Micallef, Maria C. (University of Chester, 2013-09)
Physical inactivity and excess weight are two major public health problems (World Health Organisation [WHO], 2000, 2006). In 2008, the worldwide prevalence of overweight and obesity was estimated to be more than 1.4 billion adults (over 20 years), of these over 200 million men and almost 300 million women were obese (WHO, 2008). Furthermore, WHO (2013) estimated that in 2008, globally, 31% of adults aged 15 and over were insufficiently active (28% men and 34% women). This unhealthy behaviour was estimated to cause 600,000 deaths annually and lead to a loss of 5.3 million years of healthy life due to premature death and disability (WHO, 2002). If physical inactivity were to be reduced by 10‐25%, more than 1.3 million lives could be saved annually (Lee et al., 2012). In Malta, the situation is similarly grim. It is troubling to note that Maltese men rank top in European obesity chart and Maltese women place third (Eurostat, 2011). Furthermore, Malta is labelled as one of the most sedentary populations on earth (Stagno‐Navarro, 2012), with 71.9% of the population failing to meet recommended levels of PA (Hallal et al., 2012). It was estimated that Malta could gain an increase of 1.2% years in life expectancy if physical inactivity were eliminated (Lee et al., 2012). Lee et al. (2012) revealed that Malta has the highest estimate for coronary heart disease (CHD), type 2 diabetes, breast cancer, colon cancer and all‐cause mortality, compared to other European countries, almost double to the European and Worldwide median in all variables (Table 1).
The purpose of this study was to ascertain if participation in a 12 week weight management programme results in favorable long - term changes in; weight, body composition and physical activity levels. Participants (N=35) attended the 12 week 'Lite 4 Life' programme, combining nutritional advice and diet prescription from NHS Community Dieticians, and weekly group based exercise led by qualified Exercise Advisers. Repeated measures of body weight, BMI, waist circumference and body fat percentage were taken at pre, post, 1 month post, 6 months, and 1 year post programme stage. Repeated measure ANOVA and Tukey's post hoc method of analysis of variance were adopted. Body weight (ave -2.32 kg), Waist circumference (ave -4.43cm), BMI (-0.93%), and body fat percentage (-2.72%) were significantly (p< 0.05) reduced from pre to post programme. Physical activity measured by pedometer over a 7 day period, was significantly increased (70%) from pre to post programme. At 1 month post programme significant changes in weight, BMI and Waist circumference seen at the post programme stage were maintained, but no further reductions were evident. At 6 months post programme stage, significant reductions in body weight were maintained, however reductions in waist circumference were not maintained to 6 months post programme. At 1 year post programme, due to low reporting numbers, no significant changes were evident in any variable. Participation in the Lite 4 Life programme results in significant weight loss which is maintained up to 6 months post programme, additional research is required to assess changes up to 1 year post programme.
Mullarkey, Dianne (University of Chester, 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.
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.
Aim: The study aims to investigate whether the Wigan Borough Healthy Business Award (HBA) influences the dietary attitudes and behaviours of awardees. Objectives are to: investigate the dietary attitudes of awardees prior to the HBA intervention; investigate the dietary behaviours of awardees prior to the HBA intervention; investigate the dietary attitudes of awardees post intervention; investigate the dietary behaviours of awardees post intervention; assess whether the HBA intervention has influenced attitudes and/or behaviours - positively, negatively or no change; gain a basic overview of the links between dietary attitudes and behaviours; form a set of recommendations based on the findings from the above objectives to inform best practice. Methodology: Case - control study, using purposive sampling of businesses undertaking the HBA, conducted using a pre and post intervention questionnaire and short supplementary post intervention semi structured interview, which seeks to assess whether the HBA affects the dietary attitudes and behaviours of awardees. Main findings: 6 staff from HBA businesses were compared with 7 staff from none HBA businesses. From the interview data, most participants demonstrated positive dietary attitudes and behaviours though not always directly linked with the HBA. Key themes included appreciation of learning and support, enablement to promote healthier options, benefits to the business and customers, other influences on dietary attitudes and behaviours, such as weight, family, health, individual responsibility, practical barriers such as time and society and upbringing. Where participants indicated the HBA had no direct impact on them as individuals, they still showed positive attitudes towards the receipt and recognition of the award, wanted to promote healthier options for customers and were positive about the award. Statistical analysis of the baseline and follow up questionnaire data showed the results were not significant, however due to the small sample size the relevance of this analysis for making generalisations, and identification of trends is limited. Overall conclusions: Participants involved in the HBA demonstrated positive dietary attitudes and behaviours manifesting from a range of influencing factors. The factors that linked with the HBA highlighted some key insights into the impact of the HBA and the complex interrelationship between dietary attitudes and behaviours. Whether the HBA positively influenced individuals dietary attitudes and behaviours or not, overall participants found the intervention to be worthwhile.
‘Diabesity’, the comorbid occurrence of type 2 diabetes (T2DM) with obesity, is increasing rapidly in the UK, and becoming more prevalent in younger age groups. The onset of diabetes increases risk of macro- and microvascular complications, reduced life expectancy, and decreased economic productivity and quality of life. It is also expensive to manage, through medication costs, monitoring, and management of complications. Management of obesity can improve diabetes control, but weight loss is often slower than in those without diabetes. This is often made more challenging over time, with disease progression increasing the number of medications required for glycaemic control. Dietary methods for weight loss in diabesity have been explored; restricting energy intake and regular support appears to be of more importance to success than macronutrient balance, although long-term effectiveness is unclear. However, bariatric surgery is the only current treatment option offering both the possibility of diabetes remission as well as substantial long-term weight loss. Specialist diabesity services, supported by a multidisciplinary team to manage outcomes for obesity and diabetes concurrently, have been piloted. However, these services are not commonly available at local level. It is unclear whether the existing obesity management service provision is adequately supporting weight loss for those with comorbid type 2 diabetes.
