BackgroundThe internet has emerged as a new setting within which people live their everyday lives. As such, adults' online lives provide an opportunity for health promotion to empower behaviour change. In a systematic review, we aimed to explore the use of health promotion and education activities for diet, physical activity, and smoking, delivered through the internet and social media only.MethodsWe searched the Cochrane Library, HMIC, EMBASE, Medline, and PsycINFO (in English between Jan 1, 2000, and April 14, 2016) along with reference lists of eligible studies using a combination of MeSH terms and text words (appendix). Studies of any design were eligible for inclusion provided they delivered health promotion via social media and did not include one-to-one contact or advice. We included studies that presented data on multiple measures including engagement and behaviour change. Studies considering the content of social media interactions were ineligible. Data extraction was conducted by the lead reviewer and independently checked by a second reviewer. Reviewers recorded study design and intervention details, and completed a behavioural taxonomy checklist. Risk of bias was assessed with National Institute for Health and Care Excellence methodology. We performed narrative data synthesis.FindingsSearches produced 1585 results. 11 studies were included, predominantly of weak to moderate quality. Most studies were delivered via Facebook or custom websites with social components (eg, forums). Other social media outlets (Twitter, Pinterest, YouTube) were also used. Of eight studies that measured behaviour change, four considered smoking, two weight management, and two physical activity. Studies found that the inclusion of online, social elements did not enhance smoking cessation or weight loss; however, two small studies of short duration suggested that use of social media could improve physical activity levels. Six studies reported on “reach”; some failed to engage users (eg, 225 users across 19 countries) whereas others reached large audiences (eg, >10 000 website visits over 6 weeks). Cost-effectiveness was poorly reported.InterpretationThere was insufficient evidence of quality to determine the effectiveness of health promotion delivered using social media to improve health. Evidence suggests that social media incurs a small additional cost, without producing an important benefit. More high-quality studies are required.FundingNone.

Summary Guidelines suggest that very‐low‐energy diets (VLEDs) should be used to treat obesity only when rapid weight loss is clinically indicated because of concerns about rapid weight regain. Literature databases were searched from inception to November 2014. Randomized trials were included where the intervention included a VLED and the comparator was no intervention or an intervention that could be given in a general medical setting in adults that were overweight. Two reviewers characterized the population, intervention, control groups, outcomes and appraised quality. The primary outcome was weight change at 12 months from baseline. Compared with a behavioural programme alone, VLEDs combined with a behavioural programme achieved −3.9 kg [95% confidence interval (CI) −6.7 to −1.1] at 1 year. The difference at 24 months was −1.4 kg (95%CI −2.6 to −0.2) and at 38–60 months was −1.3 kg (95%CI −2.9 to 0.2). Nineteen per cent of the VLED group discontinued treatment prematurely compared with 20% of the comparator groups, relative risk 0.96 (0.56 to 1.66). One serious adverse event, hospitalization with cholecystitis, was reported in the VLED group and none in the comparator group. Very‐low‐energy diets with behavioural programmes achieve greater long‐term weight loss than behavioural programmes alone, appear tolerable and lead to few adverse events suggesting they could be more widely used than current guidelines suggest.

Background: The importance of dietary sugar comparedwith fat in the development of obesity is currently a topic of debate. Objective:We aimed to identify dietary patterns (DPs) characterized by high sugar content, high fat content, or both and their longitudinal associations with adiposity during childhood and adolescence. Methods: Participants were 6722 children from the ALSPAC (Avon Longitudinal Study of Parents and Children) who were born in 1991–1992. DPs were characterized by percentage of total energy intake (%E) from free sugars, %E from total fat, and dietary energy density (DED) and fiber density by using reduced rank regression at 7, 10, and 13 y of age. Total body fat mass was measured at 11, 13, and 15 y of age. Regression analyses were used to adjust for dietary misreporting, physical activity, and maternal social class. Results: Two major DPs were identified: higher z scores for DP1 were associated with greater DED, greater %E from free sugars and total fat, and lower fiber density; higher z scores for DP2 were associated with greater %E from free sugars but lower %E from total fat and DED. A 1-SD increase in z score for DP1 was associated with a mean increase in the fat mass index z score of 0.04 SD units (95% CI: 0.01, 0.07; P = 0.017) and greater odds of excess adiposity (OR: 1.12; 95% CI: 1.0, 1.25; P = 0.038). DP2 was not associated with adiposity. Conclusions: An energy-dense DP high in %E from total fat and free sugars is associated with greater adiposity in childhood and adolescence. This appears to confirm the role of both fat and sugar and provides a basis for food-based dietary guidelines to prevent obesity in children. J Nutr 2016;146:778–84.

