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3rd UK Congress on Obesity 2016 University of Nottingham Veterinary Medicine & Science Building, Sutton Bonington Campus September 19-20, 2016

UKCO2016

September 19-20, 2016

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UKCO2016

September 19-20, 2016


Contents Welcome Note: Professor Pinki Sahota, Chair, Association for the Study of Obesity General Information Programme Overview Full Programme ASO COMs Network Programme – Early Career Researcher Workshop Tributes to Jane Wardle & John Garrow ASO Best Abstract Award ASO Best Practice Award Sponsors and Exhibitors Invited Speaker Presentations and Biographies Commercial Symposia Clinical Symposium Member – led Symposia Oral Presentation Abstracts Poster Presentation List Poster Presentation Abstracts 4th UK Congress on Obesity

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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 the 3rd UK Congress on Obesity 2016 in Nottingham. The Congress is the ASO’s main annual meeting for researchers, health practitioners, policymakers and other key stakeholders working on the prevention and management of obesity. UCKO2016 is the third 2-day meeting that the ASO has organised, and is fast becoming an established diary event. The Congress is designed to support the ASO mission and thereby offers unique opportunities for us all to learn, network, share and exchange our understanding in order to promote activities aimed at tackling this major public health issue. The focus of the programme this year is partnership working. The programme presents opportunities to discuss and reflect on approaches for joined-up thinking and action to improve the prevention and management of individuals who are overweight and obese. Integral to the partnership approach is the voice of advocates and people who are overweight or obese and together with researchers, practitioners, policy-makers and key stakeholders, UKCO2016 will present opportunities to consider how we should move forward in establishing productive, respectful and enduring partnerships. The breadth of the programme is impressive 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 Award. 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 us in congratulating and thanking the Local Programme Committee, in particular Professor Ian MacDonald and Dr Judy Swift for their hard work in developing an excellent, high quality programme. On behalf of the ASO we wish you an excellent UKCO2016 and happy memories of Nottingham!

Professor Pinki Sahota Chair of ASO

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General Information Congress Venue (Vet School, Gateway Building, The Barn)

Exhibition

The Congress will take place at the Veterinary Medicine & Science Building (The Vet School) at the University of Nottingham. The Vet School is situated in the Sutton Bonington Campus. Please see the accompanying map of the Sutton Bonington Campus for directions. The Vet School is marked 27 on the campus map. Some lecture sessions will take place in the Gateway Building marked 37 on the campus map. It is located next door to the Vet School. Please see the programme to check which sessions take place here. The Exhibition, Poster Sessions, Lunches and Buffet Dinner on Monday evening will take place in The Barn, marked 20 on the campus map.

Congress Registration The Registration area is located inside the main entrance of the Vet School building. The registration desk will open on Monday 19th of September from 09.00 to 10.30 and from 8.00 to 8.30 on the Tuesday. 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 Thursday September 22nd 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.

The exhibition area is located in The Barn. 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 Tuesday 13.30. The lucky winner will be announced on Tuesday at 15.30 in the main lecture room.

Lunches Lunch on Monday and Tuesday will be available in The Barn which is just a short walk from the main lecture rooms. This will be clearly signposted and we kindly ask delegates to make their way there promptly. Coffee breaks will be in the foyer of the Vet School.

Poster Session The poster sessions will take place on Monday and Tuesday during the lunch breaks in The Barn. Please see the Programme for times. We encourage all delegates to attend and vote for the best poster. Poster voting forms will be available near the poster area. Please return voting forms to the registration desk by Tuesday 13.30 for your chance to win a prize. The lucky winner will be announced on Tuesday at 15.30 in the main lecture room. If you are presenting a poster please check the programme book on pages 40-42 for your poster number. We ask that you hang your poster prior to the session on Monday which commences at 13.30. 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 ‘best poster’ by delegates, you will receive a complimentary registration to UKCO 2017. The winner for the Best Poster Prize will be announced on Tuesday at 15.30 in the main lecture room.

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

Dinner Buffet The complimentary buffet dinner takes place on the Monday evening from 19.00 to 21.30 in The Barn (marked 20 on the Campus Map). We encourage all delegates to attend - dinner, drinks and entertainment will be provided. A fully licensed bar will be open until 23.00 on the ground floor of The Barn.

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UKCO2016

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Campus Map

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Programme Overview Monday 19th September

Tuesday 20th September

08.30

Plenary Lecture 3 Obesity and non-alcoholic fatty liver disease Professor Ian Macdonald, University of Nottingham (08.30 - 09.15) Main Auditorium Registration and Coffee (09.00 - 10.30) Prize talks: Good Practice Award & Best Abstract Prize (09.15 - 09.45) Main Auditorium

10.00

Coffee Break (09.45 - 10.15) Welcome address from ASO Chair, Professor Pinki Sahota (10.30 - 10.45) Main Auditorium Plenary Lecture 1 A critical (but constructive) view of scientific progress and the challenges ahead Professor Sara Kirk, Dalhousie University, Canada (10.45 - 11.30) Main Auditorium

12.00

Symposia (10.15 - 11.45)

Infant & Toddler Forum Symposium Main Auditorium

ASO Symposium 3 Basic science - clinical partnership - obesity and fatty acid handling Room B01 (Gateway Building)

Member Led Symposium 2 The role of local level data in an applied approach to whole systems obesity Room A29

Perspectives from citizens’ council Ken Clare, EASO Patient Council & founder of WLSinfo (11.30 - 12.00) Main Auditorium

ASO Annual General Meeting (11.45 - 12.30) Main Auditorium

Symposia and Oral Abstracts (12.00 - 13.30)

Lunch, Exhibition and Posters (12.00 - 13.15) Symposia and Oral Abstracts (13.15 - 14.45)

ASO Symposium 1 Should we adopting a less weight-centred approach? Main Auditorium

Oral Abstracts 1 Obesity Practice Room B01 (Gateway Building)

13.00

Member Led Symposium 1 The workplace as a setting to facilitate dietary change and weight management Room A29

Clinical Symposium sponsored by Cambridge Weight Plan Main Auditorium

Oral Abstracts 3 Basic Science Room B01 (Gateway Building)

Lunch, Exhibition and Posters (13.30 - 15.00) Plenary Lecture 2 The role of genetics and epigenetics in obesity Professor Cecilia Lindgren, University of Oxford (15.00 - 15.45) Main Auditorium

16.00

Symposia and Oral Abstracts (15.45 - 17.15)

Slimming World Symposium Main Auditorium

17.00

Oral Abstracts 2 Clinical Research Room B01 (Gateway Building)

ASO Symposium 2 Obesity and the environment Room A29

Coffee Break (17.15 - 17.45) Roundtable discussion How can researchers, practitioners and policy makers influence and best work with industry? (17.45 - 19.00) Main Auditorium

19.00 Hot buffet dinner and drinks, exhibition and networking (19.00 - 21.30) The Barn

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Member Led Symposium 3 A critical perspective on the use of BMI to determine maternal obesity risks & interventions Room A29

Plenary Lecture 4 Supporting weight loss in primary care Professor Susan Jebb, University of Oxford (14.45 - 15.30) Main Auditorium

Poster prize announcement and closing remarks (15.30 - 15.45) Main Auditorium

End of Programme


Full Programme Monday 19th September 09.00 – 10.30

Registration and Coffee

10.30 – 10.45

Welcome address from ASO Chair

Main Auditorium

10.45 – 11.30

Plenary Lecture 1

Main Auditorium

Chair: Professor Ian Macdonald

A critical (but constructive) view of scientific progress and the challenges ahead Professor Sara Kirk, Dalhousie University, Canada

11.30 – 12.00

ASO Citizens’ Council

Chair: Dr Judy Swift and Professor Pinki Sahota

12.00 – 13.30

ASO Symposium 1 – Should we be adopting a less weight-centred approach? Main Auditorium

Chair: Dr Judy Swift, University of Nottingham

Main Foyer

Main Auditorium

Perspectives from citizens’ council Mr Ken Clare, EASO Patient Council & founder of WLSinfo

Aim: To examine the scientific and ethical value of non-anthropometric measurements and outcomes in clinical practice and obesity research. 12.00

Opening remarks: The challenge to weight-centric practice Dr Judy Swift, University of Nottingham

12.15

The importance of weighing both as an outcome and as a behaviour change tool Professor Paul Aveyard, University of Oxford

12.30

The risks of weighing children – and adults Dr Rachel Pryke, Royal College of General Practitioners

12.45

Innovations in measurements: Quality of life and economic evaluations Yemi Oluboyede, Newcastle University

13.00

Panel Discussion Ken Clare, Sara Kirk, Paul Aveyard, Rachel Pryke, Yemi Oluboyede

12.00 – 13.30

Member-led Symposium 1

Chair: Dr Moira Taylor, University of Nottingham

The workplace as a setting to facilitate dietary change and weight management

12.00

Calorie labelling: Can it affect a change in sales patterns in the retail setting? Dr Catherine Hankey, University of Glasgow

12.30

Obesity weight management and health in public sector work places: A scoping study Dr Wilma Leslie, University of Glasgow

13.00

Supporting healthier working lives through dietitian-led wellness initiatives. Dr Fiona McCullough, University of Nottingham on behalf of the British Dietetic Association.

12.00 – 13.30

Oral Abstracts Session 1 – Obesity Practice

Chair: Dr Adrienne Cullum, National Institute for Health and Clinical Excellence

Room A29

Room B01 (Gateway Building)

12.00 The development of an intervention to support Children’s Centres to promote parent engagement with an obesity prevention programme Wendy Burton, University of Leeds. 12.15 The West Midlands ActiVe lifestyle and healthy Eating in School children (WAVES) study: a cluster-randomised controlled trial testing the clinical and cost-effectiveness of a multifaceted obesity prevention intervention programme targeted at children aged six to seven years Professor Peymane Adab, University of Birmingham. Continued >

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Full Programme 12.30 Feasibility study of a child weight management programme, adapted for an ethnically and culturally diverse population: the CHANGE study Dr Miranda Pallan, University of Birmingham. 12.45

Obesity and Quality of Life in National Exercise Referral Scheme participants Hannah Spacey, University of South Wales.

13.00

echanisms of Action in Group-based Interventions (MAGI) study: Developing a conceptual framework of group M processes that can help support weight loss Dr Aleksandra Borek, University of Exeter.

um - “He’s going because he needs to lose weight”, child - “I’m going because Mum is making me”: Do parent M and child expectations of weight management align? James Nobles, Leeds Beckett University.

13.30 – 15.00

Lunch, Exhibition and Posters

15.00 – 15.45

Plenary Lecture 2

Chair: Dr Catherine Hankey, University of Glasgow

The role of genetics and epigenetics in obesity Professor Cecilia Lindgren, University of Oxford

15.45 – 17.15

ASO Symposium 2 – Obesity and the Environment

Chair: Dr Alison Tedstone, Public Health England

15.45

The role of Local Authorities in tackling obesity Carol Weir, MoreLife UK

16.15

Environmental and policy interventions for active living Dr David Ogilvie, University of Cambridge

16.45

Tackling obesity through planning and development Michael Chang, Town and Country Planning Association

15.45 – 17.15

Slimming World Symposium

13.15

The Barn Main Auditorium

Room A29

Main Auditorium

Research and Reach: Practical Solutions in an Overweight World Outline The purpose of this symposium is to discuss the role of partnership working in creating solutions which are based on understanding the needs of people who are overweight. The symposium will explore the value of multi-disciplinary, multi-agency, evidence-based and outcome driven approaches in the development and delivery of effective and scalable weight management approaches. Main aim To understand how academics, health professionals and industry partners can work together successfully, to develop and deliver effective, wide-reaching behaviour change programmes for the individual.

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Session Plan •S caling up an individualised approach: considering physiological and behavioural needs for weight loss alongside emotional burdens of weight (Amanda Avery): The importance of developing a good understanding of the individual to develop effective and sustainable weight management solutions, considering physiological and behavioural needs for weight loss alongside emotional burdens of weight. Using person-centred research to continually enhance practical support for weight control

•P artnership working to facilitate physical activity among people who are overweight or obese (Professor Ken Fox): Examples of how academic research can assist in the development of models and strategies for delivery in commercial and public settings

•W eight management in a digital world: personalising digital as a scalable solution (Dr Paul Sacher): The development of digitally delivered behaviour change interventions to provide scalable weight management solutions in today’s world. A practical overview of how the needs of the individual, research and technology are being used in developing innovative, real world digital weight management interventions

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Full Programme

Speakers • Amanda Avery, RD, Consultant Dietitian in Weight Management and Assistant Professor in Nutrition and Dietetics at the University of Nottingham. Amanda is a registered Dietitian with over 20 years of experience working as a community Dietitian in the NHS before moving into academia. For the past 7 years Amanda has worked at the University of Nottingham as part of the core team delivering the Masters of Nutrition and Dietetics programme. Amanda has also worked as a consultant dietitian for Slimming World for the past 16 years.

•P rofessor Ken Fox, Emeritus Professor of Exercise and Health Sciences, University of Bristol. Ken is Emeritus Professor of Exercise and Health Sciences at the University of Bristol. His career has focussed on the promotion of physical activity and public health with particular interest in the social psychology of behaviour change and the effect of physical activity on mental well-being and weight management

•P aul Sacher PhD, RD, Chief Research and Development Officer, Slimming World. Dr Paul Sacher is Chief Research and Development Officer for Slimming World and Research Director for MEND internationally. Over the last 21 years he has been developing, evaluating and disseminating evidence-based lifestyle weight management and digital health interventions globally. He is also Honorary Senior Research Associate at University College London and previously worked in the NHS for 11 years.

15.45 – 17.15

Oral Abstracts Session 2 – Clinical Research

Chair: Dr Barbara McGowan, Guy’s and St Thomas’ Hospital London

15.45

Systematic Review and Meta-analysis to identify the Prevalence of Obesity-associated Co-morbidities/ Co-morbidity Indicators in Children and Adolescents (aged 5-18) Vishal Sharma, University of Leeds.

Room B01 (Gateway Building)

16.00 Effects of Weight Loss Interventions for Adult Obesity on Mortality, Cardiovascular and Cancer Outcomes A systematic review and meta-analysis of long-term randomised controlled trials Chenhan Ma, University of Aberdeen. 16.15

Calorie labelling in a hospital café outlet- does it affect customer purchasing behaviour and influence sales? Dr Catherine Hankey, University of Glasgow.

16.30

eight loss and associated improvements in cardiometabolic risk factors with liraglutide 3.0 mg in the SCALE W Obesity and Prediabetes randomised, double-blind, placebo-controlled 3-year trial Professor Mike Lean, University of Glasgow.

16.45

ontinuous quality improvement in a Tier 3 weight management service C Dr Carly Hughes, University of East Anglia.

17.00

ffects of maternal anthropometrics and change in anthropometrics during pregnancy on short and long term E pregnancy outcomes in South Asian women: A systematic review Emma Slack, Newcastle University.

17.15 – 17.45

Coffee Break

Main Foyer

17.45 – 19.00 Roundtable discussion: How can researchers, practitioners and

policy makers influence and best work with industry?

Chair: Professor Simon Langley-Evans, University of Nottingham

Main Auditorium

Participants Christopher Snowden (Spectator & Institute for Economic Affairs), Prof Ian Macdonald, (University of Nottingham), Professor Susan Jebb, (University of Oxford), Paul Gately, (Leeds Beckett University), Amanda Avery, (Slimming World)

Topic How can researchers, practitioners and policy-makers influence and best work with industry?

Format Welcome and introductions (Chair). Panellists to explain how their work brings them into contact with industry. Chair will ask Susan Jebb to start proceedings with a short warts-and-all summary of her experiences of working with industry. Discussion will follow on involving all participants.

Follow up questions from the Chair to encourage discussion:

• Where do the boundaries need to be between research activity in a University that is funded by industry and industrial priorities? What pitfalls do researchers need to be aware of? (IM and SJ) • Is greater reliance on industrial funding distorting the work that researchers are doing, and are we seeing significant funder bias in the literature Continued >

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Full Programme

19.00 – 21.30

•P G and AA are both involved with the commercial weight management sector. Are there any conflicts of interest between maintaining evidence-based practice and research and the need to ensure commercial success? •L earned societies are important influencers of policy- is there a conflict in accepting sponsorship for conferences and workshops? •D oes engagement with industry undermine public confidence in ‘experts’? •T o what extent should industry be welcome at the table when we as researchers or practitioners sit down with policy-makers? •D o we have good examples of where engagement with industry has had a positive effect on their behaviour and consumer health?

Hot buffet dinner and drinks, exhibition and networking

The Barn

Tuesday 20th September 08.30 – 09.15

Plenary Lecture 3

Chair: Professor Mike Lean, University of Glasgow

Obesity and non-alcoholic fatty liver disease Professor Ian Macdonald, University of Nottingham

09.15 – 09.45

Abstract Awards

Chair: Dr Maria Bryant, University of Leeds

09.15

Best Abstract Award Emotional over- and under-eating in early childhood are learned not inherited Moritz Herle, University College London

09.30

Good Practice Award Weigh forward specialist weight management service Dr Helen Moffat, Aberdeen Royal Infirmary

09.45 – 10.15

Coffee Break

10.15 – 11.45

ASO Symposium 3

Chair: Dr Dilys Freeman, University of Glasgow

10.15

Basic science – clinical partnership – obesity and fatty acid handling

10.45

Human liver fatty acid metabolism Professor Leanne Hodson, University of Oxford

11.15

Adipose tissue expandability, lipotoxicity and the Metabolic Syndrome Dr Vanessa Pellegrinelli, University of Cambridge

10.15 – 11.45

Infant & Toddler Forum Symposium

The Obesity Challenge: Prevention is Action

Chair: Peymane Adab, Professor of Chronic Disease Epidemiology and Public Health, University of Birmingham

Main Auditorium

Main Auditorium

Main Foyer Room B01 (Gateway Building)

Adipose tissue depot functionality Professor Fredrik Karpe, University of Oxford

Main Auditorium

hild and maternal obesity are on the rise in Britain. Prevention is key to protecting future generations from obesity C and diet-related ill-health. New evidence is now clearly linking larger portion sizes to excess weight gain in children. The Infant & Toddler Forum supports health and childcare professionals with practical advice to help them support the families they work with. Simple guidance on portion sizes could be key in curbing the obesity crisis. The ITF together with partners encourages the implementation of effective tools to help change behaviours and creating an environment that encourages informed, healthy choices and personal responsibility on eating habits.

Nutritional guidance in early life should be a key public health prevention strategy if we are to improve the health of the next generation Judy More, Paediatric Dietitian and member of the Infant & Toddler Forum Judy More will cover calls for a shift in focus to prevention through the understanding of the ideal - what we should be promoting and encouraging.

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Full Programme Why is portion size so important in the fight against obesity Dr Clare Llewellyn, Lecturer in Behavioural Obesity Research, University College London Dr Clare Llewellyn will cover portion size and relation to appetite and weight gain.

Practical implementation of best practice guidance in early years settings – case study Melanie Pilcher, Policy and Standards Manager, Pre-school Learning Alliance Melanie Pilcher will cover a practical approach of best practices in early years settings based on real life examples.

www.infantandtoddlerforum.org Supported by an unrestricted educational grant from Danone Nutricia Early Life Nutrition

10.15 – 11.45

Member Led Symposium 2

Chair: Dr Alison Tedstone, Public Health England

Room A29

The role of local level data in an applied approach to whole systems obesity: A multisector co-production featuring the ESRC Strategic Network for Obesity and PHE Whole Systems Approach to Obesity Programme 10.15 Overview (objectives and outputs) of the ESRC Network for Obesity Dr Michelle Morris, University of Leeds 10.25

Overview (objectives and outputs) of the Whole System Approach to Obesity Professor Paul Gately, Leeds Beckett University

10.35 Putting public perspectives at the heart of Whole Systems Approaches to Obesity: Ways to engage and to reduce weight stigma Dr Emily Henderson, Durham University 10.45 Examples of the mutually beneficial partnership between academics and the local government. This presentation will share best practice and lessons learnt and highlight data assets within LG that are underutilised Dr Claire Griffiths, Leeds Beckett University 10.55

Experiences from LA members / those working in public health

11.15

Benefits from LA and PH in working with academics looking towards the future Representative from PHE

11.25

Questions / discussion from the audience

11.45 – 12.30 ASO Annual General Meeting

Main Auditorium

12.00 – 13.15

Lunch, Exhibition and Posters

13.15 – 14.45

SCOPE Accredited Clinical Symposium sponsored by Cambridge Weight Plan Main Auditorium

Chair: Dr Carly Hughes and Dr Louise Thompson

The Barn

Very brief GP opportunistic interventions for weight loss: What GPs say and how patients react. Findings from the BWeL trial. Professor Paul Aveyard, Nuffield Department of Primary Care Health Sciences, University of Oxford. Update on the role of pharmacotherapy and bariatric surgery in people with T2D and obesity. Dr Barbara McGowan, Consultant and honorary senior lecturer in diabetes and endocrinology at Guy’s and St Thomas hospitals.

Shared Care Models for post-bariatric follow up: Clinical reference group recommendations. Dr Helen Parretti and Dr Carly Anna Hughes.

What model of long term post-bariatric surgery care will be the most effective? Dr Barbara McGowan, Dr Carly Hughes, Dr Helen Parretti

13.15 – 14.45

Member Led Symposium 3

Chair: Professor Judith Rankin, Newcastle University

Room A29

A critical perspective on the use of BMI to determine maternal obesity risks and interventions 13.15 Introduction to the symposium – Introducing the symposium aims, speakers, structure, and setting the scene of maternal obesity research Professor Judith Rankin, Newcastle University Continued >

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Full Programme 13.20

Maternal obesity and risk of maternal and perinatal morbidity and mortality: An epidemiological perspective Professor Marian Knight, University of Oxford

13.35 The effectiveness of antenatal behaviour change interventions among obese populations: An individual risk perspective Dr Nicola Heslehurst, Newcastle University 13.50 Maternal obesity and adverse pregnancy outcomes: Potential mechanisms Mr Peter Tennant, University of Leeds 14.05 The role of anthropometric measures for maternal obesity epidemiology and intervention: A critical perspective of the use of BMI and alternative measures in pregnancy Dr Louise Hayes, Newcastle University 14.20

Summary of the key messages and symposium discussion Professor Judith Rankin, Newcastle University

13.15 – 14.45

Oral Abstracts Session 3 – Basic Science

Chair: Dr Dilys Freeman

Room B01 (Gateway Building)

13.15 The association between the ‘Fat Mass and Obesity Associated Gene (FTO)’ and Obesity-Linked Eating Behaviours in Adults and Children: a Systematic Review Joanna Brecher, University of Manchester 13.30

inking obesity and biological ageing: A study of life course adiposity and leukocyte telomere length in a L nationally representative population Wahyu Wulaningsih, King’s College London

inkgo biloba extract reduced fatty acid uptake and adipocyte volume of obese rats, independently of food/ G energy reduction Bruna Hirata, Universidade Federal de São Paulo, Brazil

14.00

Examining passive overconsumption and hedonic preference for fat in physically active and inactive individuals Kristine Beaulieu, University of Leeds

14.15

Does perceived savouriness of a familiar food relate to its perceived or actual protein content? Charlotte Buckley, University of Bristol

13.45

14.30 Randomised controlled trial of continuous versus intermittent energy restriction during adjuvant chemotherapy (The B-AHEAD 2 Trial) Mary Pegington, University of Manchester 14.45 – 15.30

Plenary Lecture 4

Chair: Dr Carly Hughes, Fakenham Medical Practice, Norfolk

upporting weight loss in primary care S Professor Susan Jebb, University of Oxford

15.30 – 15.45

Poster prize announcement and closing remarks

End of Programme

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September 19-20, 2016

Main Auditorium


ASO COMs Network

ASO UK Adult COMs Network The Association for the Study of Obesity (ASO) is proud to announce the establishment of a network of Centres for Obesity Management (adult COMs) aimed at strengthening and advancing the evidence base, improving practice and influencing policy for the management of obesity in adults within the UK. The ASO UK Adult COMs network includes members working within Tier 2, Tier 3 and Tier 4 adult obesity services delivered across a range of NHS and non NHS settings. Each service will be involved in working towards improving the management of adults with obesity.

Key Aims of the Adult COMs Network • Implement state-of-the art evidence-based care for patients with obesity • Facilitate communication and networking between ASO’s clinical practitioners, researchers, policy-makers and industry with the aim to improve the management of obesity • Promote multidisciplinary research collaborations and research projects • Deliver clinical education as part of a multi-disciplinary approach to obesity management in the form of workshops at the UKCO and annual national training courses • Contribute to consultations, practice guidance and position statements on key UK treatment issues • Provide evidence-based input of the UK perspective at a European and international level through EASO and WOF.

Interested in joining? Contact the ASO at asooffice@aso.org.uk to request an application form. To find out more please visit www.aso.org.uk/research-practice/centres-for-obesity-management

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ASO Early Career Researchers Workshop Sunday 18th September – Kegworth Hotel Programme 13.15 – 13.45 Registration and lunch 13.45 – 14.00

Welcome - ASO and Early Career Researcher Network

Dr Maria Bryant, Leeds Institute of Clinical Trials Research, University of Leeds.

14.00 – 15.00 Research impact The importance of your research making a difference, and the emerging need to evidence impact beyond publication: A workshop to help you develop an impact plan.

Dr Nicola Heslehurst, Institute of Health and Society, University of Newcastle.

15.00 – 16.00 Big Data and Obesity What is Big Data? This session will encourage thought on the context, opportunities, constraints and the environment for using Big Data in obesity research.

Dr Michelle Morris, Leeds Institute for Data analytics, University of Leeds.

Dr Claire Griffiths, School of Sport, Leeds Beckett University.

16.00 – 16.20

Break

16.20 – 17.30 Developing public health research How to design and write a case for support. Lessons learnt from a National Institute of Health Research Public Health Research programme grant: Tips for putting together a study design and planning the research. Professor Peymane Adab, Institute of Applied Health Research, University of Birmingham.

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17.30 – 17.45

Discussion and Close – All speakers Questions and wider discussion of the role of the Early Career Researcher Network in ASO.

17.45

ECRN Social Event

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Tribute to Jane Wardle Professor Jane Wardle Professor Jane Wardle passed away on 20th October 2015 shortly before her 65th birthday. She was a leading behavioural scientist in the field of cancer prevention and control, and her work revolutionised our understanding of obesity. Jane’s work exploring the aetiology of obesity established that weight is as heritable now as it was 30 years ago; despite the onset of the current obesity epidemic. This observation has been difficult to understand given the changes to the food and activity environments thought to be responsible for rising obesity rates. To explain how obesity could be caused by both genetic and environmental factors, Jane developed the ‘Behavioural Susceptibility Theory’. She proposed genes could be influencing weight through their effects on appetite. The key premise being that individuals who inherit a set of genes that make them more responsive to food cues (want to eat when they see, smell or taste delicious food), and less sensitive to satiety (take longer to feel full) are more susceptible to overeat in the current food environment, and become obese. To test this theory Jane developed a parent-report measure of children’s appetite – the Child Eating Behaviour Questionnaire (CEBQ), and explored the genetic basis of appetite using 10-year-old twins from The Twins Early Development Study. Using the CEBQ she showed for the first time that food responsiveness and satiety sensitivity both have a strong genetic basis. She also showed that the FTO gene (the first ‘obesity gene’ to be discovered in 2007), and other obesity genes, appear to be influencing weight through satiety sensitivity. After discovering that appetite is already highly heritable by age 10, Jane established Gemini - the largest study of twins ever set up to study genetic and environmental influences on weight from birth. Under Jane’s leadership Gemini has become an internationally recognised study, advancing our understanding of childhood growth.

