Perceptions of obesity as a health risk: psychometric scale development and relationship with behavioural intentions

Obesity represents a serious threat to health which can be reduced by volitional control of eating and physical activity behaviour. Social cognition theories propose that such behaviour is influenced by cognitions regarding its desirability. The role of obesity outcome expectancies in predicting weight control behaviour has not been established and there are no psychometrically sound measures of these constructs. This thesis aimed to investigate the relationship between knowledge and beliefs regarding obesity's consequences and weight control Intentions in obese patients. The Obesity Risk Knowledge Scale (ORKS-10) was developed using item analysis and rigorously evaluated in a large population (n=965). The ORKS-10 scale proved to be a short, reliable and valid measure of knowledge regarding the health risks associated with obesity. In addition, thematic analysis of data from focus groups and structured interviews was used to identify 41 salient items for a scale to measure obesity outcome expectancy beliefs. Factor and item analysis were then used to develop the Obesity Outcome Expectancy Beliefs Scale (ObEx-15). The ObEx-15 comprises three reliable and unidimensional subscales; the Health Benefits of Weight Control (HBen), Social and Aesthetic Benefits of Weight Control (SABen) and Costs of and Barriers to Weight Control (Cost). Obese adults were recruited from weight management clinics (n=110, response rate=54.19%). Multiple regression analysis indicated that weight control intentions were most strongly associated with endorsement of the social and aesthetic consequences of obesity (B=0.117, t104=2.314, p<0.05) and rejection of the costs and barriers of weight control (B=0.088, t104=2.273, p<0.05). Participants had low levels of knowledge about obesity's health risks and neither ORKS-10 scores nor HBen scores were associated with intentions. Health promotion might, therefore, benefit from focusing upon obesity's non-health impacts and the costs and barriers of weight control. Future obesity outcome expectancies research will also profit from the availability of psychometrically sound measures

Perceptions of obesity as a health risk: psychometric scale development and relationship with behavioural intentions

Obesity represents a serious threat to health which can be reduced by volitional control of eating and physical activity behaviour. Social cognition theories propose that such behaviour is influenced by cognitions regarding its desirability. The role of obesity outcome expectancies in predicting weight control behaviour has not been established and there are no psychometrically sound measures of these constructs. This thesis aimed to investigate the relationship between knowledge and beliefs regarding obesity's consequences and weight control Intentions in obese patients. The Obesity Risk Knowledge Scale (ORKS-10) was developed using item analysis and rigorously evaluated in a large population (n=965). The ORKS-10 scale proved to be a short, reliable and valid measure of knowledge regarding the health risks associated with obesity. In addition, thematic analysis of data from focus groups and structured interviews was used to identify 41 salient items for a scale to measure obesity outcome expectancy beliefs. Factor and item analysis were then used to develop the Obesity Outcome Expectancy Beliefs Scale (ObEx-15). The ObEx-15 comprises three reliable and unidimensional subscales; the Health Benefits of Weight Control (HBen), Social and Aesthetic Benefits of Weight Control (SABen) and Costs of and Barriers to Weight Control (Cost). Obese adults were recruited from weight management clinics (n=110, response rate=54.19%). Multiple regression analysis indicated that weight control intentions were most strongly associated with endorsement of the social and aesthetic consequences of obesity (B=0.117, t104=2.314, p<0.05) and rejection of the costs and barriers of weight control (B=0.088, t104=2.273, p<0.05). Participants had low levels of knowledge about obesity's health risks and neither ORKS-10 scores nor HBen scores were associated with intentions. Health promotion might, therefore, benefit from focusing upon obesity's non-health impacts and the costs and barriers of weight control. Future obesity outcome expectancies research will also profit from the availability of psychometrically sound measures

Systematic review of randomised controlled trials of interventions that aim to reduce the risk, either directly or indirectly, of overweight and obesity in infancy and early childhood

