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Background Overweight and obesity pose a big challenge to pregnancy as they are associated with adverse maternal and perinatal outcome. Evidence of lifestyle intervention resulting in improved pregnancy outcome is conflicting. Hence the objective of this study is to determine the efficacy of antenatal dietary, activity, behaviour or lifestyle interventions in overweight and obese pregnant women to improve maternal and perinatal outcomes. Methods A systematic review and meta-analyses of randomised and non-randomised clinical trials following prior registration (CRD420111122 http://www.crd.york.ac.uk/PROSPERO ) and PRISMA guidelines was employed. A search of the Cochrane Library, EMBASE, MEDLINE, CINAHL, Maternity and Infant care and eight other databases for studies published prior to January 2012 was undertaken. Electronic literature searches, study selection, methodology and quality appraisal were performed independently by two authors. Methodological quality of the studies was assessed according to Cochrane risk of bias tool. All appropriate randomised and non-randomised clinical trials were included while exclusions consisted of interventions in pregnant women who were not overweight or obese, had pre-existing diabetes or polycystic ovarian syndrome, and systematic reviews. Maternal outcome measures, including maternal gestational weight gain, gestational diabetes and Caesarean section, were documented. Fetal outcomes, including large for gestational age and macrosomia (birth weight > 4 kg), were also documented. Results Thirteen randomised and six non-randomised clinical trials were identified and included in the meta-analysis. The evidence suggests antenatal dietary and lifestyle intervention in obese pregnant women reduces maternal pregnancy weight gain (10 randomised clinical trials; n = 1228; -2.21 kg (95% confidence interval -2.86 kg to -1.59 kg)) and a trend towards a reduction in the prevalence of gestational diabetes (six randomised clinical trials; n = 1,011; odds ratio 0.80 (95% confidence interval 0.58 to 1.10)). There were no clear differences reported for other outcomes such as Caesarean delivery, large for gestational age, birth weight or macrosomia. All available studies were assessed to be of low to medium quality. Conclusion Antenatal lifestyle intervention is associated with restricted gestational weight gain and a trend towards a reduced prevalence of gestational diabetes in the overweight and obese population. These findings need to be interpreted with caution as the available studies were of poor to medium quality.

Background Obesity is a global health challenge associated with increased risk of co-morbidity and mortality. Existing government policies have failed to adequately address obesity. Mapping obesity policy actions (including prevention initiatives and weight-management services) using behavioural science can offer insights into how approaches to prevention/management could be improved. This research aimed to identify strengths and gaps in adult obesity policy actions/weight-management services in Northern Ireland by conducting a systematic scoping review of grey literature. Obesity policy actions/weight-management services were mapped out and coded using the Behaviour Change Wheel, then assessed against obesity risk factors identified from the Foresight Obesity System Map. Methods The breadth of obesity policy actions/services was mapped using Google Advanced Searches, grey literature database searches, targeted website searches and stakeholder consultations. Policy actions/services were categorised using the UK weight-management tiered system and coded by Behaviour Change Wheel intervention type. Foresight variables were coded according to the Capability-Opportunity-Motivation-Behaviour (COM-B) Model. Policy actions/services were subsequently mapped against Foresight variables and displayed using a heat map. Results Twelve Google Advanced Searches, three database searches, n=17 targeted website searches and three stakeholder interviews were conducted (and updated in 2024) identifying a wide range of relevant records (N=127). Results included policies/strategies/guidelines/campaigns/services targeting weight management/obesity. Of the identified policy actions/services, 72% were classified as tier 1 (health promotion); 21% tier 2 (community-based weight management programmes); 2% tier 3 (specialist obesity services), 5% were tier 2/3 services and 0% were tier 4 services (metabolic surgery). Education and persuasion were the most commonly coded intervention types from the Behaviour Change Wheel, followed by enablement and training. Environmental restructuring was limited, as was modelling and incentivisation approaches. Conclusions Behavioural mapping of obesity policy actions/weight-management services is a novel approach with the potential to influence policy/service development. In Northern Ireland, using this method illustrated policy gaps and significant opportunities to improve Weight-management service provision.

