Blending Behavioural Theory and Narrative Analysis to Explore the Lived Experience of Obesity and Assess Potential Engagement in a UK Weight Management Service: Theory and Narrative Approaches in Weight Management

BACKGROUND

Current treatments for people with obesity emphasise the need for person-centred approaches that consider complex biopsychosocial factors and value the lived experience of people when attempting to lose weight.

METHODS

Narrative interviews (n = 20) were conducted with people living with obesity to explore the causes of their weight gain and their expectations and engagement with treatment at a Weight Management Clinic. A mixed inductive and deductive qualitative analysis identified utterances that represented psychological constructs used to understand self-appraisal and health behaviour. A narrative analysis was used to situate these findings in the context of a participant's life story.

RESULTS

Locus of control was a dominant construct evidenced through a person's attributional style and self-efficacy. Transcripts represented a heightened sense of self-understanding and shifts in control, and styles of attribution and efficacy resulted in either stasis or self-actualisation. The Stages of Change model could be applied to narratives to ascertain a patient's motivation to access treatment. Importantly, narrative interviews also allowed for the consideration of how a person's systemic context influenced their weight.

CONCLUSION

Narrative interaction supports both self- and shared understandings of the causes and consequences of obesity for individuals, in a non-blaming or shaming manner. It provides an opportunity to enhance engagement through tailored, person-centred treatments.

Predictors of successful return to parkrun for first-time adult participants in Scotland

Physical activity is essential for promoting good health and reducing burdens on healthcare systems. parkrun organise free weekly events where participants complete a 5km route. Studies have identified characteristics of participants associated with lower levels of participation. The aim of the study was to identify predictors of the likelihood of returning to parkrun for first-time adult participants. The return rate of adult first-time participants was determined for all 5km parkrun events in Scotland over a 1-year period from February 2019. The dataset consisted of 20,191 adult participants made up of 11,459 females and 8,732 males across 58 venues. A General Linear Mixed Model was used to identify factors associated with return rate. Return rates were negatively correlated with event size and positively correlated with the proportion of first-time adult participants at the event. Age was positively correlated with return rate and males were more likely to return. New participants that finished in a relatively slow time were disproportionately less likely to return. Return rates were positively correlated with the amount of freshwater and woodland on the route. These findings provide potential opportunities to manage events to enhance their efficacy. Specific events could be promoted as first-timer days to encourage new participants to attend together. New events could be prioritised in proximity to events that currently experience high attendances to reduce attendances locally. As the presence of freshwater and woodland are associated with higher return these habitats could play a role in generating the benefits of green exercise. If so the creation of more routes running through or alongside these habitats could be beneficial. The findings are likely to be widely applicable to other mass participation events and those interesting in understanding the mechanism by which green exercise provides its benefits.

Proposal of a Mathematical Model to Monitor Body Mass over Time in Subjects on a Diet

Nowadays, slimming diet methodology works within a reduction of body mass using a decrease of dietary energy intake. However, there is no suitable method for understanding the dynamic process of body mass metabolic transformation over time. In the present paper, we have developed a biomathematic model to explain the temporal trend of body mass and its variations of people who have undergone a change in their diet using the solving equation of the model. Data relating to sex, age, body mass, and BMI were collected, and the compartmental model used to interpret the body mass trends was constructed by assuming that the mass results from the sum of the metabolic processes: catabolic, anabolic, distributive. The validation of the model was carried out by variance analysis both on the total and individual data sets. The results confirm that the trend of body mass and its variations over time depends on metabolic rates. These are specific to each individual and characterize the distribution of nutritional molecules in the various body districts and the processes catabolic, anabolic, distributive. Body mass and its variations are justified by the metabolic transformations of the nutritional quantities. This would explain why energetically equal diets can correspond to people of different body mass and that energy-different diets can correspond to people of body mass at all similar.

Suitability of random forest analysis for epidemiological research: Exploring sociodemographic and lifestyle-related risk factors of overweight in a cross-sectional design

