Effect of the Holiday Season on Weight Gain: A Narrative Review

Obese-friends club: a gamified virtual quasi-experiment for obesity control in adolescents during the COVID-19 pandemic

Purpose

The COVID-19 pandemic has sparked concerns about weight management because of the changes in population lifestyle. As previous studies suggest, these changes can affect adolescents to a greater degree, especially as schools shut down. Designing a method for weight management that accounts for the specific conditions of the pandemic can help students attend to their physical conditions during the pandemic.

Method

An online gamified peer pressure group on WhatsApp was employed to help 10th-grade boys in a high school in Tehran, Iran. The available sample consisted of 15 main group students and 13 control students. A paired t-test examined the difference between each group's initial and final state as well as the group's final state. Additionally, an ANCOVA test was done to ensure that the observed effect was because of the intervention.

Results

The initial BMI for the intervention group (µ = 30.68, δ = 3.23) and the control group (µ = 29.73, δ = 3.23) were the same (p = 0.468). Two dropouts in the intervention group were found after forty days. A significant difference between the intervention group's steady and final states (p = 0.027) was detected; however, this difference was not significant in the control group (p = 0.634).

Conclusion

Online gamified social groups can play a key role in adolescents' weight management during the COVID-19 pandemic.

Supplementary Information

The online version contains supplementary material available at 10.1007/s40200-023-01340-z.

Cookie cravings - Examining the impact of sugar content information on Christmas treat preferences via mobile eye-tracking

BACKGROUND

Diets high in added sugar can promote the development of overweight. Especially during the Holiday season, when high-sugar food is abundant, people overeat and gain more weight than during other times of the year. The present study with mobile eye-tracking glasses (Pupil Labs Invisible) investigated how sugar content information affects food preference (liking/wanting) and visual attention (where and how long one is looking) in a buffet-like situation.

METHODS

Fifty-eight participants who were well acquainted with the local Christmas traditions and foods (38 female, 19 male, one diverse; mean age = 25 years, SD = 6.3 years; mean body mass index = 22.2 kg/m2, SD = 3.2 kg/m2) were presented with four cookies and two non-food items (wrapped presents) in a free viewing task. Two of the displayed cookies were 'Christmas cookies' (cookies that are traditionally eaten only during the Holiday season) and two cookies had no Christmas association. The cookies were either labeled as cookies made with or without sugar, resulting in a 3 (Category: cookies with sugar, cookies without sugar, non-food) by 2 (Christmas association: yes, no) repeated-measures design.

RESULTS

Analyses of variance indicated that participants reported higher wanting and liking for cookies with sugar, particularly Christmas cookies (interaction effect for wanting: p = .047, ηp2 = .059; interaction effect for liking: p = .017, ηp2 = .084). Sugar-free cookies were fixated more often (p = .028; d = 0.35) and shorter (p < .001; d = 0.64) than sugar cookies.

CONCLUSION

Assuming that cookies are sugar-free reduced the reported preference for this product, which was associated with a more detail-oriented (critical) viewing pattern. The study's findings have potential implications for public health and can aid in developing targeted interventions to promote healthier food choices during festive periods. The new strategies should not focus on the sugar content of foods.

Effect of Christmas Holidays on Type 1 Diabetes Mellitus in Users of Glucose Flash Systems

OBJECTIVE

Christmas holidays can impact weight and glycemic control in type 2 diabetes, but their effect on type 1 diabetes (T1D) remains understudied. This study assessed how Christmas holidays affect individuals with T1D who use flash continuous glucose monitoring systems.

METHODS

This retrospective study involved 812 adults diagnosed with T1D recruited from 3 hospitals. Clinical, anthropometric, and socioeconomic data were collected. Glucose metrics from 14 days before January 1st, and before December 1st and February 1st as control periods, were recorded. Analyses adjusted for multiple variables were conducted to assess the holiday season's impact on glycemic control.

RESULTS

The average time in range during the holidays (60.0 ± 17.2%) was lower compared to December (61.9 ± 17.2%, P < .001) and February (61.7 ± 17.7%, P < .001). Time above range (TAR > 180 mg/dL) was higher during Christmas (35.8 ± 18.2%) compared to December (34.1 ± 18.3%, P < .001) and February (34.2 ± 18.4%, P < .001). Differences were also observed in TAR >250 mg/dL, coefficient of variation, and average glucose (P < .05). No differences were found in time below range or other metrics. Linear regression models showed that the holidays reduced time in range by 1.9% (β = -1.92, P = .005) and increased TAR >180 mg/dL by 1.8% (β = 1.75, P = .016).

CONCLUSION

Christmas holidays are associated with a mild and reversible deterioration in glucose metrics among individuals with T1D using flash continuous glucose monitoring, irrespective of additional influencing factors. These discoveries can be useful to advise individuals with diabetes during the festive season and to recognize potential biases within studies conducted during this timeframe.

Changes in weight status during the COVID-19 pandemic: impact of educational level and mental health

BACKGROUND

The COVID-19 pandemic has resulted in a disruption of daily routines and changes in health behaviors leading to widespread concerns about unfavorable changes in weight status and a potential increase in the prevalence of obesity. This study examined the long-term impact of the COVID-19 pandemic on changes in weight status and its possible dependency on educational level and mental health.

METHODS

The study utilizes the Danish Health and Well-being Survey with repeated self-reported information on weight status collected before the COVID-19 pandemic (autumn of 2019) and twice during the pandemic (autumns of 2020 and 2021). Information on educational level was derived from registers, whereas mental health was measured using validated scales. Generalized estimating equations were performed to investigate changes in mean weight and body mass index (BMI) category (BMI < 30 to BMI ≥ 30) between 2019 and 2021 and to investigate potential differences in changes in weight status by pre-pandemic educational level and mental health.

RESULTS

Mean weight significantly increased by 0.34 kg [95% confidence interval (CI): 0.16-0.51] in 2020 and by 0.46 kg (95% CI: 0.26-0.66) in 2021 compared with pre-pandemic weight status. The increase was greater among individuals with lower educational levels and poorer mental health. There were no significant changes in BMI category during the pandemic.

CONCLUSION

The results showed a significant increase in mean weight among the Danish population, particularly among individuals with lower educational levels and poorer mental health, but without detectable differences in obesity, supporting a long-term but minor impact of the COVID-19 pandemic on weight status.

Implementation and Evaluation of a mHealth-Based Community Health Worker Feedback Loop for Hispanics with and at Risk for Diabetes

BACKGROUND

Gaps in accessibility and communication hinder diabetes care in poor communities. Combining mobile health (mHealth) and community health workers (CHWs) into models to bridge these gaps has great potential but needs evaluation.

OBJECTIVE

To evaluate a mHealth-based, Participant-CHW-Clinician feedback loop in a real-world setting.

DESIGN

Quasi-experimental feasibility study with intervention and usual care (UC) groups.

PARTICIPANTS

A total of 134 participants (n = 67/group) who were all low-income, uninsured Hispanics with or at-risk for type 2 diabetes.

INTERVENTION

A 15-month study with a weekly to semimonthly mHealth Participant-CHW-Clinician feedback loop to identify participant issues and provide participants monthly diabetes education via YouTube.

MAIN MEASURES

We used pre-defined feasibility measures to evaluate our intervention: (a) implementation, the execution of feedback loops to identify and resolve participant issues, and (b) efficacy, intended effects of the program on clinical outcomes (baseline to 15-month HbA1c, systolic blood pressure (SBP), diastolic blood pressure (DBP), and weight changes) for each group and their subgroups (at-risk; with diabetes, including uncontrolled (HbA1c ≥ 7%)).