The risk factors for childhood overweight and obesity are known and can be identified antenatally or during infancy, however, the majority of effective interventions are designed for older children. This review identified interventions designed to reduce the risk of overweight/obesity that were delivered antenatally or during the first 2 years of life, with outcomes reported from birth to 7 years of age. Six electronic databases were searched for papers reporting randomised controlled trials of interventions published from January 1990 to September 2013. A total of 35 eligible studies were identified, describing 27 unique trials of which 24 were behavioural and three were non-behavioural. The 24 behavioural trials were categorised by type of intervention: (1) nutritional and/or responsive feeding interventions targeted at parents of infants, which improved feeding practices and had some impact on child weight (n = 12); (2) breastfeeding promotion and lactation support for mothers, which had a positive effect on breastfeeding but not child weight (n = 5); (3) parenting and family lifestyle (n = 4); and (4) maternal health (n = 3) interventions that had some impact on feeding practices but not child weight. The non-behavioural trials comprised interventions manipulating formula milk composition (n = 3). Of these, lower/hydrolysed protein formula milk had a positive effect on weight outcomes. Interventions that aim to improve diet and parental responsiveness to infant cues showed most promise in terms of self-reported behavioural change. Despite the known risk factors, there were very few intervention studies for pregnant women that continue during infancy which should be a priority for future research

Antenatal weight management: women’s experiences, behaviours, and expectations of weighing in early pregnancy

The current emphasis on obstetric risk management helps to frame gestational weight gain as problematic and encourages intervention by healthcare professionals. However pregnant women have reported confusion, distrust, and negative affect associated with antenatal weight management interactions. The MAGIC study (MAnaging weiGht In pregnanCy) sought to examine women’s self-reported experiences of usual-care antenatal weight management in early pregnancy, and consider these alongside weight monitoring behaviours and future expectations. 193 women (18yrs+) were recruited from routine antenatal clinics at the Nottingham University Hospital NHS Trust. Self-reported gestation was 10-27 weeks, with 41.5% (n=80) between 12-14 and 43.0% (n=83) between 20-22 weeks. At recruitment 50.3% of participants (n=97) could be classified as overweight or obese. 69.4% of highest weight women (≥30kg/m2) did not report receiving advice about weight, although they were significantly more likely to compared to women with BMI<30kg/m2. The majority of women (regardless of BMI) did not express any barriers to being weighed and 40.8% reported weighing themselves at home. Women across the BMI categories expressed a desire for more engagement from healthcare professionals on the issue of bodyweight. Women are clearly not being served appropriately in the current situation which simultaneously problematizes and fails to offer constructive dialogue

Antenatal weight management: women’s experiences, behaviours, and expectations of weighing in early pregnancy

The current emphasis on obstetric risk management helps to frame gestational weight gain as problematic and encourages intervention by healthcare professionals. However pregnant women have reported confusion, distrust, and negative affect associated with antenatal weight management interactions. The MAGIC study (MAnaging weiGht In pregnanCy) sought to examine women’s self-reported experiences of usual-care antenatal weight management in early pregnancy, and consider these alongside weight monitoring behaviours and future expectations. 193 women (18yrs+) were recruited from routine antenatal clinics at the Nottingham University Hospital NHS Trust. Self-reported gestation was 10-27 weeks, with 41.5% (n=80) between 12-14 and 43.0% (n=83) between 20-22 weeks. At recruitment 50.3% of participants (n=97) could be classified as overweight or obese. 69.4% of highest weight women (≥30kg/m2) did not report receiving advice about weight, although they were significantly more likely to compared to women with BM

Antenatal weight management: women’s experiences, behaviours, and expectations of weighing in early pregnancy

The current emphasis on obstetric risk management helps to frame gestational weight gain as problematic and encourages intervention by healthcare professionals. However pregnant women have reported confusion, distrust, and negative affect associated with antenatal weight management interactions. The MAGIC study (MAnaging weiGht In pregnanCy) sought to examine women’s self-reported experiences of usual-care antenatal weight management in early pregnancy, and consider these alongside weight monitoring behaviours and future expectations. 193 women (18yrs+) were recruited from routine antenatal clinics at the Nottingham University Hospital NHS Trust. Self-reported gestation was 10-27 weeks, with 41.5% (n=80) between 12-14 and 43.0% (n=83) between 20-22 weeks. At recruitment 50.3% of participants (n=97) could be classified as overweight or obese. 69.4% of highest weight women (≥30kg/m2) did not report receiving advice about weight, although they were significantly more likely to compared to women with BMI<30kg/m2. The majority of women (regardless of BMI) did not express any barriers to being weighed and 40.8% reported weighing themselves at home. Women across the BMI categories expressed a desire for more engagement from healthcare professionals on the issue of bodyweight. Women are clearly not being served appropriately in the current situation which simultaneously problematizes and fails to offer constructive dialogue

