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 76 - 100 of 115 abstractsEmma Hunter 1, Flora Douglas 1
Robert Gordon University, Aberdeen, Scotland
📌 Allocation: Member-led symposium
Despite being a public health priority for over 30 years, the prevalence of obesity in the UK remains high. Strategies to tackle obesity have typically focused on behaviour change at the individual level, ignoring wider health and social inequities that can increase an individual’s risk of developing obesity and decrease responsiveness to interventions. Many people living on low incomes face food insecurity: the inability to afford or reliably access food that meets recommended nutritional requirements. Ultra processed foods, often high in fat, salt and sugar which tend to be cheaper than healthier alternatives can become a sensible economic choice, however, repeated consumption can present challenges for weight management. Interventions helping support the purchase and consumption of healthy food which move beyond individual responsibility to consider the existing socio-economic factors that contribute to weight gain and prevent weight reduction are required. Additionally, research suggests eating a healthy diet, in line government recommendations (i.e., the Eatwell Guide), would also bring about environmental benefits, through associated reductions in greenhouse gas emissions, helping tackle climate change. Individuals in high income countries purchase the majority of their food in supermarkets making this the ideal context for research into and the delivery of ‘upstream’, social and economic level interventions. By exploring the experiences of people living with obesity and food insecurity, when shopping in the supermarket environment, to help identify the instrumental factors and environmental cues that currently influence the purchase of healthy, environmentally sustainable food, this study aims to provide a starting point for intervention development. Semi-structured interviews and focus groups will be conducted to explore broad experiences of shopping, choice of retailer, the receipt of emergency food provision and its impact on purchasing behaviour and external influences, i.e., others they shop for. The ways in which people living with obesity and food insecurity believe supermarkets can help support them purchase healthy, environmentally sustainable food will also be examined. Interviews will be audio recorded and transcribed verbatim and data subject to thematic analysis. Findings will be used to inform intervention development as part of the FIO (Food Insecurity in People Living with Obesity) Food project.
Conflicts of interest: None
Funding: Biotechnology and Biological Sciences Research Council (BBSRC), Strategic Priorities Fund (SPF)
Rebecca Ann Stone 1, Adrian Brown 2, Charlotte Hardman 1, on behalf of the FIO-Food Team
1. University of Liverpool, Liverpool, UK
2. University College London, London, UK
📌 Allocation: Member-led symposium
In the UK, obesity and poorer diet quality are disproportionately represented in groups experiencing socio-economic disadvantage, with current economic crises likely to exacerbate these inequalities. Lower-income households are at greater risk of food insecurity (lack of consistent access to foods that are nutritious in quality and quantity), with food choices likely constrained by the affordability and availability of healthier more sustainable foods in local food environments. Food insecurity and obesity often co-occur yet little is known about how to support people living with obesity and food insecurity to make food choices in favour of health and sustainability. The retail food environment presents one fruitful avenue for intervention, since purchasing is an antecedent to consumption. However, how supermarkets can facilitate purchase of healthier, more sustainable food in people living with obesity and food insecurity remains unclear. It is also unclear what barriers this group may encounter when trying to purchase healthier, more sustainable food. Using an online survey (N = 600), adults residing in England or Scotland with a BMI of ≥30 kg/m2 self-reported on food insecurity, diet quality, and their experiences of shopping in a supermarket (online or in-store) for healthy and sustainable food. Results showed that food insecurity was associated with lower diet quality, and also with experiencing more barriers to purchasing healthy and sustainable food in the supermarket (e.g., price, variety of products, time, mental health). Supermarket interventions based on price were deemed to be most helpful in enabling healthier, more sustainable purchasing regardless of food insecurity. These findings highlight the unique difficulties faced by people living with obesity and food insecurity when shopping for heathier, more sustainable food, and also underscore the need for policy development relating to price and affordability at a population-level.
Conflicts of interest: There are no conflicts of interest.
Funding: Biotechnology and Biological Sciences Research Council (BBSRC); BB/W018020/1 - FIO-Food, Food Insecurity in people living with Obesity - improving sustainable and healthier food choices in the retail Food environment.
Giang Nguyen 1, Zoë Bell 1, 2, Gemma Andreae1, Stephanie Scott1,3, Letitia Sermin-Reed 1, Amelia A Lake3,4, Nicola Heslehurst 1,3
1 Population Health Science Institute, Faculty of Medical Sciences, Newcastle University, Newcastle Upon Tyne, United Kingdom
2 Department of Nutritional Sciences, King’s College London, London, United Kingdom
3 Fuse, The Centre for Translational Research in Public Health, Newcastle Upon Tyne, United Kingdom
4 School of Health and Life Sciences, Teesside University, Middlesbrough, United Kingdom
📌 Allocation: Member-led symposium
Food insecurity (FI) is significantly associated with obesity and adverse health outcomes in the general population. This systematic review and meta-analysis (PROSPERO: CRD42022311669) explored associations between women experiencing FI in pregnancy, and maternal obesity, gestational weight gain, and pregnancy health outcomes for both mothers and infants.
Searches included seven databases (MEDLINE, Embase, Scopus, Web of Science, PsychInfo, ASSIA, CINAHL) and grey literature, reference lists, citations, and contacting authors and completed in April 2023. We included studies in high-income countries (HICs) reporting data on food insecurity in pregnancy from Jan 1, 2008, onwards. Screening, data extraction, and quality assessment were carried out by two authors independently. Random effects meta-analysis was performed when data were suitable for pooling, otherwise narrative synthesis was conducted. Searches identified 10,515 results; 27 studies (n=87,850 women) included: 26 from North America, 1 from the UK. Meta-analysis showed women experiencing FI had significantly reduced gestational weight gain (GWG) (MD -0.37kg 95%CI -0.58, -0.17), increased odds of maternal obesity (OR 1.53 95%CI 1.39, 1.66), inadequate GWG (OR 1.16 95%CI 1.05, 1.28), high stress level (OR 4.07, 95%CI 1.22-13.55), gestational diabetes (OR 1.63, 95%CI 1.36-1.95) and preterm delivery (OR 1.21, 95%CI 1.00-1.47). There was no statistically significant association with maternal underweight (OR 1.12 95%CI 0.89, 1.34) or overweight (OR 1.18 95%CI 0.86, 1.50), excessive GWG (OR 1.04 95%CI 0.96, 1.13), small for gestational age (OR 1.14, 95%CI 0.72-1.80), large for gestational age (OR 0.90, 95%CI 0.66-1.22) or admission to neonatal intensive care unit (OR 2.01, 95%CI 0.85-4.78). Narrative synthesis showed inconsistent data for diet outcomes, with some evidence of reduced vitamin E and diet quality, and increased red/processed meat consumption. FI was associated with dental problems, maternal serum concentration of perfluoro-octane sulfonate, pre-eclampsia, depression and anxiety, but not other organohalogen chemicals, hypertension, caesarean delivery, assisted delivery, postpartum haemorrhage, hospital admissions, lengths of stay, congenital anomalies, or neonatal morbidity. Mixed associations were reported for mood disorders and community measures.
Further research in other HICs is needed to understand the impacts of FI and maternal obesity and pregnancy health, especially those without embedded interventions in place, to inform policy and care requirements.
Conflicts of interest: The authors have no conflicts of interest to declare
Funding: The authors received no specific funding for this work.
