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 101 - 115 of 115 abstractsLem Ngongalah
Population Health Sciences Institute, Newcastle University
📌 Allocation: Member-led symposium
Black women have a higher prevalence of overweight and obesity, increasing their risk of pregnancy-related complications and mortality. Dietary behaviours significantly impact maternal and child health during pregnancy. Upon migration to high-income countries, African women tend to adopt a bicultural dietary approach, combining Westernized and traditional African behaviours. Traditional African diets are often rich in whole grains, legumes, fruits, and vegetables, which offer overall health benefits and may help prevent chronic diseases. Preserving traditional dietary practices also provides a sense of cultural identity and promotes social cohesion. However, some traditional African diets can be energy dense and high in unhealthy fats and sugars, contributing to overweight and obesity. Meanwhile, Westernized food environments in high-income countries characterized by easy access to processed and fast foods can lead to the adoption of less healthy eating habits, which can have serious implications for maternal and child health.
Resources like the Eatwell guide and midwife support are available to promote healthy eating during pregnancy. However, these are typically centered around traditional British foods and may not reflect the dietary habits or needs of African women. Findings from African migrant women in England highlight pre- and post-migration factors influencing their dietary and weight management needs during pregnancy. These include challenges in adapting to a new food and living environment, cultural restrictions on eating behaviors, differing perceptions of healthy weights, and reduced social support. The women also struggle to relate to dietary recommendations from the Eatwell guide, as examples provided differ from their familiar meals. Identifying food groups, especially in African dishes with unfamiliar English names, poses additional challenges. Women tend to rely on advice from friends, relatives, and the internet, which are not always trustworthy and could lead to further health risks. The delivery of dietary advice through leaflets is also seen as inconvenient and time-consuming. To address these challenges, my fellowship project aims to adapt the Eatwell guide to incorporate the unique needs of African women, considering their cultural and migrant backgrounds. Culturally sensitive support can help African migrant women achieve healthy diets and weights during pregnancy, ultimately improving maternal and child health outcomes.
Conflicts of interest: None
Funding: Newcastle University Faculty Fellowship
Moscho Michalopoulou 1,2, Susan A Jebb 1,2, Lucy H Mackillop 3,4, Pamela Dyson 2,5, Jane E Hirst 3,4, Amy Wire 6, Nerys M Astbury 1,2
1. Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
2. NIHR Oxford Biomedical Research Centre, Oxford, UK
3. Nuffield Department of Women’s and Reproductive Health, University of Oxford, Oxford, UK
4. Oxford University Hospitals NHS Foundation Trust, Oxford, UK
5. Oxford Centre for Diabetes, Endocrinology and Metabolism (OCDEM), University of Oxford, Oxford, UK
6. Berkshire Healthcare NHS Foundation Trust, Bracknell, UK
📌 Allocation: Member-led symposium
Carrying or gaining excessive weight during pregnancy increases the risk of gestational diabetes mellitus (GDM). Low-carbohydrate diets have shown promise for blood glucose and weight control in people with type 2 diabetes, but there is no evidence to support their use in pregnancy. Here we report results from a feasibility trial delivering a moderately reduced-carbohydrate intervention, designed to help prevent GDM. Fifty-one women who were pregnant <20 weeks’ gestation, with body mass index ≥30kg/m2, and a negative baseline oral glucose tolerance test (OGTT), were randomised 2:1 to a moderately reduced-carbohydrate diet or control (usual care). The dietary plan aimed to provide 130-150 g of total carbohydrate/day. The programme combined a 30-minute consultation by a healthcare professional, with structured written information, supplemented by up to six 10-15-minute telephone sessions for support as needed. The feasibility outcomes were: 1) adoption of the reduced-carbohydrate advice by the intervention group at 24-28 weeks’ gestation, and 2) retention of all participants, assessed by completion of a second OGTT at 24-28 weeks’ gestation. Secondary outcomes included incidence of GDM, change in markers of glycaemic control, gestational weight gain (GWG), total carbohydrate and energy intake. Process outcomes examined resource and management issues. Exploratory outcomes included further dietary changes, quality of life, maternal and neonatal outcomes, and qualitative measures. Forty-nine of 51 participants attended the 24-28-week OGTT, a retention rate of 96% (95% CI 86.8% to 98.9%). In the intervention group, total carbohydrate intake at follow-up was 190.4 (95% CI 162.5 to 215.6) g/day, an adjusted reduction of -24.6 (95% CI -51.5 to 2.4) g/day, from baseline. Potentially favourable effects of the intervention were observed with regards to blood glucose control, GWG, and blood pressure, compared to control, however, the study was not powered to detect significant differences in these. The intervention was acceptable, but some participants reported barriers to sustained adherence, mainly pertaining to competing priorities. In conclusion, retention was high, suggesting the study processes are feasible, but the reduction in carbohydrate intake in the intervention group was small, and did not meet pre-specified progression criteria, limiting the likelihood of achieving the desired goal to prevent GDM.
