Can type 2 diabetes be prevented in UK general practice? A lifestyle-change feasibility study (ISAIAH).

BACKGROUND: The increasing incidence of type 2 diabetes mellitus is attributed to increasing weight, reduced physical activity, and poor diet quality. Lifestyle change in patients with pre-diabetes can reduce progression to diabetes but this is difficult to achieve in practice. AIM: To study the effectiveness of a lifestyle-change intervention for pre-diabetes in general practice. DESIGN OF THE STUDY: A feasibility study. SETTING: A medium-sized general practice in Sheffield. METHOD: Participants were 33 patients with pre-diabetes. The intervention was a 6-month delayed entry comparison of usual treatment with a lifestyle-change programme: increased exercise and diet change, either reduction in glycaemic load, or reduced-fat diet. The main outcome measures were weight, body mass index (BMI), waist circumference, fasting glucose, lipid profile, and nutrition. RESULTS: A statistically significant difference was observed between control and intervention groups in three markers for risk of progression to diabetes (weight (P<0.03), BMI (P<0.03), and waist circumference (P<0.001)). No significant differences in fasting glucose or lipid profiles were seen. Aggregated data showed a statistically non-significant improvement in all the measures of metabolic risk of progression to diabetes in the low-glycaemic-load group when compared with a low-fat-diet group (P>0.05). Significant total energy, fat, and carbohydrate intake reduction was achieved and maintained in both groups. CONCLUSION: A lifestyle-change intervention feasibility programme for pre-diabetic patients was implemented in general clinical practice. The potential of a low-glycaemic-load diet to be more effective than a low-fat diet in promoting change in the features associated with progression to diabetes is worthy of further investigation.

Measuring the school impact on child obesity.

This article explores the impact that schools have on their pupils' obesity and so identify those where targeted input is most needed. A modelling process was developed using data that had been collected over 2 years on a socio-economically and ethnically representative sample of 2367 school pupils aged 5 and 9 years old attending 35 Leeds primary schools. The three steps in the model involved calculating the "Observed" level of obesity for each school using mean body mass index standard deviation (BMI SDS); adjusting this using ethnicity and census-derived deprivation data to calculate the "Expected" level; and calculating the "Value Added" by each school from differences in obesity at school entry and transfer. We found there was significant variance between the schools in terms of mean BMI SDS (range -0.07 to +0.78). Residential deprivation score and ethnicity accounted for only a small proportion of the variation. Expected levels of obesity therefore differed little from the Observed, but the Value Added step produced very different rankings. As such, there is variation between schools in terms of their levels of obesity. Our modelling process allowed us to identify schools whose levels differed from that expected given the socio-demographic make up of the pupils attending. The Value Added step suggests that there may be a significant school effect. If this is validated in extended studies, the methodology could allow for exploration of mechanisms contributing to the school effect, and identify schools with the highest unexpected prevalence. Resources could then be targeted towards those schools in greatest need.

The aetiology of childhood obesity: a review.

Whilst the prevention of childhood obesity is the only viable, enduring, cost-effective solution to the obesity epidemic, effective methods for it remain elusive. Furthermore, strategies to influence obesogenic environments remain relatively unexplored. In order to be able to develop powerful population-level interventions and public health policies to prevent childhood obesity, it is important to understand its aetiology and those environments that are most amenable to measurable change. First, the present paper considers why we should be concerned about obesity in children, from both the perspective of the increased health risk to the individual and the high economic cost of treatment of obesity and related diseases, highlighting why the prevention of childhood obesity is important. Next, the determinants of health behaviour and the obesogenic environment are explored, which helps us to understand why the aetiology is so complex and that potential causal factors should not be considered in isolation, as the interaction between these factors is also important. The paper then considers the multi-factorial aetiology of childhood obesity and the rationale for the increasing trends in obesity that are evident, in order to understand what is changing in society and our children's behaviour that is triggering the positive energy balance leading to obesity. The review emphasises the need for multi-level approaches if we truly want to prevent childhood obesity. It also serves to highlight that there is a need to extend the current research base in order to build a well-founded framework to form the basis of a strategy for the prevention of childhood obesity.