Associations of BMI, waist circumference, body fat, and skeletal muscle with type 2 diabetes in adults.

AIMS: Type 2 diabetes (T2D) is known to be associated with high BMI and waist circumference (WC). These measures do not discriminate well between skeletal muscle (SM) and body fat (BF), which may have opposite influences. METHODS: We conducted a secondary analysis of population-based data from 58,128 aged 18-85 yrs from Scottish Health Surveys (2003, 2008-2011) and Health Surveys for England (2003-2006, 2008-2013), excluding pregnant women and insulin-treated diabetes. Logistic regression was used to assess associations of known T2D, and of screened HbA1c > 48 mmol/mol (> 6.5%), with sex-specific quintiles of BMI, WC, and BF% and SM% estimated by validated anthropometric equations, adjusted for age, sex, smoking, ethnicity, country, and survey year. RESULTS: As expected, ORs for having known T2D rose with quintiles of BMI (1, 1.5, 2.3, 3.1, and 6.5) and WC (1, 1.8, 2.5, 3.5, and 8.7). Compared to the lowest BF% quintile, OR for having T2D in highest BF% quintile was 11.1 (95% CI = 8.4-14.6). Compared to the highest SM% quintile, OR for having T2D in lowest SM% quintile was 2.0 (1.7-2.4). Of 72 adults with T2D/HbA1c > 6.5% in the lowest quintile of BF%, 27 (37.5%) were in quintile 1 of SM%. Similar patterns of OR were observed for having HbA1c > 6.5% in those without known T2D. CONCLUSIONS: Estimated BF% associates strongly with T2D. Low SM% also has a significant association, suggesting a neglected aspect of aetiology within T2D. These two simple measures with biological relevance, available from data collected in most health surveys, may be more useful than the purely statistical terms BMI.

Effects of calorie labelling on macro- and micro-nutrients in main-meal choices made by young adults.

BACKGROUND/OBJECTIVES: There is limited evidence that prominent calorie labelling on out-of-home meals helps consumers reduce calorie intakes and avoid weight gain, but no evidence on its effects on macro- and micro-nutrients. The objective of this study was to assess the impact of prominent calorie labelling on energy, macro- and micro-nutrients. SUBJECTS/METHODS: Young adults in a catered residential setting were observed when choosing main meals over three study periods in fixed order in this observational study. Period 1: with calorie labels (20 weeks); period 2: without calorie labels (10 weeks); period 3: with calorie labels plus information on estimated energy requirements (10 weeks). Nutrient contents of meal choices were analysed from food composition tables. RESULTS: Energy, 4 macronutrients and 19 micronutrients levels were derived from 4200 meals chosen by 120 subjects over 40 weeks. Means (s.d. or Median) for key macro- and micro-nutrients were for period 1: energy=658 (94) kcal, fat=31 (8.6) g, saturated fat=10.5 (2.7) g, B12=2.5 (1.7) µg, folate=119 (46.8) µg, vitamin C=80.0 (42) mg, Ca=278 (129) mg, Na=1230 (119) mg, Fe=22 (10) g, Se=19 (10.1) µg, I=34 (10.1) µg, period 2: energy=723 (87) kcal, fat=35 (7.6) g, saturated fat=12 (2.7) g, B12=3.4 (1.7) µg, Folate=182 (13.3) µg, vitamin C=87.0 (49.7) mg, Ca=379 (149) mg, Na=1352 (114) mg, Fe=41.6 (14) g, Se=26 (10.3) µg, I=38.0 (18.4) µg, period 3: energy=578 (109) kcal, fat=27.3 (9.1) g, saturated fat=8.5 (2.7) g, B12=2.2 (0.5) µg, Folate=90 (50.8) µg, vitamin C=75.0 (34) mg, Ca=277 (119) mg, Na=1205 (99) mg, Fe=14.5 (10.9) g, Se=15.0 (10) µg, I=32.0 (18.4) µg. All macro- and micro-nutrients, except for B1, vitamin C, vitamin E and Ca were significantly different between the three periods (P<0.001), but all mean intakes remained above recommended levels. CONCLUSIONS: Calorie labelling resulted in reductions in calories, fat and saturated fat contents of the meals chosen, without compromising micronutrient consumptions.

