Dr Suzanne Mcgregor

Dementia, characterised by progressive and irreversible loss of cognitive function, affects ability to undertake activities of daily living and social autonomy. People with dementia, can still lead a physically active lifestyle and achieve a range of benefits given appropriate support, However, whilst people with dementia and their family carers perceive value in being physically active, participation levels appear lower than for the population. Understanding why and exploring appropriate strategies to reduce sedentary behaviour (SB) and support engagement in physical activity (PA) was the focus of this research. The aim to explore the understanding and experiences of SB and PA, of people with dementia and family carers living in a community setting, reflect on the findings, and make recommendations for practice. An interview study, involving ten people with dementia and eleven family carers, captured information on beliefs and knowledge of PA/SB, barriers, motivators and facilitators and support available from key stakeholders. Information was thematically analysed using template analysis. Findings identify a broad range of barriers affecting ability to be physically active, confirming the importance of a person-centred, system wide approach to enable solutions to be found. Further priorities included 1) Increasing knowledge and understanding of PA and SB through provision of relevant and relatable information and training. Current information is perceived inadequate, but a thirst for knowledge exists. Needs are variable, complex, and will change over time, requiring creative approaches in the development and communication of information. 2) Maximising the potential of walking as an intervention to reach and engage many people with dementia. The range of motives identified, and the value assigned to walking, gives a clear indication of the priority which should be given by stakeholders to supporting maintenance of walking ability, alongside promotion, and development of multiple walking opportunities. 3) Relationships can shape feelings and experiences of PA in a positive way but can also create challenges. The most influential relationship for a person with dementia is with family carers. Whilst family carers demonstrated considerable enthusiasm and motivation to facilitate active lifestyles, confidence was often lacking. Limited support from the public and various stakeholders was identified, highlighting a range of issues, including lack of knowledge, capacity, resource and minimal communication. Wider relationships and roles need to be established to ensure joined-up approaches so maximising support for active lifestyles. 4)The amount of, and quality of organised PA provision continues to create challenges. Consultation and involvement of people with dementia and family carers in the development of services and interventions would facilitate a better understanding of needs and priorities. My thesis concludes by recommending ways people with dementia can be supported, to maintain a physically active lifestyle throughout their dementia journey

Variation in the existing literature on the psychosocial benefits of weight loss in obese youth results, in part, from methodological limitations and modest weight loss. Accordingly, this research assessed perceived self-competence and low self-esteem during an intensive weight loss programme in a large sample of obese youth and related these to starting weight, gender and weight loss.Over 4 years, 303 obese male and female adolescents (body mass index [BMI] 34.3 kg m(-2) , BMI standard deviation score 2.99; 14.7 years) attended a residential weight loss camp for a mean duration of 31 d. Outcome variables included dimensional self-esteem (Harter) and weight change over the camp.At the start of camp, obese youth scored highest on social acceptance and lowest on physical appearance and athletic competence. Global self-worth and most domains of self-competence improved significantly over the intervention. The proportion with low global self-worth reduced from 35% to 16%, but there was little change in the proportion reporting high self-competence (23%). Mean weight loss was -5.5 kg (BMI standard deviation scores -0.25) with boys and those heaviest at the start losing most. Weight loss was significantly correlated with improved physical appearance (r = 0.13) and athletic competence (r = 0.19), but not global self-worth.This intensive weight loss intervention yielded significant psychological benefit, especially in self-competence and among individuals achieving most weight loss. The weak association with weight loss suggests the influence of other contributing environmental or social features that should be the focus of further research.

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.

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.

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.