Dr Hannah Greatwood

This evidence is submitted by members of the ‘Transforming UK Food Systems for Healthy People and a Healthy Environment’ (TUKFS) research community . TUKFS is a £47.5M programme supported by UKRI’s strategic priorities fund (2020-2026), in partnership with the Global Food Security Programme, BBSRC, ESRC, MRC, NERC, Defra, DHSC, OHID, Innovate UK and FSA . This submission constitutes a response to selected questions within the terms of reference related to structural challenges for sustainability and resilience across the UK food system, and their consequences for different actors, consumers and the environment.

Submitted by: Prof. Alexandra Johnstone (University of Aberdeen, Rowett Institute) and Dr Hannah Greatwood (Leeds Beckett University), on behalf of the Food Insecurity and Obesity (FIO Food*) project team, funded through the UKRI’s Transforming UK Food Systems Strategic Priority Fund**. The existing FIO Food Project aims to provide actionable evidence for policy on retail strategies to address dietary inequalities in people living with obesity and food insecurity, to support environmentally sustainable and healthier food choices in the UK food system. The multi-disciplinary team employ a food systems and collaborative approach with co-development as a key feature, through four inter-linked work packages, to combine our knowledge of large-scale population data with an understanding of lived experiences of food shopping for people living with obesity and food insecurity, to develop solutions to improve sustainable and healthier food choices.

FIO Food aims to provide actionable evidence for policy on retail strategies to address dietary inequalities in people living with obesity and food insecurity (FI), to support sustainable and healthier food choices in the UK food system. Here, as ECRs, we explain the impact of the project on our research journey. FIO Food has exposed us to the complexity of the food system with many different actors playing important roles. We have come to realise the necessity of co-produced research outputs. Throughout FIO Food, Patient and Public Involvement has been at the heart of all work packages to ensure our research is grounded in the lived experience. Beyond the development of authentic research design, senior researchers within the team have encouraged ECRs to lead in translating our complex findings into suitable dissemination formats that maximise impact with our numerous stakeholders. The development of communication skills, through academic publications, government papers and calls for evidence, blogs, podcasts and infographics, demonstrates the relevance of FIO Food beyond academia contributing to public understanding of the work we have undertaken. Our development will facilitate in the ultimate impact goal of transforming the UK food system with a new generation of well skilled trans-disciplinary researchers.

Online weight management groups are emerging, offering a platform where members can share their experiences and seek support from others in a similar position; however, the impact these groups have on psychological resilience capabilities and emotional wellbeing is not yet fully understood. Exploring how these online communities affect psychological resilience and emotional wellbeing is important to understand how they can best support people living with obesity and overweight. The proposed scoping review aims to investigate how online groups for weight management potentially relate to psychological resilience and emotional wellbeing among adults. The objectives of this study are to: - Examine the existing literature on online weight loss support groups and how they impact any relationship with psychological resilience and emotional wellbeing of people living with obesity and overweight.  - Explore the overall role of online communities in supporting psychological resilience and emotional wellbeing among PLWO/Ow during their weight management journey. - Identify elements within online support groups, such as group interaction, shared experience, which may interact with psychological resilience and emotional wellbeing.

The high prevalence of food insecurity in the United Kingdom has been exacerbated by the cost-of-living crisis. In high-income countries, those experiencing food insecurity struggle to buy and consume foods that meet Government healthy eating recommendations, and are at increased risk of obesity, linked to poor diet quality. Individuals in high-income countries purchase most of their food to consume at home from supermarkets, making this an important context within which healthier and environmentally sustainable food purchasing should be supported. However, the lived experience of supermarket food purchasing in people living with obesity and food insecurity has not been explored in depth. Adults, living in England and Scotland, who self-identified as living with obesity and food insecurity and looking to reduce their weight, were recruited to take part in semi-structured interviews (n = 25) or focus groups (n = 8) to explore their experience of shopping for food in the supermarket. Using thematic analysis, four main themes were generated: 1) the Restricted Consumer; restrictions around the type of food purchased, where food can be purchased and the resulting emotional toll, 2) the Conscious Consumer; decision making and effortful practices both in preparation of and during the shopping trip, 3) Mitigating the Rising Cost of Food; agency and actions taken to mitigate high food prices, 4) Stigma; instances of perceived and/or experienced weight and poverty-related stigma and the physical actions and cognitive social comparisons used to minimise stigma. Findings provide insights for evidence-based policy on the need for upstream changes within the wider food system to address the social determinants of health and support people living with obesity and food insecurity to eat healthier and more sustainable diets.

The high prevalence of food insecurity in the United Kingdom has been exacerbated by the cost-of-living crisis. In high-income countries, those experiencing food insecurity struggle to buy and consume foods that meet Government healthy eating recommendations, and are at increased risk of obesity, linked to poor diet quality. Individuals in high-income countries purchase most of their food to consume at home from supermarkets, making this an important context within which healthier and environmentally sustainable food purchasing should be supported. However, the lived experience of supermarket food purchasing in people living with obesity and food insecurity has not been explored in depth. Adults, living in England and Scotland, who self-identified as living with obesity and food insecurity and looking to reduce their weight, were recruited to take part in semi-structured interviews (n = 25) or focus groups (n = 8) to explore their experience of shopping for food in the supermarket. Using thematic analysis, four main themes were generated: 1) the Conscious Consumer; decision making and effortful practices both in preparation of and during the shopping trip, 2) the Restricted Consumer; restrictions around the type of food purchased, where food can be purchased and the resulting emotional toll, 3) Mitigating the Rising Cost of Food; agency and actions taken to mitigate high food prices, 4) Stigma; instances of perceived and/ or experienced weight and poverty-related stigma and the physical actions and cognitive social comparisons used to minimise stigma. Findings provide insights for evidence-based policy on the need for upstream changes within the wider food system to address the social determinants of health and support people living with obesity and food insecurity to eat healthier and more sustainable diets.

