Mothers' experiences of their own parents' food parenting practices and use of coercive food-related practices with their children

The current research examines the relationships between mothers' experiences of the ways in which they were provided food as a child, their current eating behaviours, and their use of coercive food parenting practices with their own child. Mothers (N = 907 (M = 37 years, SD = 7.7)) completed an online/paper survey that included validated measures of food parenting practices and eating behaviours. Regression analyses show that mothers' experiences of being provided food as a child, and their current eating behaviours are significant unique predictors of engagment in coercive food-related parenting practices with their child. Exploratory mediation analyses further show that the relationship between mothers' experiences of being provided food as a child and use of coercive food-related parenting practices with their child is partially mediated by mothers' eating behaviours. The findings indicate concordance between mothers' experiences of being provided food as a child and use of the same coercive food-related parenting practices with their child. Furthermore, maternal experiences of food-related parenting practices as a child are the strongest predictors of use coercive food parenting practices with their own child. There may be value in focussing on the food-related experiences mothers had as a child in addition to their existing eating behaviours prior to food-related parenting practice intervention. Longitudinal research is needed to strengthen the current findings and to further understand the links identified. [Abstract copyright: Crown Copyright © 2022. Published by Elsevier Ltd. All rights reserved.

“Is it time to throw out the weighing scales?” Implicit weight bias among healthcare professionals working in bariatric surgery services and their attitude towards non-weight focused approaches

Background: People living with overweight or obesity (PLwO) can be stigmatised by healthcare professionals (HCPs). Reducing focus on weight is a proposed strategy to provide less threatening healthcare experiences. Given the lack of research on weight bias within obesity services, this study aimed to explore implicit bias among obesity specialist HCPs and explore views on non-weight focused approaches. Methods: Obesity specialist HCPs were invited to a webinar, “An exploration of non-weight focused approaches within bariatric services”, held in October 2021. Implicit weight bias was examined using the BiasProof mobile device test, based on the Implicit Association Test. Poll data was analysed descriptively, and qualitative data was analysed using framework analysis. Findings: 82 of the 113 HCPs who attended the webinar consented to contribute data to the study. Over half (51%) had an implicit weight bias against PLwO. Most (90%) agreed/strongly agreed that obesity services are too weight focused and that patients should not be weighed at every appointment (86%). Perceived benefits of taking a non-weight focused approach included patient-led care, reducing stigma and supporting patient wellbeing, while perceived barriers included loss of objectivity, inducing risk and difficulty demonstrating effectiveness. Interpretation: Our findings indicate that half of obesity specialist HCPs in our sample of 82 providers, who are primarily dieticians and psychologists, have an implicit weight bias against PLwO. HCPs feel that a weight-focused approach within services was a barrier to patient care, but that there is a lack of alternative non-weight focused measures. Further research is needed into substitute outcome measures for clinical practice, also seeking the views of PLwO, and into interventions to address implicit weight bias. Funding: Johnson & Johnson funded the BiasProof licence and publication open access charge

Laparoscopic adjustable gastric banding – should a second chance be given?

Background: Obesity is a chronic relapsing-remitting disease and a global pandemic, being associated with multiple comorbidities. Laparoscopic adjustable gastric banding (LAGB) is one of the safest surgical procedures used for the treatment of obesity, and even though its popularity has been decreasing over time, it still remains an option for a certain group of patients, producing considerable weight loss and improvement in obesity-associated comorbidities. Methods: The aim of this study was to evaluate the impact of weight loss following LAGB on obesity-associated comorbidities, and to identify factors that could predict better response to surgery, and patient sub-groups exhibiting greatest benefit. A total of 99 severely obese patients (81.2% women, mean age 44.19 ± 10.94 years, mean body mass index (BMI) 51.84 ± 8.77 kg/m2) underwent LAGB in a single institution. Results obtained 1, 2, and 5 years postoperatively were compared with the pre-operative values using SPPS software version 20. Results: A significant drop in BMI was recorded throughout the follow-up period, as well as in A1c and triglycerides, with greatest improvement seen 2 years after surgery (51.8 ± 8.7 kg/m2 vs 42.3 ± 9.2 kg/m2, p < 0.05, 55.5 ± 19.1 mmol/mol vs 45.8 ± 13.7 mmol/mol, p < 0.05, and 2.2 ± 1.7 mmol/l vs 1.5 ± 0.6 mmol/l). Better outcomes were seen in younger patients, with lower duration of diabetes before surgery, and lower pre-operative systolic blood pressure. Conclusions: Younger age, lower degree of obesity, and lower severity of comorbidities at the time of surgery can be important predictors of successful weight loss, making this group of patients the ideal candidates for LAGB

Assessing treatment fidelity and contamination in a cluster randomised controlled trial of motivational interviewing and cognitive behavioural therapy skills in type 2 diabetes.

