'You just eyeball it': Parent and nursery staff perceptions and influences on child portion size: A reflexive thematic analysis.

Background: Childhood obesity is one of the most serious public health epidemics of the 21st century. Observational studies report that increases in portion size (PS) have occurred in parallel with levels of obesity. Increased PSs of high-energy-dense foods can promote overeating, and without compensatory behaviours, can contribute to childhood obesity. Caregivers make decisions about PSs for children in the home and nursery environment, thus are gatekeepers to child food intake. Understanding caregiver PS decisions can aid in the best practice of PS provision to young children. The aim of this study was to explore parent and nursery staff influences on child PS selection and their suggestions for useful tools/strategies in PS decisions. Methods: A qualitative design was employed using focus group discussions (FGDs) with parents and nursery staff of children aged 3-5 years. FGDs were employed given their ability to generate rich data, as well as permit the exploration of collective perceptions, attitudes, behaviours and experiences. Data were analysed using an inductive, semantic approach to reflexive thematic analysis. Results: Four FGDs were conducted: two with parents (n = 13), two with nursery staff (n = 17). Four overarching themes were derived: (i) awareness of PS guidelines; (ii) control over PS; (iii) social influences on children's eating behaviours; (iv) child-specific, social and external factors influencing parent and nursery staff PS decisions. Additionally, participants discussed tools/strategies they believe would be useful in PS decisions. Conclusion: Data from the themes suggest that caregiver control, social, child-specific and external factors are more influential than PS guidelines in both parent and nursery staff PS decisions for young children aged 3-5 years. These findings can inform future childhood obesity prevention initiatives focussed on improving parent and nursery staff provision/use of age-appropriate PSs.

Heard, valued, supported? Doctors' wellbeing during transitions triggered by COVID-19.

INTRODUCTION: Supporting doctors' wellbeing is crucial for medical education to help minimise negative long-term impacts on medical workforce retention and ultimately patient care. There is limited study of how doctors' transitions experiences impact wellbeing, particularly socially and culturally. Multiple Multidimensional Transitions (MMT) theory views transitions as dynamic, incorporating multiple contexts and multiple domains. Using MMT as our lens, we report a qualitative analysis of how transitions experienced by doctors during the pandemic impacted on social and cultural aspects of wellbeing. METHODS: Longitudinal narrative inquiry was employed, using interviews and audio-diaries. Data were collected over 6 months in three phases: (i) interviews with doctors from across the career spectrum (n = 98); (ii) longitudinal audio-diaries for 2-4 months (n = 71); (iii) second interviews (n = 83). Data were analysed abductively, narrowing focus to factors important to social and cultural wellbeing. RESULTS: Doctors described experiencing multiple interacting transitions triggered by the pandemic in multiple contexts (workplace, role, homelife and education). Patterns identifiable across the dataset allowed us to explore social and cultural wellbeing crosscutting beyond individual experience. Three critical factors contributed to social and cultural wellbeing both positively and negatively: being heard (e.g., by colleagues asking how they are); being valued (e.g., removal of rest spaces by organisations showing lack of value); and being supported (e.g., through regular briefing by education bodies). CONCLUSIONS: This study is the first to longitudinally explore the multiple-multidimensional transitions experienced by doctors during the COVID-19 pandemic. Our data analysis helped us move beyond existing perceptions around wellbeing and articulate multiple factors that contribute to social and cultural wellbeing. It is vital that medical educators consider the learning from these experiences to help pinpoint what aspects of support might be beneficial to trainee doctors and their trainers. This study forms the basis for developing evidenced-based interventions that ensure doctors are heard, valued and supported.

Direct observation of weight-related communication in primary care: a systematic review.