A qualitative study exploring why adults with intellectual disabilities and obesity want to lose weight and views of their carers.

BACKGROUND: Obesity is more prevalent in adults with intellectual disabilities (ID) compared to the general population. Motivations for weight loss may influence engagement with weight management programmes and have only been studied in adults without ID. AIMS: To determine reasons given by adults with ID and obesity for seeking weight loss and whether these reasons differ from those of their carers. METHODS: Prior to a multi-component weight management intervention, participants were asked "why do you want to lose weight?" Carers were asked their views and these were compared to the answers given by the adult with ID. Responses were themed. The Fisher's Exact analysis was used to test for any relationship between reasons for seeking weight loss and participants' level of ID, age, gender and BMI. RESULTS: Eighteen men and 32 women; age 41.6 SD 14.6 years; BMI 40.8 SD 7.5 kg/m(2); Level ID Mild (28 %), Moderate (42 %), Severe (22 %), Profound (8 %). Eleven were unable to respond. Six themes emerged; Health; Fitness / Activity / Mobility; Appearance / Clothes; Emotional / Happiness; For Others; Miscellaneous. The most frequent reason given overall and by women was "appearance." Carers cited "health" most frequently and "appearance" least, rarely agreeing with participants. "Health" was given as a reason more from older adults and those with milder ID. No statistically significant associations were found between reasons for seeking weight loss and BMI age, gender or level of ID but the differing views of adults with ID and their carers were clear. CONCLUSIONS: Views of adults with obesity and mild or moderate ID can be collected. The opposing views of adults and their carers may affect motivation for weight loss.

Weight changes in young adults: a mixed-methods study.

OBJECTIVE: In both the United States and United Kingdom, countries with high prevalence of obesity, weight gain is particularly rapid in young adulthood and especially identified among first-year students. DESIGN: A triangulation protocol was used, incorporating quantitative and qualitative research methods. A 27-question online survey was sent to all first-year undergraduates twice, with a 9-month interval. An online focus group was conducted at the end of the year, analysed by content and thematically. Self-reported weights and heights were validated against objectively measured data. RESULTS: From a total of 3010 first-year students, 1440 (female=734) responded at baseline mean (s.d.) age 20 (3.6) years, body mass index 22.3 (4.6) kg m(-2), 17% smokers and 80% alcohol drinkers. At follow-up, 1275 students reported a mean weight change of 1.8 (s.d. 2.6) kg over the 9-month period. Self-reported data correlated strongly with measured weights (r=0.999, P<0.001) and heights (r=0.998, P<0.001). Predictors of weight gain were baseline weight (P<0.001). Dairy products consumption was associated with less weight gain (P<0.001). Fruit and vegetable consumption, and time spent on physical activity or sleeping were associated with neither weight gain nor weight loss. Focus group content analysis revealed weight gain as a major concern, reported by half the participants, and increased alcohol consumption was considered the most common lifestyle change behind weight gain. Thematic analysis identified three main themes as barriers to or facilitators of healthy lifestyles and weight; budget, peer influence and time management. CONCLUSIONS: Rapid weight gain is of concern to young adults. Students living away from home are at particular risk, owing to specific obesogenic behaviours. Consumption of fruit and vegetables, and physical activity, despite popular beliefs, were not associated with protection against weight gain.

Calorie-labelling: does it impact on calorie purchase in catering outlets and the views of young adults?