ObjectiveEvidence on the effectiveness of behavioral weight management programs often comes from uncontrolled program evaluations. These frequently make the assumption that, without intervention, people will gain weight. The aim of this study was to use data from minimal intervention control groups in randomized controlled trials to examine the evidence for this assumption and the effect of frequency of weighing on weight change.MethodsData were extracted from minimal intervention control arms in a systematic review of multicomponent behavioral weight management programs. Two reviewers classified control arms into three categories based on intensity of minimal intervention and calculated 12-month mean weight change using baseline observation carried forward. Meta-regression was conducted in STATA v12.ResultsThirty studies met the inclusion criteria, twenty-nine of which had usable data, representing 5,963 participants allocated to control arms. Control arms were categorized according to intensity, as offering leaflets only, a single session of advice, or more than one session of advice from someone without specialist skills in supporting weight loss. Mean weight change at 12 months across all categories was -0.8 kg (95% CI -1.1 to -0.4). In an unadjusted model, increasing intensity by moving up a category was associated with an additional weight loss of -0.53 kg (95% CI -0.96 to -0.09). Also in an unadjusted model, each additional weigh-in was associated with a weight change of -0.42 kg (95% CI -0.81 to -0.03). However, when both variables were placed in the same model, neither intervention category nor number of weigh-ins was associated with weight change.ConclusionsUncontrolled evaluations of weight loss programs should assume that, in the absence of intervention, their population would weigh up to a kilogram on average less than baseline at the end of the first year of follow-up.

Background: The importance of dietary sugar comparedwith fat in the development of obesity is currently a topic of debate.Objective: We aimed to identify dietary patterns (DPs) characterized by high sugar content, high fat content, or both and their longitudinal associations with adiposity during childhood and adolescence.Methods: Participants were 6722 children from the ALSPAC (Avon Longitudinal Study of Parents and Children) who were born in 1991-1992. DPs were characterized by percentage of total energy intake (%E) from free sugars, % E from total fat, and dietary energy density (DED) and fiber density by using reduced rank regression at 7, 10, and 13 y of age. Total body fat mass was measured at 11, 13, and 15 y of age. Regression analyses were used to adjust for dietary misreporting, physical activity, and maternal social class.Results: Two major DPs were identified: higher z scores for DP1 were associated with greater DED, greater % E from free sugars and total fat, and lower fiber density; higher z scores for DP2 were associated with greater % E from free sugars but lower % E from total fat and DED. A 1-SD increase in z score for DP1 was associated with a mean increase in the fat mass index z score of 0.04 SD units (95% CI: 0.01, 0.07; P = 0.017) and greater odds of excess adiposity (OR: 1.12; 95% CI: 1.0, 1.25; P = 0.038). DP2 was not associated with adiposity.Conclusions: An energy-dense DP high in % E from total fat and free sugars is associated with greater adiposity in childhood and adolescence. This appears to confirm the role of both fat and sugar and provides a basis for food-based dietary guidelines to prevent obesity in children.