Zoë Bell
King’s College London, London, UK
Department of Nutritional Sciences
School of Life Course & Population Sciences
📌 Allocation: Member-led symposium
Food insecurity exists when an individual struggles to afford or access sufficient healthy food in socially acceptable ways. It is a well-established driver of obesity in high-income countries, labelled a paradox due to assumptions that hunger equals weight loss. The current UK context is one of both increasing food insecurity and inequalities in obesity prevalence. Drivers of food insecurity include poverty, unemployment and low-income, which have increased since the 2008 global financial crises, and more recently increased food and fuel costs due to Covid-19, the invasion of Ukraine, and cost-of-living crisis. These drivers influence interactions with obesogenic environments, impacting the most vulnerable in our society, with an increasing reliance on voluntary systems such as food banks for support. So is the relationship between food insecurity and obesity a paradox? To explore this requires understanding the mechanisms linking food insecurity and weight which fall into two broad categories: behavioural (e.g., substitution hypothesis, cyclical nature) and physiological (e.g., DoHAD, insurance hypothesis, chronic stress).
Conflicts of interest: N/A
Funding: N/A
Steph Scott 1, Lucy Clark 1, Gina Nguyen 1, Zoe Bell 2, Fiona McKay 3, Julia Zinga 3, Paige van der Pligt 3, Nicola Heslehurst 1.
1. Newcastle University, UK
2. King’s College London, UK
3. Deakin University, Australia
📌 Allocation: Member-led symposium
Since the 2008 global financial crisis, there has been a rise in the number of people experiencing food insecurity. Pregnant women are particularly vulnerable to food insecurity as their financial and nutritional needs increase during pregnancy. Experiencing food insecurity in pregnancy has been linked to many adverse health outcomes, such as having: obesity, clinical complications throughout pregnancy, low birth weight, increased pregnancy-related mortalities and poor mental health. This systematic review of qualitative studies focuses on the experiences of pregnant women who are food insecure in high income countries and how it affects their nutritional health and wellbeing. Six electronic databases (Medline, Scopus, Web of Science, EMBASE, CINAHL and ASSIA), were searched from 1 January 2008 to 5th April 2023, supplemented by searches of grey literature databases, relevant websites, examination of reference lists and citation searches. We included studies that focused on the experiences of pregnant women with food insecurity, from any discipline or theoretical tradition that used qualitative methods, and which included data collected from 2008 onwards in high-income countries as defined by World Bank. Title/abstract and full-text screening were conducted by two reviewers independently, with conflicts resolved by discussion or a third reviewer. Study selection follows the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) checklist. Synthesis will be guided by a thematic synthesis approach. We identified 14,442 unique records; with 81 studies assessed at full text stage. Full text screening will be completed end of May 2023. Next stages will include: reference and citation searches, data extraction and quality appraisal. Data will be synthesised thematically using the Thomas and Harden approach. The completion date for the review is end of August 2023.
Conflicts of interest: None.
Funding: None.
Nicola Firman 1, Marta Wilk 1, Milena Marszalek 1, Lucy Griffiths 2, Gill Harper 1, Carol Dezateux 1
1 Centre for Primary Care, Wolfson Institute of Population Health, Faculty of Medicine and Dentistry, Queen Mary University of London, Yvonne Carter Building, 58 Turner Street, London, E1 2AB
2 Swansea University Medical School, Faculty of Medicine, Health & Life Sciences, Singleton Park, Swansea, SA2 8PP
📌 Allocation: Three minute thesis competition
Objectives
We used a dynamic method of identifying household members from Electronic Health Records (EHRs) linked to National Child Measurement Programme (NCMP) data to estimate the likelihood of children with obesity sharing a household with an older child with obesity, accounting for individual and household characteristics.
Methods
We included 126,829 NCMP participants in four London boroughs and assigned households from encrypted Unique Property reference Numbers (UPRNs) at NCMP date for 115,466 (91%). We categorised the ethnic-adjusted body mass index of the youngest and oldest household child (underweight/healthy weight<91st, ≥91st to <98th overweight, obesity≥98th centile) and explored associations of the youngest child’s weight status with: oldest child’s weight status, number of household children (two, three or ≥4), youngest child’s sex, ethnicity and school year of NCMP participation (reception or year 6). We estimated adjusted odds ratios (aOR) and 95% confidence intervals (CI) of obesity in the youngest child.
Results
19,702 UPRNs were shared by two or more NCMP participants (youngest children: 51.2% male, 69.5% reception). 10.4% of youngest (95% CI: 10.0,10.9) and 13.0% of oldest (12.5,14.3) children were living with obesity. One third of youngest children with obesity shared a household with another child with obesity (33.2%; 31.2,35.2), compared with 9.2% (8.8,9.7) of those with a healthy weight. Youngest children living with an older child with a BMI considered overweight (aOR: 2.33; 95% CI: 2.06,2.64) or obese (4.59, 4.10,5.14), those from South Asian ethnic backgrounds (1.89; 1.64,2.19) or taking part in NCMP in year 6 (2.21; 2.00,2.43) were more likely, and girls (0.73; 0.67,0.81), children living with just one other child (0.87; 0.77,0.98) and from Black ethnic backgrounds (0.78; 0.66,0.93) less likely, to be living with obesity.
Conclusion
Linked EHRs can provide novel insights into the shared weight status of children sharing the same household. Further qualitative research is needed to understand how household food practices may vary by other household characteristics to improve our understanding of how the home environment influences childhood obesity.
Conflicts of interest: The authors declare no conflicts of interest.
Funding: This research was funded by a grant from Barts Charity ref: MGU0419.
Leila Fathi 1, Danyu Yang 1, Mark Robinson 1, Jacqueline Walker 1, 2, Robyn Littlewood 1, 2, Helen Truby 1
1 The University of Queensland, Brisbane, Australia
2 Health and Wellbeing Queensland, Brisbane, Australia
📌 Allocation: Three minute thesis competition
Background: Schools are ideal settings for supporting children to establish healthier dietary habits, through food and nutrition programs. However, most programs cease implementation within two years. Having a better understanding of the determinants of sustainability can help maximise the funding spent on the development of school-based nutrition programs and allow time for program benefits to be achieved and evaluated. The aim of this study is to explore how international school-based food and nutrition programs can successfully manage long-term implementation, using the Consolidated Framework for Implementation Research (CFIR).
Methods: Purposive and snowball sampling were used to recruit experts. Experts were identified as being influential in sustaining school-based food and nutrition programs for two years or longer. Semi-structured interviews were conducted with participants via Zoom. Interviews were transcribed verbatim and coded deductively by applying the CFIR constructs. Coding was conducted independently by two researchers and confirmed through discussion. Additional inductive codes were ascertained via discussion until consensus was reached. Thematic analysis of the coding helped to inform the development of themes.
Results: Interviews were conducted with eleven stakeholders (academics, researchers, members of government and an agency representative) from Australia, Canada, England, Italy, New Zealand, Northern Ireland and the United States of America. Forty-one deductive codes and sixteen inductive codes identified six main themes: 1) funding and integrity of its source; 2) political landscape; 3) nutrition policies and their monitoring; 4) involvement of community actors; 5) adaptability of program; 6) effective program evaluation. Themes related mostly to the ‘outer setting’ and 'process' domains of the CFIR.
Conclusion: Successful long-term implementation of school-based food and nutrition programs require careful consideration of the broader environmental influences. Relationships need to be strengthened across the whole government, local organisations and community sector. Monitoring and evaluation processes are also required to drive consistent support from internal and external leadership.
Conflicts of interest: None.
Funding: The first author (Leila Fathi) would like to acknowledge the financial contribution of the King & Amy O’Malley Trust, and the University of Queensland and Australian Government Research Training Program scholarship for the author’s Ph.D. The funding bodies had no role in the design, analysis or writing of this article.
