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Larger serving sizes and more frequent eating episodes have been implicated in the rising prevalence of obesity at a population level. This study examines the relative contributions of meal size and frequency to weight gain in a large sample of British children. Using 3-day diet diaries from 1939 children aged 21 months from the Gemini twin cohort, we assessed prospective associations between meal size, meal frequency and weight gain from two to five years. Separate longitudinal analyses demonstrated that every 10 kcal increase in meal size was associated with 1.5 g/wk or 4% (p = 0.005) faster growth rate, while meal frequency was not independently associated with growth (β = 0.3 g/wk p = 0.20). Including both meal parameters in the model strengthened associations (meal size: β = 2.6 g/wk, p < 0.001; meal frequency: β = 1.0 g/wk, p = 0.001). Taken together, the implication is that meal size promotes faster growth regardless of frequency, but meal frequency has a significant effect only if meal size is assumed to be held constant. Clearer advice on meal size and frequency, especially advice on appropriate meal size, may help prevent excess weight gain.

There is considerable evidence for both environmental and genetic causes of obesity. Increased availability of cheap, palatable food plays a role, but despite the ubiquity of the 'obesogenic' environment there is still substantial variation in weight - in fact, weight variability has gone up over recent decades. Twin and adoption studies show that adiposity is highly heritable (50-90%), and genome-wide association studies have started to identify single nucleotide polymorphisms (SNPs) associated with weight. We have proposed that genetic susceptibility to obesity is partly attributable to appetitive phenotypes, called the behavioral susceptibility theory (BST). BST proposes that individuals who inherit a more avid appetite or lower sensitivity to satiety are more likely to overeat in response to the food environment. Our laboratory has provided considerable evidence for BST using a variety of research approaches. We have used prospective epidemiological studies to demonstrate that appetite plays a causal role in the development of weight, twin designs to show that appetitive phenotypes are highly heritable and have genetic overlap with adiposity, and genomic analyses to show that obesity-related SNPs are associated with appetite and that appetite mediates some of the SNP-adiposity association. BST has helped to resolve the seeming paradox of both genetic determination and environmental determination of weight, and points to appetite as a useful target for pharmacological and behavioral interventions in the prevention and management of obesity., (Copyright © 2015 Elsevier Inc. All rights reserved.)

For over 100 years, the genetics of human anthropometric traits has attracted scientific interest. In particular, height and body mass index (BMI, calculated as kg/m2) have been under intensive genetic research. However, it is still largely unknown whether and how heritability estimates vary between human populations. Opportunities to address this question have increased recently because of the establishment of many new twin cohorts and the increasing accumulation of data in established twin cohorts. We started a new research project to analyze systematically (1) the variation of heritability estimates of height, BMI and their trajectories over the life course between birth cohorts, ethnicities and countries, and (2) to study the effects of birth-related factors, education and smoking on these anthropometric traits and whether these effects vary between twin cohorts. We identified 67 twin projects, including both monozygotic (MZ) and dizygotic (DZ) twins, using various sources. We asked for individual level data on height and weight including repeated measurements, birth related traits, background variables, education and smoking. By the end of 2014, 48 projects participated. Together, we have 893,458 height and weight measures (52% females) from 434,723 twin individuals, including 201,192 complete twin pairs (40% monozygotic, 40% same-sex dizygotic and 20% opposite-sex dizygotic) representing 22 countries. This project demonstrates that large-scale international twin studies are feasible and can promote the use of existing data for novel research purposes.

Objective: To examine associations between perceived weight discrimination and changes in weight, waist circumference, and weight status., Methods: Data were from 2944 men and women aged ≥50 years participating in the English Longitudinal Study of Ageing. Experiences of weight discrimination were reported in 2010-2011 and weight and waist circumference were objectively measured in 2008-2009 and 2012-2013. ANCOVAs were used to test associations between perceived weight discrimination and changes in weight and waist circumference. Logistic regression was used to test associations with changes in weight status. All analyses adjusted for baseline BMI, age, sex, and wealth., Results: Perceived weight discrimination was associated with relative increases in weight (+1.66 kg, P < 0.001) and waist circumference (+1.12 cm, P = 0.046). There was also a significant association with odds of becoming obese over the follow-up period (OR = 6.67, 95% CI 1.85-24.04) but odds of remaining obese did not differ according to experiences of weight discrimination (OR = 1.09, 95% CI 0.46-2.59)., Conclusions: Our results indicate that rather than encouraging people to lose weight, weight discrimination promotes weight gain and the onset of obesity. Implementing effective interventions to combat weight stigma and discrimination at the population level could reduce the burden of obesity., (© 2014 The Authors Obesity published by Wiley Periodicals, Inc. on behalf of The Obesity Society (TOS).)

