Putting The Person Back Into Weight Loss And Weight Loss Maintenance: The Role Of Affect, Cognition, Behaviour And Motivation

Obesity is one of the most serious health problems facing modern society and strategies to address this pandemic have so far been ineffective. Although weight loss (WL) is achievable, prevention of weight regain is a major challenge. The overall aim of this thesis was to identify predictors of WL and weight loss maintenance (WLM) to promote better tailored and sustainable interventions. A systematic review evaluated the evidence from 80 studies examining predictors of WL and/or WLM in behavioural and/or dietary WL interventions (with or without exercise) in overweight and obese individuals. Aside from physiological factors such as initial weight loss, a number of personal characteristics broadly conceptualised as reflecting affective, cognitive, behavioural and motivational factors were acknowledged as potential predictors of WL and/or WLM. Affective (e.g. anxiety), behavioural (e.g. eating behaviour, self-monitoring, social support, physical activity, treatment adherence, previous WL attempts) and motivational factors (e.g. self-efficacy) were the strongest predictors identified. Study 1 assessed predictors of WL and WLM in free-living participants (N=71) who received healthy eating advice with (HE+F) or without (HE) advice to increase dietary fibre. Predictors of WL were age, body weight and body image at baseline (affective), fasting plasma leptin and disinhibition (behavioural) with some differences according to diet group. These also predicted WLM at 1 month follow-up. At 12 month follow-up, having a higher body weight at week 12 and greater depression (affective) at follow-up were associated with greater weight regain. Additionally, having stronger beliefs that medical reasons cause obesity (cognitive) and less stressful life events (affective) were associated with better WLM. Study 2 utilised an online survey and cluster analysis to examine affective, cognitive, behavioural and motivational factors in a real world setting with individuals (N=314), who had previously attempted to lose weight using different WL methods. Two distinct clusters were identified: less successful (Cluster 1) and more successful (Cluster 2). Cluster 2 was associated with lower emotional and external eating, lower disinhibition and higher restraint (behavioural), less depression, anxiety and stress (affective), and significantly higher diet satisfaction, eating self-efficacy (motivational) than Cluster 1. Study 3 examined predictors of WL in an NHS delivered 12 week community based weight management programme (N=22). Higher diet satisfaction, an improvement in body image and higher baseline body weight were significant predictors of WL. Based on the evidence presented in this thesis, there are clear personal characteristics which promote and sustain obesity. WL and WLM is clearly not just a problem of appetite control. Affective (stressful life events, body image, diet satisfaction and depression), behavioural (eating behaviour) and motivational factors (self-efficacy and motivation) were the most consistent psychological predictors of WL and/or WLM across all studies. Interventions should therefore target these personal characteristics in order to promote WL and prevent weight regain. The paucity of studies incorporating long-term follow-up shows that further research is needed to examine the role of affect, cognition, behaviour and motivation in the long term. A multidisciplinary approach to tackle obesity, which addresses psychological, social, environmental, and biological factors is essential to ensure comprehensive care, best practice and outcomes

Cross-sectional study examining the association between diet quality and the prevalence of anxiety and depression in UK undergraduate students

AbstractThe prevalence of mental health issues among UK undergraduate students is growing, and poor diet quality appears to be a risk factor for poor mental health although with limited research in this area. Therefore, the objective of this study was to examine the cross‐sectional associations between diet quality and common mental disorders (CMD) such as depression and anxiety in UK undergraduate students. A cross‐sectional survey consisting of demographic information and validated questionnaires (the Short‐Form Food Frequency Questionnaire [SFFFQ] and the Hospital Anxiety and Depression Scale [HADS]) was conducted to measure diet quality and anxiety and depression in young adults in 44 UK‐based universities. Multiple regression analysis adjusting for confounding factors was used to assess the associations between them. Undergraduate university students (n = 202, 67% female) with a mean age of 20.9 ± 3.6 years and a mean body mass index (n = 170) of 22.6 ± 3.2 kg/m2 took part in the study. Prevalence of anxiety was high, with 40% of the sample having an anxiety score in the severe range (≥12 points) while the prevalence of depression was lower, with 6% of the population having a depression score in the severe range (≥12 points). Diet quality was significantly higher for females than males (p = 0.034) and was poor for 38% of the sample, being more common in males compared to females, although not significantly so (43% and 36%, respectively). Diet quality was inversely associated with anxiety (β = −0.427; p = 0.029) and was more likely to be associated with anxiety in females than males (β = 0.743; p = 0.043). No significant relationship between diet quality and depression was found. Better self‐reported health, father's qualification and smoking status were also associated with less anxiety and depression. This research supports other research suggesting that UK universities should explore whether the implementation of dietary interventions and improving the food environment would be a cost‐effective option to reduce the high prevalence of anxiety among students