Good health is viewed as essential to enable citizens to live fulfilling lives, shape communities, and drive economic growth. However, health is socially patterned. Low socioeconomic status is associated with an increased risk of non-communicable diseases, where poor dietary patterns and diet-related obesity are likely contributors. Food purchasing can be influenced by many factors, including cost and income. Most food purchased to be consumed at home is acquired from supermarkets, and any increase in food prices disproportionately impacts low-income households, contributing to food insecurity. This study explored the factors that helped and hindered people living with obesity and food insecurity in purchasing healthy, environmentally sustainable food from supermarkets. Semi-structured interviews (n = 25) and focus groups (n = 7) were conducted between June and December 2023 with adults living in Scotland and England who self-identified as living with obesity and food insecurity. Using thematic analysis, six main themes were identified: (1) Supermarket deals: perceptions surrounding the good, the bad, and the ugly side of supermarket offers and promotions; (2) Skepticism about supermarkets and the wider food system: questioning supermarket pricing motives but recognizing the role of the wider food system in food pricing; (3) Other peoples’ role in enhancing or undermining healthy diet intentions: the impact of others in shaping food purchases; (4) Financial restrictions facing non-UK nationals: additional challenges faced by those with no recourse to public funds; (5) The overwhelming in-store supermarket experience: sensory overload and attempts to prevent unintended, impulse purchases; (6) Unconscious, environmentally sustainable shopping practices: cost saving practices that lead to environmentally sustainable purchasing patterns and behaviors as a unintentionally created outcome of budget maximizing strategies. However, such strategies, that is, limiting food waste and purchasing less meat, although beneficial for environmental sustainability, do not necessarily indicate that a healthier diet is being purchased or consumed. While views on some factors believed to help or hinder healthy, environmentally sustainable food purchases varied, there was general agreement amongst participants on the need for upstream changes, including having access to adequate benefits and wages.

Background: Food insecurity (lack of reliable access to affordable and nutritious food) is a major concern in high-income countries because it increases the risk of poor nutrition, obesity and associated adverse health outcomes. Healthier diets are often also more environmentally sustainable (hereafter; sustainable), an important factor in reducing climate change. Practice-based interventions are therefore urgently needed to support people living with food insecurity and obesity to access and afford healthier and sustainable foods. Supermarkets are a key area for intervention, as purchasing can be an antecedent to consumption. However, the retailers’ perspectives on the feasibility of implementing affordability interventions is often overlooked and under-researched. Therefore, this study explored the perspectives, views, and experiences of major UK supermarket senior nutritionists on the acceptability and feasibility of using affordability interventions for healthier and more sustainable food in the supermarket.Methods: We recruited seven UK senior supermarket nutritionists who represented 85% of the UK grocery market share. We used semi-structured interviews and analysed the data using a reflective thematic analysis approach.Results: Supermarket nutritionists perceived that their business did prioritise health and environmental sustainability for customers. However, there were several challenges encountered when trying to promote healthier and more sustainable food in the supermarket environment, including profitability concerns, unpredictability of intervention outcomes, control over own-brand products, perceived intention-behaviour gap, and a belief that they are already implementing affordability interventions. Differences in how supermarkets approach the evaluation of interventions also emerged, as well as a willingness to collaborate with academics and other retailers to optimise the evaluation of interventions. Lastly, supermarket nutritionists raised the need for an operationalised definition for sustainable food products.Conclusions: Affordability interventions to support customers to purchase healthier and more sustainable food require supermarkets to consider multiple challenges. Findings highlight the need for upstream intervention that mandates and facilitates multi-lever approaches to health and sustainability without compromising commercial viability, along with practice-based approaches to implementation and evaluation.

Individuals participate in research for numerous reasons, however, the global economic downturn may have driven some to participate solely for monetary recompense. While inauthentic participation is more widely recognised in quantitative survey studies, it is increasingly becoming an issue in qualitative research. Drawing on our experiences and supported by the wider literature, we highlight ways in which inauthentic participation can be identified and addressed. We argue it is pertinent researchers are aware of the risks and potential impact of inauthentic participants and recommend researchers consider this phenomenon from study planning stages onwards. We identify Universities and ethics committees as well placed to provide training and ensure, where necessary, mitigation plans are in place before granting study approvals. We suggest funders and publishers request inauthentic participation be considered and reported. These recommendations would establish awareness, prevent wasting valuable project resources, increase transparency of reporting and ensure data integrity is protected.