Natalie Connor 1, Helen Moore 1, Andrea Burrows 1, Penny Breeze 2, Christian Reynolds 3, Claire O'Malley 1, Jane Snell 3, Amelia Lake 1
1 Teesside University, Middlesbrough, UK
2 University of Sheffield, Sheffield, UK
3 City, University of London, London, UK
📌 Allocation: Three minute thesis competition
Excess consumption of calories in the UK leads to obesity, which is a cause of diabetes and cardiovascular disease. Unhealthy diets, in which people eat excess food High in Fat, Sugar and Salt (HFSS), are causing ill health and are an influential factor in creating health inequalities. The HEALTHEI project explores which HFSS food taxes would have the greatest benefits to health, labour and work outcomes, household expenditure, environmental sustainability and inequalities within the UK food system. We present the first component of Work Package 1: a rapid review of published evidence. A systematic rapid review approach examined published evidence around HFSS taxation options for food and non-alcoholic beverages. A pre-planned framework ensured a systematic approach. A search strategy was designed a priori and adapted for use on PubMed, HMIC, Scopus, Google, Mintel/Mintel Food and Drink, and Business Source Premier Ultimate. Databases were searched for papers published between January 2010 and December 2022. Papers were included if based in high-income countries and published in English. Screening of titles and abstracts, then full text of papers was performed by the WP1 team. Reference lists of relevant systematic reviews were also hand-searched. A standardised data extraction template was developed and evidence from the included papers was extracted by the WP1 team under themes for effectiveness, costs/unintended consequences, and barriers to implementation. Data quality of papers was also assessed. Six categories of tax options were identified by the rapid review; high fat, high sugar, high salt, “junk-food”, sugar-sweetened-beverages, and meats plus sugar-sweetened-beverages, all of which had a broadly positive impact on consumption and health. An infographic was developed to concisely communicate the review findings. Five core rationales for food taxes also emerged (Change Consumption, Reduce/Prevent Harm, Change Product Affordability, Raise Revenue, and Industry Impact). The review demonstrated that there is a need to develop an impactful food tax option that incorporates a multitude of rationales, however, no obvious contender emerged from the review. The results of the review will be synthesised with evidence from stakeholder workshops and media analysis to understand the feasibility, impact and logistics of implementing a future food tax.
Conflicts of interest: No conflicts of interest to declare
Funding: National Institute of Health Research (Ref: NIHR133927)
Erin B McGrattan 1, Laura McGowan 1, Ruth F Hunter 1, Helen G Coleman 1,2 on behalf of the Ferry Fit Challenge committee
1. Centre for Public Health, Queen's University Belfast, Belfast, UK
2. Patrick G. Johnston Centre for Cancer Research, Queen's University Belfast, Belfast, UK
📌 Allocation: Three minute thesis competition
Background: Overweight/obesity, and physical inactivity, are major public health issues worldwide. Many interventions have enabled short-term weight loss and/or increased physical activity levels, but there is a lack of evidence for long-term maintenance of these changes. The aim of this secondary data analysis study was to evaluate the factors associated with continued participation and maintenance of weight loss in the community-based ‘Ferry Fit' intervention.
Methods: The Ferry Fit Challenge is a nine-week community-based weight loss and physical activity intervention based in a rural setting in County Down, Northern Ireland that ran annually between 2016-2019. Participants self-reported demographic, health and lifestyle information at baseline, with anthropometric factors measured at weekly weigh-in nights. Data cleaning and statistical analysis was conducted using Microsoft Excel and Stata software. Participants were classified as (i) Continuous - participated in Ferry Fit for at least three consecutive years within the four-year timeframe, or the most recent two consecutive years (i.e., 2018 and 2019); (ii) ‘One-off’ - participated only once; or (iii) Sporadic - all other combinations of participants, i.e., may have joined in 2016 and then again in 2018, etc.
Results: Of 438 individuals who participated in the Ferry Fit Challenge for at least 1 year, 34%, 19% and 47% were classified as continuous, ‘one-off’ or sporadic participants, respectively. The majority of all participants (77%) were female. Participants aged 40-49 years were more likely to be continuous participants, and <30 year olds more likely to be ‘one-off’ participants (p<0.001). Continuous participants did not differ from ‘one-off’ or sporadic participants according to sex, smoking status, co-morbidities, baseline anthropometrics or baseline exercise frequency. Achievement of short-term weight loss each year was evident, but there was limited evidence that weight reduction was maintained year-on-year among continuous participants. For example, the mean body mass index at Year 1 start was 30.1, declining to 28.8 by Year 1 end but increasing to 30.4 by Year 2 start.
Conclusion: Approximately one third of individuals maintained continuous annual participation in this community-based intervention, and this proportion was higher in individuals aged 40-49 years. Whether this leads to long-term maintenance of weight loss remains unclear.
Conflicts of interest: None
Funding: Erin McGrattan is a Brian Conlon Foundation PhD Fellow. Helen G Coleman holds a Cancer Research UK Fellowship.
Stacey Boardman 1, Dr Rebecca Beeken 1, Dr Alison Fildes 1, Dr Anuradha Menon 2
1 University of Leeds, Leeds
2 Leeds and York Partnership NHS Foundation Trust, Leeds
📌 Allocation: Three minute thesis competition
Appetitive traits are stable, genetically determined predispositions towards food, which can be influenced by people’s environments. Understanding the appetitive traits of people engaged in weight management, and whether these traits are associated with weight loss success could contribute to the development of tailored interventions. This study used a mixed-methods design to explore: 1) the appetitive traits of adults accessing a Specialist Weight Management Tier Three Service; 2) whether appetitive traits were related to a weight loss of 5% of total body weight or more; and, 3) participants’ own experiences of their appetitive traits during weight management. Participants (n=75) completed the Adult Eating Behaviour Questionnaire (AEBQ) and provided demographic and weight history data. Measurements of weight at baseline and follow-up (mean 28 weeks post-baseline) were obtained from participants’ medical records. Logistic regression analyses explored associations between five appetitive traits (Food Responsiveness, Satiety Responsiveness, Slowness in Eating, Emotional Over-Eating and Emotional Under-Eating) and whether 5% weight loss was achieved. After controlling for demographics, weight history and time since baseline, Satiety Responsiveness and Slowness in Eating were associated with weight loss success. Individuals who were more satiety responsive, and individuals with a slower speed of eating were more likely to achieve 5% weight loss or more (OR 3.15; 95% CI [1.38,7.16]) and OR 1.93; 95% CI[1.02,3.68] respectively). A sub-sample of participants (n=22) participated in recorded telephone interviews about their experiences and a reflexive thematic analysis of this data is underway. This is the first study to explore the appetitive traits of people accessing a UK weight management service, and to identify a relationship between appetitive traits and weight loss success. Results must be interpreted cautiously given the small sample, but the findings suggest that individual variation in responsiveness to internal feelings of satiety, and a slower speed of eating may be determinants of weight loss success. Future research should further explore the influence of appetitive traits on weight management, including the potential for tailored interventions to support individuals with more avid appetites.
Conflicts of interest: No conflicts of interest to declare.
Funding: No research funding. Funds were provided from the Max Hamilton Fund for transcription of interviews.
Bai Li 1, Selene Valerino Perea 1, Charlie Foster 1, Keith Syrett 2, Weiwen Zhou 3, Yihong Xie 4, Zouyan He 4, Yunfeng Zou 4, Frank de Vocht 5
1. Centre for Exercise, Nutrition and Health Sciences, School for Policy Studies, University of Bristol.
2. Law School, University of Bristol.
3. Centre for Diseases Control and Prevention, Guangxi, P.R. China
4. School of Public Health, Guangxi Medical University, P.R. China
5. Bristol Medical School, University of Bristol..
📌 Allocation: Oral Presentation
Background
In 2021, the Chinese government introduced nationwide regulations to restrict the time that children (7-18 years) should spend on digital games, homework, and out-of-campus learning, to improve child health and wellbeing. This was the world’s first regulatory intervention on child sedentary behaviour (SB). The impact of this intervention could have important research and policy implications globally. We evaluated the effect of this regulatory intervention on child SB.