BACKGROUND: Primary care is ideally placed to play an effective role in patient weight management; however, patient weight is seldom discussed in this context. A synthesis of studies that directly observe weight discussion in primary care is required to more comprehensively understand and improve primary care weight-related communication. OBJECTIVE: To systematically identify and examine primary care observational research that investigates weight-related communication and its relationship to patient weight outcomes. METHODS: A systematic review of literature published up to August 2015, using seven electronic databases (including MEDLINE, Scopus and PsycINFO), was conducted using search terms such as overweight, obese and/or doctor-patient communication. RESULTS: Twenty papers were included in the final review. Communication analysis focused predominantly on 'practitioner' use of specific patient-centred communication. Practitioner use of motivational interviewing was associated with improved patient weight-related outcomes, including patient weight loss and increased patient readiness to lose weight; however, few studies measured patient weight-related outcomes. CONCLUSION: Studies directly observing weight-related communication in primary care are scarce and limited by a lack of focus on patient communication and patient weight-related outcomes. Future research should measure practitioner and patient communications during weight discussion and their impact on patient weight-related outcomes. This knowledge may inform the development of a communication intervention to assist practitioners to more effectively discuss weight with their overweight and/or obese patients.

Association between common variation at the FTO locus and changes in body mass index from infancy to late childhood: the complex nature of genetic association through growth and development.

An age-dependent association between variation at the FTO locus and BMI in children has been suggested. We meta-analyzed associations between the FTO locus (rs9939609) and BMI in samples, aged from early infancy to 13 years, from 8 cohorts of European ancestry. We found a positive association between additional minor (A) alleles and BMI from 5.5 years onwards, but an inverse association below age 2.5 years. Modelling median BMI curves for each genotype using the LMS method, we found that carriers of minor alleles showed lower BMI in infancy, earlier adiposity rebound (AR), and higher BMI later in childhood. Differences by allele were consistent with two independent processes: earlier AR equivalent to accelerating developmental age by 2.37% (95% CI 1.87, 2.87, p = 10(-20)) per A allele and a positive age by genotype interaction such that BMI increased faster with age (p = 10(-23)). We also fitted a linear mixed effects model to relate genotype to the BMI curve inflection points adiposity peak (AP) in infancy and AR. Carriage of two minor alleles at rs9939609 was associated with lower BMI at AP (-0.40% (95% CI: -0.74, -0.06), p = 0.02), higher BMI at AR (0.93% (95% CI: 0.22, 1.64), p = 0.01), and earlier AR (-4.72% (-5.81, -3.63), p = 10(-17)), supporting cross-sectional results. Overall, we confirm the expected association between variation at rs9939609 and BMI in childhood, but only after an inverse association between the same variant and BMI in infancy. Patterns are consistent with a shift on the developmental scale, which is reflected in association with the timing of AR rather than just a global increase in BMI. Results provide important information about longitudinal gene effects and about the role of FTO in adiposity. The associated shifts in developmental timing have clinical importance with respect to known relationships between AR and both later-life BMI and metabolic disease risk.

The relationship between multiple sleep dimensions and obesity in adolescents: A systematic review.

Sleep is an involuntary behaviour, biologically fundamental to survival and wellbeing. However, sleep is increasingly neglected, with significant health implications. Recent research has identified associations between sleep duration, quality, timing and risk of overweight/obesity in children and adults. The aim of this review was to systematically identify and examine research that investigates the relationships between multiple objective and subjective sleep outcomes and objective adiposity measures in adolescents. A systematic review of literature, published to December 2022, was conducted using ten bibliographic databases. Search terms included objective and subjective sleep/circadian rhythm outcomes, objective adiposity measurements, and adolescents aged 8-18 years. Eighty-nine studies were included in the final review. Sleep outcomes were synthesized into three sleep domains: pre-sleep, during sleep and post-sleep outcomes. In summary, pre-sleep outcomes (including poor sleep hygiene, later chronotype and increased variability and later sleep timings) and increased sleep disturbance are consistently significantly associated with increased obesity and adiposity in adolescents. The relationship between during-sleep outcomes (sleep quality and efficiency) with adiposity and obesity measures was mixed. These findings suggest that adapting an individual's schedule to best suit chronotype preference and improving sleep hygiene, including a consistent bedtime routine, could reduce adiposity and obesity in adolescents.

The power of animation: encouraging doctors to access support for psychological wellbeing.