Background: Food insecurity (lack of reliable access to affordable and nutritious food) is a major concern in high-income countries because it increases the risk of poor nutrition, obesity and associated adverse health outcomes. Healthier diets are often also more environmentally sustainable (hereafter; sustainable), an important factor in reducing climate change. Practice-based interventions are therefore urgently needed to support people living with food insecurity and obesity to access and afford healthier and sustainable foods. Supermarkets are a key area for intervention, as purchasing can be an antecedent to consumption. However, the retailers’ perspectives on the feasibility of implementing affordability interventions is often overlooked and under-researched. Therefore, this study explored the perspectives, views, and experiences of major UK supermarket senior nutritionists on the acceptability and feasibility of using affordability interventions for healthier and more sustainable food in the supermarket.Methods: We recruited seven UK senior supermarket nutritionists who represented 85% of the UK grocery market share. We used semi-structured interviews and analysed the data using a reflective thematic analysis approach.Results: Supermarket nutritionists perceived that their business did prioritise health and environmental sustainability for customers. However, there were several challenges encountered when trying to promote healthier and more sustainable food in the supermarket environment, including profitability concerns, unpredictability of intervention outcomes, control over own-brand products, perceived intention-behaviour gap, and a belief that they are already implementing affordability interventions. Differences in how supermarkets approach the evaluation of interventions also emerged, as well as a willingness to collaborate with academics and other retailers to optimise the evaluation of interventions. Lastly, supermarket nutritionists raised the need for an operationalised definition for sustainable food products.Conclusions: Affordability interventions to support customers to purchase healthier and more sustainable food require supermarkets to consider multiple challenges. Findings highlight the need for upstream intervention that mandates and facilitates multi-lever approaches to health and sustainability without compromising commercial viability, along with practice-based approaches to implementation and evaluation.

Food insecurity (FI), is defined as unreliable access to healthy and nutritious food, and is a major health concern in higher-income countries, primarily due to its association with an increased risk of obesity. Adherence to healthy eating recommendations promotes both a healthier and more environmentally sustainable diet. Supermarket-based interventions may influence population-level food purchasing behaviour, an antecedent to consumption, however, it is unclear whether there are specific characteristics that supermarket-based interventions should employ to resonate with vulnerable groups. This scoping review aimed to explore the characteristics of supermarket-based interventions that sought to support healthier and/or more environmentally sustainable food purchasing for people living with obesity and overweight (PLWO/Ow) and/or FI. A systematic literature search identified 35 studies, representing 43 interventions, eligible for inclusion. Most interventions focused on supporting the purchase of healthy food items, with three aimed at increasing the purchase of plant-based foods. No study applied a validated measure of FI. Area-level demographic data were used to identify FI related characteristics (i.e., area of low income, low socio-economic status) and in some cases, those living with obesity. Interventions utilised the behaviour change levers of price (n=8), promotion (n=2), placement (n=7), nudges (n=4) and education (n=2), or a combination of these (n=20). High heterogeneity in the way behavioural change levers were operationalised and combined, alongside the use of proxy measures to identify FI and PLWO/Ow, presents a challenge for determining intervention characteristics which best support changes in purchasing patterns in favour of heathy, sustainable food items in this population.

ntroduction: English targets aim for an annual 1% population-increase in moderately physically activity (MPA) by 2020. This study aimed to establish the effects of motivational-interviews (Ml) on moderate physical activity (MPA) status enrolled in the local exercise action pilots (LEAP), a national evaluation examining the effects of interventions on MPA. Methodology: Ml targeted inactive participants (less-than 30 [adults] or 60 [young people] min/day MPA, five(+) times per week). Participants (n = 297) (11–75 years) gender comprised, female 227: male 70. MPA was assessed pre- and post-intervention (24 months), using 7-day self-reports and for adults the short version International Physical Activity Questionnaire. Results: Data were collected on engagement and pre- and post-MPA. Activity categories (sedentary, lightly, moderately and highly active), using guidelines for MPA MET-minutes/week, were assigned at pre- and post-intervention. Cross-tabulation established movement between three-change categories (reversal–stability–progression). Interviews with managers (n = 3) and completers (n = 3) provided insights into Ml designs effective in engaging completers. In completers overall increases in MPA of +360 MET-minutes/week (n = 77; IQR = 864 MET-minutes/week) were found. Cross-tabulation indicated 89.3% (n = 28) of lightly active completers became moderately or highly active post-intervention. Conclusion: Ml was effective in engaging participants and within an initial intervention period increasing MPA in lightly active completers. No evidence suggests Ml is effective in increasing MPA of sedentary completers. Compared with sample-size for engagement, data on MPA was a limitation. The design of Ml is important in facilitating engagement of completers. Further research with large completer (n) is required to identify the effectiveness Ml on MPA.

Introduction: English targets aim for an annual 1% population-increase in moderately physically activity (MPA) by 2020. This study aimed to establish the effects of motivational-interviews (Ml) on moderate physical activity (MPA) status enrolled in the local exercise action pilots (LEAP), a national evaluation examining the effects of interventions on MPA. Methodology: Ml targeted inactive participants (less-than 30 [adults] or 60 [young people] min/day MPA, five(+) times per week). Participants (n = 297) (11–75 years) gender comprised, female 227: male 70. MPA was assessed pre- and post-intervention (24 months), using 7-day self-reports and for adults the short version International Physical Activity Questionnaire. Results: Data were collected on engagement and pre- and post-MPA. Activity categories (sedentary, lightly, moderately and highly active), using guidelines for MPA MET-minutes/week, were assigned at pre- and post-intervention. Cross-tabulation established movement between three-change categories (reversal–stability–progression). Interviews with managers (n = 3) and completers (n = 3) provided insights into Ml designs effective in engaging completers. In completers overall increases in MPA of +360 MET-minutes/week (n = 77; IQR = 864 MET-minutes/week) were found. Cross-tabulation indicated 89.3% (n = 28) of lightly active completers became moderately or highly active post-intervention. Conclusion: Ml was effective in engaging participants and within an initial intervention period increasing MPA in lightly active completers. No evidence suggests Ml is effective in increasing MPA of sedentary completers. Compared with sample-size for engagement, data on MPA was a limitation. The design of Ml is important in facilitating engagement of completers. Further research with large completer (n) is required to identify the effectiveness Ml on MPA.

