Preventing childhood obesity in general practice: a qualitative study of GPs, practice nurses, and practice managers.

BACKGROUND: General practitioners (GPs) in Australia have an important role to play in preventing childhood obesity. Activities such as growth monitoring and promotion of healthy behaviours can contribute to obesity prevention efforts; however, the practicalities of how this is done are poorly documented. OBJECTIVES: Objectives were to understand current attitudes and practices regarding promoting healthy childhood growth and development and preventing childhood obesity in general practice, and identify practical barriers and enablers to routinely incorporating this into general practice based on the observations and personal experiences of general practice staff. METHODS: A descriptive qualitative study was undertaken with Australian general practice staff. Barriers and enablers underwent thematic analysis and mapped to the ecological model. RESULTS: Interviews were conducted with 9 GPs, 4 nurses, and 2 practice managers. Participants agreed that growth monitoring and healthy behaviour promotion should be done for children with a healthy weight. However, the thematic analysis indicated that obesity prevention in clinics is not supported well by the broader general practice system, there are complexities associated with obesity prevention discussions, and the COVID-19 pandemic has intensified challenges in general practice. Two themes for obesity prevention enablers were identified; these related to bridging the implementation gap and the need for changes outside the clinic to support behaviour within the clinic. Ecological model mapping implicated multiple ecological levels for each theme. CONCLUSION: Childhood obesity prevention through growth monitoring and healthy behaviour promotion is relevant to general practice; however, more support is needed to enable implementation and embed these practices day-to-day.

Childhood obesity prevention in general practice: supporting implementation through co-ideation.

BACKGROUND: Childhood obesity is associated with physical and psychological complications thus the prevention of excess weight gain in childhood is an important health goal. Relevant to the prevention of childhood obesity, Australian general practice-specific, preventive care guidelines recommend General Practitioners (GPs) conduct growth monitoring and promote a number of healthy behaviours. However, challenges to providing preventive care in general practice may impact implementation. In October and November, 2022, a series of three workshops focusing on the prevention of childhood obesity were held with a group of Australian GPs and academics. The objective of the workshops was to determine practical ways that GPs can be supported to address barriers to the incorporation of obesity-related prevention activities into their clinical practice, for children with a healthy weight. METHODS: This paper describes workshop proceedings, specifically the outcomes of co-ideation activities that included idea generation, expansion of the ideas to possible interventions, and the preliminary assessment of these concepts. The ecological levels of the individual, interpersonal, and organisation were considered. RESULTS: Possible opportunities to support childhood obesity prevention were identified at multiple ecological levels within the clinic. The preliminary list of proposed interventions to facilitate action included GP education and training, clinical audit facilitation, readily accessible clinical guidelines with linked resources, a repository of resources, and provision of adequate growth monitoring tools in general practice. CONCLUSIONS: Co-ideation with GPs resulted in a number of proposed interventions, informed by day-to-day practicalities, to support both guideline implementation and childhood obesity prevention in general practice.

Maternal obesity prevention: The Health in Preconception, Pregnancy, and Postpartum Early- and Mid-Career Researcher Collective.

There is a clear impetus for researchers to facilitate cross-sector and interdisciplinary collaboration to achieve collective action for maternal obesity prevention. Building early- and mid-career researchers' capacity to sustainably develop collective action into the future is key. Therefore, the national Health in Preconception, Pregnancy, and Postpartum Early- and Mid-career Researcher Collective (HiPPP EMR-C) was formed. Here, we describe the aim, key goals and future directions of the HiPPP EMR-C. Guided by the Simplified Framework for Understanding Collective Action, we aim to build our capacity as researchers, form policy stakeholder relationships and focus on generating impact to optimise maternal and child health and well-being.

What role can accredited exercise physiologists play in the treatment of eating disorders? A descriptive study.

