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Introduction This study explores what types of information obese individuals search for on the Internet, their motivations for seeking information and how they apply it in their daily lives. Method In-depth telephone interviews with an Australian community sample of 142 individuals with a BMI ≥ 30 were conducted. Theoretical, purposive and strategic samplings were employed. Data were analysed using a constant comparative method. Results Of the 142 individuals who participated in the study, 111 (78%) searched for information about weight loss or obesity. Of these, about three quarters searched for weight loss solutions. The higher the individual’s weight, the more they appeared to search for weight loss solutions. Participants also searched for information about health risks associated with obesity (n = 28), how to prevent poor health outcomes (n = 30) and for peer support forums with other obese individuals (n = 25). Whilst participants visited a range of websites, including government-sponsored sites, community groups and weight loss companies, they overwhelmingly acted upon the advice given on commercial diet websites. However, safe, non-judgemental spaces such as the Fatosphere (online fat acceptance community) provided much needed solidarity and support. Conclusions The Internet provides a convenient source of support and information for obese individuals. However, many turn to the same unsuccessful solutions online (e.g. fad dieting) they turn to in the community. Government and community organisations could draw upon some lessons learned in other consumer-driven online spaces (e.g. the Fatosphere) to provide supportive environments for obese individuals that resonate with their health and social experiences, and address their needs.

The rise of the ‘obesity epidemic’ in Western societies has led to an increased public gaze on obese individuals. Yet there is limited research that explores through qualitative methods the increas...

Public responses to obesity have focused on providing standardized messages and supports to all obese individuals, but there is limited understanding of the impact of these messages on obese adults. This descriptive qualitative study using in-depth interviews and a thematic method of analysis, compares the health beliefs and behaviors of 141 Australian adults with mild to moderate (BMI 30-39.9) and severe (BMIor = 40) obesity. Mildly obese individuals felt little need to change their health behaviors or to lose weight for health reasons. Most believed they could "lose weight" if they needed to, distanced themselves from the word obesity, and stigmatized those "fatter" than themselves. Severely obese individuals felt an urgent need to change their health behaviors, but felt powerless to do so. They blamed themselves for their weight, used stereotypical language to describe their health behaviors, and described being "at war" with their bodies. Further research, particularly about the role of stigma and stereotyping, is needed to fully understand the impact of obesity messaging on the health beliefs, behaviors, and wellbeing of obese and severely obese adults.

Eutrophication often causes hypoxia in estuarine and coastal systems, but the mechanisms that control hypoxic events vary among estuaries and are often difficult to discern. We monitored surface and bottom dissolved oxygen (DO) in the Upper Newport Bay (UNB), a tidally mixed estuary in southern California subject to anthropogenic nutrient loading, eutrophication and hypoxia. Our goal was to identify the environmental factors regulating DO dynamics. Six hypoxic events occurred between June and November and were associated with a combination of low solar radiation, increased freshwater discharge following precipitation, and enhanced haline stratification during reduced tidal range periods. At the head of the estuary, high macroalgal biomass and pronounced haline stratification resulted in high DO in the surface layer and low DO in the bottom layer. Oxygen-rich and oxygen-poor waters were transported down-estuary by ebb tides, resulting in DO heterogeneity throughout the UNB. Cross-wavelet analysis illustrated the down-estuary propagation of high/low DO signal correlated with the phases of diurnal photosynthetic and semi-diurnal tidal cycles.

Once the domain of clinicians and researchers, we must now accept that ‘obesity’ has become ingrained in popular culture. An example is the emergence of a feast of reality television shows about obesity and weight loss. The most popular show is The Biggest Loser, where contestants compete to lose weight and win cash.

Ethics is a broad discipline and in health the debate between bioethics and behavioural ethics is one that goes to the centre of public health debates.

Jim Hyde suggests that the research on building the capacity of communities and the accumulation of social capital shows that how we organize our health systems – in both micro and macro contexts – is important. He argues that collaboration, flexibility and community participation must become central in health structures. Development (1999) 42, 49–53. doi:10.1057/palgrave.development.1110083

