Search

Background Research investigating the nutritional status of older people in residential care homes is scant. Objective To determine the anthropometric measures and dietary intakes of older people in this setting as a basis for future intervention studies. Methods Dietary intake was assessed using 3-day-weighed food records, nutritional status was evaluated using anthropometric measurements (knee height to predict standing height, and body weight). Catering provision was assessed using a computer-based menu assessment tool (CORA). Results Mean body mass index (BMI) for the 34 participants was 22.2 kg m(2) (range 14.5-34.4). Six participants (17.6%) had a BMI 18.5 but <20 kg m(2). Only two subjects with BMI <18.5 kg m(2) were prescribed oral supplements. In both men and women, recorded mean energy intakes were below current estimated average requirements by 24% and 22% respectively. Conclusion Despite adequate food provision, under-nutrition was prevalent and, in the majority of cases, unidentified and untreated. A larger study is warranted to investigate whether improved nutritional intake is achievable through dietary modification. These data indicate that a sample size of around 60, with 90% power and at the 5% significance level, is required to detect a difference of 1674 kJ between groups of residents in an intervention study following a cluster randomized design. [ABSTRACT FROM AUTHOR]

OBJECTIVES: Survivors of acute myocardial infarction (MI) often experience weight changes and weight management is often appropriate. Estimates of the sample size required in intervention weight loss studies are essential to the success of future evaluations. The aims of this study were therefore two-fold: (1) to describe pilot data on the effectiveness of advice for weight loss; (2) to provide information on the sample size required for future research to assess weight management in similar patients. METHODS: Further analysis of data from a randomized controlled study carried out in 84 post-MI patients attending cardiac rehabilitation. Forty-three intervention patients received dietary advice in line with current UK guidelines. Additionally, overweight intervention subjects were given individualized weight management advice. Forty-two control patients were recruited and received usual care. Anthropometric measurements were made at baseline and followed up at 52 weeks post-rehabilitation. Power calculations were performed using these data to determine the required sample size to adequately power a study examining the effectiveness of weight management. RESULTS: Seventy patients completed the study. At 52 weeks anthropometric measurements were unchanged in the 25 overweight patients provided with weight management advice, and also for all those (n = 20) with body mass index <25 kg m-2. In contrast, anthropometric measurements increased significantly (body weight +2.4 kg, P = 0.02; waist circumference +2.6 cm, P = 0.008) in overweight control patients. A minimum sample size of 71 patients is required for a future study of weight change in overweight subjects, and 58 for a study of healthy weight subjects. CONCLUSIONS: Pilot data suggested that significant weight changes occur in patients not given nutritional or weight management advice after MI. Power calculations carried out on these data indicate that a sample size at least three times as large as the present study is required to accurately evaluate weight management in this group. [ABSTRACT FROM AUTHOR]

BACKGROUND: There are a plethora of nutrition screening tools (NSTs) in use in a variety of clinical settings that are either unvalidated and/or not client specific. There is a need for an NST for all elderly patients attending community day hospitals. At present such a validated tool is unavailable. AIMS: To assess the reliability and reproducibility of a developed NST; and to identify elderly patients attending day hospitals who have, or are at risk of, poor nutritional status. METHODS: Three day hospitals were selected and 70 admissions were prospectively assessed by Nursing staff and independently by a State Registered Dietitian (SRD) The patients' nutritional status was anthropometrically assessed using the NST. RESULTS: The level of agreement between the nurse and the dietitian for each of the levels of the NST and the overall score was either 'good agreement' or 'very good agreement' as defined by Cohen's Kappa. Spearman's Rank Correlation between objective markers of assessment and the Nurse or Dietitian score from the NST were all statistically significant (P = 0.42). As an identifier of risk, the NST has low levels of sensitivity, but high levels of specificity. CONCLUSION: The Ayrshire NST is a reliable and valid tool which can be used by qualified Nursing staff to assist in screening elderly patients at high risk of poor nutritional status. [ABSTRACT FROM AUTHOR]

Aims: Type 2 diabetes (T2D) is known to be associated with high BMI and waist circumference (WC). These measures do not discriminate well between skeletal muscle (SM) and body fat (BF), which may have opposite influences., Methods: We conducted a secondary analysis of population-based data from 58,128 aged 18-85 yrs from Scottish Health Surveys (2003, 2008-2011) and Health Surveys for England (2003-2006, 2008-2013), excluding pregnant women and insulin-treated diabetes. Logistic regression was used to assess associations of known T2D, and of screened HbA1c > 48 mmol/mol (> 6.5%), with sex-specific quintiles of BMI, WC, and BF% and SM% estimated by validated anthropometric equations, adjusted for age, sex, smoking, ethnicity, country, and survey year., Results: As expected, ORs for having known T2D rose with quintiles of BMI (1, 1.5, 2.3, 3.1, and 6.5) and WC (1, 1.8, 2.5, 3.5, and 8.7). Compared to the lowest BF% quintile, OR for having T2D in highest BF% quintile was 11.1 (95% CI = 8.4-14.6). Compared to the highest SM% quintile, OR for having T2D in lowest SM% quintile was 2.0 (1.7-2.4). Of 72 adults with T2D/HbA1c > 6.5% in the lowest quintile of BF%, 27 (37.5%) were in quintile 1 of SM%. Similar patterns of OR were observed for having HbA1c > 6.5% in those without known T2D., Conclusions: Estimated BF% associates strongly with T2D. Low SM% also has a significant association, suggesting a neglected aspect of aetiology within T2D. These two simple measures with biological relevance, available from data collected in most health surveys, may be more useful than the purely statistical terms BMI.

Hypertension is known to be associated with obesity, while its relationship to skeletal muscle, SM (SM; a marker of general health and body function), remains uncertain. We analyzed population-based data of 22 591 men (mean age: 51.6 ± 16.9 years) and 27 845 nonpregnant women (50.6 ± 16.9 years) from Scottish Health Surveys (2003, 2008-2011) and Health Surveys for England (2003-2006, 2008-2013) including 2595 non-insulin- and 536 insulin-treated diabetic patients. Compared with normotensive individuals (no hypertension history with normal systolic [SBP < 140 mm Hg] and diastolic blood pressure [DBP < 90 mm Hg]), percent body fat (BF%) was significantly higher and percent SM lower (P < 0.001) in undetected (no hypertension history with raised SBP ≥ 140 and/or DBP ≥ 90 mm Hg), controlled (hypertension history with normal BP), uncontrolled (hypertension history with raised BP), and untreated hypertension. The prevalences of hypertension within BF% quintiles were 11.8%, 24.8%, 41.4%, 56.8%, and 71.6% and SM% quintiles were 67.5%, 53.3%, 39.5%, 27.4%, and 18.5%. Compared to referent groups (lowest BF% quintile or highest SM% quintile), odds ratio (age, sex, smoking, ethnicity, country, survey year, and diabetes adjusted) for having all types of hypertension in the highest BF% quintile was 5.5 (95% confidence interval = 5.0-5.9) and lowest SM% quintile was 2.3 (2.2-2.5). Compared with those without diabetes, individuals with diabetes had a 2.3-fold-2.6-fold greater risk of hypertension, independent of confounding factors and BF% or SM%. The associations of hypertension with BF% were higher than those with body mass index (BMI). In conclusion, both BF and SM should be considered when analyzing results from health surveys, rather than relying on BMI which does not discriminate between the two., (©2018 Wiley Periodicals, Inc.)