Calorie-labelling of meals has been suggested as an antiobesity measure, but evidence for impact is scarce. It might have a particular value for young adults, when weight gain is most rapid. A systematic literature review and a meta-analysis was performed to assess the effect of calorie-labelling on calories purchased. Seven studies met the inclusion and quality criteria of which six provided data allowing a meta-analysis. Three reported significant changes, all reductions in calories purchased (-38.1 to -12.4 kcal). Meta-analysis showed no overall effect, -5.8 kcal (95% confidence interval (CI)=-19.4 to 7.8 kcal) but a reduction of -124.5 kcal (95% CI=-150.7 to 113.8 kcal) among those who noticed the calorie-labelling (30-60% of customers). A questionnaire, to gauge views on calorie-labelling, was devised and sent to young adults in higher education: 1440 young adults (mean age 20.3 (s.d.=2.9) years) completed the survey. Nearly half (46%) said they would welcome calorie information in catering settings and on alcoholic drinks. Females opposing to calorie-labelling were heavier to those who did not (64.3 kg vs. 61.9 kg, P=0.03; BMI=22.4 kg m(-2) vs. 21.7 kg m(-2), P=0.02). In conclusion, the limited evidence supports a valuable effect from clearly visible calorie-labelling for obesity prevention, and it appears an attractive strategy to many young adults.

Prevention and management of excessive gestational weight gain: a survey of overweight and obese pregnant women.

BACKGROUND: Excessive gestational weight gain is associated with adverse infant, childhood and maternal outcomes and research to develop interventions to address this issue is ongoing. The views of women on gestational weight gain and the resources they would consider helpful in addressing this are however largely unknown. This survey aimed to determine the views of newly pregnant women, living in areas of social disadvantage, on 1) their current body weight and potential gestational weight gain and 2) the resources or interventions they would consider helpful in preventing excessive gestational weight gain. METHODS: A convenience sample of overweight and obese pregnant women living in Fife, UK, were invited to complete a short anonymised questionnaire at their 12 week booking visit. RESULTS: 428 women, BMI>25 kg/m(2), completed the questionnaire. Fifty-four per cent of respondents were obese (231) and 62% were living in areas of mild to moderate deprivation. Over three-quarters of participants felt dissatisfied with their current weight (81%). The majority of women (60%) expressed some concern about potential weight gain. Thirty-nine percent were unconcerned about weight gain during their pregnancy, including 34 women (19%) who reported having retained weight gained in earlier pregnancies. Amongst those concerned about weight gain advice on physical activity (41%) and access to sports/leisure facilities were favoured resources (36%). Fewer women (12%) felt that group sessions on healthy eating or attending a clinic for individualised advice (14%) would be helpful. "Getting time off work" was the most frequently cited barrier (48%) to uptake of resources other than leaflets. CONCLUSIONS: These data suggest a lack of awareness amongst overweight and obese women regarding excessive gestational weight gain. Monitoring of gestational weight gain, and approaches for its management, should be formally integrated into routine antenatal care. Barriers to the uptake of resources to address weight gain are numerous and must be considered in the design of future interventions and services.

Carers' perspectives of a weight loss intervention for adults with intellectual disabilities and obesity: a qualitative study.

BACKGROUND: To date, no studies have explored the role of carers in supporting adults with intellectual disabilities (ID) and obesity during a weight loss intervention. The present study explored perceptions of carers supporting adults with ID, as they participated in a 6-month multi-component weight loss intervention (TAKE 5). METHODS: Semi-structured interviews were used to explore the experiences of 24 carers. The transcripts were analysed qualitatively using thematic analysis. RESULTS: Three themes emerged from the analysis: carers' perceptions of participants' health; barriers and facilitators to weight loss; and carers' perceptions of the weight loss intervention. Data analysis showed similarities between the experiences reported by the carers who supported participants who lost weight and participants who did not. Lack of sufficient support from people from the internal and external environment of individuals with ID and poor communication among carers, were identified as being barriers to change. The need for accessible resources tailored to aid weight loss among adults with ID was also highlighted. CONCLUSION: This study identified specific facilitators and barriers experienced by carers during the process of supporting obese adults with ID to lose weight. Future research could utilise these findings to inform appropriate and effective weight management interventions for individuals with ID.

Improving the dietary intake of under nourished older people in residential care homes using an energy-enriching food approach: a cluster randomised controlled study.