KEY RESULTS

CHWs identified 433 participant issues (mean = 6.5 ± 5.3) and resolved 91.9% of these. Most issues were related to supplies, 26.3% (n = 114); physical health, 23.1% (n = 100); and medication access, 20.8% (n = 90). Intervention participants significantly improved HbA1c (- 0.51%, p = 0.03); UC did not (- 0.10%, p = 0.76). UC DBP worsened (1.91 mmHg, p < 0.01). Subgroup analyses revealed HbA1c improvements for uncontrolled diabetes (intervention: - 1.59%, p < 0.01; controlled: - 0.72, p = 0.03). Several variables for UC at-risk participants worsened: HbA1c (0.25%, p < 0.01), SBP (4.05 mmHg, p < 0.01), DBP (3.21 mmHg, p = 0.01). There were no other significant changes for either group.

CONCLUSIONS

A novel mHealth-based, Participant-CHW-Clinician feedback loop was associated with improved HbA1c levels and identification and resolution of participant issues. UC individuals had several areas of clinical deterioration, particularly those at-risk for diabetes, which is concerning for progression to diabetes and disease-related complications.

CLINICAL TRIAL

NCT03394456, accessed at https://clinicaltrials.gov/ct2/show/NCT03394456.

Adoption of a Short-Term (4-Week) Vegan Diet as Part of 'Veganuary' Significantly Reduces Saturated Fatty Acid (SFA), Cholesterol, B12, and Iodine Intake in Omnivorous Individuals-An Observational Study

Global veganism campaigns like 'Veganuary' have gained popularity. We conducted an observational study to assess the impact of a 4-week vegan diet during 'Veganuary' on nutrient intake, status, knowledge, and motivations for veganism. Data were collected before and after 'Veganuary', using Food Frequency Questionnaires (FFQs) to estimate dietary intake. Micronutrient knowledge and motivation were assessed through questionnaires. A total of 154 UK adults aged 18-60 years (2019: n81; 2020: n73) participated. Groups were vegetarians and omnivores committed to a 4-week vegan diet during 'Veganuary'. Control groups were vegans and omnivores who did not transition. Short-term vegan diets significantly decreased intake of iodine, B12, cholesterol, and saturated fatty acids (SFAs) in omnivores. Micronutrient knowledge was low, and motivation for veganism varied. Short-term vegan diets reduce macro- and micronutrient intake in omnivores. Veganuary participants could benefit from nutritional guidance or supplementation. Attention is required for UK micronutrient intake and knowledge. Motivations for vegan pledges may influence diets, warranting further research.

Models of body weight and fatness regulation

Body weight and fatness appear to be regulated phenomena. Several different theoretical models are available to capture the essence of this idea. These include the set-point, dynamic equilibrium, adiposity force, control theory-settling point, Hall-Guo, operation point and dual intervention point (DIP) models. The set-point model posits a single reference point around which levels of fat are regulated. The dynamic equilibrium model suggests that the apparent regulation of body fat around a reference point is an illusion owing to the necessary impacts of weight change on energy expenditure. Control theory focuses on the importance of feedback gain and suggests set-point and dynamic equilibrium are ends of a continuum of feedback gain. Control theory models have also been called 'settling point' models. The Hall-Guo, operation point and DIP models also bring together the set-point and dynamic equilibrium ideas into a single framework. The DIP proposes a zone of indifference where dynamic equilibrium 'regulation' predominates, bounded by upper and lower intervention points beyond which physiological mechanisms are activated. The drifty gene hypothesis is an idea explaining where this individual variation in the upper intervention point might come from. We conclude that further experiments to test between the models are sorely required. This article is part of a discussion meeting issue 'Causes of obesity: theories, conjectures and evidence (Part II)'.

Veganism and body weight: An N of 1 self-experiment

The causal effect that veganism has on body weight has not been scientifically examined. An N of 1 self-experiment was conducted in which blinded body weight and additional behavioural and psychological measures were assessed during two phases of vegan vs. non-vegan lifestyle adherence. In study phase 1, body weight change was -0.8 kg over 1 month of veganism (vs. +0.5 kg non-vegan month). In study phase 2, weight change was -1.2 kg over two veganism months (vs. +1.6 kg non-vegan months). Behavioural and psychological measures were similar during vegan vs. non-vegan periods. Veganism appeared to reduce body weight in this N of 1 self-experiment.

Excessive weight gain among preschool children during the COVID-19 lockdown in China: a retrospective observational study

OBJECTIVES

We aimed to analyse weight change and risk factors associated with excessive weight gain in preschool children during the COVID-19-related lockdown in western China.

METHODS

A retrospective observational study of eight randomly selected kindergartens was conducted. Data was collected via online electronic questionnaires during the lockdown.

RESULTS

During the COVID-19 lockdown period, the incidence of overweight and obesity among preschool children involved in the study was 7.6 and 14.7 %, respectively. In addition, the incidence of obesity among children aged 3-4 years was 26.3 %, which was higher than that of other age groups. Children with excessive weight gain (weight gain ≥1.0 kg) spent more time on TV and video viewing during lockdown than children with normal gain. Among children with excessive weight gain, weight before lockdown and fathers' BMI were higher than those of children with normal weight gain. Heavier weight before lockdown (OR 1.044, p<0.05), higher father's BMI (OR 1.022, p<0.05), fresh fruit consumption during lockdown (frequently, ≥5 times/week) (OR 5.946, p<0.05), and long touch-screen device time during lockdown (OR 1.259, p<0.05) were found to be risk factors significantly associated with excessive weight gain. Living space (80-100 m2, OR=0.499, p<0.05; 100-150 m2, OR=0.467, 95 % CI 0.26, 0.83) and good mental behavior during the lockdown (OR=0.056, p<0.05) were found to be significant protective factors against excessive weight gain.

CONCLUSIONS

There was a clear trend in excessive weight gain among preschool children during the COVID-19 lockdown, especially those who had already had heavier weight before the pandemic. The obesity-promoting environment resulting from the COVID-19 pandemic may lead to a further serious exacerbation of the childhood obesity pandemic. Therefore, child health care providers must pay close attention to this and implement effective preventive measures in a timely manner.

Understanding temporal changes and seasonal variations in glycemic trends using wearable data

Seasonal variations in glycemic trends remain largely unstudied despite the growing prevalence of diabetes. To address this gap, our objective is to investigate temporal changes in glycemic trends by analyzing intensively sampled blood glucose data from 137 patients (ages 2 to 76, primarily type 1 diabetes) over the course of 9 months to 4.5 years. From over 91,000 days of continuous glucose monitor data, we found that glycemic control decreases significantly around the holidays, with the largest decline observed on New Year's Day among the patients with already poor glycemic control (i.e., <55% time in the target range). We also observed seasonal variations in glycemic trends, with patients having worse glycemic control in the months of November to February (i.e., mid-fall and winter, in the United States), and better control in the months of April to August (i.e., mid-spring and summer). These insights are critical to inform targeted interventions that can improve diabetes outcomes.

Weekly, Seasonal, and Festive Period Weight Gain Among Australian Adults

Importance

Obesity is a major global health concern. A better understanding of temporal patterns of weight gain will enable the design and implementation of interventions with potential to alter obesity trajectories.

Objective

To describe changes in daily weight across 12 months among Australian adults.

Design, Setting, and Participants

This cohort study conducted between December 1, 2019, and December 31, 2021 in Adelaide, South Australia, involved 375 community-dwelling adults aged 18 to 65 years. Participants wore a fitness tracker and were encouraged to weigh themselves, preferably daily but at least weekly, using a body weight scale. Data were remotely gathered using custom-developed software.

Exposure

Time assessed weekly, seasonally, and at Christmas/New Year and Easter.

