UK Consumers Priorities for Sustainable Food Purchases

Although interest in ‘sustainable food’ has grown substantially in recent years, an official definition for sustainability has yet to be agreed upon. ‘Sustain: the alliance for better food and farming’ provide guidance to consumers wishing to make more sustainable food purchases, in the form of seven guiding principles. Using these principles, this study seeks to assess UK consumer’s priorities towards sustainable food. A detailed structured questionnaire explored shopping habits, attitudes to sustainable food components (organic, fair-trade, local food and animal welfare), stated purchasing behaviour and demographic information. Questionnaires were sent to 2,500 randomly selected Nottinghamshire (UK) residents. A response rate of 35.6% was achieved. The data reveals that consumers prioritise packaging, how food is produced and animal welfare when considering sustainable food components. Stated purchasing behaviour demonstrates that ‘free range’ and ‘local’ products are more likely to take precedence over other sustainability aspects. Future research will seek to compare and contrast stated and actual preferences by comparing the population survey results to actual purchasing behaviour from supermarket data.Consumer, sustainable food, purchasing behaviour, free range, local, animal welfare, Food Consumption/Nutrition/Food Safety,

Perceptions of obesity as a health risk: psychometric scale development and relationship with behavioural intentions

Obesity represents a serious threat to health which can be reduced by volitional control of eating and physical activity behaviour. Social cognition theories propose that such behaviour is influenced by cognitions regarding its desirability. The role of obesity outcome expectancies in predicting weight control behaviour has not been established and there are no psychometrically sound measures of these constructs. This thesis aimed to investigate the relationship between knowledge and beliefs regarding obesity's consequences and weight control Intentions in obese patients. The Obesity Risk Knowledge Scale (ORKS-10) was developed using item analysis and rigorously evaluated in a large population (n=965). The ORKS-10 scale proved to be a short, reliable and valid measure of knowledge regarding the health risks associated with obesity. In addition, thematic analysis of data from focus groups and structured interviews was used to identify 41 salient items for a scale to measure obesity outcome expectancy beliefs. Factor and item analysis were then used to develop the Obesity Outcome Expectancy Beliefs Scale (ObEx-15). The ObEx-15 comprises three reliable and unidimensional subscales; the Health Benefits of Weight Control (HBen), Social and Aesthetic Benefits of Weight Control (SABen) and Costs of and Barriers to Weight Control (Cost). Obese adults were recruited from weight management clinics (n=110, response rate=54.19%). Multiple regression analysis indicated that weight control intentions were most strongly associated with endorsement of the social and aesthetic consequences of obesity (B=0.117, t104=2.314, p<0.05) and rejection of the costs and barriers of weight control (B=0.088, t104=2.273, p<0.05). Participants had low levels of knowledge about obesity's health risks and neither ORKS-10 scores nor HBen scores were associated with intentions. Health promotion might, therefore, benefit from focusing upon obesity's non-health impacts and the costs and barriers of weight control. Future obesity outcome expectancies research will also profit from the availability of psychometrically sound measures

Perceptions of obesity as a health risk: psychometric scale development and relationship with behavioural intentions

Obesity represents a serious threat to health which can be reduced by volitional control of eating and physical activity behaviour. Social cognition theories propose that such behaviour is influenced by cognitions regarding its desirability. The role of obesity outcome expectancies in predicting weight control behaviour has not been established and there are no psychometrically sound measures of these constructs. This thesis aimed to investigate the relationship between knowledge and beliefs regarding obesity's consequences and weight control Intentions in obese patients. The Obesity Risk Knowledge Scale (ORKS-10) was developed using item analysis and rigorously evaluated in a large population (n=965). The ORKS-10 scale proved to be a short, reliable and valid measure of knowledge regarding the health risks associated with obesity. In addition, thematic analysis of data from focus groups and structured interviews was used to identify 41 salient items for a scale to measure obesity outcome expectancy beliefs. Factor and item analysis were then used to develop the Obesity Outcome Expectancy Beliefs Scale (ObEx-15). The ObEx-15 comprises three reliable and unidimensional subscales; the Health Benefits of Weight Control (HBen), Social and Aesthetic Benefits of Weight Control (SABen) and Costs of and Barriers to Weight Control (Cost). Obese adults were recruited from weight management clinics (n=110, response rate=54.19%). Multiple regression analysis indicated that weight control intentions were most strongly associated with endorsement of the social and aesthetic consequences of obesity (B=0.117, t104=2.314, p<0.05) and rejection of the costs and barriers of weight control (B=0.088, t104=2.273, p<0.05). Participants had low levels of knowledge about obesity's health risks and neither ORKS-10 scores nor HBen scores were associated with intentions. Health promotion might, therefore, benefit from focusing upon obesity's non-health impacts and the costs and barriers of weight control. Future obesity outcome expectancies research will also profit from the availability of psychometrically sound measures