BACKGROUND: To examine whether the nutritional status of aged undernourished residents in care could be improved through dietary modification to increase energy intake but not portion size. METHODS: A 12-week cluster randomised controlled trial was carried out in 21 residential care homes. Participants comprised undernourished residents with a body mass index (BMI) <18.5 kg m(-2) . All menus were analysed to evaluate nutrient provision. Energy and macronutrient intakes of undernourished residents were estimated using 3-day weighed food intake diaries. Those resident in homes randomised to intervention had their usual meals enriched with energy-dense foods to a maximum of +1673 kJ day(-1) . RESULTS: Of 445 residents screened, 41 (9%) had a BMI <18.5 kg m(-2) and entered the study. Despite adequate food provision, energy and macronutrient intakes were below UK dietary reference values. Mean (SEM) energy intake increased [+556 (372) kJ, P = 0.154] in residents allocated to intervention but fell in those residents in 'control homes' receiving usual care [-151 (351) kJ, P = 0.676]. Weight change [+1.3 (0.53) kg, P = 0.03] was seen in intervention residents but not in controls [-0.2 (1.5) kg, P = 0.536]. Between-group differences for changes in weight and energy intake were not significant (P = 0.08 and 0.20, respectively). Six residents allocated to the intervention increased their BMI >18.5 kg m(-2) (P = 0.018). CONCLUSIONS: Achieving weight gain in frail older people is difficult. These results suggest that enriching food could help address undernutrition and slow chronic weight loss. Interventions of a longer duration are needed to confirm or exclude the value of food enrichment.

An evaluation of an obesity and weight management resource pack.

BACKGROUND: The prevention and treatment of overweight and obesity is a priority for all health professionals and requires resources that are regularly evaluated to ensure that they meet the needs of their target population. Dietitians in Obesity Management UK (DOM UK), a specialist group of the British Dietetic Association, commissioned an evaluation of their resources. These have been developed for use by Dietitians to determine the uptake and implementation of DOM UK resources in dietetic practice, as well as the opinions and suggestions of Dietitians concerning the resource pack. METHODS: A random sample of 20% (n = 33) of the 165 Dietitians who had ordered resources were selected from the DOM UK database along with 20% of DOM UK members who had not (n = 38). Data were then collected using telephone-administered questionnaires. RESULTS: Most of the Dietitians who used the resources favoured them because they improved their consultations and were liked by patients. Resources 'j' (controlling your portions) and 'k' (planning your meals) were most frequently used. However, the cost of the pack was a deterrent to both new and repeat orders. The evaluation also revealed that 17% of DOM UK members were unaware of these resources and 23% who ordered them were unaware that online samples were available. CONCLUSION: The evaluation showed that most Dietitians who used the resources found them very useful especially resources concerning meal planning and portion sizes. However, concerns about cost and the need for greater awareness about the resources among Dietitians were highlighted.

The habitual meal and snacking patterns of university students in two countries and their use of vending machines.

BACKGROUND: Dietary patterns and food choices in western and northern European countries can differ from those in countries that surround the Mediterranean basin. However, irregular meal patterns and the consumption of high-energy snacks tend to become common in most countries and their association with the prevalence of obesity has been examined in many studies. The first aim of the present study was to describe the habitual meal and snack intakes, including the use of vending machines, for two groups of first-year university students in two countries of different cultural backgrounds. The second aim was to explore the relationships between body mass index (BMI) and snacking for these two groups. METHODS: One hundred and sixty first-year undergraduate university students from two defined universities in Greece (n = 80) and Scotland (n = 80) volunteered to complete a food frequency questionnaire (FFQ). The FFQ comprised 16 questions assessing their meal and snacking habits. Self-assessed height and weight data were collected. RESULTS: The majority of the 160 students reported a BMI in the healthy range (<25 kg m(-2)). Overall, 26% of the students reported never consuming breakfast. More Scottish students (74%) used vending machines (P < 0.05). More Scottish students consumed chocolate bars and crisps than Greek students (41% and 34% versus 37.5% and 20%, respectively). Only the choice of chocolate bars from vending machines and the consumption of crisps and low fat yogurts were related to BMI (P < 0.05) for both groups. CONCLUSIONS: University students living in different countries report similar dietary patterns but differ in their snacking habits. No relationships were found between BMI and snacking. There is a need to carry out research to further our understanding of this relationship.