Trialling a microbiome-targeted dietary intervention in children with ADHD—the rationale and a non-randomised feasibility study

Background Dietary interventions have been previously explored in children with ADHD. Elimination diets and supplementation can produce beneficial behaviour changes, but little is known about the mechanisms mediating change. We propose that these interventions may work, in part, by causing changes in the gut microbiota. A microbiome-targeted dietary intervention was developed, and its feasibility assessed. Methods A non-randomised feasibility study was conducted on nine non-medicated children with ADHD, aged 8–13 years (mean 10.39 years), using a prospective one-group pre-test/post-test design. Participants were recruited from ADHD support groups in London and took part in the 6-week microbiome-targeted dietary intervention, which was specifically designed to impact the composition of gut bacteria. Children were assessed pre- and post-intervention on measures of ADHD symptomatology, cognition, sleep, gut function and stool-sample microbiome analysis. The primary aim was to assess the study completion rate, with secondary aims assessing adherence, adverse events (aiming for no severe and minimal), acceptability and suitability of outcome measures. Results Recruitment proved to be challenging and despite targeting 230 participants directly through support groups, and many more through social media, nine families (of the planned 10) signed up for the trial. The completion rate for the study was excellent at 100%. Exploration of secondary aims revealed that (1) adherence to each aspect of the dietary protocol was very good; (2) two mild adverse events were reported; (3) parents rated the treatment as having good acceptability; (4) data collection and outcome measures were broadly feasible for use in an RCT with a few suggestions recommended; (5) descriptive data for outcome measures is presented and suggests that further exploration of gut microbiota, ADHD symptoms and sleep would be helpful in future research. Conclusions This study provides preliminary evidence for the feasibility of a microbiome-targeted dietary intervention in children with ADHD. Recruitment was challenging, but the diet itself was well-tolerated and adherence was very good. Families wishing to trial this diet may find it an acceptable intervention. However, recruitment, even for this small pilot study, was challenging. Because of the difficulty experienced recruiting participants, future randomised controlled trials may wish to adopt a simpler dietary approach which requires less parental time and engagement, in order to recruit the number of participants required to make meaningful statistical interpretations of efficacy

Public beliefs and willingness to accept COVID-19 vaccines among adults in South-Western Nigeria: A cross-sectional study

Background: Despite the government's and development partners' unmatched efforts to ensure that every eligible person receives vaccinations, there have been concerns about vaccine fear, government mistrust, vaccine hesitancy and rejection expressed by the public, as well as various conspiracy theories involving the COVID-19 vaccines. This study assessed the public beliefs and willingness to accept COVID-19 vaccines and related factors among residents of Ondo State, Nigeria. Methods: Using a convenience sample technique, a cross-sectional survey of the adult population was carried out in the months of February and March of 2022. Factors influencing beliefs and willingness to accept COVID-19 vaccines were found by using univariate and multivariate statistical analysis. Results: 306 out of 323 respondents completed the survey and were included in the final analysis. The respondents mean age was 28.16 ± 16.2 years. Although n = 223, 72.9% of respondents reported to have received at least one dose of COVID-19 vaccines, (n = 205) 67.0% believed COVID-19 vaccines to be effective. Among the individuals who had not yet had any COVID-19 vaccinations, 2.6% (n = 8) of respondents were willing to accept the vaccines, whereas 14.1% (n = 43) were unwilling. Respondents' beliefs about the efficacy of COVID-19 vaccines were influenced by their gender, occupation, religion and educational attainment (p < 0.005). Conclusion: The study revealed a good level of positive beliefs about the vaccine, which was mirrored in vaccination history. However, those who had not yet received the vaccine were unwilling to do so, opening the door for more aggressive risk communication to be able to alter the course of events. In addition to addressing additional COVID-19 vaccination myths, we advise policy-makers to develop communication strategies that emphasise the safety of the COVID-19 vaccine. It is advised that all relevant stakeholders be included in government COVID-19 vaccination programmes by sharing timely, transparent information that fosters accountability