Abstract

Background The United Kingdom faces complex economic and structural challenges that have disrupted food pricing, contributing to widespread food insecurity. These fluctuations diminish the affordability and accessibility of healthy, nutrient-dense foods among vulnerable groups. In high-income countries, food insecurity is associated with higher levels of obesity, and in the UK specifically, the cost of living crisis, where the cost of food has increased quicker than wages, is likely to have exacerbated existing dietary inequalities. This qualitative paper explores insights of people living with obesity and food insecurity, in an ethnically diverse community, to develop further understanding on their food shopping experiences. Methods A secondary analysis of qualitative data from four focus groups (8–11 participants per group; 92% female) was undertaken with participants who self-reported as living with obesity and food insecurity (n = 39) and were attempting to reduce their weight. Results Three themes and eight subthemes were generated using deductive and reflexive thematic analysis: (1) the Conscious Consumer, reflects the preparation and planning participants undertook by participants to maximise their limited resources. Subthemes include advanced meal planning, and price-comparison shopping. Despite these efforts, participants frequently encountered barriers to being able to purchase nutritionally balanced foods. (2) the Restricted Consumer highlights how structural and systemic limitations, including time pressures due to work or caregiving responsibilities, further constrained participants’ food purchasing choices. and (3) Mitigating the rising cost of food, describes the actions required to manage the challenges in purchasing foods with rising costs. Subthemes include substituting affordable, less-healthy products for costlier fresh produce and bulk buying of staple items. Conclusions Findings challenge societal beliefs that people living on low incomes need to budget more carefully to afford a healthy diet. People living with obesity and food insecurity often report experiencing cognitive dissonance. In this context, participants faced difficult and emotive trade-offs, as they recognised the suboptimal nutritional value of their food purchases but felt compelled by necessity to buy unhealthier food that matched their budget. Findings provide further insights to support healthy, sustainable food purchasing, as part of transforming the UK food system.

Introduction: Food insecurity (lack of reliable access to affordable and nutritious food) is a major concern in high-income countries because it increases the risk of poor nutrition, obesity and associated adverse health outcomes. Healthier diets are often also more environmentally sustainable (hereafter; sustainable), an important factor in reducing climate change. Practice-based interventions are therefore urgently needed to support people living with food insecurity and obesity to access and afford healthier and sustainable foods. Supermarkets are a key area for intervention, as purchasing can be an antecedent to consumption. However, the retailers’ perspectives on the feasibility of implementing affordability interventions is often overlooked and under-researched. Therefore, this study explored the perspectives, views, and experiences of major UK supermarket senior nutritionists on the acceptability and feasibility of using affordability interventions for healthier and sustainable food in the supermarket. Methods: We recruited seven UK senior supermarket nutritionists who represented 85% of the UK grocery market share. We used semi-structured interviews and analysed the data using a reflective thematic analysis approach. Results: Supermarket nutritionists perceived that their business did prioritise health and environmental sustainability for customers. However, there were several challenges encountered when trying to promote healthier and more sustainable food in the supermarket environment, including profitability concerns, unpredictability of intervention outcomes, control over own-brand products, perceived intention-behaviour gap, and a belief that they are already implementing affordability interventions. Differences in how supermarkets approach the evaluation of interventions also emerged, as well as a willingness to collaborate with academics and other retailers to optimise the evaluation of interventions. Lastly, supermarket nutritionists raised the need for an operationalised definition for sustainable food products. Discussion: Affordability interventions to support customers to purchase healthier and more sustainable food require supermarkets to consider multiple challenges. Findings highlight the need for upstream intervention that mandates and facilitates multi-lever approaches to health and sustainability without compromising commercial viability, along with practice-based approaches to implementation and evaluation.

Individuals participate in research for numerous reasons, however, the global economic downturn may have driven some to participate solely for monetary recompense. While inauthentic participation is more widely recognised in quantitative survey studies, it is increasingly becoming an issue in qualitative research. Drawing on our experiences and supported by the wider literature, we highlight ways in which inauthentic participation can be identified and addressed. We argue that pertinent researchers are aware of the risks and potential impact of inauthentic participants and recommend researchers consider this phenomenon from study planning stages onwards. We identify institutions, including Universities, as well placed to provide training and ensure, where necessary, mitigation plans are in place. We suggest ethics committees, funders and publishers request inauthentic participation be considered and reported. These recommendations would establish awareness of this phenomenon, prevent wasting valuable project resources, increase transparency of reporting and ensure data integrity is protected.