Importance: Identifying early markers of future obesity risk can help target preventive interventions. Several studies have shown that a heartier appetite in infancy is a risk factor for more rapid weight gain, but to date no investigations have been able to rule out familial confounding., Objectives: To use a sibling design (data from same-sex, dizygotic twin pairs) to test the hypothesis that sibling differences in infant appetite predicted differential weight gain during childhood., Design, Setting, and Participants: Gemini is a population-based twin cohort among the general United Kingdom population born between March 1, 2007, and December 15, 2007. Growth trajectories were analyzed from birth to age 15 months. Appetite-discordant pairs were selected from 800 nonidentical, same-sex twin pairs., Exposures: Appetite during the first 3 months of life was assessed with the food responsiveness (FR) and satiety responsiveness (SR) subscales from the Baby Eating Behaviour Questionnaire. Discordance was defined as a within-pair difference of at least 1 SD., Main Outcomes and Measures: A mean of 11.5 weight measurements per child were available between birth and age 15 months. Multilevel models, adjusted for sex and birth weight, compared growth curves for the higher-appetite vs lower-appetite twins., Results: In total, 172 pairs were discordant for SR and 121 pairs for FR. Within-pair analyses showed that those with higher FR and those with lower SR grew faster than their sibling. At age 6 months, those with higher FR were 654 (95% CI, 395-913) g heavier and at age 15 months were 991 (95% CI, 484-1498) g heavier. For sibling pairs discordant for SR, the weight differences between siblings were 637 (95% CI, 438-836) g at age 6 months and 918 (95% CI, 569-1267) g at age 15 months., Conclusions and Relevance: A heartier appetite (indexed with higher FR or lower SR) in early infancy is prospectively associated with more rapid growth up to age 15 months in a design controlling for potential familial confounding, supporting a causal role for appetite in childhood weight gain. Appetite could be an early marker for risk of weight gain in the current obesogenic environment and might be a potential target for preventive interventions.

Objective: To evaluate the impact of a diet and physical activity intervention (BeWEL) on weight change in people with a body mass index >25 weight (kg)/height (m)(2) at increased risk of colorectal cancer and other obesity related comorbidities., Design: Multicentre, parallel group, randomised controlled trial., Setting: Four Scottish National Health Service health boards., Participants: 329 overweight or obese adults (aged 50 to 74 years) who had undergone colonoscopy after a positive faecal occult blood test result, as part of the national bowel screening programme, and had a diagnosis of adenoma confirmed by histopathology. 163 were randomised to intervention and 166 to control., Intervention: Participants were randomised to a control group (weight loss booklet only) or 12 month intervention group (three face to face visits with a lifestyle counsellor plus monthly 15 minute telephone calls). A goal of 7% reduction in body weight was set and participants received a personalised energy prescription (2508 kJ (600 kcal) below that required for weight maintenance) and bodyweight scales. Motivational interviewing techniques explored self assessed confidence, ambivalence, and personal values concerning weight. Behavioural strategies included goal setting, identifying intentions of implementation, self monitoring of body weight, and counsellor feedback about reported diet, physical activity, and weight change., Main Outcome Measures: The primary outcome was weight change over 12 months. Secondary outcomes included changes in waist circumference, blood pressure, fasting cardiovascular biomarkers, and glucose metabolism variables, physical activity, diet, and alcohol consumption., Results: At 12 months, data on the primary outcome were available for 148 (91%) participants in the intervention group and 157 (95%) in the control group. Mean weight loss was 3.50 kg (SD 4.91) (95% confidence interval 2.70 to 4.30) in the intervention group compared with 0.78 kg (SD 3.77) (0.19 to 1.38) in the control group. The group difference was 2.69 kg (95% confidence interval 1.70 to 3.67). Differences between groups were significant for waist circumference, body mass index, blood pressure, blood glucose level, diet, and physical activity. No reported adverse events were considered to be related to trial participation., Conclusions: Significant weight loss can be achieved by a diet and physical activity intervention initiated within a national colorectal cancer screening programme, offering considerable potential for risk reduction of disease in older adults., Trial Registration: Current Controlled Trials ISRCTN53033856.

Gemini is a cohort study of young twins in the United Kingdom designed to assess genetic and environmental influences on early childhood weight trajectories with a focus on infant appetite and the family environment. A total of 2402 families with twins born in England and Wales between March and December 2007 agreed to participate and returned completed baseline questionnaires. The sample includes 1586 same-sex and 816 opposite-sex twins. The study is currently funded for 5 years of follow-up, but is planned to continue into early adolescence and beyond, pending funding. With current funding of the study, families will be followed up when twins are: 8 months old (baseline), and then at 15, 20, 24, 36 and 48 months of age. Gemini is in its early stages, with baseline and first follow-up data collection completed. This is the first twin cohort to focus on childhood weight gain with detailed and repeated measures of children's appetite, food preferences, activity behavior and parental feeding styles, alongside detailed and repeated collection of anthropometrics. This article reviews the rationale for the Gemini study, its representativeness and the main measures.

Although perceived stress has been hypothesized to be a risk factor for obesity, epidemiological studies relating stress to weight gain have shown mixed results. We examined prospective associations between perceived stress and changes in waist circumference and BMI in a large study of adolescents. As part of the Health and Behaviour in Teenagers Study (HABITS), height, weight, and waist circumference were measured annually in 4,065 adolescents aged from 11 to 16. Waist and BMI standard deviation scores (SDS) were used as indices of adiposity. Adolescents completed a measure of perceived stress each year, from which mean stress scores over the 5-year period were also calculated and divided by tertile into lower, moderate, and higher stress. Associations between perceived stress at each year and adiposity 1-4 years later and also adiposity trajectories over the whole period in relation to mean stress were investigated. Analyses were adjusted for age, sex, ethnicity, socioeconomic deprivation, pubertal timing, and smoking. Perceived stress in any year was not related prospectively to increases in waist or BMI SDS 1-4 years later, nor was there any evidence that higher stress over the whole period was associated with greater gains in waist or BMI SDS. However, waist and BMI SDS were significantly higher in the moderate- and higher-stress groups than the lower-stress group across the whole 5-year period. Persistent stress was associated with higher waist circumference and BMI in adolescence, but did not lead to differential changes over 5 years.