ObjectiveThe longitudinal associations between a dietary pattern (DP) and cardiometabolic risk factors and cardiovascular disease (CVD) incidence were investigated in a cohort of adults with severe obesity.MethodsThe analysis included 2,037 individuals with severe obesity (>34 and >38 kg/m(2) for men and women, respectively) from the Swedish Obese Subjects study repeatedly followed up for 10 years. Reduced rank regression was used to identify a DP characterized by dietary energy density, saturated fat intake, and fiber density. Mixed models examined relationships between repeated measures of DP z-scores and cardiometabolic risk factors. Cox proportional hazards models assessed relationships between DP scores and CVD incidence.ResultsAn energy-dense, high-saturated-fat, and low-fiber DP was derived. A one-unit increase in the DP z-score between follow-ups was associated with an increase in weight [ (SE)] (1.710.10 kg), waist circumference (1.49 +/- 0.07 cm), BMI (0.60 +/- 0.34 kg/m(2)), serum cholesterol (0.06 +/- 0.01 mmol/l), and serum insulin (1.22 +/- 0.17 mmol/l; all P<0.0001), as well as in serum triglycerides (0.05 +/- 0.02 mmol/l; P<0.05), systolic blood pressure (1.05 +/- 0.27 mmHg; P<0.001), and diastolic blood pressure (0.55 +/- 0.16 mmHg; P<0.05). No significant association was observed between repeated measures of the DP z-scores and CVD incidence (HR=0.96; 95% CI=0.83-1.12).ConclusionsAn energy-dense, high-saturated-fat, and low-fiber DP was longitudinally associated with increases in cardiometabolic risk factors in severe obesity but not with CVD incidence.

Very low calorie diets (VLCDs) are an option for the management of obesity, but are not used in primary care. This abstract presents an ongoing review to examine whether VLCDs could be an effective option for GPs to manage obesity. Literature databases were searched from database inception to February 2013. Studies were included if they were randomised controlled trials that recruited overweight or obese adults, with or without comorbidities. The intervention needed to incorporate a VLCD and comparator could be a no intervention control or an intervention that could be given in primary care. The primary outcome was weight change at 12 months from baseline. Secondary outcomes were HbA1c, lipids, and blood pressure and we recorded adverse events. We included 11 studies in the analysis which randomised 425 participants to VLCD and 349 participants to a comparator. Compared with a behavioural weight loss programme, VLCDs achieved an additional −4.1 kg (−7.3 to −0.8) greater weight loss at 12 months. Using baseline observation carried forward (BOCF), the differencewas −3.4 kg (−6.7 to −0.05). The difference in weight loss using BOCF at 18–24 months was −1.6 kg (−3.3 to −0.01) and at 42–60 months was −1.5 kg (−4.0 to 1.0). Data on secondary outcomes, adverse events and subgroup analyses will be available for an updated abstract and be presented at the conference. We will conclude on whether VLCDs appear safe and effective and hence a useful option for achieving weight loss in primary care.

The FASEB JournalVolume 29, Issue S1 746.4 NutritionFree Access Fat, Sugar or Both ? A Prospective Analysis of Dietary Patterns and Adiposity in Children Gina Ambrosini, Gina Ambrosini School of Population Health University of Western Australia, Perth, Western Australia, AustraliaSearch for more papers by this authorDavid Johns, David Johns Human Nutrition Research, Medical Research Council, Cambridge, United KingdomSearch for more papers by this authorKate Northstone, Kate Northstone School of Social & Community Medicine University of Bristol, Bristol, United KingdomSearch for more papers by this authorSusan Jebb, Susan Jebb Nuffield Department of Primary Care Health Sciences University of Oxford, Oxford, United KingdomSearch for more papers by this author Gina Ambrosini, Gina Ambrosini School of Population Health University of Western Australia, Perth, Western Australia, AustraliaSearch for more papers by this authorDavid Johns, David Johns Human Nutrition Research, Medical Research Council, Cambridge, United KingdomSearch for more papers by this authorKate Northstone, Kate Northstone School of Social & Community Medicine University of Bristol, Bristol, United KingdomSearch for more papers by this authorSusan Jebb, Susan Jebb Nuffield Department of Primary Care Health Sciences University of Oxford, Oxford, United KingdomSearch for more papers by this author First published: 01 April 2015 https://doi.org/10.1096/fasebj.29.1_supplement.746.4About ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinked InRedditWechat Abstract The roles of dietary sugar and fat in childhood obesity are the subject of recent debate. We investigated dietary patterns (DP) characterized by these macronutrients and their longitudinal associations with adiposity in children. Participants were 6722 children in the UK Avon Longitudinal Study of Parents and Children. A 3-d food diary was completed at 7, 10 and 13 y of age. DP were identified according to % total energy intake (%E) from non-milk extrinsic sugars, %E from total fat, dietary energy density and fibre, using reduced rank regression. Fat mass was measured at 11, 13 and 15 y. Longitudinal models adjusted for dietary misreporting, physical activity and maternal factors. Two major DP were identified: DP1 was high in sugar, fat, energy density and low in fibre; DP2 was high in sugar but low in fat and energy density. A 1 SD increase in z-score for DP1 was associated with an average increase in fat mass index of 0.04 SD units (95%CI 0.01-0.07) and greater odds of excess adiposity (OR=12%, 95%CI 1-25%). DP2 was not significantly associated with adiposity. An energy-dense DP high in both fat and sugar is longitudinally associated with greater adiposity in childhood. This DP consists of low intakes of fruit, vegetables and wholegrains, and high intakes of sweets, cakes, sugary drinks, low-fibre cereals and breads. This provides food-based dietary guidance to prevent obesity in children that may be more meaningful to consumers than nutrient prescriptions. Funding: Medical Research Council, Wellcome Trust. Volume29, IssueS1Experimental Biology 2015 Meeting AbstractsApril 2015746.4 RelatedInformation

