• Assessment of causes of childhood obesity in 11 year-old Maltese children

      Micallef, Doreen (University of Chester, 2017-04)
      Objective The aim of this study was to show the rate of childhood obesity in 10 – 11 year old Maltese children attending year 6 in local primary schools in and to investigate whether a correlation exists between body mass index (BMI) and activity, screen-time, soft drinks consumption and sleep patterns in a cohort of Maltese children. Methods 103 boys and girls (47% and 53% respectively; mean age 10.4 years) were sampled from four different primary schools serviced by the state, Church and independent entities. The students’ height and weight were measured to determine their BMI. A questionnaire which dealt with the four areas under study was then distributed to all the participants. Data was analysed to determine whether the correlations under investigation were present. Results A negative correlation was found between BMI and (i) the number of different physical activities the students engaged in weekly, (ii) the average number of times that the students carried out these physical activities per week and (iii) the average number of hours of sleep per night reported by the children. A positive correlation was found between BMI and sugar-sweetened soft drink consumption. There seems to be no correlation between BMI and the different number of forms of screen-time the students engaged in or the total number of hours of screen-time although descriptive data shows that both factors increase with increasing BMI. 46 | P a g e Conclusion Similar studies on a larger cohort of participants should be considered in the future. The effect of involving parents, educators, general practitioners, paediatricians and other health care providers in the fight against childhood obesity should also be the primary focus of other studies.
    • Attitudes towards obesity in health care

      Fallows, Stephen; Newell, Noelle (University of Chester, 2014-10-10)
      This paper reviews the literature that has investigated individuals’ attitudes towards obesity, either quantitatively or qualitatively. This review primarily focuses on research involving trainee and registered health care professionals (HCPs). The inclusion criteria were (a) data‐ based research studies or (b) qualitative research of physicians, nurses and other HCPs; (c) evaluating obesity attitudes and beliefs of HCPs and (d) trainee HCPs; (e) studies published in English after year 2000. The results revealed that negative attitudes towards obese persons are prevalent, irrespective of health profession. Yet variables of sex, ethnicity, age, body mass index (BMI) and work experience yielded conflicting results among the selected studies. Implications include the need for additional research, awareness education and practice guidelines.
    • Behaviours of successful weight loss maintainers

      Fallows, Stephen; Gunessee, Eileen (University of Chester, 2010-11)
      Objective: The aim of this exploratory study was to determine if there were any significant differences in the behaviours of weight loss maintainers and weight loss re-gainers within a local population in the North West of England. The behaviours of the National Weight Control Registry were examined. Method: Thirty eight patients, 26 female and 12 male, with an average age of 55 years, who had been attending a weight management service for at least one year, agreed to participate in this study. Participants attended a 30 minute interview with a dietitian where they were asked questions regarding their diet, activity levels and television viewing. Based on their current weight, participants were assigned to either the weight loss maintainer group or weight loss re-gainer group. Results: Of the 38 participants, 21 were weight loss maintainers with 17 being weight loss re-gainers. Independent t-test and Mann Whitney U tests were conducted. No significant differences were found between the two groups in relation to the behaviours being examined or in baseline characteristics. There was a difference in the frequency of monitoring food intake with 57% of weight loss maintainers monitoring their food intake on a daily basis whereas 53% of weight loss re-gainers reported that they never monitored their food intake. Weight loss maintainers commented that the most important factor in maintaining their weight loss was portion control. Conclusion: There were no significant differences found in the behaviours of weight loss maintainers and weight loss re-gainers in this study population. Portion control and regular monitoring of food intake were reported as the most beneficial behaviours for long term weight maintenance.
    • Effects of breakfast and transport method to school on BMI and body fat percentage in children and adolescents

