DOI: 10.1111/obr.
13503
SUPPLEMENT ARTICLE
Poster sessions
P001 | Short-term and long-term effect of
SARS-CoV-2 infection on body composition
in COVID-19 survivor
A. Kaur; M. Mitra
Physiotherapy, MVPs College of Physiotherapy, Nashik, India
INTRODUCTION: After recovering from Covid, very little is known
about whether the patient lost weight or gained more weight during
recovery. Most of the weight loss observed in COVID-19 survivors
was mainly due to loss of lean body mass caused by systemic inflam-
mation, muscle atrophy, and bed rest. Unintentional weight loss,
which is mainly associated with loss of fat-free mass, may negatively
impact time to full recovery and patients' health status. Moreover,
fatigue is a very common problem in COVID-19 survivor, which can
negatively affect the physical activities of patients, which can further
affect their body composition. Limiting physical activity affects the
quality of life, as well as health.
The aim of this study was to assess short-term and long-term
body composition changes from hospital admission to 6 months after
discharge in COVID-19 survivors.
MATERIALS AND METHODS: It was a prospective observational
investigation. One hundred twenty-three patients above 18 years,
both male and female with a confirmed diagnosis of COVID-19 who
had been admitted to and subsequently discharged home from a
COVID-19 medical ward of Dr. Vasantrao Pawar Medical College and
Research Center, Nashik, were included in the study. Patients were
evaluated at discharge and revaluated after 1 month and 6 months of
discharge.
MEASURES: Demographic data, body mass index (BMI), abdominal
circumference, body mass, and segmental composition of the body
using the electrical bioimpedance (BIA) with the use of Omron elec-
trode body composition analyzer, physical activity data, and Occur-
rence of Specific Symptoms of Long-COVID-19 Syndrome,
Questionnaire.
RESULTS: One hundred twenty-three COVID-19 survivors (69% male,
31% females) with median age 59.1 years were included. Median BMI
did not change from admission to discharge in subjects with normal
weight but significantly decreased in subjects with overweight or obe-
sity within 1 month of COVID-19 infection. It has been noticed that
after 6 months, BMI and waist circumference significantly increased
from base line data. (Note—still results of few long-term follow up
Obesity Reviews. 2022;23(S2):e13503. wileyonlinelibrary.com/journal/obr
https://doi.org/10.1111/obr.13503
patients yet to be collected; final results will be available in June 2022,
so that's why exact statistical value is not been put.)
CONCLUSION: Patients hospitalized with COVID-19 infection shown
wide fluctuations in weight and abdominal obesity that may worsen
body composition.
CONFLICT OF INTEREST: None declared.
P002 | Micronutrient deficiencies and anemia
associated with body mass index in
Australian adults: A cross-sectional study
C. Seifu; P. Fahey; E. Atlantis
Western Sydney University, Penrith, New South Wales, Australia
INTRODUCTION: To estimate the prevalence of micronutrient defi-
ciencies and anemia, and their association with body mass index (BMI)
categories among Australian adults.
MATERIALS AND METHODS: We analyzed data from the 2011–
2013 Australian Health Survey (AHS) from 3539 participants aged
18 years and over (without known pregnancy) with measured weight
and height, and nutrient biomarkers. To address complex sampling,
survey weights were used when estimating the prevalence of micro-
nutrient deficiencies (vitamin B12 deficiency; serum vitamin
B12 < 145 pmol/L; iron deficiency; ferritin < 30 μg/L; and vitamin D
deficiency; 25-hydroxyvitamin D < 50 nmol/L) and anemia (hemoglo-
bin < 120 g/L for females and <130 g/L for males) and when assessing
associations with logistic regression models with adjusted odds ratios
(ORs) for BMI categories: healthy weight (BMI, 18.5 to <25.0 kg/m2),
reference; overweight (BMI, 25.0 to <30.0 kg/m2), obesity I (BMI,
30.0 to <35.0 kg/m2), obesity II/III (BMI, 35.0 kg/m2 or more).
RESULTS: The prevalence estimates of vitamin B12 deficiency (range
0.9%–2.8%) and anemia (range 3.9%–6.7%) were variable but not sta-
tistically different across BMI groups. The prevalence of iron defi-
ciency in the obesity class I group was 12.0 percentage points lower
than healthy weight group with an OR of 0.50 (95%CI: 0.30, 0.83).
The prevalence of vitamin D deficiency in the obesity class II/III group
was 7.9 percentage points higher than healthy weight group with an
OR of 1.62 (95%CI: 1.01, 2.60).
CONCLUSION: Clinicians and health policy makers should be aware
that severe obesity is positively associated with vitamin D deficiency
in the general population. Definitive research is required to better
© 2022 The Authors obesity reviews © 2022 World Obesity 1 of 222

2 of 222
understand the role of excess body weight in developing micronutri-
ent deficiencies.
CONFLICT OF INTEREST: C. Seifu: none declared; P. Fahey: none
declared, E. Atlantis: Grant/Research support with EA was the Found-
ing President, and now serves as the Secretary, of the National Asso-
ciation of Clinical Obesity Services (NACOS). He has received
honoraria from Novo Nordisk for speaking and participating at meet-
ings. He has received unrestricted research funding from Novo Nor-
disk and iNova on behalf of National Association of Clinical Obesity
Services.
P003 | High saturated fat diet induce
lipotoxicity causing human islet dysfunction
C. Cheung1; H. Burns1; J. E. Gunton1,2
1
Centre for Diabetes, Obesity and Endocrinology, The Westmead
Institute for Medical Research, Westmead, New South Wales, Australia;
2
Faculty of Health and Medicine, University of Sydney, Sydney, New
South Wales, Australia
INTRODUCTION: Obesity is one of the well-known risk factors for
Type 2 diabetes. Dietary intake is a critical factor in obesity and diabe-
tes. Chronic consumption of western-style high-saturated fat diet
(HSFD) increases body fat mass and free fatty acids, and in rodents
causes lipotoxicity, which is detrimental effects of lipids on pancreatic
islet function. Lipotoxicity is difficult to prove in humans.
The aim of the research is to use “humanised mice,” which are
diabetic mice transplanted with human islets to normalize their glu-
cose. These were used to test whether HSFD impacts the function of
human islets.
MATERIALS AND METHODS: Immunodeficient RAG1-null mice
(C57Bl/6 genetic background) were recipients for human islet trans-
plant. Prior to transplant, diabetes was induced by streptozotocin.
Twenty-seven female and 13 male mice each received 2000IEQ
human islets under the kidney capsule from donors with normal glu-
cose tolerance. Four weeks after transplantation mice that did not
have resolution of diabetes and were excluded. Mice with functioning
grafts (n = 24 female, 9 male) were placed on HSFD (45% of calories
from fat) or continued on normal chow. Glucose tolerance test (GTT)
and glucose stimulated insulin secretion (GSIS) were measured before
and during diet. Energy expenditure was measured by using Pro-
methion metabolic cages.
RESULTS: Mice fed HSFD had significant weight gain (≥5 g). Female
mice had approximately 1–2-fold greater weight gain than mice fed
chow, while male mice had a 2–5-fold greater weight gain. Mice fed
HSFD have higher random-fed BGL (approximately 1–3 mmol/L) than
mice from the same human donors fed chow.
On formal GTT, mice fed HSFD had gradual deterioration over
16 weeks of diet compared to their matching-donor chow-fed recipi-
ents. Their GTT results were highly significant in comparison between
diet, p < 0.0001 for both female and male recipients.
1467789x, 2022, S2, Downloaded from https://onlinelibrary.wiley.com/doi/10.1111/obr.13503 by CAPES, Wiley Online Library on [16/12/2023]. See the Terms and Conditions (https://onlinelibrary.wiley.com/terms-and-conditions) on Wiley Online Library for rules of use; OA articles are governed by the applicable Creative Commons License
SUPPLEMENT ARTICLE
Consumption of 16-weeks of HSFD caused larger weight gain
and gradual detrimental effect on human islet function and beta cell
mass, supporting the lipotoxicity hypothesis in human islets. There
was a notable difference between donors for deterioration.
There was a significant interaction between diet-group and
donor-preparation. GTT deterioration was more pronounced with
donors 014, 004, 003, 282, and 298 than donors 002 and
281 (p = 0.034 in female and p = 0.004 in male). Higher energy
expenditure was found in mice fed chow despite a similar 24-h calorie
consumption.
On assessment of grafts, mice fed chow had a greater human beta
cell mass compared to HSFD-recipients.
CONCLUSION: Consumption of 16-weeks of HSFD caused larger
weight gain and gradual detrimental effect on human islet function and
beta cell mass, supporting the lipotoxicity hypothesis in human islets.
There was a notable difference between donors for deterioration.
CONFLICT OF INTEREST: None declared.
P004 | Physical activity and body
composition among Malaysian preschool
children: Preliminary findings from the
SUNRISE study
D. Koh1; L. B. Cho1; J. E. Wong2; B. K. Poh2; A. D. Okely3
1
Centre for Community Education & Well-being, Faculty of Education,
Universiti Kebangsaan Malaysia, Bangi, Malaysia; 2Centre for Community
Health Studies (ReaCH), Faculty of Health Sciences, Universiti
Kebangsaan Malaysia, Kuala Lumpur, Malaysia; 3Early Start, University
of Wollongong, Wollongong, New South Wales, Australia
INTRODUCTION: Malaysia has the second highest prevalence of
overweight and obesity among children and adolescents in Asia, and
recent studies show that it is in an increasing trend. As overweight
and obesity are strongly associated with physical activity (PA), it is
timely to explore PA and its association with body composition among
preschool children in Malaysia.
MATERIALS AND METHODS: This cross-sectional study included
children aged 4 years recruited from rural and urban locations in Kuala
Lumpur, Selangor, and Negeri Sembilan. PA was measured using Acti-
graph GT3X+ accelerometers, worn on the waist for 5 days. Children
with at least one 24-h day of data were included in this study. Socio-
demographic data, including age, sex, and ethnicity, were obtained
through parent-reported questionnaire. Weight and height were mea-
sured, body mass index (BMI) was calculated, and BMI-for-age Z-score
(BAZ) was tabulated using Anthro software. Fat mass (FM) and fat
free mass (FFM) was estimated from anthropometric and sociodemo-
graphic information using the predictive model by Hudda et al. (2019).
RESULTS: A total of 82 children from 24 kindergartens completed all
study protocols. According to BAZ, most (81.7%, n = 67) children were
normal weight, 14 (17.1%) affected by overweight/obesity, and one
child affected by severe wasting. Mean (±SD) body composition

SUPPLEMENT ARTICLE
parameters were FM = 3.12 ± 1.58 kg; FM-Index = 2.99
± 1.25 kg m 2; %FM = 18.59 ± 4.33%; FFM = 13.04 ± 2.31 kg; and
FFM-Index = 12.67 ± 1.29 kg m . 2
Girls recorded higher
(19.67% vs. 17.51%, p = 0.023) compared to boys. Boys had higher
FFM (13.71 kg vs. 12.36 kg, p = 0.007) and FFM-Index (13.16 kg m
vs. 12.18 kg m 2, p < 0.001) compared to girls. The average time
(median) children spent in PA was 159.1 min/day of which 69.0 min
were moderate- to vigorous-intensity PA (MVPA). Boys recorded
higher total PA (179.0 min/day vs. 144.3 min/day, p = 0.033) and
MVPA (83.2 min/day vs. 57.7 min/day, p = 0.012) compared to girls.
Higher time spent in MVPA were associated with higher FFM
(rs = 0.224, p = 0.043).
CONCLUSION: The association between MVPA with FFM underlines
the importance of children participating in active play, especially those
that allows children to achieve MVPA. A more representative study is
currently being conducted to gain better understanding of these asso-
ciations among Malaysian children.
CONFLICT OF INTEREST: None declared.
P005 | Evaluating the online delivery of the
better health program—A study protocol
1 1 2 3 3 of Kerala, Kasaragod, India
D. Zhu ; Z. Davidson ; S. Gibson ; M. Freeman ; L. Marsh ;
3
T. Knight
1
Nutrition, Dietetics and Food; 2School of Clinical Sciences, Monash
University, Clayton, Victoria, Australia; 3Better Health Company,
Melbourne, Victoria, Australia
INTRODUCTION: The online Better Health Program (o-BHP) is a
10-week family-based program to promote healthy behavior changes,
using online modules on healthy eating and physical activity, phone
coaching calls, email/SMS communication, and incentives. The pro-
gram delivers evidence-based approaches in nutrition, physical activ-
ity, and behavior change. The in-person program has been
successfully delivered and evaluated in Australia for over a decade.
This study aims to evaluate the impact of the o-BHP on body
mass index (BMI), health behaviors, and quality-of-life in children aged
7–13 years who are above a healthy weight. It will explore the experi-
ence of participants (children, parents/caregiver) partaking in the pro-
gram, including barriers and enablers to successful program
engagement and/or completion.
This study has commenced recruitment and the purpose of the
proposed presentation is to describe the study protocol.
MATERIALS AND METHODS: This pragmatic randomized control
trial plans to recruit 118 participants (n = 59 in intervention group,
n = 59 in a wait-listed control group) in Victoria to complete the o-
BHP. Outcomes will be assessed pre-program and immediately,
6 months, and 12 months following program completion.
Semi-structured interviews will be conducted with interested par-
ticipants at 3-months follow-up, to collect qualitative data on the par-
ticipants' experiences while participating in the o-BHP.
1467789x, 2022, S2, Downloaded from https://onlinelibrary.wiley.com/doi/10.1111/obr.13503 by CAPES, Wiley Online Library on [16/12/2023]. See the Terms and Conditions (https://onlinelibrary.wiley.com/terms-and-conditions) on Wiley Online Library for rules of use; OA articles are governed by the applicable Creative Commons License
3 of 222
RESULTS: Primary outcomes include changes in BMI z-score, weight,
waist circumference, dietary intake, physical activity level, and quality-
%FM of-life. Secondary outcomes include identified barriers and enablers of
program completion/engagement and common features of partici-
2
pants' experiences of the o-BHP.
CONCLUSION: This research will provide insight on scalable e-health
approaches for childhood obesity, inform future family-based behav-
ioral change programs, and identify program features influencing
short- and long-term program effectiveness.
CONFLICT OF INTEREST: None declared.
P007 | Clustering of health behaviors for
cardiometabolic risk factors among adults at
high risk for type 2 diabetes in Kerala, India
G. T. D. Mello1; T. Sathish2; B. Oldenburg3; J. Panniyammakal4;
K. Thankappan5; Y.Cao3
1
Federal University of Santa Catarina, Florian
opolis, Brazil; 2McMaster
University, Hamilton, Ontario, Canada; 3Baker Heart and Diabetes
Institute, Melbourne, Victoria, Australia; 4Sree Chitra Tirunal Institute for
Medical Sciences and Technology, Trivandrum, India; 5Central University
INTRODUCTION: This study aims to examine the cross-sectional
associations between clusters of physical activity (PA), sedentary
behavior (SB), diet, sleep, alcohol, and tobacco use with cardio-
metabolic risk factors among adults at high risk for diabetes in
India.
MATERIALS AND METHODS: Kerala Diabetes Prevention Program
data (n = 1007; age 30–60 years) were analyzed. Behaviors were col-
lected using standard questionnaires and cardiometabolic risk factors
including systolic and diastolic blood pressure (SBP and DBP), waist
circumference, 2-h plasma glucose (2-hr PG), triglycerides, and low-
and high-density lipoprotein (LDL and HDL) were measured using
standard protocols. Latent class analysis identified the classes and
multilevel mixed-effects linear regression analysis identified the
associations.
RESULTS: Two classes were identified, with 30.1% of participants in
Class 1 and 69.9% in Class 2. Class 1 compared to Class 2 was rela-
tively unhealthy. The most important difference was that adults in
Class 1 had a higher probability of tobacco and alcohol use compared
to Class 2. Similarities between the classes included a high probability
of not engaging in leisure PA, and consuming <5 servings of fruit and
vegetables per day. Compared with Class 1, Class 2 was associated
with a lower SBP: 5.33 mmHg (95%CI: 8.13;-2.53), DBP:
2.49 mmHg (95%CI: 4.45;-0.53), and triglycerides: 0.26 mg/dl
(95%CI: 0.33;-0.18).
CONCLUSION: The classes were characterized by the presence of
both unhealthy and healthy behaviors. Participants in class 2, relatively
healthier, had lower levels of certain cardiometabolic risk factors.
 1467789x, 2022, S2, Downloaded from https://onlinelibrary.wiley.com/doi/10.1111/obr.13503 by CAPES, Wiley Online Library on [16/12/2023]. See the Terms and Conditions (https://onlinelibrary.wiley.com/terms-and-conditions) on Wiley Online Library for rules of use; OA articles are governed by the applicable Creative Commons License
4 of 222 SUPPLEMENT ARTICLE

TABLE 1 Association between classes and cardiovascular risk factors (n = 753)

Dependent variable β 95% CI

SBP (mmHg)
Class 2 5.33 ( 8.13; 2.53)
DBP (mmHg)
Class 2 2.49 ( 4.45; 0.53)
HDL cholesterol (mg/dl)
Class 2 0.34 ( 2.21; 2.90)
LDL cholesterol (mg/dl)
Class 2 0.19 ( 6.34;5.95)
Log Triglycerides (mg/dl)
Class 2 0.26 ( 0.33; 0.18)
Waist circumference (cm)
Class 2 0.95 ( 2.66; 0.76)
Glucose
Class 2 0.39 ( 1.97; 1.17)

Note: SBP: systolic blood pressure. BPS: diastolic blood pressure. Class 1 was the reference because was relatively unhealthy. Polling areas (clusters) was
second level on Multilevel mixed-effects linear regression analysis. Analyses were adjusted by age, occupation, marital status, and education.

F I G U R E 1 Prevalence and item-response probabilities of each risk behavior for each class. Note: PA: physical activity; F&V: fruit and
vegetables; h/d: hours per day; serving/d: serving per day.

Future longitudinal studies are encouraged to confirm these associa- Gut Health, Lifelong Health Theme, South Australian Health and Medical

tions in other LMICs. Research Institute (SAHMRI), Adelaide, South Australia, Australia;
4
CONFLICT OF INTEREST: None declared. Centre for Neuroendocrinology and Department of Anatomy, School of
Biomedical Sciences, Otago University, Otago, New Zealand; 5Intestinal
Nutrient Sensing Group; 6Centre of Research Excellence, Translating
P008 | Circadian variations in food intake Nutritional Science to Good Health, Adelaide Medical School, University
during pregnancy in mice of Adelaide, Adelaide, South Australia, Australia

G. S. Clarke1,2,3; S. R. Ladyman4; R. L. Young3,5,6; K. L. Gatford2,3;

A. J. Page1,3,6
1
Vagal Afferent Research Group; 2Robinson Research Institute, University
of Adelaide, Adelaide, South Australia, Australia; 3Nutrition, Diabetes &
INTRODUCTION: Pregnancy demands increased energy intake to
enable fetal and placenta growth and to create future lactation
reserves. Pregnant mice have increased food intake, due to increased

SUPPLEMENT ARTICLE
light-phase meal size, and reduced physical activity. Circadian rhythms
regulate food intake and activity, and murine diurnal activity are
altered during pregnancy; however, the circadian timing of feeding in
pregnancy is unknown. Therefore, this study aims to determine if diur-
nal rhythms of food intake behavior are altered across pregnancy
in mice.
MATERIALS AND METHODS: Female C57BL/6J mice (10–12 weeks
old) were randomized to the pregnant group (up to 17.5 days, N ≤ 11)
and mated or as age-matched, non-pregnant controls (N = 12). Mice
were housed individually in Promethion cages for behavioral analysis,
in a 12:12-h light:dark cycle (lights on 0700 h, zeitgeber [ZT]0).
RESULTS: Food intake during the dark-phase peaked at ZT13 in preg-
nant and non-pregnant mice; however, by day 12.5 pregnant mice dis-
played an additional peak in food intake at ZT11, advancing the onset
of food intake to a timepoint prior to dark-phase onset. By day 12.5,
the final peak in dark phase food intake was delayed and peaked at
ZT23.5 in pregnant compared to non-pregnant mice (ZT22). The pro-
portion of time spent eating did not differ during the light-phase in
pregnant or control mice; however, pregnant mice spent less time eat-
ing during the dark-phase (10.7% vs. 16.2% of 12 h, P < 0.05). Preg-
nant mice also touched the food-hopper less often during the light
(1.26% vs. 3.11%, P < 0.05) and dark-phase (2.12% vs. 5.38% of 12 h,
P < 0.05).
CONCLUSION: Food intake increases during the light-phase in preg-
nant mice due, in part, to an additional peak in feeding at the end of
the light-phase effectively advancing the onset of dark-phase feeding.
As meal number and time at the food hopper during the light phase
did not change in pregnancy, our data add support that pregnant mice
eat larger meals. These findings provide evidence that circadian timing
and behavior of food intake is altered during pregnancy, and facilitates
increased energy availability for healthy fetal growth.
CONFLICT OF INTEREST: None declared.
P009 | Association of higher serum CTX
levels with low calcium intake among healthy
adolescents in Malaysia
H. Abdul Majid1; M. A. Mustapa Kamal Basha2;
E. G. van den Heuvel3; M. C. Bragt3; Y. Jalaludin4
1
Department of Social & Preventive Medicine, University of Malaya,
Kuala Lumpur, Malaysia; 2Department of Special Care Nursing,
International Islamic University, Kuantan, Malaysia; 3FrieslandCampina,
Amersfoort, Netherlands; 4University of Malaya, Kuala Lumpur, Malaysia
INTRODUCTION: Bone mineral density has been widely used in clini-
cal research, but bone turnover markers, especially serum C-terminal
telopeptide (CTX), are limited. This study investigated the association
between vitamin D status and bone turnover and its associated fac-
tors among adolescents.
MATERIALS AND METHODS: A cross-sectional study was conducted
among 15-year-old adolescents from 15 urban and rural public
1467789x, 2022, S2, Downloaded from https://onlinelibrary.wiley.com/doi/10.1111/obr.13503 by CAPES, Wiley Online Library on [16/12/2023]. See the Terms and Conditions (https://onlinelibrary.wiley.com/terms-and-conditions) on Wiley Online Library for rules of use; OA articles are governed by the applicable Creative Commons License
5 of 222
secondary schools in Selangor, Perak, and Kuala Lumpur, Malaysia.
Subjects were from the Malaysian Health and Adolescents Longitudi-
nal Research Team Cohort study (MyHeARTs). A total of 1234 sub-
jects were recruited. Serum 25(OH)D and biomarker of bone turnover
(C-terminal telopeptide (CTX)) were assessed. The generalized linear
model was used to determine the association between vitamin D sta-
tus on bone turnover and its associated factors.
RESULTS: The prevalence of vitamin D deficiency (25(OH)
D < 50 nmol/L) among the study population was 32%. Females had
higher prevalence of serum vitamin D deficiency and CTX level (mean
± SD) than males (46% vs. 10%; 2.32 ± 0.47 vs. 2.24 ± 0.44). How-
ever, no significant association was observed between serum 25(OH)
D and CTX levels (p value > 0.1) except urban residents (β = 0.176,
p value < 0.01), low calcium intake (β = 0.161, p value < 0.01), avoid-
ance Sun-protective behavior (β = 0.248, p value < 0.01), and out-
door activities (β = 0.112, p value < 0.05).
CONCLUSION: This study showed no significant association between
25(OH)D status and serum CTX level. Urban residents, low calcium
intake, Sun-protection behavior, and outdoor activities were associ-
ated with higher serum CTX levels. Further research is needed to
identify the predictors of CTX levels.
CONFLICT OF INTEREST: None declared.
P010 | Adding essential amino acid-enriched
diet to resistance exercise training improves
exercise performance and body composition
via increases in muscle fat metabolism and
mitochondrial biogenesis in mice
H. Kim1; J. Jang2; S. Park1; J.-H. Koh1; Y. Kim1; Y. Chang1; J. Jung1;
J. Lee1; U.-Y. Yang1; H.-B. Kwak3; R. R. Wolfe4; C. S. Choi1; I.-Y. Kim1
1
Gachon University, Seongnam, Republic of Korea; 2Gil Medical Center,
Incheon, Republic of Korea; 3Inha University, Incheon, Republic of Korea;
4
University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
INTRODUCTION: Dietary essential amino acids (EAAs) and resistance
exercise training (RET) are physiologically effective anabolic stimuli for
inducing net muscle protein synthesis, resulting in muscle mass accre-
tion. Interestingly, our previous study showed that EAA supplementa-
tion enhanced mitochondrial biogenesis in mice. Therefore, we
hypothesized that addition of balanced EAA-enriched diet (ED) to RET
would improve exercise performance and body composition via mus-
cle fat oxidation due in part to mitochondrial biogenesis.
MATERIALS AND METHODS: Mice were randomly allocated to four
groups with normal diet (ND), ND with RET (ladder climbing, 3 times a
week), ED or ED with RET (ED + RET). We determined body compo-
sition (muscle mass and fat mass) and muscle strength after the
14-week intervention. The acute effects of addition of ED to RET on
muscle fat metabolism using stable isotope tracer ([U-13C16]palmitate)
and mass spectrometry and markers of mitochondrial biogenesis were
determined.

6 of 222
RESULTS: Both RET (RET and ED + RET) groups reduced relative
muscle mass and fat mass while improving grip strength and maximal
carrying capacity. Also, both ED (ED and ED + RET) groups enhanced
mitochondrial function as measured by succinate dehydrogenase
activity. In accordance, the stable isotope tracing revealed that acute
ED and ED + RET treatments significantly increased muscle fat
oxidation.
CONCLUSION: These findings suggest that addition of ED to RET
improves exercise performance and body composition, which appears
to be due in part to increased fat oxidation in muscles.
CONFLICT OF INTEREST: None declared.
P011 | Dual pharmacological targeting of
NAD+ biosynthesis and degradation
improves metabolic profile in mice
J. Banks1,2; E. Ding2; A. Samsudeen2; R. Amo-Appiah2; L. Wu2;
L.-E. Quek3; S. Hancock1,2; N. Turner1,2
1
Cellular Bioenergetics, Victor Chang Cardiac Research Institute,
Darlinghurst, New South Wales, Australia; 2Department of
Pharmacology, University of New South Wales, Kensington, New South
Wales, Australia; 3Charles Perkins Centre, The University of Sydney,
Sydney, New South Wales, Australia
INTRODUCTION: Nicotinamide adenine dinucleotide (NAD+) plays a
crucial role as a factor in redox reactions and as the substrate for
NAD+-dependent enzymes, such as sirtuins, that mediate numerous
fundamental cellular processes including energy metabolism, cell sur-
vival, DNA repair, inflammation, circadian rhythms, and lifespan.
NAD+ levels correlate with metabolic health, being lower in metaboli-
cally compromised states, such as aging and obesity, while conversely,
being elevated by metabolically beneficial interventions, including cal-
orie restriction and exercise. To date, various studies have demon-
strated positive metabolic effects of replenishing declining NAD+
levels through the provision of NAD+ precursors such as NMN or NR,
or the inhibition of NAD+-consumers such as CD38. In addition to
+
degrading NAD , CD38 has also been shown to degrade NMN,
compromising its ability to increase NAD+ in vivo. Given the promis-
ing effects of NMN administration alone, we sought to examine the
effects of NMN treatment in combination with the inhibition of CD38
through the use of the compound 78c in mice, to determine if allevi-
ated CD38-mediated breakdown of NMN, would lead to more sub-
stantial increases in tissue NAD+ levels, and greater subsequent
metabolic benefits.
MATERIALS AND METHODS: To initially verify the ability of the
treatments to increase NAD+ acutely, chow-fed C57BL/6 mice
received a single treatment (control; NMN; 78c; NMN + 78c), and
their tissues were rapidly dissected and snap-frozen 2 h later. The
+
levels of NAD and associated metabolites in the liver and skeletal
muscle were measured using mass spectrometry. A second cohort of
mice maintained on a HFD were treated for 8 weeks. Echomri,
1467789x, 2022, S2, Downloaded from https://onlinelibrary.wiley.com/doi/10.1111/obr.13503 by CAPES, Wiley Online Library on [16/12/2023]. See the Terms and Conditions (https://onlinelibrary.wiley.com/terms-and-conditions) on Wiley Online Library for rules of use; OA articles are governed by the applicable Creative Commons License
SUPPLEMENT ARTICLE
indirect calorimetry, glucose tolerance tests, and endurance tests were
performed to assess the metabolic effects of dual treatment.
RESULTS: The combination of NMN + 78c acutely raised NAD+,
NADH, and NR levels across multiple tissues as well as hepatic NMN
levels in mice, more so than NMN or 78c alone. When administered
for 8 weeks in HFD-fed mice, the most significant weight gain attenu-
ation was seen in the combined treatment group, with a more pro-
nounced effect on fat deposition in comparison to either NMN or 78c
alone, relative to HFD controls. The combination of NMN + 78c also
improved insulin sensitivity in these mice (based on an index of insulin
sensitivity).
CONCLUSION: The effects of enhancing NMN treatment with inhibi-
tion of NAD+ precursor breakdown by CD38 show promising thera-
peutic potential for metabolic conditions affecting modern society,
such as obesity and type 2 diabetes.
CONFLICT OF INTEREST: None declared.
P012 | The relevance of dietary sugar intake
and glycemic index for indices of body
fatness and glucose metabolism: A PREVIEW
sub-study
K. Della Corte1; J. Brand-Miller1; A. Raben2; I. MacDonald3; E. Jalo4
1
Charles Perkins Centre, University of Sydney, Sydney, New South Wales,
Australia; 2Department of Nutrition, Exercise and Sports, Faculty of
Science, University of Copenhagen, Copenhagen, Denmark; 3Faculty of
Medicine and Health Sciences, University of Nottingham, Nottingham,
UK; 4Department of Food and Environmental Sciences, University of
Helsinki, Helsinki, Finland
INTRODUCTION: It has been proposed that dietary sugar intake is
linked to type 2 diabetes (T2D) development and overweight. At the
same time, current scientific belief points toward glycemic index
(GI) as being more consistently relevant. Our objective was to examine
the longitudinal associations of dietary glycemic index and dietary
sugar (added, free, and total) with glycemic status and overweight dur-
ing a 3-year weight loss maintenance period in adults at high risk of
type 2 diabetes.
MATERIALS AND METHODS: We pooled data from the PREVention
of diabetes through lifestyle Intervention and population studies in
Europe and around the World (PREVIEW) randomized controlled trial,
which was designed to test the effects of four diet and physical activ-
ity interventions. A total of 658 participants with overweight or obe-
sity (age 25–70 years and BMI ≥ 25 kg
m 2
) and prediabetes at
baseline from Sydney, Helsinki, and Nottingham intervention centers
were included. Multi-adjusted linear mixed models with repeated
measurements were used to assess longitudinal associations for indi-
ces of body fatness (IBF) (body fat, body mass index [BMI], and waist
circumference) and multivariate linear regression for indices of glu-
cose metabolism (IGM) (fasting insulin, HbA1c, fasting glucose, and C-
peptide). Model A adjusted for age and intervention center. Model B

SUPPLEMENT ARTICLE
additionally adjusted for energy intake, protein intake, and saturated
fat intake as well as body fatness for glucose metabolism outcomes.
The intervention centers of Sydney and Helsinki reported on added
sugars and Nottingham reported on free sugars.
RESULTS: GI and added sugar were positively associated with body
fat, BMI, and waist circumference among combined Sydney and Hel-
sinki data (Model B: p < 0.01; n = 403) compared to added sugar
which showed no association. According to Nottingham data, no asso-
ciations were observed between free sugar and IBF (Model B:
p > 0.05; n = 255). Positive associations were observed between GI
and indices of glucose metabolism at Sydney and Helsinki (Model B:
all p < 0.05) and at Nottingham (Model B for fasting insulin and
C-peptide [p < 0.0001]). There were no prospective associations
between added or free sugars and IGM. Total sugar intake was
inversely associated with fasting insulin and C-peptide.
CONCLUSION: The present study confirms that both added sugars
and GI are associated with indices of body fatness. This study pro-
vided strong support for the role of GI as an independent predictor of
glucose metabolism. Contrary to popular belief, added/free sugars
were not associated with indices of glucose metabolism. These find-
ings add to the increasing body of evidence that GI is a key modifiable
risk factor for T2D risk.
CONFLICT OF INTEREST: None declared.
P013 | Effects of obesity on oxidative stress
biomarkers' levels in militaries
1 1 1 1 2 1
M. Sena ; M. Fortes ; S. Rosa ; P. Ferreira ; D. Mello ; A. Silva ;
M. Pereira3
1
Instituto de Pesquisa e Capacitação Física do Exército (IPCFEx), Rio de
Janeiro, Brazil; 2Escola de Educação Física do Exército (EsEFEx), Rio de
Janeiro, Brazil; 3Departamento de Bioquímica, Instituto de Química,
Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro, Brazil
INTRODUCTION: Obesity is a multifactorial disease that reached
alarming proportions all over the world, characterized by excess of
body fatness constituting a risk factor for the development of several
chronic diseases. Individuals diagnosed with obesity present several
factors that contribute to the installation of oxidative stress (OS), such
as hyperglycemia, increased muscle activity, high levels of tissue lipids,
chronic inflammation, and inadequate antioxidant defenses. OS
effects result in impaired redox control and signaling and/or molecular
damage, including the plasma membrane, proteins, and deoxyribonu-
cleic acid (DNA). Recent studies show that even soldiers who have a
more active lifestyle practicing daily physical training are not free from
the problems caused by obesity. So, the aim of this study was to ana-
lyze the effects of obesity on oxidative stress biomarkers levels in
Brazilian Army military.
MATERIALS AND METHODS: The sample was 125 male military
(38.5 ± 2.3 yd.), practitioners of regular physical exercise and classi-
fied according to body mass index (BMI) individuals with obesity
1467789x, 2022, S2, Downloaded from https://onlinelibrary.wiley.com/doi/10.1111/obr.13503 by CAPES, Wiley Online Library on [16/12/2023]. See the Terms and Conditions (https://onlinelibrary.wiley.com/terms-and-conditions) on Wiley Online Library for rules of use; OA articles are governed by the applicable Creative Commons License
7 of 222
(OB n = 23; BMI ≥ 30) and individuals without obesity (NOB
n = 102; BMI < 30). Blood samples were collected with subjects
remaining in a sitting position through the antecubital vein and after
a 12-h fasting for oxidative damage analysis: protein carbonyl (PC),
lipid peroxidation (LP), total sulfhydryl groups (TGS), total antioxidant
activity (TAA), and high-density lipoprotein (HDL-c). An automated
biochemical analyzer BT 3000 by Wierner Lab® Company was used
to determine clinical serological markers. Data normality was con-
firmed by the Shapiro–Wilk test. Therefore, mean and standard
deviation were used for descriptive statistics. Student t test for
independent samples was applied. Data were analyzed by IBM SPSS
Statistics 27 for Windows program. The value of p < 0.05 was
adopted.
RESULTS: Significant differences were observed at PC (OB: 80.2
± 39.7 and NOB: 62.2 ± 39.3; p = 0.049), PL (OB: 6.9 ± 1.6 and NOB:
5.8 ± 1.5; p = 0.002), and TGS (OB: 377.6 ± 107.2 and NOB: 323.3
± 111.8; p = 0.036). Nonetheless, it was not observed any significant
difference in the analysis of TAA (OB: 61.3 ± 5.5 and NOB: 61.8
± 6.0; p = 0.715) and HDL-c (OB: 58.4 ± 34, 1 and NOB: 62.6 ± 35.6;
p = 0.608) between groups.
CONCLUSION: Individuals diagnosed with obesity presented higher
levels of OS parameters (PC, PL, and TAA), implicating the quality of
health and life.
CONFLICT OF INTEREST: None declared.
P015 | Factors associated with higher body
mass index among postpartum mothers with
preterm infants in Malaysia: A cross-sectional
study
N. F. S. Yahya; N. I. Mohd Fahmi Teng
Faculty of Health Science, Universiti Teknologi MARA, Selangor, Malaysia
INTRODUCTION: Mothers who are affected by overweight and obe-
sity during reproductive age may predispose to several non-
communicable diseases. This study determines the factors associated
with higher body mass index (BMI) among mothers with preterm
infants in Malaysia.
MATERIALS AND METHODS: A cross-sectional study was conducted
among 308 postpartum mothers with preterm infants, recruited from
selected government hospitals with Neonatal Intensive Care Unit
(NICU) in Selangor, Malaysia, via purposive sampling. A demographic
and obstetric factors questionnaire, anthropometric measurement,
and a validated Malay version of Edinburgh Postnatal Depression
Scale (EPDS) were administered.
RESULTS: Results showed that most of the postpartum mothers
(73.4%) have higher body mass index (BMI) (overweight/obese) com-
pared to mothers with lower BMI (underweight/normal) (26.6%).
Among the mothers who were screened positive for depression
(22.7%), 71.4% of them were among the higher BMI group, while
28.6% were from the lower BMI group. However, the results indicate
 1467789x, 2022, S2, Downloaded from https://onlinelibrary.wiley.com/doi/10.1111/obr.13503 by CAPES, Wiley Online Library on [16/12/2023]. See the Terms and Conditions (https://onlinelibrary.wiley.com/terms-and-conditions) on Wiley Online Library for rules of use; OA articles are governed by the applicable Creative Commons License
8 of 222 SUPPLEMENT ARTICLE

that there is no significant association between depression and
higher BMI group (p = 0.837). A few obstetric factors such as
mothers with more than one child (aOR 2.62, 95% CI 1.38–4.98),
mothers who have extremely preterm infants (aOR 5.04, 95% CI
1.11–22.85), and mothers who undergo cesarean for the mode of
delivery (aOR 3.34, 95% CI 1.61–6.92) remained strongly associated
with higher BMI.
Factors associated with higher body mass index (BMI):
P016 | The effects of fasted versus
postprandial high-intensity exercise on
glycemic responses in men with excess
weight
N. M. Farah1; N. S. Kamarul Hisham2
1
Faculty of Health Sciences, Universiti Kebangsaan Malaysia, Kuala
Lumpur, Malaysia; 2School of Health Sciences, Universiti Sains Malaysia,
Kelantan, Malaysia

Adjusted INTRODUCTION: Evidence suggests that light-to-moderate intensity

Variables OR 95% CI p value
exercise performed 20–30 min after meal is more effective in lower-
Parity ing postprandial glycemic responses, compared to exercise before
Primiparous 1.00 meal. However, the effects of high-intensity interval exercise (HIIE) on
Multiparous 2.62 1.38–4.98 0.003* postprandial glycemia in relation to meal timings, especially in individ-
Weeks of birth (weeks) uals with overweight or obesity are unclear. The purpose of this study
<28 (Extremely Preterm) 5.04 1.11– 0.036* was to investigate the effects of HIIE performed fasted or after meal
22.85 on postprandial glucose and insulin responses in males who were
28–<32 (Very Preterm) 0.97 0.39–2.43 0.954 overweight.
32–<34 (Moderate 2.10 0.82–5.38 0.121 MATERIALS AND METHODS: Twelve, inactive and apparently
Preterm) healthy males (mean age: 25.3 ± 3.5 years, mean BMI: 26.5 ± 2.2 kg/
34–<37 (Late Preterm) 1.00 m2) completed three experimental conditions in random order: fasted
Type of child delivery exercise 30 min before meal (FE), exercise 30 min post-meal (ME), and
Normal 1.0 no-exercise control, separated by 7 days. Subjects consumed a stan-
Caesarian 3.34 1.61–6.92 0.001** dardized, carbohydrate-rich meal consisting of 800 kcal (50% carbo-

Infant's birth weight hydrate, 36% fat, 14% protein) in all conditions. The exercise was a
20 min, high-intensity interval protocol, comprised of 10 bodyweight
<1000 g 0.83 0.20–3.31 0.787
exercises, each performed for 30 s with 30-s rest intervals, in two
1000–1499 g 0.27 0.09–0.84 0.024*
sets. Exercise intensity was set at 85% HRmax. Blood glucose and
1500–2499 g 0.60 0.27–1.35 0.216
insulin was measured at baseline, and 30, 60, 120, 180, and 240 min
2500–4000 g 1.00
after meal consumption. Postprandial glucose and insulin responses
* Indicates p<0.05, ** indicates p<0.001 were analyzed using repeated two-way RM-ANOVA and were also
calculated as total area under curve (AUC240min).
CONCLUSION: In conclusion, understanding factors linked to higher RESULTS: Results showed that there was a significant main effect of
BMI in postpartum mothers will help health professionals as well as time (p < 0.001) and time  condition interaction (p < 0.001) for post-
decision-makers to develop an effective strategy such as nutrition prandial glucose responses but was not for main effect of condition.
intervention and weight management programs to combat obesity. Similarly, postprandial insulin responses were not different between
CONFLICT OF INTEREST: None declared. conditions but showed a significant main effect of time (p < 0.001)
and time  condition effect (p < 0.05). There were modest decreases
in the cumulative postprandial glucose ( 4.1%) and insulin ( 3.6%%)
AUC with fasted exercise relative to control; however, these differ-
ences were not significant. No differences were also observed
between exercise conditions.
CONCLUSION: The findings demonstrated that neither fasted (before
meal) or postprandial (after meal) high-intensity interval exercise had a
lowering effect on glycemic responses in young males with over-
weight. This finding suggests two possibilities with regards to high-
intensity exercise in the regulation of postprandial glycemia: delayed
hypoglycemic effects or impaired glucoregulation during exercise. Fur-
ther studies are warranted to establish the efficacy of HIIE in improv-
ing blood glucose control in population with excess weight.
CONFLICT OF INTEREST: None declared.

SUPPLEMENT ARTICLE
P017 | Effectiveness of preoperative dietary
interventions to induce weight loss prior to
elective non-bariatric major abdominal
surgery: A systematic literature review
S. Griffin1; M. Palmer2; E. Strodl3; R. Lai2; M. Burstow4; L. Ross1
1
Exercise and Nutrition Sciences, Queensland University of Technology,
Brisbane, Queensland, Australia; 2Nutrition & Dietetics, Logan Hospital,
Meadowbrook, Queensland, Australia; 3School of Psychology, Queensland
University of Technology, Brisbane, Queensland, Australia; 4Division of
Surgery, Logan Hospital, Brisbane, Queensland, Australia
INTRODUCTION: Obesity, excess visceral fat, and high liver volume
due to hepatosteatosis (fatty liver) are risk factors for complications
arising from major surgical procedures within the abdomen. In con-
trast to bariatric (weight loss) surgery, research on preoperative die-
tary interventions to induce weight loss for non-bariatric surgery
patients with obesity is scarce, with a lack of consensus for the best
approach. This review examined the outcomes of preoperative dietary
approaches aimed at reducing weight prior to major non-bariatric
abdominal surgery in adults with obesity.
MATERIALS AND METHODS: PRISMA guidelines were followed, and
four electronic databases (MEDLINE, CINAHL, Embase, Cochrane Tri-
als) were searched for interventional studies (with or without a control
group) that evaluated efficacy of dietary interventions used preopera-
tively for the purpose of reducing excess weight/fat in preparation
for major (invasive) elective surgical procedures within the abdomen
in adults with obesity. Articles with bariatric surgery focus or interven-
tions using pharmacotherapy/exercise only were excluded. Data
extracted included: characteristics of the studies, participants and
surgery, and outcomes of dietary adherence and anthropometric
measures.
RESULTS: Ten studies, including five randomized controlled trials
(RCTs), were eligible. In total, 764 participants (53 ± 11 years, 61%
female, body mass index 33.5 ± 6.9) were awaiting liver resection/
transplant (n = 3 studies), hernia repair (n = 3 studies), laparoscopic
cholecystectomy (n = 2 studies), gastrectomy (n = 1 study), or a com-
bination of these procedures (n = 1 study). Preoperative diet duration
ranged from 1–68 weeks (median 5 weeks). Seven studies used a very
low calorie diet (VLCD, ≤800 kcal/day, n = 6 meal replacement
shakes, n = 1 food-based). Two studies used a low calorie diet (LCD,
≤900 kcal/day, n = 1 meal replacement shakes, n = 1 food-based),
and one used general healthy eating. Surgical procedures that were in
proximity to the liver (n = 6) used VLCD/LCDs of 1–3 weeks dura-
tion, primarily to reduce fatty liver. Mean weight loss across all studies
was 7.5 ± 8 kg (range 1.4–24 kg), with waist circumference loss of
4.5 ± 1.7 cm. VLCDs (n = 7 studies, n = 347 participants) elicited a
mean weight loss of 7.7 ± 9.3 kg over a median of 3 weeks (range 1–
68 weeks).
CONCLUSION: The review demonstrated significant weight loss is
achievable using VLCDs/LCDs prior to major elective abdominal
1467789x, 2022, S2, Downloaded from https://onlinelibrary.wiley.com/doi/10.1111/obr.13503 by CAPES, Wiley Online Library on [16/12/2023]. See the Terms and Conditions (https://onlinelibrary.wiley.com/terms-and-conditions) on Wiley Online Library for rules of use; OA articles are governed by the applicable Creative Commons License
9 of 222
surgery for adults with obesity. Future RCTs should explore the
impact of these interventions on postoperative outcomes.
CONFLICT OF INTEREST: None declared.
P018 | The effects of whole-body muscle
stimulation concurrent with aerobic exercise
on body composition in women with
overweight: A randomized controlled trial
S. Ghannadi1; Z. Alizadeh2; F. Halabchi2; Z. Tavakol2; F. Maleklou2;
M. Rajabian Tabesh2; D. Bala3
1
Obesity and Eating Habits Research Center, Endocrinology and
Metabolism Clinical Sciences Institute, Tehran University of Medical
Sciences, Tehran, Islamic Republic of Iran; 2Sports Medicine Research
Center, Neuroscience Institute, Tehran University of Medical Sciences,
Tehran, Islamic Republic of Iran; 3University Hospitals of Leicester NHS
Trust, Leicester, UK
INTRODUCTION: Aerobic exercise has been shown to have positive
effects on improving body composition but has not been studied in
combination with muscle stimulation, which it claims is a new method
of weight loss. Therefore, this study aimed to determine the effect of
aerobic exercise concurrent with EMS compared to aerobic exercise
alone on body composition.
MATERIALS AND METHODS: A randomized clinical trial was con-
ducted on women with Body Mass Index (BMI) between 25–
2
29.9 kg m who were assigned to one of two groups: moderate-
intensity aerobic exercise (3 days/week) plus Whole-Body Electrical
Muscle Stimulation (WB-EMS) (2 days/week) and moderate-intensity
aerobic exercise (3 days/week). WB-EMS was conducted with inter-
mittent stimulation (6-s WB-EMS, 4-s rest; 85 Hz, 350 ms) over
20 min. The primary outcome measures were weight, body fat mass,
percent body fat (PBF), and lean body mass (LBM) based on bioimpe-
dance (BIA). Secondary outcome measures were waist and hip circum-
ferences, and abdominal and suprailiac skinfold. All measurements
were assessed at baseline and after 6 weeks of trial.
RESULTS: We recruited 44 women (age 32 ± 4.3 years; BMI 27.4
2
± 1.8 kg m ). Both groups showed positive effects on weight, body
composition parameters, and reduction in waist and hip circumfer-
ences without statistical differences between groups (p > 0.05).
Skinfold decreased in abdominal and suprailiac points in both groups
(p = 0.000), with a significant between-group difference for abdomi-
nal skinfold (p = 0.04).
CONCLUSION: Whole-body electrical muscle stimulation concurrent
with aerobic exercise just only reduced the skinfold in the abdominal
area and did not make any other improvement in body composition
and weight loss compared with the aerobic exercise group.
CONFLICT OF INTEREST: None declared.

10 of 222
P019 | A school- and home-based
intervention program to promote physical
activity and reduce and break up sedentary
behavior: Impacts on children's movement
behavior accumulation patterns and adiposity
markers
S. J. J. M. Verswijveren1; N. Ridgers2; J. Martín-Fernández3;
S. Chastin4; E. Cerin5; M. Chinapaw6; L. Arundell1; D. Dunstan7;
C. Hume8; H. Brown1; J. Della Gatta1; J. Salmon1
1
Institute for Physical Activity and Nutrition, Deakin University, Geelong,
Victoria, Australia; 2Alliance for Research in Exercise, Nutrition and
Activity, University of South Australia, Adelaide, South Australia,
3
Australia; Department of Computer Science, Applied Mathematics and
Statistics, Girona, Spain; 4School of Health and Life Sciences, Glasgow
Caledonian University, Glasgow, UK; 5Mary McKillop Institute for Health
Research, Australian Catholic University, Melbourne, Victoria, Australia;
6
Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam,
7
Netherlands; Baker Heart and Diabetes Institute, Melbourne, Victoria,
Australia; 8School of Public Health, University of Adelaide, Adelaide,
South Australia, Australia
INTRODUCTION: It is unknown if children's movement behavior
accumulation patterns change as a result of physical activity and/or
sedentary behavior interventions, and whether this impacts adiposity.
If changing movement behavior patterns has the potential to benefit
health, it may impact how interventions are designed. The aim was to
investigate the effect of the Transform-Us! intervention on children's
movement behavior accumulation patterns and adiposity.
MATERIALS AND METHODS: Accelerometer and adiposity marker
(zBMI and waist circumference) data, collected at baseline and
18-months post-intervention from the Transform-Us! 2  2 factorial
design cluster-randomized controlled trial was analyzed. Participants
were based in Melbourne and aged 8–9 years at baseline (n = 267).
Linear mixed models were fitted to examine effects of three interven-
tions that targeted either physical activity [PA-I], sedentary time [SB-
I], or both [PA + SB-I] compared to a usual practice group on post-
intervention waking movement behavior compositions. Compositions
included eight components: Sporadic and bouts of sedentary time,
light-, moderate-, and vigorous-intensity physical activity. Additional
models assessed associations with adiposity markers at 18 months.
RESULTS: Intervention effects on movement behavior accumulation
composition were small and not significant. However, inspection of
the change in compositions over time revealed that only groups with
a sedentary behavior intervention component (SB-I and PA + SB-I)
reduced time in sedentary bouts, compared to the overall sample. In
addition, only the SB-I group increased in vigorous-intensity physical
activity. The PA + SB-I had the largest proportional increase in
moderate-intensity physical activity bouts. The usual practice group
had the largest proportional increases in both sporadic and bouts of
1467789x, 2022, S2, Downloaded from https://onlinelibrary.wiley.com/doi/10.1111/obr.13503 by CAPES, Wiley Online Library on [16/12/2023]. See the Terms and Conditions (https://onlinelibrary.wiley.com/terms-and-conditions) on Wiley Online Library for rules of use; OA articles are governed by the applicable Creative Commons License
SUPPLEMENT ARTICLE
sedentary time. The intervention groups were not statistically signifi-
cant predictors of adiposity markers.
CONCLUSION: This study showed some early evidence to suggest
that the “break up your sitting” message may result in greater impact
than the “move more” message. However, there was no evidence to
suggest effects on adiposity markers. Future research, using advanced
adiposity measurements, should investigate if this type of messaging
is indeed more effective in changing movement behaviors and
benefitting health.
CONFLICT OF INTEREST: None declared.
P020 | Does the prevalence of overweight/
obesity, physical activity, and sitting time
differ by CALD background? A secondary
analysis of the Australian Longitudinal Study
on Women's Health
S. Paudel1; G. D. Mishra2; J. Veitch1; K. D. Hesketh1
1
Deakin University, Melbourne, Victoria, Australia; 2University of
Queensland, Brisbane, Queensland, Australia
INTRODUCTION: Previous studies have suggested that culturally and
linguistically diverse (CALD) communities in Australia have a higher
prevalence of poor health behaviors. However, precise estimates for
health risk factors such as physical activity (PA), sitting time, and obe-
sity are limited. This study examined the association of CALD back-
ground with PA, sitting time, and overweight/obesity.
MATERIALS AND METHODS: We used self-reported PA, sitting time,
and height and weight data from Survey 8 (2018) of the 1973–1978
cohort of the Australian Longitudinal Study on Women's Health. We
defined CALD as being born in a non-English speaking country or pri-
marily speaking a language other than English (European, Asian, or
others) at home. Multivariable-adjusted logistic and linear regression
analyses were used to examine the association of CALD background
with PA (min/week, meeting guidelines of ≥150 min/week, participa-
tion in organized sport), sitting time (min/week), and overweight/
obesity (BMI ≥ 25 kg/m2).
RESULTS: We analyzed data from 5629 participants (mean age 42.4
[1.5] years; 6.9% of CALD background). There were some differences
in the sociodemographic characteristics between CALD and non-
CALD groups, such as for university degree (66.5% CALD vs. 57.9%
non-CALD, p < 0.001). Participants of CALD background were 23%
(odds ratio (OR): 0.77 (95% CI: 0.62–0.96)) less likely to meet PA
guidelines than those with a non-CALD background (prevalence:
54.4% vs. 57.1% meeting guidelines) after adjusting sociodemographic
covariates. CALD participants were 0.66 (95% CI: [0.52–0.83]) times
less likely to participate in organized sports in the last 12 months than
non-CALD participants (prevalence: 27.1% vs. 34.1%). We did not find
evidence of an association of CALD background with weekly minutes
of PA (p = 0.171) or sitting time (p = 0.135). After adjusting sociode-
mographic and lifestyle factors, we found an inverse association

SUPPLEMENT ARTICLE
between CALD background and overweight/obesity (OR: 0.78 [0.62–
0.97]; prevalence: 51.5% in CALD vs. 59.3% in non-CALD).
CONCLUSION: Disparities existed in organized sports participation
and meeting PA guidelines between CALD and non-CALD women.
Increased efforts and investments are needed to ensure sports and
other PA promotion interventions are culturally sensitive, inclusive,
and engaging for CALD women. Future studies with a larger and more
diverse representation of CALD communities and population-specific
BMI thresholds (e.g., Asian BMI cut-offs) are recommended to estab-
lish the relationship between CALD background and overweight/
obesity.
CONFLICT OF INTEREST: None declared.
P021 | Dietary patterns and young adult body
mass change: A 9-year longitudinal study
T. W. Ushula
School of Public Health, The University of Queensland, Australia,
Brisbane, Queensland, Australia
INTRODUCTION: Young adulthood is a stage of life course character-
ized by excessive weight gain and subsequent increases in obesity
rates. However, whether dietary patterns are associated with longitu-
dinal changes in measures of body weight over the course of young
adulthood remains unknown. We examined the associations of dietary
patterns in early young adulthood with changes in body weight and
body mass index (BMI) over this course of life.
MATERIALS AND METHODS: We used data of young adults from a
long running birth cohort in Australia. Western and prudent dietary
patterns were identified applying principal component analysis to
33 food groups obtained by a food frequency questionnaire at
21-years. Body weight and height were measured at 21 and 30 years.
BMI was calculated as weight in kilograms divided by squared height
in meters at both points. Multivariable regression models, using gener-
alized estimating equations, were adjusted for concurrent changes in
socio-demographic and lifestyle variables.
RESULTS: In the fully adjusted model, young adults in the highest
tertile of the Western pattern had a mean weigh gain of 9.9 (95%
CI: 8.5, 11.3) kg compared to those in the lowest that had a mean
weight gain of 7.1 (95% CI: 5.6, 8.5) kg, with P-for linear tren-
d = 0.0015. The corresponding values for mean gains in BMI were
3.1 (95% CI: 2.7, 3.6) kg/m2 for young adults in the highest tertile
compared to 2.4 (95% CI: 1.9, 2.9) kg/m2 for those in lowest, with
P-for linear trend = 0.0164. There was no evidence of significant
association between adhering to the prudent pattern and mean
changes in body weight and BMI over time in this longitudinal
study of young adults.
CONCLUSION: In conclusion, findings of the current study show that
the Western diet had an adverse effect of increasing body weight and
BMI in young adults, whereas the prudent diet had no significant
effect on each outcome. Our results provide evidence that increased
1467789x, 2022, S2, Downloaded from https://onlinelibrary.wiley.com/doi/10.1111/obr.13503 by CAPES, Wiley Online Library on [16/12/2023]. See the Terms and Conditions (https://onlinelibrary.wiley.com/terms-and-conditions) on Wiley Online Library for rules of use; OA articles are governed by the applicable Creative Commons License
11 of 222
consumption of red meat, processed meat, refined grains and pro-
cessed foods forming the Western diets, in early young adulthood,
may play a key role in promoting excessive weight gain observed dur-
ing the course of young adulthood.
CONFLICT OF INTEREST: None declared.
P022 | Sucrose-induced fatty liver in PPARα
knockout mice
T. Yamazaki; M. Ihato
Department of Nutrition and Metabolism, National Institute of Health
and Nutrition, Tokyo, Japan
INTRODUCTION: The prevalence of obesity has increased dramati-
cally in Western societies due to excessive consumption of high-fat
and high-sucrose diets. An important consequence of obesity is
hepatic steatosis and nonalcoholic fatty liver disease. Nonalcoholic
fatty liver disease is characterized by fatty liver observed in patients
who consume little or no alcohol. Prevention or amelioration of fatty
liver development is critical because fatty liver is a precursor to the
more advanced liver disease, nonalcoholic steatohepatitis, which can
progress to cirrhosis. We fed sucrose to PPARα knockout mice and
compared fatty liver development to wild-type mice to demonstrate
the importance of fatty acid β-oxidation in the liver during sucrose
consumption.
MATERIALS AND METHODS: Studies were performed on 6-month-
old female and male littermate control and PPARα knockout mice ini-
tially housed under standard conditions with full access to standard
mouse chow and water. After this time, mice were switched to a high-
sucrose diet or control diet for 4 weeks. All mice had free access to
food and water ad libitum. Animals were housed in a temperature-
controlled environment with a 12-h dark–light cycle. At the end of
the 4-week period, mice were euthanized and tissues were immedi-
ately dissected, weighed, and frozen in liquid nitrogen. All animal pro-
cedures were in accordance with institutional guidelines. Lipids in the
liver were extracted quantitatively with an ice-cold mixture of chloro-
form and methanol (2:1, v/v). Total TG concentrations in the liver
homogenates were measured by enzymatic colorimetric methods.
RNA was extracted from the tissues and total RNA was reverse tran-
scribed. Quantitative real-time PCR was performed using gene-
specific primers.
RESULTS: We found that PPARα knockout mice accumulated more
fat in the liver when fed sucrose compared to wild-type mice. The
real-time PCR results suggested that this was due to the fact that
fatty acid β-oxidation does not proceed very well in the liver.
CONCLUSION: In the liver, PPARα has very important roles in fatty
acid β-oxidation during sucrose consumption.
CONFLICT OF INTEREST: None declared.

12 of 222
P023 | Body weight status among adults
during COVID-19 pandemic: Malaysia
experience
Y. S. Chin1; P. Y. Lim2; M. Appukutty3; N. B. Md Yusop4;
Z. Y. Wong1; R. Loganathan5; K. T. Teng5; K. R. Selvaduray5;
Y. M. Chan4
1 2
Department of Nutrition; Department of Community Health, Universiti
Putra Malaysia, Serdang, Malaysia; 3Universiti Teknologi MARA, Shah
Alam, Malaysia; 4Department of Dietetics, Universiti Putra Malaysia,
5
Serdang, Malaysia; Product Development and Advisory Services Division,
Malaysian Palm Oil Board, Bandar Baru Bangi, Malaysia
INTRODUCTION: Overweight or obese is worsened accompanying
COVID-19 pandemic, with the curtail of community or national
weight loss health promotion interventions. Information on the impact
of COVID-19 pandemic on body weight status and its associated fac-
tors among Malaysian adults is scarce. Thus, this study was conducted
to close the above research gap.
MATERIALS AND METHODS: An online nationwide cross-sectional
study was performed, and information on socio-demographic back-
ground, physical activity level, sleep quality, stress level, dietary pat-
tern, and anthropometric measurements were obtained.
RESULTS: A total of 1187 eligible adults with a mean age of 33
± 10 years old participated. Slightly more than one-third were either
overweight or obese. There was a non-significant increase of mean
body mass index during pandemic compared to before COVID-19
(t = 1.778, p = 0.076). Physical inactivity was prevalent with less than
10% achieved the physical activity recommendation. Adherence to
healthy eating concept was low while meals skipping was common in
this cohort with 35.0%, 22.0%, and 27.3% skipped breakfast, lunch,
and dinner at least once or more times per week, respectively. Stir-fry,
deep-fry, and steam were the most common cooking methods, while
palm oil, olive oil, and sunflower oil were the most frequent cooking
oils used in meal preparation. Sleep latency and short sleep duration
were evident among the respondents coupling with more than two-
thirds of them perceived moderate stress. Aged
39 (χ = 107.96, p < 0.001), female (χ = 35.95, p < 0.001), tertiary
2 2
education (χ 2 = 37.87, p < 0.001), higher family monthly income
(χ 2 = 16.69, p = 0.010), sedentary (χ 2 = 24.36, p = 0.004), shorter
sleep duration (χ 2 = 28.41, p = 0.001), low stress level (χ 2 = 15.98,
p = 0.014), consuming non-homecooked foods and drinks (χ = 8.70, 2
p = 0.034) or from western fast food restaurants (χ 2 = 13.19,
p = 0.004), and skipping lunch (χ 2 = 10.11, p = 0.018) were signifi-
cantly associated with overweight and obesity. Steaming (χ 2 = 21.03,
p = 0.002), used of sunflower oil (χ = 14.43, p = 0.002), palm oil
2
(χ 2 = 23.57, p < 0.001), sesame or gingerly oil (χ 2 = 7.91, p = 0.048),
blended cooking oil (χ 2 = 8.15, p = 0.043) were significantly associ-
ated with a healthier body weight status while reusing cooking oil
(χ = 8.15, p = 0.043) and its frequency (χ = 13.02, p = 0.043) were
2 2
significantly associated with overweight and obesity.
1467789x, 2022, S2, Downloaded from https://onlinelibrary.wiley.com/doi/10.1111/obr.13503 by CAPES, Wiley Online Library on [16/12/2023]. See the Terms and Conditions (https://onlinelibrary.wiley.com/terms-and-conditions) on Wiley Online Library for rules of use; OA articles are governed by the applicable Creative Commons License
SUPPLEMENT ARTICLE
CONCLUSION: Recognizing the impacts of obesity on health status
and quality of life among adults, appropriate intervention is warranted
to minimize such possible impacts among Malaysians.
CONFLICT OF INTEREST: None declared.
P024 | Normal and overweight males showed
similar physiological responses to graded
exercise tests in normobaric hypoxia
Z. Wang1,2; J. Li2; Y. Li3; H. T. Tin2; J. Kuang2; D. J. Bishop2;
X. Yan2,4,5; L. Peng1
1
College of Physical Education, Southwest University, Chongqin, China;
2
Institute for Health and Sport, Victoria University, Melbourne, Victoria,
Australia; 3China Institute of Sport and Health Science, Beijing Sport
University, Beijing, China; 4Sarcopenia Research Program, Australia
Institute for Musculoskeletal Sciences (AIMSS), Melbourne, Victoria,
Australia; 5Department of Medicine-Western Health, The University of
Melbourne, Melbourne, Victoria, Australia
INTRODUCTION: It is known that hypoxia (normobaric or hypobaric)
results in a decrease in peak power output (PPO), peak oxygen uptake
(VO2peak), and other physiological parameters. However, it is
unknown whether these changes are BMI dependent. The aim of this
study was to compare the response of PPO, VO2peak, peak heart rate
(HRpeak), and blood lactate threshold (LT) to acute exercises in hyp-
oxia, between males with BMI less than 25 (normal BMI) and those
with BMI above 25 (overweight). High-intensity interval exercise
(HIIE) sessions were then prescribed to the participants in normoxia
and hypoxia.
MATERIALS AND METHODS: Eleven males with normal BMI
(BMI = 22.6 ± 2.0) and 8 males with overweight (BMI = 26.2 ± 1.0)
participated in this study. Participants completed two graded exercise
tests (GXTs) under normoxia (FiO2 = 0.209) and two GXTs under nor-
mobaric hypoxia (FiO2 = 0.140). A subset of participants (6 normal
BMI and 4 overweight) then completed three HIIE sessions, including
30 to one at hypoxia (HY) and two at normoxia (one matched for the abso-
lute intensity in hypoxia, designated as NA, and one matched for the
relative intensity in hypoxia, designated as NR).
RESULTS: There was significant lower VO2peak (by 20.9 ± 8.8% and
17.9 ± 7.1%), HRpeak (by 3.9 ± 1.8% and 4.1 ± 4.1%), PPO (by 8.4
± 2.7% and 9.6 ± 3.6%), and LT (by 12.9 ± 2.7% and 13.1 ± 3.8%)
derived from GXTs in hypoxia when compared with those in nor-
moxia, for males with normal BMI and overweight, respectively. How-
ever, there was no difference between the two groups. Interestingly,
the ratio of blood lactate level immediately after HIIE in hypoxia to
the corresponding baseline blood lactate level showed a tendency to
be lower in males with overweight (11.5 ± 3.2 and 8.0 ± 1.7,
p = 0.08), while the ratio of blood lactate level immediately after HIIE
in NR to the peak blood lactate level from the GXTs showed a ten-
dency to be lower in males with overweight (130.1 ± 17.3% and
100.2 ± 31.9%, p = 0.09).

