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More people are living for longer following a cancer diagnosis, however long-term survivors are more likely to experience chronic illnesses. Improving their diet and physical activity behaviours may increase survival and reduce the risk of cancer recurrence and other non-communicable diseases. The World Cancer Research Fund and American Institute for Cancer Research recommend that cancer survivors aim to be a healthy weight and physically active; eat a diet rich in wholegrains, vegetables, fruits and beans; limit consumption of ‘fast foods’, red and processed meat, sugar sweetened drinks and alcohol; and meet nutritional needs through diet alone rather than relying on supplements. Evidence suggests that cancer survivors are receptive to receiving advice and making dietary and physical activity changes, but barriers to improving the diet and being physically active need to be explored and addressed. We collaborated with CLAN Cancer Support (an independent charity) to assess the feasibility of a two-day course designed to improve diet and physical activity in cancer survivors in Scotland. Further, it explored the barriers and facilitators that cancer survivors identify in relation to eating a healthy diet and being physically active. The course included presentations, practical activities and group discussions. Initial analysis indicates that factors specific to this population need to be designed into the delivery of the course to enhance recruitment and promote behaviour change. Research then needs to be translated into sustainable support programmes accessible by all cancer survivors. This article describes the rationale behind the study, its design and expected outcomes.

An unpublished pilot study at a charitable youth organisation in the North East of Scotland found that young people (aged 16 to 25) accommodated by the organisation consumed a diet high in sugar and low in levels of foods such as meat, fish, fruit, and vegetables (Perry, 2013). The Foodways and Futures project (2013-2016), combining ethnographic and action research methodology, set out to explore why the diet of young people was sub-optimal, despite the organisation having a number of support services in place that would—it was perceived—encourage better eating habits amongst the young people housed within the organisation. Photovoice (PV) was identified as a participatory research method that was suitable, and that would encourage young people to participate as co-researchers in the investigation. However, despite young people getting involved in other research methods that were employed in the study, PV was generally not taken up as anticipated. This article explores how the method was employed, and argues that what could be deemed the ‘failure’ of PV instead may be interpreted as evidence of young people’s awareness and sensitivity about the potential judgements of others on personal food choices. In this sense, poor uptake of PV actually reveals much more about young people’s lived experiences than the data that it generates. The use of PV as a research method is therefore powerful, in that it allows participants to indicate, through inactivity, their sensitivity to ‘discourses of blame’.

Across the globe, there can be confusion about the difference between the concepts of health education, health promotion and, often also, public health. This confusion does not limit itself to the individual terms but also to how these terms relate to each other. Some use terms such as health education and health promotion interchangeably; others see them clearly as different concepts. In this theoretical overview paper, we have first of all outlined our understanding of these individual terms. We suggest how the five principles of health promotion as outlined by the World Health Organization (WHO, 1984) fit into Tannahill’s (2009) model of three overlapping areas: (a) health education; (b) prevention of ill health; and (c) health protection. Our schematic overview places health education within health promotion and health promotion itself in the center of the overarching disciplines of education and public health. We hope our representation helps reduce confusion among all those interested in our discipline, including students, educators, journalists, practitioners, policymakers, politicians, and researchers.