Including exercise alongside other therapeutic approaches may help to address dysfunctional exercise use and improve eating disorder treatment outcomes. However, traditional treatment teams often lack the expertise needed to safely prescribe exercise. The aims of this study were to explore the perceptions and experiences of Accredited Exercise Physiologists (AEPs) relating to working with clients diagnosed with eating disorders to identify the role they play in the treatment of eating disorders and identify future training needs. Individual semi-structured telephone interviews were conducted with 12 (n = 9 females) AEPs working in the eating disorders field. Thematic analysis was conducted to extract major themes from the interview transcripts. Five major themes were identified: (1) The role of AEPs in the treatment of individuals with eating disorders is comprehensive; (2) Treatment is more effective when all components are addressed; (3) The absence of therapeutic exercise within standard treatment protocols reflects limitations of traditional scope of practice and knowledge about the role of AEPs; (4) Methods of acquiring further knowledge are insufficient for those in current practice; and (5) Accredited comprehensive training is currently unavailable but needed. This qualitative study showed that AEPs believe they can play a major role in the treatment of eating disorders and that treatment outcomes for individuals are likely to be greatly enhanced when dysfunctional exercise is addressed. Multidisciplinary training is needed.

Reframing the early childhood obesity prevention narrative through an equitable nurturing approach.

High-quality mother-child interactions during the first 2,000 days, from conception to age 5 years, are considered crucial for preventing obesity development during early life stages. However, mother-child dyads interact within and are influenced by broader socio-ecological contexts involved in shaping child development outcomes, including nutrition. Hence, the coexistence of both undernutrition and obesity has been noted in inequitable social conditions, with drivers of undernutrition and overnutrition in children sharing common elements, such as poverty and food insecurity. To date, a holistic life-course approach to childhood obesity prevention that includes an equitable developmental perspective has not emerged. The World Health Organization (WHO) Nurturing Care Framework provides the foundation for reframing the narrative to understand childhood obesity through the lens of an equitable nurturing care approach to child development from a life-course perspective. In this perspective, we outline our rationale for reframing the childhood narrative by integrating an equitable nurturing care approach to childhood obesity prevention. Four key elements of reframing the narrative include: (a) extending the focus from the current 1,000 to 2,000 days (conception to 5 years); (b) highlighting the importance of nurturing mutually responsive child-caregiver connections to age 5; (c) recognition of racism and related stressors, not solely race/ethnicity, as part of adverse child experiences and social determinants of obesity; and (d) addressing equity by codesigning interventions with socially marginalized families and communities. An equitable, asset-based engagement of families and communities could drive the transformation of policies, systems and social conditions to prevent childhood obesity.

Maternal body dissatisfaction in pregnancy, postpartum and early parenting: An overlooked factor implicated in maternal and childhood obesity risk.

BACKGROUND: Current evidence indicates that to prevent the intergenerational transfer of overweight and obesity from parent to child, interventions are needed across the early life stages, from preconception to early childhood. Maternal body image is an important but often overlooked factor that is potentially implicated in both short- and long-term maternal and child health outcomes, including maternal gestational weight gain, postpartum weight retention, obesity, child feeding practices and early parenting. AIM: The aim of this paper is to propose a conceptual model of the relationship between maternal body image (with a specific focus on body dissatisfaction) and maternal and child excess body weight risk across the pregnancy, postpartum and early childhood periods, as well as to highlight opportunities for intervention. CONCLUSION: Our conceptual model proposes factors that mediate the associations between antenatal and postpartum maternal body dissatisfaction and maternal and childhood obesity risk. Pregnancy and postpartum present key risk periods for excess weight gain/retention and body dissatisfaction. Psychosocial factors associated with maternal body dissatisfaction, including psychopathology and disordered eating behaviours, may increase maternal and child obesity risk as well as compromise the quality of mother-child interactions underpinning child development outcomes, including physical weight gain. Our conceptual model may be useful for understanding modifiable psychosocial factors for preventing the intergenerational transfer of obesity risk from mothers to their children, from as early as pregnancy, and highlights next steps for multidisciplinary research focused on combatting maternal and child obesity during critical risk periods.