Background: Social marketing has been proposed as a framework that may be effectively used to encourage behaviour change relating to obesity. Social advertising (or mass media campaigning) is the most commonly used social marketing strategy to address the issue of obesity. While social advertising has the potential to effectively communicate information about obesity, some argue that the current framing and delivery of these campaigns are ineffective, and may cause more harm than good. Methods: We used a qualitative advertising reception study. 150 family groups (comprised of 159 parents and 184 children) were shown two Australian government anti-obesity advertisements: Measure Up (focused on problems associated with obesity) and Swap It (focused on solutions for obesity). Families were engaged in a discussion about the visual appeals, verbal messages and their perceptions about the impact of the advertisements on behavioural change. Open coding techniques and a constant comparative method of analysis was used to interpret the data. Results: Many parents had strong personal resonance with the visual imagery within the campaigns. While Swap It had strong ‘likeability’ with children, many children believed that the messages about overweight and obesity were less personally relevant because they did not perceive themselves to be overweight. The content and delivery style of the verbal messages (the serious risk focused message in Measure Up compared to the upbeat, fun practical message in Swap It) influenced how different audiences (parents and children) interpreted the information that was presented. Parents assimilated practical and instructive messages, while children assimilated messages about weight loss and weight gain. Parents and children recognised that the campaigns were asking individuals to take personal responsibility for their weight status, and were at times critical that the campaigns did not tackle the broader issues associated with the causes and consequences of obesity. The lack of practical tools to encourage behavioural change was a key barrier for obese parents. Conclusions: Well-funded, targeted social marketing campaigns will play an important role in the prevention and management of obesity. It is important that these campaigns are comprehensively evaluated and are backed up with structural supports to enable and encourage population subgroups to act upon messages. Refereed/Peer-reviewed

Obesity stigma exists within many institutions and cultural settings. Most studies suggest that stigmatising experiences have a negative impact on individuals' health and social behaviours and outcomes. However, some studies indicate that obesity stigma can motivate individuals to lose weight. Limited research has examined weight-based stigma from the perspective of obese individuals, including their perceptions of, and responses to, the different types of weight-based stigma they face in their daily lives. This study advances knowledge about weight-based stigma by documenting how obese adults (mostly female) described the different types of obesity stigma that they faced, how they responded to this stigma, and how different types of stigma impact on health and social wellbeing. Semi-structured, qualitative interviews were conducted between April 2008 and March 2009 with a diverse sample of 141 obese Australian adults. Guided by Link and Phelan's (2006) categorisation of different types of discrimination, participants' experiences could be grouped into three distinct types of stigma: 1) Direct (e.g. being abused when using public transport); 2) Environmental (e.g. not being able to fit into seats on planes); and 3) Indirect (e.g. people staring at the contents of their supermarket trolley). Participants described that more subtle forms of stigma had the most impact on their health and social wellbeing. However, it was the interaction between direct, environmental and indirect stigma that created a barrier to participation in health-promoting activities. Participants rarely challenged stigma and often blamed themselves for stigmatising experiences. They also avoided situations where they perceived they would be stigmatised and constantly thought about how they could find a solution to their obesity.

Objectives To investigate obese men's health behaviors and strategies for change. Methods Qualitative interviews with 36 men (BMI 30 and over). Results All men felt personally responsible for their weight gain. Sedentary lifestyles, stress, lack of worklife balance and weight-based stigma were all significant causes of weight gain and barriers to weight loss. These factors also contributed to men's unwillingness to seek help for their over-weight. Conclusion Addressing the self-blame and stigma associated with obesity is important in developing strategies to improve the health and well-being of obese men.

Background Previous studies of public perceptions of obesity interventions have been quantitative and based on general population surveys. This study aims to explore the opinions and attitudes of obese individuals towards population and individual interventions for obesity in Australia. Methods Qualitative methods using in-depth semi-structured telephone interviews with a community sample of obese adults (Body Mass Index ≥30). Theoretical, purposive and strategic recruitment techniques were used to ensure a broad sample of obese individuals with different types of experiences with their obesity. Participants were asked about their attitudes towards three population based interventions (regulation, media campaigns, and public health initiatives) and three individual interventions (tailored fitness programs, commercial dieting, and gastric banding surgery), and the effectiveness of these interventions. Results One hundred and forty two individuals (19-75 years) were interviewed. Participants strongly supported non-commercial interventions that were focused on encouraging individuals to make healthy lifestyle changes (regulation, physical activity programs, and public health initiatives). There was less support for interventions perceived to be invasive or high risk (gastric band surgery), stigmatising (media campaigns), or commercially motivated and promoting weight loss techniques (commercial diets and gastric banding surgery). Conclusion Obese adults support non-commercial, non-stigmatising interventions which are designed to improve lifestyles, rather than promote weight loss.

Background To explore the extent to which people living with obesity have attempted to lose weight, their attitudes towards dieting, physical exercise and weight loss solutions, why their weight loss attempts have failed, and their opinions about what would be most beneficial to them in their struggle with their weight. Method Qualitative study, using open-ended interviews, of 76 people living with obesity in Victoria, Australia in 2006/7. Individuals with a BMI of 30 or over were recruited using articles in local newspapers, convenience sampling, and at a later stage purposive sampling techniques to diversify the sample. Data analysis was conducted by hand using a constant, comparative method to develop and test analytical categories. Data were interpreted both within team meetings and through providing research participants the chance to comment on the study findings. Results Whilst participants repeatedly turned to commercial diets in their weight loss attempts, few had used, or were motivated to participate in physical activity. Friends or family members had introduced most individuals to weight loss techniques. Those who took part in interventions with members of their social network were more likely to report feeling accepted and supported. Participants blamed themselves for being unable to maintain their weight loss or 'stick' to diets. Whilst diets did not result in sustained weight loss, two thirds of participants felt that dieting was an effective way to lose weight. Conclusion Individuals with obesity receive numerous instructions about what to do to address their weight, but very few are given appropriate long term guidance or support with which to follow through those instructions. Understanding the positive role of social networks may be particularly important in engaging individuals in physical activity. Public health approaches to obesity must engage and consult with those currently living with obesity, if patterns of social change are to occur.