As part of Jane’s pioneering work on obesity she developed novel, evidence-based methods for weight control. Jane recognised there was a real need for weight loss advice for the general public that is easy to communicate and straightforward to follow. She was one of the first behavioural scientists to explore whether we can teach people to form healthy habits, using habit formation theory. Jane developed the ‘Ten Top Tips’, a leaflet which describes a set of simple energy balance behaviours that can be turned into habits. Jane believed this kind of intervention, which requires little time to explain and is easy to understand, may be beneficial in primary care where time is short and effective weight management advice is needed. Jane’s work on the development and evaluation of the Ten Top Tips represents an important milestone for translational behavioural research and the Ten Top Tips has already been widely disseminated across the UK as part of Cancer Research UK’s Reduce the Risk campaign. In her lifetime Jane produced over 700 publications and trained more than 40 PhD students. She also established the award winning charity Weight Concern (www.weightconcern.org.uk) which aims to promote healthy eating and weight through evidencebased methods. Aside from her immense catalogue of obesity research, Jane also made major contributions to the fields of cancer screening, early diagnosis and survivorship. She was an unparalleled mentor and teacher who inspired unwavering loyalty among her many students and colleagues. She is greatly missed. Dr Alison Fildes

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September 19-20, 2016

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Tribute to John Garrow Professor John Stuart Garrow John Garrow was a remarkably able analyst of nutritional studies and a pioneer in the early phases of obesity research in the UK as well as a gifted inventor of the some novel instruments used in body compositional research, and in clinical medicine. Although born in Dundee, Scotland, he was educated in London before returning to Scotland to study medicine at St Andrew’s University. He revealed his unorthodox approach to life by immediately transferring after qualification to take up a junior hospital post in the newly formed Medical School in the British Colony of Jamaica where he observed the problem of severe childhood malnutrition. These very sick children often died if they were fed a full diet abruptly. Having been enormously impressed with Dr. John Waterlow’s new findings on fatty liver disease in infants, he joined the Tropical Metabolism Research Unit funded by the UK’s Medical Research Council (MRC) where he immediately improved the dietary management of the critically ill children. Then having served his military service in the RAF Institute for Aviation Medicine in Farnborough he returned to Jamaica to take charge of the MRC Unit as well as developing a 4 π liquid scintillation counter for assessing body composition from the K40 measurements. Garrow then moved in 1969 to the MRC Clinical Research Centre in Northwick Park Hospital where he began working on the problems of obesity. In order to study energy balance, he built a combined indirect and direct calorimeter for every day movement and meal responses, the first since Atwater had built his own calorimeter in the 1880s. He also built a partially water filled body plethysmograph to improve measures of body composition and analysed meticulously the published data on energy balance which led to his writing “Energy Balance and Obesity in Man.” He also worked with Joan Gandy (nee Webster), with such experimented techniques as jaw wiring and a fixed tight waist band to help obese people control eating and help to maintain their reduced body weight. Moving further into the field of nutrition, he with Phillip James began editing of the “Textbook of Human Nutrition”, previously edited by Passmore and Truswell, as well as taking over as Editor of the European Journal of Clinical Nutrition for a decade.

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He then moved to head up the Rank Human Nutrition Unit at St Bartholomew’s Hospital, London, where ran an obesity clinic for many years. He continued to employ novel methods of weight loss, and became increasing interested in the psychology of obesity and weight loss (and enjoyed many interesting discussions with John Blundell) and also evidence based medicine (as it was then called). He wrote the book, “Treat Obesity Seriously” in order to educate the public about the medical and psychological contributions to obesity. He dabbled in systematic reviewing, and became a fan of the Cochrane Collaboration. He was also a strong advocate for teaching nutrition to medical doctors and for two weeks each year, he ran a full nutrition course for all students studying medicine, dentistry, and biomedical sciences at St Bart’s, The Royal London, and Queen Mary. He was an inspirational teacher, working alongside Peter Kopelman and Jeremy Powell-Tuck. He became increasingly concerned with the fraudulent claims of medical and herbal quacks which he countered with a series of highly critical commentaries and expert witness reports for legal cases. Upon retirement he helped to found Healthwatch, a charity concerned to promote evidence-based medicine and to expose fraudulent claims. During his long career he contributed extensively to national policy analyses including as a member of the Department of Health’s Committee on Medical Aspects of Food Policy; as Chair of the Joint Advisory Committee on Nutrition Education as well as the Chair of the Association for the Study of Obesity. He was also a member of the BMJ’s ‘hanging committee’, which he enjoyed very much. His legacy lives on the walls of many doctor’s surgeries, in the famous BMI chart. John Garrow was a pioneer and inventor, and not only contributed enormously to our understanding of obesity but, as a physiologist and elegant and sophisticated writer, he constantly emphasised the importance of the highest standards in science and public service. Those who met him at conferences, will well remember his intellect and challenging questions, and his passion for mentoring the next generation. Professor Carolyn Summerbell and Professor Philip James

UKCO2016

September 19-20, 2016


ASO Best Abstract Award Moritz Herle I am third year PhD student at the Health Behaviour Research Centre, Department of Epidemiology and Public Health, University College London. My PhD is supervised by Dr Clare Llewellyn, Dr Alison Fildes and Dr Frühling Rijsdijk. I have completed a BSc in Psychology at Goldsmiths, University of London, and an MSc in Genes, Environment and Development at the Social, Genetic & Developmental Psychiatry Centre (SGDP) at the Institute of Psychiatry, King’s College London. During my PhD I am aiming to apply behavioural genetic methodologies to explore the aetiology of emotional eating in childhood and its association with weight. Data analysed is from the Gemini - Health and Development in Twins cohort. Emotional over- and under-eating in early childhood are learned not inherited Moritz Herle1, Alison Fildes1, Silje Steinsbekkl2, Clare Llewellyn1 1 University College London, London, UK, 2Norwegian University of Science and Technology, Trondheim, Norway

Background Emotional overeating (EOE) has been associated with childhood weight gain and obesity risk; while emotional undereating (EUE) may protect against obesity risk. Interestingly, EOE and EUE tend to correlate positively, but it is unclear if they reflect different aspects of the same underlying trait (i.e. a tendency to both overand under-eat in response to negative emotion), or are distinct behaviours; and their aetiologies in childhood are unknown. We established the extent to which EOE and EUE share a common genetic or environmental aetiology in early childhood. Methods Data were from 2050 5-year-old twins from the Gemini twin birth cohort. Parents rated their twins’ EOE and EUE using the Child Eating Behaviour Questionnaire. Genetic and environmental influences on variation and covariation in EUE and EOE were established using bivariate quantitative genetic modelling. Results Variation in both behaviours was largely explained by aspects of the environment completely shared by twin pairs (EOE: C=89%, 95% CI: 87%-90%; EUE: C=91%, 95% CI: 89%-92%). Genetic influence on both behaviours was low (EOE: A=9%, 95% CI: 7%-11%; EUE: A=7%, 95% CI: 6%-9%). EOE and EUE correlated positively (r=0.41, p<0.001), and the association was largely explained by EUE and EOE being shaped by the same shared environmental influences (BivC=44%, 95% CI: 39%48%); approximately half of the shared environmental influences underlying EUE and EOE overlapped (rC=0.49, 95% CI: 0.430.54). Conclusions Young children who emotionally overeat tend also to emotionally undereat. The tendency to eat more or less in response to emotion is learned rather than inherited.

UKCO2016

September 19-20, 2016

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ASO Best Practice Award Dr Helen Moffat Dr Helen Moffat trained as a clinical psychologist at the University of Leeds and has a longstanding interest in physical health. After working for many years with children and families, she has spent the last six years practising within plastic surgery and bariatric surgery services at Aberdeen Royal Infirmary. She led the development of a new specialist weight management service in NHS Grampian and has been clinical lead for the Weigh Forward service since May 2015. Weigh Forward Specialist Weight Management Service Background Evidence for effectiveness of interventions for obesity based on diet and physical activity alone is poor. Clinical guidance (NICE, SIGN and Cochrane) indicates that weight management interventions are most likely to be effective when they incorporate psychological components as part of a structured multidisciplinary approach. The Weigh Forward specialist weight management service was formed in May 2015 as a pilot project for two years. The service provides a multi-disciplinary (non surgical) approach to weight management, integrating dietary components and physical activity within an evidence based psychological framework, for patients who have previously engaged with other structured weight management programmes but failed to achieve or maintain weight loss. It addresses what was a significant gap in service provision in NHS Grampian between community based healthy weight interventions (tier 2) and bariatric surgery (Tier 4). It has been designed to meet the needs of patients not being addressed in primary care, and those whose secondary care treatment cannot progress or is complicated because of obesity. At the initial planning stage, users of existing NHS Grampian obesity services took part in a focus group discussion about how the new service would be delivered. Outline of the Weigh Forward Service Key aspects of the Weigh Forward Service include holistic, multi disciplinary assessment, group intervention where appropriate, and 12 month follow up. The initial assessment involves an interview with both the dietician and psychologist, exploring the history of the patients’ concerns about weight, physical and mental health concerns in general, and factors which may be maintaining difficulties with weight, such as emotional eating or lack of support. Clinicians work collaboratively with the patient to establish shared understanding, with emphasis on exploring what is important to the patient, in terms of their health, well-being and life in general. The team meets regularly for clinical discussion and colleagues from other services have been included in these discussions where appropriate, for example, to support them addressing concerns about patients housebound by severe obesity. The intervention is delivered over 6 months with patients attending fortnightly sessions, with the aim of achieving 5-10% weight loss which will be sustainable in the long term. The emphasis of the programme is on a moderate energy deficit (500Kcal/day), based on a healthy balanced diet and introducing a regular eating pattern, regular physical activity and substantial psychological components. Groups are delivered jointly by the dietician and psychologist and draw on evidenced based psychological approaches integrating Acceptance and Commitment Therapy, with components of Compassion Focussed Therapy. Sessions are as experiential as possible.

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Participants are encouraged to actively take part in activities and discussions rather than just being given information. Where the group intervention is not appropriate either for practical or psychological reasons, patients are offered one to one sessions, usually with both the psychologist and dietician. Patients remain in contact with the service for a further 12 months during which they will attend for review appointments at 2 months, 6 months and 12 months, attending both individual appointments and as a group. Where appropriate, reviews can be done by telephone and patients are free to contact the service at any time if they have concerns. The team have developed comprehensive patient resources (in-house) covering dietary, psychological and physical activity components with audio visual components, to support both the group and individual interventions. Our intention is to make these available on line, with interactive components where possible. Strong links with third sector providers have been established so we can signpost patients to physical activity opportunities already available within the community (including Sport Aberdeen, Aberdeen Football Club Community Trust and Grampian Cardiac Rehab Association). We are now providing a weekly chair based exercise class specifically for patients attending the service. Service Activity and Outcomes Over the first 12 months the service received over 380 referrals, with half of these coming from GP’s. The average BMI of patients who are referred is 47Kg/m2. Typically patients have two or three co-morbid long term conditions, and for over a third, this includes a mental health condition. The mean age of patients referred is 50 (range 16 to 74); 74% female, 26% male. On referral, patients are asked to actively opt into the service by phone or email. Approximately 15% of those referred do not opt in. Overall attrition rates are in line with those of similar services, with just under 50% of all those referred actively engaging with the 6 month intervention phase. While ambivalence about engaging with lifestyle change is likely to be a significant cause of attrition, we are aware that poor health is also a significant factor in patients dropping out of the service. A robust model of evaluation was established from the outset using recommended datasets from Scottish Government and the National Obesity Observatory. Outcome data indicates that in terms of weight loss, 39% of those who have completed the group intervention (n=32) have achieved a weight loss of more than 5, whilst 50% of those who have completed the one to one intervention (n=6) have achieved more than 5% weight loss. Standardised measures indicate significant improvements in mood and quality of life and reduction of binge eating and reduced HBA1c for diabetic patients. Most patients report making significant dietary changes and increased physical activity. Patients’ feedback about the service has been overwhelmingly positive. They identified a range of things they found helpful, including many aspects of their increased knowledge and opportunities to share experiences. One commented “It was not a weight loss class, more about your relationship with food... making me think and giving me more awareness”. Whilst patients are often surprised and slightly disconcerted when they are not given a diet plan early on, many later comment that they have experienced the programme as inclusive, non-judgemental and empowering, as one participant put it, “You gave us choices, not reprimands”. Other common themes in patient feedback are personal responsibility and self-compassion, for example, “I learned about being good to myself, and to take control of my life”.

UKCO2016

September 19-20, 2016


Sponsors and Exhibitors Broccoli and Brains Broccoli and Brains is full of the stuff of human hunger. We needed to write it because we needed to shout more loudly. We needed you to hear us. We needed you to know that the confusing messages we have been fed for decades around “eat less and do more” have not, and will not, solve the obesity problem raging in this country. Through our personal experience and by dedicating a significant part of our working lives to helping others to tackle their own obesity problem. We have seen how it can destroy lives and have been frustrated by the slow pace of change. Some of that work has been done through LighterLife. For the past 25 years, as an organisation, we have provided weight management solutions that focus on the psychological reasons that underpin people’s overeating. We have significant evidence that a therapeutic approach can provide most with a much better opportunity to change and achieve a healthier, more fulfilled life. What we care about most is that obesity is considered much more than just a physical symptom – that psychological support and solutions are considered and available to all who need it. We care that society changes it’s thinking about obesity. www.broccoliandbrains.co.uk

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

The College of Contemporary Health The College of Contemporary Health (CCH) is a college that combines flexible online learning with world-class academic expertise and a unique interdisciplinary curriculum to deliver state-ofthe-art university accredited obesity education to healthcare professionals that can be immediately applied in day-to-day interaction with patients. Validated by London South Bank University, CCH’s most popular postgraduate modules and courses in Obesity Care and Management include: • PG Cert / PG Dip / MSc Obesity Care and Management • Obesity and Reproductive Health • Paediatric Obesity CCH also provides CPD accredited online short courses for immediate professional development, including: • Obesity Essentials for Health Professionals • Living and Working with Obesity – Professional Short Course for Nurses • Making the Move: Working with Obese Clients – Specialist Training for Fitness Professionals

“The CCH courses make a significant contribution to the clinical education of practitioners. The modules are evidence-based, relevant and of high quality and should be recommended to all practitioners involved in obesity prevention and management”. Professor Pinki Sahota,Chair of the Association for the Study of Obesity Study online with a highly respected institution, and strong reputation, within the health sector when you want, where you want at a time that suits you. Speak to our Admissions Team on 0203 773 4895 or email info@contemporaryhealth.co.uk to discuss the courses in more detail. www.contemporaryhealth.co.uk

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. 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

Infant & Toddler Forum The Infant & Toddler Forum (ITF) brings together leading experts from paediatrics, neonatology, health visiting, dietetics, child psychology and midwifery specialising in early years nutrition and development. The ITF provides evidence-based information and practical tools for families and the healthcare professionals who advise them to make healthy lifestyle choices. It takes a life course approach to nutrition, exploring the early connection through pregnancy, infancy and toddlerhood. With maternal and child obesity on the rise, the UK is facing a preventable epidemic of obesity and diet-related ill-health. New evidence is now clearly linking larger portion sizes to excess weight gain in children. Simple guidance on portion sizes could be key in curbing the obesity crisis. Attend our symposium, The Obesity Challenge: Prevention is Action at 10.15 – 11.45 on Tuesday 20th September. Expert speakers will provide vital information on best practices by engaging practitioners with effective tools to help change behaviours and create an environment that supports informed, healthy choices on eating habits for parents and carers. www.infantandtoddlerforum.org

UKCO2016

September 19-20, 2016

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Sponsors and Exhibitors Johnson and Johnson Medical Devices Companies Johnson and Johnson Medical Devices Companies business segment produces a broad range of innovative products and solutions used primarily by health care professionals in the fields of orthopaedics, neurological disease, vision care, diabetes care, infection prevention, diagnostics, cardiovascular disease, and aesthetics. Having made significant contributions to surgery for more than a century, the Johnson & Johnson Medical Devices Companies are in the business of reaching more patients and restoring more lives. The group represents the most comprehensive surgical technology and specialty solutions business in the world, offering an unparalleled breadth of products, services, programs and research and development capabilities directed at advancing patient care while delivering clinical and economic value to health care systems worldwide. www.jnj.com

KasTech Ltd Cambridge based KasTech Ltd develops and distributes ProHealthClinical, a multicomponent computer toolbox and database for Tier 2, 3 and 4 weight management. An independent practice nurse led RTC, funded by the British Heart Foundation, demonstrated a 3-fold increase in mean weight loss when using ProHealthClinical computer tools. Some 34% of the intervention group achieved >=5% weight loss with over 80% of the patients rating the computer resources as ‘very to extremely’ helpful for achieving their lifestyle and weight loss goals. An audit of more than 60 GP practices using ProHealthClinical reported that practitioners and patients found the resources motivating and easy to use. Obesity Specialists in Tier 3 and 4 programmes state it ‘improves their team skills in exercise, diet and behaviour change’ and ‘increases their ability to deliver personalised care to patients‘. ProHealthClinical users include health care assistants, practice nurses, health trainers, fitness instructors, dietitians and doctors in various settings including primary care, specialist obesity clinics, leisure centres and workplaces. The powerful database enables practitioners to generate quick reports to review group outcomes and provide feedback to commissioners. Dietitian Sandy Evans, co-developer of ProHealthClinical, has worked in primary care and specialist obesity clinics for more than 20 years. She has won best practice awards from the RCGP, NOF and ASO for various weight management programmes and her NHS workplace pilot was recently selected as a case study and published on the NHSemployers.org website. www.kastech.co.uk

seca seca, the global leader in medical measuring and weighing, offers healthcare providers advanced wireless technology and system solutions that go beyond height, weight and BMI. Based on over 175 years of quality German engineering, seca medical devices set the standard for innovation, design and reliability. On every continent, doctors and nurses in medical practices, hospitals and nursing homes rely on the high quality of seca’s medical scales and measuring systems. NEW: mobile seca mBCA for medical body composition analysis lightweight and compact, the device is equipped with its own WiFi for immediate entry in available networks. The sophisticated technology delivers reliable and reproducible medical data and stores the results internally. The seca mBCA 525 is ideal for mobile use by nutritionists and dietitians, clinically validated against the scientific gold standard for body composition: MRI, DEXA, Bod Pod, D2O, NaBr. Our wireless product system seca 360° is the first of its kind in the world. Our products transmit their data as required via a special medical wireless protocol to a simple, fast and secure seca network. Within seconds, measurements are transmitted wirelessly and assigned to the correct patient ID in your Electronic Medical Record system, or transferred to a seca 360° wireless printer. This increased efficiency allows your facility to concentrate on what’s really important ― the well-being of your patients. NEW: seca 287 ultrasonic wireless measuring station offers fully automatic measuring of height, weight, BMI and was designed to be user-friendly for convenient use. Automated voice guidance makes it easy for the patient to use without any assistance from the nursing staff. Digital ultrasound technology ensures for precise height measurements, with constant auto-calibration. In addition, the touch-screen display keylock function ensures that you can always rely on an accurate measuring process. Visit the seca stand for more detailed information and a product demonstration or contact on: 0121 643 9349 / sales@seca.co.uk / www.uk.secashop.com

Slimming World Slimming World is the UK’s most advanced weight management organisation, helping more than 800,000 members lose weight every week in over 16,000 groups around the UK and Ireland, run by a network of 4,500 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 discuss the role of partnership working in creating solutions which are based on understanding the needs of people who are overweight. The symposium will explore the value of multi-disciplinary, multi-agency, evidence-based and outcome driven approaches in the development and delivery of effective and scalable weight management approaches. It will take place on Monday at 3.45pm in the main auditorium. www.slimmingworld.co.uk/health www.slimmingworld.co.uk/research-portfolio

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UKCO2016

September 19-20, 2016


Speaker Presentation Summaries and Biographies Paul Aveyard, Nuffield Department of Primary Care Health Sciences, University of Oxford

Clinical Symposium – Tuesday 20th, 13.15–14.45. Main Auditorium Paul Aveyard is a practising GP and professor of behavioural medicine at the University of Oxford, UK. His work has mostly been on the topic of tobacco control but has developed a programme of research in weight control, which draws on what we know about effective tobacco control. He led the systematic review team that produced the reviews for the NICE guidance on behavioural weight management. He is a former trustee of the Association for the Study of Obesity and is past president of the UK Society for Behavioural Medicine. Very brief GP opportunistic interventions for weight loss: What GPs say and how patients react. Findings from the BWeL trial. The BWeL trial is the first trial of screening for and opportunistic intervention upon obesity in primary care. In this trial we randomised 1882 people who were classified as obese and who were waiting to see 137 GPs to one of two 30-second interventions to motivate weight loss. Either the physician advised their patient that losing weight would improve their health or they offered referral to a weight management programme and facilitated that referral. Susan Jebb will present the main results in her plenary. In this session, we will look at the reaction of patients to very brief interventions coming ‘out of the blue’ on their weight. Patients completed a rating scale assessing the inappropriateness or appropriateness and unhelpfulness or helpfulness of the GP’s intervention immediately afterwards. In addition, we recorded several hundred of the consultations and are currently analysing these using a technique called conversation analysis to understand how GPs’ words and style of delivery affected participants’ responses. The analysis will examine how GPs’ words can start conversations about weight in a way that is appropriate and helpful and motivates effective action. We will share these findings in the seminar.

Michael Chang, Town and Country Planning Association

ASO Symposium – Monday 19th, 15.45-17.15. Room A29 Michael Chang is the TCPA’s Project and Policy Manager and its lead on planning for health and authored the various outputs of the Reuniting Health with Planning projects in England but in Northern Ireland and Wales. In the last three years, he has helped to facilitate up to 40 workshops with local councils across the UK and has built up a wealth of experience and insight. As a town planner he has a specific interest in promoting good place-making through the planning and development process, and has been involved in other projects on planning for culture and the arts, green infrastructure and climate change. He has a Bachelor of Planning from the University of Auckland and Master of Science in Urban Regeneration from UCL. Tackling obesity through planning and development The Town and Country Planning Association’s Reuniting Health with Planning initiative of projects and locality workshops has been going from strength to strength. Its latest publication is called ‘Building the foundations: tackling obesity through planning and development’ is supported by Public Health England, the Local Government Association and various local authorities that took part in locality workshops. The planning system is the gateway through which any development and use of land must pass through. The gateway is made up of planning policy and decisions made on individual development sites. So many of the decisions made on the built environment were made by town planners decades ago so how can we ensure the decisions made today will result in healthier communities in the future. The presentation will aim to highlight the important role of the planning system as part of a whole systems approach to tackling obesity, and how public health professionals and wider society can contribute their knowledge and evidence to the process. The presentation will also set out the various factors which the TCPA believes can help promote a healthy weight environment, and drawing on examples from across the country and how councils are tackling the issue. It will conclude by setting out key opportunities and calls for local action.

Mr Ken Clare, founder of weight loss website WLSinfo

ASO Citizens Council – Monday 19th, 11.30–12.00. Main Auditorium A Registered Nurse with over 30 years experience. I have worked as a bariatric specialist user and facilitated many group courses with post-operative patients. At the heart of my practice is a personal passionate belief in ensuring the patient’s voice is heard in elements of obesity planning, service delivery, and research. I have served as a Trustee of two large obesity organisations (Association for the Study of Obesity, British Obesity and Metabolic Surgical Society). I am the founder/Chair of WLSinfo, the UK’s largest patient obesity charity. I am the UK representative for the EASO patient council. I have taken part in NICE and NHS(E) groups. My latest role is in a PPI pilot project. I am involved in several consultancy roles and am frequently asked to lecture and present in this field.

UKCO2016

September 19-20, 2016

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Speaker Presentation Summaries and Biographies Professor Leanne Hodson, University of Oxford

ASO Symposium – Tuesday 20th, 10.15-11.45. Room B01 (Gateway Building) Leanne gained her PhD from the University of Otago, New Zealand. In 2004 she was awarded the Girdlers’ New Zealand Health Research Council Career Development Fellowship which allowed her to move to Oxford and work with Professors Keith Frayn and Fredrik Karpe and undertake complex physiological studies, using stable-isotope tracers in humans. In 2011, she was awarded a British Heart Foundation Intermediate Fellowship in Basic Science and in 2015 was awarded a British Heart Foundation Senior Fellowship. Her work focusses on human metabolism, with an emphasis on liver metabolism, using a combination of in vivo human studies and in vitro cellular models to explore this. Human liver fatty acid metabolism The liver is a complex metabolic organ that responds rapidly and dynamically to alterations in nutritional state. It is a central cross-road for fatty acid metabolism and perturbations in hepatic fatty acid metabolism have the potential to impact widely on metabolic health. The accumulation or loss of liver fat (hepatocyte TG) represents the balance between input pathways and removal pathways. In health these pathways must be closely balanced; imbalance will lead to changes in liver fat content. The concept of hepatic fatty acid partitioning is that fatty acids within the hepatocyte are broadly partitioned between two pathways: (i) esterification and (ii) oxidation. Whether fatty acids are partitioned toward oxidation or esterification pathways appears to be dependent on a number of metabolic factors; not least insulin. Insulin undoubtedly regulates the supply of fatty acids to the liver from adipose tissue, however, whether insulin has a direct intra-hepatic effect on hepatic fatty acid partitioning, in humans, remains unclear. This talk will discuss how metabolic and nutritional state may alter intrahepatic fatty acid synthesis and partitioning.

Professor Susan Jebb, Nuffield Department of Primary Care Health Sciences, University of Oxford

Plenary Lecture – Tuesday 20th, 14.45-15.30. Main Auditorium Susan Jebb is Professor of Diet and Population Health in the Nuffield Department of Primary Care Health Sciences and Senior Research Fellow at Jesus College, University of Oxford. Her research programme is focused on developing and testing interventions that might be effective to help people lose weight or reduce the risk of obesity-related diseases. This includes changes in the type of foods consumed, portion size or behavioural strategies to support people to reduce their energy intake. Susan has a particular interest in the translation of scientific evidence into policy and practice. She was formerly a science advisor to DH (2007-15), chair of the DH Expert Advisory group on Obesity (2007-11) and the DH Responsibility Deal Food Network (2010 -15). She currently chairs one of the NICE Public Health Advisory Committees and is a member of the PHE Obesity Programme Board and NHS England National Diabetes Prevention Programme Expert Group. In 2008 she was awarded an OBE for services to public health. Supporting weight loss in primary care Around two thirds of adults are overweight and almost half of all adults are trying to lose weight. At present most weight loss attempts occur without professional support, yet evidence shows that most people would welcome support from health professionals to lose weight and that formal programmes are more effective than self-management. The challenge is how to deliver effective programmes within available NHS resources at a scale that reaches all those who have the potential to benefit. This presentation will include data from new studies that offer some evidence of how we can make a positive difference. They highlight the importance of engaging with patients, practitioners and providers to create a system which embeds weight management as part of routine care.

Professor Fredrik Karpe, Oxford Centre for Diabetes, Endocrinology and Metabolism OCDEM, University of Oxford

ASO Symposium – Tuesday 20th, 10.15-11.45. Room B01 (Gateway Building) Fredrik Karpe is professor of metabolic medicine at the University of Oxford. He is known for his work on postprandial lipid and lipoprotein metabolism and more lately the focus has been on human adipose tissue function in relation to obesity and metabolic health. To promote research in translational medicine and functional genomics, he has established the Oxford Biobank (n=7,500 participants), which is incorporated into the National NIHR Bioresource. Adipose tissue depot functionality Fredrik Karpe1, Marijana Todorcevic1, Katherine Pinnick1, Matt J Neville1, Kerrin Small2, Mark I McCarthy1, Peter Arner3, Ingrid Dahlman3 and Costas Christodoulides1 1. OCDEM, University of Oxford, Oxford, UK; 2. KCL, London, UK; 3. Karolinska Institute, Stockholm, Sweden Lower body fat accumulation shows neutral of negative associations to complications to obesity, but the mechanisms by which gluteofemoral fat could be protective are not well understood. Recent evidence suggests distinct differences in adipocyte cellularity in response to weight gain in upper body vs lower body fat. The ability to recruit new adipocytes to lay down superfluous energy is likely to be part of a healthy response; this brings site-specific weight gain into the world of regional differences in stem cell recruitment and cellular ageing. In order to identify novel genetic regulators of human adipose tissue cellularity, expansion and function, we hypothesised that genomewide association studies (GWAS) on human fat distribution or insulin-resistance would provide information on pathways or specific loci. However, there is a relative absence of functionally characterised GWAS loci. To that end we have worked on LRP5 (Wnt signalling pathway, which is a prominent pathway for human fat distribution) and KLF14 (a T2D insulin resistance gene). These studies provide functional genomic data demonstrating genetic components shaping regional adipose tissue expansion. In summary, the positive health benefits from lower body fat accumulation may go further than just a statistical/epidemiological association. Differences of regional adipocyte function, partly driven by genetic variability, provide cogent mechanistic insight into epidemiological relationships.