Conflicts of interest: Lucy H Mackillop is a part-time employee of EMIS Group plc.
Funding: This trial was funded by the NIHR Oxford Biomedical Research Centre. Moscho Michalopoulou's time on this project was funded by Oxford-Medical Research Council Doctoral Training Partnership . Jane E Hirst is supported by a UK Research and Innovation Future Leaders Fellowship. This trial was sponsored by the University of Oxford, Clinical Trials and Research Governance.
Dunla Gallagher 1, Stephan U Dombrowski 2, Caroline McGirr 1, Ciara Rooney 1, Pat Hoddinott 3, Annie S Anderson 4, Chris R Cardwell 1, Lauren Edge 1, Caroline Free 5, Emma Hoey 1, Valerie A Holmes 1, Frank Kee 1, Halla Kiyan Iqbal 1, Emma McIntosh 6, Camilla Somers 6, Ian S Young 1, Jayne V Woodside 1 and Michelle C McKinley 1.
1. Queen’s University Belfast, Belfast, UK.
2. University of New Brunswick, Canada.
3. University of Stirling, UK.
4. Ninewells Medical School, Dundee, UK.
5. London School of Hygiene & Tropical Medicine, London, UK.
6. University of Glasgow, Glasgow, UK.
📌 Allocation: Member-led symposium
Weight management interventions that are sensitive to the needs of women in the postpartum period are needed, and those that combine diet and activity behaviour change and include self-regulatory behaviour change techniques (BCTs) are more likely to be successful. The SMS pilot study examined the feasibility and acceptability of an automated, 12-month, bi-directional, text-messaging intervention to support postpartum diet, activity and weight management, compared with an active control delivering child development messages. This presentation will describe change in self-regulatory behaviours, in terms of enactment of BCTs, relating to the intervention theory and how this related to intervention engagement.
This two-arm pilot randomised controlled trial recruited women in Northern Ireland, within two years of giving birth, with a BMI ≥25 kg/m2, through community groups. Mediators of behaviour change were measured using questionnaires at 0, 3, 6, 9 and 12 months. Intervention engagement was assessed via responses to the two-way text messages incorporated into the library of text messages and engagement classified as high or low based on the median response rate. Secondary data analysis using descriptive statistics examined between-groups differences in mediator change, relative to baseline, across study timepoints, and according to engagement (low vs high) in the intervention group.
One hundred women were randomised (intervention: 51; control: 49). Between 0 and 12 months, the intervention group, compared with the control group, shows greater increase in the proportion of women: 1) weighing themselves weekly (+26% vs +4%); 2) self-monitoring dietary intake (+2% vs -11%); 3) setting goals for food and drink (+22% vs -9%); and 4) planning a healthy diet (+25% vs +2%) and planning physical activity (+17% vs +5%), respectively. At 12 months, high versus low engagers with the intervention were more likely to: 1) weigh themselves weekly (94.2% vs 56.3%); 2) self-monitor dietary intake (33.3% vs 16.7%); and 3) set food and drink goals (53.3% vs 50%).
The intervention supports positive changes in self-regulatory behaviours which are more pronounced for those with the highest intervention engagement. Women in the intervention group enact key BCTs in the messages, indicating that the intervention is working as anticipated in the logic model.
Conflicts of interest: Emma McIntosh is a member of the National Institute for Health Research (NIHR) Public Health Research (PHR) Funding Board. Ian S Young was a member of the Health Technology Assessment (HTA) National Stakeholder Advisory Group (2015 to present). Frank Kee was a member of the NIHR PHR Research Funding Board and PHR Prioritisation Group (2009–19). Dunla Gallagher received funding from Slimming World (Miles-Bramwell Executive Services Ltd, Alfreton, UK) for work conducted prior to her involvement in this study.
Funding: This research was funded by the National Institute for Health Research (NIHR) Public Health Research (PHR) Programme (project number 14/67/20).
Leila Fathi 1, Jacqueline Walker 1, 2, Clare Dix 1, Jessica Cartwright 1, Suné Joubert 1, Kerri Carmichael 1, Yu-Shan Huang 1, Robyn Littlewood 1,2, Helen Truby 1
1 School of Human Movement and Nutrition Sciences, The University of Queensland, Brisbane, Australia
2 Health and Wellbeing Queensland, Brisbane, Australia
📌 Allocation: Member-led symposium
Introduction: It is vital that schools have structures in place that support children's health and offer social and physical opportunities for behaviour change. School-based nutrition programs can improve students' nutrition and and reduce the risk of developing obesity, however, most programs are abandoned within two years of implementation, which does not optimise investments of funding and resources. This review aimed to identify and synthesise the enablers and barriers that influence the long-term (≥2 years) sustainment of school-based nutrition programs.
Methods: Four databases (PubMed, Cochrane Library, Embase and Scopus) were searched to identify studies reporting on the international literature relating to food and nutrition programs aimed at school aged (5-14 years) children that had been running for ≥2 years (combined intervention and follow-up period). Eligible studies were analysed using the Integrated Sustainability Framework, which involved deductive coding of program enablers and barriers. A quality assessment was completed, using the Mixed-Methods Appraisal Tool and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines.