The 'obesogenic' environment has the potential to affect everyone, but nonetheless, individuals differ in body weight, suggesting variation in susceptibility to environmental influences. Behavioural studies indicate that obese children experience low responsiveness to internal satiety signals and high responsiveness to external food cues. In this paper we describe the results of new studies using behavioural tests and psychometric questionnaires in large samples to show that individual variation in these appetitive traits relates to body weight throughout the distribution. We also describe twin studies and genetic association studies supporting a strong genetic component to appetite. Implications include the early identification of 'at risk' children, and interventions to modify appetitive traits.

Objective: To determine if there is a socioeconomic status (SES) gradient in postpartum weight retention in women living in the UK, and examine SES differences in weight-related attitudes and practices in the postpartum period., Methods: Women (n = 2745) who had full-term live births between July and December 1999 in four London hospitals were eligible to participate in this self-report postal questionnaire study. The questionnaire included items on socio-demographic characteristics, pre-pregnancy weight, postpartum height and weight, pregnancy weight gain and duration, and postpartum weight-related attitudes (body image and weight beliefs) and practices (weight control and weight monitoring). Education was used as the indicator of SES., Results: Questionnaires were returned by 954 women (35%) on average eight months postpartum. Median postpartum weight retention was 2.7 kg and was significantly higher in the medium and lower SES women (3.2 kg) than higher SES women (1.8 kg) despite no difference in pregnancy weight gain. A greater proportion of higher SES women believed they would return to their pre-pregnant weight, and they engaged in more frequent weight monitoring. There were no SES differences in body dissatisfaction or the proportion of women trying to lose weight postpartum., Conclusion: In the postpartum period, women of higher SES retained less weight than women of lower SES. There were also differences in weight-related attitudes and frequency of weight monitoring across SES groups.

Prevalence of obesity has increased worldwide in the past 20 years, but it is not known whether this has resulted in increased numbers of young adults feeling overweight. This study evaluated weight self-perception in a large, multi-ethnic sample of 14-15 years old (n=4167) in London, UK as part of a longitudinal, school-based study of health behaviours. Weight perceptions were recorded on a simple scale from 'too thin' to 'too fat'. Results indicated that under-estimation was more common than over-estimation, with more than a quarter of overweight or obese adolescents unaware of their excess weight. Under-estimation was greatest among boys and ethnic minorities. It may be timely to reassess weight control advice given to adolescents.

Objective: This was a descriptive study examining the psychological impact of a school-based, weight-screening intervention that included feedback to parents., Methods: Children from years 3 and 6 (6-7 and 10-11 years old) in London schools were measured in school, and parents were sent information on the child's weight status. Children and parents completed questionnaires 6 weeks before and 4 weeks after the feedback; 358 children and 287 parents completed both questionnaires. The main outcome measures (parental feeding practices, parental perception of child weight, child body esteem, child eating behavior, and weight-related teasing) were assessed before and after feedback. Qualitative data on health-behavior change and parents' and children's views of the measurement and feedback process were collected at follow-up., Results: Fifty-one percent of the parents (n = 398) volunteered for child measurements and weight feedback. Feedback was not associated with changes in child feeding among parents of healthy-weight children, but dietary restriction increased in parents of overweight girls. Among healthy-weight children, restrained eating decreased and body esteem increased, but there were no significant changes among the overweight group and no changes in reports of teasing. Perceptions of child overweight did not increase significantly, but 50% of the parents of overweight children reported positive changes in health behaviors. The majority (65%) of parents wanted weight feedback on a regular basis, and most children enjoyed the measuring process., Conclusions: Weight feedback was acceptable to the majority of parents participating in an "opt-in" measurement and feedback program; adverse effects were minimal for children and parents, even when feedback indicated overweight. However, a minority of participants found it distressing, which highlights the importance of managing the process sensitively, particularly for families with overweight children.

Students in the US have been shown to gain weight during their first year at university. This study examined whether students in Britain have a similar weight change during their first year at university, and tested the hypothesis that stress plays a role. A cross-sectional survey was conducted to assess stress and perceived weight change. Two hundred and sixty eight students at University College London completed the questionnaire at the end of their first year of university. On average, students reported a significant weight increase (1.53 kg+/-2.70, p<0.001), although there was considerable variation, with 55% of the sample reporting weight gain, 12% weight loss, and 33% remaining stable. Logistic regression analyses demonstrated that stress was associated with greater risk of weight gain (OR, 1.27, 95% CI, 1.12 to 1.44, p=0.001) and weight loss (1.33, 1.10 to 1.61, p=0.003), but associations were stronger among women. The associations remained unchanged after adjustment for health behaviours. Our findings confirm a modest weight gain over the first year at university, which was associated with higher levels of perceived stress in women.