Main Outcomes and Measures

Data were visually inspected to assess the overall yearly pattern in weight change. Data were detrended (to remove systematic bias from intraindividual gradual increases or decreases in weight) by calculating a line of best fit for each individual's annual weight change relative to baseline and subtracting this from each participant's weight data. Multilevel mixed-effects linear regression analysis was used to compare weight across days of the week and seasons and at Christmas/New Year and Easter.

Results

Of 375 participants recruited, 368 (mean [SD] age, 40.2 [5.9] years; 209 [56.8%] female; mean [SD] baseline weight, 84.0 [20.5] kg) provided at least 7 days of weight data for inclusion in analyses. Across the 12-month period, participants gained a median of 0.26% body weight (218 g) (range, -29.4% to 24.0%). Weight fluctuated by approximately 0.3% (252 g) each week, with Mondays and Tuesdays being the heaviest days of the week. Relative to Monday, participants' weight gradually decreased from Tuesday, although not significantly so (mean [SE] weight change, 0.01% [0.03%]; P = .83), to Friday (mean [SE] weight change, -0.18% [0.03%]; P < .001) and increased across the weekend to Monday (mean [SE] weight change for Saturday, -0.16% [0.03%]; P < .001; mean [SE] weight change for Sunday, -0.10% [0.03%]; P < .001). Participants' weight increased sharply at Christmas/New Year (mean [SE] increase, 0.65% [0.03%]; z score, 25.30; P < .001) and Easter (mean [SE] weight change, 0.29% [0.02%], z score, 11.51; P < .001). Overall, participants were heaviest in summer (significantly heavier than in all other seasons), were lightest in autumn (mean [SE] weight change relative to summer, -0.47% [0.07%]; P < .001), regained some weight in winter (mean [SE] weight change relative to summer, -0.23% [0.07%]; P = .001), and became lighter in spring (mean [SE] weight change relative to summer, -0.27% [0.07%]; P < .001).

Conclusions and Relevance

In this cohort study of Australian adults with weekly and yearly patterns in weight gain observed across 12 months, high-risk times for weight gain were Christmas/New Year, weekends, and winter, suggesting that temporally targeted weight gain prevention interventions may be warranted.

Evaluating a Telephone and Home Blood Pressure Monitoring Intervention to Improve Blood Pressure Control and Self-Care Behaviors in Adults with Low-Socioeconomic Status

Hypertension (HTN) affects nearly 75 million in the United States, and percentages increase with low socioeconomic status (SES) due to poor access to, and quality of, care, and poor self-care behaviors. Federally Qualified Health Centers (FQHCs) employ evidence-based strategies, such as telehealth interventions, to improve blood pressure (BP) control in under-resourced communities, yet a southeastern FQHC could achieve a BP control rate of only 27.6%, well below the Health People 2020 goal of 61.2%. This pilot project used a pre/post, matched-cohort design to evaluate the effect of a telehealth intervention on BP control and self-care behaviors. Secondary outcomes included self-efficacy and perceived stress. Frequency and percentage, Wilcoxon signed-rank, and McNemar tests were used for statistical analysis of results from a convenience sample of 27 participants. Baseline HTN management guidance that incorporated home blood pressure monitoring (HBPM) was reinforced through telephone counseling every two weeks. Although BP control was not achieved, average scores for systolic and diastolic blood pressures decreased significantly: 13 mm Hg (p = 0.0136) and 5 mm Hg (p = 0.0095), respectively. Statistically significant differences were also seen in select self-care behaviors. Greater BP reduction aligned with higher self-efficacy scores and call engagement. Overall, telephone counseling and HBPM were feasible and effective in reducing BP and increasing self-care behaviors. The inability to control BP may be attributable to under-recognition of stress, lack of medication adherence/reconciliation, and underutilization of guideline-based prescribing recommendations. Findings elucidate the potential effectiveness of a sustainable telehealth intervention to improve BP in low-SES populations.

Supporting Weight Management during COVID-19 (SWiM-C): twelve-month follow-up of a randomised controlled trial of a web-based, ACT-based, guided self-help intervention

OBJECTIVES

We developed a guided self-help intervention (Supporting Weight Management during COVID-19, "SWiM-C") to support adults with overweight or obesity in their weight management during the COVID-19 pandemic. This parallel, two-group trial (ISRCTN12107048) evaluated the effect of SWiM-C on weight and determinants of weight management over twelve months.

METHODS

Participants (≥18 years, body-mass-index ≥25 kg/m²) were randomised to the SWiM-C intervention or to a standard advice group (unblinded). Participants completed online questionnaires at baseline, four months, and twelve months. The primary outcome was change in self-reported weight from baseline to twelve months; secondary outcomes were eating behaviour (uncontrolled eating, emotional eating, cognitive restraint of food intake), experiential avoidance, depression, anxiety, stress, wellbeing and physical activity.

INTERVENTIONS

SWiM-C is based on acceptance and commitment therapy (ACT). Participants had access to an online web platform with 12 weekly modules and email and telephone contact with a trained, non-specialist coach. Standard advice was a leaflet on managing weight and mood during the COVID-19 pandemic.

RESULTS

388 participants were randomised (SWiM-C: n = 192, standard advice: n = 196). The baseline-adjusted difference in weight change between SWiM-C (n = 119) and standard advice (n = 147) was -0.81 kg (95% CI: -2.24 to 0.61 kg). SWiM-C participants reported a reduction in experiential avoidance (-2.45 [scale:10-70], 95% CI: -4.75 to -0.15), uncontrolled eating (-3.36 [scale: 0-100], 95% CI: -5.66 to -1.06), and emotional eating (-4.14 [scale:0-100], 95% CI: -7.25 to -1.02) and an increase in physical activity (8.96 [MET-min/week], 95% CI: 0.29 to 17.62) compared to standard advice participants. We found no evidence of an effect on remaining outcomes. No adverse events/side effects were reported.

CONCLUSIONS

Whilst we were unable to conclude that the intervention had an effect on weight, SWiM-C improved eating behaviours, experiential avoidance and physical activity. Further refinement of the intervention is necessary to ensure meaningful effects on weight prior to implementation in practice.

TRIAL REGISTRATION NUMBER

ISRCTN 12107048.

A Christmas themed physical activity intervention to increase participation in physical activity during Advent: pilot randomised controlled trial

OBJECTIVES

To examine the recruitment, retention, and preliminary effects of a Christmas themed physical activity intervention designed to increase participation in physical activity and decrease sedentary behaviour in inactive adults.

DESIGN

Pilot randomised controlled trial.

SETTING

Recruitment from social medial platforms, workplaces, and community groups in the UK.

PARTICIPANTS

107 inactive adults (who did not meet the UK guidelines for physical activity) aged 18-75 years.

INTERVENTIONS

The intervention consisted of an email sent to participants each day of Advent (1-24 December 2021), which contained a Christmas themed physical activity idea to be completed that day. Each physical activity idea was presented in three intensity formats, including Easy Elf (light intensity), Moderate Mrs Claus (moderate intensity), and Strenuous Santa (vigorous intensity). The comparator group received a leaflet about healthy living on the 1 December.

MAIN OUTCOME MEASURES

Participants were randomly assigned (2:1) to either the intervention or control and were masked to group allocation before randomisation. Primary outcomes were recruitment rate, retention, and weekly minutes of participation in self-reported moderate-to-vigorous intensity physical activity by use of the exercise vital signs questionnaire. Primary analysis compared change in minutes of moderate-to-vigorous intensity physical activity from baseline to weeks one, two, and three during the Active Advent intervention. Secondary outcomes were participation in muscle strengthening based physical activity (days per week), accelerometer measured moderate-to-vigorous intensity physical activity, light intensity physical activity, total physical activity, and sedentary time (minutes per day), and enjoyment of and adherence to the intervention.

