Clinician resistance to broaching the topic of weight in primary care: digging deeper into weight management using strong structuration theory

Clinical trials have shown that providing advice and support for people with excess weight can lead to meaningful weight loss. Despite this evidence and guidelines endorsing this approach, provision in real-world clinical settings remains low. We used Strong Structuration Theory (SST) to understand why people are often not offered weight management advice in primary care in England. Data from policy, clinical practice and focus groups were analysed using SST to consider how the interplay between weight stigma and structures of professional responsibilities influenced clinicians to raise (or not) the issue of excess weight with patients. We found that general practitioners (GPs) often accounted for their actions by referring to obesity as a health problem, consistent with policy documents and clinical guidelines. However, they were also aware of weight stigma as a social process that can be internalised by their patients. GPs identified addressing obesity as a priority in their work, but described wanting to care for their patients by avoiding unnecessary suffering, which they were concerned could be caused by talking about weight. We observed tensions between knowledge of clinical guidelines and understanding of the lived experience of their patients. We interpreted that the practice of ‘caring by not offering care’ produced the outcome of an absence of weight management advice in consultations. There is a risk that this outcome reinforces the external structure of weight stigma as a delicate topic to be avoided, while at the same time denying patients the offer of support to manage their weight

Parental Perceptions of Children’s Weight Status in 22 Countries: The WHO European Childhood Obesity Surveillance Initiative: COSI 2015/2017

Introduction: Parents can act as important agents of change and support for healthy childhood growth and development. Studies have found that parents may not be able to accurately perceive their child’s weight status. The purpose of this study was to measure parental perceptions of their child’s weight status and to identify predictors of potential parental misperceptions. Methods: We used data from the World Health Organization (WHO) European Childhood Obesity Surveillance Initiative and 22 countries. Parents were asked to identify their perceptions of their children’s weight status as “underweight,” “normal weight,” “a little overweight,” or “extremely overweight.” We categorized children’s (6–9 years; n = 124,296) body mass index (BMI) as BMI-for-age Z-scores based on the 2007 WHO-recommended growth references. For each country included in the analysis and pooled estimates (country level), we calculated the distribution of children according to the WHO weight status classification, distribution by parental perception of child’s weight status, percentages of accurate, overestimating, or underestimating perceptions, misclassification levels, and predictors of parental misperceptions using a multilevel logistic regression analysis that included only children with overweight (including obesity). Statistical analyses were performed using Stata version 15 1. Results: Overall, 64.1% of parents categorized their child’s weight status accurately relative to the WHO growth charts. However, parents were more likely to underestimate their child’s weight if the child had overweight (82.3%) or obesity (93.8%). Parents were more likely to underestimate their child’s weight if the child was male (adjusted OR [adjOR]: 1.41; 95% confidence intervals [CI]: 1.28–1.55); the parent had a lower educational level (adjOR: 1.41; 95% CI: 1.26–1.57); the father was asked rather than the mother (adjOR: 1.14; 95% CI: 0.98–1.33); and the family lived in a rural area (adjOR: 1.10; 95% CI: 0.99–1.24). Overall, parents’ BMI was not strongly associated with the underestimation of children’s weight status, but there was a stronger association in some countries. Discussion/Conclusion: Our study supplements the current literature on factors that influence parental perceptions of their child’s weight status. Public health interventions aimed at promoting healthy childhood growth and development should consider parents’ knowledge and perceptions, as well as the sociocultural contexts in which children and families live.The authors gratefully acknowledge support from a grant from the Russian Government in the context of the WHO European Office for the Prevention and Control of NCDs. Data collection in the countries was made possible through funding by: Albania: World Health Organization through the Joint Programme on Children, Food Security and Nutrition “Reducing Malnutrition in Children,” funded by the Millennium Development Goals Achievement Fund, and the Institute of Public Health; Bulgaria: Ministry of Health, National Center of Public Health and Analyses, World Health Organization Regional Office for Europe; Croatia: Ministry of Health, Croatian Institute of Public Health and World Health Organization Regional Office for Europe; Czechia: Grants AZV MZČR 17-31670 A and MZČR – RVO EÚ 00023761; Denmark: Danish Ministry of Health; France: French Public Health Agency; Georgia: World Health Organization; Ireland: Health Service Executive; Italy: Ministry of Health; Istituto Superiore di sanità (National Institute of Health); Kazakhstan: Ministry of Health of the Republic of Kazakhstan and World Health Organization Country Office; Latvia: n/a; Lithuania: Science Foundation of Lithuanian University of Health Sciences and Lithuanian Science Council and World Health Organization; Malta: Ministry of Health; Montenegro: World Health Organization and Institute of Public Health of Montenegro; Poland: National Health Programme, Ministry of Health; Portugal: Ministry of Health Institutions, the National Institute of Health, Directorate General of Health, Regional Health Directorates and the kind technical support of Center for Studies and Research on Social Dynamics and Health (CEIDSS); Romania: Ministry of Health; Russia (Moscow): n/a; San Marino: Health Ministry; Educational Ministry; Social Security Institute; the Health Authority; Spain: Spanish Agency for Food Safety and Nutrition (AESAN); Tajikistan: World Health Organization Country Office in Tajikistan and Ministry of Health and Social Protection; and Turkmenistan: World Health Organization Country Office in Turkmenistan and Ministry of Health. The authors alone are responsible for the views expressed in this article and they do not necessarily represent the views, decisions, or policies of the institutions with which they are affiliated.info:eu-repo/semantics/publishedVersio