BACKGROUND: Competencies in psychological techniques delivered by primary care nurses to support diabetes self-management were compared between the intervention and control arms of a cluster randomised controlled trial as part of a process evaluation. The trial was pragmatic and designed to assess effectiveness. This article addresses the question of whether the care that was delivered in the intervention and control trial arms represented high fidelity treatment and attention control, respectively. METHODS: Twenty-three primary care nurses were either trained in motivational interviewing (MI) and cognitive behavioural therapy (CBT) skills or delivered attention control. Nurses' skills in these treatments were evaluated soon after training (treatment arm) and treatment fidelity was assessed after treatment delivery for sessions midway through regimen (both arms) using the Motivational Interviewing Treatment Integrity (MITI) domains and Behaviour Change Counselling Index (BECCI) based on consultations with 151 participants (45% of those who entered the study). The MITI Global Spirit subscale measured demonstration of MI principles: evocation, collaboration, autonomy/support. RESULTS: After training, median MITI MI-Adherence was 86.2% (IQR 76.9-100%) and mean MITI Empathy was 4.09 (SD 1.04). During delivery of treatment, in the intervention arm mean MITI Spirit was 4.03 (SD 1.05), mean Empathy was 4.23 (SD 0.89), and median Percentage Complex Reflections was 53.8% (IQR 40.0-71.4%). In the attention control arm mean Empathy was 3.40 (SD 0.98) and median Percentage Complex Reflections was 55.6% (IQR 41.9-71.4%). CONCLUSIONS: After MI and CBT skills training, detailed assessment showed that nurses had basic competencies in some psychological techniques. There appeared to be some delivery of elements of psychological treatment by nurses in the control arm. This model of training and delivery of MI and CBT skills integrated into routine nursing care to support diabetes self-management in primary care was not associated with high competency levels in all skills. TRIAL REGISTRATION: ISRCTN75776892 ; date registered: 19/05/2010

Older age does not influence the success of weight loss through the implementation of lifestyle modification

Objective Age is sometimes a barrier for acceptance of patients into a hospital‐based obesity service. Our aim was to explore the effect of age on the ability to lose weight through lifestyle interventions, implemented within a hospital‐based obesity service. Design Cross‐sectional study in a cohort of randomly selected patients with morbid obesity (n=242), who attended our hospital‐based obesity service during 2005‐2016 and received only lifestyle weight loss interventions. Primary outcome measures were percentage weight loss (%WL) and percentage reduction in Body Mass Index (%rBMI) following implemented lifestyle interventions. Data were stratified according to patient age at referral: group 1 (age<60 years, n=167); group 2 (age≥60 years, n=75). Weight loss was compared between groups and correlations with age at referral were explored. Results The duration of hospital‐based weight loss interventions ranged between 1 and 143 months (mean: 38.9 months; SD: 32.3). Baseline BMI at referral differed significantly between groups 1 and 2 (49.7kgm‐2 [SD: 8.7] vs 46.9kgm‐2 [SD: 6.1], respectively; P<0.05). Following implemented lifestyle interventions, between groups 1 and 2 there were no differences in %WL (6.9% [SD: 16.7] vs 7.3% [SD: 11.60], respectively; P=NS) or %rBMI (8.1% [SD: 14.9] vs 7.8% [SD: 11.7], respectively; P=NS). Overall, there was no significant correlation between patient age at referral and %WL (r=‐0.13, P=NS). Conclusions Older age does not influence the success of weight loss through the implementation of lifestyle modification within a hospital‐based obesity service. Therefore, age per se should not influence clinical decisions regarding acceptance of patients to hospital‐based obesity services

Facial disfigurement : A review of the psychological models and the development of a parental measure of appraisal

EThOS - Electronic Theses Online ServiceGBUnited Kingdo

Food parenting practices among parents with overweight and obesity : a systematic review

Given the links between parental obesity and eating psychopathology in their children, it is important to understand the mechanisms via which unhealthy relationships with eating are passed from generation to generation. The aim was to review research focusing on food-related parenting practices (FPPs) used by parents with overweight/obesity. Web of Science, PubMed and PsycINFO were searched. Studies that included a measure of FPPs were considered eligible and were required to have examined FPPs by parental weight status. Twenty studies were included. Single studies suggest differences between parents with healthy-weight vs. overweight/obesity with respect to; food accessibility, food availability and modelling. Multiple studies suggest that several parenting strategies do not differ according to parental weight status (child involvement, praise, use of food to control negative emotions, use of food-based threats and bribes, pressure, restriction, meal and snack routines, monitoring, and rules and limits). There was inconclusive evidence with respect to differences in parental control, encouragement and use of unstructured FPPs among parents with healthy-weight vs. overweight/obesity. The findings of this review imply some differences between parents with overweight/obesity and healthy-weight and the use of some food-related parenting practices, however, they should be interpreted with caution since research remains limited and is generally methodologically weak. The review highlights opportunities for further research, and suggests improvements to current measures of FPPs. View Full-Tex

Application of mindfulness in a tier 3 obesity service improves eating behaviour and facilitates successful weight-loss

Objective: To demonstrate the clinical utility of mindfulness within a tier 3 obesity service. Methods: Recruitment of participants (n=54, including n=33 completers) from patients attending a tier 3-based obesity service at University Hospitals Coventry and Warwickshire (UHCW). Each participant attended 4 group sessions over 8-weeks, at which mindfulness-based eating behaviour strategies were taught. Self-reported eating behaviour was assessed at baseline and following completion of attendance at the group sessions. Body-weight was measured at baseline and at 4-months following completion of the group sessions. Paired-sample t-tests were performed. A p-value <0.05 was considered significant. Data are reported for the 33 completers. Results: Mean age was 44.4 years (SD 11 years). There was a statistically significant improvement in self-reported eating behaviour (p=0.009), driven by improvements in ‘fast-foodism’ (p=0.031). There was a statistically significant reduction in body-weight (3.1kg [SD 5.2kg], p=0.002) at 4-months following completion of the group sessions. Participants (97%) reported improved self-esteem and confidence in self-management of body-weight. Conclusion: Application of mindfulness-based eating behaviour strategies, taught at group sessions within a tier 3 obesity service, resulted in significant improvement in eating behaviour, and facilitated subsequent weight-loss over 4-months. Such a novel strategy has potential for scalability to the wider obese population