Young Adults' Attitudes and Perceptions of Obesity and Weight Management: Implications for Treatment Development

The impact of social media interventions on eating behaviours and diet in adolescents and young adults: a mixed methods systematic review protocol

INTRODUCTION

Adolescents and young adults are susceptible population when it comes to healthy eating and dietary behaviours. The increasing use of social media by this age group presents a unique opportunity to promote healthy eating habits. Social media has become a popular platform for promoting health interventions, particularly among young people. However, there is a lack of consensus on the effectiveness of social media interventions in this population. This mixed-method systematic review aims to synthesise the available evidence on the impact of social media interventions on healthy eating behaviours among young people, their qualitative views and user experiences, and the intervention characteristics, behaviour change theories and techniques used to promote healthy eating.

METHODS AND ANALYSIS

We will conduct a comprehensive search of seven electronic databases, including ASSIA, Cochrane Library, Embase, MEDLINE, PsycINFO, Scopus and Web of Science. The search strategy will use a combination of Medical Subject Headings terms and keywords covering three domains: social media, eating behaviours and young people. The search will be limited to peer-reviewed published papers in any language, published from 2000. Three independent reviewers will screen studies based on predetermined eligibility criteria. Data will be extracted and analysed using a convergent segregated mixed-method approach. We will use random-effect meta-analysis or Synthesis Without Meta-analysis for quantitative data and thematic synthesis for qualitative data. Finally, narrative synthesis using concurrent triangulation will be used to bring together the results of the mixed-method data analysis to provide a comprehensive and integrated understanding of the impact and other features of social media interventions. This systematic review will adhere to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses.

ETHICS AND DISSEMINATION

Ethical approval is not required since this systematic review will not collect original data. The outcomes of this review will be shared through peer-reviewed publications and conference presentations and will contribute to the PhD thesis of the primary author.

PROSPERO REGISTRATION NUMBER

CRD42023414476.

Psychological approaches to obesity in young adults: state of the art

Background

Obesity has become a significant health concern among young adults aged 18-35 years. Addressing this issue is crucial, and exploring psychological treatments and perspectives specifically for this population is essential.

Methods

This literature review examines psychological treatments for obesity in young adults over the past decade. It focuses on interventions and discussions particularly relevant to this age group.

Discussion

Research on obesity often overlooks young adults, with most interventions primarily focusing on weight loss and neglecting emotional aspects. Cognitive-behavioral approaches are commonly used for self-regulation and motivation, but psychodynamic perspectives remain underutilized. While group-based methods lack a detailed analysis of benefits, hybrid approaches demonstrate higher engagement compared to technology-only interventions. There is a notable gap in tailoring obesity interventions to meet the unique needs of young adults during this transitional life phase. It's imperative to shift the focus from merely weight loss to a broader consideration of psychological, emotional, and unconscious factors. Integrating group modalities with psychodynamic approaches might offer additional benefits.

Conclusion

This review highlights the need for further research into the psychological well-being of young adults with obesity. A more comprehensive approach is required to address their distinct needs and psychological factors.

Factors influencing engagement in in-person and remotely delivered lifestyle interventions for young adults with serious mental illness: A qualitative study

AIM

Young adults (ages 18-35) are underrepresented in lifestyle interventions for people with serious mental illness (SMI), such as schizophrenia, bipolar disorder, and severe depression, and little is known about factors influencing their engagement in these programmes. This qualitative study examined factors affecting engagement amongst young adults with SMI who were enrolled in a lifestyle intervention trial at community mental health centres.

METHODS

Seventeen young adults with SMI participated in this qualitative study. Participants were drawn from a 12-month randomized controlled trial (n = 150) comparing an in-person group lifestyle intervention augmented with mobile health technology (PeerFIT) to one-on-one personalized remote health coaching (BEAT) using purposive sampling. The 17 participants completed semi-structured qualitative interviews at post-intervention to explore their perceived benefits of the intervention and factors impacting engagement. We used a team-based descriptive qualitative approach to code transcripts and identify themes in the data.

RESULTS

Participants across both interventions reported experiencing improved ability to engage in health behaviour change. Participants described managing psychosocial stressors and family and other responsibilities that limited their ability to attend in-person PeerFIT sessions. The remote and flexible BEAT remote health coaching intervention appeared to facilitate engagement even in the context of challenging life circumstances.

CONCLUSIONS

Remotely delivered lifestyle interventions can facilitate engagement amongst young adults with SMI navigating social stressors.