Global increases in childhood obesity rates demand that we tackle the problem from many directions. One promising avenue is to explore the impact of parental feeding practices, particularly those related to parental control over children's intake. In this paper, we review studies of parent feeding and child adiposity covering a range of research methodologies (case-control studies, high risk studies, cross-sectional community studies and longitudinal cohort studies). We also present results from a cross-sectional community study of pre-schoolers (n = 439) and a longitudinal study of twins from ages of 4 to 7 years (n = 3175 pairs). We conclude that parents are more likely to encourage leaner than heavier children to eat, but relationships between adiposity and other parental feeding strategies are unclear. We suggest that future research should: (i) explore the impact of a comprehensive range of authoritative and authoritarian parental feeding behaviours, preferably using the same validated scales consistently across studies; (ii) test the generalisation of existing findings to diverse socio-economic and ethnic groups and (iii) utilise experimental, prospective and genetic methodologies to explore the causal relationships between parental feeding and child weight. We describe current projects in our own group that are designed to take forward these recommendations.

This study was stimulated by J. Sobal and A. J. Stunkard's (1989) theory that differences in deliberate weight control could underlie the socioeconomic gradient in adult weight. Female adolescents (N=1,248) completed measures of socioeconomic status, social norms for weight, weight ideals, attitudes to weight, and weight control behaviors. Higher socioeconomic status adolescents had greater awareness of the social ideals of slimness and had more family and friends who were trying to lose weight. They also defined a lower body mass index as "fat" and were more likely to have used healthy weight control methods. The results support the idea that socioeconomic differences in weight-related attitudes and behaviors may mediate the development of a gradient in weight., (((c) 2004 APA, all rights reserved))

Objective: Exposure to teenage culture is widely believed to contribute to concerns about weight in children and adolescents. The current study tested the hypothesis that greater exposure to older girls at school would be associated with thinner size ideals, increased concern about weight, and more dieting., Method: Participants (n = 200) were 9 and 11-year-old girls. The age of the oldest pupils in the school defined the exposure variable. Nine-year-olds in junior schools (oldest pupils = 11) and 11-year-olds in middle schools (oldest pupils = 13) were defined as nonexposed. Nine-year-olds in middle schools (oldest pupils = 13) and 11-year-olds in secondary schools (oldest pupils = 18) were defined as exposed. Girls were weighed and measured and completed measures of ideal size, perceived weight, body esteem, eating attitudes, dieting, and self-esteem., Results: Being at a school with older pupils was associated with having a thinner ideal, feeling more overweight, having more friends who had dieted, scoring higher on the Child Eating Attitudes Test, and having lower self-esteem. Effects were strongest among the 9-year-olds., Discussion: Exposure to older girls in school may accelerate the development of negative attitudes to weight and eating., (Copyright 2004 by Wiley Periodicals, Inc. Int J Eat Disord 35: 589-596, 2004.)

Objective: The aim of this study was to explore the potential effects of diet-induced weight loss on molecular biomarkers of colorectal cancer risk in serum and colorectal tissue.Methods: This single-arm exploratory study included 20 adults with BMI ≥ 30 kg/m2 completing an 8-week, complete, low-energy liquid diet. Pre- and postintervention anthropometric measurements, fasting blood draws, and endoscopic examinations to procure colorectal biopsies were performed. Fasting insulin, glucose, insulinlike growth factor 1 (IGF-1), C-reactive protein (CRP), and blood lipids were measured in serum, and tissue markers of apoptosis (M30), colonocyte proliferation (Ki-67), and insulin signaling (phospho-mTOR) were assessed using immunohistochemical staining.Results: Participants achieved substantial weight loss (mean = 13.56%). Mean concentrations of insulin, glucose, and cholesterol were significantly reduced (P < 0.05), but IGF-1 and CRP were not. Colorectal tissue expression of Ki-67 was significantly reduced (preintervention mean score = 7, postintervention mean score = 3.9, mean % change -43.8; P = 0.027). There were no significant changes in M30 or phospho-mTOR.Conclusions: Weight loss in individuals with obesity was associated with improvements in insulin sensitivity and blood lipid profiles and a significant reduction in tissue Ki-67 expression. This is one of the first studies to demonstrate potential cancer-relevant changes in colorectal tissue following weight loss achieved through diet. [ABSTRACT FROM AUTHOR]

Background: Excess adiposity is a risk factor for poorer cancer survival, but there is uncertainty over whether losing weight reduces the risk. We conducted a critical review of the literature examining weight loss and mortality in overweight or obese cancer survivors. Methods: We systematically searched PubMed and EMBASE for articles reporting associations between weight loss and mortality (cancer-specific or all-cause) in overweight/obese patients with obesity-related cancers. Where available, data from the same studies on non-overweight patients were compared. Results: Five articles describing observational studies in breast cancer survivors were included. Four studies reported a positive association between weight loss and mortality in overweight/obese survivors, and the remaining study observed no significant association. Results were similar for non-overweight survivors. Quality assessment indicated high risk of bias across studies. Conclusions: There is currently a lack of observational evidence that weight loss improves survival for overweight and obese cancer survivors. However, the potential for bias in these studies is considerable and the results likely reflect the consequences of disease-related rather than intentional weight loss. There is a need for stronger study designs, incorporating measures of intentionality of weight loss, and extended to other cancers. [ABSTRACT FROM AUTHOR]