Background: e-epidemiology, a convenient and low-cost research method, is becoming increasingly popular. This study seeks to validate on-line self-reported heights and weights against objectively measured data in young adults., Methods: Young adults self-reported heights and weights in an on-line lifestyle survey. These were validated using two methods: (i) measurements by staff at the primary-care clinic and (ii) measurements by a researcher within two weeks of distribution of the survey. Analyses were conducted to determine differences between the self-reported and measured heights and weights and to identify characteristics associated with under- or over-reporting of these., Results: From a total of 23 010 young adults invited to the survey, 24% provided on-line data, mean age = 19.2 (SD 3.2) years, 43% male, 91% EU citizens. Both self-reported and measured data were available for 1446 individuals (547 men, 896 women and mean age 19.2 (SD2.6) years); 1278 validated using medical records, 168 by researcher measurements. Intra-class correlations between self-reported and measured parameters were weight (r = 0.99), height (r = 0.98), with acceptable levels of agreement between measured and self-reported weight, height and BMI using Bland & Altman analyses. Self-reported weight was underestimated uniformly across BMI categories, gender and ethnicity, by a mean -0.4 (SD 0.4) kg (P < 0.001). Height was accurately reported overall across BMI and gender: both self-reported and measured heights =1.72 (SD 0.01) m, P = 0.783. Discrepancies between methods caused misclassification of BMI category for 17 (1.8%) of participants., Conclusions: Engagement of young adults with on-line research is encouraging. On-line self-reporting provides acceptably reliable anthropometric data for young adults, with under-reporting of weight by just 0.4 kg., (© The Author 2017. Published by Oxford University Press on behalf of the European Public Health Association. All rights reserved.)

Background: Eating out of home has been associated with the increasing prevalence of obesity. While some chain restaurants provide nutritional information for their products, smaller independent catering facilities may not provide such information. The aim of this study was to assess the nutritional adequacy of meals provided to young adults at an independent catering facility and compare them with meals provided by chain restaurants., Methods: Meals were analysed in 2014 in the UK in relation of nutrient provision to targets for macro- and micro-nutrients. One-way ANOVA was performed to compare menus between the restaurants included in the analyses., Results: 2056 meal combinations were analysed, 210 from the student accommodation and 1,846 from five largest national chain restaurants. Mean (SD) nutritional content was: student accommodation: 1193(269)kcal, fat 52.0(22)g, saturated fat 24.5(14.5)g, protein 42.4(28.5)g, carbohydrate 117.0(30)g; chain restaurants: 922(160)kcal, fat 40.0(9.7)g, saturated fat 14.5(5.8)g, protein 31.2(6.5)g, carbohydrate 104.2(16.6)g. Meals from the student accommodation presented significantly more calories than the meals in all five chain restaurants ( p = 0.0015)., Conclusions: Meal provision in the student accommodation was in excess of energy requirements and higher than the meals offered in chain restaurants. Regulating or setting nutritional standards for all places that provide food is essential as current food provision may favour unwanted weight gain and diet-related diseases.

Background: The evidence base for weight management programmes incorporating a weight loss and a weight maintenance phase for adults with intellectual disabilities (ID) is limited. This study describes the weight maintenance phase of a multicomponent weight management programme for adults with intellectual disability and obesity (TAKE 5)., Materials and Methods: Thirty-one participants who had completed the 16 week TAKE five weight loss intervention (Phase I) were invited to participate in a 12 month weight maintenance intervention (Phase II). Content included recommendations of the National Weight Control Registry., Results: Twenty-eight participants completed Phase II with 50.4% maintaining their weight (mean weight change -0.5 kg, SD 2.2), 28.7% gaining weight (mean weight gain 5.4 kg, SD 2.2) and 21.6% losing weight (mean weight loss -8.0 kg, SD 3.0) at 12 months., Conclusion: Further research is justified to investigate the efficacy of weight loss maintenance interventions in adults with intellectual disability and obesity, using controlled study designs., (© 2015 John Wiley & Sons Ltd.)

Background/objectives: There is limited evidence that prominent calorie labelling on out-of-home meals helps consumers reduce calorie intakes and avoid weight gain, but no evidence on its effects on macro- and micro-nutrients. The objective of this study was to assess the impact of prominent calorie labelling on energy, macro- and micro-nutrients., Subjects/methods: Young adults in a catered residential setting were observed when choosing main meals over three study periods in fixed order in this observational study. Period 1: with calorie labels (20 weeks); period 2: without calorie labels (10 weeks); period 3: with calorie labels plus information on estimated energy requirements (10 weeks). Nutrient contents of meal choices were analysed from food composition tables., Results: Energy, 4 macronutrients and 19 micronutrients levels were derived from 4200 meals chosen by 120 subjects over 40 weeks. Means (s.d. or Median) for key macro- and micro-nutrients were for period 1: energy=658 (94) kcal, fat=31 (8.6) g, saturated fat=10.5 (2.7) g, B12=2.5 (1.7) μg, folate=119 (46.8) μg, vitamin C=80.0 (42) mg, Ca=278 (129) mg, Na=1230 (119) mg, Fe=22 (10) g, Se=19 (10.1) μg, I=34 (10.1) μg, period 2: energy=723 (87) kcal, fat=35 (7.6) g, saturated fat=12 (2.7) g, B12=3.4 (1.7) μg, Folate=182 (13.3) μg, vitamin C=87.0 (49.7) mg, Ca=379 (149) mg, Na=1352 (114) mg, Fe=41.6 (14) g, Se=26 (10.3) μg, I=38.0 (18.4) μg, period 3: energy=578 (109) kcal, fat=27.3 (9.1) g, saturated fat=8.5 (2.7) g, B12=2.2 (0.5) μg, Folate=90 (50.8) μg, vitamin C=75.0 (34) mg, Ca=277 (119) mg, Na=1205 (99) mg, Fe=14.5 (10.9) g, Se=15.0 (10) μg, I=32.0 (18.4) μg. All macro- and micro-nutrients, except for B1, vitamin C, vitamin E and Ca were significantly different between the three periods (P<0.001), but all mean intakes remained above recommended levels., Conclusions: Calorie labelling resulted in reductions in calories, fat and saturated fat contents of the meals chosen, without compromising micronutrient consumptions.