Evaluating evidence-based content, features of exercise instruction, and expert involvement in physical activity apps for pregnant women: systematic search and content analysis

Background: Guidelines for physical activity and exercise during pregnancy recommend that all women without contraindications engage in regular physical activity to improve both their own health and the health of their baby. Many women are uncertain how to safely engage in physical activity and exercise during this life stage and are increasingly using mobile apps to access health-related information. However, the extent to which apps that provide physical activity and exercise advice align with current evidence-based pregnancy recommendations is unclear. Objective: This study aims to conduct a systematic search and content analysis of apps that promote physical activity and exercise in pregnancy to examine the alignment of the content with current evidence-based recommendations; delivery, format, and features of physical activity and exercise instruction; and credentials of the app developers. Methods: Systematic searches were conducted in the Australian App Store and Google Play Store in October 2020. Apps were identified using combinations of search terms relevant to pregnancy and exercise or physical activity and screened for inclusion (with a primary focus on physical activity and exercise during pregnancy, free to download or did not require immediate paid subscription, and an average user rating of ≥4 out of 5). Apps were then independently reviewed using an author-designed extraction tool. Results: Overall, 27 apps were included in this review (Google Play Store: 16/27, 59%, and App Store: 11/27, 41%). Two-thirds of the apps provided some information relating to the frequency, intensity, time, and type principles of exercise; only 11% (3/27) provided this information in line with current evidence-based guidelines. Approximately one-third of the apps provided information about contraindications to exercise during pregnancy and referenced the supporting evidence. None of the apps actively engaged in screening for potential contraindications. Only 15% (4/27) of the apps collected information about the user’s current exercise behaviors, 11% (3/27) allowed users to personalize features relating to their exercise preferences, and a little more than one-third provided information about developer credentials. Conclusions: Few exercise apps designed for pregnancy aligned with current evidence-based physical activity guidelines. None of the apps screened users for contraindications to physical activity and exercise during pregnancy, and most lacked appropriate personalization features to account for an individual’s characteristics. Few involved qualified experts during the development of the app. There is a need to improve the quality of apps that promote exercise in pregnancy to ensure that women are appropriately supported to engage in exercise and the potential risk of injury, complications, and adverse pregnancy outcomes for both mother and child is minimized. This could be done by providing expert guidance that aligns with current recommendations, introducing screening measures and features that enable personalization and tailoring to individual users, or by developing a recognized system for regulating apps

Eating Behaviors and Dietary Patterns of Women during Pregnancy: Optimizing the Universal ‘Teachable Moment’