A systematic review, meta-analysis and meta-regression were conducted to evaluate the effectiveness of behavioural weight management programmes and examine how programme characteristics affect mean weight loss. Randomized controlled trials of multicomponent behavioural weight management programmes in overweight and obese adults were included. References were obtained through systematic searches of electronic databases (conducted November 2012), screening reference lists and contacting experts. Two reviewers extracted data and evaluated risk of bias. Thirty-seven studies, representing over 16,000 participants, were included. The pooled mean difference in weight loss at 12 months was -2.8 kg (95% confidence interval [CI] -3.6 to -2.1, P < 0.001). I(2) indicated that 93% of the variability in outcome was due to differences in programme effectiveness. Meta-analysis showed no evidence that supervised physical activity sessions (mean difference 1.1 kg, 95% CI -2.65 to 4.79, P = 0.08), more frequent contact (mean difference -0.3 kg, 95% CI -0.7 to 0.2, P = 0.25) or in-person contact (mean difference 0.0 kg, 95% CI -1.8 to 1.8, P = 0.06) were related to programme effectiveness at 12 months. In meta-regression, calorie counting (-3.3 kg, 95% CI -4.6 to -2.0, P = 0.027), contact with a dietitian (-1.5 kg, 95% CI -2.9 to -0.2, P < 0.001) and use of behaviour change techniques that compare participants' behaviour with others (-1.5 kg, 95% CI -2.9 to -0.1, P = 0.032) were associated with greater weight loss. There was no evidence that other programme characteristics were associated with programme effectiveness. Most but not all behavioural weight management programmes are effective. Programmes that support participants to count calories or include a dietitian may be more effective, but the programme characteristics explaining success are mainly unknown.

Understanding how dietary intake changes over time is important for studies of diet and disease and may inform interventions to improve dietary intakes. We investigated how a dietary pattern (DP) tracked over 10-years in the Swedish Obese Subjects (SOS) study control group. Dietary intake was assessed at multiple time-points in 2037 severely obese individuals (BMI 41 ± 4 kg/m(2)). Reduced rank regression was used to derive a dietary pattern using dietary energy density (kJ/g), saturated fat (%) and fibre density (mg/kJ) as response variables and score respondents at each follow-up. Tracking coefficients for the DP, its key foods and macronutrient response variables and corrected for time-dependent and time-independent covariates were calculated using generalised estimating equations to take into account all available data. The DP tracking coefficient was moderate for women (0.40; 95% CI: 0.38-0.42) and men (0.38; 95% CI: 0.35-0.41). Of the eleven foods key to this DP, fruit and vegetable intakes had the strongest tracking coefficient for both sexes. Fast food and candy had the lowest tracking coefficients for women and men respectively. Scores for an energy dense, high saturated fat, low fibre density DP appear moderately stable over a 10-year period in this severely obese population. Furthermore, some food groups appear more amenable to change while others, often the most healthful, appear more stable and may require intervention before adulthood.