Background: Participation in weight loss programs is often associated with improved wellbeing alongside reduced cardio-metabolic risk. In contrast, population-based analyses have found no evidence of psychological benefits of weight loss, but this may be due to inclusion of healthy-weight individuals. We therefore examined cardio-metabolic and psychological changes following weight loss in a cohort of overweight/obese adults. Methods: Data were from 1,979 overweight and obese adults (BMI ≥25 kg/m2; age ≥50 y), free of long-standing illness or clinical depression at baseline, from the English Longitudinal Study of Ageing. Participants were grouped according to four-year weight change into those losing ≥5% weight, those gaining ≥5%, and those whose weight was stable within 5%. Logistic regression examined changes in depressed mood (eight-item Center for Epidemiologic Studies Depression score ≥4), low wellbeing (Satisfaction With Life Scale score <20), hypertension (systolic blood pressure ≥140 mmHg or anti-hypertensives), and high triglycerides (≥1.7 mmol/l), controlling for demographic variables, weight loss intention, and baseline characteristics. Results: The proportion of participants with depressed mood increased more in the weight loss than weight stable or weight gain groups (+289%, +86%, +62% respectively; odds ratio [OR] for weight loss vs. weight stable = 1.78 [95% CI 1.29–2.47]). The proportion with low wellbeing also increased more in the weight loss group (+31%, +22%, −4%), but the difference was not statistically significant (OR = 1.16 [0.81–1.66]). Hypertension and high triglyceride prevalence decreased in weight losers and increased in weight gainers (−28%, 4%, +18%; OR = 0.61 [0.45–0.83]; −47%, −13%, +5%; OR = 0.41 [0.28–0.60]). All effects persisted in analyses adjusting for illness and life stress during the weight loss period. Conclusions: Weight loss over four years in initially healthy overweight/obese older adults was associated with reduction in cardio-metabolic risk but no psychological benefit, even when changes in health and life stresses were accounted for. These results highlight the need to investigate the emotional consequences of weight loss. [ABSTRACT FROM AUTHOR]

Background: The behavioral susceptibility model proposes that inherited differences in traits such as appetite confer differential risk of weight gain and contribute to the heritability of weight. Evidence that the FTO gene may influence weight partly through its effects on appetite supports this model, but testing the behavioral pathways for multiple genes with very small effects is not feasible. Twin analyses make it possible to get a broad-based estimate of the extent of shared genetic influence between appetite and weight. Objective: The objective was to use multivariate twin analyses to test the hypothesis that associations between appetite and weight are underpinned by shared genetic effects. Design: Data were from Gemini, a population-based birth cohort of twins in = 4804) born in 2007. Infant weights at 3 mo were taken from the records of health professionals. Appetite was assessed at 3 mo for the milk-feeding period by using the Baby Eating Behaviour Questionnaire (BEBQ), a parent-reported measure of appetite [enjoyment of food, food responsiveness, slowness in eating (SE), satiety responsiveness (SR), and appetite size (AS)]. Multivariate quantitative genetic modeling was used to test for shared genetic influences. Results: Significant correlations were found between all BEBQ traits and weight. Significant shared genetic influence was identified for weight with SE, SR, and AS; genetic correlations were between 0.22 and 0.37. Shared genetic effects explained 41-45% of these phenotypic associations. Conclusion: Differences in weight in infancy may be due partly to genetically determined differences in appetitive traits that confer differential susceptibility to obesogenic environments. [ABSTRACT FROM AUTHOR]

Background: Genetic testing for risk of weight gain is already available over the internet despite uncertain benefits and concerns about adverse emotional or behavioral effects. Few studies have assessed the effect of adding genetic test feedback to weight control advice, even though one of the proposed applications of genetic testing is to stimulate preventive action. This study will investigate the motivational effect of adding genetic test feedback to simple weight control advice in a situation where weight gain is relatively common. Methods/design: First-year university students (n = 800) will be randomized to receive either 1) their personal genetic test result for a gene (FTO) related to weight gain susceptibility in addition to a leaflet with simple weight control advice ('Feedback + Advice' group, FA), or 2) only the leaflet containing simple weight control advice ('Advice Only' group, AO). Motivation to avoid weight gain and active use of weight control strategies will be assessed one month after receipt of the leaflet with or without genetic test feedback. Weight and body fat will be measured at baseline and eight months follow-up. We will also assess short-term psychological reactions to the genetic test result. In addition, we will explore interactions between feedback condition and gene test status. Discussion: We hope to provide a first indication of the clinical utility of weight-related genetic test feedback in the prevention context. [ABSTRACT FROM AUTHOR]