Background Children with avid eating behaviour display high food responsiveness, high emotional overeating and low sensitivity to fullness; behaviours which may increase the risk of obesity and are challenging for parents to manage. This study explores the situational predictors of coercive or indulgent feeding practices among parents of children with avid eating behaviours using Ecological Momentary Assessment (EMA). Methods The study involved 109 parents of 3-5-year-old children exhibiting avid eating behaviour. Over 10 days, participants completed EMA surveys via a mobile app to report on their mood, stress, feeding goals, and feeding practices during eating occasions. Multilevel modelling was used to assess how parental mood, goals, and the eating context (e.g., meal versus snack, public versus private setting) influenced feeding practices. Results Parents were more likely to use specific coercive or indulgent feeding practices when experiencing higher stress, when aiming to avoid mealtime conflict, and during meals versus snacks. A negative meal atmosphere and a public setting also increased the likelihood of certain indulgent practices. Notably, parents were more likely to report giving their child food to calm them down or help manage their behaviour when the meal atmosphere was perceived as negative and if they aimed to reduce conflict at the meal. The findings highlight that the context of feeding occasions significantly drives the use of coercive or indulgent feeding practices. Conclusions Parental stress, goals, and the eating context are key determinants of coercive or indulgent feeding practices with children exhibiting avid eating behaviours. Interventions to support parents should consider these dynamic factors, promoting healthier feeding strategies tailored to real-life contexts.

Background Social marketing campaigns offer a promising approach to the prevention of childhood obesity. Change4Life (C4L) is a national obesity prevention campaign in England. It included mass media coverage aiming to reframe obesity into a health issue relevant to all and provided the opportunity for parents to complete a brief questionnaire (‘How are the Kids’) and receive personalised feedback about their children’s eating and activity. Print and online C4L resources were available with guidance about healthy eating and physical activity. The study aims were to examine the impact of personalised feedback and print material from the C4L campaign on parents’ attitudes and behaviours about their children’s eating and activity in a community-based cluster-randomised controlled trial. Methods Parents of 5–11 year old children were recruited from 40 primary schools across England. Schools were randomised to intervention or control (‘usual care’). Basic demographic data and brief information about their attitudes to their children’s health were collected. Families in intervention schools were mailed the C4L print materials and the ‘How are the Kids’ questionnaire; those returning the questionnaire were sent personalised feedback and others received generic materials. Outcomes included awareness of C4L, attitudes to the behaviours recommended in C4L, parenting behaviours (monitoring and modelling), and child health behaviours (diet, physical activity and television viewing). Follow-up data were collected from parents by postal questionnaire after six months. Qualitative interviews were carried out with a subset of parents (n = 12). Results 3,774 families completed baseline questionnaires and follow-up data were obtained from 1,419 families (37.6%). Awareness was high in both groups at baseline (75%), but increased significantly in the intervention group by follow-up (96% vs. 87%). Few parents (5.2% of the intervention group) returned the questionnaire to get personalised feedback. There were few significant group differences in parental attitudes or parenting and child health behaviours at follow-up. Physical activity was rated as less important in the intervention group, but a significant group-by-socioeconomic status (SES) interaction indicated that this effect was confined to higher SES families. Similar interactions were also seen for physical activity monitoring and child television time; with adverse effects in higher SES families and no change in the lower SES families. Effects were little better in families that completed the questionnaire and received personalised feedback. At interview, acceptability of the intervention was modest, although higher in lower SES families. Conclusions The C4L campaign materials achieved increases in awareness of the campaign, but in this sample had little impact on attitudes or behaviour. Low engagement with the intervention appeared a key issue. Trial registration number Current Controlled Trials ISRCTN00791709.

Background Avid eating is an eating profile which confers greater risk for childhood obesity and can be challenging for parents to manage. Using Ecological Momentary Assessment (EMA), we have previously shown that parental mood, feeding goals, and eating context determine parents’ use of coercive and indulgent feeding practices. Parents have also reported using specific noncoercive practices which provide structure (e.g., modelling) or autonomy support (e.g., nutrition education) when feeding children with avid eating behaviour more effectively. However, research is yet to examine the momentary predictors of these adaptive feeding practices. Method This EMA study aimed to examine parental mood, goals, and context as momentary predictors of parents’ use of noncoercive feeding practices during daily feeding interactions with preschool children (3–5-years-old) with an avid eating profile. Parents ( N  = 109; females n = 85) completed a 10-day EMA period which assessed momentary mood, feeding goals, feeding practices, and contextual factors. Results Parents were more likely to use structure-based feeding practices when feeding goals were health-related, the atmosphere was positive or neutral, or when parents initiated eating occasions. Parents were also more likely to use autonomy support feeding practices when their feeding goals were health-related or when parents initiated eating occasions. Encouraging children to eat or negotiating with children about how much or what food to eat was significantly associated with a negative atmosphere during eating occasions. Conclusions Together, our findings show that parental mood, feeding goals and context are momentary predictors of parents’ use of noncoercive feeding practices to manage children’s avid eating behaviour. Further work is needed to examine whether supporting parents to prioritise health-related goals at mealtimes increases the use of adaptive, noncoercive feeding practices.