BackgroundSince the introduction of the Child Poverty Act (2017) in Scotland, all health visitors, midwives and family nurses in Scotland are expected to screen and offer a financial advice referral to at-risk pregnant women and parents/carers of families with children under five in Scotland. The so-called ‘Financial Inclusion Pathway’ (FIP) emerged in 2019 as one of a number of strategies intended to tackle child poverty. At this early implementation stage, little is known about parents’ perspectives about the acceptability or impact of this initiative in relation to its aim.MethodsIn 2020, low income parents with young children living in Aberdeen City were invited to take part in a qualitative study that aimed to determine any challenges they might face engaging with the FIP policy in practice, and their perspectives about financial discussions with professionals that could help to increase household incomes through this approach.One-to-one semi-structured telephone interviews lasting between 30–40 minutes took place during July and August 2020. Interviews were fully transcribed and thematically analysed.ResultsTen women, ranging from ages 20–41 years. Each participant had between one and five child(ren), ranging in age from 2 to 18 years and all had one child under school-age. All lived in multiply deprived postcode areas within Aberdeen City. Three main themes emerged: i. difficulties associated with discussing financial concerns;ii. how to talk about the issue;iii. intervention utility. Within each of these three main themes, nine-sub themes were apparent, ranging from those indicating potential unintended negative consequences, as well as intervention benefits.DiscussionMost participants considered health visitors to be a potentially good source of help about financial challenges;they were less clear about midwives’ role here. However, parents’ perceptions of the problems they may face associated with disclosing financial difficulties to health professionals, is a distinct barrier to conversations that could lead to a financial advice referral. Given the levels of unclaimed benefit in the UK, this is important to note. Establishing trust and rapport, careful and sensitive enquiry, and positive framing of financial maximisation were recommended to aid discussion of financial challenges. These findings are important given the current and predicted economic impact of the COVID-19. The study is limited by its sample size and recruitment site, but provides valuable insights to inform a larger scale investigation. The study also indicates the importance of understanding health professionals’ associated views and experiences.

Estimates suggest that over 10% of the UK population are affected by food insecurity. International evidence indicates that food insecurity is a risk factor for many long‐term health conditions, and can adversely affect people's ability to manage existing conditions. Food insecurity is thus not only a serious social concern but also a healthcare issue requiring the attention of UK health professionals. An exploratory qualitative study was undertaken to investigate the experiences and views of health professionals in north east Scotland, with a particular focus on support for people with long‐term conditions whom they believed were affected by food insecurity. Two focus groups and nine semi‐structured interviews were undertaken with a total of 20 health professionals between March and July 2016. Thematic analysis generated three main themes. The health professionals had (a) diverse levels of understanding and experience of food insecurity, but between them identified a range of (b) negative impacts of food insecurity on condition‐management, especially for diet dependent conditions or medication regimes, and for mental health. Even for those health professionals more familiar with food insecurity, there were various (c) practical and ethical uncertainties about identifying and working with food insecure patients (it could be difficult to judge, for example, whether and how to raise the issue with people, to tailor dietary advice to reflect food insecurity, and to engage with other agencies working to address food insecurity). This study indicates that health professionals working with food insecure patients have learning and support needs that warrant further investigation. Debates about health professionals’ responsibilities, and interventions to guide and support health professionals, including tools that might be used to screen for food insecurity, must also reflect the diverse lived needs and values of people who experience food insecurity.

I question the notion of food choice and consider how much food choice someone living on low income actually has. In my fieldwork, it became clear that food choices, and hence one’s nutritional and health state, cannot be viewed in separation from the participants’ individual stories and the complexities of their lives. Daily routines, financial situation, and food accessibility have an impact on people’s food choices. In realising this, I found Amartya Sen’s (1979, 1985) capabilities approach useful, which moves beyond food entitlements. More specifically, a health capabilities approach as introduced by Venkatapuram (2007, 2011) and the association made between health and capabilities by others (e.g. Ruger Yale Joural Law Humanities 18 (2): 3, 2003) views health as the combination of the influence of socio-economic structures, as well as personal agency resulting in choices. I present the main learnings from viewing Foodways and Futures through the ‘capabilities lens’ and thus view food choices as the combination of the complex interrelations between socio-economic structures and agency.

