Our overall objective was to explore some individual and environmental determinants of eating habits with a main focus on nutrition labels and their usefulness for choosing foods for weight management. We first broadly examined these determinants using participants of the AFMNet Canadian Consumer Monitor (CCM), and found a number of attitudinal and perceived environmental barriers to healthy eating. In an experimental study with CCM respondents, we found that reduced fat claims may help consumers make better choices for weight management if calorie content on the Nutrition Facts Table is also considered. However, in our examination of foods with fat claims in the Canadian marketplace, we found that most products with fat claims are not significantly lower in calories than comparable foods without such claims. We conclude that fat claims could be useful in assisting consumers with food choices for weight management, if the foods were also reduced in calories.

Our overall objective was to explore some individual and environmental determinants of eating habits with a main focus on nutrition labels and their usefulness for choosing foods for weight management. We first broadly examined these determinants using participants of the AFMNet Canadian Consumer Monitor (CCM), and found a number of attitudinal and perceived environmental barriers to healthy eating. In an experimental study with CCM respondents, we found that reduced fat claims may help consumers make better choices for weight management if calorie content on the Nutrition Facts Table is also considered. However, in our examination of foods with fat claims in the Canadian marketplace, we found that most products with fat claims are not significantly lower in calories than comparable foods without such claims. We conclude that fat claims could be useful in assisting consumers with food choices for weight management, if the foods were also reduced in calories.

Current methods of energy restriction are not successful for achieving long-term weight loss and maintenance for the majority of individuals. As a result, the prevalence of obesity and obesity related diseases continue to increase. This calls for the development of novel lifestyle interventions to combat the obesity epidemic. Hunger has been highlighted as a major factor influencing the long-term success of weight management methods and therefore how a given dietary intervention affects the appetite regulatory system may dictate the success of the diet by augmenting long-term adherence. In addition, the effect of a given dietary intervention on exercise may determine its suitability for exercising individuals and may influence the energy deficit that can be achieved by the diet. This thesis investigated the acute effects of two novel methods of dietary restriction; breakfast omission and severe energy restriction. The main aims for this thesis were to determine the effect of these methods of energy restriction on ad-libitum energy intake, subjective appetite sensations, and peripheral concentrations of hormones involved in appetite regulation. In addition, this thesis also investigated the effects of these methods of energy restriction on metabolism and glycaemic control at rest, and performance and perceived exertion during exercise. This work found that moderate and severe energy deficits induced by breakfast omission and 24 h of severe energy restriction, respectively, resulted in either no (Chapter VIII) or partial (Chapters IV and VII) energy intake compensation over the subsequent 24-48 h. Subjective appetite was increased during (Chapters IV, V, VII and VIII) and shortly after (Chapter VII) energy restriction, but this effect was transient and was offset after an ad-libitum (Chapters IV and VII) or standardised (Chapters V and VIII) meal. In addition, none of the work presented in this thesis demonstrated an appetite hormone response to energy restriction that was indicative of compensatory eating behaviour. Compared to breakfast omission, breakfast consumption resulted in an increased in resting energy expenditure and carbohydrate oxidation, with a concurrent reduction in fat oxidation during the morning. However, there were no differences after lunch (Chapter V). In response to a standardised breakfast, resting energy expenditure was suppressed (Chapter VII) or not different (Chapter VIII) the following morning, after 24 h severe energy restriction compared to energy balance. Plasma NEFA and fat oxidation was greater, carbohydrate oxidation was reduced, and postprandial insulin sensitivity was impaired in the after 24 h severe energy restriction (Chapter VI, VII and VIII). In Chapter IV, omission of breakfast in the morning was shown to reduce exercise performance in evening, even after provision of an ad-libitum lunch 4 h before. However, there was no difference in perception of effort during steady state exercise, independent of breakfast consumption or omission in the morning (Chapters IV and V). Collectively, breakfast omission and 24 h severe energy restriction reduce energy intake and promote an appetite regulatory response conducive to maintenance of a negative energy balance. Chronic intervention studies are now required to confirm whether these effects persist after long-term practice of these dietary interventions.