Early mother-child dyadic pathways to childhood obesity risk: A conceptual model.

Understanding the emotional quality of the mother-child dyadic relationship and parent-child feeding interactions may further clarify early developmental pathways to eating behaviours and obesity risk. The quality of parent-child relationships fosters all aspects of child development but has not yet been extensively examined in relation to childhood weight gain. The aim of this paper is to propose a conceptual model, which outlines early mother-child dyadic pathways linking parent-child feeding interactions to child body mass index, where parent-child relationships have a central role. It maps out individual and dyadic mother-child factors (i.e., attachment, child temperament and maternal mental health) that influence the nature and quality of parent-child feeding interactions from infancy to toddlerhood. Our model bridges the gap between research fields by bringing together key maternal and child factors implicated in child development. Understanding early parent-child feeding interactional patterns and their influence on child self-regulation and eating behaviours may be relevant to multidisciplinary approaches toward preventing childhood obesity. High quality quantitative and observational data capturing meaningful parent, child and dyadic level interactions around food contexts, attachment security, maternal mental health, child temperament and self-regulation will help to inform new, aetiologically important, targets for preventative intervention.

Understanding problematic eating in out-of-home care: The role of attachment and emotion regulation.

Children living in Out-of-Home Care (OoHC) are thought to be especially vulnerable to developing problematic eating behaviours due to their likelihood of having insecure attachment styles and emotion regulation deficits. Despite this increased risk, our understanding of problematic eating among children in OoHC is limited. Therefore, this study aimed to; (1) Explore the rate of problematic eating behaviours among children living in OoHC, specifically residential and foster care; (2) Investigate how carers manage problematic eating and (3) Understand carers' perceptions of the role of attachment and emotion regulation in relation to problematic eating in OoHC. Semi-structured interviews, focus groups, and surveys were conducted with residential care staff (n = 36) and foster carers (n = 8) in Victoria, Australia. Interviews were recorded, transcribed, and analysed for themes, and frequency data from the survey were generated. Residential and foster carers reported that approximately 38% of the children in their care displayed problematic eating behaviours at a clinical level. Both residential and foster carers commonly understood these behaviours as a function of the child's experiences of food deprivation and limited access to healthy foods prior to entering care which, they believe, has contributed to problems with regulating food intake and/or willingness to try new foods. Carers also commonly reported that the children in their care struggle to form attachments or regulate their emotions, which impacts carers ability to manage problematic eating. It is recommended that future interventions prioritise educating community service organisations (CSOs), responsible for delivering OoHC, to better recognise and address problematic eating behaviours. This will enable CSOs to train their residential and foster carers about how best to respond to and manage problematic eating behaviours.

Do maternal perceptions of child eating and feeding help to explain the disconnect between reported and observed feeding practices?: A follow-up study.

Research demonstrates a mismatch between reported and observed maternal feeding practices. This mismatch may be explained by maternal cognitions, attitudes, and motivations relating to dyadic parent-child feeding interactions. These complex constructs may not be apparent during observations nor evidenced in self-report questionnaire. Therefore, the aim of this study was to use a qualitative approach to gain a more nuanced and contextualized understanding of (a) maternal perceptions of children's food intake control; (b) how parent-child mealtime interactions influence maternal feeding practices; and (c) ways in which mothers may promote healthy child eating and weight outcomes. Semistructured telephone interviews were conducted with 23 mothers (M = 38.4 ± 3.7 years of age) of preschool-aged children (M = 3.8 ± 0.6 years of age, 19 were normal weight, 14 were girls), who had previously completed child feeding questionnaire and participated in two home-based mealtime observations, 12 months apart. Interviews were recorded, transcribed, and themes extracted to create the database. Four major themes emerged: (a) Maternal confidence in children's ability to regulate food intake is variable; (b) Implementing strategies for nurturing healthy relationships with food beyond the dining table; (c) Fostering positive mealtime interactions is valued above the content of what children eat; and (d) Situation-specific practices and inconsistencies. Findings indicate that maternal feeding practices are shaped by both parent and child influences, and child feeding is mostly guided by controlling the family food environment, rather than by directly pressuring or restricting their child's eating. Results also highlighted the need for research to consider both parent and child influences on child feeding.

