UKCO 2015 2nd UK congress on Obesity

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2nd UK Congress on Obesity 2015 Glasgow University Western Infirmary Lecture Theatre, Gilmorehill Campus September 9-11, 2015

UKCO2015

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Contents Welcome Note: Professor Pinki Sahota, Chair, Association for the Study of Obesity General Information Programme Overview Full Programme Social Programme Programme – Early Career Researcher Workshop ASO Best Abstract Award ASO Best Practice Award Sponsors and Exhibitors Poster Presentation List Invited Speaker Presentations and Biographies Member – led Symposia Commercial Symposia Oral Presentation Abstracts Poster Presentation Abstracts

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Welcome Dear Colleagues On behalf of the ASO Board of Trustees I would like to wish you a warm welcome to Glasgow. We would like to welcome you to UKCO2015, the ASO’s main annual meeting of scientists, clinicians and health professionals who work in research, prevention and management of obesity. UKCO2015 is the second meeting that the ASO has organised, following our very successful meeting organised in Birmingham in September 2014. The Congress is designed to support the ASO mission and thereby offers unique opportunities to learn, network, share and exchange understanding about obesity in order to promote activities related to the treatment and prevention of obesity. The programme is action-packed and offers many opportunities to update and expand knowledge around a range of aspects related to obesity. It offers sessions from distinguished leading experts, a range of topical and exciting symposia, oral communications from clinicians, practitioners and early-career researchers.The programme also includes presentations of the Good Practice Award and the Best Abstract Prize. We hope that you will find the programme interesting and the experience of attending rewarding, in terms of networking and developing collaborations. We hope that you will join me in congratulating and thanking the Local Programmes Committee for their hard work in developing an excellent, high quality programme. Glasgow is a vibrant city of culture and we hope that in addition to attending the Congress that you will have an opportunity to enjoy the social activities. We look forward to meeting you, so please do come and join us for dinner and drinks on Thursday evening at Òran Mór where you will be able to experience traditional Ceilidh – Gaelic music and dance. On behalf of the ASO we wish you an excellent UKCO2015 and happy memories of Glasgow!

Professor Pinki Sahota Chair of ASO

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General Information Congress Venue (WILT)

Drinks Reception

The Congress will take place at the Western Infirmary Lecture Theatre (WILT) at Glasgow University. The WILT is situated in the Gilmorehill Campus. Please see the accompanying map of the Gilmorehill Campus for directions. The WILT is marked in red on the map. A convenient taxi drop off point is the Wolfson Medical School on University Avenue marked in yellow on the map.

Hosted by Glasgow Council, this free event takes place on Wednesday 9th from 19.30 - 20.30 at Glasgow City Chambers in George Square. Please ask at the registration desk for directions.

Congress Registration The Registration area is located inside the main entrance of the WILT building. The registration desk will open on Wednesday 9th of September from 11.30 to 13.00 and from 8.00 to 8.30 on the Thursday and Friday. Please ensure you wear your badge at all times during the Congress.

Certificates of Attendance Certificates of Attendance will not be issued at the Congress. They will be provided after the event upon request as a PDF file. Please email ukco@aso.org.uk from Monday September 14th to request a copy.

Chairpersons and Speakers All speakers should have their presentation available on a memory stick so that it can be uploaded onto the provided laptops in each of the lecture rooms. Please ensure that you submit your presentation at least 15 minutes prior to the start of the session. Technical assistance will be available in each of the rooms. We kindly ask that all chairpersons and speakers are available in the relevant lecture room at least ten minutes prior to the start of each session. Please allow 5-10 minutes for audience questions at the end of each session.

Exhibition The exhibition area is located in the main foyer. Visit each stand to get your Exhibitor Visit Card stamped for your chance to win a prize! The Exhibitor Visit Card can be found in your Congress bag. Please return completed cards to the registration desk by Friday 10.30. The lucky winner will be announced on Friday at 12.00 in the main lecture room.

Poster Session The poster session will take place on Thursday in Room 112 from 13.45 to 14.45. We encourage all delegates to attend and vote for the best poster. Poster voting forms can be found in your Congress bag. Please return voting forms to the registration desk by Friday 10.30 for your chance to win a prize. The lucky winner will be announced on Friday at 12.00 in the main lecture room. If you are presenting a poster please check the programme book on page 18 for your poster number. We ask that you hang your poster prior to the session which commences at 13.45. Help and materials will be provided to assist you. Please ensure that you are available to discuss and answer any questions from delegates during the session. If your poster is nominated as ‘best poster’ by delegates you will receive a complimentary registration to UKCO 2016. Best poster will be announced on Friday at 12.00 in the main lecture room.

WiFi Free Wifi will be available in the Congress Venue. Disclaimer: Glasgow University and the ASO will not accept any responsibility for the loss or damage of any property at the Congress.

Delegate Dinner at Oran Mor The delegate dinner takes place on Thursday 10th from 19.30 - 23.00 at Oran Mor. If you do not have a ticket yet, they can be purchased directly from the registration desk at a cost of £40. You will be treated to a traditional Ceilidh - Gaelic music and dance, (participation optional!), whilst enjoying a sumptuous 3 course meal, wine and non-alcoholic drinks. Oran Mor is just a short walk from the congress venue.

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Campus Map

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Programme Overview Wednesday 9th September

Thursday 10th September

08.30 ASO “State of the Science” Symposium New concepts in diabetes and obesity (08.30 - 10.00) Main Auditorium

ASO Symposium Obesity in young adulthood Main Auditorium

Member-led Symposium 2 Weight Stigma Room 112

Oral Abstracts 3 Clinical Research Room 114

10.00

Coffee Break & Exhibition

Coffee Break & Exhibition

10.30

Plenary Lecture 2 (10.30 - 11.15)

Symposia & Oral Abstracts (10.30 - 12.00)

Physical activity and impact on obesity Michael Fogelholm, University of Helsinki Main Auditorium

Symposia & Oral Abstracts (11.15 - 12.45) Weight Watchers Symposium - Diabetes Prevention Main Auditorium

Registration (11.30 - 13.00)

13.00 ASO “State of the Science” Symposium Aging three score years and then, obesity and the aging population (13.00 - 14.30) Main Auditorium

14.30

Coffee Break & Exhibition Plenary Lecture 1 Controlling cortisol in obesity Brian Walker, University of Edinburgh (15.00 - 15.45) Main Auditorium

16.00

Symposia Sessions (15.45 - 17.15)

ASO Symposium Ectopic Fat Main Auditorium

17.00

Member-led Symposium 1 Energy Expenditure Room 112

Oral Abstracts 1 Obesity Practice Room 114

ASO Annual General Meeting (17.15 - 18.15) Main Auditorium

Drinks Reception Glasgow City Chambers (19.30 - 20.30)

Commercial Symposium Slimming World - Emotional Eating Main Auditorium

Member-led Symposium 3 Intermittent Fasting Room 112

Oral Abstracts 4 Clinical Research Room 114

Poster Prize Announcement (12.00 - 12.15)

Oral Abstracts 2 Basic Science Room 114

Plenary Lecture 4 New approaches in obesity research Naveed Sattar, University of Glasgow (12.15 - 13.00) Main Auditorium

Lunch & Exhibition (12.45 - 13.45)

End of Programme

Poster Session (13.45 - 14.45) Room 112

Plenary Lecture 3 Adipocyte function in human obesity Peter Arner, Karolinska Institutet (14.45 - 15.30) Main Auditorium Coffee Break & Exhibition Prize talks: Good Practice Award & Best Abstract Prize (16.00 - 16.30) Main Auditorium Debate: Surgery or diet and lifestyle for who, what and when? Professor Nick Finer, University College London Professor Mike Lean, University of Glasgow Professor Jennifer Beecham, London School of Economics & Political Science (16.30 - 18.00) Main Auditorium

17.30

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Friday 11th September

Social Event Delegate Dinner and Ceilidh at Òran Mór (19.30 - 23.00)

UKCO2015

September 9-11, 2015

Early Career Researcher Workshop sponsored by Cambridge Weight Plan (13.00 – 16.30) Room 114


Full Programme Wednesday 9th September 13.00 – 14.30

ASO “State of the Science” Symposium

Aging three score years and then, obesity and the aging population Chair: Professor Pinki Sahota

13.00

ge associated hormone changes in males: Importance of weight and lifestyle factors. A Dr Tomás Ahern, Christie Hospital, Manchester

13.30

Subclinical thyroid disease, aging, bone and BMI. Professor David Stott, University of Glasgow

14.00

Weighty matters in older people. Professor Alison Avenell, University of Aberdeen

14.30 – 15.00

Coffee Break and Exhibition

15.00 – 15.45

Plenary Lecture 1

Chair: Dr Catherine Hankey

Controlling cortisol in obesity. Professor Brian Walker, University of Edinburgh

15.45 – 17.15

ASO Symposium – Ectopic Fat

15.45

Chair: Dr Dilys Freeman

16.15

Impact of dietary free sugars on liver fat and cardio-metabolic risk. Professor Bruce Griffin, University of Surrey

16.45

Ethnic differences in cardio-metabolic disease risk: Does ectopic fat play a role? Dr Jason Gill, University of Glasgow

15.45 – 17.15

Member-led Symposium – Estimating energy requirements in obesity – latest evidence, BDA Obesity Group (Formerly DOM UK)

Chair: Anna Bell-Higgs

15.45

Pros, cons and feasibility of actual REE measurement in the clinic Angela Madden Phd RD, University of Hertfordshire

15.55

Estimating total and resting energy requirements in obesity – latest evidence Hilda Mulrooney PhD RD, BDA Obesity Group and Kingston University

16.15

Measuring metabolic rates before and after weight loss – latest evidence Michelle Harvie PhD RD, Genesis Breast Cancer Prevention Centre, University Hospital South Manchester

16.25

Implications for practice - Interactive and practical session Angela Madden, Hilda Mulrooney and Michelle Harvie

16.50

Possibilities for the future – Interactive and practical session Angela Madden, Hilda Mulrooney and Michelle Harvie

Main Auditorium

Main Auditorium

Main Auditorium

Reversing type 2 diabetes using very low calorie diet produces long term normoglycaemia Professor Roy Taylor, University of Newcastle

Room 112

Continued >

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Full Programme Wednesday 9th September 15.45 – 17.15

Oral Abstracts – Obesity Practice

Chair: Dr Nicola Heslehurst

15.45

Who is trying to lose weight in England? Changes in dieting behaviours from 1997-2013 Carmen Piernas, University of Oxford

16.00

Development and validation of the Self-Regulation of Eating Behaviour Questionnaire for adults Nathalie Kliemann, University College London

16.15

Development and refinement of the Weight-specific Adolescent Instrument for Economic evaluation (WAItE) Yemi Oluboyede, University of Newcastle

Room 114

16.30 The effect of target setting on weight loss and long term weight management in a community based sample of obese adults Amanda Avery, University of Nottingham 16.45 Comparing weight outcomes in self-referred fee-paying vs primary care referred members of a commercial weight management organisation Liam Morris, Slimming World, Derbyshire 17.00 17.15 – 18.15

What foods are Northern Ireland supermarkets promoting? A content analysis of supermarket online top offers. Ruth Price, Ulster University, Coleraine

ASO Annual General Meeting

Main Auditorium

19.30 – 20.30 Drinks Reception

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Glasgow City Chambers - George Square

UKCO2015

September 9-11, 2015


Full Programme Thursday 10th September 08.30 – 10.00

ASO “State of the Science” Symposium

New concepts in diabetes and obesity Chair: Dr Barbara McGowan

08.30

Weight gain and intensive insulin therapy – What is double diabetes? Professor John Petrie, University of Glasgow

09.00

Metabolic syndrome – A useful label? Professor Edwin Gale, University of Bristol

09.30

Obesity and Type 2 Diabetes – Raising the issue of weight management in primary care. Dr Jennifer Logue, University of Glasgow

10.00 – 10.30

Coffee Break and Exhibition

10.30 – 11.15

Plenary Lecture 2

Chair: Dr Simon Williams

Physical activity and the impact on obesity. Professor Michael Fogelholm, University of Helsinki, Finland

11.15 – 12.45

Oral Abstracts – Basic Science

Chair: Dr Simon Williams

Main Auditorium

Main Auditorium

Room 114

11.15 Inhibition of the pyrophosphate transporter (ANK) enhances intra-cellular lipid accumulation in murine 3T3-L1 preadipocytes. Eleanor Cave, University of the Witwatersrand, Johannesburg, South Africa 11.30 Altered vascular reactivity in adipocyte-specific mineralocorticoid receptor overexpressing mice: role of Rho kinase and redox-sensitive PKG-1. Aurelie Nguyen Dinh Cat, University of Glasgow 11.45 Brown adipose tissue impact on vascular function through an anti-contractile effect and redox-sensitive mechanisms. Malou Friederich-Persson, University of Glasgow 12.00 The association of sedentary behaviour with adiposity-related markers differ in population of White-European, South Asians and Black ethnic background: Findings from 224,395 UK Biobank participants Carlos Celis-Morales, University of Glasgow 12.15 Assessment of the Full and Partial Normalisation of the Metabolic State Within 1-Year Post-Bariatric Surgery in Type 2 Diabetes Mellitus Patients using International Diabetes Federation Criteria Arameh Aghababaie, King’s College Hospital, London 12.30 The potential of Ginkgo biloba extract as an antiobesogenic therapy Bruna Hirata, Universidade Federal de São Paulo, Diadema - SP, Brazil 11.15 – 12.45

Weight Watchers Symposium – Diabetes Prevention

Chair: Dr.Victoria Lawson

11.15

Moving the prevention of type 2 diabetes into public health – Scalable solutions Zoe Griffiths, Head of Public Health, Weight Watchers, UK

11.40

Early outcomes from a Diabetes Prevention Programme Pilot in the UK Dr Agnes Marossy, Bromley Consultant in Public Health; Carolyn Piper, Bromley Public Health Programme Manager

Main Auditorium

12.05 The psychological wellbeing of participants with pre-diabetes prior to attending a Diabetes Prevention Programme Dr Victoria Lawson, independent Chartered Health Psychologist 12.30

The way forward – panel discussion and questions

12.45 – 13.45

Lunch & Exhibition Continued >

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Full Programme Thursday 10th September 13.45 – 14.45

Poster Session

Posters with presenters in attendance

14.45 – 15.30

Plenary Lecture 3

Chair: Dr Dilys Freeman

Adipocyte function in human obesity. Professor Peter Arner, Karolinska Institutet, Stockholm, Sweden

15.30 – 16.00

Coffee Break and Posters

16.00 – 16.30

Abstract Awards

Chair: Dr Maria Bryant

Best Abstract Prize

The effects of partial sleep deprivation on energy intake: A systematic review and meta-analysis. Ms Haya Al Khatib, King’s College London

Room 112

Main Auditorium

Main Auditorium

Good Practice Award Fakenham weight management service and the Norfolk Obesity Network: A multidisciplinary and multiprofessional collaboration. Dr Carly Hughes 16.30 – 18.00

Debate – Surgery or diet and lifestyle for who, what and when?

Moderator: Eleanor Bradford, Health Correspondent, BBC Scotland Commentator: Professor Jennifer Beecham, London School of Economics and Political Science Surgery or diet and lifestyle for who, what and when? Professor Nick Finer, University College London Professor Mike Lean, University of Glasgow

19.30 – 23.00 Social Event

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Delegate Dinner and Ceilidh at Oran Mor

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Main Auditorium


Full Programme Friday 11th September 08.30 – 10.00

ASO Symposium – Obesity in young adulthood

Chair: Dr Claire Llewellyn

08.30

The legacy of the EarlyBird Study. Professor Terry Wilkin, University of Exeter

09.00

Exploring nutritional quality of ‘Out of School’ foods popular with school pupils. Ms Fiona Crawford, Glasgow Centre for Population Health

09.30

Food choice and weight management in adolescents: Strategies for success. Dr Deborah Christie, University College London

08.30 – 10.00

Oral Abstracts - Clinical Research

Chair: Emma Boyland

Main Auditorium

Room 114

08.30 How accurate is internet-based self-reported weight and body mass index in European adults? Evidence from the Food4Me study Carlos Celis-Morales, University of Glasgow 08.45 Comparison of the Eligible Population to Those Being Referred to Glasgow and Clyde Weight Management Services Daniel Slack, University of Glasgow 09.00 The feasibility and acceptability of PhunkyFoods, a primary school-based programme targeting diet and physical activity: A cluster randomised feasibility trial Meaghan Christian, Leeds Beckett University, Leeds 09.15 Maternal Obesity and Gestational Diabetes amongst South Asian and European mothers in an English NHS Region N.A Abd Ghafar, University of Warwick, Coventry 09.30 Effects of replacing diet beverages with water on weight loss in female adults during a 24 week hypoenergetic diet plan. Ameneh Madjd, University of Nottingham 09.45

Exploring GPs experiences of identification and management of childhood obesity. Donna Sager, Stockport, Greater Manchester

08.30 – 10.00

Member Led Symposium 2 – Weight Stigma

Chair: Dr Moira Taylor, University of Nottingham

08.30

Weight bias in ‘conventional’ obesity healthcare and research Dr Judy Swift, University of Nottingham

08.45

Them and us: Disconnects with the ‘critical’ obesity movement Pre-recorded multimedia

09.00

When healthcare professionals and researchers are themselves obese Dr Duane Mellor, University of Nottingham

09.20

Moving forward: What should the priorities be for obesity healthcare and research? Dr Nicola Heslehurst, University of Newcastle

10.00 – 10.30

Coffee Break and Exhibition

Room 112

Continued >

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Full Programme Friday 11th September 10.30 – 12.00

Oral Abstracts – Clinical Research

Chair: Dr Maria Bryant

Room 114

10.30 Associations between clustered cardio-metabolic risk, waist circumference, and dietary glycaemic indices in post-pubertal adolescents. Catherine Kerr, Oxford Brookes University 10.45 Can an ICT-mediated behavioural intervention support weight loss maintenance? The design, development and interim findings of the NULevel randomised controlled trial Elizabeth Evans, Newcastle University 11.00 The Bi-directional Association between Body Mass Index and Sleep duration: The English Longitudinal Study of Ageing Victoria Garfield, University College London 11.15 One-week adherence to a very low calorie diet reduces 24 h heart rate and increases heart rate variability in obese men and women: a randomised controlled pilot study. Wendy Hall, King’s College London 11.30

Study on peri-operative management of type 2 diabetes following bariatric surgery Rahila Bhatti, Guy’s & St Thomas’ Hospital, London

11.45 Weight-lowering efficacy of liraglutide 3.0 mg in overweight and obese adults: the SCALE Obesity and Prediabetes randomised trial Barbara McGowan, Guy’s and St Thomas NHS Foundation Trust, London

10.30 – 12.00

Slimming World Symposium – The role of emotion regulation in weight loss and maintenance

Chair: Judy Swift

10.30

Emotion regulation and weight management overview Dr Marcela Matos

Main Auditorium

11.00 Studies of the mechanisms by which emotion regulation may influence weight loss and maintenance in lifestyle weight management Dr Cristiana Duarte

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11.30

Self-regulation and emotion regulation in weight loss and maintenance including practical implications Professor James Stubbs

10.30 – 12.00

Member Led Symposium 3 – Intermittent fasting

Chair: Michelle Harvie

10.30

The rationale for intermittent fasting and overview of benefits in overweight and normal weight subjects Dr Michelle Harvie, Genesis Prevention Centre, University Hospital, South Manchester

10.50

Fasting and appetite Dr Alex Johnstone, The Rowett Institute of Nutrition and Health

11.10

Intermittent calorie restriction for weight management: A systematic review and meta-analysis Ms Leanne Harris

11.30

Potential metabolic effects of intermittent diets Dr Michelle Harvie, Genesis Prevention Centre, University Hospital, South Manchester

11.45

Panel discussion and questions

12.00 – 12.15

Poster prize announcement – Professor Pinki Sahota

Main Auditorium

12.15 – 13.00

Plenary Lecture 4

Main Auditoriom

Chair: Catherine Hankey

New approaches in obesity research. Professor Naveed Sattar, University of Glasgow

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Room 112


Social Programme Glasgow City Chambers Reception Wednesday 9th September Venue: Glasgow City Chambers, George Square. Take the underground train from Hillhead station on Byres Road and get off at Buchanan Street station. George Square is a short walk away. Time: 19.30 – 21.00 Details: This is a free event hosted by Glasgow Council.

Òran Mór Glasgow City Chambers

Dinner, Drinks and Ceilidh at Òran Mór Thursday 10th September Venue: Òran Mór located at the top of Byres Road, a short walk from the Congress Venue Time: 19.30 – 23.00 Details: Tickets for this event are still available from the Registration desk at £40 each. Join friends and colleagues for dinner, drinks and Ceilidh at this magnificent venue in the heart of Glasgow’s West End. Òran Mór, Gaelic for ‘great melody of life’ or ‘big song’ is Glasgow’s foremost arts and entertainment venue. You will be treated to a traditional Ceilidh - Gaelic music and dance, (participation optional!), whilst enjoying a sumptuous 3 course meal, wine and non-alcoholic drinks.

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Early Career Researcher Workshop Friday 11th September 13.00-16.30 This inaugural Early Career Researcher workshop has been arranged to lay the foundations for an ASO Early Career Researcher Network to be organised by interested researchers. Content is skills based, including sessions for designing interventions, and advice and guidance for securing grant funding, topics requested by ASO early career researchers. ASO would like to thank Cambridge Weight Plan for their generous support in making this workshop possible.

Programme Training topic 13.00 – 13.30

Presenter Lunch

13.30 – 14.40

Tips for successful fellowship funding applications

14.40 – 15.00

Dr Maria Bryant Senior Research Fellow and Diet & Obesity lead, National Institute for Health Research (NIHR) Career Development Fellow, NIHR RDS advisor, Clinical Trials Research Unit, Leeds Institute of Clinical Trials Research, University of Leeds

Upon completion, participants will have a better understanding of the application procedure for fellowships, including where to seek funding, tips for writing the application, the key areas that reviewers are looking for, tips for success and the procedure for applying.

Refreshment break

15.00 – 16.00

Developing interventions

16.00 – 16.30

Objectives

Establishing an Early Career Researchers Network

Professor Pinki Sahota Chair of ASO, Professor of Nutrition and Childhood Obesity, Faculty of Health and Social Sciences, Leeds Beckett University

Mr Euan Woodward Executive Director, European Association for the Study of Obesity

Upon completion, participants will have an awareness of MRC framework for developing and evaluating complex interventions, including an example of the development and evaluation of a theory-based childhood obesity prevention intervention; its evaluation and findings.

Feedback and discussion session to get early career researchers views on setting up a network and the potential formats it could take.

Sessions will use an active and participative approach, including seminar/lecture style presentations, discussion and group work.

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ASO Best Abstract Award Ms Haya Al Khatib Haya Al Khatib is a first year PhD student at the Diabetes & Nutrition Sciences Division at King’s College London. She is currently studying the effects of sleeping patterns on energy balance in human subjects under free-living conditions, under the supervision of Dr. Julia Darzi, Dr. Gerda Pot, and Dr. Scott Harding. She was raised in Kuwait, and completed her BSc in Nutrition Sciences at The Pennsylvania State University – University Park. She then attended King’s College London for her MSc in Nutrition. In her free time, she enjoys reading, travelling, exploring healthy nutritious recipes, and exercising. The effects of partial sleep deprivation on energy intake: A systematic review and meta-analysis. Haya Al Khatib1, Scott Harding1, Gerda Pot1, Julia Darzi1, 1King’s College London, London, UK Throughout the last century, a reduction in sleep duration has been paralleled by a rise in obesity prevalence. However, it remains unclear if reduced sleep is implicated in weight gain, as evidence is conflicting. The objective of this systematic review was to investigate whether a shortened sleep duration (<7 hours of sleep, but not total sleep deprivation) leads to increased energy intake (EI) and changes in macronutrient intake in comparison to habitual sleep.

We systematically searched five databases (Medline, Embase, Cochrane CENTRAL, Web of Science, Scopus) with no language restrictions for intervention trials in adult humans (≥18 years) assessing EI in shortened and habitual sleep. A meta-analysis of extractable data was conducted using random-effects models. After screening 5,843 articles, we identified 10 publications suitable for inclusion. The meta-analysis included nine studies measuring 24-hour dietary intake, of which eight (n=180, 101 M, 79 F) provided extractable data. The remaining study assessed only one meal and was thus not included in the meta-analysis. Shortened sleep duration varied from approximately 4 – 5.5 hours. Most studies were conducted in a laboratory-setting, and only one was entirely free-living. We found EI was significantly higher following shortened compared to habitual sleep: 236 kcal [95% CI 1, 471] (P = 0.05), with moderate heterogeneity (I2 = 52%). Moreover, differences in macronutrient distribution were detected with low heterogeneity (I2 = 0%). Shortened compared to habitual sleep resulted in a significantly higher fat (1.7 %E [95% CI 0.9, 2.4], P < 0.0001) and lower protein (-0.6 %E [95% CI -1.02, -0.18], P = 0.006) intake, with no difference detected for carbohydrate intake (-0.8 %E [95% CI -1.7, 0.1], P = 0.08). Over extended periods of sleep restriction, the accumulated effects of approximately 236 kcal/d increase in EI is likely to result in weight gain in the longer term. This suggests healthy sleep may mitigate overconsumption of energy, and by proxy weight gain. It is unknown if less severe sleep restriction would affect EI in the same manner and if continued sleep deprivation would influence EI in the longer term without compensation. This systematic review is registered in PROSPERO www.crd.york.ac.uk (registration number CRD42014014978).

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ASO Best Practice Award Dr Carly Hughes Dr Carly Hughes developed an interest in nutrition as an undergraduate at Cambridge, working in the Dunn nutrition unit. She has been a GP for 22 years, and since 2009 has run primary care based weight management services. She is an honorary lecturer at the university of East Anglia (UEA) and lectures undergraduates and GP registrars on Obesity related topics. She was a member of the NICE CG 189 obesity guidance update group, and continues to work with NICE in obesity related areas. She is a member of the RCGP GP with interest in nutrition group, and was recently awarded fellowship of the RCGP in recognition of her obesity related work. She did an MSc at the UEA, and is involved in obesity related research. She is a World Obesity Federation (WOF) national SCOPE fellow and East of England regional representative for ASO. Fakenham weight management service and the Norfolk Obesity Network; a multidisciplinary and multi-professional collaboration. Description of the service The Fakenham weight management service (FWMS) is a multidisciplinary Tier 3 service based on NICE CG 43 (2006), NICE CG 189 (2014) guidelines, the National Obesity Forum Toolkit (2006) and complies with the RCS/BOMMS Tier 3 commissioning guidelines. FWMS accepts patients with a BMI >40 kg/m2 or >30 kg/m2 with obesity related comorbidity. Staff include; a bariatric physician, dietitian, specialist nurses, exercise professional, psychological therapist and health trainers. The one year programme delivers evidence based interventions including medical assessment, motivational interviewing to support behaviour change, dietary and activity advice, on-site gym, psychological therapies (individual and group), pharmacotherapy, medically supervised low energy liquid diets and assessment for bariatric surgery. It offers individual monthly appointments with obesity specialist nurses (OSNs) using a structured educational programme. Every patient is discussed at the weekly multidisciplinary team (MDT) meeting after assessment, and then as clinically indicated. Referrals are made to other therapists from the MDT as required, in addition to the monthly appointments. FWMS also offers group interventions for activity and disordered eating, a post-discharge monthly patient support group to enhance weight maintenance, and a patient led Facebook support group. Evaluation The results have been evaluated using the national obesity observatory standard evaluation framework (NOO SEF), all essential data in the NOO SEF is collected plus data on comorbidities, and referrals for Bariatric surgery.