SUPPLEMENT ARTICLE
CONCLUSION: Males with different BMI showed similar physiological
response to GXTs in hypoxia when compared to those in normoxia;
however, there was a trend for a different blood lactate response to a
single session of HIIE between males with normal weight and over-
weight. More participants are being tested to confirm the current
findings.
CONFLICT OF INTEREST: None declared.
P025 | A possible pattern of patients'
compliance in following weight-loss
treatment in weight management clinics: The
result of an observational study
Z. Jafarzadeh1; M. Nematy1; M. Dadgar Moghadam2; M. Safarian1;
A. Rahimi1; B. Barkhidarian1; A. Norouzy1
1
Nutrition; 2Community Medicine, Mashhad University of Medical
Sciences (MUMS), Mashhad, Islamic Republic of Iran
INTRODUCTION: The rate of obesity in Iran is on a growing trend,
yet little is known about the factors associated with weight loss; thus,
investigating the efficacy of weight loss programs seems necessary.
This study aimed to evaluate weight loss in terms of percentage of
weight loss success and to determine the rate of nutrition appoint-
ment attendance.
MATERIALS AND METHODS: This cross-sectional study was per-
formed in 1100 patients with overweight or obesity, aged 16–
65 years, who sought treatment in our nutrition clinic and met the
inclusion criteria. Odds ratios (ORs) and 95% confidence intervals (CIs)
for achieving 5% more significant weight loss by 6 months were calcu-
lated. For data analysis, SPSS version 22 was used.
RESULTS: Non-attendance rate upon referral was 58%. Fifty-four per-
cent (281) successfully lost 5% or more significant within 6 months of
the attending group. The successful and unsuccessful groups did not
differ significantly in any baseline characteristics (P < 0.05). At month
one, female participants whose average weight loss was ≥2 kg/month
were twice as likely to achieve 5% weight loss or greater by 6 months
than those who did not (OR = 2.7; 95% CI: 2.05–3.57). The regression
model indicated that the frequency of attendance (OR = 2.1)
and weight loss at months one and two was similar predictive
(ORs = 2.7–2).
CONCLUSION: In 54% of the cases during 6 months, successful
weight loss was observed, and weight loss progress at months one
and two of the treatment predicted weight loss outcomes.
CONFLICT OF INTEREST: None declared.
1467789x, 2022, S2, Downloaded from https://onlinelibrary.wiley.com/doi/10.1111/obr.13503 by CAPES, Wiley Online Library on [16/12/2023]. See the Terms and Conditions (https://onlinelibrary.wiley.com/terms-and-conditions) on Wiley Online Library for rules of use; OA articles are governed by the applicable Creative Commons License
13 of 222
P026 | Prevalence of obesity among patients
undergoing cardiac surgeries and its
association with length of ICU stay in a
tertiary care setting in Sri Lanka
A. Wickramaratne1; D. Senawiratne2
1
Nutrition; 2Surgery, National Hospital of Sri Lanka, Colombo, Sri Lanka
INTRODUCTION: Obesity is considered as an epidemic and an
emerging problem in Sri Lanka. The prevalence of overweight and
obesity in Sri Lanka is 25.2% and 9.2%, respectively. Obesity is
considered as a major modifiable risk factor for cardiovascular
disease.
MATERIALS AND METHODS: The study was carried out at National
Hospital of Sri Lanka as a retrospective cross-sectional study. Data on
all cardiac surgeries done on 2017 were collected using registers.
Patients below 18 years, pregnant women, minor, or emergency car-
diac surgeries and inadequate data were excluded from the study.
Nutritional status was categorized according to body mass index
(BMI) using Sri Lankan cutoff values.
RESULTS: The sample consisted of 589 patients with a mean age of
54.6 years (2SD ± 24 years). The 64.2% (378) were males, and 35.8%
(211) were females. Mean BMI was 23.7 (±8.52).
Prevalence of obesity was 36.6%. Prevalence of overweight, nor-
mal BMI, and underweight were 18.4%, 32.3%, and 12.7%
respectively.
Duration of ICU stay showed a positive skewness with a median
of 3 days. Gender has no significant impact on BMI or Length of ICU
stay (P > 0.05).
There was a significant difference in length of ICU stay between
BMI groups (p < 0.05). Post hoc analysis and pairwise comparison
showed a significant difference between malnourished group and nor-
mal BMI group. There was no significant difference in length of ICU
stay between any other groups at alpha level of 0.05.
CONCLUSION: Obesity and overweight are more prevalent than
underweight in a major cardiac surgical setup. However, pre-op obe-
sity or overweight was not associated with longer post-operative ICU
duration in cardiac surgeries.
CONFLICT OF INTEREST: None declared.

14 of 222
P027 | Profile of patients presenting for
treatment Bariatric Nurse Practitioner
services
C. Smith1; C. O'Donnell2
1 2
WHY Clinic, Queensland, Brendale, Australia; My Weight Loss Clinic,
Brisbane, Queensland, Australia
INTRODUCTION: In Australia approximately 68% of the population
have a body mass index (BMI) that places them outside of what is rec-
ognized as the health range and potentially needing treatment for the
disease of obesity. The disease of obesity is recognized internationally
as a chronic disease impacting significantly on both the morbidity and
mortality health outcomes of Australians. This paper describes a qual-
ity project completed across four Nurse Practitioner Bariatric clinics,
assessing several points of interest in a client group seeking weight
loss services. The four clinics use both face to face and telehealth ser-
vices. This work casts light on the issues facing Australians seeking
weight loss services and some of the key variables they present with
to Nurse Practitioner Bariatric services.
MATERIALS AND METHODS: This paper describes the clinical pre-
sentations of the client group in four Nurse Practitioner weight loss
services between October to December 2021. A retrospective digital
audit was undertaken with variables of interest identified including
age, gender, BMI, “Sick Fat” complications, “Mass Fat” complications.
and the Emdondson Obesity Staging Score (EOSS) of each patient.
RESULTS: Data revealed that the presentation BMI average was well
within the optimum treatment as per guidelines for medical weight
loss. The numbers of “Sick Fat” presentations was lower than often
discussed in patients with obesity. Pain was a significant “Mass Fat”
complication for this client groups. The EOSS results were within the
range expected for these services.
CONCLUSION: The results of the audit provide valuable data in this
area of practice and should be considered for future research. Diabe-
tes and pre-diabetes are often strongly linked in discussions about
patients with obesity but are poorly represented in this audit data.
While these patients' perception of pain presents an opportunity for
further research. Management of the disease of obesity is an impor-
tant part of practice for all Nurse Practitioners and clinical audits assist
in the evaluations of the services.
CONFLICT OF INTEREST: None declared.
1467789x, 2022, S2, Downloaded from https://onlinelibrary.wiley.com/doi/10.1111/obr.13503 by CAPES, Wiley Online Library on [16/12/2023]. See the Terms and Conditions (https://onlinelibrary.wiley.com/terms-and-conditions) on Wiley Online Library for rules of use; OA articles are governed by the applicable Creative Commons License
SUPPLEMENT ARTICLE
P028 | Current practice of dietetic
intervention in people with overweight and
obesity: A survey of dietitians
E. Clarke; R. Haslam; J. Baldwin; T. Burrows; L. Ashton; C. Collins
The University of Newcastle, Callaghan, New South Wales, Australia
INTRODUCTION: Dietitians play an important role in treatment for
individuals living with obesity. However, current best practice guide-
lines for the management of obesity need revision. The aim of this
survey was to assess current use of weight management guidelines,
contemporary practices, knowledge, and professional development
needs of dietitians who work with individuals living with obesity.
MATERIALS AND METHODS: During 2020 and 2021 an online sur-
vey was administered targeting Australian dietitians who provide
medical nutrition therapy for adults and/or children living with over-
weight and/or obesity was administered. The survey included 67 ques-
tions on areas including use of best practice management guidelines,
contemporary practice, knowledge, and professional development.
Ethics was approved by the University of Newcastle Human Research
Ethics Committee and all responses remained confidential. Findings
are reported descriptively as frequency (%).
RESULTS: One hundred seventy-eight individuals attempted the sur-
vey, with 80 respondents (45%) completing all questions. Respon-
dents mostly worked in private practice (45%) and spent >50% of
their time working with individuals with overweight and obesity.
While 68% of respondents had accessed best practice management
guidelines for the management of obesity, only 20% had completely
read these guidelines. Almost all (87%) of respondents worked with
other members of a multidisciplinary team, primarily psychologists,
physiotherapists, general practitioners, and exercise physiologists.
Dietitians reported that general healthy eating was the most frequent
(75%) dietary approach used with clients, followed by non-diet
approach eating behavior goals (60%). The types of dietary strategies
and interventions selected for patients was mostly based on client
preferences (75%). When asked about other dietary strategies used
90% of respondents reporting they used dietary manipulation, for
example, energy density, meal spacing, low glycemic index, and very
low calorie diets with clients. The majority of respondents rated their
knowledge (86%) and level of skill (81%) in obesity management as
good or above. However, 60% of respondents identified skill gaps
related to provision of behavioral therapy and counseling for individ-
uals living with obesity. Most respondents were interested in further
continuing professional development on counseling skills for behavior
change (76%), followed by evidence-based practice, practical strate-
gies, and clinical guidelines (69%).
CONCLUSION: Findings from this survey support the need for
updated best practice management guidelines for obesity manage-
ment. Professional development activities, particularly behavioral
counseling are required to support dietitians working with individuals
living with obesity.
CONFLICT OF INTEREST: None declared.

SUPPLEMENT ARTICLE
P030 | Identifying eating disorders in
adolescents and adults with overweight or
obesity: A systematic review of screening
questionnaires
E. T. House1,2; N. Lister1,2; A. Seidler3; H. Li4; W. Y. Ong4;
C. McMaster2,5; S. Paxton6; H. Jebeile1,2
1
Institute of Endocrinology and Diabetes, The Children's Hospital at
Westmead, Westmead, New South Wales, Australia; 2Children's Hospital
Westmead Clinical School, The University of Sydney, Westmead, New
South Wales, Australia; 3National Health and Medical Research Council
Clinical Trials Centre, Camperdown, New South Wales, Australia;
4
Nutrition and Dietetics Group, School of Life and Environmental
Sciences, Faculty of Science, Camperdown, New South Wales, Australia;
5
Boden Collaboration for Obesity, Nutrition, Exercise and Eating
Disorders, Faculty of Medicine and Health, The University of Sydney,
Sydney, New South Wales, Australia; 6School of Psychology and Public
Health, La Trobe University, Melbourne, Victoria, Australia
INTRODUCTION: People with overweight or obesity are at higher
risk of eating disorders (EDs). Screening for EDs as part of routine
obesity care has been suggested, yet, guidance on appropriate screen-
ing tools is limited. This systematic review aimed to examine the valid-
ity of self-report screening questionnaires for identifying ED risk in
adults and adolescents with overweight/obesity.
MATERIALS AND METHODS: Five databases were searched to
September 2020 for studies assessing validation of self-report ED
screening questionnaires against diagnostic interviews in adolescents
and adults with overweight/obesity. A narrative synthesis of results
was conducted. The review was registered with PROSPERO
(#220013).
RESULTS: Twenty-seven papers examining 15 questionnaires were
included. Most studies validated questionnaires for adults (22/27
studies), and most questionnaires (12/15) screened for binge eating or
binge-eating disorder (BED). The Sick Control One Fat Food (SCOFF)
questionnaire was most frequently validated for identification of any
ED (sensitivity = 0.67–1.00 at a cut-point of 2). The Questionnaire on
Eating and Weight Patterns (sensitivity = 0.07–0.88) and Binge Eating
Scale (sensitivity = 0.51–0.98 at a cut-point of 17) were most exten-
sively validated to identify binge eating or BED. Among adolescents,
the Adolescent Binge-eating disorder Questionnaire had highest sen-
sitivity (1.0) but lower specificity (0.27). Screening questionnaires
designed for BED generally had higher diagnostic accuracy than those
screening for EDs in general.
CONCLUSION: Validated screening tools to identify the spectrum of
EDs in adults and adolescents with overweight/obesity are lacking.
Select questionnaires may have sufficient sensitivity to identify BED
specifically. Clinical assessment should inform identification of
patients with co-morbid EDs and overweight/obesity due to lack of
validated tools. Going forward, tools specifically designed for this pop-
ulation are needed.
CONFLICT OF INTEREST: None declared.
1467789x, 2022, S2, Downloaded from https://onlinelibrary.wiley.com/doi/10.1111/obr.13503 by CAPES, Wiley Online Library on [16/12/2023]. See the Terms and Conditions (https://onlinelibrary.wiley.com/terms-and-conditions) on Wiley Online Library for rules of use; OA articles are governed by the applicable Creative Commons License
15 of 222
P031 | Impact of coconut oil versus palm oil
on obesity-related outcomes: A sequential
feeding clinical trial
H. Swarnamali1; P. Ranasinghe2; R. Jayawardena3
1
Health and Wellness Unit; 2Department of Pharmacology; 3Department
of Physiology, Faculty of Medicine, University of Colombo, Colombo,
Sri Lanka
INTRODUCTION: Overweight and obesity are major public health
consequences because they increase the risk of various co-morbid-
ities. Excess fat intake, such as from saturated fat sources has
been linked to an increase in overweight and cardiovascular risk,
particularly in developing nations. As palm oil and coconut oil are
the major saturated fat sources on a regular basis among South
Asian and South East Asian nations, it is useful to compare the
effect of coconut oil and palm oil on anthropometric parameters in
healthy adults.
MATERIALS AND METHODS: Ethical clearance was obtained
(Reference No: EC-19-046) from the ethics review committee of the
Faculty of Medicine, University of Colombo. The study was registered
in the clinical trial registry of Sri Lankan Medical Association:
SLCTR/2019/034 (https://slctr.lk/trials/slctr-2019-034).
The study was carried out as a sequential feeding clinical trial
with 40 healthy adults dividing into two feeding periods of 8 weeks
each. Participants were provided palm oil for the first feeding
period followed by coconut oil with a 16-week washout period in
between. The outcomes measured were the difference in body
weight, body mass index (BMI), waist circumference (WC), hip
circumference (HC), and waist-to-hip ratio (WHR). Dietary intake
and physical activity levels were assessed as potential confounding
variables.
RESULTS: At the initial point of palm oil feeding and the initial mea-
sure of coconut oil feeding, no significant differences in all the
anthropometric parameters were observed. No changes were
observed with respect to the body weight, BMI, and other anthro-
pometric measures (WC, HC, and WHR) after both oil treatment
periods. The effects of two treatments on anthropometric parame-
ters were compared and summarized in Table 1. No significant dif-
ference was observed for all anthropometric parameters between
the two oil treatments.
CONCLUSION: This study revealed that coconut oil in comparison to
palm oil did not change anthropometric-related cardiovascular risk
factors such as body weight, BMI, WC, HC, and WHR.
CONFLICT OF INTEREST: None declared.

16 of 222
TABLE 1 Summary of comparison between treatments
Mean (±SD) difference (final
Biochemical and physical parameters Palm oil
Anthropometric parameters
Weight (kg) 0.21 (±0.93)
2
BMI (kg/m ) 0.08 (±0.38)
Waist circumference (cm) 0.44 (±3.00)
Hip circumference (cm) 0.27 (±2.07)
Waist to hip ratio 0.01 (±0.04)
Note: Mean (±SD) differences (n = 37) between final and initial measurements (delta value) of the respective treatment groups (i.e., palm oil and coconut
oil) were subjected to paired sample t-test (p < 0.05).
Abbreviation: SD, standard deviation.
P032 | How are dietary intakes after bariatric
surgery associated with patients' post-
surgery weight changes: A systematic review
H. C. Cheung1; E. Strodl2; J. Musial3; H. MacLaughlin1,3; A. Byrnes3;
C.-A. Lewis3,4; L. Ross1,3
1
School of Exercise and Nutrition Sciences; 2School of Psychology and
Counselling, Queensland University of Technology, Brisbane, Queensland,
3
Australia; Department of Nutrition and Dietetics, Royal Brisbane and
Women's Hospital, Brisbane, Queensland, Australia; 4Faculty of Medicine,
University of Queensland, Brisbane, Queensland, Australia
INTRODUCTION: Practice guidelines focus on dietary intake in the
early stages post-bariatric surgery. The longer term impact of dietary
intakes on weight change requires investigation. This study aimed
to summarize the evidence regarding any association(s) between
dietary composition and weight outcomes at ≥1-year post-bariatric
surgery.
MATERIALS AND METHODS: Online databases CINAHL, Cochrane,
Embase, MEDLINE, and Scopus were searched for adult studies up to
June 2021 that assessed any associations between diet (≥1 macronu-
trient or food/food group) and weight outcomes (≥1 year) post-
bariatric surgery. Risk of bias and quality assessments were conducted
using the Scottish Intercollegiate Guidelines Network checklists and
the National Health and Medical Research Council's Level of Evidence
and Grades for Recommendations Guidelines. Evidence were graded
as “very good,” “good,” “satisfactory,” or “poor” based on the quality
of contributing studies to the evidence body, consistencies in study
findings, potential clinical impact, generalizability to the target popula-
tion, and applicability to the Australian healthcare context.
RESULTS: The 5923 articles were retrieved. Full text screening of
260 records resulted in the inclusion of 36 studies (9 interventional
including 5 randomized-controlled trials, and 27 observational
cohorts; sample sizes = 20–1610; total sample = 5065; follow-up
periods = 1–12 years; study grade: II to IV, risk of bias: low to high).
The evidence suggests weak associations between 1-year weight loss
and diets lower in carbohydrate (satisfactory evidence) and fat (poor
evidence), and higher in protein (satisfactory evidence), fruit, and
1467789x, 2022, S2, Downloaded from https://onlinelibrary.wiley.com/doi/10.1111/obr.13503 by CAPES, Wiley Online Library on [16/12/2023]. See the Terms and Conditions (https://onlinelibrary.wiley.com/terms-and-conditions) on Wiley Online Library for rules of use; OA articles are governed by the applicable Creative Commons License
SUPPLEMENT ARTICLE
initial) p value
Coconut oil
0.04 (±1.07) 0.331
0.02 (±0.44) 0.376
0.57 (±2.85) 0.19
0.18 (±1.64) 0.365
0.01 (±0.03) 0.07
vegetables (poor evidence). However, most associations lost signifi-
cance over time (good to satisfactory evidence). After 2 years, lower
fat (poor evidence) and better diet quality (satisfactory evidence)
remained the only dietary patterns weakly protective against weight-
regain. Among the 11 studies reporting on energy intakes, ongoing
associations with weight change were supported by nine studies.
Regardless of diet composition, a trend of lower energy intake among
subjects with greater weight losses and/or less weight regain were
observed in 15 out of 16 studies, despite only three achieved statisti-
cal significance.
CONCLUSION: Diet composition for optimizing weight outcomes
after bariatric surgery may differ over time and require individualized
dietary approaches to improve long term adherence to a low energy
diet. More studies are needed to define and measure the diet quality
of post-bariatric surgery patients.
CONFLICT OF INTEREST: None declared.
P033 | Impact of biologic agents on body
weight and obesity-related disorders in
patients with psoriasis: A nationwide
population-based cohort study
J. Kang1; S. Cheong2
1
Family Medicine; 2Dermatology, Konyang University Hospital, Daejeon,
Republic of Korea
INTRODUCTION: Recently, biologic agents, such as tumor necrosis
factor (TNF)-α inhibitor, interleukin (IL)-12/23 inhibitor, IL-17 inhibi-
tor, and IL-23 inhibitor, have been increasingly used to treat severe
psoriasis. However, there is a lack of large-scale population-based
studies on the characteristics of patients receiving biologic agents, the
association between psoriasis, obesity and its comorbidities, and
effects of biologic agents on body weight.
MATERIALS AND METHODS: This large-scale population-based
study aimed to analyze the effects of biologic agents on body weight
and obesity-related disorders in patients with psoriasis for 10 years
(January 2010 to December 2019), using the customized database

SUPPLEMENT ARTICLE
provided by the Korean National Health Insurance Service. The demo-
graphic data and health charts of 620,885 psoriasis patients, divided
into three groups according to their treatment modalities (biologics,
non-biologic systemic agents, and other agents), were analyzed.
RESULTS: Patients with severe psoriasis who were prescribed biologic
agents had a higher rate of comorbidities, such as diabetes, dyslipide-
mia, fatty liver, increased body weight, body mass index, and waist cir-
cumference than did the other treatment groups. We found that the
use of biologic agents was a significant independent risk factor for
gaining weight after correcting for age, sex, initial weight, total pre-
scription period, duration between the weight measurements before
and after psoriasis treatment, exercise, smoking, and drinking. In con-
trast, the use of non-biologic systemic agents was not a significant
independent risk factor for weight change.
CONCLUSION: As patients with severe psoriasis who are prescribed
biologic agents have a higher rate of obesity prevalence than do other
treatment groups and biologics may cause additional weight gain, cau-
tion must be exercised in their use.
CONFLICT OF INTEREST: None declared.
P034 | Does the respiratory quotient from
indirect calorimetry predict the change in
body weight during lifestyle-based weight
loss interventions in overweight and obesity?
A systematic review
J. Z. M. Lim; J. Burgess; U. Alam; D. J. Cuthbertson; J. P. Wilding
Department of Cardiovascular & Metabolic Medicine, University of
Liverpool, Liverpool, UK
INTRODUCTION: The use of non-invasive measures of gas exchange
from indirect calorimetry (IC) provides the respiratory quotient (RQ),
which serves as a proxy for substrate oxidation. Several longitudinal
studies have demonstrated that a higher RQ (indicating greater carbo-
hydrate oxidation) was predictive of subsequent weight increase, and
a lower RQ (indicating greater fat oxidation) predictive of weight loss.
OBJECTIVE: This systematic review aimed to determine whether the
measured baseline RQ correlates with weight loss. The secondary aim
was to determine if the magnitude of change in RQ during weight loss
correlates with change in body weight.
MATERIALS AND METHODS: We included randomized controlled
trials and controlled studies in people with overweight and/or obesity
who underwent diet restriction and/or increased physical activity for
weight loss with reported RQ measurements from IC. We searched
PUBMED, EMBASE, the Cochrane Central Register of Controlled tri-
als CENTRAL, PsychInfo, and CINAHL. Of the 2438 studies identified,
10 studies met the pre-defined inclusion criteria. Risk of bias was
assessed for randomized, controlled studies by the RoB v.2 tool, and
for non-randomized trials by the ROBINS-I tool.
RESULTS: The 10 studies included 661 participants. In response to
energy-restricted (500–750 kcal/day) energy deficit diets, 2/5 studies
1467789x, 2022, S2, Downloaded from https://onlinelibrary.wiley.com/doi/10.1111/obr.13503 by CAPES, Wiley Online Library on [16/12/2023]. See the Terms and Conditions (https://onlinelibrary.wiley.com/terms-and-conditions) on Wiley Online Library for rules of use; OA articles are governed by the applicable Creative Commons License
17 of 222
reported a decrease in fasting RQ during the first 2–8 weeks of the
intervention; this was more marked in carbohydrate-restricted dietary
interventions. In studies with aerobic and resistance cycle exercise,
2/3 studies showed decreased RQ. In studies with combined diet
restriction and exercise, 2/2 studies reported decrease in RQ. In con-
trast to our hypothesis we did not find a correlation between the
baseline RQ and body weight change following energy restriction.
There was also no association between decrease in RQ (from baseline)
and the change in body weight.
CONCLUSION: Discussion: We postulate that the decrease in RQ
observed in some diet intervention studies may be a consequence of
metabolic adaptation to the high-fat low-carbohydrate ketogenic diet
recommended, rather than energy restriction per se.
CONFLICT OF INTEREST: None declared.
P035 | Medically-tailored meals for type
2 diabetes and heart disease: Protocol for an
Australian trial of a “Food is Medicine”
intervention
K. Trieu1; K. Law1; B. Neal1; C. Arnott1,2,3; C. Chow1,2;
G. L. Di Tanna1; T. Lung1,2; D. Mozaffarian4; S. Berkowitz5; J. Wong3;
D. Simmons6; J. Wu1
1
The George Institute for Global Health, Faculty of Medicine, University
of New South Wales, Sydney, New South Wales, Australia; 2University of
Sydney, Sydney, New South Wales, Australia; 3Royal Prince Alfred
Hospital, Sydney, New South Wales, Australia; 4Tufts University, Boston,
Massachusetts, USA; 5University of North Carolina, Chapel Hill, North
Carolina, USA; 6Western Sydney University, Penrith, New South Wales,
Australia
INTRODUCTION: Nutrition is fundamental to the management of
obesity and chronic diseases such as type 2 diabetes (T2D). Despite
its importance, accessing and preparing nutritious meals can be chal-
lenging for individuals who struggle with daily living activities. There
are currently few established and reimbursed dietary programs that
effectively improve glycemic control and lower cardiovascular disease
risk in Australia. “Food is medicine” interventions aim to integrate
nutritious food provision into healthcare systems and are of growing
interest to healthcare providers and policy makers. “Medically Tai-
lored Meals” (MTM) is one such intervention, which involves delivery
of pre-prepared meals designed by nutritionists, to improve patients'
diets and complement pharmacologic treatments.
MATERIALS AND METHODS: Through a randomized controlled trial,
we aim to test the effectiveness of a MTM program among partici-
pants with undermanaged T2D and difficulties accessing or preparing
nutritious food. Participants will be recruited from hospital diabetes
centers and General Practices in New South Wales, Australia. Over
26 weeks, the intervention group will be prescribed 10 MTM per
week and receive three sessions of dietetic support to promote
uptake of the meals and improve diet quality overall. Controls will

18 of 222
continue with their usual clinical care and receive three grocery gift
vouchers. The primary outcome will be change in glycated hemoglobin
(HbA1c) between groups at 26 weeks, measured via pathology service
centers. Secondary outcomes include change in blood pressure, body
weight, lipid levels, medication use, and dietary intake. A mixed-
methods process evaluation and an economic evaluation will be con-
ducted to assess the feasibility, acceptability, scalability, and cost-
effectiveness of the intervention. Allowing for a 10% drop out rate,
we plan to recruit n = 212 participants (106 per arm) that will provide
80% power (p = 0.05) to detect a clinically meaningful ≥0.6% differ-
ence in mean HbA1c between groups.
RESULTS: Recruitment will commence in mid-2022, with results avail-
able mid-2024.
CONCLUSION: This Australian-first MTM trial will generate robust
data to build the case for sustained, large-scale implementation of an
innovative nutrition program to improve the management of T2D
among vulnerable groups and add to the growing evidence base for
‘Food is Medicine’ interventions internationally.
CONFLICT OF INTEREST: None declared.
P036 | Nonsurgical care of the older inpatient
with Class II or III obesity: The health
professional experience
M. Rees1; V. McDonald1,2; E. Majellano1,2; C. Collins3
1
College of Nursing and Midwifery, University of Newcastle, Callaghan,
New South Wales, Australia; 2Hunter New England Local Health District,
3
New Lambton, New South Wales, Australia; College of Health Sciences,
University of Newcastle, Newcastle, New South Wales, Australia
INTRODUCTION: Older patients with Class II or III obesity and
comorbidities have frequent hospital admissions with complex care
needs requiring management. Surgical interventions are not available
and/or desired by many within this hospital population. We explored
the Health Professional's experiences in delivering non-surgical care
to this patient population.
MATERIALS AND METHODS: Health Professionals delivering non-
surgical care to older inpatients with Class II, or III obesity were
recruited from the Medical and Interventional Service of an Australian
tertiary regional referral hospital. Qualitative semi-structured inter-
views were conducted with 24 Health Professionals from seven disci-
plines between August and December 2019. The interviews were
audio-taped, transcribed and participant reviewed for accuracy. The-
matic inductive data analysis was deductively mapped to the Theoreti-
cal Domains Framework.
RESULTS: Four major themes of Barriers, Facilitators, Current Prac-
tice, and Recommendations were identified. These major themes
included 11 subthemes (perceived patient related factors; health sys-
tem issues; provider issues; patient-centered approach; knowledge;
non-acute setting resources; exploring factors influencing clinical
management; engaging patients; access to quality care; education
1467789x, 2022, S2, Downloaded from https://onlinelibrary.wiley.com/doi/10.1111/obr.13503 by CAPES, Wiley Online Library on [16/12/2023]. See the Terms and Conditions (https://onlinelibrary.wiley.com/terms-and-conditions) on Wiley Online Library for rules of use; OA articles are governed by the applicable Creative Commons License
SUPPLEMENT ARTICLE
support and obesity as a chronic disease) that mapped to nine
domains in the Theoretical Domains Framework.
CONCLUSION: Health professional identified barriers and facilitators
to delivering non-surgical care to older inpatients with Class II or III
obesity. Using the Theoretical Domains Framework highlighted future
strategies for investigation to address the service gaps identified.
CONFLICT OF INTEREST: None declared.
P037 | Comparison between patients with
obesity and healthy weight with non-
alcoholic fatty liver disease
N. K. Vikram1; D. Roy1; P. Sethi1; A. Kumar1; S. S2; P. Ranjan1;
K. Madhusudhan3 Metabolic research Group
1
Medicine; Gastroenterology and Human Nutrition; 3Radiodiagnosis,
2
A.I.I.M.S., New Delhi, New Delhi, India
INTRODUCTION: Non-alcoholic fatty liver disease (NAFLD) is typi-
cally linked to obesity and is associated with increased risk of
metabolic syndrome, diabetes mellitus and cardiovascular disease.
It is increasingly being diagnosed in individuals who are non-obese.
We compared the body composition and metabolic characteristics
of individuals diagnosed to have NAFLD with and without obesity.
MATERIALS AND METHODS: This cross-sectional study included
56 individuals with obesity (BMI ≥ 25 kg/m2) and 47 without obesity
(BMI < 25 kg/m2), with NAFLD in the age group of 20–60 years. Mea-
surements included body composition (anthropometry and whole
body DXA scan), FibroScan, carotid intima-media thickness (CIMT, for
subclinical atherosclerosis) and biochemical profile (glucose, lipids,
fasting insulin, and hs-CRP).
RESULTS: Subjects with obesity had significantly higher % body fat,
lean mass, and skeletal muscle mass as compared to those without
obesity. Abdominal obesity (high waist circumference) was observed
in 92.9% and 61.7% of subjects with and without obesity, respec-
tively. Interestingly, the prevalence of hyperinsulinemia (31.9% and
37.5%) and elevated hs-CRP (80.8% and 89.3%) was observed to be
similar in subjects with and without obesity, respectively. On FibroS-
can assessment, the mean values of LSM (7.86 and 9.65 kPa) and CAP
(305.8 and 312.5 dB/m) were similar in subjects without and with
obesity, respectively. The prevalence of metabolic syndrome was
observed to be 55.3% and 67.8% in those without and with obesity,
respectively.
CONCLUSION: Subjects with NAFLD but without obesity had high
prevalence of abdominal obesity, insulin resistance and metabolic syn-
drome. Hepatic fibrosis and steatosis levels assessed by Fibro Scan
were also comparable in those with and without obesity. This may
suggest that presence of NAFLD and not adiposity alone may contrib-
ute to increased cardiometabolic risk. Lean individuals with NAFLD
should be screened for these risk factors and should receive appropri-
ate intervention.
CONFLICT OF INTEREST: None declared.

SUPPLEMENT ARTICLE
P038 | Relationship between Resting Energy
Expenditure and Handgrip strength in
outpatients with obesity from Southern Italy
R. Sammarco; M. Marra; R. Natale; D. Morlino; O. di Vincenzo;
I. Cioffi; A. Marzano; C. de Caprio; F. Pasanisi
Department of Clinical Medicine and Surgery, University Federico II,
Naples, Italy
INTRODUCTION: Hand Grip strength (HGS) is increasingly used in
clinical practice to assess the impact of a variety of disorders on mus-
cular function. However, the relationship between HGS and Resting
Energy Expenditure (REE) has not been widely studied in patients with
obesity. The aim of this study is to evaluate the association between
REE and HGS in adult outpatients with a BMI ≥ 30 kg/m2.
MATERIALS AND METHODS: Three hundred and six patients (207 F
and 99 M) (age range 18–70 years) participated into the study (F: age
36.8 ± 15.2 years, weight 102.3 ± 20.2 kg, height 160.8 ± 5.6 cm,
BMI 39.6 ± 7.6 kg/m2; M: 3 8.5 ± 14.8 years, 123.7 ± 26.5 kg, 174.8
± 8.3 cm, 40.4 ± 7.4 kg/m2).
Grip strength for the right and left arms was measured with a
handgrip dynamometer and REE was measured using Indirect Calo-
rimeter (Vmax Encore 229). The mean HGS was the average value of
three measurements of both hands.
All data were divided in quartiles for mean HGS, according to sex,
and the subjects in the first quartile of HGS were defined dynamope-
nic (in our study, first quartile <18.0 kg, second 18.04–22.1, third
22.17–26 and fourth >26 kg; for males first <31.1 kg, second 31.1–
38.6, third 38.7–46.1 and fourth >46.1 kg).
RESULTS: In females mean HGS was 21.9 ± 5.4 kg, REE was 1739
± 320 kcal/die, whereas in males mean HGS was 38.1 ± 10.2 and REE
was 2172 ± 440, respectively.
There was no significant differences of REE between the first quar-
tile and the other groups in females (Q1 1675 ± 307 vs. Q2 1764
± 327 vs. Q3 1721 ± 312 vs. Q4 1800 ± 333 kcal/ die, p = 0.225),
whereas in males, we found a significant difference in REE between
the first quartile and the others (Q1 1993 ± 404 vs. Q2 2155 ± 388
vs. Q3 2257 ± 431 vs. Q4 2322 ± 491 kcal/die, p = 0.04), with no dif-
ferences in age, weight, and BMI between groups.
CONCLUSION: Our preliminary findings show that dynamopenia
seems to be associated with the reduction of REE in males. Future
studies are needed in a larger sample, in order to clarify this associa-
tion and to evaluate its role in the management of obesity.
CONFLICT OF INTEREST: None declared.
1467789x, 2022, S2, Downloaded from https://onlinelibrary.wiley.com/doi/10.1111/obr.13503 by CAPES, Wiley Online Library on [16/12/2023]. See the Terms and Conditions (https://onlinelibrary.wiley.com/terms-and-conditions) on Wiley Online Library for rules of use; OA articles are governed by the applicable Creative Commons License
19 of 222
P039 | Descriptive analysis and
characteristics of people seeking metabolic
and obesity surgery privately in Western
Sydney
S. Badorrek1,2; J. Franklin3; M. Devadas1,2; M. Batterham4;
K. Williams1,2
1
Nepean Family Metabolic Health Service, Nepean Hospital, Kingswood,
New South Wales, Australia; 2Charles Perkins Centre-Nepean,
Kingswood, New South Wales, Australia; 3Metabolism and Obesity
Service, Royal Prince Alfred Hospital, Sydney, New South Wales,
Australia; 4Statistical Consulting Centre, University of Wollongong,
Wollongong, New South Wales, Australia
INTRODUCTION: Metabolic Obesity Surgery (MOS), in combination
with lifestyle support, is currently the most effective, durable strategy
for weight management. In Australia, 89% of the 23,000 MOS per-
formed each year are in the private setting. Limited pre- and post-
surgical data is available on these people, especially regarding psycho-
social and dietary traits. This prospective long-term cohort study,
recruiting at least 120 people, aims to document and comprehensively
evaluate medical, psychosocial, and behavioral factors linked to out-
come measures.
MATERIALS AND METHODS: Data collection is at the practice of a
single surgeon and was done via validated questionnaires and clinical
assessment forms from pre-surgery out to 3, 6, 12, and 24 months
post-surgery. Demographics, anthropometry, medical conditions,
mental health, QoL, dietary intake and behavior, social factors, weight
stigma, use of social networks, beliefs, and attendance at clinical
appointments will be recorded. Descriptive statistics will be used to
outline baseline characteristics and linear and generalized linear mixed
models for longitudinal data analysis.
RESULTS: Preliminary data on 87 participants at baseline (pre-surgery)
found: 67% were female with a mean age of 42.7 years (SD 11.24)
and mean BMI of 42.7 kg/m2 (SD 7). In the year prior to surgery, 67%
(n = 58) reported weight gain, with 65% (n = 38) gaining 10 kg or
more. Information on MOS was sourced mainly via the internet (70%
n = 58) and GP (61% n = 50). Personal reasons reported for MOS
include improved general health, 96.5% (n = 83) and improved Quality
of Life, 88% (n = 76). Moderate to very concerned ratings were indi-
cated for excess skin 97% (n = 77) and hair loss 84% (n = 71) after
surgery. Eating disorder scores measured via the EDE-Q indicated a
high level of eating disorder psychopathology, with a mean score of
3.68 (SD 1.03). Weight stigma, measured by the Weight Bias Internali-
zation Scale (WBIS) was high at 4.98 (SD 1.25).

20 of 222
CONCLUSION: People seeing a surgeon for MOS report significant
weight gain, high internalized weight stigma and have high scores on
EDE-Q, suggesting disordered eating. Outcomes that matter to people
undergoing surgery include QoL and general health. These findings
can be used to help inform best practice care by ensuring pre-surgery
dietitian and psychology assessments and a focus on outcomes that
matter to those having surgery.
CONFLICT OF INTEREST: None declared.
P040 | Microbiome-derived Christensenella
minuta DSM33407 improves metabolism in
people suffering from obesity
S. Claus; J.-C. Paquet; W. Mazier; F. Elustondo
Ysopia Bioscience, Bordeaux, France
INTRODUCTION: Christensenella minuta is a human gut dwelling
anaerobic bacterium supporting a rich and diverse microbiome charac-
teristic of healthiness. Individuals suffering from metabolically
unhealthy obesity host a dysbiotic gut microbiome associated with a
loss of C. minuta. The new strain C. minuta DSM 33407 has demon-
strated anti-obesity potential and acts as a keystone species, support-
ing important metabolic functions that are altered in the microbiome
of people affected by obesity. To evaluate the therapeutic potential of
C. minuta DSM 33407, we analyzed exploratory data generated during
the phase 1 clinical trial evaluating safety and tolerability in people
with a body mass index (BMI) in the normal range and with elevated
BMI. In the latter group, we evaluated its effects on the gut micro-
biome and on key metabolic parameters. The results on safety and tol-
erability have already been reported and demonstrated that C. minuta
DSM 33407-associated side effects were like those observed in the
placebo group. Here, we report the results associated with an in-depth
analysis of the biochemical and microbiological modulations induced
by this specific strain in volunteers with elevated BMI.
MATERIALS AND METHODS: This clinical trial was registered as
NCT04663139. The randomized double-blind placebo-controlled arm
2
included 30 volunteers with elevated BMI (25–35 kg/m ) affected by
at least one of the following untreated metabolic disorders related
condition: elevated triglyceridemia, low HDL cholesterol, elevated
fasting plasma glucose. Twenty volunteers received a daily oral cap-
9
sule of the investigational product (IP) containing 10 Colony Forming
Units of C. minuta DSM 33407 in a lyophilized form, and 10 received
the matching placebo. Treatment period was 12 weeks followed by a
4-week wash-out period. Blood and fecal samples were collected at
baseline, week 2, 8, 12, and 16.
RESULTS: At baseline, 55% of volunteers in the IP group had low
C. minuta levels, which were effectively restored to reach 90% of vol-
unteers with levels of C. minuta above the average healthy level at
week 12. Treatment with C. minuta DSM 33407 was associated with
an improvement of metabolic health at week 16 for 58% of the volun-
teers against 10% in the placebo group (p = 0.0064). This effect was
1467789x, 2022, S2, Downloaded from https://onlinelibrary.wiley.com/doi/10.1111/obr.13503 by CAPES, Wiley Online Library on [16/12/2023]. See the Terms and Conditions (https://onlinelibrary.wiley.com/terms-and-conditions) on Wiley Online Library for rules of use; OA articles are governed by the applicable Creative Commons License
SUPPLEMENT ARTICLE
driven by significantly lower LDL cholesterol and lower LDL/HDL
levels along reduced HOMA-IR index. The gut microbiome of these
responders was enriched in Veillonaceae and Acidaminococcaceae. Gut
microbiome function was modulated toward lower synthesis of sec-
ondary bile acids.
CONCLUSION: This work indicates that C. minuta DSM 33407 modu-
lates gut microbiome function and cholesterol metabolism in humans.
This is the first study demonstrating the therapeutic potential of
C. minuta in people suffering from obesity.
CONFLICT OF INTEREST: S. Claus Shareholder of Ysopia bioscience,
Employee of Ysopia bioscience; J.-C. Paquet Employee of Ysopia bio-
science; W. Mazier Shareholder of Ysopia bioscience, Employee of
Ysopia bioscience; F. Elustondo Shareholder of Ysopia bioscience,
Employee of Ysopia bioscience.
P041 | Lifestyle management in polycystic
ovary syndrome—Beyond diet and physical
activity
S. Cowan1; S. Lim1; C. Alycia1; S. Pirotta1; R. Thomson2;
M. Gibson-Helm3; R. Blackmore1; N. Naderpoor1; C. Bennett1;
C. Ee4; V. Rao4; A. Mousa1; S. Alesi1; L. Moran1
1
Monash University, Melbourne, Victoria, Australia; 2The University of
Adelaide, Adelaide, South Australia, Australia; 3Victoria University of
Wellington, Wellington, New Zealand; 4Western Sydney University,
Sydney, New South Wales, Australia
INTRODUCTION: Polycystic ovary syndrome (PCOS) is a common
condition affecting reproductive-aged women with reproductive,
metabolic, and psychological consequences. While weight and life-
style management are first-line therapy in international evidence-
based guidelines for PCOS, there is growing interest and research
in the potential benefit of including psychological and sleep
interventions, as well as a range of traditional, complimentary,
and integrative medicine (TCIM) approaches, for optimal PCOS
management.
MATERIALS AND METHODS: This narrative review provides an
overview of all relevant studies known to the authors investigating
the effects of lifestyle, psychological, sleep, and TCIM interventions
in PCOS.
RESULTS: There is limited evidence to recommend a specific diet
composition for PCOS with approaches including modifying protein,
carbohydrate, or fat generally having similar results. Promising evi-
dence supports the provision of vigorous aerobic exercise, which can
improve anthropometry, cardiorespiratory fitness and insulin resis-
tance. Psychological and sleep interventions are important consider-
ations, with women displaying poor emotional wellbeing and higher
rates of sleep disturbance, limiting their ability to make positive life-
style change. While optimizing sleep and emotional wellbeing may aid
symptom management in PCOS, research exploring the efficacy of
clinical interventions is lacking. Uptake of TCIM approaches, in

SUPPLEMENT ARTICLE
particular supplement and herbal medicine use, by women with PCOS
is growing. However, there is currently insufficient evidence to sup-
port integration into routine clinical practice. Meta-analyses investi-
gating inositol supplementation have produced the most promising
findings, showing improved metabolic profiles and reduced hyperan-
drogenism. Findings from emerging evidence for other supplements,
herbal medicines, acupuncture, and yoga is so far inconsistent, and to
reduce heterogeneity more research in specific PCOS populations
(e.g., defined age and BMI ranges) and consistent approaches to inter-
vention delivery, duration, and comparators are needed.
CONCLUSION: While there are a range of lifestyle components in
addition to population-recommendations for diet and physical activity
of potential benefit in PCOS, robust clinical trials are warranted to
expand the relatively limited evidence-base regarding the provision of
holistic management in PCOS. With consumer interest in holistic
healthcare rising, healthcare providers will be required to broaden
their knowledge pertaining to how these therapies can be safely
and appropriately utilized as adjuncts to conventional medical
management.
CONFLICT OF INTEREST: None declared.
P042 | The effects of medium chain
triglycerides on the appetite suppression and
weight change—A pilot study
W.-Y. Lin; H.-S. Hsu; T.-P. Chen; C.-C. Lin
Department of Family Medicine, China Medical University and Hospital,
Taichung, China
INTRODUCTION: Additive of satiated food or elements may
decrease the negative effects of low calorie diet during the weight
control. Typical obesity treatments include change of daily lifestyle,
reduce the calorie intake and do exercise regularly. Compare to
long chain fatty acid, medium chain fatty acid may raise the ther-
mic effect and consume more energy expenditure in human body.
One of the key successful methods for weight reduction is appe-
tite control. Therefore, whether added medium chain fatty acid to
daily diet can decrease the appetite and weight is need to be
understand.
MATERIALS AND METHODS: Nine adult subjects took 10 g of
medium chain triglycerides (MCT) continuously daily, ingested in
breakfast or added to their daily diet during 6 weeks trial period.
Before and after the period, an appetite assessment record and
anthropometric indices were assessed.
RESULTS: Subjects with MCT experienced significant appetite sup-
pressing effects 3 to 4 h after the meal, including decreased hunger,
physiological satiety increased, inability to eat food, and decreased
appetite for savory, sweet, salty, and fatty foods. However, long-term
use of MCT for 3 or 6 weeks had no significant effect on appetite,
and there were no significant changes in the subjects' body weight or
body fat.
1467789x, 2022, S2, Downloaded from https://onlinelibrary.wiley.com/doi/10.1111/obr.13503 by CAPES, Wiley Online Library on [16/12/2023]. See the Terms and Conditions (https://onlinelibrary.wiley.com/terms-and-conditions) on Wiley Online Library for rules of use; OA articles are governed by the applicable Creative Commons License
21 of 222
CONCLUSION: MCT shows only a short-term appetite-suppressing
effect but no long-term effect in this study. Further large-scaled study
is need to clarify the actual effect of MCT on weight control.
CONFLICT OF INTEREST: None declared.
P043 | Using a food-based modified Very
Low Energy Diet in the treatment of severe
obesity in children and adolescents
A. Grunseit1; S. Alexander2
1
Department of Nutrition and Dietetics; 2Department of Weight
Management Service and Children's Institute of Sports Medicine, The
Children's Hospital at Westmead, Westmead, New South Wales,
Australia
INTRODUCTION: The use of dietary interventions such as modified
Very Low Energy Diets (mVLED) are an essential part of treatment for
severe obesity in adolescents. A food-based mVLED has been devel-
oped for use in children and adolescents when a VLED using meal
replacement products are not appropriate, either due to the child's age
or palatability of meal replacement products. The mVLED is very similar
to phase 2 of the Protein Sparing Modified Fast Diet, a very low calorie
diet which increases the consumption of protein and limits carbohy-
drates and fats, and offers a diet which is acceptable and palatable to
the patients. Similar to a VLED, the diet is followed for approximately
12–16 weeks at which point patients are slowly transitioned off the
diet to a sustainable healthy diet for weight maintenance.
MATERIALS AND METHODS: We report two cases in which a food-
based mVLED was used at The Children's Hospital at Westmead
(CHW). Both patients had severe obesity where weight loss was
essential to reverse debilitating co-morbidities. Patient A was an
11 year old male with a BMI of 53.3 kg/m2 admitted due to severe
obstructive sleep apnea with a background family history of cardio-
vascular disease resulting in the death of his older teenage brother.
Patient B was a 14 year old female with hypothalamic dysregulation
and rapid weight gain of 18.5 kg in 9 months following diagnosis and
surgery for a Craniopharyngioma.
RESULTS: Both patients adhered to the diet and saw the cessation of
previous extreme weight gain and a reduction in weight and BMI.
Patient A had a reduction in BMI from 53.3 to 44 kg/m2 with 17.5 kg
(13%) weight loss over 4 months. Patient B had a reduction in BMI
from 38 to 36.3 kg/m2 with 4.5 kg (4.5%) weight loss over 6 months.
For patient B the most important outcome was the cessation of previ-
ous rapid weight gain.
CONCLUSION: A food based mVLED was successful in eliminating
rapid weight gain and achieving medically significant weight loss in
two children with severe obesity, in which a traditional mVLED was
not appropriate. This novel approach required regular appointments,
support and guidance (recipe ideas and meal plans) to ensure adher-
ence and dietary variety.
CONFLICT OF INTEREST: None declared.

22 of 222
P046 | Preventing and managing childhood
obesity in dental settings: A qualitative study
A. Arora1,2,3,4; K. Rana1,2,3; N. Manohar1,2; L. Li5; S. Bhole4;
1,2,3,6
R. Chimoriya
1 CONFLICT OF INTEREST: None declared.
School of Health Sciences, Western Sydney University, Penrith, New
South Wales, Australia; 2Health Equity Laboratory; 3Translational Health
Research Institute, Western Sydney University, Penrith, New South
Wales, Australia; 4Oral Health Services, Sydney Local Health District and
Sydney Dental Hospital, Sydney, New South Wales, Australia; 5School of
Science; 6School of Medicine, Western Sydney University, Sydney, New
South Wales, Australia
INTRODUCTION: Overweight or obesity and dental caries continue
to present an important public health challenge for children. Global
evidence supports the integration of childhood overweight and obe-
sity management in dental care settings. However, relevant informa-
tion on the acceptance, feasibility, enablers, and barriers to such
practices among Australian oral health care professionals (OHCPs) is
scarce. This study aimed to explore the perceptions of OHCPs on
childhood overweight and obesity screening and management in oral
health settings in the Greater Sydney region in New South Wales,
Australia.
MATERIALS AND METHODS: The OHCPs involved in the Healthy
Smiles Healthy Kids (HSHK) birth cohort study were purposively
selected for this nested qualitative study. A sample of 15 OHCPs
completed the face-to-face interviews, and thematic analysis was
undertaken to identify and analyze the contextual patterns and
themes.
RESULTS: Three major themes emerged: (1) obesity prevention and
management in dental practice; (2) barriers and enablers to obesity
prevention and management in dental settings; (3) role of oral health
professionals in promoting healthy weight status. The OHCPs
acknowledged the link between oral health and systemic health. The
OHCPs were undertaking height and weight measurements, diet
assessment, patient education, and referrals in their routine clinical
practice. However, their practices were limited due to barriers such as
limited knowledge on childhood obesity and dietary guidelines, time
constraints, uncertainty toward scope of obesity screening and
counseling during a dental appointment, and a gap in the referral path-
way process in public and private dental services. A need for an
evidence-based model of care was identified, including capacity build-
ing of OHCPs, development of resources such as anthropometric
assessment methods and lifestyle-related modification counseling,
and identification of a clear referral pathway.
1467789x, 2022, S2, Downloaded from https://onlinelibrary.wiley.com/doi/10.1111/obr.13503 by CAPES, Wiley Online Library on [16/12/2023]. See the Terms and Conditions (https://onlinelibrary.wiley.com/terms-and-conditions) on Wiley Online Library for rules of use; OA articles are governed by the applicable Creative Commons License
SUPPLEMENT ARTICLE
CONCLUSION: OHCPs are well-positioned and supportive in under-
taking obesity screening and management in their routine clinical
practice. This study provides an insight into opportunities to re-orient
the existing allied or primary health care work force involved in obe-
sity prevention and management.
P047 | The Optimal Weight for Life program
for children and teens
S. Dowden
NursePrac Australia, Fremantle, Western Australia, Australia
INTRODUCTION: NursePrac Australia is an independent,
community-based, children's health service in Perth, Western
Australia, providing healthcare by Pediatric Nurse Practitioners. In
2017, NursePrac Australia established a nurse-practitioner-led pediat-
ric weight management program: The Optimal Weight for Life (OWL)
Program, the first of its kind in Australia.
In 2017–2018, an estimated 1-in-4 children/teens in Australia
aged 2–17 were living with overweight or obesity (this equates to
150,000 children/teens in Western Australia). Children/teens living in
rural areas or with socioeconomic disadvantage are 1.5–2.4 times
more likely to be affected by overweight or obesity than those living
in major cities.
Obesity in childhood increases the risk of life-long cardio-
metabolic disease. Additionally, low self-esteem, negative body image,
bullying, and social isolation contribute to children and teens affected
by obesity suffering from anxiety, depression, and other mental health
concerns. Despite the high burden of disease, there is a paucity of ser-
vices to address childhood obesity in Western Australia and minimal
change has occurred in the last 5 years.
MATERIALS AND METHODS: The OWL Program offers a
community-based single-clinician pediatric obesity management model
as an alternative to a pediatric tertiary hospital multidisciplinary team
program for morbid obesity, as only a fraction of children and adoles-
cents living with obesity are able to access tertiary hospital programs.
The OWL Program selected best features from international chil-
dren's weight management practice, combining multi-component
behavioral change interventions in a community-based, non-medical
model. The OWL Program provides guidance, motivation, and a goal-
setting approach to achieve outcomes. The OWL Program comprises
a 1-h initial appointment and 30-min follow up appointments. Chil-
dren/teens are seen monthly and can attend more or less frequently
 1467789x, 2022, S2, Downloaded from https://onlinelibrary.wiley.com/doi/10.1111/obr.13503 by CAPES, Wiley Online Library on [16/12/2023]. See the Terms and Conditions (https://onlinelibrary.wiley.com/terms-and-conditions) on Wiley Online Library for rules of use; OA articles are governed by the applicable Creative Commons License
SUPPLEMENT ARTICLE 23 of 222

as desired. Longer program attendance is strongly linked to improved
outcomes.
RESULTS: Since 2017, 200 children/teens aged 2–19 (mean age 9.5)
have attended the OWL Program, with 140 currently active. Forty-
four percent are living with socioeconomic disadvantage.
At entry 86% of children/teens were affected by high obesity
(99th centile) or morbid obesity (>99th centile). Mean BMI z-score
2.40.
Seventy-five percent of children/teens had BMI z-score reduction
by visit 4, 85% by visit 12. Mean z-score reduction 0.18.
These outcomes are equivalent to a tertiary hospital obesity
program.
CONCLUSION: The overarching ethos of The OWL Program is child-
centered and family-centered care: we view children, teens, and their
families as equal partners in the OWL Program and as experts in their
own lives. Importantly, consideration is given to Social Determinants
of Health and their impact on physical and emotional health and well-
being. Tailoring the OWL Program to individual needs is vital and key
to our successful outcomes.
CONFLICT OF INTEREST: None declared.
P048 | Prevalence of obesity and
consumption of ready-made food/beverage:
Is there a link? Evidence from two national
surveys in Indonesia
nations, with variability. In Indonesia, this is coupled with an increase
in overweight-obesity prevalence. The emergence of modern food
distribution translates to more options available on the supply side.
Understanding dynamics between ready-made food/beverage avail-
ability toward nutrition in Indonesia is necessary. The aim of this study
is to have a deeper dive of this relationship.
MATERIALS AND METHODS: We identified relevant indicators from
the Indonesia National Statistics Agency and National Basic Health
Survey over the years. We analyzed the data descriptively to capture
the consumption and expenditure using Stata and visualized our find-
ings using Tableau 2021.
RESULTS: The prevalence of overweight in Indonesia consistently
increasing from 2007 (8.60%), 2013 (11.50%), and 2018 (13.60%),
while the prevalence of obesity more than doubled throughout these
years (10.50%, 15.4%, and 21.80%, respectively). The prevalence of
central obesity was found highest among the three (18.80%, 26.60%,
and 31.60%, respectively). Average of both per capita consumption
and expenditure by food groups highlighted the increasing trend espe-
cially on ready-made food and beverages. When analyzed by quintile,
the consumption was found higher in upper socioeconomic groups.
CONCLUSION: The consumption of ready-made food/beverages—
found higher in upper quantiles—increased sharply as the prevalence
of overweight and obesity.
CONFLICT OF INTEREST: None declared.

A. F. Saptari1; C. N. Rachmi1; H. Jusril1; S. M. Jamil2; S. Phulkerd3;

E. Borazon4; A.-M. Thow5; P. B. Koon2 the SEAoFE study working
group
1
Public Health, Reconstra Utama Integra, Jakarta, Indonesia; 2Centre for
Community Health Studies (ReaCH), Faculty of Health Sciences,
Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia; 3Institute for
Population and Social Research, Mahidol University, Phutthamonthon,
Thailand; 4Public Health, National Sun Yat Sen University, Kaohsiung,
Taiwan; 5Public Policy and Health, University of Sydney, Sydney, New
South Wales, Australia

INTRODUCTION: Within the last few decades, the worldwide popu-

lation has vastly changing consumption patterns toward foods high in
fats and sweeteners. In Asia, a trend analysis revealed increasing
household food expenditure and processed food consumption across

24 of 222
P049 | The aperitif effect of alcohol—A
putative role of alcohol in regulating protein
and energy intake
A. Grech; S. Simpson; D. Raubenheimer
The School of Life and Environmental Sciences, The University of Sydney,
Sydney, New South Wales, Australia
INTRODUCTION: The role of alcohol on body weight regulation, food
intake, and appetite has received much attention; however, the con-
sensus is that we still do not completely understand the role of alco-
hol in weight regulation. Recent evidence has demonstrated that
alcohol intake increases circulating levels of fibroblast growth factor
21(FGF-21), suppresses appetite for alcohol and carbohydrate, and
1467789x, 2022, S2, Downloaded from https://onlinelibrary.wiley.com/doi/10.1111/obr.13503 by CAPES, Wiley Online Library on [16/12/2023]. See the Terms and Conditions (https://onlinelibrary.wiley.com/terms-and-conditions) on Wiley Online Library for rules of use; OA articles are governed by the applicable Creative Commons License
SUPPLEMENT ARTICLE
increases appetite for protein. We tested the predictions that
(i) FGF21-elicited protein seeking will result in increased proportional
protein intake when drinking alcohol; (ii) the strong satiating effect of
increased protein will be associated with decreased energy intake
(“protein leverage”), but (iii) when protein seeking results in consump-
tion of umami-flavored (savory) low-protein snack foods (the “protein
decoy effect”) increased energy intake will be associated with alcohol
consumption.
MATERIALS AND METHODS: We used proportions-based nutritional
geometry and mixture models to test these in participants which were
measured with one 24-h recall in the Australian National Nutrition
and Physical Activity Survey (n = 9341 adults).
RESULTS: Alcohol intake varied by macronutrient intake and peak
alcohol intake clustered in two macronutrient regions dependent on
food selected when alcohol is consumed—one where protein (%E)

SUPPLEMENT ARTICLE
was moderate and fat (%E) attributed to higher intake of known “pro-
tein decoys” including snack foods and processed meats and total
energy intake was higher than the estimated energy requirements
(EER) for the survey population, and another where protein (%E) was
high, and carbohydrate and fat (%E) were low and foods selected
included lean meats, poultry, fish, seafood, nuts, and legumes and
energy intake was below the EER. A third peak in alcohol was associ-
ated with spirits and energy from added beverages that low in protein
and fat but high in carbohydrate and energy intake.
CONCLUSION: This indicates that the energy from alcohol energy is
compensated for by increasing protein but when consumed with
ultra-processed foods, leads to higher energy consumption. In the
context of a higher protein (%E), dietary patterns included whole
foods and alcohol is not a risk factor for energy overconsumption.
This provides evidence that FGF-21 regulates intake of protein when
alcohol is consumed and has a differential effect on energy intake
dependent on macronutrient composition of the diet. These results
imply a causal role for protein in regulating overall energy intake when
alcohol is consumed.
CONFLICT OF INTEREST: A. Grech Grant/Research support with
NHMRC; S. Simpson Grant/Research support with NHMRC;
D. Raubenheimer Grant/Research support with NHMRC.
P050 | Food reformulation in Brazil ahead of
the implementation of new front-of-package
nutrition labeling regulations
A. C. Duran
Center for Food Studies and Research, University of Campinas, Campinas,
Brazil
INTRODUCTION: Ultra-processed food consumption and poorer die-
tary nutrient profile of foods and beverages are among the main
determinants of obesity. This study aimed to assess changes in nutri-
ent content and in the number of food additives added to packaged
foods and beverages launched in Brazil over the last two decades.
Our findings will provide evidence on reformulation ahead of the
implementation of the front-of-package nutrition label (FOPNL) in
Brazil.
MATERIALS AND METHODS: We used commercial data from
33,837 unique packaged foods and beverages that have been re-
launched at least one time in the Brazilian food supply over the years
of 2001 and 2021 provided by the Mintel Global New Products Data-
base. We excluded all baby formulas, foods and beverages that did
not have information of barcodes, list of ingredients and nutrition
composition. We ran year- and product-fixed effect models to verify
to what extent there have been changes in the content of total sugars
(in grams; g), saturated fat (g), sodium (mg), and in the number of food
additives in assessed foods and beverages.
RESULTS: One third of the products were changed over the course of
10 years two times or more. The proportion of foods and beverages
1467789x, 2022, S2, Downloaded from https://onlinelibrary.wiley.com/doi/10.1111/obr.13503 by CAPES, Wiley Online Library on [16/12/2023]. See the Terms and Conditions (https://onlinelibrary.wiley.com/terms-and-conditions) on Wiley Online Library for rules of use; OA articles are governed by the applicable Creative Commons License
25 of 222
with 7–10 additives significantly increased from 5.2% to 16.4%,
where those with more than 11 additives increased by 12-fold (0.9%
to 12.5%). We did not observe changes in the content of sodium satu-
rated fat and sugar.
CONCLUSION: We did not observe reformulation in the content of
nutrients of concern to public health and obesity, but significant
changes in the proportion of foods with additives.
CONFLICT OF INTEREST: None declared.
P051 | How improvements in the
measurement of children's eating behaviors
can lead to better outcomes for obesity: Four
key recommendations
C. G. Russell1; A. Burnett2; J. Lee1; A. Russell3; E. Jansen4
1
Institute for Physical Activity and Nutrition (IPAN), School of Exercise
and Nutrition Sciences, Burwood, Victoria, Australia; 2School of Exercise
and Nutrition Sciences, Deakin University, Melbourne, Victoria, Australia;
3
College of Education, Psychology and Social work, Flinders University,
Adelaide, South Australia, Australia; 4Division of Child & Adolescent
Psychiatry, Department of Psychiatry & Behavioral Sciences, Johns
Hopkins University School of Medicine, Baltimore, Maryland, USA
INTRODUCTION: Research on children's eating and weight has
expanded rapidly over recent decades, with momentum toward trans-
lating findings into prevention and intervention programs. However,
measurement has not kept pace, and this has hindered our capacity to
understand and influence children's eating behaviors, especially when
programs cross child developmental periods. Measurement weak-
nesses have at least two consequences for child obesity programs:
they limit their design by impacting knowledge about the eating
behavior that is being targeted and they affect the capacity to mea-
sure changes in children's eating behaviors due to the programs. Here,
our purpose is to provide an overview of key challenges in measuring
children's eating behaviors and recommend strategies to advance their
measurement.
MATERIALS AND METHODS: Drawing on insight from parallel issues
that occur in the measurement of early social and emotional develop-
ment, we reviewed the literature on two overlapping themes in chil-
dren's (aged 0–12 years) eating behaviors: (1) measurement issues
related to reliability and validity and (2) associated methodological
challenges.
RESULTS: Four key recommendations emerged: (1) Identify or
develop fit-for-purpose valid and reliable measures and methods that
are developmentally focused, age-appropriate, and suitable for use in
different populations. (2) Consider and measure contextual influences
to progress understanding of stability and change of eating behaviors
and the role of different contexts in the expression of eating behav-
iors. (3) Conduct research about the measurement consequences of
differences in laboratory-based procedures and questionnaire

26 of 222
measures. (4) Utilize multi-informant, multi-method, multi-variable
designs, and levels of analysis.
CONCLUSION: Measuring eating behaviors across different popula-
tions, contexts, time, and development is challenging. However, it is
essential that measurement of children's eating behaviors is pro-
gressed to provide valid, reliable information on these behaviors and
their development, in different populations. This will provide knowl-
edge that is fundamental to progress conceptual and theoretical
understanding of children's eating behaviors and enable better target-
ing and evaluation of obesity programs that aim to influence eating
behaviors.
CONFLICT OF INTEREST: None declared.
P052 | A repeat cross-sectional analysis of
neighborhood food retail environments and
body mass index in Greater Melbourne,
Australia
1 2 1
C. J. Needham ; L. Orellana ; S. Allender ; C. Strugnell 1
1
Health and Social Development; 2Office of the Exec Dean Health,
Deakin University, Geelong, Victoria, Australia
INTRODUCTION: The food retail environment, which relates to the
access and availability of food resources within neighborhoods, is a
key area for intervention to support healthy diet and reduce preva-
lence of people with obesity. However, evidence supporting the rela-
tionship between the food environment and obesity is mixed due to
key research limitations: (1) There is no consensus regarding which
food outlet type is the most influential on diet and health, and as a
result, measures of the food environment are heterogeneous and
often limited to measures of one food outlet type and (2) the majority
of research that examines the food environment measures only a sin-
gle time point, limiting the ability to understand the direction and tem-
poral consistency of the relationship between the food environment
and health. This study aimed to further the current evidence by exam-
ining the mean body mass index (BMI) of residents with different den-
sities of Supermarkets, Healthy, Unhealthy, and total outlets within
their residential postcode over an eight-year period.
MATERIALS AND METHODS: A census of food outlets in 2008,
2012, 2014, and 2016 was used to quantify the food retail environ-
ment in 31 Local Government Areas in Greater Melbourne, Australia.
The density of food outlets per km2 was calculated for each postcode
and linked to the Victorian Population Health Survey (≥18 years of
age) for the corresponding years. Linear mixed models were used to
explore the relationship over time between BMI and density of
(1) Supermarkets, (2) Healthy outlets, (3) Unhealthy outlets, and (4) a
combined measures of all food outlet types.
RESULTS: Mean BMI of residents with low access to Supermarkets
2
and Healthy food outlets increased by up to 0.69 and 0.73 kg/m
respectively; and for those with Moderate access to Healthy food
outlets by 0.53 kg/m2. BMI of participants across all levels of access
1467789x, 2022, S2, Downloaded from https://onlinelibrary.wiley.com/doi/10.1111/obr.13503 by CAPES, Wiley Online Library on [16/12/2023]. See the Terms and Conditions (https://onlinelibrary.wiley.com/terms-and-conditions) on Wiley Online Library for rules of use; OA articles are governed by the applicable Creative Commons License
SUPPLEMENT ARTICLE
to Unhealthy outlets increased over time by up to 0.85 kg/m2. Low
access to Supermarkets was associated with higher mean BMI than
those with better access. For Healthy outlets the mean BMI of par-
ticipants living in areas with low access was significantly higher and
the contrast increased over time when compared to those with high
access by 0.51–0.81 kg/m2; as did the mean BMI of those with
Moderate access to Unhealthy outlets by 0.36–0.68 kg/m2. Using a
combined measure of all outlets, postcodes with high access to food
outlets were generally associated with a lower BMI by 0.69–
1.17 kg/m2.
CONCLUSION: This study confirmed that a consistent relationship
exists between aspects of the food retail environment and mean BMI
of residents in Melbourne. It was evident that a higher density of food
outlets, particularly healthy food outlets, was associated with
lower BMI.
CONFLICT OF INTEREST: None declared.
P054 | Pacific Islands Families study: Food
insecurity in pregnancy presages in
adolescence obesity in girls and metabolic
risk in boys
E. Rush1; E.-S. Tautolo2; L. D. Plank3
1
Health & Environmental Sciences; 2Pacific Health Research Centre & PIF
Study, Auckland University of Technology, Auckland, New Zealand;
3
Department of Surgery, University of Auckland, Auckland, New Zealand
INTRODUCTION: Obesity is a recognized form of malnutrition. What
is less well recognized are the interrelationships between food insecu-
rity, inequities, body mass accretion, and metabolic risk across the life-
course. The Pacific Islands Families (PIF) study is a birth cohort of
Pacific children born in Auckland New Zealand in the year 2000. Pre-
viously, we have shown for 14-year-old boys but not girls food inse-
curity during gestation was associated with decreased appendicular
skeletal muscle mass and increased fat mass. Here we test the
hypothesis that food insecurity is associated with obesity as defined
by the International Obesity Task force and metabolic syndrome fac-
tors for adolescents as defined by the International Diabetes
Federation.
MATERIALS AND METHODS: In the year 2000, 1376 Pacific mothers
of 6-week-old infants were asked seven questions about food security
over the last year. Out of a possible score of 14 (0 never, 1 sometimes,
and 2 often) those with a score of ≥4 were categorized as food inse-
cure. At age 14 years, 931 youth had height and weight measured. A
nested sub-sample (n = 204) was formed by randomly selecting
10 males and 10 females from each of 10 deciles of weight as deter-
mined at age 11 years. Height, weight, and waist circumference were
measured as well as resting blood pressure by sphygmomanometry
and biomarkers of metabolic risk from a fasting blood sample to allow
determination of the five metabolic syndrome factors: waist, triglycer-
ides, HDL-C, blood pressure, and glucose.