The COVID-19 pandemic has exacerbated already high rates of poor psychological wellbeing in doctors. Many doctors perceive a stigma associated with acknowledging psychological wellbeing concerns, resulting in a reluctance to seek support for those concerns. The aim of this study was to develop a theoretically-informed and evidence-based composite narrative animation (CNA) to encourage doctors to access support for psychological wellbeing, and to evaluate the acceptability of the CNA.A composite narrative was developed from an evidence-base of interviews with 27 GP participants across Scotland (May-July 2020). The Behaviour Change Wheel was used to identify behaviour change techniques (BCTs) to be embedded within the CNA. The narrative was turned into a script in collaboration with an animation company. A brief animation 'Jane the GP' was developed reflecting specific BCTs.Scottish doctors (n = 83) were asked for their views on acceptability of the CNA concept, and subsequently asked to provide views on the acceptability of the CNA after viewing it. Participants thought the concept of a CNA was novel but may not appeal to all. After viewing the CNA, the widespread view was that it portrayed an authentic experience, could reduce stigma around seeking support for psychological wellbeing, and highlighted formal routes to access such support.CNAs are a novel and acceptable intervention method for encouraging doctors to access support for psychological wellbeing. The use of a theory driven intervention development framework to create the CNA facilitates the link between theory and practice.

A qualitative study of young peoples' thoughts and attitudes to follow a more plant-based diet.

Plant-based diets (PBDs) refer to dietary habits that reduce the consumption of animal-based products and increase the consumption of nutritionally rich plant foods. PBD's have been shown to provide significant health benefits, such as reducing obesity and improving psychological wellbeing, and are environmentally friendly. However, few studies have investigated factors that influence young people's thoughts and attitudes toward following a PBD in western societies, particularly in the United Kingdom. Understanding these factors may benefit public health interventions that encourage the consumption of more fruit and vegetables. The aim of this study was to explore the factors that affect young people's intentions toward following a PBD. Twenty-one young people (18-24 years) participated in this qualitative study. Participants were asked about their views of PBDs in a semi-structured interview. Thematic analysis was utilized to explore views and the barriers and facilitators to following a PBD. The Theory of Planned Behavior (TPB) was used as a framework to organise the findings. Within attitudes, the sub-themes identified were an awareness of a healthy diet, environmental concerns, health concerns and distrust, perceptions of PBDs and associated stereotypes, perceived restriction and lack of enjoyment, and need for education. Within subjective norms, the sub-themes identified were cultural and familial norms, peer influence, and exposure through social media. Within perceived behavioral control (PBC), the sub-themes identified were a lack of independence and parental control, lack of knowledge and perceived difficulty, lack of inclusiveness and accessibility, and inconvenience. Overall, the findings suggest that increased provision of education and knowledge about PBDs to young people, and widening access to PBDs, could encourage and help improve their understanding and intention to follow this dietary style. Tailored health promotion strategies, which also consider additional barriers and facilitators found within this study, could motivate young people to consume a more PBD.

Obesity and eating behaviour in children and adolescents: contribution of common gene polymorphisms.

The prevalence of childhood obesity is increasing in many countries and confers risks for early type 2 diabetes, cardiovascular disease and metabolic syndrome. In the presence of potent 'obesogenic' environments not all children become obese, indicating the presence of susceptibility and resistance. Taking an energy balance approach, susceptibility could be mediated through a failure of appetite regulation leading to increased energy intake or via diminished energy expenditure. Evidence shows that heritability estimates for BMI and body fat are paralleled by similar coefficients for energy intake and preferences for dietary fat. Twin studies implicate weak satiety and enhanced food responsiveness as factors determining an increase in BMI. Single gene mutations, for example in the leptin receptor gene, that lead to extreme obesity appear to operate through appetite regulating mechanisms and the phenotypic response involves overconsumption and a failure to inhibit eating. Investigations of robustly characterized common gene variants of fat mass and obesity associated (FTO), peroxisome proliferator-activated receptor (PPARG) and melanocortin 4 receptor (MC4R) which contribute to variance in BMI also influence the variance in appetite factors such as measured energy intake, satiety responsiveness and the intake of palatable energy-dense food. A review of the evidence suggests that susceptibility to childhood obesity involving specific allelic variants of certain genes is mediated primarily through food consumption (appetite regulation) rather than through a decrease in activity-related energy expenditure. This conclusion has implications for early detection of susceptibility, and for prevention and management of childhood obesity.