Background: Obesity is more prevalent in adults with intellectual disabilities (ID) compared to the general population. Motivations for weight loss may influence engagement with weight management programmes and have only been studied in adults without ID., Aims: To determine reasons given by adults with ID and obesity for seeking weight loss and whether these reasons differ from those of their carers., Methods: Prior to a multi-component weight management intervention, participants were asked "why do you want to lose weight?" Carers were asked their views and these were compared to the answers given by the adult with ID. Responses were themed. The Fisher's Exact analysis was used to test for any relationship between reasons for seeking weight loss and participants' level of ID, age, gender and BMI., Results: Eighteen men and 32 women; age 41.6 SD 14.6 years; BMI 40.8 SD 7.5 kg/m(2); Level ID Mild (28 %), Moderate (42 %), Severe (22 %), Profound (8 %). Eleven were unable to respond. Six themes emerged; Health; Fitness / Activity / Mobility; Appearance / Clothes; Emotional / Happiness; For Others; Miscellaneous. The most frequent reason given overall and by women was "appearance." Carers cited "health" most frequently and "appearance" least, rarely agreeing with participants. "Health" was given as a reason more from older adults and those with milder ID. No statistically significant associations were found between reasons for seeking weight loss and BMI age, gender or level of ID but the differing views of adults with ID and their carers were clear., Conclusions: Views of adults with obesity and mild or moderate ID can be collected. The opposing views of adults and their carers may affect motivation for weight loss.

The reference organ-level body composition measurement method is MRI. Practical estimations of total adipose tissue mass (TATM), total adipose tissue fat mass (TATFM) and total body fat are valuable for epidemiology, but validated prediction equations based on MRI are not currently available. We aimed to derive and validate new anthropometric equations to estimate MRI-measured TATM/TATFM/total body fat and compare them with existing prediction equations using older methods. The derivation sample included 416 participants (222 women), aged between 18 and 88 years with BMI between 15·9 and 40·8 (kg/m2). The validation sample included 204 participants (110 women), aged between 18 and 86 years with BMI between 15·7 and 36·4 (kg/m2). Both samples included mixed ethnic/racial groups. All the participants underwent whole-body MRI to quantify TATM (dependent variable) and anthropometry (independent variables). Prediction equations developed using stepwise multiple regression were further investigated for agreement and bias before validation in separate data sets. Simplest equations with optimal R (2) and Bland-Altman plots demonstrated good agreement without bias in the validation analyses: men: TATM (kg)=0·198 weight (kg)+0·478 waist (cm)-0·147 height (cm)-12·8 (validation: R 2 0·79, CV=20 %, standard error of the estimate (SEE)=3·8 kg) and women: TATM (kg)=0·789 weight (kg)+0·0786 age (years)-0·342 height (cm)+24·5 (validation: R (2) 0·84, CV=13 %, SEE=3·0 kg). Published anthropometric prediction equations, based on MRI and computed tomographic scans, correlated strongly with MRI-measured TATM: (R (2) 0·70-0·82). Estimated TATFM correlated well with published prediction equations for total body fat based on underwater weighing (R (2) 0·70-0·80), with mean bias of 2·5-4·9 kg, correctable with log-transformation in most equations. In conclusion, new equations, using simple anthropometric measurements, estimated MRI-measured TATM with correlations and agreements suitable for use in groups and populations across a wide range of fatness., Competing Interests: There are no conflicts of interest to declare.

Objective: Preventing obesity among young adults should be a preferred public health approach given the limited efficacy of treatment interventions. This study examined whether weight gain can be prevented by online approaches using two different behavioral models, one overtly directed at obesity and the other covertly., Methods: A three-group parallel randomized controlled intervention was conducted in 2012-2013; 20,975 young adults were allocated a priori to one control and two "treatment" groups. Two treatment groups were offered online courses over 19 weeks on (1) personal weight control ("Not the Ice Cream Van," NTICV) and, (2) political, environmental, and social issues around food ("Goddess Demetra," "GD"). Control group received no contact. The primary outcome was weight change over 40 weeks., Results: Within-group 40-week weight changes were different between groups (P < 0.001): Control (n = 2,134): +2.0 kg (95% CI = 1.5, 2.3 kg); NTICV (n = 1,810): -1.0 kg (95% CI = -1.3, -0.5); and GD (n = 2,057): -1.35 kg (95% CI = -1.4 to -0.7). Relative risks for weight gain vs., Control: NTICV = 0.13 kg (95% CI = 0.10, 0.15), P < 0.0001; GD = 0.07 kg (95% CI = 0.05, 0.10), P < 0.0001., Conclusions: Both interventions were associated with prevention of the weight gain observed among control subjects. This low-cost intervention could be widely transferable as one tool against the obesity epidemic. Outside the randomized controlled trial setting, it could be enhanced using supporting advertising and social media., (© 2015 The Obesity Society.)

Pregnancy is a time when women may be receptive to health advice and interventions. This article considers the evidence for interventions to affect body weight in obese and overweight women delivered either or both pre- and post-natally. The increasing prevalence of obesity across the adult population has affected many sectors of society and increasing numbers of obese and overweight pregnant women are evident. Obesity in pregnancy is frequently associated with excessive gestational weight gains and increases the risk of developing adverse pregnancy outcomes in terms of both maternal and infant health. Pregnancy has been described as providing "a teachable moment" when women may be receptive to health advice. Some lifestyle approaches, largely incorporating strategies to alter dietary and physical activity to challenge excess body weight before and during pregnancy, have been developed and tested. While a few have shown promise with limited success in reducing body weight prior to pregnancy and post-natally, and minimising excessive weight gains during pregnancy, all interventions are not sufficiently robust and effective to justify routine inclusion in clinical practice. Weight management pre- and post-natally appears largely overlooked in usual care.

Objective: In both the United States and United Kingdom, countries with high prevalence of obesity, weight gain is particularly rapid in young adulthood and especially identified among first-year students., Design: A triangulation protocol was used, incorporating quantitative and qualitative research methods. A 27-question online survey was sent to all first-year undergraduates twice, with a 9-month interval. An online focus group was conducted at the end of the year, analysed by content and thematically. Self-reported weights and heights were validated against objectively measured data., Results: From a total of 3010 first-year students, 1440 (female=734) responded at baseline mean (s.d.) age 20 (3.6) years, body mass index 22.3 (4.6) kg m(-2), 17% smokers and 80% alcohol drinkers. At follow-up, 1275 students reported a mean weight change of 1.8 (s.d. 2.6) kg over the 9-month period. Self-reported data correlated strongly with measured weights (r=0.999, P<0.001) and heights (r=0.998, P<0.001). Predictors of weight gain were baseline weight (P<0.001). Dairy products consumption was associated with less weight gain (P<0.001). Fruit and vegetable consumption, and time spent on physical activity or sleeping were associated with neither weight gain nor weight loss. Focus group content analysis revealed weight gain as a major concern, reported by half the participants, and increased alcohol consumption was considered the most common lifestyle change behind weight gain. Thematic analysis identified three main themes as barriers to or facilitators of healthy lifestyles and weight; budget, peer influence and time management., Conclusions: Rapid weight gain is of concern to young adults. Students living away from home are at particular risk, owing to specific obesogenic behaviours. Consumption of fruit and vegetables, and physical activity, despite popular beliefs, were not associated with protection against weight gain.