Setting targets leads to greater long-term weight losses and ‘unrealistic’ targets increase the effect in a large community-based commercial weight management group

Background. Setting personal targets is an important behavioural component in weight management programmes. Normal practice is to encourage ‘realistic’ weight loss but the under-pinning evidence base for this is limited and controversial. This study investigates the effect of number and size of weight loss targets on long-term weight loss in a large community sample of adults. Methods. Weight change, attendance and target weight data for all new UK members, joining January to March 2012 was extracted from a commercial slimming organisation’s electronic database. Results. Of the 35 380 members who had weight data available at 12 months after joining, 69.1% (n=24 447)had a starting BMI≥30kg/m2. Their mean weight loss was 12.9±7.8% and for both sexes, weight loss at 12 months was greater for those who set targets (p25% was 7.6±4.0 kg/m2. A higher percentage of obese members did not set targets (p<0.001) compared to those with a BMI below 30kg/m2. Conclusions. Much of the variance in achieved weight loss in this population was explained by the number of targets set and the size of the first target. Whilst obese people were less likely to set targets, doing so increased the likelihood of achieving clinically significant weight loss and for some ‘unrealistic’ targets improved results

Red and processed meat consumption and purchasing behaviours and attitudes: impacts for human health, animal welfare and environmental sustainability

Objective: Higher intakes of red and processed meat are associated with poorer health outcomes and negative environmental impacts. Drawing upon a population survey the present paper investigates meat consumption behaviours, exploring perceived impacts for human health, animal welfare and the environment. Design: Structured self-completion postal survey relating to red and processed meat, capturing data on attitudes, sustainable meat purchasing behaviour, red and processed meat intake, plus sociodemographic characteristics of respondents. Setting: Urban and rural districts of Nottinghamshire, East Midlands, UK, drawn from the electoral register. Subjects: UK adults (n 842) aged 18–91 years, 497 females and 345 males, representing a 35·6 % response rate from 2500 randomly selected residents. Results: Women were significantly more likely (P 60 years) were more likely to hold positive attitudes towards animal welfare (P<0·01). Less than a fifth (18·4 %) of the sample agreed that the impact of climate change could be reduced by consuming less meat, dairy products and eggs. Positive attitudes towards animal welfare were associated with consuming less meat and a greater frequency of ‘higher welfare’ meat purchases. Conclusions: Human health and animal welfare are more common motivations to avoid red and processed meat than environmental sustainability. Policy makers, nutritionists and health professionals need to increase the public’s awareness of the environmental impact of eating red and processed meat. A first step could be to ensure that dietary guidelines integrate the nutritional, animal welfare and environmental components of sustainable diets

Guideline for UK midwives/health visitors to use with parents of infants at risk of developing childhood overweight/obesity

A guideline for members of the health visiting team to use with parents of infants at risk of overweight/obesity has been developed. The guideline contains recommendations about identification of infants at risk as well as a number of strategies that could be used for prevention of overweight/obesity. The guideline needs to be applied alongside health visitors’ professional judgement. It is not intended to replace normal UK clinical practice which is guided by the Healthy Child Programme and complements existing guidance such as the Framework for Action for tackling obesity

Development of an evidence-based practice guideline for UK public health nurses (health visitors) to use with parents of infants at risk of obesity

Introduction: Evidence about effective interventions that reduce obesity risk during infancy is needed. This project aimed to systematically review published Randomised Controlled Trials (RCTs) of behavioural and non-behavioural interventions which address potential risk factors for obesity to inform a guideline for UK health visitors. Methods: A multiprofessional Guideline Development Group (GDG) was convened to undertake a systematic review, based on the National Institute for Health and Clinical Excellence (NICE) guidelines. Findings from the review were used to develop a guideline which was subsequently externally reviewed by national experts and practitioners. Results: We identified 28 RCTs reporting behavioural and non-behavioural interventions delivered during infancy with breastfeeding and/or weight outcomes measured during the first two years of life. A number of on-going studies were also identified. Inclusion criteria for intervention studies included parental breastfeeding intentions and first time parents. Good evidence exists for breastfeeding promotion and support interventions. Evidence exists for parental education around responsive feeding, aspects of infant diet and soothing/sleep expectations. These behavioural components informed the guideline. Despite good evidence that infants fed lower protein formula milk gained less weight compared to milk with higher protein levels, it was not possible to incorporate the evidence from the non-behavioural studies into the guideline. Conclusion: Further research is needed to establish clinically effective interventions for obesity prevention during infancy. Continuous dialogue between commissioners, policy makers, health visitors and parents is essential to ensure existing UK policies are not a barrier to implementing obesity prevention strategies in the first year of life

