Systematic review into obesity and weight gain within male prisons

Bricolage as an expression of self and of cultural and familial foodways among people living in prison-'You make what you can with anything you can get'

In this article, we use Lévi-Strauss's (1962, The savage mind, University of Chicago Press) concept of 'bricolage' to explore informal food preparation among men in Scottish prisons. The art of 'making do with whatever is at hand', in innovative and creative ways, to give new functions to everyday items has recently been reimagined and applied to the field of food. It has been used to explore the practice of informal food networks in resource poor environments; investigate how small food businesses come up with new and innovative recipes ideas; and study the way Michelin-starred chefs responded to the COVID-19 pandemic through philanthropic activities. Our aim is to use bricolage as a lens through which to answer questions about whether more autonomy over food might contribute to overall health and wellbeing in prisons. Drawing on in-depth empirical data from qualitative interviews with 20 men in Scottish prisons, we explore how bricolage is used to escape the monotony of prison-issued meals and the tedium of the prison regime; counter threats to self and identity; create and maintain social relationships through joint enterprise and commensality; and create culinary experiences that afford a sense of control and normality in an environment synonymous with 'spoiled identity' (Goffman, 1961, Asylums: Essays on the social situation of mental patients and other inmates, Penguin.).

A Scoping Review of Nutrition Education Interventions Applied in Prison Settings

PURPOSE OF REVIEW

Over 11 million individuals are incarcerated globally, facing health challenges such as obesity, diabetes, and cardiovascular disease, possibly exacerbated by prison diets. The objective of this scoping review is to explore the various available types of nutrition education interventions that currently exist in the literature applied in prison settings.

RECENT FINDINGS

Utilizing the PRISMA Extension for Scoping Reviews, 19 databases were searched for studies on nutrition interventions in prisons from 2000 to May 2023, guided by the "PICO" structure. Inclusion criteria encompassed articles in five languages from peer-reviewed journals focusing solely on nutrition education interventions. Rayyan QCRI software was utilized for screening and data extraction. Fifteen international studies were analyzed, covering various countries and targeting different populations in prisons. Interventions varied from nutrition education to comprehensive health programs. The outcomes were inconsistent, with some showing health improvements and others encountering challenges. Few utilized established theoretical frameworks, indicating a research gap. The range of interventions highlights the potential complexity of nutrition education interventions within prisons. Implementing recognized theoretical frameworks may enhance effectiveness. The diverse outcomes highlight the challenges in creating impactful programs, emphasizing foundational issues. Recommendations focus on rigorous research designs and understanding prison-specific complexities. Nutrition education interventions in incarcerated settings present varied results, emphasizing the need for well-structured, theoretically grounded, and carefully evaluated programs. Future strategies should recognize the multifaceted nature of correctional facilities, aiming for holistic approaches to improve health in prisons.

Assessment of Nutritional Status and Health Perception among Male Inmates in Israeli Prisons

The nutritional and health perceptions of inmates are crucial to their overall well-being. However, limited research has been conducted on this topic. This study aimed to assess the nutritional and health perception state of male inmates in eleven prisons in Israel. A cross-sectional study was conducted between February and September 2019 with 176 voluntary participants. Structured questionnaires were used to collect data on socio-demographic characteristics, healthy habits, subjective health status, and prison situation variables. The study found that the prevalence of overweight (40%) and obesity (18.1%) among 18-34-year-old inmates was significantly higher than in the reference Israeli population. Short detention periods (up to one year) predicted less weight gain, while older age predicted poorer health status. Better emotional status significantly predicted better subjective health status among male inmates. There is a need for nutrition interventions to improve the health of inmates. The significant weight gain during incarceration and the associated lower health index and stress highlights the importance of increasing knowledge and promoting a healthier lifestyle in incarceration as early as possible and continuing over time.

Obesity Epidemic in U.S. Prison Populations: A Meta-Analysis and Review of the Literature

Limited existing evidence and health provider perceptions suggest that prevalence of obesity among incarcerated people residing in U.S. correctional institutions is high. Evaluating evidence of obesity and weight change during incarceration will allow for the determination of whether people are subject to weight gain during incarceration. A systematic review of three online databases, gray literature, and reference lists of articles of interest was conducted using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) checklist. A meta-analysis to obtain pooled prevalence estimates of obesity among U.S. incarcerated people was then completed. A total of 11 studies met our inclusion criteria. Results show the estimated pooled prevalence of obesity in incarcerated men (30.0%) was less than the national average. The estimated pooled prevalence of obesity in females (39.8%) was similar to the national average.

