to declare.
Funding: The work was funded by fieldwork funding, Sheffield Business School, Sheffield Hallam University.
Colette Marr 1 , Penny Breeze 1, Sophie Reale 2, Sundus Mahdi 1, Samantha J Caton 1
1. School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
2.Allied Health Professions, College of Health, Wellbeing and Life Sciences, Sheffield Hallam
University, Sheffield, UK
📌 Allocation: Oral Presentation
The early years are an important time in the development of eating habits and preferences, however children this age are failing to meet dietary recommendations. Grandparents are relied upon the most as informal caregivers of preschool aged children yet few have studied their role in shaping children’s eating. Across three studies we explored whether grandparents who care for their preschool aged grandchildren would benefit from feeding support. In Study 1 we conducted a systematic mixed methods review to synthesise the research on grandparental dietary provision, feeding practices and feeding styles with preschool aged children. In study 2, an online questionnaire and 24-hour dietary recall was used to compare the feeding practices, feeding styles and dietary provision of 44 grandparents with 72 (unrelated) parents in the UK. In study 3, semi-structured interviews were conducted to determine the barriers and facilitators to engaging grandparents to promote healthy eating in their preschool aged grandchildren. Strategies to promote healthy eating in young children should be expanded to also target grandparents. Similarities between parent and grandparent feeding behaviours suggest the content of such strategies may not need to be adapted specifically for grandparents. Like parents, grandparents are providing meals high in saturated fat and sodium and providing less than the recommended amount of fruit and vegetables. Nevertheless, UK grandparents are using feeding practices that help to provide structure to, and promote autonomy in, children’s eating. Although parents frequently describe grandparents as indulgent, this may not be true for grandparents that care for their grandchildren on a regular basis. Grandparents expressed a willingness to learn new information and an eagerness to provide a healthy diet to their grandchildren, however they may be a challenging group to engage as they perceive little need for feeding support. Grandparents spoke positively, and frequently, of learning from their grandchildren’s parents, suggesting that an indirect approach could be used to convey recommendations to them.Future work should explore the feasibility and acceptability of using parents as a conduit for early years feeding guidance for grandparents.
Conflicts of interest: None
Funding: This research was funded by the Wellcome Trust [108903/B/15/Z] and the University of Sheffield.
Oliver J Canfell 1 2 3, Elizabeth E Eakin 1, Andrew Burton-Jones 1, Clair Sullivan 4
1. The University of Queensland, Brisbane, Australia
2. Health and Wellbeing Queensland, Brisbane, Australia
3. Digital Health Cooperative Research Centre, Sydney, Australia
4. Department of Health (Queensland Government), Brisbane, Australia
📌 Allocation: Oral Presentation
Problem addressed
Obesity is slowing life expectancy growth across nations. Public health innovation is needed to integrate targeted prevention policies across the life course. Precision public health (PPH) uses real-world data (e.g., electronic medical records, social media) and digital technology to augment traditional public health approaches. There is a significant but unmet opportunity to translate the success of PPH to manage infectious diseases (e.g., COVID-19) into addressing chronic diseases such as obesity. The aim of this research program was to explore how real-world data can inform PPH for obesity using Queensland, Australia, as a test setting.
Methods
This research program adopted a pragmatic mixed-methods design across five phases (2021-2023). We conducted literature reviews (phase 1-2), co-design (phase 3-4) and population health informatics (phase 5) to achieve our aim. The setting was Queensland – a large state in Australia with a population of ~5 million. In partnership with the state public healthcare system, health promotion agency, and global academic institutions, we engaged public health practitioners, executives and managers, public health researchers, clinical informaticians, and allied health professionals to build an empirical foundation for PPH.
Results
This program completed five phases (n = 28 participants) and found:
1. Globally, PPH initiatives to address obesity are emerging but require stronger translation to policy and practice (systematic review)
2. An evidence map of obesity data for PPH in Queensland revealed electronic medical records have the highest potential utility but are currently unused for decision-making (scoping review)
3. PPH to address obesity can be conceptually achieved across three ‘horizons’: digital workflows; population health analytics; new models of PPH (co-design)
4. Decision-makers in healthcare organisations need bigger and faster data to make confident prevention decisions for obesity (co-design)
5. A digital dashboard of obesity in Queensland can geographically heatmap obesity rates across time and place for ~1 million people in the state electronic medical record (population health informatics)
Conclusions
PPH is a rapidly emerging but nascent area that requires coordinated transdisciplinary effort to improve obesity policy and practice. Future research must improve reach and representativeness in data and integrate community voices from underserved settings.
Conflicts of interest: None to declare.
Funding: This research was supported by the Digital Health Cooperative Research Centre (DHCRC-0083), Australian Government, and The University of Queensland's Business School and Faculty of Medicine.
I Gusti Ngurah Edi Putra 1, Megan Polden 2, Lettie Wareing 3, Eric Robinson 1
1 Department of Psychology, Institute of Population Health, University of Liverpool, Liverpool, UK
2 Department of Primary Care and Mental Health, Institute of Population Health, University of Liverpool, Liverpool, UK
3 Department of Psychology, Lancaster University, Lancaster, UK
📌 Allocation: Oral Presentation
This study assessed the acceptability and perceived harm of recently proposed UK public health policies to address obesity (i.e., mandatory calorie labelling, banning advertisements of unhealthy food and drinks online and before 9 pm on TV, and banning “buy one get one free” deals for unhealthy food and drinks) in adults with an eating disorder (ED) and other mental health conditions. We conducted an online survey, recruiting 1,273 participants with a self-reported doctor diagnosis of mental health condition (583 participants with an ED) from Prolific Academic and social media (September – November 2022). Multinomial logistic regression was used to compare the levels of perceptions of the policies between participants with and without an ED (but with other mental health conditions). Opinions on the potential effects of the policy on current ED symptoms were analysed using thematic qualitative analysis. We found no differences in the proportions of acceptability and perceived harm of the two policies on restricted marketing and price promotions of unhealthy food and drinks observed between participants with and without an ED. However, the proportion of support for the implementation of the mandatory calorie labelling policy was lower in participants with vs. without an ED (43% vs. 58%). Half of the participants with an ED (55%) also reported that calorie labelling may worsen their ED symptoms. Findings from multinomial logistic regression controlling for sociodemographic covariates (age, gender, ethnicity, education, household income) and body mass index category also indicated that participants with an ED were more likely to disagree with the implementation of the calorie labelling policy than their counterparts without an ED. However, participants with an ED (vs. without) agreed and disagreed (relative to neutral) that they would prefer to use a menu with calorie labelling when available. Some themes from the qualitative analysis showed that calorie labelling may provide harm (e.g., a gateway to relapse, negative effects on mood) and perceived benefits (e.g., feeling informed and reassured) for participants with an ED. Therefore, future studies are warranted to explore the potential benefits and how to mitigate the harm of calorie labelling in people with an ED.