Understanding women’s perceptions of eating behaviors and dietary patterns can inform the ‘teachable moment’ model of pregnancy. Our objectives were to describe eating behaviors and dietary patterns in pregnancy. This was a cross-sectional, national electronic survey. Women were ≥18 years of age, living in the United States, currently pregnant or less than two years postpartum, and had internet access. Age, education, race, and marriage were included as covariates in ordinal and binary logistic regressions (significance p < 0.05). Women (n = 587 eligible) made positive or negative changes to their diets, while others maintained pre-existing eating behaviors. The majority of women did not try (84.9 to 95.1% across diets) and were unwilling to try (66.6 to 81%) specific dietary patterns during pregnancy. Concerns included not eating a balanced diet (60.1 to 65.9%), difficulty in implementation without family (63.2 to 64.8%), and expense (58.7 to 60.1%). Helpful strategies included being provided all meals and snacks (88.1 to 90.6%) and periodic consultations with a dietitian or nutritionist (85 to 86.7%). Responses differed across subgroups of parity, body mass index, and trimester, notably in women with obesity who reported healthier changes to their diet (p < 0.05). Our study underscores the importance of tailoring care early to individual needs, characteristics, and circumstances

Food Insecurity Among International Post-Secondary Students Studying on a Canadian Campus: A Qualitative Description Study

Enrollment of international post-secondary students is increasing across Canadian campuses. International post-secondary students may experience challenges in accessing nutritious foods that meet their dietary needs and food preferences. These challenges can pose negative impacts on their health, well-being, and academic achievement. Our aim was to describe international post-secondary students’ perceptions of (1) challenges to attaining food security and (2) consequences of food insecurity on the university experience. We conducted individual semi-structured interviews with 11 international post-secondary students who had food insecurity, were enrolled at a public university in Canada, and who had requested emergency foodhampers from the on-campus food bank. Interviews were audio-recorded, transcribed verbatim, and analyzed using manifest, inductive content analysis. International post-secondary students reported several logistical issues related to obtaining sufficient food, including a lack of time, limited family support, modest food preparation skills, and low knowledge about supportive services and resources. Students also faced challenges in sourcing culturally appropriate foods, including issues related to food availability, accessibility, acceptability, and affordability. Further, they perceived food insecurity to negatively influence their academic performance through compromised concentration, reduced class and exam attendance, and adverse mpactson physical, mental, and social well-being. Some students reported extreme food deprivation, resulting in hunger. Our results revealed the negative impacts that food insecurity can have on international post-secondary students. Findings underscore the imperative to minimize the occurrence of food insecurity while studying in Canada by introducing and enhancing support systems on campus and in the community to enable food security.Les inscriptions d’étudiants internationaux augmentent sur les campus canadiens. Les étudiants internationaux de niveau postsecondaire peuvent vivre certaines difficultés pour accéder à des aliments nutritifs qui répondent à leurs besoins et préférences alimentaires. Ces défis peuvent avoir des effets négatifs sur leur santé, leur bien-être et leurs résultats scolaires. Notre objectif était de décrire les perceptions de ces étudiants en ce qui concerne (1) les défis pour atteindre la sécurité alimentaire et (2) les conséquences de l’insécurité alimentaire sur l’expérience universitaire. Nous avons mené des entrevues individuelles semi-structurées avec 11 étudiants internationaux de niveau postsecondaire qui souffraient d’insécurité alimentaire, qui étaient inscrits dans une université publique au Canada et qui avaient demandé des paniers alimentaires d’urgence à la banque alimentaire de leur campus. Les entretiens ont été enregistrés en audio, transcrits mot pour mot, et fait l’objet d’une analyse de contenu manifeste et  nductive. Les étudiants internationaux de niveau postsecondaire ont signalé plusieurs problèmes logistiques liés à l’acquisition de nourriture, notamment un manque de temps, l’absence de soutien familial, des compétences culinaires faibles et une faible connaissance des services et des ressources de soutien.Les étudiants disent également avoir été confrontés à des défis pour se procurer des aliments culturellement appropriés, y compris des problèmes liés à la disponibilité, à l’accessibilité, à l’acceptabilité et au prix des aliments. De plus, ils disent percevoir une influence négative de l’insécurité alimentaire sur leurs résultats scolaires à cause d’une concentration moindre, d’une réduction de la fréquentation des cours et des examens et des effets néfastes sur le bien-être physique, mental et social qu’elle entraîne. Certains étudiants ont signalé une privation alimentaire extrême entraînant la faim. Nos résultats ont révélé les effets négatifs que l’insécurité alimentaire pouvait avoir sur les étudiants internationaux de niveau postsecondaire.Les résultats soulignent l’impératif de minimiser l’occurrence de l’insécurité alimentaire pendant les études au Canada en introduisant des systèmes de soutien sur les campus et dans la communauté pour permettre la sécurité alimentaire et en améliorant ceux qui existent

