Effects of physical activity calorie equivalent food labelling to reduce food selection and consumption: systematic review and meta-analysis of randomised controlled studies

Background: There is limited evidence that nutritional labelling on food/drinks is changing eating behaviours. Physical activity calorie equivalent (PACE) food labelling aims to provide the public with information about the amount of physical activity required to expend the number of kilocalories in food/drinks (eg, calories in this pizza requires 45 min of running to burn), to encourage healthier food choices and reduce disease. Objective: We aimed to systematically search for randomised controlled trials and experimental studies of the effects of PACE food labelling on the selection, purchase or consumption of food/drinks. Methods: PACE food labelling was compared with any other type of food labelling or no labelling (comparator). Reports were identified by searching electronic databases, websites and social media platforms. Inverse variance meta-analysis was used to summarise evidence. Weighted mean differences (WMD) and 95% CIs were used to describe between-group differences using a random effects model. Results: 15 studies were eligible for inclusion. When PACE labelling was displayed on food/drinks and menus, significantly fewer calories were selected, relative to comparator labelling (WMD=-64.9 kcal, 95% CI -103.2 to -26.6, p=0.009, n=4606). Presenting participants with PACE food labelling results in the consumption of significantly fewer calories (WMD=-80.4 kcal, 95% CI-136.7 to -24.2, p=0.005, n=486) relative to comparator food labelling. Conclusion: Based on current evidence PACE food labelling may reduce the number of kilocalories selected from menus and decrease the number of kilocalories/grams of food consumed by the public, compared with other types of food labelling/no labelling. Trial registration number: CRD42018088567

Referral criteria and assessment for bariatric surgery: Summary of updated NICE guidance

Until this year, the National Institute for Health and Care Excellence (NICE) had recommended bariatric surgery as a treatment option for people with a body mass index (BMI, weight (kg)/(height (m)2) of ≥40, or with a BMI of 35-39.9 with a significant obesity-related comorbidity, only if all non-surgical interventions had been tried first and the person was receiving management in a tier 3 service. New NICE guidelines now recommend that these groups of people should be offered a comprehensive assessment for bariatric surgery without the requirement for all non-surgical interventions to have been tried first, or for patients to already be under the management of a tier 3 service. The guidelines also provide an evidence-based list of significant health conditions that can be improved by bariatric surgery, which will help clinicians make decisions about who to offer an assessment to, and recommendations on what the assessment for surgery should include. This article summarises updated recommendations published in July 2023, referring to the updated NICE guidance on weight management. These guidelines update the previously published guidelines on management of obesity, first published in 2006 and updated in 2014

“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

Socio-demographic predictors of uptake of a virtual group weight management program during the COVID-19 pandemic

Background: The COVID-19 pandemic has had a significant adverse impact on the delivery of weight management programmes (WMPs), in order to ensure the safety of patients and healthcare professionals. Videoconferencing could provide safe remote access to group WMPs during the COVID-19 pandemic. The objectives of this study were to determine the uptake of a virtual group WMP and its predictors. Methods: All patients enrolled on a face-to-face group WMP, which constitutes part of a Tier 3 WMP delivered by the NHS, at the time of the COVID-19 pandemic lockdown were invited to transfer to a virtual format of the group WMP. Baseline data included weight, BMI, age, gender, ethnicity and Index of Multiple Deprivation (IMD) quintile score. The outcomes were accept/decline transfer to the virtual group WMP. Logistic regression was performed to assess for predictors of uptake. Results: The 315 participants were included, of which 72.1% (n = 227) accepted. After adjusting for gender, deprivation and BMI; older patients (OR 0.966, [95% CI 0.944, 0.989]; p = 0.003) and Black, Asian and Minority Ethnicity (BAME) patients (OR 0.460 [95% 0.248, 0.851]; p = 0.023) were less likely to accept the virtual group WMP. Conclusion: Strategies aimed at improving uptake of group WMP among BAME and older adult groups are needed, particularly considering the increased risk of severe COVID-19 in these two groups, and the links between obesity and poor COVID-19 outcomes

“I have travelled along on my own”—Experiences of seeking help for serious non-COVID health problems during the COVID-19 pandemic: A qualitative study

Objectives: During COVID-19 the UK general population has been given strong messages to stay at home. Concurrently unprecedented changes occurred in healthcare access with moves to remote/triage systems. Data have shown that the number of people accessing healthcare services decreased and there are significant concerns that the pandemic has negatively affected help-seeking for serious conditions, with potentially increased morbidity and mortality. An understanding of help-seeking is urgently needed to inform public campaigns. We aimed to develop an in-depth, theory-based understanding of how, when and why people sought help for potentially serious symptoms (for example, related to major cardiovascular events or cancer diagnoses) during the pandemic, and what influenced their decisions. Design: Qualitative semi-structured interviews Methods: We interviewed 25 adults recruited through a targeted social media campaign. Interviews were conducted via telephone or online platform. Our topic guide was informed by the Model of Pathways to Treatment and the Capability-Opportunity-Motivation-Behaviour model. Results: Analysis identified four main themes: Delay in recognition, Holding on to concerns, Weighing it up and Long-term impacts. Multiple societal and environmental factors influenced participants’ help-seeking and motivation, capability and opportunity to seek help, with long-term impacts on well-being and future help-seeking. Conclusions: There is a need for clear guidance about pathways to raise concerns about symptoms and gain advice while usual healthcare contacts are paused or stopped. Recommendations for future interventions to support help-seeking during pandemics include clearer messaging, co-produced with end users, on when, where and how to seek help

