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Introduction: Weight loss through behavioural weight management interventions can have important health benefits for people with obesity. However, to maximise the health benefits, weight loss must be maintained. Evidence suggests that behavioural weight loss interventions do not exacerbate inequalities in the short term. However, no study has yet considered whether inequalities exist in long-term weight change following intervention. We aimed to investigate if there are inequalities in weight change following weight loss intervention. Methods: We conducted a cohort analysis of data from the Weight Loss Referrals for Adults in Primary Care (WRAP) trial (N = 1,267). WRAP randomised participants to receive a brief intervention information booklet or vouchers for 12-weeks or 52-weeks of WW (formerly WeightWatchers) and followed them for 5 years. Multiple linear regression estimated the association between exposures (indicators of inequality) and outcomes (change in weight between 1- and 5-years). Each model was adjusted for the intervention group, baseline weight, weight change between baseline and 1-year, research centre, and source of the 5-year weight data. Results: Of the 1,267 participants in WRAP, 708 had weight change data available. Mean weight change between 1- and 5-years was +3.30 kg (SD 9.10 kg). A 1 year difference in age at baseline was associated with weight change of 0.11 kg ((95% CI 0.06, 0.16), p < 0.001). We did not find evidence of associations between ethnicity, gender, education, indices of multiple deprivation, household income, or other family members participating in a weight loss programme and weight change. Conclusion: Except for age, we did not find evidence of inequalities in weight change following a behavioural intervention. Findings further support the use of behavioural weight management interventions as part of a systems-wide approach to improving population health. [ABSTRACT FROM AUTHOR]

Energy-dense food advertising affects children's eating behaviour. However, the impact of high-sugar food advertising specifically on the intake of sweet foods is underexplored. This study sought to determine whether children would increase their intake of sugar and total energy following high-sugar food advertising (relative to toy advertising) and whether dental health, weight status and socio-economic status (SES) would moderate any effect. In a crossover, randomised controlled trial, 101 UK children (forty male) aged 8–10 years were exposed to high-sugar food/beverage and toy advertisements embedded within a cartoon. Their subsequent intake of snack foods and beverages varying in sugar content was measured. A dental examination was performed, and height and weight measurements were taken. Home postcode provided by parents was used to assign participants to SES quintiles. Children consumed a significantly greater amount of energy (203·3 (95 % CI 56·5, 350·2) kJ (48·6 (95 % CI 13·5, 83·7) kcal); P = 0·007) and sugar (6·0 (95 % CI 1·3, 10·7) g; P = 0·012) following food advertisements compared with after toy advertisements. This was driven by increased intake of the items with most sugar (chocolate and jelly sweets). Children of healthy weight and with dental caries had the greatest intake response to food advertising exposure, but there were no differences by SES. Acute experimental food advertising exposure increases food intake in children. Specifically, high-sugar food and beverage advertising promotes the consumption of high-sugar food items. The debate around the negative health effects of food advertising on children should be widened to include dental health as well as overall dietary health and obesity. [ABSTRACT FROM AUTHOR]

The Milan Charter on Urban Obesity highlights the challenges of urban environments as a battleground for human health, as cities are often organized to subvert public health goals, and promote rather than prevent the development of obesity and consequent non-communicable diseases. The Charter articulates ten principles which detail actions and strategies through which general practitioners, diverse medical specialists, related healthcare professionals, administrators and healthcare practice managers, policy actors – within health systems and at a national level – along with experts across disciplines, and citizens, can work in cooperation to meet this challenge and improve public health. The Charter urges the adoption of decisions that deliver the following: (i) policies which enable our cities to become healthier and less obesogenic, more supportive of well-being and less health-disruptive in general, and (ii) policies that fully support primary prevention strategies, that address social stigma, and that ensure fair access to treatment for people living with obesity. The Milan Charter on Urban Obesity aims to raise awareness of our shared responsibility for the health of all citizens, and focuses on addressing the health of people living with obesity – not only as a challenge in its own right, but a gateway to other major non-communicable diseases, including cardiovascular diseases, type 2 diabetes, and some cancers. [ABSTRACT FROM AUTHOR]