Results: From the 7366 articles identified, 13 studies (seven qualitative, five mixed methods and one quantitative descriptive) were included, from which the enablers and barriers of 11 different nutrition-related programs were analysed. Thirty-four factors across the five domains of the Integrated Sustainability Framework were identified that influenced the sustained implementation of programs. The most common barrier was a lack of organisational readiness and resources, whereas the most common enabler was having adequate external partnerships and a supportive environment.
Conclusion: These findings have application during the initiation and implementation phases of school-based nutrition programs. Paying attention to the ‘outer contextual factors’ of the ISF including the establishment and maintenance of robust relationships across whole of government systems, local institutions and funding bodies are crucial factors for program sustainment.
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.
Niamh O’Kane 1, Ruth Hunter 1, Desiree Schliemann 1, Leandro Garcia 1, Jayne Woodside 1
1 Centre for Public Health, School of Medicine, Dentistry and Biomedical Sciences, Queen’s University Belfast
📌 Allocation: Member-led symposium
Background
Poor diet quality in childhood and adolescence is a global public health concern. Schools can act as an important potential setting for the improvement of diet quality, and the reduction of inequalities. Whole-school approaches are recommended in literature, however, the complexity of the school system can create difficulties in successfully implementing whole-school approaches. This study aimed to apply a systems lens to the secondary school food system, to understand what factors are driving food choice.
Methods
Participatory methods were used with a range of school stakeholders to co-produce a systems map of factors driving food choice in the secondary school food system. An online survey gathered an initial list of factors, and a group model building workshop was conducted to establish relationships between these factors. Two school workshops with school pupils captured the views from pupils and gathered their feedback on the map. The map then underwent final refinement by the research team and all stakeholders were offered an opportunity to provide feedback on the final version of the map.
Results
The systems map contained 24 factors with 43 relationships between them, each factor falling into one of six themes: catering and procurement, school leadership and governance, the priority of food within schools, social experience, behaviours and attitudes, the food space and experience in school and financial. The map demonstrates how each of the factors interact with each other (including direction of influence).
Conclusion
The systems map provides a visualisation of the complex secondary school food system and can be used by stakeholders in the design and evaluation of whole-school, multi-component interventions and programmes targeting food choice in secondary schools.
Conflicts of interest: N/A
Funding: This study was funded by the UK Prevention Research Partnership (UKPRP)
Sofie Power 1, Nikita Rowley 1, Michael Duncan 1 and David Broom 1
1 Coventry University, Coventry, UK.
📌 Allocation: Oral Presentation
Undertaking home-based exercise should be a positive, health enhancing, lifestyle behaviour, particularly for adults living with overweight and obesity. However, exercise programmes are seldom designed in collaboration with people with lived experience of overweight and obesity, potentially limiting adherence, efficacy and effectiveness. Considering the continued rise in the prevalence of people living with overweight and obesity, developing effective exercise programmes is becoming increasingly important. This study aims to further refine and tailor a co-designed, home-based exercise programme for adults living with overweight and obesity, by gleaning insight and feedback from people with lived experience. Concurrently, identifying programme strengths and further improvements from participants with and without involvement in the preceding programme design stage. Following institutional ethics approval, two focus groups with 13 total participants (in person n = 6 and virtual n = 7) were conducted, facilitated by SP and DB. Both focus group discussions were recorded and transcribed verbatim upon completion. Following reflection and discussion by the research team, three key priorities for home-based exercise programme design, development and alteration, specifically for adults living with overweight and obesity, were identified. These were further supported by additional pertinent findings, with corresponding participant quotes, and resulting home-based exercise programme alterations. The key priorities identified were ‘individualisation’: a person-centred programme was a non-negotiable aspect of the design. ‘Motivation’: the integration of motivational programme features was an important influencer in engaging and adhering to a home-based exercise programme. ‘More than just weight loss’: a desire for focus on alternative programme characteristics and benefits, wider than solely numerical weight loss. These priorities have led to further programme refinement, in an effort to ensure the final intervention is needs sensitive and grounded in lived experience. Following development completion and pilot testing, the home-based exercise programme will be assessed using a feasibility randomised controlled trial design. As a result, we hope that researchers can better develop and refine population specific exercise programmes, by engaging with people with lived experience and creating facilitative opportunities for their voices to be heard and acted upon.
Conflicts of interest: The authors declare no conflicts of interest.
Funding: This research was supported by Research England, through funding provided to Coventry University to support participatory research. However, the funders had no role in the design of the study, in the collection, analyses, or interpretation of data.