In the absence of routinely collected household food insecurity data, this study investigated what could be determined about the nature and prevalence of household food insecurity in Scotland from secondary data. Secondary analysis of the Living Costs and Food Survey (2007&ndash, 2012) was conducted to calculate weekly food expenditure and its ratio to equivalised income for households below average income (HBAI) and above average income (non-HBAI). Diet Quality Index (DQI) scores were calculated for this survey and the Scottish Health Survey (SHeS, 2008 and 2012). Secondary data provided a partial picture of food insecurity prevalence in Scotland, and a limited picture of differences in diet quality. In 2012, HBAI spent significantly less in absolute terms per week on food and non-alcoholic drinks (&pound, 53.85) compared to non-HBAI (&pound, 86.73), but proportionately more of their income (29% and 15% respectively). Poorer households were less likely to achieve recommended fruit and vegetable intakes than were more affluent households. The mean DQI score (SHeS data) of HBAI fell between 2008 and 2012, and was significantly lower than the mean score for non-HBAI in 2012. Secondary data are insufficient to generate the robust and comprehensive picture needed to monitor the incidence and prevalence of food insecurity in Scotland.

This article reflects on ethical limitations and dilemmas encountered during fieldwork of the Foodways and Futures project (2013–2016). Foodways and Futures is a qualitative action research project aimed at exploring the food choices of former homeless young people (aged 16–25) in Aberdeenshire. In Scotland, where over 13,000 young people become homeless every year, Foodways and Futures aims to address social injustices as well as the implications of malnutrition in young people. Four interrelated main themes surrounding ethics became apparent during fieldwork: issues of communication, trust, issues with consent forms and power relations. Reflecting on these themes makes it clear that ethical guidelines are not necessarily beneficial for researchers as well as participants, especially if they are part of so-called vulnerable groups.

There is growing policy maker and public concern about current trends in food bank use in Scotland. Yet little is known about the experiences of those seeking help from food banks in this country. This research aimed to address this issue by studying the use and operation of a food bank situated in a rich northeast city during January and June 2014. The study aimed to establish who was seeking help from the food bank, their reasons for doing so, and what those who did thought of, and dealt with the food they received from it. Consequently, an audit of the food bank's client database, four months of participant observation based in the food bank, and seven face-to-face interviews with current and former food bank clients were conducted. The audit revealed that clients came from a range of socio-economic backgrounds, with men more likely to access it compared to women. Debt and social security benefit delays were cited as the main reasons for doing so. Qualitative data confirmed that sudden and unanticipated loss of income was a key driver of use. Resourcefulness in making donated food last as long as possible, keeping fuel costs low, and concern to minimise food waste were commonly described by participants. Desperation, gratitude, shame and powerlessness were also prevalent themes. Furthermore, clients were reluctant to ask for food they normally ate, as they were acutely aware that the food bank had little control over what it was able offer. Insights from this study suggest that recent UK policy proposals to address food poverty may have limited impact, without concomitant effort to address material disadvantage. Research is urgently required to determine the precise nature and extent of household level food insecurity in Scotland, and to consider monitoring for adverse physical and mental health outcomes for those affected by it.

BACKGROUND AND OBJECTIVES: Mental illness is increasingly recognized as a global health problem. However, in many countries, including Nepal, it is difficult to talk about mental health problems due to the stigma associated with it. Hence a training programme was developed to train auxiliary nurse midwives, who otherwise are not trained in mental health as part of their pre-registration training in rural Nepal, on issues related to maternal mental health. After the training programme a selection of auxiliary nurse midwives were interviewed to establish their views on the training, its usefulness and ways to improve it. METHODS: This qualitative study reports on the analysis of interviews conducted with auxiliary nurse midwives who participated in the training programme. The interviews addressed issues associated with the training programme as well as perceptions around mental health in rural Nepal. Transcripts were thematically analysed. RESULTS: Three themes emerged from analysis: (1) issues related to training; (2) societal attitudes; and (3) support for women. The 'training' theme describes the benefits and limitations of training sessions. 'Societal attitudes' describes society's attitude towards mental health which is largely negative. 'Support' describes the positive behaviour and attitude towards pregnant women and new mothers. CONCLUSION: The study supports the need for continued training for auxiliary nurse midwives who are based in the community. This gives them the opportunity to reach the whole community group and potentially have influence over reduction of stigma; offer support and diagnosis of mental ill-health. There is still stigma around giving birth to a female child which can lead to mental health problems. It is imperative to increase awareness and educate the general public regarding mental health illnesses especially involving family members of those who are affected.