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UKCO2016

September 19-20, 2016


Speaker Presentation Summaries and Biographies Dr Sara Kirk, Dalhousie University, Canada

Plenary Lecture – Monday 19th, 10.45-11.30. Main Auditorium Dr. Sara Kirk is a Professor of Health Promotion and Canada Research Chair at Dalhousie University in Canada. Her program of research explores how we can create supportive environments for chronic disease prevention. She applies a ‘socio-ecological’ approach that takes into account how individual behaviour is influenced by other broader factors, such as income, education and societal norms. Part of her work has focused on addressing weight bias within the health system, using drama to highlight the challenges people experience when navigating a healthcare system that is not designed to effectively support chronic disease management. A critical (but constructive) view of scientific progress in obesity research, policy and practice, and the challenges ahead The last few decades have seen an increase in rates of obesity globally. There is no lack of discussion on causes and consequences of these rising rates, but little evidence that the system issues that underpin the development of obesity, and that affect us all regardless of weight status, are being adequately addressed. These system issues include income and social inequalities, reductions in physical activity, increasing time spent engage in sedentary behaviours and an abundance of energy dense, nutrient poor foods. Instead of a focus on fixing these broken systems, the prevailing narrative within society focuses on obesity as an individual problem that can be solved by eating less and moving more, which in turn fuels a cycle of blaming and shaming of people in larger bodies. This begs the question “is a focus on obesity actually helpful or harmful?”. Through a consideration of the challenges of focusing on obesity as an endpoint, this presentation will highlight what more needs to be done to place people with obesity at the centre of discussions as we work towards solutions within research, policy and practice.

Professor Cecilia Lindgren, University of Oxford

Plenary Lecture – Monday 19th, 15.00-15.45. Main Auditorium Prof. Cecilia Lindgren is currently appointed a Senior Group Leader at the Big Data Institute, Li Ka Shing Centre for Health Information and Discovery at University of Oxford after returning from 3 years as a Scholar in Residence at the Broad Institute of Harvard and MIT. She received a Ph.D. in Molecular Genetics from Lund University and continued her career as a visiting researcher at the Whitehead Institute, MIT, USA where she trained in training in statistical genetics. After post-doctoral work at the Karolinska Institute, she joined the Wellcome Trust Centre for Human Genetics at Oxford University. In this setting, her work has contributed to a substantial furthering of our understanding of the genetic landscape of T2D, obesity and fat distribution. In line with this, she is co-chairing the central adiposity team within the GiANT consortium, the obesity working group within UKBBCMC, the quantitative traits team within the GoT2DGenes consortium and chairs the Polycystic Ovary Syndrome (PCOS) consortium. She has been awarded the “Rising Star Award” from European Association for the Study of Diabetes (2010), the “Association for the Study of Obesity’s Obesity and Cardiovascular Health Award” (2011), a Senior Research Fellowship from St. Annes College in Oxford (2011) as well as the inaugural “Leena Peltonen Prize for Excellence in Human Genetics” (2013). In 2014 and 2015 she was listed amongst Thomson Reuters 100 “most highly cited researchers” in Molecular Biology and Genetics. Her research focuses on applying genetics and genomics to dissect the etiology of obesity related traits.

Professor Ian Macdonald, University of Nottingham

Plenary Lecture – Tuesday 20th, 08.30-09.15. Main Auditorium Ian Macdonald is Professor of Metabolic Physiology at the University of Nottingham and Head of the School of Life Sciences in the Faculty of Medicine and Health Sciences. His research interests are concerned with the functional consequences of metabolic and nutritional disturbances in health and disease, with specific interests in obesity, diabetes, cardiovascular disease and exercise. His recent work is focussed on the metabolic aspects of diabetes and obesity, including the effects of diet composition and weight loss, and the impact of dietary supplements on carbohydrate and lipid metabolism. Two major areas of interest relate to the use of MR imaging and spectroscopy for assessing alterations in metabolism and the influence of nutrients and metabolic disturbances on gene expression in adipose tissue and muscle. Current work in these areas relates to physical activity and inactivity (including immobilisation), obesity and diabetes. He has published over 330 peer-reviewed original research papers, together with reviews, book chapters and invited contributions. In September 2013 he was elected as a Fellow of the International Union of Nutritional Sciences. He is currently joint Editor of the International Journal of Obesity, a member of the UK Scientific Advisory Committee on Nutrition (and Chaired the SACN Carbohydrates Working Group), a Fellow of the Society of Biology, a Registered Nutritionist and an Honorary Fellow of the Association for Nutrition. Obesity and non-alcoholic fatty liver disease It is well established that obesity is linked to an increased risk of developing type 2 diabetes and cardiovascular disease. In the past few years these links have been refined somewhat , with the initial interest being in relation to the increased risk associated with abdominal or visceral fat, and more recently with increased presence of ectopic fat, particularly in skeletal muscle and the liver. It is now clear that increased liver and muscle ectopic fat content is linked with insulin resistance, and these links may even be independent of total body fat content. Of particular interest is the link between obesity and liver fat content, as recent studies indicate that in some populations more than 40% of obese individuals may have an elevated liver fat content to the extent that they have non-alcoholic fatty liver disease (NAFLD). The presence of NAFLD is a concern not only because of its links with insulin resistance but also because it can lead to non-alcoholic steatohepatitis (NASH) and eventually in some patients to liver cirrhosis. Traditionally fatty liver disease was diagnosed from the histological analysis of a liver biopsy, which is sufficiently invasive that it is only done when clinically essential. However, there has also been the use of indirect, ultrasound based methods or approaches which use plasma markers of liver function, to identify people with elevated liver fat content. In recent years the non-invasive assessment of liver fat content has been added to by the use of MR based methods, incorporating either imaging alone, or a combination of imaging and MR spectroscopy to estimate liver fat content. It is now known that short periods of positive energy balance will increase liver fat content, but there have also been claims that certain macronutrients will have greater effects than others. This overview will consider this in more detail and look at various types of carbohydrate and fats on liver fat content.

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Speaker Presentation Summaries and Biographies David Ogilvie, University of Cambridge

ASO Symposium – Monday 19th, 15.45-17.15. Room A29 David Ogilvie qualified in medicine from Cambridge and subsequently trained in general practice in Suffolk and then in public health medicine in the west of Scotland. He was a research fellow at the MRC Social and Public Health Sciences Unit in Glasgow before joining the MRC Epidemiology Unit in 2007. David leads the Unit’s Physical Activity and Public Health research programme, which explores population-level approaches to the promotion of active living by evaluating the effects of environmental and policy interventions and understanding related patterns and mechanisms of behaviour change. His methodological interests lie in the design of population-level intervention studies and in evidence synthesis. He specialises in the relationships between transport, the environment, physical activity and health and leads an interdisciplinary group of researchers working in this area, particularly on the design and analysis of natural experimental studies such as the Commuting and Health in Cambridge, iConnect and M74 studies. Further information is available at www.davidogilvie.net. Buses, bicycles and building for health: practice-based evidence from the UK Observational studies suggest a role for the built environment in shaping activity patterns, but clear evidence of the effects of changing the environment is much harder to come by. This presentation will show how innovation in local authorities and the third sector can be used to generate more robust practice-based evidence, by highlighting findings from a research programme evaluating the physical activity co-benefits of new transport infrastructure and discussing their significance for policy and practice.

Dr Helen Parretti, GP & NIHR academic clinical lecturer

Clinical Symposium – Tuesday 20th, 13.15–14.45. Main Auditorium Dr Helen Parretti is a GP and NIHR academic clinical lecturer, currently working in Birmingham. She has a research interest in the management of obesity in primary care and is currently involved with several research studies in this area. She was a member of the subgroup commissioned by NHS England Obesity CRG to develop bariatric surgery follow-up guidelines and is the RCGP representative to the RCP Joint Steering Committee for endocrinology and diabetes. She is a member of the GPs with an interest in nutrition group and led the development of RCGP endorsed guidance for the long-term management of patients post bariatric surgery in primary care in conjunction with the British Obesity and Metabolic Surgery Society. Shared Care Models for Post-Bariatric Surgery Follow-Up: Clinical Reference Group Recommendations Bariatric surgery can facilitate weight loss and improvement in co-morbidities. It has a profound impact on nutrition and patients need access to follow-up. NICE CG189 (2014) emphasised the importance of two years follow-up in a bariatric surgical service and recommended that following discharge from the surgical service, there should be annual monitoring as part of a shared care model of chronic disease management. In addition, the NCEPOD report Too Lean a Service (2012) recommended a clear, continuous long-term follow-up plan involving all appropriate healthcare professionals. Currently, there are no agreed models of shared care for these patients. The NHS England Obesity Clinical Reference Group commissioned a multi-professional subgroup, which included patient representatives, to develop bariatric surgery follow-up guidelines. Four different shared care models have been developed taking into account of variation in access to bariatric surgical services and specialist teams across the country. Common features include annual review, ability for GP to refer back to specialist centre and submission of follow-up data to NBSR. In this presentation, these four different shared care models will be presented and discussed.

Dr Vanessa Pellegrinelli, University of Cambridge

ASO Symposium – Tuesday 20th, 10.15-11.45. Room B01 (Gateway Building) Vanessa Pellegrinelli, PhD obtained her PhD in 2013 from the Université Pierre et Marie Curie. Her doctoral project focused on inflammation, fibrosis and vascular impairment in the context of human obesity. Shortly after her PhD she joined the group of Prof. Antonio Vidal-Puig at the University of Cambridge. Her current research investigates the molecular mechanisms by which dysfunctional white fat leads to lipotoxicity in peripheral organs and how that contribute to the pathogenesis of the metabolic complications of obesity. She is particularly interested in the elucidation of specific mechanisms controlling, a) the adipose tissue plasticity and expansion and b) the differentiation and activation of brown fat (BAT) in humans as therapeutical strategies to prevent lipotoxicity and the metabolic complications associated to obesity. Adipose tissue expandability, lipotoxicity and the Metabolic Syndrome Positive energy balance which leads to obesity, requires cellular and structural remodelling of the white adipose tissue (WAT) to accommodate the excess of fat. However, when obesity persists, this leads to dysfunction of the adipose depots and limitation of it expansion capacity. “Adipose tissue expandability model” identifies the limited capacity of WAT to expand and accommodate surplus of energy as a key determinant factor for the onset and progression of obesity associated metabolopathologies, as a result of ectopic deposition of excessive toxic lipid species (qualitative lipotoxicity) in important metabolic organs such as muscle or liver. Our main goal is then to a) establish mechanisms controlling adipose tissue plasticity and expansion; b) define the anti-lipotoxic effects of mitochondrial oxidation through strategies that promote the brown adipose tissue and c) identify candidate diagnostic biomarkers and therapeutic approaches based on patterns of lipid species associated with lipotoxicity in mice for subsequent validation in human translational studies. Through systems approaches based on transcriptomic and lipidomic technologies we have recently identified a set of genes that strongly associate with metabolic health in obese individuals and conversely, metabolic disturbances related to metabolic syndrome in lean individuals. The elucidation of the function of these genes and how they uncouple adipose tissue mass from metabolic complications may reveal molecular mechanisms associated to adipose tissue expansion (fat accumulation) and function, in addition to potential biomarkers of metabolic risk.

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Speaker Presentation Summaries and Biographies Rachel Pryke, MBBS MRCGL FRCP

ASO Symposium – Monday 19th, 12.00-13.30. Main Auditorium I am a part-time GP partner and trainer in Redditch, Worcestershire, with particular interests in obesity, malnutrition and women’s health. I was RCGP Clinical Champion for Nutrition until 2015 and began a NICE Fellowship in April 2015. I established the RCGP Nutrition Group in 2013. I have written two books - “Weight Matters for Children” and “Weight Matters for Young People”, Radcliffe Publishing 2006, plus many e-learning modules on obesity, child obesity and adolescent health. In 2014, I established the self-directed RCGP Introductory Certificate in Obesity Malnutrition and Health, accessed via RCGP Nutrition Web pages. www.rcgp.org.uk/clinical-and-research/clinical-resources/nutrition.aspx I run primary care obesity training courses throughout the UK (https://primarycareobesitytraining.wordpress.com/) and have collaborated with WHO on a European primary care obesity training package. I contributed to the Academy of Medical Royal Colleges Obesity Steering Group 2013 report - Measuring up: The medical profession’s prescription to the obesity crisis. I contributed to the 2013 RCP Action on Obesity: Comprehensive care for all report, which looks at how the NHS should adapt to meet the needs of an increasingly obese nation. I am a member of the Lancet Standing Commission on Liver Disease in UK. Should we be adopting a less weight-centred approach? Practitioner perspective: Exploring the triggers and drivers of weight change over time can help in understanding a patient’s weight continuum – their weight trajectory over time. Viewing weight as a symptom of more complex lifestyle interactions can help unravel the impact of direct and indirect measures of lifestyle change and how these factors then influence personal goal setting.

Carol Weir

ASO Symposium – Monday 19th, 15.45-17.15. Room A29 Carol Weir is a Registered Dietitian, Registered Public Health Nutritionist, has a Masters in Public Health and is studying for her PhD at the University of Sheffield. Carol is currently the Clinical & Operations Director for MoreLife, a subsidiary company of Leeds Beckett University delivering healthy lifestyle interventions and a Consultant on the PHE funded Whole Systems Approaches to Obesity Programme at LBU. Previously Carol was the Clinical Lead for Children’s Services in Leeds Community Healthcare NHS Trust & before that the Head of Nutrition & Dietetic Services in LCH. Carol was the Sheffield – Let’s Change4Life Director, a £10million joint city-wide obesity prevention programme taking a whole systems approach. Carol has previously worked as a Public Health Specialist, Obesity lead and Dietitian, and has undertaken a variety of work locally, developing the Rotherham Healthy Weight Framework, and nationally, including with NICE and National Obesity Observatory (NOO). Local Obesity Policy – A Qualitative Case Study in South Yorkshire, England This research explored obesity policy translation, formulation and implementation in practice, at a local area level, through case studies in 4 localities in South Yorkshire. This research explored the local policy process and perspectives, focusing on two main obesity argumentative frames: neo-liberal rationales, and social responsibility, asking how these influence decisions, and to what effect. This study used an interpretative qualitative approach, exploring the socio-political contextual factors that influence policy processes. Employing documentary analysis, a Framing Matrix, semi-structured interviews and focus groups (n=40), with Local Authority and Clinical Commissioning Group leaders, Public Health commissioners and providers of weight management services. Analysis revealed ‘messiness’. Difficulties included: people’s position and power, fractured national and local commissioning pathways, commissioning abilities, Health & Wellbeing Board governance roles, and lack of clarity/direction due to the national changes impacting on local action. Challenges were: evidence of what is effective locally; reducing resource; increasing attention on prevention and children, gaps in adult and treatment services, lack of political support and political cycles. This study offers perspectives on obesity processes locally, underlining the role of leadership, commissioning competence and pathways and discusses the ‘messy’ nature of the national and local socio-political context in which these decisions are made.

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September 19-20, 2016

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Commercial Symposia Monday September 19th 15.45-17.15

Main Auditorium

Commercial Symposium: Slimming World

Research and Reach: Practical Solutions in an Overweight World Outline The purpose of this symposium is to discuss the role of partnership working in creating solutions which are based on understanding the needs of people who are overweight. The symposium will explore the value of multi-disciplinary, multi-agency, evidence-based and outcome driven approaches in the development and delivery of effective and scalable weight management approaches. Main aim To understand how academics, health professionals and industry partners can work together successfully, to develop and deliver effective, wide-reaching behaviour change programmes for the individual. Session Plan • Scaling up an individualised approach: considering physiological and behavioural needs for weight loss alongside emotional burdens of weight (Amanda Avery): The importance of developing a good understanding of the individual to develop effective and sustainable weight management solutions, considering physiological and behavioural needs for weight loss alongside emotional burdens of weight. Using person-centred research to continually enhance practical support for weight control • Partnership working to facilitate physical activity among people who are overweight or obese (Professor Ken Fox): Examples of how academic research can assist in the development of models and strategies for delivery in commercial and public settings • Weight management in a digital world: personalising digital as a scalable solution (Dr Paul Sacher): The development of digitally delivered behaviour change interventions to provide scalable weight management solutions in today’s world. A practical overview of how the needs of the individual, research and technology are being used in developing innovative, real world digital weight management interventions Speakers • Amanda Avery, RD, Consultant Dietitian in Weight Management and Assistant Professor in Nutrition and Dietetics at the University of Nottingham. Amanda is a registered Dietitian with over 20 years of experience working as a community Dietitian in the NHS before moving into academia. For the past 7 years Amanda has worked at the University of Nottingham as part of the core team delivering the Masters of Nutrition and Dietetics programme. Amanda has also worked as a consultant dietitian for Slimming World for the past 16 years. • Professor Ken Fox, Emeritus Professor of Exercise and Health Sciences, University of Bristol. Ken is Emeritus Professor of Exercise and Health Sciences at the University of Bristol. His career has focussed on the promotion of physical activity and public health with particular interest in the social psychology of behaviour change and the effect of physical activity on mental well-being and weight management • Paul Sacher PhD, RD, Chief Research and Development Officer, Slimming World. Dr Paul Sacher is Chief Research and Development Officer for Slimming World and Research Director for MEND internationally. Over the last 21 years he has been developing, evaluating and disseminating evidence-based lifestyle weight management and digital health interventions globally. He is also Honorary Senior Research Associate at University College London and previously worked in the NHS for 11 years.

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Commercial Symposia Tuesday September 20th 10.15-11.45

Commercial Symposium: Infant & Toddler Forum

Main Auditorium

The Obesity Challenge: Prevention is Action Child and maternal obesity are on the rise in Britain. Prevention is key to protecting future generations from obesity and diet-related illhealth. New evidence is now clearly linking larger portion sizes to excess weight gain in children. The Infant & Toddler Forum supports health and childcare professionals with practical advice to help them support the families they work with. Simple guidance on portion sizes could be key in curbing the obesity crisis. The ITF together with partners encourages the implementation of effective tools to help change behaviours and creating an environment that encourages informed, healthy choices and personal responsibility on eating habits. Chair Peymane Adab, Professor of Chronic Disease Epidemiology and Public Health, University of Birmingham Speakers • Judy More, Paediatric Dietitian and member of the Infant & Toddler Forum Nutritional guidance in early life should be a key public health prevention strategy if we are to improve the health of the next generation. Judy More will cover calls for a shift in focus to prevention through the understanding of the ideal - what we should be promoting and encouraging. • Dr Clare Llewellyn, Lecturer in Behavioural Obesity Research, University College London Why is portion size so important in the fight against obesity. Dr Clare Llewellyn will cover portion size and relation to appetite and weight gain. • Melanie Pilcher, Policy and Standards Manager, Pre-school Learning Alliance Practical implementation of best practice guidance in early years settings – case study Melanie Pilcher will cover a practical approach of best practices in early years settings based on real life examples.

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September 19-20, 2016

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Clinical Symposium Tuesday September 20th 13.15-14.45

SCOPE Accredited Clinical Symposium sponsored by Cambridge Weight Plan

Main Auditorium

Chair: Dr Carly Hughes and Dr Louise Thompson Very brief GP opportunistic interventions for weight loss: What GPs say and how patients react. Findings from the BWeL trial. Prof Paul Aveyard, Nuffield Department of Primary Care Health Sciences, University of Oxford. Update on the role of pharmacotherapy and bariatric surgery in people with T2D and obesity. Dr Barbara McGowan, Consultant and honorary senior lecturer in diabetes and endocrinology at Guy’s and St Thomas hospitals. Shared Care Models for post-bariatric follow up: Clinical reference group recommendations. Dr Helen Parretti and Dr Carly Anna Hughes. What model of long term post-bariatric surgery care will be the most effective? Dr Barbara McGowan, Dr Carly Hughes, Dr Helen Parretti

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Member-led Symposia Monday September 19th 12.00-13.30

Room A29

Member-led Symposium: The workplace as a setting to facilitate dietary change and weight management University of Glasgow

Aims and session outline In the United Kingdom (UK) over 60% of adults are now overweight or obese, and the prevention and treatment of obesity is a public health priority. Primary care, community or commercial sectors are known settings for weight management programmes. Among these, the work-place has shown promise as a location for both health promoting activities, and weight management. Previous research has shown that access to worksite based weight management programmes are attractive to men, who are known to be less likely to seek weight management advice. This session will report novel findings on use of the work place as a setting to deliver general public health interventions. This symposium will comprise three papers: 1) use of labelling to guide calorie choices 2) views on obesity and needs for weight management in work place setting where shift work is common, and 3) design and implementation of a wellness programme to support healthier working lives through a dietitian led activities. Each paper will highlight the different opportunities within workplace settings to facilitate improvements in health and weight, and access at risk groups. Chair: Moira Taylor 12.00 Calorie labelling: Can it affect a change in sales patterns in the NHS? Catherine Hankey, University of Glasgow 12.30

Obesity weight management and health in public sector work places: A scoping study Wilma Leslie, University of Glasgow

13.00

Supporting healthier working lives through dietitian-led wellness initiatives. Fiona McCullough, University of Nottingham on behalf of the British Dietetic Association.

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Member-led Symposia Tuesday September 20th 10.15-11.45

Room A29

Member-led Symposium: The role of local level data in an applied approach to whole systems obesity: a multisector co-production featuring the ESRC Strategic Network for Obesity and PHE Whole Systems Approach to Obesity Programme Leeds Beckett University

Overview of ESRC Strategic Network for Obesity The ESRC funded network brings together experts from all over the UK, and beyond, from a range of disciplines in academia, local government and charities to explore and generate ideas to make best use of the wealth of data to inform positive change. The network is a data driven whole systems approach to obesity with view to positively improving these for a healthier future. The focus of the network is towards using existing and new forms of ‘big’ data to better understand the complex obesity system, for example elements of the environment which both promote and discourage the likelihood of becoming overweight or obese. The network has four key components; (i) An open and free seminar series with networking; (ii) closed workshops with network members to work through challenges in the research lifecycle applying data in a whole systems manner answer obesity related questions; (iii) a proof of concept project; (iv) training and capacity building. Whole System Approach Project overview The Whole Systems Obesity programme is commissioned by Public Health England with the support of the Local Government Association and the Association of Directors of Public Health. The programme, led by Leeds Beckett University aims to explore how local authorities can use systems thinking and whole systems working to tackle obesity more effectively. Coproduction with local authorities is an essential part of the programme, and we are working with four Pilot LAs and the wider local authority community to gain a better understanding of the opportunities and enablers for them to create a more whole systems approach. Maximising the use of all local assets is an essential – and cost effective– approach including data and the skills and knowledge of all local partners, including Universities. ESRC Strategic Network for Obesity and Whole System Approach Project Collaboration There is co-production through both initiatives and sharing of knowledge and experience. There is complimentary cross over in the area of data and lessons learned and challenges overcome in the obesity network that will be shared and applied where relevant as part of the WSA project. For example, the ESRC obesity network comprises membership from Fuse, the Centre for Translational Research in Public Health. Fuse’s Complex Systems Research Programme adopts complex systems thinking in order to take into account the contexts of public health problems that are multi-faceted and multi-levelled, and considers the various levels and sectors on which public health can be addressed, especially working in co-production with practitioners at the local level. The WSA project is a unique platform, which showcases the commitment to the obesity agenda, highlighting the investment at the local level. The ESRC obesity network brings together, for the first time, key stakeholders in understanding the complex obesity system. This coproduction, has the potential to inform policy at the local level, aligning to national agendas and findings from national data. A fundamental cornerstone of both the WSA project and the ESRC obesity network is evidenced informed decisions, it is important that we maximise the return on investment at the local level utilising data sources to inform change within the local context. This symposium will provide a brief update of the WSA project and the ESRC obesity network, showcasing examples of best practice of co-production between academics and LAs. There will be presentations from research colleagues but also from those charged with the responsibility at the local level, with case studies of best practice. We will also highlight the lessons learnt and challenges faced with the aim of informing best practice in the future. Finally, we will showcase current projects that demonstrate original thinking to the obesity system. Main aim Demonstrate the mutually beneficial partnerships between academics and local government in understanding the complex obesity system – implications for research and [local] policy. Session outline Chair: Jamie Blackshaw 10.15

Overview (objectives and outputs) of the ESRC Network for Obesity Dr Michelle Morris, University of Leeds

10.25

Overview (objectives and outputs) of the Whole System Approach to Obesity Professor Paul Gately, Leeds Beckett University

10.35 Putting public perspectives at the heart of Whole Systems Approaches to Obesity: Ways to engage and to reduce weight stigma Dr Emily Henderson, Durham University 10.45 Examples of the mutually beneficial partnership between academics and the local government. This presentation will share best practice and lessons learnt and highlight data assets within LG that are underutilised Dr Claire Griffiths, Leeds Beckett University 10.55

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Experiences from LA members / those working in public health

UKCO2016

September 19-20, 2016


Member-led Symposia 11.15

Benefits from LA and PH in working with academics looking towards the future Representative from PHE

11.25

Questions / discussion from the audience

Speakers • Dr Claire Griffiths, Senior Lecturer Physical Activity and Health, Co-Investigator of the ESRC strategic network for obesity – Leeds Beckett University • Dr Michelle Morris, University Academic Fellow, Wellcome Trust ISSF Fellow, Director of the ESRC Strategic Network for Obesity – University of Leeds • Professor Paul Gately, Professor of Exercise and Obesity, Whole System Approach Principal Investigator and Member of the ESRC Strategic Network for Obesity & Jane Riley, Whole Systems Approach Project Manager • Dr Emily Henderson, Fuse Lecturer in Knowledge Exchange in Public Health and Research Fellow in Complex Health Systems, Member of the ESRC Strategic Network for Obesity, Member of the World Health Organization Collaborating Centre for Complex Health Systems Research, Knowledge and Action – Centre for Public Policy and Health, Durham University • Representation from Local Authorities. • Representative from Public Health England

Tuesday September 20th 13.15-14.45

Member-led Symposium: A critical perspective on the use of BMI to determine maternal obesity risks and interventions Newcastle University

Room A29

Chair: Prof Judith Rankin 13.15 Introduction to the symposium – Introducing the symposium aims, speakers, structure, and setting the scene of maternal obesity research Prof Judith Rankin, Newcastle University 13.20

Maternal obesity and risk of maternal and perinatal morbidity and mortality: An epidemiological perspective Prof Marian Knight, University of Oxford

13.35 The effectiveness of antenatal behaviour change interventions among obese populations: An individual risk perspective Dr Nicola Heslehurst, Newcastle University 13.50

Maternal obesity and adverse pregnancy outcomes: Potential mechanisms Mr Peter Tennant, University of Leeds

14.05 The role of anthropometric measures for maternal obesity epidemiology and intervention: A critical perspective of the use of BMI and alternative measures in pregnancy Dr Louise Hayes, Newcastle University 14.20

Summary of the key messages and symposium discussion Prof Judith Rankin, Newcastle University

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Oral Presentation Abstracts Monday 19th September 12.00 – 13.30