Susceptibility to weight gain. Eating behaviour traits and physical activity as predictors of weight gain during the first year of university.

The transition to University has been identified as a possible period for weight gain but few studies have addressed the extent of this experience in UK Universities. The present study was conducted in four Universities in England and Scotland to directly measure changes in body weight, waist circumference and body composition in students during their first year. Two hundred and fifty first-year students completed psychometric eating behaviour questionnaires and a validated physical activity survey before attending one of the laboratories for standardised assessments of height, body weight, waist circumference and body composition at 0, 3, and 12-months. Significant but small and transitory increases in all weight outcomes (e.g. body weight=0.83±2.1 kg) were observed except for fat-free mass. Weight-related measures at baseline predicted changes in weight over 12-months but not 3-months. Disinhibition, power of food and binge eating were associated with change in fat mass while physical activity, cognitive restraint and sensitivity to reward were associated with change in fat-free mass. Weight gain occurs in the first year of University in the UK, but appears to be small and transitory. Changes in fat mass were related to opportunistic eating and the tendency to overconsume, while change in fat-free mass related to physical activity and low dietary restraint in conjunction with drive to experience reward. Psychological markers underlying changes in body composition can inform strategies to promote self-regulation in young adults during a critical life period for weight gain.

Predictors of weight discussion in primary care consultations: A multilevel modeling approach.

OBJECTIVE: To understand how primary care weight-related communication processes are influenced by individual differences in primary care practitioner (PCP) and patient characteristics and communication use. METHODS: Two multilevel logistic regression models were calculated to predict the occurrence of 1) weight-related discussion and 2) weight-related consultation outcomes. Coded communication data (Roter Interaction Analysis System) from 218 video-recorded consultations between PCPs and patients with overweight and obesity in Scottish primary care practices were combined with their demographic data to develop the multilevel models. RESULTS: Weight-related discussions were more likely to occur when a greater proportion of PCP's total communication was partnership building and activating communication. More discrete weight discussions during a consultation predicted weight-related consultation outcomes. Patient BMI positively predicted both weight-related discussion and consultation outcomes. CONCLUSION: This work demonstrates that multilevel modeling is a viable approach to investigating coded primary care weight-related communication data and that it can provide insight into the impact that various patient and PCP factors have on these communication processes. PRACTICE IMPLICATIONS: Through the increased use of partnership building and activating communications, and by engaging in shorter, but more frequent, discussions about patient weight, PCPs may better facilitate weight-related discussion and weight-related consultation outcomes for their patients.

A Social Norms and Identity Approach to Increasing Fruit and Vegetable Intake of Undergraduate Students in the United Kingdom.

This study investigated the influence of descriptive norm messages that either communicated that university students eat a sufficient amount of fruit and vegetable (F&V) or that they do not, on F&V consumption, and whether or not any effects are moderated by student identification. An online 2 (Norm: "Sufficient"/"Insufficient") × 2 (Identification: "Low"/"High") experimental design was employed. Infographics containing "sufficient"/"insufficient" F&V intake descriptive norms were presented. An identification manipulation was employed to create "high"/"low" student identifiers. F&V intake intentions were assessed after the manipulations; self-reported F&V intake was reported at 2 days post-intervention. Undergraduate students in the United Kingdom (N = 180) reported their intake intentions, of which 112 (62%) completed the behavioral follow-up. Participants were predominantly white female students from Scottish universities, mean age 20.4 (±1.6) years. Baseline mean F&V consumption was high (4.5 ± 2.8). There were no significant main effects of Norm or Identification manipulations on F&V intentions and intake. Significant norm × identification interactions were revealed for fruit intake intentions and vegetable intake at follow-up, indicating half-portion differences (~40 g) between groups. Ironic effects were observed for "high" identifiers, who neither intended to, nor acted in accordance with group norms; "low" student identifiers intended to and followed group norms, whereby the "sufficient"/"low" group intended to consume significantly more fruit portions and consumed more vegetables than the "insufficient"/"low" group. Given the half-portion differences between groups resulting from the norm × identification interactions, future research on a larger sample of young adults with low F&V intake is warranted to further explore the conditions under which moderating effects of identification are observed and the underlying mechanisms.