Background: Primary care is the first port of call for advice about weight control. There is hence a need for simple, effective interventions that can be delivered without specialist skills. We have developed such an intervention; the 10 Top Tips (10TT). This intervention was effective with respect to weight loss in a volunteer population, but has yet to be tested in primary care. The aim of this trial is therefore to test the effectiveness of the 10TT intervention in primary care, incorporating clinical outcomes and health economic analyses. Methods/Design: The trial is a two-arm, individually-randomised, controlled trial in obese (BMI ≥ 30) adults (n = 520) in primary care, comparing weight loss in patients receiving the 10TT intervention with weight loss in a control group of patients receiving usual care. The intervention is based on habit formation theory, using written materials to take people through a set of simple weight control behaviours with strategies to make them habitual; an approach that could make it more successful than others in establishing long-term behaviour change. Patients will be recruited from 14 General Practices across England. Randomisation will be through telephoning a central randomisation service using a computer-generated list of random numbers. Patients are followed up at 3, 6, 12, 18 and 24 months. The primary outcome is weight loss at 3 months, with assessment by a health professional who is blind to group allocation. Other follow-ups will be un-blinded. We will examine whether weight loss is maintained up to 24 months. We will also assess changes in the automaticity of the 10TT target behaviours and improvement in clinical markers for potential co-morbidities. Finally, we will undertake a full economic evaluation to establish cost-effectiveness in the NHS context. Discussion: If proven to be effective when delivered through primary care, 10TT could make a highly cost-effective contribution to improvements in population health. Trial Registration: ISRCTN16347068 [ABSTRACT FROM AUTHOR]

Background: Colorectal cancer (CRC) is the third most commonly diagnosed cancer and the second highest cause of cancer death in the UK. Most cases occur in people over 50 years and CRC often co-exists with other lifestyle related disorders including obesity, type 2 diabetes mellitus (T2DM) and cardiovascular disease (CVD). These diseases share risk factors related to the metabolic syndrome including large body size, abnormal lipids and markers of insulin resistance indicating common aetiological pathways. Methods/Design: This 3 year study will be a two-arm, multicentre, randomised controlled trial comparing the BeWEL lifestyle (diet, physical activity and behaviour change) programme against usual care. The pre-trial development will take 6 months and participants will be recruited over a 12 month period and undertake the intervention and follow up for 12 months (total 24 months recruitment and intervention implementation) with a further 6 months for data collection, analysis and interpretation. Four hundred and fifty two participants who have had a colorectal adenoma detected and removed (through the national colorectal screening programme) will provide 80% power to detect a weight loss of 7% over 12 months. Primary outcomes are changes in body weight and waist circumference. Secondary outcomes will include cardiovascular risk factors, psycho-social measures and intervention costs. Discussion: The results from this study will enhance the evidence base for lifestyle change in patients at higher risk of chronic disease including obesity related cancers. International Standard Randomised Controlled Trials No: ISRCTN53033856 [ABSTRACT FROM AUTHOR]

This qualitative study examined how cancer specialists answer patient questions about what might have caused their cancer. Findings showed that while they were often candid about the role of smoking and drinking in cancer onset and that of diet in cancer recurrence, body weight and exercise were rarely mentioned. Any reluctance to discuss the role of lifestyle factors in cancer onset and recurrence arose from a desire to minimize patient distress, limitations in specialists' knowledge of the causes of cancer and perceived inadequacy of the available causal explanations when risk factors are multiple and probabilistic. [ABSTRACT FROM AUTHOR]

The author discusses the role of health psychology in dealing with information on the genetics of obesity. It is said that several studies of weight heritability found that variation in weight within the population in western environments is caused by genetic differences. The author explains why fat mass obesity-associated (FTO) gene has been considered an obesity gene. She contends that the genetic etiology of obesity risk is considered an opportunity for health psychologists to contribute to public health and clinical care.

Aim To assess the effect of smoking uptake on body mass index (BMI), waist circumference and height during adolescence. Design Five-year longitudinal study. Setting Thirty-six schools in South London, England, selected by a stratified random sampling procedure designed to ensure ethnic and socio-economic diversity. Participants A total of 5863 students took part in the HABITS (Health and Behaviour in Teenagers) Study between 1999 and 2003. Measurements Self-reported smoking behaviour, saliva cotinine concentrations and measured weight, waist circumference and height were obtained, along with information on gender, ethnicity, socio-economic deprivation, pubertal status, self-reported exercise and dieting. Students were examined annually from school year 7 (ages 11–12) to year 11 (ages 15–16), with response rates ranging from 74 to 84%. A total of 2665 never smokers at year 7 with complete data for years 7 and 11 were included in the analyses. Findings Adjusting for year 7 BMI and other potential confounders, regular smokers (more than six cigarettes a week) at year 11 had significantly lower BMI ( P = 0.002) than other students. Smokers defined by a cotinine above 15 ng/ml also had lower BMI ( P < 0.0001). Waist circumferences were lower in regular smokers ( P = 0.014) and cotinine-defined smokers ( P < 0.011). No consistent association was found between smoking and height. The adjusted difference in weight between regular smokers and other students amounted to 1.8 kg (95% CI, 0.52–3.17) for an average-height student. Conclusion Taking up regular smoking during adolescence may result in a lower BMI, but the effect is small and of uncertain significance. [ABSTRACT FROM AUTHOR]