Relationship between Sports Practice, Physical and Mental Health and Anxiety-Depressive Symptomatology in the Spanish Prison Population

The objective of this study was to evaluate, in a group of Galician inmates, if there were variations in the levels of physical and mental health and anxiety-depressive symptomatology, depending on the sports' practice performed. The relationship between these constructs was also investigated. The sample was composed of 509 people deprived of liberty in prisons in the Autonomous Community of Galicia, Spain. A quantitative methodology was used, with the questionnaire as an information collection instrument, Student's t-tests, Pearson's correlation analysis and a stepwise regression analysis were carried out. The results indicated that those who performed physical activity during their stay in prison had higher levels of physical and mental health, as well as lower indicators of anxiety-depressive symptoms. People who did not practice sports showed a decrease in their perceived health levels when compared to those perceived in their pre-prison stage. A negative association was shown between perceived health levels and anxiety-depressive symptomatology. Perceived physical health, alone, explained 35% of the variance in perceived mental health. These results add to knowledge about the relationships between perceived health, anxiety-depressive symptoms and sports practice in the group of people deprived of liberty, highlighting the importance of promoting physical activity in penitentiary institutions.

Prevalence of Overweight and Associated Factors in a Male Prison Population in the Extreme South of Brazil: A Cross-Sectional Study

Background: This cross-sectional study serves as a first Brazilian inventory about overweight as a marker for metabolic health and risk factor to develop noncommunicable chronic diseases in prison populations. The prevalence of overweight, and its associated factors in prisoners of the Fifth Regional State Penitentiary of Rio Grande do Sul (5th DPR) in the extreme South of Brazil were investigated using a precoded questionnaire with sociodemographic, behavioral, and health questions, applied to proportional stratified random sampled prisoners. Methods: Five hundred eighty male prisoners (70%) in the closed regime agreed to answer the questionnaire and allowed anthropomorphic body measurement, carried out by trained scientists. We used bivariate Pearson's chi-squared test and adjusted multinomial logistic regression for analyses. Results: Considering that the studied incarcerated population is young (mean age 33 years) it is concerning that already 43.6% of them are overweight, report regular sweets and sugary soft drink consumption (77.7%, and 81.4%, respectively), 60.2% are smokers, and 19.4% are at elevated risk to develop cardiovascular diseases. Further, 13.8% of the respondents reported a diagnosis of hypertension, 4.9% hypercholesterolemia, and 2.7% diabetes mellitus type 2. Among those who reported not smoking, excess weight was almost four times higher (prevalence ratio: 3.79; 95% confidence interval: 2.61-5.50). Conclusions: Our study suggests that the prison environment promotes modifiable risk factors for chronic diseases. These data deserve attention and intervention, aiming to prevent and reduce the current levels of excess weight.

Dietary Habits, Diet Quality, Nutrition Knowledge, and Associations with Physical Activity in Polish Prisoners: A Pilot Study

Physical activity and healthy diets are determinants of the health of convicts who are deprived of freedom. However, little research has focused on these two aspects concurrently. The aim of this study is to analyze the relationships between the level of prisoners’ physical activity and their dietary habits, diet quality, and nutritional knowledge. The cross-sectional study was conducted with 226 prisoners. The inclusion criteria included male sex, age 18–65 years, and consent for the research. We excluded the subjects who met any of the following conditions: female sex, unwillingness to participate, and dangerous prisoner status. The KomPAN questionnaire was used to assess the prisoners’ eating habits, diet quality, and level of nutrition knowledge. The “Last 7d” short form of the International Physical Activity Questionnaire (IPAQ) was used to assess the prisoners’ level of physical activity. A significant correlation between the prisoners’ age and their levels of physical activity was found (p = 0.008). Prisoners who were aged 18–29 and over 40 declared a low level of physical activity, whereas those aged 30–40 reported a high or medium level. The level of physical activity of the surveyed prisoners was not significantly correlated with their dietary habits, the quality of their diet, or their nutrition knowledge.