A randomised controlled trial of the effects of kefir on behaviour, sleep and the microbiome in children with ADHD: study protocol

Introduction: Current interventions for children with ADHD are primarily medication, behavioural therapy and parent-training. However, research suggests dietary manipulations may provide therapeutic benefit for some. There is accumulating evidence that the gut microbiome may be atypical in ADHD and therefore manipulating gut bacteria in such individuals may help alleviate some of the symptoms of this condition. The aim of this study is to explore the effects of supplementation with kefir (a fermented dairy drink) on ADHD symptomatology, sleep, attention and the gut microbiome in children diagnosed with ADHD. Methods and analysis: A six-week randomised, double-blind, placebo-controlled trial in 70 children aged 8-13 years diagnosed with ADHD. Participants will be recruited throughout the UK, through support groups, community groups, schools, social media and word of mouth. Children will be randomised to consume daily either dairy kefir or a placebo dairy drink for six weeks. The primary outcome, ADHD symptomatology, will be measured by The Strengths and Weakness of ADHD-symptoms and Normal-behaviour (SWAN) scale. Secondary outcomes will include gut microbiota composition (using shotgun metagenomic microbiome sequencing), gut symptomatology (The Gastrointestinal Severity Index questionnaire), sleep (using seven-day actigraphy recordings, The Child’s Sleep Habits Questionnaire and Sleep Self Report questionnaire), inattention and impulsivity (with a computerised Go/NoGo test). Assessments will be conducted prior to the intervention and at the end of the intervention. Interaction between time (pre/post-intervention) and group (probiotic/placebo) is to be analysed using a Mixed Model Analysis of Variances (ANOVA). Ethics and dissemination: Ethical approval for the study was granted by St Mary’s University Ethics Committee. Results will be disseminated through peer-reviewed publications, presentations to the scientific community and support groups. Trial Registration: The trial protocol has been prospectively registered with ClinicalTrials.gov: NCT05155696. Registered on 13 December 2021

Concord grape Juice, cognitive function and driving performance: a 12 week, placebo controlled, randomised, crossover trial in mothers of pre-teen children

Background: Daily consumption of Concord grape juice (CGJ) over three to four months has been shown to improve memory function in adults with mild cognitive impairment, and reduce blood pressure in hypertensive adults. These benefits are likely due to the high concentration of polyphenols in CGJ. Increased stress can impair cognitive function and elevate blood pressure. Thus we examined the potential beneficial effect of CGJ in individuals experiencing somewhat stressful demanding lifestyles. Objective: To examine the effects of twelve weeks’ daily consumption of CGJ on cognitive function, driving performance, and blood pressure in healthy, middle-aged working mothers. Design: Twenty five healthy mothers of pre-teen children, aged 40-50 years, who were employed for > 30 hours/week consumed 12oz (355ml) CGJ (containing 777mg total polyphenols) or an energy, taste and appearance matched placebo daily for twelve weeks according to a randomised, crossover design with a four week washout. Verbal and spatial memory, executive function, attention, blood pressure and mood were assessed at baseline, six weeks and twelve weeks. Immediately following the cognitive battery, a subsample of seventeen females completed a driving performance assessment in the University of Leeds Driving Simulator. The twenty five minute driving task required participants to match the speed and direction of a lead vehicle. Results: Significant improvements in immediate spatial memory and driving performance were observed following CGJ relative to placebo. There was evidence of an enduring effect of CGJ such that participants who received CGJ in arm 1 maintained better performance in the placebo arm. Conclusions: Cognitive benefits associated with chronic consumption of flavonoid-rich grape juice are not exclusive to adults with mild cognitive impairment. Moreover, these cognitive benefits are apparent in complex everyday tasks such as driving. Effects may persist beyond cessation of flavonoid consumption and future studies should carefully consider the length of washout within crossover designs