Men are underrepresented in obesity services, suggesting current weight loss service provision is suboptimal. This systematic review evaluated evidence-based strategies for treating obesity in men. Eight bibliographic databases and four clinical trials’ registers were searched to identify randomized controlled trials (RCTs) of weight loss interventions in men only, with mean/median body mass index of ≥30 kg/m2 (or ≥28 kg/m2 with cardiac risk factors), with a minimum mean/median duration of ≥52 weeks. Interventions included diet, physical activity, behavior change techniques, orlistat, or combinations of these; compared against each other, placebo, or a no intervention control group; in any setting. Twenty-one reports from 14 RCTs were identified. Reducing diets produced more favorable weight loss than physical activity alone (mean weight change after 1 year from a reducing diet compared with an exercise program −3.2 kg, 95% confidence interval −4.8 to −1.6 kg, reported p < .01). The most effective interventions combined reducing diets, exercise, and behavior change techniques (mean difference in weight at 1 year compared with no intervention was −4.9 kg, 95% confidence interval −5.9 to −4.0, reported p < .0001). Group interventions produced favorable weight loss results. The average reported participant retention rate was 78.2%, ranging from 44% to 100% retention, indicating that, once engaged, men remained committed to a weight loss intervention. Weight loss for men is best achieved and maintained with the combination of a reducing diet, increased physical activity, and behavior change techniques. Strategies to increase engagement of men with weight loss services to improve the reach of interventions are needed.

This qualitative study explored frontline service providers’ perceptions of the nature of food insecurity in Scotland in 2015 to inform national policy and the provision of locally-based support for ‘at risk’ groups. A country-wide in-depth interview study was undertaken with informants from 25 health, social care, and third sector organisations. The study investigated informants’ perspectives associated with how food insecurity was manifesting itself locally, and what was happening at the local level in response to the existence of food insecurity. Data analysis revealed three key themes. First, the multiple faces and factors of food insecurity involving not only increased concern for previously recognised ‘at risk of food insecurity’ groups, but also similar concern held about newly food insecure groups including working families, young people and women. Secondly, respondents witnessed stoicism and struggle, but also resistance amongst some food insecure individuals to external offers of help. The final theme identified community participation yet pessimism associated with addressing current and future needs of food insecure groups. These findings have important implications for the design and delivery of health and social policy in Scotland and other countries facing similar challenges.

Summary Understanding the drivers for improving Scotland's dietary health is one of the key objectives within the ‘Food, Land and People’ component of the Scottish Government's Strategic Research Programme (SRP). Food producer, processor, retailer and consumer behaviour relative to diet and health are investigated through the programme's ‘Healthy Safe Diets’ theme. The research recognizes both the importance of food to Scotland's economy, health and wellbeing, as well as the challenges faced by the burden of obesity and dietary-related illness. The Healthy Safe Diets theme's analysis of diet and behaviour has a focus on the interplay of the social, biological, behavioural and environmental determinants of nutritional health and aims to develop and test prototype policy interventions relevant to improving the health of Scotland's population. Here, we argue the necessity for concerted and coordinated multidisciplinary approaches to understand and influence dietary behaviour within the changing technological, economic, social and cultural context of individuals within society. The SRP's structure encourages and is developing such interdisciplinary links. Inherent to this is the combining of qualitative and quantitative approaches; using the insights gained from in depth study of small numbers of people, both to provide a better understanding of the results of quantitative analysis and to inform new research questions. Placed in context with the SRP's wider research objectives (such as on physical activity, the role of ‘urban green space’, enhancing the health-beneficial properties of foods and the environmental sustainability of food production and supply), SRP interconnection offers significant opportunity to develop synergies and reconcile conflicts between research areas to create cohesive policy advice and enhance health and wellbeing outcomes.