Background Maternal obesity and excessive gestational weight gain are associated with adverse maternal and foetal health outcomes. Interventions targeting dietary and physical activity behaviours during pregnancy have typically been directed at women only. A digital intervention targeting couples could encourage expectant parents to support each other in improving energy balance (dietary and physical activity) behaviours. Aims This study aimed to investigate the role partners play in pregnant women’s energy balance behaviours, and to identify barriers and facilitators to participating as a couple in a digital intervention to encourage healthy eating and physical activity in pregnancy. Methods A qualitative design combined online focus groups and telephone interviews. Three focus groups were held with men ( n  = 15) and one mini focus group ( n =  3) and 12 telephone interviews were conducted with women. Participants were either in the last trimester of pregnancy or had a baby under 18 months old. Most were from more deprived population groups where prevalence of maternal obesity is higher. Data were analysed thematically. Barriers and facilitators to participating as a couple in a digital intervention were mapped to the COM-B model and the Theoretical Domains Framework. Results Four main themes were identified; partner involvement and support; partner understanding of good energy balance behaviours; couple concordance of energy balance behaviours; partner influence on her energy balance behaviours. Most facilitators to participating in a digital intervention as a couple fell within the Reflective Motivation domain of COM-B. Men were motivated by the desire to be supportive partners and good role models. Women were motivated by their belief that partner involvement would improve their success in achieving goals and enhance couple-bonding. Other facilitators included concordance in dietary behaviours (Physical Opportunity), healthcare practitioner recommendation, perceptions of pregnancy as ‘ours’ (Social Opportunity) and feeling supported and involved (Automatic Motivation). Barriers were rarely mentioned but included potential for partner conflict, perceptions of pregnancy as ‘hers’ and economic constraints. Conclusions An opportunity exists to harness partner support to improve maternal energy balance behaviours. Barriers and facilitators to participating in a digital intervention as a couple indicate its potential to benefit emotional and relationship wellbeing in addition to physical health.

Background Parental feeding practices (PFPs) have been implicated in the development of children’s eating behaviours. However, evidence suggests that feeding practices may also develop in response to their child’s weight or emerging appetitive traits. We used the twin design to test the hypothesis that parents develop their feeding practices partly in response to their child’s appetite. Methods Data were from Gemini, a population-based cohort of 2402 British families with twins born in 2007. Psychometric measures of PFPs and appetite were completed by parents when their twins were 16-months and 5-years. Within-family analyses including all twins with available data in the sample (n = 1010–1858 pairs), examined if within-pair differences in PFPs were associated with differences in appetitive traits, controlling for differences in birth weight-SDS, early feeding method and child sex. In a subsample of twin pairs who were considerably discordant for appetitive traits by ≥ 1SD (n = 122–544 pairs), the direction and magnitude of within-pair differences in feeding practices was explored. Results Within-family variation in parental feeding practices in toddlerhood and early childhood was low (discordance ranged from 0.1 to 6% of the sample), except for pressure to eat (toddlerhood: 19%; early childhood: 32%). Within-pair differences in all appetitive traits were associated with differential use of ‘pressure to eat’ at both 16-months and 5-years. In the subsample of twins most discordant for appetitive traits, parents used more pressure with the twin expressing lower food responsiveness, lower emotional overeating, lower food enjoyment, higher satiety responsiveness, slower speed of eating, higher emotional undereating and greater fussiness in toddlerhood and early childhood (p-values < 0.001). Effect sizes were small to large at 16-months (η 2 =0.02–0.09) and 5-years (η 2 =0.05–0.21). Conclusion Parents rarely varied their feeding practices between twins in toddlerhood and early childhood, except for pressure. Parents exerted greater pressure on their twin who expressed a poorer appetite compared to their co-twin, suggesting that parents develop a pressuring feeding style when their child expresses a poorer appetite or lower interest in, and enthusiasm for, eating. These findings could be used to guide interventions seeking to support parents in feeding their children in a way that nurtures the development of healthy eating behaviours.