An Overview of Diet and Physical Activity for Healthy Weight in Adolescents and Young Adults with Type 1 Diabetes: Lessons Learned from the ACT1ON Consortium

The prevalence of overweight and obesity in young people with type 1 diabetes (T1D) now parallels that of the general population. Excess adiposity increases the risk of cardiovascular disease, which is already elevated up to 10-fold in T1D, underscoring a compelling need to address weight management as part of routine T1D care. Sustainable weight management requires both diet and physical activity (PA). Diet and PA approaches must be optimized towards the underlying metabolic and behavioral challenges unique to T1D to support glycemic control throughout the day. Diet strategies for people with T1D need to take into consideration glycemic management, metabolic status, clinical goals, personal preferences, and sociocultural considerations. A major barrier to weight management in this high-risk population is the challenge of integrating regular PA with day-to-day management of T1D. Specifically, exercise poses a substantial challenge due to the increased risk of hypoglycemia and/or hyperglycemia. Indeed, about two-thirds of individuals with T1D do not engage in the recommended amount of PA. Hypoglycemia presents a serious health risk, yet prevention and treatment often necessitates the consumption of additional calories, which may prohibit weight loss over time. Exercising safely is a concern and challenge with weight management and maintaining cardiometabolic health for individuals living with T1D and many healthcare professionals. Thus, a tremendous opportunity exists to improve exercise participation and cardiometabolic outcomes in this population. This article will review dietary strategies, the role of combined PA and diet for weight management, current resources for PA and glucose management, barriers to PA adherence in adults with T1D, as well as findings and lessons learned from the Advancing Care for Type 1 Diabetes and Obesity Network (ACT1ON).

Does eating behaviour among adolescents and young adults seeking obesity treatment differ depending on sex, body composition, and parental country of birth?

BACKGROUND

Adolescents and young adults around the world experience high rates of weight gain. The underlying eating behaviours that may lead to overconsumption of energy are complex and can depend on a number of factors. The aim of this study was to explore if eating behaviour among adolescents and young adults referred to specialized obesity treatment differed depending on sex, body composition, and parental country of birth.

METHODS

Adolescents and young adults aged 16-25 years, referred for obesity treatment in 2018-2021 were included in the study. Eating behaviour was assessed using the Three Factor Eating Questionnaire, comprising domains of uncontrolled-, emotional- and cognitive restraint eating. Student's t-test was used to compare differences in eating behaviour scores between males and females, and between those having at least one parent born in a Nordic country and those with both parents born outside the Nordic countries. Associations between BMI, waist circumference, and body fat percentage, and eating behaviour as the dependent variable, were examined using linear regression.

RESULTS

A total of 463 participants, mean age 21 years and mean BMI 41.3 kg/m², were included in the analysis. Females scored statistically significantly higher than males on emotional eating (45.8 vs. 35.4, p = 0.002) and cognitive restraint eating (45.4 vs. 39.2, p = 0.009). Participants with at least one parent born in a Nordic country reported a statistically significantly lower score of uncontrolled eating (45.7 vs. 51.3, p = 0.02) compared to participants with both parents born outside the Nordic countries. Further, there were statistically significant inverse associations between cognitive restraint eating scores and BMI (β=-0.64, 95%CI: -0.97 to -0.31), waist circumference (β=-0.44, 95%CI: -0.61 to -0.27) and body fat percentage (β=-0.57, 95%CI: -1.01 to -0.14) in models adjusted for age, sex, smoking, and civil status.

CONCLUSION

Our findings suggest that sex and parental country of birth may influence eating behaviours among adolescents and young adults referred for specialist obesity treatment. We also found that cognitive restraint eating decreased with increasing BMI, waist circumference, and body fat percentage. This indicates that there may be an inverse association between the ability to restrain oneself from eating and gaining weight, however, the direction of the association must be investigated further. Increased knowledge about eating behaviours may be valuable in the clinical setting.

