Barriers and facilitators to implementation of menu labelling interventions from a food service industry perspective: a mixed methods systematic review

BACKGROUND: Eating outside the home contributes to poor dietary habits worldwide and is associated with increased body fat and weight gain. Evidence shows menu labelling is effective in promoting healthier food choices; however, implementation issues have arisen. The purpose of this systematic review was to synthesise the evidence on the perceived barriers and facilitators to implementation of menu labelling interventions from the perspective of the food service industry. METHODS: Peer-reviewed and grey literature were searched using databases, specialised search engines and public health organisation websites. Screening reference lists, citation chaining and contacting authors of all included studies were undertaken. Primary research studies relevant to direct supply-side stakeholders were eligible for inclusion. There were no restrictions on menu labelling scheme or format, study methods, publication year or language. At least two independent reviewers performed study selection, data extraction and quality appraisal. The results were synthesised using the 'best fit' framework synthesis approach, with reference to the Consolidated Framework for Implementation Research (CFIR). RESULTS: Seventeen studies met the eligibility criteria, with the majority rated as average quality (n =¿10). The most frequently cited barriers were coded to the CFIR constructs 'Consumer Needs & Resources' (e.g. lack of customer demand for/interest in menu labelling, risk of overwhelmed/confused customers) and 'Compatibility' with organisation work processes (e.g. lack of standardised recipes, limited space on menus). Frequently cited facilitators were coded to the CFIR constructs 'Relative Advantage' of menu labelling (e.g. improved business image/reputation) and 'Consumer Needs & Resources' (e.g. customer demand for/interest in menu labelling, providing nutrition information to customers). An adapted framework consisting of a priori and new constructs was developed, which illustrates the relationships between domains. CONCLUSION: This review generates an adapted CFIR framework for understanding implementation of menu labelling interventions. It highlights that implementation is influenced by multiple interdependent factors, particularly related to the external and internal context of food businesses, and features of the menu labelling intervention. The findings can be used by researchers and practitioners to develop or select strategies to address barriers that impede implementation and to leverage facilitators that assist with implementation effort

Obesity in adults: a 2022 adapted clinical practice guideline for Ireland

This Clinical Practice Guideline (CPG) for the management of obesity in adults in Ireland, adapted from the Canadian CPG, defines obesity as a complex chronic disease characterised by excess or dysfunctional adiposity that impairs health. The guideline reflects substantial advances in the understanding of the determinants, pathophysiology, assessment, and treatment of obesity. It shifts the focus of obesity management toward improving patient-centred health outcomes, functional outcomes, and social and economic participation, rather than weight loss alone. It gives recommendations for care that are underpinned by evidence-based principles of chronic disease management; validate patients' lived experiences; move beyond simplistic approaches of "eat less, move more" and address the root drivers of obesity. People living with obesity face substantial bias and stigma, which contribute to increased morbidity and mortality independent of body weight. Education is needed for all healthcare professionals in Ireland to address the gap in skills, increase knowledge of evidence-based practice, and eliminate bias and stigma in healthcare settings. We call for people living with obesity in Ireland to have access to evidence-informed care, including medical, medical nutrition therapy, physical activity and physical rehabilitation interventions, psychological interventions, pharmacotherapy, and bariatric surgery. This can be best achieved by resourcing and fully implementing the Model of Care for the Management of Adult Overweight and Obesity. To address health inequalities, we also call for the inclusion of obesity in the Structured Chronic Disease Management Programme and for pharmacotherapy reimbursement, to ensure equal access to treatment based on health-need rather than ability to pay

Milk as a rehydration fluid following exercise-induced loss of body mass.