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Results were published in Clinical Obesity Oct 2014 Vol 4 Issue 5 254-265; Evaluation of a multidisciplinary Tier 3 weight management service for adults with morbid obesity, or obesity and comorbidities, based in primary care. A. Jennings, C. A. Hughes, B. Kumaravel, M. O. Bachmann, N. Steel, M. Capehorn and K. Cheema (http://onlinelibrary.wiley.com/doi/10.1111/cob.12066/abstract). Seventy three percent of completers achieved at least 5% weight loss. The mean weight loss was 10.2 kg in completers(BOCF data in article).The dropout rate was 14.3% at 6 months and 45.1% at 1 year, and the DNA rate under 4%. Focus group participants described high levels of satisfaction. FWMS also acts as an education and research hub It offers; • Education for health trainers, nurses and GPs on obesity related topics • Links with the University of East Anglia (UEA) (clinical psychology students are involved in analysing anonymised data)). • Lectures to UEA medical students and GP registrars • Presentations at National conferences • Active involvement in obesity related research • Involvement in designing e-learning modules for both NICE and the RCGP • Co-ordination with ASO and the National Obesity forum Norfolk Obesity Network FWMS also hosts the Norfolk Obesity Network (NON).This group is open to any professional in Norfolk working with adults or children who are obese, and includes public health professionals, GP’s, nurses, health trainers, dietitians, exercise professionals and academics. NON organises a range of regular meetings; • Clinical topics; updated NICE CG 189 guidelines and discussion of post-bariatric follow up protocols • Pathway development of a Norfolk Obesity pathway including Tier 2 and Tier 3 services and public health interventions • Expert lectures ; Professor John Wilding • Joint meetings with other organisations such as the ASO. • A successful partnership with ActiveNorfolk (local provider of activity interventions) has combined NON meetings with their regular physical activity forum meetings, which encourages networking. • Clinical case discussions • Discussion of research ideas It has facilitated the sharing of good practice, and increased the knowledge of local resources in a very efficient and cost-effective manner, and is a model that could be extrapolated to other areas.

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Sponsors and Exhibitors Cambridge Weight Plan Cambridge Weight Plan manufactures formula food products used in total diet replacement regimens providing energy intakes both under 800kcal/d and above 800kcal/d. Collaboration with research scientists has generated gold-standard evidence for effective weight loss and maintenance, safety, improved nutritional status and improved cardiovascular risk status. Programmes can be delivered by trained Cambridge Consultants working in a community setting or by health care professionals and deliver average weight losses of over 10kg of body weight and weight maintenance for up to four years, with improved nutritional status, and health benefits in osteoarthritis, psoriasis, obstructive sleep apnoea and coronary artery disease. www.cambridgeweightplan.com

ECAL is also ideal for use in research and education. Our proprietary software makes review and export of data easy and immediate. ECAL is light and portable, easy to set up and each test only takes 5 minutes, providing opportunities for research outside of the academic department and within the community. In addition, ETS is currently researching a weight management system called METS, utilising ECAL technology. METS, a practitioner led individualised weight programme, combines metabolic assessment, dietetic programming and exercise prescription, particularly beneficial for YOYO dieters and those predisposed to type 2 diabetes. A pilot clinic was established in Australia in 2012. ETS believe METS can be successfully utilised in both public and private health environments. ECAL is a registered medical device with TGA, CE and ISO 13485 certification. www.energytestingsolutions.co.uk

The College of Contemporary Health

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The College of Contemporary Health (CCH) is an innovative education company that provides accredited, flexible, learning for healthcare professionals, in the field of obesity. All CCH courses are offered exclusively online using a specialised learning environment so, no matter how busy our students are with family or work commitments, or where in the world they are based, they can study anytime, anywhere. Our mission is to do all we can to make the UK’s healthcare profession “the most obesity literate in the world.” We provide access to high-quality learning that can be immediately applied in day-to-day interaction with patients. CCH courses are produced under the guidance of a distinguished Academic Advisory Board and the content is developed using the current practice guidelines are taken from relevant professional bodies including Royal College of Physicians, Royal College of Nursing, British Psychological Society, the Academy of Royal Medical Colleges and the National Institute for Health and Care Excellence (NICE). All course material is evidence based and referenced using the latest research material, and comparisons made with the guidelines in other countries to ensure students are acquainted with best practice. www.contemporaryhealth.co.uk

The seca mBCA. Insights from inside out. We have been developing and manufacturing precise measuring systems and scales of the highest quality since 1840. Today seca is the world leader in the field of medical measuring systems and scales. Benchmarks are set when this experience and passion for precision meet body analysis. The result is the seca medical body composition analyser – mBCA. Accurate and reliable data – clinically validated against the scientific gold standard for body composition – MRI, ADP, DEXA, D20, NaBr. Extremely short measuring time. Easy use.

Counterweight Ltd Counterweight Ltd is an organisation providing evidence based weight management solutions for public and private health. A strong history in UK NHS dating back to 2000, Counterweight Ltd was established as a private company in September 2011. Since then we have extended activity from purely NHS to corporate and private health as well as establishing key contracts in Canada, Australia and Ireland. Counterweight programmes are developed, tested and delivered by health care professionals. Counterweight also continues with academic research and programme development for new and emerging markets. www.counterweight.org

For more detailed information or a product demonstration contact seca: 0121 643 9349 or info.uk@seca.com www.seca.co.uk

Slimming World Slimming World is the UK’s most advanced weight management organisation, helping more than 800,000 members lose weight every week in our 13,000 groups around the UK and Ireland, run by a network of 4,000 trained consultants working in their local communities. Each year we influence over 3 million people to eat more healthily and adopt a healthier, more active lifestyle. Working with primary care since 2000, Slimming World pioneered a subsidised referral programme that allows health practitioners to offer patients membership of one of our weekly support groups. Our symposium Slimming World will be holding a symposium to review and report new insights into the role of self-regulation and emotion regulation in the control of eating behaviour and their implications for weight management at 10.30am on Friday, in the main auditorium. www.slimmingworld.co.uk/health

Weight Watchers International, Inc

Energy Testing Solutions Ltd Energy Testing Solutions Ltd, an integrated technology and health informatics company, develops long-term metabolic health solutions. Our lead technology ECAL, a small, portable, open circuit indirect calorimeter, was initially designed for primary practitioners treating various metabolic disorders such as obesity, insulin resistance and chronic fatigue.

Weight Watchers International, Inc is the world’s leading provider of healthy weight management services. Since 2005 Weight Watchers have provided weight loss services to over 100 public sector health organisations; a partnership model proven to be a cost effective, scalable and sustainable weight management solution that delivers medically significant weight loss. Weight Watchers has developed a diabetes prevention programme (DPP) in line with NICE guidance, which has RCT evidence underpinning its efficacy and is currently being rolled out across the country. www.weightwatchers.co.uk

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September 9-11, 2015

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Poster Presentations Posters are listed by alphabetical order of the presenter

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Evaluation of weight management interventions in Glasgow and Clyde Weight Management Service patients Nasser Aldekhail

02 Body composition and Energy Expenditure with Total Diet Replacement during weight loss and maintenance (BEYOND): study protocol Yasmin Algindan 03

Effects of an erratic versus a regular eating pattern on appetite regulation in healthy lean women Maha Alhussain

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Erratic meal pattern and carbohydrate metabolism Maha Alhussain

05

Evaluation of childhood obesity assessments in secondary care paediatric clinic M Rashida Begum

06 Disclosure of genetic-based personalised nutrition advice promotes bigger changes in obesity-related markers in risk carriers compared with non-risk carriers of the FTO obesity gene in the Food4Me study Carlos Celis-Morales 07 Physical activity attenuates the influence of FTO genotype on obesity-related traits in European Adults: the Food4Me study Carlos Celis-Morales 08

Prevalence and correlates of obesity in Chile: Cross-sectional findings from the National Health Survey 2009-10 Carlos Celis-Morales

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Weight Management Portfolio: the right programme, for the right patient, at the right time Anne Clarke

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Food-seeking strategies under conditions of scarcity: An experimental model Timothy Davies

11 Greater initial weight loss and increased attendance at LighterLife management groups predicts improved weight maintenance 1 year after completing a VLCD weight loss programme Elizabeth Evans 12

Metabolic changes post laproscopic gastric band insertion Camilla Gordon

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Engagement with on-line programmes to prevent weight gain in young adults Catherine Hankey

14 Visceral adipose tissue in pre-eclampsia is associated with increased activated macrophages and inflammatory adipokine release Shahzya Huda 15 Evaluation of a Primary Care Tier 3 Weight Management Programme: Impact of additional individual psychological input compared with standard care Carly Hughes 16 Why do adults with obesity and intellectual disabilities seek weight loss and do their views differ from those of their carers? Nathalie Jones 17

Obesity as an important cardiovascular risk factor among Punjabi population Manpreet Kaur

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Development and validation of the General Nutrition Knowledge Questionnaire-Revised for adults Nathalie Kliemann

19 The impact of gastrointestinal adverse events on weight loss with liraglutide 3.0 mg as adjunct to a diet and exercise programme Mike Lean 20

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Diabetes Remission Clinical Trial (DiRECT): protocol for cluster randomised controlled trial Wilma Leslie

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September 9-11, 2015


Poster Presentations 21 Effects of daily consumption of probiotic versus low fat conventional yogurt on weight loss in healthy obese female adults on an energy restricted diet (NovinDiet Protocol) Ameneh Madjd 22

Is obesity a determinant of paediatric foot dimensions? David McCarthy

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Evaluation of AlmasedÂŽ meal replacement on weight loss and glycaemia in patients with type 2 diabetes David McCarthy

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School Meals Policy in Perspective: Assessing the impact of legislation on child malnourishment from 1908 to 2010 Victoria McGowan

25 Efficacy and safety of liraglutide 3.0 mg in adult overweight and obese weight loss responders without diabetes: results of the 56-week randomised, controlled, SCALE Obesity and Prediabetes tria Barbara McGowan 26

The usefulness of a very-low-calorie diet (VLCD) for women with Polycystic Ovary Syndrome (PCOS) John S McKenzie

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Slimming World on Referral: longer term attendance and weight outcomes Liam Morris

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Evaluation of Dietary Management in a Scottish Paediatric Tier 3 Weight Management Pilot Service Jillian Morrison

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Learning Lessons From Patient Involvement In Bariatric Surgery Jane Munro

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Obesity Knowledge amongst Final Year Medical Students in Norway Anette Norsett-Carr

31 Does intermittent energy restriction have different effects on ectopic fat and insulin resistance to continuous (daily) energy restriction? Mary Pegington 32 A systematic review of qualitative research into the facilitators and barriers to weight loss within a weight management programme Daniel Slack 33

BMI and cognitive restraint influence the scheduling of food rewards in healthy female students Laura-Jean Stokes

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Socio-economic deprivation predicts engagement in a community based weight loss programme Tom Steele

35

Maternal HDL and uterine artery function Wan Noraini Wan Sulaiman

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Outcomes of a childhood evidence based weight management programme in practice Laura Stewart

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Healthy Weight Programme for Overweight and Obese Adolescents: a feasibility study Chuluuntulga Tuya

38 Factors affecting engagement and retention in a community-based, weight management intervention: a qualitative study of participant experience of Get Moving with Counterweight in Scotland, UK Kath Williamson

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Speaker Presentation Summaries and Biographies Dr Tomás Ahern, Christie Hospital, Manchester Tomás Ahern completed an obesity fellowship with Professor Donal O’Shea in Dublin, Ireland. I went on to conduct a PhD ascertaining the links between hormones with physical function and with inflammation in people with severe obesity. Thereafter I worked with Professor Frederick Wu as a reproductive endocrinology fellow in Manchester. I work currently as a consultant endocrinologist at The Christie in Manchester. I have published on novel uses of incretin therapies, on the association between steroid hormone levels with physical function in people with severe obesity and on the risk factors and consequences of hypogonadism in European men. Age associated hormone changes in males: Importance of weight and lifestyle factors. The European Male Ageing Study recruited 3,369 community dwelling men aged 40-79 years from 8 centres in Europe. Participants were followed for a median of 4.3 years. A threshold and syndromic relationship was found between sexual symptoms with a total testosterone level of less than 11 nmol/L and with a free testosterone level of less than 220 pmol/L. Men with both sexual symptoms and low testosterone (late-onset hypogonadism, LOH) have increased mortality due mainly to cardiovascular disease. Longitudinal data suggest that risk factors for LOH include obesity and smoking. Men with LOH experience a greater reduction in physical function, cognitive function and mood and are more likely to develop chronic illness. Weight loss appears to increase the chance of recovery from hypogonadism.

Professor Peter Arner, Karolinska Institutet, Sweden Peter Arner is a specialist in Internal Medicine and Endocrinology at Karolinska University Hospital and Distinguished Professor at Karolinska Institutet, Stockholm, Sweden. He heads Lipid Laboratory at the hospital/university, which is devoted to clinical and experimental research on metabolic diseases, in particular obesity, insulin resistance and type 2 diabetes. He is also deputy chairman of the large diabetes research program at the university. His own work is mainly focused on the regulation of human adipose tissue and the role of this tissue in metabolic disorders. Peter Arner has published over 400 original research paper in the field and is cited almost 40,000 times and is one of the worlds most cited scientist in obesity research according to ISI (www.esi-topics.com/obesity). His H-index is 100. Peter Arner had obtained numerous national and international awards in obesity and type 2 diabetes. His current research activities mainly concern the regulation and pathophysiological role of the turnover of human fat cells and their lipid content as well as the role of human adipose tissue in insulin resistance. Adipocyte function in human obesity. It has become increasingly evident that adipose tissue plays an important pathophysiological role in common endocrine and metabolic disorders. This concerns both its role in energy metabolism reflected as storage and release of fatty acids from fat cells and its endocrine role in form of releasing signal proteins to the circulation (so called adipokines) that act in non-adipose organs. Due to species differences in adipose tissue regulation it is clinically important to study humans. The human fat cell was previously thought to be rather static in adult life. However, recent studies suggest that the turnover of fat cells and their lipids is highly dynamic throughout adulthood. These turnover rates are markedly altered in conditions of excess body fat, insulin resistance and common as well as genetic forms of dyslipidemia. Of particular importance is the role of adipocyte turnover for development of a pernicious form of human adipose tissue morphology termed hypertrophy (few but large fat cells), which occurs in lean as well as overweight or obese individuals. Several factors of importance for the regulation of adipocyte and adipocyte lipid turnover in man have been identified including key genes and local inflammatory proteins, in particular tumor necrosis factor alpha.

Professor Alison Avenell, University of Aberdeen Alison Avenell has a Clinical Chair in Health Services Research at the Health Services Research Unit, University of Aberdeen, and is Honorary Consultant in Clinical Biochemistry in NHS Grampian. She runs secondary care diabetic clinics for patients with type 2 diabetes and has previously worked in a specialist weight management service in the NHS. She researches the evidence base for nutrition interventions (particularly for older people) and adult weight management, by undertaking systematic reviews and randomised trials. She had undertaken systematic reviews on group-based approaches to obesity, the use of individual financial incentives for weight loss, strategies for weight maintenance, and interventions for weight management in older people with obesity. She most recently led the NIHR funded ROMEO project (Review Of weight management for MEn with Obesity), which led to guidance on weight management for men from Public Health England. Weighty matters in older people. Intentional weight loss for older people with obesity is controversial, because of the so called ‘obesity paradox’, particularly for cardiac disease, where overweight or lower levels of obesity are associated with improved survival. BMI is less reliable in older people, and waist circumference may be a better measure of risk. Long-term randomised trial evidence suggests that deliberate weight loss in older people can improve mobility, reduce pain from arthritis, improve quality of life, reduce the risk of developing type 2 diabetes, reduce cognitive decline, reduce sleep apnoea, and improve cardiovascular risk factors. Large trials which have examined interventions for weight loss and have included obese older people generally show that they do as well, if not better than middle-aged adults. Interventions should include strategies to improve both diet and physical activity, and need to be tailored to issues such as accessibility, pain and mobility limitations, as well as dietary preferences. Physical activity (aerobic exercise, resistance training, flexibility and balance training) is particularly important to help mitigate the consequences of weight loss on muscle mass and bone. However, some trials with physical activity have found an increased risk of injury and bone marrow lesions near joints with osteoarthritis.

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Speaker Presentation Summaries and Biographies Professor Jennifer Beecham, London School of Economics & Political Science Jennifer Beecham is Professor of Health and Social Care Economics at the Personal Social Services Research Unit, which is based at the London School of Economics and Political Science, and the University of Kent. Over nearly 30 years Professor Beecham’s research has included studies, mainly taking economic perspective, related to services for adults and children with needs related to mental health, intellectual disabilities, eating disorders, and old age. Professor Beecham leads two research programmes at PSSRU; the Unit Cost Programme and the Children and Young People’s Services Programme. She is also currently working on the economic study of Big Lottery Fund ‘A Better Start’ initiative which supports preventative services for very young children. More information on Professor Beecham’s research can be found here: www.pssru.ac.uk/people-profile.php?id=1

Dr Deborah Christie, University College London Dr Christie is consultant clinical psychologist and reader in paediatric and adolescent psychology and clinical lead for paediatric and adolescent psychology at UCLH. Awarded Obesity Best Practice award for the Healthy Eating Lifestyle Programme (HELP), Carlotta Simons Award in Adolescent Health, Outstanding Scientific Achievement in Clinical Health Psychology and Adele Hoffman visiting professorship in adolescent health and medicine. An international presenter and trainer in motivational and solution focused therapies she works with multidisciplinary teams to communicate effectively with families living with chronic illness. Has published over 100 papers and chapters and co-editor of bestselling book Psychosocial aspects of diabetes in children, adolescents and families. Currently looking at decision making processes in bariatric surgery in adolescents and using mindfulness in chronic illness. Food choice and weight management in adolescents: Strategies for success. The presentation will review recent lifestyle interventions for children and adolescents with obesity. The challenges designing and delivering effective interventions will be reviewed. The need for effective multidisciplinary interventions targeted at the correct groups will be discussed.

Ms Fiona Crawford, Glasgow Centre for Population Health Fiona Crawford is a Consultant in Public Health (early years/child public health) working across NHS Greater Glasgow and Clyde and the Glasgow Centre for Population Health. Her role is to improve the health of babies and children and to address inequalities in their health and quality of life. Her research portfolio includes exploring the influence of food environments and policy on healthy eating among children/young people; trends, patterns and inequalities in the health impacts of transport and travel; and evaluation of parenting/nurture programmes on child development and readiness to learn. Fiona is a Fellow of the Faculty of Public Health, and an Honorary Senior Lecturer in the University of Glasgow. Exploring Nutritional Quality of ‘Out of School’ Foods Popular with School Pupils Authors: 1Fiona Crawford, 2Anne Ellaway, 3Dionne Mackison, 4John Mooney 1 Glasgow Centre for Population Health 2MRC Social and Public Health Sciences Unit 3University of Stirling 4Scottish Collaboration for Public Health Research and Policy

Healthy school food policy has an important role to play in providing and promoting healthy eating amongst children and young people during the school day but many Scottish pupils purchase lunchtime food off-site. This study compared popular offsite lunchtime food quality against the Scottish Nutrient Standards for school lunches. Food outlets in 5 study areas near secondary schools were mapped using GIS software. Observational data were gathered during one school lunchtime on characteristics of popular outlets and pupil purchasing behaviour. 45 popular savoury food items were purchased and analysed to compare key nutrients with statutory Scottish Nutrient Standards. There were diverse numbers and types of outlets present in study areas. Many outlets used marketing strategies to attract pupils. Most popular purchases contained chips. Half of the samples analysed exceeded recommended energy levels; over a half exceeded recommended fat levels; over a third exceeded recommended salt levels. Conclusions were that many secondary pupils who eat offsite at lunchtime buy unhealthy convenience food. School based initiatives to promote healthy eating may be ineffective if the external commercial environment permits unlimited access to unhealthy food offsite. Given concerns regarding childhood obesity, fiscal and regulatory measures are needed as well as education and health promotion.

Professor Nick Finer, University College Hospital, London Professor Finer is a Consultant Endocrinologist and Bariatric Physician at University College Hospital, London, and Honorary Professor in the National Centre for Cardiovascular Preventions and Outcomes within the Institute of Cardiovascular Science at University College London. Finer chairs World Obesity - Clinical Care (formerly IASO EMTF), is past-chair of the UK Association for the Study of Obesity. Finer co-authored the recent Royal College of Physicians report ‘Action on obesity: comprehensive care for all’, and is a member of the UK Government Advisory Group on Obesity, the Clinical Reference Group that advises NHS England on commissioning of specialist obesity services, and the NICE Public Health Advisory Group. Prof Finer is editor-in-chief of Clinical Obesity.

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September 9-11, 2015

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Speaker Presentation Summaries and Biographies Professor Michael Fogelholm, University of Helsinki, Finland Mikael Fogelholm has been a full professor in Public Health Nutrition since 2011. Before this, he worked as the director of Health Research Unit at the Academy of Finland (2007—2011) and as the director of the UKK Institute for Health Promotion Research, Tampere, Finland (2001—2007). His research interest has focused on the interplay between physical activity, diet and obesity, with mostly epidemiological research designs. Mikael has 120 publications listed in PubMed (July 1st, 2015), and 10 chapters in international text-books. He has been twice as a member in the project group of Nordic Nutrition Recommendations (completed 2004 and 2012) and is a member of the National Nutrition Council in Finland. He is also the president of the Finnish Society for Nutrition Science. On his free-time (what’s that?) Mikael loves outdoor endurance activities, such as trail running, orienteering and biking. He also plays the piano and as some kind of a highlight he has even performed together with Mike Lean on violin. Physical activity and the impact on obesity. The question on impact of physical activity on obesity is important, but complicated. Impacts may be context-specific, that is, different for primary prevention of obesity, for weight reduction, for prevention of weight regain after weight reduction, and for reducing the metabolic health risks of obesity, independent of weight change. Physical activity is even more complicated to define: impacts can be different for low-intensity physical activity, for more intense aerobic exercise, for strength training, and for high-intensity interval training. This presentation will examine the interaction between different types of physical activity and context-specific impacts on obesity. The effects of physical activity on metabolic health seem to be more significant than on weight per se. The strong associations between high physical activity and low obesity prevalence in cross-sectional studies are likely be partially caused by reverse causality, that is, the reducing effects of obesity on physical activity. More data are needed to understand the role of (high) exercise intensity on metabolic health, weight and compliance from a public health view-point. The conclusions of this review are also placed in an international context.

Dr Jason Gill, University of Glasgow Dr Jason Gill is a Reader in Exercise and Metabolic Health in the Institute of Cardiovascular and Medical Sciences at the University of Glasgow. He leads an active multi-disciplinary research group investigating the effects of exercise and diet on the prevention and management of vascular and metabolic diseases from the molecular to the whole-body level. Major research interests include: why certain population groups appear to be particularly susceptible to the adverse effects of a ‘Westernised’ lifestyle, and how lifestyle interventions can modulate this excess risk; the interactions between physical activity, energy balance, body fatness and disease risk; and the mechanisms by which exercise regulates lipoprotein metabolism. He is a past Chair of the British Association of Sport and Exercise Sciences (BASES) Division of Physical Activity for Health and a member of the development groups for the Scottish Intercollegiate Guidelines Network (SIGN) guidelines for the prevention and treatment of obesity and for prevention of cardiovascular disease. Ethnic differences in cardio-metabolic disease risk: Does ectopic fat play a role? Type 2 diabetes is a major public health problem, accounting for 10% of healthcare expenditure and almost 400 million cases globally. Obesity is the most important risk factor but there is now clear evidence that the adverse effects of obesity on diabetes risk are greater in south Asian and black adults than white Europeans. It has been hypothesised that south Asians have a lower capacity to store fat in the primary superficial subcutaneous adipose tissue compartment than Europeans and that this leads to earlier ‘overflow’ into more harmful secondary deep subcutaneous, visceral and ectopic depots. The mechanisms responsible are unclear but limited cross-sectional data suggest that a relative inability to increase triglyceride storage by increasing the population of fully differentiated large subcutaneous adipose cells may contribute to the insulin resistant phenotype in south Asians. This is currently being investigated in a weight-gain intervention trial in young south Asian and European men.

Professor Edwin Gale, University of Bristol Edwin Gale is Emeritus Professor of Diabetic Medicine and former Head of the University Department of Clinical Science in North Bristol. He qualified in 1972 and developed a major interest in diabetes when working with Robert Tattersall in Nottingham. He trained in Copenhagen and Oxford before becoming a Senior Lecturer (rising to Professor) at St Bartholomew’s Hospital in London. He moved from there to Bristol with his team in 1997. His research has mainly related to the pathogenesis of type 1 diabetes, but he has written reviews and opinion pieces on many aspects of diabetes, and was Editor of Diabetologia from 2003-2010. He also has an interest in drug safety issues, and chaired the Special Advisory Group on diabetes and endocrinology for the European Medicines Agency (EMA) from 20062011. He is currently engaged in setting up Diapedia, an online open-access living textbook of diabetes. Metabolic Syndrome: A useful label? The syndrome (“running together”) of central obesity, hypertension, diabetes and vascular disease was clearly described in 1951. Hyperlipidaemia was later added, and Reaven proposed a central role for insulin resistance in the 1980s. He later recanted in an article entitled “the metabolic syndrome: requiescat in pace”. The concept obtained a short-lived boost when pleiotropic drugs with weak effect on different components of the syndrome (rimonabant and the thiazolidinediones) were being promoted, but languished once these went out of favour. In the absence of a unifying hypothesis or therapy, the metabolic syndrome must be judged on its pragmatic utility as a scorecard of overlapping risk factors. Not surprisingly, the level of risk conferred by several risk factors exceeds that of one risk factor on its own, but the added predictive value is low, and adds little to routine clinical management. Advocates of the concept have yet to explain why the twentieth century epidemic of cardiovascular and cerebrovascular disease is in full retreat despite the rapidly growing number of people who satisfy metabolic syndrome criteria. In short, metabolic syndrome is useful clinical shorthand, but is not a clinical diagnosis.

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Speaker Presentation Summaries and Biographies Professor Bruce Griffin, University of Surrey Professor Griffin is a biomedical scientist with 30 years of research experience in human lipid and lipoprotein metabolism, nutrition and cardiovascular disease. He has a BSc in medical laboratory science (Portsmouth, 1984), a PhD on the effects of exercise and diet on human plasma lipoproteins (Aberdeen, 1988), and undertook postdoctoral research in pathological biochemistry at Glasgow Royal Infirmary (1988-94). Since then, he has been actively engaged in research on the effects of dietary fatty acids, cholesterol and free sugars on cardio-metabolic risk within the Faculty of Health & Medical Sciences at the University of Surrey. He is currently Professor of Nutritional Metabolism, and Research Group Leader of Nutrition, Metabolism and Diabetes. He is a Registered Nutritionist and a Theme Leader in Whole Body Metabolism for the Nutrition Society. Impact of dietary free sugars on liver fat and cardio-metabolic risk. A host of acute mechanistic studies have shown that a high intake of dietary sucrose or fructose (≥25% total energy), usually as liquids or sugar sweetened beverages, produces adverse effects on cardio-metabolic risk factors, including dyslipidaemia and the accumulation of ectopic fat in the viscera and liver. How these findings translate into dietary recommendations to prevent disease and promote human health is less clear. There is evidence to suggest that these effects may be mediated, in part, through increased energy intake and body weight. While this is of relevance to understanding how free dietary sugars impact on health, we also need to know if dietary sugars exert adverse metabolic effects at lower, every day levels of intake, given that the mean intake of free sugars in adults in the UK is probably less than 12% total energy (<50g fructose/day). Non-alcoholic fatty liver disease (NAFLD) has been described as the hepatic manifestation of metabolic syndrome. It is recognised as a potential cause and effect of adverse changes in lipid metabolism, and as a close and silent relative of the visceral adiposity that characterises ‘metabolic obesity’. This presentation will address the mechanistic links between NAFLD, dietary extrinsic sugars and dyslipidaemia. It will also allude to a large subpopulation of individuals who may have a metabolic disposition that renders them more vulnerable to the adverse effects of free sugars, and thus more responsive to current dietary guidelines.

