Trial for reducing weight retention in new mums: a randomised controlled trial evaluating a low intensity, postpartum weight management programme

BACKGROUND: Failure to return to pregnancy weight by 6 months postpartum is associated with long-term obesity, as well as adverse health outcomes. This research evaluated a postpartum weight management programme for women with a body mass index (BMI) > 25 kg m(-2) that combined behaviour change principles and a low-intensity delivery format with postpartum nutrition information. METHODS: Women were randomised at 24-28 weeks to control (supported care; SC) or intervention (enhanced care; EC) groups, stratified by BMI cohort. At 36 weeks of gestation, SC women received a 'nutrition for breastfeeding' resource and EC women received a nutrition assessment and goal-setting session about post-natal nutrition, plus a 6-month correspondence intervention requiring return of self-monitoring sheets. Weight change, anthropometry, diet, physical activity, breastfeeding, fasting glucose and insulin measures were assessed at 6 weeks and 6 months postpartum. RESULTS: Seventy-seven percent (40 EC and 41 SC) of the 105 women approached were recruited; 36 EC and 35 SC women received a programme and 66.7% and 48.6% completed the study, respectively. No significant differences were observed between any outcomes. Median [interquartile range (IQR)] weight change was EC: -1.1 (9.5) kg versus SC: -1.1 (7.5) kg (6 weeks to 6 months) and EC: +1.0 (8.7) kg versus SC: +2.3 (9) kg (prepregnancy to 6 months). Intervention women breastfed for half a month longer than control women (180 versus 164 days; P = 0.10). An average of 2.3 out of six activity sheets per participant was returned. CONCLUSIONS: Despite low intervention engagement, the high retention rate suggests this remains an area of interest to women. Future strategies must facilitate women's engagement, be individually tailored, and include features that support behaviour change to decrease women's risk of chronic health issues.

Effects of beacon administration on energy expenditure and substrate utilisation in Psammomys obesus (Israeli sand rats)

Objective: To investigate whether beacon administration affects substrate utilisation, physical activity levels or energy expenditure in Psammomys obesus. Design: Pairs of age- and sex-matched Psammomys obesus were randomly assigned to either beacon-treated (15 µg/day for 7 days (i.c.v.)) or control (i.c.v. saline) groups. Measurements: Indirect calorimetry on day 0 and day 7 to measure oxygen consumption and carbon dioxide production, which were used to calculate fat oxidation, carbohydrate oxidation and total energy expenditure. Physical activity in the calorimeter was measured using an infrared beam system. Food intake and body weight were measured daily. Results: The administration of beacon significantly increased body weight compared to saline-treated control animals. This body weight gain was primarily due to increased body fat content. Average daily food intake tended to be higher in beacon-treated Psammomys obesus, but no effect of beacon administration on substrate oxidation, activity or energy expenditure was detected. Conclusion: The effects of beacon on body weight are due to increased food intake, with no detectable effect on nutrient partitioning, physical activity or energy expenditure.

Parent, peer and media influences on body image and strategies to both increase and decrease body size among adolescent boys and girls

This study investigated the nature of body image and body change strategies, as well as the sociocultural influences on these variables, among a group of 1,266 adolescents (622 males, 644 females). In particular, it investigated weight gain and increased muscle, as well as weight loss. It was found that females were less satisfied with their bodies and were more likely to adopt strategies to lose weight, whereas males were more likely to adopt strategies to increase weight and muscle tone. Respondents with higher body mass index (BMI) evidenced greater body dissatisfaction and more weight loss strategies, but there were no differences between BMI groups in weight gain or strategies to increase muscles. Weight gain and strategies to increase muscles were more likely to be undertaken by older adolescents, but there were no grade level differences in weight loss. Media influences to alter weight, as well as feedback from mother, father, and both male and female peers, were greater for females. There were few grade level or BMI differences in regard to any of the sociocultural influences. The importance of these findings in terms of providing a better understanding of factors which may lead to a disturbed body image and body change disorders, particularly among adolescent boys, is discussed.