abstract: Excessive gestational weight gain (GWG) during pregnancy is a major public health concern. Studies have reported more than 70% of pregnant women gain excessive weight which may pose increased maternal and fetal risks. Little is known about the relationships of GWG to behavioral factors (i.e., physical activity, sleep, social support) and maternal mental health (i.e., stress, anxiety, depression) during pregnancy. This descriptive, cross-sectional study explored the relationships of GWG to behavioral factors and maternal mental health during pregnancy. Secondarily, this study described the preferences, uses of, and interests in alternative approaches as well as the mental health differences between users and non-users of alternative approaches during pregnancy. A national survey was administered to women ≥8 weeks pregnant, ≥18 years old, and residing in the United States (N=968). Bivariate correlations were used to determine relationships between GWG and variables of interest. Independent t-tests were used to observe mental health differences between users and non-users of alternative approaches. Data were analyzed throughout pregnancy and by trimester. Throughout pregnancy, significant relationships were found in GWG to stressful events (r=-.112, p<.01), depression (r=.066, p<.05), mindfulness (r=-.067, p<.05), and sleep (r=.089, p<.01). When GWG was assessed by trimester, stressful events were significant in the second (r=-.216, p<.01) and third trimesters (r=-.085, p<.05). Depression remained positively related to GWG in the first (r=.409, p<.01) and second trimesters (r=.162, p<.01). A positive relationship emerged between GWG and anxiety in the first trimester (r=.340, p<.01) and physical activity became significant in the second (r=-.136; p<.05) and third trimesters (r=-.100; p<.05). Mindfulness was the only variable significantly related to GWG throughout all time points. Mean anxiety (d=.236; p=.001) and depression (d=.265; p<.001) scores were significantly lower in users compared to non-users of alternative approaches throughout pregnancy and when assessed by trimester anxiety (d=.424; p=.001) and depression (d=.526; p<.001) were significant in the second trimester. This study provides a framework for future analyses in GWG and maternal mental health. The information presented here may inform future interventions to test the effectiveness of alternative approaches to simultaneously manage maternal mental health and GWG due to the integrative nature of alternative approaches. / Dissertation/Thesis / Masters Thesis Exercise and Wellness 2015