Background: There is considerable heterogeneity in long-term weight loss among people referred to obesity treatment programmes. It is unclear whether attendance at face-to-face sessions in the early weeks of the programme is an independent predictor of long-term success. Objective: To investigate whether frequency of attendance at a community weight loss programme over the first 12 weeks is associated with long-term weight change. Methods: Participants were randomised to receive brief support only (control, n = 211), or a weight loss programme for 12 weeks (n = 530) or 52 weeks (n = 528). This study included participants with data on session attendance over the first 12 weeks (n = 889) compared to the control group. The association between attendance (continuously) and weight loss was explored using a linear model. A multi-level mixed-effects linear model was used to investigate whether attendance (categorised as 0, 1, 2–5, 6—9, and 10–12 sessions) was associated with weight loss at 3, 12, and 24 months compared to the control. Results: For every session attended in the first 12 weeks, the average weight loss was –0.259 kg/session at 24 months (p = 0.005). Analysis by attendance group found only those attending 10–12 sessions had significantly greater weight loss (–7.5 kg [95% CI –8.1 to –6.9] at 12 months; –4.7 kg [95% CI –5.3 to –4.1] at 24 months) compared to the control group (–3.4 [95% CI –4.5 to –2.4] at 12 months, –2.5 [95% CI –3.5 to –1.5] at 24 months). Early attendance was higher for people ≥70 years, but there was no evidence of a difference by gender, ethnicity, education, or income. Conclusions: Greater attendance at a community weight loss programme in the first 12 weeks is associated with enhanced weight loss up to 24 months. Regular attendance at a programme could be used as a criterion for continued provision of weight loss services to maximise the cost-effectiveness of interventions. [ABSTRACT FROM AUTHOR]

Keywords: SARS-CoV-2; COVID-19; Pandemic; Obesity EN SARS-CoV-2 COVID-19 Pandemic Obesity 292 296 5 05/13/20 20200301 NES 200301 COVID-19, the infectious disease caused by the coronavirus SARS-CoV-2, was declared a pandemic by the World Health Organization on March 12, 2020. During quarantine, it is particularly important for all of us to maintain psychological well-being (see specific resource on "Practical advice on how to maintain healthy lifestyle habits amidst the COVID-19 pandemic" on the EASO website) [[5]]. Stigmatizing healthcare experiences may cause people with obesity to avoid or delay contacting healthcare providers during this pandemic, which may result in more severe COVID-19 outcomes [[7]]. EASO experts are developing protocols for virtual consultations for patients with obesity during the COVID-19 pandemic, which will be shared on the EASO website. [Extracted from the article]

Heterogeneity of interindividual and intraindividual responses to interventions is often observed in randomized, controlled trials for obesity. To address the global epidemic of obesity and move toward more personalized treatment regimens, the global research community must come together to identify factors that may drive these heterogeneous responses to interventions. This project, called OBEDIS (OBEsity Diverse Interventions Sharing – focusing on dietary and other interventions), provides a set of European guidelines for a minimal set of variables to include in future clinical trials on obesity, regardless of the specific endpoints. Broad adoption of these guidelines will enable researchers to harmonize and merge data from multiple intervention studies, allowing stratification of patients according to precise phenotyping criteria which are measured using standardized methods. In this way, studies across Europe may be pooled for better prediction of individuals' responses to an intervention for obesity – ultimately leading to better patient care and improved obesity outcomes. [ABSTRACT FROM AUTHOR]

Aims: Despite increased recognition as a chronic disease, obesity remains greatly underdiagnosed and undertreated. We aimed to identify international perceptions, attitudes, behaviours and barriers to effective obesity care in people with obesity (PwO) and healthcare professionals (HCPs). Materials and methods: An online survey was conducted in 11 countries. Participants were adults with obesity and HCPs who were primarily concerned with direct patient care. Results: A total of 14 502 PwO and 2785 HCPs completed the survey. Most PwO (68%) and HCPs (88%) agreed that obesity is a disease. However, 81% of PwO assumed complete responsibility for their own weight loss and only 44% of HCPs agreed that genetics were a barrier. There was a median of three (mean, six) years between the time PwO began struggling with excess weight or obesity and when they first discussed their weight with an HCP. Many PwO were concerned about the impact of excess weight on health (46%) and were motivated to lose weight (48%). Most PwO (68%) would like their HCP to initiate a conversation about weight and only 3% were offended by such a conversation. Among HCPs, belief that patients have little interest in or motivation for weight management may constitute a barrier for weight management conversations. When discussed, HCPs typically recommended lifestyle changes; however, more referrals and follow‐up appointments are required. Conclusions: Our international dataset reveals a need to increase understanding of obesity and improve education concerning its physiological basis and clinical management. Realization that PwO are motivated to lose weight offers an opportunity for HCPs to initiate earlier weight management conversations. [ABSTRACT FROM AUTHOR]

