ABSTRACT
Shift workers are known to have poorer metabolic health outcomes compared to day workers,(1) whilst those who work in rotating shift work roles have the highest risk.(2) To date, overall energy intake in shift workers has been found to be similar to day workers,(3) but it is unknown whether energy intake in workers on rotating shift schedules may be a contributing factor to the observed higher chronic disease risk. A systematic review and meta-analysis were conducted to explore how rotating shift work schedules impact total energy intake compared to fixed day/morning work schedules. Intra-person differences in energy intake amongst rotating shift workers on day/morning versus night shifts was also examined. Searches were conducted on CINAHL, Cochrane, Embase, MEDLINE PsycINFO and Scopus databases to identify articles reporting energy intake for rotating shift workers and fixed day workers. Articles were screened in duplicate against inclusion criteria using Covidence software. Data were extracted by one reviewer and checked independently by one of three reviewers. Quality assessment of included studies was assessed in duplicate using the American Dietetic Association (ADA) Quality Criteria Checklist for Primary Research. Meta-analyses were performed in RevMan using a random effects model, to compare mean difference in 24-hour energy intake with 95% confidence intervals. Heterogeneity was assessed with the I-squared test (I2). Thirty-one studies (n = 18196 participants) met the inclusion criteria and were included in the review with data for the two meta-analyses comprising 18 studies and seven studies, respectively. Overall, rotating shift workers had significantly higher average 24-hour energy intake compared to fixed day or morning work schedules (weighted mean difference [WMD] = 264 kJ;95% CI [70, 458], p < 0.008;I2 = 63%). Within rotating shift workers, the mean difference in 24-hour energy intake across morning/day shifts compared to night shifts was not statistically significant (WMD = 101 kJ;95% CI [-651, 852];p = 0.79;I2 = 77%). Results indicate workers on rotating shift schedules had a higher average 24-hour energy intake compared to their fixed day schedule counterparts. However, energy intake across shift schedules did not differ for individuals working this pattern. A higher 24-hour energy intake in rotating shift workers can contribute to gradual weight gain and higher metabolic risk in rotating shift work populations.
ABSTRACT
Introduction: Motivational interviewing (MI) is a well-evidenced person- centred approach to helping people with behavioural change, but has not been adapted to help with weight-related behaviour change during times of significant disruption (e.g. COVID-19). The project aimed to co-develop with stakeholders (e.g. people living with obesity) an adapted MI intervention to support individuals during disruption. Methods: UK-based adults with lived experience of obesity were recruited to take part in 3 virtual co-development meetings. These stakeholder-led meetings involved: (1) familiarisation with an existing MI intervention, (2) mapping out manual content and preferred delivery methods, and (3) reviewing and revising manual drafts. Co-development methodology was employed to translate discussions to a jointly developed intervention manual. Results: Twelve stakeholders attended co-development meetings in January and February 2021 which resulted in a four-phase adapted MI intervention comprising (1) Intensive professional support, (2) Continued professional support, (3) Community MI support, and (4) an Open-door hub. Key adaptations to a general MI intervention included (1) a focusing chart comprising a 'menu of options' prompting discussion of known weight management barriers during disruption, (2) explicit facilitation of a 'shared world view' discussion, and (3) integration of three techniques (attention to the present moment, if-then planning, & environmental prompt/cues) to address 'moments of vulnerability'. Intervention content and delivery is reported in line with the TIDieR checklist (Template for Intervention Description and Replication) and established taxonomies of behaviour change techniques. Conclusion: Stakeholder meetings led to the development of an adapted MI intervention which health-care practitioners could use to support people living with obesity during times of significant physical and social disruption. Future trials of the intervention will be conducted to determine its feasibility and acceptability to stakeholders.