Professor Mike Lean, University of Glasgow Mike Lean MA, MB, BChir, FRCP (Edinb), FRCPS (Glasgow) holds the Glasgow University chair of Human Nutrition, based at Glasgow Royal Infirmary, where he is also a consultant physician with NHS responsibilities for an acute medical ward and emergency receiving duties. His primary training was in Medicine, completing a Cambridge MA degree in History and Philosophy of Science. Medical undergraduate training was at St Bartholomew’s Hospital, and postgraduate training mainly in Aberdeen and Cambridge. He received research training as an MRC Clinical Scientist for 4 years at the MRC and University of Cambridge Dunn Nutrition Laboratories, and on a Leverhume Scholarship to the University of Colorado in Denver, in 2003. He has held Visiting and Adjunct Professorships at the Robert Gordon University, Aberdeen and at the University of Otago, New Zealand (currently). He has been a non-executive director of the Health Education Board of Scotland for 8 years, and chaired the Food Standards Agency Advisory Committee on Research. In 2013 he was awarded the Rank Nutrition Lectureship by Diabetes UK. Professor Lean has published over 400 peer-reviewed papers. H-Index = 79 (56 since 2010). Visit his Google Scholar page. His research, and related PhD training programmes, encompass the wide range of molecular, clinical and public health aspects of Human Nutrition, a body of integrated sciences underpinning all biomedical and health research. In 2014 he was one of only 19 Scottish researchers in the top 1% of their fields world-wide for international citations, on the Thomson-Reuters ‘Highly Cited’ Researcher listing.

Dr Jennifer Logue, University of Glasgow Jennifer Logue is a Chief Scientist Office/ NHS Education Scotland Clinician Scientist Intermediate Fellow in Metabolic Medicine. Her main research interests are the effects of obesity and weight management on co-morbidity and the most cost-effective means of achieving weight loss within the health service. She is Chief Investigator of the Surgical Obesity Treatment Study; a National Institute of Health Research funded 10 year longitudinal cohort study of patients undergoing bariatric surgery in Scotland. She was a member of the Scottish Intercollegiate Guideline Network (SIGN) obesity guideline development group, writing the guidance on bariatric surgery. Her clinical work includes diabetes, cardiovascular risk factor and obesity clinics alongside clinical biochemistry. Obesity and Type 2 Diabetes – Raising the issue of weight management in primary care. Despite weight management interventions being recommended for patients with type 2 diabetes, many patients are not being referred. Reasons for this are multifactorial and include a lack belief in the efficacy and benefits of weight management, a lack of confidence in raising the issue and a lack of knowledge of current services by clinicians in primary care. This presentation will cover the qualitative research on patients and practitioners beliefs and experiences of raising the issue of weight mangement and referring from primary care and the design of a randomised trial to increase the knowledge and skills of primary care staff in order to ensure each patient has the same opportunity to attend a weight management service.

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Speaker Presentation Summaries and Biographies Professor John Petrie, University of Glasgow John Petrie is Professor of Diabetic Medicine at the University of Glasgow and Honorary Consultant Physician/ Diabetologist at Glasgow Royal Infirmary. His research aims to understand the mechanisms of vascular disease in types 1 and 2 diabetes and thereby to develop better treatments to prevent complications. His work includes metabolic and vascular clinical investigation, larger scale cohort studies, biomarker discovery/validation, and clinical trials. He is Chief Investigator of the REMOVAL trial (http://clinicaltrials.gov/ct2/show/NCT01483560) funded by the US Juvenile Diabetes Research Foundation. REMOVAL is on track for completion in 2017 and is testing the cardiovascular effects of metformin in type 1 diabetes over three years in 500 patients in the UK, Denmark, Holland, Canada, and Australia. Prof Petrie is UK lead for two ongoing GLP-1 cardiovascular outcome trials in type 2 diabetes: LEADER (liraglutide) and the recently-completed ELIXA study (lixisenatide). He has chaired/ coordinated cardiovascular endpoint committees for several major international trials including ROADMAP, EMERGE and currently ENTRACTE. He led the initiation and development of the successful Scottish Diabetes Research Network (SDRN) from 2006-2009 and in this capacity was responsible for the current Scottish glucose-lowering therapy guidelines (SIGN 116). Weight gain and intensive insulin therapy – What is double diabetes? • Mechanisms of insulin resistance in type 1 diabetes • Insulin-induced weight gain and CV risk factors • Hepatic fat partitioning in type 1 diabetes • Double diabetes: a combination of type 1 diabetes with features of insulin resistance and type 2 diabetes • Does double diabetes increase the risk of cardiovascular disease (CVD)? • Implications for future research and clinical practice.

Professor Naveed Sattar, University of Glasgow Professor Sattar graduated in medicine in 1990 from the University of Glasgow and became Professor of Metabolic Medicine in 2005. He has published extensively in diabetes, cardiovascular disease, and obesity as well as leading and contributing to multiple clinical trials, biomarker and mechanistic studies and several national and international guidelines in these areas. Professor Sattar has been awarded national and international prizes including the prestigious Minkoswki prize from EASD for his research, has published over 500 papers (H-factor 76, >23K citations), and is on the International advisory boards for Lancet, Diabetes and Endocrinology and UK biobank. He has spoken at numerous national and international meetings and is amongst most highly cited clinical researchers in the world according to recent Thomson Reuters report. New approaches in obesity research. What are the real risks of obesity and how true are the associations? Observational data provide approximate answers to some of these questions but sometimes come up with findings which seem opposite to expectations. For example, whilst obesity is linked to diabetes and heart disease, both in turn linked to higher dementia risk, recent observational data suggest obesity is associated to lower cognitive decline. This is puzzling. How does one get beyond limitations in observational studies? Several things can be used here – first is the power of genetics; by combining genetic polymorphisms linked to obesity, one can derive a group of individuals who are on average heavier across their life course. This allows better assessments of the risks of obesity. This talk will illustrate some examples and also point out how serial BMI or weight measurements and major collaborations with careful attention to confounders / potential reverse causality and with very long follow-up can give us new insights into how obesity genuinely influences risks of multiple outcomes. 1: Sattar N, Gill JM. Type 2 diabetes as a disease of ectopic fat? BMC Med. 2014 Aug 26;12:123. 2. Sattar N. McInnes IB. Debunking the obesity paradox in Rheumatoid arthritis. Nature Reviews in Rheumatology (In press)

Professor David Stott, University of Glasgow Professor Stott is the David Cargill Chair of Geriatric Medicine at the Institute of Cardiovascular and Medical Sciences at the University of Glasgow. He is also Associate Academic at the Institute of Health and Wellbeing and Associate at the School of Medicine. Professor Stott has conducted a broad portfolio of original research directly relevant for healthcare of older people. His current primary research includes subclinical hypothyroidism in elderly people, prediction and prevention of cognitive decline in older age, screening for dementia, complications after stroke, and nutritional support in rehabilitation. He currently hold grants for 7 research projects (total value circa £6M) including lead for the EU FP7 funded study ‘Multi-modal effects of Thyroid hormone Replacement for Untreated older adults with Subclinical hypothyroidism; a randomised placebo-controlled Trial’. International collaborations include the Netherlands, Ireland and Switzerland.

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Speaker Presentation Summaries and Biographies Professor Roy Taylor, University of Newcastle Professor Taylor qualified in medicine at the University of Edinburgh, worked in Edinburgh and Dundee, and is now Professor of Medicine and Metabolism at Newcastle University and Newcastle Hospitals NHS Trust. He has been conducting research on type 2 diabetes since 1981, and has used a wide range of methods to understand the condition. Most importantly, Professor Taylor founded the Newcastle Magnetic Resonance Centre. This new facility aims to further the medical and scientific knowledge by direct study of how the body works. This has led to an understanding of how food is handled by the body in health and disease and allows understanding of why type 2 diabetes is a potentially reversible condition. Reversing type 2 diabetes using very low calorie diet produces long term normoglycaemia We have previously demonstrated normalisation of glucose control in type 2 diabetes following a very low calorie diet (VLCD; 600-800 kcal/day) and that this occurs less often in long duration compared to short duration disease. This study aimed to define the both the longer term durablility of this effect and the underlying pathophysiologic mechanisms. 29 people with type 2 diabetes were studied on 3 occasions: at baseline, after return to normal eating following an 8 week VLCD (600800kcal/day) and then after a 6 month period with structured individualized weight maintenance. Responders were defined using the standard definition of remission of diabetes (fasting plasma glucose <7 mmol/l). Following the VLCD and stabilization on an isocaloric diet, 12/29 had reversed their diabetes, and 13/29 at 6 months. Hepatic triglyceride decreased markedly and remained stable after the 6 month weight maintenance period in both responders and non-responders. Pancreas fat content decreased similarly in both groups. First phase insulin secretion improved in responders only. It continued to improve over the weight maintenance period in responders and did not change in the non-responders. The work confirms that with successful weight maintenance over 6 months, in non-responders blood glucose control remains improved off drug therapy, but in responders is normal.

Professor Brian Walker, University of Edinburgh Brian Walker is Professor of Endocrinology and Head of the BHF Centre for Cardiovascular Science at the University of Edinburgh. His research over the last 20 years has concerned the role of glucocorticoids in metabolic syndrome and cardiovascular disease, encompassing preclinical models, detailed experimental studies in humans, and pharmaco- and genetic epidemiology. His group have also developed selective 11beta-HSD1 inhibitors which are now in clinical development. His work is supported by major awards from the British Heart Foundation and Wellcome Trust. He has published more than 200 original papers, attracting more than 12,000 citations, and has delivered more than 160 invited lectures. Controlling cortisol in obesity Cortisol mediates adaptive stress responses, including of metabolism and cardiovascular regulation. In Cushing’s syndrome, prolonged glucocorticoid excess becomes maladaptive, accelerating obesity and cardiovascular disease. Our work in humans has addressed whether more subtle abnormalities in cortisol levels in plasma, or in tissue responsiveness to cortisol, contribute to cardiometabolic disease. Moreover, we have sought to target cortisol action as a therapeutic strategy. Elevated plasma cortisol is associated with cardiometabolic disease and impaired negative feedback of the hypothalamic-pituitary-adrenal (HPA) axis, perhaps due to a phenomenon of ‘relative corticosterone deficiency’. In addition, genome wide association studies by the cortisol NETwork (CORNET) consortium suggest that variations in cleavage of corticosteroid binding globulin may contribute to altered tissue delivery of cortisol and hence impaired negative feedback. Elevated tissue cortisol may also result from increased 11b-HSD1 in adipose tissue in obesity. 11b-HSD1 inhibitors reduce tissue glucocorticoid action, improve metabolic control in type 2 diabetes and may be atheroprotective and improve reperfusion after tissue ischaemia. In summary, cortisol action is determined by an interplay between the HPA axis and local control of tissue cortisol, with both dysregulated in obesity. Therapeutic targeting of tissue cortisol levels provides an opportunity for preventive medicine in the obese population.

Professor Terry Wilkin, University of Exeter Terence Wilkin trained clinically at the Universities of St Andrews and Dundee in Scotland. His research was subsequently funded for 15 years by the Wellcome Trust at the Universities of Montpellier (France) and Southampton (UK). He is currently professor of endocrinology and metabolism at the University of Exeter Medical School, and has published extensively on his vision of an ‘activitystat’ in children, based largely on data from the EarlyBird Study which monitored the physical activity objectively in a large cohort of cohort over 12 years. He currently leads adAPT (autoimmune diabetes Accelerator Prevention Trial), a five-year RCT conducted in Scotland and funded by JDRF. The Legacy of the EarlyBird Study EarlyBird was a 12-year observation study of healthy children combining objective measures of dimensions, body composition, physical activity and energy expenditure with annual blood samples to measure metabolic change and epigenetic drift. Its aim was to document the metabolic development of contemporary children and it asked the question ‘Which children become insulin resistant, and why?’ EarlyBird has published over 60 peer-reviewed papers, some of which are counter-intuitive and challenging. These will be summarised in the first part of the talk. The second part will describe recent epigenetic data, and the third will outline collaborations using the accumulated archive of genetic, serological and clinical data. EarlyBird has now begun to recall the cohort at the age of 20/21y to repeat ‘adult’ measures now that puberty is no longer a confounder.

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Member-led Symposia Wednesday September 9th 15.45-17.15

Member-led Symposium: Estimating energy requirements in obesity – latest evidence, BDA Obesity Group (Formerly DOM UK)

Room 112

Background: Increasing prevalence of obesity and associated health risks indicate the need for controlled weight loss to help reduce these risks. To achieve this, negative energy balance is required and therefore estimating energy requirements allows an optimum deficit in energy intake to be calculated. Imprecise prediction of energy requirements may lead to excessive restriction of energy. This may be unsustainable or lead to rapid weight loss including loss of lean tissue or may exceed requirements leading to further weight gain. Therefore accurate estimates of energy requirements in obesity may help individuals to achieve a safe energy deficit that will facilitate weight loss whilst maintaining optimum health. Components of total energy expenditure and the influence of body composition, gender and race are discussed. Method: A systematic review of published studies investigating resting energy expenditure (REE) and total energy expenditure (TEE) in adults with obesity was undertaken in 2013-14 to determine which equations provided the best estimates of REE and TEE. This was repeated and updated in 2014-15 according to more stringent preferred reporting items for systematic review and meta-analysis (PRISMA) guidelines (Moher et al., 2009) and further explored by body mass index (BMI) sub-group. Results: In the initial REE review, only two studies were undertaken in the UK and 36 worldwide estimated REE using prediction equations compared against indirect calorimetry and the equation by Mifflin et al., (1990) appeared to give the least inaccurate predictions of REE in more studies than other equations. The subsequent review analysed the findings from 22 studies and found that precision of predicted values varied with BMI subgroup and that estimations of REE derived using the Mifflin, Harris & Benedict (1919) and Livingston & Kohlstadt (2005) equations providing the best results, i.e. a higher proportion of predictions within 10% of measured REE, in those with BMI 30-39 and ≥40 kg/m2. Even with these equations, estimated values of REE deviated by >10% in approximately 30% of obese individuals. In the TEE review, only four studies met the inclusion criteria and none of these equations provide useful estimates of TEE in obese adults. Conclusions: There is insufficient evidence to recommend a predictive equation that provides accurate and precise estimates of resting energy expenditure (REE) in the healthy obese adults. It is recommended that where a precise value for REE is required in this population that this is measured using indirect calorimetry. No equations provide useful estimates of TEE in obesity and therefore factorial approach is recommended. It is recommended that where precise value of TEE is required for an obese adult that this is also measured. Session outline Rationale: (10mins, Angela) • Weight loss requires an energy deficit • Components of total energy expenditure • Calculating energy expenditure allows deficit to be estimated; calculations are practical but are they accurate? • Consequences of underfeeding or overfeeding if estimation is not accurate • The influence of body composition, gender & race and effect of increasing adiposity on resting energy expenditure • Methods of calculating body composition in practice Estimating resting energy expenditure: (10mins, Hilda) • Literature review and results • Resting energy expenditure evidence conclusions comparing different prediction equations Estimating total energy expenditure: (10mins, Hilda) • Literature review and results • Total energy expenditure conclusions Energy expenditure before and after weight loss: (10mins, Michelle) Implications for practice: (25mins, Angela, Hilda & Michelle). Of which: • Direct measurement tools used in practice; how do they measure up? (Interactive session, 10mins) • Case studies to allow symposium participants to calculate and compare predicted values (Practical session; please bring a calculator. 15mins) Possibilities for the future: where does this leave the Schofield equation (25mins, Angela & Michelle) • Questions for future research, including use of portable calorimetry (Interactive session, 10mins) • Group discussion on impact of uncertainty of predictions and need for accuracy and precision (Interactive session, 10mins) References • Harris, J.A. & Benedict, T.G. (1919) Biometric studies of basal metabolism in man. Washington DC: Carnegie Institute of Washington. • Livingston, E.H. & Kohlstadt, I. (2005) Simplified resting metabolic rate-predicting formulas for normal-sized and obese individuals. Obes. Res. 13, 1255-62. • Mifflin, M.D., St Jeor S.T., Hill, L.A., Scott, B.J., Daugherty, S.A. & Koh, Y.O. (1990) A new predictive equation for resting energy expenditure in healthy individuals. Am. J. Clin. Nutr. 51, 241-7. • Moher, D., Liberati, A., Tetzlaff, J., Altman, D.G. and PRISMA Group (2009) Preferred reporting items for systematic reviews and metaanalyses: the PRISMA statement. B.M.J. 339, b2535.

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Member-led Symposia Friday September 11th 08.30-10.00

Room 112

Member-led Symposium: Weight Stigma

Advances, tensions and challenges associated with recognising weight stigma in the conventional obesity narrative Weight stigma – also known as anti-fat attitude, weight bias and anti-fat prejudice – is a term that describe a negative attitude toward (dislike of), belief about (stereotype) or behaviour against (discrimination) people perceived as being ‘fat’ (Danielsdóttir et al. 2010). There is very strong evidence that obesity is a highly stigmatized condition, and that obese people are subject to prejudice and bias in relationships, the media, in education and the work-place and in health-care (Puhl & Brownell 2001; Puhl & Heuer 2009). Unfortunately weight stigma is evident even among those specialising in obesity (Teachman & Brownell, 2001; Schwartz et al. 2003) and there have been recent claims of obesity stigmatisation from obesity researchers at an ASO conference (Flint & Reale 2014). The need for action on the issue of weight stigma has been reinforced by the emerging evidence-base that details a range of negative psychological, physiological and behavioural consequences. For example, experiencing and internalizing weight stigma has been associated with poor self-esteem and poor body image (Puhl & Heuer 2009), chronic stress and CVD risk factors (Major et al. 2012; Schvey et al. 2011), unhealthy eating behaviors such as binge eating, increased caloric consumption, and reluctance to diet (Friedman et al. 2008; Puhl & Latner 2007; Schvey et al. 2011), attenuating physical activity and motivation to exercise (Vartanian & Novak 2010; Seacat & Mickelson 2009). It has long been recognized by research ethics committees, the National Health Service’s best practice guidelines (Department of Health, 2010), and the National Institute of Heath and Care Excellence that all patients and research participants should receive non-judgmental and respectful treatment. However, it has not been until very recently that this universal requirement has been supplemented with an explicit discussion about weight stigma (e.g. the NICE guidance on lifestyle weight management in adults (PH53, 2014) and a position paper from the Association for the Study of Obesity (in preparation)). Although welcome, there are significant challenges and tensions associated with recognising, and attempts to eliminate, weight stigma within the ‘traditional obesity paradigm’ (for want of a better phrase). Much work around weight stigma comes from the burgeoning ‘critical obesity’ literature using social science methods, along with social movements such as fat activism, size acceptance, and body positive. To-date there has been little interaction between these two perspectives which have been described as “two camps” (Anon, 2009) with “clear ideological differences” (MacKean & GermAnn, 2013), not least around the question of whether the problematisation of obesity is inherently stigmatising. If we wish to take the elimination of weight stigma seriously and imbed it in our work, we need to form a productive dialogue and consider a range of views outside of conventional obesity model. We wish to make a start on this process at the UKCO2015 with recognition of the advances made and the challenges ahead. Main Aim The aim of this symposium is, therefore, to describe and explore the tensions and challenges associated with recent efforts to recognise and eliminate weight stigma, bias and discrimination from healthcare professionals and scientists. To ensure that the voices outside of the conventional obesity narrative are heard, pre-recorded multimedia will be used alongside oral presentations. The session is also interactive and the discussion will hopefully lead to some plans to move forward on this issue. Session Plan • Weight bias in ‘conventional’ obesity healthcare and research (15mins, Dr Judy Swift) • Them and Us: disconnects with the ‘critical’ obesity movement (15mins, pre-recorded multimedia) • When healthcare professionals and researchers are themselves obese (20mins, Dr Duane Mellor) • Moving forward: What should the priorities be for obesity healthcare and research? (20mins, Dr Nicola Heslehurst) Speakers • Dr Judy Swift is an Associate Professor of Behavioural Nutrition at the University of Nottingham. She has debated issues associated with weight stigma at international academic conferences, as well as workshops and debates organised by industry and think-tanks for journalists and science writers, policy makers and government ministers. Her publications on weight stigma are cited in expert testimony for the National Institute for Health and Care Excellence (NICE PH53) • Pre-recorded multimedia technique will be used to voice the opinions and arguments from academics and campaigners from the ‘critical obesity’ field and the social sciences, who either do not wish or do not feel comfortable attending/addressing a conventional obesity conference. Anecdotally researchers who are a heavier weight themselves have said that they do not feel psychological safe in presenting (although this hopefully will change with a more open dialogue). • Dr Duane Mellor is a Registered Dietitian and Assistant Professor of Nutrition and Dietetics at the University of Nottingham. He is a spokesperson for the British Dietetic Association and has an interest in equality issues within the dietetic profession. • Dr Nicola Heslehurst, University of Newcastle

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Member-led Symposia References • Anonymous (2009) Comment on a blog post on Fat Chicks Rule http://fatchicksrule.blogs.com/fat_chicks_rule/2009/02/removing-the-stigma-means-more-than-just-saying-there-is-a-problem.html • Department of Health. (2010) Essence of Care, Benchmarks for Communication. Norwich: The Stationery Office. • Danielsdottir S, O’Brien KS & Ciao A. (2010) Anti-fat prejudice reduction: a review of published studies. Obes. Facts. 3, 47–58. • Flint, S. W., & Reale, S. (2014). Obesity stigmatisation by obesity researchers. The Lancet, 384, 1925-1926. • Friedman K, Ashmore J, Applegate K. (2008) Recent experiences of weight-based stigmatization in a weight loss surgery population: psychological and behavioral correlates. Obesity 16:S69Y74. • MacKean G & GermAnn K (2013) Reducing weight stigma and bias in the BC Healthcare System: Findings from a critical review of the literature and environmental scan. Personal Communication. • Major B, Eliezer D, Rieck H. (2012) The psychological weight of weight stigma. Soc Psychol Pers Sci 3:651Y8 • National Institute for Health and Care Excellence (2014) Managing overweight and obesity in adults – lifestyle weight management services. NICE guidelines [PH53] Published date: May 2014 www.nice.org.uk/guidance/ph53 • Puhl R, Brownell KD. (2001) Bias, discrimination, and obesity. Obes. Res. 9, 788–905. • Puhl R, Latner J. (2007) Stigma, obesity, and the health of the nation’s children. Psychol Bull 133:557Y80. • Puhl RM, Heuer CA. (2009) The stigma of obesity: a review and update. Obesity 17, 941–964. • Schvey N, Puhl R, Brownell K. (2011) The impact of weight stigma on caloric consumption. Obesity 10:1957Y62. • Schwartz MB, Chambliss HO, Brownell KD, Blair SN, Billingtonm C. Weight bias among healthcare professionals specializing in obesity. Obes Res 2003;11:1033–9. • Seacat JD, Mickelson KD. (2009) Stereotype threat and the exercise/dietary health intentions of overweight women. J Health Psychol 14: 556Y67. • Teachman BA, Brownell KD. Implicit anti-fat bias among health professionals: is anyone immune? Int J Obes 2001;25:1525–31. • Vartanian L, Novak S. (2010) Internalized societal attitudes moderate the impact of weight stigma on avoidance of exercise. Obesity 19:757Y62.

Friday September 11th 10.30-12.00

Room 112

Member-led Symposium: Intermittent Fasting Intermittent fasting – Latest fad or a potential tool for weight loss?

Rates of overweight and obesity are increasing in the UK and worldwide (65% overweight, and 25% obese in the UK in 2012), driving up rates of diabetes, heart disease, cancer and potentially dementia. Maintained weight loss of 5% or greater has the potential to bring about significant reductions in rates of diabetes (60%), cardiovascular disease (30%), breast cancer (25-40%), and their costs to the individual and to society. However current weight loss advice has poor adherence and success (15%-40% achieve significant weight loss ≥5%). Short term human studies suggest intermittent fasting / intermittent energy restriction may be as easy or easier for people to follow than standard daily dieting. The most studied regimens involve 5:2 diets (two days of a very low calorie intake and five days of normal healthy eating each week) or alternate day fasting (alternate days of very low calorie intake and normal eating). Our published research reported significant weight loss of ≥5% in 65% with a 5:2 diet vs. 40% with standard daily dieting (Harvie et al, Br J Nutr 2013). The 5:2 diet has also demonstrated beneficial reductions in insulin resistance and other biomarkers of disease risk compared to standard daily dieting. In addition emerging animal data suggests intermittent energy restriction may be as or even more effective for reducing rates of breast, prostate and pancreatic tumours, sarcoma, diabetes, cardiovascular disease and dementia than isocaloric daily energy restriction The 2012 BBC Horizon programme by Michael Mosley on intermittent fasting, led to huge interest in this approach to weight loss especially since it promised additional health benefits. There are increasing numbers of self-help diet books available, and an increasing interest from health care professionals interested in this approach but seeking high quality evidence. This symposium will summarise: • Current evidence for intermittent diets from human weight loss studies. • Potential benefits or problems with intermittent diets • What we need to know & future research priorities Speakers and titles Dr Michelle Harvie, Genesis Prevention Centre, University Hospital South Manchester The rational for intermittent fasting and overview of benefits in overweight and normal weight subjects (20 mins) Dr Alex Johnstone, The Rowett Institute of Nutrition and Health Fasting and appetite (20 mins) Ms Leanne Harris Intermittent Calorie Restriction for Weight Management: A Systematic Review and Meta-Analysis (20 mins) Dr Michelle Harvie, Genesis Prevention Centre, University Hospital, South Manchester Potential metabolic effects of intermittent diets (20 mins) Panel discussion and questions (15 mins)

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Commercial Symposia Thursday September 10th 11.15-12.45

Commercial Symposium: Diabetes Prevention - Weight Watchers

Main Auditorium

Scalable Solutions to prevent Type 2 Diabetes Type 2 diabetes can substantially decrease life expectancy, diminish quality of life and increase healthcare costs. It is thought that one in three people with diabetes do not know that they have it. There is a close correlation between the risk of developing type 2 diabetes (T2D) and weight, with almost 85% of people with TDM being overweight or obese. Yet T2D is largely preventable. In clinical studies ILI’s have repeatedly demonstrated a significant change in improving glycaemic control and reducing the rates of conversion to type 2 diabetes. NICE guidance (PH38) in relation to the identification and treatment of those at high risk of type 2 diabetes was published in 2012. Clear pathways and treatment options are recommended, in order to achieve outcomes that have been shown to deliver 58% reductions in 3year disease progression within treatment cohorts, with sustained benefits even 7 years down the line. PH38 recommends intensive lifestyle interventions (ILIs), involving a structured programme of advice and support on physical activity, weight management and diet, with ILI’s aiming for holistic lifestyle changes to diet and activity that can be sustained and specifically losing and maintaining a weight loss of at least 7% of starting weight and undertaking moderate intensity activity for at least 150 minutes a week. Even these, quite modest changes, can reduce progression to type 2 diabetes. Indeed, with multiple lifestyle changes, the risk of progression can be further reduced. Despite the effectiveness of these programmes, a major challenge remains as to how to translate clinical trials of ILI’s into a real world setting, and in a cost effective method. To respond to this challenge, the role that commercial weight loss programmes might play is being explored. In the US, researchers have developed the Weight Watchers programme to implement a cost effective ‘real world ILI’. This Weight Watchers Diabetes Prevention Programme has been designed so that it can be used within existing healthcare structures and without the need for training new healthcare providers. There is currently a major randomised controlled trial underway in the US to test this model and has shown promising results1 with researchers concluding that the Weight Watchers ILI is an effective DPP, with potential to quickly impact the public health landscape in regards to the prevention of type 2 diabetes. This interactive symposium delivered by experts from both academia and Public Health, will present new research on effective, scalable community-based treatment options for both the prevention and treatment of obesity and diabetes. The session will also include some early results from the service evaluation of a Diabetes Prevention Programme Pilot currently running in partnership with Bromley Public Health, GP surgeries and Weight Watchers. The session will provide delegates with outcomes from new research as well as some debate and discussion opportunities. Session Plan and Speakers Zoe Griffiths. Head of Public Health, Weight Watchers UK Moving the prevention of type 2 diabetes into Public Health – Scalable solutions. (25 mins) Dr Agnes Marossy, Bromley Consultant in Public Health; Carolyn Piper, Bromley Public Health Programme Manager Early outcomes from a Diabetes Prevention Programme Pilot in the UK. (25 mins) Dr Victoria Lawson, Independent Chartered Health Psychologist. The psychological wellbeing of participants with pre-diabetes prior to attending a Diabetes Prevention Programme. (25 mins) The way forward – Panel discussion and questions. 15 mins

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Commercial Symposia Friday September 11th 10.30-12.00

Commercial Symposium: Emotional Eating – Slimming World

Main Auditorium

The role of emotional regulation in weight loss and maintenance Outline There is good evidence that behaviour change techniques associated with self-regulation are involved in weight loss and maintenance. The most promising evidence-based behaviour change techniques for weight loss and maintenance are self-monitoring, goal setting, action control, building self-efficacy and intrinsic motivation. Recent research also suggests that stress management and emotion regulation skills are key enablers of relapse prevention and prevention of weight-regain. Important factors in weight management include behaviour, motivation, and emotion, including psychosocial stress. The modern environment facilitates weight gain, while society criticises the overweight. This leads to stress, which can undermine weight loss. Evidence suggests that developing practice and competence in self-compassion, mindfulness, acceptance and commitment can enhance stress management and psychological wellbeing. Effective support for weight loss maintenance (WLM) may therefore address behaviour change (diet, exercise) and additional psychological (stress, relapse) challenges. The purpose of this symposium is to review and report new insights into the role of self-regulation and emotion regulation in the control of eating behaviour and weight management and their implications for applications in practice. Speakers Dr Marcela Matos - Emotion regulation and weight management overview. Dr Matos will cover the theoretical approaches relating emotion regulation to eating behaviours and weight management. Cristiana Duarte - Studies of the mechanisms by which emotion regulation may influence weight loss and maintenance in lifestyle weight management. Cristiana Duarte will cover the current findings of the psychological mechanisms linking emotion regulation to eating behaviour, weight management and well-being in lifestyle weight management. We hypothesise that emotion-based stresses undermine self-regulation of eating, well-being and weight. This presentation explores, through path analysis, the mechanisms relating shame and social rank variables to weight-related emotions, measures of the control of eating behaviour and weight management. Professor James Stubbs - Self-regulation and emotion regulation in weight loss and maintenance including practical implications Professor Stubbs will cover the evidence of behaviour change techniques associated with weight loss and maintenance and the development of the NoHoW project which will examine the relative importance of self-regulation and emotion regulation in longer-term weight loss maintenance.