Keywords: COVID-19; Obesity; Vaccination EN COVID-19 Obesity Vaccination 334 335 2 06/26/21 20210501 NES 210501 The European Association for the Study of Obesity (EASO), in collaboration with the EASO European Coalition for People Living with Obesity (ECPO), is committed to sharing knowledge, evidence-based recommendations, and guidance toward the clinical, patient, research, and policy communities. Accordingly, we are calling for: Considering people living with obesity as at-risk of severe COVID-19; Prioritizing people with obesity for COVID-19 vaccination; Promoting studies that will examine the long-term efficacy of COVID-19 vaccination on neutralizing antibody levels and the infection rate in children, adolescents, and adults with obesity. [Extracted from the article]

Abstract: Television provides one of the first, and most intimate, experiences of commercial food promotion. Therefore, unsurprisingly, the effects of television advertising on children’s brand preferences are well established. However, its effect on actual food intake and the food choices in children of various weight statuses has only recently been characterised. Despite regulation, children in the UK are exposed to considerable numbers of food adverts on television. These are predominantly for foods high in fat, salt and sugar (HFSS), which are marketed to children using promotional characters and themes of fun. Such adverts have been shown to cause significant increases in intake, particularly in overweight and obese children, and enhanced preference for high carbohydrate and high fat foods in children who consume the greatest amounts of televisual media. [Copyright &y& Elsevier]

Several treatments for obesity have received regulatory approval, but health insurers and other payers typically refuse to support access to them. Thus, patients are left to bear significant out-of-pocket costs for obesity pharmacotherapy. This study aimed to assess preferences and willingness to pay (WTP) for obesity medications among people seeking weight loss in the United States and United Kingdom. An online survey was developed based on literature review, clinician interviews, and profiles of available therapies. Participants indicated their preference for hypothetical treatments which varied by seven attributes: percentage of weight loss, long-term health risk reduction, time to noticeable weight loss, delivery mode, side effects, lifestyle modification, and cost; 502 obese participants completed the survey (mean BMI 37.12 kg/m2 (±4.63); 73.5% female; 47.7 (±12.9) years of age). The participants deemed weight loss of >21 kg (United Kingdom) and >28 kg (United State) as 'acceptable'. All treatment attributes were important (P < 0.001) except 'time to noticeable weight loss.' The survey found that percentage weight loss was the most important factor for patients and a reduction in long-term health risk was relatively less important. Patients were willing to pay £6.51/$10.49 per month per percentage point of weight loss that a pharmacotherapy could provide. Participants also highly valued therapies that did not require substantial lifestyle modifications and were willing to pay £17.78/$30.77 more per month for a one-pill-per-day treatment vs. a weekly injectable. Participants placed a high value on weight loss and avoiding changes to their lifestyle, and less value on reducing long-term risks to health. [ABSTRACT FROM AUTHOR]

The serotonin (5-HT) system is implicated in the control of human appetite expression. However, previous serotonergic approaches to obesity, d-fenfluramine and sibutramine, were withdrawn over issues of safety. Selectively targeting hypothalamic 5-HT2C receptors should reduce the side effects produced by previous treatment. Lorcaserin is the first of a new generation of highly selective 5-HT2C agonists to pass through clinical development. Data is limited but the drug produces significant reductions in energy intake. These appear small compared to those reportedly produced by sibutramine and there is little evidence to indicate behavioural specificity or a clear satiety effect. However, Lorcaserin produces significant placebo-subtracted weight loss over two years of treatment which may be greater than current treatments such as the lipase inhibitor orlistat. Drugs that strengthen satiety may help individuals resist the urge to over-consume and maintain the reduction in energy intake required for successful weight control. However, for a number of patients Lorcaserin proved to be ineffective. For a centrally acting agent the drug's effect on appetite and behaviour remain poorly characterised. In summary, Lorcaserin produces statistically significant effects on energy intake, but the clinical significance of these findings is still debatable. Furthermore, the history of serotonin drugs indicates caution is warranted. [ABSTRACT FROM AUTHOR]

