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Despite substantial attention to dietary interventions on the management of obesity, there are no consensus guidelines for dietetic management of obesity in Europe. Two surveys among European dietitians have demonstrated inconsistencies in the approaches recommended within national obesity treatment guidelines. Only a small number of the guidelines include concrete actionable targets for recommended energy deficit, weight loss and weight-loss maintenance. On the other hand, dietitians frequently use 5-15% weight loss as their intervention outcome. However, they fail to monitor changes in body composition beyond weight status and to successfully monitor and prevent weight regain. Europewide guidelines on the dietary treatment of obesity are an overdue requirement for consistent dietetic practice.

Resting energy expenditure (REE) estimates are often needed in young people and can be predicted using prediction equations based on body weight. However, these equations may perform poorly in those who are obese and overweight. The aim of this systematic review was to identify equations based on simple anthropometric and demographic variables that provide the most accurate and precise estimates of REE in healthy obese and overweight young people.Systematic searches for relevant studies in healthy obese and overweight young people aged ≤18 years were undertaken using PubMed, Scopus, Cinahl, OpenGrey and Cochrane Library (completed January 2018). Search terms included metabolism, calorimetry, obesity and prediction equation. Data extraction, study appraisal and synthesis followed PRISMA guidelines.From 390 screened titles, 13 studies met inclusion criteria. The most accurate REE predictions (least biased) were provided by Schofield equations [+0.8% (3-18 years); 0% (11-18 years); +1.1% (3-10 years)]. The most precise REE estimations (percentage of predictions ± 10% of measured) for 11-18 years were provided by Mifflin equations (62%) and, for 7-18 years, by the equations of Schmelzle (57%), Henry (56%) and Harris Benedict (54%). Precision of Schofield predictions was 43% in both age groups. No accuracy data were available for those3 years or for precision for those7 years.No single equation provided accurate and precise REE estimations in this population. Schofield equations provided the most accurate REE predictions so are useful for groups. Mifflin equations provided the most precise estimates for individuals aged 11-18 years but tended to underestimate REE.

The way that health professionals talk about conditions is crucial to patient-centred care. Hilda Mulrooney explains how obesity is a condition that is often framed in negative language that needs to be changed in order to improve healthcare quality in primary care The language and images used to describe those living with obesity are often stigmatising. They can contribute to the perception that those with obesity are responsible for their own condition. Much of the rhetoric around excess weight emphasises actions that individuals can take. This ignores the complexity of how weight is gained and retained, and the roles of genetics and environmental factors. In the UK, those advocating for obesity to be recognised as a disease suggest that this may reduce levels of weight-related stigma. The use of non-stigmatising images and people-first language are recommended to help change perceptions of blame around obesity.

Being obese and overweight affects an increasing number of adults and children in the UK. Hilda Mulrooney presents an overview of the population-based approaches to improving public health and enabling more people to lose weight Obesity is a serious condition that is highly prevalent in UK adults and children. A number of population-based approaches to improve the ‘obesogenic’ environment have been put into place while more are being proposed. Many of these approaches have the advantage of potentially altering dietary intakes without individual behaviour change, and they are taking place in a wider context that encourages physical activity and partnership working. Approaches to obesity and progress made towards targets will be discussed.

OBJECTIVES: Christian Orthodox fasting (COF), a periodical vegetarian subset of the Mediterranean diet, has been proven to exert beneficial effects on human health. Athonian fasting is a pescetarian COF variation, where red meat is strictly restricted throughout the year. Previous studies have examined the COF nutritional synthesis and health effects in general population fasters (GF) and Athonian monks (AM), separately. The aim of this study is to comparatively evaluate the characteristics and effects of this nutritional advocacy between the two populations. METHODS: The study included 43 male GFs (20-45 y of age) and 57 age-matched male AMs following COF. Dietary intake data were collected in both groups during a restrictive (RD) and a nonrestrictive (NRD) day. Nutritional, cardiometabolic, and anthropometric parameters were compared between the two cohorts. RESULTS: AM presented lower daily total caloric intake for both RD (1362.42 ± 84.52 versus 1575.47 ± 285.96 kcal, P < 0.001) and NRD (1571.55 ± 81.07 versus 2137.80 ± 470.84 kcal, P < 0.001) than GF.They also demonstrated lower body mass index (23.77 ± 3.91 versus 28.92 ± 4.50 kg/m2, P

Orthorexia Nervosa (ON) has gained increased attention in academia since 1997. However, like other "Exia" conditions, there is debate around its inclusion in the Diagnostic and Statistical Manual of Mental Disorders. This study aimed to examine the experiences of those following a diet indicative of ON in the United Kingdom. This information is essential to the development of diagnostic criteria and classification of ON. Behavioural Reasoning Theory was used to explore reasons contributing to the development of ON. Ten individuals (two males and eight females), aged 23-35 years, took part in semi-structured interviews. Inductive thematic analysis was used to analyse the results. Four themes emerged from the data-journey, social, rules/control, and ethical considerations which highlighted contributing factors to the development of ON behaviours, the impact of these behaviours on individuals' social lives, and a strive for control. These findings are the first to suggest that ON involves a more complex set of behaviours than current definitions and proposed diagnostic criteria suggest and highlight the need to consider a variety of reasons for restricted diet when developing diagnostic criteria, screening tools, and classification in the DSM. ispartof: FRONTIERS IN PSYCHOLOGY vol:12 ispartof: location:Switzerland status: published