Aims: Factors that contribute to the development of overweight are numerous and form a complex structure with many unknown interactions and associations. We aimed to explore this structure (i.e. the mutual importance or hierarchy of sociodemographic and lifestyle-related risk factors of being overweight) using a machine-learning technique called random forest (RF). The results were compared with traditional logistic regression (LR) analysis. Methods: The cross-sectional FINRISK 2007 Study included 4757 Finns (aged 25–74 years). Information on participants’ lifestyle and sociodemographic characteristics were collected with questionnaires. Diet was assessed, using a validated food-frequency questionnaire. Height and weight were measured. Participants with a body mass index (BMI) ≥25 kg/m2 were classified as overweight. R-statistical software was used to run RF analysis (‘randomForest’) to derive estimates for variable importance and out-of-bag error, which were compared to a LR model. Results: In total, 704 (32%) men and 1119 (44%) women had normal BMI, whereas 1502 (69%) men and 1432 (57%) women had BMI ≥25. Estimated error rates for the models were similar (RF vs. LR: 42% vs. 40% for men, 38% vs. 35% for women). Both models ranked age, education and physical activity as the most important risk factors for being overweight, but RF ranked macronutrients (carbohydrates and protein) as more important compared to LR. Conclusions: RF did not demonstrate higher power in variable selection compared to LR in our study. The features of RF are more likely to appear beneficial in settings with a larger number of predictors.

Time trends and sex differences in associations between socioeconomic status indicators and overweight-obesity in Mexico (2006-2012)

Background

Although the associations between specific socioeconomic status (SES) indicators and overweight or obesity (OWOB) have been studied in different countries, fewer evidence exists for these associations when multiple SES indicators are considered simultaneously. Furthermore, there are few studies investigating time trends in OWOB and their relation with SES in upper-middle income countries, especially for men. The present study contributes to a better understanding of the nature and evolution of the associations between SES indicators and OWOB in the Mexican adult population.

Methods

We pooled data from the 2006 and 2012 National Health and Nutrition Surveys in Mexico and obtained covariate-adjusted prevalence from a design-based logistic multiple regression model. Covariates included a wealth index, education, occupational status, marital status, and all interactions for each covariate with sex (male/female) and survey year.

Results

For men, the association between wealth and OWOB remained positive in general but curvature was more evident in 2012. The wealth-OWOB association in women showed an inverted-U pattern at both years with a positive slope that turned into a negative one as wealth increased. Among women, OWOB prevalence at the college/university education level was approximately 12.0 ± 2.4 (percentage points ± standard error) lower compared with the elementary education level. We did not find differences between educational categories for men in 2006, but in 2012 OWOB tended to be higher among the more educated. The prevalence of obesity in women increased at wealth levels from the middle and upper-middle section of the wealth distributions. Overall OWOB prevalence was near 70 % in 2012 for both sexes.

Conclusions

Among Mexican women, the associations between SES indicators and excess body weight were consistent to those found in developed countries. Among Mexican men, higher education was not associated with a lower prevalence of OWOB but the positive association between wealth and OWOB weakened as wealth increased. The overall prevalence of OWOB was very high for both sexes; its reduction should remain a public health priority given the consequences of nutrition-related chronic diseases, disability and health care costs.

Electronic supplementary material

The online version of this article (doi:10.1186/s12889-015-2608-2) contains supplementary material, which is available to authorized users.

Obesity-Related Behaviors among Poor Adolescents and Young Adults: Is Social Position Associated with Risk Behaviors?

HighlightsDifferent measures of social position capture unique dimensions of relative rank among youth.Youth-specific measures of social position may be important in identifying the most at-risk for obesity.Lower social status youth are more likely to be at-risk for obesity-related behaviors compared to those with a higher rank. This cross-sectional study examines multiple dimensions of social position in relation to obesity-related behaviors in an adolescent and young adult population. In addition to using conventional measures of social position, including parental education and household expenditures, we explore the usefulness of three youth-specific measures of social position - community and society subjective social status and school dropout status. Data are taken from a 2004 house-to-house survey of urban households within the bottom 20th percentile of income distribution within seven states in Mexico. A total of 5,321 Mexican adolescents, aged 12-22 years, provided information on obesity-related behaviors (e.g., diet, physical activity, sedentary behavior) and indicators of subjective and objective social position. A parent in each household provided information on socioeconomic status of the parent and household. Ordinal logistic regressions are used to estimate the associations of parental, household and adolescent indicators of social position and obesity-related risk behaviors. Those adolescents with the highest odds of adopting obesity risk behaviors were the ones who perceived themselves as lower in social status in reference to their peer community and those who had dropped out of school. We found no significant associations between parental education or household expenditures and obesity-related risk behaviors. Immediate social factors in adolescents' lives may have a strong influence on their health-related behaviors. This study provides evidence for the usefulness of two particular measures, both of which are youth-specific. Adolescents and young adults who have dropped out of school and those with lower perceived relative social position within their community are more likely to be at-risk for obesity-related behaviors than those with higher relative social position. We conclude that youth-specific measures may be important in identifying the most at-risk among relatively homogeneous populations of youth.