Efficacy of water preloading before main meals as a strategy for weight loss in primary care patients with obesity::RCT

© 2015 The Obesity Society. Objective To investigate the efficacy of water preloading before meals as a weight loss strategy for adults with obesity. Methods A two-group randomized controlled trial was conducted in Birmingham, England. Eighty-four adults with obesity were recruited from general practices. All participants were given a face-to-face weight management consultation at baseline (30 min) and a follow-up telephone consultation at 2 weeks (10 min). At baseline, participants were randomized to either drinking 500 ml of water 30 min before their main meals or an attention control group where participants were asked to imagine their stomach was full before meals. The primary outcome was weight change at 12-week follow-up. Several measures of adherence were also used, including 24 h total urine collections. Results 41 participants were randomized to the intervention group and 43 to the comparator group. The water preloading group lost -1.3 kg (95% CI -2.4 to -0.1, P = 0.028) more than comparators at follow up. Adjusting for ethnicity, deprivation, age, and gender resulted in the intervention group losing -1.2 kg (95% CI -2.4 to 0.07, P = 0.063) more than the comparator. Conclusions There is preliminary evidence that water preloading before main meals leads to a moderate weight loss at follow up. ISRCTN3323815

Supporting healthcare professionals to address child weight with parents: A qualitative study

Background: Primary care and community healthcare professionals (HCP) are well placed to discuss child excess weight with parents and support them to make changes. However, HCPs have concerns about doing this. There is a need to understand the factors that influence HCPs in undertaking these activities to inform strategies to support them. Aim: To explore with HCPs working in primary care and community settings their experiences of having conversations about child weight with parents, and the factors that create barriers or facilitate them to have these conversations. Design and setting: A qualitative study with General Practitioners (GP), Primary Care Nurses (PN), and School Nurses (SN) in England. Method: GPs and PNs were recruited to participate in semi-structured interviews. SNs from a community healthcare NHS trust were recruited to participate in focus groups. Vignettes were used to stimulate discussion. Data were analysed guided by the Framework approach. Results: 13 GPs, 7 PNs, and 20 SNs participated. Identified barriers included structural, HCP-related and parent/family-related factors. Facilitating factors for having conversations with parents about child excess weight included structural changes (e.g. dedicated appointments, access to weight assessment data, joined up working across agencies), specific approaches adopted by HCPs, and enhancing HCPs’ skills (general and weight management-related) and knowledge of child weight management services. Conclusion: A range of barriers exist to HCPs addressing child excess weight with parents in primary care and community settings. Actions to effect structural changes and support HCPs in developing relevant knowledge and skills are required to overcome these

Protocol for the feasibility and acceptability of a brief routine weight management intervention for postnatal women embedded within the national child immunisation programme: randomised controlled cluster feasibility trial with nested qualitative study (PIMMS-WL)

Introduction On average women retain 5-9kg one year after giving birth which can increase the risk of later obesity and chronic diseases. Some previous trials in this population have been effective in reducing weight, but are too intensive and costly to deliver at scale. There is a need for low-cost interventions to facilitate weight loss in this population. Methods and analysis The primary aim is to assess the feasibility of delivering a weight management intervention for overweight/obese postnatal women within child immunisation appointments. We will conduct a randomised controlled cluster feasibility trial with a nested qualitative study to assess study recruitment and acceptability of the intervention. GP practice (cluster) will be the unit of randomisation, with practices randomised to offer usual care plus the intervention or usual care only. 80 women will be recruited. The intervention group will be offered brief support that encourages self-management of weight when attending child immunisation appointments. Practice nurses will encourage women to weigh themselves weekly and record this, and to make healthy lifestyle choices through using an online weight management programme. Women will be advised to aim for 0.5-1kg/week weight loss. At each child immunisation the nurse will assess progress by weighing women. The comparator group will receive a healthy lifestyle leaflet. Data on weight, body fat, depression, anxiety, body-image, eating behaviours and physical activity will be collected at baseline and follow-up. Women and nurses will be interviewed to ascertain their views about the intervention. The decision to proceed to the phase III trial will be based on pre-specified stop-go criteria. Ethics and Dissemination Data will be stored securely at the University of Birmingham. Results will be disseminated through academic publications and presentations and will inform a possible phase III trial. The National Research Ethics Committee approved the study protocol. Trial Registration number: ISRCTN1220933

Efficacy of water preloading before main meals as a strategy for weight loss in primary care patients with obesity: RCT

Objective To investigate the efficacy of water preloading before meals as a weight loss strategy for adults with obesity. Methods A two-group randomized controlled trial was conducted in Birmingham, England. Eighty-four adults with obesity were recruited from general practices. All participants were given a face-to-face weight management consultation at baseline (30 min) and a follow-up telephone consultation at 2 weeks (10 min). At baseline, participants were randomized to either drinking 500 ml of water 30 min before their main meals or an attention control group where participants were asked to imagine their stomach was full before meals. The primary outcome was weight change at 12-week follow-up. Several measures of adherence were also used, including 24 h total urine collections. Results 41 participants were randomized to the intervention group and 43 to the comparator group. The water preloading group lost -1.3 kg (95% CI -2.4 to -0.1, P = 0.028) more than comparators at follow up. Adjusting for ethnicity, deprivation, age, and gender resulted in the intervention group losing -1.2 kg (95% CI -2.4 to 0.07, P = 0.063) more than the comparator. Conclusions There is preliminary evidence that water preloading before main meals leads to a moderate weight loss at follow up. ISRCTN3323815