For seven weeks, 37 overweight adults followed a hypocaloric diet based on Orthodox Fasting (OF). A hypocaloric, time restricted eating (TRE) plan (eating between 08:00 to 16:00 h, water fasting from 16:00 to 08:00 h) was followed by 23 Body Mass Index (BMI)-matched participants. Anthropometric, glycaemic and inflammation markers and serum lipids were assessed before and after the diets. Both OF and TRE groups demonstrated reductions in BMI (28.54 ± 5.45 vs 27.20 ± 5.10 kg/m2, p

BACKGROUND: To date, research on the dietary patterns of individuals with potential orthorexic symptoms is lacking. This cross-sectional pilot study aimed to explore the feasibility of assessing dietary patterns with psychological traits and states of individuals with possible orthorexic tendencies. METHODS: Dietary intakes of 10 individuals (two males and eight females) were assessed using 24-h recall. Mean age of participants was 28.3 years; mean body mass index was 21.2 kg m-2 . Nutrient intakes were compared with current dietary guidelines and the Eatwell Guide (Public Health England, 2016). Participants completed the ORTO-15, the Eating Attitude Test (EAT-26), the Obsessive-Compulsive Inventory-Revised edition (OCI-R), Paulhus's Spheres of Control (SoC), the Rosenberg's Self-Esteem Scale (RSES) and the Multidimensional Body-Self Relations Questionnaire (MBSRQ). RESULTS: High levels of disparity across participants' psychometric scores and 24-h recall results were observed. There was no single pattern of self-imposed dietary restrictions among participants. Described dietary practices failed to meet the guidelines for several nutrients. CONCLUSIONS: The results of this pilot study suggest that an extensive investigation of the diets of individuals with possible orthorexic tendencies in a large-scale study would contribute to the understanding of this condition. In addition, the use of multiple psychometric instruments is recommended for diagnosing orthorexic nervosa. ispartof: JOURNAL OF HUMAN NUTRITION AND DIETETICS vol:34 issue:1 pages:42-53 ispartof: location:England status: published

[][1] Hilda Mulrooney is a senior lecturer in nutrition at Kingston University, London. I recently participated in a roundtable discussion organised by Vet Record , the BVA and Mars Petcare about obesity in pets. My perspective was unusual; I have no pets and I am a dietitian who has worked in primary care and public health, primarily in the field of human obesity. But, as I was preparing for the meeting, I started thinking about the overlap between obesity in animals and people. Obesity has been a serious health concern in people for several decades, and the current statistics, in both children and adults, are depressing. Unfortunately, nowadays it is more common for people to suffer from obesity or being overweight than to be a healthy weight; healthy weight is no longer ‘normal’ in the sense of being usual for … [1]: /embed/graphic-1.gif

Greek Orthodox fasting (OF), which involves 180-200 days of fasting per year, is dictated by the Christian Orthodox religion. For the first time, this cross-sectional study examines the characteristics and the effects of OF on anthropometry, cardiometabolic markers and calcium homeostasis in Athonian monks (AMs).Daily intakes of energy, macro- and micronutrients of a day during a weekend of Nativity Fast, defined as non-restrictive day (NRD), and a weekday during Great Lent, labeled as restrictive day (RD) were recorded.The daily energy intake of 70 AM (age=38.8±9.7 years) was low during both RD and NRD (1265.9±84.5 vs 1660±81 kcal, respectively, P0.001). Paired samples t-test showed statistically significant difference between daily intakes in RD and NRD: carbohydrates (159.6±21.8 vs 294.3±23.4 g, P0.0001) and saturated fat (12.7±0.0 vs 16.4±0.0 g, P0.0001) were lower, whereas protein (89.2±1.3 vs 72.35±1.3 g, P0.001) was higher during RD. A subsample of 50 monks (age=38.7±10.6 years) formed a study cohort for cardiometabolic and calcium homeostasis assessment. Body weight (74.3±12.9 kg) and body mass index (BMI; 23.8±4.1 kg/mUnaffected by variation in lifestyle factors, the results of this unique study offers clear evidence for the health benefits of the strict Athonian OF through optimal lipid and glucose homeostasis.