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.
This study investigated men’s perceptions and attitudes to weight management and weight management services. A qualitative study design used one-to-one interviews to gain insight into the thoughts and feelings of the participants involved. A semi-structured topic guide was prepared to help guide the encounter. The interviews were tape recorded and transcribed verbatim. Framework analysis was used to make sense of themes that emerged. An article was circulated on the intranet at a single local government workplace in Chester in the north west of England inviting men to take part in the study. Eleven white British men aged between 27 and 59 years of age were recruited. The study found that weight management was viewed as important for health but the pursuit of a healthy body mass index was not a consideration for the majority of the men who set their own paramaters for a healthy weight. Appearance and image were important motivators but the men noted that there did not seem to be pressure to conform to a particular ideal. Being able to take part in sports or activity to maintain fitness were very important to the participants and this became a problem when injuries were sustained, especially recurring ones. Changing priorities along the lifecourse presented individuals with different challenges for managing their weight. An interesting concept raised was that maintaining one’s health through a diet and exercise regime was seen as ‘work’. The men viewed weight management as a personal responsibility and would not attend the health service for support unless it was associated with other symptoms. They viewed traditional weight management practices such as calorie counting and weighing oneself in public as being aimed at women and preferred to put the emphasis on physical activity rather than diet when managing their weight. Flexible and expert services were a key theme with the men seeking a personalised service that went beyond the general healthy eating and exercise messages in order to make it worth their while to attend. This study illustrates that a ‘one size fits all’ approach will not be sufficient if services are to attract and engage men in health behaviour change. Implications for practice are that weight management services should be accessible without the need for a health referral and offer a range of services to allow men to find the best fit for their lifestyle. They should make the most of current technology using the internet, mobile phone apps and other forms of communication. Services should be marketed creatively to remove the stigma from attending weight management services which are seen to be for women only. Whilst developing services for men practitioners should consider the differences in men and women’s attitudes to food and activity and tailor services accordingly. For example, focusing on body composition and fat loss rather than weight alone and consider using incentives in some settings. Three main areas for further research were identified. These were exploring further men’s views on appearance and body image because this was a strong motivator for weight management; the implications of long term injuries caused by exercising on men’s ability to manage their weight along the life course and the concept of health as work.
Williamson, Kathryn (University of Chester, 2014-09-26)
Weight management programmes commonly experience high attrition rates, reducing both effectiveness and efficiency. Reasons for attrition remain unclear. Evaluating participant experience promotes identification of improvements not obvious to service providers, developing a more person‐centred service, whilst potentially reducing attrition. Aim of review: To explore factors impacting engagement and attrition of non‐commercial group based lifestyle weight management programmes in the UK, with specific reference to qualitative evaluations of participant experience. Data sources: Electronic databases (PubMed, PsychINFO) and reference lists of relevant studies were searched. Findings: Five different interventions, all including participant evaluation, were identified. Heterogeneity between studies prevented definitive conclusions. Targeted interventions, use of social marketing, pre‐intervention assessment and an integrated physical activity component all potentially promote effectiveness, person‐centred delivery and reduce attrition. Impact of group leader background appears negligible. Non‐completers views are rarely evaluated. Conclusion: UK group‐based weight management programmes are evolving away from a onesize‐fits‐all health professional delivery model. Further research on effectiveness, attrition and person‐centred delivery is required. Work on accessing noncompleters views needs prioritised.
Background Overweight and obesity are rapidly escalating to epidemic proportions in the paediatric population. Obesity has profound health and social consequences in both the short- and long-term. Multi-component interventions have been highlighted as the treatment of choice but the current evidence base is limited and many interventions have not been properly evaluated. Objective To review the effectiveness of the Carnegie International Camp (CIC) programme, an established, residential, multi-component weight management intervention, previously demonstrated to be effective across a range of health outcomes for overweight and obese youth (Gately et al., 2005). Methods Replication of the previous evaluative study (Gately et al., 2005); 290 children and adolescents (mean age 13.7 years) participated in one of three successive residential weight management programmes during the school summer holidays of 2006-2008. Design: A prospective cohort study investigation incorporating a quasi-experimental, repeated measures design across a range of physiological and psychological variables associated with overweight and obesity. Measurements were taken before, during and after the intervention period. Comparisons were made with the data from the earlier evaluative study (Gately et al., 2005). Results Significant (p<0.05) improvements were achieved in all outcome variables from baseline (pre) to post intervention. Mean reductions: body mass = 5.56kg (6.0%), total percentage body fat = 4.0%, BMI = 2.19 kgm-2, BMI SDS = 0.27 units, waist circumference = 5.47cm (5.7%), systolic pressure = 3.23mmHg (2.7%), diastolic pressure = 7.92mmHg (10.5%), and a significant increase in self-esteem scores was achieved (+0.22 units, 9.4%). Significant improvements across all outcome variables were also reported by Gately et al. (2005). Similar changes were attained in both studies; significant between-group differences were only identified in three of the outcomes measures; percentage body fat, diastolic blood pressure and self-esteem, and the magnitude of these between-group differences were only small to moderate (eta squared = 0.017; 0.024; 0.038, respectively). Conclusions The CIC programme, an established multi-component, residential weight management intervention, specifically designed to meet the needs of overweight and obese young people, has been re-evaluated and the results from the current study demonstrate its continued acute effectiveness in producing positive outcomes across a range of physiological and psychological variables associated with overweight and obesity.
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