Mutually Responsive Orientation: A novel observational assessment of mother-child mealtime interactions.

Mother-child mealtime interactions during preschool years is an important but overlooked factor when evaluating the influence of parent-child relationships on child eating and weight. This paper describes the validation of the Mutually Responsive Orientation (MRO) coding system adapted for assessing parent-child interactions during food preparation and consumption situations. Home-based mealtimes of 94 mothers and their children (3.03 ± 0.75 years) were filmed at two time points, 12-months apart. Filmed dimensions of mutual mother-child responsiveness, shared positive affect, maternal control relating to food and child compliance were assessed. Objective BMI and maternal reports of parenting, feeding, child eating, diet and child temperament were also collected. Correlations, repeated measures ANOVAs and regressions were performed to examine the validity of MRO variables and their stability across both time points. Validation analysis showed the MRO coding system performed as expected: dyads with higher MRO scores expressed lower control/power assertion, lower child non-compliance, and greater committed compliance. The measure demonstrated sensitivity to specific contexts: maternal responsiveness, mother and child positive affect were higher during food consumption compared to food preparation. Coded dimensions were stable across time points, with the exception of decreases in maternal responsiveness in food consumption and child non-compliance in food preparation. MRO and maternal dimensions were correlated with maternally reported parenting and feeding measures. Maternal responsiveness (inversely) and child responsiveness (positively) were concurrently associated with child fussy eating, and child refusal was prospectively and inversely associated with child fussy eating. Findings suggest the adapted MRO coding system is a useful measure for examining observed parent-child mealtime interactions potentially implicated in preschoolers' eating and weight development.

Reported and observed controlling feeding practices predict child eating behavior after 12 months.

BACKGROUND: Controlling feeding practices are linked to children's self-regulatory eating practices and weight status. Maternal reports of controlling feeding practices are not always significantly related to independently rated mealtime observations. However, prior studies only assessed 1 mealtime observation, which may not be representative of typical mealtime settings or routines. OBJECTIVES: The first aim was to examine associations between reported and observed maternal pressure to eat and restriction feeding practices at baseline (T1) and after ∼ 12 mo (T2). The second aim was to evaluate relations between maternal and child factors [e.g., concern about child weight, child temperament, child body mass index (BMI)-for-age z scores (BMIz)] at T1 and reported and observed maternal pressure to eat and restriction feeding practices (T1 and T2). The third aim was to assess prospective associations between maternal feeding practices (T1) and child eating behaviors (T2) and child BMIz (T2). METHODS: A sample of 79 mother-child dyads in Victoria, Australia, participated in 2 lunchtime home observations (T1 and T2). BMI measures were collected during the visits. Child temperament, child eating behaviors, maternal parenting styles, and maternal feeding practices were evaluated at T1 and T2 via questionnaires. Associations were assessed with Pearson's correlation coefficients, paired t tests, and hierarchical regressions. RESULTS: Reported restriction (T1) was inversely associated with observed restriction at T1 (r = -0.24, P < 0.05). Reported pressure to eat (T2) was associated with observed pressure to eat (T2) (r = 0.48, P < 0.01) but only for mothers of girls. Maternal weight concern was associated with reported restriction at T1 (r = 0.29, P < 0.01) and T2 (r = 0.36, P < 0.01), whereas observed restriction (T1) was prospectively associated child BMI at T2 (ß = -0.18, P < 0.05). CONCLUSIONS: Maternal reports may not always reflect feeding practices performed during mealtimes; it is possible some mothers may not be aware of their practices or observations may not capture covert controlling strategies.