      Morris, Mike; Wiseman, Alice (University of Chester, 2010-09)
      Objective: The purpose of this study was to investigate the effects of breakfast habits and transport method to school on Body Mass Index (BMI) and body fat percentage in children and adolescents living in Exeter. Methods: Twenty-three males and 34 females with a mean age of 9.3 ± 2.5 years were recruited from a local primary and secondary school. Questionnaires were used to sort participants into four independent groups - active/breakfast eaters, non-active/breakfast eaters, active/breakfast skippers and non-active/breakfast skippers. Measures of height, weight, BMI and body fat percentage were taken and used to identify subjects who were overweight/over-fat or obese. The data was analysed using SPSS 17.0 to compare the prevalence of overweight and obesity and BMI body fat percentage between groups. Results: One-hundred percent of participants reported eating breakfast on most school days, leaving only two independent groups according to transport status. Primary school children who used non-active methods of transport to school were significantly heavier (30.5 ± 6.49 kg) than those who actively commuted to school (26.3 ± 5.37 kg; p = 0.002). The prevalence of overweight (p = 0.022) and over-fat (p = 0.003) were significantly greater among year 4 children who used non-active transport methods to school (15.4%), compared to those who actively commuted to school (0%). Mean BMI (p = 0.004) and body fat percentage (p = 0.008) were significantly greater among year 4 children who used non-active transport methods to school (17.0 ± 1.37 kg/m² and 20.6 ± 3.48 %), compared to those who used active transport methods to school (14.6 ± 0.70 kg/m² and 14.7 ± 3.11). Conclusions: Active transport to school is appears to be protective against overweight and obesity among children in year 4. The effects of active transport to school on BMI and body fat percentage among the whole sample and among other sample subsets are unclear and further research is required to clarify these relationships.
    • Evaluation of a specialist weight management service for patients with severe obesity in Liverpool

      Commane, Daniel; Mullarkey, Dianne (University of ChesterNHS Liverpool, 2011-02)
      Objective: To evaluate a specialist weight management treatment for patients with severe obesity and follow up at 3 months, monitoring changes in weight, BMI and clinical outcome variables. Changes in food intake, self esteem and health related quality of life (HRQL) were also compared to pre- and post- intervention. Design: Step by step is a new obesity servive which specifically targets obese patients at greater risk of further ill health. Only patients who are referred by their G.P. or health professional have been included in the evaluation. After an assessment appointment all patients choose one of two treatment options: group programme, individual dietetic care or both. The group programme offered weekly contact over twelve weeks and monthly follow up thereafter in a community setting. One-to-one care offered monthly appointments with the Dietician over a three month period. Subjects: A total of 50 patients with a BMI>30kg/m2, mean age 59 years, mean weight for males 113.5kg, BMI 39,3kg/m2 and females 92.7kg, BMI 36.5kg/m2. Main outcome measures: weight, BMI, total cholesterol, LDL, TG, HDL, FBG, HbA1C, blood pressure, food intake, self esteem and quality of life were measured pre and post intervention. Results: Patients who attended the group programme showed significant weight loss 1.99kg (P<0.05) and BMI 0.66kg/m2 at three months. Male patients lost more weight (3.9kg) during the three month period compared to females (1.4kg). Data was not available for individual dietetic care. Patients significantly reduced intake of negative marker foods (P<0.00). No changes were observed between self esteem pre and post programme however quality of life score increased considerably, 44.83 (S.D. 34.26) to 70.37 (S.D. 15.86) P<0.001. Conclusion: Patients attending a twelve week weight management programme run by community dietians and foodworkers achieve clinically worth while reducations in weight and BMI, improvements in food choice and choice and improved HRQL.
    • Evaluation of an adult weight management service delivered by pharmacies and GP practices

      Mills, Sarah (University of Chester, 2011-10-10)
      This study aimed to determine whether an adult weight management programme delivered by pharmacies and GP practices in Birmingham was effective and if there was a difference between pharmacy and GP led programmes. In this repeated measures study (n=450) of a 12 week weight management programme consisting of weekly appointments and three follow up appointments delivered in pharmacies (n=183) and GP practices (n=267). Participants at baseline had a mean age of 42 (±12.4) years, and mean BMI of 34.5 (±6.0) kg/m² and were measured at baseline (n=450), 12 weeks (n=166) and 6 month follow up (n=82). Weight, BMI, waist circumference and quality of life (QoL) measurements were taken at each time point. Overall there was a significant decrease in weight (3.10kg (±4.32)), waist (6.20cm (±6.21)) and BMI (1.12kg/m² (±1.76)) between baseline and 12 weeks (p=0.000), and baseline and six month follow up (p=0.000). With 39% of participants losing more than 5% of their weight and 54% losing more than 5cm from their waist at 6 month follow up. QoL significantly increased between baseline and 12 weeks (p=0.000), and baseline and six month follow up (p=0.000). GP led programmes had a significantly (p=0.043) higher percentage weight loss than the pharmacy led programmes at 12 weeks. However, the pharmacy led programme demonstrated significant (p=0.009) weight loss between completing the 12 week programme and 6 month follow up, compared to the GP led programme where weight increased. The pharmacy led programme had a considerably higher retention rate and resulted in a 4.03%(±5.24) weight loss at follow up with significantly (p=0.019) more participants achieving more than 5% weight loss at the 6 month follow up compared with the GP led programme. The adult weight management programme is effective, resulting in a significant decrease in weight, BMI and waist circumference and a significant increase in quality of life at 12 weeks and maintained 6 months post intervention. The pharmacy led programme appears more effective than the GP led programme demonstrating a significantly greater retention rate with a significant percentage of participants maintaining their weight loss 6 months post intervention.
    • An evaluation of the adult weight management programme - "Weight no more"