ObjectivesAdoption of healthy lifestyle behaviours has shown promising effectiveness in reducing the high morbidity burden of cancer survivors. Health professionals (HPs) are well suited to provide lifestyle advice but few survivors report receiving guidance from them. This study aimed to explore HPs’ perspective of lifestyle advice (on healthy eating, physical activity, smoking, and alcohol) for cancer survivors.DesignIn-depth semistructured qualitative interviews were conducted by telephone or face to face. Data were analysed using qualitative content analysis.Setting and participantsTwenty-one UK HPs working in secondary care with breast, prostate or colorectal cancer survivors were interviewed.ResultsThe overarching theme was that HPs’ desire to provide lifestyle advice was not necessarily matched by knowledge and action. Three main themes were identified: (1) survivorship-centred barriers to provision, (2) HP-centred barriers to provision, and (3) optimal delivery of lifestyle advice. Results suggested that HPs’ perceptions of survivors’ current status of practising health behaviours, their perceived socioeconomic barriers and ability to practise health behaviours, and HPs’ fear for potential loss of connection with the patient influenced provision of lifestyle advice. Further factors included HPs’ knowledge of healthy lifestyle guidelines, feeling that they were not the ‘right person’ to provide advice, and lack of time and resources. HPs stressed that the optimal delivery of lifestyle advice should (1) be tailored to the individual and delivered throughout the cancer journey, (2) be focused on small and achievable changes framed as part of their treatment regimen and (3) be cost-effective for wide-scale implementation.ConclusionsIncorporation of the identified barriers when developing HP training programmes and lifestyle interventions could increase the probability of successful behavioural change, and thus improve outcomes for cancer survivors.

Parents commonly use rewards to encourage children to eat healthfully, but this practice remains controversial because rewards are suspected of undermining children's intrinsic motivation. A cluster-randomized trial examined children's acceptance of a disliked vegetable over 12 daily taste exposures. These exposures were paired with a tangible reward, a social reward, or no reward, and the findings were compared with the results from a no-treatment control condition. Liking and intake of the vegetable were assessed in a free-choice consumption task at preintervention, postintervention, I month after intervention, and 3 months after intervention. Liking increased more in the three intervention conditions than in the control condition, and there were no significant differences between the intervention conditions. These effects were maintained at follow-up. Children in both reward conditions increased consumption, and these effects were maintained for 3 months; however, the effects of exposure with no reward became nonsignificant by 3 months. These results indicate that external rewards do not necessarily produce negative effects and may be useful in promoting healthful eating.

Simulated interventions using observational data have the potential to inform policy and public health interventions where randomised controlled trials are not feasible. National childhood obesity policy is one such area. Overweight and obesity are primarily caused by energy-rich and low-nutrient diets that contribute to a positive net energy imbalance. Using data from the Avon Longitudinal Study of Parents and Children (ALSPAC), we investigated whether causal modelling techniques could be applied to simulate the potential impact of policy-relevant calorie-reduction interventions on population prevalence and inequalities in obesity in childhood. Predicted probabilities of obesity at age 11 (UK90 cut offs) were estimated from logistic marginal structural models (MSM) accounting for observed calorie consumption at age 7 and confounding, overall and by maternal occupational social class. A series of population intervention scenarios were modelled to simulate daily calorie-reduction interventions that differed in effectiveness, targeting mechanism and programme uptake level. The estimated effect of maternal social class on obesity after accounting for confounding and observed calorie intake was provided by the controlled direct effect (CDE), in which, 18.3% of children were living with obesity at age 11 years,. A universal simulation to lower median intake to the estimated average requirement (EAR) (a 6.1% reduction in daily calories) with 75% uptake reduced overall obesity prevalence by 0.6%; there was little impact on inequalities. A targeted intervention to limit consumption to the EAR for children with above average intake reduced population obesity prevalence at 11 years by 1.5% but inequalities remained broadly unchanged. A targeted intervention for children of low-income families reduced prevalence by 0.7% and was found to slightly reduce inequalities. MSMs allow estimation of effects of simulated calorie-reduction interventions on childhood obesity prevalence and inequalities, although estimates are limited by the accuracy of reported calorie intake. Further work is needed to understand causal pathways and opportunities for intervention. Nevertheless, simulated intervention techniques have promise for informing national policy where experimental data are not available.