This systematic review and meta-analysis of effectiveness trials comparing multicomponent behavioural weight management programmes with controls in overweight and obese adults set out to determine the effectiveness of these interventions implemented in routine practice. To be included, interventions must have been multicomponent, delivered by the therapists who would deliver the intervention in routine practice and in that same context, and must be widely available or feasible to implement with little additional infrastructure or staffing. Searches of electronic databases were conducted, and augmented by screening reference lists and contacting experts (November 2012). Data were extracted by two reviewers, with mean difference between intervention and control for 12-month change in weight, blood pressure, lipids and glucose calculated using baseline observation carried forward. Data were also extracted on adverse events, quality of life and mood measures. Although there were many published efficacy trials, only eight effectiveness trials met the inclusion criteria. Pooled results from five study arms providing access to commercial weight management programmes detected significant weight loss at 12 months (mean difference -2.22 kg, 95% confidence interval [CI] -2.90 to -1.54). Results from two arms of a study testing a commercial programme providing meal replacements also detected significant weight loss (mean difference -6.83 kg, 95% CI -8.39 to -5.26). In contrast, pooled results from five interventions delivered by primary care teams showed no evidence of an effect on weight (mean difference -0.45 kg, 95% CI -1.34 to 0.43). One study testing an interactive web-based intervention detected a significant effect in favour of the intervention at 12 months, but the study was judged to be at high risk of bias and the effect did not persist at 18 months. Few studies reported other outcomes, limiting comparisons between interventions. Few trials have examined the effectiveness of behavioural weight loss programmes delivered in everyday contexts. These trials suggest that commercial interventions delivered in the community are effective for achieving weight loss. There is no evidence that interventions delivered within primary care settings by generalist primary care teams trained in weight management achieve meaningful weight loss.

Weight loss can reduce the health risks associated with being overweight or obese. However, the most effective method of weight loss remains unclear. Some programs emphasize physical activity, others diet, but existing evidence is mixed as to whether these are more effective individually or in combination. We aimed to examine the clinical effectiveness of combined behavioral weight management programs (BWMPs) targeting weight loss in comparison to single component programs, using within study comparisons. We included randomized controlled trials of combined BWMPs compared with diet-only or physical activity-only programs with at least 12 months of follow-up, conducted in overweight and obese adults (body mass index >= 25). Systematic searches of nine databases were run and two reviewers extracted data independently. Random effects meta-analyses were conducted for mean difference in weight change at 3 to 6 months and 12 to 18 months using a baseline observation carried forward approach for combined BWMPs vs diet-only BWMPs and combined BWMPs vs physical activity-only BWMPs. In total, eight studies were included, representing 1,022 participants, the majority of whom were women. Six studies met the inclusion criteria for combined BWMP vs diet-only. Pooled results showed no significant difference in weight loss from baseline or at 3 to 6 months between the BWMPs and diet-only arms (-0.62 kg; 95% CI 1.67 to 0.44). However, at 12 months, a significantly greater weight-loss was detected in the combined BWMPs (-1.72 kg; 95% CI -2.80 to -0.64). Five studies met the inclusion criteria for combined BWMP vs physical activity-only. Pooled results showed significantly greater weight loss in the combined BWMPs at 3 to 6 months (-5.33 kg; 95% CI -7.61 to -3.04) and 12 to 18 months (-6.29 kg; 95% CI -7.33 to -5.25). Weight loss is similar in the short-term for diet-only and combined BWMPs but in the longer-term weight loss is increased when diet and physical activity are combined. Programs based on physical activity alone are less effective than combined BWMPs in both the short and long term.

A dietary pattern approach is useful in the study of diet and health outcomes as it accounts for the potentially cumulative effects of the whole diet. We investigated the longitudinal associations between a dietary pattern (DP) and anthropometric and biochemical metabolic disease risk factors measured repeatedly over a 10-year period in a population with severe obesity and at high risk of CVD. Dietary intake among 2037 severely obese individuals (BMI 41 (cid:1) 4 kg/m 2 ) from the control group of the Swedish Obese Subjects (SOS) study was assessed nine times over 10-years using a validated dietary questionnaire. At registration into the study a DP was derived using reduced rank regression (RRR), based on intakes of thirty-nine food groups, with dietary energy density, saturated fat and fibre density as response variables. A score for this DP was calculated at each follow-up using confirmatory RRR. Waist, BMI and weight were measured at each follow up (0, 1/2, 1, 2, 3, 4, 6, 8 and 10 years). Fasting total cholesterol, HDL, glucose and insulin were measured at registration, 0, 2 and 10 years. Mixed models were used to examine longitudinal associations between dietary pattern scores and these cardiovascular risk factors. Anthropometric models were adjusted for sex, age, smoking and physical activity. Blood lipids, glucose and insulin models were adjusted for sex, age, smoking, physical activity, BMI and relevant medication use. The DP explained 71.2, 31 and 60.4% of the variation in dietary energy density (DED), % energy from saturated fat (SF