Session 3 (Joint with the British Dietetic Association): Management of obesity: Weight-loss interventions in the treatment of obesity.

Treatments to induce weight loss for the obese patient centre on the achievement of negative energy balance. This objective can theoretically be attained by interventions designed to achieve a reduction in energy intake and/or an increase in energy expenditure. Such 'lifestyle interventions' usually comprise one or more of the following strategies: dietary modification; behaviour change; increases in physical activity. These interventions are advocated as first treatment steps in algorithms recommended by current clinical obesity guidelines. Medication and surgical treatments are potentially available to those unable to implement 'lifestyle interventions' effectively by achieving losses of between 5 kg and 10 kg. It is accepted that the minimum of 5% weight loss is required to achieve clinically-meaningful benefits. Dietary treatments differ widely. Successful weight loss is most often associated with quantification of energy intake rather than macronutrient composition. Most dietary intervention studies secure a weight loss of between 5 kg and 10 kg after intervention for 6 months, with gradual weight regain at 1 year where weight changes are 3-4 kg below the starting weight. Some dietary interventions when evaluated at 2 and 4 years post intervention report the effects of weight maintenance rather than weight loss. Specific anti-obesity medications are effective adjuncts to weight loss, in most cases doubling the weight loss of those given dietary advice only. Greater physical activity alone increases energy expenditure by insufficient amounts to facilitate clinically-important weight losses, but is useful for weight maintenance. Weight losses of between half and three-quarters of excess body weight are seen at 10 years post intervention with bariatric surgery, making this arguably the most effective weight-loss treatment.

The associations between current recommendation for physical activity and cardiovascular risks associated with obesity.

OBJECTIVE: To examine associations between current recommended physical activity levels and body mass index (BMI) with some cardiovascular disease (CVD) risk factors (total cholesterol, high-density lipoprotein cholesterol (HDL-C), non-HDL-cholesterol (non-HDL-C), C-reactive protein (CRP), fibrinogen, and blood pressure), general health score (GHQ12) and predicted coronary heart disease (CHD) risk. DESIGN: Further analysis of the cross-sectional Scottish Health Survey 1998 data. SUBJECTS: Five thousand four hundred and sixty adults 16-74 years of age. RESULTS: After controlling for some confounding factors, obesity was significantly associated with higher odds ratio (OR) for elevated cholesterol, CRP, systolic blood pressure, non-HDL-C and lower HDL-C (P<0.001), and with greater predicted CHD risk compared to BMI <25 kg/m(2). Regular self-reported physical activity was associated with smaller OR of lower HDL-C and higher CRP, and average predicted 10-year CHD risk in obese subjects, but did not eliminate the higher risk of the measured CVD risk factors in this group. The OR of these two risk factors were still high 4.39 and 2.67, respectively, when compared with those who were inactive with BMI <25 kg/m(2) (P<0.001). Those who reported being physically active had better GHQ scores in all BMI categories (P<0.001). CONCLUSION: Reporting achievement of recommended physical activity levels may reduce some CVD risk factors, predicted CHD risk and improve psychosocial health, but may not eliminate the extra risk imposed by overweight/obesity. Therefore, increasing physical activity and reducing body weight should be considered to tackle CVD risk factors.

Weight gain as an adverse effect of some commonly prescribed drugs: a systematic review.

Several drugs, or categories of drugs, listed by the WHO and other writers and used in the treatment of chronic disease, are consistently associated with weight gain as a side effect and considered 'obesogenic'. The extent to which they may contribute to the multifactorial process behind obesity is not well documented. We systematically reviewed papers from Medline 1966-2004, Embase 1980-2004, PsycINFO 1967-2004, and Cochrane Register of Controlled Trials, to determine the effect on body weight of some drugs that are believed to favour weight gain. We included randomized controlled studies of adult participants (>18 years) prescribed a drug considered obesogenic, that compared the 'obesogenic' drug with placebo, an alternative drug or other treatment, and that had a duration of at least 3 months: 43 studies totalling 25,663 subjects met these criteria. The main objective of the majority of studies was to compare the efficacy and safety of drug therapy, with weight change recorded under safety outcomes; weight change was a primary outcome measure in only six studies. There was evidence of weight gain for all drugs included, up to 10 kg at 52 weeks. Differences in dosage, patient population, duration of treatment and dietary advice make generalization of the results difficult. Data on body weight are often not recorded in published clinical trials or is reported in insufficient detail. This side-effect has potentially serious consequences, and should be mentioned to patients. Weight management measures should be routinely considered when prescribing drugs known to promote weight gain. Future clinical trials should always document weight changes.