Abstract The aim of this study was to describe the characteristic features of weight management and lifestyle changes of people of working age at risk of type 2 diabetes. Seventy-four persons at high risk of type 2 diabetes, 33 men and 41 women, took part in the study. They attended group counselling sessions led by a dietician either at distance or face-to-face. There were 5 distance groups, with the counselling given by a dietician via a videoconferencing link to participants who met in the meeting room of their local health care centre. There were 6 personal groups where the dietician and the group participants met face-to-face at the same location. Each group had 5 to 9 participants. The following were used as study material: videotaped group discussions on the benefits and barriers of lifestyle changes at the beginning of the counselling process, weight management at the beginning and at the end of the process, and weight management and the preconditions and risk factors of successful weight management at the follow-up visit 1.5 years after the end of the process. In addition, study data were gathered before the first and last interventions and before the follow-up visit with a questionnaire sent to the subjects. The subjects were weighed at the beginning and at the end of the counselling process as well as at the follow-up visit. The video material was analysed using both inductive and deductive content analysis. The data were analysed also using SPSS 16.0 software for Windows. At the beginning of the counselling process, 68%, 9% and 14% of the subjects were at the contemplation, preparation and action stages, respectively, the corresponding percentages at the end of the counselling process being 24%, 33% and 40%. Forty subjects had made progress in their lifestyle change stage, 18 had remained where they had been, while 5 had regressed. One and a half year after the end of the counselling process, about half of the subjects were at the maintenance phase in terms of various lifestyle factors (restricting the amount of food, eating regular meals, increasing the intake of nutritional fibre, unsaturated fat and physical activity, restricting alcohol intake). Twenty-one subjects reported relapses, most often in terms of restricting the amount of food intake. Improved health and functional ability were seen as the benefit of lifestyle change. A change in lifestyle calls for effort and resources. The preconditions of successful weight management were one.s own actions, motivation and resources. Weight management was made more difficult by lack of commitment to one’s own actions and lack of goals, self-discipline and motivation. The information obtained with the study may be utilised in developing interventions aimed at persons at risk of type 2 diabetes as well as their contents and methods. The results can also be made use of in improving the counselling skills of health-care students and professionals. / Tiivistelmä Tutkimuksen tarkoituksena oli kuvata tyypin 2 diabeteksen riskiryhmään kuuluvien työikäisten henkilöiden painonhallinnan ja elintapamuutoksen tunnuspiirteitä. Tutkimukseen osallistui 74 työikäistä tyypin 2 diabeteksen korkean riskin henkilöä. Tutkittavista 33 oli miehiä ja 41 naisia He osallistuivat ravitsemusterapeutin ryhmäohjaukseen joko etä- tai lähiryhmässä. Etäryhmiä oli 5. Niissä ohjaus toteutui siten, että ohjaaja oli videoneuvottelulaitteiden avulla yhteydessä ryhmäläisiin, jotka olivat kokoontuneet oman kuntansa terveyskeskuksen kokoustilaan. Lähiryhmiä oli 6. Niissä ohjaus toteutettiin siten, että ohjaaja ja ryhmäläiset olivat samassa tilassa. Kussakin ryhmässä oli 5–9 osallistujaa. Tutkimusaineistona käytettiin videoituja keskusteluaineistoja, joissa ryhmään osallistuneet kuvasivat elintapamuutoksen hyötyjä ja haittoja ohjausprosessin alussa, painonhallintatilannettaan ohjausprosessin alussa, lopussa ja seurantakäynnillä sekä painonhallinnan onnistumisen edellytyksiä ja riskitekijöistä seurantakäynnillä 1,5 vuotta ohjausprosessin päättymisen jälkeen. Lisäksi tutkimusaineistoa kerättiin ennen ensimmäistä ja viimeistä ohjauskertaa sekä ennen seurantakäyntiä tutkittaville lähetetyllä kyselyllä. Paino mitattiin ohjausprosessin alussa, lopussa ja seurantakäynnillä. Videoaineisto analysoitiin sekä induktiivisella että deduktiivisella sisällönanalyysilla. Aineiston analysoinnissa käytettiin myös SPSS 16.0 for Windows -ohjelmaa. Ohjausprosessin alussa tutkittavista 68 % oli harkintavaiheessa, 9 % valmistautumis- ja 14 % toimintavaiheessa ja ohjausprosessin lopussa 24 % oli harkinta-, 33 % valmistautumis- ja 40 % toimintavaiheessa. Tutkittavista 40 edistyi elintapamuutosvaiheessaan, 18 pysyi ennallaan ja 5 taantui. Puolentoista vuoden kuluttua ohjausprosessin päättymisestä noin puolet tutkittavista oli ylläpitovaiheessa jonkun elintavan suhteen (kuidun ja rasvan käyttö, ruokamäärä, ateriarytmi, liikunta, alkoholin käyttö). Repsahduksista raportoi 21 henkilöä. Niitä oli tapahtunut eniten ruokamäärän rajoittamisen suhteen. Elintapamuutoksen hyötynä nähtiin terveyden ja toimintakyvyn paraneminen. Elintapamuutos vaatii vaivannäköä ja voimavaroja. Painonhallinnan onnistumisen edellytyksiä olivat oma toiminta, motivaatio ja voimavarat. Sitoutumattomuus omaan toimintaan, tavoitteiden, itsekurin ja motivaation puute vaikeuttivat painonhallintaa. Tutkimuksen avulla saatua tietoa voidaan käyttää kehitettäessä tyypin 2 diabeteksen riskiryhmiin kuuluvien henkilöiden ohjauksen sisältöä ja menetelmiä. Tuloksia voidaan hyödyntää myös terveydenhuollon opiskelijoiden ja ammattihenkilöiden ohjaustaitojen kehittämisessä.

Magister Public Health - MPH / The global problem of overweight and obesity is disturbing judging by the World Health Organization 2008 statistics which estimate that 1.4 billion and 500 million adults are overweight and obese. Thus, as a major risk for non-communicable diseases (NCDs) which are the foremost cause of disability and death, the problem of obesity needs to be addressed not only globally but in South Africa as well. South Africa’s burden of disease includes NCDs and causes of death of diseases such as diabetes (3%), cardiovascular diseases (CVDs) (11%), cancer (7%) and chronic respiratory diseases (3%). The HealthKick study is a school-based nutrition and physical activity intervention programme in the Western Cape, S.A., aimed to promote healthy behaviours such as healthful eating and physical activity in children, parents and teachers to reduce the risk of non-communicable diseases. During the formative phase of the study it emerged that educators were at high risk for NCDs because of their high levels of obesity. This study therefore aimed to describe primary school educators’ perceptions regarding body weight, related health risks and barriers to weight management. A qualitative approach was used to collect data and included focus group discussions (FGDs), and in-depth individual interviews (IDIs). In addition anthropometric measurements were taken. Four schools were purposively selected and a total of thirty one male and female educators participated in the seven focus group discussions and four in-depth interviews from the four schools. Male FGDs and IDIs and female FGDs and IDIs were conducted separately. The focus group discussions and in-depth interviews were digitally recorded and transcribed verbatim. Thematic data analysis was conducted with the use of ATLAS ti 6.1 computer software.The results of the study indicate that educator perceptions regarding their own body weight varied slightly from the actual. Positive and negative weight loss experiences and feelings regarding their own body weight were expressed. Educators appeared knowledgeable about overweight/obesity and its health risks for particular NCDs. Several personal barriers were identified by the educators; however, of particular interest were the barriers relating to the school environment, identified barriers included lack of time, heavy workloads and school responsibilities. Several factors for consideration emerged relating to implementing an educator weight management programme in the schools. These included: the involvement of the department of education (DOE), the type of activities planned and the time of implementation.

