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ObjectivesTo describe trends in reported weight loss attempts among school-aged children and to investigate its sociodemographic determinants.DesignWe analysed data of children who participated in the Health Survey for England from 1997 to 2016 (n=34 235). This repeated cross-sectional survey reported weight loss attempts and sociodemographic characteristics. Body weight and height were measured by trained interviewers, and body mass index for age z-score was calculated. Multivariable logistic regression was used to investigate the sociodemographic determinants.SettingEngland.ParticipantsChildren (8–17 years).Main outcome measuresWeight loss attempts by year, age group, gender, BMI for age z-score, ethnicity and household income.ResultsThe prevalence of reported weight loss attempts increased significantly from 21.4% (1997–1998) to 26.5% (2015–2016). The increase was significant for boys, older children, Asian children, children from lower income households and in all categories of BMI for age z-score. Significant predictors of weight loss attempts included having overweight (8–12 years old, OR 4.01 (%CI 3.47 to 4.64); 13–17 years old, OR 1.96 (%CI 1.58 to 2.42)) or obesity (8–12 years old, OR 13.57 (%CI 11.94 to 15.43); 13–17 years old, OR 4.72 (%CI 3.94 to 5.66)) as well as being older, girls, from ethnic minority groups or low household income.ConclusionThe prevalence of reported weight loss attempts among children is increasing at a faster rate than the rise in excess weight and includes an increasing proportion of children with a ‘healthy’ weight. The increase in the prevalence of reported weight loss attempts among children is greatest among subgroups with lower baseline prevalence.

Funder: nihr oxford biomedical research centre; funder-id: http://dx.doi.org/10.13039/501100013373, Funder: national institute for health research; funder-id: http://dx.doi.org/10.13039/501100000272, OBJECTIVES: The aim was to investigate the impact of a group-based weight management programme on symptoms of depression and anxiety compared with self-help in a randomised controlled trial (RCT). METHOD: People with overweight (Body Mass Index [BMI]���28kg/m2) were randomly allocated self-help (n = 211) or a group-based weight management programme for 12 weeks (n = 528) or 52 weeks (n = 528) between 18/10/2012 and 10/02/2014. Symptoms were assessed using the Hospital Anxiety and Depression Scale, at baseline, 3, 12 and 24 months. Linear regression modelling examined changes in Hospital Anxiety and Depression Scale between trial arms. RESULTS: At 3 months, there was a -0.6 point difference (95% confidence interval [CI], -1.1, -0.1) in depression score and -0.1 difference (95% CI, -0.7, 0.4) in anxiety score between group-based weight management programme and self-help. At subsequent time points there was no consistent evidence of a difference in depression or anxiety scores between trial arms. There was no evidence that depression or anxiety worsened at any time point. CONCLUSIONS: There was no evidence of harm to depression or anxiety symptoms as a result of attending a group-based weight loss programme. There was a transient reduction in symptoms of depression, but not anxiety, compared to self-help. This effect equates to less than 1 point out of 21 on the Hospital Anxiety and Depression Scale and is not clinically significant.

Objective: To determine if characteristics of behavioural weight loss programmes (BWMPs) influence weight change trajectories following programme end. Design: Systematic review, meta-analysis and meta-regression. Data sources: Trial registries, 11 electronic databases, forward citation searching (from database inception; latest search Dec-19). Eligibility criteria for selecting studies: Randomised trials of BWMPs in adults with overweight/obesity reporting outcomes at >=12 months, including at and after programme end, were identified by two independent reviewers. Two reviewers independently screened with discrepancies resolved through discussion. 5% of the studies identified in the searches met the inclusion criteria. Data extraction and synthesis: One reviewer extracted data; these were checked by a second. Risk of bias was assessed using Cochrane’s Risk of Bias tool (v1). Main outcome measure: We calculated weight trajectories (kg/month; translated to kg/year for interpretability) after programme end in intervention versus control groups using a mixed model with a random intercept. We tested for associations between trajectories and pre-specified variables. Results: We analysed data from 249 trials (n=59,081) with mean length of follow-up 2 years, longest 30 years. Fifty-six percent of studies were at unclear risk of bias, 21% at low risk, and 23% at high risk. Weight regain was faster in intervention versus no intervention control groups at 0.12 to 0.32 kg/year, but between-group difference was maintained for at least five years. Each kilogram of weight lost at programme end was associated with 0.13-0.19 kg/year faster weight regain. Financial incentives for weight loss were associated with 1-1.5kg/year faster regain. Compared to those with no meal replacements, interventions involving partial meal replacement were associated with faster regain, but not after adjustment for weight loss during the programme. Participant access to the BWMP outside the study was associated with slower regain. Programmes that diminished in intensity were also associated with slower weight regain in the multivariable analysis, although the point estimate suggested that the association was small. Other characteristics did not explain the heterogeneity in weight regain. Conclusion: Faster weight regain after weight loss was associated with greater initial weight loss, but greater initial weight loss was still associated with added benefits for at least five years after programme end, after which there was a paucity of data. Continued availability of the programme predicted slower weight gain and provision of financial incentives predicted faster regain; no other clear associations were found. Though to the best of our knowledge this is the most comprehensive review in this field, limitations persist in regards to reporting, risk of bias, and a paucity of data at greater than 5 years from programme end.