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Oral Presentation Abstracts Wednesday 9th September 15.45 – 17.15 Oral Abstracts – Obesity Practice

Room 114

Who is trying to lose weight in England? Changes in dieting behaviours from 1997-2013 Carmen Piernas1, Paul Aveyard1, Susan Jebb1, 1University of Oxford, Nuffield Department of Primary Care Health Sciences, Oxford, UK Background: In the face of an increasing prevalence of obesity we sought to identify the characteristics of the population who are actively trying to lose weight, in order to identify whether health messages are reaching the target population. Objectives: a)To describe changes in the prevalence of dieting from 1997-2013 in the Health Survey for England (HSE); b)To investigate differences in body mass index (BMI) among dieters over time; and c)To examine demographic and health predictors of dieting. Methods: We included adults ≥18y who participated in the HSE 1997 (n=8,066) or 2013 (n=7,591). Individuals self-reported if they were intentionally trying to lose weight along with their demographic characteristics (age, gender, ethnicity, social class and education) and other health-related conditions/medications. Measures of height, weight, waist and blood pressure were collected by trained nurses. Results: The prevalence of dieting in England increased from 39% in 1997 to 47% in 2013. Increases were observed across all demographic and BMI categories but was greater among men than women (30 to 40% vs. 46 to 54% respectively, p<0.05). In 2013, 23% of healthy weight, 53% of overweight and 76% of obese individuals were trying to lose weight. Using multivariable quintile regression models, we showed that dieters in 2013 were heavier across all quintiles of the BMI distribution compared to dieters in 1997, with significantly higher BMIs starting from the 50th centile onwards. In multivariable logistic regression analyses, overweight/obese individuals with health conditions were more likely to diet compared to their healthy counterparts in 1997 but not in 2013. Conclusions: Almost half of the English population is currently trying to lose weight. People who are overweight are more likely to be currently attempting to lose weight but are more overweight than dieters in 1997. Having an obesity-related comorbidity seems not to motivate weight loss attempts in the same way it did in 1997. Development and validation of the Self-Regulation of Eating Behaviour Questionnaire for adults Nathalie Kliemann1, Fiona Johnson1, Jane Wardle1, 1Health Behaviour Research Centre, Department of Epidemiology and Public Health, University College London, London, UK Background: Self-regulation of eating behaviour is the ability to eat in the way you intend to, even when you are faced with tempting food. It is a continual process by which humans alter their behaviour, cognitions, affect, attention and environment in favour of their eating intentions. Recent research has highlighted that self-regulation is an important individual factor that helps people to cope with the food environment and achieve a healthy diet and weight. However, there are no validated instruments to measure eating self-regulatory capacity in adults. The present study developed and validated a Self-Regulation of Eating Behaviour Scale (SREBQ) for use in the general adult population. Methods: Items were developed based on existing questionnaires for assessing self-regulation and on the relevant literature about selfregulation and eating behaviour. An extensive list of items was first piloted using members of the research team and then in a pilot study with university students and staffs. Two validation studies were carried out. In the first study the factor structure was investigated in an online sample of 271 participants. The second study confirmed the factor analyses as well as testing the reliability and validity of the 24item SREBQ in an online sample of 932 participants. Results: Exploratory factor analyses revealed a two-factor solution, representing Overcoming barriers and Active control, and confirmatory factor analyses indicated a good fit (NFI=.90; CFI=.91; TLI=.90; RMSEA=.06). Both factors had good internal reliability (Cronbach’s alpha: .91-.92) and external reliability (ICC=.79-.84). Construct validity was good, with each factor correlating positively with use of self-regulation strategies (Self-regulatory Success in Dieting Scale: r= .53-.59 p<.001) and global self-regulation (Self-Control Scale: r=.55-.63 p<.001). Convergent validity was also good, with mean scores for each factor being significantly and independently associated in the expected directions with BMI, motivation, healthy diet and health status in multiple regression analysis (F [13, 886]= 96.82; p<0.001). Together these variables accounted for 58.1% of the variance in the SREBQ total score. Conclusion: We conclude that the SREBQ is a valid and reliable measure to assess eating self-regulatory capacity in the adult population.

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Oral Presentation Abstracts Development and refinement of the Weight-specific Adolescent Instrument for Economic evaluation (WAItE) yemi oluboyede1, Claire Hulme0, 1Newcastle University, Newcastle, UK, 2University of Leeds, Leeds, UK Purpose: Very few weight specific outcome measures, developed specifically for obese and overweight adolescents, exist and none are suitable for the elicitation of utility values. These values can be used in the examination of cost effectiveness of weight management interventions. The purpose of this study was to develop a new weight specific measure, informed by adolescents, that is appropriate for the elicitation of preference values. Methods: The development of the tool comprised of two distinct studies. In the first study qualitative interviews with adolescents and discussions with specialists in the field of adolescent obesity lead to the identification of a long list of items and associated response options to describe weight specific health states. In the second study adolescents completed the long list questionnaire. A final item set and associated response options was identified with the application of psychometric assessments and Rasch analysis. Results: The qualitative study comprised 16 one-to-one and three focus group interviews with adolescents aged 11 to 18 years. From this an initial 29 item set and two possible five level response scales (frequency or severity) were identified. In the quantitative study 315 eligible adolescents completed two version of the 29 item questionnaire. Psychometric assessments and Rasch analysis lead to the identification of seven dimensions and one item was selected from each dimension. The frequency response scale was also selected due to better performance. The Weight-specific Adolescent Instrument for Economic-evaluation (WAItE) was created. Conclusions: The WAItE is a new tool that can be used to measure condition specific benefits when investigating cost effectiveness of alternative weight management interventions. In its current form the instrument cannot be used for the calculation of QALYs and a valuation study is necessary for this. The effect of target setting on weight loss and long term weight management in a community based sample of obese adults Amanda Avery1, Judy Swift1, Simon Langley-Evans1, 1University of Nottingham, Nottingham, UK Background: Setting targets is important in any lifestyle modification programme. It is normal practice to encourage realistic weight loss and yet obese patients may have much higher personal targets. The aim of this study was to investigate the effect of weight loss targets on long-term weight loss in a large community sample of obese adults. Methods: Data was extracted from the electronic database of a commercial slimming organisation, focusing on new members, joining between January and March 2012. Data was included on all members aged ≥18years and not pregnant. The extracted data included date of recruitment, date of birth, sex, height, start weight and weight changes, personal weight loss targets and date of target achievement for up to 18 months. Results: The screened data-set resulted in a sample of 308,890 subjects. Mean starting BMI was 33.1±6.4 kg/m2 and age was 43.1±13.6 years. Target setting behaviour differed on the basis of initial BMI and a higher percentage of obese members did not set targets (p<0.001). The main analysis focused on 24,447 individuals who had a starting BMI≥30kg/m2 and weight data available at 12 months after joining the commercial slimming organisation. Mean weight loss for this group at 12 months was 14.3±7.9% for those who set targets and 10.1±(6.7) in those who did not (p<0.001). Those that set ≥ 4 targets achieved the greatest loss (p<0.001). OR for clinically significant weight loss (≥10% of initial weight) at 12 months was 10.3 (CI 9.7- 11.1, p<0.001) for subjects who set a weight loss target compared to those who did not. The magnitude of weight loss target was related to achieved weight loss, with bigger initial targets associated with greater loss over 12 months. At the highest quintile of initial weight loss target, the size of the first target explained 47.2% (p<0.001) of the variance in weight loss achieved at 12 months. Conclusion: Much of the variance in achieved weight loss in this large community sample was explained by the number of personal weight loss targets set and the size of the first target. Whilst obese people were less likely to set targets, doing so increased the likelihood of achieving clinically significant weight loss. Current clinical guidelines prioritise the setting of realistic weight loss targets, but the findings of this analysis suggest that high target setting may lead to greater and clinically significant weight loss.

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September 9-11, 2015


Oral Presentation Abstracts Comparing weight outcomes in self-referred fee-paying vs primary care referred members of a commercial weight management organisation Liam Morris1, Carolyn Pallister1, Sarah Hillier1, Emma Dowse1, Jacquie Lavin1, 1Slimming World, Derbyshire, UK Introduction: Slimming World on Referral is widely used within obesity pathways in the UK and involves health professionals referring patients to local Slimming World community groups for weekly weight management support. Referral packages cover 12 (or multiples of 12) weekly sessions and are free for the patient (funded by the health trust). Offering a service which is free to the patient could raise a concern that this may result in reduced motivation or commitment to a service and result in less success. This study evaluates whether referral to Slimming World is as effective in terms of attendance and weight outcomes when compared to regular self-funded attendance. Methods: Electronic weekly weight records were collated from Slimming World members joining between January 2010 and April 2012. Using a last observation carried forward model, this analysis reports weight change outcomes in 45,382 participants during their first 12 session referral period in comparison with data from 1.3 million self-referred, fee-paying members during their first 3 months attendance collected over the same time period (Stubbs 2013). Data were analysed using Microsoft Excel and the R statistical program. Results: On average, members referred to Slimming World from primary care were younger, 46.3 years (14.5) vs 42.3 years (13.6), heavier, 98kg (19.7) vs 88.4kg (18.8) and had higher BMI’s on joining, 36.5kg/m2 (6.3) vs 32.6kg/m2 (6.3), than fee-paying members, with twice as many members being male, 10.5% vs 5%. On average referral members attended a greater number of sessions, 8.6 (3.5) vs 7.8 (4.3). Referral members experienced greater absolute weight loss, 4.5kg (3.7) vs 3.9kg (3.6), slightly higher percentage weight loss -4.6% (3.6) vs -4.4% (3.8) and change in BMI 1.7kg/m2 (1.3) vs 1.4kg/m2 (1.3) than fee-paying members. Conclusion: This data demonstrates that Slimming World’s community-based weight management programme is as equally as effective for members referred and paid for by primary care in terms of attendance, weight loss and BMI change as it is for regular fee-paying members and suggests that having a paid for service does not affect outcomes. What foods are Northern Ireland supermarkets promoting? A content analysis of supermarket online top offers Ruth Price1, Lynsey Hollywood1, Barbara Livingstone1, 1Ulster University, Coleraine, N.Ireland, UK Introduction: Price promotions are widely used by supermarkets to encourage purchase of targeted products more quickly, more frequently, and/or in greater quantities. These promotions have been shown to be effective in altering consumer behaviour, albeit in the short-term (Hawkes 2009; Hamlin et al. 2012). US research has shown that price promotions favour processed, energy dense foods (Ethan et al. 2013). On the other hand, price promotions have been successful in increasing the sales of healthier food (French 2003, Waterlander et al. 2012, 2013a) suggesting that appropriately targeted pricing strategies could be used effectively to improve diet patterns. Aim: To conduct a content analysis of online ‘Top Offers’ promoted by supermarkets across Northern Ireland (NI). Methods: Food promotions (n=1279; food (n=1098, 86%), beverages (n=181, 14%); Branded (n=958, 75%), Own-brand products (n=321, 25%)) from the ‘Top Offer’ section of leading NI supermarkets (Tesco, ASDA, and Sainsbury’s) and a convenience store (SPAR) were collected online every 3 weeks between April 2014 and November 2014 (8 months; 12 data collections). For each food product promoted the energy and nutrient information was obtained (per 100g / 100ml) and the healthiness assessed using 1.) Nutrient Quality (NQ) scoring method based on the Food Standard Agency’s Front-of-Pack labelling system (focusing on the risk nutrients sugar, salt, fat, saturated fat) and energy cut-offs defined by Bell et al. (1998), and 2.) Food Type score, as defined by the sections of Public Health England (PHE)’s Eatwell Plate. Results: Overall NQ scores for the food items collected was high (mean 10.69 / 15 +SD 2.88) and the median score was in the high NQ band (>13 NQ score; 40%), followed by the medium NQ (9-12 NQ score; 32%) and lastly the low NQ band (<8 NQ score; 28%). There was no significant difference between the NQ score obtained by supermarkets and the convenience store (P=0.528), or between branded and own-branded products (p=0.107). Food types promoted differed significantly to the PHE Eatwell recommendations (P<0.001; Pearson Chi-squared value = 744.2) and were as follows (current study vs Eatwell recommendations) ‘High Fat High Sugar Foods’ (30.7% vs 7%), ‘Bread, Rice, Potatoes & Pasta’ (23.6% vs 33%), ‘Meat, Fish Eggs and Beans’ (22.3% vs 12%), ‘Fruit and Vegetables’ (12.6% vs 33%), ‘Milk and Dairy Products’ (10.8% vs 15%). Conclusion: In contrast to the popular perception that food promotions favour less healthy foods, findings in the current study showed that NI supermarkets are promoting a wide range of both healthy (high NQ) and less healthy (low NQ) foods, with the majority of foods falling into the high NQ band. However there was some over-representation of ‘High fat High sugar foods’ and under-representation of ‘Fruit and Vegetables’ compared with the PHE Eatwell plate recommendations. More research is needed to investigate how findings within the present study impact on consumer behaviour and food intake. References: Bell, E, Castellanos, V, Pelkman, C, Thorwart, M & Rolls, B (1998) Energy density of foods affects energy intake in normal-weight women. Am J Clin Nutr 67, 412-420. Ethan, D et al. (2013) An analysis of Bronx-based Online Grocery Store Circulars for Nutritional Content of Food and Beverage Products. J. Community Health 38: 521-528. French (2003) Pricing effects on food choices. J Nutr 133: 841S-843S. Hamlin, RP et al. (2012) Retailer branding of consumer sales promotions. A major development in food marketing? Appetite.58:256-264 Hawkes, C. (2009) Sales promotions and food consumption. Nutr Rev 67: 333-342. Waterlander, WE et al. (2012) The effects of a 25% discount on fruits and vegetables: results of a randomized trial in a three-dimensional web-based supermarket. Int J Behav Nutr Phys Act 9: 11Waterlander, WE et al. (2013) Effects of different discount levels on healthy products coupled with a healthy choice label, special offer label or both: results from a web-based supermarket experiment.

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Oral Presentation Abstracts Thursday 10th September 11.15 – 12.45 Oral Abstracts – Basic Science

Room 114

Inhibition of the pyrophosphate transporter (ANK) enhances intra-cellular lipid accumulation in murine 3T3-L1 preadipocytes. Eleanor Cave1, Nigel Crowther2, 1University of the Witwatersrand, Johannesburg, South Africa, 2National Health Laboratory Services, Johannesburg, South Africa Introduction: The development of obesity and the regulation of intracellular lipid accumulation (ICLA) within adipocytes has been linked to proteins traditionally associated with bone mineralisation. Alkaline phosphatase (ALP) hydrolyses pyrophosphate (PPi) to phosphate (Pi) and inhibition of this enzyme blocks ICLA during adipogenesis in preadipocytes. The ANK protein transports PPi out of cells, and is known to be expressed in preadipocytes. Polymorphisms in ANK have been associated with obesity. We hypothesised that in inhibition of ANK within adipocytes would result in raised PPi and this would increase ALP activity in an attempt to maintain the PPi/Pi balance. ALPgenerated Pi would mediate ICLA by stimulating transcription of the appropriate genes. Pi is known to facilitate differentiation of osteoblasts which share a common progenitor with adipocytes. The aim of this study was therefore to determine the effect of ANK inhibition, and hence increased intracellular PPi, on ALP activity and ICLA in 3T3-L1 preadipocytes. Methods: 3T3-L1 cells were cultured in the presence and absence of an ANK inhibitor probenecid. Intracellular PPi and intracellular lipid accumulation were monitored after initiation of adipogenesis. The effect of ANK inhibition on ALP activity and ICLA was determined. Results: Four days after initiating ICLA, intracellular PPi levels (expressed as a % of levels in cells at day 0) in cells treated with probenecid were significantly higher (159.37 ± 6.3%) when compared to cells not treated with probenecid (64.1 ± 9.1 %; p=0.012). Tracking the PPi levels, TNAP activity in cells treated with probenecid was significantly higher than in untreated cells (232.45.5 ± 57.8% vs. 129.39 ± 22.2%; p=0.023). The level of ICLA was consistently higher in cells treated with probenecid reaching a maximum of 507.4 ± 24.1% compared to 337.6 ± 12.8% in untreated cells (p=0.015). Conclusions: These data suggest that the inhibition of ANK increases intracellular PPi levels. The PPi acts as a substrate for TNAP whose activity is increased leading to high levels of Pi, which in turn induces increased ICLA. This could Further experiments are required to determine the effects of ANK gene silencing and the mechanisms by which Pi increases ICLA. Altered vascular reactivity in adipocyte-specific mineralocorticoid receptor overexpressing mice: role of Rho kinase and redoxsensitive PKG-1. Aurelie NGUYEN DINH CAT1, Tayze T. ANTUNES2, Glaucia E. CALLERA2, Augusto C. MONTEZANO1, Ying HE2, Ana SANCHEZ3, Sofia TSIROPOULOU1, Maria G. DULAK-LIS1, Frederic JAISSER4, Rhian M. TOUYZ1, 1Cardiovascular Research and Medical Sciences Institute, University of Glasgow, Glasgow/Scotland, UK, 2Kidney Research Centre, Ottawa Hospital Research Institute, University of Ottawa, Ottawa/Ontario, Canada, 3Departamento de Fisiología, Facultad de Farmacia, Universidad Complutense, Madrid, Spain, 4Inserm Unit 1138 Team 1, Centre de Recherche des Cordeliers, University Pierre and Marie Curie, Paris, France Aldosterone (aldo) plays a role in obesity and cardiovascular diseases, such as hypertension. We previously demonstrated that adipocytederived factors regulate vascular function and vascular smooth muscle cell signaling. Moreover, adipocytes express aldosterone synthase and produce aldo. The mineralocorticoid receptor (MR), which is responsible for aldo signaling, is also found in these cells, but its role in regulating adipose tissue interactions with the vasculature is unknown. In this study, we investigated whether MR activation in adipocytes regulates vascular reactivity. Conditional transgenic mice that overexpress MR in an adipocyte-specific manner were studied. Vascular reactivity of resistance mesenteric arteries to acetylcholine (ACh), sodium nitroprusside and phenylephrine (Phe), in the absence or presence of fat conditioned medium (Fcm) from control and adipocyte overexpressing MR (MROE) mice, was performed by myography. In basal conditions, endothelial dysfunction was not observed in MROE or control (Ctr) mice. However, exposure of arteries from control mice to Fcm from MROE mice induces endothelial dysfunction (ACh 10-6M: 77.5±9.6% no Fcm vs. 49.8±7.5% Fcm, p<0.05), an effect blocked by N-acetyl-cysteine (an antioxidant) (ACh 10-6M: 82.2±6.6%). Resistance arteries from MROE mice had decreased Phe-induced contraction, compared to control mice (Phe 10-5M: 2.7±0.2 mN/mm Ctr vs. 1.7±0.2 mN/mm MROE, p<0.05). Rho Kinase activity, which regulates vascular contraction, is decreased in arteries and adipo tissue from MROE (mesenteric arteries, Ctr: 100±16.2% vs. MROE: 31.1±6.1%, arbitrary units, p<0.01; adipose tissue, Ctr: 100±12.6% vs. MROE: 51.3±9.3%, arbitrary units, p<0.01). In conclusion, MR in adipocytes may play an important role in the regulation of vascular function, through redox-sensitive pathways and activation of Rho kinase. These data indicate a cross-talk between adipocyte MR and vascular function and identify novel molecular mechanisms through redox-sensitive PKG-1 and ROCK. Our findings may be important in obesity/adiposity where adipocyte MR expression/signaling is amplified and where vascular risk is increased.

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Oral Presentation Abstracts Brown adipose tissue impact on vascular function through an anti-contractile effect and redox-sensitive mechanisms. Malou Friederich-Persson1, Aurelie Nguyen Dinh Cat1, Augusto Montezano1, Rhian Touyz1, 1University of Glasgow, Institute of Cardiovascular and Medical Sciences, Glasgow, UK Introduction: White (WAT) and brown (BAT) adipose tissue are phenotypically different. Under physiological conditions, WAT secretes “adipocyte-derived relaxing factors” (ADRF) and promotes vasorelaxation, an effect that is lost during pathological conditions such as obesity. Whether BAT influences vascular function remains unclear. In this study, we investigated whether BAT regulates vascular reactivity. Methods: Vascular reactivity of wild-type mouse mesenteric arteries to acetylcholine (Ach) and noradrenaline (NA) was performed by wire myography. Vessels were studied in the absence of perivascular adipose tissue (PVAT) and were incubated for 30 minutes with BAT (obtained from the interscapular region) alone or in combination with inhibitors of nitric oxide synthase (L-NAME, 100 µM), cyclooxygenase (indomethacin, 10 µM), voltage-gated K-channels (4-aminopyridine, 0.1-2 mM) or the scavenger of hydrogen peroxide (PEG-catalase, 300 U/ml). Fitted curves were evaluated for EC50 and maximal contraction (MC). Results: BAT exerts a strong anti-contractile effect (P<0.0001 EC50 and MC vs. PVAT-denuded arteries, N=10-11). There was no effect of BAT on vascular relaxation (N=4, all NS). The anti-contractile effect of BAT also remained unaffected with L-NAME, indomethacin or 4-aminopyridine (BAT+drug P<0.0001 EC50 and MC vs. PVAT-denuded arteries and NS vs. BAT alone, N=3-11) but was completely blocked by PEG-catalase (N=3-11). Conclusion and discussion: Our results indicate that BAT mediates an anti-contractile effect and may impact on vascular function through hydrogen peroxide-dependent mechanisms. Indeed, hydrogen peroxide is a suggested candidate for the ADRF and it is of interest to note that mRNA expression of NOX-4, a hydrogen peroxide producer, is approximately 8-fold higher in BAT compared to WAT (N=4). Importantly, the present study suggests that BAT may influence vascular function through processes that involve hydrogen peroxide. Precise molecular mechanisms and targets underlying these phenomena await clarification. Our findings may be important in obesity/adiposity where BAT could be of interest for new therapeutic strategies as it could play an important role to attenuate the vascular complications in obesity. The association of sedentary behaviour with adiposity-related markers differ in population of White-European, South Asians and Black ethnic background: Findings from 224,395 UK Biobank participants Carlos Celis-Morales1, Uduakobong Tuk2, Jana Anderson2, Daniel Mackay2, Naveed Sattar1, Jill Pell2, Jason Gill1, 1BHF Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK, 2Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK Background: Adults spend ~55% of their waking time sedentary. However, there is limited evidence on whether the effect of sedentary behaviour (SB) on adiposity-related markers differs by ethnicity. Therefore, the aim of this study was to investigate the association between SB and adiposity-related markers in adults of White-European, South Asians (SAs) and Black ethnic background. Methods: A cross-sectional analysis was conducted in 224,395 individuals recruited in the UK Biobank, with ages ranging from 40 to 73 years. Linear regression analyses were used to explore the association between SB and adiposity-related markers (body mass index (BMI), waist circumference (WC) and % body fat). SB was derived from self-reported spent watching TV, sitting in front of a computer or driving (hours/day). Results: Mean ± SD self-reported total SB was 5.31±2.5, 5.26±2.9 and 6.07±3.2 hours per day for white, SAs and black population, respectively. Significant SB*ethnicity interaction effect were found for BMI, WC and Body fat (p<0.0001 for all). SB (hours/day) was significantly associated with an increase in BMI (β±SE) [white: 0.32±0.01 kg.m-2, p<0.0001; SAs: 0.23±0.03 kg.m-2, p<0.0001 and Black: 0.55±0.03 kg.m-2, p<0.0001], WC [white: 0.81±0.03 cm, p<0.0001; SAs: 0.69±0.08 cm, p<0.0001 and Black: 1.12 ±0.07 cm, p<0.0001] and % of body fat [white: 0.51±0.02, p<0.0001; SAs: 0.69±0.04, p<0.0001 and Black: 0.79 ±0.04, p<0.0001]. All analysis was adjusted for age, sex, education level, total physical activity and total energy intake. Main Findings: Our results revealed that SB is associated with an increased BMI, WC and body fat in populations of different ethnic background independent of physical activity and energy intake. Moreover, the detrimental effect of SB on adiposity-related markers differ by ethnicity, with Black population showing a higher increase in adiposity compare to Whites and SAs for BMI, WC and % body fat. However, SAs shows a higher effect of SB on % of body fat than the White-European population.