Calorie-labelling of meals has been suggested as an antiobesity measure, but evidence for impact is scarce. It might have a particular value for young adults, when weight gain is most rapid. A systematic literature review and a meta-analysis was performed to assess the effect of calorie-labelling on calories purchased. Seven studies met the inclusion and quality criteria of which six provided data allowing a meta-analysis. Three reported significant changes, all reductions in calories purchased (-38.1 to -12.4 kcal). Meta-analysis showed no overall effect, -5.8 kcal (95% confidence interval (CI)=-19.4 to 7.8 kcal) but a reduction of -124.5 kcal (95% CI=-150.7 to 113.8 kcal) among those who noticed the calorie-labelling (30-60% of customers). A questionnaire, to gauge views on calorie-labelling, was devised and sent to young adults in higher education: 1440 young adults (mean age 20.3 (s.d.=2.9) years) completed the survey. Nearly half (46%) said they would welcome calorie information in catering settings and on alcoholic drinks. Females opposing to calorie-labelling were heavier to those who did not (64.3 kg vs. 61.9 kg, P=0.03; BMI=22.4 kg m(-2) vs. 21.7 kg m(-2), P=0.02). In conclusion, the limited evidence supports a valuable effect from clearly visible calorie-labelling for obesity prevention, and it appears an attractive strategy to many young adults.

Objective: Calorie-labeling has been suggested as an anti-obesity measure but there is no evidence for its effect, to date. Early adulthood is a critical life-cycle period for unwanted weight gain and obesity development. This study examined whether providing calorie information would help young adults to avoid weight gain., Methods: Using a pragmatic interrupted time-series study design, weight changes over 36 weeks were reported among two year-groups, each of 120 young adults, similar in age, gender, and ethnicity, living in fully-catered accommodation. Year 1: subjects were observed without calorie-labeling, apart from a 5-week pilot. Year 2: calorie-labeling was present prominently and consistently at main meals for 30 of the 36 weeks., Results: Mean weight changes over 36 weeks, per protocol, were +3.5 kg (95% CI = 2.8-4.1 kg) (n = 64) in Year 1 and -0.15 kg (95% CI = -0.7-0.3 kg) (n = 87) in Year 2. Weight changes were significantly different between years, for males and females (both P < 0.001). Intention-to-treat analysis showed similar results. Relative Risk for weight gain in Year 2, compared to Year 1, was 0.5 (P < 0·0001)., Conclusions: Calorie-labeling was associated with a 3.5 kg less weight gain, representing a low-cost "nudging" approach to combat the rapid weight gain seen in young adults., (© 2014 The Obesity Society.)

Objective: Obesity is the biggest challenge facing preventive medicine. Calorie-labelling has been suggested as a way of changing the architecture of an 'obesogenic' environment without limiting consumer choice. This study examined the effect of calorie-labelling on sales of food items at catering outlets on a city-centre university campus., Methods: Sales data were collected for two consecutive months in 2013 on three UK university sites (two with calorie-labelling during second month, one control) and analysed with chi-square 'Goodness-of-Fit' tests. A questionnaire seeking consumers' views and use of the calorie-labelling was administered and analysed at group-level with chi-square tests., Results: In intervention vs control sites, total sales of all labelled items fell significantly (-17% vs -2%, p<0.001) for the month with calorie-labelling. Calorie-labelling was associated with substantially reduced sales of high-calorie labelled items, without any compensatory changes in unlabelled alternative items. Among 1166 student- and 646 staff-respondents, 56% reported using the calorie-labels, 97% of them to make lower-calorie choices. More females (63%) than males (40%) reported being influenced by calorie-labels when choosing foods (p=0.01)., Conclusions: This study provides evidence, beyond that from single-meal exposures, for the acceptability of meal calorie-labelling and its potential as an effective low-cost anti-obesity measure., (Copyright © 2014 Elsevier Inc. All rights reserved.)

Objective: To test the appeal of the eatwell week, a nutritionally balanced 7 d menu which satisfies nutritional guidelines of the Food Standards Agency in Scotland; determine the clarity and understanding of the main messages; and gather views on the usability and acceptability of the eatwell week resource format., Design: Focus group discussions with consumers and health professionals., Setting: Four locations across the UK., Results: The eatwell week was considered realistic by consumers as it contained foods they recognised and already ate. A preconceived idea had been that there would be more fruit and vegetables and fewer 'treats'. Consumers found the recipes simple and lack of cooking skills was not an apparent barrier. However, the message of 'balance' was poorly understood. Consumers often lacked the knowledge to make informed substitutions in the week. Both the general public and some health professionals felt the menu contained too much carbohydrate. Health professionals felt it was unclear who the eatwell week was intended for and what purpose it served., Conclusions: Use of familiar foods and the provision of simple, easy-to-follow recipes have the potential to overcome some barriers to healthy eating encountered by the general public and encourage improvements in dietary intakes. The eatwell week shows promise as a resource to facilitate implementation of the principles of the eatwell plate and supports government priorities and policies for health.

Identification and management of sarcopenia are limited by lack of reliable simple approaches to assess muscle mass. The aim of this review is to identify and evaluate simple methods to quantify muscle mass/volume of adults. Using Cochrane Review methodology, Medline (1946-2012), Embase (1974-2012), Web of Science (1898-2012), PubMed, and the Cochrane Library (to 08/2012) were searched for publications that included prediction equations (from anthropometric measurements) to estimate muscle mass by magnetic resonance imaging (MRI) in adults. Of 257 papers identified from primary search terms, 12 studies met the inclusion criteria. Most studies (n = 10) assessed only regional/limb muscle mass/volume. Many studies (n = 9) assessed limb circumference adjusted for skinfold thickness, which limits their practical applications. Only two included validation in separate subject-samples, and two reported relationships between whole-body MRI-measured muscle mass and anthropometry beyond linear correlations. In conclusion, one simple prediction equation shows promise, but it has not been validated in a separate population with different investigators. Furthermore, it did not incorporate widely available trunk/limb girths, which have offered valuable prediction of body composition in other studies., (© 2014 International Life Sciences Institute.)