      Fallows, Stephen; Martin, Angela (University of Chester, 2013-10-31)
      The aim of this study is to provide an evaluation of the “Weight No More”, adult weight management programme which is part of the “Active Lifestyles” service. This evaluation is a retrospective study, analysing before and after data of male and female participants (n = 154) who took part in the “Weight No More” programme during January 2011 to August 2013. Participants attended circuit based exercise classes and received additional weight management support. Height, weight and BMI were all recorded at the participant’s initial visit and then weight and BMI repeated frequently. Sessions were open access and participants chose which venue to attend, attendance ranged from one to 66 weeks, however for the purpose of this study repeat measurements were investigated at 4 (n = 30), 8 (n = 20) and 12 (n = 13) weeks. There were statistically significant decreases in weight at baseline and 4 weeks (P= 0.010) of -1.2kg, baseline and 8 weeks (P= 0.003) of -1.88kg and baseline and 12 weeks of -2.9kg (P= 0.010). Those involved in the programme were predominantly of white ethnicity (64.9%), female (94%) with a mean age of 47 years. 8.9% of the participants involved were from the top 10% most deprived wards in Manchester. Providing a physical opportunity for weight management in Manchester can attract those who are overweight and obese and is effective at reducing weight. Further support is available for participants to continue to be active and maintain weight loss by accessing further physical activity sessions through the “Active Lifestyles” service.
    • A focused qualitative assessment of primary school education needs to inform tailored resources supporting childhood obesity

      McNamara, Sorcha (University of Chester, 2017-09)
      Objective: To examine primary school education-needs to inform tailored resources supporting childhood obesity. Design: A qualitative study based on 8 semi-structured interviews. Questions addressed schools' approach to childhood obesity, resources, barriers, and possible enablers. Setting: Primary schools from the Manchester City Council jurisdiction. Participants: A purposive sample of 8 senior leadership school staff members (100% female). Phenomenon Of Interest: Types of perceived barriers and supportive tools to empower obesity discussions with parents. Analysis: Transcriptions were coded and analysed based on a socioecological framework using thematic analysis. Results: Five key themes emerged: complex families, primary schools as a key setting, the food environment, difficulties raising obesity and empowerment. The enabler training pack developed in response to these themes was received positively by school staff and initial feedback indicated it helped bridge perceived knowledge and skill gaps. Conclusions and Implications: Significant barriers exist to health behaviour change for families of a lower socio-economic status. Each school’s approach to childhood obesity varied greatly but all expressed a need for more healthcare professional guidance. Implications include training and tailored resources that can be applied to all primary schools and their staff.
    • Food, physical activity and climate change perspectives in relationship to allotment ownership

      Burek, Cynthia V.; Ellahi, Basma; Hunt, Ann (University of Chester, 2010)
      Obesity and climate change are two of the biggest public health crises that the world currently faces and will face for many years to come, unless action is taken to halt the causes. The link between diet, physical activity and obesity has been firmly established. The causes of obesity are however, a multi-faceted problem, as are the causes of climate change. Current food production has been linked to increasing levels of CO2, and current eating habits can be responsible for a large carbon footprint. Growing your own food has been suggested as a method of reducing one’s carbon footprint, increasing physical activity levels and improving diet, little evidence exists to support this theory. This study looks at the fruit and vegetable consumption, physical activity levels and climate change awareness of allotment holders in two wards of Stockport. Qualitative and quantitative data was collected via face to face questionnaires (n=28) at both allotments sites. Fruit and vegetable intakes of allotment holders were above those of the U.K. general public and intake increased after allotment ownership. Physical activity levels were on average, higher than the recommendation of thirty minutes a day for at least five days per week and generally increased after uptake of the allotment. Allotment owners rent their plots for a combination of reasons, the majority wanting to grow their own food, and get exercise and most also cite some form of environmental issue. All participants were aware of climate change and although not all thought it would affect allotments; most had ideas of what they would do to adapt to changes. There are synergies between solving climate change issues, such as Green House Gas emissions and improving our health, both physically and nutritionally. Growing your own fruit and vegetables on an allotment can increase your consumption of fruit and vegetables significantly, increase your exercise levels and reduce your CO2 emissions.
    • Intermittent Fasting: how long is enough?