SUPPLEMENT ARTICLE
RESULTS: Of the 931 youth, 42% were obese at age 14 years and
31% were food insecure during gestation. Separately by gender girls
(n = 100) were 1.88-fold (95% CI 1.26, 2.79, p < 0.001) more likely to
be classified as obese if food insecure. For boys there was no associa-
tion. In the subsample, 36% of girls and 65% of boys had at least one
risk factor for metabolic syndrome, 67% girls and 79% of boys were
born into food secure households yet boys were 2.88-fold (0.89, 9.2
p = 0.054) more likely to have a metabolic risk factor if food insecure
but for girls there was no association with metabolic risk factors.
CONCLUSION: The associations of food insecurity early in life with
body composition and metabolic risk in adolescence differ by gender
and are a public health concern exacerbated by inequities in food
access and the effects of climate change and Covid19 on the global
food supply.
CONFLICT OF INTEREST: None declared.
P055 | The relationship between vitamin B1
deficiency and increasing abdominal fat ratio
in Iranian female
F. Berahmandpour
Nutrition and Health Promotion Center, Tehran, Islamic Republic of Iran
INTRODUCTION: In a simple definition, abdominal fat ratio (AFR) is a
simple ratio that illustrate the relationship between anterior abdomi-
nal wall fat and intra-abdominal fat. There are several factors that can
increase AFR in male and female. However, the majority of studies
have showed that the increasing AFR is more popular in female than
male. Some researchers argue that the situation of vitamin B1 intake
is related to the AFR status.
The aim of study is to investigate the relationship between vita-
min B1 storage of body and the situation of ratio abdominal fat in
Iranian woman age between 22 and 72.
MATERIALS AND METHODS: The study was a cross-sectional study.
The magnetic resonance analyzer (MRA) was the assessment method
to detect the situation of Vitamin B1 and AFR. The study was done
during 2016 to 2022. The participants were 125 females who lived in
Tehran/Iran. The participants were selected from 2051 people who
were assessed by MRA. The sampling method was random sampling.
The age of participants was 22–72.
RESULTS: The results show that 50% of participants with Vitamin B1
deficiency had AFR more than standards. The majority of the partici-
pants with vitamin B1 deficiency were 20–33 years old. Vitamin B1 is
an essential factor in cell-metabolism and low intake of Vitamin B1
can be effective factor to low rest metabolic rate and increasing vis-
ceral fat in waist and hips in women. Food recall survey show that
refined carbohydrate consumption (especially bread and rice) is the
most reason that is related to vitamin B1 deficiency among participa-
tion with high AFR.
Therefore, increasing the intake of Vitamin B1 can be a solution
for decreasing AFR. However, the study show that intake of vitamin
1467789x, 2022, S2, Downloaded from https://onlinelibrary.wiley.com/doi/10.1111/obr.13503 by CAPES, Wiley Online Library on [16/12/2023]. See the Terms and Conditions (https://onlinelibrary.wiley.com/terms-and-conditions) on Wiley Online Library for rules of use; OA articles are governed by the applicable Creative Commons License
27 of 222
B1 supplements cannot improve the problem, and it is needed that
the natural vitamin B1 is used from natural food.
The participants used the high fiber diet during 8 weeks and the
assessments (by MRA every 4 weeks) were showed that the Vitamin
B1 deficiency was improving and AFR was decreasing.
CONCLUSION: High refined carbohydrate consumption in long time
can be related to vitamin B1 deficiency. Vitamin B1 deficiency can be
an indirect factor to increasing AFR in women. Therefore, dietitians
recommend that high fiber diet, whole bread and brown rice in diet
can be a good solution to control of AFR in women.
CONFLICT OF INTEREST: None declared.
P058 | Comparison of sedentary behavior
and physical activity level based on body
weight status among female adolescence
A. Ahmad Bahathig1,2; H. Abu Saad1; N. Shukri3; N. Md Yusof3;
E.-D. MME2,4
1
Department of Nutrition, Faculty of Medicine and Health Sciences,
Universiti Putra Malaysia, Serdang, Malaysia; 2Department of Nutrition
and Food Science, College of Home Economics, Northern Border
University, Arar, Saudi Arabia; 3Faculty of Medicine and Health Sciences,
Universiti Putra Malaysia, Serdang, Malaysia; 4Department of Nutrition
and Food Science, Faculty of Home Economics, Helwan University, Cairo,
Egypt
INTRODUCTION: The aim of this study was to compare the seden-
tary behavior (SB) and physical activity (PA) level of the adolescence
based on their body weight status.
MATERIALS AND METHODS: A total of 399 female adolescence
aged 13–14 years old were selected randomly from four public inter-
mediate schools in Saudi Arabia. Weight, height, and waist circumfer-
ence (WC) were measured. Body mass index for age (BAZ) and waist
to height ratio (WHtR) were calculated based on standard formula. PA
and SB were assessed by using a validated questionnaire. Data were
analyzed by using SPSS software version 21. Mean, standard devia-
tion (SD), frequency, and percentage were determined. Chi-square
test and U Mann–Whitney test were used to determine the relation-
ship between variables.
RESULTS: Overall, the prevalence of physical inactivity among respon-
dents was high (88.5%). The percentage of respondents classified as
having low level of PA were higher among those with BAZ > +1 SD,
WC ≥ 72.3 cm, and WHtR ≥ 0.5 compared to those with BAZ ≤ +1
SD, WC < 72.3 cm, and WHt < 0.5, respectively. Whereas prevalence
of moderately active were higher among those with BAZ ≤ 1 SD,
WC < 72.3 cm, and WHtR < 0.5 compared to those with BAZ > +1
SD, WC ≥ 72.3 cm, and WHtR ≥ 0.5. But based on statistical analysis,
there was no significant association between PA status with all indica-
tors of body weight status (BAZ, WC, and WHtR; p > 0.05). About
90% of the respondents spending ≥4 h/day in SB daily. The percent-
age of respondents spending ≥4 h/day in SB on weekdays and

28 of 222
weekends were higher among those with BAZ > +1
WC ≥ 72.3 cm compared to those with BAZ ≤ +1 SD
WC < 72.3 cm, but the association was not statistically significant
(p > 0.05).
CONCLUSION: Based on assessment by using a validated question-
naire, this study showed high prevalence of SB and physical inactivity
among this group of population. Further research should be carried
out by using objective methods of assessment to assess SB and
PA. Health interventions program and promotion activities should be
implemented to reduce SB and increase PA among respondents of
this study.
CONFLICT OF INTEREST: None declared.
P059 | Meal patterns and its association with
obesity among children aged 7 to 12 years:
Findings from the South East Asian Nutrition
Survey Malaysia
S. T. Lee1; J. S. M. Chia2; G. S. Yeo1; J. E. Wong1; N. S. Safii1;
R. A. Talib1; M. J. Sameeha1; I. Khouw3; B. K. Poh1 on behalf of the
SEANUTS II Malaysia Study Group
1
Faculty of Health Sciences, Universiti Kebangsaan Malaysia, Kuala
Lumpur, Malaysia; 2School of Pharmacy, Management and Science
University, Shah Alam, Malaysia; 3FrieslandCampina, Amersfoort,
Netherlands
INTRODUCTION: Irregular meal pattern has been attributed as a risk
factor for the rising prevalence of childhood obesity. The objective of
the present study is to examine the association between meal intake
frequencies and prevalence of obesity among primary school children
in Malaysia.
MATERIALS AND METHODS: Children aged 7 to 12 years who are
attending primary schools in urban and rural areas of Central, North-
ern, East Coast, and Southern regions of Peninsular Malaysia were
recruited as participants of the South East Asian Nutrition Survey
(SEANUTS II) in Malaysia. A total of 1077 primary school children
(51.7% boys) participated in this study, representing 1.73 million chil-
dren aged 7 to 12 years old from Peninsular Malaysia. Body weight
and height were measured; body mass index (BMI), and BMI-for-age
(BAZ) were calculated. Meal intake frequency was assessed using a
Child Food Habit Questionnaire to obtain the children's habitual eat-
ing pattern.
RESULTS: The overall prevalence of overweight and obesity among
Malaysian primary school children was 15.5% and 14.3%, respectively.
No more than 54.9% of primary school children consumed breakfast
daily, while 74.4% and 72.5% of children consumed daily lunch and
dinner, respectively. Overall, only half (51.8%) of children consumed
three main meals every day. Sociodemographic factors, including age,
ethnicity, sex, income level, and area of residence were significantly
associated with daily meal consumption (p < 0.05). Daily intake of
breakfast and lunch distribution between both genders were
1467789x, 2022, S2, Downloaded from https://onlinelibrary.wiley.com/doi/10.1111/obr.13503 by CAPES, Wiley Online Library on [16/12/2023]. See the Terms and Conditions (https://onlinelibrary.wiley.com/terms-and-conditions) on Wiley Online Library for rules of use; OA articles are governed by the applicable Creative Commons License
SUPPLEMENT ARTICLE
SD, approximately the same, whereas higher proportion of boys (77.6%)
and consumed dinner daily as compared to girls (67.0%) (p < 0.01). Chil-
dren who reside in urban locations had higher meal intake frequencies
(breakfast: 57.3%; lunch: 76.1; dinner: 76.3%) than those residing in
rural locations (breakfast: 48.2%; lunch: 69.9; dinner: 61.9%). A lower
percentage of older children (10.0–12.9 years old) consumed break-
fast, lunch, or dinner daily as compared to younger children (7.0–
9.9 years old). Children who did not consume breakfast (OR: 1.73;
95%CI: 1.11–2.71) or dinner (OR: 1.87; 95%CI: 1.11–3.12) on a daily
basis were more likely to be obese. On the other hand, children who
did not consume lunch daily were less likely to be obese compared to
their counterparts who did (OR: 0.53; 95% CI: 0.30–0.96).
CONCLUSION: In conclusion, children who skip breakfast or dinner
are more likely to be obese. Intervention programs and knowledge
dissemination on the importance of regular meal consumption are
required to address this issue.
CONFLICT OF INTEREST: S. T. Lee: None declared; J. S. M. Chia:
none declared; G. S. Yeo: none declared; J. E. Wong: none declared;
N. S. Safii: none declared; R. A. Talib: none declared; M. J. Sameeha:
None declared; I. Khouw: Employee of FrieslandCampina; B. K. Poh:
Grant/Research support with FrieslandCampina.
P060 | Shaping primary school environments
for children to learn about and eat vegetables
and fruit: A whole-of-school program
L. K. Chai1; M. Dick1; C. Morrison1; A. Cleary2; M. Robinson2;
L. McDaid2
1
Health and Wellbeing Queensland, Milton, Queensland, Australia;
2
Institute for Social Science Research, The University of Queensland,
Brisbane, Queensland, Australia
INTRODUCTION: One in four Australian children are living with over-
weight or obesity. Healthy eating habits shaped from a young age are
beneficial to having a healthy weight lifelong. National health surveys
show that only 6% of Australian children meet the dietary guidelines.
Less than 6% of Queensland children eat enough vegetables and 44%
have sugar sweetened beverages weekly. Alongside home, schools
play an important role in teaching children the knowledge and skills to
support healthy eating. This learning is reinforced when it occurs in
environments that enable healthy choices. The Pick of the Crop pro-
gram aims to support primary schools to create environments for chil-
dren to learn about and make healthy food and drink choices.
MATERIALS AND METHODS: The whole-of-school program was
underpinned by complex adaptive systems theory and used a co-
design approach to engage and support school level actions across
five areas: Farmer and Food Connections; Teaching and Learning Pro-
grams; Vegetables and Fruit at Schools; Healthy School Environments;
and Parent Connections. The program was implemented in
31 Queensland state primary schools in 2021. Data were collected
from teachers in 24 schools and three program coordinators via mixed

SUPPLEMENT ARTICLE
method surveys, interviews, and focus groups. Evaluation focused on
understanding the program's implementation and short-term impact
on four selected domains (policy, practice, networks, and mindsets)
embedded within an evaluation framework. The Most Significant
Change method was used to interpret case studies from schools to
understand staff perspectives on change.
RESULTS: Teachers reported improvement in student awareness
and knowledge of vegetables and fruit, and willingness to try them,
as well as teachers' knowledge on vegetables and fruit, and willing-
ness to integrate food and nutrition content in their lessons/
classroom practices. Improved availability of vegetables and fruit at
schools was achieved through school gardens, classroom snack ini-
tiatives, tuckshop reviews, connections with farmers, and food
growers. The flexible implementation model that allowed schools to
integrate program activities that meet their priorities was key to the
program's success. Lack of time and resources were barriers to
implementation.
CONCLUSION: Small changes led by schools can have big impacts
with higher chance of being sustainable. The program is feasible and
valued by school communities to improve healthy food and drink
choices in complex school environments. Each schools' unique circum-
stances resulted in different strategies to promote vegetables and
fruit. Further evaluation is needed in a larger sample and to under-
stand the long-term impact and sustainability of the program beyond
the intervention period.
CONFLICT OF INTEREST: None declared.
P061 | The profiling of diet and physical
activity in reproductive-aged women and
their association with body mass index
1 2 3 4
M. A. Awoke ; T. P. Wycherley ; A. Earnest ; H. Skouteris ;
L. J. Moran1
1
Monash Centre for Health Research and Implementation, Monash
University, Melbourne, Victoria, Australia; 2Alliance for Research in
Exercise, Nutrition and Activity, University of South Australia, Adelaide,
South Australia, Australia; 3Epidemiology and Preventive Medicine,
School of Public Health and Preventive Medicine, Melbourne, Victoria,
Australia; 4Health and Social Care Unit, School of Public Health and
Preventive Medicine, Monash University, Melbourne, Victoria, Australia
INTRODUCTION: Pre-pregnancy, pregnancy, and postpartum are key
reproductive life stages in women associated with higher future obe-
sity risk. However, the sociodemographic groups of these women at
highest risk for suboptimal lifestyle behaviors and the core lifestyle
components associated with excess adiposity are unclear. This study
sought to identify subgroups of women who meet diet and physical
activity (PA) recommendations in relation to sociodemographic char-
acteristics and to assess diet and PA components associated with
body mass index (BMI) across these life stages.
1467789x, 2022, S2, Downloaded from https://onlinelibrary.wiley.com/doi/10.1111/obr.13503 by CAPES, Wiley Online Library on [16/12/2023]. See the Terms and Conditions (https://onlinelibrary.wiley.com/terms-and-conditions) on Wiley Online Library for rules of use; OA articles are governed by the applicable Creative Commons License
29 of 222
MATERIALS AND METHODS: Cross-sectional data from the National
Nutrition and Physical Activity Survey 2011–2012 were analyzed for
women at pre-pregnancy, pregnancy, and postpartum.
RESULTS: Women did not adhere to population diet and PA recom-
mendations at all life stages. Intake of grains/cereals, discretionary
foods, and PA differed by country of birth, education, and socio-
economic disadvantage in pre-pregnant women. For postpartum
women, intake of vegetables and fruit, and grains/cereals and discre-
tionary foods were associated with education, country of birth,
employment, and PA was associated with education and socio-
economic disadvantage. In pre-pregnant women, BMI was inversely
associated with higher whole grain intake (β = 1.58, 95% CI 2.96,
0.21; P = 0.025) and energy from alcohol (β = 0.08, 0.14,
0.005; P = 0.035). In postpartum women, BMI was inversely associ-
ated with increased fiber intake (β = 0.06, 95% CI 0.11, 0.004;
P = 0.034) and PA (β = 0.002, 95% CI 0.004, 0.001; P = 0.013).
CONCLUSION: Diet and PA were suboptimal across reproductive life
stages and differed based on country of birth and sociodemographic
factors. Whole grains, fiber, and PA were most strongly associated
with BMI in these women.
CONFLICT OF INTEREST: None declared.
P062 | Adherence of Mediterranean diet
among individuals with type 2 diabetes
mellitus
N. S. Alaufi1; Y. M. Chan1; Y. S. Chin1; N. Ahmad2;
B. N. Mohd Yusof1; M. Waly3; N. Al Busaidi4; S. Al Shereiqi4;
K. Al Amri4; F. Al Bulushi4; S. Al Bulushi4
1
Department of Dietetics; 2Department of Community Health, Universiti
Putra Malaysia, Serdang, Malaysia; 3Department of Food Science and
Nutrition, Sultan Qaboos University, Muscat, Oman; 4National Diabetic
and Endocrine Center, Muscat, Oman
INTRODUCTION: This paper presented the baseline data of a ran-
domized controlled trial aimed to determine the effectiveness of
Mediterranean Diet intervention on glycemic control and cardiovas-
cular risks among individual with type 2 diabetes mellitus (T2DM)
in Oman.
MATERIALS AND METHODS: A total of 134 eligible individual with
T2DM were recruited from National Diabetic and Endocrine Center
(NDEC), Royal Hospital Muscat, Oman. Fasting blood was withdrawn
by qualified nurses and analyzed for cardiovascular parameters while
anthropometric parameters and blood pressure were assessed using
standard protocols. Adherence to the Mediterranean diet was
assessed by using a validated self-administered questionnaire. All data
were analyzed using SPSS.
RESULTS: Means weight, height and body mass index of the subjects
were 113.3 ± 23.8 kg, 162.2 ± 8.9 cm, and 43.0 ± 7.9 kg/m2, respec-
tively. Approximately two-thirds (65.1%) were either severely or mor-
bid obese while 8 in 10 were abdominally obese. Mean MedDiet

30 of 222
score of the subjects was 4.33 ± 1.93. While approximately three-
quarters of the subjects had poor adherence to Mediterranean diet,
only less than 2% adhered to Mediterranean Diet. Specifically, adher-
ence was relatively higher for chicken, turkey, or rabbit meat (0.84
± 0.37), red meat or meat products (0.52 ± 0.50), and legumes (0.51
± 0.50). On the other hand, subjects had poor adherence for fruits
(0.42 ± 0.50), vegetables (0.21 ± 0.41), wine (0.06 ± 0.23), nuts (0.02
± 0.15), and olive oil (0.14 ± 0.35), which are the important food
groups to promote healthy eating in the Mediterranean dietary pat-
tern approach.
CONCLUSION: Adherence to Mediterranean Diet was poor among
individuals with diabetes who were overweight and obese in Oman.
While Mediterranean Dietary Pattern is evident for its effectiveness
on weight management, relevant intervention studies are warrant in
non-Mediterranean countries like Oman.
CONFLICT OF INTEREST: None declared.
P063 | Nutrition-related outcomes of baby-
led compared to parent-led weaning in
infants aged 6 month to 2 years: A scoping
review
N. Hudson 1,2,3 1,2,3,4,5
; A. Hall 1,2,3,4,5
; K. O'Brien
; C. Gardner ;
1
J. Pinfold ; R. Sutherland 1,2,3,4,5
1
Hunter New England Population Health, Wallsend, Newcastle, New
South Wales, Australia; 2Hunter Medical Research Institute, Lambton,
Newcastle, New South Wales, Australia; 3School of Medicine and Public
4 5
Health; Priority Research Centre for Health Behaviour; National Centre
for Implementation Science, University of Newcastle, Callaghan,
Newcastle, New South Wales, Australia
INTRODUCTION: Infant feeding impacts on children's growth, and
the development of future health conditions, including obesity. Some
research suggests the emerging practice of baby-led weaning (BLW)
may be an alternative method to parent-led weaning (PLW). However,
current national and international guidelines do not provide recom-
mendations that support BLW. Methods used in BLW research have
been largely inconsistent. The aim of this scoping review was to exam-
ine current methodologies used to compare BLW to PLW. Developing
an understanding of study designs and nutrition-related measures
used in current research, will inform the synthesis of future evidence-
based guidelines.
MATERIALS AND METHODS: Four electronic databases were
searched to identify peer-reviewed studies, published in English, from
January 2013 to September 2021, which assessed infant-specific
nutrition-related outcomes of BLW compared to PLW. Studies con-
ducted in OECD countries that recommend exclusive breastfeeding to
6 months, included data on full-term infants, reported outcomes
between 6 and 24 months, and did not specifically target underlying
health conditions, were considered eligible for this review.
1467789x, 2022, S2, Downloaded from https://onlinelibrary.wiley.com/doi/10.1111/obr.13503 by CAPES, Wiley Online Library on [16/12/2023]. See the Terms and Conditions (https://onlinelibrary.wiley.com/terms-and-conditions) on Wiley Online Library for rules of use; OA articles are governed by the applicable Creative Commons License
SUPPLEMENT ARTICLE
RESULTS: From 3224 articles identified, nine studies were included
(five cross-sectional, two prospective cohort, and two randomized
control trials). Fifty-six nutrient-related outcomes were identified and
categorized into foods, nutrients, biochemical and anthropometric
measures, and infant feeding behaviors. The most frequently used
data collection method to assess food and nutrients (n = 7) was 24-h
recall (n = 4), with some studies assessing intake (n = 3), while others
measured provision (n = 3). Fruits and vegetables (n = 5), added
sugars (n = 5), and iron (n = 5) were most frequently assessed. Stud-
ies reporting infant feeding behaviors (n = 5) most commonly used
the Child Eating Behaviours Questionnaire (n = 3). Variations were
observed in definitions of BLW, with inconsistencies across studies of
biochemical (n = 5) and anthropometric (n = 5) measures.
CONCLUSION: This review highlights inconsistencies in definitions,
methodologies, and outcomes of research comparing BLW to PLW,
making it difficult to synthesize the existing evidence. This scoping
review serves to better define these variations and move toward a
standardized approach to conducting research in this field that can
better inform practice.
CONFLICT OF INTEREST: None declared.
P064 | Fruit and vegetable acquisition and
3
supply in Solomon Islands: Identifying
opportunities for improved health outcomes
P. Farrell; Anne Marie Thow; Erica Reeve; Michael Sharp;
Tom Brewer; Jessica Bogard; Anna Farmery; Jillian Tutuo
The University of Sydney, Sydney, New South Wales, Australia
INTRODUCTION: Solomon Islands is in the midst of the nutrition
transition, and non-communicable diseases, overweight, and obesity
are rapidly increasing. Consuming the World Health Organization
recommended five serves of fruit and non-starchy vegetables (FNSV)
per day is important for preventing these conditions, which are plac-
ing significant burden on the Solomon Island health system. Yet FNSV
consumption is inadequate: on average FNSV consumption is less
than half of the recommended intake. There is a data gap in terms of
understanding how FNSV are acquired and distributed in
Solomon Islands.
MATERIALS AND METHODS: This study applies a consumption-
oriented approach and the High Level Panel of Experts food system
framework to analyze FNSV acquisition in the food environment, as
well as production, supply, and distribution in Solomon Islands. We
analyzed multiple datasets: household income and expenditure survey
(household level acquisition and sociodemographic distribution), FAO-
Stat (production 1960–2018), Pacific Trade database (international
imports and exports 1995–2018), and market vendor survey data
from three provinces (retail and distribution). We overlaid our analysis
of these food system surveys and datasets with an analysis of
Solomon Islands government policies relevant to FNSV production
and supply, to identify priority policy focus points.

SUPPLEMENT ARTICLE
RESULTS: Acquisition and distribution: In urban areas, people are less
likely to consume the daily recommended amount than in rural areas.
Rural FNSV acquisition is mostly directly from gardens and planta-
tions. In urban areas FNSV are predominantly purchased with cash
from market vendors. Household income, price, and reliance on retail
are important access levers. The vast majority of produce sold by mar-
ket vendors in Auki and Gizo originates from the province of sale. Pro-
duce sold at Honiara Central Market mostly originates from the same
province (Guadalcanal), but produce from a combination of other
provinces is also sold in Honiara.
Production: Net FNSV production is increasing, but on a per
capita basis it is declining and the country is not producing enough for
each person to consume the recommended five serves per day.
Trade: Imports of fresh and frozen vegetables and fruit have been
increasing both at net rate and per capita rates, however, in terms of
per capita provision, imported FNSV continue to provide a negligible
proportion of the recommended daily amount to consume for good
health. Export quantities of FNSV were trivial.
CONCLUSION: Policy priority areas our integrated analysis identi-
fied included the following: (1) Technological development and
advancement for producers and manufacturers to promote effi-
cient, sustainable farming systems and (2) national and provincial
investment in transport, market infrastructure, warehousing, and
cold storage.
CONFLICT OF INTEREST: None declared.
P065 | A scoping review to understand the
influence of the digital food retail
environment on diet and health
R. Bennett1; M. Keeble2; C. Zorbas1; G. Sacks1; C. Driessen1;
L. Grigsby-Duffy1; J. Adams2; T. Burgoine2; K. Backholer1
1
Global Obesity Centre, Institute for Health Transformation, Deakin
2
University, Geelong, Victoria, Australia; University of Cambridge,
Cambridge, UK
INTRODUCTION: The digital food retail environment is an emerging
and poorly understood aspect of the wider food system. We aimed to
synthesize the literature on the potential influence of the digital food
retail environment on population diets and health.
MATERIALS AND METHODS: Six databases (across health, business,
and marketing) and gray literature were searched using terms relating
to “food and beverages,” “digital,” and “purchasing,” published before
February 2022. Studies were included if they examined any aspect of
the digital food retail environment (defined as a digital platform, app,
or website where food can be purchased by shoppers for personal
consumption) where outcomes were examined with a health-related
intent. This scoping review considered all study designs, including
quantitative, qualitative, observational, and experimental, but reviews
and conference abstracts were excluded.
1467789x, 2022, S2, Downloaded from https://onlinelibrary.wiley.com/doi/10.1111/obr.13503 by CAPES, Wiley Online Library on [16/12/2023]. See the Terms and Conditions (https://onlinelibrary.wiley.com/terms-and-conditions) on Wiley Online Library for rules of use; OA articles are governed by the applicable Creative Commons License
31 of 222
RESULTS: The scoping literature search identified 15,871 studies, of
which 547 were removed as duplicates. One hundred and two articles
were read in full and assessed against the inclusion and exclusion cri-
teria with 35 articles eligible for inclusion.
Of the 35 included studies, 21 examined online grocery retailers,
11 examined online food delivery platforms, and three examined meal
kit subscription services. Twenty-four of the 35 included studies used
cross-sectional methodology, three used longitudinal methodology,
four were randomized control trials, three were mixed method stud-
ies, and one was a content analysis qualitative study.
Of the 15 studies examining online grocery shoppers, four studies
found that customers believed they purchased fewer unhealthy food
and beverages when compared to shopping in-store. Despite this, cus-
tomers also perceived that their ability to choose healthy products
was reduced when shopping online due to more difficulty in compar-
ing products. Studies that examined online food delivery platforms
primarily found that they promoted unhealthy foods and beverages
more often than healthy options, through extensive use of marketing
tools such as price discounts and images, and that there is a high prev-
alence of unhealthy offerings on these platforms. Meal kit subscrip-
tion services provided mostly healthy meals, with studies suggesting
that they may help primary meal providers alleviate some of their
“mental load” and stress related to cooking family meals.
CONCLUSION: Further research is needed to understand the poten-
tial implications of the increasing popularity of the digital food retail
environment on population diets and health and on strategies to
improve the healthiness of purchases through online platforms, espe-
cially given the growing user base following the onset of the COVID-
19 pandemic.
CONFLICT OF INTEREST: None declared.
P066 | Decreased frequency of sugar
sweetened beverages intake among young
children probably linked to the
implementation of the health promotion levy
in South Africa
S. Kruger1,2; M. Monyeki3; T. Van Zyl1; R. Kruger2,4
1
Centre of Excellence for Nutrition, Potchefstroom, South Africa;
2
Medical Research Council Unit for Hypertension and Cardiovascular
Disease, Potchefstroom, South Africa; 3Physical Activity, Sport and
Recreation, Potchefstroom, South Africa; 4Hypertension in Africa
Research Team, North-West University, Potchefstroom, South Africa
INTRODUCTION: A health promotion levy was implemented on sugar
sweetened beverages (SSB) in South Africa in 2018 to decrease SSB
intakes and prevent obesity. This study aimed to assess the associa-
tion between baseline sociodemographic variables, body composition
and 4-year changes in intake from healthy and unhealthy food groups
including SSBs among children in the North West Province,
South Africa, after the implementation of a health promotion levy.

32 of 222
MATERIALS AND METHODS: In a prospective cohort study 1065
children aged 5–9 years were selected from 10 schools in 2017. Fre-
quency of intake from healthy (meat, milk, fruit, vegetables) and
unhealthy food groups (fast-food, SSB, hot sweet beverages, salty
snacks, candy, and cookies) was assessed. Height, weight and socio-
demographic information were collected. Body mass index (BMI) z-
scores were calculated. The health promotion levy was implemented
1 year after baseline. Follow-up measurements were performed after
4 years. Changes in frequencies of intakes were assessed using the
Wilcoxon test for paired data in subgroups of the participants based
on sociodemographic variables and BMI z-score.
RESULTS: At baseline most children had normal weight, while more
children were living with overweight/obesity (19.4%) than under-
weight (3.8%). The median frequency of intake from the meat (5–
6 days/week) and vegetable groups (3–4 days/week) did not change
from baseline. The intake frequency of most unhealthy foods (salty
snacks, candy 3–4 days/week, and the cookies group 1–2 days/week)
remained unchanged. The median frequency of SSB intake decreased
significantly from 5–6 to 3–4 days/week, but the frequency of milk
intakes also declined. Median intake frequency from the fast-food
group showed a trend of an increase, while staple foods were eaten
daily. Changes in frequency of intakes from the milk, fast-food and
SSB groups were not different between the income, parent education
level or BMI categories. The observed decreased frequency of intake
from SSBs could probably be linked to the implementation of the
health promotion levy after baseline, in line with reports of national
decreases in SSB sales in South Africa since 2017.
CONCLUSION: The decreased frequency of SSB intake across
income, education, and weight status groups could probably be linked
to the implementation of the health promotion levy in South Africa.
CONFLICT OF INTEREST: None declared.
P067 | Dietary beliefs and eating patterns in
type 2 diabetes: Evidence from South India
S. A. Valiyagath
Pathology, Al Iqbal Hospital, Thrissur, India
INTRODUCTION: Almost 15% of India's urban adult populace now
lives with type 2 diabetes. This study aimed to characterize the eating
patterns, knowledge, beliefs, and determinants of food choice, and
assess associations with the metabolic health among urban Asian
Indians with type 2 diabetes.
MATERIALS AND METHODS: A cross-sectional study of 258 individ-
2
uals (mean age 55.7 ± 10 years; body mass index 27.1 ± 4.8 kg/m ;
diabetes duration 10.1 ± 6.5 years) attending two out-patient clinics
in Calicut, Kerala, India. Food-related information was collected during
a semi-structured interview. Clinical, anthropometric, and biochemical
data were recorded.
RESULTS: Beliefs related to health and diabetes played a role deter-
mining food choice and dietary patterns; erroneous views were
1467789x, 2022, S2, Downloaded from https://onlinelibrary.wiley.com/doi/10.1111/obr.13503 by CAPES, Wiley Online Library on [16/12/2023]. See the Terms and Conditions (https://onlinelibrary.wiley.com/terms-and-conditions) on Wiley Online Library for rules of use; OA articles are governed by the applicable Creative Commons License
SUPPLEMENT ARTICLE
associated with the poor food choices and greater metabolic pertur-
bations. Average consumption of fruits/vegetables was low. Intakes
were positively associated with intentions to manage diabetes;
inversely associated with the waist circumference and negatively cor-
related with one's degree of personal responsibility for food choice.
Household saturated fat usage was common. High fat intakes were
positively associated with the taste preference, ratings of perceived
“health-value”; waist circumference, glycosylated hemoglobin per-
centage (HbA1c%), and lipids.
CONCLUSION: Strategies to enhance diabetes control among Asian
Indians are required and should encourage fruit/vegetable intake, per-
sonal accountability, and consider individual beliefs and preferences.
CONFLICT OF INTEREST: None declared.
P068 | Foods sold in the surroundings of
public and private schools in Kenya
S. W. Mugo1; C. Karugu1; M. Wanjohi1; V. Ojiambo2;
M. Holdsworth3; A. Laar4; S. Vandevijvere5; G. Asiki1
1
Health and Systems for Health Department, African Population Health
Research Center; 2Public and Global health, University of Nairobi,
Nairobi, Kenya; 3NUTRIPASS Unit: IRD-Univ, French National Research
Institute for Sustainable Development (IRD), Montpellier, France; 4Public
Health, University of Ghana, Accra, Ghana; 5Sciensano, Service of
lifestyle and chronic diseases, Brussels, Belgium
INTRODUCTION: Since children spend long periods in schools, the
availability of foods sold around schools can influence their eating
practices and potentially lead to obesity and non-communicable dis-
eases. We compared the types of foods sold around public and private
schools in Kenya to establish if there is a difference in the healthiness
of these foods by school type.
MATERIALS AND METHODS: This was a cross-sectional study con-
ducted in three Kenyan counties (Nairobi-urban, Mombasa-urban, and
Baringo-rural) from July 2021 to August 2021. Through a multi-stage
and population proportionate sampling, 500 schools were randomly
selected across Nairobi, Baringo and Mombasa counties, stratified into
private and public schools and by level (primary, n = 257; secondary,
n = 101; and mixed secondary and primary n = 142). We used the
INFORMAS outdoor retailing protocol to map food outlets around
schools within a 250-m radius. The NOVA classification was used to
classify the healthiness of food sold into unprocessed or minimally
processed food, processed culinary ingredients, processed foods, and
ultra-processed foods. We compared the proportion of foods sold
by healthiness in private and public schools using a Pearson chi
square test.
RESULTS: As shown in Table 1, unprocessed/minimally processed
foods are the most commonly sold foods in all schools regardless of
type. However, ultra-processed and processed (unhealthy foods) are
mainly sold around public schools (primary and secondary) at 30.4%
 1467789x, 2022, S2, Downloaded from https://onlinelibrary.wiley.com/doi/10.1111/obr.13503 by CAPES, Wiley Online Library on [16/12/2023]. See the Terms and Conditions (https://onlinelibrary.wiley.com/terms-and-conditions) on Wiley Online Library for rules of use; OA articles are governed by the applicable Creative Commons License
SUPPLEMENT ARTICLE 33 of 222

TABLE 1 Healthiness of foods using the NOVA classification by school type

Unprocessed or minimally Processed culinary Ultra-

Processed processed ingredients processed
School type n (%) n (%) n (%) n (%)
Primary (Private) 148 (2.3%) 4553 (70.8%) 48 (0.8%) 1678 (26.1%)
Primary (Public) 157 (5.2%) 1938 (63.9%) 19 (0.6%) 921 (30.4%)
Secondary (Private) 55 (2.3%) 1784 (73.1%) 13 (0.5%) 590 (24.2%)
Secondary (Public) 68 (3.3%) 1430 (69.1%) 10 (0.5%) 561 (27.1%)
Mixed secondary and primary schools 95 (1.5%) 4799 (75.9%) 60 (1.0.%) 1371 (21.7%)
(Private)
Mixed schools secondary and primary 42 (2.7%) 1153 (73.3%) 16 (1.0%) 362 (23.0%)
(Public)

and 27.1% for ultra-processed and processed at 5.2% and 3.3%
respectively(p = 0.000,<0.005).
CONCLUSION: These findings highlight the availability of healthier
food options sold around both private and public schools. However
substantial amount of unhealthy foods are sold around public schools.
There is a need to institute regulatory measures to limit the sale of
unhealthy foods around schools in Kenya.
CONFLICT OF INTEREST: None declared.
P070 | Sugar labeling in Brazil: Will the new
food labeling regulation help to reduce the
sugar overconsuming in the country?
T. Scapin
Nutrition in Foodservice Research Centre (Núcleo de Pesquisa de
Nutrição em Producão de Refeições, NUPPRE), Universidade Federal de
Santa Catarina, Florianopolis, Brazil
INTRODUCTION: Brazil is the world's second-largest producer and
fourth-largest consumer of sugars, with 64% of the adult population
eating more free sugar than recommended by the World Health
Organization. Packaged foods are the main source of sugar intake
as 71% of the packaged food available for sale at supermarkets has
at least one type of sugar ingredient added to their composition.
The Brazilian National Health Surveillance Agency (ANVISA) began
debating the implementation of a sugar label format in 2014, with
the final changes published in 2020 to be enforced in October
2022. The changes include food manufacturers declaring the total
and added sugar contents of their products in the nutritional
information panel (NIP) on the back of the pack and displaying a
front-of-package (FOP) magnifying shaped warning for “high-in-
sugar” products. This study aimed to assess how the changes in
sugar labeling in Brazil can help individuals avoid high-in-sugar pack-
aged foods.
MATERIALS AND METHODS: Four sugar label formats were tested
in a five-arm study on 1277 adults via a randomized controlled online
survey. The formats were (i) no sugar information—control, (ii) total
and added sugar content displayed in the NIP, (iii) the FOP magnifying
glass warning for “high-in-sugar” products, (iv) a front-of-package
(FOP) octagonal warning for “high-in-sugar” products similar to the
one applied in other Latin American countries, and (v) a “high-in-
sugar” warning text embedded on the NIP. Participants understanding
of the sugar content of three tested packaged foods and their inten-
tion of purchase behavior were assessed.
RESULTS: All intervention sugar formats improved participants'
understanding of the sugar content of the tested food products, with
the FOP warning formats (iii and iv) showing the best results. While
non-significant differences among label conditions were observed for
the intent of purchase outcome, the FOP octagonal warning
prompted participants to choose high-in-sugar products less often.
Participants also reported the FOP octagonal warning format as the
most useful and easy to understand.
CONCLUSION: Given current public policy agendas aiming to reduce
added sugar intake, there is a need to strengthen food labeling policies
that target the display of added sugar and build consumer awareness
in using these tools to avoid high-in-sugar products. Brazil's recently
approved sugar labeling format is not aligned with the label formats
implemented in other Latin American countries. Neither seems to be
the most useful format to help consumers reduce their choices of
high-in-sugar products.
CONFLICT OF INTEREST: None declared.
P071 | Breastfeeding and infant feeding
practices, and utilization of Child and Family
Health Nursing services for infant feeding
support: A cross-sectional study
T. Delaney1,2; L. Wolfenden1,2; N. Hudson1; P. Craven1; M. Hayes1;
S. Redman1; S. Young2; J. Wiggers1,2; D. Groombridge1;
R. Sutherland1,2
1
Hunter New England Local Health District, New Lambton, New South
Wales, Australia; 2University of Newcastle, Wallsend, New South Wales,
Australia

34 of 222
INTRODUCTION: Evidence-based infant feeding guidelines recom-
mend infants be exclusively breastfed to 6 months. While Child
and Family Health Nursing services (CFHN) have the capacity to
support to families to establish best practice infant feeding
behaviors, little is known about whether women access CFHN for
infant feeding support and if the provision of support would be
acceptable via technology based modalities. As such, the aim of
this study was to (i) describe women's infant feeding practices;
(ii) the proportion of women accessing CFHN for infant feeding
support; and (iii) the acceptability of technology based CFHN
support.
MATERIALS AND METHODS: Telephone surveys were conducted
between September and November 2021 with 357 women who
had given birth in the previous 6–8 months from public hospitals in
one local health district in Australia. Women were asked if they had
initiated breastfeeding; breastfed and provided their baby with
infant formula (in the last 24 h); provided their baby with solids
(yes/no); and the age their baby was first introduced solids (months).
Women were asked if they sought advice on breastfeeding/formula
feeding and introducing solid foods from CFHN (yes/no). Women
were asked to report on a Likert scale (strongly agree to strongly
disagree) on the acceptability of receiving CFHN support via tech-
nology (text message, website, telehealth, telephone, and email) and
by health topics (breastfeeding/formula feeding; growth checks/
immunization reminders; introducing solids; fussy eating; sleep;
development milestones; healthy growth; healthy eating; mental
health; social support; parent groups). Results are presented
descriptively.
RESULTS: Almost all women initiated breastfeeding (97.2%), of
these 62.8% had breastfed their baby in the last 24 h. The majority
of women (53.2%) had provided their baby with formula in the last
24 h. Of those that had introduced solids (98.0%), the mean age of
introduction was 5.3 months. Over 63% of women reported acces-
sing CFHN for breastfeeding or formula feeding advice and 36.1%
accessed CFHN for advice on solids. The majority of women
‘agreed/strongly agreed’ that receiving information from CFHN via
technology would be acceptable (range: 82.0%–91.9%) and across
a range of health topics (range: 89.5%–97.7%).
CONCLUSION: While guidelines suggest babies should be exclusively
breastfed to 6 months, the majority of babies had received solid
foods by this age. CFHN services are commonly accessed by women
for infant feeding support and interventions that utilize technology
based modalities are acceptable to women and warrant further
investigation.
CONFLICT OF INTEREST: None declared.
1467789x, 2022, S2, Downloaded from https://onlinelibrary.wiley.com/doi/10.1111/obr.13503 by CAPES, Wiley Online Library on [16/12/2023]. See the Terms and Conditions (https://onlinelibrary.wiley.com/terms-and-conditions) on Wiley Online Library for rules of use; OA articles are governed by the applicable Creative Commons License
SUPPLEMENT ARTICLE
P072 | The association between EAT-Lancet
Planetary Health Diet, body mass index, and
polygenic risk score for obesity in the Finnish
adult population
T. Suikki1; M. Maukonen1; N. Kaartinen1; H. Marjonen1;
A.-M. Pajari2; S. Männistö1 Leg4Life Project Consortium
1
Finnish Institute for Health and Welfare, Helsinki, Finland; 2University of
Helsinki, Helsinki, Finland
INTRODUCTION: The current environment with the easy availability
of energy-dense and palatable foods and possibilities to engage in
sedentary behaviors have created an ideal ground for obesity epi-
demic. Some people, however, are more susceptible to gain weight in
the obesogenic environment than others. At the same time the cur-
rent way we eat and produce food are also threatening environmental
sustainability. Therefore, the EAT-Lancet Commission has recently
launched the Planetary Health Diet (PHD) to consider both human
health and environmental aspects. Thus far, the association between
PHD and body mass index (BMI) has barely been studied, and espe-
cially the role of inheritance on this context. Therefore, we examined
the association between PHD and BMI and further evaluated whether
the association differs by the level of genetic susceptibility for
obesity.
MATERIALS AND METHODS: This cross-sectional study included
participants from the national FinHealth 2017 Study (n = 4377, aged
≥18 years, female 56%). A validated food frequency questionnaire
was used to assess the habitual diet. For assessing diet quality, we
developed an energy-standardized (2500 kcal) dietary index based on
the EAT-Lancet PHD adapted for the Nordic food culture, including
13 food and nutrient groups (score range 0–13 points). Genetic sus-
ceptibility for obesity was evaluated with polygenic risk score (PRS)
based on one million obesity associated single nucleotide polymor-
phisms (SNP) found from previous genome-wide association studies
(GWAS). Linear regression was used for the statistical analyses.
RESULTS: The mean PHD score for all participants was 4.0 (SD 1.5)
and the mean BMI 27.4 (SD 5.0). There was a positive association
between PRS and BMI (p < 0.001), but no association was found
between the PHD index and PRS (mean PHD score in the highest PRS
quartile 3.97 vs. 3.95 in the lowest quartile). There was a borderline
negative association between PHD and BMI (β 0.01 95% CI 0.02,
0.00). When the genetic susceptibility for obesity was considered, this
negative association was observed in two lowest quartiles of PRS
(lower susceptibility for obesity) (p < 0.05). Instead, the association
attenuated when the obesity associated PRS was higher.
CONCLUSION: The adherence to PHD was relatively low in Finnish
adult population which may have diluted the strength of our findings.
Our findings, however, suggested that individuals with lower genetic
susceptibility for obesity may benefit from the better adherence to a
healthy and sustainable diet in terms of weight maintenance.
CONFLICT OF INTEREST: T. Suikki Grant/Research support with:
Research related to this abstract was funded by the scholarship from

SUPPLEMENT ARTICLE
Juho Vainio Foundation, and the Strategic Research Council at the
Academy of Finland (grant numbers 327699 and 327698).
M. Maukonen: None declared. N. Kaartinen: None declared.
H. Marjonen: None declared. A.-M. Pajari: None declared.
S. Männistö: None declared.
P073 | Gut microbiota modulation of lipid
and immune response to fermented rye
intervention
W. Li1; Y. Liu1; R. Landberg2; K. Xue1; G. He1
1
School of public health, Fudan University, Shanghai, China; 2Department
of Biology and Biological Engineering, Chalmers University of Technology,
Gothenburg, Sweden
INTRODUCTION: Whole grain intervention has received increasing
attention in the treatment of cardiovascular disease and immune dis-
eases. However, the effects of whole grains on blood lipids and
inflammation are inconsistent, and the underlying mechanism is still to
be elucidated. In this study, we aimed to investigate the effects of
high-fiber whole grain foods with added fermented rye bran (FRB)
versus refined wheat (RW) on subjects with normal weight or obesity
who have low habitual consumption of high fiber cereal foods.
MATERIALS AND METHODS: A parallel dietary intervention was
conducted and 182 subjects with normal weight or obesity were ran-
domly assigned to FRB group or RW group for 12 weeks. Anthropo-
metric measurements, fasting blood sample collection, and gut
microbiota determination were performed at week 0, 6, and 12. Bac-
terial communities were measured by 16S rRNA sequencing and sig-
nificant species taxonomic features between week 12 and baseline
were identified by STAMP software with an effect size threshold of
1.0 and p value threshold of 0.05.
RESULTS:
1. Compared with the RW group, the FRB group had significantly
lower low-density lipoprotein cholesterol (LDL-C) levels and high-
sensitivity C-reactive protein (hs-CRP) after 12-week intervention.
No significant difference was found in total cholesterol (TC) and
triglyceride (TG) levels between the FRB and RW groups.
2. In the subjects with obesity, hs-CRP was significantly reduced in
the FRB group, while TC, LDL-C, and TG showed no significant
changes after 6- and 12-week intervention. In the subjects with
normal weight, TC, LDL-C, and TG levels were significantly
reduced in the FRB group at week 12, while hs-CRP remained
unchanged.
3. In the subjects with obesity, the relative abundance of Lachnospir-
aceae was significantly increased in the FRB group (LDA = 4.16),
and the Gammaproteobacteria (LDA = 3.66), Enterobacteriaceae
(LDA = 3.65), and Enterobacterales (LDA = 3.65) were signifi-
cantly increased in the RW group at week 12. In the subjects with
normal weight, the relative abundance of Lachnoclostridium was
1467789x, 2022, S2, Downloaded from https://onlinelibrary.wiley.com/doi/10.1111/obr.13503 by CAPES, Wiley Online Library on [16/12/2023]. See the Terms and Conditions (https://onlinelibrary.wiley.com/terms-and-conditions) on Wiley Online Library for rules of use; OA articles are governed by the applicable Creative Commons License
35 of 222
significantly increased in the FRB group (LDA = 3.78), while no gut
microbiota significantly changed in the RW group after 12-week
intervention.
CONCLUSION: Long-term intake of high-fiber whole grains contain-
ing fermented rye bran influenced lipid metabolism and inflammation.
In the subjects with obesity, the Lachnospiraceae with anti-
inflammatory features may be involved in alleviating inflammatory
response after rye intake, whereas the conditionally pathogenic bacte-
ria Enterobacterales increased and the inflammatory state was not
relieved after refined wheat intake. In the subjects with normal
weight, Lachnoclostridium may be a mediator in the amelioration of
lipid metabolism and inflammation caused by rye intervention.
CONFLICT OF INTEREST: None declared.
P074 | A systematic review conceptualizing
settings with multiple, competitive food retail
outlets
A. Gupta1; D. Mann1; G. Sacks1; J. Gittelsohn2; A. Peeters1
1
Global Obesity Centre (GLOBE), Institute for Health Transformation,
Deakin University, Burwood, Victoria, Australia; 2Department of
International Health, Johns Hopkins Bloomberg School of Public Health,
Baltimore, Maryland, USA
INTRODUCTION: Food retail outlets are a critical interface through
which people interact with the broader food system. Emerging evi-
dence on efforts to create healthy food environments is largely
focused on single food retail outlets, such as supermarkets and restau-
rants. However, as these food retail outlets are often situated in close
proximity to one another, there has been limited exploration of ways
in which the characteristics of these more complex food environments
impact the healthiness of food purchases. Thus, this systematic review
aimed to (1) identify and describe the characteristics of the different
settings that include multiple, competitive food outlets and (2) synthe-
size the evidence on the impact of healthy food retail interventions in
such settings, including an exploration of barriers and facilitators to
change.
MATERIALS AND METHODS: A search strategy to identify studies
published up until June 2021, was applied to four databases namely,
Medline Complete, Global Health, Embase, and Business Source com-
plete. The Effective Public Health Practice Project tool was used to
assess risk of bias of eligible studies. Review findings were synthe-
sized narratively.
RESULTS: Eighteen studies met the inclusion criteria, of which three
studies were rated as moderate quality, while all the remaining studies
were evaluated as weak quality. Eleven studies were conducted in
university campus settings and seven in hospitals across multiple
high-income countries. The interventions implemented at cafeterias;
canteens, convenience stores within these settings included product,
place, profile, portion, pricing, promotion, healthy default picks,

36 of 222
priming or prompting, and proximity, either as a standalone strategy
or in combination with each other on healthy eating. Successful inter-
ventions were mostly a combination of marketing mix interventions
targeting both environmental and individual-level determinants of
healthy eating behaviors. Universities and hospitals were identified as
promising settings to implement healthy food retail interventions for
two reasons: 1. for their ability to reach a large and diverse cross-
section of the population from across the socio-demographic spec-
trum; and 2. these settings have a moral (and economic) obligation to
engage with health promoting efforts to support healthy choices.
However, with little to no governance, food retail outlets in such set-
tings are typically required to sustain competition with other nearby
food retail outlets and to maximize profit, thus presenting challenges
to implementing healthy food retail interventions.
CONCLUSION: More work is needed to understand how to enhance
uptake of healthy food retail interventions in settings with multiple
food outlets in close proximity.
CONFLICT OF INTEREST: None declared.
P075 | A scoping review of outdoor food
marketing: Exposure, power, and impacts on
eating behavior and health
A. Finlay1; E. Robinson1; A. Jones1; M. Maden2; C. Cerny3; M. Muc1;
R. Evans1; H. Makin1; E. Boyland1
1
Department of Psychology; 2Liverpool Reviews and Implementation
3
Group, University of Liverpool, Liverpool; Obesity Health Alliance,
London, UK
INTRODUCTION: There is convincing evidence that unhealthy food
marketing is extensive on television and in digital media, uses power-
ful persuasive techniques, and impacts dietary choices and consump-
tion, particularly in children. It is less clear whether this is also the
case for outdoor food marketing, in part because of a lack of evidence
synthesis. This lack of synthesis is likely a factor impeding policy pro-
gress in this area. This scoping review (i) identifies common criteria
used to define outdoor food marketing, (ii) summarizes research meth-
odologies used, (iii) identifies available evidence on the exposure,
power (i.e., persuasive creative strategies within marketing) and
impact of outdoor food marketing on behavior and health, and
(iv) identifies knowledge gaps and directions for future research.
MATERIALS AND METHODS: A systematic search was conducted of
Medline (Ovid), Scopus, Science Direct, Proquest, PsycINFO, CINAHL,
PubMed, the Cochrane Database of Systematic Reviews, the
Cochrane Central Register of Controlled Trials, and a number of gray
literature sources. Titles and abstracts were screened by one
researcher. Relevant full texts were independently checked by two
researchers against eligibility.
RESULTS: Fifty-three studies were conducted across 21 countries.
The majority of studies (n = 39) were conducted in high-income coun-
tries. All measured the extent of exposure to outdoor food marketing,
1467789x, 2022, S2, Downloaded from https://onlinelibrary.wiley.com/doi/10.1111/obr.13503 by CAPES, Wiley Online Library on [16/12/2023]. See the Terms and Conditions (https://onlinelibrary.wiley.com/terms-and-conditions) on Wiley Online Library for rules of use; OA articles are governed by the applicable Creative Commons License
SUPPLEMENT ARTICLE
12 also assessed power and three studies examined the impact on
behavioral or health outcomes. Criteria used to define outdoor food
marketing and methodologies adopted were highly variable across
studies. Almost a quarter of advertisements across all studies were for
food (mean of 22.1%) and the majority of advertised foods were
unhealthy (mean of 63%). The evidence on differences in exposure by
SES is heterogeneous, which makes it difficult to draw conclusions;
however, the research suggests that ethnic minority groups have a
higher likelihood of exposure to food advertising outdoors. The most
frequent persuasive strategies were premium offers and use of charac-
ters. There was limited evidence on the relationship between exposure
to outdoor food marketing and eating behavior or health outcomes.
CONCLUSION: This review highlights the extent of unhealthy out-
door food marketing globally and the powerful methods used within
this marketing. There is a need for consistency in defining and mea-
suring outdoor food marketing to enable comparison across time and
place. Future research should attempt to measure direct impacts on
behavior and health.
CONFLICT OF INTEREST: A. Finlay: None declared. E. Robinson
Grant/Research support with: ER has previously received research
funding from Unilever and the American Beverage Association for
unrelated research projects. A. Jones: None declared. M. Maden: None
declared. C. Cerny: None declared. M. Muc: None declared. R. Evans:
None declared. H. Makin: None declared. E. Boyland: None declared.
P076 | Regulation of infant and toddler
foods: Current state of play in Australia,
international recommendations and parents'
perceptions
A. Schmidtke1; C. Gascoyne2; R. Godwin2; Y. J. M. Chen2; M. Hoq3;
J. Martin1; M.-A. Measey4; B. Morley2; A. Rhodes5,6
1
Obesity Policy Coalition; 2Centre for Behavioural Research in Cancer,
Cancer Council Victoria, Melbourne, Victoria, Australia; 3Clinical
Epidemiology & Biostatistics Unit, Murdoch Children's Research Institute,
Melbourne, Victoria, Australia; 4RCH National Child Health Poll,
Melbourne, Victoria, Australia; 5RCH National Child Health Poll, The
Royal Children's Hospital, Melbourne, Victoria, Australia; 6Department of
Paediatrics, The University of Melbourne, Melbourne, Victoria, Australia
INTRODUCTION: Research shows that the first 3 years of life are a
critical opportunity to support healthy dietary habits and to prevent
overweight and obesity. As the popularity of commercial foods for
young children continues to increase there is growing concern that
some of these foods are undermining optimal complementary feeding.
This presentation will explore the current, limited regulations in
Australia for commercial infant and toddler foods, parents' perceptions
of what is regulated and what they think should be. It will discuss the
growing international recognition of the importance of ending the
inappropriate promotion of commercially available foods for children
under 36 months of age, for example, recommendations from the

SUPPLEMENT ARTICLE
World Health Organization and a policy framework based on the
Australian context as outlined in the Obesity Policy Coalition's work
Kids are sweet enough and how these could be used as the Australian
government considers strengthening regulations in Australia.
MATERIALS AND METHODS: As part of the quarterly cross-sectional
Royal Children's Hospital, National Child Health Poll, a representative
sample of Australian households with children under 5 years of age
was surveyed (N = 1023). Parents were surveyed about their percep-
tions of these foods and how they are regulated, and what they think
should be regulated.
RESULTS: Sixty percent of parents agreed with the statement
“there are laws about what is allowed to be put in foods for
babies and toddlers,” and 53% agreed “there are laws to ensure
ready-made foods for babies provide good nutrition.” Nine in
10 parents agree that there should be laws about the amount of
salt, saturated fat, and harmful sugars in foods for both infants and
toddlers.
CONCLUSION: The laws in place in Australia to regulate foods for
infants and toddlers do not align with parents' expectations or inter-
national recommendations. Australia should better protect the health
if infants and toddlers by regulating foods for toddlers to set higher
standards for what can be in foods for infants.
CONFLICT OF INTEREST: None declared.
P077 | Characteristics of food retail
environment at urban poor locations in Kuala
Lumpur, Malaysia
S. Mohd Jamil1; B. K. Poh1; A. M. Mohd Sakri1; S. Sivabalan1;
C. A. Che Wel2; Y. K. Cheah3; C. N. Rachmi4; E. Q. Borazon5;
6 7
S. Phulkerd ; H. Trevena ; A.-M. Thow 7
1
Centre for Community Health Studies (ReaCH), Faculty of Health
Sciences, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia;
2 1
Center for Value Creation and Human Well-being, Faculty of Economics
and Management, Universiti Kebangsaan Malaysia, Bangi, Malaysia;
3
School of Economics, Finance and Banking, College of Business,
Universiti Utara Malaysia, Sintok, Malaysia; 4Public Health, Reconstra
Utama Integra, Jakarta, Indonesia; 5College of Social Sciences, National
Sun Yat-sen University, Kaohsiung, China; 6Institute for Population and
Social Research, Mahidol University, Nakhon Pathom, Thailand; 7Menzies
Centre for Health Policy and Economics, University of Sydney, Sydney,
New South Wales, Australia
INTRODUCTION: The obesogenic food environment and high intakes
of unhealthy foods have been implicated as the main factors that led
to the rise in non-communicable diseases among the population in
Malaysia. Among the lower socio-economic groups, it is particularly
important to ensure availability and accessibility of healthy foods at
an affordable price. As such, the aim of this study is to describe the
characteristics of the food retail environment in Kuala Lumpur, focus-
ing on its urban poor areas.
1467789x, 2022, S2, Downloaded from https://onlinelibrary.wiley.com/doi/10.1111/obr.13503 by CAPES, Wiley Online Library on [16/12/2023]. See the Terms and Conditions (https://onlinelibrary.wiley.com/terms-and-conditions) on Wiley Online Library for rules of use; OA articles are governed by the applicable Creative Commons License
37 of 222
MATERIALS AND METHODS: Existing data and information from
food retail industry reports were searched to obtain a national level
overview. Data sources include annual reports published by Euromo-
nitor International, the retail industry, government agencies as well as
food retailer websites. For the urban poor areas in Kuala Lumpur,
three parliament constituencies with the highest percentage of urban
poor population were selected, namely, Bandar Tun Razak, Batu and
Kepong; and Geographic Information System (GIS) was used to map
the density of food retailers in these locations.
RESULTS: The data show a total of 469,024 establishments with more
than 2 million employees in retail and wholesale trade in Malaysia. In
Kuala Lumpur alone, there were a total of 3890 store-based food
retailers and 31,119 stall-based, street mongers or mobile food
retailers. Five major industry players based on market share are
99 Speedmart Sdn Bhd, Dairy Farm International Holdings Ltd, AEON
Group, Tesco Plc and Jaya Grocer. GIS analysis shows Bandar Tun
Razak has 461 food retailers with retail density of 18.44 retailers per
square km catering to a population of 273,870 people. Batu and
Kepong, home to a total combined population of 102,310 people, has
818 food retailers with a density of 22.72 retailers per square km. In
these three locations, food retail outlets comprise of modern hyper-
markets, supermarkets, and convenience stores, as well as traditional
sundry shops, and wet and dry markets.
CONCLUSION: These findings imply that strengthening food retail
policy, particularly for urban poor areas, is important to ensure acces-
sibility to affordably priced healthy foods.
CONFLICT OF INTEREST: None declared.
P078 | Regional action framework on
protecting children from the harmful impact
of food marketing in the Western Pacific
B. Kelly1; K. Backholer2; N. S. Hoe1
Early Start, University of Wollongong, Wollongong, New South Wales,
Australia; 2Deakin University, Melbourne, Victoria, Australia
INTRODUCTION: The marketing of unhealthful foods and beverages,
and breast-milk substitutes, is shown to negatively influence children's
diets and caregivers' feeding practices. Despite international mandates
and commitments to protect children from the harmful impacts of
food marketing, widespread marketing of these products continues,
leading to sub-optimal infant and child nutrition. In response to the
lack of policy progress to restrict food marketing, in 2017 the WHO
Regional Committee for the Western Pacific endorsed a resolution
calling for the development of a regional action plan to protect chil-
dren from the harmful impact of food marketing. This presentation
will describe the development of the Regional Action Framework on
Protecting Children from the Harmful Impact of Food Marketing.
MATERIALS AND METHODS: The Regional Action Framework was
developed in consultation with experts and Member States. It drew
on the extensive evidence base to underpin the harmful impacts of

38 of 222
food marketing on children, and considered lessons learnt and best
practices for food marketing policy development and implementation.
Supplementary materials were also developed to provide technical
support to countries in adopting the Regional Action Framework,
including an operational manual and case studies.
RESULTS: The Regional Action Framework aims to support Member
States to: eliminate exposure of the general public to marketing of
breast-milk substitutes; end the inappropriate promotion of foods for
infants and young children; reduce children's exposure to marketing
of food high in saturated fats, trans-fatty acids, free sugars, or salt;
and minimize the persuasive appeal of marketing of these foods to
children. To achieve these aims, the Framework encourages Member
States to consider 10 key actions under four pillars related to the pol-
icy framework, multisectoral, and multi-stakeholder collaboration,
advocacy, and communication, and monitoring and evaluation. The
operational manual and case studies provide detail on the recom-
mended actions, prioritized according to the stages of the policy cycle,
including agenda setting, and policy formulation, implementation, and
review.
CONCLUSION: The Regional Action Framework was endorsed by the
Regional Committee in October 2019 (WPR/RC70.R1). Together with
the operational manual, the Framework supports Member States to
recognize food marking as a priority policy to support healthy diets
and to undertake the necessary sequence of actions to progress food
marketing policy given the national context.
CONFLICT OF INTEREST: None declared.
P079 | The online obesogenic environment:
Perspectives from different actors
C. Nieto; I. Valero-Morales; A. García; M. White; S. Barquera
Instituto Nacional de Salud Pública, Mexico City, Mexico
INTRODUCTION: Digital marketing of unhealthy foods and beverages
(those high in energy, fats, sugar, and/or salt) increases children's
immediate intake. Systematic reviews highlight the detrimental effects
of food marketing. To date, few qualitative studies have explored how
food and beverage digital marketing is perceived by different actors
(children and adolescents, their parents, and food industry advertisers).
This was a qualitative study that was inspired by the CLICK framework
to understand the online environment. Thus, the purpose of this study
was to explore how children and adolescents, their parents, and food
industry advertisers perceive the online food environment.
MATERIALS AND METHODS: We conducted three focus groups
with children aged 6–11 years and four focus groups with adolescents
aged 12–19 years. In addition, four focus groups were conducted with
mothers of children and adolescents, and we performed four inter-
views with food industry advertisers. Focus groups were done from
September to October of 2020. All sessions were performed via Zoom
and Google meet because the country was in strict lockdown due to
the COVID-19 pandemic. Focus groups and interviews were audio
1467789x, 2022, S2, Downloaded from https://onlinelibrary.wiley.com/doi/10.1111/obr.13503 by CAPES, Wiley Online Library on [16/12/2023]. See the Terms and Conditions (https://onlinelibrary.wiley.com/terms-and-conditions) on Wiley Online Library for rules of use; OA articles are governed by the applicable Creative Commons License
SUPPLEMENT ARTICLE
recorded and transcribed verbatim. Subsequently, we generated a
glossary to compile different testimonials in Nvivo 12. Once the testi-
monials were grouped according to the subcategories present in the
glossary of terms, a thematic analysis was carried out.
RESULTS: Inductive thematic analysis identified five themes from chil-
dren, adolescents, and mother's discussions: (1) Influencers fill a gap in
children's lives, (2) different marketing strategies provoke the need to
purchase the product and immediate consumption, (3) children and
adolescents tend to imitate influencer's behaviors, (4) influencer mar-
keting is effective because they are not “strangers,” and (5) children
pester their mothers to get money to purchase the advertised prod-
uct. On the other hand, results from the food industry's advertisers
showed that (1) digital marketing has become one of the most impor-
tant channels to communicate messages, (2) marketing should be
holistic so they employ diverse techniques to increase the appeal to
children, (3) their objective is to sell regardless of the nutritional qual-
ity of the product, and (4) influencer marketing allows them to form
the brand identity and to reach consumers in an organic way.
CONCLUSION: Testimonies from children, adolescents, mothers, and
advertisers coincide. The online environment promotes unhealthy
foods that are linked to obesity. Food industry advertisers admitted to
use marketing techniques to increase appeal even though the product
is unhealthy. These data show the need for mandatory regulations of
digital marketing to protect children and adolescents, since they are
not always aware of the intent to sell.
CONFLICT OF INTEREST: C. Nieto Grant/Research support with
Bloomberg Philanthropies. I. Valero-Morales Grant/Research support
with Bloomberg Philanthropies. A. García Grant/Research support
with UNICEF México. M. White Grant/Research support with Bloom-
berg Philanthropies. S. Barquera Grant/Research support with UNI-
CEF México.
P080 | Stories of challenge: Understanding
drivers and developing responses to the
double burden of malnutrition
C. N. Rachmi1; A. F. Saptari1; H. Jusril1; A. Hanifah1; S. Trisnasari1;
A. A. Fitri1; A.-M. Thow2
1
Public Health, Reconstra Utama Integra, Jakarta, Indonesia; 2Public
Health, University of Sydney, Sydney, New South Wales, Australia
Introduction: The double burden of malnutrition is a prevailing health
challenge in Indonesia. Transitioning nutrition policy to simultaneously
address the double burden of malnutrition (DBM) has proved chal-
lenging. The policy context relevant to DBM in Indonesia is character-
ized by a progressive decentralization. We aim to identify challenges
and opportunities for developing and implementing policy to
address DBM.
MATERIALS AND METHODS: This study design is qualitative policy
analysis. We obtained 143 policies from eight sectors at the national
and subnational level relevant to nutrition. We analyzed the policy

SUPPLEMENT ARTICLE
content focusing on the coherence of policy objectives and actions
relevant to addressing DBM. We also conducted 36 in-depth inter-
views with national and subnational policy makers, private sector rep-
resentatives, and non-government actors.
RESULTS:
Problem stream: Most respondents identified the food environ-
ment influences diets and nutrition. Residence (urban or rural) affects
food choices as much as food availabilities. Education was identified
as an ambiguous factor, as respondents noted that highly educated
people also consume unhealthy food.
Policy stream: Currently, policies is perceived to prioritized one
nutritional issue-stunting. Several informants confirmed that they
acknowledged that overnutrition exists, yet current focus remains on
stunting. We classified four level-policies from various policy hierar-
chies that are undernutrition-specific. Undernutrition-specific policies
were mentioned across hierarchies, from Law to the ministrial level
(1996 to 2020). Contrary, we found only one Ministrial Level policy
that addressed overnutrition (2013). Several policies were halted dur-
ing the internal discussions between several ministries (e.g., SSB pol-
icy), while others have weak implementation. Interview identified a
tendency for a rather weak coordination links between levels of
government.
Politics stream: Political priority for nutrition in Indonesia is high,
although this is limited primarily to stunting priority. Indonesia joined
the Scaling Up movement, which has led to development of several
networks now. Implementation was identified as a major challenge
by national level policy makers, especially in coordination and
communication.
CONCLUSION: The current policy environment in Indonesia relevant
to DBM is robust and largely reflects best practice recommendations.
Similar to findings regarding policy coherence challenges, we found a
focus on the MoH as bearing primary responsibility for nutrition pol-
icy. Overall, we also observed a lack of concerns about conflict of
interest, despite significant engagement with industry actors specifi-
cally in relation to nutrition policy by the central government agency.
CONFLICT OF INTEREST: None declared.
P081 | Smiles 4 Miles: Creating supportive
environments in early childhood services
through policy change
C. Bastian1; D. Diacogiorgis2
1
Health Promotion, Dental Health Services Victoria, Melbourne, Victoria,
Australia; 2Health Promotion, Ballarat Community Health, Ballarat,
Victoria, Australia
INTRODUCTION: Oral health is essential to overall health and well-
being. Using a common risk factors approach, Smiles 4 Miles promotes
oral health and supports obesity prevention. Smiles 4 Miles is an ini-
tiative of Dental Health Services Victoria and has been operating for
1467789x, 2022, S2, Downloaded from https://onlinelibrary.wiley.com/doi/10.1111/obr.13503 by CAPES, Wiley Online Library on [16/12/2023]. See the Terms and Conditions (https://onlinelibrary.wiley.com/terms-and-conditions) on Wiley Online Library for rules of use; OA articles are governed by the applicable Creative Commons License
39 of 222
18 years. It is a capacity building model targeting high risk areas across
Victoria, partnering with 34 community organizations who at a local
level engage and support 750 early childhood services (ECS), reaching
51,000 children and families.
MATERIALS AND METHODS: Smiles 4 Miles is a 2-year award pro-
gram delivered in ECS that aims to
• improve the oral health of preschool aged children (0–5 years) and
their families
• support the health and wellbeing of early childhood educators and
staff, and
• engage families and the wider community in a whole of service
approach.
The primary focus is on promoting good oral health through
• simple messaging—supporting the skills and knowledge of early
childhood educators, and
• creating healthy eating and oral health promoting environments.
To be awarded, ECS must successfully meet seven criteria including
developing or reviewing a Healthy Eating and Oral Health Policy.
Smiles 4 Miles has partnered with the Achievement Program and the
Healthy Eating Advisory Service to develop a policy checklist. To
meet all requirements, ECS need to cover each statement in their pol-
icy. Those who are successfully awarded can also instantly achieve
advanced standing for the Healthy Eating and Oral Health priority
area within the Achievement Program.
RESULTS: Partnerships are an integral part of the program's suc-
cess. The results of the program from a local level perspective will
be presented using Ballarat Community Health (BCH) as a case
study. BCH manages the Smiles 4 Miles program in City of Ballarat
and Golden Plains Shire, located in regional Victoria north-west of
Melbourne.
A key strategy is working closely with ECS and Early Years
Managers to achieve changes to policies and practices that support
healthy eating and oral health. The presentation will describe how
policy changes have resulted in improvements to practices, for
example, promoting healthy food and drinks and discouraging dis-
cretionary food and drinks; ensuring celebrations, fundraising and
events promote healthy food options; educating children about
healthy eating and oral health; providing information to families;
and supporting educators to access professional development and
resources. The program ensures adherence to these policies
through continual support from the local community organizations,
capacity building of educators and renewal of the award every
2 years.
CONCLUSION: Working with ECS and Early Years Managers to
strengthen policies not only creates an environment that supports
healthy eating and oral health, it also ensures these changes are
embedded and sustainable.
CONFLICT OF INTEREST: None declared.