To evaluate the clinical effectiveness of weight management interventions in adults with intellectual disabilities (ID) and obesity using recommendations from current clinical guidelines for the first line management of obesity in adults. Full papers on lifestyle modification interventions published between 1982 to 2011 were sought by searching the Medline, Embase, PsycINFO and CINAHL databases. Studies were evaluated based on (1) intervention components, (2) methodology, (3) attrition rate (4) reported weight loss and (5) duration of follow up. Twenty two studies met the inclusion criteria. The interventions were classified according to inclusion of the following components: behaviour change alone, behaviour change plus physical activity, dietary advice or physical activity alone, dietary plus physical activity advice and multi-component (all three components). The majority of the studies had the same methodological limitations: no sample size justification, small heterogeneous samples, no information on randomisation methodologies. Eight studies were classified as multi-component interventions, of which one study used a 600 kilocalorie (2510 kilojoule) daily energy deficit diet. Study durations were mostly below the duration recommended in clinical guidelines and varied widely. No study included an exercise program promoting 225-300 minutes or more of moderate intensity physical activity per week but the majority of the studies used the same behaviour change techniques. Three studies reported clinically significant weight loss (≥ 5%) at six months post intervention. Current data indicate weight management interventions in those with ID differ from recommended practice and further studies to examine the effectiveness of multi-component weight management interventions for adults with ID and obesity are justified.

Background: To examine whether the nutritional status of aged undernourished residents in care could be improved through dietary modification to increase energy intake but not portion size., Methods: A 12-week cluster randomised controlled trial was carried out in 21 residential care homes. Participants comprised undernourished residents with a body mass index (BMI) <18.5 kg m(-2) . All menus were analysed to evaluate nutrient provision. Energy and macronutrient intakes of undernourished residents were estimated using 3-day weighed food intake diaries. Those resident in homes randomised to intervention had their usual meals enriched with energy-dense foods to a maximum of +1673 kJ day(-1) ., Results: Of 445 residents screened, 41 (9%) had a BMI <18.5 kg m(-2) and entered the study. Despite adequate food provision, energy and macronutrient intakes were below UK dietary reference values. Mean (SEM) energy intake increased [+556 (372) kJ, P = 0.154] in residents allocated to intervention but fell in those residents in 'control homes' receiving usual care [-151 (351) kJ, P = 0.676]. Weight change [+1.3 (0.53) kg, P = 0.03] was seen in intervention residents but not in controls [-0.2 (1.5) kg, P = 0.536]. Between-group differences for changes in weight and energy intake were not significant (P = 0.08 and 0.20, respectively). Six residents allocated to the intervention increased their BMI >18.5 kg m(-2) (P = 0.018)., Conclusions: Achieving weight gain in frail older people is difficult. These results suggest that enriching food could help address undernutrition and slow chronic weight loss. Interventions of a longer duration are needed to confirm or exclude the value of food enrichment., (© 2012 The Authors Journal of Human Nutrition and Dietetics © 2012 The British Dietetic Association Ltd.)

Objective: To develop a menu and resource to illustrate to consumers and health professionals what a healthy balanced diet looks like over the course of a week., Design: Development and analysis of an illustrative 7 d 'eatwell week' menu to meet current UK recommendations for nutrients with a Dietary Reference Value, with a daily energy base of 8368 kJ (2000 kcal). Foods were selected using market research data on meals and snacks commonly consumed by UK adults. Analysis used the food composition data set from year 1 (2008) of the UK National Diet and Nutrition Survey rolling programme. The eatwell week menu was developed using an iterative process of nutritional analysis with adjustments made to portion sizes and the inclusion/exclusion of foods in order to achieve the target macronutrient composition., Results: Three main meals and two snacks were presented as interchangeable within the weekdays and two weekend days to achieve adult food and nutrient recommendations. Main meals were based on potatoes, rice or pasta with fish (two meals; one oily), red meat (two meals), poultry or vegetarian accompaniments. The 5-a-day target for fruit and vegetables (range 5-6·7 portions) was achieved daily. Mean salt content was below recommended maximum levels (<6 g/d). All key macro- and micronutrient values were achieved., Conclusions: Affordable foods, and those widely consumed by British adults, can be incorporated within a 7 d healthy balanced menu. Future research should investigate the effect of using the eatwell week on adults' dietary habits and health-related outcomes.

Background: Excessive gestational weight gain is associated with adverse infant, childhood and maternal outcomes and research to develop interventions to address this issue is ongoing. The views of women on gestational weight gain and the resources they would consider helpful in addressing this are however largely unknown. This survey aimed to determine the views of newly pregnant women, living in areas of social disadvantage, on 1) their current body weight and potential gestational weight gain and 2) the resources or interventions they would consider helpful in preventing excessive gestational weight gain., Methods: A convenience sample of overweight and obese pregnant women living in Fife, UK, were invited to complete a short anonymised questionnaire at their 12 week booking visit., Results: 428 women, BMI>25 kg/m(2), completed the questionnaire. Fifty-four per cent of respondents were obese (231) and 62% were living in areas of mild to moderate deprivation. Over three-quarters of participants felt dissatisfied with their current weight (81%). The majority of women (60%) expressed some concern about potential weight gain. Thirty-nine percent were unconcerned about weight gain during their pregnancy, including 34 women (19%) who reported having retained weight gained in earlier pregnancies. Amongst those concerned about weight gain advice on physical activity (41%) and access to sports/leisure facilities were favoured resources (36%). Fewer women (12%) felt that group sessions on healthy eating or attending a clinic for individualised advice (14%) would be helpful. "Getting time off work" was the most frequently cited barrier (48%) to uptake of resources other than leaflets., Conclusions: These data suggest a lack of awareness amongst overweight and obese women regarding excessive gestational weight gain. Monitoring of gestational weight gain, and approaches for its management, should be formally integrated into routine antenatal care. Barriers to the uptake of resources to address weight gain are numerous and must be considered in the design of future interventions and services.

Background: To date, no studies have explored the role of carers in supporting adults with intellectual disabilities (ID) and obesity during a weight loss intervention. The present study explored perceptions of carers supporting adults with ID, as they participated in a 6-month multi-component weight loss intervention (TAKE 5)., Methods: Semi-structured interviews were used to explore the experiences of 24 carers. The transcripts were analysed qualitatively using thematic analysis., Results: Three themes emerged from the analysis: carers' perceptions of participants' health; barriers and facilitators to weight loss; and carers' perceptions of the weight loss intervention. Data analysis showed similarities between the experiences reported by the carers who supported participants who lost weight and participants who did not. Lack of sufficient support from people from the internal and external environment of individuals with ID and poor communication among carers, were identified as being barriers to change. The need for accessible resources tailored to aid weight loss among adults with ID was also highlighted., Conclusion: This study identified specific facilitators and barriers experienced by carers during the process of supporting obese adults with ID to lose weight. Future research could utilise these findings to inform appropriate and effective weight management interventions for individuals with ID., (© 2012 The Authors. Journal of Intellectual Disability Research © 2012 Blackwell Publishing Ltd.)