Child temperament and maternal predictors of preschool children's eating and body mass index. A prospective study.

Research has previously identified relationships between child temperament and BMI during childhood. However, few studies have addressed the broader implications of child temperament on the development of obesogenic risk factors, such as maternal feeding, child eating and body mass index (BMI) of pre-schoolers. Hence, the current study evaluated cross-sectional and prospective associations between child temperament, maternal feeding, maternal parenting styles, mother-child interaction, preschoolers' eating behaviours and BMI. Child irritability, cooperation-manageability and easy-difficult temperaments, mother-child dysfunctional interaction, maternal pressure to eat and restriction were significantly cross-sectionally associated with child eating behaviours. Child enjoyment of food was significantly associated with child BMI. Child easy-difficult temperament and mother-child dysfunctional interaction predicted child eating behaviours longitudinally and baseline child BMI measures predicted child BMI longitudinally. Average maternal ratings of child temperament were relatively neutral, potentially explaining why most associations were not robust longitudinally. Future research should include a sample of greater socio-economic and BMI diversity as well as objective measures of child temperament, diet composition, maternal feeding practices, and mother-child interaction.

How are health, nutrition, and physical activity discussed in international guidelines and standards for children in care? A narrative review.

BACKGROUND: Children in care (CiC) have often experienced trauma and, as a result, are at high risk for poor health outcomes. It is imperative that human-service stakeholders provide trauma-informed health services and interventions. However, little is known about how health promotion is addressed in the standards and guidelines for CiC. For this scoping review, the aim was to examine and compare how nutrition and physical activity are discussed in: 1) federal standards for CiC across the United Kingdom, the United States, New Zealand, and Australia; and 2) state and territory guidance in Australia. METHOD: The grey literature was searched for documents outlining key child-welfare standards, guidelines, or policies for the provision of care across foster, kinship, or residential care. Documents were examined for the inclusion of recommendations and/or strategies focused on primary health and the promotion of nutrition and/or physical activity. RESULTS: A total of 52 documents were included in this review: 28 outlining international federal guidance and 24 Australian documents. In the United States, New Zealand, and Australia, references to physical activity were often broad, with minimal direction, and nutrition was often neglected; the United Kingdom provided more detailed guidance to promote nutrition and physical activity among CiC. CONCLUSION: There is a lack of consistency and specificity in guidelines supporting healthy lifestyle interventions for CiC both internationally and within Australia. It is recommended that 1) specific trauma-informed health promotion guidelines are developed for CiC; and 2) trauma-informed health promotion training is provided to carers. Doing so will ensure that care is provided in a manner in which stakeholders recognize the signs and consequences of trauma in order to determine the most appropriate health interventions to improve outcomes and prevent ongoing trauma for this population.

Barriers and enablers to consumer and community involvement in research and healthcare improvement: Perspectives from consumer organisations, health services and researchers in Melbourne, Australia.

Partnering with consumers and patients and the community and public is a research and healthcare improvement imperative. Consumer and community involvement (CCI) requires behaviour change at the individual (researcher, health professional, manager), organisational (health service, university, medical research institute) and system level (funding policies, collaboration between organisations). To understand the barriers and enablers to meaningful CCI, a qualitative descriptive study was undertaken with researchers, health professionals, representatives from consumer organisations, and health services and ethics committees in Melbourne, Australia. Twenty-eight semi-structured interviews and one focus group were conducted in May-August 2019. Ethics approval was obtained. Thematic analysis was guided by the Capability, Opportunity and Motivation and Behaviour model (COM-B). Training of researchers and health professionals in CCI, benefits and systems and processes to undertake CCI, alongside incorporating CCI as a requirement for funding were identified as enablers. Lack of time and resources for CCI, challenges in finding consumers for projects and a perceived lack of evidence of the impact of CCI were barriers. These identified barriers and enablers will inform strategies to build the capacity of CCI at the individual, organisation and system level within the Australian Health Research Alliance.