40 of 222
P083 | Policies and regulatory gaps related to
healthy food environment in Tanzania:
Implications on policy priorities for
prevention of nutrition- related non-
communicable diseases
1 1 2 3 2
F. H. Omar ; F. Levira ; M. Njeri ; F. Mauniko ; G. Asiki ; S. Mtenga
1
Health System Policy and Impact Evaluation, Ifakara Health Institute,
Dar es salaam, United Republic of Tanzania; 2Health Systems for Health
Research, African Population and Health Research Center, Nairobi,
3
Kenya; Food Standards, Tanzania Bureau of Standards, Dar es salaam,
United Republic of Tanzania
INTRODUCTION: Nutritional related non-communicable diseases
(NR-NCDs) is a growing burden on the healthcare system in Tanzania
and contribute to a high mortality and morbidity, and social and eco-
nomic impact on the population. Policy actions to create a healthy
food environment for preventing NR-NCDs are needed. We explored
policy evidence gaps on healthy food environments in Tanzania to
inform actions for prevention of NR-NCDs.
MATERIALS AND METHODS: We conducted a desk review of poli-
cies, regulations, and related infrastructure support for healthy food
environment in Tanzania. The review was guided by a Healthy Food
Environment Policy Index (Food EPI) tool adapted for Tanzania with
13 domains and 55 indicators. March 2022, 15 key informant inter-
views with experts from government and private sector were con-
ducted to complement the desk review. Content analysis of the
documents and interviews were conducted to identify key gaps and
challenges in developing or implementing policies.
RESULTS: A total of 68 documents that include government policies
and 45 academic publications were reviewed. We found that
Tanzania has a clear description of food labeling policies and transpar-
ency on packed foods. The existence of a clear regulation on restric-
tion of marketing of breastmilk substitute to young children by all
form of media. A set of mandatory policies on food fortification to
increase availability of micronutrients in staple food is also available.
In addition, the NCD Strategic Plan (2016) establishes targets for
reduction in salt, sugar and saturated fats consumption as nutrients of
concern. However, the review identified important areas that lack evi-
dence to promote healthy food availability: these include lack of regu-
lations to restrict exposure and power of promotion of unhealthy
foods to children and adolescents. No support for price reduction of
healthy food such as vegetables and fruits were found. Some policies
are outdated and do not reflect the current nutrition changes (nutri-
tion policy of 1992). The interview findings in relation to the gaps are
in agreement with the desk review. However, participants felt that
the government has recognized the double burden of malnutrition
and has started to generate these policies.
CONCLUSION: Tanzania has made a good step in institutionalizing
health food policies and environment specifically on food labeling,
composition, and fortification. However, concrete regulations that
1467789x, 2022, S2, Downloaded from https://onlinelibrary.wiley.com/doi/10.1111/obr.13503 by CAPES, Wiley Online Library on [16/12/2023]. See the Terms and Conditions (https://onlinelibrary.wiley.com/terms-and-conditions) on Wiley Online Library for rules of use; OA articles are governed by the applicable Creative Commons License
SUPPLEMENT ARTICLE
restrict promotion and consumption of nutritional of concerns such
sugar, salt, and fatty are still underdeveloped.
CONFLICT OF INTEREST: None declared.
P084 | Uncovering the association of
symptomatic and self-reported attention
1
deficit hyperactivity disorder and obesity in
health care settings
H. Khalifa; A. Poulton
Nepean Clinical School, University of Sydney, Sydney, New South Wales,
Australia
INTRODUCTION: Obesity is a multifactorial, chronic disease that is
prevalent both globally and in Australia. There is evidence that
attention deficit hyperactivity disorder (ADHD) is not only under-
diagnosed in the community but may also be more prevalent in peo-
ple with obesity (Altfas BMC Psychiatry 2002; 2 9–9). Our primary
objective was to survey healthcare workers to determine the preva-
lence of obesity and look for an association with self-reported symp-
toms of ADHD.
MATERIALS AND METHODS: Data were collected via an anonymous
online survey across multiple healthcare sites in Sydney between
December 2021 and April 2022. The survey included demographic
questions (age, gender, ethnicity, location, height, and weight). Diag-
nostic data for ADHD and oppositional defiant disorder were col-
lected using a standardized rating scale that also included five
questions about current functioning. This was the Nepean ADHD Pro-
ject Symptomatic Scale (NAPSS), which is an adaptation of the ADHD
Self-Report Screening Scale for DSM-5 (ASRS-5). We also asked the
participants to indicate whether they had ADHD, either confirmed or
suspected and whether they considered themselves to be below, at or
above a healthy weight. The association between ADHD and obesity
(body mass index, BMI) was tested using the Pearson correlation and
linear modeling controlling for age.
RESULTS: Responses were received from 214 people (195 women,
91%). Based on their BMI, 159 (74%) were above a healthy weight
(61 were categorized as overweight [28%], 98 [46%] were considered
obese). Only one had a BMI of <18.5. The participants' perception of
their weight status (whether they were below, at or above a healthy
weight) closely correlated with their BMI category (r = 0.586,
p < 0.01). ADHD was also highly prevalent in this cohort, with
32 (15%) meeting criteria on diagnostic ratings. Only four had a defi-
nite diagnosis although a further 45 (21%) suspected they had ADHD.
The BMI was non-significantly higher in those with ADHD (diagnosed
or suspected) (32.5 ± 7.8 vs. 30.1 ± 8.0, p = 0.07). However, linear
modeling controlling for age demonstrated an association between
ADHD (confirmed or suspected) and BMI (p = 0.01).
CONCLUSION: This predominantly female cohort of workers and
attendees at healthcare settings had high rates of obesity and self-
suspected ADHD, with 15% meeting diagnostic criteria for ADHD.

SUPPLEMENT ARTICLE
They were clearly aware of their weight status, but only 2% had been
formally diagnosed with ADHD. Undiagnosed ADHD could have an
impact on obesity management. It may be logical to screen for ADHD
in individuals being treated for weight management with a view to
offering a more comprehensive treatment.
CONFLICT OF INTEREST: H. Khalifa Employee of: pharmaceutical
company from 2019–2020, A. Poulton Consultant for: Paid atten-
dance at single board meeting in 2015.
P085 | Direct healthcare cost and non-direct
cost of non-communicable diseases and their
risk factors in Malaysia
H. N. Q. Tran1; J. Ananthapavan1; A. Chandran2; F. I. Mustapha2;
N. Zakariah2; T. Tanaka3; M. Moodie1
1
Faculty of Health, School of Social Development, Deakin University,
Melbourne, Victoria, Australia; 2Malaysia Ministry of Health, Malaysia
Ministry of Health, Kuala Lumpur, Malaysia; 3World Health Organisation,
World Health Organisation, Kuala Lumpur, Malaysia
INTRODUCTION: Non-communicable diseases (NCDs)
(i.e., cardiovascular diseases, diabetes, and cancer) and their complica-
tions are the leading cause of disability and death in Malaysia. The ris-
ing prevalence of NCDs results in substantial healthcare costs and
economic losses due to reduced labor productivity. This study aimed
to assess the direct and indirect cost of NCDs in Malaysia.
MATERIALS AND METHODS: Direct healthcare costs related to pre-
vention, diagnosis, treatment, and management of diabetes, heart dis-
ease, and cancers, and their complications were examined. The cost
estimates were based on top-down and bottom-up approaches and
analyzed separately for seven cost categories: hospitalizations, pri-
mary care, and outpatient attendances, medication, medical tests,
medical consumables, traditional and complementary medicine, and
health promotion. Indirect costs associated with four main risk factors
for NCDs (unhealthy diet, physical inactivity, smoking, and alcohol
consumption) included (1) productivity losses related to presenteeism,
absenteeism, and early retirement due to premature death, and
(2) monetary valuation of healthy life lost due to disability. These cost
categories were estimated using both human capital and friction cost
approaches. All costs were expressed in 2017 Malaysian ringgit (RM).
RESULTS: Total direct healthcare costs were estimated at RM9.65 bil-
lion in 2017, which accounted for 16.8% of total health expenditure
(approximately RM301 per capita). Primary care and outpatient atten-
dances was the largest cost category, accounting for RM 4.2 billion or
44% of the total direct healthcare costs. Productivity losses were esti-
mated at RM12.88 billion. Total direct and indirect costs were approx-
imately RM22.53 billion, equating to 1.56% of Malaysia's 2017 gross
domestic product.
CONCLUSION: The economic burden of NCDs in Malaysia highlight
the urgent need to invest in preventive health initiatives.
CONFLICT OF INTEREST: None declared.
1467789x, 2022, S2, Downloaded from https://onlinelibrary.wiley.com/doi/10.1111/obr.13503 by CAPES, Wiley Online Library on [16/12/2023]. See the Terms and Conditions (https://onlinelibrary.wiley.com/terms-and-conditions) on Wiley Online Library for rules of use; OA articles are governed by the applicable Creative Commons License
41 of 222
P086 | Citizen Science approaches to
crowdsourcing food environment data: A
systematic scoping review
C. Zorbas1; J. Monaghan1; K. Backholer2; R. Christidis1;
A.-L. McKelvey1; A. Borda3; C. Calyx4; A. Crocetti1; C. Dove1
1
Global Obesity Centre, Institute for Health Transformation, Deakin
University, Melbourne, Victoria, Australia; 2Global Obesity Centre,
Institute for Health Transformation, Deakin University, Geelong, Victoria,
Australia; 3Melbourne Medical School, The University of Melbourne,
Melbourne, Victoria, Australia; 4Centre for Social Impact, University of
New South Wales, Sydney, New South Wales, Australia
INTRODUCTION: Policy actions to regulate the healthiness of food
environments have been slow in many countries. This is partly due to
the complexity associated with monitoring dynamic food environ-
ments and a lack of citizen demand for action. Crowdsourcing is a Citi-
zen Science approach that can increase the extent and nature of food
environment data collection by engaging citizens as sensors or volun-
teered computing experts. There has been no literature synthesis to
guide the application of crowdsourcing in this way. A systematic scop-
ing review was conducted to address this gap.
MATERIALS AND METHODS: Four major search term categories
were identified: “citizen science/crowdsourcing,” “crowdsourcing
tools” (e.g., camera and mobile application), “food,” and “environ-
ments.” These search terms and relevant synonyms were systemati-
cally applied across five electronic databases: Medline, Informit,
CINAHL, Global Health, and Scopus. Studies were only included if
they aligned with the definition of “crowdsourcing” (i.e., engaging
citizens to actively participate and act as sensors to contribute the
targeted and systematic collection of data), involved primary data
collection across one or more of the major food environment
domains (i.e., food availability, affordability, labeling, promotion, and
nutritional quality), focused on built or digital food environments,
and were published in English prior to 2011. Findings were narra-
tively synthesized across population groups and the five food envi-
ronment domains.
RESULTS: Thirty-nine articles met our eligibility criteria. Thirty-two
focused on crowdsourcing data on multiple aspects of food environ-
ments, three on food composition/labeling, two on food availability,
one on food price, and one on food advertising. Photovoice tech-
niques were the most employed methodological approaches (n = 24
studies), commonly used to understand overall access to healthy food.
Fewer studies made purpose-built apps to collect food price or nutri-
tional composition data at-scale. Sample sizes ranged from seven to
15,000 citizens. Twenty-seven studies crowdsourced food environ-
ment data by engaging priority populations (e.g., households receiving
low incomes, people residing in rural areas, or children).
CONCLUSION: There is growing potential to develop scalable crowd-
sourcing platforms to understand food environments through the eyes

42 of 222
of everyday citizens. Such crowdsourced data may improve public and
policy engagement with key food policy actions.
CONFLICT OF INTEREST: None declared.
P088 | Global menu labeling policies: Policy
approaches, evaluations and research gaps
1,2 1,2 3 1,2
L. Vanderlee ; C. Vaillancourt ; D. Simmons ; A. Gaucher-Holm
M. Rancourt-Bouchard2
1
School of Nutrition, Université Laval, Québec City, Québec, Canada;
2 1
Centre Nutrition, Santé et Société (NUTRISS), INAF, Université Laval,
3 3
Québec City, Québec, Canada; Food Directorate, Health Products and
Food Branch, Health Canada, Ottawa, Ontario, Canada
INTRODUCTION: The provision of nutrition information on menus,
or menu labeling, is a policy lever used to improve the nutrition
information environment when foods are purchased in restaurants
and other out-of-home food settings. This study aimed to provide
a comprehensive overview of governmental menu labeling policies
implemented globally and to examine related policy evaluations.
MATERIALS AND METHODS: A policy scan was conducted to iden-
tify menu labeling policies planned or implemented globally as of
August, 2021. Semi-structured interviews with stakeholders from
identified jurisdictions were conducted to validate and complement
the information collated in the scan. A narrative review examined the
prominent evaluations of the policies that emerged from the system-
atic policy scan of gray and published literature.
RESULTS: A total of 22 jurisdictions with 25 relevant menu labeling
policies were identified. Overall, 17 policies were mandatory and
required calorie or sodium labeling directly on menus and eight used
voluntary “healthy” symbols or logos. There was some degree of pro-
cess or outcome evaluation identified for 16 of the 25 policies, but
the scale and scope of these evaluations varied greatly. Overall,
11 policies had been exclusively evaluated internally (e.g., by govern-
ments), external evaluations and internal evaluations were identified
for four policies, and one policy was exclusively evaluated externally
(e.g., by independent researchers). Evaluation methods included inter-
cept surveys outside of restaurants, population-level surveys (con-
ducted online or via telephone), surveys with industry, monitoring
data (e.g., rates of participation or compliance), and monitoring of the
food supply. Outcome evaluations included indicators to assess
awareness and noticing of nutrition information (n = 9), self-reported
understanding and use (n = 9), energy and nutrients ordered and con-
sumed (n = 4), calorie estimation for items or meals (n = 3), knowl-
edge of daily energy intake guidelines (n = 6), public support (n = 8),
and the nutritional quality of restaurants foods (n = 2).
CONCLUSION: The results demonstrate an ongoing interest among
governments worldwide to implement menu labeling policies. To date,
limited real-world research has evaluated the various impacts of menu
labeling policies post-implementation using rigorous research
methods. This research demonstrates an opportunity for greater use
1467789x, 2022, S2, Downloaded from https://onlinelibrary.wiley.com/doi/10.1111/obr.13503 by CAPES, Wiley Online Library on [16/12/2023]. See the Terms and Conditions (https://onlinelibrary.wiley.com/terms-and-conditions) on Wiley Online Library for rules of use; OA articles are governed by the applicable Creative Commons License
SUPPLEMENT ARTICLE
of “natural experiments” to evaluate policy impacts and to help iden-
tify factors that may support effective menu labeling policy develop-
ment and implementation.
CONFLICT OF INTEREST: None declared.
P089 | Uganda's priority actions for creating
a healthy food environment: An expert panel
; prioritization
M. M. Guloba1; T. Odokonyero2; B. Atwine1; T. Akurut1; G. Asiki3
Micro; 2Sectoral, Economic Policy Research Centre, Kampala, Uganda;
African Population and Health Research Centre, Nairobi, Kenya
INTRODUCTION: In Uganda, non-communicable diseases (NCDs)
account for 35% of adult mortality. Obesity in urban areas increased
by 35% (1992–2005), and it doubled among children (MoH, 2020).
Unhealthy food environment significantly contributes to this burden.
We engaged stakeholders to identify and prioritize actions that are
important and feasible to implement in Uganda's effort to create a
healthier environment.
MATERIALS AND METHODS: Based on the INFORMAS model, a
comprehensive evidence pack that assessed policies and context spe-
cific regulatory interventions on creating a healthier food environment
was undertaken. On Thursday February 10, 2022, experts were
invited to a work shop to rank the level of implementation of policies
(reported elsewhere) and identify actions that are important and feasi-
ble to implement. The actions covering the policy and infrastructure
policy domains were then vetted by the entire team in which
22 actions were identified and the individual experts ranked these
actions in terms of importance and feasibility of implementation in
Uganda. The actions with the highest rank in terms of both impor-
tance and feasibility were considered priority actions.
RESULTS: Of the 22 ranked actions, only two actions were priori-
tized (highly important and highly feasible) for Uganda. These
actions were both under the food composition domain. First was on
review and improve the quality of existing standards and develop new
standards in areas where there are no standards (e.g., on regulating
nutrients of concern, nutrient declaration, etc.). This includes age-
specific categorization related standards. The second was on aware-
ness creation, documentation, and popularization of standards and
practices for uptake and scaling up (standards promotion). Food label-
ing, in particular, establishing a system for implementing menu
boards in restaurants was considered the least important and least
feasible to implement in Uganda.
CONCLUSION: The national panel of experts have prioritized the
review of food standards and awareness creation about the standards
as the immediate steps toward creating a healthier food environment.
There is need to work closely with the Uganda national bureau of
standards to implement these actions.
CONFLICT OF INTEREST: None declared.

SUPPLEMENT ARTICLE
P090 | Scoping the preventive health
decision-making process within Victorian
local governments
M. Adam; M. Blake; J. Ananthapavan
GLOBE, Deakin University, Melbourne, Victoria, Australia
INTRODUCTION: In Australia, two thirds of the total burden of dis-
ease is from chronic conditions, including obesity. However, preven-
tive health is often overlooked by policymakers. As the third tier of
government in Australia, local governments (LGs) work closely with
their community, to improve community wellbeing. This study aimed
to understand the key considerations and processes for preventive
health decision-making within LGs.
MATERIALS AND METHODS: The study employed a sequential qual-
itative research methodology. First, a scoping review captured the
context and decision-making processes for preventive health activities
in LGs in Australia, with a specific focus on the state of Victoria. The
review synthesized the peer-reviewed and gray literature narratively
and findings were grouped according to the “Policy,” “Politics,” and
“Problem” domains of the Multiple Streams Framework (MSF).
Second, a focus group was conducted with employees from
Victorian LGs, who were working in preventive health. Participants
were recruited via purposive and snowball sampling. The focus group
explored the key considerations and processes of preventive health
resource allocation decision-making. Deductive content analysis of
the transcript was guided by the MSF domains.
RESULTS: The scoping review included 42 documents. The review
illustrated that decision-making within LGs is not well-researched.
Themes elicited related to MSF domains of “Problem”—knowledge
translation, organizational capacity, collaboration and partnerships;
“Politics”—leadership and organizational alignment; and “Policy”—
supporting and mandatory legislation, planning tools, access to quality
evidence, and governance frameworks.
The nine focus group participants represented seven LGs. Partici-
pants identified preventive health strategies were based on stake-
holder engagement and partnerships, and assessments of community
needs. LGs identified that decision-making was characterized by the
need to be flexible to emergent priorities and opportunities. Barriers
to evidence-based decision-making included councilor influence and
the need to pursue funding opportunities even when mal-aligned to
evidence on the most effective and cost-effective preventive health
actions. Key enablers included capitalizing on learnings from other
councils. Evidence based preventive health decision-making could be
further enhanced by more readily available local evidence on effective
and cost-effective preventive health interventions.
CONCLUSION: LG preventive health decision-making is characterized
by the need to be flexible and act when opportunities for funding
arise. Readily available effectiveness and cost-effectiveness data will
enhance evidence-based action when the opportunity arises.
CONFLICT OF INTEREST: None declared.
1467789x, 2022, S2, Downloaded from https://onlinelibrary.wiley.com/doi/10.1111/obr.13503 by CAPES, Wiley Online Library on [16/12/2023]. See the Terms and Conditions (https://onlinelibrary.wiley.com/terms-and-conditions) on Wiley Online Library for rules of use; OA articles are governed by the applicable Creative Commons License
43 of 222
P091 | Sociodemographic differences
affecting food security in Thai population
during the COVID-19 pandemic
N. Thongcharoenchupong; S. Thapsuwan; S. Phulkerd
Mahidol University, Institute for Population and Social Research, Nakhon
Pathom, Thailand
INTRODUCTION: The COVID-19 pandemic has affected not only
population health but also country economic growth, which together
pose a great challenge to food security of population in many coun-
tries especially in low- and middle-income countries. To better pre-
pare for future pandemic, it is important to understand the socio-
demographic characteristics of the populations at high risk of food
insecurity. This study aimed to examine the influence of socio-
demographic characteristics on food insecurity in Thai population dur-
ing the COVID-19 pandemic.
MATERIALS AND METHODS: Data were collected by a cross-
sectional survey of a nationally representative sample of Thai popula-
tion aged 15 years or older from four geographic regions and Bangkok
in Thailand (N = 5146). Information on food security and socio-
demographic characteristics was collected via questionnaire. The
study used Food Insecurity Experience Scale (FIES) to measure
experienced-based food security of individual respondents. Binary
regression analysis was used to examine the association between
socio-demographic factors and food security.
RESULTS: The results show that 2.8% of the population was severely
food insecure, while 91.6% and 5.6% experienced mild and moderate
levels of food insecurity, respectively. The most worrying issues
among the respondents were that “they would not have enough food
to eat” (28.7%), “they were unable to eat healthy and nutritious food”
(18.6%), and “they ate only a few kinds of foods” (16.1%). Age, sex,
place of residence, occupation, income, and education were signifi-
cantly associated with level of food insecurity. Respondents who were
female were in working-age group, lived in rural areas, worked in man-
ual labor, and had primary school education, lower or no education
had the highest probability of having moderate to severe food insecu-
rity (p < 0.01, p < 0.05, p < 0.05, p < 0.01, and p < 0.01, respectively).
The respondents who earned monthly income between 10,000–
29,999 baht were 53.2% less likely to have moderate to severe food
insecurity (p < 0.05) than those who had higher income.
CONCLUSION: Findings indicate important differences in food inse-
curity among respondents across population groups, and several
sociodemographic characteristics are associated with moderate to
severe food insecurity. The study suggests that both government and
local agencies need to consider food security promotion policies and
develop intervention and prevention strategies by taking into consid-
eration the potential sociodemographic characteristics affecting food
insecurity of Thais during and after the COVID-19 pandemic. Longitu-
dinal data are also needed to investigate the causal relationship
between the sociodemographic determinants and food insecurity.
CONFLICT OF INTEREST: None declared.

44 of 222
P092 | The effectiveness of nutrition-related
food outlet-level accreditation schemes: A
systematic review
O. Huse; S. Schultz; T. Boelsen-Robinson; J. Ananthapavan;
A. Peeters; G. Sacks; M. R. Blake
Global Obesity Centre, Institute for Health Transformation, Faculty of
Health, Deakin University, Geelong, Victoria, Australia
INTRODUCTION: Unhealthy diets are associated with many adverse
health impacts. The in-store environment of food retail outlets is
known to have an important influence on dietary choices. Healthy
food and beverage accreditation schemes, including awards and rec-
ognition programs, represent one avenue for promoting healthy
choices in food retail outlets. Using predefined criteria to assess orga-
nizational practice(s), accreditation schemes are designed to promote
healthy eating by improving the relative availability, placement, pro-
motion, and price of healthier options. The aims of this systematic
review were to (i) assess the impact of nutrition-related food outlet-
level accreditation schemes on outlet practices and customer purchas-
ing behavior and (ii) identify the accreditation scheme characteristics
that were associated with scheme impacts, and the barriers and
enablers to accreditation scheme implementation.
MATERIALS AND METHODS: Electronic databases and gray litera-
ture were systematically searched to identify studies related to retail
outlet-level healthy food and beverage accreditation schemes across
any retail setting including restaurants, convenience stores, schools
and childcare, healthcare, and workplaces. Findings were summarized
according to (i) accreditation scheme characteristics, including food
environment targets, scheme governance, support offered for imple-
mentation, and monitoring and compliance; (ii) scheme outcomes,
including uptake, certification, impact on purchasing, customer per-
spectives, and retailer perspectives; and (iii) barriers and enablers to
accreditation scheme implementation. Identified studies were narra-
tively synthesized to report findings by retail setting.
RESULTS: From 19,891 records screened, 46 records were included,
covering 26 different healthy food retail accreditation schemes. The
majority of schemes (16) targeted restaurants (8 schemes) or conve-
nience stores (8 schemes). Average scheme uptake was 65% of eligi-
ble retailers. All 26 schemes targeted improvements in the healthiness
of products available, as well as other elements of the food environ-
ment. Healthiness of customer purchases improved across many set-
ting types (convenience stores, schools, and hospitals), but evidence
from restaurant schemes was mixed. Key enablers of scheme success
included support provided for scheme implementation and mainte-
nance, flexibility for retailers in meeting scheme criteria, and motiva-
tion of retailers and staff.
CONCLUSION: Nutrition-related accreditation schemes represent a
promising mechanism for engaging food retailers to improve the
healthiness of food retail environments. Further research is required
1467789x, 2022, S2, Downloaded from https://onlinelibrary.wiley.com/doi/10.1111/obr.13503 by CAPES, Wiley Online Library on [16/12/2023]. See the Terms and Conditions (https://onlinelibrary.wiley.com/terms-and-conditions) on Wiley Online Library for rules of use; OA articles are governed by the applicable Creative Commons License
SUPPLEMENT ARTICLE
on the impacts of accreditation scheme participation on healthiness of
customer purchases and population diets.
CONFLICT OF INTEREST: None declared.
P093 | Best practices for healthy eating
environments in recreation and sport
settings: A scoping review
N. Lawlor; R. Powell; R. Prowse
Memorial University of Newfoundland, St. John's, Newfoundland, Canada
INTRODUCTION: Food environments in recreation and sport settings
(RSS) are targets for public health interventions to support healthy
eating practices in children, youth, and families. This scoping review
aimed to generate best practices for achieving healthy food environ-
ments in RSS to help design and evaluate healthy eating policy and
practice interventions.
MATERIALS AND METHODS: A systematic search of peer-reviewed
and gray literature was conducted in September 2020 using six data-
bases (Ovid MEDLINE, Embase, Global Health, Food Science and
Technology Abstracts, APA PsycInfo, and Scopus) and Google. After
title, abstract, and full-text screening, data were extracted from
100 gray documents and 30 peer-reviewed publications according to
Canada's Food Guide messages. Extracted data were synthesized
using an adapted evidence-based framework for generating healthy
food environments with nine nudging strategies: Place, Profile, Por-
tion, Pricing, Promotion, Picks, Priming, Proximity, and Policy (Kraak
et al Obes Rev 2017;18[8] 852–868).
RESULTS: Documents retrieved were formal policies (n = 37, 28%),
real-life practices (n = 31, 24%), guidelines/recommendations (n = 51,
39%), and toolkits (n = 11, 29%). Four foundational principles to
achieve healthy food environments in RSS were emphasized:
(i) healthy foods and beverages are available; (ii) the pricing and place-
ment of food and beverage favors healthy options; (iii) promotional
messages related to food and beverages support healthy eating;
(iv) facilities commit to supporting healthy eating and healthy food
environments. Best practices were identified within each principle,
related to (i) the absolute and relative availability, and variety of
healthy and unhealthy foods and beverages (e.g., healthy foods con-
tribute at least 50% of all options); (ii) the pricing, placement, and pro-
motion of healthy foods and beverages relative to unhealthy foods
and beverages (e.g., combo deals are offered only with water);
(iii) alignment of messages between healthy food promotion (social
marketing) and commercial marketing (which is traditionally
unhealthy) (e.g., unhealthy food or beverages are not used for
rewards, incentives, or vouchers); and (iv) the use of policy and infra-
structure investment to support implementation and maintenance of
healthy food environment actions (e.g., healthy food availability is
mandated through policy).
CONCLUSION: Numerous best practices related to food and bever-
age availability, pricing, promotion, and policy were identified.

SUPPLEMENT ARTICLE
Implementing best practices in RSS may support effective evidence-
based multi-component interventions and improve consistency in
research methods. Resources to support action to improve healthy
eating environments in RSS should be developed in consultation with
the recreation sector.
CONFLICT OF INTEREST: None declared.
P094 | Change in the food environment and
change in measured adiposity in adulthood: A
longitudinal study from the Christchurch
Health and Development birth cohort,
Aotearoa New Zealand
M. Hobbs 1,2 3 4 1
; G. McLeod ; J. Mackenbach ; L. Marek ; J. Wiki ; 1
B. Deng1,2; P. Eggleton2; J. Boden3; D. Bhubaneswor3; M. Campbell1;
J. Horwood3
1 M. R. Blake1; M. Rozman2; A. Peeters1
GeoHealth Laboratory; 2School of Health Sciences, University of
Canterbury, Christchurch, New Zealand; 3Psychological Medicine,
4
University of Otago, Christchurch, New Zealand; Department of
Epidemiology & Data Science, Amsterdam UMC, Amsterdam,
Netherlands
INTRODUCTION: This study investigates associations between
change in access to food outlets and change in measured body mass
index (BMI) and waist circumference (WC).
MATERIALS AND METHODS: We use data from the Christchurch
Health and Development Study, a birth cohort of 1265 babies born in
Christchurch, New Zealand (NZ), in 1977. Trained interviewers
obtained WC (cm), height (cm), and weight (kg). BMI was calculated at
age 30 (2007) and 40 (2017). Nationwide food outlet locations for
fast-food outlets and supermarkets in 2005 and 2015 were then
linked to the CHDS NZ resident population at 30 and 40 years. We
defined nationwide access using driving distance along the road net-
work for (i) proximity to nearest outlet, (ii) proximity to nearest five
outlets, and (iii) an enhanced two-step floating catchment area model.
Relative percentage change in distance allowed for a standardized dif-
ference between 2005 and 2015 (e.g., ([Distance 2015 Distance
2005]/Distance 2005) *100). Mixed effects models investigated asso-
ciations between relative percentage change in distance to food out-
lets and change in measured adiposity.
RESULTS: On average, both BMI (2.19 kg/m2 [±3.12]) and WC
(5.87 cm [±9.76]) increased between 30 and 40 years. Cohort mem-
bers who experienced a greater percentage change toward closer
proximity to fast-food outlets had the larger increases in BMI and
WC. In contrast, cohort members who experienced a greater percent-
age change toward closer proximity to supermarkets had the smaller
increases in BMI and WC. Importantly, the larger increases in BMI and
WC were seen for those who had the greater proportional change
toward closer proximity to fast-food outlets and who stayed at the
same address. Such increases in BMI and WC for those who stayed at
the same residence may therefore be due to the number of fast-food
1467789x, 2022, S2, Downloaded from https://onlinelibrary.wiley.com/doi/10.1111/obr.13503 by CAPES, Wiley Online Library on [16/12/2023]. See the Terms and Conditions (https://onlinelibrary.wiley.com/terms-and-conditions) on Wiley Online Library for rules of use; OA articles are governed by the applicable Creative Commons License
45 of 222
outlets increasing in their neighborhood rather than due to selection
bias attributable to individuals moving.
CONCLUSION: We provide longitudinal evidence for statistically sig-
nificant but small associations between changes in access to food out-
lets and change in measured adiposity as represented by measured
BMI and waist circumference in New Zealand adults over a 10-year
period. While effects were small and sometimes inconsistent, they
may help to explain the changes and increase in BMI and WC at a
population level.
CONFLICT OF INTEREST: None declared.
P096 | Testing implementation resources
with end-users: The creation of a healthy
food retail Implementation Toolkit
T. Boelsen-Robinson1; T. Bowling1; V. Hobbs1; A. Gupta1;
1
Institute for Health Transformation, Deakin University, Burwood,
Victoria, Australia; 2Victoria Division, Nutrition Australia, Melbourne,
Victoria, Australia
INTRODUCTION: Creating healthy food environments is a critical
lever to improving population diets and preventing obesity. The
introduction of government voluntary and mandatory healthy food
retail policies in community settings (e.g., health services, recreation
settings, universities, and local government) has created the need for
the development of resources to assist retailers in implementing
these guidelines. Most resources are not developed or tested with
end-users (retailers) and do not meet their specific needs. This study
aimed to determine end-user perceptions of the content, concepts,
and processes of a recently developed Implementation Toolkit (the
“Toolkit”) to ensure it was fit-for-purpose, practical, accessible, and
easy-to-use.
MATERIALS AND METHODS: Focus groups and interviews were
conducted with a cross-section of Australian food service retailers to
gather insights and make recommendations regarding the Toolkit, in
the context of implementing and maintaining healthy food retail envi-
ronments. Participants were recruited to represent a range of regional
and metropolitan, small to medium-sized food outlets located within
healthcare facilities, universities, and recreation centers. Participants
were asked to read the Toolkit prior to the focus group or interview
and were asked questions on the perceived usefulness and usability,
and clarity and format for each aspect of the Toolkit, in the context of
their own experience.
RESULTS: Ten food service retailers participated in this study, includ-
ing managers and staff, capturing diverse knowledge and experiences.
Of these, seven retailers had previous experience making healthy
changes in their food outlets, with three not having implemented any
changes. Retailers identified key characteristics essential to the
Toolkit: emphasizing a gradual approach to implementing healthy food
changes; the inclusion of “troubleshooting” boxes; the relevance of

46 of 222
information on engaging staff and customers; and links to marketing
materials to promote healthy options. Participants requested
expanded space dedicated to the financial ‘business case’ for imple-
mentation, further case studies representing a variety of settings, and
clearly identified opportunities for further support from their own
organization or government services.
CONCLUSION: This study highlights the importance of developing
and tailoring resources according to the needs of the end-users to
enhance its usefulness and usability when implementing healthy food
retail policies by retailers and provides direction for future resource
development.
FUNDING: This study was funded by the Victorian Department of
Health.
CONFLICT OF INTEREST: None declared.
P097 | Food environment policies for the
prevention of double burden of malnutrition
in Uganda: National expert panel's
assessment using a modified Food EPI index
1 2 2 2 3
T. Odokonyero ; M. Guloba ; B. Atwine ; T. Akurut ; G. Asiki
1
Research–Sectoral; 2Economic Policy Research Centre, Kampala,
3
Uganda; African Population and Health Research Centre, Nairobi, Kenya
INTRODUCTION: In many low- and middle-income countries such as
Uganda, there is coexistence of under nutrition and over nutrition but
there have not been sufficient efforts to these simultaneously by gov-
ernments. We assessed the extent of government actions in addres-
sing the double burden of malnutrition in Uganda.
MATERIALS AND METHODS: We started off with adapting the Food
EPI tool to include 12 indicators measuring double duty actions giving
a total of 55 indicators. We then conducted a desk review through
searching websites for relevant government sectors and private
organizations in addition to a manual search of documents from
government offices to gather evidence on policy development and
implementation using the new Food EPI index as a guide. With this
evidence we engaged 24 national experts in rating extent to which
the available policies are in relation to the policy development cycle
and against international benchmarks.
RESULTS: Out of the 55 indicators, none was in initiation phase of
the policy development cycle, 20 were in agenda setting, 34 were in
implementation, and only 1 was under evaluation. Of the 12 double
duty actions, 1 was in agenda setting, 10 were in implementation,
and 1 was in evaluation. Adoption of national policy on breastfeed-
ing, accompanied by an action plan to implement and promote the
policy such as baby friendly initiatives were the most developed
policies (score of 78) followed by country level targets for exclu-
sive breastfeeding and complementary feeding (score of 75) and
large-scale food fortification programs (73.81) were those highly
rated double duty actions. The weakest area of implementation
under double duty actions is in regular monitoring of food safety
1467789x, 2022, S2, Downloaded from https://onlinelibrary.wiley.com/doi/10.1111/obr.13503 by CAPES, Wiley Online Library on [16/12/2023]. See the Terms and Conditions (https://onlinelibrary.wiley.com/terms-and-conditions) on Wiley Online Library for rules of use; OA articles are governed by the applicable Creative Commons License
SUPPLEMENT ARTICLE
indicators such as microbial safety, mycotoxin levels, and chemical
components in food. In relation to international best practice, we
observed a very good progress of implementation in regard to
national policy on breastfeeding and its action plan, which is the
only highly rated double duty action. Little or no progress was
made in the other double burden policy areas, as well as the rest
of the policy areas.
CONCLUSION: Introduction of the double burden duty indicators to
Food EPI enabled a more comprehensive assessment of government
actions in Uganda. It is evident that there is a strong leadership sup-
port to implement double duty actions; however, more effort geared
toward double duty policy actions is needed in Uganda.
CONFLICT OF INTEREST: None declared.
P098 | Impact of lifestyle risk factors on
admission to nursing home care: A cohort
study of 127,108 people aged 60 years and
over
A. A. Gibson1; J. Gale1; E. Stamatakis2; R. Lindley3; L. Fontana2;
P. Cistuli2; N. Nassar2
1
The Menzies Centre for Health Policy, Camperdown, New South Wales,
Australia; 2Charles Perkins Centre, Camperdown, New South Wales,
Australia; 3Westmead Applied Research Centre, University of Sydney,
Sydney, New South Wales, Australia
INTRODUCTION: Population aging is one of the most significant
social and economic changes affecting almost every country in the
world. Effective strategies to prevent or delay older adults entering
nursing home care will help ensure society can adequately care for its
increasing number of older people. The aim of our study was to deter-
mine the association of lifestyle risk factors with nursing home
admission.
MATERIALS AND METHODS: This study used data from 127,108
men and women, aged ≥60 years, recruited to The 45 and Up Cohort
Study between 2006 and 2009, with data linkage to health records. A
healthy lifestyle score categorized participants into three risk groups
based on five equally contributing risk factors: smoking, physical activ-
ity, sitting, sleep, and diet quality. The main outcome was hazard
ratios for incident nursing home admission, estimated using multivari-
able cox proportional hazards model. Results were stratified by age
and body mass index (BMI).
RESULTS: Our study sample included 127,108 participants. One-
quarter were in the low-risk healthy lifestyle group, 62% were in the
medium-risk group, and 14% in the high-risk (least healthy) group.
During a median (IQR) follow-up of 11.3 years, 23,094 participants
were admitted to a nursing home for the first time. Compared with
those in the low-risk group, risk of nursing home admission was 43%
higher among participants in the high-risk group (multivariable
adjusted hazard ration (aHR) 1.43; 95% Confidence Interval (CI) 1.36,
1.50); and participants in the medium-risk group had an intermediate

SUPPLEMENT ARTICLE
12% greater risk (aHR 1.12; 95%CI 1.08,1.16). The risk of nursing
home admission increased linearly, on average, by 19% (aHR1.19,
95%CI 1.16–1.22) with every unit decrease in healthy lifestyle score.
Specifically, those with the lowest lifestyle score (<2 out of 10) and
least healthy had an over twofold (aHR 2.01 95%CI 1.60,2.53)
increase in the risk of nursing home admission. Higher risk of nursing
home admission was found among younger participants aged 60–64
(aHR 2.15; 95%CI 1.82,2.54) and 65–74 years (aHR 1.61; 95%CI
1.48,1.75) compared with 75–84 (aHR 1.36; 95%CI 1.27,1.44) and
85 year olds (aHR 1.16; 95%CI 1.01,1.32) measured at baseline. Risk
estimates of individuals with obesity were similar to the main results.
CONCLUSION: An unhealthy lifestyle was associated with a marked
increased risk of admission to a nursing home in adults aged 60+
years. This association was strongest in men and women aged 60–
74 years compared to those aged 75+. It is important to consider life-
style risk factors not only in the prevention of chronic diseases but
also in reducing or delaying long-term nursing home admission.
CONFLICT OF INTEREST: None declared.
P099 | Early childhood education and care
staff perspective on the implementation of a
healthy eating and physical activity program:
A qualitative study
A. Renda1,2; S. Taki1,3; A. Bonnefin1; K. Varas1; H. Dirkis1
1 A. L. Seidler1; J. Williams1; M. Aberoumand1; K. Hunter1;
Health Promotion, Sydney Local Health District, NSW Health, Sydney,
New South Wales, Australia; 2University of Newcastle, Newcastle, New
South Wales, Australia; 3University of Sydney, Sydney, New South Wales,
Australia
INTRODUCTION: In Australia, childhood obesity is an major public
health issue with 17% children aged 5–14 overweight and 7.7% obese
(AIHW, 2020). A World Health Organization report identified Early
Childhood Education and Care (ECEC) as an integral setting for obe-
sity prevention programs. Research exploring ECEC educators' experi-
ence in implementing obesity prevention practices is limited. The aim
of this study is to explore the staff experience and intentions of
undertaking an online training course to promote obesity prevention
practices in ECEC services in New South Wales (NSW), Australia.
MATERIALS AND METHODS: Semi-structured interviews were con-
ducted with ECEC staff (educators, directors, and cooks) who com-
pleted the online course during 2016–2018 (Group 1), who attempted
to complete (Group 2), or did not complete a healthy eating and physi-
cal activity online training course during 2014–2018 (Group 3). Three
broad themes were explored including experience during the online
course; how their motivation, confidence, and knowledge was
affected; and barriers and facilitators to implementing their learnings
at work. Through thematic analysis, interviews were analyzed using
NVivo 12. Initially, one author developed the coding dictionary by
coding five random interviews. Then, to ensure coding reliability,
three authors coded the same interviews and met to discuss
1467789x, 2022, S2, Downloaded from https://onlinelibrary.wiley.com/doi/10.1111/obr.13503 by CAPES, Wiley Online Library on [16/12/2023]. See the Terms and Conditions (https://onlinelibrary.wiley.com/terms-and-conditions) on Wiley Online Library for rules of use; OA articles are governed by the applicable Creative Commons License
47 of 222
discrepancies. Codes and sub-codes were modified, rearranged, and
removed. Then all interviews were coded with the finalized version of
the coding dictionary.
RESULTS: Twenty interviews were conducted with ECEC educators.
Eleven participants in Group1 were interviewed; two participants of
Group 2; and seven of Group 3 were interviewed. Preliminary findings
from the three themes revealed what motivated the educators to
enroll including wanting to contribute to children's health and past
experiences that shaped the perceived value of the online course. Par-
ticipants expressed positive critique of the webinar, naming the facili-
tator and interactive features such as characteristics that could enable
implementation. Lastly, the analysis showed that the implementation
of the post-online course completion is affected by management sup-
port, and personal interests.
CONCLUSION: This study provides an understanding of the ECEC
staff experiences during an online course to promote healthy eating
and physical activity practices in the ECEC setting in NSW, Australia.
It provides evidence to inform the design of future obesity prevention
online training courses.
CONFLICT OF INTEREST: None declared.
P100 | Regulatory barriers to collaborative
approaches in obesity prevention—Case
study of the TOPCHILD Collaboration
B. Johnson2; S. Libesman1; A. Barba1; A. Webster1 on behalf of the
TOPCHILD Collaboration
1
NHMRC Clinical Trials Centre, University of Sydney, Sydney, New South
Wales, Australia; 2Caring Futures Institute, Flinders University, Adelaide,
South Australia, Australia
INTRODUCTION: Obesity prevention is so complex that no individual
research team can address it in a silo. In recent years, initiatives to
facilitate collaboration and data sharing have gained traction. For
instance, in the Transforming Obesity Prevention for CHILDren
(TOPCHILD) Collaboration, investigators from 48 studies have joined
forces to answer the following question: “Which components of com-
plex interventions are effective in preventing early childhood obe-
sity?” We aimed to identify administrative demands and main
“chokepoints” impacting collaboration and data sharing.
MATERIALS AND METHODS: A mixed methods study, including a
case study of experience requesting individual participant data from
TOPCHILD trials. Using a custom-built database, we recorded study
characteristics (e.g., year, sample size, and country), and data sharing
status and logged each email contact with TOPCHILD trialists. We
interviewed the two researchers responsible for negotiating data
sharing contracts for TOPCHILD. We calculated median and inter-
quartile range (IQR) of total duration from first data request until
data receipt, and number of emails required. We qualitatively ana-
lyzed email content and data sharing contracts, and interview

48 of 222
responses, to identify barriers and facilitators to data sharing in obe-
sity research.
RESULTS: Data were analyzed from the 48 trials that have joined
the Collaboration and agreed to share data and unpublished inter-
vention materials. The median time from requesting to receiving
data and unpublished materials was 64 (IQR 108) days. After
399 days, 11 requests are still outstanding. Where a data sharing
contract was required, an average of 22 (SD 16) emails were sent
between the data collation center and individual trialists, mostly
dealing with minor changes. Most contracts were similar in con-
tent, but varied greatly in format and detail, ranging from 7 to
33 pages. Barriers to collaboration and data sharing identified in
the interviews and emails included: varying and changing legisla-
tions around privacy and data sharing across different jurisdictions
(e.g., new EU legislation), and different cross-institutional expecta-
tions, for instance, around authorship rights and duration of data
storage.
CONCLUSION: Collaboration across institutions and countries to
answer key questions in obesity prevention is impacted by major
delays in the sharing of data and intervention materials caused by leg-
islative and institutional demands and barriers. This delays the genera-
tion of much needed evidence. Based on this work, we will outline
opportunities to streamline contracts, to reduce the bureaucratic bur-
den and facilitate faster pathways to collaboration.
CONFLICT OF INTEREST: None declared.
P101 | Assessing the content, quality and
behavior change potential of digital tools
(apps and websites) for managing gestational
weight gain: A systematic search and
evaluation
B. R. Brammall1; R. Garad1; J. Boyle2; M. Hayman3; S. de Jersey4;
H. Teede1; Q. V. Hong5; A. Carrandi1; C. Harrison1
1
Monash Centre for Research and Implementation, Monash University,
Clayton, Victoria, Australia; 2Faculty of Medicine, Nursing and Health
Sciences, Eastern Health Clinical School, Box Hill, Victoria, Australia;
3
School of Health, Medical and Applied Sciences, Appleton Institute,
Rockhampton, Queensland, Australia; 4Department of Nutrition and
Dietetics, The Royal Brisbane and Women's Hospital, Herston,
Queensland, Australia; 5Monash University, Clayton, Victoria, Australia
INTRODUCTION: Gestational weight gain (GWG) outside recom-
mendations is a prevalent public health concern that increases risks
of adverse maternal and neonatal outcomes. Self-monitoring has
been shown to be an effective strategy in weight management. This
study aims to evaluate digital tools (apps and websites) that enable
and promote self-monitoring of GWG. Evaluation includes overall
quality and functionality, as well as the potential of the digital tool
to promote health-and-lifestyle related behavior change and
1467789x, 2022, S2, Downloaded from https://onlinelibrary.wiley.com/doi/10.1111/obr.13503 by CAPES, Wiley Online Library on [16/12/2023]. See the Terms and Conditions (https://onlinelibrary.wiley.com/terms-and-conditions) on Wiley Online Library for rules of use; OA articles are governed by the applicable Creative Commons License
SUPPLEMENT ARTICLE
effectively communicate GWG and lifestyle recommendations and
associated risks.
MATERIALS AND METHODS: Digital tools were identified using
key search terms via website search engines (Google, Bing, and
Yahoo) and online application stores (Apple App Store and Google
Play). Eligible digital tools were evaluated using the Mobile App
Rating Scale (MARS), the App Behaviour Change Scale (ABACUS)
as well as criteria to evaluate the quality of health-and-evidence-
based information and the rigor and safety of GWG content and
tools.
RESULTS: A total of n = 1085 digital tools were screened for inclu-
sion (n = 162 websites and n = 923 apps). The final sample
included n = 19 digital tools eligible for analysis (n = 1 website and
n = 18 apps). The overall mean MARS quality score ranged from
2.26 to 4.39 (out of 5.00). The overall ABACUS score was 6 (3.4),
out of 21; didactic or simple behavior change functions such as
instructions, data export and sending of reminders, were much
more frequent than interactive techniques like goal setting (n = 1,
5.3%), providing encouragement (n = 0, 0%) or material/social
rewards (n = 0, 0.0%) and ascertaining willingness to change (n = 0,
0.0%). The 21-item quality evaluation yielded a mean (SD) of 5.4
(2.9) out of 21. For GWG criteria, n = 11 (57.9%) of the 19 tools
met three or less criteria, with two (n = 2, 10.5%) scoring zero.
Very few (n = 2, 10.5%) tools alerted the user weight gain was
outside of the recommended range, and none directed the user to
consult a health professional if their weight entry was outside the
recommendations.
CONCLUSION: This review emphasizes significant limitations in
current digital resources in monitoring GWG, disseminating relevant
public health messaging and facilitating behavior change. The
majority of tools were of low quality, had minimal behavior change
strategies, and were potentially unsafe, with minimal linkage to
evidence-based information or partnership with healthcare.
CONFLICT OF INTEREST: None declared.
P102 | Impact of COVID-19 on weight status,
diet quality, physical activity, and sedentary
behavior, sleep sufficiency, and health-
related quality of life among regional
Victorian primary school children in Australia
(2019–2022)
C. Strugnell1; J. Hayward1; M. Jackson1; D. Becker2; M. Hillenaar1;
I. Gribben1; A. Brown1; V. Brown1; C. Bell1; L. Orellana2; S. Allender1;
J. Whelan1
1
Global Obesity Centre, Deakin University, Geelong, Victoria, Australia;
2
Biostatistics Unit, Deakin University, Melbourne, Victoria, Australia
INTRODUCTION: Data on the measured prevalence of overweight
and obesity and associated behaviors among Australian children is
lacking. We have developed one of Australia's largest opt-out

SUPPLEMENT ARTICLE
childhood obesity surveillance systems in North-East Victoria. This
data can reveal the impact of COVID-19 on measured weight status,
self-reported behaviors, and wellbeing among primary school children
in 12 North-East Victorian local government areas (LGAs).
MATERIALS AND METHODS: All 162 primary schools across the
Goulburn Valley and Ovens Murray LGAs were invited to participate
in 2019 (April–June) and 2022 (April–August) through the RESPOND
NHMRC Project. Participating students in Grade 2, 4, and 6 were
invited to have their height and weight measured and complete a self-
report behavior and wellbeing questionnaire (Grade 4 + 6). Changes
in prevalence of overweight and obesity (WHO), adherence to physi-
cal activity (≥60 min/day), sedentary behavior (<2 h/day), vegetable
(≥5 or 5.5 serves/day*), fruit (≥2 serves/day), unhealthy snacks (<1/
day), and sleep sufficiency (9–11 h/night) recommendations, and
changes in self-rated health-related quality of life (HRQoL) using the
PedsQL index will be examined between 2019 and 2022 using mixed
model adjusting for intervention effect.
RESULTS: In 2019, 91/163 (56%) primary schools and 3888/4736
(82.1%) eligible students participated. Prevalence of overweight and
obesity was similar among boys (35.4%, 95%CI: 32.7; 38.1) and girls
(36.0, 95%CI: 33.2;38.8). Gender differences were detected in self-
reported adherence to the physical activity recommendation on
≥5 days 51.3% (46.5;56.0) and 39.1% (34.3;43.9); sedentary behavior
68.4 (65.1;71.7) and 77.0 (74.1;79.9) on ≥5 days; and fruit sufficiency
68.3 (65.2;71.4) and 77.4 (74.7;80.1) in boys and girls, respectively.
No differences in vegetable or sleep sufficiency were detected.
HRQoL global scores were similar in boys 75.5 (74.4;76.6) and girls
75.3 (74.2;76.3).
2022 data and impact of COVID-19: These data are currently
being collected and will be analyzed in-time for ICO 2022 in
Melbourne.
CONCLUSION: Routine surveillance data on overweight/obesity and
associated behaviors is of critical public health importance to examine
disparities in prevalence, impact of intervention(s), policies, global and
local shocks (e.g., COVID-19, bushfires, and floods), to enhance
awareness, sustain political investment, and action and accountability.
We present the findings from one of the only Australian studies able
to examine the impact of COVID-19 using high participatory, mea-
sured height and weight.
CONFLICT OF INTEREST: None declared.
1467789x, 2022, S2, Downloaded from https://onlinelibrary.wiley.com/doi/10.1111/obr.13503 by CAPES, Wiley Online Library on [16/12/2023]. See the Terms and Conditions (https://onlinelibrary.wiley.com/terms-and-conditions) on Wiley Online Library for rules of use; OA articles are governed by the applicable Creative Commons License
49 of 222
P103 | Exploring the application of behavior
change technique taxonomies in childhood
obesity prevention interventions: A
systematic scoping review
D. Chakraborty1; B. Bailey1; B. Johnson2; A. L. Seidler1; S. Yoong3;
K. Hunter1; R. Hodder4; A. Webster1
1
National Health and Medical Research Council Clinical Trials Centre,
Camperdown, New South Wales, Australia; 2University of Sydney,
Sydney, New South Wales, Australia; 3Swinburne University of
Technology, Hawthorn, Victoria, Australia; 4School of Medicine and
Public Health, The University of Newcastle, Newcastle, New South Wales,
Australia
INTRODUCTION: Behavior change technique (BCT) taxonomies pro-
vide one approach to unpack the complexity of childhood obesity pre-
vention interventions. This scoping review sought to examine how
BCT taxonomies have been applied to understand childhood obesity
prevention interventions targeting children aged 12 years or under
and/or their caregivers.
MATERIALS AND METHODS: A systematic search was conducted in
Medline, Embase, PsycINFO, Cochrane Central Register of Controlled
Trials, Cochrane Database of Systematic Reviews, CINAHL and PROS-
PERO. Eligible studies included any study design that applied a BCT
taxonomy and evaluated behavioral childhood obesity prevention
interventions targeting children aged 12 years or under and/or their
parents or caregivers.
RESULTS: Sixty-three records, describing 54 discrete studies were
included; 32 applied a BCT taxonomy prospectively to design inter-
ventions (e.g., randomized controlled trials, intervention development
studies) and 23 applied them retrospectively to assess interventions
(e.g., systematic reviews, multi-method studies); one study did both.
Forty-nine studies had results available, five were registration/proto-
col. The BCT taxonomy v1(BCTTv1) was the most frequently used
taxonomy in prospective (15 of 32) and retrospective (18 of 23) appli-
cations. There was substantial variation in the methods used to apply
BCT taxonomies and to report BCT-related methods and results. For
example, few prospective studies reported BCTs with their corre-
sponding number and label from a taxonomy (n = 8) (Table 1). In ret-
rospective studies BCTs were most frequently coded from published
materials only (n = 12). There was a paucity of detail reported in
how BCTs were selected in studies applying BCT taxonomies
prospectively.