RESULTS

323 individuals expressed interest in participating in the trial and 107 were randomly assigned to the intervention (n=71) or the comparator (n=36) group. The recruitment target (n=105) was reached within 19 days of starting recruitment. 23 (21%) of 107 participants were lost to follow-up. On average, the groups reported participation in similar minutes of moderate-to-vigorous intensity physical activity in weeks one and two. At week three, the adjusted mean difference between groups was 20.6 minutes of participation in moderate-to-vigorous intensity physical activity per week (95% confidence interval -29.7 to 70.9) in favour of the intervention group. Accelerometer data showed that the intervention group spent fewer minutes sedentary per day than comparators (mean difference -58.6 (-113.5 to -3.8)). Overall, 42 (70%) of 60 participants in the intervention group reported that they liked the intervention and 41 (69%) of 59 reported that they completed the Active Advent intervention ideas each day.

CONCLUSIONS

The public were interested to participate in a Christmas themed physical activity intervention during Advent, which might increase physical activity and reduce time sedentary. Enjoyment of, and adherence to the intervention shows the potential benefit that Christmas themed physical activity campaigns/initiatives might have for improving public health.

TRIAL REGISTRATION

ISRCTN12415556.

Effect of vacation on urinary symptoms in health care workers: an Italian multicenter study

BACKGROUND

Aim of our study was to assess the impact of vacation on urinary symptoms in health care workers.

METHODS

Between March 2018 to October 2019 a survey was carried out by enrolling health care system workers in three centers. Demographic and clinical characteristics of health care workers (i.e. age, smoking status, medical history) were collected. Lower urinary tract symptoms (LUTS) and work related quality of life were assessed before and after vacation with validated questionnaires: Overactive Bladder Questionnaire Short Form (OABq-sf), International Prostate Symptom Score (IPSS), Work-related Quality of Life (WRQOL) and SF-36 questionnaires. As well, night shift workers (NSWs), defined as working at least one time a week from 8 pm to 8 am, were compared to traditional workers (TWs).

RESULTS

A total of 236 participants (118 males and 118 females) with a median of 41 (32/49 IQR) years old were included in the survey. Healthcare workers presented after vacation an improvement in LUTS, in work related quality of life and overall health. Overall, 89 (37%) were NSWs and 147 (62%) subjects were TWs. NSWs reported a significant higher median OABq Total Score and IPSS than TWs: respectively, 27 (IQR 23-34) vs. 20 (IQR 19-24) P=0.01, 2 (0/6) vs. 0 (0/2) (P<0.01). No significative differences were found for WRQOL and SF36, respectively 66 (IQR 59/77) vs. 67 (IQR 61/82) (P<0.29) and 98 (97/101) vs. 98 (97/100) (P<0.79).

CONCLUSIONS

NSWs present worst urinary symptoms when compared to TWs. Vacation has a beneficial effect, particularly in NSWs, on urinary symptoms and work-related quality of life.

Impact of the first COVID-19 lockdown on body weight: A combined systematic review and a meta-analysis

The coronavirus disease 2019 (COVID-19) and the imposed lockdowns in order to control the pandemic, had undoubtedly influenced the lifestyle of millions of people worldwide. The period of confinement, which was characterized by seizing most business activities and allowing only for e-classes at schools and universities, leading also to a lower physical activity, could have affected eating behaviors of people of all ages. In this study we aimed to investigate the impact of the first lockdown period (March-May 2020) on body weight (BW) and on body mass index (BMI) in both adults and adolescents (>16 years old). A systematic literature search was conducted in PubMed®, Scopus®, Web of Science® and EMBASE® databases and 36 observational (35 cross-sectional and one cohort) studies were included. BW and BMI changes after/during the lockdown period were examined. BW was stated as increased in a significant part of the individuals (11.1-72.4%), although a range of 7.2-51.4% of individuals reported weight loss. A significant higher BW was observed with a weighted mean between-group difference (WMD) 1.57 (95% CI 1.01 to 2.14) in the post-lockdown period compared to the before lockdown time and higher BMI, 0.31 WMD (95% CI, 0.17 to 0.45) was identified before the lockdown period. At variance with general trends, one study in older adults (>60 years old) notably reported a significant BW loss, suggesting a higher risk for lockdown-induced weight loss and potentially malnutrition in the elderly population. Overall increments in BW are an alarming effect of lockdown during the COVID-19 pandemic, leading to potential higher incidence of overweight, obesity and related health-risks as well as other noncommunicable diseases. Further studies are needed to assess potential group-specific impacts, with particular regard to weight gain in younger people and risk of weight loss, malnutrition and sarcopenia in older adults.

Systematic review of the effects of pandemic confinements on body weight and their determinants

Pandemics and subsequent lifestyle restrictions such as ‘lockdowns’ may have unintended consequences, including alterations in body weight. This systematic review assesses the impact of pandemic confinement on body weight and identifies contributory factors. A comprehensive literature search was performed in seven electronic databases and in grey sources from their inception until 1 July 2020 with an update in PubMed and Scopus on 1 February 2021. In total, 2361 unique records were retrieved, of which forty-one studies were identified eligible: one case–control study, fourteen cohort and twenty-six cross-sectional studies (469, 362 total participants). The participants ranged in age from 6 to 86 years. The proportion of female participants ranged from 37 % to 100 %. Pandemic confinements were associated with weight gain in 7·2–72·4 % of participants and weight loss in 11·1–32·0 % of participants. Weight gain ranged from 0·6 (sd 1·3) to 3·0 (sd 2·4) kg, and weight loss ranged from 2·0 (sd 1·4) to 2·9 (sd 1·5) kg. Weight gain occurred predominantly in participants who were already overweight or obese. Associated factors included increased consumption of unhealthy food with changes in physical activity and altered sleep patterns. Weight loss during the pandemic was observed in individuals with previous low weight, and those who ate less and were more physically active before lockdown. Maintaining a stable weight was more difficult in populations with reduced income, particularly in individuals with lower educational attainment. The findings of this systematic review highlight the short-term effects of pandemic confinements.

Combatting Sedentary Behaviors by Delivering Remote Physical Exercise in Children and Adolescents with Obesity in the COVID-19 Era: A Narrative Review

The coexistence of childhood obesity (or its risk) and COVID-19 pandemic put children and adolescents in greater risk to develop respiratory and cardiovascular diseases. In fact, the restrictions introduced to limit the spread of the virus had detrimental effects on various lifestyle components, especially in young population. This resulted in augmented levels of physical inactivity and sedentary behaviors and a reduced time spent in play outdoors or sport practices. Contrariwise, the increased use of technology led clinicians, teachers, and trainers to maintain relations with obese children/adolescents so as to reduce sedentary behaviors and the associated health risks. This narrative review aims to describe the role of Telehealth and Tele-exercise as useful tools in the management of pediatric obesity during COVID-19 pandemic. Telehealth and Tele-exercise were effective in promoting self-monitoring and behavioral changes, including adherence to exercise training programs in children and adolescents. Moreover, tele-exercise platforms such as applications or exergames allowed flexible scheduling, limiting the infection risks.

"You Are Always at War With Yourself" The Perceptions and Beliefs of People With Obesity Regarding Obesity as a Disease

Obesity as a disease remains poorly understood by key stakeholders. Here, in people living with severe obesity, perceptions and beliefs relating to obesity as a disease and obesity causality were examined. Semi-structured interviews were conducted in a tertiary care obesity clinic. 23 people with obesity (10 males, 13 females) volunteered. An overall agreement that obesity is a disease was present. Perceptions related to why obesity is and is not a disease were diverse: Lack of control and addiction, biological determinism, and personal responsibility. For weight loss maintenance, the perceptions and beliefs were heterogeneous with biological factors not considered a determinant of success. Instead, exercise, support, and willpower were described as associated with success. Barriers related to remaining in a weight-reduced state included the following: Emotional eating, sustainability of diet, occupational impact, and defeatism due to misaligned expectation and outcome. In conclusion, people living with obesity tend to agree obesity is a disease yet an incomplete understanding of the disease is present.