We systematically reviewed the randomised controlled trial (RCT) evidence for long-term (≥12 months) weight management interventions for obese men in contrast to women to help understand whether programmes should be designed differently for men. We searched 11 databases up to October 2014. Twenty-two RCTs reported data separately for men and women in weight loss or weight maintenance interventions. We found men were under-represented in RCTs of weight loss interventions open to both sexes. Men comprised 36% of participants (4771 from 13,305 participants). Despite this, men were 11% (95% CI 8-14%, p

There is growing recognition that poor adolescent mental well-being is a serious global health issue. Research exploring adult mental well-being issues has shown positive and negative associations with environmental factors such as quality of the neighbourhoods and social support. However, little is known about young people's notions of mental well-being, or factors they associate with generating, sustaining or eroding it. A qualitative community-based participatory research study was conducted using photovoice (PV), with young people attending a youth project based in a deprived inner-city neighbourhood in Scotland. The research enabled participants to identify and explore aspects of their neighbourhood they experienced as having a direct impact on their mental well-being. The following themes emerged as those most important to participants' mental well-being: (1) perceived levels of local neighbourhood investment and care; (2) access to various forms of capital (including social, economic and natural ca...

ObjectiveTo develop a timeline for evaluating public health nutrition policy interventions.DesignConcept mapping, a stakeholder-driven approach for developing an evaluation framework to estimate the ‘time to impact’ for policy interventions. The Schools (Health Promotion and Nutrition) (Scotland) Act 2007 was used as the model to develop the evaluation timeline as it had typical characteristics of government policy. Concept mapping requires stakeholders to generate a list of the potential outcomes, sort and rate the outcomes. Multidimensional scaling and hierarchical cluster data analysis were used to develop an anticipated timeline to impact for the policy.SettingUnited Kingdom.SubjectsOne hundred and eleven stakeholders representing nutrition, public health, medicine, education and catering in a range of sectors: research, policy, local government, National Health Service and schools.ResultsEighty-five possible outcomes were identified and grouped into thirteen clusters describing higher-level themes (e.g. long-term health, food literacy, economics, behaviour, diet, education). Negative and unintended consequences were anticipated relatively soon after implementation of the policy, whereas positive outcomes (e.g. dietary changes, health benefits) were thought likely to take longer to emerge. Stakeholders responsible for implementing the legislation anticipated that it would take longer to observe changes than those from policy or research.ConclusionsDeveloping an anticipated timeline provides a realistic framework upon which to base an outcome evaluation for policy interventions and identifies positive and negative outcomes as well as considering possible unintended consequences. It offers benefit to both policy makers and researchers in mapping the progress expected towards long-term health goals and outcomes.

After a pilot study at a charitable youth organisation in the North East of Scotland found no considerable improvements in the food choices of former homeless young people accommodated by the organisation (Perry, 2013), the Foodways and Futures project (2013-2016) set out to explore why. Both members of staff at the same organisation as well as young people were invited to voice their views and opinions on the factors influencing young people’s food choices. Whilst everyone’s contribution was considered equally informative for our findings, I was attentive to where the information originated from. In this, I found that three conflicting discourses of blame pervade the participants’ expressions of the rationales underlying young people’s food choices. Trying to make sense of these, I employ Strauss’ Social Worlds Theory (1978). I find that the different discourses of blame make sense in the context of the complex organisational structures. In objecting to a tendency in the literature to assign standardised discourse of blame primarily to youth workers’ practice, these discourses showcase mutual understanding instead.

Background: Partnership working has been a key tenet of health policy in Scotland since 1997. Much has been written about the benefits of partnership working, but it has been difficult to prove its effectiveness. This paper describes the reality of working in partnership when undertaking an evaluation of a complex intervention aimed at engaging with hard-to-reach men to improve their health. Methods: A collaborative model of working was used to develop an evaluation tool to assess the effectiveness of the intervention. Six phases were used in the developmental process each involving a different group of stakeholders. The progress through these phases was not linear; it involved numerous iterative feedback loops. A number of challenges were faced at each phase and steps were taken to overcome them. Results: Four lessons emerged which are more generally applicable. Collaborative working is a slow process, a fact which key advocates in the field have failed to recognise. Study participants need to b...

