This paper was the work of Roza Kouvelioti, who did her undergraduate project with me a few years ago. Roza has just been accepted as a PhD student at Brock University in Canada.
The effects of exercise and diet on weight loss maintenance in overweight and obese adults: a systematic review.
Kouvelioti, Vagenas and Langley-Evans, Journal of Sports Medicine and Physical Fitness, 2014 In Press.
Overweight and obesity are widespread nutritional disorders. Their treatment aims at effective weight loss (WL) and weight loss maintenance (WLM). Previous systematic reviews show weight regain, after recommended exercise and diet combined. However, certain experimental and methodological inconsistencies in the original studies and in these reviews left space for a substantial revisit of this problem. This study aimed at systematically reviewing the effectiveness of exercise combined with diet on WLM in overweight and obese adults. Literature was searched through Embase and Sport Discus (up to 2008), and PubMed (Medline) and ISI Web of science (up to 2012). 14 randomized clinical trials (RCT) were retained, their quality was assessed by the Jadad scale, and detailed methodological and statistical characteristics were evaluated. Overall estimations showed a WL of 11.1 kg (about 13%) after an average of about 4 months from baseline, a WLM of 5.8 kg (about 52%) after 1 year, and a weight regain occurred in all 14 studies with an average of 5.1 kg. WL was successful but almost half of it (about 48%) was regained, which agrees with previous findings. The Jadad score showed very good to excellent quality for all 14 studies. However, further assessment revealed serious weakness such as high average dropout (>20%), not estimating experimental power or not using a control group in more than half of the studies, possible lack of adherence and variability in demographic traits. Future studies may focus on improving these limitations for more accurate results in this crucial research field.
Our paper describing the outcome of the Lincoln Bumps and Beyond antenatal weight intervention has been accepted for publication by Journal of Human Nutrition and Dietetics.
Limiting antenatal weight gain improves maternal health outcomes in severely obese pregnant women: findings of a pragmatic evaluation of a midwife-led intervention
Ailsa McGiveron, Sally Foster, Joanne Pearce, Moira A Taylor, Sarah McMullen, Simon C Langley-Evans.
Background: Antenatal obesity in pregnancy is associated with complications of pregnancy and poor obstetric outcomes. Although most guidance on pregnancy weight is focused on the pre-pregnancy period, pregnancy is widely viewed as a period where women are open to lifestyle change to optimise their health.
Method: The hospital-based Bumps and Beyond intervention invited all pregnant women with a BMI of over 35 kg/m2 to take part in a programme of health education around diet and exercise, accompanied by one-to-one guidance and monitoring of dietary change. This service evaluation compares 89 women who completed at a programme of 7 sessions with healthy lifestyle midwives and advisors (intervention) with a group of 89 women who chose not to attend (non-intervention).
Results: Weight gain in the intervention group (4.5±4.6 kg) was less than in the non-intervention group (10.3±4.4 kg) between antenatal booking and 36 weeks gestation (<0.001). This was associated with a 95% reduction in the risk of gestational hypertension during pregnancy and a general reduction in pregnancy complications. There was no effect of the intervention upon gestational diabetes or complications in labour other than post-partum haemorrhage (reduced 55%). The impact of the intervention on gestational weight gain was greater in women with BMI over 40 kg/m2 at booking. There were no adverse effects of the intervention, even though 21% of the intervention group lost weight during their pregnancy.
Conclusion: Intensive, personalised weight management intervention may be an effective strategy for prevention of hypertensive disorders during pregnancy.
We have a vacancy for an academic post in the Division of Nutritional Sciences. Please circulate to anybody who may be interested.
About this time last year I posted an account of our involvement in the evaluation of the Lincoln County Hospitals Trust Bumps and Beyond intervention. Well, that work was completed in the autumn and we have submitted a paper for publication, which I hope will be accepted soon.
The Bumps and Beyond intervention was designed by the Healthy Lifestyle Midwife lead for Lincolnshire Community Health Services. For our evaluation of a new clinical service we targeted recruitment at April 2012 to February 2013. All pregnant women attending clinics at Lincoln hospital (UK) with a BMI of ≥ 35 kg/m2 were invited to take part in the intervention, which was delivered on a one-to-one basis by either a midwife or healthy lifestyle advisor at hospital antenatal clinics or local community ‘health shops’. The full intervention comprised eight sessions, beginning when women were around 16 weeks pregnant and continuing every 2-4 weeks until week 36 of pregnancy. The intervention comprised an introduction and overview of lifestyle changes and the benefits of avoiding excessive weight gain during pregnancy along with general and pregnancy-specific nutrition guidance including food safety information, the Eatwell plate model and population-based dietary advice such as reducing intakes of fat, sugar and salt and increasing consumption of fruit, vegetables and fibre. These were accompanied by recommendations for the duration and intensity of appropriate physical activity during pregnancy and guidance on food labelling, shopping cooking and eating out. Advice was given on eating behaviour, the benefits of breastfeeding for weight loss/maintenance and guidance on the maintenance of healthy lifestyle changes beyond the intervention. All women who took part in the intervention kept a food diary to help identify and modify individual dietary patterns or behaviours and were also provided with a course booklet listing further sources of advice and information for pregnancy, healthy eating and weight management. The booklet was updated once during the course of the intervention following feedback from staff and participants.
Our evaluation focused on the impact of the intervention upon pregnancy weight gain and the complications associated with severe obesity during pregnancy. The results were dramatic with:
21% of women actually losing weight during pregnancy (with no adverse effect) and the average weight gain of the intervention group being within the healthy guidance range. Women who took part in the intervention gained nearly 5kg less than those who did not.