Seasonal variation in lifestyle behavior in Poland: Google searches and market sales analysis

Background

Detection of the seasonal patterns of healthy and unhealthy behavior could be helpful for designing individual and population health interventions programs. This study investigates the seasonal variation in sales of common types of products in Poland and Polish Google queries related to healthy behavior.

Methods

Data of index sales from a large Polish retail store franchise, from January 2014 to August 2019, has been analyzed. The commercial data included twelve types of products. The interest of Google users was investigated using Google Trends statistics for the same period for six lifestyle-related topics. The seasonality was checked using time series analysis.

Results

Six of the consumer goods (dairy, ready-made meals, salty snacks, meats, beer, and cigarettes) were most commonly purchased in summer months, four (processed fish, food fats, wine, and alcohol 30%+) in December, and two (bread and sweets) in October. The lowest sales indexes were observed mostly in February. The interest in four topics that have been analyzed (“Diet,” “Dietitian,” “Weight loss,” and “Gym”), was highest in January, while interest in “Dietary supplements” was high in February, and “Running” in May. The search volume of the Google topics were the lowest in December.

Conclusion

The purchase of food, drinks, and cigarettes, and the interest in information regarding different components of a healthy lifestyle has seasonal variation. New Year and Lent might be good periods to encourage healthy behavior. The motivation may decrease in summer and during Christmas.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12889-021-11543-9.

Obesity and responsibility: Is it time to rethink agency?

Despite obesity declared a disease, there still exists considerable weight stigma in both popular culture and health care, which negatively impacts policy making regarding prevention and treatment. While viewed as a choice or a failure of willpower by many, evidence exists to challenge the argument that both weight gain and failure to achieve weight loss maintenance are the individuals' fault due to personal failure or lack of responsibility. In this article, we draw upon literature from obesity treatment, neuroscience, philosophy of mind, and weight stigma to challenge the commonly held beliefs that individuals are free to choose how much they can weigh, and achievement of long-term weight loss maintenance is completely subject to conscious choice. In reality, the regulation of hunger, satiety, energy balance, and body weight takes place in subcortical regions of the brain. Thus, hunger and satiety signals are generated in regions of the brain, which are not associated with conscious experience. This points towards biological determinism of weight and challenges ideas of willpower and resultant moralization regarding body weight regulation. In this article, we will thus argue that in the context of dysregulation of hunger and satiety contributing to the obesity epidemic, a wider discourse related to personal responsibility and the stigma of obesity is needed to enhance understanding, prevention, and treatment of this complex disease. Obesity is a chronic disease requiring personalized treatment. Lifestyle interventions alone may not be enough to achieve medically significant and sustained weight loss for many individuals with obesity. By understanding that obesity is not due to a lack of motivation or willpower, the availability and utilization of additional treatments or combination of treatments such as lifestyle, pharmacotherapy, and surgery are likely to improve the quality of life for many suffering with this disease.

Strategies to manage weight during the holiday season among US adults: A descriptive study from the National Weight Control Registry

BACKGROUND

Holidays are challenging for weight control and are consistently associated with weight gain. Managing holiday weight gain may be especially difficult for individuals with higher body weight or a history of overweight/obesity. The current study evaluated how individuals with a history of successful weight loss plan for the holiday season and how the use of weight control strategies was associated with weight change.

METHODS

A subgroup of participants in the National Weight Control Registry (NWCR) were asked to complete a survey before (November) and after the holidays (January). At pre-holiday, participants reported height, weight, and weight goals for the holiday season (lose, maintain, minimize gains, or gain), and selected the top three weight control strategies they planned to use (from a list of 18). Post-holiday, participants reported weight and how often (frequently, infrequently, or not at all) they used each of the 18 strategies throughout the holidays.

RESULTS

Individuals who completed both surveys were included in the analysis (n = 683; 69% female, 93% white, 54.6 years [SD: 13.2], 26.9 kg/m2 [SD: 5.5]). Pre-holiday, 64% of participants were currently trying to lose weight. Only 35% of the sample wanted to continue losing weight during the holiday season. The most common strategies individuals planned to use during the holiday season were evidence based (maintaining exercise, monitoring portions, tracking foods, and self-weighing). Participants gained 0.66 kg (SD: 1.85) from pre- to post-holiday and reported using an average of 12/18 strategies. A greater number of strategies were associated with less weight gain (F[1, 670] = 4.28, p = 0.04). Daily self-weighing (p = 0.03) and prioritizing food choices (p = 0.02) were individually associated with less weight gain.

DISCUSSION

Participants in the NWCR entered the holiday season with a variety of goals for their weight and used many different strategies to control their weight. Having a wider range of strategies may be helpful to navigate the challenges to weight control during the holidays.

COVID-19-related school closing aggravate obesity and glucose intolerance in pediatric patients with obesity

It is important to pay attention to the indirect effects of the social distancing implemented to prevent the spread of coronavirus disease 2019 (COVID-19) pandemic on children and adolescent health. The aim of the present study was to explore impacts of a reduction in physical activity caused by COVID-19 outbreak in pediatric patients diagnosed with obesity. This study conducted between pre-school closing and school closing period and 90 patients aged between 6- and 18-year-old were included. Comparing the variables between pre-school closing period and school closing period in patients suffering from obesity revealed significant differences in variables related to metabolism such as body weight z-score, body mass index z-score, liver enzymes and lipid profile. We further evaluated the metabolic factors related to obesity. When comparing patients with or without nonalcoholic fatty liver disease (NAFLD), only hemoglobin A1c (HbA1c) was the only difference between the two time points (p < 0.05). We found that reduced physical activity due to school closing during COVID-19 pandemic exacerbated obesity among children and adolescents and negatively affects the HbA1C increase in NAFLD patients compared to non-NAFLD patients.

A community perspective of COVID-19 and obesity in children: Causes and consequences

The pandemic of childhood obesity that has been increasing over the last decade has collided with the current pandemic of COVID-19. Enforced behavioural changes have resulted in a myriad of problems for children particularly in weight management. Restricted activity is the most obvious but many other aspects of life have exacerbated biological, psychosocial, and behavioral factors identified as risks for childhood obesity. Significant effort is required to turn around the prevailing tide of weight gain necessitating changes in personal and family behavior and diet, as well as high-level governmental and educational policy. Evidence-based, focused, long-term interventions which are adequately funded are required. Enthusiasm and optimism for change coupled with public engagement by utilization of new technology as well as traditional methods offers hope for change. Public health interventions in isolation are inadequate and bolder changes to central policies and social structure are needed for sustained change. This will allow some mitigation of the affects of COVID-19 but also reduce negative outcomes in future comparable situations.

Preliminary Results of the Planet Nutrition Program on Obesity Parameters in Mexican Schoolchildren: Pilot Single-School Randomized Controlled Trial

School-based obesity prevention programs are key to promoting healthy habits. The aim of this study was to evaluate the effect of the Planet Nutrition program on BMI z-score and other parameters compared to a control group of Mexican schoolchildren after 9 weeks of intervention. The effect of the summer holidays on the BMI z-score was also evaluated at 23 weeks. A pilot randomized controlled trial design was used and 41 schoolchildren were randomized (21 intervention group and 20 control). The program included 18 nutrition education sessions, 20 physical activity classes and six brochures for parents. At 9 weeks, no significant differences were found between the intervention and control groups in the change in BMI z-score (-0.11, 95% CI -0.23, 0.01). Significant differences were observed in some secondary outcomes: body fat percentage (-1.72, 95% CI -3.42, -0.02), waist circumference (-3.45, 95% CI -5.55, -1.36), physical activity (0.44, 95% CI 0.01, 0.88) and nutrition knowledge (1.15, 95% CI 0.27, 2.03). Summer holidays negatively affected the BMI z-score in both groups, reducing the difference observed between groups at 9 weeks (-0.07, 95% CI -0.22, 0.07). The Planet Nutrition program showed favorable effects in some obesity and lifestyle parameters in the short term.