At both UK and global level, dietary consumption patterns need to change to address environmental, health and inequality challenges. Despite considerable policy interventions, the prevalence of overweight and obesity in the United Kingdom has continued to rise with obesity now a leading cause of mortality and morbidity. Obesity prevalence is greater among those on lower incomes and the current UK food system, including government policy, does not effectively address this. Current behavioural approaches, without the support of structural changes in the system, may even widen the inequalities gap. Hence, using behavioural insights from those living with obesity and food insecurity, the project will explore potential avenues that can be applied in the food system to promote healthier choices in the food retail environment. The National Food Strategy report recommends that the UK food system should ensure "safe, healthy, affordable food; regardless of where people live or how much they earn". However, the association between food insecurity and the development of obesity is not well understood in relation to purchasing behaviours in the UK retail food environment, nor is the potential effectiveness of interventions that seek to prevent and reduce the impact of diet-induced health harms. The FIO Food (Food insecurity in people living with obesity - improving sustainable and healthier food choices in the retail food environment) project provides a novel and multi-disciplinary collaborative approach with co-development at the heart to address these challenges. Using four interlinked work packages, the FIO Food project will combine our knowledge of large-scale population data with an understanding of lived experiences of food shopping for people living with obesity and food insecurity, to develop solutions to support more sustainable and healthier food choices in the UK retail food environment.

ObjectiveTo assess whether calorific screening thresholds improved the agreement between objective consumer purchase data, from supermarket transaction records, and self-reported dietary intake, from a Food Frequency questionnaire (FFQ), for people living with (PLWOw/Obwith) and without (PLWOw/Obwithout) overweight/obesity.DesignParticipants were recruited across a one-year period (1st June 2020 – 31st May 2021). Six screening thresholds were employed, using the estimated number of calories purchased for the individual, to filter participant data. Bland-Altman analyses were compared between PLWOw/Obwith and PLWOw/Obwithout for energy, sugar, total fat, saturated fat, protein and sodium.SettingPartnered with a large UK retailer.ParticipantsParticipants (N=1788) were recruited via the retailer’s loyalty card customer database. Participants with completed FFQs, shared transaction records, height, weight and household composition data were included for analysis (N=642).ResultsAgreement was found between objective purchase data and self-reported dietary intake at ≥1000 Kcal/day (energy, sugar, total fat and saturated fat) and ≥1500 Kcal/day (protein and sodium). PLWOw/Obwith consumed greater energy (19%), sugar (36%), total fat (22%) and saturated fat (25%) than they were estimated to have purchased at the retailer. PLWOw/Obwithout only consumed greater sugar (19%). ConclusionsThe application of screening thresholds based on estimated individual calories purchased may provide a valuable preprocessing step within the analysis of consumer purchase data, allowing agreement to be found for absolute nutrient values. Differences in bias between PLWOw/Obwith and PLWOw/Obwithout show that insights into purchase and consumption patterns can be identified using consumer purchase data.

Background: With an established, yet avoidable, link between dietary intake and poor health, the nutritional habits of adolescents remains a public health concern. Previous studies report an inverse relationship between dietary intake and socio-economic status (SES), although few studies have considered the influence of the SES gradient. The present study compared the nutritional profiles of neighbouring schools with pupils from middle to high economic backgrounds. Methods: One hundred and ninety pupils from a high SES school (HSESS) and 159 pupils from a middle SES school (MSESS) (aged 11–12 years) completed a 63-item validated food frequency questionnaire. Pupils rated their diet quality and this was compared with a composite Healthy Eating Index (HEI). Results: Children attending MSESS consumed significantly higher intakes of energy (P < 0.001), carbohydrate (P = 0.001), fat (P < 0.001) and protein (P = 0.001). As a percentage of energy contribution, pupils in both schools consumed excess saturated fat (HSESS, +5% boys, +4% girls; MSESS, +4% both boys and girls) and sugar (HSESS, +9% boys, +11% girls; MSESS, +10% boys, +11% girls). When HEI was compared with self-report diet quality, 96% HSESS pupils and 94% MSESS pupils over-rated the quality of their diet. Conclusions: The present study identified that, although pupils from MSESS consume a significantly higher intake of energy and macronutrient compared to a nearby HSESS, the percentage of energy contribution of saturated fat and sugar is above government recommendations for pupils from both schools. Additionally, the majority of pupils from both schools substantially over-rated their diet quality compared to a HEI.

The Impact of Obesity when Validating Supermarket Transaction Records In Dietary Evaluation: FIO-STRIDE 1,2Thomas Sawczuk, 1Hannah C Greatwood, 1Mark S Gilthorpe, 3,4Michelle A Morris, 3,4Victoria Jenneson, 1Claire Griffiths, on behalf of the FIO-Food Team 1Obesity Institute, Leeds Beckett University, Leeds, LS6 3QT, UK; 2Carnegie Applied Rugby Research (CARR) Centre, Carnegie School of Sport, Leeds Beckett University, Leeds, LS6 3QT, UK; 3Leeds Institute for Data Analytics, Level 11 Worsley Building, Clarendon Way, University of Leeds, Leeds, LS2 9JT, UK; 4School of Food Science and Nutrition, University of Leeds, Willow Terrace Road, Leeds, LS2 9JT, UK. Background: Supermarket transaction data reflect dietary purchasing behaviours. FIO-STRIDE compares dietary purchase patterns (supermarket transactions) with consumption (Food Frequency Questionnaire (FFQ)) for people living with and without overweight/obesity. Methods: Participants (n=683) in England were recruited via a UK retailer’s loyalty card database within the Supermarket Transaction Records In Dietary Evaluation (STRIDE) study, where survey data were collected including: height, weight, and FFQ (Jenneson et al. 2023). Bland-Altman plots assessed agreement for absolute measures of: Kcal, sugar, fat, saturated fat, protein, and sodium among people living with and without overweight/obesity. Participant purchase data were filtered by estimated individual calorific consumption:≥1000 Kcal/day/person and ≥1500 Kcal/day/person. Results: People living with overweight/obesity consumed greater kcal, sugar, fat, and saturated fat than they purchased, whereas those living without consumed greater sugar. Agreements were observed among participants for their consumption of kcal, sugars, fat, and saturated fat after filtering for ≥1000 Kcal/day consumption, and for their consumption of protein and sodium after filtering for ≥1500 Kcal/day consumption. Conclusions: Agreement between food purchase and consumption records differed by weight status. The number of calories purchased should be considered as a filter to exclude inconsistent shoppers when using supermarket purchase data as a proxy for consumption.