Room A28

Oral Abstracts – Obesity Practice

The development of an intervention to support Children’s Centres to promote parent engagement with an obesity prevention programme Wendy Burton1, Pinki Sahota2, Maureen Twiddy1, Julia Brown1, Maria Bryant1, 1University of Leeds, Leeds, UK, 2Leeds Beckett University, Leeds, UK Background: Children’s Centres are a key setting for public health initiatives but some programmes are threatened by local implementation barriers such as poor uptake or lack of resources. HENRY (Heath, Exercise and Nutrition in the Really Young) is a programme widely delivered in Children’s Centres across England and Wales that aims to reduce childhood obesity by promoting positive behaviours for obesity prevention across the whole family. However, some Centres struggle to engage with the required number of parents to make HENRY implementation economically viable. Therefore, we developed an intervention to support Centres to promote parent engagement. Methods: A rapid ethnography study was conducted in Children’s Centres to understand barriers and levers to engaging parents with HENRY. The sample included 5 Centres that ranged in existing parent engagement levels, geographic location and area deprivation. The findings informed the development of a complex intervention by a multi-disciplinary team, including parents, using guidance from the Behaviour Change Wheel; a method to develop theory based interventions. Results: Framework analysis was applied to identify factors influencing parent engagement. These included; perceptions of HENRY and the supporting evidence base, implementation climate, parental eligibility to enrol, staff knowledge and facilitator characteristics. The team ranked potential behaviours to target in the intervention using APEASE criteria (affordability, practicability, effectiveness, acceptability, side effects and equality). The intervention functions were then defined and the behaviour change techniques agreed. The intervention aims to increase local commissioner and manager ‘buy in’ of HENRY and provide Centres with parent engagement strategies. Intervention components include; staff training, regular outcome data provision, peer to peer recruitment, revised branding and the encouragement of Centres to adopt a ‘whole-Centre’ implementation approach, widened eligibility criteria and the delivery of taster sessions. Conclusions: Understanding the barriers and levers to parent engagement informed the development of an intervention utilising a multilevel approach. The effectiveness, process and fidelity are now being measured in a national cluster RCT and process evaluation. The West Midlands ActiVe lifestyle and healthy Eating in School children (WAVES) study: a cluster-randomised controlled trial testing the clinical and cost-effectiveness of a multifaceted obesity prevention intervention programme targeted at children aged six to seven years Peymane Adab1, Miranda Pallan1, Emma Lancashire1, Karla Hemming1, Emma Frew1, Timothy Barrett1, Raj Bhopal2, Janet Cade3, Joanne Clarke1, Amanda Daley1, Jon Deeks1, Joan Duda1, Ulf Ekelund4, Paramjit Gill1, Tania Griffin1, Eleanor McGee5, Kiya Hurley1, Jayne Parry1, Sandra Passmore6, KK Cheng1, 1The University of Birmingham, Birmingham, UK, 2The University of Edinburgh, Edinburgh, UK, 3University of Leeds, Leeds, UK, 4Norwegian School of Sport Sciences, Oslo, Norway, 5Birmingham Community Healthcare NHS Trust, Birmingham, UK, 6Services for Education, Birmingham, UK. Background: School based interventions can be effective in preventing childhood obesity, but better designed trials are needed. We assessed the effectiveness of the WAVES intervention, compared with usual practice, in preventing obesity among primary school children. Design: Cluster randomised controlled trial including 5-6 year olds from 54 primary schools in the W Midlands at baseline. The 12-month intervention encouraged healthy eating and physical activity through school, including an additional 30 minutes of physical activity opportunities within each school day and healthy cooking skills workshops. Primary outcomes: difference in BMI-z score between arms at 15 and 30 months and cost per Quality Adjusted Life Year (QALY) (costeffectiveness outcome). Secondary outcomes: further anthropometric, dietary, physical activity and psychological measurements, and difference in BMI-z between arms at 39 months in a sub-set of schools (Group 2 schools). Results: 54 schools with 1397 pupils were randomised. The mean difference in BMI-z score between control and intervention arms was -0.075 (95% CI -0.183, 0.033) at 15 months and -0.027 (95% CI -0.137, 0.083) at 30 months. There was no evidence of differences between arms in any of the secondary outcomes for the main analyses. Third follow up included data on 467 pupils from 27 schools, with mean difference in BMI-z score of -0.20 95%CI -0.40, -0.01. Post-hoc analysis in response to this finding showed heterogeneity between schools that did or did not have the 3rd follow-up measurement, with baseline differences in adiposity and significant interaction between Group and trial arm. The mean cost of the intervention was £155.53 per child. The incremental cost-effectiveness ratio (ICER) associated with the base case was £46,083 per QALY. Conclusions: The primary analyses show no evidence of effectiveness of the WAVES study intervention, which was also not costeffective. Post-hoc analysis, driven by findings from third follow-up outcome measurements, suggests a possible intervention effect, which could have been attenuated by baseline imbalances. There was no evidence of an intervention effect on measures of diet or physical activity and no evidence of harm.

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UKCO2016

September 19-20, 2016


Oral Presentation Abstracts Feasibility study of a child weight management programme, adapted for an ethnically and culturally diverse population: the CHANGE study Miranda Pallan1, Tania Griffin1, Kiya Hurley1, Emma Lancashire1, Peymane Adab1, 1University of Birmingham, Birmingham, UK. Background: Group-based children’s weight management programmes are widely available but no programmes have been specifically adapted for different ethnic and cultural communities. We have adapted a programme for delivery in diverse communities. Key programme features include interactivity, fostering peer-support, and tailoring within sessions to meet individual family needs. Objectives: To assess the feasibility and acceptability of the adapted child weight management programme, and the feasibility of a future full-scale trial. Methods: Families referred to Birmingham child weight management services during a 6-month period were recruited to participate. Twenty-four child weight management programmes delivered within this period were randomised to be the adapted or existing programme with a 2:1 ratio. Participants attended their local programme. Programme acceptability and feasibility were assessed by the proportion of families completing the adapted programme, observation of delivery, and interviews with parents, children and programme facilitators. Outcome data collected through home visits included BMI, %body fat, waist circumference, accelerometry, food intake, quality of life, body image, family food and physical activity habits, parenting styles and feeding practices. Results: The programme was feasible to deliver and enjoyed by children, parents and facilitators. The proportion of families completing the adapted programme was 75.9% (95% CI: 68.0-84.7) compared with 58.1% (95%CI: 48.4-69.8) in the comparator arm. Data collection was feasible with low attrition of participants. Logistical issues with achieving timely baseline data collection were identified. Conclusions: The adapted programme is highly acceptable and feasible to deliver. Several significant issues will need to be addressed when planning a future trial. Obesity and Quality of Life in National Exercise Referral Scheme participants Hannah Louise Spacey1, Christopher Retallick1, Simon Williams1, 1University of South Wales, Pontypridd, UK. Aim: The aims of this study were to investigate the association between quality of life (QoL) and obesity in National Exercise Referral Scheme (NERS) participants. Participants: 225 records were selected from the NERS database and after exclusions, 201 were used in the final analysis. The sample included male (n=100) and female (n=101) participants with a mean ± SD age of 58.7 ± 14.2 years (male) and 53.9 ± 15.1 years (female) and waist circumference of 107.4 ± 15.8cm (male) and 99.4 ± 15.6cm (female). Methods: Obesity and QoL were examined by frequency of problems reported within EQ-5D dimensions. Differences in frequencies and proportions were tested between non-obese males and females, obese males and females, non-obese and obese females, non-obese and obese males and age groups using chi-square and Z-tests. Results: FFrequencies of problems reported were not statistically significantly different between non-obese and obese males in any EQ-5D dimension. Greater frequencies of problems were reported in the mobility dimension by obese females (74%, [95% CI, 64.183.8]) compared to non-obese females (48%, [95% CI, 28.4-67.5]). Obese females reported greater frequencies of problems in mobility (p=0.011), usual activities (p=0.0006), pain and discomfort (p=0.016) and anxiety and depression (p=0.0005) compared to obese males. Frequencies of problems reported were significantly different between obese males and females in the 61+ age group. Conclusion: Obese males reported fewer problems within the EQ-5D compared to obese females. This finding supports previous research that suggests females experience a greater burden of obesity and lower performance-based functional capacity than males, while males typically underestimate weight, limiting the negative effects of obesity. The role of social expectation and socioeconomic status is important in the reporting of QoL in males and may explain the reporting of fewer problems within this group.

UKCO2016

September 19-20, 2016

33


Oral Presentation Abstracts Mechanisms of Action in Group-based Interventions (MAGI) study: Developing a conceptual framework of group processes that can help support weight loss Aleksandra Borek1, Jane Smith1, Charles Abraham1, Colin Greaves1, Sarah Morgan-Trimmer1, Fiona Gillison2, Matthew Jones3, Jaine Keable4, Mark Tarrant1, Rose McCabe1 1University of Exeter, Exeter, UK, 2University of Bath, Bath, UK, 3University of the West of England, Bristol, UK, 4Westbank Healthy Living Centre, Exminster, UK Introduction: Many weight-loss programmes are delivered in group settings, but consideration of how groups facilitate behaviour change to support weight loss is often limited. A better understanding of inter-personal processes that are beneficial in weight-loss groups, and how these can be facilitated, is needed. Methods: The MAGI study aims to develop a conceptual framework of inter-personal change processes in group-based interventions, and identify practical strategies and behaviour change techniques that can be used to facilitate these group processes. The conceptual framework is based on three sources: (1) literature reviews, including literature on group dynamics, group influence processes, qualitative studies of weight-loss groups, and quantitative measures of group processes, (2) qualitative coding of delivery manuals and session recordings from three recent group-based weight-loss studies, and (3) expert and lay feedback. Results: An initial conceptual framework of change processes in groups has been developed, including five themes: set-up processes, group dynamics, inter-personal processes, intra-personal processes, and group closure processes. Change techniques and facilitation strategies that can help instigate these processes have been mapped. The framework will be populated with practical examples from recordings of group sessions. Conclusions: Our framework helps to identify mechanisms underpinning how weight-loss groups work so that effective processes can be harnessed by intervention designers and facilitators. We will seek feedback on the framework from practitioners and others with expertise in weight-loss groups, and hope to establish an expert network of those interested in this area for future consultations and collaborations. Mum – “He’s going because he needs to lose weight”, child – “I’m going because Mum is making me”: Do parent and child expectations of weight management align? James Nobles1, Claire Griffiths1, Andy Pringle2, Paul Gately1, 1Leeds Beckett University, Leeds, UK, 2MoreLife, Leeds, UK Background: Childhood weight management programmes (WMP) are used within the UK to stem the rising prevalence of pediatric obesity. These WMPs often provide children and young people (CYP) and their family’s with methods of stabilising and reducing the severity of the weight issue. That said, low engagement in WMPs is often encountered but the reasoning is not well known. Misaligned and unrealistic outcome expectations have been hypothesised as a reason for low engagement. This paper explores 1) the parent and CYP outcome expectations of a WMP, and 2) the qualitative level of agreement between parent and CYP expectations. Methods: 30 families were recruited from three, UK-based WMPs (10 families per programme). Qualitative research methods were used to examine both the parent and CYP outcome expectations. Participatory research methods were used with CYP and semi-structured interviews with parents. Data were collected from parents and CYP independently, and notably, were collected from participants within two weeks of starting a WMP. Data were analysed using thematic analysis. In separate analyses, the alignment between parent and CYP responses were examined. Results: Preliminary findings indicate that parents reported 24 different outcome expectations (varying from ‘anger management’ to ‘weight management [not loss]’ to ‘understanding consequences of obesity’), whilst CYP reported 25 expectations (ranging from ‘aesthetic improvement’ to ‘physical activity opportunities’ to ‘not wanting to attend’). Weight loss was the most cited outcome expectation amongst parents and CYP, however friendship, CYP confidence, dietary education, and the reinforcement of parent messages were also strongly cited. Of note, weight loss was not always cited as the primary outcome expectation. The qualitative level of agreement between CYP and parents shall be reported. Conclusions: Families do not always initiate a WMP for the sole purpose of weight loss and management. Practitioners would benefit from understanding what families hope to achieve during their attendance, and subsequently tailor the programme, comments and feedback to reflect this. By tailoring messages and feedback directly to the family expectations, families may see a greater benefit in WMP attendance and therefore be encouraged to persist in treatment. Attendance and weight-related outcomes are strongly correlated.

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UKCO2016

September 19-20, 2016


Oral Presentation Abstracts Monday 19th September 15.45 – 17.15

Room A28

Oral Abstracts – Clinical Research

Systematic Review and Meta-analysis to identify the Prevalence of Obesity-associated Co-morbidities/Co-morbidity Indicators in Children and Adolescents (aged 5-18). Vishal Sharma1, Susanne Coleman1, Jane Nixon1, Linda Sharples1, Maria Bryant1, 1University of Leeds, Leeds, UK Aim: Identify the prevalence of weight-related co-morbidities in children and adolescents aged 5-18. Data sources: Embase, Medline, Medline-in-Process, PsycINFO, and Web of Science; from database inception up to March 2015. Inclusion: Observational studies reporting prevalence of obesity-associated co-morbidities/co-morbidity indicators by weight/BMI category in children/adolescents aged 5-18 from any country; Exclusion: Non-English articles. Appraisal/Data Extraction: Abstracts were screened for eligibility by VS and MB. Prevalence data for each co-morbidity/co-morbidity indicator was extracted by weight status (healthy weight/overweight/obese) and prevalence ratios calculated for comparable studies using a random effects meta-analysis. Results: Of the 10,391 abstracts screened, 215 eligible studies (1,930,906 participants) reported 24 co-morbidities (e.g. diabetes, hypertension) and 39 indicators (e.g diabetes had 6 indicators including fasting glucose and Hb1Ac). Overall prevalence ratios ranged from 0.9 (95% CI 0.6-1.4) for traumatic dental injuries to 11.9 (95% CI 7.1-20.2) for metabolic syndrome for participants who were overweight relative to healthy weight participants. For participants with obesity relative to healthy weight participants, prevalence ratios ranged from 0.6 (95% CI 0.5-1.1) for traumatic dental injuries to 53.3 (95% CI 30.4-67.1) for metabolic syndrome. Study quality scores (assessed using the Joanna Briggs Institute’s Appraisal Checklist) ranged from 1-10 out of 10. Conclusion: The majority of co-morbidities and co-morbidity indicators (e.g. metabolic syndrome and non-alcoholic fatty liver disease), were more prevalent in children/adolescents with overweight/obesity. However, some co-morbidities (e.g. dental injuries and depression), were less or equally prevalent in children/adolescents with overweight/obesity than those of a healthy weight. The results have implications for screening and management of children/adolescents with obesity. Effects of Weight Loss Interventions for Adult Obesity on Mortality, Cardiovascular and Cancer Outcomes – A systematic review and meta-analysis of long-term randomised controlled trials Clenhan Ma1, Alison Avenell1, Fiona Stewart1, Clare Robertson1, Pawana Sharma, Graeme MacLennan, 1Health Services Research Unit, University of Aberdeen, Aberdeen, Scotland UK Aims To systematically review evidence for weight loss interventions in obese adults on mortality and morbidity outcomes using long-term randomised controlled trials (RCTs). Data Sources and Study Identification MEDLINE, Embase and the Cochrane Central Register of Controlled Trials (CENTRAL) were used to identify RCTs in obese adults undergoing a dietary weight loss intervention with ≥1 year of follow-up. Excluded studies were those in pregnancy, postpartum or lactation. The primary outcomes were all-cause mortality, cardiovascular mortality, and cancer mortality. The secondary outcomes were participants developing cardiovascular events, participants developing cancers and weight changes at final follow-up. Subgroup analyses for age, gender, BMI, diabetes, ethnicity and physical activity interventions at baseline were performed for all outcomes. Sensitivity analyses using percentage followed-up and risk of bias for allocation concealment were performed for all outcomes. Data Extraction Data were collected by one systematic reviewer and checked by a second systematic reviewer. Mortality and morbidity data were assessed using random-effects Mantel-Haenszel meta-analysis as Risk Ratios (RR) and 95% Confidence Intervals (95% CI). Weight data were assessed using a random-effects Inverse Variance methods as Mean Differences and 95% CI. Study quality were assessed using the Cochrane Collaboration’s Risk of Bias Tool. Results 49 RCTs with 27098 participants were identified, which were conducted mainly in Europe and N. America. A significant reduction in all-cause mortality was found for dietary weight loss interventions compared to control interventions (RR 0.82, 95% CI 0.71-0.95). There were also a significantly greater mean difference in weight change at final follow-up in the dietary intervention compared to the control group (Mean difference -2.86 kg, 95% CI -3.38, -2.33). No other statistically significant results were found for other main outcomes or subgroup or sensitivity analyses of mortality or morbidity outcomes. Conclusions The results from randomised controlled trials suggest that dietary weight loss interventions may be effective in reducing mortality in obese individuals. Trialists should provide greater details on adverse events and mortality in all weight loss trials.

UKCO2016

September 19-20, 2016

35


Oral Presentation Abstracts Calorie labelling in a hospital café outlet- does it affect customer purchasing behaviour and influence sales? Catherine Hankey1, Stefanie Heinrich1, Lisa Hutchison1, Wilma Leslie1, 1University of Glasgow, North Lanarkshire, UK Purpose: Calorie labelling offers a simple approach to alert consumers to the energy content of items bought, influence purchasing behaviour and promote healthier eating patterns. Methods: Calorie labelling of soups, snacks, cakes and drinks in a café located in the foyer of a Glasgow hospital. Sandwiches were categorised into high, medium and low calorie. Labels were introduced for a 2 week period and sales data examined for this period and compared with the 2 weeks prior to and following labelling. Customers were invited to complete a 13-item questionnaire following their purchase to elicit their views on calorie labelling. Results: Total sales decreased (-2.2%) during calorie labelling with a further decrease in the 2-weeks afterwards (-2.5%). Sales shifted from higher to lower calorie items, sandwiches sales +7%; low; -12%; medium; -21%). high calorie selection:-Fruit sales increased (+7%), while cake sales fell (-15%). Hot drink sales rose slightly, lower calorie hot drink sales increased (+8%) as did higher calorie options (+2%). Sales of crisps, biscuits, snacks, cold drinks and total sandwich sales did not differ between the study periods. 142 customers who completed the questionnaire, approximately half noticed the calorie labels (51%) and 44% of them said the labelling had influenced their purchase (78% chose a lower calorie option). Over half believed that they were a normal weight but wanted to avoid weight gain (68%). The main reasons given for ignoring calorie information included a lack of interest in calorie contents (26%) and habitual ordering (49%). Conclusion: Calorie labelling was easy to implement. The negative impact on sales could be ameliorated if orders could be altered weekly. Labelling was noticed by consumers and influenced their purchases suggesting promise as an effective but low cost intervention. Weight loss and associated improvements in cardiometabolic risk factors with liraglutide 3.0 mg in the SCALE Obesity and Prediabetes randomised, double-blind, placebo-controlled 3-year trial M. Lean1, K. Fujioka2, F. Greenway3, M. Krempf4, C. Le Roux5, R. Vettor6, L. Shapiro Manning7, S. Kruse Lilleøre7, A. Astrup8, 1University of Glasgow, Glasgow, UK, 2Scripps Clinic, La Jolla, CA, USA, 3Pennington Biomedical Research Center, Baton Rouge, LA, USA, 4Hopital Nord Laennec, Nantes, France, 5University College Dublin, Dublin, Ireland, 6University of Padua, Padua, Italy, 7Novo Nordisk A/S, Søborg, Denmark, 8University of Copenhagen, Frederiksberg, Denmark Aims/Objectives: Obesity and prediabetes are risk factors for developing T2D. 5–10% weight-loss can reduce risk of developing T2D by >50%. The 3-year part of this phase 3 trial investigated effects of liraglutide 3.0mg, as adjunct to diet+exercise, in delaying onset of T2D over 3 years, body-weight and cardiometabolic risk factors in adults with obesity or overweight with comorbidities, and diagnosed with prediabetes at screening. Methods: Individuals (BMI ≥30kg/m2, or ≥27kg/m2 with ≥1 comorbidity) were randomised 2:1 to once-daily subcutaneous liraglutide 3.0mg (n=1505) or placebo (n=749) and advised on a 500-kcal/day deficit diet and 150-min/week exercise. Efficacy data are observed means, with last-observation-carried-forward (LOCF) imputation. (NCT01272219) Results: Baseline characteristics were (mean±SD): age 47.5±11.7 y, 76.0% female, weight 107.6±21.6kg, BMI 38.8±6.4kg/m2. With continued treatment over 160 weeks, estimated time to onset of diabetes was 2.7 times longer with liraglutide 3.0 mg than with placebo (95% CI, 1.9 to 3.9, p<0.001), corresponding to a HR of 0.2. Based on the Kaplan-Meier plot of cumulative probability of a diagnosis of diabetes, 3% of patients in the liraglutide group vs. 11% in the placebo group were diagnosed with diabetes by week 160 while on treatment. More individuals on liraglutide (66%) vs. placebo (36%) regressed to normoglycaemia by week 160 (OR 3.6 [3.0;4.4], p<0.001). Individuals on liraglutide 3.0 mg lost more weight than on placebo (6.1% vs. 1.9%; ETD -4.3% [95%CI 4.9;-3.7]), accompanied by greater mean reductions in waist circumference (ETD 3.5 [4.2;2.8] cm), SBP (ETD 2.8 [-3.8;-1.8] mmHg), triglycerides (ETD -6%[9;-3]) and highsensitivity C-reactive protein (ETD 29% [-34;-23]) (all p<0.001). Mean pulse increased with liraglutide 3.0mg vs. placebo (ETD 2.0 [1.2;2.7] beats/min, p<0.0001). AE incidence was 94.7% with liraglutide 3.0mg vs. 89.4% with placebo, SAEs 15.1% vs. 12.9%. Adjudicated major adverse CV events (non-fatal MI, stroke, cardiovascular death) were low overall (0.19 vs. 0.20 events/100 patient-years-of-observation for liraglutide 3.0mg vs. placebo). Conclusion: Liraglutide 3.0 mg for 3 years, as an adjunct to diet+exercise, was associated with lower risk of T2D and greater weight loss, and improved cardiometabolic risk factors compared with placebo.

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UKCO2016

September 19-20, 2016


Oral Presentation Abstracts Continuous quality improvement in a Tier 3 weight management service Carly Anna Hughes1, Sandy Evans2, Sharon Thompson3, Anna Coleridge3, 1University of East Anglia, Norwich, UK, 2Kastech, Cambridge, UK, 3Fakenham weight management service, Fakenham, UK There is limited published evidence on the most effective design of Tier 3 multidisciplinary weight management services. An existing Tier 3 service providing a mixture of individual and group interventions, and with a high degree of patient participation used the Plan, Do, Study, Act (PDSA) model (Institute for Healthcare improvement) to trial specific new interventions. The core intervention was based on NICE CG 189, and incorporates dietary and physical activity advice, medical and psychological interventions using established principles of behaviour change. New interventions were designed to meet patient led needs and to improve service efficiency. Principles of continuous quality improvement were used to design new interventions using the behaviour change wheel model, capability, opportunity and motivation (Michie et al). The changes to this service were planned with the multidisciplinary team, initiated and then rapidly evaluated before incorporating them (or not) into the core protocol. This has been facilitated by using bespoke software, ProHealthClinical Kastech, to allow rapid comparison of characteristics and outcomes of people using new interventions. Qualitative data has been provided by focus groups, analysis of comments from patient questionnaires, and feedback from current and past participants. Examples of interventions include new group sessions on emotional eating, carbohydrate craving, bariatric surgery, physical activity and a bespoke electronic dietary coaching system Oviva. The emotional eating group and the bariatric surgery information group were cost-effective. People attending the bariatric surgery group had a mean weight loss of 7.9kg compared to a mean loss of 5kg in the whole cohort. The Oviva system was helpful for some people, but uptake was low, limiting quantitative data. The physical activity group was poorly attended although existing individual and group sessions at the on-site gym were well attended. The methods of evaluation and the results will be presented and discussed. Conclusion. Within current financial constraints new interventions or methods of delivery must be cost-effective. Using the principles of continuous quality improvement, and aided by a bespoke software system the service can improve care without increasing cost. Effects of maternal anthropometrics and change in anthropometrics during pregnancy on short and long term pregnancy outcomes in South Asian women: A systematic review Emma Slack1, Dan Jones2, Judith Rankin1, Nicola Heslehurst1, 1Newcastle University, Newcastle upon Tyne, UK, 2Teeside University, Middlesborough, UK Background: NICE identified a need for research on UK-specific ethnic groups to inform gestational weight gain (GWG) guidelines. This systematic review investigates associations between maternal anthropometrics (e.g. weight, body fat) in early pregnancy, the change in anthropometrics during pregnancy and pregnancy outcomes in South Asian and White women. Methods: Twelve electronic databases, reference lists and citations of all included studies were searched. Observational studies published in English at any date, reporting maternal anthropometrics or anthropometric change, and pregnancy outcomes in South Asian and White women were included. Two researchers performed screening, data extraction and quality assessments. Descriptive synthesis was used to summarise the evidence-base of independent and combined effects of maternal anthropometrics and anthropometric change during pregnancy on pregnancy outcomes. Results: Nineteen studies were identified (births n=346,319) from the UK (n=12), Australia and Norway (n=2 each), Spain, USA and Canada (n=1 each). Studies were published between 1981 and 2015, using maternal anthropometrics (n=18), anthropometric change (n=2), or a combination of both (n=2). South Asian women had an increased risk of gestational diabetes mellitus (GDM), stillbirth, and congenital anomalies in all BMI groups reported compared with White women. South Asian women with obesity (BMI >30kg/m2) had an increased risk of GDM, stillbirth, macrosomia, hypertensive disorders and caesarean section when compared with South Asian women of recommended BMI (BMI 20-24.9kg/m2). Anthropometric change was associated with increased risk of GDM in South Asian women, despite their lower total gain. The combined effect on GDM and post-partum weight retention was greater in South Asian women. Conclusion: The increased risk of adverse pregnancy outcomes at lower weight and GWG in South Asian women should be considered in guidelines for weight management during pregnancy.