The effectiveness of 0.1% fat milk (M) at restoring fluid balance after exercise and heat induced hypohydration was compared to a commercially available carbohydrate-electrolyte (CE) sports drink and water (W) using a metered rate of fluid ingestion. After losing 2.1 (0.2) % body mass, participants (n = 7) consumed a drink volume equivalent to 150% of their body mass loss, over a period of 2.5-3 hours. A metered rate of fluid ingestion was chosen as it is widely acknowledged that rapid ingestion (1000ml) can over-stimulate diuresis. Blood and urine samples were collected before and for 5 hours after exercise-induced loss of body mass. Mean plasma osmolality was higher in the M trial 289 (3) mOsmol/kg compared to W 286 (3) mOsmol/kg and CE 287 (3) mOsmol/kg, during this 5 hour period (p = 0.021). Indicative of a reduced diuretic response, urine volume was lower and urine osmolality higher in the M trial compared with CE and W. Total urine volume during the M trial was 774 (92) mL compared to CE 1314 (434) mL and W 1429 (345) mL (p = 0.023). A net positive fluid balance from 2h to 5h was achieved in the M trial, whereas the CE and W trials returned to net negative balance by the end of the 5h rehydration period. Final net fluid balance in the M trial was 117 (122) mL compared to CE -381 (460) mL and W trials -539 (390) mL (p = 0.049). This represents a final relative net fluid balance of 5.9 (5.9) % in the M trial compared with CE -22.7 (23.3) % (p = 0.048) and W - 30.9 (22.7) % (p = 0.012)

A metered intake of milk following exercise and thermal dehydration restores whole-body net fluid balance better than a carbohydrate-electrolyte solution or water in healthy young men

Appropriate rehydration and nutrient intake in recovery is a key component of exercise performance. This study investigated whether the recovery of body net fluid balance (NFB) following exercise and thermal dehydration to -2 % of body mass (BM) was enhanced by a metered rate of ingestion of milk (M) compared with a carbohydrate-electrolyte solution (CE) or water (W). In randomised order, seven active men (aged 262 (sd 61) years) undertook exercise and thermal dehydration to -2 % of BM on three occasions. A metered replacement volume of M, CE or W equivalent to 150 % of the BM loss was then consumed within 2-3 h. NFB was subsequently measured for 5 h from commencement of rehydration. A higher overall NFB in M than CE (P=0001) and W (P=0006) was observed, with no difference between CE and W (P=069). After 5 h, NFB in M remained positive (+117 (sd 122) ml) compared with basal, and it was greater than W (-539 (sd 390) ml, P=0011) but not CE (-381 (sd 460) ml, P=0077, d=16). Plasma osmolality (P-osm) and K remained elevated above basal in M compared with CE and W. The change in P-osm was associated with circulating pre-provasopressin (r(s) 0348, P001), a biomarker of arginine vasopressin, but could not account fully for the augmented NFB in M compared with CE and W. These data suggest that a metered approach to fluid ingestion acts in synergy with the nutrient composition of M in the restoration of NFB following exercise and thermal dehydration

Improved Quality of Life, Fitness, Mental Health and Cardiovascular Risk Factors with a Publicly Funded Bariatric Lifestyle Intervention for Adults with Severe Obesity: A Prospective Cohort Study

Background: Lifestyle modification is the cornerstone of management for patients with severe and complicated obesity, but the effects of structured lifestyle programmes on quality of life, anxiety and depression scores and cardiovascular risk factors are not well-described. We sought to describe changes in self-reported quality of life and mental health-related outcomes as well as cardiovascular risk factors in patients completing a 10-week multidisciplinary lifestyle-modification programme. Methods: We conducted a prospective cohort study of all patients referred from our bariatric service who completed the programme between 2013 and 2019. In addition to weight, body mass index (BMI), blood pressure, HbA1c, lipid profile and functional capacity, we quantified health-related quality of life using the Dartmouth COOP Questionnaire and the European Quality of Life Questionnaire Visual Analogue Scale (EQVAS) and mental health using the Hospital Anxiety and Depression Scale (HADS). Results: Of 1122 patients who started the programme, 877 (78.2%) completed it and were included in per protocol analyses. Mean age was 47.3 ± 11.9 years, 66.9% were female, 34.8% were in full- or part-time employment and 69.4% were entitled to state-provided medical care. BMI decreased from 47.0 ± 7.8 to 46.2 ± 7.8 kg m−2 and weight decreased from 131.6 ± 25.5 to 129.5 ± 25.4 kg (both p p < 0.001). Small but statistically significant reductions in LDL cholesterol, systolic blood pressure and HBA1c were also observed. Conclusions: Adults with severe and complicated obesity completing a specialised bariatric lifestyle-modification programme showed significant improvements in self-reported mental health and quality of life, in addition to reductions in cardiovascular risk factors