Risk Factors for Overweight and Obesity within the Home Environment of Preschool Children in Sub-Saharan Africa: A Systematic Review.

Sub-Saharan Africa (SSA) is experiencing an increasing prevalence of young children being overweight and obese. Many feeding and physical activity-related behaviours are established at home during preschool years, yet the precise factors that contribute to preschool overweight and obesity have not been fully elucidated. This review aims to identify factors in the home environment associated with overweight and or obesity in preschool children in SSA. Ovid MEDLINE, EMBASE, CINAHL, Scopus, Web of Science, Africa Journals Online (AJOL) and the African Index Medicus databases were systematically searched for qualitative and quantitative studies published between 2000 and 2021. Eleven studies (ten quantitative, one qualitative) met the inclusion criteria. Overall, the results highlight the paucity of studies exploring factors in the home environment associated with overweight and obesity in preschool children in Sub-Saharan Africa. The home food environment and maternal BMI appear to be important factors associated with overweight and obesity in preschool children; however, the information for all other factors explored remains unclear due to the lack of evidence. For successful obesity prevention and treatment interventions to be developed, more research in this area is required to understand how different aspects of the home environment contribute to overweight and obesity in preschool Sub-Saharan African children.

Supporting doctors' well-being and resilience during COVID-19: A framework for rapid and rigorous intervention development.

This paper aims to outline the development of a theoretically informed and evidence-based intervention strategy to underpin interventions to support the well-being of doctors during COVID-19 and beyond; delineate new ways of working were employed to ensure a rapid and rigorous process of intervention development and present the resulting novel framework for intervention development. The research comprised four workstreams: literature review (WS1), qualitative study (WS2), intervention development and implementation (WS3) and evaluation (WS4). Due to time constraints, we employed a parallel design for WS1-3 with the findings of WS1-2 informing WS3 on a continual basis. WS3 was underpinned by the Behaviour Change Wheel. We recruited expert panels to assist with intervention development. We reflected on decisions taken to facilitate the rapid yet rigorous process of intervention development. The empirical output was a theoretically informed and evidence-based intervention strategy to underpin interventions to support doctors' well-being during COVID-19 and beyond. The methodological output was a novel framework that facilitates rapid and rigorous development of interventions. The intervention strategy provides a foundation for development and evaluation of tailored interventions to support doctors' well-being. The novel framework provides guidance for the development of interventions where the situation demands a rapid yet rigorous development process.

An obesity-associated FTO gene variant and increased energy intake in children.

BACKGROUND: Variation in the fat mass and obesity-associated (FTO) gene has provided the most robust associations with common obesity to date. However, the role of FTO variants in modulating specific components of energy balance is unknown. METHODS: We studied 2726 Scottish children, 4 to 10 years of age, who underwent genotyping for FTO variant rs9939609 and were measured for height and weight. A subsample of 97 children was examined for possible association of the FTO variant with adiposity, energy expenditure, and food intake. RESULTS: In the total study group and the subsample, the A allele of rs9939609 was associated with increased weight (P=0.003 and P=0.049, respectively) and body-mass index (P=0.003 and P=0.03, respectively). In the intensively phenotyped subsample, the A allele was also associated with increased fat mass (P=0.01) but not with lean mass. Although total and resting energy expenditures were increased in children with the A allele (P=0.009 and P=0.03, respectively), resting energy expenditure was identical to that predicted for the age and weight of the child, indicating that there is no defect in metabolic adaptation to obesity in persons bearing the risk-associated allele. The A allele was associated with increased energy intake (P=0.006) independently of body weight. In contrast, the weight of food ingested by children who had the allele was similar to that in children who did not have the allele (P=0.82). CONCLUSIONS: The FTO variant that confers a predisposition to obesity does not appear to be involved in the regulation of energy expenditure but may have a role in the control of food intake and food choice, suggesting a link to a hyperphagic phenotype or a preference for energy-dense foods.