Pre-eclampsia and gestational hypertension were reduced by 90-95% in the intervention group.
Women undertaking the intervention 3 times more likely to breastfeed their babies.
The findings of the evaluation were fascinating and we now hope to conduct further work which will help us understand how and why the intervention was so effective. This understanding will be critical if the programme is to be exported to other centres.
My Head of School has set me a bit of a challenge. I have to write something about why academics use social media and why it might be a worthwhile thing to persuade colleagues to get involved with. This post is a bit of a practice I suppose, or maybe I will make this my report (that would be really novel). Until the beginning of 2013 I really couldn’t see the point myself and thought that Twitter was a pointless load of tosh, where morons followed every decree of celebrities or trolls patrolled on the hunt for vulnerable souls. I have since seen the light (or maybe become one of the morons…) and am an avid twitterer (tweeter? twit?) and of course have two blogs to manage.
As I see it social media serves several purposes for me:
Public comment on news stories and other people’s research
Dissemination of my activities and results from our work
Keeping in touch with what people within my collaborator network are doing
Finding about about BBSRC and other funder priorities as soon as they announce them
Monitoring publications from my favourite journals
Showcasing what our students are doing
Celebrating achievement within the School of Biosciences
Showing students that I just human and approachable
Outreach activity- the next generation of scientists are social media savvy and find this mode of communication normal and palatable
Messing about… laughing at pictures of kittens, etc (but we can gloss over that)
Publicity and an opportunity to comment on certain issues: I blog a lot more on my other channel for the Journal of Human Nutrition and Dietetics and have used that site as a chance to produce some non-standard publications (guides on writing, guides on peer review) which get a lot of visitors.
Dissemination: I can write about lab activities and our published papers on here. I can discuss results ahead of publication if I really want to and generally use this as a shop window for what we do.
Keeping in touch: I know that there are some people who read my blogs regularly and so I have begun to shape my posts for that audience. The coverage is immense. This blog for example attracts maybe 10 hits a day, with good coverage in the UK and USA. but the JHND blog gets an average of 100 visits per day, with global coverage.
‘Social’ media is just that- this is not static writing
Dissemination of information via social media is useful as it sparks debate in real time and is an interactive experience. It can provide a medium for open discussion of research (e.g. a new paper is published and people discuss and critique on Twitter), relevant news stories (e.g. in Nutritional Sciences we often openly respond to nutrition in the news stories via Twitter), publicise conference material for those who can’t be there, showcase student activity. Post a story and nine times out of ten, somebody will respond and pass it on to other people. We can get people and excited by posting simple comments about much deeper subjects. On Twitter it is OK to be quirky and funny to gain interest and prompt a more serious debate.
The great thing is- it isn’t time consuming. Stories can be initiated and read in a matter of minutes. There is no need to sweat over the quality of text. We can just say ‘Look at my new paper- it’s really exciting! Here it is.’ Users of social media form networks and groups for discussion. I know of many instances where postdocs in the lab tweet each other for advice on technical problems. The power of being able to tweet the whole world with ‘Does anybody know how to grow HUVECs #cellculturetips’ is awesome- because somebody WILL respond. Some of the networks that are made include people that we wouldn’t normally meet and as such it is a tool for the initiation of collaborations that may be built through other means. The conference that I am attending next week for example has set up a conference app that allows us all to exchange contact details, including Twitter addresses and follow each others reactions to the presentations. This may be a good way of finding the like-minded people in the hotel so that I can go and talk to them.
How could social media be used more widely?
The use of these tools could be greatly extended and there would be further advantages for the University community. In my area, we get many requests from the media to comment on stories about nutrition and health. 90% of these are real horrors that we shouldn’t touch wit a bargepole and the remainder usually require us to say something authoritative about work from another institution that we haven’t yet had the time to read in detail and provide a fair critique. It would be great if the media contact we had was about our own work for a change. Social media would be a great vehicle for driving that. Tweet an eye-catching picture with a link to a news story on our web pages, or just direct to our journal articles. If the picture is good, it will be retweeted many, many times and may eventually catch a journo’s eye.
It is the exponential nature of Twitter that makes it so attractive as a tool for communication. if you tweet something to your 500 followers and just half a dozen of them retweet it to their 500 followers each and then a couple of the next group do likewise, then you have potentially hit 10000 recipients of the message. It is instant too and doesn’t require anyone to go searching for information- these things just pop up on their phone. Some of the key institutions that we deal (BBSRC for example) with have Twitter feeds too and they will pick up on our news and activities by reading our tweets. Maybe they will pass them on by retweeting to many thousands of followers, and maybe they will note what we are doing and be impressed.
Any other reasons that I should be considering? Let me know. Go on! Prove that this is an interactive experience!
There are of course dangers- it is very easy to be unprofessional via social media, so it is really important to either keep control over idle fingers after a glass or two of wine, or ensure that you insert a disclaimer against your name to make it clear that your views are your own and not those of the University… However, what our School has to consider is the value of having an official Twitter feed or blog that is used in marketing, recruitment, news dissemination, etc, so these issues should not be a problem.
Update- this really is instant. I posted this blog at 1636 and by 1640 it had received 15 visitors…
The thousands of avid readers of this blog may have been wondering how things went with my latest outreach adventures in the world of ‘I’m a Scientist get me out of here’. I was one of the experts lined up for the Hungry Zone in March and it all turned out to be a bit disappointing. No schools got involved and so no questions came my way, no live chats brightened my day.