The structure of the perceived sociocultural influences on body image and body change questionnaire

This article is concerned with the development and evaluation of the Perceived Sociocultural Influences on Body Image and Body Change Questionnaire. The scale was designed to assess the perceived nature of feedback received from mother, father, best male friend, and best female friend to gain weight, lose weight, and increase muscle tone. The perceived feedback from the media on each of these areas also was assessed. Exploratory factor analysis was conducted with 240 adolescent boys (mean age = 13.83 years) and 204 adolescent girls (mean age = 13.70 years). A 3-factor structure was found for the 4 scales that related to perceived feedback from mother, father, best male friend, and best female friend. Feedback on muscle tone loaded with both weight loss and weight gain. The three factors related to (a) general feedback; (b) encourage, tease, and modeling to gain weight and increase muscle tone, and (c) encourage, tease, and modeling to lose weight and increase muscle tone. The factor structure and the items that made up these factors were the same for both boys and girls for each of the 4 scales. The Perceived Media Influences Scale formed 3 factors for girls. These factors related to gaining weight, losing weight, and increasing muscle tone. For boys, the same 9 items formed a single factor. The same items were retained for boys and girls. A confirmatory factor analysis with 822 adolescents (382 boys, mean age = 14.02 years; 440 girls, mean age = 13.82 years) confirmed the previously described factor structure. These results demonstrate that the Perceived Sociocultural Influences on Body Image and Body Change Questionnaire is able to assess body image and body change strategies that are relevant for both boys and girls.

Behavioural determinants of the obesity epidemic

Obesity is a serious and growing public health problem affecting developed and developing countries. It is generally agreed that the causes of the current obesity epidemic are not genetic in origin, but are the result of changes in the environments in which we live. While acknowledging the importance of environmental factors, the central role of behaviour in the obesity epidemic cannot be ignored. It is our eating, physical activity and sedentary behaviours that form the interface between our biology and the environments to which we are exposed. However, a lack of understanding of the specific behaviours that are important in the aetiology of obesity poses a major constraint to preventing obesity. A better understanding of the behaviours that contribute to weight gain and obesity is critical in order to plan and implement effective obesity prevention initiatives.Theory-driven investigations of eating, physical activity and sedentary behaviours, their determinants, and their role in weight gain and obesity among different population groups are urgent research priorities. Without an understanding of the key behaviours that contribute to weight gain, and the influences on these behaviours, it will remain difficult to identify where to intervene in the environment and be confident that action will prevent obesity.

Beacon interacts with cdc2/cdc28-like kinases

Previously we found elevated beacon gene expression in the hypothalamus of obese Psammomys obesus. Beacon administration into the lateral ventricle of P. obesus stimulated food intake and body weight gain. In the current study we used yeast two-hybrid technology to screen for proteins in the human brain that interact with beacon. CLK4, an isoform of cdc2/cdc28-like kinase family of proteins, was identified as a strong interacting partner for beacon. Using active recombinant proteins and a surface plasmon resonance based detection technique, we demonstrated that the three members of this subfamily of kinases (CLK1, 2, and 4) all interact with beacon. Based on the known sequence and functional properties of beacon and CLKs, we speculate that beacon could either modulate the function of key regulatory molecules such as PTP1B or control the expression patterns of specific genes involved in the central regulation of energy metabolism.

A longitudinal analysis of the role of biopsychosocial factors in predicting body change strategies among adolescent boys.