      Jawadwala, Rehana; de Castro, Andreia Filipa Luis (University of Chester, 2013-12)
      The rise in obesity numbers worldwide have led to an increase in associated co morbidities and consequently to a rise in the direct and indirect costs to society. For these reasons it is essential to treat obese and overweight individuals and to prevent the emergence of new cases. However, one of the most widely used approaches for the treatment of obesity, the daily calorie restriction diets, have been shown to be ineffective due to low adherence, becoming urgent to find new methods for control and treat this multifactorial disease. Therefore, intermittent fasting approaches have gained popularity because they have been shown to be effective in reducing body weight and body fat, while preserving lean tissue and, as such, have been seen as a solution to the replacement of traditional daily caloric restriction diets.
    • Investigation of Orlistat as an intervention for obesity and cardiovascular risk factors: A systematic review

      Fallows, Stephen; Wrigley, Daniel K. (University of Chester, 2010-09)
      Background – Obesity is an ever increasing problem in modern society. Numerous pharmacological interventions have been introduced to combat the detrimental effects of this major health issue, including the lipase inhibitor, orlistat. Objectives – To investigate, and assess, the pharmacological effect of two differing doses of orlistat (xenical® 120mg; and alli™ 60mg), on weight loss parameters and cardiovascular risk factors. Search Strategy – Studies were obtained through computerised searches of MEDLIN, PUBMED, CINAHL, EMBASE, The Cochrane Library, Web of Knowledge, and from manual searches in recognised scientific journals. Selection Criteria – Randomised controlled trials in adult only subjects, of any study duration, comparing orlistat against surgical interventionm alternative medical intervention, and placebo, for weight loss and cardiovascular risk factors. Data Extraction & Synthesis – One reviewer independently assessed relevant studies, risk of bias, and extracted data. Main Results – Nineteen studies deemed relevant were included for final review. No study included cardiovascular mortality as an outcome. All studies reported significant (p<0.05) weight loss in orlistat treated patients from baseline to end of treatment. Most frequent side effects were mainly gastrointestinal in nature. Onset of diabetes progression was reduced in orlistat patients. Other cardiovascular risk factors were shown to decrease in orlistat patients. Conclusion – In patients with body mass index ≥27kg/m², orlistat, sibutramine, and metformin reduce body weight to a similar degree. Orlistat reduces waist circumference to the greatest degree. Orlistat induces greater gastrointestinal side effects and a greater attrition rate. Alli™ needs greater investigation of effects.
    • Knowledge and attitudes of obesity in university students

      Fallows, Stephen; Morris, Mike; Giglia, Melissa (University of Chester, 2012-09)
      This paper reviews the literature which has measured individual’s knowledge on the health risks associated with obesity, and individual’s attitudes towards obese persons. This review primarily focuses on studies that recruited students, health care professionals, and the general population. The inclusion criteria was: students, health care professionals, general population, studies that used the Obesity Risk Knowledge (ORK-10) scale, studies that used the Attitudes Towards Obese Persons (ATOP) scale, and any other validated questionnaire which measured obesity risk knowledge (ORK), and attitudes towards obese persons. Results revealed high obesity risk knowledge among health care professionals, primarily dieticians and general practitioners, and low obesity risk knowledge amongst the general population. Negative attitudes towards obese persons were prevalent in most studies, and were evident in students, health care professionals and the general population. The variables gender and BMI yielded conflicting results among the selected studies. Education is needed to increase obesity risk knowledge among a number of health care professionals and the general population, this will aid preventative techniques towards overweight and obesity. In addition, educational tools to raise awareness and reduce weight related bias and stigma need to be implemented in employment and educational settings, amongst the general population and health care professionals.
    • Lowering dietary carbohydrates to manage obesity and related disease: A systematic review and theoretical framework