To develop an in-depth picture of both lived experience of obesity and the impact of socio-cultural factors on people living with obesity.Qualitative methodology, utilizing in-depth semi-structured interviews with a community sample of obese adults (body mass indexor=30). Community sampling methods were supplemented with purposive sampling techniques to ensure a diverse range of individuals were included.Seventy-six individuals (aged 16-72) were interviewed. Most had struggled with their weight for most of their lives (n=45). Almost all had experienced stigma and discrimination in childhood (n=36), as adolescents (n=41) or as adults (n=72). About half stated that they had been humiliated by health professionals because of their weight. Participants felt an individual responsibility to lose weight, and many tried extreme forms of dieting to do so. Participants described an increasing culture of 'blame' against people living with obesity perpetuated by media and public health messages. Eighty percent said that they hated or disliked the word obesity and would rather be called fat or overweight.There are four key conclusions: (i) the experiences of obesity are diverse, but there are common themes, (ii) people living with obesity have heard the messages but find it difficult to act upon them, (iii) interventions should be tailored to address both individual and community needs and (iv) we need to rethink how to approach obesity interventions to ensure that avoid recapitulating damaging social stereotypes and exacerbating social inequalities.

Over time, the definition of prevention has expanded so that its meaning in the context of health services is now unclear. As risk factors are increasingly considered to be the equivalent of ‘‘diseases’’ for purposes of intervention, the concept of prevention has lost all practical meaning. This paper reviews the inconsistencies in its utility, and suggests principles that it should follow in the future: a population orientation with explicit consideration of attributable risk, the setting of priorities based on reduction in illness and avoidance of adverse effects, and the imperative to reduce inequities in health.

The Clinical Support Systems Program (CSSP) includes the management of clinical practice using clinical and consumer pathways, outcome and performance indicators, clinical measurement and review in a continuous improvement cycle using the best available extant evidence. The Royal Australasian College of Physicians is testing the CSSP model through four consortia around Australia. There are 17 project sites in three States. The funded projects address major clinical problems including congestive heart failure and acute coronary syndromes, acute stroke management, and colorectal cancer care. There is some early evidence of the CSSP influencing change in areas beyond the bounds of the project settings and the College has developed a plan to promote wider adoption of best practice. This approach recognises the College’s role in providing Fellows with the practical tools of quality improvement, the means to collect data and compare their practice to other clinicians, while traversing the appropriate educational framework.

Background We are a society that is fixated on the health consequences of 'being fat'. Public health agencies play an important role in 'alerting' people about the risks that obesity poses both to individuals and to the broader society. Quantitative studies suggest people comprehend the physical health risks involved but underestimate their own risk because they do not recognise that they are obese. Methods This qualitative study seeks to expand on existing research by exploring obese individuals' perceptions of public health messages about risk, how they apply these messages to themselves and how their personal and social contexts and experiences may influence these perceptions. The study uses in depth interviews with a community sample of 142 obese individuals. A constant comparative method was employed to analyse the data. Results Personal and contextual factors influenced the ways in which individuals interpreted and applied public health messages, including their own health and wellbeing and perceptions of stigma. Individuals felt that messages were overly focused on the physical rather than emotional health consequences of obesity. Many described feeling stigmatised and blamed by the simplicity of messages and the lack of realistic solutions. Participants described the need for messages that convey the risks associated with obesity while minimising possible stigmatisation of obese individuals. This included ensuring that messages recognise the complexity of obesity and focus on encouraging healthy behaviours for individuals of all sizes. Conclusion This study is the first step in exploring the ways in which we understand how public health messages about obesity resonate with obese individuals in Australia. However, much more research - both qualitative and quantitative - is needed to enhance understanding of the impact of obesity messages on individuals.

"Joined-up' government and 'whole-of-government' approaches have evolved over the past two decades from the simple 'one-stop-shop' concept to much more formal organisational structures mandated at the highest levels. In many cases, the participants in these developments were learning on the job, as they responded to community and political demands for better service delivery and more accountability. This paper looks back at some of those developments and proposes a schema to assess and place policies, strategies and programs.

The issue of equity and health has been a central concern of the NSW Department of Health for many years. A major focus has been on ensuring the equitable distribution of health resources and health services through the Resource Distribution Formula (RDF). This has resulted in a significant redistribution of health services and health service funding based on population need rather than where health services, especially hospitals, had historically developed.