Reducing meat consumption is central to many of the scientific debates on healthy, sustainable diets because of the high environmental impact of meat production. Missing from these debates are the public perspectives about eating less meat and consideration of cultural and social values associated with meat. The aim of this study was to explore public awareness of the environmental impact of food and their willingness to reduce meat consumption. Twelve focus groups and four individual interviews were conducted with adults from a range of socio-economic groups living in both rural and urban settings in Scotland. Public understanding of the link between food, environment and climate change was explored, with a focus on meat and attitudes towards reducing meat consumption. Data were transcribed and analysed thematically. Three dominant themes emerged: a lack of awareness of the association between meat consumption and climate change, perceptions of personal meat consumption playing a minimal role in the global context of climate change, and resistance to the idea of reducing personal meat consumption. People associated eating meat with pleasure, and described social, personal and cultural values around eating meat. Some people felt they did not need to eat less meat because they had already reduced their consumption or that they only ate small quantities. Scepticism of scientific evidence linking meat and climate change was common. Changing non-food related behaviours was viewed as more acceptable and a greater priority for climate change mitigation. The study highlights the role meat plays in the diet for many people, beyond nutritional needs. If healthy, sustainable dietary habits are to be achieved, cultural, social and personal values around eating meat must be integrated into the development of future dietary recommendations.

Background: Systematic reviews often investigate the effectiveness of interventions for one sex. However, identifying interventions with data presented according to the sex of study participants can be challenging due to suboptimal indexing in bibliographic databases and poor reporting in titles and abstracts. The purposes of this study were to develop a highly sensitive search filter to identify literature relevant to men's health and to assess the performance of a range of sex-specific search terms used individually and in various combinations. Methods: Comprehensive electronic searches were undertaken across a range of databases to inform a series of systematic reviews investigating obesity management for men. The included studies formed a reference standard set. A set of sex-specific search terms, identified from database-specific controlled vocabularies and from natural language used in the titles and abstracts of relevant papers, was investigated in MEDLINE and Embase. Sensitivity, precision, number needed to read (NNR) and percent reduction in results compared to searching without sex-specific terms were calculated. Results: The reference standard set comprised 57 papers in MEDLINE and 63 in Embase. Seven sex-specific search terms were identified. Searching without sex-specific terms returned 31,897 results in MEDLINE and 37,351 in Embase and identified 84% (MEDLINE) and 83% (Embase) of the reference standard sets. The best performing individual sex-specific term achieved 100%/98% sensitivity (MEDLINE/Embase), NNR 544/609 (MEDLINE/Embase) and reduced the number of results by 18%/17% (MEDLINE/Embase), relative to searching without sex-specific terms. The best performing filter, compromising different combinations of controlled vocabulary terms and natural language, achieved higher sensitivity (MEDLINE and Embase 100%), greater reduction in number of results (MEDLINE/Embase 24%/20%) and greater reduction in NNR (MEDLINE/Embase 506/578) than the best performing individual sex-specific term. Conclusions: The proposed MEDLINE and Embase filters achieved high sensitivity and a reduction in the number of search results and NNR, indicating that they are useful tools for efficient, comprehensive literature searching but their performance is partially dependent on the appropriate use of database controlled vocabularies and index terms.

This paper discusses the use of diary‐keeping as part of an evaluation of a complex, community‐based health promotion initiative, using the Mobile Information Bus (MIB) as an example. The MIB was designed to provide health and related information for living adolescents in rural areas of Northeast Scotland. The general strengths and limitations of diary‐keeping as a research method are discussed alongside an account of the evaluators' experiences of using this method within the MIB context, as well as suggestions for improving the efficacy of diary‐keeping as a research method. In addition, the results of an extensive literature search on the topic of diaries as a research method are reported. As part of the MIB evaluation, the diary provided a contemporaneous, in‐depth account of the intervention in operation. Those engaged in evaluation of similar types of projects (particularly related to process evaluation) may find the use of a project diary a useful adjunct to other research methods.