      Fallows, Stephen; Verma, Radhika (University of Chester, 2012-09)
      This study aimed to evaluate the lowering of carbohydrates from conventionally recommended levels of ->55% of energy intake as a valid and safe treatment option for managing obesity and related disease. The study was a qualitative systematic review of fourteen randomized controlled studies, each with at least one study arm that lowered intake of carbohydrates to either ketogenic levels (->50g/) (Atkins type diet) or non-ketogenic levels including Zone type diets (>50g/d to 40-45% of energy intake). Low carbohydrate diets have generally implied increased protein intake to around 30% of energy intake. Outcomes evaluated included weight and fat loss; dyslipidemia; blood sugar control; hypertension; nutritional adequacy; hunger and satiety; adherence and safety. A synthesis of process, results and implications was used towards generating a theoretical weight maangement framework. In the short to medium term of up to six months both the ketogenic and non-ketogenic lowering of carbohydrates within the context of a calorie reduction of 300-750 kcal/day generated clinically meaningful weight loss results of 5-10% Lower-carbohydrates diet plans generated similar or better results for most of the main outcomes examined as comparted with conventional higher-carbohydrate/low-fat diet alternatives. Longer-term studies were few in number but weight loss results were in the range of 2-6% with no significant diet difference noted. Potential impact of ketogenic diets on dyslipidemia, renal and bone health needs further evaluation. When lowering carbohydrates or calories, nutritional adequacy may require maangement with the use of supplementation. Lowering carbohydrates may provide an important and useful strategy to achieve a regular daily caloriee deficit, generate clinically meaningful weight loss and improve related metabolic health markers. Recommended weight management protocols may be individualised based on a theoretical model that considers individual health risks and genetics, dietary preferences, carbohydrate sensitivity and is geared towards improved adherence.
    • Physical activity and functional capacity and normal-weight, overweight and obese Greek young adults

      Buckley, John P.; Fallows, Stephen; Psichogiou, Athinais-Georgia (University of Chester, 2010-09)
      Objective: The aims of this study were to present information regarding the physical activity (PA) profile, functional capacity (FC) status and body composition of normal-weight, overweight and obese young Greeks, to investigate the impact of overweight and obesity on the subjects’ PA and FC and to explore possible interrelations between their anthropometric characteristics, PA and FC. Method: Sixty-two healthy, Greek young adults (27 males), with a mean age of 23.9 ± 3.9 years, attended a single testing session during which they were subjected to anthropometric and physiological measurements, they completed the Greek version of the Short International Physical Activity Questionnaire (IPAQ-SGR) and they performed two six-minute walk tests (6MWT) using a standardised protocol. Analysis of variance and post hoc analysis was used to investigate possible differences between the three groups, while bivariate correlational techniques were used to assess possible interrelations between the subjects’ anthropometric characteristics, their PA and FC. Results: During the 6MWT, overweight subjects walked significantly further (624.0 ± 88.8 m) than obese subjects (544.9 ± 108.4 m) (p<0.01). No significant differences were observed between the three groups regarding IPAQ scores. Significant associations were mainly detected between the subjects’ anthropometric characteristics and 6MWT-related variables. Conclusions: The FC of normal and overweight subjects appeared to be similar and better than that of obese subjects, while, all subjects, regardless of BMI categorisation, were found to have similar PA profiles. This study further supports the association between obesity indices and functional capacity.
    • A realistic evaluation of an NHS community weight management programme

      Ellahi, Basma; Hogg, Samantha (University of ChesterNHS Ashton, Leigh and Wigan, 2010-11)
      The “Lose Weight, Feel Great” (LWFG) pathway was commissioned by NHS Ashton, Leigh & Wigan with the aim to reduce the rising tide of obesity within the Wigan Borough (Hogg et al. 2010). The Community Weight Management Programme (CWMP) is one of the services offered and involves dietary advice, physical activity sessions and methods for behavioural change. Approximately 35% of service users are successful at losing 5% or more of their initial body weight; however other service users are not as successful. The aim of this dissertation was to understand the context and mechanisms which may facilitate or impede success. Method: Following a framework of Realistic Evaluation (Pawson & Tilley, 1997), 25 semi-structured telephone interviews where undertaken with people who had previously accessed CWMP. The interviews where transcribed verbatim and then analysed using Thematic Analysis to identify common themes (Howitt & Cramer, 2007). Findings: Seven Themes emerged from the interviews. Four themes related to mechanisms of CWMP, two themes related to contexts surrounding CWMP and one theme related to outcomes from CWMP. Mechanisms involved: group sessions; Slimming World consultant & Wigan Leisure Culture Trust activity officers; physical activity sessions; the Slimming World Eating Plans. Contexts involved: the Healthy Foundations Segmentation Model; motivation & Readiness to Change. Outcome: Change in Lifestyle. Conclusion: Changes could be made to CWMP, such as increasing the number of free sessions, offer other LWFG services if CWMP does not appear to be appropriate, and provide more extensive information during the induction sessions. However, it is also important to take into account people’s motivation to change, the segment that they may fit into and that changes to lifestyle are not just limited to the service users, but also family members. Changes to the programme will improve success rate and ensure that resources are used effectively.
    • Social and cultural construction of obesity among Pakistani Muslim women in North West England