Both the NHS and Public Health are keen to identify how best to manage long term health condition’s as a result from obesity and vice-versa. There is evidence to support the efficacy of psychological support in weight management programmes. This study explored the perceived importance of psychological support within weight management services; perspectives of both client and healthcare practitioners, in view of considering the implications for the role of a counselling psychologist. There were nine interviews conducted with five healthcare practitioners and four clients. The professionals’ disciplines included: physiologist, dietician, health psychologist, programme manager, and a medical consultant. Of the four patients, two had accessed psychology services as part of their weight management programme and two had not. Data was analysed using thematic analysis. Five overarching themes were identified. Tension (pivotal central theme) this connected to: Lifestyle; Quality of Life (QoL); Service Delivery Model; and Professional and Personal beliefs and values. The findings highlighted that perceived importance of psychological support was influenced by an individuals’ background and experiences by both groups. The implications for the role of a counselling psychologist was to provide training to health professionals as well as raising clients’ awareness of the role of counselling and psychological support within such programmes. Further research is needed to understand better the potential of psychological support within weight management services to help contain UK obesity.

Background: The United States Preventive Services Task Force guidelines support screening and provision of intensive multi-component behavioral counseling for adults who have obesity. One barrier to providing such counseling is lack of training in medical school. Not much is known about factors associated with medical students’ perceived weight management counseling (WMC) skills or whether preceptors model or teach WMC during primary care clerkships. Methods: A mixed methods approach addressed factors affecting WMC training during primary care clerkships. A secondary analysis of 3rd year medical students (n=730) described students’ perceived WMC skills, attitudes and frequency of engagement in 5As educational experiences. Linear mixed models were used to determine associations between educational experiences and perceived skills. Semi-structured interviews (n=12) and a survey were administered to primary care preceptors (n=77). Interviews described individual, inter-personal and institutional factors associated with preceptors’ WMC. The survey described preceptors’ frequency of modeling WMC behaviors, perceived WMC skills, and attitudes. Results: Students perceived themselves to be moderately skilled (M=2.6, SD=0.05, range 1-4). Direct patient experiences and specific instruction were associated with higher perceived skill. Preceptors support WMC curricula but do not perceive themselves to be experts in WMC. Preceptors perceive themselves to be moderately skilled (M=2.8, SD=0.06, range 1-4) but only sometimes model WMC (M=3.3, SD=0.05, range 1-5) to students during clerkships. Conclusion: Preceptor modeling WMC may not be feasible or necessary during primary care clerkships. Providing specific WMC instruction and working with patients may provide more benefit as they were more strongly associated with students’ perceived skills.

Background: The Self-Regulation of Eating Behavior Questionnaire (SREBQ) is an economical way of assessing an individual’s self-regulatory abilities regarding eating behavior. Such scales are needed in the German population; therefore, the purpose of the present study was the translation and validation of a German version of the SREBQ. Method: First, we conducted a pilot study (Study 1; N = 371) after the translation procedure. Second, we assessed the final scale in a representative sample of the German population (Sample 2; N = 2,483) and its underlying factor structure. Further, we tested for measurement invariance and evaluated the SREBQ’s associations with related scales to explore convergent and discriminant validity. Finally, we considered differences in SREBQ based on sociodemographic variables and provided derived reference scores (norm values). Results: Factor analysis revealed deficiencies in the original model. Thus, we shortened the scale based on statistical considerations and the adapted version showed improved fit in Confirmatory Factor Analysis and reliability. We also found evidence for partial strict invariance, which means the measure is equivalent for the tested groups of age and gender. Item and scale psychometric properties of the shortened version were satisfactory. In terms of diagnostic validity, it was shown that individuals with higher body mass index (kg/m2) have worse self-regulation of eating behavior than those with lower. Conclusion: In sum, the SREBQ evidenced good validity and reliability and is suitable for application in medical, psychological, and nutritional research.

No description available.