Clinical practice guidelines for the prevention of childhood obesity: A systematic review of quality and content.

Obesity in childhood is a significant global issue, and prevention is key to reducing prevalence. Healthcare providers can play an important role in the prevention of obesity. The aim of this systematic review was to identify and evaluate clinical practice guidelines (CPGs) for preventing childhood obesity with a focus on the role of medical doctors. Peer-reviewed literature and gray literature sources were searched for CPGs published from 2010 to 2021. Eleven CPGs were identified. Quality was evaluated using the Appraisal of Guidelines for Research and Evaluation Collaboration (AGREE II) instrument; seven CPGs were higher quality and four lower quality. Recommendations within the CPGs covered three main areas: growth monitoring, maintaining a healthy weight, and managing overweight. The importance of involving the whole family and healthy lifestyle behaviors was emphasized. The majority of the CPGs rated poorly in guideline applicability highlighting the need for practical implementation tools. Although our review identified a number of CPGs relevant to the prevention of obesity for doctors working with children and their families, more research is needed to produce high-quality meaningful and applicable CPGs to maximize uptake, implementation, and ultimately, benefit to children and their families.

Content Analysis of #Postpartumbody Images Posted to Instagram.

Understanding the imagery on social media targeting postpartum women is an important step in determining the utility of Instagram as a potential avenue for targeting public health messages to this group. This study (1) describes the content of images on Instagram tagged with #postpartumbody and; (2) compares images from 'Top' posts ('trending' or 'popular') with 'Recent' posts. 600 images tagged with #postpartumbody (300 'Top' and 300 'Recent') were systematically captured from Instagram and coded using a predefined framework. Images of women were coded for adiposity, muscularity, pose and attire. Chi-square tests were used to compare 'Top' and 'Recent' posts. Most (n = 409) images were of a woman who generally had low/average adiposity (91%) and little-to-none/some visible muscle definition (93%). Most women (52%) were posing in a non-specific manner, 5% were posing to accentuate a postpartum body feature and 40% were wearing fitness attire. Compared with 'Recent', 'Top' posts were less likely to be text-focused (p < 0.001), photos of food (p < 0.001) or linked to a product/program (p < 0.001). Women of lower adiposity are more likely to post images of themselves on Instagram tagged with #postpartumbody than women of higher adiposity, which may reflect increased body pride in this group, but could reduce body satisfaction for some viewers. Conveying health information on Instagram may be necessary to interrupt potentially harmful content.

Nurturing children's development through healthy eating and active living: Time for policies to support effective interventions in the context of responsive emotional support and early learning.

Fostering the growth, development, health, and wellbeing of children is a global priority. The early childhood period presents a critical window to influence lifelong trajectories, however urgent multisectoral action is needed to ensure that families are adequately supported to nurture their children's growth and development. With a shared vision to give every child the best start in life, thus helping them reach their full developmental potential, we have formed the International Healthy Eating Active Living Matters (HEALing Matters) Alliance. Together, we form a global network of academics and practitioners working across child health and development, and who are dedicated to improving health equity for children and their families. Our goal is to ensure that all families are free from structural inequality and oppression and are empowered to nurture their children's growth and development through healthy eating and physical activity within the context of responsive emotional support, safety and security, and opportunities for early learning. To date, there have been disparate approaches to promoting these objectives across the health, community service, and education sectors. The crucial importance of our collective work is to bring these priorities for early childhood together through multisectoral interventions, and in so doing tackle head on siloed approaches. In this Policy paper, we draw upon extensive research and call for collective action to promote equity and foster positive developmental trajectories for all children. We call for the delivery of evidence-based programs, policies, and services that are co-designed to meet the needs of all children and families and address structural and systemic inequalities. Moving beyond the "what" is needed to foster the best start to life for all children, we provide recommendations of "how" we can do this. Such collective impact will facilitate intergenerational progression that builds human capital in future generations.