Methods
With a pre-post natural experiment design, we used surveillance data collected by the Guangxi Autonomous Region authority from 9 to 18 years students, before (wave 1) and after (wave 2) the introduction of the regulatory intervention, for longgitudial analyses (n=7,054) and repeated cross-sectional analyses (n=99,947). The regionally representative data were collected using a multi-stage random sampling from 31 counties. Pre-post differences were analysed for self-reported total SB time and key SB outcomes (e.g. homework time, out- of- campus learning time, screen viewing time and electronic device use time), using multilevel models adjusted for relevant covariates. We also explored subgroup differences by sex, stage of education, residency, and baseline weight status.
Results
At wave 2, students reduced their total SB time by 13.8% (95% CI: -15.9 to -11.7%, approximately 46 minutes less) on average and spent significantly less time on homework (and were 2.8 times more likely to meet the standards set by the regulation, 95% CI: 2.47-1.14) and out-of-campus learning. Students also reduced their screen-viewing time by 6.4% (95%CI: -9.6 to -3.3%, approximately 10 minutes less), and were 20% more likely to meet international daily screen time recommendations (95% CI: 1.1 to 1.3). The reduction in homework and screen-viewing time was larger in secondary school students (p<0.0001 for interaction) than in primary school students. We did not find an intervention effect on other outcomes. Population-level (repeated cross-sectional) analyses showed similar findings as the longitudinal (repeated) analyses.
Conclusions
The regulatory intervention has been effective in reducing total SB time among Chinese children and adolescents, mainly through reducing time spent on homework, out-of-campus learning and screen viewing. Similar but culturally appropriate regulatory interventions could be considered by policy makers in other countries.
Conflicts of interest: We have no conflicts of interest to declare.
Funding: Wellcome Trust/Elizabeth Blackwell Institute for Health Research
Tom Steiner 1, Jennifer Forsyth 1, Lorraine Tulloch 1, Megan Dickson 2
1 Obesity Action Scotland, Glasgow, Scotland
2 Diffley Partnership, Edinburgh, Scotland
📌 Allocation: Oral Presentation
Introduction: Information and public discourse around obesity and the food environment is often dominated by numbers. In Scotland, we believe there is a knowledge gap for qualitative data and first-hand public opinion on the issues of diet and obesity prevention. Therefore, we carried out multiple focus groups with members of the Scottish public to hear about their experiences with these matters and whether they supported proposed healthy weight interventions. It is hoped this research will offer the chance to use personal experiences as a tool to advocate for prevention policies that can address high levels of overweight and obesity in Scotland.
Methods: A public survey was issued to identify key characteristics of individuals which were used to form a balanced focus group panel representative of the Scottish public. Three focus group sessions were carried out between November 2022 and March 2023. Each session covered different themes relating to diet, obesity and the food environment. During each session the panel was presented with evidence to help inform their discussions. Short polls were distributed to participants in the lead up to each session with the results used to prompt in-session responses. All panel discussion was transcribed in full and analysed using QDA Miner software to identify common themes.
Results: Thematic analysis revealed that participants were largely able to agree on root issues relating to the food environment and how it contributes to dietary outcomes and obesity. However, disagreements were more obvious when discussing potential policy solutions. The presentation of relevant evidence within each session appeared to surprise some participants and influence their views, while others seemed less affected. The wide-range of mixed opinions across the panel strongly reflected the complexity of obesity and its causes.
Conclusion: The use of qualitative data to tell the stories of everyday people is a powerful tool which is arguably under-utilised by public health groups. This focus group research aims to fill a gap in the advocacy space for healthy diet and weight in Scotland. It also provides rare insight in understanding which areas of obesity prevention gain most public support and where further efforts are needed.
Conflicts of interest: None.
Funding: No funding to report.
Prof Lindsay Jaacks 1, Lorraine Tulloch 2, Robin Ireland 2
1 University of Edinburgh, Edinburgh, UK
2 Obesity Action Scotland, Glasgow, UK
📌 Allocation: Oral Presentation
A national roll out of the whole system approach (WSA) to diet and healthy weight is planned for 2023 in Scotland. Our objective was to develop guidance on effective local levers for diet and healthy weight in the Scottish context. This guidance will be integrated into a package of materials.
Local levers are actions available for local authorities, health boards, schools, and the private and third sectors to support community health by ensuring everyone can get affordable, healthy food and integrate safe and enjoyable physical activity into their daily lives. An emphasis was placed on addressing the social and commercial determinants of health given persistent health inequalities especially with regards to childhood obesity. Our approach involved reviewing existing reports of what works for obesity prevention – for example, from WHO and NICE. Many actions were excluded because they were beyond the scope of local authorities, such as taxation. Other actions were excluded because they focused on individual behaviour change.
Ultimately, seven levers were identified.
1. Restrict outdoor marketing of products high in fat, salt or sugar.
2. Utilise local planning to restrict licensing of takeaways within 800m of schools and to avoid clustering of takeaways.
3. Strengthen public food procurement and provision standards.
4. Work with local food outlets to reduce calories on the menu through reformulation and offering smaller portion sizes.
5. Improve uptake of school meals by pursuing universal free school meals and improving the aesthetics of and social interactions in school dining areas.
6. Promote and support physical activity by following Public Health Scotland’s systems-based approach to physical activity.
7. Protect, promote, and support breastfeeding.
It was recognised that no one of these levers alone will have a huge impact and that as many of the levers as feasible should be implemented in order to take advantage of synergies – for example, between levers #2, #4 and #5. In addition to the roll out of the WSA, the Good Food Nation (Scotland) Act 2022 presents an opportunity for local authorities and health boards to consider these levers in their Good Food Nation plans.
Conflicts of interest: None
Funding: Funded by a grant from Scottish Government
Sophia Bird 1, Ilona Johnson 1
Nutrition and Obesity Prevention, Health Improvement Division, Public Health Wales, Wales
📌 Allocation: Oral Presentation
Welsh Government has committed to improving healthy weight at a national level, through the ‘Healthy Weight: Healthy Wales’ 10-year strategy (2019). One of the 4 themes within the strategy is promoting leadership and enabling change through a whole systems approach (WSA), promoting collaboration and involvement at all levels. Through the strategy, funding has been provided to deliver this approach at a national and local level. This abstract describes the method and early learnings of a WSA for Healthy Weight across Wales. Initially, regional and national system leads were established. System leads and PH Consultant leads networks were developed alongside a programme of training and development in systems thinking and delivering WSA. Assets were developed to support this approach, including an evidence-based 9 step process to guide local systems leads through the approach. The funding provided resource to coordinate this public health way of working across the Health Boards, as well as to take forward the approach at a national level. Nearly 30 Strategic System Engagement events have been held across Wales. At a National and Health Board level, priority subsystems are identifying levers for action around overweight and obesity, and the national evaluation framework to map progress is underway. Qualitative and quantitative data was collated from reports and meetings. Synthesis of data was undertaken using the key components of systems approaches as a framework for analysis. This approach helped identify the strengths and challenges to date. The early results suggest that capacity for a WSA has developed through engagement with senior stakeholders and organisations. In conclusion, Wales has applied a WSA to Healthy Weight at a national and regional level. This approach has significant advantages, including the creating of an enabling environment for stakeholder engagement and buy in; formal and informal learning opportunities; and opportunities to enable policy change. Communication channels have developed nationally and regionally, and system leadership is becoming increasingly established, creating a strong systems working approach. Challenges include maintaining momentum, engagement, capacity and focus on agreed priority systems and subsystems. Further challenges include effective evaluation to fully capture and communicate the system changes over time.