Seonad K Madden 1,2, Kiran DK Ahuja 1, Briony Hill 2, Claire Blewitt 2, Helen Skouteris 2, Andrew P Hills 1
1. School of Health Sciences, College of Health and Medicine, University of Tasmania, Launceston, TAS 7250, Australia
2. Health and Social Care Unit, School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC 3004, Australia
📌 Allocation: Oral Presentation
Rising numbers of women are entering pregnancy with overweight and obesity, gaining excess weight during pregnancy, and retaining weight postpartum. Workplaces, including educational institutions, are opportune locations to engage preconception women in obesity prevention and health promotion. Digital health interventions for preconception, pregnant, and postpartum (PPP) women have shown promise in community service workplace and healthcare contexts. Using an Intervention Mapping approach, we aimed to co-design and assess the feasibility of a contextualised university workplace portal to promote the health practices and wellbeing of PPP working women. Development consisted of 1) a needs assessment including a systematic review, context definition, a work and wellbeing survey (n = 241), five semi-structured focus groups with 25 women employees, and an environmental assessment conducted at 10 worksites within the university to determine the availability of resources to support the health and transition to parenthood of women during the PPP periods; 2) formation of a design group and an advisory group; 3) a series of online co-design activities to identify determinants and project goals, discuss multi-level strategies for change, and specify portal design and content; and 4) portal production and feasibility testing. Needs assessment participants described contextual enablers and barriers to engaging in health practices and their wellbeing, including the physical work environment, workplace culture, the job role (i.e., working in academia and insecure contracts), and leadership. Design group participants stressed the importance of not ‘reinventing the wheel’ when it came to incorporating existing wellbeing resources into the portal, as well including a manager toolkit and wellbeing calendar. While design group participants appreciated the value of content relating to their health practices, they did not wish to have an overall focus on weight. The resulting portal includes guides, links to evidence-based information, goal-setting features, workplace policies and procedures, infographics, and videos (e.g., women in research) for employees and managers. Further research is required to determine 1) the impact of the portal and accompanying recommended organisation-level strategies in positively influencing the health practices and wellbeing of PPP women employees and 2) the core and context-specific components of digital health interventions for PPP women.
Conflicts of interest: Dr Ahuja and Prof Hills are employees at the University of Tasmania (site of study) and Ms Madden is a PhD Candidate at the University of Tasmania.
Funding: Ms Madden was funded by an Australian Government Research Training Program (RTP) Stipend and RTP Fee-Offset Scholarship. Funding for the creation and distribution of the Work and Wellbeing Survey was provided by People and Wellbeing at University of Tasmania, Australia. Dr Hill was funded by an Australian Research Council Discovery Early Career Researcher Award (DE230100704).
Funding for this research was provided by the Australian Government’s Medical Research Future Fund (MRFF; TABP-18-0001) and the National Health and Medical Research Council (NHMRC) through the Centre for Research Excellence in Health in Preconception and Pregnancy (CRE HiPP) (GNT1171142). The MRFF provides funding to support health and medical research and innovation, with the objective of improving the health and wellbeing of Australians. MRFF funding has been provided to The Australian Prevention Partnership Centre under the MRFF Boosting Preventive Health Research Program. Further information on the MRFF is available at www.health.gov.au/mrff.
Jo Howe 1, Maura MacPhee 2, Emilia Piwowarczyk 2, Geoff Wong 3, Hafsah Habib 1, Sheri Oduola 4, Amy Ahern 5, Suzanne Higgs 6, Dan Rowbotham 7, Katherine Allen 8, Alex Kenny 7, Justine Lovell 7, Ian Maidment 1
1 Aston University, Birmingham, UK
2 University of British Columbia, Vancouver, Canada
3 University of Oxford, UK
4 University of East Anglia, Norwich, UK
5 University of Cambridge, UK
6 University of Birmingham, UK
7 McPin Foundation, London, UK
8 Birmingham and Solihull Mental Health Foundation Trust, Birmingham,UK
📌 Allocation: Oral Presentation
Introduction
Antipsychotic medication is a key treatment for severe mental illness (SMI). These medications are associated with a range of side-effects, one of which is weight gain. Obesity rates in SMI are double the general population and contribute to serious, life-limiting physical health conditions, such as heart disease and diabetes. Although obesity is life-limiting, there is relatively limited research on obesity management for people living with SMI in the “real world”. This presentation will address the realist question: What, how, when, and why should practitioners address weight gain with service users (SUs) with SMI?
Methods
RESOLVE is a 28-month long research study, currently underway, using secondary data from literature and primary data from realist interviews with service users (SUs) living with SMI and antipsychotic-related weight gain, practitioners who treat SUs with SMI, and carers of SUs with SMI who have experienced antipsychotic weight gain. Primary data are from interviews purposively sampled with participants recruited from five NHS Trusts in England, social media, professional networks, and the McPin Foundation (a charity working in SMI and co-applicant on RESOLVE). A programme theory and context-mechanism-outcome configurations are being co-produced by researchers and an advisory group of stakeholder representatives.