Highlights • Smaller portion sizes are associated with lower energy intake. • We test a norm range model of the portion size effect on intended intake. • A wide range of portion sizes were perceived as normal. • Portions perceived as normal did not prompt intended compensatory eating. • Portions perceived as smaller than normal prompted intended compensation.

Background: Traditionally studies investigating diet and health associations have focused on single nutrients. However, key nutrients co-exist in many common foods and studies focusing solely on individual nutrients may obscure their combined effects on cardiovascular disease (CVD) and all-cause mortality. We aimed to identify food-based dietary patterns which operate through excess energy intake and explain high variability in energy density, free sugars, saturated fat and fiber intakes; and to investigate their association with total and fatal CVD and all-cause mortality. Methods: Detailed dietary data was collected using a 24h online dietary assessment on two or more occasions (n=116,806). We used reduced rank regression to derive dietary patterns explaining the maximum variance. Multivariable Cox-proportional hazards models were used to investigate prospective associations with all-cause mortality and fatal and non-fatal CVD. Results: Over an average of 4.9 years of follow up, 4,245 cases of total CVD, 838 cases of fatal CVD and 3,629 cases of all-cause mortality occurred. Two dietary patterns were retained that jointly explained 63% of variation in energy density, free sugars, saturated fat and fiber intakes in total. The main dietary pattern was characterized by high intakes of chocolate and confectionery, butter and low-fiber bread and low intakes of fresh fruit and vegetables. There was a positive linear association between the dietary pattern and total CVD [hazard ratio (HR) per z score 1.07, 95% confidence interval (CI) 1.04-1.09; HRtotal CVD 1.40, 95%CI 1.31-1.50, and HRall-cause mortality 1.37, 95%CI 1.27-1.47 in highest quintile]. A second dietary pattern was characterized by a higher intakes of sugar-sweetened beverages, fruit juice, and table sugar/preserves. There was a non-linear association with total CVD risk and all-cause mortality, with increased risk in the highest quintile [HRtotal CVD 1.14, 95%CI 1.07-1.22; HRall cause mortality 1.11, 95%CI 1.03-1.19]. Conclusions: We identified dietary patterns which are associated with increased risk of CVD and all-cause mortality. These results help identify specific foods and beverages which are major contributors to unhealthy dietary patterns and provides evidence to underpin food based dietary advice to reduce health risks.

Background: Guidelines recommend clinicians identify individuals at high cardiometabolic risk and support weight loss in those with overweight or obesity. However, individual level data quantifying the benefits of weight change for individuals, to guide these discussions in primary care, is lacking. Aim: Examine how weight change affects cardiometabolic risk factors, to facilitate shared decision-making between patients and clinicians regarding weight loss. Design and setting: Observational analysis using data from two trials of referral of individuals with overweight or obesity in primary care to community weight loss groups. Method: Linear mixed effects regression modelling, examining the association between weight change and change in systolic and diastolic blood pressure (SBP, DBP), fasting glucose, HbA1c, and lipid profile across multiple timepoints (baseline to 24 months). Subgroup analyses examined changes in individuals with hypertension, diabetes and hyperlipidaemia. Results: 2041 participants had a mean(±SD) age of 50 ±13.5 years, baseline weight 90.6 ±14.8kg and Body Mass Index 32.7 ±4.1kg/m2. Mean(±SD) weight change was -4.3 ±6.0kg. All outcome measures showed statistically significant improvements. Each 1kg weight loss was associated with 0.4mmHg reduction in SBP and 0.3mmHg reduction in DBP, or 0.5mmHg and 0.4mmHg/kg respectively in people with hypertension. Each 1kg weight loss was associated with 0.2mol/mol reduction in HbA1c, or 0.6mmol/mol in people with diabetes. Effects on plasma lipids were negligible. Conclusion: Weight loss achieved through referral to community weight loss programmes, which are commonly accessible in primary care, can lead to clinically relevant reductions in blood pressure and glucose regulation, especially in those at highest risk., EM was funded by an NIHR In‐Practice Fellowship and is currently funded by a Wellcome Trust Doctoral Research Fellowship. PA and SAJ are National Institute for Health Research (NIHR) Senior Investigators and funded by NIHR Oxford Applied Research Centre. PA, SAJ, and JO are supported in part by the NIHR Oxford Biomedical Research Centre (BRC). ALA is supported by the Medical Research Council (grant MC_UU_12015/4). The WRAP trial was funded by the National Prevention Research Initiative through research grant MR/J000493/1. The cost of the Weight Watchers programme and the costs of blood sampling and analysis were funded by Weight Watchers International as part of an MRC Industrial Collaboration Award.