Annual rhythms in adults' lifestyle and health (ARIA): protocol for a 12-month longitudinal study examining temporal patterns in weight, activity, diet, and wellbeing in Australian adults

BACKGROUND

Almost one in three Australian adults are now obese, and the rate continues to rise. The causes of obesity are multifaceted and include environmental, cultural and lifestyle factors. Emerging evidence suggests there may be temporal patterns in weight gain related, for example, to season and major festivals such as Christmas, potentially due to changes in diet, daily activity patterns or both. The aim of this study is to track the annual rhythm in body weight, 24 h activity patterns, dietary patterns, and wellbeing in a cohort of Australian adults. In addition, through data linkage with a concurrent children's cohort study, we aim to examine whether changes in children's body mass index, activity and diet are related to those of their parents.

METHODS

A community-based sample of 375 parents aged 18 to 65 years old, residing in or near Adelaide, Australia, and who have access to a Bluetooth-enabled mobile device or a computer and home internet, will be recruited. Across a full year, daily activities (minutes of moderate to vigorous physical activity, light physical activity, sedentary behaviour and sleep) will be measured using wrist-worn accelerometry (Fitbit Charge 3). Body weight will be measured daily using Fitbit wifi scales. Self-reported dietary intake (Dietary Questionnaire for Epidemiological Studies V3.2), and psychological wellbeing (WHOQOL-BREF and DASS-21) will be assessed eight times throughout the 12-month period. Annual patterns in weight will be examined using Lowess curves. Associations between changes in weight and changes in activity and diet compositions will be examined using repeated measures multi-level models. The associations between parent's and children's weight, activity and diet will be investigated using multi-level models.

DISCUSSION

Temporal factors, such as day type (weekday or weekend day), cultural celebrations and season, may play a key role in weight gain. The aim is to identify critical opportunities for intervention to assist the prevention of weight gain. Family-based interventions may be an important intervention strategy.

TRIAL REGISTRATION

Australia New Zealand Clinical Trials Registry, identifier ACTRN12619001430123 . Prospectively registered on 16 October 2019.

Changes in Season Affect Body Weight, Physical Activity, Food Intake, and Sleep in Female College Students: A Preliminary Study

The current study examined how body weight and lifestyle fluctuate between spring, autumn, and winter in Japanese female college students and whether weight gain is associated with changes in physical activity, food intake, and sleep. We measured body weight and lifestyle factors in 31 participants from May 2017 to January 2018. Weight was measured daily in participants’ homes. Physical activity and sleep were measured for three weeks in three seasons using two accelerometers. Food intake was assessed using a validated food frequency questionnaire. Body weight significantly decreased in autumn compared with spring (p < 0.001). Body weight in winter tended to increase compared with autumn (p = 0.052). Step counts and energy intake were significantly different between seasons (p < 0.05). Total time in bed was not significantly different between seasons. In comparisons of changes in lifestyle patterns from autumn to winter between the weight gain (≥0.5 kg) and weight maintenance groups, seasonal changes in lifestyle factors were not significantly different between groups (p > 0.05). The results indicated that body weight and lifestyle were affected by seasonal variability in female college students, but no significant relationships existed between seasonal weight gain and changes in lifestyle patterns.

Dietary Cholesterol Exacerbates Statin-Induced Hepatic Toxicity in Syrian Golden Hamsters and in Patients in an Observational Cohort Study

PURPOSE

Statins are inhibitors of 3-hydroxy-3-methyl glutaryl coenzyme A (HMG-CoA) reductase, which is involved in cholesterol synthesis. The major side effects of statins include muscle- and liver-related toxicity. Muscle toxicity is highly associated with polymorphisms in cytochrome P450 proteins (CYPs), as predicted by pharmacogenomics. However, the mechanisms of hepatotoxicity are not well understood. Due to differences in cholesterol metabolism, statins are well tolerated in mice. In contrast, hamsters exhibit metabolic traits similar to humans and are suitable for studying the hepatotoxicity of statins.

METHODS

We investigated the effect of rosuvastatin (RSV) on liver damage in wild-type (WT) hamsters fed a high-cholesterol diet (HCD) and LDLR knockout (LDLR^-/-) hamsters that developed spontaneous hypercholesterolemia. Two cohorts of clinical subjects (clinical registry number: 2017001) taking atorvastatin (ATV) were recruited for direct (assessment of cholesterol intake individually, n = 44) and indirect (celebratory meals/holiday season, n = 1993) examination of dietary cholesterol intake and liver damage, as indicated by elevation of alanine aminotransferase (ALT).

RESULTS

RSV at a dose of 10 mg/kg caused fatal liver damage only in HCD-fed WT hamsters, while LDLR^-/- hamsters with the same cholesterol levels were resistant to this toxic effect. In the human studies, we observed that the incidence of hepatic toxicity in patients receiving long-term ATV treatment was higher in patients with greater dietary cholesterol intake and in patients who consumed more food during Chinese holidays.

CONCLUSION

Our results propose, for the first time, that dietary cholesterol significantly contributes to statin-related hepatotoxicity, providing valuable insight into the clinical use of statins.

Understanding Weight Loss via Online Discussions: Content Analysis of Reddit Posts Using Topic Modeling and Word Clustering Techniques

BACKGROUND

Maintaining a healthy weight can reduce the risk of developing many diseases, including type 2 diabetes, hypertension, and certain types of cancers. Online social media platforms are popular among people seeking social support regarding weight loss and sharing their weight loss experiences, which provides opportunities for learning about weight loss behaviors.

OBJECTIVE

This study aimed to investigate the extent to which the content posted by users in the r/loseit subreddit, an online community for discussing weight loss, and online interactions were associated with their weight loss in terms of the number of replies and votes that these users received.

METHODS

All posts that were published before January 2018 in r/loseit were collected. We focused on users who revealed their start weight, current weight, and goal weight and were active in this online community for at least 30 days. A topic modeling technique and a hierarchical clustering algorithm were used to obtain both global topics and local word semantic clusters. Finally, we used a regression model to learn the association between weight loss and topics, word semantic clusters, and online interactions.

RESULTS

Our data comprised 477,904 posts that were published by 7660 users within a span of 7 years. We identified 25 topics, including food and drinks, calories, exercises, family members and friends, and communication. Our results showed that the start weight (β=.823; P<.001), active days (β=.017; P=.009), and median number of votes (β=.263; P=.02), mentions of exercises (β=.145; P<.001), and nutrition (β=.120; P<.001) were associated with higher weight loss. Users who lost more weight might be motivated by the negative emotions (β=-.098; P<.001) that they experienced before starting the journey of weight loss. In contrast, users who mentioned vacations (β=-.108; P=.005) and payments (β=-.112; P=.001) tended to experience relatively less weight loss. Mentions of family members (β=-.031; P=.03) and employment status (β=-.041; P=.03) were associated with less weight loss as well.

CONCLUSIONS

Our study showed that both online interactions and offline activities were associated with weight loss, suggesting that future interventions based on existing online platforms should focus on both aspects. Our findings suggest that online personal health data can be used to learn about health-related behaviors effectively.

