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Issue Addressed: Obesity is at crisis proportions. Individuals of low socio-economic status (SES) are more likely to consume higher energy dense diets than their high socio-economic status counterparts. The contribution of supermarket purchases of energy dense, nutrient poor foods has not been well-researched and has largely depended on unverified self-report., Methods: We estimated the proportion of supermarket shelf space dedicated to non-core foods in nine supermarkets (in five high and four low SES areas) in metropolitan Sydney. We analysed 204 shoppers' dockets (102 from high and 102 from low SES areas) for purchases of confectionery; sugar sweetened, carbonated beverages and cordials, sweet biscuits and cakes, and crisps and popcorn., Results: After adjusting for the number of people shopped for, low SES shoppers purchased significantly more non-core foods than high SES shoppers (p=0.039), especially chips and sugar sweetened, carbonated beverages and cordials. There was no difference in the shelf space dedicated to non-core foods, or between non-core foods purchased and the proportion of shelf space occupied by them in either low or high SES areas., Conclusions: Increased purchase of non-core foods by low SES shoppers who are already at higher risk of obesity than high SES shoppers is cause for concern. Further research is required to explore underlying reasons for this association.

Background: Type 2 diabetes is a common and costly chronic disease which is associated with significant premature mortality and morbidity. Although patient education is an integral component of diabetes care, there remain uncertainties regarding the effectiveness of different methods and modes of education., Objectives: To evaluate the effectiveness of individual patient education on metabolic control, diabetes knowledge and psychosocial outcomes., Search Strategy: Multiple electronic bibliographic databases were searched, including The Cochrane Library, MEDLINE, Premedline, ERIC, Biosis, AMED, Psychinfo, EMBASE, CINAHL, APAIS-health, Australian Medical Index, Web of Science, dissertation abstracts and Biomed Central., Selection Criteria: Randomized controlled and controlled clinical trials which evaluated individual education for adults with type 2 diabetes. The intervention was individual face-to-face patient education while control individuals received usual care, routine treatment or group education. Only studies that assessed outcome measures at least six months from baseline were included., Data Collection and Analysis: Information was extracted by two reviewers who summarized both study characteristics and outcome statistics. A meta-analysis using a fixed-effect model was performed if there were adequate studies with a specified outcome of sufficient homogeneity. For outcomes where there were too few studies or the assessment measurements were not standardized or variable, the results were summarised qualitatively., Main Results: Nine studies involving 1359 participants met the inclusion criteria. Six studies compared individual education to usual care and three compared individual education to group education (361 participants). There were no long-term studies and overall the quality of the studies was not high. In the six studies comparing individual face-to-face education to usual care, individual education did not significantly improve glycaemic control (weighted mean difference (WMD) in HbA1c -0.1% (95% confidence interval (CI) -0.3 to 0.1, P = 0.33) over a 12 to 18 month period. However, there did appear to be a significant benefit of individual education on glycaemic control in a subgroup analysis of three studies involving participants with a higher mean baseline HbA1c greater than 8% (WMD -0.3% (95% CI -0.5 to -0.1, P = 0.007). In the two studies comparing individual to group education, there was no significant difference in glycaemic control between individual or group education at 12 to 18 months with a WMD in HbA1c of 0.03% (95% CI -0.02 to 0.1, P = 0.22). There was no significant difference in the impact of individual versus usual care or group education on body mass index systolic or diastolic blood pressure. There were too few studies to perform a meta-analysis on the effect of individual education on dietary self management, diabetes knowledge, psychosocial outcomes and smoking habits. No data were available on the other main outcome measures of diabetes complications or health service utilization and cost analysis in these studies., Authors' Conclusions: This systematic review suggests a benefit of individual education on glycaemic control when compared with usual care in a subgroup of those with a baseline HbA1c greater than 8%. However, overall there did not appear to be a significant difference between individual education and usual care. In the small number of studies comparing group and individual education, there was an equal impact on HbA1c at 12 to 18 months. Additional studies are needed to delineate these findings further.