Features predicting weight loss in overweight or obese participants in a web-based intervention: randomized trial

BACKGROUND: Obesity remains a serious issue in many countries. Web-based programs offer good potential for delivery of weight loss programs. Yet, many Internet-delivered weight loss studies include support from medical or nutritional experts, and relatively little is known about purely web-based weight loss programs. OBJECTIVE: To determine whether supportive features and personalization in a 12-week web-based lifestyle intervention with no in-person professional contact affect retention and weight loss. METHODS: We assessed the effect of different features of a web-based weight loss intervention using a 12-week repeated-measures randomized parallel design. We developed 7 sites representing 3 functional groups. A national mass media promotion was used to attract overweight/obese Australian adults (based on body mass index [BMI] calculated from self-reported heights and weights). Eligible respondents (n = 8112) were randomly allocated to one of 3 functional groups: information-based (n = 183), supportive (n = 3994), or personalized-supportive (n = 3935). Both supportive sites included tools, such as a weight tracker, meal planner, and social networking platform. The personalized-supportive site included a meal planner that offered recommendations that were personalized using an algorithm based on a user's preferences for certain foods. Dietary and activity information were constant across sites, based on an existing and tested 12-week weight loss program (the Total Wellbeing Diet). Before and/or after the intervention, participants completed demographic (including self-reported weight), behavioral, and evaluation questionnaires online. Usage of the website and features was objectively recorded. All screening and data collection procedures were performed online with no face-to-face contact. RESULTS: Across all 3 groups, attrition was high at around 40% in the first week and 20% of the remaining participants each week. Retention was higher for the supportive sites compared to the information-based site only at week 12 (P = .01). The average number of days that each site was used varied significantly (P = .02) and was higher for the supportive site at 5.96 (SD 11.36) and personalized-supportive site at 5.50 (SD 10.35), relative to the information-based site at 3.43 (SD 4.28). In total, 435 participants provided a valid final weight at the 12-week follow-up. Intention-to-treat analyses (using multiple imputations) revealed that there were no statistically significant differences in weight loss between sites (P = .42). On average, participants lost 2.76% (SE 0.32%) of their initial body weight, with 23.7% (SE 3.7%) losing 5% or more of their initial weight. Within supportive conditions, the level of use of the online weight tracker was predictive of weight loss (model estimate = 0.34, P < .001). Age (model estimate = 0.04, P < .001) and initial BMI (model estimate = -0.03, P < .002) were associated with frequency of use of the weight tracker. CONCLUSIONS: Relative to a static control, inclusion of social networking features and personalized meal planning recommendations in a web-based weight loss program did not demonstrate additive effects for user weight loss or retention. These features did, however, increase the average number of days that a user engaged with the system. For users of the supportive websites, greater use of the weight tracker tool was associated with greater weight loss.Emily Brindal, Jill Freyne, Ian Saunders, Shlomo Berkovsky, Greg Smith, Manny Noake

Compliance with children's television food advertising regulations in Australia

Extent: 6p.Background: The objective of this study was to assess the effectiveness of the Australian co-regulatory system in limiting children’s exposure to unhealthy television food advertising by measuring compliance with mandatory and voluntary regulations. An audit was conducted on food and beverage television advertisements broadcast in five major Australian cities during children’s programming time from 1st September 2010 to 31st October 2010. The data were assessed against mandatory and voluntary advertising regulations, the information contained in an industry report of breaches, and the Australian Guide to Healthy Eating. Results: During the two months of data collection there were a total of 951 breaches of the combined regulations. This included 619 breaches of the mandatory regulations (CTS) and 332 breaches of the voluntary regulations (RCMI and QSRI). Almost 83% of all food and beverages advertised during children’s programming times were for foods classified as ‘Extras’ in the Australian Guide to Healthy Eating. There were also breaches in relation to the amount of advertising repetition and the use of promotional appeals such as premium offers, competitions, and endorsements by popular children’s characters. The self-regulatory systems were found to have flaws in their reporting and there were errors in the Australian Food and Grocery Council’s compliance report. Conclusions: This audit suggests that current advertising regulations are inadequate. Regulations need to be closely monitored and more tightly enforced to protect children from advertisements for unhealthy foods.Michele Roberts, Simone Pettigrew, Kathy Chapman, Caroline Miller and Pascale Queste

Focusing on fast food restaurants alone underestimates the relationship between neighborhood deprivation and exposure to fast food in a large rural area

<p>Abstract</p> <p>Background</p> <p>Individuals and families are relying more on food prepared outside the home as a source for at-home and away-from-home consumption. Restricting the estimation of fast-food access to fast-food restaurants alone may underestimate potential spatial access to fast food.</p> <p>Methods</p> <p>The study used data from the 2006 Brazos Valley Food Environment Project (BVFEP) and the 2000 U.S. Census Summary File 3 for six rural counties in the Texas Brazos Valley region. BVFEP ground-truthed data included identification and geocoding of all fast-food restaurants, convenience stores, supermarkets, and grocery stores in study area and on-site assessment of the availability and variety of fast-food lunch/dinner entrées and side dishes. Network distance was calculated from the population-weighted centroid of each census block group to all retail locations that marketed fast food (<it>n </it>= 205 fast-food opportunities).</p> <p>Results</p> <p>Spatial access to fast-food opportunities (FFO) was significantly better than to traditional fast-food restaurants (FFR). The median distance to the nearest FFO was 2.7 miles, compared with 4.5 miles to the nearest FFR. Residents of high deprivation neighborhoods had better spatial access to a variety of healthier fast-food entrée and side dish options than residents of low deprivation neighborhoods.</p> <p>Conclusions</p> <p>Our analyses revealed that identifying fast-food restaurants as the sole source of fast-food entrées and side dishes underestimated neighborhood exposure to fast food, in terms of both neighborhood proximity and coverage. Potential interventions must consider all retail opportunities for fast food, and not just traditional FFR.</p