Findings
Preliminary findings indicate disjointed, siloed services for physical and mental health, resulting in barriers for SUs with SMI accessing obesity management care. Internalised stigma associated with SMI and obesity hinders the ability of SUs to initiate discussions about weight gain. SU’s preferences are for frequent conversations about weight to be initiated by their trusted mental health practitioners in respectful and non-judgmental ways. However, interviews with practitioners indicate this is an area where they lack the appropriate skills and confidence to have these “difficult conversations” related to weight gain.
Implications for practice
The stigma associated with SMI and obesity may prevent timely and effective interventions for this population; a population that requires additional practitioner support to effectively manage weight gain. A potential practice implication could include training in obesity management for staff working within mental health services to enable them to feel more confident conducting “difficult conversations” with service users and carers.
Conflicts of interest: None
Funding: RESOLVE is funded by the National Institute for Health and Care Research (NIHR), Health and Social Care Delivery Research (HS&DR( (Ref No: 131871)
Elizabeth H. Evans 1, Angela Incollingo Rodriguez 2, Taniya S. Nagpal 3, Shelina Visram 4, Charlotte Hardman 5, Nicola Heslehurst 4
1 Durham University, Durham, UK
2 Worcester Polytechnic Institute, Massachusetts, USA
3 University of Alberta, Alberta, Canada
4 Newcastle University, Newcastle upon Tyne, UK
5 University of Liverpool, Liverpool, UK
📌 Allocation: Oral Presentation
In 2019, a UK cancer research charity aimed to raise awareness of the link between obesity and cancer with billboard advertisements designed to resemble cigarette packets stating, “obesity is a cause of cancer too”. The campaign ignited a media debate about the ethics and efficacy of this public health framing. Little is known about the public interpretation of campaigns framing obesity in this way. Consequently, this quantitative, experimental between-groups study examined whether adult participants (N=414) who viewed and answered memory recall questions about the obesity-focused billboards reported greater post-exposure weight stigma than those who viewed a non-obesity related campaign. A subset of participants (n=138) provided qualitative responses regarding perceived risks, benefits, and overall acceptability of the obesity-focused campaign. Quantitative data showed that participants who had viewed the obesity-focused campaign did not differ in levels of weight stigma from participants who did not (F(1,412=0.00, p=0.99). Descriptive thematic analysis of the qualitative data found that perceived potential benefits of the campaign included raising awareness of obesity risks, promoting healthy lifestyle, and improving health outcomes. However, many participants perceived no benefits and most considered it unlikely that benefits would be realised. Perceived potential risks included shame, stigmatisation, reduced self-esteem, and increased risk of mental health difficulties for people living with obesity. Participants were polarised but broadly equally divided on whether the campaign’s benefits outweighed its risks; few took a neutral stance. When comparing across quantitative and qualitative data, participants with a higher BMI were more likely to view the campaign as stigmatising (r=0.23, p=0.01) and were less likely to believe that it would educate the public (r=-0.21, p=0.02). Participants with more stigmatising attitudes towards obesity were more likely to perceive the campaign as justified (t(112)=2.76, p=0.003). Overall, this controversial campaign provoked responses as mixed in our participants as it did in the surrounding media furore. Brief experimental exposure to the advertisement did not appear to increase weight stigma, but participants perceived increased stigma as a primary longer-term risk. Consensus was lacking on whether campaign risks outweighed benefits, but there was overall agreement that it was unlikely to reduce either obesity or cancer.
Conflicts of interest: We have no conflicts of interest to declare.
Funding: This research was not funded.
Clare B Kelly1, Julia McClelland1, Sarah E Moore1, Laura McGowan1, Dunla Gallagher1, Rebecca J Beeken2, Chris R Cardwell1, Helen Croker3, Kelly-Ann Eastwood1,4, Caroline McGirr1, Roisin O’Neill1, Jayne V Woodside1 and Michelle C McKinley1
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: Oral Presentation
In the United Kingdom and Ireland, more than half of pregnant women have overweight or obesity at their first routine antenatal appointment. There is limited support for weight management available during pregnancy. This study aimed to test the feasibility and acceptability of delivering a brief, habit-based intervention, 'Healthy Habits in Pregnancy and Beyond (HHIPBe)', to pregnant women with overweight or obesity during routine antenatal care in Northern Ireland (NI) and Republic of Ireland (ROI).
The HHIPBe intervention was developed based on the Ten Top Tips for a Healthy Weight (10TT) intervention, which was adapted for pregnancy to improve nutrition and physical activity behaviours, and aid weight management. Participants (with BMI 25-38 kg/m2) were recruited in early pregnancy (10-14 weeks) from three sites (NI= 2; ROI= 1) and randomised to the HHIPBe intervention (receiving a 15–20-minute intervention, supported by a leaflet, logbook and app, plus routine antenatal care) or the control group (receiving routine antenatal care). Data, including weight, was collected at baseline, 36-weeks gestation and 6-weeks postpartum. Habit formation for 13 health-promoting food and activity related behaviours was assessed in the intervention group, using participant-reported frequencies of carrying out the behaviours and the ‘Self-Report Behavioural Automaticity Index (SRBAI)’.