The interdisciplinary Foodways and Futures project (2013-2016) is based on a pilot study which found noimprovement in the nutritional state of formerly homeless young people (16-25), now in supported accommodationat a charitable youth organization. Because a healthy food intake during adolescence is important, and because youngpeople with socioeconomic lower backgrounds face difficulties in maintaining a healthy diet (Beasley at al., 2005), Iinvestigated how the young people themselves experience their relationship to food. In this paper I explore linksbetween the lived experience before and during their stay with the organization of this vulnerable group, and theirfood choices and practices. The study illustrates the ways in which those choices and practices may appearnutritionally undesirable, but are nevertheless linked to the young people’s search for ontological security and socialconnectedness, in their new living environment. In this, I draw on and extend Schlossberg’s (1981) transition theoryin order to better understand the rationales underlying an individual’s subjective food choices.

While there is evidence that weight-loss interventions reduce morbidity, indications of their acceptability are limited. Understanding preferences for lifestyle interventions will help policymakers design interventions. We used a discrete choice experiment to investigate preferences for lifestyle interventions to reduce adult obesity. Attributes focused on: the components of the programme; weight change; short-term and longer-term health gains; time spent on the intervention and financial costs incurred. Data were collected through a web-based questionnaire, with 504 UK adults responding. Despite evidence that dietary interventions are the most effective way to lose weight, respondents preferred lifestyle interventions involving physical activity. While the evidence suggests that behaviour change support improves effectiveness of interventions, its value to participants was limited. A general preference to maintain current lifestyles, together with the sensitivity of take up to financial costs, suggests financial incentives could be used to help maximise uptake of healthy lifestyle interventions. An important target group for change, men, required more compensation to take up healthier lifestyles. Those of normal weight, who will increase in weight over time if they do not change their lifestyle, required the highest compensation. Policymakers face challenges in inducing people to change their behaviour and adopt healthy lifestyles.

Background: The high prevalence of childhood obesity is a concern for policy makers and health professionals, leading to a focus on early prevention. The beliefs and perspectives of parents about early childhood obesity, and their views and opinions about the need for weight management interventions for this age group are poorly understood. Methods: A formative qualitative focus group study with parents of pre-school children took place in eight community-based locations throughout North-East Scotland to explore their ideas about the causes of early childhood obesity, personal experiences of effective weight management strategies, and views about the format and content of a possible child-orientated weight management programme. Study participants were recruited via pre-school nurseries. Results: Thirty-four mothers (median age 37 years) took part in the study, but only two believed their child had a weight problem. Participants (who focussed primarily on dietary issues) expressed a strong sense of personal responsibility to ‘get the balance right’ regarding their child’s weight, and were generally resistant to the idea of attending a weight management programme aimed at very young children. At the same time, they described a range of challenges to their weight management intentions. These included dealing with intrinsic uncertainties such as knowing when to stop ‘demand feeding’ for weight gain, and judging appropriate portion sizes - for themselves and their children. In addition they faced a range of extrinsic challenges associated with complex family life, i.e. catering to differing family members dietary needs, food preferences, practices and values, and keeping their ‘family food rules’ (associated with weight management) when tired or pressed for time. Conclusions: The findings have important implications for health professionals and policy makers wishing to engage with parents on this issue, or who are currently developing ‘family-centred’ early childhood weight management interventions. The challenge lies in the fact that mothers believe themselves to be the primary (and capable) agents of obesity prevention in the early years – but, who are at the same time, attempting to deal with many mixed and conflicting messages and pressures emanating from their social and cultural environments that may be undermining their weight management intentions.