In this study we examined the role of biopsychosocial factors on adolescent boys' body modification strategies over an 8-month period. Participants were 434 adolescent boys aged between 11 and 16 years. The majority of respondents were from Anglo-Australian backgrounds (83%); the others were from Asian and European non-English-speaking backgrounds. The results indicated a consistent relationship between perceived encouragement to engage in body change strategies and increases in adolescents' body modification strategies, including muscle gain, weight gain, and weight loss. In addition, poor parent relations, being younger, and higher scores on the pubertal development scale predicted increased use of food supplements. However, the stability of the body modification strategies and the examined variables over the 8-month period were low. Further studies are needed to examine the stability of adolescent self-perceptions over both longer and shorter periods. Moreover, researchers need to include other factors that may be more relevant for adolescent boys (e.g., involvement in sports).

A longitudinal study of body change strategies among adolescent males

This study was designed to examine the factors predicting a range of body change strategies among adolescent males over an 8-month time period. This is the first published longitudinal study of body change strategies to increase weight and muscles among males. The 5 body change strategies in the present study were eating and exercise to lose weight, increase weight, increase muscles, bingeing, and use of food supplements. The extent to which Body Mass Index (BMI) and these body change strategies predicted each other over an 8-month period was evaluated. The role of pressure from parents and peers to lose weight, increase weight, or increase muscles was also evaluated. After controlling for the Time 1 level of each variable, only bingeing, and use of food supplements were predicted by other Time 1 body change variables. Bingeing at Time 1, and a combination of all of the other variables predicted bingeing at Time 2; use of food supplements and bingeing at Time 1 predicted the use of food supplements at Time 2. Perceived pressure from parents and peers to lose weight at Time 1 predicted strategies to lose weight at Time 2; perceived pressure from parents and peers to increase weight at Time 1 predicted strategies to increase weight at Time 2; and perceived pressure to lose weight, increase weight, and increase muscles at Time 1 predicted the use of food supplements at Time 2. These results indicate that extreme body change strategies are predicted by the adoption of more normative body change strategies at an earlier point in time, and that a range of body change strategies among adolescent males are affected by perceived pressures from parents and peers.

Two important exceptions to the relationship between energy density and fat content: food with reduced-fat claims and high-fat vegetable-based dishes

Objective: To test the hypothesis that many foods with reduced-fat (RF) claims are relatively energy-dense and that high-fat (HF) vegetable-based dishes are relatively energy-dilute.

Design: Nutrient data were collected from available foods in Melbourne supermarkets that had an RF claim and a full-fat (FF) equivalent. Nutrient analyses were also conducted on recipes for HF vegetable-based dishes that had more than 30% energy from fat but less than 10% from saturated fat. The dietary intake data (beverages removed) from the 1995 National Nutrition Survey were used for the reference relationships between energy density (ED) and percentage energy as fat and carbohydrate and percentage of water by weight.

Statistics: Linear regression modelled relationships of macronutrients and ED. Paired t-tests compared observed and predicted reductions in the ED of RF foods compared with FF equivalents.

Results: Both FF and RF foods were more energy-dense than the Australian diet and the HF vegetable-based dishes were less energy-dense. The Australian diet showed significant relationships with ED, which were positive for percentage energy as fat and negative for percentage energy as carbohydrate. There were no such relationships for the products with RF claims or for the HF vegetable-based dishes.

Conclusion: While, overall, a reduced-fat diet is relatively energy-dilute and is likely to protect against weight gain, there appear to be two important exceptions. A high intake of products with RF claims could lead to a relatively energy-dense diet and thus promote weight gain. Alternatively, a high intake of vegetable-based foods, even with substantial added fat, could reduce ED and protect against weight gain.

Reducing sedentary behaviour and increasing physical activity among 10-year-old children: overview and process evaluation of the 'Switch-Play' intervention