Orthorexia Nervosa: Examining the reliability and validity of two self-report measures and the predictors of orthorexic symptoms in elite and recreational athletes.

Objectives: Orthorexia nervosa (ON) is characterised by a pathological fixation on healthy eating. Athletes are at a greater risk of developing eating disorders (EDs) and since ON is sharing many features with EDs, is considered an emerging health concern as it might compromise athlete’s health and performance. Despite recent interest in orthorexia, there are still a lot of inconsistencies around ON and the sensitivity of the available instruments used to assess ON is questioned. The present study aimed to examine the psychometric properties of two self-reported measures of ON, to assess differences in ON between elite and recreational athletes, and to explore correlates of orthorexic scores among athletic individuals. Methods: Cross-sectional study of 215 athletes; 59 elite (mean age 26.71 ±6.83 years) and 156 recreational athletes (mean age 36.13 ± 14.33 years) completed the Teruel Orthorexia Scale (TOS), Eating Habits Questionnaire (EHQ), Short Form Food Frequency Questionnaire (SFFFQ), Eating Attitudes Test-26 (EAT-26), and the Hewitt-Flett Multidimensional Perfectionism Scale Short Form (HF-MPS-SF). Results: Exploratory factor analysis revealed two-factor structures for both the TOS and the EHQ. Elite athletes exhibited higher scores for ‘healthy orthorexia’ (HeOr) (p=.016), ‘knowledge of healthy eating’ (EHQ-Knowledge) (p=.038), diet quality score (DQS) (p=.013) and self-orientated perfectionism scores (p=.032) compared to recreational athletes. Multiple linear regression analysis revealed DQS to be a consistent and significant predictor of all ON symptoms (both TOS and EHQ). BMI was negatively associated with HeOr (β=-.21, p<.001). EAT-26 dieting, bulimia and oral subscales predicted ‘orthorexia nervosa’ (OrNe; smallest p=.015) and ‘problems associated with healthy eating’ (EHQ-Problems; smallest p=.012). Other-orientated perfectionism (OOP) was the only perfectionism construct to predict HeOr (β=.23, p<.01), EHQ-Knowledge (β=.34, p<.001), EHQ-Problems (β=.18, p<.01) and EHQ-Total (β=.27, p<.001). Conclusions: Findings suggest TOS is a reliable measure of ON symptomatology in athletes and further refinement of the EHQ is required. Improvements in assessment tools, study methodology and classification of athlete characteristics are required to advance our understanding of ON in athlete populations

Randomised controlled trial of the effects of kefir on behaviour, sleep and the microbiome in children with ADHD: a study protocol