Health risks and potential remedies during prolonged lockdowns for coronavirus disease 2019 (COVID-19)

As coronavirus disease 2019 (COVID-19) pandemic continues, an increasing number of countries and territories are adopting restrictive measures based on physical ("social") distancing, aimed at preventing human-to-human transmission and thereby limiting virus propagation. Nationwide lockdowns, encompassing mass quarantine under stay-at-home ordinances, have already been proven effective to contain the COVID-19 outbreak in some countries. Nevertheless, a prolonged homestay may also be associated with potential side effects, which may jeopardize people's health and thus must be recognized and mitigated in a way without violating local ordinances. Some of the most important undesirable consequences of prolonged homestay such as physical inactivity, weight gain, behavioral addiction disorders, insufficient sunlight exposure and social isolation will be critically addressed in this article, which also aims to provide some tentative recommendations for the alleviation of side effects.

Weekly, seasonal and holiday body weight fluctuation patterns among individuals engaged in a European multi-centre behavioural weight loss maintenance intervention

BACKGROUND

Technological advances in remote monitoring offer new opportunities to quantify body weight patterns in free-living populations. This paper describes body weight fluctuation patterns in response to weekly, holiday (Christmas) and seasonal time periods in a large group of individuals engaged in a weight loss maintenance intervention.

METHODS

Data was collected as part The NoHoW Project which was a pan-European weight loss maintenance trial. Three eligible groups were defined for weekly, holiday and seasonal analyses, resulting in inclusion of 1,421, 1,062 and 1,242 participants, respectively. Relative weight patterns were modelled on a time series following removal of trends and grouped by gender, country, BMI and age.

RESULTS

Within-week fluctuations of 0.35% were observed, characterised by weekend weight gain and weekday reduction which differed between all groups. Over the Christmas period, weight increased by a mean 1.35% and was not fully compensated for in following months, with some differences between countries observed. Seasonal patterns were primarily characterised by the effect of Christmas weight gain and generally not different between groups.

CONCLUSIONS

This evidence may improve current understanding of regular body weight fluctuation patterns and help target future weight management interventions towards periods, and in groups, where weight gain is anticipated.

Change in eating pattern as a contributor to energy intake and weight gain during the winter holiday period in obese adults

Background/Objectives:

The winter holiday season in the US, which spans mid-November to mid-January, contributes to over half of annual body weight gain. Although self-reported data has linked this weight change to both increased energy intake and reduced physical activity, objective techniques have never been used and thus the actual cause of holiday weight gain is controversial. Here, we aimed to determine changes in components of energy balance leading to the holiday weight gain.

Methods:

Body weight change was compared between the pre-holiday (mid-September to mid-November) and the holiday period (mid-November to early January). Total energy expenditure (TEE) was measured using doubly labeled water during holiday time (early to mid-December). Subjective (ratings) and physiological (appetite-regulating hormones) measures of appetite, eating-away-from-home frequency, and incentive salience of food pictures were also evaluated.

Results:

In 23 obese adults (87% female), body weight change during the holidays (0.41 ± 0.42 kg) was significantly higher (P=0.02) than the body weight change during the pre-holiday period (−0.86 kg ± 0.42 kg). The TEE was unchanged during the two periods, suggesting no role of energy expenditure on weight gain. However, participants reported lower satisfaction after a meal pre-load which was significantly correlated with increased body weight during the holiday period. An increase in number of episodes of eating at sit-down restaurants was also reported during that period. Overall, these changing behaviors were supported by a non-significant increase in energy intake (+80 kcal/day, P=0.07) observed during the study holiday period.

Conclusion:

We conclude that a decrease in energy expenditure does not result in the weight increase, but that an increase in food intake is the more likely cause. Our data imply that compromised internal satiety mechanisms in presence of external food cues and diet related behavioral variables during the holidays may influence this weight gain.

Text messaging to help women with overweight or obesity lose weight after childbirth: the intervention adaptation and SMS feasibility RCT

Background

There is a need to develop weight management interventions that fit seamlessly into the busy lives of women during the postpartum period.

Objective

The objective was to develop and pilot-test an evidence- and theory-based intervention, delivered by short message service, which supported weight loss and weight loss maintenance in the postpartum period.

Design

Stage 1 involved the development of a library of short message service messages to support weight loss and weight loss maintenance, with personal and public involvement, focusing on diet and physical activity with embedded behaviour change techniques, and the programming of a short message service platform to allow fully automated intervention delivery. Stage 2 comprised a 12-month, single-centre, two-arm, pilot, randomised controlled trial with an active control.

Setting

This study was set in Northern Ireland; women were recruited via community-based approaches.

Participants

A total of 100 women with overweight or obesity who had given birth in the previous 24 months were recruited.

Interventions

The intervention group received an automated short message service intervention about weight loss and weight loss maintenance for 12 months. The active control group received automated short message service messages about child health and development for 12 months.

Main outcome measures

The main outcomes measured were the feasibility of recruitment and retention, acceptability of the intervention and trial procedures, and evidence of positive indicative effects on weight. Weight, waist circumference and blood pressure were measured by the researchers; participants completed a questionnaire booklet and wore a sealed pedometer for 7 days at baseline, 3, 6, 9 and 12 months. Outcome assessments were collected during home visits and women received a voucher on completion of each of the assessments. Qualitative interviews were conducted with women at 3 and 12 months, to gather feedback on the intervention and active control and the study procedures. Quantitative and qualitative data were used to inform the process evaluation and to assess fidelity, acceptability, dose, reach, recruitment, retention, contamination and context.

Results

The recruitment target of 100 participants was achieved (intervention, n = 51; control, n = 49); the mean age was 32.5 years (standard deviation 4.3 years); 28 (28%) participants had a household income of < £29,999 per annum. Fifteen women became pregnant during the follow-up (intervention, n = 9; control, n = 6) and withdrew from the study for this reason. At the end of the 12-month study, the majority of women remained in the study [85.7% (36/42) in the intervention group and 90.7% (39/43) in the active control group]. The research procedures were well accepted by women. Both groups indicated a high level of satisfaction with the short message service intervention that they were receiving. There was evidence to suggest that the intervention may have a positive effect on weight loss and prevention of weight gain during the postpartum period.

Limitations

The interviews at 3 and 12 months were conducted by the same researchers who collected other outcome data.

Conclusions

An evidence- and theory-based intervention delivered by short message service was successfully developed in conjunction with postpartum women with overweight and obesity. The intervention was acceptable to women and was feasible to implement in the 12-month pilot randomised controlled trial. The progression criteria for a full randomised controlled trial to examine effectiveness and cost-effectiveness were met.

Future work

Some minor refinements need to be made to the intervention and trial procedures based on the findings of the pilot trial in preparation for conducting a full randomised controlled trial.

Trial registration

Current Controlled Trial ISRCTN90393571.

Funding

This project was funded by the National Institute for Health Research (NIHR) Public Health Research programme and will be published in full in Public Health Research; Vol. 8, No. 4. See the NIHR Journals Library website for further project information. The intervention costs were provided by the Public Health Agency, Northern Ireland.

The Relationship Between Feasting Periods and Weight Gain: a Systematic Scoping Review

PURPOSE OF REVIEW

Whilst evidence indicates that weight gain occurs over holidays, the contribution of specific festive periods and celebrations to eating behaviour and weight gain is unclear. We aimed to synthesise literature on how festive periods and celebrations contribute to population weight gain and weight-related outcomes.

RECENT FINDINGS

Thirty-nine studies examining (i) body weight changes, (ii) determinants of eating behaviour or (iii) weight-gain prevention interventions during festive periods were systematically reviewed. Of the 23 observational studies examining changes in body weight during festive periods, 70% found significant increases (mean 0.7 kg). Only four studies investigated exposure to food cues and overeating during these periods, with heterogeneous results. All six intervention studies found that weight gain can be mitigated by self-weighing/self-monitoring and intermittent fasting. Interventions targeting festive periods could have a significant impact on population weight gain. The scalability and sustainability of such interventions require further investigation, as do the broader socioecological factors driving unhealthy eating during festive periods.