50 of 222
TABLE 1 Summary of prospective (n = 32) and retrospective (n = 23) BCT taxonomy applications in childhood obesity prevention
Type BCTs reported with number and label from a taxonomy
Prospective studies Yes: 8
No: 24
Retrospective studies Yes: 12
No: 6
N/A: 5
Abbreviation: BCT, behavior change technique.
CONCLUSION: Our review provides important insight into the appli-
cation of BCT taxonomies in childhood obesity prevention. We identi-
fied several ongoing challenges in the reporting of BCT-related
methods and results, pointing to the need for best practice reporting
guidance to improve applications in this evolving research field.
CONFLICT OF INTEREST: None declared.
P104 | Regional differences in cardiovascular
diseases mortality and morbidity in Ethiopia:
A systematic subnational analysis of global
burden of disease 2019
F. H. Tesfay1; S. Bowe2; K. Backholer1; S. Allender2; C. Bennett1
1
Institute for Health Transformation, Deakin University, Burwood,
Victoria, Australia; 2Institute for Health Transformation, Deakin
University, Geelong, Victoria, Australia
INTRODUCTION: Noncommunicable diseases are an emerging public
health problem in Ethiopia. In 2017, noncommunicable diseases and
injuries comprised 45% of mortality in the Ethiopian population and
contributed to 39.3% of total deaths, 53% of the age-standardized
death rate, and 34% of disability-adjusted life years (DALYs). Cardio-
vascular diseases (CVDs) are the leading cause of premature mortal-
ity in Ethiopia and contributed to 41.8% of all NCD deaths. In a
recent systematic review we conducted, hypertension followed by
overweight, and obesity were the commonest risk factors in Ethiopia.
Despite this, little is known about regional (sub-national) distribution
of CVDs. In this study, we aimed to determine changes in the burden
of CVD over time and across sub-national jurisdictions within
Ethiopia.
MATERIALS AND METHODS: This study used data from the global
burden of disease (GBD) study for Ethiopia from 1990–2019. Annual
summary statistics and associated 95% uncertainty intervals were
estimated for CVD prevalence, CVD mortality rates and DALYs attrib-
uted to CVDs for each of the regional states across Ethiopia between
1990 and 2019. Cause of death by age, gender, and year were esti-
mated using cause of death ensemble modelling (CODEm) that models
1467789x, 2022, S2, Downloaded from https://onlinelibrary.wiley.com/doi/10.1111/obr.13503 by CAPES, Wiley Online Library on [16/12/2023]. See the Terms and Conditions (https://onlinelibrary.wiley.com/terms-and-conditions) on Wiley Online Library for rules of use; OA articles are governed by the applicable Creative Commons License
SUPPLEMENT ARTICLE
Average number of BCTs reported
Studies reporting BCTTv1:
Median 14
Range 6 to 30 per study
Studies reporting BCTTv1:
Published materials only (n = 8)
5.6 median (4.3 to 9)
Unpublished materials (only or in addition to published) (n = 4)
17.5 median (13.9 to 45)
incidence, prevalence, and mortality on the basis of the performance
of the fitted models.
RESULTS: The number of people with CVD conditions increased by
134% from 1,514,280 (95% uncertainty interval (UI) (1,353,233–
1,693,236)) in 1990 to 3,537,762 (95% UI: 3,114,626–3,994,300) in
2019. The age-standardized prevalence of CVD increased between
1990 and 2019 for all regional states with the highest increase of
14.1% in Somali (5.5%–6.3%), 8.2% in Afar (5.9%–6.1%), 10.3% Harari
(6.0%–6.4), and 6.7% Benshangul Gumuz (6.0–6.4) from 1990 to
2019. The number of people who died from CVDs in Ethiopia
increased by 26.9% from 60,662.8 (UI:48,824.5–73293.7) persons in
1990 to 76,975.2, (UI: 66,580.0–88,228.8) persons in 2019 while
age-standardized mortality is declining. The number of DALYs due to
CVDs among all ages increased by 4.1% in the same period from
1,929,815 (95% UI: 1,529,777–2,344,873) in 1990 to 2,012,732 (UI:
1,743,631–2,296,962) in 2019.
CONCLUSION: The CVD burden in Ethiopia is increasing, with sub-
stantial regional variation. CVD mortality is generally higher in less
developed regions, with few exceptions, consistent with what is
expected given the importance of social determinants in CVD. Inter-
ventions targeting high blood pressure, obesity, and overweight is
important in the rest of the regions in Ethiopia where cardiovascular
conditions diabetes mellitus, cancer and respirator conditions are the
leading the NCDs respectively.
CONFLICT OF INTEREST: None declared.
P105 | Exploring Australian night shift
workers' food experiences within and outside
of the workplace: A qualitative photovoice
study
G. K. Leung1; K. Huggins1,2; M. Bonham1; S. Kleve1
1
Nutrition, Dietetics and Food, Monash University, Clayton, Victoria,
Australia; 2Global Obesity Centre, Deakin University, Melbourne, Victoria,
Australia
INTRODUCTION: Night shift workers are at a 20% to 40% increased
risk of metabolic diseases, including obesity, type-2 diabetes and

SUPPLEMENT ARTICLE
cardiovascular disease. This increased disease risk may be associated
with the disruptions in their eating patterns, caused by their shift work
schedule. This qualitative study explores the ways in which shift work
influences Australian workers' eating habits, both within and outside
of the workplace, in order to identify target areas for health promo-
tion strategies.
MATERIALS AND METHODS: Eligible participants had at least
6 months of night shift work experience and were working at least
three overnight shifts per month. The photovoice method was used,
whereby participants were asked to take photos that represent their
typical eating habits, during their night shifts and rostered days-off.
These photos were incorporated as prompts in a semi-structured
interview, which explored three main areas: (i) description of eating
habits on night shifts and days-off, (ii) factors influencing the above,
and (iii) perceptions and enablers to healthy eating, with a focus on
workplace influence. A thematic analysis approach was used, via an
iterative inductive coding process.
RESULTS: Ten participants (four females, age: 19 to 66 years) com-
pleted the study, whom worked in healthcare, emergency services,
and security. Thematic analysis generated four main themes, which
were mapped onto the Social Ecological Model (SEM). Aligned with
the SEM, our results show night shift workers' eating habits are influ-
enced by intrapersonal, interpersonal, and (work) organizational levels.
In particular, participants reported that at work, appropriate food
preparation facilities are required to enable healthy food choices. In
addition, participants expressed limited ability and motivation to
engage in healthy eating even outside of work, due to prolonged
fatigue caused by poor shift work rostering. As a result, night shift
workers seem to require additional supports from their social net-
works (e.g., colleagues and family) and enhanced food literacy skills
(for efficient food preparation), in order to adopt/maintain healthy
eating behaviors.
CONCLUSION: Night shift work creates individual and environmen-
tal barriers to healthy eating, which are present during and outside
of work. In order to encourage healthy eating in this population,
health promotion strategies should include multiple approaches,
targeting individual factors (e.g., food literacy skills) and also
environmental factors (e.g., workplace setting and guidelines on
rostering).
CONFLICT OF INTEREST: None declared.
P106 | Prevalence and associated risk factors
of obesity among adult population in Dubai:
Findings from the Dubai Household Health
Survey, 2019
H. Mohamed; W. Al Nakhi; H. Hussein
Research & Studies, Dubai Health Authority, Dubai, United Arab Emirates
INTRODUCTION: Overweight and obesity has emerged as one of the
most important public health issues in the United Arab Emirates in the
last two decades. Global wise, WHO (World Health Organization)
1467789x, 2022, S2, Downloaded from https://onlinelibrary.wiley.com/doi/10.1111/obr.13503 by CAPES, Wiley Online Library on [16/12/2023]. See the Terms and Conditions (https://onlinelibrary.wiley.com/terms-and-conditions) on Wiley Online Library for rules of use; OA articles are governed by the applicable Creative Commons License
51 of 222
projects that by 2015, approximately 2.3 billion adults will be over-
weight and more than 700 million will be obese.
MATERIALS AND METHODS: To study the prevalence of overweight
and obesity with their associated risk factors among the adults in
Dubai. Design and setting: A cross-sectional survey, with multistage,
stratified random sample design was carried out in the Emirate of
Dubai in 2019. Participants: 2142 adults +18 years (includes both
UAE nationals and non-nationals).
RESULTS: The overall prevalence of obesity (BMI ≥ 30) was 17.8%
(16.6% in males and 21.6% in females). The highest obesity rates were
seen among the UAE nationals (39.6%), followed by Arabs non-
nationals (27.7%). Moreover, 39.8% of the population were over-
weight (BMI ≥ 25–29.9). The multivariate logistic regression showed
associations between obesity and age, gender, nationality groups,
hypertension, and the individuals' occupation. Older individuals aged
40–49 years, 50–59 years, and 60+ years had greater risk of obesity
[OR = 3.38 (95% CI 1.26–9.04), OR = 4.30 (95% CI 1.57–11.78),
OR = 3.94 (95% CI 1.33–11.61)], compared to the reference group,
respectively. Females had a higher risk of obesity compared to males
(OR = 1.62 (95% CI 1.10–2.38). UAE nationals, other Arabs, and
Asians were more likely to be obese compared to the reference group
[OR = 2.08 (95% CI 1.18–3.67), OR = 3.61 (95% CI 2.40–2.40),
OR = 1.98 (95% CI 1.12–3.50), respectively]. Clerical and service
workers and elementary and unskilled occupations categories had
higher risk of obesity compared to professionals (OR = 4.50 and 2.57;
p < 0.01, respectively). Hypertensive individuals had a higher risk of
obesity compared to the normotensives (OR = 3.96, p < 0.01).
CONCLUSION: Obesity and overweight are highly prevalent among
adults in Dubai and remarkably linked to some sociodemographic and
behavioral risk factors. Establishing a comprehensive strategic initia-
tive to control obesity, within the higher risk population, is urgently
needed in the Emirate of Dubai.
CONFLICT OF INTEREST: None declared.
P107 | Association of body mass index from
childhood to mid-adulthood with health-
related quality of life and health state utility
values in mid-adulthood: Evidence from a
30-year follow up of children's cohort
J. Tian1; L. Blizzard1; J. Campbell1; S. Gall1; T. Dwyer2,3; A. Venn1
1
Menzies Institute for Medical Research, University of Tasmania, Hobart,
Tasmania, Australia; 2Menzies Institute for Medical Research, Hobart,
Tasmania, Australia; 3The George Institute for Global Health, University
of Oxford, Oxford, UK
INTRODUCTION: The associations of obesity with health-related
quality of life (HRQoL) and health state utility values (HSUVs) have
been investigated, usually with obesity assessed at only one or two
time points. We aimed to examine the associations of life-course body
mass index (BMI) from childhood with HRQoL and HSUVs in later life.

52 of 222
MATERIALS AND METHODS: Data were from a cohort study of
Australian school children (n = 2254, mean baseline age 12.0 [2.0]
years in 1985, 46.8% male). Weight and height were measured in
childhood and measured or self-reported on average 20, 25, and
30 years later. Age and sex standardized BMI-z score was calculated
at each time point. Physical and mental HRQoL and HSUVs were
measured by SF-12 and SF-6D at the last adult follow-up. Linear
regression was used to examine the associations with adjustment for
age, sex, and childhood health status.
RESULTS: Higher BMI-z score in childhood (adjusted β (βadj): 1.39,
95% confidence interval (CI): 1.73 to 1.05) and increases in BMI-z
score from childhood to young adulthood (βadj: 1.82, 95% CI: 2.17
to 1.46) and from young to mid-adulthood (βadj: 1.77, 95% CI:
2.28 to 1.26) were associated with lower physical HRQoL in mid-
adulthood. Similar results were found for mid-adulthood HSUVs (βadj
ranged 0.006 to 0.014, all P < 0.05). Only BMI-z score increase
from young to mid-adulthood significantly related to poorer mental
HRQoL (βadj: 0.74, 95% CI: 1.29 to 0.19) in mid-adulthood.
CONCLUSION: Life-course BMI from childhood to mid-adulthood
was statistically significantly associated with HRQoL and HSUs in
mid-adulthood, though the strength of these associations was weak.
CONFLICT OF INTEREST: None declared.
P108 | Strategies of collaboration
management to maximize synthesis of
obesity prevention evidence—TOPCHILD
Collaboration
J. G. Williams1; K. Hunter1; on behalf of TOPCHILD Collaboration;
2 1 1
B. Johnson ; A. Barba ; M. Aberoumand ; S. Libesman ; 1 gestational weight gain: A study exploring
A. L. Seidler 1
TOPCHILD Collaboration
1
NHMRC Clinical Trials Centre, University of Sydney, Sydney, New South
Wales, Australia; 2Caring Futures Institute, Flinders University, Adelaide,
South Australia, Australia
INTRODUCTION: The Transforming Obesity Prevention for CHIL-
Dren (TOPCHILD) Collaboration brings together early obesity preven-
tion trialists to undertake an individual participant data (IPD) meta-
analysis and intervention deconstruction project, with the aim to
determine which interventions (using behavior change techniques) are
most effective in preventing early childhood obesity. Projects of this
size are challenging and resource intensive, where low trialist partici-
pation rates and poor engagement can lead to project failure. We
aimed to use TOPCHILD as a case study to identify efficient and suc-
cessful collaboration management strategies.
MATERIALS AND METHODS: Information from our custom made
TOPCHILD database was extracted to analyze communication modes
and frequency, recruitment details, and resource input across all
stages of the project, including invitations to join the collaboration,
protocol development, data requests and agreements, data queries,
and administrative matters. We identified a list of challenges facing
1467789x, 2022, S2, Downloaded from https://onlinelibrary.wiley.com/doi/10.1111/obr.13503 by CAPES, Wiley Online Library on [16/12/2023]. See the Terms and Conditions (https://onlinelibrary.wiley.com/terms-and-conditions) on Wiley Online Library for rules of use; OA articles are governed by the applicable Creative Commons License
SUPPLEMENT ARTICLE
researchers performing IPD meta-analyses through consultation with
TOPCHILD team members. Each team member was asked to describe
specific examples of how they successfully approached challenges
encountered. We then used thematic analyses to derive key strategic
themes for successful approaches to these challenges.
RESULTS: Of the 76 identified eligible trials, to date 48 have agreed
to join the TOPCHILD Collaboration (13 planned/ongoing and 35 com-
pleted). Of those trials that are complete, 24 (44%), including 25,761
(72%) of eligible participants have already provided IPD and interven-
tion materials. Key strategic themes for managing the collaboration
were identified as (1) a well-resourced multi-disciplinary team, (2) clear,
personalized and dynamic communication, (3) knowledge of ethical
and contractual processes, (4) availability of information in compre-
hensive databases and contact logs, and (5) clarity in collaboration
governance. Communication in the TOPCHILD Collaboration was esti-
mated to account for over 450 h of staff time per year.
CONCLUSION: Evidence synthesis using individual participant data is
a resource-intensive yet powerful method to answer complex
research questions such as “what are the most effective interventions
for early childhood obesity prevention?” The outlined strategies on
collaboration management derived from experiences of the TOP-
CHILD Collaboration will guide other researchers during evidence
synthesis. Additionally, our findings provide trialists with a better
understanding of what is involved in an IPD meta-analysis and
encourage them to build or seek collaborative opportunities in the
future.
CONFLICT OF INTEREST: None declared.
P109 | MHealth for the management of
user needs and values
K. Butten1; M. Varnfield2
1
Australian eHealth Research Centre, Herston, Queensland, Australia;
2
Australia eHealth Research Centre, CSIRO, Brisbane, Queensland,
Australia
INTRODUCTION: More than 50% of Australian women gain more
gestational weight than is recommended during pregnancy. Obesity
during pregnancy and excessive gestational weight-gain (GWG) has
negative implications for birth outcomes, gestational diabetes mellitus
(GDM), future Type 2, and juvenile diabetes.
The CSIRO has a mobile health platform (MoTHer), which sup-
ports management of GDM during pregnancy in hospitals. Using a
patient-facing mobile app and a web-based clinician portal, MoTHer
supports users to effectively manage blood glucose levels with
increased resilience in the face of health service disruptions due to
COVID-19. The purpose of this project is to expand this platform to
support recommended diet and activity behaviors and weight man-
agement during pregnancy and post-birth. Reducing the risk of GDM
complications and future diabetes diagnosis.

SUPPLEMENT ARTICLE
MATERIALS AND METHODS: Using qualitative inquiry, the project
will explore user interest of the mHealth platform (e.g., apps and
SMS/text messages) for diet and activity behaviors, and what
devices (e.g., wearables) women would utilize for self-monitoring
and support. Informed by user consultation, the project will aim to
add functionality to the current platform to incorporate GWG man-
agement capacity and evaluate the uptake and acceptability of the
platform by users, investigating how it fits into clinical workflow
with respect to GWG.
RESULTS: Current practice for GWG support is limited to brief
counseling and paper-based materials, which are delivered in tandem
with prenatal care (GWG messaging can be diluted as other goals take
priority, such as blood glucose education). If additional support is
needed, face to face meetings can be arranged, but these are often
out of reach given limited hospital resources, the competing priorities
of mothers, as well as socio-economic, and geographic barriers. Digital
health interventions such as the proposed mHealth platform are able
to transcend traditional access barriers and provide more equitable,
consistent and literally, at-hand support and information to a variety
of populations. The current platform is available in 10 languages and
resources can be tailored to the needs of the site and population,
reaching those that are often underserved.
CONCLUSION: Given the prevalence of obesity in pregnancy and
associated risks, finding a cost-effective, accepted, and sustainable
method of managing GWG effectively is a public health priority. The
proposed project will shed light on the usability and acceptability of
mHealth for GWG management.
CONFLICT OF INTEREST: None declared.
P111 | Routine and compensatory dietary
restraint in Chinese adults with different
weight status
M. Ho; C. Y. Chung; P. H. Chau; D. Y. T. Fong
School of Nursing, The University of Hong Kong, Hong Kong
INTRODUCTION: Under the restraint theory, dietary restraint is a risk
factor of overweight and eating disorders. However, some research
suggested that dietary restraint can be an effective component for
healthy weight management. The aim of this study was to examine
the different constructs of dietary restraint in Chinese adults with dif-
ferent weight status.
MATERIALS AND METHODS: It was a cross-sectional online survey.
Subjects were 949 Chinese adults (739 females, mean age 32.6,
SD13.7 years). A validated 13-item Chinese version of Weight-related
Eating Questionnaire was used to measure routine restraint (rigid
restraint), compensatory restraint (flexible restraint), emotional eating,
and susceptibility to external cues. The total scores of routine and
compensatory restraint ranged from 1 to 5 with higher scores indicate
a higher tendency of dietary restraint. Body mass index (BMI) was cal-
culated from the self-reported height and weight and used to
1467789x, 2022, S2, Downloaded from https://onlinelibrary.wiley.com/doi/10.1111/obr.13503 by CAPES, Wiley Online Library on [16/12/2023]. See the Terms and Conditions (https://onlinelibrary.wiley.com/terms-and-conditions) on Wiley Online Library for rules of use; OA articles are governed by the applicable Creative Commons License
53 of 222
categorize subjects to underweight, normal weight, and overweight/
obese using the Asian BMI cutoffs. Correlation between variables
were assessed by Pearson's correlation coefficients. ANCOVA was
conducted to compare the scores of dietary restraint among respon-
dents who were underweight, normal weight, and overweight/obese
with adjustment made for sex, age, and educational levels.
RESULTS: Among 949 respondents, 14.6% was underweight, 53.5%
normal weight, and 31.9% overweight/obese. Females reported
higher scores of both routine (2.09 ± 0.87 vs. 1.88 ± 0.78, P = 0.001)
and compensatory restraint (2.90 ± 0.99 vs. 2.51 ± 0.99, P < 0.001)
than males. Both routine and compensatory restraints were positively
correlated with emotional eating (routine restraint r = 0.258,
P < 0.001; compensatory restraint r = 0.235, P < 0.001) and suscepti-
bility to external cues (routine restraint r = 0.112, P < 0.001; compen-
satory restraint r = 0.194, P < 0.001). Results from ANCOVA analysis
showed that overweight and obese respondents scored higher on rou-
tine restraint than normal weight and underweight respondents (2.14
± 0.05 vs. 1.99 ± 0.04 vs. 1.59 ± 0.08, P < 0.001). However, the com-
pensatory restraint scores did not differ between the normal weight
and overweight/obese respondents (P = 0.878). Underweight respon-
dents reported a significantly lower scores of compensatory restraint
than normal and overweight/obese respondents (2.42 ± 0.09 vs. 2.74
± 0.05 vs. 2.75 ± 0.06, P < 0.001).
CONCLUSION: Overweight/obese Chinese adults reported a higher
tendency of rigid dietary restraint than normal weight adults, but not
the flexible dietary restraint. Longitudinal studies are required to eval-
uate the impact of rigid and flexible dietary on weight management.
CONFLICT OF INTEREST: None declared.
P113 | Differences in preferences for the
delivery of lifestyle intervention after
childbirth between Australian and Asian
women: A cross-sectional study in Australia
M. Chen1; M. Makama1; L. Moran1; C. Harrison1; T. Choi2;
C. Bennett2; M. Hutchesson3; S. Lim4
1
Monash Centre for Health Research and Implementation, Monash
University, Clayton, Victoria, Australia; 2Department of Nutrition,
Dietetics and Food, School of Clinical Sciences, Monash University,
Notting Hill, Victoria, Australia; 3School of Health Sciences, Faculty of
Health and Medicine, University of Newcastle, Callaghan, New South
Wales, Australia; 4Eastern Health Clinical School, Monash University, Box
Hill, Victoria, Australia
INTRODUCTION: Postpartum weight retention contributes to mater-
nal obesity and is more pronounced in ethnic minority women.
Despite the well-established benefits of lifestyle interventions on
weight management, little is known about how to effectively reach
and engage women of childbearing age, especially for ethnic minority
groups. This study aimed to compare the preferences for the delivery

54 of 222
of lifestyle interventions after childbirth between Australian and Asian
women living in Australia.
MATERIALS AND METHODS: A cross-sectional survey was con-
ducted among women within 5 years of childbirth in Australia in
November 2021, using a structured questionnaire developed on the
basis of the Template for Intervention Description and Replication
(TIDieR) framework. Ethnic groups were categorized as Australian or
Asian according to the Australian Bureau of Statistics. Independent-
sample t tests and Chi-square tests were used to compare demo-
graphic characteristics and lifestyle intervention preferences between
groups.
RESULTS: The 228 Australian and 174 Asian women completed the
survey, of which 90.8% and 93.7% showed interest in participating
in lifestyle interventions respectively. The most preferred interven-
tion timepoint (within 3 months of childbirth), intervention duration
(1 year), and intervention frequency (monthly) were the same for
the two groups. However, Asian women were more likely to favor
interventions that were initiated later following birth, over a
shorter duration and with less intervention frequency compared to
Australian women (all P < 0.01). Also, Asian women desired a
shorter duration of each session (between 15 and 30 min) than
Australian women (between 30 and 45 min; P = 0.009). Australian
women preferred individual, face-to-face consultation (58.3%),
while Asian women preferred individual consultation either face-to-
face (49.4%) or via technology remotely (49.4%). There were no
differences in the preferences for intervention provider and loca-
tion of intervention between women from both groups (both
P > 0.05).
CONCLUSION: Both Australian and Asian women expressed the
desire for lifestyle interventions after childbirth, whereas ethnic differ-
ences were found in the preferences for the intervention delivery.
The findings suggest a need for the development of culturally appro-
priate intervention strategies to optimize engagement in healthy life-
styles for women from different ethnic backgrounds.
CONFLICT OF INTEREST: None declared.
P115 | Reducing postpartum weight
retention through lifestyle management:
Perceived barriers and facilitators by
postpartum women using the Capability,
Opportunity and Motivation Behaviour
model
1 2 2 3
S. Lim ; M. Savaglio ; H. Skouteris ; L. Moran
1
Health Systems and Equity, Eastern Health Clinical School, Monash
2
University, Box Hill, Victoria, Australia; Health and Social Care Unit,
Monash University, Melbourne, Victoria, Australia; 3Monash Centre of
Health Research and Implementation, Monash University, Clayton,
Victoria, Australia
1467789x, 2022, S2, Downloaded from https://onlinelibrary.wiley.com/doi/10.1111/obr.13503 by CAPES, Wiley Online Library on [16/12/2023]. See the Terms and Conditions (https://onlinelibrary.wiley.com/terms-and-conditions) on Wiley Online Library for rules of use; OA articles are governed by the applicable Creative Commons License
SUPPLEMENT ARTICLE
INTRODUCTION: Postpartum weight retention is a significant con-
tributor to weight gain and obesity in women of reproductive age.
Achieving and maintaining a healthy lifestyle during this period could
be challenging. This study aimed to synthesize the barriers and facili-
tators to engaging in a healthy lifestyle during the first 2 years post-
partum using the Capability, Opportunity, Motivation and Behaviour
(COM-B) model.
MATERIALS AND METHODS: Women who have given birth within
the last 2 years and currently living with the child were recruited
through convenience and snowball sampling to complete an interview
(30–40 min) via Zoom. Informed consent was obtained at the start of
the interviews. Interviews were audio-recorded and transcribed using
a professional transcription service. All interview transcripts were
coded by one author (MS), with a 10% subset independently coded by
other authors (SL, LM). Thematic analyses were conducted using an
open coding approach. The main themes were subsequently mapped
to the COM-B domains.
RESULTS: Eleven themes for barriers and 16 themes for facilitators
were mapped against seven COM domains. Postpartum women
face barriers and facilitators within capability (e.g., sleep depriva-
tion, stress and mental burden, ability to organize and plan, ability
to create time, and space for self-care), opportunity (e.g., lack of
time, practical and social support from family or friends, and work
arrangement enabling self-care), and motivation (e.g., difficulty pri-
oritizing self, exercise as an emotional coping strategy).
CONCLUSION: Postpartum women experienced barriers to lifestyle
management, including sleep deprivation, stress, lack of time, lack
of practical support from family and friends, and difficulty prioritiz-
ing self. Facilitators to lifestyle management include the ability to
organize and plan, having restful time and space for self, a work
arrangement that facilitates self-care, peer support, practical and
social support from partners, and exercise as an emotional coping
strategy. Interventions that address issues with women and infant
sleep, stress, and lack of time; empower mothers to prioritize self-
care; and facilitate support from partners and peers may increase
long-term engagement in behavior change.
CONFLICT OF INTEREST: None declared.
P116 | Physical activity assessment is crucial
for obesity risk prediction in adolescent
patients
T. Totomirova; M. Arnaudova; I. Arabadzhieva
Clinic of Endocrinology and Metabolic Diseases, Military Medical
Academy, Sofia, Bulgaria
INTRODUCTION: Physical activity is assumed to be a factor of great
importance for weight maintenance. Assessment of physical activity
in childhood should be done for identifying patients at risk and predic-
tion of obesity development. The aim of our study was to assess

SUPPLEMENT ARTICLE
physical activity importance as risk factor for weight changes in boys
and girls 8–18 years aged.
MATERIALS AND METHODS: The study include 262 subjects
(128 boys, 134 girls) in single country region in Bulgaria (mean age
12.02 ± 3.03 years, mean BMI 20.38 ± 4.36 kg/m2). Children were
asked to answer unified questions considering information about
physical activity (time spent in sport, open air activities and before
screen time). The information was assessed regarding BMI and weight
problems.
RESULTS: Results show that 26.87% of girls and 17.19% of boys have
previous problems with body weight and 10.45% of girls and 10.93%
of boys were with increase body weight at the moment. Two of girls
(1.49%) and six of boys (6.25%) were diagnosed with obesity. BMI
showed negative correlation with average time spent in physical activ-
ity (r = 0.301) and open-air activities (r = 0.321) and positive cor-
relation with before screen time (r = 0.274). No other correlations
between healthy and unhealthy activity habits were established. No
differences in gender and age were found.
CONCLUSION: Based on our data we found out that physical
activity assessment is of great importance for adolescent weight
gain and risk of obesity development. The increase in active sport
activity and decrease of before screen time is crucial for weight
maintenance and should be focused by parents in establishing of
daily child habits.
CONFLICT OF INTEREST: None declared.
P117 | Body mass index loss reduces the
need for knee replacement: A survival
analysis using multi-cohort data
Z. Salis1; A. Sainsbury2
1
Centre for Big Data Research in Health, The University of New South
Wales, Sydney, New South Wales, Australia; 2School of Human Sciences,
The University of Western Australia, Perth, Western Australia, Australia
INTRODUCTION: The annual healthcare cost of total knee replace-
ment surgery due to osteoarthritis in Australia is expected to reach A
$3.40 billion by 2030. While associations between osteoarthritis and
obesity are well-established, and while inter/national osteoarthritis
guidelines recommend weight loss for patients with overweight/obe-
sity, the effects of weight loss on progression to knee replacement is
unclear. We aimed to determine the relationship between change in
BMI and the risk of knee replacement.
MATERIALS AND METHODS: We used data from three cohort
studies: the Osteoarthritis Initiative (OAI) as well as the Multicenter
Osteoarthritis Study (MOST) from the United States of America,
and the Cohort Hip and Cohort Knee (CHECK) study from the
Netherlands, which collected data over 7–10 years from adults
(45–79 years of age) with or at risk of clinically significant knee
osteoarthritis.
1467789x, 2022, S2, Downloaded from https://onlinelibrary.wiley.com/doi/10.1111/obr.13503 by CAPES, Wiley Online Library on [16/12/2023]. See the Terms and Conditions (https://onlinelibrary.wiley.com/terms-and-conditions) on Wiley Online Library for rules of use; OA articles are governed by the applicable Creative Commons License
55 of 222
We conducted a time-to-event survival analysis (i.e., Cox propor-
tional hazards regression analysis) with clustering of both knees per
person to determine the association between change in BMI and the
incidence of primary knee replacement over 7 to 10 years' follow-up.
The exposure was change in BMI (in kg/m2) between baseline and
the last follow-up visit before knee replacement, or—for knees that
were not replaced—the last follow-up visit. The analysis was adjusted
for age, sex, cohort study (i.e., OAI, MOST, and CHECK), and the
baseline value of the following variables: BMI category, radiographic
knee osteoarthritis grade (i.e., Kellgren–Lawrence [KL] grade), pres-
ence of persistent knee pain, walking or not for activity, marriage
status, number of comorbidities, employment status, and education
status.
RESULTS: A total of 16,362 knees from 8181 participants (61.5%
female), with mean ± SD age of 60.7 ± 8.6 years, and with mean ± SD
BMI of 29.1 ± 5.3 kg/m2, were included in the knee analysis. Mean
follow up time was 6.9 years.
BMI change had a positive, dose-responsive association with
the risk of knee replacement (adjusted hazard ratio [HR] 1.03; 95%
confidence interval [CI] 1.00–1.06). There were no significant inter-
actions between change in BMI and baseline BMI in the associa-
tion with knee replacement. In other words: every 1-unit reduction
in BMI was associated with a 3% reduced risk of knee replace-
ment, regardless of baseline BMI. Calculation of the population
attributable fraction (PAF) showed evidence that if all people with
or at risk of clinically significant knee osteoarthritis and with a
BMI ≥ 25 kg/m2 lost 1 BMI unit (assuming nothing else changed),
then 3.2% (range: 0.3–5.9%) of knee replacements would be
avoided.
CONCLUSION: Public health strategies that incorporate weight loss
interventions have the potential to reduce the burden of knee
replacement surgery.
CONFLICT OF INTEREST: Z. Salis Shareholder of: ZS owns 50% of
the shares in Zuman International, which receives royalties and
other payments for educational resources and services in adult
weight management and research methodology. A. Sainsbury
Shareholder of: AS owns 50% of the shares in Zuman International,
which receives royalties and other payments for educational
resources and services in adult weight management and research
methodology. Consultant for: AS served on the Nestlé Health Sci-
ence Optifast VLCD advisory board from 2016 to 2018. Paid
Instructor for: AS additionally reports receiving presentation fees
and travel reimbursements from Eli Lilly and Co, the Pharmacy
Guild of Australia, Novo Nordisk, the Dietitians Association of
Australia, Shoalhaven Family Medical Centres, the Pharmaceutical
Society of Australia, and Metagenics.

56 of 222
P118 | Correlation between rate pressure
product and visceral adipose tissue
A. T. B. Tito; P. Fernandez; M. Sena; S. da Rosa; R. Marson
Instituto de Pesquisa da Capacitação Física do Exército (IPCFEx), Rio de
Janeiro, Brazil
INTRODUCTION: The obesity pandemic is increasing with each pass-
ing year, with heart failure as the leading cardiovascular complication
even in patients with good cardiovascular risk factor management.
The early identification of individuals more susceptible to die from
cardiovascular diseases is important for planning strategies of public
health measures. The rate pressure product (RPP) seems to be a pow-
erful predictor of cardiovascular disease (CVD) and mortality. Some
studies showed universal obesity is associated with an increase in
RPP. However the relation involving visceral obesity and RPP aren't
well understood. The purpose of this study was to verify the correla-
tion between RPP and visceral adipose tissue (VAT).
MATERIALS AND METHODS: Thirty male military from Brazilian
Army personnel who participated in the MetS Monitoring Program of
the Army's Physical Training Research Institute (IPCFEx) were evalu-
ated (39.1 ± 9.7) y.d., body mass: 97.2 ± 13.1 kg, BMI: 33.2 ± 3.5 kg/
m2, FMI: 12.0 ± 2.4 kg/m2, visceral adipose tissue (VAT): 2353.7
± 916.3 cm3, classified in two groups according to FMI values. Group
1 (fat excess): 37.9 (22–51) y.d, FMI: 7.4(6.3–8.6) kg/m2 and group
2
2 (Obesity): 40.3 (30.0–61.0) years, FMI: 12.0(9.0–17.1) kg/m . The
body composition was recorded using double X-ray absorptiometry.
Heart rate (HR) and blood pressure (BP) were collected at pre-exercise
and before the interruption of the ergometric treadmill effort, using
the progressive linear, ramp protocol, then the rest, maximum and
reserve rate pressure product, also called Double Product (DP), was
calculated. Kolmogorov–Smirnov normality test was applied and the
subsequently statistical approach was performed according to the
result of normality test. The data were analyzed by Statistics 12.0,
running a Student's t-test for independent samples and Pearson's cor-
relation, with a p value < 0.05. The processing and statistical analysis
of the data were performed using the statistical software Statistics
version 12.
RESULTS: We observed on group 1 (VAT: 1091.4 ± 446.7; DPrest:
8758.7 ± 1954.2; DPmax 32,324.3 ± 4340.9 and DPreserve:
23,565.7 ± 5043.8) and on group 2 (VAT: 2353.7 ± 916.3; DP rest:
9586.3 ± 1163.5; DPmax 30,520.0 ± 4923.0 and DPreserve:
21,605.7 ± 4691.3). Regarding the main variables obtained it was
observed a moderate negative correlation between VAT (cm3) and DP
maximum (r = 0.482, p = 0,007) and DP reserve (r = 0.403,
p = 0.027). No significant correlation was found between all DP types
and all other variables.
CONCLUSION: Contrary to expectation, elevated RPP had an inverse
correlation with VAT. The effect of the excess of fat and obesity on
hemodynamic parameters are not completely elucidated.
CONFLICT OF INTEREST: None declared.
1467789x, 2022, S2, Downloaded from https://onlinelibrary.wiley.com/doi/10.1111/obr.13503 by CAPES, Wiley Online Library on [16/12/2023]. See the Terms and Conditions (https://onlinelibrary.wiley.com/terms-and-conditions) on Wiley Online Library for rules of use; OA articles are governed by the applicable Creative Commons License
SUPPLEMENT ARTICLE
P120 | Effects of peripheral neuropeptide Y-
Y1 receptor signaling in controlling energy
and glucose homeostasis under intermittent
fasting in mice
J. Zhang1,2; K. Lee1,2; Z. Gao1; Y. Shi1,2
1
Diabetes and Metabolism Division, Garvan Institute of Medical
Research, Sydney, New South Wales, Australia; 2St Vincent's Clinical
School, UNSW Sydney, Sydney, New South Wales, Australia
INTRODUCTION: Neuropeptide Y-Y1 receptor (NPY-Y1R) signaling
is critical in controlling energy balance. We recently showed block-
ing peripheral Y1R using a selective Y1R antagonist, BIBO3304,
protects mice from continuous high fat diet (HFD)-induced
obesity (DIO) via enhancing energy expenditure. Intermittent fasting
(IF) has been shown to be a potent behavioral measure in
reducing body weight in HFD-fed mice and human. However, it
remains unclear whether BIBO3304's benefits will persist in
the context of IF and whether there are combined effects of phar-
macological treatment and behavioral modification in
managing DIO.
MATERIALS AND METHODS: Here, male C57BL/6J mice fed on
HFD were divided into three groups: continuous HFD feeding,
alternate-day fasting (ADF), and refeeding on HFD with concurrent
daily oral jelly containing BIBO3304 or vehicle for 9 weeks. Pheno-
typic characterization was performed, including body weight, body
composition, glucose and insulin tolerance tests, and indirect
calorimetry.
RESULTS: ADF-treated mice gained less body weight and fat mass
compared to continuous HFD group. Although BIBO treatment did
not further prevent overall BW and fat mass gain, ADF + BIBO
group had significant reduction in epididymal white adipose tissue
(WAT) weight. Energy expenditure was increased in both ADF
groups, accompanied by a lower respiratory exchange ratio (RER)
suggesting a fuel preference toward fat oxidation, though BIBO did
not cause further decrease. Energy intake in ADF-treated mice was
remarkably reduced due to fasting–refeeding cycles, while BIBO
treatment did not impact it. ADF reduced DIO WAT hypertrophy,
presumably via induction of inguinal WAT beiging, a benefit that
was enhanced in ADF + BIBO treatment. Furthermore,
ADF + BIBO treatment protected against ADF-associated brown
adipose tissue (BAT) whitening, thus restoring its thermogenic
capacity. Notably, BIBO potentiated ADF-induced improvement in
an in vivo glucose tolerance test, which was mechanistically accom-
panied by an increase in beta cell insulin secretion assessed by an
ex vivo GSIS assay.

SUPPLEMENT ARTICLE
CONCLUSION: Collectively, these findings suggest the anti-obesity
profile of peripheral Y1R signaling blockade has been altered under
an ADF setting. BIBO3304 treatment enhanced WAT beiging and
BAT thermogenesis and improved insulin secretion, while there is
no further phenotypic improvement in BW reduction. This may
partially due to the potent effect of ADF itself. Therefore,
using BIBO3304 as an example of pharmacotherapy and ADF as
an example of behavior measure, we demonstrated that the effi-
cacy of pharmacotherapies should be assessed under different met-
abolic settings and care should be taken when combining
pharmacological treatment with behavioral modification
managing DIO.
CONFLICT OF INTEREST: None declared.
P121 | Overexpression of neurosecretory
protein GL-precursor gene induces fatty liver
in ICR mice
K. Ukena; M. Kato; Y. Narimatsu; S. Moriwaki; M. Furumitsu;
E. Iwakoshi-Ukena
Graduate School of Integrated Sciences for Life, Hiroshima University,
Higashi-Hiroshima, Japan
INTRODUCTION: We have found a novel gene encoding a small
secretory protein of 80 amino acids and named neurosecretory
protein GL (NPGL). In C57BL/6J mice, chronic intracerebroventricu-
lar (i.c.v.) infusion of NPGL increases food intake with considerable
fat accumulation under a medium-fat/medium-sucrose diet (MFSD),
whereas it induces moderate fat accumulation without changing
food intake in normal chow (NC)-fed mice. Notably, overexpression
(OE) of the NPGL precursor gene (Npgl) in the mouse hypothala-
mus increases food intake and fat deposits under NC and MFSD
conditions and elevates blood insulin levels without changing the
blood glucose levels. However, the effects of NPGL on other
mouse strains have not been elucidated. In this study, we investi-
gated the effect of Npgl OE on food intake, body mass gain, body
composition, blood parameters, and mRNA expression of metabolic
regulatory genes in ICR mice fed with a low-fat/medium-sucrose
diet (LFMSD).
MATERIALS AND METHODS: Male ICR mice (7 weeks old) were

housed individually under standard conditions (25 ± 1 C under a 12-h
light/dark cycle) with ad libitum access to water and LFMSD (10% of
calories from fat/17% of calories from sucrose). For Npgl OE, mice
were bilaterally injected with adeno-associated virus (AAV)-based
vectors at the mediobasal hypothalamic region. Npgl OE was main-
tained for 13 or 63 days. Food intake and body mass were measured
during experiments. Body composition, blood parameters, and mRNA
expression of metabolic regulatory genes were measured at the
experimental endpoint of Npgl OE. Furthermore, the measurement of
triglycerides and the morphological analysis were conducted in the
liver.
1467789x, 2022, S2, Downloaded from https://onlinelibrary.wiley.com/doi/10.1111/obr.13503 by CAPES, Wiley Online Library on [16/12/2023]. See the Terms and Conditions (https://onlinelibrary.wiley.com/terms-and-conditions) on Wiley Online Library for rules of use; OA articles are governed by the applicable Creative Commons License
57 of 222
RESULTS: Npgl OE significantly increased cumulative food intake,
body mass gain, and masses of white adipose tissues after 13 or
63 days of treatments. The treatment elevated the blood
glucose levels and increased the mass of liver after 63 days, unlike
13 days. The measurement of triglycerides and morphological
analysis revealed fatty liver after 13 days and 63 days of Npgl
OE. The real-time PCR analysis showed that the expressions of
gluconeogenesis-related genes (G6pase and Pepck) were upregulated
in the liver after 13 days of Npgl OE. In addition, blood
insulin levels were increased after both 13 days and 63 days of
in Npgl OE.
CONCLUSION: In our previous study, we have never found the
increase in blood glucose levels by i.c.v. infusion of NPGL or Npgl OE
in the obesity-prone mouse strain, C57BL/6J. In the present study,
we observed significantly high levels of glucose after 63 days of Npgl
OE in ICR mice. Furthermore, we found fatty liver after 13 and
63 days of Npgl OE. These results suggest that Npgl OE induces a con-
dition similar to diabetes through insulin resistance in the liver of
ICR mice.
CONFLICT OF INTEREST: None declared.
P122 | Investigating the role of orexin in a
mouse model of female “emotional” stress-
induced binge eating
M. O'Shea1,2; M. M2,3; R. Anversa2; P. Sumithran4; A. Gogos2;
L. Walker2,3; R. Brown1,2
1
Department of Biochemistry and Pharmacology, University of
Melbourne, Parkville, Victoria, Australia; 2Florey Institute of Neuroscience
and Mental Health, Parkville, Victoria, Australia; 3Florey Department of
Neuroscience and Mental Health, Parkville, Victoria, Australia;
4
Department of Medicine (St Vincent's), University of Melbourne,
Parkville, Victoria, Australia
INTRODUCTION: It is well established that stress and negative affect
(e.g., sadness, anger, and loneliness) trigger overeating. This form of
maladaptive eating behavior, commonly referred to as “emotional
eating,” is particularly common in women and is associated with binge
eating and higher risk of obesity. The neural mechanisms that under-
pin this form of dysregulated eating are yet to be elucidated but likely
implicate neuronal substrates involved in both homeostatic and
hedonic feeding. The orexin system (or hypocretin) represents a dis-
tinct population of lateral hypothalamic neurons, that has been previ-
ously implicated in reward, stress, and feeding. Thus, we aim to
investigate the role of the orexin system in stress-induced binge eat-
ing in females.
MATERIALS AND METHODS: To do so, a mouse model was
employed that used a mild, psychological stressor and intermittent
access to highly palatable food to induce binge eating in test mice.
Mice exposed to the frustrative stressor and food reward consumed
significantly more than control mice exposed to the food reward only.

58 of 222
Immunohistochemistry for the neuronal activity marker Fos was used
to assess the recruitment of lateral hypothalamic neurons, including
orexin during this behavior.
RESULTS: Statistical analysis of cell counts has revealed significant
activation in neurons throughout the lateral hypothalamus of
stress-induced binge eating mice (p < 0.05). Early analysis of
orexin data is indicative of a trend toward significant neuronal
activation; however, full quantification of orexin data is ongoing.
We hypothesize that orexin neurons will be significantly
activated as a result of stress-induced binge eating as compared to
control.
CONCLUSION: Our preliminary evidence indicates a significant
role for neurons of the lateral hypothalamus in female stress-
induced binge eating, and a potential role for the orexin system.
Investigation into the extent of orexin's involvement remains ongo-
ing. When completed, the results of this study will provide insight
into the neurobiological processes underlying stress-driven binge
eating.
CONFLICT OF INTEREST: None declared.
P123 | Regional brain volume changes in
Catholic nuns with obesity
S.-H. Kim; J. Chung
The Catholic University of Korea, Seoul, Republic of Korea
INTRODUCTION: Although previous studies have demonstrated an
association between obesity and brain volume, no studies have evalu-
ated structural brain changes in obese Catholic nuns. The present
study aimed to identify the pattern of regional brain volume change
according to obesity in Catholic nuns.
MATERIALS AND METHODS: The subjects of this study were the
catholic sisters between the ages of 31 and 80 who are members of
the charity of St. Vincent de Paul, Korea. A total of 86 asymptomatic
Catholic sisters (27 obese and 59 non-obese) underwent 3T brain MRI
scans and compared cortical and sub-cortical volume between groups
across multiple locations using our in-house U-Net++ deep learning-
based automatic segmentation tool.
RESULTS: ANCOVA adjusted for age, education, total intracranial vol-
ume (TIV), and gender revealed significant volume reductions in the
right lateral occipital and left-rostral-anterior-cingulate in the obese
group compared with the control group. On the other hand, a group
comparison analysis of the regional cortical volume between the two
groups revealed significant increases in cortical volume in the obese
group in the left caudal-middle-frontal, isthmus-cingulate, and right
paracentral cortices compared with those of the non-obese control
group (p < 0.05, FDR corrected).
CONCLUSION: We demonstrated the changes in cortical volume in
obese Catholic nuns, especially in areas involved in body weight
control and cognitive function. The unique characteristics of our
study subjects, which minimize potential confounding factors,
1467789x, 2022, S2, Downloaded from https://onlinelibrary.wiley.com/doi/10.1111/obr.13503 by CAPES, Wiley Online Library on [16/12/2023]. See the Terms and Conditions (https://onlinelibrary.wiley.com/terms-and-conditions) on Wiley Online Library for rules of use; OA articles are governed by the applicable Creative Commons License
SUPPLEMENT ARTICLE
strengthen the relationship between obesity and brain structural
change.
CONFLICT OF INTEREST: None declared.
P124 | A novel combination treatment that
targets serotonin-2c receptor mediated
signaling to reduce obesity
V. B. S. C. Thunuguntla; P. Sinnayah; M. L. Mathai
Institute of health and sport, Victoria University, Melbourne, Victoria,
Australia
INTRODUCTION: The imbalance of energy intake over energy expen-
diture raises concerns for fat deposition and obesity. The hypotha-
lamic pro-opiomelanocortin (POMC) neurons regulate satiety after
sufficient energy consumption by the system. These POMC neurons
induce satiety by anorexigenic signaling pathways. The 5HT2cRs are
the subtype of serotonin receptors present on POMC neurons of the
arcuate nucleus in the hypothalamus. The 5HT2cR has a pivotal role
in mood and behavior and are further involved in activating the mela-
nocortin pathway to promote satiety. The succulent extract Caralluma
Fimbriata (CFE) reduces food intake and obesity in rodents. Clinical tri-
als also reported a reduction in body weight and waist circumference.
The 5HT2cR specific agonist, lorcaserin, has been used for the treat-
ment of obesity; however, the long-term usage is controversial with
changes in dosage recommendation moving forward. This study was
designed to explore lorcaserin combined with a dietary supplement
CFE as an alternative to treat obesity symptoms in high fat diet
induced mice.
MATERIALS AND METHODS: We showed that CFE increased
expression levels of 5HT2cR-mRNA in SHSY5Y derived neurons, sug-
gesting that central satiety mechanisms may be activated in animal
and human studies. We tested the effect of treatment with CFE
(100 mg/kg bwt) in combination with a relatively low dose of the
5HT2cR agonist lorcaserin (5 mg/kg bwt) in high-fat diet (HFD) fed
mice. The food intake, body composition, and anxiety-like behavior
were measured to confirm the effect of combination therapy through
satiety signaling.
RESULTS: The HFD mice showed a significant increase (8.99 ± 0.33 g
in 8 weeks with p < 0.0001) in body fat deposition and reduced
energy expenditure compared to control diet-fed (3.32 ± 0.26 g) mice
and HFD mice treated with CFE and lorcaserin (7.52 ± 0.30 g vs. HFD
mice with p = 0.017). Furthermore, control and combination treat-
ment groups showed reduced anxiety (elevated plus maze and light
and dark box) and depression (tail suspension and forced swim test)
like behavior compared to HFD mice. The results given us an indica-
tion of increased (p = 0.0002) energy expenditure (indirect calorime-
try via Promethion cage monitoring) of combination therapy (12.03
± 0.23 kcal/kg bwt) group compared to high fat fed mice (9.22
± 0.38 kcal/kg bwt).

SUPPLEMENT ARTICLE
CONCLUSION: The combination therapy that targets the 5HT2cR
could be an alternate treatment for appetite control in obesity and
overeating disorders, with low risk of side effects on mood.
CONFLICT OF INTEREST: None declared.
P125 | Interaction between GDF15 and leptin
pathways to reduce body weight and
adiposity
1 1 1 1
V. W. Tsai ; R. Manandhar ; M. Lee-Ng ; H.-P. Zhang ; D. A. Brown ;
S. N. Breit1
1 K. Lee1,2; X. Zhang1; Z. Gao1; Y. Shi1,2
St Vincent's Centre for Applied Medical Research, St Vincent's Hospital
and University of New South Wales, Darlinghurst, New South Wales,
2
Australia; The Centre for Allergy and Immunology Research, University
of Sydney and NSW Health Pathology, Sydney, New South Wales,
Australia
INTRODUCTION: GDF15 is a regulator of body weight and appetite
and a potential therapeutic for obesity. Systemic treatment with
recombinant GDF15 substantially reduces body weight, fat mass, and
lean mass in the mice fed with standard chow, while the same dose in
mice with obesity induced significantly more weight loss with prefer-
ential loss of fat over lean mass. GDF15 exerts its anorexic effects
through neurons in the hindbrain area postrema (AP) and nucleus of
the solitary tract (NTS), where its receptor, glial-derived neurotrophic
factor receptor alpha like (GFRAL), is largely expressed. However, the
neural circuits and mechanisms engaged by the GDF15-GFRAL axis to
reduce body fat and obesity resistance are not yet fully understood.
The fact that GDF15-treated mice affected by obesity lost much more
body weight and adiposity than normal mice suggest the actions of
GDF15 may be enhanced by interaction with other appetite regulators
elevated in obesity such as leptin. In this study we demonstrate that
part of GDF15's effect is due to interaction with the leptin pathway.
MATERIALS AND METHODS: To examine the impact of leptin on the
action of GDF15 in body weight and adiposity, metabolic measurements
were performed on (1) 28 weeks old male mice affected by obesity due
to HFD, each implanted with two 14-day mini-osmotic pumps, which
separately infuse GDF15 (GDF15 group), leptin (leptin group), GDF15
and leptin (GDF15 + leptin group) or the vehicle (vehicle group),
(2) ob/ob mice with obesity infusion with GDF15 or vehicle, and (3) nor-
mal chow fed mice infused with pegylated leptin antagonist PEG-SMLA
as well as GDF15 or vehicle. Neuronal activation was evaluated by quan-
tification of FOS and pERK immunoreactivity in hindbrain region of nor-
mal or mice with obesity treated with an IP injection of vehicle, GDF15
or leptin alone or in combination.
RESULTS: In both HFD and normal mice, combined GDF15 and leptin
treatment induced greater body weight and adiposity reduction com-
pared to single treatment. The effect of GDF15 on body weight and adi-
posity is significantly reduced in leptin deficient mice and in mice whose
endogenous leptin action was inhibited. Further, increased FOS and
1467789x, 2022, S2, Downloaded from https://onlinelibrary.wiley.com/doi/10.1111/obr.13503 by CAPES, Wiley Online Library on [16/12/2023]. See the Terms and Conditions (https://onlinelibrary.wiley.com/terms-and-conditions) on Wiley Online Library for rules of use; OA articles are governed by the applicable Creative Commons License
59 of 222
pERK immunoreactive neurons in the hindbrain were observed in the
combine GDF15 and leptin treated compared to that in single treatment.
CONCLUSION: Overall, this study suggests that part of GDF15's meta-
bolic actions might be enhanced by interaction with the leptin signaling
pathway.
CONFLICT OF INTEREST: None declared.
P126 | Dual actions of Y4 receptor signaling
in regulating adiposity and glucose
2 homeostasis
1
Neuroendocrinology Group, Garvan Institute, Darlinghurst, New South
Wales, Australia; 2St Vincent's Clinical School, UNSW Sydney, Sydney,
New South Wales, Australia
INTRODUCTION: Y4 receptor (Y4R) signaling is important for regu-
lating energy homeostasis and activation of Y4R by its cognate ligand
pancreatic polypeptide (PP) inhibits food intake. However, it is unclear
whether Y4R signaling is also involved in the regulation of glucose
metabolism, especially under conditions of obesity.
MATERIALS AND METHODS: Here, germline Y4R deletion mice
/
(Y4R ) were fed on a high-fat diet (HFD) for 10 weeks, and pheno-
typic characterization, including glucose and insulin tolerance tests
(GTT and ITT), was carried out.
/
RESULTS: We found that HFD-fed Y4R mice gained significantly
less body weight and fat mass compared to control mice, which
was associated with increased energy expenditure in these mice.
/
Conssitent to less adiposity, Y4R mice displayed improved glu-
cose tolerance which can be explained by improved insulin respon-
siveness and a concurrent increase in insulin secretion. This
enhanced in vivo insulin secretory response during a GTT was con-
firmed during an ex vivo GSIS assay.
/
In the lipotoxicity model, we found that Y4R islets were pro-
tected from palmitate-induced insulin hypersecretion during basal glu-
cose stimulation and displayed enhanced high-glucose insulin
secretion compared to Y4R+/+ islets. Mechanistically, this improved
/
beta cell function under lipotoxic conditions in Y4R islets was asso-
ciated with downregulation of mRNA expression of fatty acid recep-
tors (Cd36, Gpr40, Cpt1a), beta-oxidation genes (Acaa1, Acaa2) and
lipid stress markers (Srebp1c, Foxo1).
CONCLUSION: Together, these findings suggest that in addition to
regulating feeding, Y4R signaling is critical for regulating adiposity and
governing insulin secretion and glucose homeostasis especially under
conditions of obesity through the modulation of the expression of key
beta cell markers.
CONFLICT OF INTEREST: None declared.

60 of 222
P127 | Deletion of TRIM28 in the
hypothalamus promotes obesity but
preserves glucose tolerance
Y. Wang1; C. Yang1; A. Calkin1; G. Head1; C. Vaisse2; B. Drew1
1 Higashi-Hiroshima, Japan
Baker Heart and Diabetes Institute, Melbourne, Victoria, Australia;
2
Univeristy of California, San Francisco, San Francisco, California, USA
INTRODUCTION: Tripartite motif-containing 28 (TRIM28) is a multi-
domain protein that interacts with chromatin to suppress gene tran-
scription. TRIM28 haploinsufficiency in humans triggers obesity.
Moreover, Trim28 haploinsufficient mice and adipose specific Trim28
KO mice develop obesity that influences whole body metabolism.
TRIM28 is highly expressed in hypothalamic nuclei that regulate
energy and glucose metabolism, including the arcuate nucleus (ARC).
However, the importance of neuronal TRIM28 in energy and glucose
metabolism remains to be determined.
MATERIALS AND METHODS: To examine the role of hypothalamic
TRIM28 in regulating energy and glucose metabolism, we crossed
Trim28fl/fl mice with Leptin receptor (LepR)-Cre mice to generate male
and female Trim28fl/flLepR-Cre mice with deletion of Trim28 specifi-
cally in LepR-expressing neurons. To eliminate the effects of develop-
mental compensation, we also performed experiments whereby we
injected adeno-associated virus (AAV) expressing Cre into the ARC of
10-week old Trim28fl/fl mice, to generate mice with Trim28 deletion in
the ARC in adult mice.
RESULTS: Male Trim28fl/flLepR-Cre mice fed on a chow diet exhibited
modest but significantly increased body weight, and there was a trend
for an increase in fat mass compared to their Trim28fl/fl counterparts.
Moreover, neither glucose tolerance (ipGTT, 2 g/kg lean mass) nor
insulin sensitivity (ipITT, 0.6 U/kg lean mass) were affected by dele-
tion of Trim28 in LepR-neurons in male mice. In chow fed female
Trim28fl/flLepR-Cre mice, although body weight was not affected, there
was also a trend for increased fat mass, and this was associated with
significantly improved glucose tolerance and insulin sensitivity com-
pared with littermate control mice.
In the post-developmental model, our data demonstrated that after
just 10 weeks, chow fed male mice with deletion of Trim28 in the ARC
as adults were 23% heavier than mice injected with a control AAV. This
significant increase in body weight was attributed to an increase in fat
mass, with no difference in lean mass observed. Interestingly, glucose tol-
erance was only modestly impaired in these mice, despite having twice
as much fat mass. Similarly, female mice with post-developmental dele-
tion of Trim28 in the ARC exhibited modest but significantly increased
body weight, as well as fat mass compared to their control AAV-injected
counterparts. Glucose tolerance was not changed in these mice.
CONCLUSION: Together, these studies suggest that deletion of
TRIM28 in the hypothalamus promotes obesity but preserves glucose
tolerance. Further studies are warranted to understand the underlying
mechanisms by which TRIM28 mediates these effects.
CONFLICT OF INTEREST: None declared.
1467789x, 2022, S2, Downloaded from https://onlinelibrary.wiley.com/doi/10.1111/obr.13503 by CAPES, Wiley Online Library on [16/12/2023]. See the Terms and Conditions (https://onlinelibrary.wiley.com/terms-and-conditions) on Wiley Online Library for rules of use; OA articles are governed by the applicable Creative Commons License
SUPPLEMENT ARTICLE
P128 | Neurosecretory protein GL easily
leads to obesity in mice
Y. Narimatsu; E. Iwakoshi-Ukena; M. Furumitsu; K. Ukena
Graduate School of Integrated Sciences for Life, Hiroshima University,
INTRODUCTION: Excessive energy intake over expenditure readily
causes fat accumulation and eventually obesity. Hence, further stud-
ies on the regulation of feeding behavior and energy homeostasis are
required. We have recently identified a novel cDNA encoding a small
secretory protein termed neurosecretory protein GL (NPGL) in the
hypothalamus of mammals. Our previous reports show that NPGL
induced feeding behavior and fat accumulation in rodents. However,
the findings on the mechanisms of NPGL-induced obesity have been
limited. This study aimed to investigate the impact of NPGL on energy
homeostasis and its biological mechanisms using adeno-associated
virus (AAV)-dependent overexpression of NPGL-precursor gene (Npgl)
in obesity-prone mouse strain C57BL/6J.
MATERIALS AND METHODS: Male C57Bl/6J mice (7 weeks old)
were singly housed under standard conditions (25 ± 1 C under a 12-h
light/12-h dark cycle) with ad libitum access to water and normal
chow (NC) or a high-calorie diet (HCD). For Npgl overexpression, we
generated AAV-based vectors AAV-DJ/8-NPGL-IRES-GFP for NPGL
(AAV-NPGL) and AAV-DJ/8-IRES-GFP for control (AAV-CTL). Mice
were bilaterally injected with AAV-based vectors (AAV-CTL or AAV-
NPGL) into the mediobasal hypothalamus. After 9 weeks of stereo-
taxic surgery, the mediobasal hypothalamus, adipose tissues, organs,
and skeletal muscles were collected, weighed, and frozen in liquid
nitrogen. To assess the action of NPGL on the white adipose tissue
(WAT) and the liver, the mRNA expressions were measured using
quantitative RT-PCR (qRT-PCR).
RESULTS: Hypothalamic overexpression of Npgl increased food intake,
body mass, the mass of the adipose tissues, and the liver under both NC
and HCD. Notably, Npgl overexpressed mice displayed observable obe-
sity within 8 weeks under HCD feeding conditions. Npgl overexpression
lowered energy expenditure during a dark period. qRT-PCR revealed that
mRNA expression of lipid metabolic factors was upregulated in the WAT
and the liver. Although fat accumulation was accelerated in the WAT by
Npgloverexpression, the expressions of marker genes for classically acti-
vated M1 macrophages were downregulated and alternatively activated
M2 macrophages were upregulated in the WAT of Npgl overexpressed
mice. Furthermore, the expressions of marker genes of lymphoid cells
were attenuated by Npgl overexpression.
CONCLUSION: Our present study suggests that Npgl overexpression
may easily lead to obesity in mice with the maintenance of the popu-
lations of immune cells at steady levels in the WAT. In the future, the
flow cytometry of the WAT is required to assess the effects of NPGL
on populations of immune cells. Our data will provide new insight into
the research of obesity and metabolic syndromes.
CONFLICT OF INTEREST: None declared.

SUPPLEMENT ARTICLE
P129 | Impacts of bariatric surgery on
metabolic, inflammatory and gut markers
over 24 weeks post-surgery
A. Cox1,2; N. Wylie3; R. Ramsey1; R. Moss3; K. Hatton-Jones1;
A. Cripps2,4; N. West1,2
1
School of Pharmacy and Medical Sciences; 2Menzies Health Institute
Queensland, Griffith University, Southport, Queensland, Australia;
3
Toowoomba Weight Loss Surgery, Toowoomba, Queensland, Australia;
4
School of Medicine and Dentistry, Griffith University, Southport,
Queensland, Australia
INTRODUCTION: Despite increases in use of bariatric surgery to pro-
vide accelerated weight loss and promote improvements in metabolic
health in individuals living with obesity, there remains a need for charac-
terization of impacts on metabolic, inflammatory, and gut markers, and
consideration of implications for gut microbial composition and function.
MATERIALS AND METHODS: Fourteen adults (12 F/2 M; 43.2
± 7.8 years; BMI: 40.1 ± 4.9) undergoing bariatric surgery were
assessed 2–3 weeks prior to surgery (Pre), day of surgery (Day 0), and
4, 8, 12, and 24 weeks post-surgery. Body composition was assessed,
and blood samples collected to determine changes in a range of meta-
bolic and inflammatory markers during the post-surgical follow-up
period. A fecal sample was collected at Pre for bacterial compositional
profiling using 16s rRNA sequencing. Microbial composition was com-
pared to matched healthy weight individuals (12F/2 M; 43.4
± 7.7 years; BMI: 24.1 ± 1.5) from the AussieGut™ sample collection
to assess a baseline gut microbial composition from which post-
surgery changes could be considered.
RESULTS: There was a significant reduction in BMI (p = 0.001), with
an average 23.0 ± 4.7% body weight loss at 24 weeks. Reductions in
insulin (p = 0.001) and HOMA-IR (p = 0.02) were noted in the post-
surgery period, despite no individual having evidence of impaired fast-
ing plasma glucose (>6.1 mmol/l) or elevated HbA1c (>6.5%) at the
Pre. Decreases in Leptin (p < 0.0001) across the post-surgery period
were noted. Changes in other adipokine and inflammatory markers
were more modest. No differences were noted in microbial diversity
using OTU (222 ± 54 vs. 202 ± 37; p = 0.26) or Shannon index (4.7
± 0.8 v 4.8 ± 0.6; p = 0.46) metrics at the Pre when compared to Aus-
sieGut™ controls. There were few differences in aspects of microbial
composition, with the exception of some differences in relative abun-
dance of particular taxa belonging to the Firmicutes phylum, notably
the Lachnospiraceae family (19.4 ± 10.3% vs. 29.9 ± 12.5%, p = 0.03).
CONCLUSION: Observations of weight loss with improved glycemic
control support the potential for positive metabolic effects following
bariatric surgery, even in the absence of overt metabolic disease pre-
surgery. Modest changes in other adipokine and inflammatory
markers need further consideration in relation to sample size but also
more broadly in the context of the paradigm of altered inflammatory
signaling in obesity-associated disease. The largely consistent gut
microbial composition in patients pre-surgery compared to
1467789x, 2022, S2, Downloaded from https://onlinelibrary.wiley.com/doi/10.1111/obr.13503 by CAPES, Wiley Online Library on [16/12/2023]. See the Terms and Conditions (https://onlinelibrary.wiley.com/terms-and-conditions) on Wiley Online Library for rules of use; OA articles are governed by the applicable Creative Commons License
61 of 222
AussieGut™ controls provides a platform from which changes in
microbial composition in the post-surgery follow-up can be
considered.
CONFLICT OF INTEREST: None declared.
P130 | The influence of unhealthy maternal
diet on maturation of rat offspring gut
microbiota
K. Hasebe1; M. Kendig1; N. Kaakoush1; A. Tajaddini1; F. Westbrook2;
M. Morris1
1
School of Medical Sciences; 2School of Psychology, UNSW, Sydney, New
South Wales, Australia
INTRODUCTION: Despite well-known effects of diet on gut micro-
biota diversity, relatively little is known about how maternal diet
quality shapes the longitudinal maturation of gut microbiota in
offspring.
MATERIALS AND METHODS: We fed female rats standard chow
(Chow) or high-fat cafeteria diet (Caf), comprising a variety of foods
high in fat and sugar, prior to and during mating, gestation and lacta-
tion. At weaning (3 weeks), male and female offspring were either
maintained on their mother's diet (ChowChow, CafCaf groups) or
switched to the other diet (ChowCaf, CafChow). Fecal microbial com-
position was assessed in dams and longitudinally in offspring at 3, 7,
and 14 weeks of age. The effect of maternal diet on the maturation of
offspring gut microbiota was assessed by examining alpha and beta-
diversity measures, and Deseq2/LEfSe and SourceTracker analyses.
RESULTS: Weanling gut microbiota composition was characterized by
reduced alpha- and beta-diversity profiles that clustered away from dams
and older siblings. After weaning, offspring gut microbiota came to
resemble an adult-like gut microbiota, with increased alpha-diversity and
reduced dissimilarity of beta-diversity. Similarly, Deseq2/LEfSe analyses
found that the number of altered operational taxonomic units (OTUs)
between groups reduced from weaning to adulthood. SourceTracker
analyses indicated a greater overall contribution of Caf dams' microbial
community (up to 20%) to that of their offspring than the contribution of
Chow dams (up to 8%). Groups maintained on the maternal diet
(ChowChow, CafCaf), versus those switched to the other diet (ChowCaf,
CafChow) post-weaning significantly differed from each other at
14 weeks (Permutational Multivariate Analysis of Variance), indicating
interactive effects of maternal and post-weaning diet on offspring gut
microbiota maturation. Nevertheless, this developmental trajectory was
unaffected by sex and appeared consistent between ChowChow, Caf-
Caf, ChowCaf, and CafChow groups.
CONCLUSION: Introducing solid food at weaning triggered the matura-
tion of offspring gut microbiota toward an adult-like profile in rats, in line
with previous human studies. Postweaning Caf diet exposure had the
largest impact on offspring gut microbiota, but this was modulated by
maternal diet history. An unhealthy high fat maternal Caf diet did not
alter the developmental trajectory of offspring gut microbiota toward an

62 of 222
adult-like profile, insofar as it did not prevent the age-associated increase
in alpha-diversity and reduction in beta-diversity dissimilarity.
CONFLICT OF INTEREST: None declared.
P131 | The influence of INSR gene variant on
the long-term response to childhood obesity
intervention: A 31-month clinical controlled
trial
J. Chen; W.-C. Xiao; Z. Liu
Department of Maternal and Child Health, School of Public Health,
Peking University, Beijing, China
INTRODUCTION: Genome-wide association studies have estab-
lished a cross-sectional association of the insulin receptor (INSR)
gene with obesity. However, it is to be explored whether the
effects of a longitudinal, lifestyle-based obesity intervention differ
by INSR genotype in children, especially for the effects at multiple
time points in the long term. In addition, which specific behavior
(diet alone, physical activity alone, or both) modify the genetic
effects on obesity remains unclear.
MATERIALS AND METHODS: We genotyped seven independent
SNPs in the INSR gene in 382 Han Chinese children, who were
randomly assigned to an intervention (diet and physical activity) or
a control group (usual practice without a focus on obesity preven-
tion) and had follow-up investigations at 9 and 31 months after
baseline. In longitudinal analyses, we assessed the changes in
obesity-related indicators [waist circumference, waist-to-hip ratio
(whr), waist-to-height ratio (WHtR), waist circumference adjusted
by BMI (WCadjBMI), whr adjusted by BMI (WHRadjBMI), and other
four indicators] during three periods (from baseline to 9 months,
from baseline to 31 months, and from 9 to 31 months) by the
genotype of each SNP, and compared whether the changes dif-
fered by the intervention or control group (i.e., gene-group interac-
tion). In cross-sectional analyses, we assessed the interaction
between the gene and behaviors (diet and physical activity) on the
obesity-related indicators to clarify which behavior modified the
genetic effect on obesity.
RESULTS: At 9 months, children with rs4804416 G allele had a less
increment in waist circumference and a greater reduction in whr,
WHtR, WCadjBMI, and WHRadjBMI than those non-carriers in the
intervention group, whereas the genetic effect was opposite in chil-
dren assigned to the control group (P for gene-group interaction
<0.05). We did not find a significant interaction between
rs4804416 and group on the changes in indicators from baseline to
31 months or from 9 to 31 months. Overall findings in other SNPs
were broadly similar to rs4804416. In cross-sectional analyses, we
found a significant interaction between rs4804416 and unhealthy
diet behaviors (snack consumption, excessive eating behaviors) on
waist circumference, WHtR, and so on (all P for gene-behavior
1467789x, 2022, S2, Downloaded from https://onlinelibrary.wiley.com/doi/10.1111/obr.13503 by CAPES, Wiley Online Library on [16/12/2023]. See the Terms and Conditions (https://onlinelibrary.wiley.com/terms-and-conditions) on Wiley Online Library for rules of use; OA articles are governed by the applicable Creative Commons License
SUPPLEMENT ARTICLE
interaction <0.05). Specific dietary or physical activity behaviors
also modified the genetic effect of other SNPs on obesity.
CONCLUSION: Our data suggested that children carrying rs7508679
(C allele), rs10420008 (G allele), rs11883325 (C allele), or rs4804416
(G allele) may benefit more from a lifestyle intervention in the
improvement of obesity-related indicators, but the effect appeared to
be attenuated in the long term. Specific dietary and physical activity
behaviors may modify the genetic effect of INSR on childhood
obesity.
CONFLICT OF INTEREST: None declared.
P132 | Using transcriptomics to predict
weight loss success
K. Day1; H. Truby2; B. Edwards3,4; D. O'Driscoll5,6; A. Young5,6;
G. Hamilton7,8; C. Murgia9
1
Department of Nutrition, Dietetics and Food, Monash University,
Melbourne, Victoria, Australia; 2School of Human Movement and
Nutrition Sciences, University of Queensland, Brisbane, Queensland,
Australia; 3Department of Physiology and Biomedicine Discovery
Institute, Melbourne, Victoria, Australia; 4Department of Psychological
Sciences and Turner Institute for Brain and Mental Health, Melbourne,
Victoria, Australia; 5Eastern Health Clinical School, Monash University,
Box Hill, Victoria, Australia; 6Department of Respiratory & Sleep
Medicine, Eastern Health, Melbourne, Victoria, Australia; 7Department of
Lung, Sleep Allergy & Immunology, Monash Health, Clayton, Victoria,
Australia; 8School of Clinical Sciences, Monash University, Clayton,
Victoria, Australia; 9School of Agriculture and Food, University of
Melbourne, Melbourne, Victoria, Australia
INTRODUCTION: Personalized treatment options for obesity offer
the opportunity to harness inter-individual variability to improve out-
comes for all individuals seeking obesity treatment. To realize person-
alization, robust biomarkers of response are required. The
transcriptome represents the effects of both genetics and environ-
ment on treatment response. This study aimed to assess whether the
peripheral blood mononuclear cell (PBMC) transcriptome could pre-
dict weight loss response.
MATERIALS AND METHODS: A discovery cohort was used to
determine a definition of treatment success and predictors. PBMCs
were extracted from whole blood before and after a 16-week die-
tary restriction intervention. RNA was quantified via RNA-
sequencing and outputs aligned to the human genome via the
RNA-sik pipeline from Monash Bioinformatics. Differentially
expressed genes between responder groups were analyzed via lin-
ear mixed modeling within the DESeq2 package using Benjamini–
Hochberg multiple testing correction. A validation cohort from
interventions independent from the discovery cohort was used to
validate predictors via logistic regression.
RESULTS: The discovery cohort (n = 18) comprised of Caucasian
males with obesity and obstructive sleep apnea (OSA). High

SUPPLEMENT ARTICLE
responders (HR) were defined by ≥5% decrease in weight and waist
circumference and a decrease in OSA severity. Mixed responders
(MR) met one or two of these criteria and low responders (LR) met
none. Four transcripts were significantly differentially expressed
between HR and LR and HR and MR: ELANE (logFC: 2.8 vs. LR and
2.2 vs. MR), OLFM4 (logFC: 6.4 vs. LR and 5.4 vs. MR), DEFA3
(logFC: 4.0 vs. LR and 4.53 vs. MR), and MS4A3 (logFC: 3.2
vs. LR and 2.9 vs. MR). Logistic regression in the validation cohort
(n = 37) revealed OLFM4 and baseline weight were predictive of suc-
cess. The algorithm had a receiver-operator curve of 0.76 represent-
ing very good prediction capability.
CONCLUSION: The transcriptome of PBMCs shows promise in dis-
criminating and describing responders to weight loss treatment.
CONFLICT OF INTEREST: None declared.
P133 | Transcriptomic differences between
monozygotic twins discordant for metabolic
syndrome following weight loss: A case study
1 2 1 3,4 5,6,7
K. Day ; H. Truby ; A. McCubbin ; J. Brown ; M. Southey
1 Netherlands
Department of Nutrition, Dietetics and Food, Monash University,
Melbourne, Victoria, Australia; 2School of Human Movement and
Nutrition Sciences, University of Queensland, Brisbane, Queensland,
Australia; 3Department of Pediatric Endocrinology and Diabetes, Monash
Children's Hospital, Clayton, Victoria, Australia; 4Department of
Pediatrics, Monash University, Clayton, Victoria, Australia; 5Cancer
Epidemiology Division, Cancer Council Victoria, Melbourne, Victoria,
Australia; 6Department of Clinical Pathology, University of Melbourne,
Parkville, Victoria, Australia; 7Precision Medicine Group, Monash
University, Melbourne, Victoria, Australia
INTRODUCTION: This case reports on the transcriptomic changes
in a pair of male monozygotic pediatric twins with metabolic syn-
drome (MetS) seeking assistance with weight loss. The transcrip-
tome sits as a nexus between genetics and environmental
influences of obesity and may be a good early biomarker of treat-
ment response. Particularly, perturbations in the peripheral blood
mononuclear cell (PBMC) transcriptome may precede the develop-
ment of chronic low-grade inflammation, a precursor to many
obesity-related chronic diseases.
MATERIALS AND METHODS: Two 14-year-old boys presented for
weight loss treatment with similar baseline biochemistry and
body composition. RNA was extracted from PBMCs before and
after weight loss and was analyzed via Monash Bioinformatics
RNA-sik pipeline. Gene network analysis was conducted via
Cytoscape.
RESULTS: After 16 weeks, body weight loss (%) was similar (Twin
A 12% and B 13%). MetS resolved in one twin only (Twin A)
with Twin B maintaining elevated triglycerides after weight loss.
Analysis of the PBMC transcriptome before and after weight loss,
revealed very different changes in gene expression, in genes
1467789x, 2022, S2, Downloaded from https://onlinelibrary.wiley.com/doi/10.1111/obr.13503 by CAPES, Wiley Online Library on [16/12/2023]. See the Terms and Conditions (https://onlinelibrary.wiley.com/terms-and-conditions) on Wiley Online Library for rules of use; OA articles are governed by the applicable Creative Commons License
63 of 222
relating to immune cell activation. 48.7% of genes were oppositely
regulated between twins. Twin A saw reductions in expression
levels of immune cell activation genes as well as the resolution of
MetS. Conversely, Twin B saw an elevation in expression levels of
immune cell activation genes and a maintenance of MetS despite
comparable weight loss to Twin A.
CONCLUSION: This novel case discusses the influence the PBMC
transcriptome may have on the development of chronic low-grade
inflammation and metabolic disfunction and whether transcriptomic
alterations in immune cells may precede more traditional
biomarkers of chronic pro-inflammation. These monozygotic twins
present an example of divergence of phenotypic outcomes despite
identical genetic background and similar treatment response.
CONFLICT OF INTEREST: None declared.
P134 | The Dutch 16p11.2 microdeletion and
microduplication syndrome cohort study
N. Vos; L. Kleinendorst; L. van der Laan; M. van Haelst
Human Genetics, Amsterdam UMC, Location AMC, Amsterdam,
INTRODUCTION: Copy number variation (CNV) of chromosome
16p11.2 is relatively common, with an estimated incidence of >1 in
2000 individuals that have a known 16p11.2 CNV that has been
linked to syndromic features. However, many clinicians and caregivers
have not yet heard of 16p11.2 microdeletion and microduplication
syndromes and accompanying clinical features. Different recurrent
16p11.2 CNVs (microdeletions and microduplications) have been
identified. Patients with a 16p11.2 microdeletion typically show
hyperphagia, obesity (up to 75% of adult patients), macrocephaly, and
development of speech and language is more delayed than motor
development, while 16p11.2 microduplication carriers seem to have
an opposite (“mirror”) phenotype. They present with underweight,
microcephaly and more often motor developmental delay. Other typi-
cal clinical features of patients carrying one of both types of 16p11.2
CNV are developmental delay, (mild) intellectual disability, autism
spectrum disorder (ASD; 25%), attention deficit hyperactive disorder
(ADHD; 30%–40%), and epilepsy (25%). There is, however, large clini-
cal heterogeneity. We here present our cohort of Dutch patients with
16p11.2 CNVs.
MATERIALS AND METHODS: Dutch patients carrying a 16p11.2
CNV were seen and included at our expertise 16p11.2 syndromes
clinic in Amsterdam UMC between 2017 and 2022. All patients
underwent the same medical interview, including family history,
and detailed physical (dysmorphological) examination was
performed.
RESULTS: So far, a total of 99 patients (age range: 7 months to
60 years, mean age: 14.8 years) with a 16p11.2 CNV were
included. Of these 99 patients, 84 (85%) carried a 16p11.2 micro-
deletion and 15 (15%) carried a 16p11.2 microduplication.

