Healthy Happy Family Eating: An investigation into the effectiveness of interventions aimed at improving family eating behaviours

Unhealthy eating in children is a widespread problem, associated with poor cognitive and physical development. Increasingly, evidence indicates that poor eating habits in children track into adulthood. Parents’ feeding practices are consistently found to predict children’s eating behaviours and many interventions have been developed to target parents as the main agents of change in family eating interventions. However, parents cite time, stress and convenience as barriers both to implementing positive feeding practices and to participating in healthy eating intervention studies. The research described in this thesis sought to investigate the effectiveness of interventions aimed at improving family eating behaviours, with a particular focus on enjoyment and stress reduction. The first paper is a comprehensive Systematic Review of family eating interventions delivered in the family home. The Review found that, in order to be effective, interventions should be robustly theory and evidence driven as well as engaging and burden-free for parents. The second paper describes the detailed development of a healthy eating intervention, the Healthy Happy Family Eating programme, which was delivered online and emphasised implementing enjoyable mealtimes. The design of a Randomised Controlled Trial is described in the subsequent three chapters. These describe measure selection and design, including the third paper which identifies the lack of and reports the design of a parental feeding goal measure; a report of the trial itself (the fourth paper) and supplementary analyses and information about the trial. Throughout these studies, attention is given to parents’ goals, motivations and engagement. Collectively, the studies indicate that future intervention studies should prioritise stress-reduction at mealtimes as well as paying careful attention to the theory and evidence base; parents’ preferences for the type of help they receive with their children’s eating should be given more attention, as well as their feeding goals and the potential conflicts between these

Healthy eating interventions delivered in the family home: a systematic review

Unhealthy eating habits have long term health implications and can begin at a young age when children still consume the majority of their meals at home. As parents are the principal agents of change in children’s eating behaviours, the home environment is the logical location for the delivery of interventions targeting healthy family eating. Despite the recent proliferation of published studies of behaviour-change interventions delivered in the home, there has been little attempt to evaluate what makes such interventions successful. This review provides a systematic evaluation of all healthy eating interventions delivered to families in the home environment to date and seeks to identify the successful elements of these interventions and make recommendations for future work. Thirty nine studies are described, evaluated and synthesised. Results show that evidence- and theory-based interventions tended to be more successful than those that did not report detailed formative or evaluative work although details of theory application were often lacking. Careful analysis of the results did not show any further systematic similarities shared by successful interventions. Recommendations include the need for more clearly theoretically driven interventions, consistent approaches to measuring outcomes and clarity regarding target populations and desired outcomes

Healthy happy family eating: development and feasibility of an online intervention to improve family eating behaviours

Unhealthy eating in children is a global problem, associated with poor long-term health outcomes and evidence indicates that unhealthy eating habits developed early in life may track into adulthood. Increasingly, description of behaviour change intervention development is encouraged. This paper describes the development and refinement of an online intervention designed to improve family eating behaviours. Part 1 describes three pilot studies designed to collect quantitative and qualitative feedback about the intervention to inform its development. This is followed by Part 2, which describes an additional study covering other formative work involved in developing the intervention, including theoretical approaches, evidence-base review and stakeholder input. The resulting, robustly refined intervention is described, the efficacy of which is being evaluated by a randomised controlled trial

Effects of Protein Load Prior to the Main Meal of the Day: A Pilot Trial

Background: High protein diets increase satiety and may decrease energy intake. Many overweight people overeat in the evening. We hypothesized that ingesting protein prior to the evening meal may limit successive calorie intake and generate weight loss. Aims: To explore whether protein pre-load before the evening meal will lead to weight loss compared to eating as usual. Methods: 129 adults with a Body Mass Index (BMI) ≥25 reporting eating large evening meals were randomized to either consume a 20 g protein bar 30 minutes before their evening meal daily for two weeks (Protein pre-loading (PP) arm) or not (No protein pre-loading (NP) arm). Hunger ratings were recorded, immediately prior to each evening meal. Participants returned at the end of weeks one and two to provide their weight and rating of hunger and any changes in evening food consumption since baseline. Results: There was no significant difference in weight loss between the study arms (Week1 PP: -0.13 kg, [SD=0.74] vs. NP: -0.06 kg, [SD=0.75], not significant (NS); Week2 PP: +0.06 kg, [SD=0.82] vs. NP: -0.005 kg, [SD=0.82], NS). Participants in the PP arm reported less hunger before evening meals than those in the NP arm (Week1: 4.97 [SD=0.94] vs. 3.72[SD=0.65], p < .0011; Week2: 4.95 [SD=0.94] vs. 3.69[SD=0.71], p < .001). They also reported eating less at their evening meals (Week1: 2.59[SD=0.53] vs. 2.11[SD=0.54], p < .001; Week2: 2.63[SD=0.49] vs. 2.10[SD=0.50], p < .001). Conclusion: Consuming 20 g of protein before the evening meal reduced hunger and self-reported food intake in the evening, but had no effect on weight

A mixed-methods approach to understanding barriers and facilitators to healthy eating and exercise from five European countries: highlighting the roles of enjoyment, emotion and social engagement