“I would rather be told than not know” - A qualitative study exploring parental views on identifying the future risk of childhood overweight and obesity during infancy

BACKGROUND: Risk assessment tools provide an opportunity to prevent childhood overweight and obesity through early identification and intervention to influence infant feeding practices. Engaging parents of infants is paramount for success however; the literature suggests there is uncertainty surrounding the use of such tools with concerns about stigmatisation, labelling and expressions of parental guilt. This study explores parents' views on identifying future risk of childhood overweight and obesity during infancy and communicating risk to parents. METHODS: Semi-structured qualitative interviews were conducted with 23 parents and inductive, interpretive and thematic analysis performed. RESULTS: Three main themes emerged from the data: 1) Identification of infant overweight and obesity risk. Parents were hesitant about health professionals identifying infant overweight as believed they would recognise this for themselves, in addition parents feared judgement from health professionals. Identification of future obesity risk during infancy was viewed positively however the use of a non-judgemental communication style was viewed as imperative. 2) Consequences of infant overweight. Parents expressed immediate anxieties about the impact of excess weight on infant ability to start walking. Parents were aware of the progressive nature of childhood obesity however, did not view overweight as a significant problem until the infant could walk as viewed this as a point when any excess weight would be lost due to increased energy expenditure. 3) Parental attributions of causality, responsibility, and control. Parents articulated a high level of personal responsibility for preventing and controlling overweight during infancy, which translated into self-blame. Parents attributed infant overweight to overfeeding however articulated a reluctance to modify infant feeding practices prior to weaning. CONCLUSION: This is the first study to explore the use of obesity risk tools in clinical practice, the findings suggest that identification, and communication of future overweight and obesity risk is acceptable to parents of infants. Despite this positive response, findings suggest that parents' acceptance to identification of risk and implementation of behaviour change is time specific. The apparent level of parental responsibility, fear of judgement and self-blame also highlights the importance of health professionals approach to personalised risk communication so feelings of self-blame are negated and stigmatisation avoided

Proactive Assessment of Obesity Risk during Infancy (ProAsk): A qualitative study of parents' and professionals' perspectives on an mHealth intervention

Background: Prevention of childhood obesity is a public health priority. Interventions that establish healthy growth trajectories early in life promise lifelong benefits to health and wellbeing. Proactive Assessment of Obesity Risk during Infancy (ProAsk) is a novel mHealth intervention designed to enable health professionals to assess an infant’s risk of future overweight and motivate parental behaviour change to prevent childhood overweight and obesity. The aim of this study was to explore parents’ and health professionals’ experiences of the overweight risk communication and behaviour change aspects of this mHealth intervention. Methods: The study was conducted in four economically deprived localities in the UK. Parents (N=66) were recruited to the ProAsk feasibility study when their infant was 6-8 weeks old. Twenty two health visitors (HVs) used a hand-held tablet device to deliver ProAsk to parents when their infants were 3 months old. Parents (N=12) and HVs (N=15) were interviewed when infants in the study were 6 months old. Interview data were transcribed and analysed thematically using an inductive, interpretative approach. Results: Four key themes were identified across both parent and health visitor data: engaging and empowering with digital technology; unfamiliar technology presents challenges and opportunity; trust in the risk score; resistance to targeting. Most participants found the interactivity and visual presentation of information on ProAsk engaging. Health visitors who were unfamiliar with mobile technology drew support from parents who were more confident using tablet devices. There was evidence of resistance to targeting infants at greatest risk of future overweight and obesity, and both parents and health visitors drew on a number of reasons why a higher than average overweight risk score might not apply to a particular infant. Conclusions: An mHealth intervention actively engaged parents, enabling them to take ownership of the process of seeking strategies to reduce infant risk of overweight. However, cognitive and motivational biases that prevent effective overweight risk communication are barriers to targeting an intervention at those infants most at risk

Adjunctive rifampicin for Staphylococcus aureus bacteraemia (ARREST): a multicentre, randomised, double-blind, placebo-controlled trial.