Abstract: Environmental changes have facilitated the rapid increase in childhood obesity. One such change is increased presence of food marketing which promotes intake of high-fat, energy-dense foods. This study tested the hypotheses that overweight (OW) children are more sensitive to the intake-enhancing effects of food branding than non-OW children, and that the relationship between weight status and intake of branded foods is mediated by level of food brand awareness. Forty-three non-OW (n =23) and OW (n =20) children from diverse ethnic backgrounds participated in four dinnertime visits to test their intake of meals where food brands were present (“branded”) or absent (“unbranded”). Food brand awareness was assessed by testing children''s abilities to match food brand logos with correct foods and name specific brands from recall. Weight and height were measured on the first visit to determine BMI z-score and weight status. OW children consumed significantly more energy per meal than non-OW. Child age and brand awareness were positively associated. OW children consumed an additional 40kcal in branded vs. unbranded meals whereas non-OW children consumed 45kcal less in branded meals. Overweight children showed greater responsiveness to food branding, and they may be at risk in environments that are highly inundated with messages about food. [Copyright &y& Elsevier]

Abstract: The current obesity pandemic imposes a major global disease burden. However, sustained weight loss of between 5 and 10% in the obese confers marked health benefits. Currently available pharmacotherapies, orlistat and sibutramine, can induce weight loss of between 5 and 10% over 2 years or more. However, in these trials, drug induced weight loss tends to be only 2–4kg greater than that produced by placebo control. Despite this, in the XENDOS trial, the modest placebo-subtract weight loss produced by orlistat (2.8kg) reduced the incidence of diabetes by over a third. Recent data on the potential anti-obesity drug rimonabant are also reviewed. [Copyright &y& Elsevier]

The impact of television (TV) advertisements (commercials) on children''s eating behaviour and health is of critical interest. In a preliminary study we examined lean, over weight and obese children''s ability to recognise eight food and eight non-food related adverts in a repeated measures design. Their consumption of sweet and savoury, high and low fat snack foods were measured after both sessions. Whilst there was no significant difference in the number of non-food adverts recognised between the lean and obese children, the obese children did recognise significantly more of the food adverts. The ability to recognise the food adverts significantly correlated with the amount of food eaten after exposure to them. The overall snack food intake of the obese and overweight children was significantly higher than the lean children in the control (non-food advert) condition. The consumption of all the food offered increased post food advert with the exception of the low-fat savoury snack. These data demonstrate obese children''s heightened alertness to food related cues. Moreover, exposure to such cues induce increased food intake in all children. As suggested the relationship between TV viewing and childhood obesity appears not merely a matter of excessive sedentary activity. Exposure to food adverts promotes consumption. [Copyright &y& Elsevier]

• Discussion, Diagnosis, Direction are key for effective obesity management • Formal training/education could encourage healthcare professional engagement • Recorded obesity diagnoses increase the likelihood of weight management discussions • Formal diagnosis is likely to result in follow-up appointments, providing direction • Understanding the impact of obesity is as important as recognising it as a disease The care of people with obesity is often suboptimal due to both physician and patient perceptions about obesity itself and clinical barriers. Using data from the ACTION-IO study, we aimed to identify factors that might improve the quality of obesity care through adoption of the 3D approach (Discussion, Diagnosis and Direction [follow-up]) by healthcare professionals (HCPs). An online survey was completed by HCPs in 11 countries. Exploratory beta regression analyses identified independent variables associated with each component of the 3D approach. Data from 2,331 HCPs were included in the statistical models. HCPs were significantly more likely to initiate weight discussions and inform patients of obesity diagnoses, respectively, if (odds ratio [95% confidence interval]): they recorded an obesity diagnosis in their patient's medical notes (1.59, [1.43–1.76] and 2.16 [1.94–2.40], respectively); and they were comfortable discussing weight with their patients (1.53 [1.39–1.69] and 1.15 [1.04–1.27]). HCPs who reported feeling motivated to help their patients lose weight were also more likely to initiate discussions (1.36 [1.21–1.53]) and schedule follow-up appointments (1.21 [1.06–1.38]). By contrast, HCPs who lacked advanced formal training in obesity management were less likely to inform patients of obesity diagnoses (0.83 [0.74–0.92]) or schedule follow-up appointments (0.69 [0.62–0.78]). Specific actions that could improve obesity care through the 3D approach include: encouraging HCPs to record an obesity diagnosis; providing tools to help HCPs feel more comfortable initiating weight discussions; and provision of training in obesity management. NCT03584191. [Display omitted] [ABSTRACT FROM AUTHOR]