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Oral Presentation Abstracts Assessment of the Full and Partial Normalisation of the Metabolic State Within 1-Year Post-Bariatric Surgery in Type 2 Diabetes Mellitus Patients using International Diabetes Federation Criteria Arameh Aghababaie1, Rahila Bhatti2, Adi Gordon1, Kathryn Waller2, Daniele Tassinari1, Angelo Salerno1, Francesco Rubino1, Anthony Wierzbicki2, Barbara McGowan2, 1King’s College Hospital, London, UK, 2Guy’s & St Thomas’ Hospital, London, UK Objective: To assess the percentage of patients with type 2 diabetes (T2DM) achieving criteria for full and partial normalisation of metabolic state according to criteria set out by the International Diabetes Federation (IDF) within 1 year post-bariatric surgery. Methods: In this retrospective study, data were collected on patients with T2DM who underwent gastric band (GB), gastric bypass (RYGB), and sleeve gastrectomy (SG) between March 2009 and December 2014. IDF targets for full normalisation of metabolic state are defined as: HbA1c ≤6%, no hypoglycaemia, blood pressure <135/85mmHg, weight loss >15%, total cholesterol <4mmol/l, triglycerides <2.2mmol/l, LDL<2mmol/l, and a reduction in the number or dose of pre-operative medications. IDF targets for partial normalisation of the metabolic state are defined as: HbA1c reduction >20%, blood pressure <135/85mmHg, LDL <2.3mmol/l, and a reduction in the number or dose of pre-operative medications. Results: 113 patients with T2DM underwent surgery but a full metabolic data set was only available on 68 patients and these were analysed in this study (24 GB, 15 RYGB, and 29 SG patients). The mean (±SD) age of the patients was 53±7 years and 59% were women. The mean pre-op BMI was 49.2±8.1 kg/m2 and mean HbA1c was 8.3±1.9%. Within 12 months post-surgery, there were significant reductions in BMI to a mean of 39.6±6.7 kg/m2 (p<0.001) and mean HbA1c to 6.7±1.6% (p<0.001). Within 12 months post-surgery, 28% (n=19/68; 3 GB, 7 RYGB, and 9 SG patients) achieved IDF criteria for full normalisation, and 22% (15/68; 5 GB, 2 RYGB, and 8 SG patients) achieved criteria for partial normalisation of the metabolic state; individual IDF targets for HbA1c, weight loss, BP, TC, TG, LDL, and pre-operative medications were attained by 59% (n=40/68), 73% (n=46/63), 85% (n=58/68), 60% (n=41/68), 93% (n=63/68), 63% (n=43/68) and 86% (n=57/66) respectively, within 12 months post-op. Conclusion: 50% of patients undergoing bariatric surgery achieve full or partial normalisation of metabolic state within 12 months of surgery. A large proportion of patients achieved individual IDF targets within 1 year post-surgery. These results re-enforce the role of bariatric surgery as both a metabolic and weight-loss intervention. The potential of Ginkgo biloba extract as an antiobesogenic therapy Bruna Hirata1, Maysa Cruz1, Roberta Sá1, Maria Isabel Alonso-Vale1, Lila Oyama2, Eliane Ribeiro2, Monica Telles1, 1Universidade Federal de São Paulo, Diadema - SP, Brazil, 2Universidade Federal de São Paulo, São Paulo - SP, Brazil The intake of high fat diets leads to obesity and consequently to the development of metabolic disorders such as type 2 diabetes mellitus and cardiovascular diseases. Taking into consideration the severity and risks of this condition, new treatment strategies are highly necessary. We have previously demonstrated that Ginkgo biloba extract (GbE) treatment reduced body adiposity and improved insulin signalling and sensitivity in obese rats, suggesting that GbE might be a good therapy alternative to treat obesity and its related disorders. However, it remains unknown the mechanisms by which GbE promotes the loss of adiposity and body weight. In this context, the aim of the present study was to evaluate the effect of GbE on adipose tissue metabolism. Male rats were fed from 2 to 4-mo-old with high fat diet and thereafter treated for 14 days with 500mg/kg of GbE. Rats were then euthanized and epididymal fat depot was removed. The adipocyte isolation was performed as previously described by Rodbell (1964). A small amount of adipocytes was photographed under an optic microscope and the mean adipocyte diameter was determined by measuring 50 cells. Lipolysis was estimated as rate of glycerol release in the incubation medium and measurement of glycerol release (Free Glycerol determination kit – Sigma). Fatty acid uptake was measured by intracellular accumulation of [3H]-oleate and the gene expression of ATGL, Perilipin and FAS was evaluated by RT-PCR. The treatment with GbE promoted a significant reduction on both food/energy intake (6.3%, p=0.031) and adipocyte diameter (14.96%, p=0.007). Neither basal nor stimulated lipolysis were altered, but fatty uptake in the treated group was reduced by 43.36% (p=0.017). ATGL, Perilipin and FAS gene expression was also reduced in comparison to the non-treated group (47%, p=0.028; 95%, p=0.015; 76%, p=0.001, respectively). The data suggest that GbE might have potential as an antiobesogenic therapy, modulating fatty acid uptake, adipocyte hypertrophy and the gene expression of genes involved in lipolysis and lipogenesis. It is important to note that the GbE effects were observed in rats kept feeding with high fat diet. The GbE beneficial effects herein demonstrated may encourage further studies of this potential new line of therapy, especially for obese subjects resistant to adhere to a nutritional education program.

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Oral Presentation Abstracts Friday 11th September 08.30 – 10.00

Room 114

Oral Abstracts – Clinical Research

How accurate is internet-based self-reported weight and body mass index in European adults? Evidence from the Food4Me study Carlos Celis-Morales1, Katherine Livingstone1, Clara Woolhead2, Eileen Gibney2, Lorrain Brennan2, Marianne Walsh2, Rosalind Fallaize3, Santiago Navas-Carretero4, J. Alfredo Martinez4, Cyril Marsaux5, George Mochonis6, Yannis Manios6, Silvia Kolossa8, Hannelore Daniel8, Iwona Traczyk9, Wim Saris5, Christian Drevon7, Julie Lovegrove3, Mike Gibney2, John Mathers1, 1Human Nutrition Research Centre, Institute of Cellular Medicine, Newcastle University, Newcastle, UK, 2Institute of Food and Health, University College Dublin, Dublin, Ireland, 3Hugh Sinclair Unit of Human Nutrition and Institute for Cardiovascular and Metabolic Research, University of Reading, Reading, UK, 4Department of Nutrition, Food Science and Physiology, University of Navarra, Pamplona, Spain, 5Department of Human Biology, NUTRIM, Maastricht University, Maastricht, The Netherlands, 6Department of Nutrition and Dietetics, Harokopio University of Athens, Athens, Greece, 7Department of Nutrition, Institute of Basic Medical Sciences, Faculty of Medicine, University of Oslo, Oslo, Norway, 8ZIEL Research Center of Nutrition and Food Sciences, Biochemistry Unit, Technische Universität München, Munich, Germany, 9National Food & Nutrition Institute (IZZ), Warsaw, Poland Background: With the growing numbers of e-health intervention studies, there are concerns about the validity and reliability of internetbased self-reported data. The aim of this study was to assess the validity of internet-based self-reported (SR) anthropometric and sociodemographic data compared with standardized measurements performed face-to-face in a validation study (VS). Methods: A total of 140 participants from 7 European countries, participating in the Food4Me Study were invited to take part in the VS. Participants visited the research centre of each country within two weeks of self-reporting their data via an internet-based questionnaire. For SR data, participants were given detailed instructions, including photographs and online videos, on how to take each measurement. Results: The results demonstrate a strong Intraclass Correlation Coefficient between SR and VS for anthropometric data (height 0.992 [95% CI 0.988 to 0.993], p<0.0001; weight 0.996 [0.995 to 0.997], p<0.0001 and BMI 0.993 [0.990 to 0.995], p<0.0001). However, SR for height (Δ 0.003 m [95% limits of agreement -0.027 to 0.032], p=0.046) was slightly higher than the VS measurements but lower for weight (Δ -0.65 kg [-3.6 to 2.2], p<0.0001) and for BMI (Δ -0.30 kg.m-2 [-1.56 to 0.96] p<0.0001). In addition, Bland-Altman analyses show that just 4.2, 7.1 and 5.0% of the total participants fell outside 95% limits of agreements for height, weight and BMI, respectively. Conclusion: Our findings confirm the reliability of internet-based self-reported anthropometric data collected remotely in European adults. Comparison of the Eligible Population to Those Being Referred to Glasgow and Clyde Weight Management Services Daniel Slack1, Nasser Aldekhail1, Jennifer Logue1, 1University of Glasgow, Glasgow, UK Background: An ideal NHS weight management service will be accessed by all eligible groups within the catchment area. We investigated the characteristics and demographics of the eligible population in NHS Greater Glasgow and Clyde to those referred by their GP to the weight management service. Methods: Using data from the Scottish Health Survey 2008-11 we compared the eligible population (BMI >35 or >30 + diabetes, CVD or hypertension) to those referred to Glasgow and Clyde weight management service (GCMWS) between 2008 and 2014. Results: 15.3% of the referred population were age 18-29 compared to just 5.9% of the eligible population. 40% of those eligible were male but only 28.6% of those referred were. The spread of deprivation across the eligible and referred population were similar. BMI >50 was over-represented in the referred cohort (8.6% vs 0.7% of the eligible population). Proportions of patients with co-morbid conditions were broadly similar across both groups. Conclusion: In keeping with other services, females are generally over-represented in GCWMS. The over-representation of younger adults and those with very high BMI is probably appropriate given the opportunity for intervention in these groups. While it is reassuring that those in deprived areas are being referred equally to affluent areas, these individuals probably have greater need and less resources. Further targeting of referrals to those at higher risk may be required.

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Oral Presentation Abstracts The feasibility and acceptability of PhunkyFoods, a primary school-based programme targeting diet and physical activity: A cluster randomised feasibility trial Pinki Sahota1, Meaghan Christian1, Rhiannon Day1, Kim Cocks2, 1Leeds Beckett University, Leeds, UK, 2KCStats Consultancy, Leeds, UK Objective: To evaluate the feasibility and acceptability of a primary school-based intervention to promote healthy nutrition and physical activity, and the measurements required to assess outcomes to inform a definitive trial. Design: Cluster randomised feasibility trial. Setting: 8 primary schools from North of England. Participants: 358 pupils aged 6-9 years. Intervention: 18 month school-based intervention targeting dietary and physical activity knowledge and behaviours. Main outcome measures: Acceptability and feasibility of the intervention and of measurements required to assess outcomes in a definitive trial. Healthy Lifestyle Knowledge Questionnaire (HLKQ), Dietary intake using the Synchronised Nutrition and Activity Program (SNAP) (SNAPTM), height and weight, interviews with teachers and parental questionnaires. Results: Eight schools were recruited and retained; data was collected from 358 children at baseline; 337 (94.1%) at 6 months; 325 (90.8%) at 18 months. The intervention is feasible in schools and acceptable to teachers, pupils and parents. The outcome tools were appropriate. At 18 month follow-up the HLKQ indicated no difference in the total knowledge score, healthy balance score and nutrition score between Intervention and Control groups. There was a trend towards a higher mean physical activity knowledge score in the Intervention group (mean difference of 1.9 (95% CI -0.1 to 1.8, p=0.08)). Year 4 Intervention pupils indicated a statistically significant higher mean healthy balance knowledge score (mean difference of 5.1, (95% CI 0.1-10.1, p=0.05). At 18 months Intervention pupils compared to Control pupils reported a greater liking for fruit (76.1% vs. 66.4%) and vegetables (54.2% vs. 44.2%) and an indication of reduced intake of full sugar fizzy drinks, chocolate/biscuits, takeaways and increased vegetable intake and pies/pasties. Conclusion: Although not powered to examine intervention outcomes, it was found that the direction of effect on knowledge and dietary change were in favour of the intervention, supporting the need for a definitive trial. Maternal Obesity and Gestational Diabetes amongst South Asian and European mothers in an English NHS Region N.A Abd Ghafar1, A Francis2, W Robertson1, J Gardosi2, 1University of Warwick, Coventry, UK, 2Perinatal Institute, Birmingham, UK Objective: We wanted to identify the prevalence of maternal obesity and its association with gestational diabetes in first and later generation South Asians and compare them with European mothers in the West Midlands. Design: Population based observational study. Setting: West Midlands, United Kingdom. Population: A total of 141,945 complete records of pregnancies delivered between 2009 and 2012, with 122,144 European (86.1 %) and 19,801 South Asian (14.7%) mothers, including 10,622 (7.5%) born in the UK (SAbUK) and 9,179 (6.5%) South Asians not born in UK (SAnbUK). Methods: Maternal height and weight was measured at the booking visit in early pregnancy. Obesity was defined according to the WHO classification (South Asian: BMI >27.5, European: >30.0). Multiple variables were assessed by logistic regression analyses. Main Outcome Measures: Prevalence of obesity and gestational diabetes in different ethnic groups. Main Results: Compared to the prevalence of obesity in European mothers (18.6%), South Asians born in the UK had a prevalence of obesity of 29.3% (OR 2.2; 95% CI 2.1-2.4), while mothers not born in the UK had a prevalence of 25.5% (OR 1.9; 1.8-2.0). In each Ethnic group, obese mothers had a significantly increased risk of gestational diabetes, with the largest increase in risk being in South Asian mothers not born in UK: Obese European mothers: OR 5.5, CI 5.0-6.1; SAbUK: OR 8.8, CI 7.5 – 10.3; and SAnbUK: OR 15.5; CI13.5-17.7. Conclusion: South Asian mothers have a high prevalence of obesity and an increased risk of developing gestational diabetes compared to their European counterparts. This risk is highest in first generation migrants.

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Oral Presentation Abstracts Effects of replacing diet beverages with water on weight loss in female adults during a 24 week hypoenergetic diet plan. Ameneh Madjd1, Moira Taylor1, Ian Macdonald1, Hamid Farshchi2, 1School of Life Sciencess, The University of Nottingham, Nottingham, UK, 2Novindiet Clinic, Tehran, Iran Background: Obese people believe that drinking diet beverages (DBs) may be a simple strategy to achieve weight loss. However, nutritionists advise drinking water (W) when attempting to lose weight. It is unclear how important drinking water instead of DBs is during a weight loss program. Objective: To compare the effect on weight loss of either replacing DBs with water or continuing to consume DBs, in adults during a 24 week weight loss program. Design: Overweight and obese females [n = 89; BMI = 27- 40 kg/m²; age= 18-50 y] who usually consumed DBs in their diet, , were asked to either substitute water for DBs (Water group) or continue drinking DBs five times per week after their lunch for 24 weeks (DBs group), whilst on a weight loss program. Results: 62 participants (71%) completed the trial (32 in DBs group, 30 in Water group). Baseline variables were not significantly different between groups. A significant reduction in anthropometric measurements and significant improvements in cardiometabolic risk characteristics were observed over 24 weeks in both groups. Compared with DBs group, Water group had a greater decrease in weight (Water: -8.8 ± 1.9 kg; DBs: -7.6 ± 2.1 kg; P =0.015, time × group), fasting insulin (Water: -2.84 ± 0.77 mU/l; DBs: -1.78 ± 1.25 mU/l P<0.001), HOMA IR (Water:-0.097 ± 0.049; DBs: -0.057 ± 0.042, P<0.001) and 2h post prandial (2hpp) glucose (Water: -1.02 ± 0.25 mmol/l; DBs: -0.72 ± 0.27 mmol/l; P<0.001) over the 24 weeks. However, there was no significant time × group interaction for waist circumference, fasting plasma glucose and lipid profiles within both groups over 24 weeks. Conclusion: Replacement of DBs with water after the main meal may lead to greater weight reduction during a weight loss program. It may also offer clinical benefits to improve insulin resistance. Exploring GPs experiences of identification and management of childhood obesity. Donna Sager1, 1Stockport, Greater Manchester, UK National policies (DoH, 2008; 2011) propose a clear role for GPs in responding to the increase in childhood obesity, despite a limited evidence base which would secure such an emphasis. Previous research has indicated multiple barriers to the engagement of GPs in this clinical activity due to the sensitivities of the subject, low levels of role competence and confidence and limited access to specialist services. Using interpretive phenomenological analysis, this study explored how GPs made sense of their experiences of identifying and managing childhood obesity in order to provide a unique insight into these professional behaviours. Retrospective semi-structured interviews were carried out with ten GPs from Stockport, who had been in practice for over 25 years. Four themes emerged. The first ‘understanding the family’ demonstrated how the GPs utilised their knowledge of the family’s health beliefs, motivations, skills, and wider socio economic factors to compile a unique understanding of the family which framed their responses to the obese child. The second ‘flexibility and responsiveness’ explored how this complex knowledge of the family was used to negotiate and address the different physical and emotional needs of the child. The third theme ‘professional and individual dilemmas’ explored areas of professional uncertainty, the identification of perceived legitimate role boundaries and the personal belief systems of the GPs regarding childhood obesity. The final theme ‘organisational challenges’ highlighted how time pressures, competing priorities, and structural constraints challenged their abilities to provide effective responses. An extended explanatory insight is provided by exploring the GPs’ dominant epistemological framework which resulted in the identification of 4 role types, using Laws et al., (2009) theoretical framework. The role types are considered in relation to the GPs’ professional identities and their contextual responses to the child and family. The research concludes with practical recommendations for service improvement at the practitioner, commissioner and national policy level.

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Oral Presentation Abstracts Friday 11th September 10.30 – 12.00

Room 114

Oral Abstracts – Clinical Research

Associations between clustered cardio-metabolic risk, waist circumference, and dietary glycaemic indices in post-pubertal adolescents. Catherine Kerr1, Daniel Bailey2, Steve Kozub2, Ben Davies3, 1Oxford Brookes, Oxford, UK, 2University of Bedfordshire, Bedford, UK, University of Bristol, Bristol, UK

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Introduction: The glycaemic index (GI) and glycaemic load (GL) of the diet have been associated with obesity and associated metabolic risk factors in adult populations, but there is less evidence in adolescent populations and has been limited by lack of consideration of the effects of pubertal status on insulin resistance1. Methods: 72 post-pubertal adolescents (45 males, 27 females), mean age 17.4±1.4 years, were recruited. Habitual nutritional intake was assessed using 3 day weighed food diaries. Clustered metabolic risk score was constructed by summing standardised scores for: diastolic blood pressure, triglyceride (TG), inverse high-density lipoprotein (HDL), blood glucose and waist circumference (WC). High clustered metabolic risk (Crisk) score was defined as ≥ 1 SD above the mean for the population2. Binary logistic regression analyses were conducted to assess the odds (Odds Ratio, OR) of being in a high risk category according to dietary GI or GL. Results: Per unit increase in GI, there was an increased likelihood of increased WC (OR 1.70, CI 1.16-2.50; P= 0.007), and in males only; low HDL (2.09, 1.11-3.93; P = 0.022), and a high Crisk (2.57, 1.02-6.46; P= 0.045). In contrast, there was no association between GL and WC and a unit increase in GL was associated with a reduced likelihood of having the following metabolic risk factors: TG (OR 0.00, CI 0.00-0.26; P= 0.030); low HDL (OR 0.00, CI 0.00-0.17; P= 0.034) and cumulative risk as assessed by Crisk (OR 0.00, CI 0.00-0.93; P= 0.049). Conclusion: The results show an increased likelihood of higher WC and cardio-metabolic risk (statistically significant only in males) with higher dietary GI. Increased GL was associated with reduced odds for cardio-metabolic risk factors. These findings suggest that it may be more important to emphasise lowering dietary GI rather than GL to reduce the risk of cardio-metabolic risk and adiposity in adolescents. Nielsen BM, Nielsen BM, Bjornsbo KS, Tetens I and Heitmann BL (2005). Dietary glycaemic index and glycaemic load in Danish children in relation to body fatness. The British Journal of Nutrition, 94, 992-997. 2 Andersen LB, Harro M., Sardinha LB, Froberg K, Ekelund U, Brage S, Anderrssen SA (2006) Physical activity and clustered cardiovascular risk in children: a cross-sectional study (The European Youth Heart Study). The Lancet, 368, 299-304. 1

Can an ICT-mediated behavioural intervention support weight loss maintenance? The design, development and interim findings of the NULevel randomised controlled trial Elizabeth Evans1, Kirby Sainsbury1, Dominika Kwasnicka1, Mia Campbell2, Vera Araujo-Soares1, Falko Sniehotta1, 1Newcastle University, Newcastle, UK, 2Northumbria University, Newcastle, UK Effective weight loss interventions are widely available, but after weight loss, most individuals regain weight. Interventions to help prevent regain in obese individuals following weight loss are lacking. We report the development, sample characteristics and interim findings of an ongoing randomised controlled superiority trial (NULevel) evaluating a tailored ICT-mediated weight loss maintenance (WLM) intervention. To develop the behavioural intervention, we assembled and drew on a comprehensive evidence base, including a systematic review of extant WLM interventions, qualitative interviews with formerly obese individuals avoiding weight regain, and a behaviour maintenance theory review. Mobile phone internet technology and SIM-enabled weighing scales were utilised to generate a flexible, inexpensive, potentially scalable intervention. 288 obese adults who had lost ≥5% body weight in the prior 12 months were recruited from the community, commercial providers and social media. They were allocated 1:1 to receive 12 months of either a minimal-contact control condition or the NULevel intervention. Intervention group participants attended a WLM consultation, used a mobile internet platform to self-monitor their diet, daily activity (via pedometer) and weight (via daily self-weighing on the SIM-enabled scales), and received semi-automated tailored feedback via SMS. Participants in the control condition received scales and a quarterly SMS. Change in weight (kg) from baseline was the primary outcome; other measures at 0, 6 and 12 months included blood pressure, accelerometery, psychological variables and health service use. Interim findings show the intervention procedures to be both acceptable and feasible, and study retention to be excellent. We report baseline and 6-month data for the sample and present findings from a qualitative process evaluation. We reflect on a) the role of technology in delivering intervention content and providing interactions with the study team in a cost-effective manner and b) the next steps in developing a rigorous science of weight loss maintenance with the potential to influence both policy and practice.

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Oral Presentation Abstracts The Bi-directional Association between Body Mass Index and Sleep duration: The English Longitudinal Study of Ageing Victoria Garfield1, Meena Kumari2, Meena Kumari1, 1University College London, London, UK, 2University of Essex, Colchester, UK It is hypothesized that there is an association between higher body mass index (BMI) and shorter sleep and/or problematic sleep, and that this relationship may be bi-directional in nature. The literature suggests that further large-scale observational studies are necessary to help elucidate the direction of this association as the majority of studies are cross sectional in nature. We used data from waves 4 (2008, baseline) and 6 (2012, follow up) from the English Longitudinal Study of Ageing – a representative sample of household residents aged fifty years or older – to examine whether BMI at baseline is associated with change in sleep duration (N=5,414), and separately whether sleep duration at baseline is associated with change in BMI (N=5,193). Results from linear regression revealed the existence of an inverse association between baseline BMI and sleep duration at follow up, after adjusting for multiple co-variates (β= -.008, Confidence Interval (CI) =-0.013 – -0.002). However, we found no evidence for a prospective association between baseline sleep duration and BMI at follow up (β= -0.024, CI= -0.107 – 0.059), when adjusting for the same covariates. In conclusion, our findings suggest that the direction of the association between BMI and sleep duration is primarily such that BMI precedes changes in sleep duration, rather than from sleep duration to changes in BMI in older age groups. One-week adherence to a very low calorie diet reduces 24 h heart rate and increases heart rate variability in obese men and women: a randomised controlled pilot study. Ruth Allan1, Amelia White1, Frances Fitzpatrick1, Ana Pinto1, Wendy Hall1, 1King›s College London, London, UK Obesity is associated with increased risk of cardiovascular events including sudden cardiac death (SCD). Contemporary very low calorie diets (VLCD) provide <800 kcal/day, supply dietary recommended values for all nutrients, and induce rapid weight loss. Heart rate variability (HRV) is the variability in the duration of time intervals between heart beats and reflects the capacity of the autonomic nervous system to adapt to physiological demands. Low HRV indicates inadequacy of autonomic modulation of the heart, and is predictive of risk of SCD. Weight loss is associated with improved HRV, but the effects of VLCD have never been compared to a control weight loss diet. This pilot study compared the acute effects of VLCD and a moderately-low calorie diet (MCD) on HRV. Primary outcomes were changes from baseline in 24 h SDNN (an estimate of overall variability) and body weight. We hypothesised that HRV would increase more following a 7-day VLCD compared to an MCD (usual energy intake minus 500 kcal). Non-smoking, obese (BMI 30-42 kg/m2) men and women were recruited according to inclusion/exclusion criteria, then randomised to VLCD (LighterLife UK Ltd, n=9) or the control standard weight loss diet (MCD, n=8) using minimisation to balance groups for age, sex, BMI and ethnicity. Heart rate, interbeat interval (IBI) recordings (24 h), seated blood pressure and body weight/composition were measured at baseline (day 1) and endpoint (day 7-8). Raw IBI data were downloaded and processed using Kubios software to produce 24 h HRV parameters. Mean differences in the change from baseline between groups (95% CI) are shown; P<0.05 is taken as statistically significant. Independent t-tests showed there were statistically significant greater reductions in body weight and fat mass following VLCD (ΔVLCD-ΔMCD: -1.6 kg; -2.7, -0.4 and -1.4 kg; -2.2,-0.6, respectively). Univariate ANCOVA (factors: diet and sex; covariate: age) showed that 24h heart rate significantly decreased following VLCD (ΔVLCD-ΔMCD: -15 bpm; -25, -5), and the relative increase in SDNN was borderline significant (ΔVLCD-ΔMCD: 27 msec; -3, 57). High frequency power and pNN50 (ΔVLCD-ΔMCD: 378 msec2; 55, 701 and 9 %; 0, 18, respectively) were also relatively increased following VLCD. Adherence to a 1-wk VLCD may have rapid effects in improving cardiac autonomic function; a larger sample size is required to confirm these preliminary findings.