64 of 222
Obesity was seen in 50% of patients with a 16p11.2 microdeletion
and 7% of patients with a 16p11.2 microduplication. Hyperphagia
was reported by 46% of patients with 16p11.2 microdeletion and
none of patients with 16p11.2 microduplication. We will present
various subgroups of 16p11.2 microdeletions and 16p11.2 microdu-
plications, more obesity-related factors (e.g., comorbidities and
medication use) and the prevalence of other symptoms in our
cohort.
CONCLUSION: In this study we describe our unique Dutch cohort of
patients carrying a 16p11.2 microdeletion or microduplication. Our
results are in line with previous studies highlighting the importance of
timely weight management for patients with 16p11.2 microdeletions
and the great clinical heterogeneity seen in patients who carry a dis-
ease causing 16p11.2 CNV.
CONFLICT OF INTEREST: None declared.
P135 | The joint effect of PNPLA3 rs738409
and UGT1A1 rs10929303 on non-alcoholic
fatty liver disease in children
P. Zhang
Department of Maternal and Child Health, School of Public Health,
Peking University, Beijing, China
INTRODUCTION: To investigate the joint effect of patatin-like phos-
pholipase domain containing 3 (PNPLA3) rs738409(C > G) and UDP
Glucuronosyltransferase Family 1 Member A1 (UGT1A1) rs10929303
(C > T) on non-alcoholic fatty liver disease (NAFLD) in children, and to
provide scientific evidence for genetic studies.
1467789x, 2022, S2, Downloaded from https://onlinelibrary.wiley.com/doi/10.1111/obr.13503 by CAPES, Wiley Online Library on [16/12/2023]. See the Terms and Conditions (https://onlinelibrary.wiley.com/terms-and-conditions) on Wiley Online Library for rules of use; OA articles are governed by the applicable Creative Commons License
SUPPLEMENT ARTICLE
MATERIALS AND METHODS: In total, 1027 children aged 7–
18 years were recruited. Trained field health workers recorded the
students' basic characteristics and medical history, measured height
and weight, and performed liver ultrasound. Additionally, fasting
venous blood were collected to measure biochemical indicators and
extract DNA. The genetic variants of PNPLA3 rs738409 and
UGT1A1 rs10929303 were genotyped. Binary logistic regression
was applied to analyze the associations and joint effect between
those two SNPs and NAFLD.
RESULTS: The GG genotype of PNPLA3 rs738409 and CC genotype
of UGT1A1 rs10929303 were associated with increased risk of
NAFLD by 89% (OR = 1.89, 95%CI: 1.11–3.23, P = 0.019) and
96% (OR = 1.96, 95%CI: 1.21–3.17, P = 0.006), respectively, and
those who carry both genotypes simultaneously have an increased
risk of NAFLD by 306% (OR = 4.06, 95%CI: 1.90–8.66, P < 0.001)
than those who do not.
CONCLUSION: The joint effect of PNPLA3 and UGT1A1 could sub-
stantially increase the risk of NAFLD in children, providing new evi-
dence for genetic susceptibility of NAFLD.
CONFLICT OF INTEREST: None declared.

SUPPLEMENT ARTICLE
P136 | Additive effect of common obesity-
related SNP variants in admixed Brazilian
population: 2015 ISA-nutrition study
J. L. Pereira1; C. Souza2; J. Soler2; M. Rogero1; F. Sarti3; R. Fisberg1
1
Department of Nutrition, School of Public Health, University of São
Paulo; 2Department of Statistics, Institute of Mathematics and Statistics,
3
University of São Paulo; School of Arts, Sciences and Humanities,
University of Sao Paulo, São Paulo, Brazil
INTRODUCTION: Large-scale genome-wide association studies
(GWAS) have identified many loci associated with obesity; however,
most evidence refers to populations of European or Asian ancestry.
Considering the importance of diversity and the participation of multi-
ethnic groups in genomic studies, we aimed to identify loci associated
with obesity in admixed Brazilian population from São Paulo city.
MATERIALS AND METHODS: The analyses included 841 free-living
individuals aged ≥12 years of the cross-sectional population-based
Health Survey of São Paulo with Focus on Nutrition (2015 ISA-
Nutrition). Obesity was defined according to BMI cutoff points
specific for age group, using measured height and weight values.
Genotyping was obtained from blood using Axiom™ PMR Array,
resulting in 731,392 high-performing markers, after quality control
pruning. Population structure and global ancestry inference were
accessed through principal component analysis, comparing data
with 1000 Genomes Project phase 3 (1 KGP). A list of 1500
markers previously associated with obesity-related traits in other
GWAS reported by NHGRI-EBI GWAS Catalog was selected to
perform initial evaluation of possible markers associated with obe-
sity in the ISA-Nutrition sample. We used a logistic regression
model with obesity as a dependent variable, adjusted by sex,
age group, interaction sex and age group, marital status, plasma
C-reactive protein levels, presence of diabetes mellitus, hyperten-
sion, dyslipidemia, and the two first principal components of global
ancestry, assuming initially an additive effect of the markers.
RESULTS: The population included 49.7% of women, 29.7% adoles-
cents, 34.5% adults and 35.8% older adults (mean age = 47 years;
min. = 12; max = 93) with 22.8% prevalence of obesity. The mean
ancestry proportion was: 53% European, 23% African, 23% Native
American, and 1% Asian (East and South). There were 14 obesity-
related candidate SNP that reached significance (P < 0.01). Eleven
SNP markers were previously associated with obesity-related traits
in a study evaluating Hispanic children from Houston, TX, USA.
The rs1993709 (OR_AG/AA = 1.774, OR_GG/AA = 3.147) and
rs1514177 (OR_CG/CC = 0.6158191, OR_GG/CC = 0.3792331)
were previously associated with obesity and BMI in other studies with
European populations, the rs259067 (OR_TG/GG = 0.6178696,
OR_TT/GG = 0.3817628) was associated with obesity in East Asians,
and the rs1421085 in gene FTO (OR_CT/TT = 0.5582767, OR_CC/
TT = 0.3116728) was associated with obesity and obesity-related
traits in studies with diverse populations.
1467789x, 2022, S2, Downloaded from https://onlinelibrary.wiley.com/doi/10.1111/obr.13503 by CAPES, Wiley Online Library on [16/12/2023]. See the Terms and Conditions (https://onlinelibrary.wiley.com/terms-and-conditions) on Wiley Online Library for rules of use; OA articles are governed by the applicable Creative Commons License
65 of 222
CONCLUSION: The findings provide an entry point to characterize
common obesity loci that may be ancestry-specific in the Brazilian
population.
DISCLOSURE OF INTEREST: None declared.
P138 | The effect of an acute bout of intense
aerobic exercise on cerebrospinal fluid and
plasma metabolome and levels of adiponectin
in healthy young individuals
B. Ukropcova1,2; K. Li3,4; M. Schon1; J. Naviaux3,5; K. Malenovska2,6;
J. Monk7; N. Alchus Laiferova2,6; L. Wang3,4; I. Straka8;
P. Matejicka8; P. Valkovic8,9; M. Tarnopolsky10; R. Naviaux11,12;
J. Ukropec13
1
Center of Physical Activity Research, Biomedical Research Center Slovak
Academy of Sciences; 2Faculty of Medicine Comenius University,
Bratislava, Slovakia; 3The Mitochondrial and Metabolic Disease Center,
University of California, San Diego School of Medicine; 4Department of
Medicine; 5Department of Neurosciences, UCSD, San Diego School of
Medicine, San Diego, USA; 6Biomedical Research Center Slovak Academy
of Sciences, Bratislava, Slovakia; 7Department of Bioengineering,
University of California, San Diego School of Medicine, San Diego, USA;
8
2nd Department of Neurology, Faculty of Medicine Comenius
University; 9Institute of Normal and Pathological Physiology, SAS,
Bratislava, Slovakia; 10Department of Pediatrics, McMaster University,
Hamilton, Canada; 11The Mitochondrial and Metabolic Disease Center,
University of California, San Diego School of Medicine, San Diego, CA,
USA; 12Departments of Medicine, Pediatrics and Pathology, UCSD, San
Diego School of Medicine, San Diego, CA; 13Department of Metabolic
Disease Research, Biomedical Research Center Slovak Academy of
Sciences, Bratislava, Slovakia
INTRODUCTION: Obesity and sedentary lifestyle accelerate cogni-
tive ageing. Exercise has a potential to improve cognition by largely
unknown mechanisms. We have previously shown that adiponectin,
known for its neuroprotective properties, was regulated in cerebrospi-
nal fluid/CSF of healthy young humans. We aimed at identifying
changes in metabolome after 90-min run in CSF and plasma, and to
explore correlation network of metabolome and adiponectin.
MATERIALS AND METHODS: Study population included 19 young
healthy adults (M/F 13/6; median age 25(IQR 22–31)yrs, BMI 23.2
(IQR 21.7–24.5)kg/m2 & VO2max 47(IQR 38.1–51.2)mL/kg/min).
Sampling was performed before (CSF/plasma), immediately after
(plasma) and 60 min after (CSF/plasma) 90-min run. Targeted, broad-
spectrum metabolomics was performed by HPLC, tandem mass
spectrometry. Adiponectin in CSF and plasma was determined by
ELISA and immunoblotting. Cognitive functions were assessed by
computerized tests.
RESULTS: In the CSF, 56 metabolites were changed 1 h after the
90-min run, with 16 decreased and 40 increased after run. Purines
and pyrimidines represented 32% and neurotransmitters 14% of the

66 of 222
metabolic impact. In plasma, fatty acids metabolites accounted for
46%–60% of changes immediately and 1-h after run, resp. We have
confirmed regulation of adiponectin by 90-min run and described its
interrelations with cognitive functions. Correlation analysis revealed
relationships between adiponectin and specific metabolites in
CSF/plasma.
CONCLUSION: Results of this study indicate that adiponectin and
specific metabolic signature in cerebrospinal fluid could contribute to
the processes mediating the neuroprotective effects of endurance
exercise in human brain.
GRANT SUPPORT: APVV 20-0466, UCSD Christini Fund
DISCLOSURE OF INTEREST: None declared.
P139 | Morphofunctional changes in adipose
tissue and its relationship with obesity
B. Almeida1; B. Aguiar2; C. Pereira3; P. Gomes4; F. Raposo1;
P. Matafome5
1 2
APDP - Diabetes Portugal; Portugal Directorate-General of Health,
3 4
Lisbon; Hospital Prof. Doutor Fernardo da Fonseca, Amadora; Centro
Hospitalar e Universitário de Coimbra; 5Faculty of Medicine, University of
Coimbra, Coimbra, Portugal
INTRODUCTION: Currently, adipose tissue is considered a very
active endocrine organ that secretes different hormones, cytokines,
and chemocytokines.
MATERIALS AND METHODS: Patients waiting for bariatric inter-
vention in Centro Hospitalar e Universitário de Coimbra were
included (AMTAO study). The following parameters were evaluated:
BMI, waist circumference, total body fat, visceral and subcutaneous
fat assessment by abdominal CT. Systemic biochemical characteriza-
tion included glucose, HbA1c, renal function, lipid profile, fatty acids,
insulin, high sensitivity C-reactive protein, adiponectin, resistin, lep-
tin, and RBP-4. Two small fragments of visceral and subcutaneous
tissue were removed. Tissues were preserved at 80 C or in 10%
buffered formaldehyde. Glyoxalase 1—an enzyme that participates in
the detoxification of methylglyoxal, a cytotoxic byproduct of glycoly-
sis that induces protein modification (advanced glycation end-prod-
ucts, AGEs)—was quantified in visceral adipose tissue (main pro
inflammatory tissue).
RESULTS: We present the preliminary data: a total of 125 patients
with obesity (93 nondiabetic and 22 diabetics) were included, with a
medium age of 45 years old (±11.9); the average body mass index in
these patients was 45.18 kg/m2 (minimum 33.7 kg/m2 and maximum
2
70.83 kg/m ). The Homeostatic Model Assessment of Insulin Resis-
tance index (HOMA-IR) was calculated: average HOMA was 3.95
(min 0.47; max 12.63), with a median level of 3.43 (±2.53). Even
though obesity is a frequent cause of insulin resistance and poses a
major risk for diabetes no linear correlation was found between
HOMA and body mass index (Pearson correlation coefficient 0.3).
The average level of glyoxalase in visceral adipose tissue was higher
1467789x, 2022, S2, Downloaded from https://onlinelibrary.wiley.com/doi/10.1111/obr.13503 by CAPES, Wiley Online Library on [16/12/2023]. See the Terms and Conditions (https://onlinelibrary.wiley.com/terms-and-conditions) on Wiley Online Library for rules of use; OA articles are governed by the applicable Creative Commons License
SUPPLEMENT ARTICLE
in patients with HOMA > 3.5 vs < 3.5 (181 u/L vs 163 u/L,
p < 0.05); this may demonstrate that the levels of methylglyoxal
could be elevated in these insulin-resistant patients. No correlation
between BMI and glyoxalase 1 was found. The average levels of adi-
ponectin were lower in patients with HOMA > 3.5 vs < 3.5 (5.7 u/L
vs 9.8, p < 0.05).
CONCLUSION: In an era where obesity needs to be addressed as a
pandemic, understanding the metabolic benefits and decrease in risk
of cardiovascular disease accomplished by weight loss may help physi-
cians understand how to prioritize patients for surgical/medical
weight loss based on individual risk. The quantification of visceral/
subcutaneous fat and the definition of biochemical risk markers (such
as HOMA) will become essential (more than isolated BMI) to stratify
cardiovascular risk and prioritize patients where weight reduction
should be urgent.
DISCLOSURE OF INTEREST: None declared.
P140 | Sex-hormone binding globulin is a
weight-independent marker of metabolic
dysfunction and metabolic-associated fatty
liver disease in a super-obese cohort
H. Xue1; K. Chan1; A. Macdonald2; A. Phu3; R. Bishay1,4;
G. Ahlenstiel1,3,5
1
School of Medicine, Western Sydney University, Campbelltown;
2
Blacktown Metabolic and Weight Loss Program, Department of
Endocrinology, Blacktown Hospital, Blacktown; 3Storr Liver Centre,
Westmead Millennium Institute, University of Sydney; 4Blacktown
Metabolic and Weight Loss Program, Department of Endocrinology,
Blacktown Hospital, Sydney; 5Department of Gastro and Hepatology,
Blacktown Hospital, Blacktown, Australia
INTRODUCTION: Low sex hormone binding globulin (SHBG) is asso-
ciated with obesity and related metabolic diseases including
metabolic-associated fatty liver disease (MAFLD), dyslipidaemia and
type 2 diabetes, but the clinical utility of SHBG for stratifying meta-
bolic risk and MAFLD is unclear, particularly for super-obese, commu-
nity dwelling patients of varying gender and menopausal status.
MATERIALS AND METHODS: Prospective cross-sectional study
within the Blacktown Hospital Metabolic and Weight Loss Program,
enrolling patients of BMI ≥ 35 kg/m2 with T2D or ≥40 kg/m2 with ≥2
obesity complications. Clinical history, metabolic and hormonal assays,
and anthropometric and Fibroscan® measurements were correlated
with SHBG by univariate and partial Spearman analyses.
RESULTS: In the cohort of 219 patients (49 ± 12 yrs, 67% female,
BMI 51 ± 12 kg/m2), mean SHBG was 28 nmol/L in men, 36 nmol/L
in premenopausal women and 35 nmol/L in postmenopausal women.
SHBG did not correlate with anthropometric measurements, and pos-
itively correlated with age in men and premenopausal women.
Regarding glucose homeostasis, in men and premenopausal women,
SHBG negatively correlated with HOMA2-IR and hyperinsulinaemia

SUPPLEMENT ARTICLE
(p < .01) but did not correlate with fasting glucose (p = .4, .6) or gly-
cosylated haemoglobin (p = .9, .6). This pattern was reversed in post-
menopausal women where SHBG negatively correlated with
glycaemia (p = .01) but not insulin resistance (p = .3). Regarding
lipids, low SHBG uniformly associated with higher triglycerides and
lower HDL cholesterol. Regarding MAFLD, SHBG negatively corre-
lated with CAP (controlled attenuation parameter) in men (p = .02)
and premenopausal women (p < .01), and ALT in premenopausal
women (p < .01), other trends approaching significance. Adjusting for
CAP variably weakened but did not abolish associations with glycae-
mic and lipid profile. SHBG correlated with combined oral contracep-
tion use but no other medications including thyroxine and did not
correlate with fT4, but inversely correlated with IGF-1 in men and
postmenopausal women (p = .01).
CONCLUSION: In our cohort of community-dwelling severe complex
obesity, low SHBG was a weight-independent marker of metabolic
health. Low SHBG was robustly associated with dyslipidaemia regard-
less of gender and menopausal status, while relationships with steato-
sis, glycaemia, insulin resistance and IGF-1 varied depending on
menopausal status which merits further investigation. While SHBG is
closely associated with steatosis from a pathophysiological perspec-
tive, its metabolic correlates were at least partially independent of
CAP measurements.
DISCLOSURE OF INTEREST: None declared.
P141 | DUSP-1 gene expression in natural
killer cells at the intersection of obesity,
cardiovascular risk, and chronic stress as a
social determinant of health in African
American women
T. Powell-Wiley 1,2 1 3 1
; Y. Baumer ; C. Gutierrez Huerta ; M. Pirooznia ;
K. Singh 1 and Meta-Analysis
1
Division of Intramural Research, National Heart Lung and Blood
Institute; 2Intramural Research Program, National Institute on Minority
Health and Health Disparities, Bethesda, MD; 3Medicine and Physiology,
Medical College of Wisconsin, Milwaukee, WI, USA
INTRODUCTION: Obesity is a global epidemic disproportionally
affecting ethnic minority US populations, including African American
(AA) women. Natural killer (NK) cells, which are critical in the immune
response against viruses like SARS-CoV2, are functionally impaired in
obesity and by psychosocial stress. Little is known about biologic
pathways by which obesity and other cardiovascular (CV) risk factors
interact with psychosocial stressors to affect NK cell function.
MATERIALS AND METHODS: NK cells were isolated from peripheral
blood of AA women with BMI < 25 (n = 5) or BMI ≥ 40 (n = 5). In
parallel, NK cells isolated from healthy blood bank donors were trea-
ted overnight with LDL (500 ug/ml = 50 mg/dl as experimental
hyperlipidemic state, n = 4) or control. RNA was isolated and
sequenced from each NK cell population. An unbiased approach of
1467789x, 2022, S2, Downloaded from https://onlinelibrary.wiley.com/doi/10.1111/obr.13503 by CAPES, Wiley Online Library on [16/12/2023]. See the Terms and Conditions (https://onlinelibrary.wiley.com/terms-and-conditions) on Wiley Online Library for rules of use; OA articles are governed by the applicable Creative Commons License
67 of 222
comparative RNA-seq analysis was used to identify genes commonly
regulated in obesity and hyperlipidemia. We compared differentially
expressed (DE) genes from LDL-treated NK cells (versus control) and
NK cells from AA women with obesity (versus lean) using a custom
pathway database to test DE genes in pathway enrichment analysis.
Expression of commonly upregulated genes was correlated with
amygdala activity measured by 18FDG-PET/CT imaging as a marker of
chronic stress-related neural activity in the study cohort.
RESULTS: DE analysis of NK cells from AA women with obesity ver-
sus lean resulted in 1645 significantly regulated genes, with 1126
upregulated genes and 519 downregulated genes. DE analysis of LDL
treated versus control NK cells resulted in 170 significantly regulated
genes, with 55 upregulated genes and 115 downregulated genes.
Comparison of DE genes from both datasets resulted in 14 commonly
regulated genes (7 regulated in opposing directions, 3 upregulated,
and 4 downregulated). Dual specificity protein phosphatase 1 (DUSP-
1) was upregulated with highest significance in both NK cell datasets
(with obesity versus lean: logFC = 2.8 p = 0.00009 and LDL-treated
versus control: logFC = 0.6 p = 0.004). Of the common DE genes,
increasing DUSP-1 gene expression positively associated with amyg-
dala activity (R2 = 0.79, p = 0.04).
CONCLUSION: DUSP-1 gene expression may serve as a major regula-
tor of NK cell dysfunction in the setting of obesity, hyperlipidemia,
and chronic stress in AA women. More research is needed to under-
stand the intersectional roles of obesity and other CV risk factors with
chronic stress as a social determinant of health to further identify bio-
logic mechanisms by which adverse psychosocial factors promote dis-
parate health outcomes in under-resourced populations.
DISCLOSURE OF INTEREST: None declared.
P142 | Association Between Weight Gain and
Knee Osteoarthritis: A Systematic Review
P. Solanki1,2; S. M. Hussain1; J. Abidi1; J. Cheng1,2; J. L. Fairley1,2;
M. J. Page1; F. M. Cicuttini1,2; A. E. Wluka1,2
1
School of Public Health and Preventive Medicine, Monash University;
2
Alfred Health, Melbourne, Australia
INTRODUCTION: Weight loss has a multitude of clinical benefits,
including in the management of knee osteoarthritis (KOA). However,
achieving and sustaining significant weight loss is incredibly challenging
for many individuals with KOA (who may have limitations to mobilisa-
tion), especially considering that adults tend to gain rather than lose
weight as they age. Hypothesising that weight gain may be detrimental
to KOA, we conducted a systematic review and data synthesis to inves-
tigate the association between weight gain and KOA (clinical features,
structural progression), and likelihood of total knee replacement (TKR).
MATERIALS AND METHODS: MEDLINE and EMBASE (via OVID)
were systematically searched (from inception until 16 February 2022)
for controlled trials and cohort studies of participants with (or at risk

68 of 222
of) KOA examining the relationship between weight gain and KOA
clinical features (pain, function, quality of life), structural progression,
and TKR. Risk of bias was assessed using the ROBINS-I tool. Results
were organised by outcome, with meta-analyses performed where
feasible.
RESULTS: Twenty studies were included, of overall moderate risk of
bias. Results showed a significant detrimental effect of weight gain on
pain (4 of 6 studies), stiffness (2 of 2 studies), function (6 of 6 studies),
quality of life (1 of 1 study), and clinical and radiographic KOA (1 of 1
study). Weight gain adversely affected cartilage (5 of 8 studies), bone
marrow lesions (1 of 3 studies), meniscal damage (1 of 2 studies) and
effusion/synovitis (1 of 1 study). Weight gain significantly increased
rates of TKR (2 of 4 studies, with meta-analysis demonstrating a
significant increase in TKR/5kg weight gain in women, OR 1.34 (95%
CI 1.18-1.51), and in men, OR 1.25 (95% CI 1.16-1.34).
CONCLUSION: Weight gain is associated with increased clinical and
structural KOA, and increased likelihood of TKR. Despite current KOA
management guidelines focussing only on weight loss, the prevention
of weight gain should also be considered.
DISCLOSURE OF INTEREST: None declared.
P143 | Ameliorative effect of saffron on
hyperglycemia, hyperlipidemia, oxidative
stress and NLRP3 inflammasome-mediated
pyroptosis in patients with obesity and type
2 diabetes: A double-blind randomized
controlled clinical trial
1 2 3 3
A. Tajaddini ; F. Tajaddini ; N. Roshanravan ; M. Mobasseri ;
3 3 3
A. Aeinehchi ; P. Sefid mooye azar ; A. Ostadrahimi
1
UNSW, Sydney, Australia; 2Shahid Beheshti University of Medical
Sciences, Tehran; 3Tabriz University of Medical Sciences, Tabriz, Iran,
Islamic Republic Of
INTRODUCTION: Obesity is a worldwide health problem associated
with an increased levels of inflammation leading to insulin resistance
and type 2 diabetes which is one of the most common metabolic dis-
orders. As some beneficial effects of saffron have been reported in
obesity, the present study examined the effect of saffron consump-
tion on glycemic status, lipid profile, oxidative stress and NLRP3
inflammasome-mediated pyroptosis in individuals with obesity and
type 2 diabetes.
MATERIALS AND METHODS: In a double-blind randomized placebo
controlled clinical trial, 60 people (30–60 years) with BMI ≥ 30 kg/m2
who were affected by type 2 diabetes were randomly allocated into
two groups to receive 100 mg/day of saffron or placebo for 8 weeks.
Dietary intake, anthropometric parameters, fasting plasma glucose
(FPG), insulin, HbA1c, lipid profile, malondialdehyde (MDA), nitric
oxide (NO), total antioxidant capacity (TAC), superoxide dismutase
(SOD), glutathione peroxidase (GPx) and catalase (CAT) were deter-
mined at baseline and at 8 weeks. mRNA expression level of TLR-2,
1467789x, 2022, S2, Downloaded from https://onlinelibrary.wiley.com/doi/10.1111/obr.13503 by CAPES, Wiley Online Library on [16/12/2023]. See the Terms and Conditions (https://onlinelibrary.wiley.com/terms-and-conditions) on Wiley Online Library for rules of use; OA articles are governed by the applicable Creative Commons License
SUPPLEMENT ARTICLE
TLR-4, NLRP3, TXNIP, Caspas1, IL-18 and IL-1 were measured by
RT-PCR.
RESULTS: At 8 weeks, saffron supplementation significantly
decreased FPG, insulin, HOMA-IR, TG, MDA and NO (all p < 0.05).
Significant increase in TAC (p < 0.05) and GPx (p < 0.01) level was
observed in the intervention group. Saffron consumption significantly
decreased mRNA expression level of TLR-4, NLRP3, TXNIP (all
p < 0.05) and IL-1β (p < 0.01), while there was no significant effect in
TLR-2, Caspas1 and IL-18 expression level. There was no significant
effect of saffron supplementation on dietary intake and anthropomet-
ric measures. These results held after adjustment for age, sex, medica-
tions, disease duration and baseline measurements.
CONCLUSION: Saffron consumption (100 mg/day) for 8 weeks
improved glycemic status, lipid profile and oxidant/antioxidant bal-
ance in individuals with obesity and type 2 diabetes, while also
improving pancreatic beta cell function and insulin resistance by
decreasing expression level of pyroptosis related genes. Overall, more
clinical studies are necessary to confirm whether saffron is an effec-
tive complementary therapy for obesity and type 2 diabetes.
DISCLOSURE OF INTEREST: None declared.
P144 | Evaluating a digital health program in
bariatric surgery: A mixed-method process
evaluation pilot study
C. Wright1,2; J. Kelly3,4; J. Byrnes5; K. Campbell6; R. Healy7;
J. Musial7; K. Hamilton1,2
1
School of Applied Psychology, Griffith University, Mount Gravatt;
2
Menzies Health Institute, Griffith University, Gold Coast; 3Centre for
Online Health, Faculty of Medicine; 4Centre for Health Services Research,
The University of Queensland, Brisbane; 5School of Medicine and
Dentistry, Centre of Applied Health Economics, Griffith University, Gold
Coast; 6Healthcare Excellence and Innovation, Metro North Hospital and
Health Service; 7Nutrition and Dietetics, Royal Brisbane and Women's
Hospital, Brisbane, Australia
INTRODUCTION: Interventions that provide behavioral support via
digital health are emerging. This study aimed to conduct a pilot study
to assess the feasibility of a digital health program in bariatric surgery.
MATERIALS AND METHODS: A mixed-methods approach was uti-
lized. The intervention included text messages, email newsletters,
online resources, and videos in addition to usual care via telehealth. A
historical control group (usual care via face-to-face) was used to
determine intervention effect.
RESULTS: One hundred and seventy-seven participants completed
the study (n = 129 historical control, n = 48 intervention group; mean
age = 56 years). Participants were predominantly female (n = 104,
59%), underwent Roux-en-Y gastric bypass (n = 146, 83%). The addi-
tional cost associated with the intervention was $1.20/person over
three months. The survey, delivered to the intervention group, had a
31% response rate (n = 15). Text message recipients reported always

SUPPLEMENT ARTICLE
reading them (n = 14, 93%), agreed/strongly agreed they were easy
to understand (n = 15, 100%), and agreed/strongly agreed they sup-
ported new behaviors (n = 13, 87%). However, they neither agreed/
disagreed that the text messages motivated goal setting or self-
monitoring (n = 6, 40%), diet behaviour change (n = 7, 47%) or physi-
cal activity behaviour change (n = 7/, 47%). Email newsletter recipi-
ents agreed the information was useful (n = 7, 88%), they would
always read them (n = 6, 75%), and agreed/strongly agreed they were
easy to understand (n = 7, 88%). From interviews four main themes
were generated: ‘Motivators and expectations’, ‘Preferences and rele-
vance’, ‘Reinforced information’, and ‘Wanting social support’. The
email newsletters were found to be lengthy and reading them on a
mobile device was challenging. Text messages were favored due to
their concise nature however, the need for tailoring and experiential
advice was emphasized. There was no significant difference in weight
at 12-month post-operatively.
CONCLUSION: Overall, the intervention was low cost, provided posi-
tive patient experience, and an additional option. Text messages are
ready for continued implementation in routine practice. However, tai-
loring would be beneficial, and they may be best administered once
patients have reached their nadir weight, weight regain is observed, or
unproductive habits emerge.
DISCLOSURE OF INTEREST: None declared.
P145 | Self-managed weight loss in Australian
adults: Characteristics, predictors, strategies
and barriers
1 2 1
D. Ramachandran ; A. Li ; T. Gill
1 1
The Boden Initiative, Charles Perkins Centre, The University of Sydney,
2
Camperdown; The University of Melbourne, Melbourne, Australia
INTRODUCTION: With limited access to clinical obesity services,
self-management could be seen as an important option in obesity
care. Current research has focussed on factors associated with behav-
iour change and weight loss, in clinical settings. This study aimed to
examine factors predicting these outcomes among those that self-
manage their weight loss.
MATERIALS AND METHODS: Adults attempting weight loss on their
own were recruited through Facebook in Jan-Mar 2020 to an online
12-week follow-up survey study. Data was collected for over 50 theo-
retically relevant factors. Univariate analysis was conducted to iden-
tify variables with strong influence on outcomes. Multiple linear and
logistic regressions modelling was carried out to assess influence of
factors on the outcomes. Answers to open ended questions on strate-
gies and barriers were thematically analysed.
RESULTS: 102 participants completed both surveys. Participants were
female (87.3%), married (72.5%), and English-speaking (85.3%). Most
(88%) had overweight (23%) or obesity (65%). Mean weight loss was
2.07 kg (SD 4.89; p ≤ 0.001). 32.4% lost ≥3% of initial body weight.
18.6% had clinically significant weight loss of = > 5%. Higher initial
1467789x, 2022, S2, Downloaded from https://onlinelibrary.wiley.com/doi/10.1111/obr.13503 by CAPES, Wiley Online Library on [16/12/2023]. See the Terms and Conditions (https://onlinelibrary.wiley.com/terms-and-conditions) on Wiley Online Library for rules of use; OA articles are governed by the applicable Creative Commons License
69 of 222
BMI ( 0.24, p = 0.022, 95%CI = 0.43, 0.04), non-English ( 4.2,
p = 0.016, 95%CI = 7.95, 0.88), use of meal replacement or pre-
pared meals ( 2.39, p = 0.023, 95%CI = 4.438, 0.334) were pre-
dictive of weight loss. Increased intake of discretionary foods (0.27,
p = 0.01, 95%CI = 0.53, 0.045) predicted weight gain. Increase in dis-
cretionary foods ( 0.628, p = 0.005, 95%CI = 0.628, 0.199) and
SSBs ( 0.628, p = 0.005, 95%CI = 0.628, 0.199) were associated
with reduced F&V intake. Those who perceived their health as ‘fair’
(B = 129.195, p = 0.018, 95%CI = 25, 233) showed increase in vig.
physical activity. Thematic analysis found issues influencing weight
loss with food intake themes on snack and portion control, dieting
and eating rules; exercise themes about walking; more exercise;
routines and monitoring. Barriers were health issues, state of mind;
motivation loss, relapsing; unconducive environments and unhelpful
social situations. Other themes were ‘I am trying’ and ‘perpetual
struggle’.
CONCLUSION: Factors influencing weight and behaviour outcomes
among self-managed weight losers and were found similar to those in
clinical settings. Results are limited by small sample size. Study of self-
management has applications in obesity management strategies.
DISCLOSURE OF INTEREST: None declared.
P146 | Prevalence of anxiety, depression and
chronic stress in adults with Class 3 Obesity
attending a multidisciplinary weight
management program in South West Sydney
E. Hickey1; R. Chimoriya2; K. Grudzinskas1; C. Tesoriero1; P. Hay1,2;
N. Kormas1; M. Piya1,2
South Western Sydney Metabolic Rehabilitation and Bariatric Program,
Camden and Campbelltown Hospitals; 2Department of Medicine,
Western Sydney University, Sydney, Australia
INTRODUCTION: There is a higher reported prevalence of mental
health disorders with obesity. This study aimed to evaluate symptoms
of anxiety, depression and chronic stress in adults with class 3 obesity
(BMI ≥ 40 kg/m2), and assess the effect of a multidisciplinary weight
management program over 12 months.
MATERIALS AND METHODS: This retrospective cohort study
included adults with class 3 obesity enrolled in a publicly funded mul-
tidisciplinary weight management program in Sydney between March-
2018 and January-2022. The Depression Anxiety and Stress Score
21 (DASS21) was completed at baseline. A subset of participants com-
pleted follow-up DASS21 at 12 months.
RESULTS: The studied population (n = 178) had a mean age of 49.6
± 13.0 years, mostly Caucasian ethnicity (68.5%) with female predom-
inance (68.5%). At baseline, mean BMI was 51.7 ± 10.2 kg/m2. Com-
mon metabolic complications included hypertension (51.9%),
dyslipidaemia (44.2%), and Type 2 diabetes (T2DM) (38.8%), while
70% reported joint pain, 46.4% gastroesophageal reflux disease and
45.4% obstructive sleep apnoea. Based on the DASS21 scores, at

70 of 222
baseline, 53.9% (n = 96) had moderate to extremely severe symptoms
of depression, while 39.3% (n = 70) had moderate to extremely
severe symptoms of chronic stress. Moderate to extremely severe
anxiety symptoms were reported in 51.1% (n = 91), with 30.3%
(n = 54) experiencing extremely severe anxiety symptoms at base-
line. DASS21 scores were not affected by baseline BMI or presence
of T2DM. For the subset who had completed the DASS21 at
12 months (n = 49) there was mean total weight loss of 9.5% (134.3
± 21.1 kg vs 127.0 ± 19.8, p < 0.001), regardless of the presence of
T2DM. Most participants achieved at least 5% weight loss (57.1%) or
10% weight loss (20.4%). A negative correlation was found between
weight loss and baseline DASS21 Stress score (r = 0.314,
p = 0.028) and DASS21 total score (r = 0.286, p = 0.046). No sta-
tistically significant improvement in symptoms of depression, anxiety
or stress was found.
CONCLUSION: This study demonstrates a very high prevalence of
symptoms of depression, anxiety and chronic stress in adults with
class 3 obesity. More than 1 in 2 studied participants were experienc-
ing moderate to extremely severe symptoms of depression and anxi-
ety, and almost 1 in 3 reported levels of anxiety in the extremely
severe range. Although high baseline symptoms of depression, anxiety
and chronic stress predicted less weight loss, significant weight loss
was still achieved by most participants in a multidisciplinary weight
management program.
DISCLOSURE OF INTEREST: None declared.
P147 | Does a set-point “nadir” weight really
exist for adults living with obesity? A
retrospective audit of patients who have
regained weight after bariatric surgery and
subsequently treated with semaglutide in an
Australian tertiary obesity service
G. Rigas
St George Private Hospital, Kogarah, Sydney, Australia
INTRODUCTION: Weight cycling is often experienced by many peo-
ple living with obesity (PwO). Some weight regain after all anti-obesity
therapies is normal and expected, due to metabolic adaptation and
other reasons. There is a paucity of data on whether an adult's
reported pre-therapy nadir weight [PTNW] can be reached and/or
superseded after treatment with bariatric surgery [BS] and/or sema
for 12 months after weight regain. We undertook this audit in order
to offer insights into weight cycling before and after treatment.
MATERIALS AND METHODS: A retrospective analysis of 84 adults
who presented for BS aftercare, had experienced weight regain and
were treated with sema for 12 months (dose ≤2 mg/week). Demo-
graphic factors including PTNW and age, presence of comorbidities,
type of BS (primary vs revisional) were documented. The post-BS sur-
gery nadir weight [PBSNW] and post-12 mo of sema treatment nadir
weight [PSemNW] were documented, total percentage weight loss
1467789x, 2022, S2, Downloaded from https://onlinelibrary.wiley.com/doi/10.1111/obr.13503 by CAPES, Wiley Online Library on [16/12/2023]. See the Terms and Conditions (https://onlinelibrary.wiley.com/terms-and-conditions) on Wiley Online Library for rules of use; OA articles are governed by the applicable Creative Commons License
SUPPLEMENT ARTICLE
[%TWL] (calculated from the preoperative weight) including age at
these time points.
RESULTS: 67 patients, 83.6% female, had data available for interim-
analysis at time of submission. Of these, the majority had undergone
primary BS (74.6%), median preop age 43 yo (range 24–62) and BMI
42 (range 31.4–56.4). Majority (91%) had ≥1 comorbidity, with hyper-
lipidemia, hypertension and insulin resistance being the most preva-
lent (55.2, 47.8 and 41.8% respectively).
At PBSNW, median age 46 yo (range 24–73), median 30.4%
TBWL (range 3.2–52.8) and median BMI 29.2 (range 19–37.6). At
PSemNW, median age 53 yo (range 34–76), median 31.5% TBWL
(range 6.7–56.5) and median BMI 28.4 (range 19.4–39.5). The
PBSNW was lower than the PSemNW in 43.3% patients (n = 29). The
PTNW occurred at a median age of 20 yo (range 18–46), with a
median nadir weight of 75 kg (range 48–129.7) and median BMI 27.3
(range 17.7–38.1). The PTNW was lower than any post-treatment
nadir weight in 62.7% of patients (n = 42).
CONCLUSION: Interestingly 67.2% of the BS patients treated with
adjunct sema for weight regain either equalled or surpassed their
post-BS nadir weight. However, the lowest reported pre-therapy
weight was still lower than any post therapy (BS alone OR
BS + adjunct GLP-1 agonist) nadir weight, in 62.7% of the cohort.
These preliminary findings would suggest that perhaps a set-point
“nadir” weight really exists and is “set” in early adulthood for PwO,
though unlikely to be reached again later in life. It is evident that fur-
ther research is required to identify possible predictors of a patient
reaching or superseding their lightest reported adult nadir weight.
DISCLOSURE OF INTEREST: G. Rigas Consultant for: NovoNordisk
Pharmaceuticals Global & Australia, iNova Pharmaceuticals Australia,
Johnson and Johnson Australia, Nestle HealthScience Australia,
Reshape HealthSciences Australia, Speakers bureau with: NovoNor-
disk Pharmaceuticals Global & Australia, iNova Pharmaceuticals
Australia, Johnson and Johnson Australia, Nestle HealthScience
Australia, Reshape HealthSciences Australia, W.L.Gore Australia.
P148 | Role of gut microbiome in the
pathogenesis and management of obesity
H. M. Heshmati
Endocrinology Metabolism Consulting, LLC, Anthem, AZ, USA
INTRODUCTION: Obesity is a worldwide pandemic causing increased
morbidity and mortality. Gut microbiome is a community of trillions of
microorganisms living in the digestive tract, containing bacteria, fungi,
protozoa, archaea, and viruses, and millions of genes. Important
changes affecting diversity, abundance, and function of gut micro-
biome are observed in obesity. This review presents an update on gut
microbiome role in the pathogenesis and management of obesity.
MATERIALS AND METHODS: A systematic search of literature was
conducted using the search terms obesity, gut microbiome, pathogen-
esis, and management.

SUPPLEMENT ARTICLE
RESULTS: Gut microbiome impacts body weight through different fac-
tors (e.g., short-chain fatty acids, lipopolysaccharides, and bile acids).
Although there are some data discrepancies, numerous studies have
reported a decrease in gut microbiome gene richness and diversity, a
higher abundance of Firmicutes phylum (with higher presence of Lac-
tobacillus genus), an increase in Firmicutes to Bacteroidetes phyla
ratio, a lower abundance of Bacteroidetes phylum, and a lower abun-
dance of Verrucomicrobia phylum (with lower presence of Akkerman-
sia genus) in obesity. Several tools including diet, prebiotics,
probiotics, bariatric surgery, and fecal microbiota transplantation have
been used to modulate gut microbiome, change host metabolism, and
manage obesity. There is a complex relationship between nutrition
and gut microbiome. A diet low in calories, low in fat, high in protein,
and high in fiber has a favorable effect on gut microbiome (increase in
richness and decrease in Firmicutes to Bacteroidetes phyla ratio) and
induces weight loss. Administration of a prebiotic (oligofructose-
enriched inulin) to children with overweight/obesity causes a signifi-
cant increase in Bifidobacterium (genus belonging to Actinobacteria
phylum) and a significant attenuation of weight gain. Intake of a probi-
otic [fermented milk containing Lactobacillus gasseri species (LG2055)]
in adults with overweight/obesity promotes significant weight loss.
Bariatric surgery leads to significant changes in gut microbiome, inde-
pendently of body weight, through reduced caloric intake, reduced
gastric emptying, alterations in gastric acid production and bile acids,
modifications of gut hormones, and malabsorption. Roux-en-Y gastric
bypass induces an increase in gut microbiome gene richness and
diversity, a decrease in Firmicutes-to-Bacteroidetes phyla ratio, an
increase in Proteobacteria phyla, and an increase in Akkermansia
genus. These changes counteract those observed in obesity and fur-
ther enhance weight loss.
CONCLUSION: Gut microbiome is an important factor involved in
obesity. A better understanding of its role in the pathogenesis of obe-
sity can help the development of guidelines for the type of diet and
the composition, dose, and regimen of prebiotics and probiotics in the
prevention and management of obesity.
DISCLOSURE OF INTEREST: None declared.
P150 | Antenatal care for gestational weight
gain for women with overweight or obesity:
Women's receipt and acceptability of care
J. Hollis1,2,3; J. Daly1,2; B. Tully1,2; M. Licata1,2; J. Dray2,3;
E. Doherty1,2,3; N. Bennett4; M. Foster4; C. Pennell4; J. Wiggers1,2,3;
M. Kingsland1,2,3
1
Hunter New England Population Health; 2Hunter Medical Research
Institute; 3School of Medicine and Public Health, University of Newcastle;
4
Maternity and Gynaecology, John Hunter Hospital, Hunter New England
Health, Newcastle, Australia
INTRODUCTION: Internationally, between 10 and 43% of pregnant
women are affected by an overweight or obesity pre-pregnancy body
1467789x, 2022, S2, Downloaded from https://onlinelibrary.wiley.com/doi/10.1111/obr.13503 by CAPES, Wiley Online Library on [16/12/2023]. See the Terms and Conditions (https://onlinelibrary.wiley.com/terms-and-conditions) on Wiley Online Library for rules of use; OA articles are governed by the applicable Creative Commons License
71 of 222
mass index (BMI), and up to 80% of these women gain weight outside
of their gestational weight gain (GWG) recommendations. The assess-
ment and management of GWG for all women is recommended to
improve pregnancy and birth outcomes, and maternal and child
chronic disease risk. Little is known about the provision and accept-
ability of such antenatal care practices for women with overweight
and obesity. This study reports the: (i) proportion of pregnant women
with overweight and obesity who were assessed and offered support
to manage GWG in line with the Australian Pregnancy Care guide-
lines, (ii) characteristics of pregnant women and antenatal services
associated with care receipt, and (iii) women's acceptability of
recommended care.
MATERIALS AND METHODS: Telephone surveys with women who
had recently attended public maternity services were undertaken in
one health district in Australia. Women's self-reported GWG, and
receipt and acceptability of guideline recommended care were exam-
ined. Characteristics associated with receipt of recommended care
were analysed using multiple logistic regression.
RESULTS: A total of 221 women with an overweight or obesity pre-
pregnancy BMI completed the survey. Eighty-one percent of women
gained weight below (22%) or above (59%) the GWG guidelines. Only
9% of women received recommended GWG care. Women who were
in their first pregnancy, identified as Aboriginal, with a higher pre-
pregnancy BMI, and resided in an area of greatest disadvantage were
more likely to receive recommended GWG care. Ninety-two percent
of Aboriginal and 92% of non-Aboriginal women with overweight or
obesity agreed that recommended care for GWG should be provided
as routine antenatal care.
CONCLUSION: Most women did not receive antenatal care for GWG
as recommended by the Australian Pregnancy Care guidelines, despite
high acceptability of receiving such care. There is a need for service-
wide practice change to increase care to address GWG in pregnancy
for women of all pre-pregnancy BMIs.
DISCLOSURE OF INTEREST: None declared.
P151 | Usefulness of bioelectrical impedance
analysis in type 2 diabetes mellitus
J. Ko
Endocrinology, Internal medicine, Haeundae Paik Hospital, Inje University,
Busan, Korea, Republic Of
INTRODUCTION: There are several methods to assess obesity. Body
mass index (BMI) and waist circumference are most commonly used.
However, various metabolic diseases may appear in sarcopenic
patients. The aim of this study was to evaluate the variables in bio-
electrical impedance analysis (BIA) in patients with type 2 diabetes
mellitus in order to analyze the usefulness of variables in controlling
blood glucose levels. We also determined whether fat-to-muscle ratio
(FMR) was related to the severity of type 2 diabetes mellitus.

72 of 222
MATERIALS AND METHODS: This was a cross-sectional retrospec-
tive study, performed at a primary medical center. We enrolled
89 patients with type 2 diabetes mellitus. We obtained the BIA mea-
sures and insulin resistance (IR) using the homeostasis model assess-
ment 2 model (IR: HOMA-IR) /insulin sensitivity [IS] (IS: HOMA-S).
RESULTS: This study enrolled 89 individuals, 49 females and 40 males.
The age ranged from 26 to 63 years. Their mean age was 41.28
± 9.35 years. Their mean Body weight (Bwt) was 79.95 ± 17.50 kg
and HbA1c was 7.28 ± 1.67%. The mean HOMA-IR was 2.36 ± 1.23.
Arm circumference (right arm r = 0.54, left arm r = 0.55, mean
arm r = 0.54, p < 0.001) and neck circumference (NC) (r = 0.51,
p < 0.001) showed a significant correlation with HOMA-IR. HOMA-S
was also significantly correlated with AC and NC. FMR had a statisti-
cally significant correlation with HOMA-IR (r = 0.54, p < 0.001).
HOMA-IR and FMR had a statistically significant correlation, but
showed a lower correlation than the correlation coefficient with fat
mass alone. When analyzed again between fat mass/skeletal muscle
ratio and HOMA-IR, it showed a rather lower value of 0.29. However,
when analyzing by dividing into two groups based on the median
value (FMR 0.55), the average of the group with an FMR of less than
0.55 was 2.06, and the group with an FMR of 0.55 or higher was
2.66, showing a significant difference between the two groups.
(HOMA-IR: FMR < 0.55 mean 2.06, FMR ≥ 0.55 mean 2.66,
p = 0.001, HOMA-S: FMR < 0.55 mean 61.23, FMR ≥ 0.55 mean
43.89, p = 0.001).
CONCLUSION: BIA is the useful tool to identify the severity of type
2 DM. NC and AC derived from BIA is the useful as a clinical surrogate
indicator of insulin resistance in type 2 DM. Educating patients to
observe changes in these factors by themselves may help improving
blood glucose level. FMR could also be useful factor, but further stud-
ies with a greater number of subjects will be needed.
DISCLOSURE OF INTEREST: None declared.
P152 | Coparenting-focused preventive
intervention reduces postnatal maternal body
mass index and buffers impact of cortisol
L. Moran1; J.-K. Lee2; D. Jones3; K. Fronberg4; M. Feinberg4
1
Monash Centre for Health Research and Implementation, Monash
University, Melbourne, Australia; 2Institute for Poverty Alleviation and
International Development, Yonsei University, Seoul, Korea, Republic Of;
3
Edna Bennett Pierce Prevention Research Center; 4College of Health and
Human Development, Pennsylvania State University, State College, USA
INTRODUCTION: Postpartum is a key life-stage contributing to
increased maternal obesity risk. Currently lifestyle interventions do
not consider the role of a women's partner in reducing stress and sup-
porting lifestyle change. The objective of this study was to assess the
effect of an intervention that seeks to enhance coparenting relation-
ship quality on maternal body mass index (BMI) from preconception
1467789x, 2022, S2, Downloaded from https://onlinelibrary.wiley.com/doi/10.1111/obr.13503 by CAPES, Wiley Online Library on [16/12/2023]. See the Terms and Conditions (https://onlinelibrary.wiley.com/terms-and-conditions) on Wiley Online Library for rules of use; OA articles are governed by the applicable Creative Commons License
SUPPLEMENT ARTICLE
to 12-months postpartum and if the intervention moderated the asso-
ciation of changes in cortisol and BMI.
MATERIALS AND METHODS: A randomized controlled trial assessing
an intervention (8 classes: 4 during/4 following pregnancy) focusing
on enhancing couple coparenting relationships during pregnancy/
postpartum (n = 57) compared to standard care (n = 53).
RESULTS: Main outcome measures were changes in maternal BMI
and cortisol. There was less increase in BMI for mothers in interven-
tion compared to control groups ( 1.03 ± 0.42 kg/m2, p = 0.015).
There was an interaction between intervention status and cortisol
change predicting BMI change (p = 0.026) such that cortisol change
significantly predicted BMI change among mothers in control
(p = 0.049) but not intervention groups (p = 0.204).
CONCLUSION: A coparenting intervention improved maternal post-
partum BMI with this effect potentially related to ameliorating the
negative effect of stress, as measured by cortisol, on BMI. The role of
enhanced coparenting in improving maternal anthropometry warrants
urgent attention.
DISCLOSURE OF INTEREST: None declared.
P153 | Exploring the utility of N-
acetylcysteine for the treatment of loss-of-
control eating: An open-label study
M. Muthmainah1,2; D. Sketriene2,3; P. Sumithran4; A. Gogos2;
R. Brown2,3
1
Florey Department of Neuroscience and Mental Health; 2Florey Institute
of Neuroscience and Mental Health; 3Department of Biochemistry and
Pharmacology; 4Department of Medicine (St Vincent's), The University of
Melbourne, Melbourne, Australia
INTRODUCTION: Compulsive eating is a common feature of obesity
and several eating disorders. A core feature of compulsive eating is a
sense of loss of control, that is, eating despite the intent or desire not
to. Currently treatment options for compulsive eating are limited. We
recently determined that pro-drug N-acetylcysteine reduces
compulsive-like eating in a rat model of diet-induced obesity. N-
acetylcysteine is a powerful antioxidant and restores dysregulated glu-
tamate in the brain. This study is a single site, open-label pilot study
to examine the feasibility of a randomised controlled trial (RCT) of N-
Acetylcysteine (NAC) on loss of control eating.
MATERIALS AND METHODS: All eligible participants will receive
NAC orally at a daily dose of 2400 mg for 12 weeks. Loss-of-control
eating will be assessed 1 week before commencement of treatment
and for 1 week at the end of treatment using questionnaires (Eating
Loss of Control Scale, Palatable Eating Motives Scale: Coping sub-
scale, Emotional Eating Scale, Food Craving Inventory, Reward-based
Eating Scale, Perceived Stress Scale) and ecological momentary
assessment (EMA) via an application installed on the participants
mobile phone (SEMA3, University of Melbourne). Community resi-
dents in greater Melbourne will be recruited to participate in the

SUPPLEMENT ARTICLE
study. A total of 36 adults with loss-of-control eating will be
required. Individuals with cognitive impairment, known previous
hypersensitivity to NAC, any serious medical illness that NAC may
adversely affect, current use of a formal weight loss program or any
contraindicated medications will be excluded. Pregnant or lactating
participants will also be excluded.
RESULTS: Our primary outcome is participant retention rate at week
12, recruitment rate and medication adherence. Our secondary out-
come is the change in the degree of loss of control eating from base-
line to week 12. Data on treatment outcome will be compared
between pre- and post-intervention using paired t-test or Wilcoxon
signed-rank test depending on the outcome distribution.
CONCLUSION: The results of this study will inform the feasibility of a
RCT of NAC.
DISCLOSURE OF INTEREST: None declared.
P154 | Weight change trajectory in patients
who undergo renal transplantation
N. Barakati1; S. A. L. Price1; S. Fourlanos1; S.-J. Tan2; P. Hughes2;
R. Masterson2; B. Sobey2; J. Wentworth1
1
Endocrinology; 2Nephrology, Royal Melbourne Hospital, Melbourne,
Australia
INTRODUCTION: Weight gain post renal transplant is a common
issue and can adversely affect transplant outcome.
MATERIALS AND METHODS: The aim of this study was to determine
the weight change trajectory and its potential impact on short and
long term complications in patients who underwent renal transplant.
We analyzed data collected retrospectively from adult patients who
had renal transplant at Royal Melbourne Hospital between 2017 and
2021 (N = 407). We assessed the average weight change at 3, 6,
9 and 12 months post renal transplant and compared it with the base-
line weight at the time of transplant.
RESULTS: Prior to transplant, 9 patients (2%) were underweight (Body
Mass Index <18 kg/m2), 125 patients (31%) had normal weight (BMI
2
18–24.9 kg/m ), 148 patients (36%) were overweight (BMI 25–
29.9 kg/m2) and 125 patients (31%) had obesity (BMI > 30 kg/m2).
Maximum weight gain occurred at 9–12 months post transplantation
in all BMI categories. On average, patients gained 3.7 kg at 12 month
post renal transplant (P value = 0.003). Patients who were under-
weight prior to transplant experienced more weight gain compared to
other BMI categories. (Percentage of weight gain at 12 months in
underweight group was 25.7% vs 7.6% in normal weight group vs
4.7% in Overweight group and 2% in obesity group).
CONCLUSION: We conclude that weight gain is common post renal
transplant and is likely multifactorial (e.g., pre-transplant weight, pre-
existing comorbidities, changes in lifestyle post transplant, and the
use of steroid and other immunosuppressive medications). Further
studies are being performed to determine the factors contributing to
1467789x, 2022, S2, Downloaded from https://onlinelibrary.wiley.com/doi/10.1111/obr.13503 by CAPES, Wiley Online Library on [16/12/2023]. See the Terms and Conditions (https://onlinelibrary.wiley.com/terms-and-conditions) on Wiley Online Library for rules of use; OA articles are governed by the applicable Creative Commons License
73 of 222
weight gain post renal transplant and how to prevent them to improve
the transplant outcome.
DISCLOSURE OF INTEREST: None declared.
P156 | Evaluating the effect of type
2 diabetes on weight-loss outcomes and
obesity-related comorbidities following
bariatric surgery
G. Belessis1; J. Franklin1,2; E. Manson2; H. Nelthorpe2; G. Loughnan2;
T. Markovic1,2,3; S. Hocking1,2,3
1
Central Clinical School, Faculty of Medicine and Health, The University
of Sydney; 2Metabolism and Obesity Service, Royal Prince Alfred
Hospital; 3Boden Initiative, Charles Perkins Centre, The University of
Sydney, Sydney, Australia
INTRODUCTION: Individuals with type 2 diabetes mellitus (T2DM)
achieve lower weight loss with lifestyle interventions and anti-obesity
pharmacotherapy compared to those with normal glucose tolerance.
Although bariatric surgery is superior to best medical therapy for the
management of T2DM in people with obesity, studies suggest the
presence of T2DM at baseline predicts worse weight loss response to
bariatric surgery. We explored the effect of type 2 diabetes mellitus
on weight loss and obesity-related comorbidities following bariatric
surgery at an Australian tertiary weight management clinic (MOS).
MATERIALS AND METHODS: A retrospective cohort of patients
attending MOS between October 2009 and December 2021 was
identified. T2DM was defined as HbA1c ≥ 6.5% or random blood glu-
cose level ≥ 11.1 mmol/L. Bodyweight was measured prior to bariatric
surgery (BSx) and at 1, 2 and 3-years after surgery. Obesity comorbid-
ities including hypertension, dyslipidaemia and use of lipid-lowering
medications were determined at baseline (before BSx) and at 3 years.
RESULTS: Of 97 individuals, 47 had T2DM. Prior to BSx, individuals
with T2DM were older (55.3 vs 50.9 years) and had lower BMI (45.8
vs 49.3 kg/m2) than those without T2DM. At 1-year post-BSx, people
with T2DM had lost 4.2% less weight than those without T2DM
(27.8% vs 23.6%, p = 0.01). This trend was eliminated at 2 and 3 years
after BSx, with those with T2DM and those without T2DM losing sim-
ilar weight (24.3% vs 25.8%, p = 0.47 and 22.8% vs 24.2%, p = 0.51,
respectively). Comorbidities did not differ significantly between the
groups at baseline and at 3 years.
CONCLUSION: Individuals with T2DM lost less weight than those
without T2DM at 1 year post BSx. However, the presence of T2DM
prior to BSx did not affect weight-loss at 2 or 3 years. BSx remains an
effective long-term weight-loss intervention regardless of the pres-
ence of T2DM.
DISCLOSURE OF INTEREST: None declared.

