Older people's diet-related beliefs and behaviours: Intervention implications

Dimensions of the diet-exercise relationship in later life: A qualitative study

OBJECTIVE

Diet and physical activity are two lifestyle behaviours that are critical for healthy ageing. The aim of this study was to explore how older adults negotiate dietary and physical activity decisions to identify areas of intersection between these two behaviours and inform health promotion interventions targeting both diet and exercise.

METHODS

This exploratory study utilised a novel data collection approach that involved lay interviewers recruiting their peers to (i) participate in two interviews over a period of six months and (ii) make notes on their thoughts relating to diet and physical activity. Participants were 75 adults aged 60+ years in Western Australia (n = 64 females).

RESULTS

Three primary themes were identified: (i) the importance but difficulty of achieving energy balance; (ii) issues relating to managing food intake before, during, and after physical activity; and (iii) reciprocal opportunities for eating and physical activity.

CONCLUSIONS

Diet and physical activity are linked in complex ways, highlighting the need for multi-factorial interventions.

IMPLICATIONS FOR PUBLIC HEALTH

When developing communications strategies designed to encourage older people to both improve their diets and increase their physical activity, consideration could be given to leveraging existing perceived alignments between healthy eating and being active.

Perspectives on Healthy Eating of Adult Populations in High-Income Countries: A Qualitative Evidence Synthesis

BACKGROUND

Understanding how individuals currently perceive healthy eating is essential for developing food policies and dietary recommendations that improve the health and well-being of populations. The purpose of this qualitative evidence synthesis was to systematically outline the views and understandings of healthy eating, focusing on how foods are classified as healthy and unhealthy and what meanings are attached to food and eating by the general adult population in high-income countries.

METHODS

A systematic search of four electronic databases was conducted and yielded 24 relevant primary qualitative studies of generally healthy, community-dwelling adults.

RESULTS

Thematic synthesis of the included studies identified three analytic themes: constructions of healthy and unhealthy eating, considerations on dietary recommendations, and meanings attached to food and eating. Study participants generally understood what constitutes a healthy and unhealthy diet which was in line with dietary recommendations, but those of lower socioeconomic status exhibited gaps in nutrition knowledge. Participants expressed diverse opinions on dietary recommendations, including skepticism and a lack of trust. Food and eating were associated with various meanings, including pleasure, stress relief, and feelings of guilt. Moral, health, and sociocultural considerations also played a role in dietary behaviors.

CONCLUSIONS

The findings suggest that improving population diet requires considering how dietary recommendations are phrased and communicated to ensure that healthy eating is associated with pleasure and immediate well-being. This review provides valuable insights for developing consumer-oriented, practicable, and acceptable food policies and dietary recommendations that effectively improve population health and well-being.

Optimising an intervention to support home-living older adults at risk of malnutrition: a qualitative study

Background

In the UK, about 14% of community-dwelling adults aged 65 and over are estimated to be at risk of malnutrition. Screening older adults in primary care and treating those at risk may help to reduce malnutrition risk, reduce the resulting need for healthcare use and improve quality of life. Interventions are needed to raise older adults’ risk awareness, offer relevant and meaningful strategies to address risk and support general practices to deliver treatment and support.

Methods

Using the Person-based Approach and input from Patient and Public Involvement representatives, we developed the ‘Eat well, feel well, stay well’ intervention. The intervention was optimised using qualitative data from think aloud and semi-structured process evaluation interviews with 23 and 18 older adults respectively. Positive and negative comments were extracted to inform rapid iterative modifications to support engagement with the intervention. Data were then analysed thematically and final adjustments made, to optimise the meaningfulness of the intervention for the target population.

Results

Participants’ comments were generally positive. This paper focuses predominantly on participants’ negative reactions, to illustrate the changes needed to ensure that intervention materials were optimally relevant and meaningful to older adults. Key factors that undermined engagement included: resistance to the recommended nutritional intake among those with reduced appetite or eating difficulties, particularly frequent eating and high energy options; reluctance to gain weight; and a perception that advice did not align with participants’ specific personal preferences and eating difficulties. We addressed these issues by adjusting the communication of eating goals to be more closely aligned with older adults’ beliefs about good nutrition, and acceptable and feasible eating patterns. We also adjusted the suggested tips and strategies to fit better with older adults’ everyday activities, values and beliefs.

Conclusions

Using iterative qualitative methods facilitated the identification of key behavioural and contextual elements that supported engagement, and issues that undermined older adults’ engagement with intervention content. This informed crucial revisions to the intervention content that enabled us to maximise the meaningfulness, relevance and feasibility of the key messages and suggested strategies to address malnutrition risk, and therefore optimise engagement with the intervention and the behavioural advice it provided.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12875-021-01572-z.

Effects of a physical activity and nutrition program in retirement villages: a cluster randomised controlled trial

Background

This cluster randomised controlled trial aimed to determine if a 6- month home-based intervention could improve the physical activity and dietary behaviours of adults aged 60 to 80 years living in retirement villages located in Perth, Western Australia.

Methods

Participants (n = 363) from 38 retirement villages were recruited into the trial and allocated to the intervention (n = 197: 17 sites) or control (n = 166: 21 sites) group and were blinded. Previously validated instruments-Fat and Fibre Barometer and International Physical Activity Questionnaire, along with anthropometric measures (weight, height, waist and hip circumferences) and blood pressure were collected at baseline and 6 -month time period. Comparisons between intervention and control groups were undertaken pre- and post- intervention using univariate chi-square and t-tests. Multi-level mixed regression analyses were then conducted to ascertain the effects of the intervention on changes in the outcome variables over time and between groups.

Results

A total of 139 (70.5%) intervention and 141 (84.9%) control group participants completed the program and post-test assessments. The intervention group demonstrated significant increases in time (80 min more per week on average) devoted to moderate-intensity physical activity, engagement in strength exercises (from 23.7% to 48.2%), frequency of fruit consumed as well as fat avoidance and fibre intake scores, in addition to a 0.5 kg mean reduction in weight post program, whereas no apparent changes were observed in the control group. Mixed regression results further confirmed statistically significant improvements in weight loss (p < 0.05), engagement in strength exercises (p < 0.001) and fruit intake (p = 0.012) by the intervention participants at post-test relative to their controls.

Conclusions

Retirement offers a time to reassess lifestyle, and adopt positive health enhancing physical activity and dietary behaviours. This intervention was successful in improving weight, engagement in strength exercises, increasing levels of moderate-intensity physical activity and consumption of fruit among retirement village residents. Further investigation is needed on how to better engage retirement village managers in such programs.

Trial registration

Australia and New Zealand Clinical Trial Registry (ACTRN12612001168842) registered November 2, 2012.

Electronic supplementary material

The online version of this article (doi:10.1186/s12966-017-0543-6) contains supplementary material, which is available to authorized users.

Unconscious agendas in the etiology of refractory obesity and the role of hypnosis in their identification and resolution: a new paradigm for weight-management programs or a paradigm revisited?

Hypnosis has long been recognized as an effective tool for producing behavioral change in the eating disorders anorexia and bulimia. Despite many studies from the latter half of the last century suggesting that hypnosis might also be of value in managing obesity situations, the efficacy of hypnotherapy for weight reduction has received surprisingly little formal research attention since 2000. This review presents a brief history of early clinical studies using hypnosis for weight reduction and describes a hypnotherapeutic approach within which a combination of instructional/pedagogic and exploratory therapeutic sessions can work together synergistically to maximize the potential for sustained weight loss. Hypnotic modulation of appetite- and satiation-associated peptides and hormone levels may yield additional physiological benefits in Type 1 and Type 2 diabetes.