Direct observation(s) of energy intake (EI) via buffet meals served in the laboratory are often carried out within short-term exercise intervention studies. The reproducibility of values obtained has not been assessed either under resting control conditions or post-exercise, in overweight and obese females. A total of fourteen sedentary, pre-menopausal females (BMI 30.0 (SD 5.1) kg/m²) completed four trials; two exercise and two control. Each trial lasted 24 h spanning over 2 d; conducted from afternoon on day 1 and morning on day 2. An exercise session to expend 1.65 MJ was completed on day 1 of exercise trials, and three buffet meals were served during each trial. Reproducibility of post-exercise changes in energy and macronutrient intakes was assessed at each individual buffet meal by intraclass correlation coefficient (r(i)). Only the r(i) values for post-exercise changes in energy (r(i) 0.44 (95 % CI - 0.03, 0.77), P = 0.03) and fat intake (r(i) 0.51 (95 % CI 0.04, 0.81), P = 0.02) at the lunch buffet meal achieved statistical significance; however, these r i values were weak and had large associated 95 % CI, which indicates a large degree of variability associated with these measurements. Energy and macronutrient intakes at the breakfast and evening buffet meals were not reproducible. This study concludes that the frequently used laboratory-based buffet meal method of assessing EI does not produce reliable, reproducible post-exercise changes in EI in overweight and obese women.

Background: Fear of weight gain is a barrier to smoking cessation and significant cause of relapse for many people. The provision of nutritional advice as part of a smoking cessation programme may assist some in smoking cessation and perhaps limit weight gain. The aim of this study was to determine the effect of a structured programme of dietary advice on weight change and food choice, in adults attempting smoking cessation., Methods: Cluster randomised controlled design. Classes randomised to intervention commenced a 24-week intervention, focussed on improving food choice and minimising weight gain. Classes randomised to control received "usual care"., Results: Twenty-seven classes in Greater Glasgow were randomised between January and August 2008. Analysis, including those who continued to smoke, showed that actual weight gain and percentage weight gain was similar in both groups. Examination of data for those successful at giving up smoking showed greater mean weight gain in intervention subjects (3.9 (SD 3.1) vs. 2.7 (SD 3.7) kg). Between group differences were not significant (p = 0.23, 95% CI -0.9 to 3.5). In comparison to baseline improved consumption of fruit and vegetables and breakfast cereal were reported in the intervention group. A higher percentage of control participants continued smoking (74% vs. 66%)., Conclusions: The intervention was not successful at minimising weight gain in comparison to control but was successful in facilitating some sustained improvements in the dietary habits of intervention participants. Improved quit rates in the intervention group suggest that continued contact with advisors may have reduced anxieties regarding weight gain and encouraged cessation despite weight gain. Research should continue in this area as evidence suggests that the negative effects of obesity could outweigh the health benefits achieved through reductions in smoking prevalence.

Adults with intellectual disabilities experience high rates of obesity. Despite this higher risk, there is little evidence on the effectiveness of weight-loss interventions for adults with intellectual disabilities and obesity. The present study examined the effectiveness of the TAKE 5 multi-component weight-loss intervention. Adults with obesity were invited using specialist intellectual disability services to participate in the study. Obesity was defined as a BMI of 30 kg/m2 or greater. TAKE 5 included a daily energy-deficit diet of 2510 kJ (600 kcal), achieved via a personalised dietary prescription. Participants' body weight, BMI, waist circumference and levels of physical activity and sedentary behaviour were measured before and after the intervention. A total of fifty-four individuals consented to participate, of which forty-seven (87 %) completed the intervention in the study period. There was a significant decrease in body weight (mean difference - 4·47 (95 % CI - 5·91, - 3·03) kg; P < 0·0001), BMI (- 1·82 (95 % CI - 2·36, - 1·29) kg/m(2); P < 0·0001), waist circumference (- 6·29 (95 % CI - 7·85, - 4·73) cm; P < 0·0001) and daily sedentary behaviour of participants (- 41·40 (95 % CI - 62·45, - 20·35) min; P = 0·00 034). Of the participants who completed the intervention, seventeen (36·2 %) lost 5 % or more of their initial body weight. Findings from the study suggest that TAKE 5 is an effective weight-loss intervention for adults with intellectual disabilities and obesity. The effectiveness of TAKE 5 should be examined further in a controlled study.

Background: The prevention and treatment of overweight and obesity is a priority for all health professionals and requires resources that are regularly evaluated to ensure that they meet the needs of their target population. Dietitians in Obesity Management UK (DOM UK), a specialist group of the British Dietetic Association, commissioned an evaluation of their resources. These have been developed for use by Dietitians to determine the uptake and implementation of DOM UK resources in dietetic practice, as well as the opinions and suggestions of Dietitians concerning the resource pack., Methods: A random sample of 20% (n = 33) of the 165 Dietitians who had ordered resources were selected from the DOM UK database along with 20% of DOM UK members who had not (n = 38). Data were then collected using telephone-administered questionnaires., Results: Most of the Dietitians who used the resources favoured them because they improved their consultations and were liked by patients. Resources 'j' (controlling your portions) and 'k' (planning your meals) were most frequently used. However, the cost of the pack was a deterrent to both new and repeat orders. The evaluation also revealed that 17% of DOM UK members were unaware of these resources and 23% who ordered them were unaware that online samples were available., Conclusion: The evaluation showed that most Dietitians who used the resources found them very useful especially resources concerning meal planning and portion sizes. However, concerns about cost and the need for greater awareness about the resources among Dietitians were highlighted.

Background: Dietary patterns and food choices in western and northern European countries can differ from those in countries that surround the Mediterranean basin. However, irregular meal patterns and the consumption of high-energy snacks tend to become common in most countries and their association with the prevalence of obesity has been examined in many studies. The first aim of the present study was to describe the habitual meal and snack intakes, including the use of vending machines, for two groups of first-year university students in two countries of different cultural backgrounds. The second aim was to explore the relationships between body mass index (BMI) and snacking for these two groups., Methods: One hundred and sixty first-year undergraduate university students from two defined universities in Greece (n = 80) and Scotland (n = 80) volunteered to complete a food frequency questionnaire (FFQ). The FFQ comprised 16 questions assessing their meal and snacking habits. Self-assessed height and weight data were collected., Results: The majority of the 160 students reported a BMI in the healthy range (<25 kg m(-2)). Overall, 26% of the students reported never consuming breakfast. More Scottish students (74%) used vending machines (P < 0.05). More Scottish students consumed chocolate bars and crisps than Greek students (41% and 34% versus 37.5% and 20%, respectively). Only the choice of chocolate bars from vending machines and the consumption of crisps and low fat yogurts were related to BMI (P < 0.05) for both groups., Conclusions: University students living in different countries report similar dietary patterns but differ in their snacking habits. No relationships were found between BMI and snacking. There is a need to carry out research to further our understanding of this relationship.