Background: Persons experiencing food insecurity (FI) compared to lower levels are more likely to live with obesity and purchase foods of lower dietary quality. Communications within the retail environment have potential to influence behaviours, but little is known on how the messaging is perceived by this target audience. This qualitative paper explores the insights of people living with obesity (PLWO) and FI on two national campaigns targeted at: i) supporting customers with increased food prices; and ii) promoting the consumption of healthy sustainable meals. Methods: PLWO and FI (n=39) expressed their perceptions of purchasing healthier and more environmentally sustainable foods through four focus groups. Reflexive thematic analysis was used to generate themes. Results: Five themes and 12 subthemes were generated: (i) Do I have the resource? i.e. financial and/or time (ii) Do I know what it means? e.g. clarity of images (iii) Do I trust it? e.g. authentic images (iv) Do I want it? e.g. lack of appeal (v) Recommendations for future promotional communications. Conclusions: Findings provide insights for retailers on the need for upstream changes within the wider food system and the importance of tailored communications and messaging that supports PLWO and FI purchase healthier and more sustainable foods.

Background: Dietary behaviours of adolescence are concerning, and this may impact long-term well-being. Aim: This study examined the socio-ecological determinants of dietary behaviours in a national prospective cohort study of English adolescents. Methods: Latent class analysis was used to identify the typologies of eight dietary behaviours: fruit, vegetable, breakfast, sugar-sweetened beverages, artificial-sweetened beverages, fast-food, bread, and milk from 7402 adolescents aged 13-15 years (mean 13.8 ± 0.45 years) (50.3% female and 71.3% white ethnicity) participating in the U.K. Millennium Cohort Study (sixth survey). Multinomial logistic regression and path analysis predicted associations between personal characteristics, individual, influential others, social environment and physical environment determinants and three distinct diet typologies: (1) healthy, (2) less-healthy and (3) mixed, (reference category = mixed). Results: Within Path analysis, the magnitudes of coefficients were small to moderate suggesting a relatively weak relationship between the variables. Model 1 reported adolescents within the less-healthy compared to mixed typology had lower levels of physical activity (β = 0.074, 95% CI = -0.115, -0.033), and have siblings (β = 0.246, 95% CI = 0.105, 0.387). Model 2 reported adolescents within the healthy compared to mixed typology had lower screen time (β = 0.104, 95% CI = 0.067, 0.141), and lower social media usage (β = 0.035, 95% CI = 0.024, 0.046). Conclusion: This study highlights the importance of considering multiple dietary determinants. These findings are likely to be useful in supporting the development of multi-faceted interventions. They emphasise the need to move away from investigating silo behaviours on individual diet components and a step towards more systems thinking to improve adolescent eating behaviours.

Abstract

Objective: To evaluate the effect of a high‐protein diet on anthropometry, body composition, subjective appetite, and mood sensations in overweight and obese children attending a residential weight‐loss camp.

Research Methods and Procedures: Children (120; BMI, 33.1 ± 5.5 kg/m2; age, 14.2 ± 1.9 years) were randomly assigned to either a standard or high‐protein diet group (15% vs. 22.5% protein, respectively). All children were assessed at baseline and at the end of the camp for anthropometry, body composition, blood pressure, biochemical variables (n = 27), and subjective appetite and mood sensations (n = 50).

Results: Attendance at the weight‐loss camp resulted in significant improvements in most measures. Campers lost 5.5 ± 2.9 kg in body weight (p < 0.001) and 3.8 ± 5.4 kg in fat mass (p < 0.001) and reduced their BMI standard deviation score by 0.27 ± 0.1 (p < 0.001) and their waist circumference by 6.6 ± 2.8 cm (p < 0.001). Subjective sensations of hunger increased significantly over the camp duration, but no other changes in appetite or mood were observed. There were no significant differences between the two diets on any physical or subjective measures.

Discussion: Weight‐loss camps are effective in assisting children to lose weight and improve on a range of health outcomes, independently of the protein content of the diet. The implications of an increase in hunger associated with weight loss needs to be considered. Further work is warranted to investigate whether higher levels of dietary protein are feasible or effective in longer‐term weight‐loss interventions of this type.