UKCO2016

September 19-20, 2016

37


Oral Presentation Abstracts Tuesday 20th September 13.15 – 14.45 Oral Abstracts – Basic Science

Room A28

The Association Between the ‘Fat Mass and Obesity Associated Gene (FTO)’ and Obesity-Linked Eating Behaviours in Adults and Children: a Systematic Review Joanna Brecher1, 1University of Manchester, Manchester, UK FTO has been recognised as one of the principle candidate genes predisposing to common obesity in humans and numerous weightassociated single nucleotide polymorphisms (SNP) of FTO have been identified. However, understanding of the mechanism of action by which FTO contributes to obesity is limited. The objective of this systematic review is to investigate the hypothesis that weight-associated variants of the FTO gene elicit their effect on adiposity by influencing eating behaviour. To achieve this objective, an exhaustive database search was conducted, with 16 studies selected for analysis after relevance screening in line with PRISMA guidelines and rigid inclusion and exclusion criteria. The effects of five FTO SNPs were assessed across the 16 studies: rs9939609, rs1421085, rs17817449, rs1121980 and rs9939973. All five of the SNPs were significantly associated with increased adiposity in at least one study. The rs9939609 SNP was significantly related to multiple appetitive behaviours with the potential to predispose to obesity, including: increased energy and fat intake, risky eating behaviour, decreased satiety responsiveness and preference for energy-dense foods. The effects of the rs9939609 variant on appetite were predominately observed in children. The rs1421085, rs17817449, rs1121980 and rs9939973 variants were not linked to eating behaviour in either children or adults. These results provide insight into one possible mechanism by which FTO may contribute to obesity, specifically in children. One practical application of these results could be to encourage close monitoring of dietary intake in riskallele carriers of the rs9939609 SNP as a method of obesity prevention. Linking obesity and biological ageing: A study of life course adiposity and leukocyte telomere length in a nationally representative population Wahyu Wulaningsih1,2,3, Johnathan Watkins3,4, Rebecca Hardy1, 1Medical Research Council Unit for Lifelong Health and Ageing, University College London, London, UK, 2Division of Cancer Studies, King’s College London, London, UK, 3PILAR Research and Education, Cambridge, UK, 4Institute for Mathematical and Molecular Biomedicine, King’s College London, UK Objectives: To investigate the association between adiposity and biological ageing, indicated by leukocyte telomere length (LTL), through an assessment of current adiposity, adiposity at early life and life course overweight trajectories. Methods: We included a total of 7,008 participants of the 1999-2002 U.S. National Health and Nutrition Examination Survey (NHANES). Assessment of adiposity at examination included measurements of body mass index (BMI), waist circumference, and percent body fat. Additionally, we assessed BMI at age 25 and overweight trajectories using self-reported history. Leukocyte telomere length (LTL) relative to a standard DNA reference (T/S ratio) was quantified by polymerase chain reaction (PCR). Multivariable linear regression was used to examine the difference in LTL across adiposity measures at examination, BMI at age 25, and overweight trajectories. Models took into account age, sex, race/ethnicity, education, smoking status, alcohol intake, and physical activity. Result: A 0.2% decrease in telomere length (95% CI: -0.3 to -0.07%) was observed for every increase in BMI, whereas a unit increase in waist circumference and percent body fat contributed to a 0.09% and 0.01% decrease in LTL, respectively. Associations were similar when adiposity binned into categories, and when the median (50th quantile) of LTL was assessed with our findings suggesting a nonlinear relationship between BMI and percent body fat. Higher BMI and being obese at age 25 contributed to lower LTL at age 3040. LTL decreased among those who were overweight at age 25 but normoweight at age 30-40, and increased among those who were normoweight at age 50-60, compared to those who were normoweight at age 25 and at examination. Conclusion: Excess adiposity corresponds to shorter telomere lengths. The observed associations between BMI in early adulthood, life course trajectories and LTL signify the potential impact of life course dynamic of adiposity on biological ageing. Ginkgo biloba extract reduced fatty acid uptake and adipocyte volume of obese rats, independently of food/energy reduction 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 Ginkgo biloba extract (GbE) has been pointed as an antiobesogenic therapy. We have previously demonstrated that GbE reduced food/ energy intake, adipocyte diameter and fatty acid uptake of obese rats. Nevertheless, we herein investigated if these effects might be a direct action of GbE or an indirect effect associated to the reduction of food/energy intake promoted by GbE. For this purpose, male Wistar rats were fed from 2 to 4-mo-old with high fat diet and thereafter divided into 3 groups: 1) OG group - rats fed ad libitum and treated for 14 days with 500mg/kg/day of GbE; 2) OV group - rats fed ad libitum and daily treated with saline; 3) PF group - rats pair fed to OG group and treated with saline. During the treatment, food intake and body weight gain were daily measured. After the treatment period, rats were euthanized and epididymal fat depot was collected. The treatment promoted a significant reduction on food/energy intake of both OG and PF groups in comparison to OV group (7.1% and 8.5%, p=0.003, respectively). Adipocyte volume was reduced in OG by 37% (p<0.001) in comparison to OV group while no differences were observed in PF group. Neither basal nor stimulated lipolysis were altered by the treatment. However, GbE treatment reduced fatty acid uptake by 54% and 57% (p<0.001), in comparison to OV and PF groups, respectively. The data suggest that GbE might have a direct effect on adipose tissue metabolism, modulating fatty acid uptake and adipocyte volume, independently of food/energy reduction.

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UKCO2016

September 19-20, 2016


Oral Presentation Abstracts Examining passive overconsumption and hedonic preference for fat in physically active and inactive individuals Kristine Beaulieu1, Mark Hopkins2, John Blundell1, Graham Finlayson1, 1University of Leeds, Leeds, UK, 2Sheffield Hallam University, Sheffield, UK Dietary fat has the lowest satiating efficiency of the macronutrients, which can lead to a passive overconsumption of energy. Habitually active individuals show enhanced satiety signalling; thus, we hypothesized that these individuals would be less susceptible to passive overconsumption and have a reduced preference for high-fat foods. The appetite response to meals varying in fat and carbohydrate was investigated in 20 active (PAC: 10 F; age: 29.9±9.6 y; BMI: 22.6±1.9 kg/m2) and 19 inactive (PIN: 11 F; age: 30.4±9.3 y; BMI: 23.1±2.7 kg/m2) individuals. In a randomized crossover design, participants consumed an individually fixed breakfast and returned 4 h later for a covertly manipulated ad libitum high-fat (HFAT; 50% fat) or high-carbohydrate (HCHO; 70% CHO) lunch. Energy intake, appetite ratings, and liking and wanting for high-fat relative to high-carbohydrate foods (Leeds Food Preference Questionnaire) were measured. Both groups showed similar response to passive overconsumption, with energy intake being greater at HFAT compared to HCHO (∆EI PAC: 385±302 vs. PIN: 394±280 kcal; p=0.92). Hunger, fullness and palatability ratings did not differ between groups and conditions. There was a significant reduction in liking (PAC: -7.0±14.9 vs. PIN: -8.4±10.6) and wanting (PAC: -26.9±33.5 vs. PIN: -26.7±25.1) for high-fat foods after lunch (time effect p≤0.001), but no group differences. These data demonstrate that, in lean habitually active compared to inactive individuals, there is a similar susceptibility to passive overconsumption and preferences for high-fat relative to high-carbohydrate foods. Whether these effects extend to individuals who are overweight or obese remains to be elucidated. Does perceived savouriness of a familiar food relate to its perceived or actual protein content? Charlotte Buckley1, Peter Rogers1, 1University of Bristol, Bristol, UK An appetite for protein has been linked to the savoury taste of foods, and selecting savoury foods after a protein depleted diet has been argued to reflect protein seeking behaviour. The present study aimed to investigate the relationship between protein content (perceived and actual) and the savoury taste of familiar foods. Participants (n=20) completed 100mm VAS ratings of the sensory qualities of 18 foods, from three categories (high protein savoury, low protein savoury, low protein sweet). The categories did not differ in pleasantness, familiarity or desire to eat. Perceived protein content of foods was significantly different between categories F(2,44) = 231.54, p< .001., and the high protein category was correctly rated as being the highest (M=63.5, SE=1.5). While savouriness ratings were significantly different between all categories F(2,44) = 61.41, p< .001, it was in fact low protein savoury foods that were rated as the most savoury (M=76.8, SE=2.7). Perceived protein content and savoury taste ratings were not correlated for any categories (Low Protein Savoury: r=.061, p=.797, High Protein Savoury: r=-.293, p=.210, Low Protein Sweet: r=.409, p=.073). These preliminary data indicate that estimating the protein content of foods may not rely strongly on taste perception, and that other strategies may exist for estimating foods nutritional composition (e.g. declarative memory processes). This may be important when investigating protein-seeking behaviour, which could be disrupted by a modern dietary environment containing an abundance of highly processed savoury foods, which are not necessarily high in protein. Randomised controlled trial of continuous versus intermittent energy restriction during adjuvant chemotherapy (The B-AHEAD 2 Trial) Mary Pegington2, Nigel Bundred1, Julie Morris4, Judith Adams5, Lee Graves6, Louise Gorman1, Alastair Greystoke7, Sacha Howell3, Anthony Howell1, Michelle Harvie1, 1The Nightingale Centre and Genesis Prevention Centre, University Hospital of South Manchester NHS Foundation Trust, Manchester, UK, 2Division of Molecular & Clinical Cancer Sciences, University of Manchester, Manchester, UK, 3 Department of Medical Oncology, The Christie Hospital NHS Foundation Trust, Manchester, UK, 4Department of Medical Statistics, University Hospital of South Manchester NHS Foundation Trust, Manchester, UK, 5Institute of Population Health, University of Manchester, Manchester, UK, 6Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, Liverpool, UK, 7Northern Centre for Cancer Care, Freeman Hospital, Newcastle-upon-Tyne, UK. Background: Observational data indicate that excess weight at breast cancer diagnosis and weight gain during adjuvant chemotherapy increases risk of recurrence and death. We have reported that continuous energy restriction (CER) and exercise is only partially effective for weight control during chemotherapy. Randomised trials in healthy subjects indicate that intermittent energy restriction (IER) may be equivalent or superior to CER for weight control, and animal data suggest reduced chemotherapy toxicity with IER. Here we will report the results of a randomised comparison of IER vs. CER amongst 172 women receiving adjuvant / neoadjuvant chemotherapy. Methods: Women were recruited immediately after surgery. IER (n = 86) or CER (n = 86) was administered throughout the 4.5–6 month course of chemotherapy for weight loss amongst overweight subjects (n=110) and maintaining a healthy weight amongst normal weight subjects (n =62). The primary end points were body weight, body fat and lean body mass assessed with DXA. Secondary endpoints were chemotherapy toxicity (self-report CTCAE), quality of life (FACT scales) and serum markers associated with prognosis (insulin sensitivity, adiponectin, leptin). Results: Uptake was 39%. Twenty eight women (16%) failed to complete the study; 19 IER and 9 CER. An intention to treat analysis accounting for changes in body water caused by chemotherapy showed greater weight loss with IER vs CER; -2.1 (95% CI -2.9 to -1.2) kg compared with -0.7 (-1.5 to 0.1) kg, p=0.020. There was a tendency for greater loss of body fat with IER vs. CER (IER -2.1 [-2.9 to -1.3] kg vs CER -1.1 [-1.8 to -0.3] kg, p=0.056) and greater gain in lean body mass with CER (IER 0.1 [-0.3 to 0.5] kg vs CER 0.6 [0.2 to 0.9] kg, p=0.070) but these differences were not statistically significant. Conclusion: High uptake and adherence reflects interest and motivation of women to make positive changes to lifestyle at the time of diagnosis. IER was marginally better than CER for controlling weight during chemotherapy, with non-significant differences in body fat lean body mass. Further analyses of secondary endpoints will be performed before the meeting in September.

UKCO2016

September 19-20, 2016

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Poster Presentations Posters are listed by alphabetical order of the presenter

01

Relationship between eating behaviours and food cravings; influence of FTO genotype Hanan Abdella

02 Greater weight loss following extended referral to a commercial weight loss programme: 2 year outcomes from the WRAP trial Amy Ahern 03 The Use of the COM-B model in Developing a Survey to Assess Barriers and Facilitators to Physical Activity amongst Saudi Women Aljoharah Aljanlan 04

Child weight status affects the outcome of a short-term energy restriction on insulin sensitivity in severely obese adults Emma Baldry

05 Exercise and weight loss in obese adults diagnosed with lower limb osteoarthritis: An evaluation of the Cwm Taf Joint Care Programme Samuel Belcher 06 Exploring the evidence for Tier 3 weight management interventions for children and adults: a systematic review plus stakeholder interviews Tamara Brown 07 Does a weight management programme promoting satiation and satiety lead to greater appetite control, weight loss, improved health and weight loss experience compared to a calorie restrictive programme? The SWIPS trial Nicola Buckland 08

Obesity and Healthcare Resource Utilisation - Results from CPRD Barrie Chubb

09 Gender differences in the relationship between school-time allocation for breaks and PE, and physical activity levels in 5-6 year old children Joanne Clarke 10

Do making habits or breaking habits influence weight loss and weight loss maintenance? A randomised controlled trial Gina Cleo

11

National Mapping of Weight Management Services: Provision of Tier 2 and Tier 3 Services in England Vicki Coulton

12

User and stakeholder experiences of weight management interventions: A qualitative study Vicki Coulton

13 Effect of repeated consumption of a satiety enhancing dairy product in conjunction with an exercise intervention on body composition and appetite control: results from the SATIN project Michelle Dalton 14 A database of healthy males for phenotypic studies on the effects of exercise on obesity-related traits in variants of the FTO gene James Dorling 15 Acute exercise, appetite regulatory hormones, hunger perceptions and ad libitum energy intake in lean and overweight/ obese men and women Jessica Douglas 16

Optimisation of the use of hormone assays and visual analogue scales (VAS) for assessing satiety phenotype Hameida El Farssi

17 Intervening to reduce antenatal weight gain in severely obese women reduces pregnancy complications: findings from the Lincolnshire Bumps and Beyond service Sarah Ellis

40

18

H20- Health to Outcome- A Patient-Provider Solution for Obesity Christine Ferguson

19

Does hunger and thirst differentially affect intake of water and low- and high-caloric beverages? Jennifer Ferrar

20

Analysis of baseline quality of life data in patients undergoing primary bariatric surgery in Scotland David Hamilton

UKCO2016

September 19-20, 2016


Poster Presentations 21 The effects of supervised exercise training 12-24 months after bariatric surgery on physical function and body composition: a randomised controlled trial Louisa Y Herring 22 Body mass index and risk of advanced chronic kidney disease:analyses from a primary care cohort of 1.4 million United Kingdom adults William Herrington 23

Maternal body mass index and post-term birth: a systematic review and meta-analysis Nicola Heslehurst

24

The impact of different snack foods on appetite control in the low satiety phenotype Sophie Hollingworth

25 Does personalised information about risk of cardiovascular disease and diabetes enhance uptake and adherence to a weight loss programme amongst women in the NHS Breast Cancer Screening Programme? Anthony Howell 26

Factors influencing weight regain following bariatric surgery Jennifer James

27

Exploring determinants of overweight and obesity in South Asian Adolescents in England Gurnam Johal

28

Iron Deficiency Anaemia (IDA) and Obesity – Are the two conditions linked? Husna Kaya Kacar

29

Efficacy of Weight Loss and Physical Activity Intervention in Non-Alcoholic Fatty Liver Disease: A Systematic Review Sue Kenneally

30

Applying an extended Theory of Planned Behaviour to predict breakfast consumption in adolescents Sarah Kennedy

31 Are we where we eat? Eating at food outlets, leisure settings and “on the go” is associated with less healthy food choices than home Sara Kirk 32 Characteristics of individuals developing type 2 diabetes in the SCALE Obesity and Prediabetes randomised, doubleblind, liraglutide vs placebo trial Mike Lean 33 Men’s attitudes to body weight, barriers to weight loss and desired elements of a weight management programme: survey of Police Scotland officers and staff. Wilma Leslie 34

Inequalities in childhood obesity throughout primary school. Results of a longitudinal study in Birmingham Susan Lowe

35 Beneficial effects of replacing diet beverages with water on Type 2 diabetic obese women following a hypo-energetic diet a randomized, 24 week clinical trial Ameneh Madjd 36

Anthropometric predictors of pulmonary function in relation to insulin sensitivity in adults with asthma David McCarthy

37 Reduction in the risk of developing type 2 diabetes (T2D) with liraglutide 3.0 mg in people with prediabetes from the SCALE Obesity and Prediabetes randomised, double-blind, placebo-controlled trial Barbara McGowan 38

Addressing malnutrition and high obesity rates in children 1 - 4 years through evidence based portion size ranges Judy More

39

Helping the nation lose weight: A partnership approach between PHE’s OneYou campaign and Slimming World Liam Morris

40 Exploring barriers and facilitators of fruit and/or vegetable consumption in pre-school children: a meta-synthesis using the Theoretical Domains Framework Claire O’Malley

UKCO2016

September 19-20, 2016

41


Poster Presentations 41 Group-based weight management programme versus multisession advice in general practice in areas of high social deprivation: A randomised controlled trial Sarrah Peerbux 42 Proactive Assessment of Obesity Risk during Infancy (ProAsk): Can UK Health Visitors deliver a targeted prevention programme? Jennie Rose 43

Exploring the obesogenic environment: Understanding the health impact of contemporary urban living Rachael H Sibson

44

Adolescent drink preferences and weight Andrea Smith

45

Beyond the individual – context and community in social policy Sophie Spencer

46 How group interventions are delivered in Tier 3 weight management programmes across the UK: A scoping review of current practice Dawn Swancutt 47

Perceived Barriers to Weight Loss: A Case Study Report Daisy Thompson-Lake

48 Poster: Hosting a specialist weight management service in a cardiovascular rehabilitation setting: Another useful step towards ‘generic’ lifestyle services? Russell Tipson 49

Getting Serious About Obesity: Connecting research to policy and local to national in Scotland Lorraine Tulloch

50 Evaluation of a brief intervention to increase awareness that of new recommendations on free sugars within a in a University setting Claire Wright 51 Is dietary sugar essential? University-based surveys before and after SACN (2015) suggest that most respondents believe it is. Claire Wright 52

42

Reflecting on trans-disciplinarity in obesity research Chris Yuill

UKCO2016

September 19-20, 2016


Poster Presentation Abstracts 01 Poster: Relationship between eating behaviours and food cravings; influence of FTO genotype Hanan Abdella1, Hameida El Farssi1, Dawn Hadden1, David Broom1, Caroline Dalton1, 1Sheffield Hallam University, Sheffield, UK Background: Eating behaviours such as cognitive restraint, uncontrolled eating and emotional eating have been associated with increased BMI; cravings for sweet or high fat foods also have an effect on BMI. In addition, genome-wide association studies have identified the FTO polymorphism rs9939509 as having the strongest genetic association with weight-related phenotype. Aim: To investigate the relationship between eating behaviours and food cravings, and to determine the influence of FTO genotype on this relationship. Design: 214 healthy volunteers (131F, 83M; BMI 24.3 ± 5.2 kg/m2) completed the three-factor eating questionnaire (TFEQ) to measure cognitive restraint, uncontrolled eating and emotional eating, and food cravings inventory (FCI) to measure cravings for high-fat foods, sweet foods, carbohydrates and fast foods. Buccal swabs were taken, DNA extracted and genotyping was carried out using Taqman assays for the FTO single nucleotide polymorphism rs9939509. Results: FTO genotype had a significant effect (p<0.05) on the relationship between cognitive restraint and cravings for both high fat foods, and total food cravings. The TT genotype (which is not associated with weight-gain) was associated with a significant negative correlation between cognitive restraint and cravings for high-fat foods (r=-0.590; p<0.005), and total food cravings (r=-0.526, p<0.01) in contrast in the group with AA and AT genotypes there was no correlation (high fats foods r=-0.008; total food cravings r=0.109). Conclusion: FTO rs9939509 genotype may influence the relationship between eating behaviour and food cravings, this is a possible mechanism by which this SNP influences BMI. 02 Poster: Greater weight loss following extended referral to a commercial weight loss programme: 2 year outcomes from the WRAP trial. Amy Ahern1, Graham Wheeler6, Paul Aveyard2, Jason Halford3, Emma Boyland3, Adrian Mander6, Marc Suhrcke7, Jennifer Woolston5, Susan Jebb2, 1University of Cambridge, Cambridge, UK, 2University of Oxford, Oxford, UK, 3University of Liverpool, Liverpool, UK, 4 University of East Anglia, Norwich, UK, 5MRC Human Nutrition Research, Cambridge, UK, 6MRC Biostatistics Unit, Cambridge, UK, 7 University of York, York, UK The WRAP trial evaluated whether referral to a commercial weight loss programme (CP; Weight Watchers) achieves greater weight loss at 2 years than a brief intervention (BI); and whether an extended 52 week programme (CP52) achieves greater weight loss than the standard 12 week programmes (CP12) currently commissioned in the NHS. Adults who were overweight (n=1269; mean BMI 34.5 kg, mean age 53 years, 68% female) were recruited via their GP and randomised to BI, CP12, or CP52 in a 2:5:5 allocation. Weight was measured at 3 months, 1 year and 2 years and analysed using mixed effects models in a hierarchical closed testing procedure (combined CP vs BI, then CP52 vs CP12). At 2 years, mean weight change was -2.30 kg (BI), -3.00 kg (CP12) and -4.29 kg (CP52) (compared to -3·40 kg (BI), -4·99 kg (CP12) and -7·03 kg (CP52) at 1 year). At 2 years CP participants had lost more weight than BI [-1.43 kg (95% CI -2.87,-0.00); p=0.025] and CP52 had lost more weight than CP12 [-1.31 kg (95% CI -2.45,-0.18); p=0.023]. There were no significant differences in weight between CP12 and BI [-0.74 kg (95%CI -2.45, 0.77); p=0.338]. Referral to a CP led to greater weight loss than brief intervention over 2-year follow up and the extended referral group had greater weight losses than the shorter referral group at all time points. On average, all groups lost weight during the trial, but after 2 years weight losses in the 12 week programme and the brief intervention groups were similar. 03 Poster: The Use of the COM-B model in Developing a Survey to Assess Barriers and Facilitators to Physical Activity amongst Saudi Women Aljoharah Aljahlan1, Joanne Clarke1, Peymane Adab1, Miranda Pallan1, 1University of Birmingham, Birmingham, UK. Saudi women have particularly low levels of physical activity (PA). Understanding the barriers/facilitators to PA, and which of these exert the biggest influence on inactivity, are critical to the successful development of an intervention programme. In order to explore this, a survey to assess a) the prevalence of previously identified barriers/facilitators to PA in women, and b) self-reported PA levels, will be administered to female college students in Saudi Arabia. The Capability, Opportunity, Motivation and Behaviours (COM-B) model has been used to guide development of the survey tool. First the literature was searched to identify studies exploring barriers/facilitators to PA in women. The search was then narrowed to focus on Middle Eastern women and Saudi women in particular. Data on specific factors identified as encouraging or prohibiting PA were extracted from identified papers, and were grouped into four categories: individual, social, environmental, and policy. They were then mapped to the COM-B model components. Following this, existing validated questionnaires measuring factors relating to capability, opportunity and motivation were identified. Items were developed de novo if no pre-existing survey tool was found to measure an identified barrier/facilitator. To measure PA, the International Physical Activity Questionnaire (IPAQ) was included in the survey. Data collected using this survey will enable the prevalence of PA barriers/facilitators to be identified in this population and it will also enable an assessment of the relative influences of capability, opportunity and motivation on PA behaviour. This will inform design of an intervention to target the greatest influences on PA.

UKCO2016

September 19-20, 2016

43


Poster Presentation Abstracts 04 Poster: Child weight status affects the outcome of a short-term energy restriction on insulin sensitivity in severely obese adults Emma Baldry1, Guruprasad Aithal2, Paul Leeder3, Andrew Bennett1, Ian Macdonald1, 1University of Nottingham, Nottingham, UK, 2NIHR Nottingham Digestive Diseases Biomedical Research Unit, Nottingham, UK, 3Royal Derby Hospital, Derby, UK Background: Ectopic lipid accumulation is a common factor underlying non-alcoholic fatty liver disease (NAFLD) and Type 2 diabetes (DM). Adipose tissue capacity, fixed in adolescence and overwhelmed in obesity in adulthood, is one explanation for this deposition. Acute energy restriction reduces lipid deposits in the liver and reverses DM; we aimed to investigate the effect of childhood weight status on these outcomes. Methods: We analysed the self-reported childhood weight status recorded as a part of a randomised controlled trial (EnR-Lin study) comparing a food-based diet (FD) with a meal replacement plan (MRP) (LighterLife Ltd., U.K.) over 2 weeks prior to bariatric surgery. Clinical and anthropometric data and fasting blood were collected pre and post diet. Results: 60 participants were recruited and 54 completed the study; food-based diet n=26, meal plan n=28. Baseline demographic features, dietary energy intake and weight loss post-diet were not significantly different between diet groups, however macronutrient intakes were. 61% of all participants reported being overweight or obese as a child (OC) (n=33). This subgroup had higher median body mass index (BMI) pre and post diet, pre 51.9kgm-2, post 50.3kgm-2, lean childhood BMI group pre 47.3kgm-2, post 46.2kgm-2. However, BMI change was not statistically significant between childhood weight groups (P=0.65). Reduction in insulin resistance (HOMAIR) was significant following MRP, median (range) -1.0 (-26.3-5.9) (p=0.02) when compared with FD -0.1 (-9.1-18.7) (p=0.91). Reduction in HOMAIR remains significant only in the MRP OC group median (range) -1.0 (-26.3-3.0) P=0.01 as opposed to lean -0.04 (-5.9-5.9) P=0.64. Conclusions: People who self-reported overweight/obesity in childhood had a greater change in insulin sensitivity following an energy restrictive meal replacement plan. This could indicate that both adipose tissue capacity and type of diet, including macronutrient intake, could play a role in insulin sensitivity following energy restriction in severe obesity. 05 Poster: Exercise and weight loss in obese adults diagnosed with lower limb osteoarthritis: An evaluation of the Cwm Taf Joint Care Programme. Samuel Belcher1, Diane Gibbons2, Rachel Reed2, Emma Cahill2, Shelley Wyer2, Angela Jones2, Rhodri Martin2, Simon Williams1, Christopher Retallick1, 1University of South Wales, Pontypridd, UK, 2Cwm Taf Health Board, Merthyr Tydfil, UK Objective: To evaluate the effectiveness of the Cwm Taf Joint Care Programme’s (JCP) weight loss and exercise intervention in achieving improvements in pain and function in obese adults diagnosed with hip and knee osteoarthritis (OA). Methods: 87 participants (66% female) with a mean ± SD age of 56.9 ± 11.4 years and BMI of 40.4 ± 7.8 kg/m² were recruited and referred to a 16-week community diet and exercise intervention delivered by local health care professionals. The study had a noncontrolled pre-test post-test design with the effect of the intervention determined using paired-samples t-tests and effect sizes (ES). Statistical significance was set at P=0.05. The primary outcome measure was change in self-reported pain score in the form of Oxford knee scores (OKS). Secondary outcomes included changes in Oxford hip score (OHS), functional fitness, weight (kg), BMI (kg/m2) and waist circumference (cm). Results: At 16 weeks the mean change in OKS was 5.0 ± 9.1 (95%CI: 3.0, 7.0; P<0.001; ES = 0.43). 39% of participants achieved a clinically significant improvements (change in OKS score >5.2). Among secondary outcome measures, OHS improved by a mean of 4.4 ± 9.1 (95%CI: 2.2, 6.6; P<0.001; ES 0.33) and there were mean decreases in weight (-4.3 ± 4.1 kg, 95%CI: -3.4, -5.3; P<0.001; ES=0.16), BMI (-1.6 ± 1.6 kg/m2, 95%CI: -1.3, -2.0; P<0.001; ES=0.20) and waist circumference (-6.2 ± 4.6 cm, 95%CI: -5.1, -7.2; P<0.001; ES=0.39). Six-minute walk test results were considered clinically significant with a mean improvement of 122 ± 87.3 metres (95%CI: 103, 142; P<0.001; ES=0.97). Conclusion: Among overweight and obese adults diagnosed with lower limb OA, a 16-week combined exercise and diet intervention appears effective in achieving improvement in pain and function. A longer term study with randomisation and a control group are recommended.

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UKCO2016

September 19-20, 2016


Poster Presentation Abstracts 06 Poster: Exploring the evidence for Tier 3 weight management interventions for children and adults: a systematic review plus stakeholder interviews Tamara Brown1, Louisa Ells2, Rebekah McNaughton2, Claire O’Malley1, Janet Shucksmith2 Carolyn Summerbell1, 1Durham University, Durham, UK, Teesside University, Middlesbrough, UK Background: Clinical commissioning groups, local authorities and NHS England commission tier 3 services for severely obese people but there is no universal provision of tier 3 services across England. Aim: Public Health England commissioned this research to establish the evidence base for tier 3 services which will feed into and inform a wider work programme, aimed at developing commissioning blueprints for commissioners and providers of obesity services. Methods: Systematic review plus stakeholder interviews to explore service characteristics, effectiveness and implications for practice. Inclusion criteria for review of effectiveness: BMI >99.6th centile or >98th centile with co-morbidities (child), BMI ≥40kg/m2 or ≥35kg/m2 with co-morbidities or ≥30 kg/m2 with diabetes (adults). Multicomponent, specialist, multidisciplinary interventions in community, primary or secondary care, UK since 2005, any design, any duration. Stakeholder interviews: 2 child and 2 adult tier 3 services were invited to participate to gather qualitative information on stakeholder experience. Results: 12 child studies were included and data extracted. Interventions were associated with statistically significant reduction in zBMI that ranged from -0.13 to -0.41 over one to 24-months, in children aged ten to 14. The evidence suggests that significant reduction in zBMI can be achieved in a variety of settings including hospital clinics, primary care, school, residential camp, and other community settings. 26 adult studies were included and analysis is ongoing. Interviews have been conducted with commissioners of 2 adult and 2 child services and with providers of 2 adult services; transcription analyses is ongoing. 07 Poster: Does a weight management programme promoting satiation and satiety lead to greater appetite control, weight loss, improved health and weight loss experience compared to a calorie restrictive programme? The SWIPS trial Nicola Buckland1, Diana Camidge1, Fiona Croden1, Marion Hetherington1, James Stubbs1, John Blundell1, Graham Finlayson1, 1University of Leeds, Leeds, UK Weight management programmes (WMPs) that promote satiation and satiety by encouraging behaviour changes towards unrestricted intake of low energy density (LED) food choices might be more effective than self-led calorie reduction WMPs. The SWIPS trial examined the effect of a commercial weight loss programme promoting unrestricted intake of LED foods [Slimming World, UK (SW)] on body weight, health markers and weight loss experience compared to a self-led calorie-reduction standard care WMP [Live Well, NHS standard care (SC)]. Secondly, the trial examined the effects of meals varying in energy density (consistent with SW approach) on appetite and energy intake. Ninety-six women who were overweight or obese (age: 41.8±1.4y; BMI: 33.3±0.4kg/m²) were recruited from SW and SC weight management arms of a 14-week clinical trial. Results showed that LED meals increased participants’ subjective sensations of fullness and reduced sensations of hunger throughout the day and, reduced total day energy intake compared to high energy dense meals (all ps<.001). The SW group lost more weight and were more likely to achieve clinical weight loss (>5%) compared to the SC group. The SW group experienced greater control over eating, found the WMP easier to adhere to, experienced more enjoyment losing weight, were more satisfied with the WMP and were more motivated to continue the programme compared to the SC group. A commercial WMP supporting behaviour changes towards LED food choices is an effective strategy for weight loss with health benefits and improved experience above self-led calorie reduction programmes [funded by Slimming World, UK; CT#NCT02012426].