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Oral Presentation Abstracts Study on peri-operative management of type 2 diabetes following bariatric surgery Rahila Bhatti1, Daniele Tassinari2, Angelo Salerno2, Kathryn Waller1, Nadeem Abbas2, Omar Mustafa2, Anthony Wierzbicki1, Francesco Rubino2, Barbara McGowan1, 1Guy’s & St Thomas’ Hospital, London, UK, 2King’s College Hospital, London, UK Aim: Increasingly patients with type 2 diabetes (T2DM) are undergoing bariatric surgery. The glycaemic response peri-operatively is variable and this study aimed to determine glycaemic control and insulin management peri-operatively. Methods: This retrospective study included patients with T2DM (n = 70) who underwent bariatric surgery from 2011 to 2015. Glycaemic data were collected 24-48 hours post-surgery and 3 months post-surgery. Results: Mean (± SD) age was 51 years ± 9.9, HbA1c 8% ± 1.7, weight 145 kg ± 26, BMI 51 ± 7.7, duration of diabetes 6.0 ± 5.1 years. Bariatric procedures were as follows: 13 gastric bands, 38 sleeve gastrectomies, 19 gastric bypasses. Pre-operatively, 46 patients were on oral hypoglycaemic medication alone, 19 on basal insulin +/- oral hypoglycaemics and 1 on diet alone. Median (range) total daily dose of insulin pre-operatively was 126 (10-290) units, reduced to 42 (9-110) units 24 hrs post-operatively (p< 0.05) and 7.5 (0-91) units 48 hrs post-operatively (p<0.05). 40/65 patients continued metformin on discharge. At 3 months, mean (± SD) HbA1c decreased from 8% ± 1.7 to 7% ± 1.9. Insulin dose requirements reduced from 1.0 ± 0.7 units/kg body weight to 0.4 ± 0.4 units/kg body weight at 3 months. 7/19 patients stopped insulin on discharge (3 gastric bands, 3 sleeve gastrectomies and 1 gastric bypass) and 1 stopped at 3/12 (gastric bypass). Insulin requirements were reduced by approximately 2/3 within 48 hours of surgery. Those who stopped insulin had a mean duration of diabetes of 8.4 years pre-operatively versus 12.3 years for those who needed to continue insulin post-operatively. Mean (± SD) HbA1c was similar in both groups pre-operatively (9% ± 1.8). Conclusions: Considerable insulin titration and monitoring is required peri-operatively for patients with T2DM who have undergone bariatric surgery. For patients with persistent hyperglycaemia post-surgery, we recommend starting on 1/3 rd of pre-operative total daily dose of insulin with close follow-up. Weight-lowering efficacy of liraglutide 3.0 mg in overweight and obese adults: the SCALE Obesity and Prediabetes randomised trial Barbara McGowan1, Frank Greenway2, Ken Fujioka3, Arne Astrup4, Alfredo Halpern5, Michel Krempf6, David Lau7, Carel le Roux8, Rafael Violante Ortiz9, John Wilding10, Christine Jensen11, Nnanyelu Nzeakor12, Xavier Pi-Sunyer13, 1Guy’s and St Thomas NHS Foundation Trust, London, UK, 2Pennington Biomedical Research Center, Baton Rouge, LA, USA, 3Scripps Clinic, La Jolla, CA, USA, 4University of Copenhagen, Frederiksberg, Denmark, 5University of São Paulo Medical School, São Paulo, Brazil, 6Université de Nantes, Nantes, France, 7University of Calgary, Calgary, Canada, 8University College Dublin, Dublin, Ireland, 9Instituto Mexicano del Seguro Social, Hospital Regional num. 6, Ciudad Madero, Tamaulipas, Mexico, 10University of Liverpool, Liverpool, UK, 11Novo Nordisk A/S, Søborg, Denmark, 12 Novo Nordisk Ltd, Gatwick, UK, 13Columbia University, New York, NY, USA Background/Methods: The SCALE Obesity and Prediabetes trial investigated the safety and efficacy of liraglutide 3.0 mg vs placebo (PBO) over 56 weeks for weight management, as adjunct to a 500 kcal/day deficit diet and exercise (D&E) programme. Adults with BMI ≥27 kg/m² and ≥1 comorbidity or with BMI ≥30 kg/m² were randomised 2:1 to once-daily liraglutide 3.0 mg (n=2487) or PBO (n=1244). Results: More individuals on liraglutide (92%) experienced weight loss (WL) vs PBO (65%; Figure). Completers on liraglutide (72%) vs PBO (64%) had WL of 9.2% (9.7 kg) vs 3.5% (3.8 kg), respectively (p<0.0001). WL ≥5% occurred in 73% of completers on liraglutide vs 36% on PBO (p<0.0001); WL >10% occurred in 41% vs 15% (p<0.0001), respectively. WL with liraglutide was similar in those with and without prediabetes at screening (–8.0% vs –7.9%, respectively, p=0.59) and across baseline BMI subgroups (interaction between BMI subgroup and treatment for relative WL: p=0.054 and absolute WL: p=0.54). Non-completion was mainly due to gastrointestinal adverse events for liraglutide. Conclusions: Liraglutide 3.0 mg, as adjunct to D&E, induced significant WL vs PBO. WL was independent of baseline prediabetes status and BMI. Liraglutide 3.0 mg was generally well tolerated and gastrointestinal disorders were most commonly reported. No new safety signals emerged.

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Poster Presentation Abstracts 01 Poster: Evaluation of weight management interventions in Glasgow and Clyde Weight Management Service patients Nasser Aldekhail1, David Morrison1, Jennifer Logue1, 1University of Glasgow, Glasgow, UK There is a paucity of evidence on the effectiveness of weight management services. Our aim was to evaluate the effectiveness of phase 1 (lifestyle) and phase 2 (Orlistat, low calorie diet or lifestyle) of NHS Glasgow and Clyde Weight Management Service (GCWMS) in achieving ≥5 kg, exploring the effects of age, sex, initial weight, BMI and co-morbidities such as diabetes and hypertension. Methods: GCWMS is providing care for patients with BMI ≥35 kg/m2 or BMI ≥30 kg/m2 with co-morbidities and accessible to patients aged ≥ 18 years. In this prospective observational study we included all individuals who started GCWMS between 2008 and 2014. Last observation carried forward (LOCF) and programme completers were reported by using the mean weight changes, 5 kg and 5% weight losses at the end of phase 1 and phase 2 in three different interventions. Results: Of 23650 patients referred to GCWMS, 13255 attended assessment and 8173 (61.5%) individuals attended a first session. 7329 and 3262 individuals attended at least two sessions in phase 1 and phase 2, respectively. 72.92% were female, 40.46% were from the most deprived quintile, 21.45% had diabetes, 37.66 had hypertension, mean weight and BMI were 115.21 kg and 42.2 kg/m2 respectively. 30.5% lost ≥ 5 kg at the end of phase 1, 31%, 22% and 83% at end of phase 2 orlistat, low calorie diet and further weight loss, respectively. Conclusion: This weight management programme was effective at achieving 5kg weight loss, but only for a minority of patients. Patients who completed the programme were more likely to lose ≥ 5 kg. Targeting the effective interventions at specific populations and increasing the intensity of phase 2 interventions may improve the overall effectiveness. 02 Poster: Body composition and Energy Expenditure with Total Diet Replacement during weight loss and maintenance (BEYOND): study protocol Mike Lean1, Yasmin Algindan1, Naomi Brosnahan1, George Thom1, Louise McCombie2, Catherine Hankey1, Giles Roditi5, Rosario LopezGonzalez5, Matthew Banger4, Stephan Dombrowski3, Elani Rizou1, Konstantinos Gerasimidis1, Lindsay Govan1, 1University of Glasgow, Glasgow, UK, 2Counterweight Ltd., Edinburgh, UK, 3University of Stirling, Stirling, UK, 4University of Strathclyde, Glasgow, UK, 5NHS Greater Glasgow and Clyde, Glasgow, UK Introduction: Long-term maintenance of non-surgical weight loss remains the most significant problem in obesity treatment. This study seeks to integrate physiological and behavioural perspectives to advance the field of weight loss and maintenance science. This study will examine: 1. changes in body composition with substantial weight loss using published anthropometric prediction equations and MRI as the reference method, 2. metabolic adaptations (including resting energy expenditure (REE), gut microbiota and hormonal factors), 3. Associations between people’s views and perceptions and their weight loss maintenance status and 4. serial measurements of Binge Eating Disorder (BED), quality of life (QOL) and strategies to prevent weight regain. Methods: 20 patients will be recruited via posters. Main inclusion criteria: women aged 18-65 years, all ethnicities, body mass index >30kg/m2, <45kg/m2. Counterweight Plus, which includes 12-20 weeks total diet replacement (TDR), 8 weeks food reintroduction (FR) and 104 weeks weight loss maintenance. All participants will be followed up for 2 years. Results: Primary outcomes: muscle and adipose tissue mass will be estimated using published prediction equations and compared with measured values from whole body MRI. Findings will be investigated in relation to functional muscle strength and QOL. Patient’s views and perceptions, metabolic adaptations, BED and repeated use of TDR and FR as a weight loss maintenance strategy will also be evaluated. Conclusion: This study will establish validation for predictive equations for muscle and adipose tissue mass and their relation to muscle strength, and improve our understanding of the physiological and psychological changes that occur prospectively during weight loss, maintenance, and weight regain. Results will be available from 2016 onwards. Conflicts of Interest: NB & LM are shareholders and employees of Counterweight Ltd. Funding/Support: Department of Clinical Nutrition University of Dammam, Department of Human Nutrition University of Glasgow. Trial Registration ISRCTN03267836

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Poster Presentation Abstracts 03 Poster: Effects of an erratic versus a regular eating pattern on appetite regulation in healthy lean women Maha Alhussain1, Moira Taylor1, Ian Macdonald1, 1University of Nottingham, Nottingham, UK Background: Eating habits have been suggested as a possible moderator of appetite regulation and hence may be important in obesity management. Objective: To investigate the effect of erratic eating on gut hormones and subjective appetite in healthy lean women. Design: 11 healthy lean women undertook either an erratic (2 weeks; varying from 3 to 9 meals/day) or a regular (2 weeks; 6 meals/d) eating pattern in a randomised crossover design, separated by a 2-week (wash out) period. In the two intervention periods, identical foods were provided to a subject in amounts designed to keep body weight stable. Subjects attended the laboratory after an overnight fast at the start and end of each intervention period. GLP-1, PYY and ghrelin levels were measured fasted and for 3h after consumption of a milkshake, test drink. Subjects were then offered an ad libitum pasta meal. Subjective appetite ratings were collected using visual analogue scales (VAS) before and for 3h after the test drink; for 1h after the ad libitum meal; pre and post-meals in day 7 and 14, when 6 meals/d were consumed in both intervention periods. Results: Fasting GLP-1 and PYY response to the test drink showed a significant main effect of visit (p<0.05). On day 7, higher post-meal ratings for hunger (14.5±7.0 vs 23.4±6.0 mm; p=0.01) and lower for fullness (80.6±4.4 vs 73.6± 5.3 mm; p<0.01) were observed in the erratic compared with the regular period. Furthermore, on day 14, pre-meal hunger ratings were significantly greater in the erratic period than in the regular one (58.0±8.7 mm and 51.0±11.5 mm respectively; p<0.05). Post-meal hunger ratings were significantly higher in the erratic period (18.9±4.5 and 22.8±5.0 mm for regular and erratic period respectively; p<0.05). The values for the other VAS ratings did not show significant differences between the two intervention periods. Conclusion: Erratic eating for a 2-week period led to greater post meal ratings for hunger and lower for fullness, suggestion a reduction in the satiation resulting from the food consumption. 04 Poster: Erratic meal pattern and carbohydrate metabolism Maha Alhussain1, Moira Tyalor1, Ian Macdonald1, 1University of Nottingham, Nottingham, UK Background: Meal pattern might have an impact on metabolic status and therefore impacts on health. Objective: To investigate the effects of meal pattern on blood lipids, glucose and insulin. Design: In a randomized crossover study, 11 healthy normal-weight females (18–40 years) underwent two 14-day intervention periods (with an intervening 14-day wash-out period). In period 1, participants consumed either an erratic (between 3 and 9meals/day) or a regular meal pattern (6 meals/day). In period 2, participants followed the alternative meal pattern to that followed in period 1. Identical foods were provided to a participant in amounts designed to keep body weight constant in both intervention periods. Participants were asked to visit the laboratory at the start and end of each period after an overnight fast. Blood was sampled before and for 3h following the consumption of a high-carbohydrate test drink to determine lipids, glucose and insulin concentrations. Glucose concentrations were monitored under free-living conditions using the continuous glucose monitoring system (CGMS) for 3 consecutive days in both intervention periods (day 7, 8 and 9) Results: Fasting lipids, glucose and insulin concentrations were not significantly affected by meal pattern. However, post-prandial (test drink+3h) AUC for glucose was greater after the erratic compared to the regular meal pattern (245.2±110.6 and 200.3±88.7 mmol/L in 3h respectively; p<0.05) with no difference in the insulin response. Furthermore, with CGMS, post-prandial (breakfast+90min) AUC for glucose on day 7 (same type and amount of foods were consumed in both intervention periods) was significantly higher in the erratic compared to the regular meal pattern (95.7±70.8 and 50.2±54.4 mmol/L in 90min respectively; p <0.05). The post-prandial (Lunch+90min) AUC on day 9 showed a similar difference (102.8±74.7 and 51.39±43.9 mmol/L in 90min in erratic and regular meal pattern respectively; p<0.05). Conclusion: Participants adopting an erratic meal pattern exhibit a greater glucose response to the test drink and some meals which may indicate a deleterious effect on glycemic control. Therefore, an erratic meal pattern could be a potential environmental risk factor that may influence health.

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Poster Presentation Abstracts 05 Poster: Evaluation of childhood obesity assessments in secondary care paediatric clinic M Rashida Begum1, A R Moodambail0, 1Barts and The London Medical School, London, UK, 2Barts Health NHS Trust, London, UK Aim of Study: to evaluate clinical assessment of obesity in a secondary care paediatric set up against current OSCA Guidelines for childhood obesity assessments in UK. Method: 72 children (1-16 yrs) were primarily assessed for obesity; data entered on to a pro forma based upon OSCA guidelines, for analysis. Results: 33 patients (46%) were classified as morbidly obese, 24(33%) severely obese, 15(21%) obese. Evaluation showed 46% of children and young persons with obesity had not been assessed well and adequately. Clinical examination (in 85%) and investigations (in 76%) were adequate in majority of patients, but adequate history assessment was lacking in 90% of patients. This would lead to nonidentification of causation and co-morbidities, and further leading to possible lack of adequate timely interventions. The most common co-morbidity newly identified was Vitamin D deficiency (40%). Significant co-morbidities like PCOS (36% of adolescent girls), Type 2 Diabetes, Impaired glucose tolerance, hypertension, dyslipidaemia and psychological distress/bullying were also newly identified through the assessments. Children with neurodevelopmental/behavioural/learning difficulties were at higher risk to develop obesity. The clinical assessment for obesity related sleep disorders was grossly inadequate, and did not use recommended Paediatric Sleep Questionnaires. Conclusion: We suggest use of a Obesity Assessment Pro-forma in clinics to improve assessments in secondary care. The Study suggests pragmatic approach to check Vitamin D level in all, and sex hormone profile in pubertal girls (to exclude PCOS) with obesity. The evaluation highlights lack of customised physical activity programmes; some children will benefit from psychology support while dealing with their weight management. 06 Poster: Disclosure of genetic-based personalised nutrition advice promotes bigger changes in obesity-related markers in risk carriers compared with non-risk carriers of the FTO obesity gene in the Food4Me study Carlos Celis-Morales1, Katherine Livingstone1, Santiago Navas-Carretero2, Anna Macready Macready3, Clare O’Donovan4, Eileen Gibney4, Lorrain Brennan4, Marianne Walsh4, Silvia Kolossa5, Hannelore Daniel5, George Mochonis6, Yannis Manio6, Cyril Marsaux7, Wim Saris7, Christian Drevon8, Mike Gibney4, Julie Lovegrove3, J. Alfredo Martinez2, John Mathers1, 1Human Nutrition Research Centre, Institute of Cellular Medicine, Newcastle University, Newcastle, UK, 2Department of Nutrition and Physiology, Pamplona, 31008, University of Navarra CIBER Fisiopatología Obesidad y Nutrición (CIBERobn), Instituto de Salud Carlos III, Spain (SN-C & JAM), Pamplona, Spain, 3 Hugh Sinclair Unit of Human Nutrition and Institute for Cardiovascular and Metabolic Research, University of Reading, Reading, UK, 4 UCD Institute of Food and Health, University College Dublin, Dublin, Ireland, 5ZIEL Research Center of Nutrition and Food Sciences, Biochemistry Unit, Technische Universität München, Munich, Germany, 6Department of Nutrition and Dietetics, Harokopio University, Athens, Greece, 7Department of Human Biology, NUTRIM, School for Nutrition and Translational Research in Metabolism. Maastricht University Medical Centre, Maastricht, The Netherlands, 8Department of Nutrition, Institute of Basic Medical Sciences, Faculty of Medicine, University of Oslo, Oslo, Norway Background: Tailored interventions aimed at weight reduction have been shown to be more effective than “one size fits all” approaches. However, there is limited evidence whether genetic-based tailored advice could provide extra benefits in reducing body weight. The aim of this study was to investigate the effect of genetic-based tailored advice on reducing obesity-related markers. Methods: 1607 adults from 7 European countries were recruited to an internet-based intervention (Food4Me) and randomised to different levels of personalised nutrition (PN). For this analysis, a subset of the Food4Me cohort (n=186), who received personalised advice to reduce their body weight, was used to investigate the effect of tailored advice based on diet + phenotypic + genetic information to carriers versus non-carriers of the FTO gene (rs9939609) risk variant. Outcomes were changes in body weight, waist circumference (WC) and BMI at month 6 of the intervention. All analyses were adjusted for baseline values, age, sex, and country. Results: Participant mean age was 45.2 years (range 23 to 72y), 65% of participants were female and mean BMI was 31.1 kg.m-2. At month 6, risk carriers who received FTO-based PN advice significantly reduced their body weight (-2.2 kg [95%CI -3.1 to -1.5] p<0.0001 vs. -1.1 [-2.5 to 0.3] p=0.121), WC (-4.3 cm [-5.7 to -2.9] p<0.0001 vs. -1.1 cm [-4.4 to 0.2] p=0.075) and BMI (-0.91 kg.m-2 [-1.2 to -0.67] p<0.0001 vs. -0.40 kg.m-2 [-0.85 to 0.05] p=0.078) as compared with non-risk carriers who received FTO-based PN advice. Conclusions: Disclosing genetic-based information on FTO as part of PN advice promotes larger reductions in obesity-related markers in individuals who are carriers of the risk variant as compared to the non-carriers.

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Poster Presentation Abstracts 07 Poster: Physical activity attenuates the influence of FTO genotype on obesity-related traits in European Adults: the Food4Me study Carlos Celis-Morales1, Katherine Livingstone1, Cyril Marsaux2, Santiago Navas-Carretero3, Rodrigo San-Cristobal3, Hannah Forster4, Eileen Gibney4, Lorrain Brennan4, Marianne Walsh4, Rosalind Fallaize5, George Mochonis6, Yannis Manios6, Silvia Kolossa7, Hannelore Daniel7, Christian Drevon8, Julie Lovegrove5, J. Alfredo Martinez3, Mike Gibney4, Wim Saris2, John Mathers1, 1Human Nutrition Research Centre, Institute of Cellular Medicine, Newcastle University, Newcastle, UK, 2Department of Human Biology, NUTRIM, School for Nutrition and Translational Research in Metabolism. Maastricht University Medical Centre, Maastricht, The Netherlands, 3Department of Nutrition and Physiology, Pamplona, 31008, University of Navarra CIBER Fisiopatología Obesidad y Nutrición (CIBERobn), Instituto de Salud Carlos III, Spain (SN-C & JAM), Pamplona, Spain, 4UCD Institute of Food and Health, University College Dublin,, Dublin, Ireland, 5Hugh Sinclair Unit of Human Nutrition and Institute for Cardiovascular and Metabolic Research, University of Reading, Reading, UK, 6Department of Nutrition and Dietetics, Harokopio University, Athens, Greece, 7ZIEL Research Center of Nutrition and Food Sciences, Biochemistry Unit, Technische Universität München, Munich, Germany, 8Department of Nutrition, Institute of Basic Medical Sciences, Faculty of Medicine, University of Oslo, Oslo, Norway Background: The FTO gene harbours the strongest known susceptibility locus for obesity. Although many studies have suggested that physical activity (PA) may attenuate the effect of FTO on obesity risk, other studies have not confirmed this interaction. The aim of this study was to investigate whether the effect of the FTO gene on obesity-related traits is modulated by PA levels in European adults. Methods: 1,483 Individuals from the Food4Me randomised controlled trial were genotyped for the FTO gene (rs9939609). PA data were measured objectively using accelerometers (TracmorD, Philips) and anthropometric measures (BMI, and waist circumference; WC) were self-reported via the internet. PA was categorised into active or inactive individuals using PA guidelines (active ≥150 min of MVPA per week). The interaction effect of PA and FTO on anthropometric measures was evaluated using General Linear Models. Results: Participant mean age was 39.8 years (range 18 to 79y), 58% of participants were female and mean BMI was 25.4 kg.m-2. FTO genotype was significantly associated with BMI (β: 0.59 kg.m-2 per risk allele, SE: 0.2 p=0.001) and WC (β: 1.2 cm, SE: 0.4 p=0.004). 77% of the participants met the PA guidelines. PA level attenuated the effect of FTO on BMI (P for interaction = 0.028). In active individuals, FTO increased BMI by 0.35 units-per allele (p=0.049) whereas the increase in BMI was significantly more pronounced in inactive individuals (1.04 units, p=0.033). We observed similar effects for WC (P for interaction = 0.009): the risk allele increased WC by 2.8 cm per allele among inactive individuals but by only 0.52 cm in active individuals. Conclusion: Our results show that PA attenuates the effect of FTO genotype on BMI and WC. This observation has important public health implications because we showed that genetic susceptibility to obesity induced by FTO variation can be reduced by adopting a physically active lifestyle. 08 Poster: Prevalence and correlates of obesity in Chile: Cross-sectional findings from the National Health Survey 2009-10 Carlos Celis-Morales1, Carlos Salas2, Ana Maria Labraña3, Eliana Duran3, Maria Adela Martinez4, Ana Leiva5, Naomi Willis6, 1Institute of Cardiovascular & Medical Sciences, Glasgow University, Glasgow, UK, 2School of Sport Science, University of Concepcion, Concepcion, Chile, 3Department of Nutrition, Faculty of Pharmacy, University of Concpecion, Concepcion, Chile, 4Institute of Pharmacy, Faculty of Science, University Austral of Chile, Valdivia, Chile, 5Institute of Anatomy, Faculty of Medicine, University Austral of Chile, Valdivia, Chile, 6 Human Nutrition Research Centre, Institute of Cellular Medicine, Newcastle University, Newcastle, Chile Background: The numbers of overweight people continues to rise globally and more than one billion adults have a body mass index (BMI) greater than 25kg.m−2. However, the factors contributing to the increase in obesity prevalence may differ by country. Therefore, the aim of this study is to estimate the prevalence of obesity and identify correlates that could contribute to the obesity level in Chile. Methods: A representative sample of 5,434 Chilean adults aged ≥18 years (59% women) who participated in the National Health Survey (2009-2010) were included. Socio-demographic data (age, sex, environment, education, income and smoking status), anthropometric (weight, height, waist circumference and BMI), diet and physical activity data were collected. Prevalence of obesity was estimated using the WHO guidelines for BMI. Results: Overall 64.5% (95%CI: 62.0, 66.8) of the cohort were overweight or obese. Logistic regression analysis reveals that individuals living in urban compared to rural environments (OR: 0.78; 95%CI: 0.65, 0.94) and people with a middle or high level of education compared to a low level of education (OR: 0.66; 95%CI: 0.56, 0.77) were less likely to be overweight or obese. Conversely, people spending more than 4 hours per day sitting (OR: 1.14; 95%CI: 1.01, 1.29) and smokers (OR: 1.57; 95%CI: 1.33, 1.85) were more likely to be overweight or obese. Conclusion: The Chilean National Health Survey reveals that overweight and obesity is highly prevalent in the Chilean population. In addition, our analysis shows that modifiable socio-demographic, dietary and physical activity–related lifestyle factors are associated with the level of obesity in Chile. These findings provide evidence of factors that should be tackled through the implementation of public health interventions to reduce obesity levels in the Chilean population.

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Poster Presentation Abstracts 09 Poster: Weight Management Portfolio: the right programme, for the right patient, at the right time Anne Clarke1, Lesley Hetherington1, Lesley Slaughter1, Anna Bell-Higgs2, Naomi Brosnhan2, Louise McCombie2, 1NHS Forth Valley, Forth Valley, UK, 2Counterweight Ltd, Northants, UK Introduction: Weight management strategy involves a tiered approach.NHS interventions should 1) optimise impact of available NHS resource 2) achieve 5-10kg loss for BMI>28kg/m2 or 15-20kg loss for BMI 35kg/m2 3) demonstrate optimal attendance 4) reduce comorbidities. Patient choice is important therefore a portfolio of programmes which meet weight loss expectations of patients and clinicians is needed. Methods: NHS Forth Valley dietetic services offer three weight management options: one to one (CO) and group delivery (CG) of the Counterweight Programme for BMI>30kg/m2 and one to one Counterweight Plus (CP) for BMI>30kg/m2 with T2DM or BMI>35kg/m2. Data from 254 patients was reviewed to establish the key characteristics of patients in each group, programme retention, weight change at 3, 6 and 12m and changes in HbA1c mmol/mol as one measure of related co-morbidity. Results: baseline characteristics showed those recruited to CG were older (mean age 53y) and had lower BMI (38kg/m2) compared CO & CP groups (mean age 48y and mean BMI 46kg/m2 for both)Retention for CG, CO and CP at 3m was 63%, 68% and 89% respectively, 6m was 38%, 54% and 73% respectively and 12m for CO and CP (data not available for CG) 34% and 50% respectively.Mean weight change for CG, CO and CP at 3m was 3.4kg, 2.8kg and 11.4kg respectively, at 6m 11kg, 3.5kg and 12.4kg respectively and at 12m for CO and CP 6.45kg and 12kg respectively. Mean reductions in HbA1c in CP (with T2DM) was 7.5 and 8.0mmol/mol at 3 and 12m respectively. Conclusion: The heterogenous population seeking weight management need a portfolio of options that address individual patient needs adn long term weight loss maintenance. Group delivery is often viewed to make better use of clinician time but these data indicate higher loss to follow up in the CG and CO group compared with CP. However those maintaining engagement with CG demonstrated good weight loss at 6m, this also observed at 12m in the CO group. Retention and weight loss was greatest at each time point in the CP group potentially reflecting a key motivator for patients being initial weight loss and a generally greater level of weight loss/ weight loss maintenance. Positive changes in co-morbidity measures further support the weight management service portfolio approach. 10 Poster: Food-seeking strategies under conditions of scarcity: An experimental model Timothy Davies1, Catherine Winstanley2, Robert Rogers1, 1Bangor University, Bangor, UK, 2The University of British Columbia, Vancouver, Canada Human patterns of food consumption are suggested to be rooted in evolutionary adaptation and that once adaptive foraging strategies in humans are likely contributors to obesity in our contemporary obesogenic environment. This experiment investigated human preferences for immediately consumable real food rewards following different delay intervals in both abundant and scarce conditions. Following a two hour fast, 38 male and female participants made binary choices between an option that resulted in either a (risky) variable delay (0s or 30s) before the delivery of a preferred reward or an option with a fixed intermediate delay (15s). For one group of participants (abundant), 100% of choices were followed by food reward; for another group of participants (restricted), only 70% of choices were reinforced. Overall, participants exhibited a bias for the variable delay that was facilitated when food rewards were delivered immediately on the preceding selection, yet abolished when participants experienced the long delay with no reinforcement. Preference for the variable delay was associated with state hunger. Male participants were more likely than female participants to repeat risky choice selections in the foodrestricted condition when the previous reward had been delivered immediately. Analogous to animal foraging models, these findings suggest that food-seeking behaviours for energy-dense edibles in humans are sensitive to uncertain delays, relative scarcity, and recent action-outcome contingencies, possibly offering a model for food-seeking in healthy and unhealthy eating.