Abundance of undiagnosed cardiometabolic risk within the population of a long-stay prison in the UK

BACKGROUND

The health of people in prisons is a public health issue. It is well known that those in prison experience poorer health outcomes than those in the general community. One such example is the burden of non-communicable diseases, more specifically cardiovascular disease (CVD), stroke and type 2 diabetes (T2DM). However, there is limited evidence research on the extent of cardiometabolic risk factors in the prison environment in Wales, the wider UK or globally.

METHODS

Risk assessments were performed on a representative sample of 299 men at HMP Parc, Bridgend. The risk assessments were 30 min in duration and men aged 25-84 years old and free from pre-existing CVD and T2DM were eligible. During the risk assessment, a number of demographic, anthropometric and clinical markers were obtained. The 10-year risk of CVD and T2DM was predicted using the QRISK2 algorithm and Diabetes UK Risk Score, respectively.

RESULTS

The majority of the men was found to be either overweight (43.5%) or obese (37.5%) and/or demonstrated evidence of central obesity (40.1%). Cardiometabolic risk factors including systolic hypertension (25.1%), high cholesterol (29.8%), low HDL cholesterol (56.2%) and elevated total cholesterol: HDL ratios (23.1%) were observed in a considerable number of men. Ultimately, 15.4% were calculated at increased risk of CVD, and 31.8% predicted at moderate or high risk of T2DM.

CONCLUSIONS

Overall, a substantial prevalence of previously undiagnosed cardiometabolic risk factors was observed and men in prison are at elevated risk of cardiometabolic disease at a younger age than current screening guidelines.

Impact of incarceration on cardiovascular disease risk factors: a systematic review and meta-regression on weight and BMI change

OBJECTIVE

Cardiovascular disease is an underappreciated issue in prison medicine. Recent studies have revealed a higher prevalence of cardiovascular disease risk factors (CVDRFs) among individuals in prison, but the impact of incarceration on CVDRFs over time is not well understood. This review aimed to assess available literature and quantify the relationship between incarceration and trends in major CVDRFs in high-income countries.

DESIGN

Systematic review following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement. Meta-regression on weight change and obesity.

DATA SOURCES

Medline, Embase, PubMed, Cochrane Central Wiley and Web of Science.

ELIGIBILITY CRITERIA FOR SELECTING STUDIES

Longitudinal studies reporting on the incidence of, or trends in any CVDRF among current or former people in prison over time, in high-income countries.

DATA EXTRACTION AND SYNTHESIS

Two authors independently screened articles for eligibility, extracted data and assessed quality using an adapted version of the Newcastle-Ottawa Scale. Trends in CVDRFs during and following incarceration were summarised and in those with sufficient data a meta-regression was performed.

RESULTS

Twenty-six articles were identified. CVDRFs assessed included obesity, hypertension, diabetes, dyslipidaemia, tobacco use, physical inactivity and unhealthy diet. A meta-regression on change in weight during incarceration found a mean increase of 5.3 kg (95% CI 0.5 to 10.1) and change in body mass index of 1.8 kg/m² (95% CI -0.9 to 4.6) at 2 years. Weight gain appeared most pronounced right after entering prison and then plateaued at 2 years. Concerning hypertension, the results were inconclusive, despite a trend towards rising blood pressure or prevalence of hypertension during incarceration, and an increased incidence of hypertension following incarceration. Results are contradictory or inconclusive for the other CVDRFs reviewed.

CONCLUSION

Possible explanations for the association between incarceration and weight include a sedentary lifestyle, unhealthy diet, forced smoking cessation, psychotropic medication use and high levels of stress. Incarceration may be an independent risk factor for cardiovascular disease.