Sleep duration and metabolic body size phenotypes among Chinese young workers

The evidence linking sleep duration and metabolic body size phenotypes is limited, especially in young adulthood. In this study, we aimed to examine the association between sleep duration and metabolic body size phenotypes among Chinese young workers and investigate whether discrepancies exist among shift and non-shift workers. A cross-sectional study was performed between 2018 and 2019 in Wuhan, China and 7,376 young adults aged 20-35 years were included. Self-reported sleep duration was coded into four groups: <7, 7-8, 8-9, and ≥9 h per day. Participants were classified into four metabolic body size phenotypes according to their body mass index and metabolic health status: metabolically healthy normal weight, metabolically unhealthy normal weight, metabolically healthy overweight/obesity (MHO), and metabolically unhealthy overweight/obesity (MUO). Multinomial logistic regression models were used to explore the associations between sleep duration and metabolic body phenotypes. Compared with those who slept 7-8 h each night, those with sleep duration <7 h per day had higher odds of MHO (OR 1.27, 95% CI: 1.02-1.56) and MUO (OR 1.22, 95% CI: 1.03-1.43), irrespective of multiple confounders. Stratification analyses by shift work showed that the association between short nighttime sleep and increased odds of MUO was only observed in shift workers (OR 1.26, 95% CI 1.03-1.54). Sleep duration is independently associated with metabolic body size phenotypes among Chinese young adults, while shift work could possibly modulate the association. These results may provide evidence for advocating adequate sleep toward favorable metabolic body size phenotypes in young workers.

Group Lifestyle Intervention With Mobile Health for Young Adults With Serious Mental Illness: A Randomized Controlled Trial

OBJECTIVE

Evidence-based lifestyle interventions tailored to young adults with serious mental illness are needed to reduce their cardiometabolic risk. This study evaluated the effectiveness of a group lifestyle intervention ("PeerFIT") enhanced with mobile health (mHealth) compared with one-on-one mHealth coaching (basic education supported by activity tracking [BEAT]) for young adults with serious mental illness who were overweight or obese.

METHODS

Participants were young adults ages 18-35 years with serious mental illness and a body mass index ≥25 kg/m², who were randomly assigned to PeerFIT or BEAT. Research staff collected data at baseline and at 6 and 12 months. Main outcomes were clinically significant changes from baseline in weight (≥5% weight loss), cardiorespiratory fitness (CRF; increase of >50 m on the 6-minute walk test), and cardiovascular disease (CVD) risk reduction (clinically significant weight loss or CRF improvement).

RESULTS

Participants were 150 young adults with a mean ± SD body mass index of 37.1±7.4. Intent-to-treat analyses revealed no significant between-group difference for weight-loss, CRF, or CVD outcomes at 6 and 12 months. Participants in both conditions achieved clinically significant CVD risk reduction, weight loss, and CRF from baseline to 6 and 12 months, and all these improvements were statistically significant (p<0.01).

CONCLUSION

The PeerFIT group lifestyle intervention was not superior to one-on-one mHealth coaching in achieving clinically significant changes in weight, CRF, and CVD risk reduction. Although both interventions improved outcomes, low-intensity mHealth coaching may be a more scalable approach for addressing modifiable cardiometabolic risk factors among young adults with serious mental illness.

Anthropometric and Biochemical Parameters in Relation to Dietary Habits as Early Indicator of Cardiovascular Impairment in Young Adult Cohort

Adjusted dietary assessment questionnaire was used to determine dietary habits of medical students which were related to biochemical and anthropometric markers of studied cohort. Thirty-seven young and healthy volunteers aged 19–28 years old entered the protocol and were divided according to sex and according to residence. Subjects were given questionnaires for tracking food/beverage consumption. Venous blood samples were taken after overnight fast (n = 32). Nutrient status and energy consumption were determined and analyzed. Study population had normal weight and body mass index (BMI). Biochemical characteristics were within normal reference range, while some participants had lipid profile disbalance. Men had significantly higher BMI than women. Average BMI was significantly higher in participants with elevated cholesterol levels compared to participants with normal cholesterol levels. Majority of participants consumed less than five meals per day with no major differences between students according to residence and sex. Men had significantly higher protein intake and consumed at least four meals daily compared to woman who had three or less meals daily with no differences in intake according to residence. Students with normal lipid profile consumed more carbohydrates than students with increased cholesterol. Results suggest that students with bad dietary habits have potentially higher risk for future cardiovascular problems, even before the onset of adverse effects.

Understanding Self-Guided Web-Based Educational Interventions for Patients With Chronic Health Conditions: Systematic Review of Intervention Features and Adherence

Background

Chronic diseases contribute to 71% of deaths worldwide every year, and an estimated 15 million people between the ages of 30 and 69 years die mainly because of cardiovascular disease, cancer, chronic respiratory diseases, or diabetes. Web-based educational interventions may facilitate disease management. These are also considered to be a flexible and low-cost method to deliver tailored information to patients. Previous studies concluded that the implementation of different features and the degree of adherence to the intervention are key factors in determining the success of the intervention. However, limited research has been conducted to understand the acceptability of specific features and user adherence to self-guided web interventions.