Background: The consideration of dietary changes over time, or tracking, is important in studies of diet and disease risk. However, there has been no work carried out on dietary tracking in obese adults, who may be prone to weight loss attempts and changes in their dietary intake. The aim of this study was to investigate tracking of a dietary pattern (DP), food groups and macronutrient intake in a severely obese population over a 10-year period. Methods: Dietary intake was assessed nine times over 10-years using a dietary questionnaire in the control group of the Swedish Obese Subjects (SOS) study. At registration (t = R), a DP was derived using reduced rank regression (RRR), based on intakes of 39 food groups with dietary energy density, saturated fat and fibre density as response variables. Exploratory RRR analyses resulted in a similar DP that was high in energy density and saturated fat and low in fibre. To assess real change in this DP over time, confirmatory RRR analysis was applied to calculate a score for the DP identified at registration at each of the subsequent follow-ups. Average daily intakes of food groups and macronutrients were calculated at each follow-up and standardised in relation to intakes at registration. A tracking coefficient for the DP was calculated using generalised estimating equations (GEE) (Twisk et al., 1996) falling between 0 (no tracking) and 1 (perfect tracking). The models were adjusted for age at registration. Further GEE analyses were carried out to calculate tracking coefficients for selected food group intakes and response variables. These models included adjustment for age and total energy intake. Results: The control group contained 2037 severely obese individuals [mean (SD) body mass index 41 (4) kg m−2] who reported total mean (SD) energy intakes of 13 045 (6146) kJ [3118 (1469) kcal] and 10 614 (5096) kJ [2537(1218) kcal] for men and women respectively at t = R. The tracking coefficient for this DP from study registration to 10 years was 0.38 for men and 0.40 for women (Table 1). The DP tracking coefficients were stronger when follow-up time was shorter (Table 1). For both men and women, the strongest tracking coefficients were for vegetable intake [β1 = 0.52 (95% confidence interval [CI], 0.48–0.56); β1 = 0.37 (95% CI, 0.35–0.39), respectively] and fruit intake [β1 = 0.46 (95% CI, 0.43–0.49); β1 = 0.36 (95% CI, 0.34–0.38)]. We observed significantly lower tracking coefficients for less healthy food groups in men and women respectively, including fast food [β1 = 0.25 (95% CI, 0.22–0.27); β1=0.14 (95% CI, 0.13–0.15)] and candy [β1 = 0.10 (95% CI, 0.08–0.12); β1 = 0.18 (95% CI, 0.17–0.20)]. Of the three response variables, fibre density displayed the greatest tracking coefficient. Table 1. Tracking coefficient and 95% CI of a standardised dietary pattern score of 2037 severely obese Swedish men and women over an average 11 years of follow-up Dietary pattern score (time points) Men Women Tracking coefficient 95% CI Tracking coefficient 95% CI (R-10) 0.38* 0.35–0.41 0.40* 0.38–0.42 (0–10) 0.39* 0.36–0.41 0.45* 0.43–0.47 (2–10) 0.45* 0.31–0.49 0.50* 0.44–0.55 (6–10) 0.47* 0.38–0.57 0.53* 0.46–0.61 All coefficients are significantly different from zero (P < 0.01). *Adjusted for age and smoking. All other coefficients are adjusted for age, smoking and total energy intake. Discussion: In this novel analysis, low to moderate tracking of the identified DP, as well as food group and nutrient intakes, was observed over a 10-year period. As such, baseline diet may be a poor reflection of dietary intake over a prolonged follow-up in the severely obese. GEE uses all available data; considers between and within person differences; and accounts for repeated observations from the same individual. If the prevalence of under-reporting increased during the 10 years, then the tracking coefficient may be affected, and is a limitation of this method. Conclusions: Dietary intake in severely obese adults is not fixed over time and is likely susceptible to dietary change. Furthermore, the observed differences in tracking between some food groups suggest that particular foods may be better targets for dietary change. Reference: Twisk, J.W.R., Kemper, H.C.G., Mellenbergh, G.J., Van Mechelen, W. & Post, G.B. (1996) Relation between the longitudinal development of lipoprotein levels and lifestyle parameters during adolescence and young adulthood. Ann. Epidemiol.6, 246–256.