• Comfort when talking to healthcare professionals was linked to weight loss motivation. • Those motivated often regarded healthcare professionals as an information source. • Weight loss motivation was associated with exercise, goal setting and peer support. • Knowing how to lose weight and ease of weight loss increased the odds of motivation. • Understanding weight loss motivations may improve support for people with obesity. People with obesity (PwO) often struggle to achieve and maintain weight loss. This can perpetuate and/or be influenced by feelings of low motivation. This analysis from ACTION-IO data identified factors associated with PwO motivation to lose weight. PwO completed an online survey in 11 countries. Exploratory multinomial logistic regression analyses identified independent variables associated with self-report of feeling motivated versus not motivated to lose weight. Data from 10,854 PwO were included (5,369 motivated; 3,312 neutral; 2,173 not motivated). Variables associated with feeling motivated versus not motivated included (odds ratio [95% confidence interval]): acknowledgement of healthcare professional (HCP) responsibility to contribute to weight loss (2.32 [1.86–2.88]), comfort in talking to their HCP about weight (1.46 [1.24–1.72), agreement that it is easy to lose weight (1.73 [1.30–2.31]), and a goal of reducing risks from excess weight (1.45 [1.22–1.73]). Conversely, if PwO considered obesity less important than other diseases they were less likely to report feeling motivated (0.49 [0.41–0.58]). PwO who reported being motivated to lose weight were more likely to exercise ≥5 times a week versus <1 time a week (2.77 [2.09–3.68]) than those who reported they were not motivated. Positive interactions with HCPs, self-efficacy, setting goals and knowledge of the importance of weight management, in addition to regular exercising, may increase PwO motivation for weight loss. Appropriate HCP support may help PwO who are ready to engage in weight management. : NCT03584191. [Display omitted] [ABSTRACT FROM AUTHOR]

Abstract: This article reviews the regulation of appetite from a biopsychological perspective. It considers psychological experiences and peripheral nutritional systems (both episodic and tonic) and addresses their relationship with the CNS networks that process and integrate their input. Whilst such regulatory aspects of obesity focus on homeostatic control mechanisms, in the modern environment hedonic aspects of appetite are also critical. Enhanced knowledge of the complexity of appetite regulation and the mechanisms that sustain obesity indicate the challenge presented by management of the obesity epidemic. Nonetheless, effective control of appetite expression remains a critical therapeutic target for weight management. Currently, strategies which utilise a combination of agents to target both homeostatic and hedonic control mechanisms represent the most promising approaches. This article is part of a Special Issue entitled ‘Central Control of Food Intake’. [Copyright &y& Elsevier]

Abstract: The aim of this study was to quantify the nature and extent of use of persuasive marketing techniques in television advertisements (adverts) to promote foods to children. Popular UK commercial television channels broadcasting children’s/family viewing were recorded for 2days (6am–10pm) every month in 2008 and recordings were screened for adverts. Eighteen thousand eight hundred and eighty eight adverts were for food and these were coded for peak/non-peak children’s viewing time and representation of core (healthy)/non-core (unhealthy)/miscellaneous foods. The analysis assessed use of persuasive appeals, premium offers, promotional characters (brand equity and licensed characters), celebrity endorsers and website promotion in food adverts. Promotional characters, celebrity endorsers and premium offers were used more frequently to promote non-core than core foods, even on dedicated children’s channels. Brand equity characters featured on a greater proportion of food adverts than licensed characters. A food brand website was promoted in a third of food adverts (websites are not covered by the statutory regulation on food advertising). This extensive analysis of television adverts demonstrated that the use of persuasive marketing techniques to promote unhealthy foods was extensive in broadcasting popular with children despite regulations. Further studies should incorporate an analysis of the content of websites promoted during food adverts. [Copyright &y& Elsevier]