      Ellahi, Basma; Cox, Peter; Ludwig, Alison F. (University of Liverpool (University of Chester), 2012-04)
      Higher rates of obesity, Type 2 diabetes and coronary heart disease are observed in British Pakistani women compared to the general UK population. This qualitative research explored the links between the participant’s understanding of health risks related to obesity, body image and dietary patterns in a cohort of first- and second-generation Pakistani women, living in Greater Manchester, England. Pakistani women act as gatekeepers to family nutrition and health. The research aims to inform promotion strategies, focusing on healthier changes, and to create increased levels of awareness of the strategies. Beyond South Asian [SA] languages, effective and ethnically appropriate approaches are essential to reach these goals. Research outcomes can no longer just be interesting or show potential, as they ought to contribute to improving women’s health and advice public health professionals when making relevant recommendations. Qualitative techniques, using focus groups and one-to-one interviews, with 55 women, were recruited from the Pakistani community via snowballing and cold calling at community and resource centres. The participants were either active in their local communities or were deemed “hard to reach” in relation to accessibility. The interviews were conducted in the participants’ homes or at the venues. Third-person fictitious vignettes were used to stimulate and promote discussion. A series of vignettes were intended to resonate with the participant’s own lives. The interviews were audio-recorded, transcribed then analysed. One researcher as a community insider and the other as an outsider, along with sociological analysis, reflected upon then coded the data. Using ethnography and an interpretive, phenomenological framework, allowed for data description and interpretation of an emerging understanding. The rich data uncovered issues relating to faith, family and broader socio-cultural influences, all of which had an impact on daily life and in particular to food choices. Despite an acknowledgement of obesity in themselves and around them, there appeared to be a lack of awareness linking obesity to health outcomes. The participants in both generations turned to and, in part, relied upon both traditional food and western health beliefs. As an outcome of the data analysis, a multi-directional theoretical model was developed specifically for this group of women in Manchester, called the Health Action Transition (HAT) model. The HAT model is intended to be used as a working tool in a clinical setting to aid in understanding of the Pakistani women’s socio-cultural structures and to provide a framework for recommendations relating to health promotion for these women.
    • A systematic review of the effects of dieting on food cravings in an overweight or obese population

      Fallows, Stephen; Meadows, Angela (University of Chester, 2012-10-30)
      The objective of this dissertation is to systematically search and evaluate the literature on the effects of weight-loss dieting on food craving in overweight or obese adults. Studies were obtained from searches of multiple electronic bibliographic databases. Inclusion criteria were: (1)adult participants (18 years and older), classified as overweight or obese by body mass index (BMI>25 kg/m2) at baseline, and currently following a hypocaloric diet for the purposes of weight loss; (2) a non-dieting overweight/obese control; (3) at least one outcomes measure relating to frequency, intensity, or behavioural dimensions of food cravings. No restrictions on study design were made. Relevant studies were assessed for risk of bias and study charactertistics, details of dietary intervention, patient details, and cravings outcomes were extracted. Eight studies met the inclusion criteria and were included in the review, although none provide longitudinal comparisons of the impact of dieting versus non-dieting in an exclusively overweight population. Wide heterogeneity between studies in terms of design, dietary interventions and outcome measures used precluded pooling of data. Overall, low-calorie dieting appeared to have little or no effect on frequentcy, intensity, or type of cravings, although severe caloric restriction did appear to reduce the frequency of both general and intense cravings. These is some evidence that restricted foods are craved less, rather than more, during weight-loss dieting. The data do not support lay perceptions that dieting increases food cravings; however, these findings are based on a small number of studies, and methodological issues limit the conclusions that can be drawn from these studies.
    • Systematic review of the efficacy of high intensity interval training versus continuous training for weight loss in overweight and obese individuals