Conflicts of interest: none
Funding: Welsh Government provided the funding for this programme to PHW
Cathy Breen1, Susie Birney1,2, Karen Gaynor1,3, Donal O’Shea3, Ximena Ramos-Salas4, Jean O’Connell1
1Association for the Study of Obesity on the Island of Ireland, Dublin, Ireland
2Irish Coalition for People Living with Obesity, Dublin, Ireland
3Irish Healthcare Executive National Clinical Programme for Obesity, Dublin, Ireland
4Research and Policy Consultant to Obesity Canada and the European Association for the Study of Obesity Consultant, Sweden
📌 Allocation: Oral Presentation
Background: The 2020 Canadian Adult Obesity Clinical Practice Guideline (CPG) was developed over 4 years through a systematic GRADEd and patient-orientated process. The CPG introduced a new obesity definition based on health not body size, incorporated lived experience, and addressed weight bias and stigma in healthcare systems. In 2021, the Association for the Study of Obesity on the Island of Ireland in conjunction with the National Clinical Programme for Obesity and the Irish Coalition for People Living with Obesity successfully bid to become the first European country to adapt the CPG.
Methods: A project co-ordinator, and research assistant were appointed and an Executive Committee with key stakeholders provided governance. The ADAPTE framework was used to ensure the adaptation was relevant, generalisable, and applicable in an Irish setting. The AGREE II and Tools 11, 13, 14 and 15 from the ADAPTE Toolkit were used to guide and quality-assure the adaptation. Sixty-five specialists with wide multidisciplinary and geographical representation, and ICPO representatives, volunteered their time and expertise to contextually adapt eighteen chapters.
Results: Eighteen chapters and 80 recommendations were adapted over an 18-month period. Adaptations included alignment with the Irish model of care for obesity healthcare delivery e.g. the service levels where care is provided and the addition of psychological support before surgery, professional registrations in Ireland, adaptations for European Medicines Agency regulations, and consistency with existing guidance that is used in Ireland e.g. Food Safety Authority of Ireland guidance in relation to sarcopenia and weight loss in older adults, and British Obesity and Metabolic Surgery Society guidelines. There were also language adaptations and reference to 155 pieces of Irish obesity-related research. The adapted CPG was made available on the ASOI website with a summary published in a peer reviewed journal Obesity Facts1.
Conclusion: Adapting the CPG was feasible and reduced development time compared with creating de novo guidelines. The adaptation and implementation of the CPGs will support clinicians and policy makers in Ireland to provide high-quality, standardised, non-stigmatising care to people living with obesity, in line with the model of care for obesity.
1Breen et al (2022), Obes Facts; 15(6):736-752 https://doi.org/10.1159/000527131
Conflicts of interest: The OC adaptation grant was used to provide part-time clinical backfill for Cathy Breen to act as project coordinator. She reports receiving honoraria for educational events or conference attendance from Astra Zeneca, Behaviour Change Training Ltd., Diabetes Ireland, EASO, International Medical Press, Eli Lily, Medscape, MSD, Novo Nordisk and Sanofi Aventis and is a member of the ONCP Clinical Advisory Group, and MECC working group. She is also Chair of ASOI. Susie Birney reports funding to ICPO from the HSE, Novo Nordisk, and the European Coalition for People Living with Obesity (ECPO) and consulting fees or honoraria from Diabetes Ireland, ECPO, Novo Nordisk, and International Medical Press. She also reports that she is the Secretary of ECPO. Karen Gaynor reports receiving honoraria from Behaviour Change Training Ltd. and is Programme Manager with the ONCP. Jean O’Connell reports honoraria for educational events or conference attendance from Novo Nordisk and MSD. Donal O’Shea reports that he is the National Clinical Lead with the ONCP. Ximena Ramos Salas is an independent consultant and has received consulting fees from Obesity Canada, the European Association for the Study of Obesity and the World Health Organization Regional Office for Europe
Funding: Funding for producing the original Canadian CPG came from the Canadian Institutes of Health Research Strategic Patient-Oriented Research initiative, OC’s Fund for Obesity Collaboration and Unified Strategies (FOCUS) initiative, CABPS, and in-kind support from the scientific and professional volunteers engaged in the process. The adaptation pilot funding came from Obesity Canada and EASO based on an unrestricted grant from Novo Nordisk Global. Novo Nordisk was not involved with the implementation of the project. Committee members and adapting authors were volunteers and were not remunerated for their services.
Fiona Gillison (1)
1. University of Bath, Bath, UK
📌 Allocation: Member-led symposium
Across the UK we need to address the dual challenges of rising rates of childhood obesity alongside rising rates of poor mental health and wellbeing, reflected in a recent upward trend in weight loss attempts in children and adolescents. The National Child Measurement Programme (NCMP) in England (and other national measurement programmes) provide excellent data on the prevalence of childhood obesity but have been criticised for failing to adequately consider the potential unintended negative consequences on wellbeing. The aim of this presentation is to provide an overview of the research conducted on the impact of the NCMP on parents and children and explore different interpretations of these findings.
A growing number of studies report on the behavioural and psychosocial outcomes of the NCMP, using a range of different research designs, outcome measures and scale. Many are limited by a low response rate, particularly among families of children classified as having overweight. By the nature of the topic, we lack definitive trials of the impact of a one-off weight measurement such as the NCMP, and it can be hard to separate the impact of measurement and feedback from the exposure children and parents have to information and commentary about weight from other sources. The interpretation of some published studies has also for working from, and failing to challenge the assumption that the benefits of the NCMP and similar schemes outweigh the potential risks. We will reflect on these points to explore why and how some of the published evidence has been used simultaneously to both support and oppose the current model of practice.
To illustrate how people and organisations with different perspectives can be brought together to ensure the best possible outcomes for children, we will present the example of our experience of a recent modified Delphi study undertaken as part of the process of developing guidance for parents on talking to children about weight. This provides a worked example of an occasion when points of agreement and tension were aired and negotiated to find a common acceptable approach.
Conflicts of interest: None to declare
Funding: Unfunded
Jordan R. Marwood, Louisa J. Ells
The Obesity Institute, Leeds Beckett University, Leeds, UK
📌 Allocation: Member-led symposium
Disordered eating is common in people living with obesity, and while there is growing awareness of the severity of this issue, there continues to be a lack of appropriate support. Some reasons for this include underfunded and under resourced eating disorder services, and an historic focus on eating disorders associated with underweight. However, there are also systemic entrenched differences in the philosophies and working practices of eating disorder and weight management researchers and practitioners, for example views on the effectiveness of weight management attempts and their role in eating disorder risk, and the suitability of programmes such as the NCMP. These differences have yet to be examined, but may impact the development and implementation of appropriate support for people living with obesity and disordered eating. This talk will present initial findings from an ongoing mixed-methods project exploring perceived barriers and facilitators to developing shared working across obesity and eating disorder research and practice. Participants will be researchers and practitioners working within the fields of obesity and/or eating disorders and data will be collected using a survey followed by interviews; participants who completed the survey will be asked if they are willing to take part in a semi-structured 1:1 interview, conducted online, in order to examine some of the key themes from the survey in more detail (approximately n=8, with 2 participants from each field and discipline). Closed questions from the survey data will be summarised and presented descriptively. Open questions from the survey and interview data will be analysed using thematic/content analysis. PPIE will be integral to the project and will be used to inform the question development and to interpret findings. The presentation will explore findings in relation to the perception of causes of obesity/disordered eating and how the relationship between these conditions is conceptualised by researchers and clinicians. The presentation will invite audience participation to consider the next steps for research, and integration with policy to bridge the gap between these fields.
Conflicts of interest: None to declare
Funding: Internal funding
Corrigan, Nicola
Office Health Improvement and Disparities Yorkshire and Humber Region
📌 Allocation: Member-led symposium
“at least 14 strategies, 689 policies and 10 targets, and at least 14 key institutions and agencies variously created and abolished”1 ran a report in the Guardian, based on findings by the Institute for Government. Working in the field of Obesity in Public Health we are wrestling with issues such as:
• How can we reconcile public health policy, designed for population level impact, with impact on the individual?