Background\ud Obesity increases the risk of many serious illnesses such as coronary heart disease, type 2 diabetes and osteoarthritis. More men than women are overweight or obese in the UK but men are less likely to perceive their weight as a problem and less likely to engage with weight-loss services.\ud Objective\ud The aim of this study was to systematically review evidence-based management strategies for treating obesity in men and investigate how to engage men in obesity services by integrating the quantitative, qualitative and health economic evidence base.\ud Data sources\ud Electronic databases including MEDLINE, EMBASE, PsycINFO, the Cochrane Central Register of Controlled Trials, the Database of Abstracts of Reviews of Effects and the NHS Economic Evaluation Database were searched from inception to January 2012, with a limited update search in July 2012. Subject-specific websites, reference lists and professional health-care and commercial organisations were also consulted.\ud Review methods\ud Six systematic reviews were conducted to consider the clinical effectiveness, cost-effectiveness and qualitative evidence on interventions for treating obesity in men, and men in contrast to women, and the effectiveness of interventions to engage men in their weight reduction. Randomised controlled trials (RCTs) with follow-up data of at least 1 year, or any study design and length of follow-up for UK studies, were included. Qualitative and mixed-method studies linked to RCTs and non-randomised intervention studies, and UK-based, men-only qualitative studies not linked to interventions were included. One reviewer extracted data from the included studies and a second reviewer checked data for omissions or inaccuracies. Two reviewers carried out quality assessment. We undertook meta-analysis of quantitative data and a realist approach to integrating the qualitative and quantitative evidence synthesis.\ud Results\ud From a total of 12,764 titles reviewed, 33 RCTs with 12 linked reports, 24 non-randomised reports, five economic evaluations with two linked reports, and 22 qualitative studies were included. Men were more likely than women to benefit if physical activity was part of a weight-loss programme. Reducing diets tended to produce more favourable weight loss than physical activity alone (mean weight change after 1 year from a reducing diet compared with an exercise programme -3.2 kg, 95% CI -4.8 kg to -1.6 kg). The type of reducing diet did not affect long-term weight loss. A reducing diet plus physical activity and behaviour change gave the most effective results. Low-fat reducing diets, some with meal replacements, combined with physical activity and behaviour change training gave the most effective long-term weight change in men [-5.2 kg (standard error 0.2 kg) after 4 years]. Such trials may prevent type 2 diabetes in men and improve erectile dysfunction. Although fewer men joined weight-loss programmes, once recruited they were less likely to drop out than women (difference 11%, 95% CI 8% to 14%). The perception of having a health problem (e.g. being defined as obese by a health professional), the impact of weight loss on health problems and desire to improve personal appearance without looking too thin were motivators for weight loss amongst men. The key components differ from those found for women, with men preferring more factual information on how to lose weight and more emphasis on physical activity programmes. Interventions delivered in social settings were preferred to those delivered in health-care settings. Group-based programmes showed benefits by facilitating support for men with similar health problems, and some individual tailoring of advice assisted weight loss in some studies. Generally, men preferred interventions that were individualised, fact-based and flexible, which used business-like language and which included simple to understand information. Preferences for men-only versus mixed-sex weight-loss group programmes were divided. In terms of context, programmes which were cited in a sporting context where participants have a strong sense of affiliation showed low drop out rates and high satisfaction. Although some men preferred weight-loss programmes delivered in an NHS context, the evidence comparing NHS and commercial programmes for men was unclear. The effect of family and friends on participants in weight-loss programmes was inconsistent in the evidence reviewed - benefits were shown in some cases, but the social role of food in maintaining relationships may also act as a barrier to weight loss. Evidence on the economics of managing obesity in men was limited and heterogeneous.\ud Limitations\ud The main limitations were the limited quantity and quality of the evidence base and narrow outcome reporting, particularly for men from disadvantaged and minority groups. Few of the studies were undertaken in the UK.\ud Conclusions\ud Weight reduction for men is best achieved and maintained with the combination of a reducing diet, physical activity advice or a physical activity programme, and behaviour change techniques. Tailoring interventions and settings for men may enhance effectiveness, though further research is needed to better understand the influence of context and content. Future studies should include cost-effectiveness analyses in the UK setting.