Feeding infants and young children. From guidelines to practice.

Following a workshop on infant feeding held at the Rowett Institute of Nutrition and Health, University of Aberdeen on March 17, 2010 experts were invited to exchange ideas and to review evidence on both pre and post natal dietary environments in shaping children's eating habits. A central theme during the workshop was the idea of "sensitive periods" during infancy for learning about foods and a particular focus was developed around acceptance and intake of fruits and vegetables. Presentations covered the guidelines provided by various governments on how to feed infants during weaning; the importance of the in utero experience; the impact of varying the sensory experience at weaning; the effect of parenting styles and practices on children's eating habits; the use of visual experience in promoting intake of vegetables; and reports from mothers regarding their decisions about weaning and the introduction of vegetables. This collection of papers seeks to review guidance from governments on feeding infants and to consider current evidence on parental feeding practices with the aim of enhancing insight into best practice in establishing healthy eating in children.

Food Security in Ghanaian Urban Cities: A Scoping Review of the Literature.

Urbanisation in Ghana could be negatively impacting the state of food security, especially in economically vulnerable groups. Food supply, safety, and quality are all aspects of food security which could be impacted. We conducted a scoping literature review to understand the nature and magnitude of evidence available on the urban food security situation in Ghana. A literature search was conducted in Medline, CINAHL, Embase, Global Health, Scopus, Web of Science, Africa Wide Information and Google Scholar to identify relevant peer-reviewed and grey literature. 45 studies, mainly cross-sectional surveys/food samples analysis, met the inclusion criteria. The majority of studies were concentrated in the Greater Accra Region (n = 24). Most studies focused on food safety and quality (n = 31). Studies on supply and stability were, however, scarce. Qualitative research methods were uncommon in the included studies. The existing literature on food security are concentrated in two regions: The Greater Accra and Ashanti regions. Future studies exploring food security in urban Ghana should focus on exploring the lived experiences and perceptions of food insecurity and food stability by urban-dwellers using qualitative methods. The evidence suggesting that the safety/quality of foods sold in Ghanaian markets is poor should be a concern to consumers and policy makers.

Interventions for the well-being of healthcare workers during a pandemic or other crisis: scoping review.

OBJECTIVES: The aim of this scoping review was to identify pre-existing interventions to support the well-being of healthcare workers during a pandemic or other crisis and to assess the quality of these interventions. DESIGN: Arksey and O'Malley's five-stage scoping review framework was used to identify the types of evidence available in the field of well-being interventions for healthcare workers during a pandemic. PubMed, PsycINFO, Embase, Scopus, Web of Science, CINAHL and ERIC databases were searched to find interventions for the well-being of doctors during pandemics. Owing to a lack of results, this search was expanded to all healthcare workers and to include any crisis. Databases were searched in June 2020 and again in October 2020. INCLUSION/EXCLUSION CRITERIA: Articles were included that studied healthcare workers, reported an intervention design and were specifically designed for use during a pandemic or other crisis. Well-being was defined broadly and could include psychological, physical, social or educational interventions. RESULTS: Searching produced 10 529 total academic references of which 2062 were duplicates. This left 8467 references. Of these, 16 met our inclusion criteria and were included in data extraction. During data extraction, three more papers were excluded. This left 13 papers to summarise and report. Of these 13 papers, 6 were prospective studies and 7 were purely descriptive. None of the interventions were theoretically informed in their development and the quality of the evidence was generally deemed poor. CONCLUSIONS: There are no high-quality, theory-based interventions for the well-being of healthcare workers during a pandemic or other crisis. Given that previous pandemics have been shown to have a negative effect on healthcare workers well-being, it is imperative this shortcoming is addressed. This scoping review highlights the need for high-quality, theory-based and evidence-based interventions for the well-being of healthcare workers during a pandemic.