• How can we support stakeholders to support the health and wellbeing outcomes of their populations in the face of conflicting and competing research and evidence?
• How do we ensure that we prioritise reaching those populations experiencing the highest inequalities in health outcomes?
Using the example of a region of England this talk will share personal reflections of the population-based attempts to address increasing prevalence of excess weight and obesity. Drawing on local case study examples of a range approaches, including whole systems, to illustrate the conflict that funding, partnerships, and ideology can have in this space. Also looking at how research and practice collaborations can support the development of the evidence base to incorporate emerging ideas and theories on how best to address the resultant mental and physical health outcomes.
1. How UK governments from Major to Johnson tried to tackle obesity | Obesity | The Guardian 19th April 2023
Conflicts of interest: None
Funding: None
Claire Torrens 1, Alice McLean 1, Catriona O’Dolan 1, Lisa Macaulay 1, Pat Hoddinott 1 (on behalf of the Game of Stones Trial Team)
1 University of Stirling, Stirling, UK
📌 Allocation: Oral Presentation
The World Health Organisation estimates that around 650 million people worldwide are living with obesity and around 1 in 8 are living with a mental health condition. Obesity is associated with higher prevalence of depression and anxiety, and people with mental health conditions have an increased risk for obesity, diabetes and cardiovascular diseases compared to the general population. Behavioural Weight Management Interventions can improve physical and mental health (MH). The Game of Stones (GoS) Trial randomised men (n=585) living with obesity in the UK into three groups: 1) receiving text messages plus financial incentives; 2) receiving texts only; 3) a waiting list control group. The primary outcome is weight loss at 12 months. The aim of this qualitative study, embedded within the GoS process evaluation, is to better understand how living with MH problems and obesity can impact on men’s experiences. Men took part in semi-structured interviews (n=53) after completing their 12-month outcome assessment (30 men received texts and incentives; and 23 received texts only). Of the men interviewed, 13 self-reported a MH condition, while 13 had a Patient Health Questionnaire (PHQ-4) score ≥3 at baseline (suggesting the presence of anxiety and/or depression). Data were analysed thematically using the Framework Method. The analysis (ongoing) considers similarities and differences evident across the men’s accounts whether living with or without MH problems. Early findings indicate differences in perspectives across several inter-related themes: ‘the frequency, content and usefulness of the text messages’; ‘weight loss targets and weight assessment appointments as motivators or stressors’; ‘reflections on financial incentives for weight loss’ and ‘facilitators and barriers to behaviour change’. While men with MH conditions can be daunted by weight loss targets, describing weight assessment appointments as inducing fear of failure and potential feelings of shame or disappointment, others describe weight loss targets as motivating and weight assessment appointments as opportunities for encouragement and renewal of focus. This exploration of perspectives, from men with differing experiences of MH and wellbeing, offers insights for future development and implementation.
Conflicts of interest: None
Funding: This trial is funded by the National Institute for Health and Care Research (NIHR), UK (Ref: NIHR 129,703)
Shokraneh Moghadam 1, Dawn Swancutt 2, Jenny Lloyd 1, Ross Watkins 1, Lily Hawkins 1, Helene Davis 1, Rod Sheaff 2, Jonathan Pinkney 2, Mark Tarrant 1
1 University of Exeter, Exeter, UK
2 University of Plymouth, Plymouth, UK
📌 Allocation: Oral Presentation
Healthcare professionals need a comprehensive skillset to deliver care in specialist weight management services. Evidence suggests that group-based programmes could be an effective strategy for supporting people living with obesity, as they have the potential to improve motivation and capability to change behaviour, as well as providing basis to form meaningful connections. However, training requirements to deliver this type of care are not yet defined. Therefore, identifying and addressing practitioner training needs is essential to improve the likelihood of successful service and health outcomes. Our project aimed to assess the extent to which the PROGROUP training programme met practitioner needs to deliver specialist weight management group-based care, as part of a feasibility randomised controlled trial. Five healthcare professionals and behaviour change experts from well-established specialist weight management services and institutions across the UK participated in a 4-day remote training package. The content of the training package was driven by evidence, psychological theory, and expert practitioner experience. Healthcare professionals were interviewed to elicit feedback about their experience of training. Inductive thematic analysis was carried out using the Framework approach to data management. Overall, healthcare professionals greatly valued walk-through practice examples with the trainers, as well as the opportunity to share and exchange ideas with fellow practitioners, as this gave them the opportunity to rehearse skills, ask questions, and discuss solutions to common challenges. Healthcare professionals showed strong preference for time efficient and self-directed training, due to busy work and life schedules. More guidance about managing processes that occur within a group, as well the delivery of behavioural components to a group, were needed to improve practitioner training experience. In conclusion, practitioners require thorough guidance on group management skills as well the delivery of behavioural components within groups. Flexible learning options are also highly valued. The PROGROUP training package is currently being optimised to address practitioner needs by adopting an online, modular and self-directed approach to training, with the addition of two online workshops to introduce the programme and consolidate learnings.
Conflicts of interest: None.
Funding: Written on behalf of the PROGROUP programme team. This project is funded by the National Institute for Health and Care Research (NIHR) [PROGROUP (NIHR201038)] and in conjunction with the Applied Research Collaboration South West Peninsula [PenARC (NIHR200167)]. The views expressed are those of the author(s) and not necessarily those of the NIHR or the Department of Health and Social Care.
Dimitris Papamargaritis 1,2, Werd Al-Najim 3, Jonathan ZM Lim 4, James Crane 5, Danielle H Bodicoat 6, Mike Lean 7, Barbara McGowan 5, Donal O’Shea 8, David R Webb 1, John PH Wilding 4, Carel W le Roux 3, Melanie J Davies 1
1. University of Leicester, Leicester, UK
2. Kettering General Hospital, University Hospitals of Northamptonshire NHS Group, Kettering, UK
3. University College Dublin, Dublin, Ireland
4. University of Liverpool, Liverpool, UK
5. Guy's and St Thomas' NHS Foundation Trust, London, UK
6. Independent statistician, Leicester, UK
7. Human Nutrition, University of Glasgow, Glasgow, UK
8. St Vincent’s University Hospital, Dublin, Ireland
📌 Allocation: Oral Presentation
A clinically effective and cost-effective prescribing pathway for liraglutide 3mg may improve treatment access for people with severe and complex obesity. We therefore conducted a phase four, open label, real world, randomised controlled trial assessing the clinical effectiveness of a targeted prescribing pathway for liraglutide 3mg with multiple stopping rules as adjunct to standard care in specialist weight management services (SWMS) vs standard SWMS care alone at 52 and 104 weeks (ClinicalTrials.gov:NCT03036800). The trial enrolled adults with BMI ≥35 kg/m2 plus prediabetes, diabetes, hypertension or sleep apnoea from five SWMS in Ireland and UK. Participants were randomly allocated (2:1, stratified by centre and BMI) to a targeted prescribing pathway for liraglutide 3mg with stopping rules at 16 (≥5% weight loss, WL), 32 (≥10% WL) and 52 weeks (≥15% WL) plus SWMS care (intervention) or to SWMS care alone (control). The primary outcome was ≥15% WL at 52 weeks (complete cases analysis). Overall, 392 participants randomized (260 intervention; 132 control) and 294 (201 intervention; 93 control) were included in the 52 weeks primary analysis. Majority of participants was White (86.5%) and female (64.3%), with mean age 51.3 years and mean BMI 45.99 kg/m². A greater proportion of participants at the intervention group achieved WL ≥15% at 52 weeks compared to controls [51/201 (25.4%) vs 6/93 (6.5%); odds ratio 5.18; 95% CI 2.09, 12.88; p<0.001]. Of those achieved ≥15% weight loss at 52 weeks with the targeted prescribing pathway for liraglutide 3mg, 54.8% maintained ≥10% WL at 104 weeks. Mean %WL at 52 weeks was -8.13% with the intervention vs -2.67% at the control group and -5.18% vs -1.21% at 104 weeks respectively. Greater improvements were observed in waist circumference, HbA1c and some quality of life parameters in the intervention group. No new safety signals observed. In summary, a targeted prescribing pathway for liraglutide 3mg with multiple stopping rules is effective in helping more people with severe and complex obesity achieve ≥15% WL at 52 weeks than standard care alone. Directing the long-term liraglutide 3mg use to people achieving ≥15% WL with this prescribing pathway may optimise the cost-effectiveness of medication use.