Purpose: Epidemiological studies have suggested that cholesterol lowering could affect psychological functioning. This study was designed to test whether cholesterol-lowering diets adversely affect mood and cognitive function.5.2 mM [198 mg/dL]) to either a low-fat diet, a Mediterranean diet, or a waiting-list control. Cholesterol levels, psychological well-being (depression, anxiety, hostility), and cognitive function were assessed at baseline, 6 weeks, and 12 weeks.Results: Total serum cholesterol levels fell significantly more in the intervention groups (8.2% reduction) than in the control group (P <0.001). All three groups showed a modest improvement in psychological well-being during the 12-week treatment period, but there were no differences among the groups. There were no between-group differences on three measures of cognitive function, but for a fourth measure, which involved the task with the greatest processing load, the two intervention groups did significantly worse (P <0.001) than the control group. The change in performance was correlated with the change in total serum cholesterol level (r = 0. 21, P = 0.01).Conclusions: Two dietary interventions that successfully lowered serum cholesterol levels had no adverse effect on mood. There was some evidence for a relative impairment in cognitive function in the treated groups in one of four cognitive tests, but additional studies will be required to determine the relevance of this finding. [ABSTRACT FROM AUTHOR]

The comparatively lower prevalence of eating disorders among Asian and Afro-Caribbean than Caucasian women in the UK has often been attributed to cultural differences in pressures for slimness. However, there have been no attempts to evaluate cultural differences in ideals for female physique directly among women in the at risk age groups. In the present study, cultural influences on body image were evaluated by comparing the body size ideals , body image and dieting concerns in a sample of 274 young white and Asian British women. The results indicate that Asian women are less likely to describe themselves as too fat, were less dissatisfied with their body size, less likely to want to lose weight and less restrained. However, Asian women were slimmer than white women and, after controlling for the difference in body size, the effects were reduced. The hypothesis that any body satisfaction differences could be explained by difference in ideal body sizes between the two groups were not supported; Asian women favoured even slimmer ideal body sizes than white women. Alternative explanations in terms of cultural differences in evaluation of fatness are discussed. [ABSTRACT FROM AUTHOR]

Objectives To examine changes in public perceptions of overweight in Great Britain over an eight year period. Design Comparison of data on self perceived weight from population surveys in 1999 and 2007. Setting Household surveys of two representative samples in Great Britain. Participants 853 men and 944 women in 1999, and 847 men and 989 women in 2007. Main outcome measures Participants were asked to report their weight and height and classify their body size on a scale from "very underweight" to "obese." Results Self reported weights increased dramatically over time, but the weight at which individuals perceived themselves to be overweight also rose significantly. In 1999,81% of overweight participants correctly identified themselves as overweight compared with 75% in 2007, demonstrating a decrease in sensitivity in the self diagnosis of overweight. Conclusions Despite media and health campaigns aiming to raise awareness of healthy weight, increasing numbers of overweight people fail to recognise that their weight is a cause for concern. This makes it less likely that they will see calls for weight control as personally relevant. [ABSTRACT FROM AUTHOR]

Objective To examine the developmental trajectory of obesity in adolescence in relation to sex, ethnicity, and socioeconomic status. Design Five year longitudinal cohort study of a socioeconomically and ethnically diverse sample of school students aged 11-12 years at baseline. Setting 36 London schools recruited to the study in 1999 by a stratified random sampling procedure. Participants 5863 students participated in one or more years. Main outcome measures Weight, height, and waist circumference measured annually by trained researchers; overweight and obesity defined according to International Obesity Task Force criteria; adiposity and central adiposity indexed by body mass index (BMI) and waist standard deviation scores relative to 1990 British reference values. Results In school year 7 (age 11-12), the prevalence of overweight and obesity combined was almost 25%, with higher rates in girls (29%) and students from lower socioeconomic backgrounds (31%) and the highest rates in black girls (38%). Prevalence of obesity increased over the five years of the study at the expense of overweight, but no reduction occurred in the proportion of students with BMIs in the healthy range. Waist circumferences were high compared with 1990 norms at age 11 (by 0.79 SD in boys and by 1.15 SD in girls) and increased further over time. Both BMI and waist circumference tracked strongly over the five years. Conclusions Prevalence of overweight and obesity was high in London school students, with significant socioeconomic and ethnic inequalities. Little evidence was found of new cases of overweight or obesity emerging over adolescence, but few obese or overweight adolescents reduced to a healthy weight. The results indicate that persistent obesity is established before age 11 and highlight the need to target efforts to prevent obesity in the early years. [ABSTRACT FROM AUTHOR]

The mechanisms through which genes influence body weight are not well understood, but appetite has been implicated as one mediating pathway. Here we use data from two independent population-based Finnish cohorts (4632 adults aged 25-74 years from the DILGOM study and 1231 twin individuals aged 21-26 years from the FinnTwin12 study) to investigate whether two appetitive traits mediate the associations between known obesity-related genetic variants and adiposity. The results from structural equation modelling indicate that the effects of a polygenic risk score (90 obesity-related loci) on measured body mass index and waist circumference are partly mediated through higher levels of uncontrolled eating (βindirect = 0.030-0.032, P < 0.001 in DILGOM) and emotional eating (βindirect = 0.020-0.022, P < 0.001 in DILGOM and βindirect = 0.013-0.015, P = 0.043-0.044 in FinnTwin12). Our findings suggest that genetic predispositions to obesity may partly exert their effects through appetitive traits reflecting lack of control over eating or eating in response to negative emotions. Obesity prevention and treatment studies should examine the impact of targeting these eating behaviours, especially among individuals having a high genetic predisposition to obesity. [ABSTRACT FROM AUTHOR]