A systematic review of humour-based strategies for addressing public health priorities.

OBJECTIVE: To systematically review research into the use of humour-based health promotion strategies for addressing public health issues during the past 10 years. METHOD: The systematic review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. RESULTS: Thirteen studies were included in the review. Mental health, breast and testicular cancer self-examination, safe sex, skin cancer and binge drinking public health issues were targeted. Humour-based strategies were used to influence health attitudes and behaviours, encourage interpersonal sharing to indirectly affect health behaviour, and investigate the level of threat and humour associated with positive outcomes. Findings provided some evidence to support the use of humour-based strategies as determined by the right combination of audience characteristics, level of humour and amusement evoked, and message persuasion and behaviour change methods underpinning strategies. CONCLUSION: Methodologies varied limiting comparability, although overall results indicate that humour-based health promotion strategies may be a useful tool for increasing awareness and help-seeking behaviour for public health priorities, particularly those associated with stigma. Implications for public health: Humour interventions vary widely because there can never be a standardised approach to evoking humour. Further research examining humour and public health promotion is needed.

Lifestyle and Psychological Factors of Women with Pregnancy Intentions Who Become Pregnant: Analysis of a Longitudinal Cohort of Australian Women.

Preconception lifestyle and psychological factors are associated with maternal and offspring outcomes. Both are important considerations for women planning pregnancy. The aim of this study was to explore associations between lifestyle/psychological factors and long-term pregnancy intentions in women who go on to become pregnant. Data from the cohort born 1973-1978 from the Australian Longitudinal Study of Women's Health were utilised. Women were included if they had a new pregnancy occurring between Waves 3 and 5, resulting in 2203 women for analysis. Long-term pregnancy intentions (aspirations for children in 5-10 years), demographic, anthropometric, lifestyle (sedentary behaviour, physical activity, diet quality, smoking, alcohol use), and psychological factors (depression, anxiety, stress) were assessed at Wave 3. Multivariable logistic regression was employed to evaluate the associations between pregnancy intentions and lifestyle/psychological factors, adjusting for other explanatory variables. Younger age and being married were associated positively with pregnancy intentions, while living with obesity was associated negatively with pregnancy intentions. No lifestyle or psychological factors were significantly associated with pregnancy intentions. Our findings highlight potential opportunities to identify women who have longer-term pregnancy intentions during clinical care, offering a pivotal moment for preconception care relating to lifestyle health, psychological wellbeing, and family planning.

Weight stigma and obesity-related policies: A systematic review of the state of the literature.

Weight stigma is an important issue colliding with obesity-related policies; both have population health and social impacts. Our aim was to conduct a systematic review of the peer-reviewed literature that combined the concepts of stigma, obesity, and policy. We searched PsycINFO, Medline, Scopus, and Google Scholar for peer-reviewed articles amalgamating terms relevant to stigma, obesity, and policy. Of 3219 records identified, 47 were included in the narrative synthesis. Two key types of studies emerged: studies investigating factors associated with support for obesity-related policies and those exploring policy implementation and evaluation. We found that support for nonstigmatizing obesity-related policies was higher when obesity was attributed as an environmental rather than individual problem. An undercurrent theme suggested that views that blame individuals for their obesity were associated with support for punitive policies for people living in larger bodies. Real-world policies often implicitly condoned stigma through poor language choice and conflicting discourse. Our findings inform recommendations for policy makers that broader socioecological stigma-reduction approaches are needed to fully address the issue of weight stigma in obesity-related policies. Efforts are needed in the research and policy sectors to understand how to improve the design and support of nonstigmatizing obesity-related policies.