Treatments to induce weight loss for the obese patient centre on the achievement of negative energy balance. This objective can theoretically be attained by interventions designed to achieve a reduction in energy intake and/or an increase in energy expenditure. Such 'lifestyle interventions' usually comprise one or more of the following strategies: dietary modification; behaviour change; increases in physical activity. These interventions are advocated as first treatment steps in algorithms recommended by current clinical obesity guidelines. Medication and surgical treatments are potentially available to those unable to implement 'lifestyle interventions' effectively by achieving losses of between 5 kg and 10 kg. It is accepted that the minimum of 5% weight loss is required to achieve clinically-meaningful benefits. Dietary treatments differ widely. Successful weight loss is most often associated with quantification of energy intake rather than macronutrient composition. Most dietary intervention studies secure a weight loss of between 5 kg and 10 kg after intervention for 6 months, with gradual weight regain at 1 year where weight changes are 3-4 kg below the starting weight. Some dietary interventions when evaluated at 2 and 4 years post intervention report the effects of weight maintenance rather than weight loss. Specific anti-obesity medications are effective adjuncts to weight loss, in most cases doubling the weight loss of those given dietary advice only. Greater physical activity alone increases energy expenditure by insufficient amounts to facilitate clinically-important weight losses, but is useful for weight maintenance. Weight losses of between half and three-quarters of excess body weight are seen at 10 years post intervention with bariatric surgery, making this arguably the most effective weight-loss treatment.

Objective: To examine associations between current recommended physical activity levels and body mass index (BMI) with some cardiovascular disease (CVD) risk factors (total cholesterol, high-density lipoprotein cholesterol (HDL-C), non-HDL-cholesterol (non-HDL-C), C-reactive protein (CRP), fibrinogen, and blood pressure), general health score (GHQ12) and predicted coronary heart disease (CHD) risk., Design: Further analysis of the cross-sectional Scottish Health Survey 1998 data., Subjects: Five thousand four hundred and sixty adults 16-74 years of age., Results: After controlling for some confounding factors, obesity was significantly associated with higher odds ratio (OR) for elevated cholesterol, CRP, systolic blood pressure, non-HDL-C and lower HDL-C (P<0.001), and with greater predicted CHD risk compared to BMI <25 kg/m(2). Regular self-reported physical activity was associated with smaller OR of lower HDL-C and higher CRP, and average predicted 10-year CHD risk in obese subjects, but did not eliminate the higher risk of the measured CVD risk factors in this group. The OR of these two risk factors were still high 4.39 and 2.67, respectively, when compared with those who were inactive with BMI <25 kg/m(2) (P<0.001). Those who reported being physically active had better GHQ scores in all BMI categories (P<0.001)., Conclusion: Reporting achievement of recommended physical activity levels may reduce some CVD risk factors, predicted CHD risk and improve psychosocial health, but may not eliminate the extra risk imposed by overweight/obesity. Therefore, increasing physical activity and reducing body weight should be considered to tackle CVD risk factors.

Several drugs, or categories of drugs, listed by the WHO and other writers and used in the treatment of chronic disease, are consistently associated with weight gain as a side effect and considered 'obesogenic'. The extent to which they may contribute to the multifactorial process behind obesity is not well documented. We systematically reviewed papers from Medline 1966-2004, Embase 1980-2004, PsycINFO 1967-2004, and Cochrane Register of Controlled Trials, to determine the effect on body weight of some drugs that are believed to favour weight gain. We included randomized controlled studies of adult participants (>18 years) prescribed a drug considered obesogenic, that compared the 'obesogenic' drug with placebo, an alternative drug or other treatment, and that had a duration of at least 3 months: 43 studies totalling 25,663 subjects met these criteria. The main objective of the majority of studies was to compare the efficacy and safety of drug therapy, with weight change recorded under safety outcomes; weight change was a primary outcome measure in only six studies. There was evidence of weight gain for all drugs included, up to 10 kg at 52 weeks. Differences in dosage, patient population, duration of treatment and dietary advice make generalization of the results difficult. Data on body weight are often not recorded in published clinical trials or is reported in insufficient detail. This side-effect has potentially serious consequences, and should be mentioned to patients. Weight management measures should be routinely considered when prescribing drugs known to promote weight gain. Future clinical trials should always document weight changes.

Obesity is more prevalent in adults with intellectual disabilities than in the general population, and has been shown to contribute to their reduced life expectancy, and increased health needs. Relatively few studies have examined the effectiveness of weight loss interventions for adults with intellectual disabilities. However, there is evidence to support interventions that take account of the context of the lives of adults with intellectual disabilities, including carer involvement in interventions. To reduce the health inequalities experienced by adults with intellectual disabilities, there is a clear need to develop accessible, evidence-based clinical weight management services.

People with intellectual disabilities experience significant health inequalities compared with the general population, including a shorter life expectancy and high levels of unmet health needs. Another accepted measure of health inequalities, the prevalence of obesity, has been shown to be higher in adults with intellectual disabilities than in the general population. While the factors contributing to the increased prevalence among adults with intellectual disabilities are not well understood, the high rates of obesity among younger adults highlight the need for further research involving children and adolescents with intellectual disabilities. To take forward the priorities for research and the development of effective, accessible services, there is a need for collaboration between professionals working in the fields of intellectual disabilities and obesity.

Aims: Overweight, obesity and smoking are well-established risk independent factors for cardiovascular diseases. The combination of overweight or obesity with smoking may modify other cardiovascular disease risk factors. We examined the impacts of smoking, overweight and obesity on cardiovascular risk factors: total cholesterol, high-density lipoprotein (HDL)-cholesterol, non-HDL-cholesterol, C-reactive protein and fibrinogen., Methods and Results: Data from 5460 adults who participated in the cross-sectional Scottish Health Survey 1998 were analysed. In multivariable analysis body mass index and smoking were the most important risk factors for cardiovascular disease. Smoking was independently associated with higher C-reactive protein and fibrinogen concentrations in both sexes, and lower HDL cholesterol and higher non-HDL cholesterol in females (P<0.001). Overweight or obesity (body mass index 25-30 or > or = 30 kg/m) were independently associated with higher C-reactive protein, total cholesterol, non-HDL-cholesterol and lower HDL-cholesterol in both sexes, and higher fibrinogen in females (P<0.001). Overweight or obese current smokers had higher C-reactive protein and fibrinogen and lower HDL-cholesterol concentrations than the reference group of never-smokers with body mass index below 25 kg/m (P<0.001). Obese current smokers had the highest mean value and odds ratio (OR) for the risk factors across the categories, particularly for lower HDL cholesterol (OR=11) and elevated C-reactive protein (OR=9) (P<0.001)., Conclusion: The combination of smoking and overweight or obesity aggravates cardiovascular disease risk factors, particularly HDL-cholesterol and C-reactive protein. These results justify early intervention for overweight/obese current smokers.