UKCO2016

September 19-20, 2016

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Poster Presentation Abstracts 08 Poster: Obesity and Healthcare Resource Utilisation – Results from CPRD Barrie Chubb1, Emil Nørtoft2, Anders Borglykke2, 1Novo Nordisk Ltd, Gatwick, UK, 2Novo Nordisk A/S, Søborg, Denmark. Background: Obesity is among the leading causes of morbidity and mortality worldwide. Previous studies from the US based on insurance claims databases have shown associations between increased BMI and increased health care costs. It remains unclear whether the same associations can be found in a large population-based Electronic Medical Records (EMR) database from the UK. Objective: To estimate the association between obesity and healthcare resource utilisation by comparing rates of GP contacts, prescriptions and hospital admissions respectively comparing normal weighted individuals to increasing BMI categories. Material and Methods: Using data from the Clinical Practice Research (CPRD), a cohort was created consisting of patients who have a current registration date prior to 01.01.2010 and acceptable data as defined by CPRD. Patients below 18 years of age at baseline are excluded leaving 1,923,100 UK patients. The association between categories of BMI and five-year rates of GP contacts, hospitalisations and prescriptions respectively are analysed using a Zero Inflated Poisson Regression model adjusted for gender and age. Results: Statistical significant (all P<0.0001) Rate Ratios of GP contacts, hospitalisations and prescriptions respectively by BMI categories are shown below. Healthcare Resource Utilisation BMI class GP contacts Hospitalisations 18.5-24.9 Ref Ref 25-29.9 1.127 1.032 30-34.9 1.267 1.099 35-39.9 1.390 1.176 40-70 1.563 1.269

Prescriptions Ref 1.275 1.610 1.950 2.481

Conclusion: The utilisation of GPs, hospitals and pharmaceuticals increases significantly with increasing BMI categories. 09 Poster: Gender differences in the relationship between school time allocation for breaks and PE, and physical activity levels in 5-6 year old children Joanne Clarke1, Miranda Pallan1, Emma Lancashire1, Peymane Adab1, 1University of Birmingham, Birmingham, UK. Opportunities exist within schools to increase levels of children’s physical activity (PA), yet there is little evidence of the impact of school PA policies on children’s health. This study investigates the relationship between school-time allocation for breaks and physical education (PE), and PA levels in 5-6 year olds, within and outside of school. We used baseline data from 962 children from 50 schools in the West Midlands participating in the WAVES childhood obesity prevention trial. PA was measured using accelerometers worn for up to 5 days. School PA opportunities were identified via school questionnaire. Adjusted random effects multilevel models were developed to determine associations between school PA opportunities and children’s inand out-of-school PA. Gender differences were explored. In adjusted models, children attending schools with more breaktime have significantly greater levels of moderate-vigorous PA (MVPA) (B=3.67 min/day (0.54, 6.80), p=0.03) within school. However, when split by gender, significant associations exist only for boys. Overall, there is a trend of decreasing school-time sedentary behaviour with increased school PA opportunities. However, gender-specific analyses suggest that school PA opportunities are somewhat associated with both less overall and out-of-school sedentary time in boys, but the opposite in girls. There was a significant positive association between school provision of PE/breaks and non-school sedentary time in girls (B=8.89 min/day (1.00, 16.79), p=0.027). School PA opportunities are associated with higher MVPA levels among children in school time, particularly in boys. The relationship between school PA opportunities and girls’ out-of-school sedentary time is concerning and warrants further investigation.

46

UKCO2016

September 19-20, 2016


Poster Presentation Abstracts 10 Poster: Do making habits or breaking habits influence weight loss and weight loss maintenance? A randomised controlled trial. Gina Cleo1, Elizabeth Isenring1, Rae Thomas2, Paul Glasziou2, 1Bond University, Robina, Australia, 2Center for Research in Evidence Based Practice, Robina, Australia Background: Despite the significance placed on lifestyle interventions for obesity management, around 40% of weight loss is regained over the first year following treatment, and much of the rest over the next three years. Two psychological concepts (habitual behaviour and automaticity) have been suggested as the most plausible explanation of this overwhelming lack of long-term weight loss success. Method: We evaluated the efficacy of two interventions that explore these theories: Ten Top Tips (10TT) and Do Something Different (DSD). 10TT promotes automaticity; this is the ability to perform tasks without awareness or deliberation. Therefore, diet and exercise related behaviours become automatic or habitual. Conversely DSD promotes behavioural flexibility. This program disrupts daily routines by assigning an individual with unstructured tasks to perform. Behavioural flexibility therefore has an inverse relationship with automaticity and is defined as the measure of an individual’s range of mindful behaviours. In previous studies, both interventions have achieved significant weight loss with results suggesting potential for maintenance of the weight lost. The research however is limited and long-term (12 month) results are yet to be explored. Men and women (n = 75), aged 51 + 6 (s.d.) years with body mass index 34.5 + 4.1 kg/m² were randomised to 12-week 10TT, DSD or no treatment control. Active intervention participants underwent 12 weeks of the program with 12-months follow-up. Results: We collected data for weight, BMI, waist circumference as well as habitual behaviour and wellbeing. After 12 weeks intervention, weight loss averaged 4.6kg in the 10TT group, 4.1kg in the DSD group and 1.3kg in the control group. There was significant improvement in wellbeing in the 10TT and DSD groups. Significance of research: Results from this RCT have the potential to help in understanding the mechanisms relating to weight loss maintenance. 11 Poster: National Mapping of Weight Management Services: Provision of Tier 2 and Tier 3 Services in England Vicki Coulton1, Sakhi Dodhia1, Louisa Ells1, Jamie Blackshaw1, 1Public Health England, London, UK Background: England is dealing with an obesity epidemic and hence, tackling obesity and its causes is high on the public health agenda. Local Authorities (LA) and Clinical Commissioning Groups (CCG) are responsible for commissioning weight management services (WMS) in England based on local need; however the extent of WMS provision in England is unknown. Objective: To determine the provision of locally commissioned WMS across England and understand how these services are delivered. Methods: A mixed methods approach involving data collection workshops and an e-survey were disseminated to all PHE regional centres that distributed to LA and CCG obesity leads. Data collection covered; referral routes, entry criteria, service details, cost, exit routes and barriers to commissioning. Results: 73% of LA’s and 18% of CCG’s responded. 56% of LA’s reported a child tier 2 (CYPT2) service and 61% of LA’s reported an adult tier 2 (AT2) service. The majority of CYPT2 and AT2 services were commissioned by LA’s, delivered in community and/or leisure settings over 12 weeks, and over half undertook 12 month follow up of participants. Commissioners reported 6 key themes relating to barriers; evidence and outcomes, national guidance, funding and resource, commissioning, the obesity pathway, and service model. Discussion: This exercise is the first of its kind in England and demonstrated encouraging findings, with most services commissioned utilising national guidance. However, it highlighted fragmented local provision for the treatment of child and adult obesity and the need for national guidance to go further than what currently exists. Furthermore, Tier 3 WMS are an important part of the obesity pathway for both children and adults, however the poor response rate from these services resulted in insufficient and incomplete data, which meant it was not possible to fully analyse. 12 Poster: User and stakeholder experiences of weight management interventions: A qualitative study Vicki Coulton1, Lindsay Reece1, David Broom1, Helen Crank1, Robert Copeland1, 1Sheffield Hallam University, Sheffield, UK. England is facing a childhood obesity epidemic and whilst there is no simple solution, effective weight management interventions (WMI) form part of the myriad of actions that are required to tackle it (WHO, 2016). Few studies have identified the barriers and facilitators to families attending WMI and utilised the findings to inform the design of interventions (Stanniford et al, 2011). Methods: A qualitative study explored 1) the experiences of professional stakeholders including commissioners, facilitators and referrers of WMI and 2) the experiences of children and families who were eligible or had attended WMI, through focus groups. The data was transcribed and thematically analysed. Results: Families and stakeholders consistently identified social and emotional concerns attached to childhood obesity, for example stigma, as a key barrier to attending WMI. However, dissonance between the families and stakeholders existed; with stakeholders attributing complex family circumstances which may result in weight being deprioritised, as a key concern. Conclusion: To improve WMI efficacy, facilitator traits such as empathy and avoiding scenarios where stigma and a ‘blame culture’ may be associated, is fundamental. Intervention design and training of facilitators should address the incongruence between stakeholders and service users.

UKCO2016

September 19-20, 2016

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Poster Presentation Abstracts 13 Poster: Effect of repeated consumption of a satiety enhancing dairy product in conjunction with an exercise intervention on body composition and appetite control: results from the SATIN project M Dalton1, A Myers1, C Gibbons1, S Hollingworth1, MW Kanning2, RMAJ Ruijschop2, A Bonnema3, J Halford4, J Harrold4, JE Blundell1 & G Finlayson1 1School of Psychology, Faculty of Medicine and Health, University of Leeds, UK, 2NIZO Food Research, NL, 3Cargill, Inc, Minneapolis, MN, USA, 4Psychological Sciences, University of Liverpool, UK Changing the composition and structure of foods to induce early satiation or enhance satiety has the potential to reduce energy intake and aid appetite control. The SATIN project has led to the development of several new food products designed to have beneficial effects for weight management through novel food processing. The current study examined the effect of acute (1-day) and medium-term (12-week) consumption of a new dairy yoghurt/pudding (YP) alongside an exercise intervention on satiation, satiety, psychological and biological markers of appetite control and changes in body composition. The YP was developed to have a dual-action targeting satiation and satiety; the yoghurt was hypothesised to induce early satiation via enhanced flavour release and the pudding contained an active ingredient that was hypothesised to prolong satiety by delayed gastric emptying. Thirty-two female participants (Age: 32±11.4; BMI: 28.2±2.8) were randomised to consume either the Active YP or matched Control product 4-times per week over 12-weeks. Effects on satiation, satiety, gut peptides and appetite control were assessed using intensive probe days at baseline and post-intervention. Body composition was assessed at baseline and post-intervention using BodPod and body weight was assessed weekly. Following acute consumption, the Active YP induced earlier satiation, reduced overall test-day energy intake and reduced factors and behaviours known to contribute to poor appetite control. These findings suggest that beneficial physiological effects on body weight may be observed in the longer-term. [Work funded by EUFP7 project “Satin” under grant agreement #289800]. 14 Poster: A database of healthy males for phenotypic studies on the effects of exercise on obesity-related traits in variants of the FTO gene. James Dorling1, Rachel Batterham2, James King1, David Stensel1, 1Loughborough University, Loughborough, UK, 2University College London, London, UK Introduction: Variations in the fat-mass and obesity gene (FTO) have been linked with obesity and impaired satiety. However, physical activity attenuates the effect of FTO on adiposity. We aimed to establish a database of males who were screened for FTO, physical activity and eating behaviours in order to perform controlled trials investigating the influence of exercise on appetite and obesity risk factors in variants of FTO. Methods: A total of 361 males of mixed European descent were recruited. A blood sample was collected for genotyping of FTO rs9939609 single nucleotide polymorphism. Skinfold measurements, height, mass and waist circumference were recorded. Habitual physical activity levels were measured using the short International Physical Activity Questionnaire. The Three-Factor Eating Questionnaire was used to assess eating dimensions of dietary restraint, eating disinhibition and perceived hunger. Results: Seventy four subjects (21%) were homozygous for the risk A allele, 120 (34%) were homozygous for the T allele, and 161 (45%) were AT heterozygotes. Most participants were defined as highly (76%) or moderately (21%) active. There were no significant associations between FTO genotype and adiposity-related traits (p > 0.05). The FTO genotype was not related to physical activity levels or scores on eating dimensions (p > 0.05). Highly active individuals presented lower sum of eight skinfolds than moderately active and inactive individuals (82 ± 2 v 95 ± 5 mm; p < 0.05). Conclusions: FTO was not related to adiposity traits in a physically active cohort. Activity levels may have greater influence on adiposity than FTO.

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UKCO2016

September 19-20, 2016


Poster Presentation Abstracts 15 Poster: Acute exercise, appetite regulatory hormones, hunger perceptions and ad libitum energy intake in lean and overweight/ obese men and women. Jessica Douglas1, James King1, Melanie Davies3, David Stensel1, 1School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, UK, 2The Leicester–Loughborough Diet, Lifestyle & Physical Activity Biomedical Research Unit, University Hospitals of Leicester & Loughborough University, Leicester and Loughborough, UK, 3Department of Health Sciences, University of Leicester, Leicester, UK In lean individuals hunger and ghrelin are suppressed and peptide-YY (PYY) is elevated during and immediately after vigorous exercise whilst energy intake remains unchanged in the short term. Less is known about responses in overweight/obese (ow/ob) individuals. This study compared responses of 47 healthy lean and ow/ob men and women. Each completed exercise (E, 1h treadmill walk/run at 60% VO2 peak followed by 7h of rest) and control (C, 8h of rest) trials in a random order. Energy intake was assessed using an ad libitum meal, hunger was assessed using visual analogue scales and 12 venous blood samples were collected for hormone measurement. Data were analysed via two and three-factor ANOVAs (Table). BMI Energy N (kg/m2)† Intake (kJ)* C 2497±1158 Lean female 11 22±2 E 2149±998 C 2830±1378 ow/ob female 11 29±3 E 2525±1575 C 3869±1295 Lean male 11 23±1 E 3976±1858 C 3964±1578 ow/ob male 14 30±3 E 4340±1566

Hunger AUC (0-8h) Acylated ghrelin 217±97 708±416 170±90 766±558 261±117 676±363 237±117 742±561 312±127 396±150 288±146 372±169 226±86 619±634 221±85 594±681

AUC (pg/mL 8h) Total PYY 947±497 1034±548 985±535 1034±494 1041±302 1080±393 775±570 761±625

Total GLP-1# 154±85 179±108 178±63 219±113 186±74 215±97 178±57 244±152

Values are mean±SD. *Significant difference between males vs. females, †lean vs. ow/ob and #C vs. E (all P≤0.01). Males consumed more kilocalories than females. Total GLP-1 concentrations were higher in the exercise than control trial. However, hunger, appetite hormone, and energy intake responses did not differ significantly between lean and ow/ob individuals in the 7h after exercise. 16 Poster: Optimisation of the use of hormone assays and visual analogue scales (VAS) for assessing satiety phenotype. Hameida El Farssi1, Hanan Abdella1, Dawn Hadden1, David Broom1, Caroline Dalton1, 1Sheffield Hallam University, Sheffield, UK Background: Previous studies have shown that it is possible to identify individuals with a low satiety phenotype using hormone assays and visual analogue scale (VAS) measures of subjective appetite sensations. This usually involves a test meal with multiple blood samples and measurements taken over several hours, which is expensive and time consuming. Aim: To optimise the use of hormone assays and VAS measures to assess satiety phenotype. Design: 15 healthy volunteers who were overweight or obese (BMI 31.3 ± 5.65 kg/m2) received a test meal after a 12 hour overnight fast. Blood samples and VAS measures of appetite were taken immediately before the meal and at time points over 4 hours. Ghrelin, GLP-1, PYY, and PP were assayed and area under the curve (AUC) was calculated for hormones and VAS. Results: There was a significant correlation between the fasting concentration and AUC of three of the hormones: ghrelin (r=0.839, p<0.0001), GLP-1 (r=0.723, p=0.002), PYY (r=0.964, p<0.0001), the correlation for PP was not significant (r=0.317). There was no significant correlation between the VAS measures taken immediately before the meal and the VAS AUC. The correlations between hormone measures (fasting or AUC) and VAS measures were similar to those previously reported. Conclusion: The fasting hormone measurement is representative of the AUC in response to a test meal for ghrelin, GLP-1 and PYY; indicating that measurement of a single, fasting sample is sufficient when investigating satiety responses using hormone analysis. In contrast, measuring subjective appetite sensations requires post-prandial measurements over a time course.

UKCO2016

September 19-20, 2016

49


Poster Presentation Abstracts 17 Poster: Intervening to reduce antenatal weight gain in severely obese women reduces pregnancy complications: findings from the Lincolnshire Bumps and Beyond service. Sarah Ellis1, Alisa McGiveron2, Judy Swift1, Simon Langley-Evans1, 1University of Nottingham, Nottingham, UK, 2United Lincolnshire Hospitals NHS Trust, Lincolnshire, UK Bumps & Beyond (B&B) is a maternal weight management programme for obese women delivered in acute and community settings throughout Lincolnshire. It consists of six sessions of healthy lifestyle advice delivered by midwives or health trainers. A previous service evaluation showed that women who attended the programme had fewer pregnancy and birth complications. In order to validate these results, a further evaluation has been completed. Audit sheets, completed by hospital staff after the birth of the baby were anonymised and input into SPSS v20 for analysis, as previously reported. Women who attended all six sessions were classed as attendees, women who attended 5 sessions or less were partial attendees, and women who attended no sessions were classed as non-attendees. A total of 676 records were used in the analysis, which recorded 646 live singleton births. Initial BMI at booking was 39.25, 29.4 and 39.4kg/m2 for attenders, partial attenders and non-attenders respectively. Women who attended all six sessions of the weight management programme gained less weight (4.93kg vs 9.14kg in non-attenders, P<0.001) over the course of the pregnancy than non-attendees, and were less likely to have pregnancy complications overall. The prevalence of gestational diabetes (6.9% vs 11.9%) and hypertension (19% vs 8.9%) was significantly lower in attendees. Attendees appeared to be more likely to require intervention during delivery than non-attendees. A number of attendees lost weight whilst on the programme with no ill-effect seen on the foetus (similar birth weights and apgar scores at 1 minute and 5 minutes). Women who attended were more likely to breastfeed at birth than non-attendees (72% v 48%, P<0.001). Analysis of this larger dataset has shown that B&B continues to be a successful weight management programme for severely obese pregnant women. This shows that one-to-one support in weight management can improve antenatal health and pregnancy outcomes. 18 Poster: H20- Health to Outcomes, a Patient-Provider Solution for Obesity Christine Ferguson1, 1Leverage Global Consulting, Jamestown, RI, USA Obesity rates are on the rise in the US and globally with over 641 million individuals with obesity, a major risk factor for many chronic diseases. The American Board of Obesity Medicine has certified 1,590 Diplomats, but there continues to be a lack of obesity specialists available to patients and most turn to their primary care provider for help. Studies show that patients and providers want to have better understanding of different treatment options currently available as well as new innovations. There is a need for solutions that bridge the knowledge gap for both patients and providers as well as enable patient engagement and drive patient outcomes in obesity care. H20- Health to Outcomes, a Patient-Provider Solution for Obesity, is being developed by a team of cross-sector professionals that includes obesity specialists, doctors, clinicians, consumer groups, data scientists, information experts and technology specialists. It will enable providers to determine the closest treatment match for similarly situated patients. In addition, it will support real-time patient engagement and monitoring throughout the treatment cycle including feedback loops to reinforce or adjust treatment. By combining medical science, individual status, lifestyle, behaviour and other data sources the solution engine will leverage different machine learning and statistical methods to generate best fit patient treatment options. These options are based on identification of patient type, high responders, as well as cost, quality, outcome and utilization data. The goal of H20 is to provide each patient with an individual plan using insights about individual patients and a comprehensive set of treatment approaches from lifestyle and behaviour to surgical interventions it will match patients with the treatment options most likely to be effective given their health status, cultural context, insurance coverage, demographics, lifestyle attributes and treatment intricacies. 19 Poster: Does hunger and thirst differentially affect intake of water and low- and high-caloric beverages? Jennifer Ferrar1, Peter J. Rogers1 1University of Bristol, Bristol, UK This study investigated how hunger and thirst affected intake of water and sweetened beverages. 17 females and 15 males, randomized to receive water (N=10), Ribena Light (N=12), or Ribena (N=10), labelled appropriately, were tested in the laboratory after an overnight fast on four separate days. Participants consumed a pre-load of food (thirsty), water (hungry), neither (hungry and thirsty), or both. 20 minutes after the pre-load, ad-libitum intake of the test beverage was measured. Groups were well matched on various characteristics (BMI, demographics, diet history, TFEQ scores, study foods/beverages ratings). Irrespective of beverage type, more fluid was consumed when thirsty (regardless of hunger or fullness), F(2,58) = 5.42, p =.007, η² = .16. There were no differential effects of beverage type on fluid intake, F(2,29) = .837, p=.443, η² =.06. Exploratory analyses revealed that intake of Ribena did not differ whether hungry nor thirsty, F(1,9) = .085, p =.777, η² =.001, but intake of water was greater when thirsty compared to when hungry, F(1,9) = 17.34, p=.002, η² = .66. Intake of water was not significantly different from intake of Ribena when hungry, t(18) = -1.98, p=.064, d=.93, but there were differential effects between the water and the Ribena group in reported hunger, t(18) = 3.09, p=.006, d = 1.46, fullness, t(18) = -2.92, p=.009, d = 1.38, but not thirstiness, t(18) = .617, p=.545, d = .29, after the ad-libitum intake. The findings of this study highlight considerable complexity in motives for beverage consumption, even in the absence of caffeine and alcohol.

50

UKCO2016

September 19-20, 2016


Poster Presentation Abstracts 20 Poster: Analysis of baseline quality of life data in patients undergoing primary bariatric surgery in Scotland David Hamilton1, Jennifer Logue2, 1University of Aberdeen, Aberdeen, UK, 2University of Glasgow, Glasgow, UK Intro: SurgiCal Obesity Treatment Study (SCOTS) is a national, prospective, observational cohort study of patients undergoing bariatric surgery in Scotland. SCOTS collects a multitude of data from patients before and after bariatric surgery, one of which is patients self reported quality of life (QOL). Aims: To analyse the baseline QOL data from patients participating in SCOTS in order to elicit if any particular group has a poorer QOL prior to undergoing bariatric surgery. Method: 136 patients had fully completed SCOTS questionnaires to date and were therefore included in this study. Answers from 2 QOL questionnaires, the SF12 and the EQ5D5L were analysed by BMI, age, deprivation status, marital status and education level in order to assess trends in QOL. Results: The physical component QOL score was markedly reduced with increasing BMI, the lowest BMI group had a score of 43.83 (9.29) in comparison to the highest BMI group with a score of 29.84 (9.40) (p<0.001). Patients within the group of highest deprivation reported poorer QOL in comparison to the least deprived groups in mobility (p<0.05) as well as pain and discomfort (p<0.05) domains. There was no significant difference in pre-operative QOL between age, marital status or education level categories however these showed trends in keeping with previous published studies. 21 Poster: The effects of supervised exercise training 12-24 months after bariatric surgery on physical function and body composition: a randomised controlled trial. Louisa Y Herring1, Clare Stevinson2, Patrice Carter3, Stuart JH Biddle4, David Bowrey1, Christopher Sutton1, Melanie J Davies5, 1University Hospitals of Leicester NHS Trust, Leicester, UK, 2Loughborough University, Loughborough, UK, 3University of Cambridge, Cambridge, UK, 4 Victoria University, Melbourne, Australia, 5University of Leicester, Leicester, UK, 6National Institute for Health Research (NIHR) LeicesterLoughborough Diet, Lifestyle and Physical Activity Biomedical Research Unit, Leicestershire, UK Bariatric surgery is an effective weight-loss intervention for patients who are morbidly obese and is successful in the treatment of obesity and related diseases. There is increasing evidence of weight regain in patients after bariatric surgery, generally occurring between 12-24 months post-surgery. Weight regain increases the risk of physical function decline which negatively affects an individual’s ability to undertake activities of daily living and is related to all-cause mortality. The trial aimed to assess the effects of a 12-week supervised exercise intervention on physical function and body composition in patients between 12-24 months post bariatric surgery. 24 inactive (≤150 minutes MVPA weekly) adult bariatric surgery patients whose body mass index remained ≥30kg∙m2 12-24 months post-surgery, were randomised to an exercise training arm (n=12) or control arm (n=12). Supervised exercise consisted of three 60-minute gym sessions per week of moderate intensity aerobic and resistance training for 12 weeks. Control participants received usual care. The incremental shuttle walk test (ISWT) was used to assess functional walking performance after the 3-month intervention, and at 6-months follow up. Measures of anthropometric, physical activity, cardiovascular, psychological, and biochemical outcomes were also examined. Using an intention to treat protocol, independent t-tests were used to compare outcome measures between groups. Significant improvements in the exercise group were observed for the ISWT, body composition, physical function, cardiovascular and self-efficacy measures from baseline to 3-months. A significantly different between group change in the ISWT was observed at 3-months (p<0.001). The exercise group at 6-months recorded an overall mean improvement of 143.3 ± 86.6 metres and the control group a reduction of -32.50 ± 75.9 metres. Findings show a 5.6kg difference between groups in body mass change from baseline to 6-months favouring the exercise group. A 12-week supervised exercise intervention led to significant improvements in functional walking ability post-intervention, with further improvements at the 6-month follow up.