Objective

This systematic review aims to understand how web-based intervention features are evaluated, to investigate their acceptability, and to describe how adherence to web-based self-guided interventions is defined and measured.

Methods

Studies published on self-guided web-based educational interventions for people (≥14 years old) with chronic health conditions published between January 2005 and June 2020 were reviewed following the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) Statement protocol. The search was performed using the PubMed, Cochrane Library, and EMBASE (Excerpta Medica dataBASE) databases; the reference lists of the selected articles were also reviewed. The comparison of the interventions and analysis of the features were based on the published content from the selected articles.

Results

A total of 20 studies were included. Seven principal features were identified, with goal setting, self-monitoring, and feedback being the most frequently used. The acceptability of the features was measured based on the comments collected from users, their association with clinical outcomes, or device adherence. The use of quizzes was positively reported by participants. Self-monitoring, goal setting, feedback, and discussion forums yielded mixed results. The negative acceptability was related to the choice of the discussion topic, lack of face-to-face contact, and technical issues. This review shows that the evaluation of adherence to educational interventions was inconsistent among the studies, limiting comparisons. A clear definition of adherence to an intervention is lacking.

Conclusions

Although limited information was available, it appears that features related to interaction and personalization are important for improving clinical outcomes and users’ experience. When designing web-based interventions, the selection of features should be based on the targeted population’s needs, the balance between positive and negative impacts of having human involvement in the intervention, and the reduction of technical barriers. There is a lack of consensus on the method of evaluating adherence to an intervention. Both investigations of the acceptability features and adherence should be considered when designing and evaluating web-based interventions. A proof-of-concept or pilot study would be useful for establishing the required level of engagement needed to define adherence.

Maboo wirriya, be healthy: Community-directed development of an evidence-based diabetes prevention program for young Aboriginal people in a remote Australian town

Supporting healthy lifestyle behaviours is a key aspect of preventing type 2 diabetes which disproportionately affects disadvantaged groups from a younger age. Formative participatory research was undertaken to design a program for young Aboriginal people in a remote town in North West Australia with a high level of health needs and relatively few prevention initiatives. Focus groups and advisory discussions with Aboriginal community members were used to determine the nature of the program. The need for a comprehensive program was consistently expressed and limited healthy lifestyle knowledge and difficulties with healthy eating influenced by food environments were noted to be important. With guidance from the Derby Aboriginal Health Service, findings were integrated with previous international research evidence to develop a program tailored to local Aboriginal people aged 15-25 years and refine it after piloting. This 8-session program, 'Maboo wirriya, be healthy' involved an education component consistent with the US Diabetes Prevention Program and practical activities including group exercise. Changes to program structure and documentation were made after piloting for future use. The community-directed approach used in this study is vital to ensure relevance of localised chronic disease prevention programs in a range of settings.

Effectiveness of gender-targeted versus gender-neutral interventions aimed at improving dietary intake, physical activity and/or overweight/obesity in young adults (aged 17-35 years): a systematic review and meta-analysis

BACKGROUND

Young adulthood has become synonymous with the development of poor lifestyle behaviours associated with an increased risk of preventable chronic disease in later years. Interventions aiming to improve health behaviours may be more engaging and effective if they are targeted to males or females than interventions with a gender-neutral approach. This review will examine the outcome effectiveness of gender-targeted and gender-neutral interventions targeting nutrition, physical activity or overweight/obesity in young adults (17-35 years).

METHODS

Six electronic databases were searched for randomised controlled trials (RCTs) published up to December 2019 that evaluated nutrition, physical activity and/or overweight/obesity interventions in young adults (17-35 years). An effective intervention was one where the change in one or more primary outcome was positive and statistically significantly different from baseline, compared with control, or if no control comparator, compared with another active intervention. Effectiveness of outcomes was compared between gender-targeted and gender-neutral studies.