Healthy adults are consistently falling below national and international recommendations for physical activity and dietary intake across Europe. This study took a co-creative approach with adult samples from five European countries to qualitatively and quantitatively establish motivators, barriers and sustaining factors for positive health behaviour change. Stage 1 delivered a newly-designed online programme, creating a community who identified challenges, motivators and solutions to sustaining positive healthy eating and physical activity behaviours. Stage 2 administered an online survey (developed from Stage 1 findings) to a larger sample to quantify the relative importance of these motivators and barriers. Results from both stages indicated enjoyment, positive emotions, and reward as key motivators for both behaviours across all five countries. Barriers included habit-breaking difficulties, temptation and negative affective states. Those with a high BMI placed more importance on social pressure than those with healthy BMI. Participants’ reports of motivators and barriers reflected relevant approaches from consumer science, behavioural economics, and psychology. Interventions supporting adults who are not chronically ill but would benefit from improved diet and/or physical activity should not focus exclusively on health as a motivating factor. Emphasis on enjoyable behaviours, social engagement and reward will likely improve engagement and sustained behaviour change

Harmonization and standardization of nucleus pulposus cell extraction and culture methods

Background: In vitro studies using nucleus pulposus (NP) cells are commonly used to investigate disc cell biology and pathogenesis, or to aid in the development of new therapies. However, lab‐to‐lab variability jeopardizes the much‐needed progress in the field. Here, an international group of spine scientists collaborated to standardize extraction and expansion techniques for NP cells to reduce variability, improve comparability between labs and improve utilization of funding and resources. Methods: The most commonly applied methods for NP cell extraction, expansion, and re‐differentiation were identified using a questionnaire to research groups worldwide. NP cell extraction methods from rat, rabbit, pig, dog, cow, and human NP tissue were experimentally assessed. Expansion and re‐differentiation media and techniques were also investigated. Results: Recommended protocols are provided for extraction, expansion, and re‐differentiation of NP cells from common species utilized for NP cell culture. Conclusions: This international, multilab and multispecies study identified cell extraction methods for greater cell yield and fewer gene expression changes by applying species‐specific pronase usage, 60–100 U/ml collagenase for shorter durations. Recommendations for NP cell expansion, passage number, and many factors driving successful cell culture in different species are also addressed to support harmonization, rigor, and cross‐lab comparisons on NP cells worldwide

Exercise changes and challenges across two lockdowns in England: a mixed-methods exploratory study

While physical activity has been extensively positively associated with physical and mental health, evidence indicates that some individuals have struggled to maintain sufficient exercise levels during the recent Covid-19 lockdowns. Using a mixed-methods design, this study aimed to characterise the features of lockdown-related physical activity and exercise behaviour changes and explore the challenges that people faced during these periods. Adult participants (N=163) who had experienced both the first and second formal lockdowns in England in 2020 were recruited to take part in an online survey. The questionnaire included demographic questions, measures of physical activity and resilience, and four open-ended questions about challenges and changes in physical activity over lockdown. Results indicated that younger adults were more likely to have reduced their activity over lockdown than others and that commonly reported challenges to exercise included logistical, motivational and time-related difficulties. Strategies to accommodate these challenges often relied on technology. Implications for future interventions are discussed

Food & meal decision making in lockdown: how and who has Covid-19 affected?

The Covid-19 lockdown resulted in all but essential shops closing in many countries, with inevitable and immediate impact on food availability and choice. Reasons for specific food choices influence diet and mealtimes and can affect psychological and physical well-being. The current study aimed first to investigate whether individuals and families in the UK have changed their food choice motivations over lockdown and second to identify sub-groups in particular need of support in the event of future lockdowns. Two hundred and forty adult participants from the UK completed an online survey, consisting of a series of demographic questions, the Food Choice Questionnaire, the Family Mealtime Goals Questionnaire and some short open-ended questions. They were asked to consider their goals and motivations around food and mealtimes at two timepoints: before lockdown and Summer 2020. Results indicated that the sample placed more importance on health, weight control and mood when choosing their food after lockdown than they had before, and less importance on familiarity. A number of sub-groups were identified who may be particularly vulnerable to food-related challenges in future lockdowns including younger adults, parents and carers of children, those self-isolating and individuals who do not live within close proximity to food shops. These results are preliminary and larger sub-group sample sizes will be necessary to draw firm conclusions. Future research should consider the nature and impact of these challenges in more detail across a more varied population

Family mealtimes: characteristics, correlates, outcomes and interventions. A systematic umbrella review

Abstract: Systematic reviews have examined the multitude of studies investigating family mealtimes and their importance to child/adolescent health and psychosocial outcomes, but the focus of each is limited to specific aspects of family meals (e.g. frequency) and/or specific outcomes (e.g. nutrition). Their findings require synthesis and so a systematic umbrella review was undertaken. Databases were searched to identify systematic reviews (with or without meta-analysis/meta-synthesis) addressing at least one of the following questions: what are the characteristics and/or correlates of family mealtimes; what outcomes are associated with family mealtimes; are interventions aimed at promoting family mealtimes effective? Forty-one eligible reviews were retrieved. Their findings demonstrate that families with children/adolescents typically eat together at least a few days each week. More frequent family meals are predicted by a more positive mealtime environment, more positive attitudes towards family meals, the presence of younger children, and families having more time. Greater family meal frequency protects children/adolescents against a poorer diet, obesity, risk behaviours, poorer mental health and wellbeing, and poorer academic outcomes. Findings from interventions seeking to promote family mealtimes are mixed. This umbrella review provides a comprehensive and integrated understanding of research into family mealtimes, establishing where evidence is sound and where further research is needed