A natural experiment comparing the effectiveness of the “healthy eagles” child weight management intervention in school versus community settings

Behavioural weight management interventions are recommended for the treatment of obesity in children. However, the evidence for these is limited and often generated under trial conditions with White, middle-class populations. Healthy Eagles is a behavioural weight management intervention designed to treat excess weight in children. It ran in the London Borough of Croydon from 2017 to 2020 and was delivered in both school and community settings, providing a natural experiment to compare outcomes. A total of 1560 participants started the Healthy Eagles programme; 347 were in the community setting and 703 in the school setting. Data were analysed for those who completed 70% of the programme. In the school setting, there was a small but significant reduction in BMI z-score (M = −0.04, 95% CI = −0.08, −0.01) for participants above a healthy weight, especially in those with severe obesity (M = −0.09, 95% CI = −0.15, −0.03); there was no significant change in any subgroup in the community setting. Linear regression analysis showed the school setting was associated with a 0.26 (95% CI = 0.13, 0.49) greater reduction in BMI z-score than the community setting after adjusting for ethnicity, deprivation, age and gender. Across both programmes, the effect was somewhat greater in participants from a Black (African/Caribbean/Other) ethnic background (M = −0.06, 95% CI = −0.09, −0.02) and from the two most deprived quintiles (M = −0.06, 95% CI = −0.11, −0.01). Data were limited, but minimal changes were measured in nutrition and physical activity behaviours regardless of setting. This evaluation provides indirect evidence of a small but significant benefit to running weight management interventions in a school versus community setting

Conceptualising lifestyle “choices:” A qualitative study of GP attitudes towards patients living with “obesity” in the UK

As a complex condition that often arises due to numerous social, environmental and political factors, “obesity” can be understood by healthcare providers as a health outcome that is directly linked to issues that are outside of individual control. UK GPs who participated in a series of focus groups examining attitudes about the role of individual responsibility in weight loss often demonstrated contradictory beliefs when asked about the relationship between obesity, personal responsibility and their patients’ (in)ability to take individual action. Whilst GPs who practised in affluent areas were more likely to draw connections between poverty and high rates of obesity, GPs who practised in disadvantaged areas were more likely to discuss the need for all patients to assume personal responsibility for their health behaviours regardless of their individual circumstances. This article examines how GPs from both groups conceptualised personal responsibility in relation to their patients’ weight and socioeconomic circumstances. We conclude by outlining the need for GPs to demonstrate empathy when engaging in weight-loss discussions with patients and offer practical support for patients who seek it that is mindful of their material circumstances

Infant Feeding Varies Across Eating Behavior and Feeding Modalities in Mothers With Low Income

OBJECTIVE: To examine if eating behaviors in mothers with low income relate to attitudes toward infant feeding and whether associations differed between breastfeeding and formula-feeding mothers. DESIGN: Cross-sectional study. PARTICIPANTS: Forty postpartum women (aged ≥ 18 years, body mass index ≥ 25 and \u3c 40 kg/m2) in the Louisiana Women, Infants, and Children program participated in a telehealth postpartum intervention for health and weight loss. MAIN OUTCOME MEASURE(S): Maternal eating behaviors and infant feeding styles, assessed 6-8 weeks after birth (baseline) using validated questionnaires. ANALYSIS: Significance was detected using independent t tests, chi-square tests for independence, or linear models (P \u3c 0.05). RESULTS: Most mothers formula-fed (n = 27, 68%). In formula-feeding mothers, maternal disinhibition and perceived hunger were positively associated with restrictive infant feeding (β = 0.41, P \u3c0.001 and β = 0.41, P = 0.001, respectively). These relationships were significantly higher (Δ = -0.85, P = 0.006 and Δ = -0.59, P = 0.003, respectively) than among breastfeeding mothers. Comparatively, pressuring/overfeeding was lower in formula-feeding mothers than among breastfeeding mothers with dietary restraint (Δ slopes: 1.06, P = 0.02). CONCLUSIONS AND IMPLICATIONS: In this cohort of mothers with low income, maternal eating behavior was associated with infant feeding styles only when feeding modality was considered. Mothers may benefit from education on how their eating behaviors can influence their infants and children