RESULTS

In total 21,582 manuscripts were identified and 107 RCTs were included; 30 gender-targeted studies (28%) and 77 gender-neutral (72%). Most gender-targeted studies were female targeted (n = 22, 73%). Primary outcome/s were adiposity (n = 36, 34%), nutrition (n = 29, 27%), physical activity (n = 28, 26%), or a combination of (n = 14, 14%). A greater proportion of gender-targeted than gender-neutral studies were effective in improving nutrition (n = 6, 100% and n = 17, 74% of studies respectively) and physical activity outcomes (n = 6, 86% and n = 14, 67% respectively), where as a greater proportion of gender-neutral studies were effective in improving adiposity outcomes (n = 13, 59% and n = 5, 36% respectively). None of these differences were statistically significant. Meta-analyses for weight found no significant differences between gender-targeted and gender-neutral studies for weight loss or weight gain prevention studies. Meta-analysis for fruit and vegetable intake demonstrated a significantly greater increase in intervention participants in gender-targeted studies of +158 g/day for > 3 months.

CONCLUSIONS

Although differences in outcome effectiveness were identified between gender-targeted and gender-neutral studies, these were not significantly different. This is likely due to an insufficient number of studies to detect a difference. The meta-analysis for fruit and vegetable intake findings should be interpreted with caution due to including only two gender-targeted studies. The findings collectively are suggestive of a potential difference requiring further investigation. To truly determine the effectiveness of gender-targeted interventions, well-designed RCTs comparing gender-targeted interventions with gender-neutral and control are needed.

REGISTRATION

This systematic review is a secondary analysis of studies included in a systematic review examining the effectiveness of interventions targeting nutrition, physical activity, or overweight/obesity in young adults, for which a predefined protocol was registered with PROSPERO (CRD42017075795).

Text messaging as an intervention for weight loss in emerging adults

BACKGROUND AND PURPOSE

Rates of overweight and obesity in emerging adults are rapidly increasing and associated with many chronic illnesses, quality of life concerns, and increased health care spending. Effective weight management interventions are needed for this population. The purpose of this study was to examine effects of a text-messaging weight loss intervention on motivation, stage of change for weight loss, and BMI.

METHODS

Overweight and obese emerging adults were enrolled (n = 188) and randomized to control or intervention groups. Weight loss information was delivered via a website to both groups. The intervention group also received daily weight loss-related text messages. Motivation, stage of change, and BMI were assessed online, via self-report at baseline, 4, and 8 weeks.

CONCLUSIONS

Ninety-five participants were included in the final data analysis. There was a significant increase in motivation and stage of change and decrease in BMI over the study duration, with no significant differences between groups.

IMPLICATIONS FOR PRACTICE

Nurse practitioners are well positioned to provide innovative weight loss interventions in a variety of settings. These results provide important insights for the design of effective weight loss treatment for emerging adults and support the use of web-based and text message-based interventions.

Associations between weight misperception, contextual factors, and weight loss behaviours in young adult men with overweight/obesity

OBJECTIVE

Young men are less likely to engage in weight loss behaviours than their female counterparts. This may be because of an increased likelihood for young men, particularly young black men, with overweight/obesity to misperceive their weight status. This study examined racial differences in weight status perception accuracy and associations between this perception and weight loss behaviours among young men. Associations between weight loss behaviours and contextual factors were also explored.

METHODS

Data from 1417 young adult (YA) men with overweight/obesity from the 2007 to 2014 National Health and Nutrition Examination Survey (NHANES) were analysed. Associations between weight status perception accuracy, contextual factors, and weight loss attempts and behaviours were examined with logistic regression.

RESULTS

YA men with overweight/obesity were more likely to report weight loss attempts and behaviours if they perceived themselves as being overweight (OR = 3.10; 95% CI, 2.18-4.41; P < .01; OR = 3.20, 95% CI, 2.16-4.72, P < .01, respectively). Greater education and income were associated with a greater likelihood of reporting weight loss attempts and healthy weight loss behaviours. Greater reported depressive symptoms were associated with reported weight loss attempts but not healthy weight loss behaviours. There were no differences by race for reported weight loss attempts or behaviours.

CONCLUSION

Among YA men with overweight/obesity, perceiving oneself as overweight was associated with reporting weight loss attempts and healthy weight loss behaviours. Future research should consider how weight status perception accuracy affects weight loss attempts among YA men and what additional factors may account for racial differences.