A review of weight loss interventions for adults with intellectual disabilities.

Obesity is more prevalent in adults with intellectual disabilities than in the general population, and has been shown to contribute to their reduced life expectancy, and increased health needs. Relatively few studies have examined the effectiveness of weight loss interventions for adults with intellectual disabilities. However, there is evidence to support interventions that take account of the context of the lives of adults with intellectual disabilities, including carer involvement in interventions. To reduce the health inequalities experienced by adults with intellectual disabilities, there is a clear need to develop accessible, evidence-based clinical weight management services.

The prevalence and determinants of obesity in adults with intellectual disabilities.

People with intellectual disabilities experience significant health inequalities compared with the general population, including a shorter life expectancy and high levels of unmet health needs. Another accepted measure of health inequalities, the prevalence of obesity, has been shown to be higher in adults with intellectual disabilities than in the general population. While the factors contributing to the increased prevalence among adults with intellectual disabilities are not well understood, the high rates of obesity among younger adults highlight the need for further research involving children and adolescents with intellectual disabilities. To take forward the priorities for research and the development of effective, accessible services, there is a need for collaboration between professionals working in the fields of intellectual disabilities and obesity.

Unidentified under-nutrition: dietary intake and anthropometric indices in a residential care home population.

BACKGROUND: Research investigating the nutritional status of older people in residential care homes is scant. OBJECTIVE: To determine the anthropometric measures and dietary intakes of older people in this setting as a basis for future intervention studies. METHODS: Dietary intake was assessed using 3-day-weighed food records, nutritional status was evaluated using anthropometric measurements (knee height to predict standing height, and body weight). Catering provision was assessed using a computer-based menu assessment tool (CORA). RESULTS: Mean body mass index (BMI) for the 34 participants was 22.2 kg m(2) (range 14.5-34.4). Six participants (17.6%) had a BMI < or =18.5 kg m(2) with a further seven identified as having a BMI >18.5 but <20 kg m(2). Only two subjects with BMI <18.5 kg m(2) were prescribed oral supplements. In both men and women, recorded mean energy intakes were below current estimated average requirements by 24% and 22% respectively. CONCLUSION: Despite adequate food provision, under-nutrition was prevalent and, in the majority of cases, unidentified and untreated. A larger study is warranted to investigate whether improved nutritional intake is achievable through dietary modification. These data indicate that a sample size of around 60, with 90% power and at the 5% significance level, is required to detect a difference of 1674 kJ between groups of residents in an intervention study following a cluster randomized design.

Weight management: a survey of current practice in secondary care NHS settings in 2004.

OBJECTIVE: To determine the current practices in relation to weight management currently provided for overweight/obese patients attending different secondary care outpatient clinics. METHODS: Postal questionnaire sent to 100 consultant clinicians working in a range of specialist areas in three NHS Trust areas in Scotland, between January and March 2004. RESULTS: Overall response rate was 55%. Only 9% (five) of clinicians reported having a protocol in place for the management of patients who were overweight or obese. Lack of expertise and inaccessibility to expertise were cited frequently as reasons for having no protocol in place. Fifty-one per cent felt that weight management (including obesity treatment) should be undertaken by a specialist service either run by general practitioners (GPs), or by clinicians in a secondary care setting. Around a third of all those surveyed reported willingness to incorporate obesity management within their own routine specialty practice. CONCLUSION: Clinicians acknowledged the adverse health effects of obesity within their specialist area, but felt unskilled and under-resourced to provide effective management. Effective prevention and management are required to challenge the obesity epidemic and will require the involvement of both primary and secondary care NHS settings. It is encouraging that a third of respondents felt prepared to incorporate obesity and weight management within their routine specialist practice.