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Poster Presentation Abstracts 11 Poster: Greater initial weight loss and increased attendance at LighterLife management groups predicts improved weight maintenance 1 year after completing a VLCD weight loss programme Kelly Johnston2, Elizabeth Evans1, 1Newcastle University, Newcastle upon Tyne, UK, 2LighterLife UK Ltd, Harlow, Essex, UK LighterLife Total, a commercial weight-loss programme for obese individuals, utilises a tripartite approach consisting of a very-low-calorie diet (VLCD) in conjunction with behavioural-change therapy underpinned by group support. Post-weight loss, the LighterLife Management programme helps clients sustain healthy lifestyle changes and maintain their weight loss. Weight records for 4897 individuals who had lost 25.5±11.3kg from their initial weight of 97.4±15.8kg on a VLCD+TCBT® and who had completed at least 12 months’ post-loss Management were analysed to identify determinants of regain at one year. Percentage weight loss regain was regressed (OLS) upon potential predictors, including demographic data, baseline weight, % baseline weight loss and total number of group attendances (SPSS 21.0 Chicago, IL, USA). Clients maintained a mean of 25% of their weight loss (±32%). Clients who lost a greater % of their baseline weight (β=.12, t(4894)=8.5, p<.0001) and who attended management groups more frequently (β=.18, t(4894)=12.4, p<.0001) showed lower subsequent regain 12 months after the cessation of VLCD weight loss. Demographic variables and baseline weight did not explain significant additional amounts of variance in regain. The amount of weight regained 12-months post weight loss following a VLCD was inversely related to: a) the amount of weight initially lost; and b) the number of weekly groups attended. Whilst historical data demonstrate weight regain is common after any weight-loss method, these results indicate that individuals who achieved larger initial weight loss and who regularly attended management groups for a year after losing weight, were more likely to sustain their weight loss. Research relating to this abstract was funded by LighterLife. 12 Poster: Metabolic changes post laproscopic gastric band insertion Camilla Gordon1, Tamar Saeed1, Theingi Aung1, Louisa Herring2, 1Royal Berkshire Hospital, Reading, UK, 2Loughborough University, Loughborough, UK Background: Obesity is a worldwide epidemic, affecting children, adolescents, and adults. Bariatric surgery remains the only effective sustained weight loss option for morbidly obese patients, and the performance of bariatric surgical procedures has significantly increased in the last 10 years. The American Society for Metabolic and Bariatric Surgery (ASMBS) estimated that in 2008 alone, 220,000 people in the United States underwent a weight loss operation. In addition to achieving weight loss, bariatric procedures result in marked improvement or resolution of many obesity-related health problems, such as type II diabetes. Methodology: Metabolic data were gathered for 53 patients between 2009 and 2012 pre and post laparoscopic gastric band insertion. The values were compared between one year pre-operatively to three to eighteen months post operatively. Findings: 81.1% of patients were female with an average age of 49; 18.9% were male with an average age of 44. A number of metabolic results were examined including HbA1c, cholesterol ratios, LFTs and haematinics. Notably HbA1c was found to decrease by an average of 12.9 mmol/L; fasting glucose by 1.3 mmol/L and total cholesterol/HDL ratio by 0.14. This indicates a benefit in diabetic and lipid control. However ALT increased by 26 iU/L and ferritin decreased by 6.25 ng/mL demonstrating at one year fatty liver disease is not improved and there are impacts on nutrition. Conclusion: Our study showed there was significant improvement of HbA1c (12.9mmol/mol on average) between three to eighteen months post laproscopic gastric band insertion with reduction of total cholesterol/HDL ration by 0.14 on average. Laparoscopic Roux-en-Y gastric bypass (RYGB) surgery was not studied because of the insufficient post-operative data which will warrant further studies.

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Poster Presentation Abstracts 13 Poster: Engagement with on-line programmes to prevent weight gain in young adults Qian Liang1, Micheal Lean1, Charoula Nikolaou1, Catherine Hankey1, 1University of Glasgow, Glasgow, UK Introduction: Understanding how young adults engage with and use on-line resources for obesity prevention may provide valuable information to modify programme design and maximise impact. Methods: Two 19-week on-line programmes shown to help to prevent weight gain were delivered by random allocation to university students; P1) a ‘rational-model’ (on weight-control), P2) a ‘stealth-model’ (global food issues). 2051 participants, mean age 20.0 SD 3.6 years, BMI 22.4 SD 4.7 kg/m2 who viewed the resources at least once, were included in this analysis, relating participant characteristics, residence-type and body-satisfaction to frequency and timing of log-ins and topic popularity. Results: P1 attracted 1196 and P2 527 participants, more female (57.8%): 45% of all participants were satisfied with their weight but 75% would welcome advice on weight control. Mean log-in frequency by 19-week programme for P1 was 8.9 (SD 12.3) and 4.9 (SD 6.9) P2. Log-in frequency did not differ by university faculty, residence-type or gender. For P1, interest in weight management advice and baseline BMI were related to log-in frequency. Obese participants logged in on more occasions per programme; 12 vs. <8 for others with BMI <30 kg/m2 (p=0.012). Most frequent viewings for both programmes were in the first 2 weeks and programme usage decreased over time. The timings of log-in occasions (day/night, weekend/weekdays) were not associated with weight change. Conclusion: On-line programmes designed to prevent weight gain are attractive to a range of young adults. Declining usage over time is the single biggest obstacle, so a series of shorter programmes might be more effective than a single long one. 14 Poster: Visceral adipose tissue in pre-eclampsia is associated with increased activated macrophages and inflammatory adipokine release. Shahzya Huda2, Fiona Jordan1, Naveed Sattar1, Dilys Freeman1, 1University of Glasgow, Glasgow, UK, 2NHS Forth Valley, Larbert, UK Introduction: Increasing BMI is a risk factor for preeclampsia - a maternal syndrome of increased inflammation, dyslipidaemia, insulin resistance and endothelial dysfunction. The aim of this study was to compare adipokine production and macrophage infiltration from visceral and subcutaneous adipose tissue (VAT, SAT) in a case control study of preeclampsia (PE) and relate this to direct measures of insulin resistance in the tissue. Methods: Non-labouring women with PE (n=13) were matched for age, BMI and smoking with healthy controls (n=13). Biopsies of VAT and SAT were collected at caesarean section. A sample was frozen at -70°C for later analysis of mRNA expression by quantitative real time PCR. Adipocyte suspensions were prepared by collagen digestion. Lipolysis in response to isoproterenol (200 nmol/L) and insulin (10 nmol/L) was assessed. Fat cell insulin sensitivity index (FCISI) was calculated as the percentage inhibition of isoproterenol-stimulated lipolysis by insulin. Adipokine production was measured in supernatants using a multiplex suspension array system (Bioplex) after two hour incubation with lipopolysaccharide (LPS 1ug/ml). Total and activated macrophages (CD68+ and cfms+) were localised using ICC and tissue macrophage densities were expressed as cell count per adipocyte. Results: TNFα secretion was significantly increased between basal and LPS stimulated VAT in PE but not in controls (57.3[75.5] vs 81.2[96.5] pg/ml/ugDNA, p=0.03). IL-6 secretion was significantly increased in VAT in PE but not in controls (566[696] vs 852[914] pg/ ml/ugDNA, p=0.019). Basal TNFα release from VAT in PE negatively correlated with the FCISI (r=-0.60 R2=30.3 p=0.03). Median TNFα expression in VAT was higher in PE relative to controls (0.8[0.0-1.3] vs 1.94[1.1-4.1] target gene to PPIA ratio p=0.006). The mean percentage of cfms+ macrophage/adipocyte in VAT was higher in PE relative to controls (6.7[2.56] vs 15.2[8.8] %, p=0.040) as was the mean cfms mRNA expression (24.8[11.0] vs 51.0[29.9], p=0.011). Conclusions: Our data provides evidence of regional differences in adipose tissue functionality in relation to PE. In VAT, there is increased infiltration of activated macrophages and corresponding increased release of inflammatory adipokines which could contribute to the metabolic and vascular disturbances apparent in this maternal syndrome potentially mediated through insulin resistance.

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Poster Presentation Abstracts 15 Poster: Evaluation of a Primary Care Tier 3 Weight Management Programme: Impact of additional individual psychological input compared with standard care. Chantel Robinson1, Deirdre Williams1, Carly Hughes2, 1University of East Anglia, Norwich, UK, 2Fakenham Medical Practice, Norfolk, UK Clinical guidelines advocate a multidisciplinary approach to obesity, including psychological treatment (NICE CG 189 2014). The aim was to evaluate the effectiveness of a primary care Tier 3 weight management programme on weight and quality of life (QoL), and to investigate the impact of individual psychological input on these outcomes. Participants were programme completers (n=145 standard care without individual psychological input; n= 90 with psychological input). Data were collected in accordance with the National Obesity Observatory standard evaluation framework (2009).QoL was measured using the EQ-5D-5L questionnaire (EuroQol group 1990). Pre-post and between-group analyses were performed using non-parametric tests. Results revealed significant weight loss and QoL improvements in both groups. In the standard care group mean baseline weight was 118.99kg (SD 25.72), and mean final weight was107.86kg (SD 19.11). The psychological input group mean baseline weight was 135.97kg (SD 31.3) , and mean final weight was 126.53kg (SD 29.28).In the standard care group the mean baseline EQ-VAS ( EQ-5D-5L visual analogue scale) was 62.35 (SD 19.57), and mean final EQ-VAS was 72.86 (SD 19). The psychological input group mean baseline EQ-VAS was 45.86 (SD 20.95), and mean final EQ-VAS was 66.64 (SD 20.53). Weight loss was comparable across the two groups, and clinically effective but increase in QoL was more pronounced in the group with psychological input, supporting the value of incorporating it within the service. However, no strong conclusions can be drawn about this due to significant baseline differences and methodological limitations. 16 Poster: Why do adults with obesity and intellectual disabilities seek weight loss and do their views differ from those of their carers? Nathalie Jones1, Craig Melville1, Leanne Harris1, Louise Bleazard1, Catherine Hankey1, 1University of Glasgow, Glasgow, UK Objectives: Motivation to lose weight has only been studied in adults without ID. Reason(s) for weight loss may influence outcome and engagement with weight management programs Aims: 1) to determine reasons given by adults with obesity and ID for seeking weight loss 2) whether reasons differ from those of adults without ID 3) whether responses from individuals and carers differ. Methods: Prior to a weight loss intervention, participants were asked “why do you want to lose weight?” Participants’ carers were asked why they thought the individual should lose weight. Responses were themed. Results: Eighteen men and 32 women; age 41.6 SD 14.6 years; BMI 40.8 SD 7.5 kg/m2; Level ID mild (28%), moderate (42%), severe (22%), profound (8%) participated. Eleven were unable to respond. Six themes emerged: Health; Fitness / Activity / Mobility; Appearance / Clothes; Emotional / Happiness; For Others; Miscellaneous. “Appearance” was cited most frequently overall and by women. Men cited “fitness” most frequently. Carers cited “health” most and “appearance” least, rarely agreeing with participants. “Health” was cited more from those with mild ID and higher BMIs. Conclusions: It was possible to collect views of adults with obesity and mild to moderate ID, and those of their carers, though agreement was poor. Views differed between adults with and without ID where health was a priority. Understanding motivations for losing weight may help shape weight management treatments to maximise engagement. 17 Poster: Obesity as an important cardiovascular risk factor among Punjabi population Manpreet Kaur0, 1Department of Human Genetics, Guru Nanak Dev University, Amritsar, India The present study was undertaken to analyze the importance of obesity parameters in increasing the risk of developing cardiovascular diseases among females of Brahmin and Jat Sikh population using principal component analysis (PCA), which is a multiple correlation technique. A total of 750 females (398 Brahmin and 352 Jat sikh) were recruited for the present study to identify cardiovascular risk factors. Blood samples were obtained for biochemical analysis. Different anthropometric, physiometric and metabolic variables were taken. Principal component factor analysis (PCA) was employed to identify the risk factors associated with cardiovascular diseases. Relationships between components were explained by factor loadings. PCA reduced twenty risk factors to five components that explained maximum (83%) of the total variance among the females of both the groups. The eigenvalue of BMI (6.264) and waist circumference (4.53) in Brahmin and weight (4.32) and waist circumference (2.23) in Jat sikh population have been found to be the highest. The comparison of factor loading pattern of five factors (principal components) in both the groups was done. Only variables with factor loading > 0.7 were considered for present interpretation among the two groups. The present analysis has shown that BMI, WHR and waist circumference are core predictors for cardiovascular diseases.

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Poster Presentation Abstracts 18 Poster: Development and validation of the General Nutrition Knowledge Questionnaire-Revised for adults Nathalie Kliemann1, Helen Croker1, Jane Wardle1, 1Health Behaviour Research Centre, Department of Epidemiology and Public Health, University College London, London, UK Background: The General Nutrition Knowledge Questionnaire (GNKQ), a 110-item instrument, has been widely used. However, it was developed in the 1990s and advances in research have expanded understanding of relationships between diet and health and led to changes in expert advice. This study aimed to bring the GNKQ up-to-date with current recommendations and to establish its validity and reliability. Methods: Following a review of current recommendations, new items were generated and a revised version of the GNKQ created (the GNKQ-R). This consisted of 88 items in four sections: Dietary recommendations; Diet, disease and weight associations; Food groups and Healthy food choices. The content was assessed by 15 Nutrition and Dietetic students as adequate. The reliability and validity of the revised measure were determined by a four-stage process. 1) Reliability was examined using an online sample (n=266). 2) Construct validity was assessed using the “known-groups” method. 96 Nutrition students and 89 English students completed the GNKQ-R online. 3) The samples from stages 1 and 2 (n=451) were combined and associations between nutrition knowledge and demographic characteristics examined. 4) Sensitivity to change was examined by measuring GNKQ-R scores pre- and post- exposure to online nutrition information in written (n=65) and video (n=41) formats. Results: 1) The internal reliability of the entire GNKQ-R was high (Cronbach’s alpha = .93), as was each section (Cronbach’s alpha = .70-.86). The test-retest scores were greater than .7 in all sections (ICC=.72-.83). 2) The questionnaire showed good construct validity with Nutrition students scoring significantly higher than English students (t=10.7 (129.1), p<.001). 3) Scores were significantly higher among females vs. males (t=-7.8 (449), p<.001), people with degree or higher vs. without (t=-5.8 (447), p<.001) and people with very good vs. poor or good health status (F=15.3 (2,448), p<.001), and lower in those older than 50 years vs. younger adults (F=3.7 (2, 446), p<.001), as expected. 4) Scores were significantly greater after the nutrition interventions in written (t=5.2 (64), p<.001) and video (t=-6.9 (40), p<.001) formats. Conclusion: The revised 88-item instrument is a consistent, reliable, valid and sensitive to change measure of nutrition knowledge. The GNKQ-R is a potentially useful tool to assess nutrition knowledge among the UK adult population. 19 Poster: The impact of gastrointestinal adverse events on weight loss with liraglutide 3.0 mg as adjunct to a diet and exercise programme Mike Lean1, Carel le Roux2, Ken Fujioka3, Ian Caterson4, Christine Jensen5, Nnanyelu Nzeakor6, David Lau7, 1University of Glasgow, Glasgow, UK, 2University College Dublin, Dublin, Ireland, 3Scripps Clinic, La Jolla, CA, USA, 4University of Sydney, Sydney, Australia, 5Novo Nordisk A/S, Søborg, Denmark, 6Novo Nordisk Ltd, Gatwick, UK, 7University of Calgary, Calgary, Canada Objective: To explore any associations between GI AEs and weight loss with liraglutide 3.0 mg/day in addition to a diet and exercise programme in individuals without type 2 diabetes who were obese (BMI ≥30 kg/m2) or overweight (BMI 27–29.9 kg/m2) with at least one comorbidity Methods: The SCALE Obesity and Prediabetes trial was a randomised, double-blind, multicentre trial in which individuals (mean age 45.1 y, 78.5% female, mean weight 106.2 kg, mean BMI 38.3 kg/m2, 61% with prediabetes) were enrolled in a long-term weight management programme and randomised to liraglutide 3.0 mg (n=2487) or placebo (n=1244). These data are from an exploratory analysis based on groups of individuals defined by occurrence of GI AEs (0–16 wks, 0–56 wks). Weight loss at wk 56 is presented as least squares means using LOCF, with p-values denoting whether or not GI AEs had a significant effect on treatment. Results: Liraglutide 3.0 mg was associated with a greater weight loss from baseline vs. placebo (8.0% vs. 2.6%, respectively, p<0.0001). As expected, more individuals on liraglutide 3.0 mg (68.3%) compared with placebo (40.3%) reported GI AEs; the most prevalent GI AEs were nausea (40.2 vs. 14.7%), diarrhoea (20.9 vs. 9.3%), constipation (20.0 vs. 8.7%) and vomiting (16.3 vs. 4.1%), occurring mostly within the first 16 wks of treatment. There was no significant difference in weight loss between individuals who did or did not experience ≥1 episode of nausea/vomiting (n/v) during 0–56 wks, regardless of treatment (liraglutide 3.0 mg: n/v, -7.8%, no n/v, -8.1%; placebo: n/v -2.5%, no n/v -2.6%, p=0.81 for interaction between n/v and treatment). Similar results were seen if all other types of GI AEs combined were included. No significant differences were observed at wk 56 for weight loss in individuals who experienced 0, 1, 2–3, or ≥4 GI AEs in the first 16 wks (7.7–8.2% with liraglutide 3.0 mg vs. 2.3–3.0% with placebo, p=0.24), or during the entire 56 wks of treatment (7.7–8.4% with liraglutide 3.0 mg vs. 2.4–3.2% with placebo, p=0.55). These results were further supported by comparable mean weight loss profiles over time across the 0, 1, 2–3, or ≥4 GI AE groups. Conclusion: The weight loss observed with liraglutide 3.0 mg is not explained by the occurrence of GI AEs, including n/v.

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Poster Presentation Abstracts 20 Poster: Diabetes Remission Clinical Trial (DiRECT): protocol for cluster randomised controlled trial Wilma Leslie1, Naomi Brosnahan1, Alison Barnes2, George Thom1, Naveed Sattar1, Louise McCombie3, Hazel Ross3, Roy Taylor2, Mike Lean1, for the DiRECT Project1, 1University of Glasgow, Glasgow, UK, 2Newcastle University, Newcastle-Upon-Tyne, UK, 3Counterweight Ltd, UK, UK Introduction: Type 2 diabetes mellitus (T2DM) can be reversed by an energy restricted diet and around 15kg weight loss. This nonsurgical approach can be provided at relative low cost in Primary Care, where obesity and T2DM can be routinely managed, using a structured weight management programme. This 5 year study will establish the frequency with which it is possible to produce remission of T2DM at 12 months and sustain this over 2 years. Methods: Cluster-randomised design with GP practices the unit of randomisation: 280 patients from c.30 practices in Scotland and Tyneside will be allocated either to continue usual guideline-based care or to add Counterweight Plus, which includes 12-20 weeks total diet replacement (TDR), food reintroduction and long-term weight loss maintenance. Main inclusion criteria: men and women aged 2065 years, all ethnicities, T2DM 0-6 years duration, body mass index >27kg/m2, <45kg/m2. Tyneside subjects will undergo MR studies of pancreatic and hepatic fat, and metabolic studies of insulin secretion to determine mechanisms underlying T2DM reversal. All participants will be followed up at 1 and 2 years. Results: Co-primary endpoints: weight reduction 15kg or more and reversal of diabetes (HbA1c <48mmol/mol) at one year. Conclusion: This study will establish if a structured weight management programme, delivered in Primary Care by practice nurses or dietitians, is a viable treatment to achieve T2DM remission and guide future management. Results will be available from 2018. Conflicts of Interest: Formula diet provided by Cambridge Weight Plan. ML and NB have received funding from Cambridge Weight Plan for conference attendance and for related departmental research. NB, HR & LM are shareholders and employees of Counterweight Ltd. Funding: Diabetes UK Trial Registration ISRCTN03267836 21 Poster: Effects of daily consumption of probiotic versus low fat conventional yogurt on weight loss in healthy obese female adults on an energy restricted diet (NovinDiet Protocol) Ameneh Madjd1, Moira Taylor1, Ian Macdonald1, Hamid Farshchi2, 1School of Life Sciencess, The University of Nottingham, Nottingham, UK, 2Novindiet Clinic, Tehran, Iran Background: Despite evidence for the beneficial effects of probiotics and low fat dairy products, there is no study to compare the effect of consuming a probiotic yogurt (PY) with that of consuming a low-fat yogurt as control during a weight loss program. Objective: We compared the effect of the PY vs. LF yogurt consumption on body weight, other anthropometric measurements and cardiometabolic risk factors in female adults during a weight loss program. Design: Overweight and obese females [n = 109; BMI (n) = 27- 40 kg/m²; age= 18-50 y] who usually consumed standard low fat yogurts in their diet, were asked to either consume PY or consume LF yogurt every day with their lunch for12 weeks, whilst on a weight loss program. Results: 81 participants (73%) completed the trial (41 in LF group, 39 in PY group). Baseline variables were not significantly different between groups. A significant reduction in anthropometric measurements and significant improvements in cardiometabolic risk characteristics were observed from 0 to 12 weeks in both groups. Compared with LF group, PY group had a greater decrease in total cholesterol (PY=-14.1±3.89 mg/dl ;LF= -11.95 ± 4.05 mg/dl, P= 0.023), low-density lipoprotein cholesterol (PY= -13.91 ± 4.09 mg/dl ;LF= -11.57 ± 4.5 mg/dl, P=0.025), HOMA IR (PY=-0.43± 0.2 :LF -0.55± 0.32 ,P=0.038), 2h post prandial (2hpp) glucose (PY=-5.38 ± 2.63mg/dl ;LF= – 7.9 ± 3.36 mg/dl, P=0.002) and fasting serum insulin concentration (PY=-1.77±1 mU/ml ;LF= -1.33±0.61 mU/ml, P=0.018) over the 12 weeks. However, no significant differences were found for weight, BMI, WC, FPG, HDL and TG within both group over the 12 weeks. Conclusion: Consumption of PY compared with LF yogurt with main meals may have positive effects on lipid profiles and insulin sensitivity during a weight loss program. However, no significant differences were observed in weight loss between groups.

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Poster Presentation Abstracts 22 Poster: Is obesity a determinant of paediatric foot dimensions? H. David McCarthy1, Ryan Mahaffey2, Stewart C. Morrison2, 1London Metropoolitan University, London, UK, 2University of East London, London, UK Purpose: The aim of this study was to determine if obesity is a determinant of paediatric foot dimensions. Methods: A retrospective analysis of anthropometric foot data from the Anthrokids database (Synder, 1977) was undertaken. A sample of 3713 children and youths aged 3–18 years were included. Foot length (FL) and foot width (FW) were measured using modified callipers with the participants in relaxed standing. FL was defined as the measurement from the posterior calcaneus to the most distal aspect of the longest toe. FW was calculated between the medial aspect of the first metatarsal head and the lateral aspect of the fifth metatarsal head. Logistic regression was used to determine the relationships between FL and FW and the selected predictor variables of mass SDS, height SDS, and BMI SDS. Results: Compared to obese males, typical weight (FL: p = ≤ .05, OR .83; FW: p = ≤ .05, OR .56) and underweight (FL: p = ≤ .05, OR .83; FW: p = ≤ .05, OR .56) males were associated with significantly shorter and narrower feet. Compared to obese females, overweight (FL: p = .02, OR .88; FW: p = .02, OR .72), typical weight (FL: p = ≤ .05, OR .77; FW: p = ≤ .05, OR .47) and underweight (FL: p = ≤ .05, OR .70; FW: p = ≤ .05, OR .33) females were associated with significantly shorter and narrower feet. Conclusion: The findings from this work demonstrated that obesity was a predictor of paediatric foot dimensions. Given the dramatic rise in the prevalence of obesity in children and young people, these findings may have population wide implications on a number of foot related matters. 23 Poster: Evaluation of Almased® meal replacement on weight loss and glycaemia in patients with type 2 diabetes H. David McCarthy1, Aloys Berg2, Daniel Koenig3, Sadaf Koohkan2, 1London Metropoolitan University, London, UK, 2Albert-LudwigsUniversität Freiburg, Freiburg, Germany, 3Universitatsklinikum Freiburg, Freiburg, Germany Introduction and objective: Obesity is a major risk factor for type 2 diabetes (T2DM) and weight loss is key to improving glycaemia. Almased® is a soy-based meal replacement product which can be used as part of a weight loss strategy and may help patients with T2DM. The objective was to compare Almased® with standard healthy eating/lifestyle advice on weight loss and measures of glycaemic control in a group of patients with T2DM. Participants and Methods: 48 overweight/obese patients with diagnosed T2DM who met the inclusion criteria were randomised to receive either Almased® or standard health eating/lifestyle advice. Almased® meal replacement was consumed either for breakfast or lunch every day for 12 months. Healthy eating/lifestyle sessions were delivered monthly. Body weight and composition, HbA1c and fasting blood glucose and insulin levels were measured at baseline and after 6 and 12 months. Data were compared between groups using an unpaired t test and 6 month data are presented. Results: 11 patients dropped out by 6 months. Weight loss (p<0.03) and decreases in BMI (p<0.02), body fat (p<0.02) and waist (p=NS) were all greater in the Almased® group compared with the healthy eating/lifestyle advice group. For the blood variables, improvements in HbA1c, fasting glucose and fasting insulin were all greater for the Almased® group but did not reach statistical significance. Conclusion: These preliminary findings indicated that T2DM patients performed better by 6 months when consuming Almased®. A larger study may confirm these positive benefits and recommend Almased® as an effective means to promote weight loss and improve glycaemia in patients with T2DM.

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Poster Presentation Abstracts 24 Poster: School Meals Policy in Perspective: Assessing the impact of legislation on child malnourishment from 1908 to 2010 Victoria McGowan1, 1Teesside University, Middlesbrough, UK Purpose: According to government papers, during the Boer War from 1899 to 1902 over 60% of recruits to the Army were rejected due to their poor physical health as a result of malnutrition. The Physical Deterioration Committee was set up to investigate the health of the population and make recommendations to reverse this worrying trend. The Committee’s 1905 report highlighted that poorer children were shorter and underweight compared to their more affluent peers and recommended feeding children in schools. As a result, the 1906 (Provision of Meals) Act was introduced which allowed Local Education Authorities to provide meals to children in school. This paper analyses whether UK government policies relating to school meals have, since their introduction, had a genuine impact on observed, longitudinal changes in childhood nutrition. Methods: Mixed methods combining qualitative grey literature searches for government documents with quantitative analysis of a series of cross-sectional data for children’s heights and weight collected in the UK from 1908 to 2010. These data were assessed in order to estimate average changes in malnutrition (including underweight, overweight, and obesity) for UK children which was then mapped against school meal legislative changes to understand whether policy has impacted child growth. Results: Government legislation for school meals has fluctuated from a permissive to mandatory requirement since the introduction of the 1906 Act, with nutritional standards only becoming mandatory in 1998 and implemented from 2001. Results highlighted potential areas for more in-depth investigation, such as the perceived removal of nutritional standards by the 1980 Education Act and the increase in overweight and obesity shortly afterwards. However, there were also clear indications that other sociological phenomena could be attributed to fluctuations in childhood nutrition, such as World War I and II. Conclusions: This study suggests there is limited evidence to directly attribute changes in childhood malnourishment to alterations in government legislation. However, the school meal is generally accepted as forming part of the welfare system in the UK. This study argues that any beneficial effects from school meals can be reversed if the meal is not protected from wider governmental welfare reforms. 25 Poster: Efficacy and safety of liraglutide 3.0 mg in adult overweight and obese weight loss responders without diabetes: results of the 56-week randomised, controlled, SCALE Obesity and Prediabetes trial Barbara McGowan1, Patrick O’Neil2, Ken Fujioka3, Violante Ortiz Rafael4, Christine Jensen5, Nnanyelu Nzeakor6, Arne Astrup7, 1Guy’s and St Thomas NHS Foundation Trust, London, UK, 2Medical University of South Carolina, Charleston, SC, USA, 3Scripps Clinic, La Jolla, CA, USA, 4Instituto Mexicano del Seguro Social, Hospital Regional num. 6, Ciudad Madero, Tamaulipas, Mexico, 5Novo Nordisk A/S, Søborg, Denmark, 6Novo Nordisk Ltd, Gatwick, UK, 7University of Copenhagen, Frederiksberg, Denmark Aims/Methods: In the SCALE Obesity and Prediabetes trial, individuals with BMI ≥27 kg/m² with ≥1 comorbidity or BMI ≥30 kg/m² were randomized 2:1 to liraglutide 3.0 mg (n=2487) or placebo (PBO; n=1244) once daily as adjunct to diet and exercise for weight loss (WL). This post-hoc analysis compared key efficacy and safety outcomes of responders (≥5% WL from baseline) vs non-responders (<5% WL from baseline) at week 56 for liraglutide and PBO. Results: At week 56, more individuals on liraglutide were responders vs PBO (63.2% vs 27.1%; p<0.0001). WL was greater in responders vs non-responders (liraglutide: -11.7 vs 1.7%, PBO: -10.0 vs 0.1%). Responders in both treatment arms had more improvement than nonresponders across a range of efficacy outcomes, but greater improvements in fasting plasma glucose and systolic blood pressure were seen with liraglutide vs PBO (Figure). Gastrointestinal adverse events (AE) were the most common AEs, occurring with similar frequency in responders and non-responders (liraglutide 69.2 and 67.2%; PBO 44.4 and 39.6%, respectively). Gallbladder events were more common in liraglutide responders than PBO responders (3.4 vs 1.2 events/100 PYE, respectively) but similar in both non-responder arms (1.2 vs 1.1 events/100 PYE, respectively). Conclusion: More patients on liraglutide 3.0 mg had WL ≥5% at week 56, with greater mean WL in responders. In both arms, responders had greater improvements in glycaemic, cardiometabolic and health-related quality of life outcomes, but AE rates were generally equivalent in responders and non-responders.