74 of 222
P157 | Effects of Oral ingestion of
Bifidobacterium breve B-3 on body fat and
lipids in adults with obesity: A randomized,
double-blind, placebo-controlled trial
S. Y. Lee; Y. L. Lee
Family Medicine, Pusan National University Yangsan Hospital, Busan,
Korea, Republic Of
INTRODUCTION: Some evidence suggests an association between
changes in microbial diversity and composition and the development
of obesity, raising the possibility of gut microbiota administration as a
target for new anti-obesity therapies. A previous clinical study with
Japanese adults with overweight tendencies found Bifidobacterium
breve B-3 have anti-obesity effects through improving the intestinal
barrier function, which results in repressed systemic inflammation
reaction and controlled body fat. However, Bifidobacterium animalis
ssp. lactis GCL2505 had no effect on body fat or weight loss in
Japanese adults. Here, we investigated the efficacy and tolerability of
Bifidobacterium breve B-3 for improvement of body composition in
Korean with obesity as in Japanese. Also, the effects of Bifidobacter-
ium breve B-3 on lipid profiles were further examined.
MATERIALS AND METHODS: One hundred volunteers with obesity
(men, 34%) aged 43.7 ± 11.7 years with mean body mass index of
29.1 ± 4.1 kg/m2 were evenly assigned to the intervention group
(IG) which received 160 mg of B-3 per day or to the control group
(CG) given placebo for 12 weeks and 96 (96%) participants completed
the study. We confirmed that the Bifidobacterium breve B-3 capsules
contained approximately 1.6  1010 colony-forming units per capsule
by microbial colony count using reinforced clostridial agar (Oxoid)
before the clinical trial. Changes in body fat were evaluated using dual
energy X-ray absorptiometry as a primary efficacy endpoint. Lipid pro-
files were measured as a secondary efficacy endpoint, and reports of
adverse events were collected throughout the study.
RESULTS: After 12 weeks of trial, no differences in total body weight,
the percentage of body fat, body fat mass (kg), free fatty acid, and adi-
ponectin were observed between the two groups. However, low-
density lipoprotein-cholesterol in IG was found to be significantly bet-
ter than those of subjects in CG ( 6.5% vs. 7.1%, p = 0.008). Applica-
tion of Bifidobacterium breve B-3 was well tolerated, and no notable
adverse effects were reported from both groups.
CONCLUSION: These results suggest the beneficial potential of Bifi-
dobacterium breve B-3 in reduction of low-density lipoprotein-
cholesterol in obese adults. Further studies are required to determine
the optimal dose and duration of Bifidobacterium breve B-3 supple-
mentation to confirm the first-stage study results for clinical
application.
DISCLOSURE OF INTEREST: None declared.
1467789x, 2022, S2, Downloaded from https://onlinelibrary.wiley.com/doi/10.1111/obr.13503 by CAPES, Wiley Online Library on [16/12/2023]. See the Terms and Conditions (https://onlinelibrary.wiley.com/terms-and-conditions) on Wiley Online Library for rules of use; OA articles are governed by the applicable Creative Commons License
SUPPLEMENT ARTICLE
P158 | Weight loss intervention alleviates
pain and improves quality of life in adults
with overweight and obesity
S. Ward1,2; A. Coates1,3; S. Carter1,3; K. Baldock3; T. Stanton3,4;
C. Yandell1,3; J. Buckley1,3; S.-Y. Tan5; G. Rogers6; C. Berryman3,4;
A. Hill1,2
1
Alliance for Research in Exercise, Nutrition and Activity (ARENA);
2
Clinical and Health Sciences; 3Allied Health and Human Performance;
4
IMPlementation And Clinical Translation (IIMPACT), University of South
Australia, Adelaide; 5Institute for Physical Activity and Nutrition (IPAN),
Deakin University, Melbourne; 6Microbiome and Host Health Programme,
South Australian Health and Medical Research Institute (SAHMRI),
Adelaide, Australia
INTRODUCTION: The evidence linking excess weight and musculo-
skeletal (MSK) pain is growing, with both factors adversely impacting
an individual's health, functioning, and quality of life (QoL). Weight
loss in people with overweight or obesity appears effective in manag-
ing MSK pain, hypothesised to occur through reduced mechanical
loading and amelioration of inflammation associated with fat mass.
However, the change in pain profile is less commonly reported in
weight loss studies. The aim of this study was to evaluate the effect
of a 3-month energy restricted weight-loss diet on participants' pain
profile and QoL.
MATERIALS AND METHODS: One hundred and forty adults (aged
25–65 years) with overweight or obesity (body mass index (BMI)
27.5–34.9 kg/m2) were recruited to participate in a 3-month
energy restriction study (30% energy deficit) to induce weight loss.
Body weight and pain were assessed at baseline and 3-months.
Participants identified current sites of pain and pain duration on a
body chart. Pain-related QoL was captured with the Short-Form
36 Bodily Pain subscale. In those reporting pain, the Short Form
McGill Pain Questionnaire (total score) was used to quantify
pain severity. McNemer's exact test was used to determine if
there was a difference in the proportion of participants reporting
pain at baseline versus 3 months. Paired t-tests determined differ-
ences in pain-related QoL and pain severity at baseline versus
3 months.
RESULTS: One hundred and nineteen adults completed the weight
loss intervention. The majority were women (n = 83, 69.7%); 48.2
± 10.6 years, 30.7 ± 2.3 kg/m2 (mean ± standard deviation). On aver-
age, participants achieved 7.0 ± 3.5 kg weight loss, which represented
an 8.0 ± 3.6% reduction in body mass. Compared to baseline, fewer
participants reported current pain at 3 months (baseline, n = 77
(64.7%) vs 3-months, n = 51 (43.6%); p < 0.001) and there was an
improvement in pain related QoL (baseline, 73.5 ± 21.02 vs 3-months,
79.7 ± 18.9; p < 0.001). Pain severity was lower at 3 months com-
pared to baseline in those who reported pain (baseline, 7.1 ± 5.9 vs
3 months, 4.1 ± 5.3; p < 0.001).
CONCLUSION: Participation in a 3-month weight loss intervention
was effective in improving the pain profile of participants. The desire

SUPPLEMENT ARTICLE
to reduce pain may motivate individuals to engage in weight loss
interventions.
DISCLOSURE OF INTEREST: S. Ward: None Declared, A. Coates
Grant/Research support with: Almond Board of California, S. Carter:
None Declared, K. Baldock: None Declared, T. Stanton: None
Declared, C. Yandell: None Declared, J. Buckley Grant/Research sup-
port with: Almond Board of California, S.-Y. Tan Grant/Research sup-
port with: Almond Board of California, G. Rogers Grant/Research
support with: Almond Board of California, C. Berryman: None
Declared, A. Hill Grant/Research support with: Almond Board of
California.
P159 | Recommendations for weight
management in osteoarthritis: A systematic
review of clinical practice guidelines
Y. Z. Lim1; J. Wong1; S. M. Hussain1; M. M. Estee1; L. Zolio2;
M. J. Page1; C. L. Harrison3; A. E. Wluka1; Y. Wang1; F. M. Cicuttini1
1
School of Public Health and Preventive Medicine, Monash University;
2 3
Alfred Health; Monash Centre for Health Research and Implementation
(MCHRI), School of Public Health and Preventive Medicine, Monash
University, Melbourne, Australia
INTRODUCTION: Weight loss interventions are often recommended
to target overweight and obesity in the clinical practice guidelines
(CPGs) for the management of osteoarthritis. This is despite evi-
dence from meta-analyses of clinical trials that significant weight
loss results in modest improvements in symptoms and minimal
effects on disease progression. There is evidence that weight gain is
associated with increase in knee pain. In countries such as USA,
adults gain on average 0.5 to 1 kg per year from early to middle
adulthood. Preventing weight gain is easier to achieve and sustain
than losing weight. Given that weight loss is accepted as fundamen-
tal to osteoarthritis management, we systematically reviewed the
recommendations and approaches for weight management in all cur-
rent osteoarthritis CPGs.
MATERIALS AND METHODS: Nine databases were searched (1st
January 2010 to 30th September 2021) to identify guidelines inform-
ing the non-pharmacological management of osteoarthritis. Three
reviewers appraised guidelines according to the AGREE II instrument,
and independently extracted data on their characteristics. One author
extracted and summarised guideline recommendations on weight
management. This systematic review is registered on PROSPERO
(CRD42021274195).
RESULTS: Fifteen CPGs from developed and developing countries
were included. Weight loss was recommended for knee (12 of
13 guidelines) and hip (10 of 11 guidelines) but not hand osteoarthritis
(0 of 4 guidelines). Combination approaches of diet and/or exercise
were recommended for overweight or obese individuals (knee: 8 of
12; hip: 4 of 10), with 2 guidelines specifying ≥5% weight loss for
knee and hip osteoarthritis. One of 15 guidelines specified strategies
1467789x, 2022, S2, Downloaded from https://onlinelibrary.wiley.com/doi/10.1111/obr.13503 by CAPES, Wiley Online Library on [16/12/2023]. See the Terms and Conditions (https://onlinelibrary.wiley.com/terms-and-conditions) on Wiley Online Library for rules of use; OA articles are governed by the applicable Creative Commons License
75 of 222
for weight loss and maintenance of lost weight. Two of 15 guidelines
recommended controlling body weight for osteoarthritis, regardless of
obesity status.
CONCLUSION: Most CPGs for knee and hip osteoarthritis include
recommendations for weight loss in those with overweight or obe-
sity as key to managing osteoarthritis, despite evidence of modest
at best effect of weight loss on symptoms and no effect on
joint structure. Given obesity is a major risk factors for osteoarthri-
tis, the prevention of weight gain may be more effective and prac-
tical in improving clinical outcomes for osteoarthritis, and hence
should be considered as part of the key management in
osteoarthritis.
DISCLOSURE OF INTEREST: None declared.
P160 | What do Ghanaian parents know
about healthy eating, and school food and
nutrition policies?
A. Adjei; S. Nanema; G. Amevinya; A. Tandoh; A. Laar
MEALS4NCDs Project Team
Population, Family and Reproductive Health, University of Ghana, Accra,
Ghana
INTRODUCTION: Eating habits during childhood is a strong predic-
tor of long-term dietary habits and disease risk during adulthood.
Promoting healthy eating habits can help prevent childhood obesity
and parents can play a significant role. Thus, assessing the
parents' or caregivers' nutritional knowledge is imperative in order
to determine educational focus areas and interventions. This study
explored the nutritional knowledge of parents/caregivers of school-
going children in selected public primary and high schools (basic
schools) in the Greater Accra region, Ghana. Secondarily, the study
assessed participants' awareness of school food and nutrition
policies.
MATERIALS AND METHODS: A cross-sectional study using qualita-
tive approaches was used. A semi-structured interview guide was
administered to 60 parents of children enrolled in public basic schools.
Issues discussed included knowledge of healthy diet, diet-disease
associations, food hygiene, malnutrition, awareness of any nutrition
policy implemented at the school level and their satisfaction with the
nutritional quality of the food provided or sold to their children during
school hours. The interviews were recorded, transcribed and coded
inductively in excel. Thematic analysis was used to analyse the
transcripts.
RESULTS: Parents commonly described healthy diets as “fruits and
vegetables,” “meals made from staples such as maize,” “foods that
give strength to work” and “native foods.” They linked the healthiness
of foods to food safety and hygiene. Some parents believe that obe-
sity is “natural” or a “family trait” and therefore could not be resolved.
Some participants attributed overweight or obesity to lifestyle factors
(laziness or sleeping immediately after eating and poor diets such as

76 of 222
eating oily and sweet foods). A few parents reported low dietary
diversity and low nutrients density of food as the causes of malnutri-
tion. Some parents were unaware of existing nutrition policies at their
wards' school but were commonly dissatisfied with the nutritional
quality of the food sold or given to the children at school. They indi-
cated time constraints as a barrier to cooking nutritious food for their
children to eat during school hours.
CONCLUSION: The nutrition literacy of parents/caregivers' is limited.
We recommend educating parents/caregivers on nutrition focusing
on healthy diets. Second, the development and implementation of
school level nutrition policies and programmes should sufficiently, and
meaningfully involve parents.
DISCLOSURE OF INTEREST: None declared.
P161 | Ultra-processed foods and
discretionary foods dilute protein and
correlate with obesity in the USA
A. Grech; S. Simpson; D. Raubenheimer
The School of Life and Environmental Sciences, The University of Sydney,
Sydney, Australia
INTRODUCTION: The protein leverage hypothesis posits that die-
tary protein dilution has contributed to the obesity epidemic. In
the past 20 years ultra-processed food (NOVA, category 4 foods)
consumption has risen from contributing 52% to 57% of total
energy intake in the USA in adults. Categorising the extent of con-
sumption of UPF into quintiles of the population has been shown
to be associated with protein dilution from 13.3% to 18.2% and
significantly higher energy intakes whereas absolute protein intake
remains consistent across quintiles. The NOVA system categorises
foods according to their extent of processing. It is unclear how die-
tary patterns classified under nutrient-focused classification sys-
tems, which identify nutritionally undesirable foods (“discretionary
foods”) as those high in added sugar, saturated fats, added salt or
alcohol, compare to processing-based classification systems such
as NOVA.
MATERIALS AND METHODS: The Geometric Framework for Nutri-
tion was applied to data from NHANES, 2017–2018. Foods were
either classified using the NOVA system as UPF or using the
Australian Dietary Guidelines as DF, and participants were cate-
gorised into quintiles based on the percentage energy from UPF
and DF.
RESULTS: UPF contributed 57.2% of daily energy intake and DF
contributed 44.5% of energy intake. Increasing UPF across quintiles
led to protein dilution from 17.5% to 12.5% and non-protein
energy intake rose by 893 kJ across quintiles to a maximum on the
highest quintile of UPF intake. There was also a decrease in the
proportion of energy from protein by 18.7% and 12.4% across
quintiles for DF, with energy intake rising by 2308 kJ to a maxi-
mum on the highest quintile of DF intake. The mean BMI,
1467789x, 2022, S2, Downloaded from https://onlinelibrary.wiley.com/doi/10.1111/obr.13503 by CAPES, Wiley Online Library on [16/12/2023]. See the Terms and Conditions (https://onlinelibrary.wiley.com/terms-and-conditions) on Wiley Online Library for rules of use; OA articles are governed by the applicable Creative Commons License
SUPPLEMENT ARTICLE
excluding low energy reporters increased across DF quintiles from
28.4 to 29.9 kg/m2 and from 27.8 to 30.5 kg/m2 across quintiles
of UPF for the adult population.
CONCLUSION: DF and UPF comprise a substantial proportion of
energy intake in the USA and increased intake results in protein dilu-
tion in the diet and higher energy intakes, but to a greater degree for
DF. Both UPF and DF are associated with obesity and interventions
to improve dietary patterns are critical.
DISCLOSURE OF INTEREST: A. Grech Grant/Research support with:
NHMRC, S. Simpson Grant/Research support with: NHMRC,
D. Raubenheimer Grant/Research support with: NHMRC.
P162 | Addressing food industry interference
in nutrition policies through conflict of
interest rules
A. Lucas
McCabe Centre for Law and Cancer, Melbourne, Australia
INTRODUCTION: The global food system is comprised of various
food industry actors whose interests often influence food and nutri-
tion polices including measures to address diet-related noncommunic-
able diseases (NCDs).
This presentation will look at various issues related to engage-
ment with the food industry in policymaking and the rules that are
needed to govern this engagement. It will discuss the need for an
appropriate international legal framework to prevent industry inter-
ference, such as conflict of interest rules which protect the devel-
opment and implementation of nutrition policies from the food
industry.
MATERIALS AND METHODS: The research methods used to develop
this abstract comprise the analysis of primary documents, such as
reports and legal and non-binding international instruments, and sec-
ondary research, such as review of academic and other secondary
materials.
RESULTS: Firstly, the presentation will address various related issues
including:
• Who is the food industry?
• How do food industry actors attempt to influence policymaking?
• Are there situations where engagement with the food industry
should be permissible?
Secondly, the presentation will focus on the role that the law can
play in managing conflicts of interest with food industry actors and
protecting the development and implementation of public health
policies. Although there are currently no binding international obli-
gations for governments to manage conflict of interest with the
food industry, there are several non-binding instruments which
may be relevant. The presentation will discuss these instruments
and the need for an appropriate international framework, with clear

SUPPLEMENT ARTICLE
and comprehensive rules, for preventing food industry interference.
This includes rules which:
• define conflict of interest
• identify relevant food industry actors
• limit engagement with the food industry
CONCLUSION: This presentation will conclude by arguing that an
appropriate international legal framework is needed to effectively
manage conflicts of interest with the food industry and, ultimately, to
reduce obesity and the diet-related NCD burden.
DISCLOSURE OF INTEREST: None declared.
P163 | Attitudes, perceptions, and knowledge
about food policies in Colombia: A cross-
sectional study
S. Sanchez-Franco; A. M. Claro; C. Piñeros
Red PaPaz, Bogota, Colombia
INTRODUCTION: High consumption of ultra-processed food has
been associated to obesity and other non-communicable diseases
(Chen et al. NJ 2020; 19). Dietary risks and malnutrition are some of
the top 10 behavioural risks factors that drive the most death and dis-
ability in Colombia (Vos et al Lancet 2020, 396; 10258). 75% of school
children (5–12 years old) consume at least one sugar-sweetened drink
per day and 24.4% of the same age group have overweight (MinSalud
et al. 2017; MinSalud et al. 2015).
Control of the obesity epidemic requires States' commitment
to implementing policies that promote healthy food environments
including front-of-package warning labelling, taxes to unhealthy
food, restriction for advertising and school food environment
(PAHO 2017; UNICEF 2021). His study aims to describe attitudes,
perceptions, and knowledge on the four mentioned food policies in
Colombia.
MATERIALS AND METHODS: A cross-sectional study was conducted
between October and December of 2021 in Colombia. The sample
design was non-probabilistic and included women and men between
18 and 70 years old, living on the main geographical regions of the
country (Andina, Caribe and Pacifico).
Participants were required by social media, and after a consent
form, participants filled a self-reported survey in a digital way. All data
collection and statistical analysis were conducted by an independent
survey company.
RESULTS: In total, 803 adults were surveyed. 63.5% of them were
women, 71.8% were 18–37 years old, and 56.7% were parents or
caregivers of minors.
Participants perceived that low cost (61.4%), easy access (68.6%),
and early consumption (74.6%) have a high influence on frequent
eating of ultra-processed food and drinks. Moreover, parents and
caregivers reported in their children's schools there is no availability
1467789x, 2022, S2, Downloaded from https://onlinelibrary.wiley.com/doi/10.1111/obr.13503 by CAPES, Wiley Online Library on [16/12/2023]. See the Terms and Conditions (https://onlinelibrary.wiley.com/terms-and-conditions) on Wiley Online Library for rules of use; OA articles are governed by the applicable Creative Commons License
77 of 222
T A B L E 1 Proportion of participants that agrees with
implementation of food policies in Colombia
Food policy %
Taxing sugar-sweetened drinks 64.4
Octagonal front-of-package warning labelling for ultra- 88.3
processed food and drinks with excessive added sugars,
sodium, and saturated fats
Forbidding the advertising of ultra-processed food and drinks 73.4
targeted to children
Forbidding the market of sweetened drinks in schools 72.0
Forbidding the market of ultra-processed food in schools 73.7
Forbidding advertising of ultra-processed food and drinks in 74.7
schools
of fruits, vegetables, or salads (51%) nor free drink of water (59%). In
overall, the participants had attitudes in favour of implementation
food policies.
CONCLUSION: Implementing food policies is urgent in order to
reduce health inequalities and reach the Agenda 2030, because evi-
dence have demonstrated that children and deprived population are
the most affected by the malnutrition in all its form (Clark et al. Lancet
2020; 395:605–658).
DISCLOSURE OF INTEREST: S. Sanchez-Franco Shareholder of: The
authors declare no conflicts of interest from financial influence.
Authors have advocated as civil society for the food policies evaluated
in the research. A. M. Claro: None declared, C. Piñeros: None
declared.
P164 | Between group differences of the
effect of Health at Every Size ® interventions
on health and health related outcomes:
Update of a systematic review
E. Clarke; R. Haslam; C. Collins
The University of Newcastle, Callaghan, Australia
INTRODUCTION: Health at Every Size (HAES)® focuses on support-
ing health behaviour change without focussing on body weight or
size. A 2018 systematic review (Ulian et al Obes Rev 2018;
19 1659–1666) examined the impact of HAES® interventions on
weight, health and wellbeing. The previous review did not report
between group findings, limiting conclusions that could be drawn
regarding the superiority of HAES® compared to other interventions
aimed at managing physical and psychological health in people living
with overweight/obesity. The aim of this study was to determine
whether HAES® is more effective at improving physical/
psychological health compared to comparison groups within studies
published in the 2018 review.
MATERIALS AND METHODS: Between group data were extracted
from the individual studies previously included in the 2018 review. Of

78 of 222
the seven originally included studies, four reported between group
differences. Data were extracted for anthropometric (n = 4), cardio-
vascular (n = 4), wellbeing/body image (n = 4), dietary intake (n = 1)
and eating behaviour outcomes (n = 3).
RESULTS: Of the four studies included in the review (data reported
across seven papers), all were randomised controlled trials (RCTs). Of
the four studies that reported anthropometric outcomes, one study
found a significantly greater reduction in weight at 3 months in those
following HAES® compared to control, however the remaining three
reported no significant between group differences. While 2/4 studies
reporting cardiovascular outcomes reported significant improve-
ments in total and LDL cholesterol in the HAES® interventions,
between group differences for cholesterol and blood pressure were
not significantly different in all four studies. Wellbeing and body
image outcomes were assessed in all four studies with different
measures used between studies. Significant between group improve-
ments in HAES® groups were identified for wellbeing and body
image in two studies and no significant between group differences
were reported in the remaining two studies. Only one study
reported dietary intake, with no significant differences in intake
reported between groups. Eating behaviours were assessed in three
studies using different measures across studies. Significant improve-
®
ments in eating behaviours in HAES groups were observed in all
three studies. However, only one study reported a significant
between group difference.
CONCLUSION: HAES® interventions have not yet shown greater
effectiveness in improving health and wellbeing in those living with
overweight and obesity. Further research is needed to evaluate the
impact of HAES® interventions on physical and psychological health.
DISCLOSURE OF INTEREST: None declared.
P165 | The acute and repeated ingestion
effects of sugar vs. high-intensity sweetened
biscuits on sweet food preferences and
subjective appetite in men and women with
overweight/obesity
D. O'connor; B. O'Hara; K. Beaulieu; M. Hopkins; G. Finlayson;
C. Gibbons On behalf of the SWEET Consortium
School of Psychology, University of Leeds, Leeds, UK
INTRODUCTION: Increased availability and consumption of palat-
able, but energy-dense food is contributing to the increasing obe-
sity rates globally. High-intensity sweeteners provide a possible
means of reducing energy density, whilst maintaining the desired
sweet taste. Currently, the preponderance of evidence regarding
sweetener consumption is provided via ingestion of beverages,
with limited evidence available regarding their inclusion in a solid
food matrix.
MATERIALS AND METHODS: 27 participants (age range: 18–
60 years; BMI: 25–35 kg/m2) completed a double-blind randomised,
crossover trial, completing three intervention blocks (one sucrose
1467789x, 2022, S2, Downloaded from https://onlinelibrary.wiley.com/doi/10.1111/obr.13503 by CAPES, Wiley Online Library on [16/12/2023]. See the Terms and Conditions (https://onlinelibrary.wiley.com/terms-and-conditions) on Wiley Online Library for rules of use; OA articles are governed by the applicable Creative Commons License
SUPPLEMENT ARTICLE
control and 2 high-intensity sweeteners). Participants attended
6 clinical investigation days (CID), at which they consumed an
intervention product and completed assessment of food prefer-
ences (liking/wanting pre- and post-consumption) and serial appe-
tite ratings (e.g., hunger and fullness) pre- and for 3 h post-biscuit
serving. Following the first CID for each intervention block (CID
1, 3, 5) participants substituted a food item in their habitual diet
with a portion of the intervention product and consumed daily for
12 days, before completing a second CID (CID's 2, 4, 6) on day
14, followed by a 2 week wash-out period. Intervention products
were jam filled biscuits containing (i) Sucrose, (ii) Stevia Reb M or
(iii) Neotame.
RESULTS: At the time of writing, data collection is ongoing (ending
June 2022 with results available prior to ICO2022). For the PhD asso-
ciated with this project, analysis will consist of two components.
Repeated measures ANOVAs will examine the differences in liking/
wanting scores from (i) pre- to post-consumption, as well as (ii) pre- to
post-intervention, across conditions. Secondary outcomes of interest
include serial appetite ratings.
CONCLUSION: The study design enables examination of the acute as
well as the repeated ingestion effects of consuming sucrose vs. high-
intensity sweeteners on sweet food preferences. The implications for
individuals living with overweight/obesity will be discussed.
This project received funding from the European Union's Horizon
2020 research and innovation programme under grant agreement No
774293.
CLINICALTRIALS.GOV IDENTIFIER: NCT04633681.
DISCLOSURE OF INTEREST: None declared.
P166 | Gene–environment correlation in
controlling and less controlling food
parenting practices
E. Jansen1; G. Thapaliya1; M. Naymik2; M. Huentelman2; S. Deoni3;
S. Carnell1
1
Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine,
Baltimore; 2Neurogenomics Division, The Translational Genomics
Research Institute (TGen), Phoenix; 3Advanced Baby Imaging Lab, Hasbro
Children's Hospital, Rhode Island Hospital, Providence, USA
INTRODUCTION: Food parenting practices are associated with child
weight. Such associations may reflect effects of parents' practices
on children's intake and weight. However, longitudinal, qualitative,
and behavioral genetic evidence suggests these associations could
also reflect parents responding to children's genetically-influenced
appetitive characteristics and body weight—an instance of gene–
environment correlation.
MATERIALS AND METHODS: We tested for gene–environment
correlation across multiple domains of food parenting using data
from RESONANCE, an ongoing pediatric cohort study. Data on rel-
evant variables were available for N = 153 parent–child

SUPPLEMENT ARTICLE
dyads (7.84 ± 2.65 years; 46.4% girls). Children's
polygenic risk scores (PRS) were derived based on adult GWAS
data. Parents reported on their parental feeding
(Comprehensive Feeding Practices Questionnaire) and their child's
eating behavior (Child Eating Behavior Questionnaire). Regression
analyses were used to examine associations between obesity PRS
and parental feeding, adjusting for child age, BMIz, and child eating
behaviors.
RESULTS: Out of the 12 parental feeding practices, 3 showed
bivariate associations with child obesity PRS, namely child control
(r = .159, p = .042), restriction for weight control (r = .232,
p = .003) and teaching about nutrition (r = .240, p = .002).
Associations of child obesity PRS with the controlling practices
restriction for weight control and child control were largely
unchanged in models adjusting for child age, BMIz and child eating
behavior.
CONCLUSION: Our results suggest that parents may mold their
feeding practices in response to a child's propensity toward higher
or lower BMI, independent of the child's current actual weight.
This effect may be especially evident in the case of restriction of
food intake. Research using prospective data from infancy is
needed to investigate potential development changes in gene–
environment interplay including gene–environment correlation.
DISCLOSURE OF INTEREST: None declared.
P167 | Effects of food consumption,
according to the food processing degree, on
plasmatic fatty acids and lipidogram of
women with severe obesity
F. C. Corgosinho1,2; K. L. Soares2; N. Figueiredo1; F. Martins Kattah2;
B. Paixão Gois2; R. Neves de Mello2; L. M. Oyama3; R. G. Moreira4;
2
G. D. Pimentel ; G. Carielo 2 or popular science? An analysis of 7 years of
1 2
Medicine; Nutrition, Universidade Federal de Goiás, Goiânia; Nutrition,3
Universidade Federal de São Paulo; 4Instituto de Biociências,
Universidade de São Paulo, São Paulo, Brazil
INTRODUCTION: Diet acts as an important factor for weight gain
and consequent biochemical changes. The high consumption of pro-
cessed foods in recent years may be related to the increase in obesity
and disorders involving the metabolism, transport and storage of fatty
acids. Thus, the aim of the present study was to evaluate whether the
consumption of ultra-processed foods influences the lipid profile of
women with severe obesity.
MATERIALS AND METHODS: This is a cross-sectional study carried
out with women with severe obesity. Data collection consisted of
an anthropometric assessment, application of a Food Frequency
Questionnaire (FFQ) and blood collection to perform a lipidogram
and serum fatty acid measurement. The foods consumed were
identified through the FFQ and classified according to the degree
of processing, and the frequencies of consumption
1467789x, 2022, S2, Downloaded from https://onlinelibrary.wiley.com/doi/10.1111/obr.13503 by CAPES, Wiley Online Library on [16/12/2023]. See the Terms and Conditions (https://onlinelibrary.wiley.com/terms-and-conditions) on Wiley Online Library for rules of use; OA articles are governed by the applicable Creative Commons License
79 of 222
obesity transformed into scores. The significance level of the statistical
analyzes was set at 5%.
practices RESULTS: This study included 44 women, with a mean age of
40.59 and a mean BMI of 48.61 kg/m2. An inverse association was
observed between the consumption of fresh foods and the occur-
rence of hypertriglyceridemia (p = 0.021), while the consumption
of processed foods was positively associated (p = 0.044). A nega-
tive correlation was found between “average consumption of ultra-
processed foods” and plasmatic “HDL” (p = 0.035). Twenty-two
serum fatty acids were identified (40, 72% of saturated fatty acids,
36.05% of polyunsaturated fatty acids and 23.22% of monounsatu-
rated fatty acids). Regarding the lipid profile, there was an inverse
association between the consumption of fresh foods and the vari-
ables “triglycerides” (p = 0.048), “total cholesterol” (p = 0.031) and
“VLDL-c” (p = 0.040), and a positive association of ultra-processed
consumption with “total cholesterol” (p = 0.041). Consumption
of processed foods was inversely associated with the total amount
of omega 3 (p = 0.011). The consumption of ultra-processed
foods was negatively associated with the “omega 3/6 ratio”
(p = 0.001), while the consumption of processed foods was directly
associated with the “omega 6/3 ratio” of serum fatty acids
(p = 0.001).
CONCLUSION: The consumption of fresh foods seems to have a pro-
tective effect against the occurrence of hypertriglyceridemia, while
the consumption of processed foods favors its development. Data
from the present study suggest that disproportionate consumption
among different degrees of food processing could favor an imbalance
between omega 3/6 and 6/3 ratios.
FUNDINGS: CNPq(434159/2018-2)
DISCLOSURE OF INTEREST: None declared.
P168 | Practical suggestions, personal stories
blog readership in the LiveLighter® campaign
G. Myers; A. Finch; A. Sartori
Cancer Council WA, Perth, Australia
INTRODUCTION: LiveLighter® is a long-running public health pro-
gram that aims to reduce the burden of weight-related chronic ill-
ness in Western Australia by encouraging adults to adopt healthier
eating and movement behaviours. In addition to mass media, advo-
cacy, and stakeholder support, the program hosts a website that
provides information, interactive tools and practical resources to
the community. The blog is a key tool for driving traffic to the
website and providing new content for social media and newslet-
ters. To better understand what makes an appealing blog, an analy-
sis was conducted of all posts published since the blog was started
in 2015.
MATERIALS AND METHODS: A measure of topic interest, page
were views, and measures of engagement, including the average time on

80 of 222
page and exit rate (the proportion of people who did not click to
another page on the LiveLighter® website after viewing the post),
were sourced for individual blog posts from Google Analytics. Post
features, including the number of words, pictures, and subheadings,
and topics were assessed against measures of engagement to see if
any relationships emerged. Individual posts were categorised into
topic areas, and the median page views, average time on page, and
exit rate was determined across categories.
RESULTS: Over 200 blog posts were published between July 2015
and March 2022, accounting for over 270,000 page views. Traffic to
the blog came primarily from unpaid search (30%), e-newsletters
(28%) and links from other websites (19%). Topics of most interest to
the audience were alcohol, weight, and food planning and prepara-
tion. Posts with the lowest interest were those on advocacy, gar-
dening, and case studies. Posts that linked to a particular time
period or event (e.g., COVID, Christmas, and current season), per-
formed very strongly. A moderate correlation was observed
between word count and average time on page (Pearson
correlation = 0.40), with no evidence of a drop-off in engagement
on longer posts. Surprisingly, there was no clear relationship
observed between the number of pictures or subheadings and the
average time on page or exit rate.
CONCLUSION: Public health campaigns must compete against many
other online information sources of various quality for audience atten-
tion. Understanding which topics are of most interest to the commu-
nity, and what features of blog posts increase engagement with
messages will support health promotion professionals to target com-
munications more effectively.
DISCLOSURE OF INTEREST: None declared.
P171 | Aboriginal Data and Action on
Prevention Together (ADAPT): Results from a
Victorian primary school health survey
1 2 2 3
J. Browne ; D. Becker ; L. Orellana ; J. Ryan ; T. Walker ; 1
1 1 4 4
J. Whelan ; L. Alston ; B. Johnson ; A. Rossignoli ; K. Bolton ; 1
K. Backholer1; S. Allender1; C. Strugnell1; A. Brown1; C. Bell1;
P. Fraser1; J. Hayward1
1
Global Obesity Centre; 2Biostatistics Unit; 3School of Health and Social
Development, Deakin University, Geelong; 4Victorian Aboriginal
Community Controlled Health Organisation, Melbourne, Australia
INTRODUCTION: Aboriginal children experience unacceptable health
inequities. Yet limited information is available about the health and
wellbeing of Aboriginal children in the state of Victoria. We aimed to
report the prevalence of healthy weight, healthy diet, physical activity,
sedentary behaviour, sleep sufficiency and mean health-related qual-
ity of life (HRQoL) among Aboriginal and non-Aboriginal primary
school-aged children in regional Victoria; and explore associations
between these factors and HRQoL.
1467789x, 2022, S2, Downloaded from https://onlinelibrary.wiley.com/doi/10.1111/obr.13503 by CAPES, Wiley Online Library on [16/12/2023]. See the Terms and Conditions (https://onlinelibrary.wiley.com/terms-and-conditions) on Wiley Online Library for rules of use; OA articles are governed by the applicable Creative Commons License
SUPPLEMENT ARTICLE
MATERIALS AND METHODS: We applied a strengths-based
approach to the analysis of cross-sectional data from two cluster ran-
domised controlled trials (WHOSTOPS and RESPOND) which were
collected across April–June 2019 from North-East and South-West
Victoria. Measured height and weight and self-reported behaviours
were collected. A sub-sample of children was invited to wear an accel-
erometer. Linear or logistic mixed models adjusting for potential con-
founders were used to compare outcomes between Aboriginal
(n = 303) and non-Aboriginal children (n = 3026).
RESULTS: 76% of Aboriginal children met guidelines for fruit (≥2
serves/day), 67% consumed sweetened drinks < once per day, 79%
consumed takeaway ≤ once per week, 73% achieved sleep time rec-
ommendations (9–11 h/day), 68% met screen time recommendations
(≤2 h/day) and 84% met physical activity recommendations when
examined by accelerometry (≥60 MVPA min/day). Aboriginal children
were more likely to meet vegetable consumption guidelines (≥5
serves/day, ≥5.5 for boys 12+) (OR = 1.42, 95%CI: 1.05, 1.93), but
less likely to have a healthy weight (OR = 0.66, 95%CI: 0.52, 0.85),
consume takeaway once per week or less (OR = 0.61, 95%CI: 0.45,
0.83) and meet screen-time guidelines (OR = 0.76, 95%CI: 0.58, 0.99)
than non-Aboriginal children. For all children HRQoL scores were pos-
itively associated with healthy weight and meeting fruit, screen time
and physical activity guidelines.
CONCLUSION: The majority of Aboriginal children in this study met
the guidelines for fruit, physical activity, screen time and sleep, and
those meeting these guidelines had significantly higher HRQoL. Pro-
moting nutrition, physical activity and sleep is likely to benefit all chil-
dren. Culturally relevant resources have been developed to
communicate these findings to Aboriginal community-controlled orga-
nisations, who can use these data to design programs to improve
health and wellbeing in their local communities.
DISCLOSURE OF INTEREST: None declared.
P172 | Embedding prevention into clinical
care: Empowering the future rural medical
workforce to address childhood obesity
E. Schwartzkoff1; G. Popovic2; N. Kerr3; J. L. Macer-Wright4;
A. Bailey1; D. Gasevic5; L. Ferrington4
1
Mid North Coast Local Health District, Port Macquarie, Australia; 2Stats
Central, Mark Wainwright Analytical Centre, University of New South
Wales, Sydney; 3Mid North Coast Local Health District, Coffs Harbour,
Australia; 4School of Clinical Medicine, Rural Clinical Campus, Port
Macquarie, University of New South Wales, Port Macquarie, Australia;
5
School of Public Health and Preventive Medicine, Monash University,
Melbourne, Australia
INTRODUCTION: Despite being a preventable condition, in 2017–
18, 29% of children and adolescents living in regional and remote
areas were overweight or obese compared with 23% in major cities.
Primary care physicians rate obesity as their second greatest concern

SUPPLEMENT ARTICLE
for Australia's future health however their adherence to published
treatment guidelines is reportedly as low as 50%, which may be
related to their knowledge of childhood obesity management and
their confidence to deliver care. Educational interventions focussing
on obesity can improve medical students' and doctors' self-reported
knowledge, competence and patient care but it is reported that obe-
sity and dietary education is lacking in medical school curricula.
MATERIALS AND METHODS: We conducted a cross-sectional single
arm pre-post study. Medical students (n = 229) enrolled in a 6-year
undergraduate medical programme at the University of New South
Wales (UNSW) Rural Clinical School were invited to complete a
25-item multiple choice questionnaire. Following the survey, partici-
pants could elect to attend a comprehensive programme of childhood
obesity specific teaching, in addition to standard classes following
which students repeated the questionnaire.
RESULTS: 93 students completed the pre-survey, and 58 students
completed the post-survey. Prior to the intervention, we found no
evidence (F = 0.994, df = 2, p = 0.374) of knowledge differences
by year of study, and strong evidence (F = 5.50, df = 2, p = 0.006)
of confidence differences by year of study, with year 5/6 students
describing themselves as 0.599 points (95%CI:0.145–1.052) more
confident than year 1/2 students (t = 3.15, df = 89, p = 0.006),
and no evidence of pairwise differences between other years.
Post-intervention, we found weak evidence (t = 1.97, df = 83,
p = 0.053) that knowledge increased with time by 0.695 points
(95%CI: 0.007–1.397), and strong evidence (t = 5.716, df = 144,
p < 0.001) that confidence increased with time by 0.619 points
(95%CI:0.405–0.834).
CONCLUSION: The current medical curriculum does not increase
rural students' knowledge of childhood obesity. While medical stu-
dents' confidence to address childhood obesity in clinical practice
increased as they progressed through medical school, childhood obe-
sity knowledge did not and it is concerning that students may be gain-
ing confidence to initiate these conversations without sufficient
knowledge to provide patients with evidence-based care. Our future
rural clinical workforce must have both knowledge and confidence to
tackle these difficult conversations which have been shown to be
effective in reducing population mean weight.
DISCLOSURE OF INTEREST: None declared.
P173 | Two waves of the Crunch&Sip
®
“Hero
Healthy Habits” campaign in Western
Australia
M. Atkinson; A. Sartori
Cancer Council WA, Perth, Australia
INTRODUCTION: Crunch&Sip® is a primary school nutrition program
which aims to improve the dietary habits of Western Australian pri-
mary school children. Crunch&Sip® allows students a set time during
the school day to eat extra serves of vegetables and fruit and to drink
1467789x, 2022, S2, Downloaded from https://onlinelibrary.wiley.com/doi/10.1111/obr.13503 by CAPES, Wiley Online Library on [16/12/2023]. See the Terms and Conditions (https://onlinelibrary.wiley.com/terms-and-conditions) on Wiley Online Library for rules of use; OA articles are governed by the applicable Creative Commons License
81 of 222
water in the classroom. The program is delivered by Cancer Council
WA and funded by Healthway. In 2021 Crunch&Sip® introduced their
first digital only campaign which encouraged parents to keep the pro-
gram front of mind and remember to prioritise vegetables and ensure
water is packed when preparing the Crunch&Sip® break. Eating well is
essential for growth and development, supports the immune system
and improves concentration—all factors which improve performance
in the classroom and during play and break times.
MATERIALS AND METHODS: Cancer Council WA worked with local
advertising and media agencies to develop creative executions and a
social media schedule to highlight the key message ‘Hero Healthy
Habits’. A handful of partner organisations were encouraged to cross
promote the campaign on their social media channels and WA schools
were provided a social media toolkit designed to simplify the access
and application of campaign resources.
The paid social media campaign was developed as two instal-
ments which ran across two waves (October–November 2021 and
January–March 2022). Each campaign wave was evaluated using rates
of engagement and increased website traffic. The campaign was com-
plimented by organic posts as well as updated Crunch&Sip® website
content.
RESULTS: Campaign advertising reached 375,294 people in Burst
1 (58% of all parents in WA) with 1.1 million impressions and 323,047
people in Burst 2 (50% of all parents in WA) with just under 1.7 mil-
lion impressions. Recommendations include diversifying the channels
of delivery for future campaigns to ensure incremental reach.
CONCLUSION: Rates of vegetable consumption remain low and sug-
ary drink consumption high amongst WA children. Programs such as
Crunch&Sip® are vital to providing children with the opportunity to
embed healthy habits from a young age. Ongoing advocacy activities
are required to build support for the program and maintain engage-
ment amongst parents and across schools within WA.
DISCLOSURE OF INTEREST: None declared.
P175 | Changes of beverage consumption
during Covid-19 quarantine order among
women in Malaysia
N. I. Mohd Fahmi Teng1; J. Norsham2
1
Faculty of Health Sciences, Universiti Teknologi MARA, Bandar Puncak
Alam; 2Faculty of Medicine and Health Sciences, Universiti Sains Islam
Malaysia, Nilai, Malaysia
INTRODUCTION: Quarantine due to COVID-19 pandemic has chan-
ged people's lifestyle and habits. Sugar-sweetened beverage (SSB) is a
global public health concern and was reported to be associated with
various non-communicable diseases. The aim of this study is to assess
the change of SSB consumption among Malaysians women following
quarantine order.
MATERIALS AND METHODS: A cross-sectional study was conducted
using a set of an online questionnaire among 520 women, aged
 1467789x, 2022, S2, Downloaded from https://onlinelibrary.wiley.com/doi/10.1111/obr.13503 by CAPES, Wiley Online Library on [16/12/2023]. See the Terms and Conditions (https://onlinelibrary.wiley.com/terms-and-conditions) on Wiley Online Library for rules of use; OA articles are governed by the applicable Creative Commons License
82 of 222 SUPPLEMENT ARTICLE

Table Frequency SSB consumption data before and during quarantine. P176 | Rapid infant weight gain and later
obesity: Should we use weight, weight for
During Total, n length, or body mass index?
quarantine Moderate
Before None or high 95% R. Taylor1; J. Haszard2; A.-L. Heath3; B. Galland4; A. Gray2;
quarantine n (%) n (%) OR CI P value
K. Meredith-Jones1; L. Fangupo1; L. Daniels1; B. Taylor4
***
None 73 (52.5) 66 (47.5) 139 17.22 10.06– 0.000 1
Medicine; 2Biostatistics Centre; 3Human Nutrition; 4Women's and
Moderate 23 (6.0) 358 (94.0) 381 29.46
Children's Health, University of Otago, Dunedin, New Zealand
or High
Total 96 424

***Significant p < 0.001.

FIGURE 1 Changes of BMI before and during quarantine
between 18 to 55 years old. Data were collected using self-
administered questionnaires that consisted of sociodemographic and
Beverage Intake Questionnaire (BEVQ). The respondents' weight and
height before and during quarantine were self-reported.
RESULTS: The results show a significant increase in BMI (p < 0.001)
during quarantine. Plain water, caffeinated drinks with added sugar or
cream and malt drinks were the most frequently consumed beverages
by respondents. The result shows a significant increase in SSB con-
sumed (p < 0.001) during quarantine as compared to before. Higher
SSB consumption was mostly observed amongst overweight and
obese (64% and 63.9%, respectively).
CONCLUSION: In conclusion, SSB consumption was increased during
quarantine and the trend is worrying. A strategy to increase aware-
ness towards better dietary intake especially beverages choice should
be implemented urgently.
DISCLOSURE OF INTEREST: None declared.
INTRODUCTION: Rapid infant weight gain is considered a strong risk
factor for later obesity in children. However, which age- and sex-
specific z-score measure should be used (weight, weight-for-length, or
body mass index (BMI)), and what the optimal time frame is
(e.g., change from 0–6 months, 6–12 months, or 12–24 months etc)
remains uncertain. The aim of this study was to determine which
growth indicator and time frame was the strongest predictor of obe-
sity risk at 11 years of age.
MATERIALS AND METHODS: This is a secondary data analysis from
children participating in the Prevention of Overweight in Infancy ran-
domized controlled trial, an early life obesity prevention programme
(intervention ante-natal to 2 years, follow-up at 11 years). 802 children
had measures of weight and length undertaken at birth (child health
records), and 6, 12, 18 and 24 months, and 11 years of age (trained
researchers). Rapid infant weight gain (RIWG) was defined as an
increase of more than 0.67 z-scores (WHO reference data) between
two time points. The sensitivity, positive predictive value and odds
ratio (95% CI) of each measure and time frame were calculated in rela-
tion to obesity (BMI ≥ 95th percentile WHO reference data) at
11 years of age.
RESULTS: Prevalence of RIWG ranged from 1.0 to 60.6% depending
on the indicator and time frame chosen, with agreement between the
three indicators ranging from 57.2 to 95.2%. The sensitivity of RIWG
to predict obesity at 11 y was lowest for weight-defined RIWG from
18–24 months (1.2%) and highest for weight-for-length-defined
RIWG from 0–12 months (61.6%). Positive predictive value (% of
those with RIWG who had high BMI at 11 y) was lowest for BMI-
defined RIWG at 6–18 months (7.8%) and highest for weight-defined
RIWG from 18–24 months (33.3%). Having obesity at any of the four
time points in the first 2 years of life was individually a stronger risk
factor than any indicator of RIWG for obesity at 11 years. Overall,
obesity at 6 months of age was the strongest predictor of obesity at
11 y.
CONCLUSION: Which indicator of RIWG is chosen, and the time
frame over which the gain in weight is measured, markedly affects the
prediction of obesity risk at 11 years of age. In general, RIWG defini-
tions using weight-for-length or BMI were more sensitive predictors
of obesity than RIWG defined using weight alone, although this varied
by age. However, a simple measure of obesity at 6 months of age was
a much stronger risk factor for later obesity than RIWG assessed by
any of the three indicators, over any time frame.
DISCLOSURE OF INTEREST: None declared.

SUPPLEMENT ARTICLE
P179 | Mapping the outcomes of the Centre
of Research Excellence in food retail
environments for health (RE-FRESH)
S. Naughton; A. Peeters the Centre of Research Excellence in
Food Retail Environments for Health
Institute for Health Transformation, Deakin University, Geelong, Australia
INTRODUCTION: The NHMRC funded the Centre of Research Excel-
lence in Food Retail Environments for Health (RE-FRESH) as a
focused investment to support collaboration and capacity building,
forming the first international centre for healthy food retail research
and practice. Through collaboration across a wide range of disciplines,
RE-FRESH aims to transform food retail environments to improve diet
and health at a population level. As RE-FRESH approaches the end of
its funding, this project aims to measure our progress against our aims,
our collective impact, and identify key themes and evidence gaps.
MATERIALS AND METHODS: A living systematic review of RE-
FRESH publications is underway, with thematic analysis performed to
group outputs and map evidence and gaps. Key to identifying gaps in
the wider evidence base is a series of systematic reviews investigating
a range of food retail environment topics. The living systematic review
is supplemented with impact statements from other outputs
(e.g., reports, translated research pieces, and media) and evidence of
new collaborations and projects spurred by RE-FRESH. Citations of
our work in policy and government documents are being monitored.
Outputs are assessed against meeting the original aims of RE-FRESH,
and its research streams.
RESULTS: Currently, 85 peer reviewed publications (with 536 cita-
tions), 5 reports and 20 research translation pieces are in the living
review. Major themes identified in our work so far relate to character-
istics of, and initiatives in, rural and remote food environments, moni-
toring and benchmarking of food environments, monitoring of food
cost and affordability, and new tools for codesigning, implementing,
and measuring the outcomes of food retail environment initiatives.
Identified gaps in the existing body of evidence relate to assumptions
made when evaluating interventions, and the absence of consistent
outcomes reported in initiative analyses.
Though early in an impact timeline, RE-FRESH papers have
been cited in 14 policy documents, from sources including the
World Health Organisation, UNICEF, The Public Health Agency of
Sweden, The International Development Research Centre, and the
Governments of Malaysia and the Netherlands. Multiple projects
and activities have built both research and practitioner capacity to
transform food retail environments to improve population health.
CONCLUSION: RE-FRESH has produced a significant body of new
evidence on food retail environments in a range of retail and geo-
graphic settings. Though still actively producing research, we are
already seeing evidence generated by RE-FRESH adopted as policy
and integrated into best practice recommendations.
DISCLOSURE OF INTEREST: None declared.
1467789x, 2022, S2, Downloaded from https://onlinelibrary.wiley.com/doi/10.1111/obr.13503 by CAPES, Wiley Online Library on [16/12/2023]. See the Terms and Conditions (https://onlinelibrary.wiley.com/terms-and-conditions) on Wiley Online Library for rules of use; OA articles are governed by the applicable Creative Commons License
83 of 222
P180 | What do Queenslanders want when
eating out of home? Using consumer insights
to drive healthier food environments
S. Cluff; M. Dick
Health and Wellbeing Queensland, Brisbane, Australia
INTRODUCTION: Modern food environments can promote
unhealthy dietary patterns, with excessive marketing and an abun-
dant supply exacerbating the intake of energy-dense and nutrient
poor food and drinks. With Australians spending nearly a third of
their household budget on eating out, these environments are con-
tributing to the growing burden of obesity and weight related
chronic disease.
Health and Wellbeing Queensland (HWQld) are committed to
driving healthier food environments with the implementation of
nutrition policies and programs in Queensland schools, restaurants
and cafes, and sport and recreation centres. This project seeks to
better understand the attitudes and behaviours of consumers pur-
chasing within these environments, to tailor initiatives to meet
community needs and subsequently increase program uptake and
success.
MATERIALS AND METHODS: HWQld engaged a market research
company to co-design an online survey, which was distributed to
750 Queensland parents with children aged 5–12 years. Participant
values, attitudes, knowledge and behaviours when eating out of home
were explored.
RESULTS: Key themes emerging from the research, including the
major barriers and enablers for consumers to purchase healthier food
and drinks in Queensland food environments, will be presented. The
relevance of these findings to existing HWQld nutrition policies and
programs will be discussed, including their applicability to maximise
consumer engagement.
CONCLUSION: The consumer insights gathered from this project will
enhance HWQld initiatives, ensuring their relevance, practicality and
effectiveness to drive healthier food environments in Queensland. As
well, this research will assist building the evidence base and inform
strategies for improving provision and promotion of healthier food
and drinks in the places Queenslanders spend their time. This will con-
tribute to reducing the prevalence of overweight and obesity amongst
the population.
DISCLOSURE OF INTEREST: None declared.

84 of 222
P182 | A pilot cluster randomized controlled
trial of a choice architecture intervention,
embedded in an online canteen, to increase
the purchase of healthier recess items from
high-school canteens
T. Delaney1,2; L. Wolfenden1,2; C. Lecathelinais2; H. Lamont1,2;
R. Sutherland1,2; S. L. Yoong2,3; R. Wyse1
1
University of Newcastle; 2Hunter New England Local Health District,
3
Wallsend; Swinburne Technology University, Melbourne, Australia
INTRODUCTION: High school canteens are a key setting for public
health nutrition intervention. Across Australia, there has been a rapid
uptake of ‘online canteens’ which enable students to pre-order and
pay for menu items via the web or mobile app. Online canteens pro-
vide ideal infrastructure to support the purchase of healthier items via
the use of choice architecture strategies. Despite this, no trial has
tested the efficacy of choice architecture strategies within an online
canteen on improving the nutritional quality of high school student
purchases at recess. Therefore the aim of this study was to assess the
impact of embedding choice architecture strategies into an online can-
teen (including menu labelling, prompts, item positioning, and feed-
back) on the nutritional quality of school canteen recess purchases of
high school students (aged 12–19 years).
MATERIALS AND METHODS: A cluster randomized controlled trial
was conducted with 6 high schools in one Australian state. Schools
were randomized to receive either the choice architecture interven-
tion, or usual online ordering. Nutrient quality was assessed using rou-
tine data collected by the online canteen. Primary outcomes were the
proportion of ‘Everyday’, ‘Occasional’, and ‘Should Not Be Sold’ items
purchased, categorized using the state healthy canteen policy. Linear
mixed models were used to assess outcomes.
RESULTS: A total of 161 eligible students from 6 schools were
included in the analysis. There were no between group differences
over time for the intervention group in the mean percentage of online
recess items per student that were ‘Everyday’ (8.0%; [95% CI - 6.0,
22.1]; P = 0.26), ‘Occasional’ ( 8.0%; [95% CI - 20.6, 4.3]; P = 0.20)
or ‘Should Not Be Sold’ (0.7%; [95% CI - 9.4, 10.7]; P < 0.90).
CONCLUSION: While in the expected direction, statistical tests did
not identify any significant between-group differences over time in
‘Everyday’, ‘Occasional’ or ‘Should Not Be Sold’ items purchased at
recess, suggesting that a choice architecture intervention has limited
effects on increasing the purchase of healthier recess items from
high-school online canteens. Further research is warranted, to confirm
this finding including a larger sample size and other ordering periods
(lunch).
DISCLOSURE OF INTEREST: None declared.
1467789x, 2022, S2, Downloaded from https://onlinelibrary.wiley.com/doi/10.1111/obr.13503 by CAPES, Wiley Online Library on [16/12/2023]. See the Terms and Conditions (https://onlinelibrary.wiley.com/terms-and-conditions) on Wiley Online Library for rules of use; OA articles are governed by the applicable Creative Commons License
SUPPLEMENT ARTICLE
P184 | The nourish network: A multi-sector
collective working to increase demand,
availability and access to healthy, sustainable
and affordable food
V. L. Hobbs; A. Peeters on behalf of Nourish Network Advisory
Committee
Institute for Health Transformation, Deakin University, Melbourne,
Australia
INTRODUCTION: Formed in Victoria in 2018, the Nourish Network
(NN) brought together a dedicated coalition of food citizens from aca-
demic institutions, public agencies, food business operators, non-
profit organisations and communities to work collaboratively to make
healthy and sustainable food provision available and accessible to all.
Using a collective impact model, NN aims to transform food retail
environments for the better health of people and the planet. Here we
review the growth, activities and impact of NN to reflect on the
potential for this model to support the transformation of food retail
environments.
MATERIALS AND METHODS: The Nourish Network is organised
according to a collective impact model, with a small backbone team
funded by Deakin University, an advisory committee with representa-
tion from various sectors, and action teams that self-form around
areas identified by NN as requiring focussed, collaborative cross-
sectoral action. Several action teams; Local Government Food Policy,
Campus Food Environments, Healthy Food Retail Recognition and
Farm to Organisation have been established since inception, with a
Healthy Supermarkets Community of Practice also adopted. Backbone
support is provided via a Coordinator, who works to generate engage-
ment across sectors, support the advisory committee, formulate the
operating strategy, seed and support action teams and build commu-
nications platforms. Action teams work together to identify a project
supported by research and with the potential for rapid translation into
practice. NN has also provided advocacy for aligned public health
initiatives.
RESULTS: The Nourish Network membership has expanded, repre-
senting a wide variety of sectors. Its reach is also identified through
growing social media profiles developed in 2021, and registrations at
its in-person and virtual events. Regular surveys with our members
have demonstrated a strong alignment between NN and their profes-
sional roles. Members have noted it is a “great way to build capacity,”
and “feel like you are part of a bigger effort to leverage change.” The
NN action teams have developed 8 new collaborative projects, which
in turn have led to new research publications, new research funding
and development of resources tailored by and for the food retail sec-
tor. The NN has also led to impact through increasing awareness of
the need for focussed research and partnerships to progress healthy
food retail, with NN included in local government action plans, partner
annual reports and health service provider communications.
CONCLUSION: The Nourish Network is a novel model to drive action
towards healthier food retail provision. NN supports public health

SUPPLEMENT ARTICLE
practitioners and academics to work together with food retailers to
identify the evidence, resources, tools and policy settings required for
transformation of food retail environments.
DISCLOSURE OF INTEREST: None declared.
P185 | Obesity-related factors among older
adults in West Africa: Findings from the
SIREN study
A. P. Okekunle1,2; O. Asowata3; O. Akpa3; A. Fakunle4; F. Sarfo5;
K. Wahab6; R. Obiako7; R. Akinyemi8; B. Ovbiagele9; M. Owolabi4
SIREN
1
College of Medicine, University of Ibadan, Nigeria, Ibadan, Nigeria;
2
Research Institute of Human Ecology, Seoul National University, Seoul,
3
Korea, Republic Of; Department of Epidemiology and Medical Statistics,
College of Medicine; 4Department of Medicine, College of Medicine,
University of Ibadan, Nigeria, Ibadan, Nigeria; 5Department of Medicine,
Kwame Nkrumah University of Science and Technology, Accra, Ghana;
6 1
Department of Medicine, University of Ilorin Teaching Hospital, Ilorin;
7 8
Department of Medicine, Ahmadu Bello University, Zaria; Institute of
Advanced Medical Research and Training, University of Ibadan, Nigeria,
Ibadan, Nigeria; 9Weill Institute for Neurosciences, University of
California San Francisco, San Francisco, USA
INTRODUCTION: Obesity is a public health challenge that signifi-
cantly affects the health and quality of life of populations globally.
However, little is known about the burden and characterization of
obesity among older adults, particularly in low- and middle-income
countries (LMICs). Therefore, this study was designed to characterize
the prevalence and risk factors of obesity among older adults from
West Africa.
MATERIALS AND METHODS: We identified 1813 stroke-free older
adults (≧60 years) recruitment from 18 communities around study
sites of the Stroke Investigation Research and Educational Network
(SIREN) study in Ghana and Nigeria. Data on sociodemographic and
lifestyle characteristics were obtained through in-person interviews.
The World Health Organization (WHO) guidelines was applied by
trained personnel for anthropometric measurements; weight (in kg),
height (in cm), and body mass index (BMI) estimation. Overweight/
obesity (BMI ≥ 25 kg/m2) was defined according to the WHO cut-off
points. Logistic regression was applied to estimate the adjusted odds
ratio (aOR) and 95% confidence interval (CI) for the relationship of
sociodemographic and lifestyle factors with the odds of being affected
by overweight/obesity at P < 0.05.
RESULTS: Overall, mean age was 69.5 ± 7.9 years, 49.0% were
females, and 46.0% resided in rural areas. Mean BMI was
25.5 ± 5.7 kg/m2, and 47.5% of participants were affected by over-
weight/obesity. The prevalence of older adults affected by over-
weight/obesity was higher in Nigeria (58.3%) than in Ghana (42.9%)
and among females (59.3%) than males (37.5%). Being female (aOR:
3.1; 95% CI: 2.5, 4.0), Urban dwellers (aOR: 1.9; 95% CI: 1.6, 2.4),
1467789x, 2022, S2, Downloaded from https://onlinelibrary.wiley.com/doi/10.1111/obr.13503 by CAPES, Wiley Online Library on [16/12/2023]. See the Terms and Conditions (https://onlinelibrary.wiley.com/terms-and-conditions) on Wiley Online Library for rules of use; OA articles are governed by the applicable Creative Commons License
85 of 222
high-income earners - >$100/month (aOR: 1.6; CI: 1.3, 2.0) and hav-
ing at least primary school education (aOR: 1.5; 95% CI: 1.2, 2.0) was
associated with higher odds of being affected by overweight/obesity.
The findings were not different after stratifying the analyses by sex
and country of residence.
CONCLUSION: Older adults in this sample were significantly affected
by obesity, and factors associated with being affected by obesity
include urban livelihoods, higher-income earnings, and formal educa-
tion. Public health interventions targeted at these prime risk factors
might assist in managing older populations affected by obesity in
LMICs.
DISCLOSURE OF INTEREST: None declared.
P186 | Developing an automated approach to
monitoring front-of-pack marketing targeting
children and caregivers
A. Chung1; H. Skouteris1; L. Westerman2; K. Backholer3
School of Public Health and Preventive Medicine, Monash University;
2
VicHealth, Melbourne; 3Global Obesity Centre (GLOBE), Deakin
University, Geelong, Australia
INTRODUCTION: Unhealthy diets and excess weight are leading risk
factors for the global burden of disease. Early childhood presents a
critical opportunity to establish healthy behaviours as dietary prefer-
ences and weight trajectories are established in early life. Clear and
consistent evidence demonstrates that food marketing negatively
influences children's dietary behaviours, increasing their preference
for and consumption of unhealthy food and drinks. Marketing is per-
vasive on food and beverage product packaging, targeting children
and their caregivers with the use of colourful images and logos, popu-
lar children's characters, and health and nutrition claims, influencing
purchase and consumption decisions. The aim of this study is to
develop a comprehensive, automated approach to monitoring child-
and caregiver-directed marketing on food packaging to inform advo-
cacy and policy reform.
MATERIALS AND METHODS: This study will (1) investigate the util-
ity of an automated approach to collect front-of-pack images of food
and drink products using child- or caregiver-directed marketing;
(2) test and compare various research, policy and industry frameworks
for classifying child- or caregiver-directed marketing, and examine the
prevalence and types of marketing techniques used on the front of
food and drink packages to target children and their caregivers;
(3) examine and compare nutritional profiles of foods marketed to
children and caregivers using nutrient-based and food classification
models.
RESULTS: An automated data scraping tool has been applied to collect
front-of-pack images of approximately 30,000 food and drink prod-
ucts sold in major Australian supermarkets, matched with nutritional
information and price. Findings will report on the comparative preva-
lence of child-and caregiver-directed marketing techniques across

86 of 222
different food groups, using different classification frameworks. Find-
ings will additionally report on the nutritional profiles of foods mar-
keted to children and caregivers.
CONCLUSION: Children and their caregivers are being deliberately
targeted by food industry marketing on food and drink packaging. This
study demonstrates the utility of a novel automated approach to mon-
itoring front-of-pack marketing, which, with ongoing application, will
allow analysis of trends over time, identification of violations to indus-
try codes, and alignment with regulations in countries where policies
have been implemented to protect children's diets from the influences
of targeted front-of-pack marketing. Findings will contribute to evi-
dence for policy reform to protect children's diets from the harmful
influences of food marketing.
DISCLOSURE OF INTEREST: None declared.
P188 | Effects of low sugar claims on young
women's perceptions and hypothetical
consumption of alcoholic products: An online
experiment
A. Haynes1,2; S. Cao1; C. Tang1; I. Carboon1; C. Hayward1,3;
H. Capes3; Y. J. M. Chen2; E. Brennan1,2; H. Dixon1,2,4;
1,2
M. Wakefield
1 1
Melbourne School of Psychological Sciences, University of Melbourne;
2
Centre for Behavioural Research in Cancer, Cancer Council Victoria;
3
Empirica Research, Melbourne; 4School of Population Health, Curtin
University, Bentley, Australia
INTRODUCTION: Alcohol is energy dense and alcoholic products are
the largest discretionary source of energy in the diets of Australian
drinkers. Excess alcohol consumption can increase the risk of weight
gain and chronic diseases such as cancer and heart disease. Up to one
in five alcoholic products in selected categories on the Australian mar-
ket feature a ‘low sugar’ or other sugar-related claim. Such claims
have the potential to create a ‘health halo’, misleading consumers to
perceive products displaying them as healthier than other options,
which may increase consumption.
MATERIALS AND METHODS: Australian women aged 18–35
(N = 501) viewed and rated six images of alcoholic products in a ran-
domised 2 (claim condition: low sugar claim, no claim control) 
2 (drink type: cider, ready-to-drink spirits) between-subjects online
experiment.
RESULTS: Products with low sugar claims were rated as significantly
lower in sugar and kilojoules, healthier, less harmful to health, and
more suitable for weight management and a healthy diet than identi-
cal products with no claim (p = .002 to p < .001). Despite participants
being informed that all products were of equivalent alcohol and stan-
dard drink content, those with low sugar claims were rated as signifi-
cantly lower in alcohol than products with no claim (p < .001). There
were no significant differences between conditions in anticipated
social approval associated with consuming the products or
1467789x, 2022, S2, Downloaded from https://onlinelibrary.wiley.com/doi/10.1111/obr.13503 by CAPES, Wiley Online Library on [16/12/2023]. See the Terms and Conditions (https://onlinelibrary.wiley.com/terms-and-conditions) on Wiley Online Library for rules of use; OA articles are governed by the applicable Creative Commons License
SUPPLEMENT ARTICLE
hypothetical intentions to consume the products, but participants
who viewed low sugar claims were significantly less likely to intend to
compensate for kilojoules/cal in the products by modifying their food
intake or physical activity (p = .007).
CONCLUSION: Low sugar and related claims on alcoholic products
generate a health halo, whereby consumers generalise from a specific
favourable attribute (low sugar) to other attributes (lower in kilojoules,
alcohol) and global appraisals of the product (healthier, less harmful,
better for weight management). These claims also have the potential
to impact diet and activity behaviours following consumption. Find-
ings demonstrate that low sugar claims on alcoholic products can be
misleading and support policy options to prohibit such claims on alco-
holic products and/or counter their effects (e.g., via health warning
labels and/or mandatory energy labelling).
DISCLOSURE OF INTEREST: None declared.
P191 | The effect of voluntary health star
rating labels on healthier food purchasing in
New Zealand: Longitudinal evidence using
representative household purchase data
C. Ni Mhurchu1; L. Bablani2; B. Neal3; C. Skeels2; K. Staub2;
T. Blakely2
National Institute for Health Innovation, The University of Auckland,
Auckland, New Zealand; 2University of Melbourne, Melbourne; 3The
George Institute for Global Health, Sydney, Australia
INTRODUCTION: Front-of-pack labelling (FoPL) aims to promote
healthier diets by altering consumer food purchasing behaviour. We
quantify the impact of the voluntary Health Star Rating (HSR) FoPL
adopted by New Zealand (NZ) in 2014, on (i) the quantity of foods
purchased by HSR scores and food groups, and (ii) the quantities of
different nutrients purchased.
MATERIALS AND METHODS: We used Nielsen Homescan
household-purchasing panel data over 2013–2019, linked to Nutri-
track packaged food composition data. Fixed effects analyses were
used to estimate the association of HSR with product and nutrient
purchasing. We controlled for NZ-wide purchasing trends and poten-
tial confounding at the household- and product level.
RESULTS: In 2019, HSR-labelled products (n = 2890) accounted for
24% of all products in the dataset and 32% of purchasing volume. Of
HSR-labelled products, 1339 (46%) displayed a rating of 4.0–5.0 stars
and 556 (19%) displayed a rating of 0.5–2.0 stars.
We found little or no association between HSR labelling and the
quantities of different foods purchased. Introduction of HSR was,
however, associated with lower sodium ( 9%, 95% CI -13% to 5%),
lower protein ( 3%, 95% CI -5% to 0%) and higher (5%, 95% CI 2% to
7%) fibre purchases when purchased products carrying an HSR were
compared to the same products prior to introduction of the program.
CONCLUSION: Robust evidence of HSR labelling changing consumer
purchasing behaviour was not observed. The positive effect on

SUPPLEMENT ARTICLE
nutrient purchasing of HSR-labelled foods likely arises from reformu-
lation of products to achieve a better HSR label.
DISCLOSURE OF INTEREST: None declared.
P192 | Are online supermarkets providing
sufficient nutrition information to support
consumer decision-making?
D. Maganja; T. Davies; K. Trieu; J. Wu
The George Institute For Global Health, Sydney, Australia
INTRODUCTION: Retail food environments are major determinants
of consumer dietary behaviour and downstream diet-related health
outcomes including obesity. Online supermarkets provide new ways
for retailers and manufacturers to influence consumer choices,
however very few studies have assessed characteristics of these
increasingly popular settings. The objective of the current study is
to evaluate the prevalence of required product labelling (including
ingredients, Nutrition Information Panel [NIP], allergens, country-of-
origin) and voluntary summary nutrition labelling (Health Star Rat-
ing (HSR)) on the online stores of two major supermarket retailers
in Australia.
MATERIALS AND METHODS: Data will be obtained from the online
stores of two leading retailers in Australia using bespoke data scraping
programming in Python. This will collect information including bar-
code, brand, product name and product characteristics, including pres-
ence of labelling information, from individual product pages. Full
nutrition information of products will be obtained by matching the
scraped product barcodes to the Australian FoodSwitch database, a
large nutrition composition database with data collected in-store on
>100,000 products.
RESULTS: Initial testing with a single retailer in February 2022 identi-
fied 14,689 individual food and non-alcoholic beverage product
pages. Preliminary analyses suggest one-fifth (22.0%) of product
pages did not provide ingredients and almost a third (30.9%) did not
meet the minimum Australian regulatory requirement to report
energy, protein, total carbohydrate, total sugars, sodium, total fat and
saturated fat content in a NIP. Looking at select allergens, 21.2% of
products that listed “peanut,” 17.3% of products that listed “sesame”
and 15.7% of products that listed “egg” as ingredients did not specifi-
cally declare them as allergens, as required by regulation.
CONCLUSION: Preliminary findings suggest information that is
intended to support consumer decision-making in physical retail
stores is frequently not being included in the online setting. These
results potentially indicate a need to update labelling regulations to
encompass these increasingly important food environments. A com-
prehensive audit across multiple retailers will help to assess and quan-
tify the full extent of the issue, with these updated results to be
provided at the conference.
DISCLOSURE OF INTEREST: None declared.
1467789x, 2022, S2, Downloaded from https://onlinelibrary.wiley.com/doi/10.1111/obr.13503 by CAPES, Wiley Online Library on [16/12/2023]. See the Terms and Conditions (https://onlinelibrary.wiley.com/terms-and-conditions) on Wiley Online Library for rules of use; OA articles are governed by the applicable Creative Commons License
87 of 222
P194 | Restricting fast-food outlets in WA
using policy driven research and advocacy
E. Groves; A. Sartori
Cancer Council WA, Perth, Australia
INTRODUCTION: Current Western Australian planning legislation
and land use regulations do not consider the public health risk of the
location and density of fast-food outlets or meet community expecta-
tion for their concerns to be adequately considered. Most of the prod-
ucts made by major fast-food chains are unhealthy, sold in oversized
servings, extensively marketed and their consumption is linked to
poor diets and higher body weight. Using planning powers to con-
strain the expansion of the fast-food industry will be an important
strategy in the development of healthy, sustainable food systems for
obesity prevention and requires a well-planned advocacy campaign.
MATERIALS AND METHODS: Through funding from Healthway,
Cancer Council WA (in partnership with the Telethon Kids Institute)
undertakes advocacy to advance obesity prevention policies in West-
ern Australia, particularly time sensitive, policy driven research and
communication. As part of this program of works, Cancer Council
WA has prioritised advocating for restricting the proliferation of fast-
food outlets near schools, a recommendation in the Sustainable
Health Review Final Report. The model used to inform our strategies
is based on a previously developed policy map for public health pol-
icy issues.
To advance this policy priority, essential components were identi-
fied including addressing gaps in empirical evidence of the public
health risks of fast-food outlets and commissioning research to fill
those gaps; understanding the legislative governance structure and
the identification of policy windows; analysis of stakeholders including
opponents and their arguments; investing in strategic relationships;
forming consensus and presenting a unified solution; and building
community support.
RESULTS: Funding was used to commission research into (i) the cur-
rent location and density of fast-food outlets in the Perth metropoli-
tan area, (ii) the effect of newly established fast-food outlets next to
schools on student and broader community preferences, intentions
and dietary intake and (iii) a review of the legal regulatory framework
governing local planning in consideration of public health.
The above was complemented by engaging with a non-
government coalition of health and medical agencies to create a uni-
fied clear solution, implementing communication and PR strategies
with key stakeholders to raise awareness and support for the issue
and responding to any identified policy window opportunities.
CONCLUSION: The presentation will provide an overview of the find-
ings and progress on advocacy strategies to date and will discuss
future direction and challenges faced. It will demonstrate how rapid
policy-informed research can be used to build evidence and cross-
sectoral engagement, for campaigning to address restricting the future
growth in fast-food outlets.
DISCLOSURE OF INTEREST: None declared.

