ABSTRACT
Objectives: We developed a guided self-help intervention (Supporting Weight Management during COVID-19, “SWiM-C”) to support adults with overweight or obesity in their weight management during the COVID-19 pandemic. This study evaluated the effect of SWiM-C on weight and determinants of weight management over twelve months.Methods: Participants (≥18 years, body-mass-index ≥25kg/m2) were randomised to the SWiM-C intervention or to a standard advice group. Participants completed online questionnaires at baseline, four months, and twelve months. The primary outcome was change in self-reported weight from baseline to twelve months; secondary outcomes were eating behaviour (uncontrolled eating, emotional eating, cognitive restraint of food intake), experiential avoidance/psychological flexibility, mental health (depression, anxiety, stress), wellbeing and physical activity. Interventions: SWiM-C is based on acceptance and commitment therapy (ACT). Participants had access to an online web platform with 12 weekly modules and limited email and telephone contact with a trained, non-specialist coach. Standard advice was a leaflet on managing weight and mood during the COVID-19 pandemic. Results: 388 participants were randomised (SWiM-C: n=192, standard advice: n=196). The baseline-adjusted difference in weight change between SWiM-C and standard advice participants was -0.81kg (95% CI: -2.24 to 0.61kg). SWiM-C participants reported a greater reduction in experiential avoidance (-2.45, 95% CI: -4.75 to -0.15), uncontrolled eating (-3.36, 95% CI: -5.66 to -1.06), and emotional eating (-4.14, 95% CI: -7.25 to -1.02) and an increase in physical activity (8.96, 95% CI: 0.29 to 17.62) compared to standard advice participants.Conclusions: Whilst the effect of the SWiM-C intervention on weight was inconclusive, SWiM-C improved eating behaviours, psychological flexibility and physical activity. These factors have been previously identified as determinants of successful weight management. Further refinement of the SWiM-C intervention is necessary to ensure meaningful effects on weight prior to implementation in practice.
Subject(s)
COVID-19ABSTRACT
Background: As COVID-19 vaccination programs are being rolled out globally, we studied the ethnic, deprivation, household size and comorbidity ‘patterning’ of existing vaccination programs in populations at high-risk for COVID-19, to inform risk-stratified vaccination strategies and mitigate health inequalities. Methods: A population-level cohort study of UK adults aged 65 years or older, using a large primary care database. We used multivariable logistic regression to assess uptake of influenza, pneumococcal and shingles vaccination across ethnic groups, deprivation quintile, household size, and comorbidities, computing odds ratios (OR) adjusted for age, sex, demographics, body mass index and smoking. Offers and refusals of each vaccination type were analysed in those not receiving them. Findings: The cohort comprised 2,054,463 patients from 1,318 general practices. 1,452,014 (70.7%) patients received influenza vaccine, 1,391,228 (67.7%) received pneumococcal vaccine, and 690,783 (53.4%) received shingles vaccine. Compared to Whites, influenza vaccination uptake was lower in Pakistani (adjusted odds ratio (OR) 0.82; 99% confidence interval: 0.74-0.90), Black Caribbean (OR 0.46; 0.43-0.48), Black African (OR 0.63; 0.58-0.68), Chinese (OR 0.70; 0.64-0.76) and ‘Other ethnic group’ (OR 0.65; 0.63-0.69). The Black Caribbean group had higher vaccination refusal than the White group for influenza vaccination (OR 1.17; 1.05-1.30). Vaccination uptake was lower among the more deprived and those living in household sizes above 3 or more persons, with some significant interactions between ethnicity and comorbidities. Uptake of all three vaccines was higher in those with asthma, COPD, type 2 diabetes, hypertension and learning disability, whilst lower in those with dementia. Interpretation: Whilst uptake and refusal of influenza, shingles and pneumococcal vaccination are patterned by ethnicity, deprivation, household size and comorbidities, vaccination offer is mostly patterned by comorbidities. This information can inform national policies to ensure equitable implementation of COVID-19 vaccination programs to avoid exacerbating health inequalities.Funding Statement: This project was funded by the Medical Research Council (Grant Ref: MR/V027778/1).Declaration of Interests: PST reports previous consultation with AstraZeneca and Duke-NUS outside the submitted work. KK is a Member of the Scientific Advisory Group for Emergencies (SAGE), Member of Independent SAGE, Director of the University of Leicester Centre for Black Minority Health and Trustee of the south Asian Health Foundation. JHC is a member of several SAGE committees and chair of the risk stratification subgroup of the NERVTAG. She is unpaid director of QResearch and founder and former medical director of ClinRisk Ltd (outside the submitted work). MP, AKC, HDM, DS, TAR, FZ, BRS, SJG, CC, CG have no interests to declare.