Background: The United Kingdom faces complex economic and structural challenges that have disrupted food pricing, contributing to widespread food insecurity. These fluctuations diminish the affordability and accessibility of healthy, nutrient-dense foods among vulnerable groups. In high-income countries, food insecurity is associated with higher levels of obesity, and in the UK specifically, the cost of living crisis, where the cost of food has increased quicker than wages, is likely to have exacerbated existing dietary inequalities. This qualitative paper explores insights of people living with obesity and food insecurity, in an ethnically diverse community, to develop further understanding on their food shopping experiences.Methods: A secondary analysis of qualitative data from four focus groups (8–11 participants per group; 92% female) was undertaken with participants who self-reported as living with obesity and food insecurity (n=39) and were attempting to reduce their weight. Results: Three themes and eight subthemes were generated using deductive and reflexive thematic analysis: (1) the Conscious Consumer, reflects the preparation and planning participants undertook by participants to maximise their limited resources. Subthemes include advanced meal planning, and price-comparison shopping. Despite these efforts, participants frequently encountered barriers to being able to purchase nutritionally balanced foods. (2) the Restricted Consumer highlights how structural and systemic limitations, including time pressures due to work or caregiving responsibilities, further constrained participants’ food purchasing choices. and (3) Mitigating the rising cost of food, describes the actions required to manage the challenges in purchasing foods with rising costs. Subthemes include substituting affordable, less-healthy products for costlier fresh produce and bulk buying of staple items. Conclusions: Findings challenge societal beliefs that people living on low incomes need to budget more carefully to afford a healthy diet. People living with obesity and food insecurity often report experiencing cognitive dissonance. In this context, participants faced difficult and emotive trade-offs, as they recognised the suboptimal nutritional value of their food purchases but felt compelled by necessity to buy unhealthier food that matched their budget. Findings provide further insights to support healthy, sustainable food purchasing, as part of transforming the UK food system.

Background: People experiencing food insecurity (FI) are more likely to live with obesity and purchase foods of lower dietary quality. Retail campaigns have the potential to influence food purchasing behaviours. Still, little is known about how the retailers’ messaging is perceived by people living with obesity (PLWO) and FI. This qualitative paper explores the insights of PLWO and FI on two national online and in-store campaigns targeted at i) supporting customers with increased food prices, and ii) promoting the consumption of healthier and more environmentally sustainable meals. Methods: Participants who self-reported as living with obesity and FI (n=39) expressed their perceptions of campaign images, from one retailer, through four in-person focus groups. Findings from the focus groups were then presented to the retail partner in an online participatory workshop. Themes were generated using reflexive thematic analysis.Results: Five themes and 12 subthemes were generated from the focus groups: (i) ‘Do I have the resources needed?’ Finances and, or time influenced participants’ food purchasing. (ii) ‘Do I know what it means?’ Participants did not always understand the images presented. (iii) ‘Do I trust it?’ Participants questioned whether the prices or images in the campaigns were authentic. (iv) ‘Do I want it?’ Participants questioned whether the food presented in the images appealed to them. (v) ‘Recommendations for future promotional communications’. Participants outlined how they wanted messaging to apply to them by using ethnically diverse food images that are suitable for a range of health conditions. From the retail partner participatory workshop we identified one theme and three subthemes. (i) ‘It is a conundrum’, the diverse needs of subgroups for national campaigns make it challenging for retailers to communicate healthy sustainable food promotions.Conclusions: These findings provide insights for retailers on the need for tailored communications, that reflect the requirements of different customers, to support PLWO and FI to purchase healthier and more sustainable foods. Acknowledging and addressing the inherent complexity of promoting healthier and more environmentally sustainable food is vital to making meaningful improvements to the food environment.

The consumption frequency and portion size of discretionary snacks are thought to contribute to a greater food intake and risk of overweight or obesity in the developed world but evidence from epidemiological studies is inconclusive. To investigate this, we systematically evaluated evidence on the effects of discretionary snack consumption on weight status, energy intake, and diet quality. Articles involving discretionary snacks reported against the outcome measures of any primary, peer-reviewed study using human participants from free-living conditions for all age groups were included. A total of 14,780 titles were identified and 40 eligible publications were identified. Three key outcomes were reported: weight status (n = 35), energy intake (n = 11), and diet quality (n = 3). Increased discretionary snack consumption may contribute modestly to energy intake, however, there is a lack of consistent associations with increased weight/BMI. Although cross-sectional analyses offered conflicting findings, longitudinal studies in adults showed a consistent positive relationship between discretionary snack intake and increasing weight or body mass index. Given that experimental findings suggest reducing the size of discretionary snacks could lead to decreased consumption and subsequent energy intake, food policy makers and manufacturers may find it valuable to consider altering the portion and/or packaging size of discretionary snacks.