Introduction Current interventions for children with attention-deficit/hyperactivity disorder (ADHD) are primarily medication, behavioural therapy and parent training. However, research suggests dietary manipulations may provide therapeutic benefit for some. There is accumulating evidence that the gut microbiome may be atypical in ADHD, and therefore, manipulating gut bacteria in such individuals may help alleviate some of the symptoms of this condition. The aim of this study is to explore the effects of supplementation with kefir (a fermented dairy drink) on ADHD symptomatology, sleep, attention and the gut microbiome in children diagnosed with ADHD.Methods and analysis A 6-week randomised, double-blind, placebo-controlled trial in 70 children aged 8–13 years diagnosed with ADHD. Participants will be recruited throughout the UK, through support groups, community groups, schools, social media and word of mouth. Children will be randomised to consume daily either dairy kefir or a placebo dairy drink for 6 weeks. The primary outcome, ADHD symptomatology, will be measured by The Strengths and Weakness of ADHD-symptoms and Normal-behaviour scale. Secondary outcomes will include gut microbiota composition (using shotgun metagenomic microbiome sequencing), gut symptomatology (The Gastrointestinal Severity Index questionnaire), sleep (using 7-day actigraphy recordings, The Child’s Sleep Habits Questionnaire and Sleep Self Report questionnaire), inattention and impulsivity (with a computerised Go/NoGo test). Assessments will be conducted prior to the intervention and at the end of the intervention. Interaction between time (preintervention/postintervention) and group (probiotic/placebo) is to be analysed using a Mixed Model Analysis of Variances.Ethics and dissemination Ethical approval for the study was granted by St Mary’s University Ethics Committee. Results will be disseminated through peer-reviewed publications, presentations to the scientific community and support groups.Trial registration number NCT05155696

Medical Encounters at Community-Based Physical Activity Events (parkrun) in the United Kingdom

Objective: To determine the incidence, clinical correlates and exposure risk of medical encounters during community-based physical activity events in the UK. Methods: An analysis of medical data from weekly, community-based physical activity events (parkrun) at 702 UK locations over a 6-year period (29,476,294 participations between 2014 and 2019) was conducted in order to define the incidence and clinical correlates of serious life-threatening, non-life-threatening, and fatal medical encounters. Results: 84 serious life-threatening encounters (overall incidence rate = 0.26/100,000 participations) occurred including 18 fatalities (0.056/100,000 participations). Statistical modelling revealed that the probabilities of serious life-threatening encounters were exceptionally low, however, male sex, increasing age, slower personal best parkrun time, and less prior running engagement/experience (average number of runs per year and number of years as a parkrun participant) were associated with increased probability of serious life-threatening encounters. These were largely accounted for by cardiac arrest (48/84, 57%) and acute coronary syndromes (20/84, 24%). Non-life-threatening medical encounters were mainly attributed to tripping or falling, with a reported incidence of 38.1/100,000 participations. Conclusions: Serious life-threatening and fatal medical encounters associated with parkrun participation are extremely rare. In the context of a global public health crisis due to inactivity, this finding underscores the safety and corollary public health value of community running/walking events as a strategy to promote physical activity. Funding: A grant was provided by parkrun to complete this work

Dietary intake of 20 polyphenol subclasses in a cohort of UK women

Background: Establishing and linking the proposed health benefits of dietary polyphenols to their consumption requires measurement of polyphenol intake in appropriate samples and an understanding of factors that influence their intake in the general population. Methods: This study examined polyphenol intake estimated from 3- and 7-day food diaries in a sample of 246 UK women aged 18–50 years. Estimation of the intake of 20 polyphenol subclasses commonly present in foods consumed by the sample studied was done using Phenol-Explorer® and USDA polyphenol databases. Women were participants in the Leeds Women’s Wellbeing Study (LWW) (n = 143), a dietary intervention study aimed at overweight women (mean age 37.2 ± 9.4 years; mean BMI 30.8 ± 3.1 kg/m2), and the Diet and Health Study (DH) (n = 103) which aimed to examine the relationship between polyphenol intake and cognitive function (mean age 25.0 ± 9.0 years; mean BMI 24.5 ± 4.6 kg/m2). Results: The estimated intake of polyphenol subclasses was significantly different between the two samples (p < 0.01) with consumption of 1292 ± 844 and 808 ± 680 mg/day for the LWW and DH groups, respectively. Flavanols and hydroxycinnamic acids were the most important contributors to the polyphenols consumed by both groups, owing to tea and coffee consumption. Other major polyphenol food sources included fruits, vegetables and processed foods. Conclusion: Older women consumed more polyphenol-containing foods and beverages, which was due to the higher coffee and tea consumption amongst the LWW participants