Objective: To determine the current practices in relation to weight management currently provided for overweight/obese patients attending different secondary care outpatient clinics., Methods: Postal questionnaire sent to 100 consultant clinicians working in a range of specialist areas in three NHS Trust areas in Scotland, between January and March 2004., Results: Overall response rate was 55%. Only 9% (five) of clinicians reported having a protocol in place for the management of patients who were overweight or obese. Lack of expertise and inaccessibility to expertise were cited frequently as reasons for having no protocol in place. Fifty-one per cent felt that weight management (including obesity treatment) should be undertaken by a specialist service either run by general practitioners (GPs), or by clinicians in a secondary care setting. Around a third of all those surveyed reported willingness to incorporate obesity management within their own routine specialty practice., Conclusion: Clinicians acknowledged the adverse health effects of obesity within their specialist area, but felt unskilled and under-resourced to provide effective management. Effective prevention and management are required to challenge the obesity epidemic and will require the involvement of both primary and secondary care NHS settings. It is encouraging that a third of respondents felt prepared to incorporate obesity and weight management within their routine specialist practice.

Objective: To define relationships between smoking status, body mass index (BMI), waist and hip circumferences (WC, HC) and waist to hip ratio (WHR)., Design: Further analysis of the cross-sectional Scottish Health Survey 1998 data., Subjects: Nationally representative sample of 9047 adults aged 16-74 y., Results: Body mass index (BMI) was lower in current smokers and higher in ex-smokers (P<0.001) when compared with nonsmokers in the survey population as a whole. After adjustment for confounding factors (age, social class, physical activity and alcohol intake), these differences still remained. However, examination of age categories showed no such differences in BMI between current smokers and nonsmokers in men aged 16-24 y or women aged below 55 y. In the age category 16-24 y, prevalence of cigarette smoking was highest at 51% (men) and 43% (women) in obese subjects and lowest at 35% (men) and 33% (women) in people with BMI of 25-30 kg/m(2). For women current smokers, mean WC and WHR were higher and HC was lower compared with nonsmokers (P<0.001). In men, only HC was lower in current smokers compared with nonsmokers for the entire sample (P<0.001)., Conclusion: Cigarette smoking is associated with a lower BMI in adults over 24 y particularly in men, but not in younger people. In women, smoking is linked to the development of central adiposity. The gender-related central adiposity of men is not further increased by smoking, but a lower HC could suggest a reduction in muscle mass.

Objective: To evaluate the response to simple innovative dietary counselling in post myocardial infarction patients., Design: Randomised controlled trial., Setting: Cardiac rehabilitation programmes of two acute hospitals in Lanarkshire, Scotland., Patients: A total of 69 men and 29 women aged 35-75 y who survived acute myocardial infarction and participated in the cardiac rehabilitation programmes of the study hospitals between 1st September 1997 and 1st August 1998., Results: At 12 weeks follow-up, diet composition had improved significantly in intervention subjects, but no such change was evident in the control group. The target of five portions of fruit and vegetables per day was achieved by 65% of intervention subjects but only 31% of control subjects (P=0.004). Between-group differences in food intakes were no longer evident at 1 y. Diet composition did however remain in line with current dietary targets in intervention subjects., Conclusion: Compared to conventional cardiac rehabilitation, this intervention, focused on targets known to improve mortality, improved diet in post myocardial infarction patients. However, a more sustained programme is required to maintain improvements. Delivery of the intervention was expensive and further research is required to determine the feasibility of a group approach using the same package., Sponsorship: The study was supported by Chief Scientist Office of the Scottish Executive Department of Health.

Objective: To describe the types and delivery of obesity treatment currently favoured by General Practitioners (GPs) working in Scotland., Design: Representative cross-sectional survey using a postal questionnaire which included case stories as stimuli for questions about the GPs' nutrition guidance to overweight female patients., Subjects: A systematic sample of 1400 general practitioners (GPs) from a total of 3593 GPs working in Scotland in 1997., Results: From 1363 eligible GPs, 609 returned the full questionnaire and a further 132 took part in a telephone mini-interview. Net response was 54.4% (741/1363). Almost half of the GPs (45.6%) reported that they had read the recent national clinical guideline for integrating obesity prevention with weight management (SIGN 1996). The majority of GPs (89.6%) agreed that nutrition has an important role to play in the management of disease and 82.4% agreed that they can offer healthy eating advice to patients. However, only 34.8% of GPs believed that they had been successful in treating overweight patients. Routinely used treatments involve either a dietitian, practice nurse and/or a commercial slimming group and realistic weight loss was considered one criteria of successful treatment by some GPs. Age, year qualified and location of practice were found to have little influence over variations in GP treatment while weak associations between gender of GP and treatment were found., Conclusions: The readership of the clinical guidelines in Scotland has been moderate so far although a multidisciplinary approach to obesity treatment is recognised. Further investigations of any relationships between nutrition education-obesity treatment are needed.

This chapter discusses lifestyle management strategies for obesity in adults and is based on an assumption that treatment, resulting in appropriate and sustained weight loss, is of benefit to individuals. It examines dietary management strategies including the use of very low calorie diets, moderate energy restriction and individual and group approaches in commercial and non-commercial environments. It explores the role of physical activity in the treatment of obesity in particular focusing on the associated health benefits and the increasing evidence of the importance of physical activity in weight maintenance. It discusses the effect of behavioural interventions on achieving and maintaining weight loss and briefly offers suggestions for the organisation of lifestyle interventions.

Objectives: To estimate the nutritional provision to elderly patients, to compare with United Kingdom (UK) Government dietary reference values (DRV), to modify food provision to correct any major deficiencies, and to evaluate these modifications for their acceptability and consumption., Methods: Energy, principal macro nutrients, vitamins, minerals and non-starch polysaccharide (NSP) and dietary fibre provision were measured prospectively throughout the menu cycle in a 72-bedded hospital for patients over 65 years before and after dietary supplementation with both energy-rich foods and high-fibre cakes., Results: At baseline, mean energy provision was 1472(320) kcal, 6153(1340) kJ, representing less than the estimated average requirement (EAR) for elderly males and females. Fat provided 49% of total energy, daily protein provision exceeded the EAR for males and females (16% energy) and provision of the micro nutrients thiamine, riboflavin, vitamins B12, C, A, calcium and iron met or exceeded these recommendations. Vitamin B6 provision was only adequate for females. Provision of niacin, folate, vitamin D, NSP and dietary fibre was also below recommendations. Supplementation allowed energy provision to reach the target EAR and fibre provision the reference nutrient intake., Conclusions: Nutritional provision in hospital is meeting some, but not all, available Government standards for nutritional guidelines in elderly people. Increased fibre provision was poorly tolerated, but dietary supplementation with energy-rich foods was well tolerated.