Research in nutrition and health has primarily targeted the treatment of chronic diseases. However, research suggests food intake can also affect mood (Geary, 2001: The food and mood handbook. London: Thornsons). Food intake may impact important self-perceptions, however little is known of the role played by nutrition on self perception in children. This gave the purpose to the current study. With institutional ethical approval, 146 year 7 pupils (females [n=92]; mean age=11.60, s=0.32) completed a modified version of the Harter Self-Perception Profile for Children (SPPC; Harter, 1985: Manual of the self-perception profile for children. Denver, CO: University of Denver). The SPPC provides a multi-dimensional overview of an individual’s ratings of competence on five elements sports competence, appearance, social acceptance, scholastic competence and behavioural conduct, combining in a single score for Global Self Worth. Two questions were drawn from the original 6 per subscale. Participants also completed a Food Frequency Questionnaire (FFQ), comprising 63 food categories, with six levels for frequency of consumption (Margetts et al., 1989: International Journal of Epidemiology 18, 868–873). Separate standard portion sizes for boys and girls were used in the analysis (Macdiarmid & Blundell, 1997: European Journal of Clinical Nutrition, 51, 199–200). Data were collected during PE lessons at the beginning of the academic year. Based on responses participants were categorized as either high/low self-perceptions around the mean subscale split. Pearsons Product Moment correlations found no significant relationship between Global Self Worthand energy intake. However, there was a significantlynegative correlation between total energy intake and (i) Appearance (r(146)=-0.166, P=0.021 and (ii) Behaviour (r(146)=-0.210, P=0.036) subscales, suggesting that as total energy intake increased perceptions of appearance and behaviour decreased The results provide preliminary findings to support a potential relationship between energy intake and self-perceptions in children. Findings highlight that children who report higher energy intakes have reduced levels of self-perception in certain subscales. It suggests that while energy intake was not negatively related to Global Self-worth, it is negatively linked to perceptions at the lower domain levels of appearance and behaviour. This confirms a potential detrimental effect of increased energy intake with how children view the way they look and the way they behave. Findings suggest that schools should be aware of the risk that higher energy intakes may have on self-perceptions and seek to develop strategies to enhance their beneficial elements.

An increasing number of studies in children are being published using accelerometry to determine the levels of moderate-to-vigorous physical activity (MVPA). Although accelerometry is regarded as an objective measure, a review of the literature reveals a large disparity in the proportions of children meeting current MVPA recommendations. Therefore, the aim of the present study was to evaluate the variability of MVPA estimates in children using published accelerometry threshold values. With institutional ethical approval, 46 (27 males) children, aged 11–12 years, participated in the study. Weekday physical activity was measured using an Actigraph GT1M accelerometer, set at 10-s epochs. Time spent in MVPA was calculated using five adjusted intensity thresholds based on previously published counts per minute (cpm) values: (i) 1130 (Freedson et al., 1997: Medicine and Science in Sports and Exercise, 29, S45), (ii) 2000 (Ekelund et al., 2004: American Journal of Clinical Nutrition, 80, 584–590), (iii) 3000 (Treuth et al., 2004: Medicine and Science in Sports and Exercise, 36, 1259–1266), (iv) 3200 (Puyau et al., 2002: Obesity Research, 10, 150–157) and (v) 3600 (Riddoch et al., 2007: Archives of Disease in Childhood, 92, 963–969). Additionally, using each threshold the percentage of children acquiring an average of 60 min MVPA per day was calculated. Using the five intensity thresholds, participants spent (in ascending order) (i) mean 100, s=32 min, (ii) mean 59, s=23 min, (iii) mean 32, s=15 min, (iv) mean 28, s=13 min and (v) mean 21, s=11 min per weekday in MVPA, respectively. All differences were statistically significant (P<0.001). Within each threshold, the percentage of children acquiring an average of 60 min MVPA was 93, 41, 9, 2 and 0%, respectively. Although based on only a small sample, these findings illustrate the variability of defining MVPA using different thresholds. Although accelerometry overcomes many of the reliability and validity problems associated with self-report, pedometer and heart-rate assessment, careful consideration is warranted when interpreting accelerometry data. Indeed, even though acceleroAn increasing number of studies in children are being published using accelerometry to determine the levels of moderate-to-vigorous physical activity (MVPA). Although accelerometry is regarded as an objective measure, a review of the literature reveals a large disparity in the proportions of children meeting current MVPA recommendations. Therefore, the aim of the present study was to evaluate the variability of MVPA estimates in children using published accelerometry threshold values. With institutional ethical approval, 46 (27 males) children, aged 11–12 years, participated in the study. Weekday physical activity was measured using an Actigraph GT1M accelerometer, set at 10-s epochs. Time spent in MVPA was calculated using five adjusted intensity thresholds based on previously published counts per minute (cpm) values: (i) 1130 (Freedson et al., 1997: Medicine and Science in Sports and Exercise, 29, S45), (ii) 2000 (Ekelund et al., 2004: American Journal of Clinical Nutrition, 80, 584–590), (iii) 3000 (Treuth et al., 2004: Medicine and Science in Sports and Exercise, 36, 1259–1266), (iv) 3200 (Puyau et al., 2002: Obesity Research, 10, 150–157) and (v) 3600 (Riddoch et al., 2007: Archives of Disease in Childhood, 92, 963–969). Additionally, using each threshold the percentage of children acquiring an average of 60 min MVPA per day was calculated. Using the five intensity thresholds, participants spent (in ascending order) (i) mean 100, s=32 min, (ii) mean 59, s=23 min, (iii) mean 32, s=15 min, (iv) mean 28, s=13 min and (v) mean 21, s=11 min per weekday in MVPA, respectively. All differences were statistically significant (P<0.001). Within each threshold, the percentage of children acquiring an average of 60 min MVPA was 93, 41, 9, 2 and 0%, respectively. Although based on only a small sample, these findings illustrate the variability of defining MVPA using different thresholds. Although accelerometry overcomes many of the reliability and validity problems associated with self-report, pedometer and heart-rate assessment, careful consideration is warranted when interpreting accelerometry data. Indeed, even though accelerometry counts may be regarded as an objective assessment of physical activity, analysis of the data still requires a subjective choice of MVPA threshold. Moreover, until a quantifiable evidencebased definition of MVPA is developed in association with appropriate accelerometry thresholds, any conclusion regarding the proportions of 11–12 year old school children meeting current government guidelines must be interpreted with caution.