Background: Health behavior change following a cancer diagnosis has the potential to improve long-term outcomes. However, many patients do not receive professional advice about lifestyle and are therefore increasingly using the Internet to seek further information. The statutory and charitable sectors and cancer centers all play an important role in the provision of information and have been found to be favored by cancer survivors searching for information. However, to date there has been no systematic evaluation of the lifestyle information available online for cancer survivors. Objective: The purpose of this review was to identify the lifestyle information provided for cancer survivors by statutory and charitable sector organizations and cancer centers in the United Kingdom. We aimed to identify information on tobacco, physical activity, diet, weight, and alcohol designed for people who have been diagnosed with breast, prostate, or colorectal cancer. Methods: The National Health Service (NHS) website was the focus of the search for information provided by the statutory sector. Cancer centers were identified from the Organization of European Cancer Institutes and an Internet search, and charitable sector organizations were identified by searching the Charity Commission database. The three largest generic, breast, prostate, and colorectal cancer charitable organizations were included. A systematic search of the organizations was conducted to identify lifestyle information for cancer survivors. Results: Ten organizations had some lifestyle information for cancer survivors on their websites. The Christie NHS Foundation Trust, Macmillan Cancer Support, and Prostate Cancer UK had the most comprehensive guides, covering physical activity, diet, weight management, smoking, and alcohol. The NHS website did not provide any information but had a link to Cancer Research UK's information about diet. Eight organizations suggested talking to a health professional before making any changes. Conclusions: The majority of organizations included in this review would benefit from updating their websites to include adequate information and advice about lifestyle for cancer survivors, or they risk cancer survivors turning to less reliable sources of information. Health professionals should be appropriately trained to deal with questions about lifestyle and to advise cancer survivors about lifestyle changes following their diagnosis. [ABSTRACT FROM AUTHOR]

The article discusses research on the impact of a body weight and physical activity intervention called BeWEL, initiated through a national colorectal cancer screening programme in four National Health Service (NHS) boards in Scotland. The research finds that a personalised, behaviourally-focused weight loss programme was associated with sustained changes in body weight, physical activity, and eating habits. It also notes that the programme offers potential risk reduction of disease in adults.

Background and objective: Parental control over feeding has been linked to child overweight. Parental control behaviours have been assumed to be exogenous to the child, but emerging evidence suggests they are also child-responsive. This study tests the hypothesis that parental control in early infancy is responsive to infant appetite and weight. Subjects and methods: Participants were 1920 mothers from the Gemini twin cohort, using one randomly selected child per family. Data come from questionnaires completed when the children were approximately 8 months. Mothers completed measures of ‘pressure’ and ‘restriction’, reported feeding method (breast- and bottle feeding), rated their infant's appetite during the first 3 months, provided health professional recorded weight measurements, and reported their concerns about their infant's weight. Logistic regression examined predictors of ‘pressure’ and ‘restriction’, adjusting for maternal demographics and BMI. Interactions between feeding method and control were also tested. Results: ‘Pressure’ was associated with lower birth weight (OR = 0.79, 95% CI: 0.65–0.97), greater concern about underweight (OR = 1.88, 1.29–2.75), and lower infant appetite (OR = 0.59, 0.47–0.75). ‘Restriction’ was associated with higher appetite (OR = 1.44, 1.09–1.89) and bottle feeding (OR = 2.86, 2.18–3.75). A significant interaction with feeding method indicated that infants with high appetites were more likely to be restricted only if they were bottle-fed (OR = 1.52, 1.13–2.04). Conclusion: Mothers vary in their levels of control over milk-feeding and this is partly responsive to the infant's characteristics. They tend to pressure infants who are lighter and have a smaller appetite, and restrict infants with larger appetites if they are bottle-fed. Guidance on infant feeding may be better received if it acknowledges that parents respond to infant characteristics in order to achieve their feeding goals. [ABSTRACT FROM AUTHOR]

Abstract: The purpose of this review is to spark integrative thinking in the area of eating behaviors by critically examining research on exemplary constructs in this area. The eating behaviors food responsiveness, enjoyment of eating, satiety responsiveness, eating in the absence of hunger, reinforcing value of food, eating disinhibition and impulsivity/self-control are reviewed in relation to energy intake, body mass index and weight gain over time. Each of these constructs has been developed independently, and little research has explored the extent to which they overlap or whether they differentially predict food choices, energy intake and weight gain in the naturalistic environment. Most available data show positive cross-sectional associations with body mass index, but fewer studies report associations with energy intake or food choices. Little prospective data are available to link measures of eating behaviors with weight gain. Disinhibition has the largest and most consistent body of empirical data that link it prospectively with weight gain. An overarching conceptual model to integrate the conceptual and empirical research base for the role of eating behavior dimensions in the field of obesity research would highlight potential patterns of interaction between individual differences in eating behaviors, specific aspects of the individual’s food environment and individual variation in state levels of hunger and satiety. [Copyright &y& Elsevier]