UKCO2016

September 19-20, 2016

51


Poster Presentation Abstracts 22 Poster: Body mass index and risk of advanced chronic kidney disease: Analyses from a primary care cohort of 1.4 million United Kingdom adults William Herrington1, Margaret Smith1, Clare Bankhead1, Mark Woodward1, 1University of Oxford, Oxford, UK Aim: To quantify the relevance of elevated body mass index (BMI) to advanced chronic kidney disease (CKD) among different types of people in the United Kingdom (UK). Methods: Population-based cohort study using the Clinical Practice Research Datalink records with linkage to secondary care/mortality data. Cox models were adjusted for age, sex, smoking and social deprivation and subgroup analyses undertaken for these variables plus potential mediators of risk (baseline diabetes, hypertension and vascular disease). Results: 1,405,016 UK adults aged 20-79 years with a BMI measurement recorded between 2000-2011 and at least 3 years followup were identified. Mean BMI was 27.4±5.6 kg/m2 and 71% of men (415,480/587,296) and 57% of women (464,895/817,720) were overweight or obese (BMI ≥25 kg/m2). During a median of 7.5 years follow-up, 11,347 participants developed CKD stages 4 or 5. After adjustment for age, sex, smoking and deprivation, compared to those with a BMI of 20 to <25 kg/m2, BMIs of 25 to <30 kg/m2, 30 to <35 kg/m2 and ≥35 kg/m2 were associated with 35%, 96%, and 212% increased risk of CKD stages 4 or 5 respectively (hazard ratios 1.35, 95% confidence interval [CI] 1.31-1.39; 1.96, 1.89-2.04; and 3.12, 2.97-3.28). A baseline history of diabetes, uncontrolled hypertension or prior vascular disease increased the risk of advanced CKD, but the shape and relative strength of BMI associations were similar among those with and without these mediators of risk, but were steeper among older adults and slightly steeper among women. Since 2000, among adults aged 40-79 seen in UK primary care, an estimated 39% (95% CI 36-42%) of incident cases of CKD stages 4 or 5 in women, and 27% (23-31%) in men, was associated with being overweight or obese. Conclusion: Compared to lean individuals, adults over the age of 40 who are overweight or obese are at increased risk of advanced CKD, both in the presence and absence of diabetes, uncontrolled hypertension or prior cardiovascular disease. 23 Poster: Maternal body mass index and post-term birth: a systematic review and meta-analysis Nicola Heslehurst1, Rute Vieira1, Louise Hayes1, Lisa Crowe1, Dan Jones1, Shannon Robalino1, Emma Slack1, Judith Rankin1, 1Newcastle University, Newcastle upon Tyne, UK Background: Post-term birth is a preventable cause of perinatal mortality and severe morbidity. This systematic review and meta-analyses examined the association between maternal BMI and post-term birth ≥42 weeks, and ≥41 weeks, gestation. Methods: Searches were carried out in 5 databases. Reference lists and citations were hand-searched; and authors contacted. Observational studies published in English since 1990, reporting maternal weight and post-term birth were included. Linear and nonlinear dose-response meta-analyses were conducted using random effects models. Sensitivity analyses assessed robustness of results. Meta-regression and sub-group meta-analyses explored sources of heterogeneity. Obesity classes were defined by BMI: I (30.0-34.9kg/ m2), II (35.0-39.9kg/m2), and III (≥40kg/m2; IIIa 40.0-44.9kg/m2, IIIb ≥45.0kg/m2). Studies unsuitable for meta-analyses were summarized narratively. Results: Meta-analysis was carried out for 19 studies of births ≥42 weeks (2,501,803 births), and 11 for births ≥41 weeks (444,706 births). A nonlinear association between maternal BMI and births ≥42 weeks was identified. The ORs and 95% CIs for obesity classes I-IIIb were 1.42 (1.27-1.58), 1.55 (1.37-1.75), 1.65 (1.44-1.87) and 1.75 (1.50-2.04) respectively. BMI was linearly associated with births ≥41 weeks with OR of 1.13 (95% CI 1.05-1.21) for each 5 unit increase in BMI. Conclusions: The strength of the association between BMI and post-term birth increases with increasing BMI. Odds are greatest for births ≥42 weeks among class III obesity; a double burden of disease among women with morbid obesity and substantial socio-economic inequalities. Targeted interventions to prevent the adverse outcomes associated with post-term birth should consider the differences in risk between obesity classes.

52

UKCO2016

September 19-20, 2016


Poster Presentation Abstracts 24 Poster: The impact of different snack foods on appetite control in the low satiety phenotype. Sophie Hollingworth1, Michelle Dalton1, John Blundell1, Graham Finlayson1, 1University of Leeds, Leeds, UK Introduction: Some individuals exhibit a weak satiety response to food and may be susceptible to overconsumption. Snack foods can be substantial contributors to daily energy intake, with different types of snacks exerting potentially different effects on satiety per calorie consumed. The current study compared the effect of consuming different snack foods on measures of appetite and food reward in women systematically classified as weak or strong satiety responders. Methods: In a crossover design, 42 female participants (age: 26.0 Âą7.9; BMI: 22.0 Âą2.0) consumed three different mid-morning snacks: raw almonds, savoury crackers or water. Appetite sensations, energy intake, food reward and craving were assessed under controlled laboratory conditions. Satiety responsiveness was determined using the satiety quotient (SQ). Results: A distinct low satiety phenotype (LSP) was identified. The LSP consumed more energy and reported greater craving for sweet foods compared to the high satiety phenotype. In addition, they reported greater levels of hunger, desire to eat and prospective consumption. Consumption of almonds had a greater satiating efficiency in the LSP compared to the comparator snack (crackers). Conclusion: Weak satiety responsiveness is a reliable trait, identifiable using the SQ. The LSP is characterised by behavioural and psychological characteristics indicating a risk for overeating. Furthermore, it may be possible to improve the satiety responsiveness of such at risk individuals. Research funded by Almond Board California. 25 Poster: Does personalised information about risk of cardiovascular disease and diabetes enhance uptake and adherence to a weight loss programme amongst women in the NHS Breast Cancer Screening Programme? Michelle Harvie1, Mary Pegington1, Gareth Evans2, Christi Deaton3, Basil Issa4, Louise Gorman1, Helen Ruane1, Chris Armitage5, David French5, Lee Graves6, Debbie McMullan1, Grace Cooper1, Julie Pickford7, Phil Foden1, Anthony Howell1, 1Nightingale Centre & Genesis Prevention Centre, University Hospital of South Manchester (UHSM), Manchester, UK, 2Central Manchester University Hospitals NHS Foundation Trust, Manchester, UK, 3University of Cambridge, Cambridge, UK, 4University Hospital of South Manchester (UHSM), Manchester, UK, 5Manchester Academic Health Science Centre, University of Manchester, Manchester, UK, 6The School of Sport and Exercise Sciences, Liverpool John Moores University, Liverpool, UK, 7Public Health Manchester, Manchester City Council, Manchester, UK Background: Excess weight and unhealthy lifestyles are common amongst women in the NHS breast screening programme (NHSBSP). They increase the burden of breast cancer, CVD and diabetes, but are not currently addressed within the NHSBSP. This feasibility study is assessing the uptake and adherence to a standard breast cancer prevention programme (BCPP) weight loss programme and a multiple disease prevention programme (MDPP) which includes personalised risk information on CVD and diabetes risk (NHS Health Check). Methods: Women from the NHSBSP were pre-randomised and invited by mailshot to either the BCPP (n=45) or the MDPP (n=81). The 12 month programme included individualised diet and exercise advice to follow a 5:2 diet and meet exercise recommendations (>150 min / week) and was mainly supported by a self-monitoring web site and tailored e-mails. Changes in weight, body composition and diet and exercise behaviours were assessed at 3, 6 and 12 months. Results: Uptake was comparable between the groups at 8.9% for the BCPP vs 9.6% for the MDPP. Four subjects in the BCPP group (8.9%) and 16 in the MDPP (19.8%) withdrew before 6 months (p=110). Both programmes invoked a good and comparable amount of weight loss at 6 months. LOCF analysis: mean (SD) weight loss BCPP -9.1 (6.1) % and MDPP -9.9 (5.4) %, p=0.471. The percentage of women achieving a clinically significant 5% weight loss at 6 months was 71.1 and 71.6% in the BCPP and MDPP groups, p=0.953. Conclusion: This web-supported weight loss programme achieved good levels of weight loss. At 6 months, results suggest that having an NHS Health Check and counselling women on personalised CVD and diabetes risk does not improve weight outcomes with the programme. Further analyses of 12 month findings will be presented at the ASO meeting in September 2016.

UKCO2016

September 19-20, 2016

53


Poster Presentation Abstracts 26 Poster: Factors influencing weight regain following bariatric surgery Jennifer James1, John Wilding1, 1University of Liverpool, Liverpool, UK. Following weight loss surgery, some individuals struggle to maintain their new lower weight and subsequently regain some or all of their lost weight. In this study participants reporting weight regain after surgery (Roux- en- Y gastric bypass, n=7; 5 female), were interviewed via semistructured interview, transcripts were analysed according to grounded theory as the theoretical framework. Participants were 48.6 (35-59) years, current weight 125.4 ± 11.4 kg. They were 5.7 years (3-10 years) since their surgery and on average achieved a maximal weight loss of 50.3 kg (34.65-58kg). Mean weight regain of participants was 50.6% (36-66%) of their maximal weight loss. Pre-operative behaviours that might identify risk of regain included; a history of ‘yo-yo dieting’ and ‘a lack of weight loss before surgery’ (despite engagement with specialist services). Behaviours present before and after surgery included ‘eating habits and behaviours inconsistent with weight management’ and ‘comfort eating or drinking’. Post operatively ‘the diminishing effects of surgery’, ‘inadvertent sabotage’, ‘lack of self monitoring’ and ‘lack of post operative support’ emerged as themes consistent across participant accounts. Identifying patients likely to struggle following bariatric surgery should be a priority for health care professionals. These people should not be denied surgery for their severe obesity, but identification of new strategies or care pathways should be considered to help identify these individuals before surgery, so that adequate support can be provided to help them achieve and maintain their weight loss goals for as long as possible. 27 Poster: Exploring determinants of overweight and obesity in South Asian Adolescents in England. Gurnam Johal1, Ellen Klemera2, Ruth Bell2, Fiona Brooks2, Therese Hesketh2, 1University College London, London, UK, 2Public Health England, London, UK, 3WHO Regional Office for Europe, Copenhagen, Denmark, 4Centre for Research in Primary and Community Care, University of Hertfordshire, Hertfordshire, UK. Introduction: The World Health Organization (WHO) stated that childhood obesity is one of the most serious challenges facing Public Health in the 21st Century, with obese children and adolescents facing a plethora of health complications. Data from 2014/15 National Child Measurement Programme (NCMP) highlighted obesity prevalence of 27.3% in Bangladeshi, 20.7% in Indian and 25.1% Pakistani 10-11 year olds (collectively ‘South Asian’) compared to 17.5% for White British. This research describes results of a literature review coupled with results of quantitative analysis of the WHO Health Behaviour in SchoolAged Children (HBSC) data exploring obesogenic behaviours in this demographic. Methods: The literature review involved undertaking electronic searches of computerised databases as well as searches of references of relevant papers. Grey literature including non-peer reviewed sources were included. The quantitative secondary analysis involved pooling the last three rounds of survey data (2006, 2010 and 2014) and examined variables including behaviours in these South Asian ethnic groups. Results: Key findings were that South Asians have lower physical activity levels compared to their white peers, have worse dietary behaviours and identified barriers to engaging in healthier lifestyles, compared to their non-ethnic counterparts. The findings from the analysis provide robust statistical evidence. Conclusion: This research found that negative lifestyle behaviours have been identified and there is a need for careful consideration of upstream policy and local health service provision/interventions in South Asian ethnic adolescents in England. Taking this ‘evidence into action’ will be crucial in addressing the obesity epidemic and reducing the existing health inequalities.

54

UKCO2016

September 19-20, 2016


Poster Presentation Abstracts 28 Poster: Iron Deficiency Anaemia (IDA) and Obesity – Are the two conditions linked? Husna Kaya Kacar1, Fiona McCullough1, Amanda Avery1, Sarah-Elizabeth Bennett2, 1University of Nottingham, Nottingham, UK, 2Slimming World, Derbyshire, UK Background: Obesity and iron deficiency are both global public health issues. A number of studies suggest that individuals who are obese are more likely to have an impaired iron status1. The study aim was to identify associations between body mass index (BMI) and indicators of iron status, including dietary intake, tiredness and low physical activity. Methods: Ethical approval was obtained to carry out an online survey, with female adult members of Slimming World (SW). 533 eligible non-pregnant female participants aged 19-49 took part. The questionnaire collected data before joining SW. Data including weight, height, eating habits, past medical history (PMH) of iron deficiency anaemia, use of iron supplements and level of fatigue2 experienced were reported using a combination of validated questionnaires. Data were analysed by BMI category. Results: Early analysis indicates that there was no significant difference between the two BMI groups in terms of PMH of iron deficiency anaemia. Number (%) Mean BMI Mean age Diagnosis of IDA (%) Treatment for IDA (%) Level of fatigue (%)

BMI<30 kg/m2 131 (24.6%) 27.2 35.5 36.9% 35.4% 38.6%

BMI≥30 kg/m2 365 (68.5%) 38.0 37.1 38.6% 37.9% 50.0%

p-value P<0.001 P=0.06 P=0.612 P=0.814 P=0.06

Conclusion: People with a higher BMI were more likely to have experienced fatigue but the finding was not significant. Refrerences 1. Cepeda-López, A.C. (2015). The double burden of malnutrition: obesity and iron deficiency (Doctoral dissertation, Wageningen: Wageningen University). 2. Belza, B. L., Henke, C. J., Yelin, E. H., Epstein, W. V., & Gilliss, C. L. (1993). Correlates of fatigue in older adults with rheumatoid arthritis. Nursing research, 42(2), 93-99. 29 Poster: Efficacy of Weight Loss and Physical Activity Intervention in Non-Alcoholic Fatty Liver Disease: A Systematic Review Sue Kennedy1, Joanna Sier2, Kathryn H Hart1, J. Bernadette Moore2, 1University of Surrey, Guilford, UK, University of Leeds, Leeds, UK Non-alcoholic fatty liver disease (NAFLD) is the most common cause of chronic liver disease worldwide with prevalence above 30% in many adult populations. As NAFLD is strongly associated with obesity, weight loss through diet and lifestyle change is the first clinical recommendation in its management. However, patients and general practitioners often question which dietary and physical activity interventions are most efficacious and periodic reassessment of the evidence base is essential. Therefore, the aim of this work was to systematically evaluate trials assessing weight loss, exercise, or a combination of weight loss and exercise interventions at reducing steatosis and/or improving histological and biochemical markers of liver disease in adult NAFLD patients. Medline, Scopus and Cochrane databases were searched from 1980 until December 31, 2015 for intervention trials assessing the effects of diet, weight loss, exercise or any combination thereof, on NAFLD disease markers. Inclusion criteria were studies in human adults with confirmed NAFLD measuring liver biochemical, radiological or histological markers as primary outcomes in response to diet, exercise, weight loss or combination interventions. The review was conducted in accordance with Prisma guidelines and is registered at Prospero (CRD42016032764). Risk of publication bias and study quality was assessed using the American Dietetic Association Quality Criteria Checklist. A total of 1483 records were derived from database searches. Thirty-six articles met the inclusion and exclusion criteria. The systematic search is currently being independently repeated and conclusions synthesised. This review will enable evidence-based recommendations for weight loss and exercise in the management of NAFLD.

UKCO2016

September 19-20, 2016

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Poster Presentation Abstracts 30 Poster: Applying an extended Theory of Planned Behaviour to predict breakfast consumption in adolescents. Sarah Kennedy1, Lisa Ryan2, Emma Davies1, Miriam Clegg1, 1Oxford Brookes University, Oxford, UK, 2Galway-Mayo Institute of Technology, Galway, Ireland Breakfast skipping increases during adolescence and is associated with lower levels of physical activity and weight gain. Theory-based interventions promoting regular breakfast consumption in adolescents report mixed findings, potentially due to limited information identifying which determinants to target. This study aimed to: (i) utilise the Theory of Planned Behaviour (TPB) to identify the relative contribution of attitudes (affective, cognitive, behavioural) in the predication of intention to eat breakfast and breakfast consumption in adolescents; (ii) determine whether gender moderates the relationship between TPB variables, intention and behaviour. Questionnaires were completed by 434 students (mean 14 ± 0.9 years) measuring breakfast consumption (0-2, 3-6 or 7 days), physical activity levels and TPB measures. Data were analysed by breakfast frequency and gender using hierarchical and multinomial regression analyses. Breakfast was consumed every day by 57% of students with boys more likely to eat a regular breakfast, report higher activity levels and more positive attitudes towards breakfast than girls (p<.001). TPB variables (except affective attitudes) significantly predicted 58% of the variation in intention. The model predicted breakfast consumption (p<.001), but the relative contribution of TPB constructs varied depending on breakfast frequency. Interactions between gender and intentions were significant when comparing 0-2 and 3-6 day breakfast eaters only, highlighting a stronger intention-behaviour relationship for girls. Findings confirm that the TPB is a successful model for predicting breakfast intentions and behaviours in adolescents. The potential for a direct effect of attitudes on behaviours should be considered in the implementation and design of breakfast interventions. 31 Poster: Are we where we eat? Eating at food outlets, leisure settings and “on the go” is associated with less healthy food choices than home Nida Ziauddeen1, Sara Kirk3, Tarra Penney2, Pablo Monsivais2, Sonja Nicholson1, Polly Page1, Eva Almiron-Roig1, 1MRC Human Nutrition Research, Cambridge, UK, 2UKCRC Centre for Diet and Activity Research (CEDAR), Cambridge, UK, 3School of Health and Human Performance, Dalhousie University, Halifax, Canada Background: Eating location has been linked with variations in diet quality including the consumption of low nutrient, energy dense food a recognised risk factor for obesity. With more occasions for eating taking place away from home, we explored food consumption patterns by eating location using data from a representative survey of the UK population. Methods: Cross-sectional data from participants aged 1.5 yrs and over from Years 1-4 of the UK National Diet and Nutrition Survey Rolling Programme (2008-12) were analysed. Eating location was categorized as home, school (in children aged 1.5-18 yrs only), work (in those aged 11 yrs+), leisure settings, food outlets and “on the go”. Foods were classified into two groups; core (those included in the principal food groups and considered important or acceptable within a healthy diet) and non-core (all other foods, for example biscuits, processed meat, etc). Other variables explored included percentage of meals eaten at home, age, sex, ethnicity, BMI, income, region, frequency of eating out, frequency of takeaway meal consumption, frequency of alcohol consumption and smoking status. Results: The main eating location across all age groups was home (67-90% of eating occasions) with the highest energy intake. The percentage of eating occasions in leisure settings, food outlets and “on the go” combined increased with age from 5% (1.5-3 yrs) to 9% (19-34 yrs) and decreased again to 5% (65 yrs+). Energy intakes from non-core foods were also higher than from core-foods in these locations. Children aged 4-10 yrs who ate school lunches had higher intakes of core foods and reduced intakes of non-core foods at school compared to those that had packed lunches. Regression analysis showed that participant age and frequency of takeaway meal consumption were significant factors affecting consumption patterns in children whereas participant age, frequency of eating out and alcohol consumption were significant factors in adults (p<0.01 for all comparisons). Conclusions: Supporting the availability and access to healthy foods in leisure settings, other food outlets, including those selling foods to eat “on the go”, may improve food choices. At the same time, the high percentage of eating occasions at home and school suggest these remain an important target for intervention.

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UKCO2016

September 19-20, 2016


Poster Presentation Abstracts 32 Poster: Characteristics of individuals developing type 2 diabetes in the SCALE Obesity and Prediabetes randomised, doubleblind, liraglutide vs placebo trial M. Lean1, D. Lau2, M. Blüher3, L. Van Gaal4, D. Rubino5, G. Guerrero6, L. Shapiro Manning7, J. Wilding8, 1University of Glasgow, Glasgow, UK, 2University of Calgary, Calgary, AB, Canada, 3University of Leipzig, Leipzig, Germany, 4Antwerp University Hospital, Antwerp, Belgium, 5 Washington Center for Weight Management and Research, Arlington, VA, USA, 6Novo Nordisk Inc, Plainsboro, NJ, USA, 7Novo Nordisk A/S, Søborg, Denmark, 8University of Liverpool, Liverpool, UK Background: The 3-year part of this trial examined the effect of liraglutide 3.0 mg, as adjunct to diet+exercise, in delaying onset of T2D (primary endpoint) in adults with prediabetes and BMI ≥30 kg/m2, or ≥27 kg/m2 with comorbidities. Methods: Individuals were randomised 2:1 to once-daily s.c. liraglutide 3.0 mg (n=1505) or placebo (n=749), with a 500-kcal/day deficit diet and 150-min/week exercise. Efficacy data are observed means, with LOCF. Clinicaltrials.gov NCT01272219. Results: Compared with the entire randomised population, at baseline, individuals who developed T2D by week 160 (liraglutide 3.0mg, n=26; placebo, n=46) were on average older (population developing T2D by week 160): liraglutide 48.4±8.3 years; placebo 49.3±13.2 vs entire population: liraglutide 47.5±11.7; placebo 47.3±11.8), had more dyslipidaemia (14 patients [54%]; 21 patients [46%] vs 499 patients [33%]; 249 patients [33%]) and hypertension (19 patients [73%]; 18 patients [39%] vs 635 patients [42%]; 312 patients [42%]), had higher baseline HbA1c (mean[SD]) (6.1±0.4%; 5.9±0.4%; vs 5.8±0.3%; 5.7±0.3%) and FPG (mean [SD]) (6.0±0.6 mmol/L; 5.9±0.6 mmol/L; vs 5.5±0.6 mmol/L; 5.5±0.5 mmol/L) and a higher BMI (40.2±8.6; 40.4±7.0; vs 38.8±6.4; 39.0±6.3 kg/m2). With continued treatment over 160 weeks, the estimated time to onset of diabetes was 2.7 times longer with liraglutide than with placebo (95% CI, 1.9 to 3.9, p<0.001), corresponding to a hazard ratio of 0.2. Mean weight loss at 3 years for the entire study population was 6.1% with liraglutide 3.0 mg vs 1.9% with placebo (estimated difference 4.3% [95%CI -4.9;-3.7], p<0.0001). Most individuals who developed T2D (>90% in both groups) lost less body-weight than the treatment group mean. In those with T2D, one hypoglycaemic event was reported with liraglutide 3.0 mg vs five with placebo, none severe. Liraglutide 3.0 mg was generally well tolerated. Conclusion: Liraglutide 3.0 mg for 3 years, as an adjunct to a low-calorie diet and increased physical activity, was associated with lower risk of type 2 diabetes and greater weight loss compared with placebo. 33 Poster: Men’s attitudes to body weight, barriers to weight loss and desired elements of a weight management programme: survey of Police Scotland officers and staff Wilma Leslie1, Kyla Booth1, Catherine Hankey1, 1University of Glasgow, Glasgow, UK. Purpose: Men are under-represented in weight loss interventions and research is needed to shed light on the reasons for this. The police force, a large employer of men, has received negative media attention regarding obesity and provided an ideal setting for this research. The present survey aimed to elicit men’s views on overweight/obesity; reasons for not engaging in weight management; preference regarding the content of weight management programmes (WMP), and explore if these differed from the views of women. Methods: Four hundred and sixty five Police Scotland staff members completed an anonymised, online survey (SurveyMonkey®). Results. The majority of respondents (91%), were police officers, 62% were men. A higher proportion of men were overweight or obese (50% & 17% respectively). The majority of all respondents (90%) viewed overweight/obesity as an important health issue, 83% felt it could impede job performance. In comparison to women, overweight men were more likely to report being comfortable with their weight (p=0.02). The majority of those actively trying to manage their weight were men (60%). Men would join a WMP and the majority (86%) would prefer a mixed gender programme. Shift work and getting time off work were the most frequently cited barriers to joining a WMP. The WMP element most frequently desired by men was gym membership. Views and preferences of female respondents were similar. Conclusion: While aware of the negative impact of obesity on both health and work performance, men tended not to view themselves as overweight which is a barrier to weight management. Initiatives are required to improve self-recognition of obesity among men in particular. Within the Police Force annual fitness checks provide an ideal opportunity for the identification and subsequent management of increasing body weight among male and female officers.

UKCO2016

September 19-20, 2016

57


Poster Presentation Abstracts 34 Poster: Inequalities in childhood obesity throughout primary school. Results of a longitudinal study in Birmingham. Susan Lowe1, 1Birmingham City Council, Birmingham, UK A longitudinal study of 26,728 primary school children in Birmingham. Investigating the factors affecting obesity prevalence within Birmingham. Tracking their weight status from Reception and followed up in Year 6. Undertaken using Birmingham City Council’s National Child Measurement Programme (NCMP) data. Tracking children using their measurements from Reception year in 2006/07, 2007/08 and 2009/10 and matching with those taken at the end of Primary School in 2012/13, 2013/14 and 2014/15. Mixed effect linear regression carried out examining effect of Reception year BMI z score on the z score at Year 6 adjusting for sex, ethnicity and socio-economic status using the deprivation scores from the Income Domain Affecting Children Index (IDACI) – 2010. Whilst generally obesity prevalence increases throughout primary school there are significant differences in BMI z score increases between socio-economic groups, ethnicities and gender between Reception and Year 6 children. Those in most deprived areas are more likely to become obese whilst at primary school. Boys are more likely than girls to move from a healthy weight to being obese. Largest increase in mean BMI z scores in Asian boys. Large local study using tracked NCMP data. Provides further insight into development of obesity through primary school. The findings highlight widening inequalities. 35 Poster: Beneficial effects of replacing diet beverages with water on Type 2 diabetic obese women following a hypo-energetic diet - a randomized, 24 week clinical trial Ameneh Madjd1, Moira Taylor1, Ian Macdonald1, Hamid Farshchi1, 1School of life sciences, Nottingham, UK. Aims: To compare the effect of replacing diet beverages (DBs) with water or continuing to drink DBs, on weight loss in Type 2 diabetes during a 24 week weight loss program. Materials and Methods: 81 Overweight and obese women with type 2 diabetes, who usually consumed DBs in their diet, were asked to either substitute water for DBs or continue drinking DBs five times per week after their lunch for 24 weeks (DBs group), while they were on a weight loss program. Results: Compared with the DBs group, the Water group had a greater decrease in weight (Water: -6.40 ± 2.42 kg; DBs: -5.25 ± 1.60 kg; P =0.017), BMI (Water: -2.49 ± 0.92 kg/m2; DBs: -2.06 ± 0.62 kg/m2; P =0.018), FPG(Water: -1.63 ± 0.54 mmol/l; DBs: - 1.29 ± 0.48 mmol/l, P=0.003), Hb A1C (Water: -1.16 ± 1.09%; DBs: -0.42 ± 0.21%, P<0.001),Fasting Insulin (Water: -5.71 ± 2.30 m lU/ml; DBs: -4.16 ± 1.74 m lU/ml, P=0.001), HOMA IR (Water:-3.20 ± 1.17; DBs: -2.48 ± 0.99, P=003) and 2h post prandial glucose (Water: -1.67 ± 0.62 mmol/l; DBs: -1.35 ± 0.39 mmol/l; P=0.009) over the 24 weeks. However, there was no significant group * time interaction for waist circumference or lipid profiles within both groups over 24 weeks. Conclusion: Replacement of DBs with water after the main meal in patients with type 2 diabetes may lead to more weight reduction during a weight loss program. It offers the clinical benefits of improved plasma glucose and insulin sensitivity.