      Fallows, Stephen; O'Keeffe, Chris (University of Chester, 2015-09)
      The increasing prevalence of individuals being overweight and obese in conjunction with the associated co-morbidities continues to be a major public health concern. The traditional exercise prescription to accomplish weight loss in such a population has been to perform sustained low to moderate intensity aerobic exercise termed “continuous (CONT) training.” More recently high intensity interval training (HIIT) has been suggested as a more effective alternative for weight loss. HIIT involves short periods of high intensity efforts interspersed with recovery periods of lower intensity. The rationale for such an approach is that individuals can achieve similar results to longer CONT type training but in less time. The purpose of this systematic review is to compare the effects of HIIT and CONT training on weight loss and other anthropometric measures in overweight and obese adults when both training protocols are matched for energy expenditure. A total of nine studies met the selection criteria for inclusion in the review. Four studies included only overweight participants. Of these four, one showed that both CONT training and HIIT were similarly effective for reducing body mass, BMI, body fat, FFM and waist circumference, whilst one concluded that CONT training rather than HIIT was more effective at reducing total body fat and android fat. The remaining two found neither CONT nor HIIT to be effective at reducing overall body mass. Three studies used only obese participants. One found both CONT and HIIT to be equally effective in reducing measures of body mass, BMI and body fat. One found CONT training and HIIT were both equally effective in reducing body mass, fat mass, and gynoid fat mass when combined with a strict calorie controlled diet. The third found neither exercise protocol to be successful for weight or regional fat loss despite the inclusion of dietary guidance as part of the intervention. Of the two studies that included both overweight and obese participants one revealed that both CONT training and HIIT were equally effective in favourably altering body mass, BMI and waist circumference whilst the second showed that both protocols were equally effective at reducing body fat and waist circumference. This review does not support the premise that HIIT is superior to CONT training for weight and fat loss in overweight and obese adults when both exercise protocols are isocalorific in terms of energy expended. Rather, both approaches appear to be similarly effective for inducing favourable anthropometric changes and a combination of the two may be considered as a means to achieving weight loss in overweight and obese adults based on individual preference.
    • A text message based weight management intervention

      Fallows, Stephen; Donaldson, Eleanor L. (University of ChesterLeicestershire Nutrition & Dietetic Service, 2010-10-21)
      Purpose: This study aimed to determine whether a text message based intervention helped participants maintain or lose weight following completion of a weight loss programme. Low fat diet, regular exercise, breakfast consumption, goal setting and self monitoring are behaviours of weight losers and maintainers (Wing & Hill, 2001). Weight management interventions can be enhanced using mobile telephone technology to deliver support in real time, real world settings (Heron & Smyth, 2010) Methods: In this controlled study, overweight adults completing a weight management programme participated in an additional 12-week text message based intervention (‘LEAP Beep’). Participants (n=17, 7 males; 10 females; mean age 58.3 ± 12.1 years) were allocated daily targets for steps, fruit, vegetable and breakfast consumption. Twice weekly, participants ‘texted’ with progress and received practitioner feedback. Pre and post intervention body mass, waist circumference, Body Mass Index (BMI), quality of life (QOL), anxiety and depression measurements were collected and compared retrospectively to a control group (n=17; 4 males, 13 females; mean age 59.1 ± 9.5 years) receiving optional weight checks only (standard care). Paired t tests and Wilcoxon signed ranks tests evaluated differences between pre and post intervention variables. Results: Compared to the control, intervention group body mass, waist circumference and BMI reduced significantly (p=0.006; p=0.0005; p=0.03). QOL and depression scores improved, but not significantly (p=0.134; p=0.228). No difference was found between group anxiety scores (table 1.) Satisfaction surveys showed 100% (n=14) of participants strongly agreed they were satisfied with the overall programme. Conclusions: ‘LEAP Beep’ resulted in weight and waist circumference losses, improved quality of life parameters and was highly acceptable to participants. Text messaging is a cheap, portable, convenient and innovative contact medium that promotes goal setting, self monitoring and facilitates information exchange with patients. Text messaging inclusive of practitioner feedback opens up increasing possibilities for practitioner to patient support and helps maintain a positive weight outcome following initial weight loss. Further improvements to automation whilst maintaining individual support are necessary to ease practitioner burden.