Aspects of the built environment associated with obesity in children and adolescents: A narrative review

OBJECTIVE: To perform a narrative literature review to describe the availability of food retailers (groceries and eateries) and their association with obesity in schoolchildren and adolescents. METHODS: The review included studies published from 2003 to 2013 listed in three databases with data on the child's school and/or home surroundings. RESULTS: There was a higher concentration of fast foods near the schools, especially high schools, public schools, or schools located in low-income regions. Moreover, children and adolescents living in areas further from convenience stores had better diets. CONCLUSION: Acknowledging the relationship between built environment and obesity by establishing scientific evidence is necessary for developing specific strategies that help to control the spread of obesity in this age group, aiming to construct healthier spaces.

What are the main barriers to healthy eating among families? A qualitative exploration of perceptions and experiences of Tehranian men

Despite women playing a pivotal role in shaping nutritional patterns in their families, it is the men whose ideas and preferences, after children, influence the selection and consumption of daily foods among Iranian families. This study focused on exploring the main barriers to healthy eating as experienced by male participants of the Tehran Lipid Glucose Study (TLGS). A grounded theory approach was used for analyzing participants' experiences and their perceptions regarding these barriers. Participants were 98 men, aged 25-65 years, selected and recruited from the TGLS cohort. Data collection was conducted through fourteen semi-structured focus group discussions, between 2008 and 2009. All interviews and focus group discussions were audio recorded and transcribed verbatim. Constant comparative analysis of the data was conducted manually according to the Strauss and Corbin analysis method. The most important barriers to healthy eating were: (i) Personal factors, which included two subthemes--lack of knowledge and personal taste, (ii) Communication and modeling included two subthemes--other individuals and media/advertisements; (iii) Modernization included two subthemes--nutrition transition and women's role; and (iv) Lack of access to healthy foods, which included four subthemes--Inadequate confidence, perceived risk, high cost and time limitations. Appropriate attention and prioritized policy-making to modify the socio-environmental barriers to healthy eating were explored in the current study, along with effective educational programs that could help to promote healthy eating among Iranian families.

Association between obesity and selected morbidities: a study of BRICS countries

Objective

Over the past few decades, obesity has reached epidemic proportions, and is a major contributor to the global burden of chronic diseases and disability. There is little evidence on obesity related co-morbidities in BRICS countries. The first objective is to examine the factors associated with overweight and obesity in four of the five BRICS countries (China, India, Russia and South Africa). The second is to examine the linkage of obesity with selected morbidities.

Methods

We used data from the Study on Global Ageing and Adult Health (SAGE) survey conducted by the World Health Organization (WHO) in China, India, Russia and South Africa during 2007–10. The morbidities included in the analysis are Hypertension, Diabetes, Angina, Stroke, Arthritis and Depression.

Findings

The prevalence of obesity was highest in South Africa (35%) followed by Russia (22%), China (5%) and India (3%). The prevalence of obesity was significantly higher in females as compared to males in all the countries. While the wealth quintile was associated with overweight in India and China, engaging in work requiring physical activity was associated with obesity in China and South Africa. Overweight/obesity was positively associated with Hypertension and Diabetes in all the four countries. Obesity was also positively associated with Arthritis and Angina in China, Russia and South Africa. In comparison, overweight/obesity was not associated with Stroke and Depression in any of the four countries.

Conclusion

Obesity was statistically associated with Hypertension, Angina, Diabetes and Arthritis in China, Russia and South Africa. In India, obesity was associated only with Hypertension and Diabetes.

Understanding academic clinicians' varying attitudes toward the treatment of childhood obesity in Canada: a descriptive qualitative approach

BACKGROUND

This qualitative study aims to understand academic physicians' attitudes towards the treatment of pediatric obesity in Canada.

METHODS

A stratified sample of 24 participants (surgeons, pediatricians, family practitioners) were recruited from 4 Canadian regions. Semi-structured interviews were conducted and transcribed. A codebook was developed through iterative data reduction and conceptual saturation ensured. Validity was ensured through triangulation, audit trail, and member-checking.

RESULTS

This study revealed 45 themes with regional, specialty, and experiential differences. Quebec and Ontario emphasized education of physicians and parents to improve treatment and favored surgical intervention. Half of surgeons felt surgery was the only successful treatment option, while non-surgeons favored behavioral interventions. Experienced physicians in Western Canada desired more evidence to improve patient care, while inexperienced physicians focused on early detection and home environments. Across Canada participants advocated for program development and system change. Respondents expressed family involvement as integral to treatment success and shifting away from blame and moving towards a healthy lifestyles approach.