Twenty-five women were recruited into the HHIPBe study. At baseline, the average weight in the control and intervention group was 74.7±7.0 and 86.5±18.2 (kg; mean±SD), respectively. At 36-weeks gestation, 45.5% of the control group and 30.8% of the intervention group had gestational weight gain above the Institute of Medicine recommendations.
Between baseline and 36-weeks gestation, there was an increase in behaviour frequency and SRBAI scores reported by the intervention group for the majority of the 13 behaviours; in particular ‘keeping track’, ‘prepare shopping list’ and ‘avoiding large portions’. At 6-weeks postpartum, the frequency and automaticity of behaviours remained higher, or similar, to baseline (except for ‘choose reduced fat food’).
Data supports positive trends in the adoption of healthy behaviours during pregnancy, continuing into the early postpartum period. The similar trends in frequency and automaticity suggest that habit formation may be a potential mechanism for the increase in health-promoting behaviours.
Conflicts of interest: None disclosed.
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.
Sundus Mahdi 1, Emily Michalik-Denny 1, Jim Chilcott 1, Nicola J Buckland 1
1 University of Sheffield, Sheffield, UK
📌 Allocation: Rapid Fire Talks
The Change4Life Food Scanner app raises awareness about the nutritional content of packaged foods using images such as sugar cubes. To understand its intended mechanism of behaviour change, and whether behaviour change techniques (BCTs) translate to changes in behaviour, this research aimed to: (1) map out BCTs of the Change4Life Food Scanner app; and (2) pilot test and assess the feasibility of a trial testing the effectiveness of the app in reducing children’s sugar and energy intake. To address the first aim, two independent coders undertook a descriptive comparative analysis of BCTs in the Food Scanner app using the BCT Taxonomy. To address the second aim, 126 parents of 4-11 year olds were randomised into a Food Scanner app exposure condition (n=62), or no intervention control (n=64). Participants completed baseline and 3-month post-intervention measures of dietary intake using myfood24®, psychological predictors of behaviour change, health-related quality of life measures, healthcare resource use, and open- and closed-ended trial acceptability measures. The intervention arm also completed fortnightly app engagement measures and provided app feedback through open-ended responses. BCT mapping identified eight BCTs, including ‘goal setting (behaviour)’, ‘feedback on behaviour’, ‘behaviour substitution’, ‘social support (unspecified)’, ‘instruction on how to perform behaviour’, ‘salience of consequences’, ‘prompts/cues’ and ‘credible source’. 64 participants (51%) completed the pilot study (intervention: n=29; control: n=35). Of those, 80% reported that the study was easy to complete, though 27% reported that food diaries were too much work. Preliminary analyses suggested no significant intervention effects and no significant changes in psychological predictors of behaviour change after receiving the intervention. App engagement (minutes) decreased throughout the study (week 2: n=34, M=14.13, SD=14.69; week 12: n=29, M=6.76; SD=11.56). Barriers to app effectiveness included issues relating to healthier food affordability, and app functionality. App improvement suggestions included healthier substitute recommendations and access to discounts for healthier alternatives. Findings from this research suggest that although the app used effective BCTs, app engagement could impact on the exposure and effect of BCTs on dietary intake. Alternatively, revisions to the use and delivery of appropriate BCTs through improvements to app content and features may be warranted.
Conflicts of interest: We declare no competing interests.
Funding: This research was funded in whole, or in part, by the Wellcome Trust (108903/B/15/Z). The Wellcome Trust had no role in the study design, analysis, or writing of this Abstract.
Elanor C. Hinton1, Jennifer S. Cox1, Aidan Searle1, Gail Thornton2, Julian P Hamilton-Shield1
1 National Institute for Health Research Bristol Biomedical Research Centre Diet and Physical Activity Theme, University of Bristol, Bristol, UK
2 PPI Representative, Bristol, UK
📌 Allocation: Rapid Fire Talks
Childhood obesity levels continue to rise, resulting in significant costs to individuals, the NHS and society. A long-standing weight-management clinic (CoCO) for young people in Bristol has helped many service users improve weight. However, a qualitative review of families’ experiences of the clinic revealed that, for those who had not lost weight, complex lives and an external locus of control resulted in young people and parents feeling they lacked ability to make meaningful change.
These qualitative findings along with patient and public involvement recommendations and a COM-B analysis were utilised to co-develop a template intervention, ‘AIM2Change’, based on Acceptance and Commitment therapy (ACT). ACT is a third-wave cognitive behavioural therapy, through which individuals begin to accept their challenges and commit to making changes in their behaviour.
Thirteen young people from the CoCO clinic have been recruited to co-develop this intervention. The seven-session ACT programme is delivered one-to-one to the young people, using a secure online platform. In a method informed by the person-based approach, qualitative interviews were conducted with young people following each session to explore the acceptability and value of the intervention. Qualitative data are reviewed regularly to make iterative changes to the intervention, recorded in a Table of Changes.
