Weight management interventions that include dietary components for young people with chronic health care needs: A systematic review.

AIMS: To identify and describe weight management interventions that include a dietary component for young people with chronic healthcare needs and overweight or obesity and their effect on body mass index (BMI) or weight. METHODS: Six databases were searched in 2017 and 2020 for experimental studies in English: Ovid MEDLINE, Ovid Embase, Ovid AMED, EBSCO CINAHL, Scopus and Cochrane Central Register of Controlled Trials and Database of Systematic Reviews. Two independent reviewers conducted data extraction and quality assessment using the Cochrane Risk of Bias tool. Eligible studies included young people with chronic healthcare needs ≤18 years with overweight or obesity with an intervention that included a dietary component. Eligible outcomes were BMI or weight. Data were synthesised narratively. RESULTS: The search identified 15 293 references, 12 studies were included (randomised controlled trials n = 5, before-after comparisons n = 7). Participant diagnoses were neurodevelopmental disabilities (n = 5) and mental illness (n = 1); survivors of cancers or tumours (n = 4); congenital heart disease (n = 1) and; migraine (n = 1). No studies addressed weight management in physical disabilities. Eight studies demonstrated a significant reduction in BMI or weight. Of these, most interventions used dietary counselling or an energy deficit, were family-focused, multicomponent and delivered by a multidisciplinary team including dietitians. A high risk of bias was detected across studies. CONCLUSIONS: There is limited high-quality evidence about effective dietary solutions for the management of overweight and obesity for young people with chronic healthcare needs. While more research is required, dietary management appears to be important to manage weight in these populations.

Using realist approaches in nutrition and dietetics research.

AIM: The aim of this study was to explore the use and future potential of realist approaches to research in nutrition and dietetics. METHODS: A targeted literature review was used to search key journals (n = 7) in nutrition and dietetics to identify existing research using a realist approach. A narrative synthesis was conducted to explore findings in relation to the research aim. RESULTS: Nine research papers (four realist evaluations, five realist reviews) describing seven nutrition interventions were found, which revealed the application of realist research in nutrition and dietetics has focused on public health interventions. Realist research provided a deeper, more nuanced understanding of varied outcomes including the role of context, and contributed to the development of theory about how and why interventions work. As a theory-driven research method, realist research was able to assist in overcoming methodological shortcomings to contribute to meaningful, transferable findings. CONCLUSION: The results highlight the potential contribution of the realist research in nutrition and dietetics to evaluate interventions and inform future practice.

For whom and under what circumstances do nutrition-education cooking interventions work: a realist synthesis.

OBJECTIVE: To explore for whom and under what circumstances nutrition-education cooking interventions affect nutrition outcomes in adults. METHODS: A realist synthesis was undertaken. The CINAHL, Ovid Medline, Scopus, and Web of Science databases were searched for literature published between 1980 and 2019, using the terms "cook" and "intervention" and their synonyms; 5759 articles were identified. Grey literature was sourced for further additional program context. A total of 23 articles (n = 11 programs) met inclusion criteria for analysis. Program data were coded in duplicate for context, outcome, and mechanism configurations, and used to build a refined program theory. RESULTS: Nutrition-education cooking interventions targeted at low-socioeconomic-status and marginalized populations produced a range of positive nutrition outcomes. Outcomes were observed when the program involved hands-on cooking and a skilled facilitator coupled with individual self-efficacy, knowledge gain, family support, and an expectation of positive health outcomes. CONCLUSION: These findings highlight key program components to achieve improvements in nutrition and important recommendations for nutrition-education cooking interventions.

Evaluation of health promotion capacity gains in a state-wide rural food literacy intervention.

Building capacity to enhance health promotion intervention effectiveness is a desirable, difficult to achieve and rarely evaluated aspect of practice. This study aims to describe an approach for evaluating capacity building embedded in a state-wide health promotion intervention that had a primary objective of enhancing food literacy and secondary objective of building health promotion capacity. The multi-strategy rural food literacy intervention centred on a group-based, hands-on learning workshop series. Logic modelling, theory of change and clarification of the explicit assumption of the intervention relating to food literacy and capacity building objectives were documented. The evaluation approach acknowledged the complexity of the intervention that utilised a food literacy program as a vessel to build relationships, enabling capacity-building strategies over time, and used multiple forms of data to measure organisational, community and individual capacity. The development of a shared mixed method program evaluation plan was achieved through co-design. One-hundred and twenty-two peer facilitators were trained across 81 communities and reported increases in self-efficacy for health promotion action. There was broad awareness and support for the program within the organisation. The majority (75%) of communities involved in the intervention implemented at least one health promotion activity, demonstrating some health promotion capacity gain.