Conflicts of interest: Papamargaritis D: Acted as speaker for NovoNordisk and has received grants from NovoNordisk, NovoNordisk UK Research Foundation, and Academy of Medical Sciences.
Al-Najim W: Nil
Lim JZM: Nil
Crane J: Educational grants from NovoNordisk
Bodicoat DH: Nil
Lean M: Honoraria for lectures/manuscript writing from NovoNordisk, Roche, Sanofi, Merck, Nestle, and Oviva; departmental research support from NovoNordisk, Diabetes UK, and NIHR; participation in advisory boards of Nestle and NovoNordisk; and unpaid medical advice to Counterweight
McGowan B: Shareholder of Reset Health and serves on advisory board for Pfizer, NovoNordisk, Lilly, Johnson and Johnson. Educational grant from NovoNordisk and educational consultancies for NovoNordisk, Sanofi-Aventis, Biogen and Lilly.
O’Shea D: Honoraria as a speaker for NovoNordisk, AstraZeneca, Sanofi-Aventis and Lilly.
Webb DR: Honoraria as a speaker for AstraZeneca, Sanofi-Aventis, and Lilly, and received research funding support from NovoNordisk.
Wilding JPH: Consultancy / advisory board work contracted via the University of Liverpool (no personal payment) for AstraZeneca, Boehringer Ingelheim, Lilly, Napp, NovoNordisk, Mundipharma, Rhythm Pharmaceuticals, Sanofi, Saniona, Tern, Shionogi & Ysopia. Named grantholder (at University of Liverpool) for research grants for clinical trials from AstraZeneca and NovoNordisk. Personal lecture fees from AstraZeneca, Boehringer Ingelheim, Napp, NovoNordisk and Rhythm in relation to lectures about diabetes and/or obesity.
le Roux CW: Grants from the Irish Research Council, Science Foundation Ireland, Anabio, and the Health Research Board. He serves on the advisory boards of NovoNordisk, Herbalife, GI Dynamics, Eli Lilly, Johnson & Johnson, Sanofi Aventis, AstraZeneca, Janssen, Bristol-Myers Squibb, Glia, and Boehringer Ingelheim. Member of the Irish Society for Nutrition and Metabolism outside the area of work commented on here. Chief medical officer and director of the Medical Device Division of Keyron since January, 2011. Both are unremunerated positions.
Davies MJ: Consultancy, advisory board member and speaker for Boehringer Ingelheim, Lilly, NovoNordisk and Sanofi, an advisory board member and speaker for AstraZeneca, an advisory board member for Janssen, Lexicon, Pfizer and ShouTi Pharma Inc, a speaker for Napp Pharmaceuticals, Novartis and Takeda Pharmaceuticals International Inc. and has received grants in support of investigator and investigator initiated trials from NovoNordisk, Sanofi Aventis, Lilly, Boehringer Ingelheim, Astrazeneca and Janssen.
Funding: This was an investigator-initiated study funded by Novo Nordisk. The funder of the study had no role in study design, data collection, data analysis and data interpretation.
Pedro Miguel Magalhães 13, José Eduardo Teixeira 12, José Augusto Bragada 13, Vítor Pires Lopes 13
1 Polytechnic Institute of Bragança, Bragança, Portugal (IPB)
2 Polytechnic Institute of Guarda, Guarda, Portugal (IPG)
3 Research Centre in Sports, Health and Human Development, Vila Real, Portugal (CIDESD)
📌 Allocation: Oral Presentation
The beneficial effects of regular physical exercise on glycaemic control and resting systolic and diastolic blood pressure in patients with type 2 diabetes (T2D), are relatively well documented in the literature, namely in short (4 to 16 weeks) and medium (16 to 26 weeks) duration programs. Less consensuses exists about long-term exercise effects on body composition and insulin resistance, where the literature shows contradictory results. The present study aims to evaluate the effects of a long duration exercise intervention program on body composition and insulin resistance (HOMA-IR) in patients with T2D from a northeast Portuguese primary health care. Participated in this study 23 patients with T2D (15 women and 8 men; mean age of 63,7±6,9 years). A long-term moderate-intensity training program (32 months) was implemented, mostly aerobic (walking at ±6 km·h-1 speed, water aerobics exercises), five times a week (4 land sessions and 1 aquatic session per week), with a 55 minutes duration per session. We made an assessment every 4 months, resulting in a total of 9 assessments throughout the duration of the experimental protocol. The data were analysed by hierarchical linear modelling. Between each assessment, we observed a significant effect of the training program on the reduction of body mass index (BMI) [-0.092 Kg·m2 (95% CI: -0,127; -0.057)], waist circumference (WC) [-0.403 cm (95% CI: -0.522; -0.283)], waist-hip ratio [-0.002 (95% CI: -0.002; -0.001)], sum of skinfolds [-0.179 mm (95% CI: -0.339; -0.019)], and insulin resistance (homeostasis model assessment insulin resistance – HOMA-IR) [-0,080 units (95% CI: -0.142; -0.019)]. We conclude that this supervised regular structured exercise program, when maintained over time, and if participants' assiduous adherence can be maintained, can be a useful and safe component of the therapy lifestyle to improve body composition and reduce insulin resistance. As a practical application, the incorporation of this type of supervised intervention, in association with nutritional and physical activity prescription at the level of health centres, may represent a relevant strategy in health promotion, namely as a primary and secondary prevention for T2D.
Conflicts of interest: The authors declare that there is no conflict of interest.
Funding: This research was funded by the Project “GreenHealth Digital strategies in biological assets to improve well-being and promote green health” (Norte-01-0145-FEDER-000042), supported by North Portugal Regional Operational Programme (NORTE 2020), under the PORTUGAL 2020 Partnership Agree.
Fannie Lajeunesse-Trempe 1,2, Dominika Okroj 3, Eduard Ostarijas 4, David Llewellyn 1, Chris Harlow 1, Nikhil Chandhyoke 1, Alan Ramalho 2, Eve-Julie Tremblay 2, Andre Tchernof 2, Caroline Copeland 5, Georgios K. Dimitriadis 1,6
1 )Department of Endocrinology ASO/EASO COM, Kings College Hospital NHS Foundation Trust
2) Quebec Heart and Lung Institute, Laval University
3)Department of Endocrinology and Internal Medicine, Faculty of Medicine, Medical University of Gdańsk, Gdańsk, Poland
4) University of Pecs Medical School
5) Pharmaceutical Medicine, Kings College of London
6) Obesity T2D and Immunometabolism Research Group, Faculty of Cardiovascular and Metabolic Medicine & Sciences, King’s College London
📌 Allocation: Oral Presentation
Background: Bariatric and metabolic surgery is increasingly performed in the UK, as it remains the most effective treatment for severe obesity and associated comorbidities. However, little is known about the impact of these interventions on oral drug and supplement absorption.
Objectives: To evaluate the impact of bariatric surgery on the pharmacokinetic (PK) parameters of orally administered drugs and supplements.