Relationships between cigarette smoking, body size and body shape.

OBJECTIVE: To define relationships between smoking status, body mass index (BMI), waist and hip circumferences (WC, HC) and waist to hip ratio (WHR). DESIGN: Further analysis of the cross-sectional Scottish Health Survey 1998 data. SUBJECTS: Nationally representative sample of 9047 adults aged 16-74 y. RESULTS: Body mass index (BMI) was lower in current smokers and higher in ex-smokers (P<0.001) when compared with nonsmokers in the survey population as a whole. After adjustment for confounding factors (age, social class, physical activity and alcohol intake), these differences still remained. However, examination of age categories showed no such differences in BMI between current smokers and nonsmokers in men aged 16-24 y or women aged below 55 y. In the age category 16-24 y, prevalence of cigarette smoking was highest at 51% (men) and 43% (women) in obese subjects and lowest at 35% (men) and 33% (women) in people with BMI of 25-30 kg/m(2). For women current smokers, mean WC and WHR were higher and HC was lower compared with nonsmokers (P<0.001). In men, only HC was lower in current smokers compared with nonsmokers for the entire sample (P<0.001). CONCLUSION: Cigarette smoking is associated with a lower BMI in adults over 24 y particularly in men, but not in younger people. In women, smoking is linked to the development of central adiposity. The gender-related central adiposity of men is not further increased by smoking, but a lower HC could suggest a reduction in muscle mass.

A transferable programme of nutritional counselling for rehabilitation following myocardial infarction: a randomised controlled study.

OBJECTIVE: To evaluate the response to simple innovative dietary counselling in post myocardial infarction patients. DESIGN: Randomised controlled trial. SETTING: Cardiac rehabilitation programmes of two acute hospitals in Lanarkshire, Scotland. PATIENTS: A total of 69 men and 29 women aged 35-75 y who survived acute myocardial infarction and participated in the cardiac rehabilitation programmes of the study hospitals between 1st September 1997 and 1st August 1998. RESULTS: At 12 weeks follow-up, diet composition had improved significantly in intervention subjects, but no such change was evident in the control group. The target of five portions of fruit and vegetables per day was achieved by 65% of intervention subjects but only 31% of control subjects (P=0.004). Between-group differences in food intakes were no longer evident at 1 y. Diet composition did however remain in line with current dietary targets in intervention subjects. CONCLUSION: Compared to conventional cardiac rehabilitation, this intervention, focused on targets known to improve mortality, improved diet in post myocardial infarction patients. However, a more sustained programme is required to maintain improvements. Delivery of the intervention was expensive and further research is required to determine the feasibility of a group approach using the same package. SPONSORSHIP: The study was supported by Chief Scientist Office of the Scottish Executive Department of Health.

Eating habits, beliefs, attitudes and knowledge among health professionals regarding the links between obesity, nutrition and health.

OBJECTIVE: To document knowledge, attitudes, beliefs and eating habits of health professionals with respect to obesity, nutrition and weight management. DESIGN: A self-complete questionnaire postal survey. SETTING: Primary care and dietetic practice in Scotland. SUBJECTS: A systematic stratified sample of 2290 subjects incorporated general practitioners (n=1400), practice nurses (n=613) and all practising dietitians (n=360) who were members of the British Dietetic Association. RESULTS: The overall response rate was 65%. All professionals showed a clear understanding of nutrition and health. Understanding of obesity as a disease and of the effectiveness of weight management using low-energy diets was limited. Below 10% had carried out audit to determine the incidence of obesity and overweight, and most were uncertain about their own effectiveness in delivering weight management advice. CONCLUSION: This study confirms that health professionals have some knowledge of nutrition and weight management but are unclear how to deliver effective weight management advice. Further training is justified to ensure the effective provision of nutritional advice to patients.