Background: Previous cross‐sectional research has identified that the desire to lose weight is prevalent amongst young people (McCabe & Ricciardelli, 2003; McCabe & Ricciardelli, 2005). What is less well understood is the extent to which these young people are justified in their desire to lose weight. It is thought that increasing weight‐loss desires are justified by increasing obesity rates. Identifying those young people with appropriate, excessive and insufficient concerns is important because of the differing needs and public health approaches that these groups will require. Therefore, this study aimed to investigate the prevalence of weight‐loss desires amongst adolescents between 1997 and 2006 and to identify changes in the appropriateness of these weight‐related attitudes.Methods: Data were collected by the School Health Education Unit annually over 10 years using a self‐completed survey (further information on data collection is available at http://www.sheu.org.uk) providing a sample of 243 206 young people. The survey assessed weight‐related desires (‘I would like to put on weight’, ‘I am happy with my weight as it is’ and ‘I would like to lose weight’) and self‐reported height and weight. Body mass index (BMI) was calculated and participants were categorised as underweight, overweight and obese. Participants were classified as having: (i) weight‐related desires appropriate to their bodyweight (e.g. a healthy bodyweight and happy with their weight or overweight and wanting to lose weight); (ii) insufficient concerns (e.g. overweight but happy with their weight); or (iii) excessive concerns (e.g. a healthy bodyweight but wanting to lose weight). All data were analysed using SPSS, version 15 (SPSS Inc., Chicago, IL, USA). Trends for weight‐loss desires and appropriate and inappropriate concerns were displayed graphically by year, gender and ethnicity, factors discovered to independently affect a person's weight‐related desire. ‘Standard error of proportions’ identified significant changes.Results: Weight loss desires are higher in females than in 14–15‐year‐old males. Weight loss desires are more prevalent in 12–13‐year‐old males than those in Year 10; however, the reverse is true for females. In each year throughout the last decade, boys were significantly more likely to have weight‐related desires appropriate for their weight classification compared to girls. Excessive concern about being overweight was consistently most prevalent among girls. Older girls (14–15 years) were consistently more likely to have excessive concerns compared to younger girls (12–13 years). However, the proportion of older girls with excessive concerns decreased slightly over the 10‐year period, whereas the proportion of younger girls with excessive concerns increased slightly. The above observations were consistent across all ethnicities.Discussion: Although the expected patterns in weight‐loss desires were not found, the study demonstrates that many young people in the UK do not have weight‐related desires that are appropriate for their bodyweight. Although previous cross‐sectional research (McCreary & Sasse, 2000; McCabe & Ricciardelli, 2003) has demonstrated that older females have a greater prevalence of excessive concern, it is encouraging to observe that this has slightly decreased over the past 10 years. What previous studies have been unable to demonstrate are the rises in excessive concern amongst younger girls, suggesting the possibility for a novel target audience for health promotion campaigns.Conclusions: Inappropriate concern, particularly excessive concern, is consistently found throughout the last 10 years in the UK population of young people. It is important to acknowledge that young people are not a homogenous group but have differing beliefs and needs regards health promotion, and that people who want to lose weight, despite not needing to, do not need their concerns reinforced.References McCabe, M.P. & Ricciardelli, L.A. (2003) Sociocultural influences on body image and body change strategies among adolescent boys and girls. J. Soc. Psychol.143, 5–26.McCabe, M.P. & Ricciardelli, L.A. (2005) A longitudinal study of body image and strategies to lose weight and increase muslces among children. Appl. Dev. Psychol.26, 559–577.McCreary, D.R. & Sasse, D.K. (2000) An exploration of the drive for muscularity in adolescent boys and girls. J. Am. Coll. Health48, 297–304.