Inter-individual differences in the nutrition response: from research to recommendations.

The 2019 Nutrition Society Spring Conference, which convened in Dundee, focused on the challenges presented by inter-individual differences in the responses to nutrition and in conducting nutritional research. The programme brought together national and international experts to discuss the collective evidence on inter-individual nutritional responses and impacts on health. Speakers and delegates from across the UK, Europe and the USA debated new methods of conducting research in nutrition and discussed the development of appropriate dietary interventions to maintain health and prevent disease in diverse populations. Symposium 1 focused on the effects of ethnicity on nutrient availability and type 2 diabetes and cardio-metabolic disease. Symposium 2 explored sex differences in nutrient availability and health and metabolism. The final symposium examined genetic and phenotypic variation, nutrition and health. The meeting ended with a panel discussion about how we take research to recommendations and concluded with a need to consider inter-individual differences in planning, conducting and analysing nutritional research.

Primary care patient and practitioner views of weight and weight-related discussion: a mixed-methods study.

OBJECTIVE: To understand the beliefs that primary care practitioners (PCPs) and patients with overweight and obesity have about obesity and primary care weight management in Scotland. SETTING: Seven National Health Service (NHS) Scotland primary care centres. PARTICIPANTS: A total of 305 patients and 14 PCPs (12 general practitioners; two practice nurses) participated. DESIGN AND METHODOLOGY: A cross-sectional mixed-methods study. PCPs and patients completed questionnaires assessing beliefs about obesity and primary care weight communication and management. Semi-structured interviews were conducted with PCPs to elaborate on questionnaire topics. Quantitative and qualitative data were synthesised to address study objectives. RESULTS: (1) Many patients with overweight and obesity did not accurately perceive their weight or risk of developing weight-related health issues; (2) PCPs and patients reported behavioural factors as the most important cause of obesity, and medical factors as the most important consequence; (3) PCPs perceive their role in weight management as awareness raising and signposting, not prevention or weight monitoring; (4) PCPs identify structural and patient-related factors as barriers to weight communication and management, but not PCP factors. CONCLUSIONS: Incongruent and/or inaccurate beliefs held by PCPs and patient may present barriers to effective weight discussion and management in primary care. There is a need to review, standardise and clarify primary care weight management processes in Scotland. Acknowledging a shared responsibility for obesity as a disease may improve outcomes for patients with overweight and obesity.

An analysis of directly observed weight communication processes between primary care practitioners and overweight patients.

OBJECTIVE: To analyse weight-related communication prevalence and processes (content/context) between primary care practitioners (PCPs) and overweight patients within routine primary healthcare consultations. METHODS: Consultations between 14 PCPs and 218 overweight patients (BMI ≥ 25 kg/m2) were video recorded. Weight communication was coded using the Roter Interaction Analysis System (RIAS) and the novel St Andrews Issue Response Analysis System (SAIRAS). Communication code frequencies were analysed. RESULTS: Weight discussion occurred in 25% of consultations with overweight patients; 26% of these had weight-related consultation outcomes (e.g. weight-related counselling and referrals, stated weight-related intention from patients). Weight discussions were more likely to occur if PCPs provided space to patient attempts to discuss weight (p = 0.013). Longer weight discussions (p < 0.001) and contextualising weight as problematic when PCP/patient-initiated weight discussion (p < 0.001) were associated with weight-related consultation outcomes. CONCLUSION: Weight was rarely discussed with overweight patients, however PCP space provision to patient weight-discussion initiation attempts increased weight discussion. When weight was discussed, increased time and/or contextualising weight as a problem increased the likelihood of weight-related consultation outcomes. PRACTICAL IMPLICATION: PCP use of specific communication approaches when discussing, contextualising and responding to patient weight may facilitate weight-related discussion and consultation outcomes and could lead to more effective patient weight management.