Evaluating Ten Top Tips (10TT): Brief Dietary and Physical Activity Counseling in Rural Overweight and Obese Adults

Adults living in rural areas are at greater risk of becoming overweight and obese due to health care disparities. A pre-/postmatched cohort design was used to evaluate a brief weight-loss counseling intervention, Ten Top Tips (10TT), in a rural primary care setting. The rank sum scores for total weight-loss behaviors and the subscales for dietary changes, self-monitoring, physical activity, and psychological coping taken before and 12 weeks after the intervention differed significantly (P = .0001). Ten Top Tips offers rural community clinics an effective weight-loss intervention.

Are the Levels of Lipid Parameters Associated with Biometeorological Conditions?

Lipid disorders, especially hypercholesterolemia, are one of the most thoroughly investigated cardiovascular risk factors. Their correlation with biometeorological conditions has been reported, with authors stressing seasonal increases of total cholesterol (TC) levels, mostly occurring in winter. This study aims at determining the correlation between the level of lipid parameters (LP) and meteorological conditions, analyzing seasonal variations in LP levels, and attempting to answer the following questions: do changes in LP levels result from the organism’s response to cold or heat stress, or are they secondary to seasonal dietary variations? An observational study comprised ambulatory patients from the city of Olsztyn (Poland), for whom laboratory test were performed in 2016–2018, with 106,325 records of TC, high-density lipoprotein (HDL), and triglycerides (TG). LP levels were matched with atmospheric conditions on the day when the test was conducted and expressed by the universal thermal climate index (UTCI). We demonstrated seasonal increases of TC in cold stress (in wintertime) and of TG in heat stress (summer). The analysis of LP levels in specific periods revealed the increase of TC levels after holidays (i.e., Christmas and Easter) in men by 4.56%, and the increase of TG levels in women by 13.46% in the same period. Our results suggest the secondary, diet-dependent underlying cause of the observed changes. This work contributes to the discussion concerning the impact of biometeorological factors on LP levels and may be of significance when planning population-dedicated preventive activities.

Seasonal Variations in the Achievement of Guideline Targets for HbA1c, Blood Pressure, and Cholesterol Among Patients With Type 2 Diabetes: A Nationwide Population-Based Study (ABC Study: JDDM49)

OBJECTIVE

Precise monthly achievement rates for reaching guideline targets for HbA_1c, blood pressure (BP), and lipid levels remain unknown. We evaluated achievement rates on a monthly basis in persons with type 2 diabetes mellitus (T2DM) and explored related factors.

RESEARCH DESIGN AND METHODS

This retrospective study initially analyzed data on 104,601 persons with T2DM throughout Japan. Patients whose HbA_1c, BP, and LDL cholesterol were measured ≥12 times during a 24-month period were included. We evaluated monthly achievement rates. Achieved targets were defined as HbA_1c <7%, BP <130/80 mmHg, and LDL cholesterol <100 mg/dL. Achievement of all targets was expressed as the "all ABC achievement."

RESULTS

A total of 4,678 patients were analyzed. The achievement rates of all ABC, HbA_1c, BP, and LDL cholesterol were lowest in winter, with those for systolic BP (SBP) being particularly low (all ABC, summer 15.6%, winter 9.6%; HbA_1c, 53.1%, 48.9%; SBP, 56.6%, 40.9%; LDL cholesterol, 50.8%, 47.2%). In winter, age ≥65 years (odds ratio 0.47 [95% CI 0.34-0.63]) was independently related to decreased achievement rates for SBP, BMI ≥25 kg/m² (BMI 25-30 kg/m², 0.45 [0.29-0.70]; BMI ≥30 kg/m², 0.35 [0.22-0.57]), and diabetes duration ≥10 years (0.53 [0.37-0.76]) were independently related to lower achievement rates for HbA_1c. Insulin use and sulfonylurea use were independently associated with the decreased all ABC achievement rates in both summer and winter.

CONCLUSIONS

The all ABC achievement rate for guideline targets changed on a monthly basis. Seasonal variations in the all ABC achievement rate should be considered when managing T2DM in ordinary clinical practices.

Can the Easter break induce a long-term break of exercise routines? An analysis of Danish gym data using a regression discontinuity design

OBJECTIVES

Many sedentary individuals are aware of the health benefits of regular physical activity and start becoming more physically active. Yet, despite good intentions, many struggle to keep up initial exercise levels and experience a decline in exercise frequency. A possible explanation is that it is hard to establish habits or routines, and that such routines-once established-might be easy to break. In this paper, we analyse whether a break in habitual/routine behaviour-induced by the Easter holidays-results in individuals exercising less after the break.

METHODS

The study included a sample of 1210 members of a Danish chain of fitness centres who were gym members at least since the preceding New Year's Day. Participants granted access to gym attendance data, which were automatically recorded when entering the gym. We use a regression discontinuity design encompassing a time period of 10 weeks prior to and 10 weeks after Easter.

RESULTS

We found a significant and relevant discretionary drop in exercise frequency right after the Easter holidays of 0.24 times per week (p=0.001) corresponding to a fall of 12.25% compared with the week prior to the Easter holidays. The effect was especially profound for individuals below retirement age and for individuals who had attended the gym with a higher frequency (twice a week or more) in the 6 weeks prior to the Easter break.

DISCUSSION

This information is potentially relevant for helping individuals maintain an exercise habit. Motivational support should focus on the time period after normative breaks, such as Easter or other holidays.

Effectiveness of a brief behavioural intervention to prevent weight gain over the Christmas holiday period: randomised controlled trial

OBJECTIVE

To test the effectiveness of a brief behavioural intervention to prevent weight gain over the Christmas holiday period.

DESIGN

Two group, double blinded randomised controlled trial.

SETTING

Recruitment from workplaces, social media platforms, and schools pre-Christmas 2016 and 2017 in Birmingham, UK.

PARTICIPANTS

272 adults aged 18 years or more with a body mass index of 20 or more: 136 were randomised to a brief behavioural intervention and 136 to a leaflet on healthy living (comparator). Baseline assessments were conducted in November and December with follow-up assessments in January and February (4-8 weeks after baseline).

INTERVENTIONS

The intervention aimed to increase restraint of eating and drinking through regular self weighing and recording of weight and reflection on weight trajectory; providing information on good weight management strategies over the Christmas period; and pictorial information on the physical activity calorie equivalent (PACE) of regularly consumed festive foods and drinks. The goal was to gain no more than 0.5 kg of baseline weight. The comparator group received a leaflet on healthy living.

MAIN OUTCOME MEASURES

The primary outcome was weight at follow-up. The primary analysis compared weight at follow-up between the intervention and comparator arms, adjusting for baseline weight and the stratification variable of attendance at a commercial weight loss programme. Secondary outcomes (recorded at follow-up) were: weight gain of 0.5 kg or less, self reported frequency of self weighing (at least twice weekly versus less than twice weekly), percentage body fat, and cognitive restraint of eating, emotional eating, and uncontrolled eating.

RESULTS

Mean weight change was -0.13 kg (95% confidence interval -0.4 to 0.15) in the intervention group and 0.37 kg (0.12 to 0.62) in the comparator group. The adjusted mean difference in weight (intervention-comparator) was -0.49 kg (95% confidence interval -0.85 to -0.13, P=0.008). The odds ratio for gaining no more than 0.5 kg was non-significant (1.22, 95% confidence interval 0.74 to 2.00, P=0.44).

CONCLUSION

A brief behavioural intervention involving regular self weighing, weight management advice, and information about the amount of physical activity required to expend the calories in festive foods and drinks prevented weight gain over the Christmas holiday period.

TRIAL REGISTRATION

ISRCTN Registry ISRCTN15071781.