Personal health & wellbeing are rated more highly in those with higher educational qualifications than those without, and good health & wellbeing are likely to impact upon student attendance and hence attainment at university. It is important to understand factors which may affect perceived health and wellbeing from a student perspective in order to develop university-specific campaigns to correct misinformation. In addition, multidisciplinary working is characteristic in the post-graduation world, but is difficult to truly replicate within formal university teaching. This project had two aims. First, through a cross-disciplinary staff-student collaboration, to explore student perceptions of health and wellbeing in Kingston University. Second, to enable students from a range of disciplines to work in active partnership with each other and with academic staff. A quiz was completed by almost 300 undergraduate students. Results from this and focus group discussions demonstrated reasonable knowledge of a range of lifestyle risk factors affecting health, but misinformation about the safety of vaccines and the importance of nutrition, activity and adequate sleep for maximising health, wellbeing and thus, potentially, university attainment. Future work is planned with Kingston University undergraduate students to address identified misconceptions. Student partners highly rated the opportunity for active learning, partnership working with staff and being part of a cross-disciplinary project team.Keywords: Partnership, cross disciplinary, health, active learning, wellbeing

Hilda Mulrooney provides an overview of the contributing factors of obesity in people with learning disabilities and discusses practical ways to approach weight management

Authentic learning opportunities replicating working environments will enhance learners’ employability and intrinsic motivation. Within most undergraduate curricula, opportunities for students to experience hands-on learning opportunities which mimic public health practice are limited. A pilot university cook and eat programme (the Cook School) was developed based upon community cook and eat programmes. The aim was to enable trained undergraduate Nutrition students to facilitate healthy eating activities to their peers, as a voluntary co-curricular activity. Two cook and eat programmes, each of five weeks duration, were offered to undergraduate students (12 participants per programme). Cooking was delivered by trained chefs and the healthy eating components were facilitated by trained undergraduate Nutrition students. Participants did not know beforehand that sessions would include nutrition information & activities in addition to cooking. Facilitators identified ‘employability’ as a key driver for their participation in this project. Their post-course evaluations suggested that key employability skills like team work, time management, communication and organisation were enhanced by involvement in the Cook School. Participants suggested that attending Cook School improved their knowledge of healthy eating. Whether this translates into improved diets long term is currently unknown. This pilot project offered undergraduate Nutrition students a unique opportunity to gain key employability skills within an authentic learning environment, working in partnership with their peers. Keywords: Authentic learning, Peer learning, Motivation, Partnership, Employability

To enhance employability opportunities, a range of co-curricular opportunities are offered to Nutrition students at Kingston University. Student uptake of these opportunities tends to be limited to a small group of highly motivated students. Using an unpaid public health project undertaken as a staff-student partnership as a case study, both the processes involved in the project and the motivation of staff and student partners are explored. Understanding what elements of motivation were involved may help to pinpoint aspects of co-curricular work to focus upon in order to increase student uptake, thus potentially enhancing graduate employability.Keywords: Intrinsic motivation, extrinsic motivation, partnership, autonomy, engagement

Estimates of energy requirements are needed in weight management and are usually determined using prediction equations. The objective of these two systematic reviews was to identify which equations based on simple anthropometric and demographic variables provide the most accurate and precise estimates of (1) resting energy expenditure (REE) and (2) total energy expenditure (TEE) in healthy obese adults.Systematic searches for relevant studies in healthy adults with body mass index (BMI) ≥25 kg m(-2) and published in English were undertaken using Cinahl, Cochrane Library, OpenGrey, PubMed and Web of Science (completed March 2014). Search terms included metabolism, calorimetry, obesity and prediction equations. Data extraction, study appraisal and synthesis followed guidelines from PRISMA (Preferred Reporting Items for Systematic reviews and Meta-Analyses).From 243 REE papers and 254 TEE papers identified, 21 and four studies, respectively, met the inclusion criteria. (1) The most accurate REE predictions varied with BMI subgroup: WHO (weight and height) ≥25 and ≥30 kg m(-2) ; Mifflin 30-39.9 kg m(-2) ; Henry ≥40 kg m(-2) . The most precise REE predictions were obtained using Mifflin in BMI 30-39.9 and ≥40 kg m(-2) , where approximately 75% of predictions were within 10% of measured REE. (2) No accurate or precise predictions of TEE were identified.No single prediction equation provides accurate and precise REE estimates in all obese adults. Mifflin equations are recommended in this population, although errors exceed 10% in 25% of those assessed. There is no evidence to support the use of prediction equations in estimating TEE in obesity.

Being overweight or obese increases the risk of many physical conditions. However, weight may also have an effect on mental health. Hilda Mulrooney discusses the evidence for this possibility and how health professionals can assist

Many students do not engage with reading the scientific literature, which is a core skill in undergraduate students. The learning environment has an important impact upon learning. It was postulated that taking reading out of the formal learning environment might impact upon students’ willingness to engage with the literature, and confidence in doing so. A staff-student research partnership initiative funded by Kingston University allowed this hypothesis to be tested. Three Tea Club sessions, informal drop-in reading sessions were offered in a student-owned space within the Students’ Union. Refreshments were supplied, aiming for a ‘coffee house’ feel. Although the numbers of students who engaged with the Tea Club were small, evaluations were positive. In particular students valued the opportunity for peer learning. However the chosen environment was too noisy. Future sessions will be offered within a different, less noisy environment with facilities for refreshments, and will be offered throughout the academic year to facilitate student engagement.Keywords: Learning environment, peer support, extracurricular, scientific reading