Overweight and obesity has doubled among children in Australia. There is an urgent need to develop primary prevention strategies to prevent current and future unhealthy weight gain. The aims of this paper are to describe a randomized controlled trial (‘Switch-Play’) developed to prevent unhealthy weight gain among 10-year-old children and to report the findings of the process evaluation. Children from three government primary schools were randomized by class to one of four conditions: a behavioural modification group (BM; n = 69); a fundamental motor skills group (FMS; n = 73); a combined BM and FMS group (n = 90); or a control (usual classroom lessons) group (n = 61). Children in the BM group participated in 19 sessions that encouraged them to reduce screen-based behaviours, and identified physical activity alternatives. The FMS group participated in 19 lessons that focused on mastery of six skills: run, throw, dodge, strike, vertical jump and kick. The combined group participated in all the BM and FMS activities. The intervention specialist teacher reported that the children showed high enjoyment and engagement (88% lessons attended) in most aspects of the programme. At-home tasks were completed by 57–62% of the children, and 92% completed the in-class tasks. Two-thirds of the children in the BM group participated in the behavioural contracting to switch off the TV. Most of the children reported high enjoyment of the programmes, and only a small proportion (7–17%) reported difficulties in switching off their nominated TV shows. More than half the children reported reducing their TV viewing; however, less than half reported increasing their physical activity. It was found that most aspects of the intervention arms of the programme were successfully delivered to the majority of children participating in ‘Switch-Play’; that the programmes were delivered as intended; and that the programmes were favourably evaluated by participating children and their parents.

Post-migration food habits of sub-Saharan migrants in Victoria: a cross-sectional study

Objective: (i) To describe sub-Saharan African (SSA) post-migration food habits and eating patterns; and (ii) to examine how the food habits of SSA households in Victoria reflect post-migration acculturation.
Design: A cross-sectional survey using a snowball sampling technique. Data on food habits and eating patterns were obtained using semi-structured, face-to-face interviews from November 2001 to April 2002.
Subjects: A total of 139 households of demographically diverse recent migrants from across sub-Saharan Africa.
Setting: Melbourne metropolitan and Melbourne fringes.
Analysis: Data were summarised using descriptive statistics.
Results: SSA migrants and refugees indicated dietary acculturation characterised by three processes: substitution, supplementation and modification of recipes. They experienced difficulty locating their traditional foods, in particular, African vegetables (34.2%), unprocessed maize meal (29.1%), camel milk (23.1%) and maize grain (13.7%). The new foods adopted since arrival were pizza, breakfast cereals and fast foods, but also included new fruits and vegetables. Takeaway food such as Pizza Hut or McDonalds featured prominently in the SSA post-migration diet. Reasons for eating out were favourite food (48.3%), routine family outing (38.3%), special occasion (33.3%) and no time to cook (25%). A significant change in meal pattern was the inclusion of breakfast, although 21% reported skipping breakfast.
Conclusion: Many of the observed dietary changes were not consistent with good health and may predispose this population to rapid weight gain and chronic disease. Rapid modernisation and the Anglo-Australian culture interact in a complex way with traditional eating and socialisation practices of SSA migrants. Understanding these forces can allow effective health promotion and community development strategies to be developed for the future health of SSA migrants and their communities.

Body image attitudes and concerns among indigenous Fijian and European Australian adolescent girls

Research on body image has primarily been conducted among Western women who highly value the thin ideal body size. There has been limited research that has examined body image attitudes among Fijian adolescent girls who are exposed to both traditional sociocultural pressures that promote a larger body size and Western pressures that promote slimness. Using in-depth semi-structured interviews, we examined the factors associated with body image attitudes and concerns among a sample of 16 indigenous Fijian and 16 European Australian adolescent girls aged between 13–18 years. An inductive analysis of girls’ responses indicated that both groups of girls experienced body image concerns including body dissatisfaction, a preference for thinness and concerns associated with weight gain. These findings have implications for our understanding of the role of culture in shaping body image among girls and may prove useful in the development of future survey research that can be implemented among both Fijian and Western adolescents.