To date, eight young people from diverse backgrounds have completed the co-development process, with five still to complete. The programme has been viewed positively, and the young people’s (and their parents if attended) opinions have informed changes made so far. Changes include a greater focus on eating behaviour strategies such as mindful eating, dealing with cravings and goal setting. The use of explanatory videos has been augmented with more tailored explanations by the therapist, to be more meaningful for the individual, and more ‘hands on’ tasks, which have increased engagement.
Insights from the young people thus far have helped shape the AIM2Change intervention, enabling us to make changes to optimise the intervention’s value for young people. Following an upcoming consensus meeting, a ‘proof of concept’ trial will test for efficacy, in order, if successful, to provide evidence to incorporate AIM2Change into the UK-wide Complication of Excess Weight Clinics.
Conflicts of interest: Dr Elanor Hinton also works part-time for Oxford Medical Products as a Clinical Studies Manager. This role is completely independent of the presented research. The remaining authors declare no conflict of interest.
Funding: This project is funded by an NIHR Research for Patient Benefit grant (NIHR203605). This research is supported by the NIHR Biomedical Research Centre at University Hospitals Bristol and Weston NHS Foundation Trust and the University of Bristol. The views expressed in this publication are those of the authors and not necessarily those of the NHS, the National Institute for Health and Care Research or the Department of Health and Social Care.
Arwa Alruwaili1,2,3,4, Kevin Deighton5, Benjamin M Kelly5,6, Zhining Liao5, Aidan Innes5, Joseph Henson2,7, Tom Yates2,7, Alice E Thackray1,2, David J Stensel1,2, James A King1,2, Scott A Willis1,2
1. National Centre for Sport and Exercise Medicine, School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, UK.
2. NIHR Leicester Biomedical Research Centre, University Hospitals of Leicester NHS Trust and University of Leicester, Leicester, UK.
3. Department of Respiratory Therapy, College of Applied Medical Sciences, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia.
4. King Abdullah International Medical Research Center, Riyadh, Saudi Arabia.
5. Nuffield Health Research Group, Nuffield Health, Epsom, Surrey, UK.
6. Department of Health Professions, Faculty of Health and Education, Manchester Metropolitan University, Manchester, United Kingdom.
7. Diabetes Research Centre, College of Life Sciences, University of Leicester, Leicester, UK.
📌 Allocation: Rapid Fire Talks
Individuals who smoke typically have a lower body mass index (BMI) than their non-smoking counterparts, while smoking cessation is associated with weight gain. Pre-clinical research suggests that nicotine in tobacco smoking may suppress appetite and influence subsequent eating behaviour; however, the relationship between smoking and eating behaviour in humans is unclear. This study examined associations of smoking with different eating and dietary behaviours in a large, population-based cohort of UK adults. This cross-sectional study included data for 83,781 men and women (mean±SD: age, 43.1±10.4 years; BMI, 25.7±4.2 kg∙m-2; 62% male) collected from health assessment programmes between 2004-2022 within a UK-based healthcare charity (Nuffield Health). Participants were stratified into two groups based on their status as a smoker (n=6454) or non-smoker (n=77327). Pre-assessment questionnaires assessed demographic variables (including smoking status and an index of multiple deprivation [IMD]) and selected eating and dietary behaviours (Likert scales), while BMI was measured during baseline health assessments. Ordinal logistic regression models, adjusted for age, sex, IMD and BMI, examined associations of smoking with different eating and dietary behaviours. In fully-adjusted models, smokers were more likely to skip meals, have fewer meals per day, leave food on their plate and go more than three hours without food compared to non-smokers (all adjusted odds ratio [aOR]≥ 1.22; 95% confidence interval [CI]≥ 1.162–1.281; P<0.001). Conversely, smokers were less likely to overeat, snack between meals and eat food as a reward or out of boredom compared to non-smokers (aOR≤0.988; 95% CI≤0.982–0.993; P<0.001). Additionally, compared to non-smokers, smokers were less likely to eat dessert and consume sweet foods between meals (aOR≤0.79; 95% CI≤0.755–0.826; P<0.001), but were more likely to eat fried food and add salt and sugar to meals (aOR≥1.313; 95% CI≥1.253–1.375; P<0.001). Several of the aforementioned relationships were modified by age, sex, socioeconomic deprivation, and BMI. In conclusion, smoking is associated with eating behaviour patterns consistent with inhibited food intake and poor dietary quality, which could help explain the weight gain commonly observed during smoking cessation. These observations underscore the importance of providing weight management and nutritional support to individuals seeking to quit smoking.
Conflicts of interest: None of the authors have any conflicts of interest to declare.
Funding: The research was supported by the National Institute for Health Research Leicester Biomedical Research Centre. Miss Arwa Alruwaili received a PhD scholarship from King Saud bin Abdulaziz University for Health Sciences in Riyadh, Saudi Arabia.