CONCLUSIONS

Canadian regional differences in physicians' attitudes towards pediatric obesity treatment exist, influenced by experience and specialty. We will understand how themes identified in this study influence real life clinical decision making by applying these results to create a discrete choice-based conjoint survey.

Barriers to healthy nutrition: perceptions and experiences of Iranian women

Background

A sound understanding of community perceptions and experiences regarding barriers to a healthy diet is a prerequisite for the design of effective interventions aimed at prevention of diet-related non-communicable diseases (NCDs). This study focused on exploring barriers to healthy nutrition as experienced by women participating in the Tehran Lipid Glucose Study (TLGS).

Methods

A grounded theory approach was used for analyzing the participants’ experiences and their perceptions regarding these barriers. Data collection was conducted through sixteen semi-structured focus group discussions, between 2008 and 2009. Participants were 102 women, aged 25-65 years, selected and recruited from the TGLS cohort. All interviews and focus group discussions were audio recorded and transcribed verbatim. Constant comparative analysis of the data was conducted manually according to the Strauss and Corbin analysis method.

Results

The study revealed that the most important barriers to healthy nutrition were: 1) Interpersonal/cultural effects, 2) Lack of access to healthy foods, and 3) Food preferences.

Conclusions

Understanding these barriers might contribute to existing literature by providing evidence from a different culture, and help design effective preventive strategies, and implement appropriate interventions among Tehranian families.

A review of different behavior modification strategies designed to reduce sedentary screen behaviors in children

Previous research suggests that reducing sedentary screen behaviors may be a strategy for preventing and treating obesity in children. This systematic review describes strategies used in interventions designed to either solely target sedentary screen behaviors or multiple health behaviors, including sedentary screen behaviors. Eighteen studies were included in this paper; eight targeting sedentary screen behaviors only, and ten targeting multiple health behaviors. All studies used behavior modification strategies for reducing sedentary screen behaviors in children (aged 1-12 years). Nine studies only used behavior modification strategies, and nine studies supplemented behavior modification strategies with an electronic device to enhance sedentary screen behaviors reductions. Many interventions (50%) significantly reduced sedentary screen behaviors; however the magnitude of the significant reductions varied greatly (-0.44 to -3.1 h/day) and may have been influenced by the primary focus of the intervention, number of behavior modification strategies used, and other tools used to limit sedentary screen behaviors.

Personal, social and environmental correlates of healthy weight status amongst mothers from socioeconomically disadvantaged neighborhoods: findings from the READI study

BACKGROUND

Socioeconomically disadvantaged mothers are at high risk of obesity, yet the aetiology of obesity in this group remains poorly understood. The aim of this study was to examine the perceived personal, social and physical environmental factors associated with resilience to obesity among mothers from socioeconomically disadvantaged neighbourhoods.

METHODS

Survey data were provided by a cohort of 1840 women aged 18-46 years with dependent children (aged 0-18 years) from 40 urban and 40 rural socioeconomically disadvantaged neighbourhoods across Victoria, Australia. Mothers responded to a number of questions relating to personal, social and environmental influences on their physical activity and eating habits. Mothers' weight status was classified as healthy weight (BMI: 18.5-24.99), overweight (BMI: 25-29.99) or obese (BMI: 30+).

RESULTS

Mothers' weight status was bivariably associated with factors from all three domains (personal, social and physical environmental). In a multivariable model, mothers' perceived ability to make time for healthy eating (OR = 1.34) and physical activity (OR = 1.11) despite family commitments, and the frequency with which families ate healthy low-fat foods with mothers (OR = 1.28) remained significantly positively associated with healthy weight status. The frequency with which families encouraged eating healthy low-fat foods remained negatively associated (OR = 0.81) with weight status; ie greater encouragement was associated with less healthy weight status.

CONCLUSIONS

Drawing on the characteristics of mothers resilient to obesity might assist in developing intervention strategies to help other mothers in socioeconomically disadvantaged neighbourhoods to manage their weight. Such strategies might focus on planning for and prioritising time for healthy eating and physical activity behaviours, and including family members in and encouraging family mealtimes.