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UKCO2016

September 19-20, 2016


Poster Presentation Abstracts 36 Poster: Anthropometric predictors of pulmonary function in relation to insulin sensitivity in adults with asthma Roham Sadeghimakki1, David McCarthy1, 1London Metropolitan University, London, UK. Background: There is a bidirectional association between asthma and metabolic syndrome. Insulin resistance (IR) and hyperinsulinemia also have strong molecular links with pulmonary disease. Moreover, obesity is another etiologic factor for both IR and asthma, but it is unclear which measures of adiposity is a better predictor of this relation. Objective: This study aims to investigate the strength of different adiposity measures in predicting impaired lung function among insulin resistant adults with asthma. Methodology: A cross-sectional study was performed on a sample of 1276 adults, extracted from NHANES 2009-2012. Based on HOMAIR values (<2.5 or ≥2.5), the individuals were divided into the insulin sensitive or insulin resistant group, respectively. Anthropometric variables (BMI, waist circumference (WC), waist to height ratio (WHtR), and conicity index) and pulmonary function measures (FEV1, FVC, and FEF 25-75%) were examined. Spearman’s correlation as well as multivariate linear regression were utilised to evaluate the relationships between obesity measures and spirometric parameters in asthmatic adults. Results: Two groups displayed significant correlations (p<0.005) between measures of obesity (BMI, WC, WHtR, and conicity index) and pulmonary function measures, although the associations were stronger in the insulin sensitive group: FVC (r=-0.19, -0.09, -0.34, and -0.16, respectively), FEV1(r=,-0.23,-0.21, -0.42, and -0.31, respectively), and FEF 25-75% (r=-0.22, -0.32, -0.41, and -0.43, respectively). WHtR was the strongest correlate of all spirometric parameters followed by the conicity index. After adjustment for age, height squared, gender, and smoking, the regression models could significantly predict the variability in FVC (p<0.01) and FEV1 (p<0.05) in the insulin resistant group. Again, WHtR and conicity index were better predictors of reduced FVC (127 and 121 ml for each 0.1 unit increase, respectively) and decreased FEV1 (82 and 75 ml for each 0.1 unit increase, respectively). However, no significant relationship was found in regression models for the insulin sensitive group. Conclusion: The abdominal obesity seems to predict impaired lung function better than general obesity in the insulin resistant asthmatic adults. 37 Poster: Reduction in the risk of developing type 2 diabetes (T2D) with liraglutide 3.0 mg in people with prediabetes from the SCALE Obesity and Prediabetes randomised, double-blind, placebo-controlled trial B. McGowan1, C. Le Roux2, A. Astrup3, K. Fujioka4, F. Greenway5, L. Lau6, L. Van Gaal7, R. Violante Ortiz8, J. Wilding9, T. Skjøth10, L. Shapiro Manning10, X. Pi-Sunyer11, 1Guy’s and St Thomas’ NHS Foundation Trust, London, UK, 2University College Dublin, Dublin, Ireland, 3 University of Copenhagen, Frederiksberg, Denmark, 4Scripps Clinic, La Jolla, CA, USA, 5Pennington Biomedical Research Center, Baton Rouge, LA, USA, 6University of Calgary, Calgary, AB, Canada, 7Antwerp University Hospital, Antwerp, Belgium, 8Instituto Mexicano del Seguro Social, Cuidad Madero, Mexico, 9University of Liverpool, Liverpool, UK, 10Novo Nordisk A/S, Søborg, Denmark, 11Columbia University, New York, NY, USA Background: The 3-year part of this trial investigated the effect of liraglutide 3.0 mg, as an adjunct to diet+exercise, in delaying onset of T2D (primary endpoint) in adults with prediabetes and obesity (BMI ≥30 kg/m²) or overweight (≥27 kg/m²) with comorbidities. Methods: Participants were randomised 2:1 to once-daily subcutaneous liraglutide 3.0 mg or placebo plus 500 kcal/day deficit diet and 150 min/week exercise. Efficacy data are observed means, with last observation carried forward for missing values. Clinicaltrials.gov ID: NCT01272219. Results: Of 2254 randomised individuals with prediabetes (age 47.5±11.7 years, 76.0% female, weight 107.6±21.6 kg, BMI 38.8±6.4 kg/ m2, mean±SD), 1128 completed 160 weeks (52.6% on liraglutide, 45.0% on placebo). At Week 160, mean weight loss (WL) was 6.1% with liraglutide vs. 1.9% with placebo (estimated treatment difference 4.3% [95%CI -4.9;-3.7], p<0.0001). Comparing liraglutide and placebo, 49.6% vs. 23.7% of individuals achieved ≥5% WL (estimated odds ratio [OR] 3.2 [2.6;3.9]) and 24.8% vs. 9.9% achieved >10% WL (OR 3.1 [2.3;4.1]), both p<0.0001. Based on the Kaplan-Meier plot of cumulative probability of a diagnosis of diabetes that takes censoring into account, 3% of patients in the liraglutide group vs. 11% in the placebo group were diagnosed with diabetes by week 160 while on treatment. With continued treatment over 160 weeks, the estimated time to onset of diabetes was 2.7 times longer with liraglutide than with placebo (95% CI, [1.9;3.9], p<0.001), corresponding to a hazard ratio of 0.2. Liraglutide was generally well tolerated. Gallbladder-related events (2.9 vs. 1.2/100 patient-years of observation [PYO]) and confirmed pancreatitis (0.29 vs. 0.13 events/100 PYO) were low, but more frequent with liraglutide. Conclusion: Liraglutide 3.0 mg for 3 years, plus diet+exercise, was associated with lower risk of T2D and greater weight loss compared with placebo.

UKCO2016

September 19-20, 2016

59


Poster Presentation Abstracts 38 Poster: Addressing malnutrition and high obesity rates in children 1 - 4 years through evidence based portion size ranges Judy More1, 1Infant & Toddler Forum, London, UK. Aim: To increase the evidence base and guidance on portion sizes and healthy eating guidelines to address malnutrition and obesity in 1-4 year olds. Method: Data from two large UK nutritional surveys – the Avon Longitudinal Study of Parents and Children (ALSPAC) and the National Diet and Nutrition Survey (NDNS) were used to develop portion size ranges. 1-4 year old’s appetites vary from meal to meal and day to day, therefore ranges (e.g. ½-1 medium slice of bread) rather than set amounts were considered more useful. The ranges were ratified using nutritional analysis software to show that combining the mid-point of the range of each food and drink according to healthy eating guidelines, the energy and nutrient requirements for this age group were met, with the exception of vitamin D for which a supplement is needed. Results: Guidance on balanced eating plans and portion size ranges were published in a peer reviewed scientific journal, and illustrated printed and online materials for parents and healthcare professionals developed. Conclusion: The portion size ranges are useful to: • guide parents and carers on how to safely limit energy intakes of 1-4 year olds who are at risk of overweight or obesity through eating to excess • dissuade parents from coercing children to eat larger portions than they need • guide parents on providing balanced diets for their children to prevent malnutrition such as iron deficiency. 39 Poster: Helping the nation lose weight: A partnership approach between PHE’s OneYou campaign and Slimming World Liam Morris1, Laura Holloway1, Sarah Bennett1, Emma Dowse1, Jacquie Lavin1, 1Slimming World, Derbyshire, UK Background: Scalable solutions bringing together partners from public and private organisations offer a valuable option in tackling public health priorities such as the national epidemic of overweight and obesity. Public Health England’s (PHE) OneYou campaign encourages adults, particularly aged 40-60, to lead a healthier lifestyle. Slimming World (SW) partnered with PHE to provide weight loss support. Preliminary uptake figures are reported. Methods: 20,602 adults were referred to SW via the ‘How Are You?’ tool – a questionnaire accessed via the PHE/SW websites providing personalised health-related recommendations. Where weight loss support was recommended, people were offered a choice of 12 weeks discounted group sessions and free membership or 3 months discounted online membership with SW. Results: SW data were processed producing 18,539 complete records with 60.7% of these choosing SW group membership. Consistent with current figures, 95.1% of those joining SW via OneYou were female. In comparison with recent SW audit data, of those choosing group support via OneYou, a greater proportion were aged 40-60 (54.5 vs 44.5), were older (44.9 vs 42.3yr), and had a higher mean start BMI (33.7kg/m2 vs 32.6kg/m2). For those choosing online support, figures were consistent with previous SW audit data across mean start BMI (31.8kg/m2 vs 31.9kg/m2) and age (41.3 vs 41.6yr). With a higher proportion of those aged 40-60 (50.5% vs 47.9%). Conclusion: The OneYou campaign in partnership with SW has been successful in encouraging large numbers of targeted adult groups to access a clinically effective weight loss programme.

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UKCO2016

September 19-20, 2016


Poster Presentation Abstracts 40 Poster: Exploring barriers and facilitators of fruit and/or vegetable consumption in pre-school children: a meta-synthesis using the Theoretical Domains Framework Claire O’Malley1, Carolyn Summerbell1, Helen Moore1, Nicola Heslehurst2, 1Durham University, Stockton-on-Tees, UK, 2Newcastle University, Newcastle upon Tyne, UK Background: Fruit and vegetable consumption has been shown to play a significant role in the prevention of chronic diseases. Children establish eating behaviours at a very young age, particularly within the first five years of life. Responsibility of food provision lies heavily with parents and caregivers and consequently influences child behaviour. Identifying barriers and facilitators to this provision is key in designing effective and sustainable interventions to increase fruit and vegetable consumption in this age group. This mixed methods systematic review aimed to identify potential determinants of parental and caregiver behaviours which may influence fruit and/or vegetable consumption in pre-school children. Methods: Eight databases were searched. Reference lists and citation searches were also performed (PROSPERO registration number: CRD42015024627). 30 qualitative and questionnaire studies among parents or preschool childcare providers were included. Data are currently being analysed using the Theoretical Domains Framework (TDF). The TDF is an integrative theoretical framework comprised of 33 psychological theories, integrated into 12 domains. These domains represent the scope of theoretical constructs which are considered either barriers or facilitators of specific behaviours, in this case parents behaviours and the impact this has on their ability to provide fruit and/or vegetables to children in their care. Results: The results from this review will identify barriers and facilitators to provision of fruit and/or vegetables to young children. Data generated will guide the development of a theory-based behaviour change obesity prevention intervention which aims to increase F&V consumption in pre-school children. 41 Poster: Group-based weight management programme versus multisession advice in general practice in areas of high social deprivation: A randomised controlled trial Hayden McRobbie1, Peter Hajek1, Sarrah Peerbux1, Brennan C Kahan2, Sandra Eldridge2 Dominic Trepel3, Steve Parrott3, Chris Griffiths4, Sarah Snuggs1, Katie Myers-Smith1, 1Health and Lifestyle Research Unit, Wolfson Institute of Preventive Medicine, Queen Mary University of London, Health and Lifestyle Research Unit, London, UK, 2Pragmatic Clinical Trials Unit, Queen Mary University of London, Barts and The London School of Medicine and Dentistry, London, UK, 3Department of Health Sciences, The University of York, York, UK, 4Centre for Primary Care and Public Health, Blizard Institute, Queen Mary University of London, Barts and The London School of Medicine and Dentistry, London, UK Background: An increasing number of people require help to manage their weight. Evidence-based treatments are needed that can be disseminated economically. We compared a group-based weight management programme (Weight Action Programme; WAP) with a ‘best practice’ intervention provided in primary care by a practice nurse. Methods: 330 adults living in areas of high social deprivation with a body mass index (BMI) ≥ 30 kg/m2 or BMI ≥ 28 kg/m2 with comorbidities were randomised in a 2:1 ratio to the WAP or practice nurse arms. WAP comprised eight weekly group sessions concerning diet and physical activity followed by ten monthly maintenance sessions. The Practice Nurse intervention consisted of four one-to-one sessions delivered over eight weeks that provided standard advice on diet and physical activity. The primary outcome was the change in weight at 12 months. Results: 221 participants were allocated to WAP and 109 to the Practice Nurse intervention. 291 participants (WAP=194 (88%); Nurse=97 (88%)) provided at least one recorded outcome and were included in the primary analysis. Weight loss at 12 months was greater in the WAP arm (-4.2kg vs. -2.3kg; difference = -1.9kg, 95% CI: -3.7 to -0.1; p=0.04). Participants in the WAP arm were also more likely to lose at least 5% of their body weight (41% vs. 27%, OR = 14.61 95% CI: 2.32 to 91.96, p=0.004). Conclusions: A group-based programme was more effective than a ‘best practice’ intervention. WAP can provide a public-domain template that can reach clients from diverse ethnic and socio-economic backgrounds. This project was funded by the National Institute for Health Research Heath Technology Assessment (project number 09/127/34). The views and opinions expressed therein are those of the authors and do not necessarily reflect those of the Health Technology Assessment, NIHR, NHS or the Department of Health.

UKCO2016

September 19-20, 2016

61


Poster Presentation Abstracts 42 Poster: Proactive Assessment of Obesity Risk during Infancy (ProAsk): Can UK Health Visitors deliver a targeted prevention programme? Jennie Rose1, Sarah A Redshell1, Chris Glazebrook2, Jo Ablewhite2, Judy Swift2, Aloysius Niroshan Siriwardena3, Nathan Dilip4, Stephen Weng2, Heather Wharrad2, Pippa Atkinson5, Vicki Watson5, Fiona McMaster1, Ken Ong6, Rajalakshmi Lakshman6, 1Anglia Ruskin University, Cambridge, UK, 2University of Nottingham, Nottingham, UK, 3University of Lincoln, Lincoln, UK, 4Nottingham University Hospitals Trust, Nottingham, UK, 5Nottingham CityCare Partnership, Nottingham, UK, 6University of Cambridge, Cambridge, UK. Background: ProAsk is an interactive digital tool that calculates an infant’s risk of becoming overweight using a validated algorithm. It enables Health Visitors (HVs) to feedback to parents an infant’s overweight risk status and to deliver a targeted Motivational Interviewing (MI) based intervention to reduce risk. This paper reports the results of a feasibility study of the implementation of ProAsk with UK HVs. Methods: HVs (N=49) based at four socially deprived localities received training in ProAsk delivery and MI before parents (N=66) of 6-8 week old infants were recruited to the study. HVs used ProAsk with parents (N=53) when the infants were three months old. Quantitative data were collected on infant risk factors. Qualitative data on the HVs’ (N=15) experiences of using ProAsk were collected using semi-structured interviews. Results: The median risk score was 6.7%. With a risk threshold of 10%, 21 (40%) infants were at above average risk. Those at risk had a higher birthweight (3.86kg vs 3.28kg, p<0.001), weight for age z-score (0.32 vs -0.67, p<0.001) and paternal BMI (30.1kg vs. 26.5kg, p=0.017). A thematic analysis of HV interviews identified three themes about ProAsk delivery: (1) Stimulating dialogue on reducing obesity risk (2) Mastering unfamiliar technology (3) Mismatch between HVs’ universal role and targeted intervention. Conclusions: HVs were able to use ProAsk to calculate infant obesity risk and to support discussions with parents about strategies for obesity prevention. However, HVs lack of experience using technology in a clinical setting and their desire to deliver a universal rather than targeted intervention presented challenges for intervention fidelity and protocol adherence. Strategies to support HVs to deliver ProAsk are needed. 43 Poster: Exploring the obesogenic environment: Understanding the health impact of contemporary urban living. Rachael H Sibson1, Chris Yuill1, Arthur Stewart1, Iain Broom1, Giovanna Bermano1, 1Robert Gordon University, Aberdeen, UK This study aims to explore multiple and interrelated processes, with respect to behaviour and attitudes of individuals in an obesogenic environment, that may help to understand underlying pre-conditions for the aetiology of obesity. Seven validated questionnaires and semistructured interviews were used to investigate the way individuals relate themselves to food and what affects their choices, how they view themselves and their outlook on life. Twenty-nine participants from the North East of Scotland (convenience sample) age 18-70 y, were grouped according to BMI, obese (OB, n=6, BMI ≥30kg/m2), overweight (OW, n=11, 25≤BMI<29.99kg/m2), and normal weight (NW, n=12, 18.5≤BMI<24.99kg/m2). Results suggest the OB participants have a poor body image, low levels of self-esteem and an instrumental approach toward food. The OW participants present a more relaxed attitude toward body image and higher levels of self-esteem, with a clear love for food. The NW participants display a mix of either like or dislike toward their body image and somewhat lower levels of self-esteem. The NW and OW participants have more overlap in how they relate to food, though NW participants may possess greater discipline than OW participants. These preliminary findings may cast doubt on the traditional understanding that being overweight is on a pathway of ‘disease progression’ to obesity. This pilot work forms the basis for a larger study on a more diverse population and the outcome could have important implications for government policy in relation to food choice and availability. 44 Poster: Adolescent drink preferences and weight Andrea Smith1, Alison Fildes1, Lucy Cooke1, Clare Llewellyn1, 1Health Behaviour Research Center, Department of Epidemiology and Public Health, University College London, London, UK, Background: There is growing concern over high consumption of energy-dense beverages (e.g. sugar-sweetened beverages, SSBs) among children and adolescents. Preferences are important drivers of actual intake; increased liking for caloric beverages may therefore predispose to higher intake, and overweight. We tested the hypothesis that greater liking for caloric beverages is associated with higher BMI in adolescence. Methods: 2865 twins (18-19 years old) from the Twins Early Development Study reported preferences for 9 beverage types (SSBs, non-nutritive sweetened carbonated beverages [NNSBs], orange juice, fruit squash, milk, tea, coffee, tea, beer, wine) using a 5-point Likert scale. BMI was calculated from self-reported height and weight. Complex Samples General Linear Models were used to establish associations between beverages types with BMI, adjusting for clustering of twins in families and confounders. Results: Higher preference for NNSBs, beer and fruit squash was positively associated with BMI. Maximum versus minimum liking scores (5 versus 1) were associated with a difference of 1.08 (NNSBs), 0.81 (beer) and 0.65 (fruit squash) BMI units. Individuals in the top versus the lowest 10% of BMI percentiles had significantly higher liking for NNSBs (3.93 versus 3.53, p<0.01). Conclusions: Increased liking for beer and fruit squash among higher weight adolescents supports the hypothesis that greater liking for energy-dense beverages predisposes to overweight. The positive association between liking for NNSBs and BMI could reflect increased dieting behaviour among higher weight adolescents, or NNSBs predisposing to overweight. Longitudinal studies are needed to establish the direction of the relationship between beverage preferences and weight.

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UKCO2016

September 19-20, 2016


Poster Presentation Abstracts 45 Poster: Beyond the individual – context and community in social policy. Sophie Spencer1, Giovanna Bermano1, Arthur Stewart1, Iain Broom1, Chris Yuill1, 1Robert Gordon University, Aberdeen, UK. It is proposed that social policy at all levels, which intends to speak to issues of obesity, needs to be radically reoriented to be much wider than a narrow focus on individual behaviour, food and weight. The fundamental objection to these prevailing individualised approaches to obesity is that they ignore the contexts, resources, symbolic cultures, material and spatial circumstances that shape and condition both people and the communities they inhabit, in an interdependent linkage between food choice, eating behaviour and body shape. To be more effective social policy needs to tackle the issues and circumstances that both address the complexities of peoples’ lives and tackle underlying social structural barriers to effective change. What some of those policy changes will be discussed here and are informed by our recent trans-disciplinary research. It was found that policy needed to be geared to the specific needs of communities and the structural barriers they encounter that prevent change as opposed to a focus on individual decision-making. Fundamental was that policy should focus on creating the context for people to live meaningful lives. For example, the spatial isolation of groups of people living in areas classified as being economically deprived prevented access not just to cheaper food purchasing options but also wider richer food cultural practices. An affordable integrated public transport policy may be one way to achieve that. The presentation therefore will briefly outline the study that informs the suggested policy directions, while making the wider case for innovative policy solutions. 46 Poster: How group interventions are delivered in Tier 3 weight management programmes across the UK: A scoping review of current practice. Dawn R Swancutt1, Mark Tarrant2, Jonathan Pinkney1, 1Plymouth University, Plymouth, UK, 2University of Exeter, Exeter, UK Background: In response to rising demand for specialist Tier 3 weight-management clinics, many NHS providers have developed group programmes. However, there is limited information on how groups are used in these services, or evidence on the indications for, and optimal structure and delivery of these approaches. We undertook a scoping exercise to describe current use of group approaches in Tier 3 to begin to address this knowledge gap. Methods: Current use of group-based approaches was investigated at ASO Centres of Obesity Management. Centres shared information on their use, or non-use, of group sessions for patients and on design and delivery of these groups. Results: Among responders, group approaches were widespread but not universal. In centres using groups, the objectives, methods, structure and content of group activities varied widely, and included both meetings and social media. Duration of individual sessions ranged from 40 minutes to 2 hours, and sometimes included physical activity. Some programmes explicitly based content on behavioural change theory, whereas others took a more pragmatic approach, incorporating ongoing content development and update. Some centres provided group approaches for selected indications (eg eating disorders, psychological support, pre and post bariatric surgery), whereas others routinely adopted group approaches for all patients. There was little data on performance and outcomes. Discussion: A range of highly innovative uses of group treatments was observed, but there was substantial variation in use, design and delivery. The optimum design and best practice for these potentially important interventions in Tier 3 weight management are unclear. 47 Poster: Perceived Barriers to Weight Loss: A Case Study Report Daisy G.Y. Thompson-Lake1, Hayden McRobbie1, Richard De La Garza II2, Peter Hajek1, 1Queen Mary University, London, UK, 2 Baylor College of Medicine, Houston, Texas, USA Background: Obesity is a major health concern leading to physical complications and associated with mental disorders. Increasing behavioral and neurological similarities between substance use disorder and non-substance use disorders, such as food addiction, have been reported in scientific literature. However, while case studies of nicotine-, alcohol- and substance-use disorder exist, to our knowledge, there currently exists no case studies of individuals who are willing, and who desire, to lose weight and yet are unable to do so. Participants: Four participants (3 female) were recruited from Bart’s Obesity and Metabolic Clinic to discuss perceived barriers of weight loss. Mean age was 43 years old (SD±10.2), mean weight 132.8 Kgs (SD±20.8), and mean BMI 45.1 (SD±7.8). Results: Similarities and differences were summarized across cases. All participants left school before age 17, had high levels of stress in their daily lives and feelings of guilt or shame around their weight gain. Two participants showed evidence of food addiction and reported eating in response to negative emotions. One participant believes that genetic and environmental factors were the biggest barriers to weight loss, and one participant was resistant to lifestyle changes that may impact his continued weight gain. Discussion: These case studies demonstrate the different perceived barriers and therefore the importance of individual tailored therapy to help individuals with weight loss. This study is also the first case study to report perceived barriers in weight loss in those unable to lose weight despite a desire to do so.

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Poster Presentation Abstracts 48 Poster: Hosting a specialist weight management service in a cardiovascular rehabilitation setting: Another useful step towards ‘generic’ lifestyle services? Russell Tipson1, Linzi Murray1, Anne Welsh1, Mark Lynch1, Harkesh Verdi2, Jane Flint2, 1Action Heart, Dudley, UK, 2Dudley Group of Hospitals NHS Foundation Trust, Dudley, UK. Introduction: The Action Heart Cardiovascular Rehabilitation Programme (AHCRP) agreed to develop and deliver a specialist weight management service for adults with obesity, due to its experience and success in delivering lifestyle interventions to a wide range of patient populations. Methods: Individuals satisfying the referral criteria (generally BMI >40 kg/m2) were eligible to be referred to the new service, attending the ‘Action Weight’ clinic once per week for twelve weeks. All patients were set a 5% weight loss target and were allowed to progress to a maintenance programme if they were successful in achieving this target. In line with NICE guidelines, the Action Weight Team comprised of a dietitian, a CBT counsellor and an exercise professional, all of whom were associated with the AHCRP. The participants were encouraged to exercise in the Action Heart Centre, alongside other patient populations and hospital staff. Results: In the first twelve months, 93 patients started the course (female 71%, male 29%). Of these, 27 patients (29%) dropped out prior to completing the programme. At the time of analysis, 13 patients were still active in the programme. Of the 53 completers, 27 patients (51%) were successful in achieving the 5% weight loss target, including 4 patients (8%) achieving a 10% weight loss. Of the 53 completers, 52 had reduced their weight on completion of the 12 week programme. Conclusion: The above results suggest a weight management programme can be hosted successfully in a cardiovascular rehabilitation setting. The cardiovascular rehabilitation environment proved to be inspiring, encouraging the majority of Action Weight patients to undertake regular exercise at the Action Heart Centre. The new weight management service also received appropriate ‘cross-referrals’ from the AHCRP, providing this CVD population with additional valuable support in achieving their rehabilitation goals. 49 Poster: Getting Serious About Obesity: Connecting research to policy and local to national in Scotland Lorraine Tulloch1, Anna Strachan1, 1Obesity Action Scotland, Glasgow, UK Obesity Action Scotland is a new unit based within the Royal College of Physicians and Surgeons of Glasgow. It was established in June 2015 at a time when evidence and policy on obesity prevention was moving quickly. In order to get early wins and to see progress it had to build profile, establish alliances, make impact and respond quickly yet credibly to a fast moving public and political debate. One of its early tasks was to set up an alliance of organisations across Scotland with an interest in tackling obesity. With a population of 5.29 million, Scotland is often seen as a country where the scale of organisations is large enough to make a difference but small enough to be well connected and focused. Successful alliances have already made a difference in the areas of tobacco and alcohol. A partnership event was held on 29th April 2016 where 30 organisations from public sector, third sector and research came together to discuss the concept of an alliance within Scotland. This was the first time this concept was discussed within Scotland. A core planning group has been established to consider the purpose, structure and priority issues for the Alliance. This presentation will outline the journey that has been undertaken by Obesity Action Scotland in establishing itself. It will consider the subtle policy and political differences of tackling obesity within a devolved setting. It will consider the distinct approaches Obesity Action Scotland has undertaken to make an impact and respond credibly and tactically to a fast paced policy area. The presentation will consider what a devolved setting means when looking for policy solutions to obesity? What connections exist and can be enhanced between academia and policy and between national and local players through an alliance? 50 Poster: Evaluation of a brief intervention to increase awareness that of new recommendations on free sugars within a in a University setting Claire Wright1, 1University of Chester, Chester, UK This study assessed awareness of new advice that sugar should comprise ≤ 5% of daily energy including the ‘free sugars’ present fruit juices and smoothies. Online surveys were distributed to university staff and students before and after, a brief intervention. This was an e-newsletter, which summarised recommended sugar intake and free sugar content of a range of drinks and snacks including fresh fruit. Response to the initial survey was 680 and to both surveys 403 (201 staff, 202 students), median (IQR) age: 28 (21-40) years, 77% were female, 38% reported weight gain in the previous 12 months. Following the intervention the proportion of respondents who were aware of the advice increased significantly: 62% vs 87%, p=0.0005. At baseline respondents were within 1 level teaspoon (tsp=4g) of the correct sugar content of a 45g bar of chocolate but significantly underestimated the median (IQR) sugar content of a smoothie by: -4.5 tsp (-9.5,3.5), flapjack: -5 tsp (-7,-1) and fruit cordial: -4.5 tsp (-7.5,-0.5). The brief intervention had little effect on ability to estimate sugar, this only improved significantly for a fruit smoothie (p=0.014). Following intervention the proportion of respondents who believed that whole fruit contains zero free sugars increased (3 vs 12%, p<0.0005) but most (88%) remained unclear that fruit has no ‘free sugars’ and further education is required on this term.

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Poster Presentation Abstracts 51 Poster: Is dietary sugar essential? University-based surveys before and after SACN (2015) suggest that most respondents believe it is. Claire Wright1, 1University of Chester, Chester, UK Sugar has no Dietary Reference Value outlining a minimum intake for health. This study surveyed beliefs about the role of sugar in the diet in a university setting. Two surveys were conducted before and after the SACN report in July 2015 which advised a reduction in the UK guideline for sugar intake from ≤10 to ≤5% of energy. The first online survey distributed to staff and students in February 2015 included questions about the COMA guidelines for maximum recommended dietary sugar in men and women. Both surveys included a question on whether sugar was perceived to necessary in the diet. The November survey in addition asked whether respondents believed that there is a “minimum dietary requirement for sugar”. In the February 2015 survey 8% of respondents (110/1310) correctly assigned the COMA guidelines on average sugar intake for men (≤70g/d) and 13% for women (≤50g/d), 37% and 35% responded “don’t know”, about half (54% and 49%) underestimated intake. In February 70% agreed (920/1310) that “sugar in the diet is necessary for energy”, 11% were unsure and 19% disagreed, post-SACN in November results were similar; 64% (437/680) agreed, 15% were unsure and 21% disagreed. About half respondents (49%) in the November survey believed there is a minimum dietary sugar requirement for health, 26% were unsure and 25% disagreed. This study suggests that most people, even in a university setting, mistakenly believe that dietary sugar is essential for health. In March 2016 the revised Eatwell information removed sugary foods from the purple section of the guide. Further evaluation is required to determine if this will improve public understanding of the role of sugar in the diet. 52 Poster: Reflecting on trans-disciplinarity in obesity research Chris Yuill1, Sophie Spencer1, Arthur Stewart1, Giovanna Bermano1, Iain Broom1, 1Robert Gordon University, Aberdeen, UK. Many commentators have noted that a satisfactory understanding of obesity must reach beyond the confines and silos of specific individual disciplines. By doing so, the various articulations between the biological, psychological, sociological, anatomical and other aspects of obesity could be identified in order to derive a full account of the causality of obesity and the lived experiences of people with obesity. Drawing from a pilot research study, reflections are provided on an attempt to develop not just a multi-disciplinary approach to the study of obesity but one that sought to be trans-disciplinary that synthesised the knowledge of the different discipline practitioners. The research that provides the focus for this presentation involved researchers from nutritional and health science, and sociology. We began with a distinct ontological position that informed the research. It posited obesity as an emergent property of different interacting and internally-related mechanisms and processes that existed in all spheres of human existence. The critical realism of Bhaskar and other post-empiricist thinkers was critical at this juncture. That grounding consequently influenced the research methods and the novel modes of analysis that were adopted. The main innovation we developed was a biological and social profile of each research participant, which allowed us to begin tracking linkages in obesity. The presentation will therefore outline the above methodology in greater detail but also discuss the very real challenges of what it means to work beyond traditional discipline delineations.

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UKCO2017 Cardiff, Wales 4th UK Congress on Obesity - September 2017 Details to follow at www.aso.org.uk

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