Methods: Systematic searches of bibliographic databases MEDLINE, EMBASE, CENTRAL, EudraCT, ClinicalTrials.gov, TOXNET, MedRvix, CINAHL and SCOPUS were conducted to identify relevant studies. Pooled effect estimates from different surgical procedures were calculated using a random-effects model.
Results: Quantitative data were synthesised from 56 studies including a total of 1985 participants. Whilst 45 drugs and 8 supplements were evaluated across these studies, heterogeneity and missing information on surgery type reduced the scope of the meta-analysis to the following drugs and supplements: atorvastatin, paracetamol, omeprazole, midazolam, vitamin D, calcium, zinc and iron supplements, with data variability on drug/supplement dose and formulation, time point of post-operative sampling, and consideration of weight loss persisting as potential confounders of data interpretation. The remaining 41 drugs and 4 supplements were included in a systematic review. There were no significant differences in PK parameters post-surgery for the drugs atorvastatin and omeprazole, and supplements calcium, ferritin and zinc. Paracetamol showed reduced clearance (mean difference (MD)= -15.56L/hr, p=0.0002, I2=67%), increased maximal concentration (MD=4.78g/ml, p=0.006, I2=92%) and increased terminal elimination half-life (MD=0.49hr, p<0.0001, I2=3%) post-surgery. 25OH-vitD concentration significantly increased post-operatively on oral supplementation (MD=6.38ng/ml, p<0.0001, I2=98%). Overall, 18 of the 53 drugs and supplements in this meta-analysis and systematic review showed post-operative changes in PK parameters.
Conclusion: Our study demonstrates significant heterogeneity in practice and could not reach conclusive findings for most PK parameters. There is urgent need for well-designed prospective studies to inform best practice and enhance patient healthcare and safety.
Conflicts of interest: The authors of this manuscript declare that there is no conflict of interest that could be perceived as prejudicing the impartiality of the research reported.
Funding: This research did not receive any specific grant from any funding agency in the public, commercial or not-for-profit sector.
Danielle Schoenaker 1,2, Judith Stephenson 3, Helen Smith 4, Helen Duncan 4, Keith M Godfrey 2,5, Mary Barker 5,6, Nisreen A Alwan 1,2,7
1 School of Primary Care, Population Sciences and Medical Education, Faculty of Medicine, University of Southampton, Southampton, UK
2 NIHR Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton, UK
3 Elizabeth Garrett Anderson Institute for Women's Health, University College London, London, UK
4 Department of Health and Social Care, Office for Health Improvement and Disparities, London, UK
5 MRC Lifecourse Epidemiology Centre, University of Southampton, Southampton, UK
6 School of Health Sciences, Faculty of Environmental and Life Sciences, University of Southampton, Southampton, UK
7 NIHR Applied Research Collaboration Wessex, Southampton, UK
📌 Allocation: Member-led symposium
Preconception overweight and obesity can have significant adverse transgenerational health impacts, including increased risk of infertility, pregnancy complications and offspring obesity and chronic metabolic conditions. This study aimed to describe socio-demographic differences in preconception overweight and obesity among pregnant women in England. Among 652,880 women who had a first antenatal (booking) appointment recorded in the national Maternity Services Dataset between April 2018 and March 2019, 496,331 (76.0%) had valid data on BMI and were included in analysis. Height and weight were self-reported or measured and included if women had their appointment <14 weeks gestation when BMI is likely unaffected by pregnancy-related weight gain. Women’s age was based on date of birth, ethnicity was self-reported, and level of deprivation was based on postcode and expressed as the Index of Multiple Deprivation. Descriptive analyses examined differences in overweight (BMI 25.0-29.9 kg/m2) and obesity (≥30.0 kg/m2) prevalence by age, ethnicity and level of deprivation (quintiles). Proportions and 95% confidence intervals (CI) were estimated, and mutually adjusted for socio-demographic characteristics and previous pregnancy. Women included in the analysis had a mean age of 30y (SD 5.6), a median gestational age of 9 weeks and 3 days at booking (interquartile range 59-75) and 36.4% were pregnant for the first time. One in two women (50.3%) had overweight (28.0%) or obesity (22.3%). Overweight was least prevalent in women aged <20y (22.3%, 95% CI 20.6-24.0) which increased to 30.8% (29.9-31.6) among women aged ≥40y. The prevalence of obesity did not show a trend across age. Both overweight (33.8, 32.9-34.8) and obesity (29.8, 29.0-30.7) were most prevalent among women of black ethnicity. The proportion of women with overweight did not differ by level of deprivation, while the prevalence of obesity substantially increased from 17.0% (16.6-17.4) (least deprived area) to 28.9% (28.5-29.2) (most deprived). These findings identify an urgent need for public health interventions to support women of reproductive age to prevent and manage overweight and progression to obesity. The mixed pattern of socio-demographic differences suggests tailored efforts may be needed to reduce transgenerational inequalities in overweight, obesity and the associated health, social and economic impact.
Conflicts of interest: None.
Funding: This work was funded by the National Institute for Health and Social Care Research (NIHR), Southampton Biomedical Research Centre [IS-BRC-1215-20004]. The views expressed are those of the authors and not necessarily those of the NIHR or the Department of Health and Social Care.
Emma H Cassinelli 1, Michelle C McKinley 1, Lisa Kent 1, Kelly-Ann Eastwood 1-2, Danielle AJM Schoenaker 3, Laura McGowan 1
1. Centre for Public Health & Institute for Global Food Security, School of Medicine, Dentistry and Biomedical Sciences, Queen’s University Belfast, Belfast (United Kingdom).
2. University Hospitals Bristol NHS Foundation Trust, Bristol (United Kingdom).
3. School of Primary Care, Population Sciences and Medical Education, Faculty of Medicine, University of Southampton, Southampton (United Kingdom).
📌 Allocation: Member-led symposium
Living with obesity can give rise to unique reproductive challenges and compromise preconception health, defined as the overall health of non-pregnant individuals of childbearing age (15-49 years). Folic acid supplementation is a key preconception health behaviour, and women with obesity are recommended a higher dose (5mg/day) to reduce the risk of fetal complications. This study aimed to explore 1) trends in Body Mass Index (BMI) in the preconception and early pregnancy period in Northern Ireland (NI), and 2) the prevalence of folic acid supplementation across BMI categories.
Anonymised national data routinely collected in the Northern Ireland Maternity System (NIMATS) dataset were accessed. Multiple linear regressions explored trends in BMI between January 2011 and December 2021 and χ2 tests explored associations between BMI categories and self-reported folic acid supplementation between December 2014 and December 2021.
The analyses included a total of 255117 pregnancies, with missing data addressed per variable. The percentage of women entering pregnancy with a healthy BMI decreased between 2011 and 2021 (48.65%, n=12144, and 39.55%, n=4316, respectively), while the percentage of women with obesity increased over the same period (18.11%, n=4520, and 27.36%, n=2986, respectively). Regression models exploring BMI trends were statistically significant (p<0.001) in both the unadjusted model and the model adjusted for age, deprivation and number of previous births, suggesting an average increase of ~1 unit of BMI per calendar year in women entering pregnancy.
In the whole sample, folic acid supplementation was mostly initiated after conception (59.03%, n=86319), with only 33.01% (n=48267) and 4.53% (n=6628) of pregnancies being supplemented with 400mcg and 5mg before conception, respectively. Among women living with obesity, the recommended preconception supplementation of 5mg of folic acid was low (8.74%, n=2990). A further 23.87% (n=8168) of pregnancies from women with obesity were supplemented with 400mcg of folic acid before conception.
Overall, analyses demonstrated an increased number of women entering pregnancy with an elevated BMI and suboptimal preconception folic acid supplementation, particularly at the recommended dosage for women with obesity. This study highlights the need to optimise preconception health in NI, including among women living with obesity.