Living with a very low fat diet

Aims: This study investigated compliance with the very low fat diet used by some clinics in the UK to treat severe hypertriglyceridemia and the patients’ experience of the diet. Methodology: Eight adults with severe hypertriglyceridemia attending the Lipid Clinic at Manchester Royal Infirmary, Manchester, UK took part in the study. Compliance with the therapeutic diet was assessed by analysis of telephone based diet histories and diet diaries using dietary assessment software. The patients’ experience of the diet was investigated using telephone based semi-structured qualitative interviews and analysed using thematic analysis. Main findings: The diet histories revealed the mean percentage energy contribution from fat was 22.5%. This is significantly higher than the target of 15% prescribed by the very low fat diet. The qualitative interviews revealed that patients considered complete compliance difficult. The patients understood the health benefits of the diet. Their level of adherence was affected by their perception of vulnerability to the health consequences of non-adherence. Barriers to adherence included lack of accessible nutritional information, increased patient burden, lack of appropriate food choices, other peoples’ ignorance with regard to the diet, lack of flavour and variety in the diet, a desire to broaden the palate, cost, social pressure to conform and negative experiences with dietitians. Enablers to compliance included nutritional awareness, desire to maintain good health, building on their nutritional knowledge base, behaviour and lifestyle modification, developing a routine, the support of family and friends and supportive eating environments. Conclusions: Compliance with the very low fat diet could be improved through extensive education on labelling, eating during special occasions such as Christmas, birthdays and eating out of home. Dietetic professionals need to work with food retailers and outlets to promote clear disclosure of the nutritional content of food to facilitate adherence to therapeutic diets

The dynamics of change among community development corporations in Inner North/Northeast Portland, 1987-2006

This project is a comparative case study of five Community Development Corporations (CDCs) that emerged in the seven central neighborhoods of Inner North/Northeast Portland, Oregon in the late 1980s. Of the five organizations that began at that time, only two exist currently. Analyzing how and why these organizations rose and fell, merged and failed, struggled and survived in a compressed time frame and geographic area will elucidate the different paths that each organization chose in a neighborhood that changed from derelict to gentrified. Drawing on the overlapping bodies of literature that cover low-income and affordable housing development, CDC structure and evolution, and neighborhood revitalization, this study will highlight issues of local government participation in the expansion of CDCs and a changing community context. The choices that organizations made, or were compelled to make, in response to these particularly local conditions contribute either to their fortitude or their demise. This case study is intended to fill in gaps in the existing CDC and gentrification literature and to contribute an understanding of survival strategies for CDCs in an intensely competitive environment

Mapping communities as complex adaptive systems: A study of the response to violence against women by communities in Samoa

This paper explores the concept of communities as complex adaptive systems in the context of violence against women (VAW) prevention. Using thematic network analysis on data from 80 semi-structured interviews with community members in Samoa, we found that communities exhibit many properties of complex adaptive systems. Within nested systems, diverse and dynamic agents interact based on their knowledge and attitudes, which changes over time, leading to emergent and unpredictable outcomes. The functioning of communities and their response to VAW is a product of non-linear and emerging relationships and interactions between systems components at the community level. The approach we propose for conceptualising communities as complex adaptive systems provides a structured method for designing and evaluating community-based interventions that are grounded in the local context and existing resources. With in-depth knowledge of how a community works, interventions can be better equipped to address wicked problems such as VAW

Do the outcomes of interventions for the treatment of obesity and overweight in children aged under ten years, delivered by a health care professional, vary by socio-demographic characteristics? A review of Cochrane reviews

To review the evidence from five Cochrane systematic reviews of interventions to treat overweight and obesity in children. Applying a social determinants of health perspective and focusing on interventions delivered by health care professionals, for children aged less than ten years, and the challenging phases of interventions including recruitment, adherence and follow-up. The analysis of the social determinants of health is based on the PROGRESS-Plus approach (place of residence, race/ethnicity, occupation, gender, religion, education, socioeconomic status, social capital, age, disability and sexual orientation). The aims are to improve our understanding of the barriers to successful obesity treatment for children, delivered by health care professionals in a setting linked to the provision of health care services, and to identify the characteristics of these children and highlight knowledge gaps. Overarching question: what are the barriers to successful treatment delivered by health care professionals in a setting linked to the provision of health care services for children aged less than ten years, and do these barriers vary by socio-demographic characteristics? Sub-questions: a. What are the best practices management strategies for recruitment to obesity treatments for children aged less than ten years and do these strategies vary by socio-demographic characteristics? b. What are the best practice management strategies for adherence to obesity treatments for children aged less than ten years and do these strategies vary by socio-demographic characteristics? c. What are the best practice management strategies for follow-up in obesity treatment for children aged less than ten years and do these strategies vary by socio-demographic characteristics?This is a protocol for a systematic review

‘Pizza every day – why?’: A survey to evaluate the impact of COVID‐19 guidelines on secondary school food provision in the UK

The nutritional requirements of adolescence and the reported poor UK eating behaviours of young people are a significant public health concern. Schools are recognised as an effective ‘place’ setting to enable improvement to nutrition outcomes. The COVID‐19 pandemic resulted in UK school closures from March 2020. In re‐opening in September 2020, schools were required to meet guidelines to ensure the minimised impact of COVID‐19 on the population (DfE 2020). We aimed to evaluate the impact of COVID‐19 school guidelines on secondary and post‐16 (16–18 years) food provision. An online survey was posted on 8th October to 1st December 2020, targeted at young people, parents and staff of secondary/post‐16 education establishments in the UK. Two hundred and fifty‐two responses were received, of which 91% reported a change in their school food provision, 77% reported time for lunch was shortened and 44% indicated the provision was perceived as less healthy during September 2020 (post‐lockdown school return) compared with March 2020 (pre‐lockdown). Analyses demonstrated that time, limited choice and healthiness impacted negatively upon young people's school food experience. The COVID‐19 pandemic has presented a huge challenge to the delivery of healthy school food to young people. Therefore, schools require more support in following national food standards and incorporating nutrition education and behaviour change strategies within current guidelines

Exploring the evidence base for Tier 3 specialist weight management interventions for children aged 2–18 years in the UK: a rapid systematic review

Background: The impact of specialist weight management services (Tier 3) for children with severe and complex obesity in the UK is unclear. This review aims to examine the impact of child Tier 3 services in the UK, exploring service characteristics and implications for practice. Methods: Rapid systematic review of any study examining specialist weight management interventions in any UK setting including children (2–18 years) with a body mass index >99.6th centile or >98th centile with comorbidity. Results: Twelve studies (five RCTs and seven uncontrolled) were included in a variety of settings. Study quality was moderate or low and mean baseline body mass index z-score ranged from 2.7 to 3.6 units. Study samples were small and children were predominantly older (10–14 years), female and white. Multidisciplinary team composition and eligibility criteria varied; dropout ranged from 5 to 43%. Improvements in zBMI over 1–24 months ranged from −0.13 to −0.41 units. Conclusions: Specialist weight management interventions for children with severe obesity demonstrated a reduction in zBMI, across a variety of UK settings. Studies were heterogeneous in content and thus conclusions on service design cannot be drawn. There is a paucity of evidence for Tier 3 services for children, and further research is required