obesity (6)

Personalised Nutrition

As individuals seek increasingly individualised nutrition and lifestyle guidance, numerous apps and nutrition programmes have emerged. However, complex individual variations in dietary behaviours, genotypes, gene expression and composition of the microbiome are increasingly recognised. Advances in digital tools and artificial intelligence can help individuals more easily track nutrient intakes and identify nutritional gaps. However, the influence of these nutrients on health outcomes can vary widely among individuals depending upon life stage, genetics and microbial composition. For example, folate may elicit favourable epigenetic effects on brain development during a critical developmental time window of pregnancy. Genes affecting vitamin B12 metabolism may lead to cardiometabolic traits that play an essential role in the context of obesity. Finally, an individual's gut microbial composition can determine their response to dietary fibre interventions during weight loss. These recent advances in understanding can lead to a more complete and integrated approach to promoting optimal health through personalised nutrition, in clinical practice settings and for individuals in their daily lives. The purpose of this review is to summarise presentations made during the DSM Science and Technology Award Symposium at the 13th European Nutrition Conference, which focused on personalised nutrition and novel technologies for health in the modern world.

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Background

Coronavirus disease 2019 (COVID-19) has led to unprecedented changes in the way we live, particularly for people at higher risk of severe illness from COVID-19. People with pre-existing health conditions have been markedly impacted and, in some instances, left unsupported due to reduced provision of routine healthcare services. People living with obesity (PLWO) are identified as at higher risk of severe illness from COVID-19 infection. Currently, there is a paucity of evidence about the impact of the first COVID-19 lockdown on PLWO, including those accessing weight management and bariatric surgery services (WMS).

Methods

543 adults (16–80 years) with obesity (BMI ≥ 30 kg/m2) were recruited between 14th May and 9th July 2020 through social media advertisements, professional and patient obesity organisations and WMS. Participants completed an online survey regarding the impact of the first COVID-19 lockdown upon, mental health, well-being, health-related behaviours, risk mitigating behaviours, access to WMS and weight stigma.

Findings

During the first COVID-19 lockdown, the majority of PLWO reported deterioration of their mental health and health-related behaviours such as diet, physical activity (PA) and sleep. With 55% reporting an unhealthier diet, 61% reduced PA and 80% worsening of their sleep. Higher depression and lower wellbeing scores were found to associate with the greatest adverse impact upon health-related behaviours. PLWO who were attending WMS prior to the first lockdown reported a greater deterioration of their diet, with nearly 50% reporting worsening of their diet and PA worsening compared to PLWO who were not attending WMS. Most participants took two or more risk mitigating actions (73%). PLWO attending WMS reported reduced access (44%) with insufficient information (49%) from their clinical service providers. The majority of participants reported no change in perceived weight stigma.

Interpretation

This study shows the detrimental impact of the first COVID-19 lockdown on PLWO in relation to health-related behaviours, mental health and access to WMS. Our findings show that PLWO with poor mental health and those attending WMS were most adversely impacted and highlights the need for greater mental health support and continued provision of support from WMS for PLWO during future lockdowns.

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Solving the obesity crisis

Obesity is on the rise; current initiatives and policies aimed at fighting obesity have been insufficient to reverse the trend. The success of tackling the obesity pandemic depends on governments, businesses and civil society working together to fix inadequacies in our food and health systems, focusing on better nutrition and diets for all.

This year, on World Obesity Day, it has never been more important to recognise that improving nutrition and addressing poor diets needs to be at the forefront of collective efforts to tackle obesity. The COVID-19 pandemic is interlinked with the slower, yet no less devastating pandemic of food and nutrition insecurity, obesity, diabetes and other diet-related conditions. The top predictors of severe COVID-19 complications, other than age, are diet-related risks such as obesity, diabetes, hypertension and cardiovascular disease. In fact, a recent global analysis suggests that being obese doubles the risk of hospital treatment and increases the risk of dying from Covid by nearly 50 percent.

To read more click here: Solving the obesity crisis

And here: COVID-19 and Obesity: The 2021 Atlas

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Context

In England, the majority of adults, and more than a quarter of children aged 2 to 15 years live with obesity or excess weight. From 1992 to 2020, even though the government published 14 obesity strategies in England, the prevalence of obesity has not been reduced. We aimed to determine whether such government strategies and policies have been fit for purpose regarding their strategic focus, nature, basis in theory and evidence, and implementation viability.

Method

We undertook a mixed‐methods study, involving a document review and analysis of government strategies either wholly or partially dedicated to tackling obesity in England. We developed a theory‐based analytical framework, using content analysis and applied thematic analysis (ATA) to code all policies. Our interpretation drew on quantitative findings and thematic analysis.

Findings

We identified and analyzed 14 government strategies published from 1992 to 2020 containing 689 wide‐ranging policies. Policies were largely proposed in a way that would be unlikely to lead to implementation; the majority were not interventionist and made high demands on individual agency, meaning that they relied on individuals to make behavior changes rather than shaping external influences, and are thus less likely to be effective or to reduce health inequalities.

Conclusions

The government obesity strategies’ failure to reduce the prevalence of obesity in England for almost 30 years may be due to weaknesses in the policies’ design, leading to a lack of effectiveness, but they may also be due to failures of implementation and evaluation. These failures appear to have led to insufficient or no policy learning and governments proposing similar or identical policies repeatedly over many years. Governments should learn from their earlier policy failures. They should prioritize policies that make minimal demands on individuals and have the potential for population‐wide reach so as to maximize their potential for equitable impacts. Policies should be proposed in ways that readily lead to implementation and evaluation.

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8060374068?profile=RESIZE_710x Food Standards Scotland’s updated Situation Report – The Scottish Diet: It Needs to Change 2020 highlights the ongoing challenge for people in Scotland to have a healthier diet, including new exploration of the out of home environment, such as food bought ‘on the go’, and from deliveries and takeaways.

It is important to note that this data was captured prior to the COVID-19 pandemic, and therefore provides a baseline for further investigation on its impact on diet in Scotland.

The report shows that:

  • There continues to be a lack of progress towards the Scottish dietary goals and improving obesity and diet related poor health
  • Two out of three people in Scotland remain either overweight or obese, with a higher proportion of people living with obesity in the most deprived areas compared to the least deprived
  • We continue to buy a lot of discretionary foods and drinks, such as confectionery, cakes, biscuits, pastries, savoury snacks and sugary drinks from shops and supermarkets, and these tend to be heavily promoted
  • The food and drink we purchase from the out of home environment tend to be less healthy, with fried chicken and burger meals and sides among the top takeaway meals and dishes
  • People in Scotland support the food environment providing healthier food to make it easier to choose a healthier diet.

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In late July, following considerable interest and reporting on the relationship between obesity and COVID-19, the UK Government released a policy paper:

‘Tackling obesity: empowering adults and children to live healthier lives’

As a group of nutrition researchers, educators and clinicians, we recognise the complexity which spans diet, nutrition and health interfacing with diverse domains such as the social sciences, economics and politics on one hand as well as genetics and biomedical sciences on the other. We also recognise the complexities associated with obesity and weight loss. Therefore, we advocate for the appreciation and adoption of a wider, complete understanding of the science behind obesity and the strategies which are needed to address it.

In its' response to the UK Government policy paper on obesity, NNEdPro discussed four points of the proposed obesity strategy and provide recommendations for a more comprehensive and impactful response.

Read full NNEdPro response.

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