Session 5: Nutrition communication Obesity and social marketing: works in progress

Internationally, socio-economic trends reinforce the complex physiological mechanisms that favour positive energy balance, leading to an accumulation of excess body weight and associated metabolic disorders. This so-called ‘obesogenic environment’ is characterised by increasing accessibility and affordability of energy-dense foods and declining levels of physical activity. In the face of such rapidly-rising obesity rates there is general consensus that strategies to address trends in weight gain must go forwards in the absence of complete evidence of cause or effective prevention strategy. Thus, strategy implementation and evaluation must contribute to, as well as be informed by, the evidence base. Social marketing research and practice has a track record that strongly indicates that it can contribute to both the evolving knowledge base on obesity and overweight control policy and the development of effective intervention strategies. Social marketing draws pragmatically on many disciplines to bring about voluntary behaviour change as well as requisite supporting policy and environmental change. Key objectives include: generating insights into the drivers of current behaviour patterns; important barriers to change; client-oriented approaches to new desirable diet and lifestyle choices. Social marketing recognises that target clients have the power to ensure success or failure of obesity control policies. Social marketing seeks to identify genuine exchange of benefits for target adopters of behaviour change and the advocates of change, and how they may be developed and offered within an appropriate relevant context. Social marketing adopts a cyclical approach of learning, strategic development and evaluation, and therefore is well placed to integrate with the multi-disciplinary demands of obesity prevention strategies.

Crenças e influências sobre dietas de emagrecimento entre obesos de baixa renda

A obesidade tornou-se uma epidemia carente de controle imediato, principalmente entre pobres, mulheres e pessoas de baixa escolaridade. A OMS solicita e vários estudos corroboram que estudos esclarecedores sobre os comportamentos psicológicos e sociais interferentes na aderência terapêutica aos regimes devem ser encorajados. Este estudo usou a Teoria da Ação Racional - TAR, de M. Fishbein, em Psicologia Social, e comparou duas séries de entrevistas abertas (em 2001 e 2005) que eliciaram as crenças positivas (vantagens) e negativas (desvantagens) sobre fazer dieta entre obesos de baixa renda de João Pessoa, Paraíba, além dos referentes (pessoas de opinião influente) destes pacientes quanto a segui-la. Os resultados de 2001 foram corroborados em 2005, revelando o medo das doenças relacionadas à obesidade e a vontade de sentir mais saúde e leveza de corpo. Mães, filhos e principalmente o cônjuge aparecem como apoiadores do regime. Ressaltou-se que não bastaria força de vontade, mas também reflexão e construção de habilidades de controle, apropriação e modificação das condições de vida. Preocupações estéticas não foram prioritárias. Estas informações podem fomentar melhores resultados na aderência terapêutica.

How feasible are healthy eating and physical activity for young women?

Objective:

This study investigated young women's perceptions of the feasibility of physical activity and healthy eating behaviours, and how these vary by socio-economic status, domestic characteristics and weight status.

Design:

This population-based study used a mailed questionnaire to investigate perceptions of the feasibility of commonly recommended healthy eating and physical activity behaviours among a sample of young women. The feasibility of 29 physical activity behaviours (e.g. relating to frequency, intensity, duration, domain/setting) and 15 healthy eating behaviours (e.g. relating to location/setting, fruit and vegetable intake, fat/sugar intake) was assessed. Height, weight and sociodemographic details were also obtained.

Setting:

Nation-wide community-based survey.

Subjects:

A total of 445 women aged 18–32 years selected randomly from the Australian electoral roll.

Results:

Most women reported that they either were already engaged in many of the healthy eating behaviours or saw these as highly feasible. Many physical activity behaviours, on the other hand, were perceived as less feasible, particularly among women with children and women who were overweight.

Conclusions:

Health promotion messages and strategies aimed at increasing physical activity and healthy eating are unlikely to succeed unless they take into account perceptions that these behaviours are not feasible. For young women, this may involve promoting more time-effective, flexible ways of achieving recommended physical activity. Messages specifically targeted to women with children, and women who are overweight, are required.

An investigation of psychological, social and environmental correlates of obesity and weight gain in young women

OBJECTIVES

This study explored the biological, psychological, social and environmental correlates of young women's current weight and retrospective 2-year weight change.

METHODS

A total of 790 young women (mean age 26.8 years), sampled from the Australian Longitudinal Study on Women's Health, provided self-reported data on their height and weight, sociodemographics and a range of biological, psychological, social and environmental variables.

RESULTS

Several variables from all domains (biological, psychological, social support and environmental) were correlated with higher body mass index, and less strongly greater 2-year weight change. Key correlates included the tendency to never put on weight, no matter what; self-efficacy for avoiding weight gain, and for healthy eating; attention paid to weight; family support and friends' support/sabotage of physical activity/healthy eating; and perceived difficulty of taking the stairs rather than the elevator as part of the daily routine.

CONCLUSIONS

Intervention strategies aimed at reducing weight gain and obesity may need to focus on social and environmental, as well as psychological factors; however, further research is necessary to confirm these findings given that a number of hypothesized associations were not observed.