Does an Age-Specific Treatment Program Augment the Efficacy of a Cognitive-Behavioral Weight Loss Program in Adolescence and Young Adulthood? Results from a Controlled Study

Research on weight-loss interventions in emerging adulthood is warranted. Therefore, a cognitive-behavioral group treatment (CBT), including development-specific topics for adolescents and young adults with obesity (YOUTH), was developed. In a controlled study, we compared the efficacy of this age-specific CBT group intervention to an age-unspecific CBT group delivered across ages in an inpatient setting. The primary outcome was body mass index standard deviation score (BMI-SDS) over the course of one year; secondary outcomes were health-related and disease-specific quality of life (QoL). 266 participants aged 16 to 21 years (65% females) were randomized. Intention-to-treat (ITT) and per-protocol analyses (PPA) were performed. For both group interventions, we observed significant and clinically relevant improvements in BMI-SDS and QoL over the course of time with small to large effect sizes. Contrary to our hypothesis, the age-specific intervention was not superior to the age-unspecific CBT-approach.

Health and appearance reasons for weight loss as predictors of long-term weight change

This study investigated whether women’s initial reasons (health, appearance to others, or appearance to self) for wanting to lose weight influenced their weight change over a 30-month web-based intervention. Multilevel modeling with 1416 observations revealed that only appearance in relation to one’s self was a significant (negative) predictor. Women highly motivated to lose weight to improve their appearance in relation to themselves gained weight at 30 months, whereas those not motivated for this reason achieved clinically significant weight loss. Results suggest examining participants’ initial reasons for weight loss as an important component of intervention failure or success.

Improved confidence in performing nutrition and physical activity behaviours mediates behavioural change in young adults: Mediation results of a randomised controlled mHealth intervention

BACKGROUND

The burden of weight gain disproportionally affects young adults. Understanding the underlying behavioural mechanisms of change in mHealth nutrition and physical activity interventions designed for young adults is important for enhancing and translating effective interventions.

PURPOSE

First, we hypothesised that knowledge, self-efficacy and stage-of-change for nutrition and physical activity behaviours would improve, and second, that self-efficacy changes in nutrition and physical activity behaviours mediate the behaviour changes observed in an mHealth RCT for prevention of weight gain.

METHODS

Young adults, aged 18-35 years at risk of weight gain (n = 250) were randomly assigned to an mHealth-program, TXT2BFiT, consisting of a three-month intensive phase and six-month maintenance phase or to a control group. Self-reported online surveys at baseline, three- and nine-months assessed nutrition and physical activity behaviours, knowledge, self-efficacy and stage-of-change. The mediating effect of self-efficacy was assessed in multiple PROCESS macro-models for three- and nine-month nutrition and physical activity behaviour change.

RESULTS

Young adults randomised to the intervention increased and maintained knowledge of fruit requirements (P = 0.029) compared to controls. Intervention participants' fruit and takeaway behaviours improved to meet recommendations at nine months, with a greater proportion progressing to action or maintenance stage-of-change (P < 0.001 and P = 0.012 respectively) compared to controls. Intervention participants' vegetable and physical activity behaviours did not meet recommendations, thereby halting progress to action or maintenance stage-of-change. Indirect effects of improved nutrition and physical activity behaviours at three- and nine-months in the intervention group were explained by changes in self-efficacy, accounting for 8%-37% of the total effect.

CONCLUSIONS

This provides insights into how the mHealth intervention achieved part of its effects and the importance of improving self-efficacy to facilitate improved eating and physical activity behaviours in young adults.

Barriers to influenza vaccine uptake in obese people in Italy: Changes 2005-2013

BACKGROUND

Obesity is an independent risk factor for developing flu-related complications.

OBJECTIVE

The aim of this study was to analyze influenza vaccine uptake (VU) in the Italian obese, before and after the introduction of obesity among the national recommendations, and to evaluate factors associated to VU.

METHODS

The comparison of two editions of the national survey carried out in 2004-2005, before the inclusion of obese people among the specific high risk categories for flu complications, and in 2013, reaching a sample of 21,857 persons who declared to have a BMI>30. Multilevel logistic regression was used to evaluate potential independent predictors of influenza immunization.

RESULTS

Influenza vaccination coverage was 27.16% in 2013, versus 31.61% in 2005. A significant reduction of VU was registered after the introduction of obesity among the high risk conditions, for which flu VU was recommended. Regression modeling, both in adults and in older people, confirmed that barriers to VU in 2013 were younger age, medium level of education, absence of chronic disease, smoking habit, and reporting no contacts with GPs during the previous 12months. Among those aged 65 or more, the role of regional policies was associated to VU.

CONCLUSIONS

Immunization rates among young obese population are low, especially if not affected by comorbidities. Moreover, a reduction was registered in 2013 with respect to 2005. Flu vaccine uptake among the older population seems to be influenced by regional vaccination strategies. The development of novel strategy is warranted, especially among the young adults.