Nutritional consequences of a fast food eating occasion are associated with choice of quick-service restaurant chain

Aim: the aim of the present study was to explore fast food purchasing behaviours and motivations and to assess whether eating at different quick-service restaurant (QSR) chains affects macronutrient consumption of a fast food eating occasion. Methods: a cross-sectional computer-based survey was completed by consumers at a local fair or via an external hyperlink. Consumers were at least 16years and had purchased items from McDonald's, Hungry Jack's, KFC, Domino's or Red Rooster in Australia within the last 6 months. Custom-written software captured the items consumed by the respondent, contextual data, reason for consumption and demographic information. Results: five hundred twenty-three adolescents and adults (76.6% female; 81.3% Australian born) completed the survey. They reported commonly purchasing takeaway (69.7%) and from McDonald's (35.5%). Consumption was primarily convenience driven but varied by QSR. General linear models indicated that energy consumed (kJ; M +/- SE) from fast food items varied significantly between chains, being higher at Hungry Jack's (4383 +/- 138) and KFC (4277 +/- 154) compared with Domino's Pizza (2725 +/- 239) and McDonald's (3263 +/- 124). Total saturated fat, sodium and percentage of energy from fat also varied significantly by QSR chain (all P < 0.001). Total energy consumed on one visit was positively associated with frequency of fast food consumption (P = 0.008). No demographic variable consistently associated with nutritional characteristics of the fast food eaten. Conclusions: the nutritional implications of fast food consumption are not uniform across different QSR chains. To our knowledge, this is the first study to indicate an association between frequency of fast food consumption and energy intake at a fast food eating occasion.Emily Brindal, Carlene Wilson, Philip Mohr, Gary Witter

Does meal duration predict amount consumed in lone diners? An evaluation of the time-extension hypothesis

The time-extension hypothesis has been proposed to describe why social facilitation (the tendency for presence of co-eaters to increase the amount eaten) occurs amongst groups of diners. However, it is possible that time-extension could increase the amount eaten in the absence of social effects. Therefore, the aim of this study was to assess whether prolonged exposure to a food environment without social interaction could increase consumption. Lone diners (n=141) were observed eating in a fast food environment. The items consumed, meal duration, estimated demographics (sex, weight status and age) and whether or not the participant was reading were recorded unobtrusively. Lone diners who were reading spent longer eating (M=17.36; SD=8.23) than those who were not (M=8.88; SD=5.47), but energy intake was less than 200 kJ greater, and not overall related to time spent eating. The fact that time-extension did not alter the amount eaten in lone diners is discussed in the context of previous studies and the theory of social facilitation.Emily Brindal, Carlene Wilson, Philip Mohr, Gary Witter

Contextual and environmental influences on reported dietary energy intake at evening eating occasions

Abstract not availableChelsea Lock, Emily Brindal, Gilly A. Hendrie, David N. Co

Improving children's dairy food and calcium intake: can intervention work? A systematic review of the literature

Published online: 21 May 2012OBJECTIVE: Strategies are needed to address the shortfall in children's dairy food and Ca intakes. The present review identified interventions targeting an increase in children's dairy food or Ca intakes, and determined characteristics associated with successful intervention. DESIGN: A systematic literature search identified fourteen intervention studies, published in English, between 1990 and 2010. Studies were evaluated for study population, setting and mode of delivery, dietary targets and outcome measures, measures of intervention intensity, intervention description, the use of behaviour change techniques and intervention effectiveness. SETTING: Interventions targeting an increase in dairy food or Ca intake. SUBJECTS: Children aged 5-12 years. RESULTS: Ten of the fourteen studies were considered to be effective. Studies focusing on encouraging intake of dairy foods or Ca alone were all effective, compared with 55 % of studies promoting dairy within the context of a healthy diet. Effective interventions tended to be higher in intensity, provide dairy foods and were delivered across a variety of settings to a range of primary targets. The number of behaviour change techniques used did not differentiate effective and ineffective interventions, but the use of taste exposure and prompting practice appeared to be important for effective intervention. CONCLUSIONS: Interventions that target an increase in children's dairy food or Ca intake could potentially increase children's dairy food intake by about one serving daily. Research conducted outside the USA is needed. The review has identified some promising strategies likely to be part of effective interventions for improving dairy and Ca intakes in countries where children's intake is insufficient.Gilly A Hendrie, Emily Brindal, Danielle Baird and Claire Gardne

Obesity and the effects of choice at a fast food restaurant

SummaryFast food is often mentioned when investigating the obesity epidemic. While many health professionals generally perceive of fast foods as 'bad', a new perspective of manageable fast food consumption has been suggested. The macronutrient content of traditional fast food meals and healthier choices from six of the dominant fast food chains in Australia were calculated to determine the nutritional outcomes of a fast food meal. On average, a traditional fast food meal accounted for 47.47% of an 8400 kJ daily guideline. Total fat, however, accounted for between 47.08% and 93.48% of a daily guideline. The healthier choices were lower in overall kilojoule (kJ) and total fat. Fast food is increasingly becoming part of our eating patterns. Traditional fast food meals are indeed energy dense. In terms of kilojoule intake alone, a traditional fast food meal can be incorporated reasonably into a daily intake without necessarily promoting obesity. Health professionals should educate consumers of the simple 'healthy' choices they can make when eating fast food.:Emily Brindal, Philip Mohr, Carlene Wilson, Gary Witter