BACKGROUND: Staphylococcus aureus bacteraemia is a common cause of severe community-acquired and hospital-acquired infection worldwide. We tested the hypothesis that adjunctive rifampicin would reduce bacteriologically confirmed treatment failure or disease recurrence, or death, by enhancing early S aureus killing, sterilising infected foci and blood faster, and reducing risks of dissemination and metastatic infection. METHODS: In this multicentre, randomised, double-blind, placebo-controlled trial, adults (≥18 years) with S aureus bacteraemia who had received ≤96 h of active antibiotic therapy were recruited from 29 UK hospitals. Patients were randomly assigned (1:1) via a computer-generated sequential randomisation list to receive 2 weeks of adjunctive rifampicin (600 mg or 900 mg per day according to weight, oral or intravenous) versus identical placebo, together with standard antibiotic therapy. Randomisation was stratified by centre. Patients, investigators, and those caring for the patients were masked to group allocation. The primary outcome was time to bacteriologically confirmed treatment failure or disease recurrence, or death (all-cause), from randomisation to 12 weeks, adjudicated by an independent review committee masked to the treatment. Analysis was intention to treat. This trial was registered, number ISRCTN37666216, and is closed to new participants. FINDINGS: Between Dec 10, 2012, and Oct 25, 2016, 758 eligible participants were randomly assigned: 370 to rifampicin and 388 to placebo. 485 (64%) participants had community-acquired S aureus infections, and 132 (17%) had nosocomial S aureus infections. 47 (6%) had meticillin-resistant infections. 301 (40%) participants had an initial deep infection focus. Standard antibiotics were given for 29 (IQR 18-45) days; 619 (82%) participants received flucloxacillin. By week 12, 62 (17%) of participants who received rifampicin versus 71 (18%) who received placebo experienced treatment failure or disease recurrence, or died (absolute risk difference -1·4%, 95% CI -7·0 to 4·3; hazard ratio 0·96, 0·68-1·35, p=0·81). From randomisation to 12 weeks, no evidence of differences in serious (p=0·17) or grade 3-4 (p=0·36) adverse events were observed; however, 63 (17%) participants in the rifampicin group versus 39 (10%) in the placebo group had antibiotic or trial drug-modifying adverse events (p=0·004), and 24 (6%) versus six (2%) had drug interactions (p=0·0005). INTERPRETATION: Adjunctive rifampicin provided no overall benefit over standard antibiotic therapy in adults with S aureus bacteraemia. FUNDING: UK National Institute for Health Research Health Technology Assessment

Are Anti-Stigma Films a Useful Strategy for Reducing Weight Bias Among Trainee Healthcare Professionals? Results of a Pilot Randomized Control Trial

Background: Weight bias is an important clinical issue that the educators of tomorrow's healthcare professionals cannot afford to ignore. This study, therefore, aimed to pilot a randomized controlled trial of the effects of educational films designed to reduce weight stigmatization toward obese patients on trainee dietitians' and doctors' attitudes. Methods: A pre-post experimental design with a 6-week follow-up, which consisted of an intervention group (n = 22) and a control group (n = 21), was conducted to assess the efficacy of brief anti-stigma films in reducing weight bias, and to test whether future, larger-scale studies among trainee healthcare professionals are feasible. Results: Participants at baseline demonstrated weight bias, on both implicit and explicit attitude measures, as well as strong beliefs that obesity is under a person's control. The intervention films significantly improved explicit attitudes and beliefs toward obese people, and participant evaluation was very positive. The intervention did not significantly improve implicit anti-fat bias. Conclusion: The current study suggests both that it is possible to conduct a substantive trial of the effects of educational films designed to reduce weight stigma on a larger cohort of trainee healthcare professionals, and that brief educational interventions may be effective in reducing stigmatizing attitudes in this population