Long-term 5-year effects of a reduced-fat diet intervention in individuals with glucose intolerance

OBJECTIVE: To determine whether reducing dietary fat would reduce body weight and improve long-term glycemia in people with glucose intolerance. RESEARCH DESIGN AND METHODS: A 5-year Follow-up of a 1-year randomized controlled trial of a reduced-fat ad libitum diet versus a usual diet. Participants with glucose intolerance (2-h blood glucose 7.0-11.0 mmol/l) were recruited from a Workforce Diabetes Survey. The group that was randomized to a reduced-fat diet participated in monthly small-group education sessions on reduced-fat eating for 1 year. Body weight and glucose tolerance were measured in 136 participants at baseline 6 months, and 1 year (end of intervention), with follow-up at 2 years (n = l04), 3 years (n = 99), and 5 years (n = 103). RESULTS: Compared with the control group, weight decreased in the reduced-fat-diet group (P < 0.0001); the greatest difference was noted at 1 year (-3.3 kg), diminished at subsequent follow-up (-3.2 kg at 2 years and -1.6 kg at 3 years), and was no longer present by 5 years (1.1 kg). Glucose tolerance also improved in patients on the reduced-fat diet; a lower proportion had type 2 diabetes or impaired glucose tolerance at 1 year (47 vs. 67%, P < 0.05), but in subsequent years, there were no differences between groups. However, the more compliant 50% of the intervention group maintained lower fasting and 2-h glucose at 5 years (P = 0.041 and P = 0.026 respectively) compared with control subjects. CONCLUSIONS: The natural history for people at high risk of developing type 2 diabetes is weight gain and deterioration in glucose tolerance. This process may be ameliorated through adherence to a reduced fat intake

Relationship between stress, eating behavior and obesity

Stress is thought to influence human eating behavior and has been examined in animal and human studies. Our understanding of the stress-eating relation is confounded by limitations inherent in the study designs; however, we can make some tentative conclusions that support the notion that stress can influence eating patterns in humans. Stress appears to alter overall food intake in two ways, resulting in under- or overeating, which may be influenced by stressor severity. Chronic life stress seems to be associated with a greater preference for energy- and nutrient-dense foods, namely those that are high in sugar and fat. Evidence from longitudinal studies suggests that chronic life stress may be causally linked to weight gain, with a greater effect seen in men. Stress-induced eating may be one factor contributing to the development of obesity. Future studies that measure biological markers of stress will assist our understanding of the physiologic mechanism underlying the stress-eating relation and how stress might be linked to neurotransmitters and hormones that control appetite.

Association of key foods and beverages with obesity in Australian schoolchildren

Objective: To examine the pattern of intake of key foods and beverages of children aged 4–12 years and the association with weight status.
Design and setting: A computer-assisted telephone interview was used to determine the intake of fruit, vegetables, packaged snacks, fast foods and sweetened drinks ‘yesterday’ and ‘usually’ as reported by parents/guardians of a representative sample of 2184 children from the Barwon South-Western region of Victoria, Australia.
Results: Children who consumed .2–3, .3–4 and .4 servings of fruit juice/drinks ‘yesterday’ were, respectively, 1.7 (95% confidence interval (CI) 1.2–2.2), 1.7 (95% CI 1.2–2.5) and 2.1 (95% CI 1.5–2.9) times more likely to be overweight/obese compared with those who had no servings of fruit juice/drink ‘yesterday’, adjusted for age, gender and socio-economic status (SES). Further, children who had $3 servings
of soft drink ‘yesterday’ were 2.2 (95% CI 1.3–3.9) times more likely to be
overweight/obese compared with those who had no servings of soft drink ‘yesterday’, adjusted for age, gender and SES. In addition, children who ‘usually’ drank fruit juice/drinks twice or more per day were 1.7 (95% CI 1.2–2.4) times more likely to be overweight/obese compared with those who drank these beverages once or less per week, adjusted for age, gender and SES. Although fast foods and packaged snacks were regularly eaten, there were no associations between weight status and
consumption of these foods.
Conclusions: Intake of sweetened beverages was associated with overweight and obesity in this population of Australian schoolchildren and should be a target for intervention programmes aimed at preventing unhealthy weight gain in children.