Maternal mindful eating as a target for improving metabolic outcomes in pregnant women with obesity.

BackgroundMaternal diet and eating behaviors have the potential to influence the metabolic milieu in pregnancies complicated by obesity, with implications for the developmental programming of offspring obesity. Emerging evidence suggests that mindfulness during eating may influence metabolic health in non-pregnant populations, but its effects in the context of pregnancy is less well understood. This study explored the individual and combined effects of mindful eating and diet quality on metabolic outcomes among pregnant women with obesity.MethodsIn 46 pregnant women (body mas index >30 kg/m2) enrolled in the MomEE observational study, mindful eating (Mindful Eating Questionnaire, MEQ) and energy-adjusted dietary inflammatory index (DII, from 7 days of food photography) was assessed at two time points and the mean pregnancy values computed. Rate of gestational weight gain (GWG) and fat mass gain per week were determined from measured weight and body composition using a three-compartment method, respectively, at each assessment. Homeostasis Model Assessment of Insulin Resistance (HOMA-IR) and ghrelin concentrations were determined from fasting blood samples in late gestation (35-37 weeks). Linear regression was used to examine the association of the MEQ and its subscales (where higher values indicate more mindful eating) with metabolic outcomes, adjusting for covariates: maternal age, pregravid body mass index, race, parity, DII. The effects of the MEQ*DII interaction was also tested.ResultsTotal MEQ scores were not associated with rate of weight or fat mass gain, although greater distracted eating behavior was associated with greater adiposity gain (weight and fat mass). Mindful eating was inversely associated with insulin resistance, although this was attenuated to non-significance after additional adjustment for GWG. Total MEQ and the external eating subscale was significantly inversely associated with fasted ghrelin, such that less tendency to eat under the influence of external cues was associated with lower ghrelin concentrations. After false discovery rate adjustment for multiple testing, only the association of the total MEQ and external eating subscale with ghrelin levels trended towards significance. The DII was not associated with MEQ scores or outcome variables, nor did it moderate the effect of MEQ on any of the outcomes.ConclusionThis study generates early evidence to suggest that mindful eating holds potential as a tool to improve metabolic health outcomes in pregnant women with obesity, although further research is required on this topic. Prenatal lifestyle interventions should consider including mindfulness during eating to determine its efficacy for reducing adverse pregnancy and offspring health outcomes associated with maternal obesity

Adolescent and Caregiver Perspectives on Family Navigation to Improve Healthcare Access and Use for Managing Pediatric Obesity

We interviewed families to explore their views on the role of family navigation (FN) to improve access to and use of health services for managing pediatric obesity. From March to December, 2020, we conducted individual, structured telephone interviews with adolescents with obesity (13-17 years old) and their caregivers from Edmonton and Calgary, Canada. Among our 37 participants (14 adolescents, 23 caregivers), most (n = 27; 73.0%) reported FN could improve their access to obesity management. Participants recommended several activities to support healthcare access and use, including appointment reminders, evening/weekend appointments, parking/transportation support, and in-clinic childcare, all of which help families to attend appointments over an extended period to support obesity management. Most participants preferred FN be offered by healthcare professional ‘navigators’ who were approachable, empathic, and compassionate since issues regarding health and obesity can be sensitive, emotional topics to discuss. Overall, families supported integrating FN into multidisciplinary pediatric obesity management to improve healthcare access and use by navigators who apply a range of practical strategies and relational skills to enhance long-term access and adherence to care