Implementation of Dietary Reference Intake Standards in Prison Menus in Poland

Adequate nutrition in prisons should constantly be monitored due to the limited possibilities of external control as well as the low catering budget for prison meals and poorly defined requirements in this regard. The aim of the study was to assess the nutritional value of meals served in Polish prisons. Using a computer program, 14-day regular and bland diets from 30 prisons were analyzed. The energy value of the meals and the percentage of energy provided by protein, fat, and carbohydrate contained therein were found to meet the recommendations of the Polish National Food and Nutrition Institute. The amount of minerals supplied with the diet did not cover the recommended dietary allowance (RDA) in the case of calcium and magnesium. Particularly disturbing was the excessive supply of sodium in the regular and bland diets, which covered 537% and 311% of the dietary reference intake (DRI), respectively, as well as phosphorus (194 and 192% of RDA). The largest vitamin deficiencies were recorded for vitamins D and C and folate. An especially excessive supply was observed for vitamins A and B₁₂. The type of diet significantly differentiated the average content of over half of the analyzed components, whereas the season of the year turned out to be statistically insignificant. The results of the present investigations indicate a need for development of more accurate legal provisions to regulate the nutrition in Polish prisons in terms of not only the energy value and macronutrient supply but also the intake of minerals and vitamins.

How did the tobacco ban increase inmates' body weight during incarceration in Canadian federal penitentiaries? A cohort study

OBJECTIVE

This study aimed to determine how inmates' body weight changed during incarceration in Canadian federal penitentiaries, based on their history of tobacco use. Since tobacco was banned from all Canadian federal penitentiaries in 2008, little is known about the unintended health consequences of this ban, especially on inmates' body weight.

DESIGN

Cohort study.

SETTING

Participants were male and female inmates incarcerated for at least 6 months in Canadian federal penitentiaries. We collected data from 10 institutions in two Canadian regions (Ontario and Atlantic).

PARTICIPANTS

We collected data from 754 inmates who volunteered to participate in the study.

INTERVENTION

This study examined weight change in relation to a history of tobacco use. In 2016-2017, anthropometric data were collected and compared with recorded anthropometric data at the beginning of incarceration (mean follow-up of 5.0±8.3 years). Self-reported data on tobacco and substance use were collected. Weight change was compared between inmates with and without a history of tobacco use.

OUTCOMES

The main outcome measures were body weight change (kg), body mass index (BMI) change (kg/m²), annual weight change (kg/year), and BMI and waist circumference (cm) at the time of the interview.

RESULTS

During incarceration, ex-smokers gained more than twice the amount of weight compared with non-smokers (7.5 kg weight gain for smokers vs 3.7 kg weight gain for non-smokers). Once adjusted for covariates in a regression analysis, for inmates who gained the most weight (75th and 90th percentiles), non-smokers had, respectively, 1.64 and 2.3 lower BMI points than ex-smokers.

CONCLUSIONS

During incarceration in Canadian federal penitentiaries, inmates with a history of tobacco use gained significantly more weight than non-smokers. This put them at increased risk of developing obesity-related health problems. This information is important for the prison setting when planning related programmes and regulation.

Influence of physical activity, screen time and sleep on inmates' body weight during incarceration in Canadian federal penitentiaries: a retrospective cohort study

OBJECTIVE

Recent research found that inmates experience undesirable and rapid weight gain during incarceration in Canadian federal penitentiaries. However, little is known about what factors and daily movement behaviours (e.g., physical activity, screen time, and sleep) influence weight gain during incarceration. This study examines how these 24-h movement/non-movement behaviours contribute to weight gain during incarceration.

METHODS

This retrospective cohort study explored how weight change outcomes during incarceration (weight change, body mass index (BMI) change, and yearly weight gain) were influenced by physical activity, screen time, and sleep in a convenience sample of 754 inmates. The outcome measures were taken twice, once from participants' medical chart at admission and again during a face-to-face follow-up interview (conducted in 2016-2017; mean follow-up time of 5.0 ± 8.3 years). Physical activity, screen time, and sleep were self-reported. The statistical analysis was chi-square testing, non-parametric median comparison testing, and regression analysis to control for confounders.

RESULTS

Inmates who engaged in at least 60 min of daily physical activities gained less weight (4.5 kg) compared to inmates who reported not exercising (8.3 kg). Different types of exercise (cardiovascular exercises, weight lifting, and team sports) were helpful at limiting weight gain, but playing sports was the most effective. Screen time and sleep were not associated with weight gain outcomes.

CONCLUSION

Among the behaviours examined, physical inactivity was significantly associated with higher weight gain during incarceration. However, even high levels of physical activity (> 60 min/day) were not sufficient to eliminate weight gain during incarceration in Canada.