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Poster Presentation Abstracts 26 Poster: The usefulness of a very-low-calorie diet (VLCD) for women with Polycystic Ovary Syndrome (PCOS) John S McKenzie1, John G Love1, Iain Broom1, 1 Robert Gordon University, Aberdeen, UK Polycystic Ovary Syndrome (PCOS) is variously reported to affect between 5-26 % of reproductive age women in the United Kingdom and it accounts for up to 75% of women attending fertility clinics due to anovulation. The first-line treatment option for overweight/obese women with PCOS is diet and lifestyle interventions, however optimal dietary guidelines are missing with very little research having been done in this area. This paper presents the findings from a comparative study of women’s experience of the Very Low Calorie Diet (VLCD), Lighterlife Total, a commercial weight loss programme which utilises a very-low-calorie diet (VLCD) in conjunction with behavioural-change therapy underpinned by group support. The research involved in-depth interviews with 18 overweight women, ten of whom had poly-cystic ovarian syndrome (PCOS) and eight who did not. We investigated the women’s history of obesity, their experiences of other diets compared with Total and the on-going impact that this has had on their lives. Findings show that most women reported greater success using this weight loss programme in terms of achieving and maintaining weight-loss when compared with other diets. Furthermore all the women nominated VLCD as their model weight-loss intervention with few modifications. A comparison between the two groups of women revealed that whilst women in both groups had common experiences some important differences emerged. This paper will highlight some of factors behind the apparent success of the VLCD. 27 Poster: Slimming World on Referral: longer term attendance and weight outcomes Liam Morris1, Carolyn Pallister1, Sarah Hillier1, Emma Dowse1, Jacquie Lavin1, 1Slimming World, Derbyshire, UK Introduction. The Slimming World on Referral partnership service is a well-established solution for weight management in the UK and involves health professionals referring patients to local Slimming World community groups for weekly weight management support. Referral packages cover 12 (or multiples of 12) weekly sessions and are free for the patient (funded by the health trust). To support further weight loss, additional referral periods are offered in some cases or members may choose to pay to continue to attend the service. This study evaluates longer term weight outcomes in referral members and looks specifically at continued attendance after the initial referral period. Methods. Electronic weekly weight records were collated from Slimming World on Referral members joining between January 2010 and June 2011. Using a last observation carried forward model this analysis reports weight outcomes in 29,093 referral participants during their first 12 months following an initial 12 week referral. Members were categorised by whether or not they made at least one fee-paying attendance after their initial 12 week referral period. Data were analysed using Microsoft Excel. Results. 40.2% (11,682) of referral members went on to self-fund after their referral period (self-funders), whereas 59.8% (17,411) did not (non-self-funders). Self-funders attended an average of 29.6 (13.8) sessions in their first 12 months, of which 16.5 (7.9) were additional referred attendances and 13.1(11.7) were self-funded. This compares to 8.8 (6.6) referral sessions for non-self-funders. Self-funders experienced greater absolute weight loss, 9.7kg (7.8) vs 3.4kg (3.9), percentage weight loss, 9.8% (7) vs 3.5% (3.7) and reduction in BMI, 3.6kg/m2 vs 1.3kg/m2, compared to non-self-funding members. Comparing the two groups self-funders were older, 49 years (14.2) vs 44.5 years (14.2), slightly heavier, 98.3 (19.9) vs 97.5 (19.3) and had slightly higher joining BMI’s, 36.4kg/m2 (6.3) vs 36.0kg/m2 (6.1), than nonself-funders. There were more men amongst self-funders, 10.9% vs 9.6%. Conclusion. These data demonstrate that a substantial proportion of Slimming World on Referral members go on to self-fund for an average of 13 weeks following their initial 12 week referral period, achieving significant weight loss and BMI change at 12 months compared to those that don’t.

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Poster Presentation Abstracts 28 Poster: Evaluation of Dietary Management in a Scottish Paediatric Tier 3 Weight Management Pilot Service. Jillian Morrison1, Peri Wallach1, Ethel McNeil1, Jeremy Jones1, Ruth Hind1, Sue Robinson1, M. Guftar Shaikh1, 1Royal Hospital for Sick Children, Glasgow, UK There is a recognised epidemic of childhood obesity in developed countries, with some 3 in 10 children aged 2 – 15 years in Scotland being classified as overweight or obese. Over the past 3 years a pilot paediatric multidisciplinary weight management service has been established in Glasgow. Children and young people aged 0-16 years are recruited into the programme if BMI SDS>3.5 or >3.0 with evidence of obesity related co-morbidities. Following medical review patients and their families are referred to a joint assessment clinic where a Clinical Psychologist and Dietitian conduct further assessment and discuss treatment options. Treatment may include: one to one psychology or dietetic input (monthly appointments over 6 months) or a group programme for families (MEND). MEND includes dietary education, family and peer support and physical activity over a 12 week period and is delivered by 2 Therapy Assistants. Of the 49 patients who attended the joint assessment clinic during a one year period, 11 families attended one to one dietetics and 15 families completed the group programme. Patients attending one to one dietetics or the group programme either maintained or reduced their BMI (p<0.05) (table), but no difference between groups (See table). Weight stabilisation is an acceptable aim and outcome for obese children and young people (SIGN, 2010). These initial results would suggest that the group programme is as successful as one to one dietetics, and may be more cost effective. More sophisticated analysis of a larger data set is needed to determine whether this positive outcome is a product of the combined team’s interventions, which included clinical psychology input, and to determine if the results are maintained over a longer period of time. One to one dietitics Group Programme

Baseline mean BMI SDS 3.95 3.76

After 6 months BMI SDS 3.78 3.58

29 Poster: Learning Lessons From Patient Involvement In Bariatric Surgery Jane Munro1, Sally Stewart1, Jennifer Logue1, 1University of Glasgow, Glasgow, UK Background: The SurgiCal Obesity Treatment Study (SCOTS) is longitudinal cohort study focusing on the long term outcomes and complications of bariatric surgery. In order to achieve high rates of recruitment, completion of questionnaires and retention, we involved patients within the design phase of the study. Methods: A focus group of five patients who had previously undergone bariatric surgery was formed, four females and one male, three had surgery in the private sector and two in the NHS. Patients were provided with a role description outlining the broad function of the group and the role and responsibilities of the participants and facilitators. The group met twice, each meeting lasting 3-4 hours; participants were also contacted by email periodically to seek views and opinions. Topics consulted over included information provided to the patients about the study (patient information sheets, invitation letters and website), content and design of electronic and patient reported questionnaires and communication throughout the study such as reminder letters. Results: Piloting of questionnaires was undertaken during the developmental phase of the study. While the researchers considered some of the questions to be of a sensitive nature e.g. sexual function and continence these were not considered ‘sensitive’ by the group. However, items relating to diet, exercise and benefits were considered to be particularly sensitive because they felt participants may feel ‘judged’. The group also identified important topics to include such as the need for dental work after bariatric surgery and an easy low cost alternative to incentivising ongoing participation with promotional merchandise. Conclusion: Patient involvement in the design of the SCOT Study has demonstrated how the scientific quality, feasibility and practicality of research can be improved by involving members of the public.

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Poster Presentation Abstracts 30 Poster: Obesity Knowledge amongst Final Year Medical Students in Norway Anette Norsett-Carr, BSc Hons University of Glasgow, MSc NTNU Norway, affiliating authors: Dr Catia Martins, PhD, Associate Professor, NTNU, Norway Background/Objectives: Obesity as a threat to quality of life, mortality and morbidity is affecting the health of the Norwegian population. Little is known on how well equipped general practitioners are in dealing with obesity and their knowledge when treating the obese patient. Previous studies in other countries have shown that medical students and doctors lack adequate knowledge, confidence and skills when dealing with obese patients. Subjects/Methods: The primary aim was to compare level of obesity knowledge in final year medical students in Norway by comparing them to each other, as well as to an expert group and first year medical students. Secondary aims were to compare the four Norwegian medical schools in terms of their attitude towards obesity as a condition and confidence levels when meeting patients with obesity. A 20item questionnaire addressing aspects ranging from diagnostics to treatment and follow-up was specifically designed for this purpose. All four medical schools in Norway were included, with a total of 226 final year students participating. For validation and comparison purposes, an expert group (n=13), and first year medical students (n=96) from one university were also included. Results: There were significant differences (p < 0.05) in the total score of the questionnaire between experts (14.6; median 15.0, IQR 13.5-16.0) final (10.8; median 11, IQR 9.0-12.0) and first year (8.6; median 9, IQR 7.0-10.0) students, with experts scoring significantly higher than both student groups. Final year students scored significantly higher than the first years. No significant differences between medical schools when comparing total scores, but differences existed when looking at individual questions. No differences were found when comparing subjective questions. Conclusion: Final year medical students in Norway show inadequate knowledge levels, especially in aetiology, diagnosis and treatment of obesity, although a significant improvement was seen during the course of medical education. Regional differences were found, indicating inconsistencies in curriculum and teaching practices among the medical schools. Subjective questions reveal that medical students trust their acquired knowledge, but feel pressured by time constraints and experience barriers to long-term follow-up of this complex patient group. Further studies are needed to clarify the implications these results may have on future treatment practices of obese patients by doctors in Norway. 31 Poster: Does intermittent energy restriction have different effects on ectopic fat and insulin resistance to continuous (daily) energy restriction? Mary Pegington, Genesis prevention centre, University Hospital, South Manchester Hypothesis: Energy restricted diets cause reductions in hepatic and visceral fat and reduced insulin resistance. Intermittent energy restriction (IER) is an increasingly popular method of dieting which involves short spells of severe restriction and spells of normal intake. We have shown that IER leads to a greater reduction in insulin resistance than daily dieting with comparable weight loss (Harvie et al Int J obesity 2010). We hypothesise that these beneficial effects are due to a greater overall reduction in hepatic fat. Study design: A randomised controlled trial to compare two eight-week dietary interventions - (i) an Intermittent Energy Restriction (IER) diet (ii) a Daily Energy Restriction (DER) diet. Outcomes are measured in weeks seven and eight of dietary intervention with week seven measurements occurring after two days of severe energy restriction in the IER group. Primary endpoints 1. The quantity and character of intrahepatic fat determined using MR spectroscopy. 2. Insulin resistance determined using oral glucose tolerance testing. Secondary endpoints 1. Other MR-derived fat stores; visceral, subcutaneous, pancreatic, and intramyocellular fat 2. Lean body mass (L3 skeletal muscle area) and resting energy expenditure 3. Markers of inflammation (IL-6), adipokines (leptin and adiponectin), IGF-I and serum lipids. Study Population: 26 obese pre-menopausal women, aged 30- 45 years, Body Mass Index of between 30 and 45 Kg/m2, and nonsmokers. Women will be at increased risk of breast cancer and will be identified within a regional Family History Clinic at the Genesis Prevention Centre. We plan to present results for this study at the conference. This study will help define the metabolic effects of intermittent compared to standard daily dieting.

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Poster Presentation Abstracts 32 Poster: A systematic review of qualitative research into the facilitators and barriers to weight loss within a weight management programme. Daniel Slack1, Jennifer Logue0, 1University of Glasgow, Glasgow, UK Background: In the majority of weight management programmes, <50% of participants lose 5kg. Evidence suggests that failure to lose weight within the first few weeks of a programme may be a strong predictor of failure to achieve target weight loss throughout the programme. In order to better understand the possible reasons for poor early weight loss, with the potential for providing early intervention, we conducted a systematic review of qualitative studies that explore barriers and facilitators for weight loss amongst participants in weight management programmes. Methods: EMBASE and MEDLINE database searches were conducted for papers written in English from 1946 to present. The search used the terms weight management OR obesity treatment OR weight loss AND compliance OR adherence OR health knowledge OR patient experience OR physician patient relationship OR patient education OR facilitator* OR barriers AND qualitative OR interviews OR focus group OR survey. The Capability-Opportunity-Motivation behavioural diagnosis form was used to synthesize the results. Results: Of 1082 articles found, 6 studies were included which allowed us to identify a number of potential behaviours that could be targeted to improve weight lose outcomes. Examples included capability – improved knowledge of the link between obesity and disease, knowledge of how to plan diet around social activities and work, coping strategies for stress; opportunity – checklists and reminders, social support; motivation – knowledge of effect on existing health conditions, peer-group support. Conclusion: this review identified a number of potential facilitators of weight loss, however must studies included those who were successful and unsuccessful at weight loss and did not present results separately. Far more barriers than facilitators were discussed, impeding the use of the data for intervention design. 33 Poster: BMI and cognitive restraint influence the scheduling of food rewards in healthy female students Laura-Jean Stokes1, Catharine Winstanley2, Robert Rogers1, 1Bangor University, North Wales, UK, 2University of British Columbia, Vancouver, Canada Foraging studies suggest that animals will take considerable risks to gain food at the soonest possible opportunity. In today’s obesogenic environment, such foraging strategies may promote weight gain. Here, we examined the choices people make about the intervals to the next food reward using real edibles eaten immediately. We explored how young female students make choices between a variable delay option that delivers food immediately or following long delays, and a certain option that delivers food following fixed intermediate delays. Following a two hour fast, 60 healthy females participants were presented with two boxes on screen, associated with a fixed delay (15 seconds) until the delivery of a favourite treat, or a variable delay (0 seconds or 30 seconds, with a 0.5 probability of either outcome). Height and weight were measured to calculate BMI, and measures of eating behaviour, mood, impulsivity and IQ were also completed. Participants were carefully screened to exclude those satisfying ‘caseness’ for current depression or eating disorders. Overall, and consistent with animal foraging models, participants preferred the variable delay option compared to the fixed delay option. Females with high BMI were more likely to choose the variable delay option when the previous food reward had been delivered immediately. In addition, those who tended not to consciously limit their food intake also made more choices for the variable delays when previous food rewards had been delivered immediately. These findings demonstrate that, in young females, two risk factors associated with longer-term weight gain (BMI and cognitive restraint) are associated preferences for food-seeking strategies that deliver food rewards quickly.

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Poster Presentation Abstracts 34 Poster: Socio-economic deprivation predicts engagement in a community based weight loss programme Tom Steele1, Ram Prakash Narayanan1, Claire Rigby1, Michaela James1, Daniel J Cuthbertson2, Nicky Mazey1, John P H Wilding2, 1 Aintree University Hospital, Liverpool, UK, 2University of Liverpool, Liverpool, UK Background: Community weight loss programmes are important in the management of severe obesity. However extent of patient engagement can restrict potential health benefits. Aintree LOSS is a community based multi-disciplinary weight loss intervention for severe obesity, serving areas with high socio-economic deprivation in Liverpool. Aim: Identify predictors of engagement with a community weight management programme Methods: Pseudonymised data was collected retrospectively for the period October 2009- October 2014. Townsend score, based on postcode of patient residence indicated level of socioeconomic deprivation. Engagement was defined as a binary outcome measure based on >2 attendances on the programme. Results: 3199 patients were referred to the Aintree LOSS programme in the study period (71.1% female, mean age 48 SD±13.8 years, mean BMI 45.6±6.8 kg/m2, Townsend score >0 in 83.5%) of which 1470 (46%) engaged with the service. Non-engagers were younger (mean age 46.3±13.9 vs 50.5±13.4 years, p<0.001) and had higher Townsend scores (3.71±3.06 vs 3.22±3.93 p=0.001) and both factors predicted non-engagement (age OR 0.978 95% CI 0.971-0.984 p<0.001; Townsend score OR 1.039 1.011-1.066 p=0.005) on multivariate logistic regression. Only 27.9% of those <40 years and in the most deprived quartile of the study population engaged with the service (n=876), compared with 37.9% in the remainder of this age group (p=0.007). Of all those who engaged (n=1470), 23.4% lost ≥5% body weight with no differences across levels of deprivation. Conclusion: Younger age and higher deprivation predicted non-engagement in our weight loss programme. Individuals from these categories who did engage had outcomes comparable to the rest of the population. Targeted weight management initiatives for younger patients in more socioeconomically deprived areas may offer public health benefits. 35 Poster: Maternal HDL and uterine artery function Wan Noraini Wan Sulaiman1, Elisabeth Beattie1, Fiona Jordan1, Delyth Graham1, Dilys Freeman1, 1University of Glasgow, Glasgow, Scotland, UK Introduction: Obesity is a risk factor for pre-eclampsia (PE). Both obese and PE pregnant women have been shown to have low plasma concentration of HDL and reduced endothelial function compared healthy pregnancy. HDL has been shown to have a variety of vasculoprotective properties. We hypothesised that HDL in healthy pregnancy protects the vascular endothelium and this fails to occur in obese pregnancy and PE. Objective: To compare the in vitro effect of human HDL from 3rd trimester pregnancy on the uterine artery function of non-pregnant and pregnant rats. Study design: A pilot, in vitro comparative study. Methods: HDL from healthy pregnant women was prepared by gradient density ultracentrifugation of plasma and desalted using a PD Minitrap G-25 column. Uterine arteries from WKY non-pregnant rats aged 14.5 weeks old were pre-incubated in 2% pregnant HDL, 2% pregnant plasma or physiological salt solution (PSS) overnight before mounting on a wire myograph for assessment of vascular function. Arteries were pre-constricted with noradrenaline (NA) (1x 10-9 -1x 10-5 M) and the degree of vessel relaxation with carbachol (1x10-8 1x10-5 M) was measured. Results: In non-pregnant rat uterine arteries (n=3), there were no differences in maximal contraction(MC) to NA [mean (SD) : 38 (12), 44 (4), 32 (9) kPa]; NA ED50 [1.9 (0.3), 1.6 (0.7), 2.1 (1.1) x 10-6 M]; % relaxation [56.2 (14.7), 38.2 (17.0), 70.2 (21.9)%]or active effective pressure (AEP)[16.9 (9.1), 27.1 (5.9), 10.1 (9.8) kPa] to carbachol between exposure to PSS alone, 2% pregnant plasma or 2% pregnant HDL respectively. A power calculation indicated that a sample size of 14 is required to have 80% power to detect a significant 60% difference in functional attributes. An initial experiment in pregnant rat uterine artery suggests that vessels under control conditions are less contractile (NA ED50=4.28 x 10-6 M) and showed more relaxation to carbachol (AEP=4.34kPa). Experiments in the presence of HDL are underway. Conclusion: A protocol for the assessment of HDL on artery function has been established. Our pilot data suggest that the effect of human pregnant HDL on non-pregnant rat uterine arteries is negligible. A preliminary experiment confirms reports in the literature that vascular function is enhanced in pregnancy. Further studies on the effects of HDL on rat pregnant arteries will be completed before transferring the technique to human.

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Poster Presentation Abstracts 36 Poster: Outcomes of a childhood evidence based weight management programme in practice. Laura Stewart1, Caroline Dakers1, Jenny Gillespie1, 1NHS Tayside, Perth, UK Background: Since 2008 the Scottish Government has invested in each Scottish Health Board to tackle childhood obesity. NHS Tayside set up a specialist Paediatric Overweight Service (POST) to implement an evidence based service to children and young people aged 0-16 years. NHS Tayside covers 3 local government councils with a mixture of a large rural population and a major city. All families referred to the service are asked to opt in. Trained practitioners deliver the family programme Scottish Childhood Overweight Treatment Trial (SCOTT), and for younger children (< 8 years) SCOTTlite, in weekly clinics across Tayside. Children have concurrent physical activity sessions or individual counselling by local partners. The service has a dedicated Clinical Psychologist. Methods: As part of routine evaluation the following is collected weight, height, Body Mass Index (BMI), BMI standard deviation (SD), number of sessions attended, numbers completing (≥ 75% of sessions), geographic mapping of referrers and clients. Short evaluation questions on how clients perceive the service during the programme are undertaken. Outcome measures are available to 2012 and will be available to 2014. Results: From May 2009 – March 2014 a total of 921 children and young people, including re-referrals, were referred to the POST service. From May 2009 until March 2012 there were 530 children and young people referred once, 47.2% male/52.5% female, mean BMI SD 3.14 (0.72), 52% in SIMD quintiles 1&2. 70.2% opted into the service, 285 to the SCOTT programme and 87 to SCOTTlite. For those who completed the programme the change in BMI SD for SCOTTlite (n=59) was -0.20 (95% CI: -0.32, -0.07), p=0.002 and for SCOTT (n=127) -0.14 (95% CI: -0.17, -0.10), p<0.001. Conclusion: These results show that a childhood weight management programme which started as a research project can be used in routine practice, giving a standard, quality service delivered in community settings by trained practitioners. The demographics indicate that children in the very severely obesity range are being typically referred, highlighting the need to promote normalisation of discussions around child weight issues. The results show that the SCOTT, and particularly SCOTTlite, programmes have a place in managing childhood obesity. 37 Poster: Healthy Weight Programme for Overweight and Obese Adolescents: a feasibility study Chuluuntulga Tuya1, Leone Craig1, Neil Campbell1, Geraldine McNeill1, 1University of Aberdeen, Aberdeen, UK Childhood obesity has reached epidemic proportions globally. The UK has one of the highest levels of obesity among developed countries. The purpose of the present study was to develop and assess the implementation of a healthy weight programme for overweight and obese adolescents. Adolescents aged 12-16 years and their parents were recruited. The study was conducted in three phases. In Phase 1 (screening), a total of 1821 adolescents were contacted via three secondary schools in Aberdeen city and asked to complete a short questionnaire on self-reported height and weight. From those, 47 (26 girls and 21 boys) adolescents replied and 19 of these with self-reported BMI ≥91st percentile for their age and gender, in relation to the UK 1990 growth charts, were invited for anthropometric measurements. In Phase 2 (intervention), a total of 15 (9 girls and 6 boys) adolescents with actual BMI ≥91st percentile (Mean BMI 96.1 centile) and mean age 13.4 years (SD 1.24) attended a 12-week programme comprising of bi-weekly sessions (1.5 hours) of mixed education (nutrition and behaviour modification) and physical activity in 2014. The sessions were run by sports centre coaches and involved taster sessions of a wide range of sports plus hands on food activities (food labelling, menu planning, cooking session, supermarket trips for making healthy food choices and fruit/vegetable tasting). Participants were taught key behaviour change methods such as goal setting, overcoming hurdles and implementation of a reward scheme to help motivate them to improve their health. Six adolescents dropped out of the programme due minor illness, examinations and school trips. By inviting parents to attend regular meetings with the programme staff, allowed them to provide continual motivation and support to their children. In Phase 3 (focus groups), 9 adolescents and 8 parents attended focus group discussions or one-to-one interviews. Adolescents reported that the programme allowed them to discover a wide range of opportunities such as to try out new activities, meet new people, make friends and build upon their social and emotional health. Our focus group insights on views and experiences of obese adolescents and parents on a variety of aspects of the programme’s design, structure and delivery supported the key components of the intervention and provided valuable suggestions for improving recruitment.

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Poster Presentation Abstracts 38 Poster: Factors affecting engagement and retention in a community-based, weight management intervention: a qualitative study of participant experience of Get Moving with Counterweight in Scotland, UK. Kath Williamson, affiliation NHS Lothian Weight Management Team and University of Chester Aims: High attrition rates commonly reduce the effectiveness and efficiency of weight management interventions. Participant experience offers valuable insights into factors affecting engagement and attrition, with results informing intervention optimisation and future service development. Get Moving with Counterweight is an innovative joint-working initiative between National Health Service and local authority partners, representing an entry level, large-scale, community-based, lifestyle group weight management intervention for individuals with BMI ≥30 kg/m2. Methods: A qualitative methodological approach was adopted using a convenience, purposive sample of participants in Get Moving with Counterweight. 15 semi-structured interviews were undertaken, including four men, three non-completers, one ethnic minority participant and spanning a wide age range. Data was thematically analysed. Results: Five themes were identified. Participants experienced high levels of uncertainty and anxiety regarding initial engagement. These were exacerbated by concerns about participating in physical activity. Individualisation of physical activity was key in promoting engagement. Group dynamic was facilitated by identifying “someone like me”, whilst extensively heterogeneous groups limited group cohesion. Multiple factors caused non-attendance, with non-completer’s attributing attrition to illness or perceiving the intervention ineffective. Diverse timings facilitated access and non-health professional group leaders were well received. Conclusion: Service providers need to recognise the impact of referral route and psychosocial barriers on engagement and retention. From a participant perspective, a one-size-fits-all approach limits the effectiveness of group-based delivery, meriting continued development of targeted approaches. Individualisation of physical activity is critical to engagement. Non-completers’ views potentially differ from those of completers, making their inclusion essential to increase the validity and robustness of subsequent intervention optimisation and future service provision.

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UKCO 2015: Commercial Symposium Weight Watchers Session: Thursday 10th September, 11.15-12.45 Venue: Room Tbc, Glasgow University

Community partnerships proven to prevent type 2 diabetes Complementing the UKCO agenda and ASO “State of the Science” Symposium ‘New concepts in diabetes and obesity’, this session will examine new evidence - and crucially stimulus around the operational challenges of implementation of Diabetes Prevention Programmes; offering solutions and ideas for integration in other areas. Relevant to clinicians, researchers and decision makers involved in diabetes care & planning.

Speakers: Chair: Dr Victoria Lawson, Independent Chartered Health Psychologist. How can we reach people at scale – and will it work? Frances Mason, Registered Nutritionist. Delivering a DPP – Real world experience of implementation; challenges and learnings for the national DPP roll out: Dr Agnes Marossy, Consultant in Public Health and Carolyn Piper, Public Health Programme Manager, London Borough of Bromley.

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The psychological wellbeing of participants with pre-diabetes prior to attending a Diabetes Prevention Programme Dr Victoria Lawson, independent Chartered Health Psychologist.

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Introducing ECAL – Indirect Calorimeter Research – Education - Clinical use • Light weight and portable • Affordable • Easy to use • Comprehensive and accessible datasets • Designed specifically to assess resting energy production and metabolism • Certified medical device, CE and ISO13485 For more information please contact Energy Testing Solutions UK Ltd Office 122, 20 Winchcome Street. Cheltenham, Glos, GL52 2LY peter.robins@energytestingsolutions.co.uk

Weight management: the portfolio solution

Successful weight management requires the right programme for the right person at the right time. Counterweight Ltd. offers a portfolio of proven weight management solutions with published evidence of outcomes for differing needs.

The Counterweight Programme

A 12m lifestyle programme for the management of overweight and obesity, evaluated in primary care. Covers all aspects of weight management encompassing behavioural techniques to equip people with skills to manage weight for life. Developed and refined over 15 years, it encompasses robust screening to ensure suitability. Historically the Programme was delivered face to face; individually and via groups. However as expectations of populations change it is important that weight management solutions address individual needs. Counterweight Ltd have subsequently introduced an interactive online programme with e-practitioner support allowing choice and accessibility.

Counterweight Plus

Counterweight observed those presenting for weight management consisted of 14% T2DM and 25% BMI>40kg/m2. The weight loss required for these individuals is >15kg which lifestyle interventions do not achieve. In line with Continuous Improvement Methodology and ensuring the right programme ethos, Counterweight Plus was developed. This offers a unique solution between lifestyle and bariatric surgery including a total diet replacement followed by food reintroduction and weight loss maintenance. Feasibility results demonstrated 12m mean weight loss of 14.7kg.

The Evidence

The Counterweight Programmes have a worldwide reputation due to the large body of peer reviewed evidence accessible on www.counterweight.org

Access

Counterweight Ltd provides complete packages of weight management support. For information on commissioning contact Louise McCombie, COO, louise.mccombie@counterweight.org, +44 (0) 7701 281651.

www.counterweight.org

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