Validation, optimal threshold determination, and clinical utility of the Infant Risk of Overweight Checklist (IROC) for early prevention of child overweight

Background: Previous research has demonstrated the predictive validity of the Infant Risk of Overweight Checklist (IROC). This study further establishes the predictive accuracy of the IROC using data from the Avon Longitudinal Study of Parents and Children (ALSPAC) and examines the optimal threshold for determining high risk of childhood overweight. Methods: Using the IROC algorithm, we calculated the risk of being overweight, based on International Obesity Task Force (IOTF) criteria, in the first year of life for 980 children in the ALSPAC cohort at 5 years. Discrimination was assessed by the area under the receiver operating curve (AUC c¬¬-statistic). Net reclassification index (NRI) was calculated for risk thresholds ranging from 2.5% to 30% which determine cut-offs for identifying infants at risk of becoming overweight. Results: At five years of age, 12.3% of boys and 19.6% of girls were categorised overweight. Discrimination (AUC c-statistic) ranged from 0.67 (95% CI 0.62 – 0.72) when risk scores were calculated directly to 0.93 (95% CI 0.88 – 0.98) when the algorithm was recalibrated and missing values of the risk factor algorithm were imputed. The NRI showed there were positive gains in reclassification using risk thresholds from 5% to 20%, with the maximum NRI being at 10%. Conclusions: This study confirms the IROC has moderately good validity for assessing overweight risk in infants and offers an optimal threshold for determining high risk. The IROC algorithm has been imbedded into a computer programme for Proactive Assessment of Obesity Risk during Infancy (ProAsk) which facilitates early overweight prevention through communication of risk to parents. http://online.liebertpub.com/doi/full/10.1089/chi.2015.024

Systematic review of randomised controlled trials of interventions that aim to reduce the risk, either directly or indirectly, of overweight and obesity in infancy and early childhood

The risk factors for childhood overweight and obesity are known and can be identified antenatally or during infancy, however, the majority of effective interventions are designed for older children. This review identified interventions designed to reduce the risk of overweight/obesity that were delivered antenatally or during the first 2 years of life, with outcomes reported from birth to 7 years of age. Six electronic databases were searched for papers reporting randomised controlled trials of interventions published from January 1990 to September 2013. A total of 35 eligible studies were identified, describing 27 unique trials of which 24 were behavioural and three were non-behavioural. The 24 behavioural trials were categorised by type of intervention: (1) nutritional and/or responsive feeding interventions targeted at parents of infants, which improved feeding practices and had some impact on child weight (n = 12); (2) breastfeeding promotion and lactation support for mothers, which had a positive effect on breastfeeding but not child weight (n = 5); (3) parenting and family lifestyle (n = 4); and (4) maternal health (n = 3) interventions that had some impact on feeding practices but not child weight. The non-behavioural trials comprised interventions manipulating formula milk composition (n = 3). Of these, lower/hydrolysed protein formula milk had a positive effect on weight outcomes. Interventions that aim to improve diet and parental responsiveness to infant cues showed most promise in terms of self-reported behavioural change. Despite the known risk factors, there were very few intervention studies for pregnant women that continue during infancy which should be a priority for future research

Systematic review of randomised controlled trials of interventions that aim to reduce the risk, either directly or indirectly, of overweight and obesity in infancy and early childhood

The risk factors for childhood overweight and obesity are known and can be identified antenatally or during infancy, however, the majority of effective interventions are designed for older children. This review identified interventions designed to reduce the risk of overweight/obesity that were delivered antenatally or during the first 2 years of life, with outcomes reported from birth to 7 years of age. Six electronic databases were searched for papers reporting randomised controlled trials of interventions published from January 1990 to September 2013. A total of 35 eligible studies were identified, describing 27 unique trials of which 24 were behavioural and three were non-behavioural. The 24 behavioural trials were categorised by type of intervention: (1) nutritional and/or responsive feeding interventions targeted at parents of infants, which improved feeding practices and had some impact on child weight (n = 12); (2) breastfeeding promotion and lactation support for mothers, which had a positive effect on breastfeeding but not child weight (n = 5); (3) parenting and family lifestyle (n = 4); and (4) maternal health (n = 3) interventions that had some impact on feeding practices but not child weight. The non-behavioural trials comprised interventions manipulating formula milk composition (n = 3). Of these, lower/hydrolysed protein formula milk had a positive effect on weight outcomes. Interventions that aim to improve diet and parental responsiveness to infant cues showed most promise in terms of self-reported behavioural change. Despite the known risk factors, there were very few intervention studies for pregnant women that continue during infancy which should be a priority for future research