Danai Markousi 1, Jason C.G. Halford 2, Joanne A. Harrold 1
(1) University of Liverpool, Liverpool, UK
(2) University of Leeds, Leeds, UK
📌 Allocation: Rapid Fire Talks
Current measurement tools have limited our understanding of the feeding practices parents use in response to children’s eating difficulties. Very few tools have been validated for children under 2 years, and fewer allow for cross-age and cross-cultural comparisons.
This study aimed to validate the English versions of four questionnaires: Children's Eating Difficulties Questionnaire (CEDQ), Feeding Strategy Questionnaire (FStrQ), Feeding Style Questionnaire (FStylQ), and Child Food Motivation Questionnaire (CFMQ).
The translated questionnaires underwent psychometric assessment, including Confirmatory Factor Analysis to determine their factor structure, reliability (content validity, face validity, and internal consistency), test-retest reliability within two weeks, convergent validity through correlations with related measures, and construct validity through associations with children's fruit and vegetable (F&V) consumption and liking. The CEDQ and CFMQ were validated for UK children of an extended age range of 6-36m (n=506). Measurement invariance was assessed to confirm that the constructs were measured equivalently for younger (6-20m) and older children (20-36m), and direct comparisons can be drawn between age groups. The FStrQ and FStylQ were validated for UK children aged 20-36 months (n=248).
The CEDQ 4-factor structure was confirmed, whereas the CFMQ favoured a 5-dimension solution over the original 6-dimension one. Both questionnaires demonstrated excellent reliability, temporal stability, convergent validity, and scalar factorial invariance. Eating difficulties were strongly negatively correlated with vegetable intake and liking and moderately negatively correlated with fruit intake and liking. The FStrQ exhibited a good fit for its 4-factor model, showing good overall reliability and test-retest reliability, except for the preference subscale, which had poor internal consistency. The FStylQ's 3-factor model had a near-acceptable fit after modifications, with good test-retest reliability and convergent validity, although internal reliability varied among subscales. No significant associations were found between parents' feeding styles-strategies and children's F&V liking and consumption.
The psychometric evaluation and validation of the FStrQ and FStylQ provide valuable insights for future modifications. The validated CEDQ and CFMQ enable cross-cultural comparisons between UK and French children. This study is one of a few to have tested for measurement invariance, confirming the questionnaires' validity in assessing changes in eating difficulties and parents' food-buying behaviour in children 6-36m.
Conflicts of interest: None
Funding: Danai Markousi was in receipt of a Funds for Women Graduates (FfWG) Main Grant.
Dr Andrea Smith 1,2*, Dr Alice Kininmonth 2*, David Boniface 2, Professor Christina Vogel 3 and Dr Clare Llewellyn 2
1 MRC Epidemiology Unit, University of Cambridge, Cambridge (UK)
2 Research Department of Behavioural Science and Health, UCL, London (UK)
3 Centre for Food Policy, City University, London (UK)
*Denotes joined first authorship
📌 Allocation: Rapid Fire Talks
Inequalities in childhood obesity in England are stark and widening despite decades of targeted policies. Existing childhood obesity prevention strategies are not sufficiently effective. The Family Food Experience Study-London aims to understand how the contexts into which existing childhood obesity interventions are delivered impact families across the socioeconomic spectrum (SES). A diverse sample of families, across the Income Deprivation Affecting Children Index (IDACI; n=739; with a child aged 4-11), were recruited via primary schools from four London boroughs. A survey on eating behaviour and family food culture (incl. child BMI) was completed with 30.6% administered in-person and 69.4% via telephone. Complex samples generalised linear models examined cross-sectional associations between neighbourhood-level IDACI and family-level SES and family food culture-related outcomes and child BMI. Analyses were adjusted to account for clustering at the school-level and child sex, age, and ethnicity. Alpha level was set at <0.01. Families with lower family-level SES had a more obesogenic home food environment (β=-0.19, p<.001) but households in neighbourhoods with higher levels of deprivation, did not (β=-0.03, p=0.51). Both lower family SES and living in more deprived neighbourhoods were independently associated with more obesogenic child eating behaviours (greater emotional overeating; desire to drink). Lower family SES also related to greater use of parental emotional (β=-0.10, p<.05) and instrumental feeding (β=-0.10, p<.04); less modelling of healthy eating (β=0.10, p<.03) or restriction of unhealthy foods (β=0.10, p<.02) and reduced preference for snack (β=-0.17, p<.01) and starchy foods (β=-0.11, p<.01) among children. In contrast, families living in more deprived neighbourhoods reported: greater encouragement of their children to eat (β=-0.08, p=.001); lower control over meals (β=-0.07, p<.04); lower preference for snack foods (β=-0.10, p=.05) and greater liking of vegetables (β=0.08, p<.04) among children. Both lower family SES (β=-0.16; p<.01) and greater higher neighbourhood deprivation (β=0.13; p<.01) were positively associated with child BMI-SDS. The well-established association between SES and childhood obesity may operate via these cultural food norms and behavioural processes. The results underscore the importance of context, both social and environmental factors, as key determinants of food-related behaviours within families that should be accounted for when delivering childhood obesity interventions.