88 of 222
P195 | The utilisation of normative
instruments by United Nations actors
regarding restricting the exposure of children
to unhealthy food and beverage marketing: A
scoping review and content analysis
F. Sing1; S. Mackay1; M. Cina2; B. Swinburn1
1
University of Auckland, Auckland, New Zealand; 2O'Neill Institute for
National and Global Health Law, Washington, DC, USA
INTRODUCTION: United Nations (UN) entities are influential actors
in global health who can introduce a suite of legal and normative
instruments to call on Member States to act on pressing issues such
as the exposure of children to unhealthy food and beverage market-
ing. This paper seeks to examine the deployment and strength of
global health law instruments used by UN actors to call on Member
States to restrict the exposure of children to unhealthy food and bev-
erage marketing.
MATERIALS AND METHODS: Global Health Law instruments were
identified from a scan of four UN entities that have a mandate over
children's exposure to marketing of unhealthy food and beverage
products namely: the World Health Organization (WHO); the Food
and Agriculture Organization (FAO); the United Nations General
Assembly (UNGA) and the Office of Human Rights. Each instrument
was coded using a coding framework including the date, type of
instrument, and any content regarding Member States responsibilities
to act on harmful marketing practices. The strength of the instru-
ments, over time, was assessed by analysing the type of global health
law instrument and the language used, through a descriptive qualita-
tive content analysis.
RESULTS: A wide range of global health law instruments have been
used over time by the four UN entities: eight by the WHO and the
FAO over thirteen years; three by the UNGA over eight years; and
eight by the child rights agencies over twenty-one years. The lan-
guage calling for action on restricting marketing of unhealthy food to
children by the World Health Organization and Food and Agriculture
was weaker overall than the rights-based instruments from the
Human Rights infrastructure. The WHO, FAO and UNGA instruments
do not call for Member States to implement mandatory regulations.
The strength of the language is also not consistent, does not get
stronger over time and varies based on the type of instrument. In con-
trast, the child rights instruments do call for government regulations
to be enacted in a more directive manner.
CONCLUSION: While some of the existing global health law instru-
ments are weak, in large part due to the impact of the political envi-
ronment and power dynamics of the multiple global health actors at
play, the existing infrastructure could be strengthened to call on more
Member States to regulate unhealthy food and beverage marketing.
Combining global health law with other global governance tools, par-
ticularly stronger accountability and conflict of interest mechanisms
and introducing further instruments to clarify Member States
1467789x, 2022, S2, Downloaded from https://onlinelibrary.wiley.com/doi/10.1111/obr.13503 by CAPES, Wiley Online Library on [16/12/2023]. See the Terms and Conditions (https://onlinelibrary.wiley.com/terms-and-conditions) on Wiley Online Library for rules of use; OA articles are governed by the applicable Creative Commons License
SUPPLEMENT ARTICLE
obligations, could increase the utility of global health law and the
influence of UN actors.
DISCLOSURE OF INTEREST: None declared.
P196 | Teenagers' responses to unhealthy
food and drink marketing on Instagram
H. Dixon1,2,3; M. Scully1; Y. J. M. Chen1; M. Wakefield1
1
Centre for Behavioural Research in Cancer, Cancer Council Victoria,
Melbourne; 2Melbourne School of Psychological Sciences, The University
of Melbourne, Parkville; 3Curtin School of Population Health, Faculty of
Health Sciences, Curtin University, Bentley, Australia
INTRODUCTION: Adolescence is an important life stage for estab-
lishing healthy eating habits, ensuring good nutrition for healthy
growth and development, and preventing diet-related chronic disease
later in life. However, as avid users of social media, teenagers are fre-
quently targeted with marketing for unhealthy food and drinks on
social media. The aim of this study is to investigate the impact of
unhealthy food and drink marketing via the social media platform,
Instagram, on teenagers' awareness of, and attitudes and preferences
towards unhealthy food and drink brands.
MATERIALS AND METHODS: Australian adolescents aged 13 to
17 years (N = 900) will be recruited for a between-subjects web-
based experiment. Participants will be randomly assigned to one of
three Instagram marketing conditions: (A) control (non-food brand),
(B) sugary drink brand, and (C) fast food brand; and shown fictional
Instagram posts with embedded marketing posts representing their
assigned condition. Each condition will feature an equivalent range of
types of marketing posts (e.g., posts featuring a popular teen celeb-
rity/influencer endorsing the product; posts depicting peers consum-
ing the product; posts with a branded image of the product) and
sources (e.g., posts of teens shown as shared by a peer; branded food
image shown as coming from the company). As participants view their
assigned stimuli, engagement with each post will be measured by
viewing time, and reported “likes” or “shares.” Participants' awareness
of, attitudes and preferences towards featured food and drink brands
will then be assessed using an online questionnaire.
RESULTS: Data are being collected this June and results will be avail-
able for presentation at the conference.
CONCLUSION: Findings will add to the evidence base on impacts of
youth-targeted unhealthy food marketing via social media, and help
inform policy and advocacy regarding food marketing to children.
DISCLOSURE OF INTEREST: None declared.

SUPPLEMENT ARTICLE
P197 | Cost–benefit analysis to demonstrate
the potential value-for-money of
supermarket shelf tags promoting healthier
packaged products in Australia
J. Ananthapavan1; G. Sacks1; L. Orellana1; J. Marshall1; E. Robinson1;
M. Moodie1; M. Blake1; A. Brown2; R. Carter1; A. Cameron1
1
Deakin University, Melbourne; 2City of Greater Bendigo, Bendigo,
Australia
INTRODUCTION: The supermarket environment has a major
impact on the healthiness of food purchased and consumed. Shelf
tags that alert customers to healthier packaged products have the
potential to improve the healthiness of overall purchases. This
study assessed the potential value-for-money of implementing a
three-year shelf tag intervention across all major supermarket
chains in Australia.
MATERIALS AND METHODS: Cost–benefit analysis (CBA) using a
societal perspective was conducted based on results of a 12-week
non-randomised controlled trial of a shelf tag intervention in seven
Australian supermarkets. The change in energy density of all pack-
aged foods purchased during the trial was used to estimate poten-
tial changes in mean daily energy intake and body weight at a
population level. A multi-state, multiple-cohort Markov model
estimated the subsequent obesity-related health impacts quantified
as health-adjusted life years (HALYs) gained and healthcare cost
savings resulting from the shelf tag intervention compared to no
intervention over the lifetime of the 2019 Australian population.
HALYs gained were monetised using the value of a statistical life
year. Consumer surplus resulting from the additional information
provided by shelf tags was also incorporated into the analysis.
RESULTS: The intervention was estimated to produce a mean reduc-
tion in population body weight of 1.09 kg resulting in 50,923 HALYs
gained and healthcare cost-savings of A$542.5 million. The total inter-
vention cost was A$29.8 million. The net present value of the inter-
vention was approximately A$17 billion, the majority from monetised
health benefits. Over 98% of the intervention costs were borne by
supermarkets, whereas individuals and the Australian federal govern-
ment were the main beneficiaries.
CONCLUSION: The importance of intervening in the supermarket set-
ting has been highlighted in the Australian National Obesity Strategy.
This study demonstrated that shelf tags to alert customers of healthier
packaged products are potentially highly cost-effective, and should be
considered as one of the components of a comprehensive approach
to obesity prevention. Given the majority of implementation costs fall
on supermarkets, opportunities to reduce costs and demonstrate ben-
efits to retailers need to be explored and mandatory implementation
considered.
DISCLOSURE OF INTEREST: None declared.
1467789x, 2022, S2, Downloaded from https://onlinelibrary.wiley.com/doi/10.1111/obr.13503 by CAPES, Wiley Online Library on [16/12/2023]. See the Terms and Conditions (https://onlinelibrary.wiley.com/terms-and-conditions) on Wiley Online Library for rules of use; OA articles are governed by the applicable Creative Commons License
89 of 222
P198 | Regulated nutrition claims increase
healthiness perceptions of a discretionary
and ultra-processed toddler snack food and
an ultra-processed toddler milk: A discrete
choice experiment
J. Mccann1; J. Woods1; G. Russell1; M. Mohebbi2
1
IPAN, Deakin University, Geelong; 2Faculty of Health, Deakin, Burwood,
Australia
INTRODUCTION: There has been a prolonged increase in global sales
and consumption of ultra-processed, discretionary foods and ultra-
processed milks aimed at toddlers. These products display numerous
on-pack claims to influence health perceptions. Little is known about
the relative impact of regulated and unregulated claims on consumer
perceptions of healthiness, a key driver of purchase. Thus, this study
investigated the relative impact of various regulated and unregulated
claims on parent perceptions of the healthiness of a discretionary/
ultra-processed toddler snack food and an ultra-processed toddler
milk in Australia.
MATERIALS AND METHODS: Participants aged 18+ years com-
pleted an online survey including discrete choice experiments
(DCE) for an ultra-processed, discretionary toddler snack food and
an ultra-processed toddler milk, which displayed different combina-
tions of regulated and unregulated claims across nutrition, health
and other domains. Participants were asked to choose the ‘most
healthy’ and ‘least healthy’ products between three alternatives
over seven choice sets. Data were analysed using an ordinal logis-
tic regression model.
RESULTS: Likelihood-ratio tests revealed the most important contri-
bution to the full models for both DCEs was variation in the regulated
nutrition-content claims. For the snack food, participants were nearly
14 times more likely to perceive a product with the regulated
nutrition-content claim “no added sugar, no added salt” as most
healthy (OR 13.71; CI: 10.93–17.22, p < 0.001), compared to when
no regulated nutrition-content claim was present. For the toddler milk,
participants were more than two and a half times more likely to
choose a product that contained the regulated nutrition-content claim
“2 serves = up to 50% of RDI recommended dietary intake of 14 vita-
mins and minerals” as most healthy (OR 2.65; CI 2.14–3.29,
p < 0.001) compared to when no regulated nutrition-content claim
was present.
CONCLUSION: In Australia, regulated nutrition-content claims can be
displayed on packaged foods regardless of healthiness. These results
indicate that such claims increase perceptions of healthiness of ultra-
processed and discretionary toddler snack foods and ultra-processed
toddler milks. Further controls are required to regulate the use of
nutrition content and health claims and to facilitate informed con-
sumer choice.
DISCLOSURE OF INTEREST: None declared.
 1467789x, 2022, S2, Downloaded from https://onlinelibrary.wiley.com/doi/10.1111/obr.13503 by CAPES, Wiley Online Library on [16/12/2023]. See the Terms and Conditions (https://onlinelibrary.wiley.com/terms-and-conditions) on Wiley Online Library for rules of use; OA articles are governed by the applicable Creative Commons License
90 of 222 SUPPLEMENT ARTICLE

P199 | COVID-19 and related social examine the effect of systematic social distancing system, participants
distancing induced significant metabolic who underwent health check-up (visit 3) in the period between July

complication without prominent weight gain
in Korean adults
K.-K. Kim1; H.-J. Ko2; Y. J. Cho3 Study for Obesity and Metabolic
Syndrome
1
Department of Family Medicine, Gachon University College of Medicine,
Incheon; 2Department of Family Medicine, School of Medicine,
Kyungpook National University; 3Department of Family Medicine, Daegu
Catholic University School of Medicine, Daegu, Korea, Republic Of
INTRODUCTION: With spiking cases of COVID-19 in summer 2020,
Korean government set up detailed systematic social distancing to
cope with the rapid spread of the pandemic. Because the high-level
social distancing recommended stay-at-home and restricted the usage
of multi-person facilities including fitness centers and swimming pool,
it could decrease physical activity abruptly, and induce weight gain
with metabolic deteriorations. In this study, we tried to confirm
changes in weight and cardiometabolic parameters, before and after
strengthening the regulation level of social distancing with objectively
measured health examination data in Korean adults.
MATERIALS AND METHODS: This retrospective cohort study was
conducted with health check-up data from 13 university hospitals.
The study period was from January 2, 2018, to July 30, 2020. To
Visit 2 Visit 3
2020 and July 2021, id est. during the full-scale social distancing,
along with previous twice health check-ups (visit 1 and 2) between
January 2018 and June 2020, that was before the social distancing,
were selected. Totally 7875 participants' data were analyzed. Linear
mixed-effect models were used to calculate the estimates and 95%
confidence intervals of anthropometric indices and metabolic markers
of visit 2 and 3 with the reference of visit 1.
RESULTS: Levels of metabolic markers, including blood pressure,
HbA1c, total and LDL cholesterol were elevated in the period of
systematic social distancing compared to previous two examination
before social distancing, although body weight, BMI, and fat per-
centage increased steadily in the whole study period. Levels of
fasting glucose and HDL-cholesterol increased steadily.
CONCLUSION: Metabolic markers became worse since the applica-
tion of high-level social distancing measure, while there were only
steady increases for anthropometric indices and body fat.
DISCLOSURE OF INTEREST: None declared.
P201 | Adolescent participation in policy and
guideline development for obesity and
chronic disease prevention: A scoping review
M. Mandoh1; J. Redfern1; S. Mihrshahi2; H. L. Cheng3;
P. Phongsavan1; S. R. Partridge1
1
University of Sydney, Camperdown; 2Macquarie University, Sydney;
3
University of Sydney, Westmead, Australia

Estimate Estimate
(95% CI) P-value (95% CI) P-value
Weight (kg) 0.16 <0.001 0.33 <0.001 INTRODUCTION: International and national health agencies, such as
(0.09, 0.22) (0.26, 0.39) the World Health Organization recognise that resource allocation and
BMI (kg/m2) 0.07 <0.001 0.12 <0.001 program development for effective obesity and chronic disease pre-
(0.05, 0.10) (0.09, 0.14)
vention in adolescents requires them to be engaged in high level
Body fat (%) 0.20 <0.001 0.65 <0.001 decision-making. Yet, adolescents are often overlooked in obesity and
(0.13, 0.27) (0.59, 0.72)
chronic disease prevention policy and guideline development. The aim
Systolic BP 0.79 <0.001 2.40 <0.001
of this study is to describe the mode and nature of adolescent partici-
(mmHg) (0.54, 1.05) (2.15, 2.65)
pation in obesity and chronic disease prevention policies and
Diastolic BP 0.29 0.003 0.73 <0.001
guidelines.
(mmHg) ( 0.48, (0.54, 0.93)
0.10) MATERIALS AND METHODS: A systematic scoping review was con-

Glucose (mg/dL) 1.10 <0.001 1.73 <0.001 ducted to map the grey literature. Included policy and guideline docu-
(0.85, 1.34) (1.48, 1.98) ments involved adolescents aged 10–24 years in obesity or chronic
HbA1c (%) 0.00 0.566 0.06 <0.001 disease prevention policy and guideline development. Published and
( 0.01, 0.01) (0.05, 0.07) current policy and guideline documents from countries with similar
Total cholesterol 0.03 ( 0.60, 0.936 2.35 <0.001 health ethos and demographics were included, namely, Australia, USA,
(mg/dL) 0.66) (1.72, 2.98) UK, and Canada. International databases of the United Nations and
Triglyceride 1.42 ( 0.10, 0.066 1.57 0.043 World Health Organisation were examined as they shape global public
(mg/dL) 2.93) (0.05, 3.08)
health agendas. The mode and nature of adolescent participation in
HDL-cholesterol 0.72 <0.001 1.42 <0.001 the policy and guideline development process were assessed based
(mg/dL) (0.54, 0.90) (1.24, 1.60)
on the Lansdowne/UNICEF conceptual framework for measuring out-
LDL-cholesterol 0.01 0.961 0.72 0.011
comes of adolescent participation and the NHMRC consumer engage-
(mg/dL) ( 0.57, 0.54) (0.16, 1.28)
ment framework.

SUPPLEMENT ARTICLE
RESULTS: Eight policy and guideline documents met all inclusion cri-
teria and were examined in this review. Overall, three documents
were under international jurisdiction. Five national documents were
identified: two Australian, two Canadian and one from the
UK. Improving health and wellbeing was the focus of the documents
reviewed. The number of participants ranged from 10 to 4804, all
documents reported demographic characteristics of participants
vaguely. Four documents involved disadvantaged youth. Adolescents
were predominantly engaged in a consultative capacity (6/8), in the
formative stages (7/8) of the policy or guideline development process,
with four documents engaging adolescents in more than one stage of
the policy and guideline development process. Consultation exercises,
discussion and focus groups were the most common participatory
method used (8/8). Lack of participatory outcome data indicates that
adolescent participation is often tokenistic in nature.
CONCLUSION: This review identified a contradiction between con-
sumer engagement recommendations made by health agencies and
current practice in policy and guideline development processes for
adolescent chronic disease prevention. For policies and guidelines to
positively impact adolescent populations, their participation in the pol-
icy and guideline development process must be meaningful, inclusive,
and transparent.
DISCLOSURE OF INTEREST: None declared.
P202 | Healthy eating and physical activity
practice implementation in early childhood
education and care services across Australia:
A cross-sectional study
M. Lum1,2; S. L. Yoong1,2,3; L. Wolfenden1,2; A. Grady1,2; J. Jones1,2
1 N. Thongchareonchupon
Medicine and Public Health, University of Newcastle, Newcastle;
2
Hunter New England Population Health, Wallsend; 3Health Sciences,
Swinburne University of Technology, Melbourne, Australia
INTRODUCTION: To reduce the risk of obesity across the lifespan,
the development of healthy habits at a young age is recommended.
Early childhood education and care (ECEC) services provide an oppor-
tune setting to improve the healthy eating- and physical activity-
related behaviours of children aged 0–6 years, as they reach a high
proportion of this population. Recommended and evidence-based
healthy eating and physical activity practices (e.g., training educators
in child healthy eating) in this setting can improve such behaviours in
children, however the implementation of these practices across
Australia in unknown. The aim of this study is to (i) describe the preva-
lence of implementation of evidence-based healthy eating and physi-
cal activity practices in ECEC services nationally; and (ii) examine
differences in the prevalence of implementation of these practices by
service characteristics (i.e., socioeconomic status and locality).
MATERIALS AND METHODS: A random sample of 2050 centre-
based ECEC services across Australia was invited to complete a cross-
sectional survey via telephone or online (August 2021–April 2022).
1467789x, 2022, S2, Downloaded from https://onlinelibrary.wiley.com/doi/10.1111/obr.13503 by CAPES, Wiley Online Library on [16/12/2023]. See the Terms and Conditions (https://onlinelibrary.wiley.com/terms-and-conditions) on Wiley Online Library for rules of use; OA articles are governed by the applicable Creative Commons License
91 of 222
Items included service demographic information and implementation
of evidence-based healthy eating and physical activity practices,
which were developed by the research team and based on valid and
reliable tools. Statistical analyses were performed using Stata/IC 14.2
statistical software. Descriptive statistics were used to describe the
proportion of services implementing evidence-based healthy eating
and physical activity practices. To examine differences in implementa-
tion of evidence-based practices by service characteristics, linear
mixed regression analyses will be performed. Statistical significance
will be set at p < 0.05 for all tests.
RESULTS: To date, 111 services have reported to be ineligible. Of the
eligible sample (n = 1939), 972 services (50.1%) have consented to
participate. Consent rates by state are approximately equivalent to
state distribution. Preliminary analyses indicate that more than 50%
of services are implementing 9 of the 13 evidence-based practices
assessed. Association analyses are expected to be completed by mid-
2022.
CONCLUSION: The findings of this study will provide an understand-
ing of the current prevalence of implementation of evidence-based
healthy eating and physical activity practices in ECEC services, as well
as identify differences in implementation by service characteristics.
This will indicate areas in which additional support is required, and
also guide future health promotion programs and policies in this set-
ting to reduce the risk of obesity at a population level.
DISCLOSURE OF INTEREST: None declared.
P203 | Media exposure and media heath
literacy among adolescents in Thailand
N. Jindarattanaporn; S. Phulkerd; S. Thapsuwan;
Mahidol university, Institute for Population and Social Research, Nakorn
Pathom, Thailand
INTRODUCTION: Health content through media may influence
unhealthy behaviors such as unhealthy diet among adolescents.
Media health literacy (MHL) that refers to the skill to identify and
analyze health content through media plays a significant role to
assist adolescents and adolescents to make appropriate, healthy
decisions on diet and exercise. However, how adolescents' media
exposure and level of their MHL were less understood. The objec-
tive of this study was to explore media exposure and MHL among
Thai adolescents aged 10–14 years.
MATERIALS AND METHODS: A cross-sectional survey was con-
ducted with a representative sample of Thais age 10–14 years
(N = 1871) from all regions of Thailand. Qualtrics Offline Survey
application was employed to assist face-to-face interviews. The data
collected include socio-demographic characteristics of adolescents,
and their nutritional status based on Body Mass Index (BMI), media
exposure, and MHL. Four ability domains of MHL were assessed
which were perceiving and understanding, analysis, evaluation, and

92 of 222
intention to act. Frequency and percentage were used to describe
media exposure and MHL among Thai adolescents.
RESULTS: More than half (58.8%) of the sample regularly accessed
the Internet to view content on social media such as YouTube, Face-
book, and/or TikTok, followed by on-line games, TV programs and
movies, respectively. Adolescents with overweight (41%) and obesity
(42.6%) were exposed to YouTube more than adolescents who had
normal weight (35.4%). They also used longer screen time (1/2–3 h)
than other adolescent groups. The overall of mean score for MHL in
this study was 36.8 (of total 60) (±6.580) with minimum of 12 and
maximum of 54. The median of MHL was 37. The mean score for per-
ceiving and understanding, analysis, evaluation, and intention to act
domains are 7.3 (of total 12), 9.6 (of total 20), 9.2 (of total 12), and
10.5 (of total 16), respectively. Adolescents with obesity had higher
MHL score for perceiving and understanding (65.5%) than adolescents
with normal weight, underweight and overweight, respectively. Ado-
lescents with overweight had lower MHL score for analysis (74.1%)
than adolescents with normal weight. There were no score differences
for evaluation, and intention to act domains among adolescents by
nutritional status.
CONCLUSION: The findings suggest a need for policies for develop-
ing adolescent's analytical skill such as Thinking-based Learning in cur-
riculum and a combination of learning experiences in and outside a
classroom, including outdoor for improving MHL among Thai
adolescents.
DISCLOSURE OF INTEREST: None declared.
P204 | Adult overweight and obesity
prevalence in urban Mongolia, 2018
O. Chimeddamba1; O. Davaadamdin2; N. Dashdorj3
1
Global Leadership University; 2Onom foundation; 3Onoom foundation,
Ulaanbaatar, Mongolia
INTRODUCTION: Overweight and obesity have been dramatically on
the rise in low- and middle-income countries, particularly in urban set-
tings for the last three decades. Consequently, prevalence of obesity
across the world has tripled since 1980. In the past decade obesity
has started to increase in emerging economies, including a number of
Asian nations.
We conducted an analysis to update the prevalence estimates of
overweight and obesity among urban Mongolian adults in 2018
according to international and Asian-specific BMI and WC cut-off
values.
MATERIALS AND METHODS: Data were analysed from the survey
on the prevalence of arterial hypertension risk factors and sustainable
drug use conducted in 2018. The survey was a cross-sectional, urban
representative using the WHO NCD STEPwise approach to chronic
disease risk factor surveillance methodology with behavioural, anthro-
pometric and biomedical measurements among the population over
20 years of age in Ulaanbaatar city, the capital city of Mongolia. All
1467789x, 2022, S2, Downloaded from https://onlinelibrary.wiley.com/doi/10.1111/obr.13503 by CAPES, Wiley Online Library on [16/12/2023]. See the Terms and Conditions (https://onlinelibrary.wiley.com/terms-and-conditions) on Wiley Online Library for rules of use; OA articles are governed by the applicable Creative Commons License
SUPPLEMENT ARTICLE
cases (n = 4511) were pronounced eligible, as they presented all data
required for a detailed assessment of the body composition variables
under study.
The prevalence of each BMI and WC risk category was calculated
both overall and stratified by age group and sex, using the interna-
tional and Asian-specific BMI and WC cut-off values. Linear regres-
sion was used to investigate the association between each of BMI
and WC. The regression analyses were adjusted for age group, sex
and education.
RESULTS: Mean BMI and WC of urban Mongolian adults increased
for all age groups and genders. The highest mean BMI (27.4581 kg/
m2) was observed for men aged between 40 and 49 vs (27.9307 kg/
m2) was observed for women aged 50 and over. The overall mean WC
continuously increased as age increased in both genders. According to
international BMI cutoffs, 37.5% of men and 34.4% of women were
overweight whereas 19.3% of men and 20.3% in women were with
obesity in 2018 in urban areas of Mongolia. However, prevalence of
obesity using the Asian-specific BMI cutoffs was approximately twice
more likely to be greater than prevalence estimates based on the
international BMI cutoffs. The prevalence of urban individuals with
central obesity was 2.5 times higher for women (85.0%) than men
(33.8%).
CONCLUSION: We observed the age patterned gradient in over-
weight and obesity in urban adults in Mongolia. The prevalence of
central obesity increased more rapidly in men than women. Therefore,
obesity control and prevention strategies should be public health pri-
orities in urban Mongolia.
DISCLOSURE OF INTEREST: O. Chimeddamba Shareholder of: no,
Grant/Research support with: no, Consultant for: no, Employee of:
no, Paid Instructor for: no, Speakers bureau with: no, O. Davaadamdin
Shareholder of: no, Grant/Research support with: no, Consultant for:
no, Employee of: no, Paid Instructor for: no, Speakers bureau with: no,
N. Dashdorj Shareholder of: no, Grant/Research support with: no,
Consultant for: no, Employee of: no, Paid Instructor for: no, Speakers
bureau with: no.
P205 | Generation U: A government response
involving a unique connected range of policy,
programs and partnerships, to improve the
health and wellbeing of the next generation
J. Hardt; S. Pavey; R. Littlewood
Health and Wellbeing Queensland, Milton, Australia
INTRODUCTION: The past 50 years has seen a steep, unpredictable
and worsening incline of non-communicable and preventable diseases.
Concurrently, rates of obesity have continued to escalate across the
globe, with more than 1 billion people living with obesity. Australia is
no exception to these trends, with 2 in 3 adults and 1 in 4 children
affected by overweight or obesity. Investment in treatment initiatives
fails to address the complexity of obesity and tackle the root cause.

SUPPLEMENT ARTICLE
Consequently, the health and life expectancy of current and future
generations is threatened to decline.
MATERIALS AND METHODS: Generation U, is an evidence-based,
overarching child-focussed public health strategy involving a unique
connected range of policy, programs and partnerships. Two key
frameworks including: (1) Obesity Prevention Action Plan for
Queensland and (2) Queensland Equity Framework, will establish a
clear theory of change and governance framework. Digital assets
and a strong evaluation component will support the scalability of
Gen U, contextualising the strategy for each population across the
globe.
RESULTS: Children born into the time of Generation U will experience
better health outcomes than the generations before them. The strat-
egy will present as an effective, connected and population-based
intervention, halting the rising rates of obesity and chronic disease,
supporting generational change towards good health and promoting
longevity for all children, no matter where they live.
CONCLUSION: Generation U is the only prevention package that is
supported by a strong research and evaluation agenda, a clear theory
of change and country-specific data and equity frameworks. Popula-
tions experiencing isolation and vulnerability will be identified, allow-
ing governments to target regions in need and generate equitable
outcomes. Children across the world will live longer and better lives—
what better legacy is there?
DISCLOSURE OF INTEREST: None declared.
P206 | Is urban poor neighbourhood food and
built environment associated with adolescent
overweight/obesity risk in Kuala Lumpur,
Malaysia?
J. E. F. Tay1; S. K. Nachatar Singh1; W. Y. Gan2; N. N. Che'Ya3;
C. H. Tan1; S. E. H. Tung4
1
Department of Food Science and Nutrition, Faculty of Applied Sciences,
UCSI University, Cheras; 2Department of Nutrition, Faculty of Medicine
and Health Sciences; 3Department of Agriculture Technology, Faculty of
Agriculture, Universiti Putra Malaysia, Serdang; 4Department of Public
Health Medicine, Faculty of Medicine and Health Sciences, Universiti
Malaysia Sabah, Kota Kinabalu, Malaysia
INTRODUCTION: Understanding the role of neighbourhood environ-
ment in the development of obesity is particularly important in
addressing obesity epidemic, especially in the urban poor context.
This study aimed to determine the relationship between neighbour-
hood food and built (physical activity) environment and obesity among
urban poor adolescents in Kuala Lumpur, Malaysia.
MATERIALS AND METHODS: A total of 219 adolescents aged 10–
17 years were recruited from eight People Housing Programme (PPR)
in Kuala Lumpur, Malaysia during November 2021 through February
2022. Perceived neighbourhood food and built (physical activity) envi-
ronment data were obtained from parents using Physical Activity
1467789x, 2022, S2, Downloaded from https://onlinelibrary.wiley.com/doi/10.1111/obr.13503 by CAPES, Wiley Online Library on [16/12/2023]. See the Terms and Conditions (https://onlinelibrary.wiley.com/terms-and-conditions) on Wiley Online Library for rules of use; OA articles are governed by the applicable Creative Commons License
93 of 222
Neighbourhood Environmental Survey (PANES) and Perceived Nutri-
tion Environment Measures Survey (NEMS-P), respectively. Adoles-
cent's weight and height were measured, and body mass index-for-
age (BAZ) was calculated using WHO Anthro Plus.
RESULTS: A total of 39% of the adolescents were OW/OB while 61%
were non-overweight/obese (NOW/OB). The food environment in
the urban poor neighbourhood is perceived to have low availability of
healthy items at home (5.0 ± 2.1) while poor accessibility to store
(10.1 ± 2.3) and restaurant (7.7 ± 2.1) were reported. Besides, parents
generally perceived their neighbourhood environment supports physi-
cal activity with good access to transit (2.8 ± 1.2), but high crime (2.1
± 1.0) and traffic (2.2 ± 0.8) safety issues were reported. In the food
environment model, greater access to healthy food (fruit and vegeta-
bles) at home is associated with lower BAZ (b = 0.217, p = 0.008).
In the built environment model, parental perception of better pedes-
trian infrastructure in the neighbourhood is associated with lower
BAZ (b = 0.205, p = 0.019). In food and built environment model,
only adolescents whose parents reported to have greater accessibility
to healthy food (fruit and vegetables) at home was associated with
0.235 decrease in BAZ (b = 0.235, p = 0.006) after adjusted for
adolescent's age, educational level and monthly household income.
No significant associations were found between other neighbourhood
environment variables with obesity.
CONCLUSION: The study provides a better understanding of the
urban poor neighbourhood environment in relation to adolescent
obesity, in which the food environment is more important than the
built environment in obesity prevention. Future studies are recom-
mended focus on objectively assessing of food and built environ-
ment to better understand underlying causes of obesity in urban
poor adolescents.
DISCLOSURE OF INTEREST: J. E. F. Tay: None declared, S. K. Nacha-
tar Singh Grant/Research support with: Fundamental Research Grant
Scheme [FRGS/1/2020/SKK06/UCSI/02/2], W. Y. Gan: None
declared, N. N. Che'Ya: None declared, C. H. Tan: None declared, S. E.
H. Tung: None declared.
P207 | Systems science in a broad municipal
health approach
S. O'halloran1; J. Hayward1; S. Kilpatrick2; J. Poorter1; P. Fraser1;
C. Needham1; E. Rhook3; T. Felmingham1; S. Demaio2; S. Allender1
1
Global Obesity Centre, Institute for Health Transformation, Deakin
University, Geelong; 2VicHealth, Melbourne; 3Southern Grampians
Glenelg Primary Care Partnership, Hamilton, Australia
INTRODUCTION: A key challenge for obesity prevention is to tackle
the complexity between individual behaviour and the societal drivers of
obesity. To meet this challenge a whole of community-based approach
supported by systems science methods is required. Embedding systems
science practice at the local government level to support municipal
health planning is a significant step in obesity prevention efforts. In

94 of 222
2020 the Victorian Health Promotion Foundation (VicHealth) estab-
lished the VicHealth Local Government Partnership (VLGP), to support
local governments to create environments for youth to be active,
socially connected, mentally and physically healthy, and to amplify the
voices of children and young people in local government decision mak-
ing processes. The partnership included 15 Victorian municipal councils,
who implemented evidence-based health promotion modules coordi-
nated by VicHealth. We present one of the VLGP modules - Connecting
the Dots – creating solutions for lasting change (CtD), which supported
13 VLGP councils to use community-based system dynamics (CBSD)
principles to guide municipal planning and health promotion.
MATERIALS AND METHODS: The CtD team consisted of academic
experts in systems thinking methodologies. The CtD module includes
two impact streams: (1) understanding systems thinking approaches;
(2) actioning new systems thinking approaches. Through a series of
capacity-building activities, the first impact stream upskilled council
teams on the foundations of systems thinking, and CBSD methods.
This included group model building (GMB), supported by a systems
mapping platform called STICKE. Councils then formed facilitation
teams to lead and deliver the second impact stream, which was a
series of GMB workshops with young people, council stakeholders
and community members to explore the complex drivers of youth
health and wellbeing.
RESULTS: Each council, working with their community participants,
developed causal loop diagrams and corresponding community-
informed actions addressing the complexity of youth health and well-
being. The next step for council teams will be to leverage the systems
insights into actions and council structure and planning frameworks to
ensure the promotion of systems thinking and the perspectives of the
community are supported.
CONCLUSION: We have demonstrated an approach to embed sys-
tems practice and community co-creation in municipal planning and
health promotion. A key challenge for the next phase of CtD is how
to best implement the outcomes of this co-creation into sustainable
change and CBSD practice in the municipal setting.
DISCLOSURE OF INTEREST: None declared.
P208 | Purchases of price-promoted
packaged foods and beverages: Do they
differ according to nutritional quality and
socioeconomic status in Australia?
T. Davies; D. Coyle; M. Shahid; S. Pettigrew; J. Wu; M. Marklund
The George Institute for Global Health, Sydney, Australia
INTRODUCTION: As part of its childhood obesity prevention plan,
the UK recently became the first country to impose restrictions on
price promotion for unhealthy foods and beverages. There is interest
to implement similar restrictions in Australia; however, there is a lack
of Australia-specific research on the current influence of price promo-
tions to inform such an intervention. In this cross-sectional study, we
1467789x, 2022, S2, Downloaded from https://onlinelibrary.wiley.com/doi/10.1111/obr.13503 by CAPES, Wiley Online Library on [16/12/2023]. See the Terms and Conditions (https://onlinelibrary.wiley.com/terms-and-conditions) on Wiley Online Library for rules of use; OA articles are governed by the applicable Creative Commons License
SUPPLEMENT ARTICLE
examined the prevalence of price promotion among purchases of
packaged foods and beverages in Australia according to (i) nutritional
quality and (ii) socio-economic status.
MATERIALS AND METHODS: We utilised grocery purchase data
from a nationally representative panel of 10,000 Australian house-
holds in 2019 (NielsenIQ Homescan panel), combined with a packaged
food dataset that contained information on the energy content and
nutritional quality of purchased products (Australian FoodSwitch data-
base). Nutritional quality was defined using the Australian and
New Zealand Health Star Rating (HSR), where products with an
HSR < 3.5 were classified as ‘less healthy’ and products with an
HSR ≥ 3.5 were classified as ‘healthy’. The socio-economic status
(SES) of households was described as ‘low’, ‘middle’, and ‘high’ using
tertiles based on the socio-economic index for areas (SEIFA). Appar-
ent energy intake was expressed as the total energy content of all
purchases per day per capita. One-factor analysis of variance was
used to assess differences in the prevalence and magnitude of pur-
chases involving a claimed price promotion.
RESULTS: Overall, four in 10 packaged products were purchased on
price promotion. Compared to ‘healthy’ products, ‘less healthy’ prod-
ucts were more frequently purchased on price promotion (33% vs
47%, p < 0.001), but had a slightly lower mean magnitude of price pro-
motion (22% and 21%, p = 0.026). Purchases of price-promoted prod-
ucts were greatest for ‘confectionery’ (66%) and ‘snack foods’ (61%),
while considerably lower for ‘fruits and vegetables’ (31%). The appar-
ent energy intake derived from price-promoted ‘healthy’ products
varied minimally according to SES (627 vs. 615 kJ/day/capita for
households of ‘low’ and ‘high’ SES, respectively, p = 0.029). How-
ever, there was a substantial socio-economic gradient in the energy
intake derived from price-promoted ‘less healthy’ products (1139
vs. 963 kJ/day/capita for households of ‘low’ and ‘high’ SES, respec-
tively, p < 0.001).
CONCLUSION: Restricting price promotions for ‘less healthy’ foods
and beverages could potentially improve diet quality and dietary
inequalities in Australia. Further studies are needed to understand how
consumers and the food industry will respond to such restrictions.
DISCLOSURE OF INTEREST: None declared.
P209 | Should physical activity calorie
equivalent (PACE) labelling be implemented
in food settings? Views of a nationally
representative sample of adults in the
United Kingdom
A. Daley; V. Kettle; A. Roalfe
Centre for Lifestyle Medicine and Behaviour, Loughborough University,
Loughborough, UK
INTRODUCTION: Nutritional labels support people to make food
choices and traffic light labelling is the UK standard. However, many
people do not understand the meaning of kilocalories (kcals or

SUPPLEMENT ARTICLE
calories) or grams of fat displayed on food labels, and often underesti-
mate the number of calories when labelling is not provided. Another
approach to nutrition labelling is to provide calorie information with a
meaningful interpretation of what the calorie content of the food
means in terms of energy expenditure. This approach has been termed
physical activity calorie equivalent labelling (PACE), which aims to
illustrate how many minutes of physical activity are equivalent to the
calories contained in food. For example, “calories in this cake requires
90 minutes of walking to burn off.” There is evidence that PACE label-
ling may be effective in reducing calorie consumption, but there is a
lack of evidence about the views of the public concerning potential
implementation.
MATERIALS AND METHODS: This study obtained data from a
nationally representative sample of adults recruited via the UK Ipsos
KnowledgePanel. Panellists are recruited via a random probability
unclustered address-based sampling method where every household
in the UK has a known chance of being selected to join the panel. The
KnowledgePanel contained 14,016 panellists and 4000 were ran-
domly invited to participate. The sample was stratified by education,
region, ethnicity, deprivation, urbanity of home, age and gender. Par-
ticipants were asked to compare their views about traffic light and
PACE labelling regarding which they preferred, found easier to under-
stand, caught their attention the most, and more likely to help them
avoid high calorie foods.
RESULTS: 2668 (67%) of those invited participated. More participants
preferred traffic light (43%, n = 1178 vs. 33%, n = 859) than PACE
labelling. Compared to traffic light labelling, more participants
reported PACE was easier to understand (41%, n = 1063 vs 27%,
n = 719), and more likely to catch their attention (49%, n = 1274 vs
31%, n = 847). Respondents who were physically active at least 3–4
times p/w and ≥5 times p/w were 40% more likely to report PACE
would catch their attention than traffic light labelling, compared with
participants who were active 0–2 times p/w (weighted adj
RRR = 1.42 (1.00–2.00) and 1.45 (1.03–2.05 respectively)). Partici-
pants thought PACE was more likely to help them avoid high calorie
food than traffic light labelling (44%, n = 1124 vs 28%, n = 780).
PACE labelling was chosen less often by those aged 65 years or more,
compared to the youngest group (weighted adj RRR = 0.60 (0.42 to
0.87)).
CONCLUSION: Findings highlight that PACE labelling is a potentially
important policy-based approach to strengthen current approaches to
food labelling.
DISCLOSURE OF INTEREST: None declared.
1467789x, 2022, S2, Downloaded from https://onlinelibrary.wiley.com/doi/10.1111/obr.13503 by CAPES, Wiley Online Library on [16/12/2023]. See the Terms and Conditions (https://onlinelibrary.wiley.com/terms-and-conditions) on Wiley Online Library for rules of use; OA articles are governed by the applicable Creative Commons License
95 of 222
P210 | Understanding the dynamics of
obesity-related behaviours in adolescents
from a multi-actor complex systems
perspective
A. Luna Pinzon; K. Stronks; W. Waterlander LIKE
Department of Public and Occupational Health, Amsterdam UMC
location University of Amsterdam, Amsterdam, Netherlands
INTRODUCTION: Childhood overweight and obesity result from mul-
tiple factors interacting with each other within a complex system.
Those factors range from individual behaviours (e.g., daily sugar
intake) to more upstream factors (e.g., food marketing regulations).
Mapping those factors can aid in developing an understanding of the
system which is necessary for interventions aiming to successfully
transform the system. In this study we aimed to identify and under-
stand the dynamics that drive obesity-related behaviours in adoles-
cents by conducting systems-based analysis from a multi-actor
perspective.
MATERIALS AND METHODS: This study is part of the Lifestyle Inno-
vations Based on Youth Knowledge and Experience (LIKE) programme.
LIKE focuses in the transition from child to adolescent (10–14 years)
and is conducted in lower socioeconomic, ethnically diverse neigh-
bourhoods in Amsterdam, The Netherlands. To understand the system
dynamics of obesity-related behaviours we performed a Needs
Assessment using a mixed methods approach. Methods included mak-
ing causal loop diagrams (CLD) based on scientific literature; participa-
tory action research with adolescents; group model building with
stakeholders; and interviews with healthcare professionals. Data were
integrated into a multi-actor complex systems perspective CLD and
systems-based analysis was subsequently performed to identify sub-
systems and their corresponding system goals.
RESULTS: The multi-actor complex systems perspective CLD con-
tained 126 factors and 33 feedback loops. Herein we identified six
sub-systems with their corresponding system goals: (1) interaction
between adolescents and the food environment with maximizing
profits from unhealthy food as goal; (2) interaction between adoles-
cents and the physical activity environment with maximizing utility for
limited outdoor space as goal; (3) interaction between adolescents
and the online environment with maximizing profits from technology
as goal; (4) interaction between adolescents, parenting and the wider
socioeconomic environment whereby the goal is set around individual
parental responsibility; (5) interaction between families and healthcare
with the current goal evolving around treating obesity as an isolated
problem; and (6) transition from child to adolescence with the goal
centering around adolescents' vulnerability.
CONCLUSION: Integration of a multi-actor complex systems perspec-
tive and applied systems analysis revealed valuable insights in the
form of system structures and goals of the underlying dynamics that
currently drive obesity-related behaviours in adolescents. These
insights can aid in finding points to intervene in the system so that
interventions can be developed and implemented that target these

96 of 222
underlying dynamics thereby helping to reduce childhood overweight
and obesity.
DISCLOSURE OF INTEREST: None declared.
P212 | Lessons learnt from using a behaviour
change technique taxonomy to code the
intervention content of early child obesity
prevention interventions
B. J. Johnson1; S. Shaw1; R. Golley1; A. L. Seidler2; K. Hunter2;
P. Chadwick3 On behalf of the Transforming Obesity Prevention
for CHILDren (TOPCHILD) Collaboration
1
Caring Futures Institute, Flinders University, Adelaide; 2NHMRC Clinical
3
Trials Centre, The University of Sydney, Sydney, Australia; University
College London, London, UK
INTRODUCTION: Parents play a key role in shaping children's envi-
ronment and behaviours, particularly in the first year after birth.
Deconstructing interventions into their behaviour change components
can provide important information about the behaviour change tech-
niques used to change parents' behaviour. While infant behavioural or
weight outcomes are typically the focus for early obesity prevention,
parents are the agents of change. This study sought to develop a
codebook to apply behaviour change technique taxonomy to parent-
focussed early obesity prevention interventions.
MATERIALS AND METHODS: The Transforming Obesity Prevention
in CHILDhood (TOPCHILD) Collaboration was formed in 2020, bring-
ing together parent-focussed obesity prevention interventions com-
mencing antenatally or in the first year after birth. One project is
focused on deconstructing interventions into their components. A
codebook was developed using the behaviour change technique tax-
onomy (v1) to code behaviour change content related to parental
behaviours to impact infant outcomes (e.g., dietary intake, movement
behaviours and sleep). The development process involved generating
examples of how each of the 93 techniques could apply to parental
behaviours, as well as determining which techniques were not applica-
ble to the target population. This was an iterative process, drawing on
previous intervention coding in obesity prevention and expert knowl-
edge of the study team.
RESULTS: We were only able to derive examples for 72 (of 93) tech-
niques in the codebook. Through this process, we identified several
techniques that were not relevant to parent-focussed early obesity
prevention interventions and thus no examples could be articu-
lated. Each technique that was flagged as not relevant was dis-
cussed within the study team, prior to determining it was not
applicable to the target population and context (e.g., providing
pharmacological support). To assist with coding accuracy, we
included additional guidance in the codebook of examples of what
would not be considered relevant content describing several of the
techniques.
1467789x, 2022, S2, Downloaded from https://onlinelibrary.wiley.com/doi/10.1111/obr.13503 by CAPES, Wiley Online Library on [16/12/2023]. See the Terms and Conditions (https://onlinelibrary.wiley.com/terms-and-conditions) on Wiley Online Library for rules of use; OA articles are governed by the applicable Creative Commons License
SUPPLEMENT ARTICLE
CONCLUSION: The codebook developed in this study provides a
standardised process to apply the behaviour change technique taxon-
omy when coding parent-focused early obesity prevention interven-
tions. This process highlighted the potential ambiguity of applying
behaviour change techniques, which usually target an individual's own
behaviour and outcomes, to parental behaviours to impact infant out-
comes. Application of the codebook will provide a greater understand-
ing of the behaviour change approaches used in early child obesity
prevention interventions.
DISCLOSURE OF INTEREST: None declared.
P213 | Conceptualising weight management
for night shift workers: A mixed methods
systematic review
C. Davis1; C. E. Huggins2; S. Kleve1; G. K. Leung1; M. Bonham1
1
Nutrition, Dietetics and Food, Monash University, Notting Hill; 2Global
Obesity Centre (GLOBE), Institute for Health Transformation, School of
Health and Social Development, Deakin University, Burwood, Australia
INTRODUCTION: Shift workers make up 16% of the Australian work-
force and are at greater risk of obesity, type 2 diabetes, and cardiovas-
cular disease. Working at night predisposes people to weight gain due
to biological consequences of circadian disruption and unique psycho-
social/environmental factors. This study aimed to undertake a mixed-
methods systematic literature review to: (1) identify enablers/barriers
of weight change in the context of night shift work; and (2) examine
the effectiveness of interventions for night shift workers that target
behaviours related to weight loss.
MATERIALS AND METHODS: Electronic databases were searched
(August 2021) using a structured strategy (Scopus, Cochrane, MED-
LINE, PsycINFO, EMBASE, CINAHL). Articles were screened by title
and abstract, followed by a second-pass full-text review. Eligible quali-
tative studies were those documenting the perceived experience of
behaviours related to weight change in the context of night shift
work. Eligible quantitative studies were behaviour change interven-
tions with night shift workers that included change in weight or BMI
as primary or secondary outcomes. Qualitative data were extracted,
and a thematic synthesis of barriers/enablers undertaken using the
social-ecological model (SEM). Data extracted from interventions
included weight and body composition change that was synthesised
narratively; and intervention components mapped to a behaviour
change taxonomy. A narrative synthesis of all studies was undertaken
to identify if interventions addressed perceived barriers and enablers.
RESULTS: The search strategy yielded 8194 articles, with 6 qualita-
tive and 9 quantitative studies included. Frequently reported barriers
were: intrapersonal (time, fatigue, stress); interpersonal (work rou-
tines/cultural norms); organisational (lack of routine, lack of sched-
uled breaks/unpredictable work, fatigue, and lack of healthy food
options at work); and community (lack of healthy food options sur-
rounding work). Frequently reported enablers were: intrapersonal

SUPPLEMENT ARTICLE
(knowledge of health benefits); and interpersonal (positive role
modelling at work). Of the nine intervention studies, only one
reported a clinically significant result for weight loss, which was not
sustained at 6-months follow-up. For most studies, the primary out-
come was not weight loss but other positive behavioural/health
outcomes, and thus participants within the overweight/obese cate-
gories were not targeted. Most studies did not address many identi-
fied enablers/barriers.
CONCLUSION: To improve the metabolic health of this essential
workforce, there is a need for weight management interventions that
target night shift workers within the overweight/obese categories and
that aim to address barriers/enablers for weight management at multi-
ple levels of the SEM.
DISCLOSURE OF INTEREST: C. Davis Grant/Research support with:
NHMRC project grant ID 1159762, C. E. Huggins Grant/Research
support with: NHMRC project grant ID 1159762, S. Kleve Grant/
Research support with: NHMRC project grant ID 1159762, G. K.
Leung Grant/Research support with: NHMRC project grant ID
1159762, M. Bonham Grant/Research support with: NHMRC project
grant ID 1159762.
®
P214 | LiverLighter
origin story: Where we
came from and where we are now
E. Hart1; J. Stevens-Cutler1; A. Sartori1; B. Morley2
1
Cancer Prevention and Research, Cancer Council WA, Perth; 2Centre for
Behavioural Research in Cancer, Cancer Council Victoria, Melbourne,
Australia
INTRODUCTION: Overweight and obesity present a significant prob-
lem for the health of individuals and the Western Australian
(WA) community. Prevalence of overweight and obesity in Australia
has increased in the last three decades from 56% in 1995 to 67% in
2017–18. As part of a comprehensive approach to address this prob-
lem, the LiveLighter® campaign was launched in WA in 2012.
LiveLighter® is a public health campaign that aims to reduce the
burden of weight-related chronic illness by encouraging adults to
adopt healthier eating and movement behaviours. The campaign is
delivered by Cancer Council WA and funded by the WA Department
of Health. The campaign uses mass media channels as well as support-
ing resources to encourage and assist WA adults to participate in
behaviours that aid in maintaining or becoming a healthy weight. Live-
Lighter® is one of the first comprehensive obesity prevention cam-
paigns of its kind in the world and has been licensed by other
Australian jurisdictions.
To mark 10 years of LiveLighter®, we reflect on the original con-
ception of the campaign and the extensive exploration and research
that was done to develop an effective obesity prevention campaign.
MATERIALS AND METHODS: Significant work was done prior to the
launch of the campaign to ensure an evidence-based, impactful cam-
paign was developed. Key steps included:
1467789x, 2022, S2, Downloaded from https://onlinelibrary.wiley.com/doi/10.1111/obr.13503 by CAPES, Wiley Online Library on [16/12/2023]. See the Terms and Conditions (https://onlinelibrary.wiley.com/terms-and-conditions) on Wiley Online Library for rules of use; OA articles are governed by the applicable Creative Commons License
97 of 222
• Literature review of previous related national and international
nutrition and physical activity campaigns
• Development of a behavioural model to guide communications
• Development of a best-practice framework
• Advertising brief developed and agency appointed
RESULTS: As a result of the preliminary research and development
work that was done a suite of advertising concepts were created and
tested with the target audience, prior to deciding on the concept that
was produced into the first LiveLighter® campaign; ‘Toxic Fat’.
After airing in 2012, evaluation of ‘Toxic Fat’ showed that:
• Top of mind awareness of the campaign was high
• The campaign ads elicited a strong cognitive response and were
seen as personally relevant by the target audience
• Modest increases were seen in weight-loss self-efficacy, and the
belief that the benefits of losing weight outweigh the costs
• There was an increase in awareness of the seriousness of chronic
diseases commonly associated with overweight and contemplation
of the harms to health of being overweight, most prominently
among overweight adults
CONCLUSION: The formative research and preparation performed
prior to the launch of LiveLighter® ensured that the campaign was
evidence-based and relevant for the target audience. This provided
the foundation for a decade of campaign activity and led to an ongo-
ing commitment to research and evaluation that continues to monitor
the effectiveness of each campaign wave, and informs the develop-
ment of new campaign messaging.
DISCLOSURE OF INTEREST: None declared.
P216 | Systematic investigation of response
inhibition training duration delivered by
mobile app on food preferences, appetite,
and intake in adults
H. Moore1; N. King1; M. White1; G. Finlayson2
1
Faculty of Health, Queensland University of Technology, Brisbane,
Australia; 2Faculty of Medicine and Health, University of Leeds, Leeds,
UK
INTRODUCTION: Previous studies have demonstrated that response
inhibition training can modify the appeal of palatable and energy-
dense foods, thus serving as a potential intervention for weight loss
or maintenance, via changes in food selection and intake. However,
empirical findings of efficacy have been inconsistent across studies
due to heterogeneous approaches to measuring salient appetitive out-
comes, training implementation strategies, and sample recruitment.
Systematic assessment of both affective and motivational compo-
nents of food reward may help appropriately characterise how food
stimuli are devalued after training.

98 of 222
MATERIALS AND METHODS: In this randomised, cross-over experi-
ment, a non-clinical, adult sample completed time-matched single
sessions with gamified, mobile response inhibition training and con-
trol tasks of short (n = 27) or long (n = 25) duration. Participants
were assessed on two discrete, but related constructs related to
human food reward pre- and post-training: pleasure (i.e., explicit
liking) and desire (i.e., implicit wanting) for visual food stimuli dif-
fering in energy-density. Consumption of snacks categorised by
energy density was also assessed in a laboratory ad libitum taste
test post-training.
RESULTS: No significant differences were found between interven-
tion and control sessions in explicit liking or implicit wanting for
energy-dense foods. Moreover, participants ate a similar volume of
snack foods during both sessions. Training duration did not signifi-
cantly moderate differences between intervention and control ses-
sions in primary outcomes. Variance between intervention and
control sessions in chocolate intake and frequency of choice for
energy-dense foods, but not explicit liking, was primarily observed in
participants of higher BMI.
CONCLUSION: Findings suggest that implicit wanting (i.e., incentive
salience) may be a more appropriate assessment of intervention effi-
cacy to alter eating behaviour in individuals characterised by appeti-
tive susceptibility. Benefits of additional cognitive training could
potentially to manifest over time in adequately spaced training
sessions.
DISCLOSURE OF INTEREST: None declared.
P217 | Organics and the metaverse: How to
grow your audience with an unpaid social
media strategy
J. Teo; A. Sartori
Cancer Council Western Australia, Perth, Australia
INTRODUCTION: Since the emergence of social media, organisations
which deliver public health campaigns have increasingly invested in
developing their social media presence, due to the widespread use of
these platforms, relatively low cost of entry and potential to more
efficiently reach specific target audiences.
LiveLighter® is a public health campaign funded by the WA
Department of Health and delivered by Cancer Council WA. Since
LiveLighter® began in 2012, it has progressively adapted its communi-
cation strategy to include more organic (unpaid) social media that sup-
port the target audience (WA adults aged 25–64).
MATERIALS AND METHODS: To have an effective organic social
media campaign, LiveLighter® considers the following:
• Engaging content creation consistent with the overarching brand
• Effective social media tools and platforms
• Consideration of publication timing
• Insights and analytics to explore post performance
1467789x, 2022, S2, Downloaded from https://onlinelibrary.wiley.com/doi/10.1111/obr.13503 by CAPES, Wiley Online Library on [16/12/2023]. See the Terms and Conditions (https://onlinelibrary.wiley.com/terms-and-conditions) on Wiley Online Library for rules of use; OA articles are governed by the applicable Creative Commons License
SUPPLEMENT ARTICLE
• Continual improvement to the social media strategy
LiveLighter® social media channels encourage followers to engage
with content through the use of a consistent call to action;
i.e., clicking through to the LiveLighter® website. As part of the plan-
ning process, content for each month is planned and developed in
advance. The content consists of a suite of social tiles, primarily cre-
ated through an online, cost-effective graphic design tool. All tiles are
created with reference to the LiveLighter® brand guidelines, which
ensure that posts maintain a consistent look and feel. The social tiles
are accompanied by short blurbs. Content is posted consistently, sev-
eral times a week, across all social platforms.
Platform insight tools are collected weekly to evaluate each post,
which then allows content to be tailored to audience interest. Collect-
ing weekly data helps identify engaging content and trends, which are
used to refine the social media strategy.
RESULTS: Between April 2019 and April 2022, an increase in fol-
lowers was seen across all of LiveLighter®'s social media platforms,
including Facebook (29,182 followers in April 2019 cf. 31,360 in April
2022), Instagram (1878 cf. 3359) and Twitter (2793 cf. 2899).
Overall, there has been a total growth of 7.5% on Facebook, 79%
on Instagram and 3.8% for Twitter over the three-year period and
highlights the effectiveness of the LiveLighter® organic social media
strategy.
CONCLUSION: The findings demonstrate that a planned organic
social media strategy can enhance campaign exposure and extend the
reach of public health campaigns, as well as build and maintain recog-
nition of the overarching brand. It is an effective, efficient, and eco-
nomical strategy that successfully reaches the campaign target
audience.
DISCLOSURE OF INTEREST: None declared.
P218 | Building better lifestyle habits
together: A co-designed, informative and
interactive online program for Queensland
families to tackle and prevent childhood
obesity
R. Farletti1; K. Cuthbert1; J. Walker1,2; L. K. Chai1; J. Munro1
1
Health and Wellbeing Queensland, Milton; 2The University of
Queensland, St Lucia, Australia
INTRODUCTION: Healthy eating behaviours are established in child-
hood and are important for healthy growth. Alarmingly, less than 5%
of Queensland children eat enough vegetables, and 1-in-4 live with
overweight or obesity. Supporting children and families to adopt and
maintain healthy behaviours can make a significant difference over
the life course. Currently, there are no free, universally available ser-
vices targeting child obesity prevention in Queensland.
MATERIALS AND METHODS: The current project aimed to develop
a play-centric, app-based wellbeing program, supporting children and

SUPPLEMENT ARTICLE
families across Queensland to build better lifestyle habits together. An
app was co-designed with families and health professionals from
across Queensland, and in collaboration with cross-sector partners
using a family-based multi-component program approach. Digital
delivery was used as a cost-effective and scalable method to over-
come geographical barriers to access.
RESULTS: The program will be piloted in mid-2022 with ~20 families
before launching statewide in Queensland. Post-launch, it will be eval-
uated by analysing data from ~100 families over a 12-month period,
to determine program feasibility, fidelity, satisfaction, and health
behaviour change outcomes. Insights from co-design activities and
preliminary post-launch findings will be presented at the conference.
CONCLUSION: Program evaluation will determine the app's effective-
ness in supporting family-based behaviour change. This digital pro-
gram can offer valuable insights regarding the development and
dissemination of an accessible, scalable and evidence-based healthy
lifestyle program for families. The app provides an innovative, highly
tailored and first of its kind approach that aims to empower families,
and in turn, tackle childhood obesity across Queensland.
DISCLOSURE OF INTEREST: None declared.
P219 | Twenty-four-hour movement
behaviour profiles: Comparison by obesity
status among Malaysian schoolchildren
J. E. Wong1; S. T. Lee1; D. Koh2; B. K. Poh1 SEANUTS II Malaysia
Study Group
1
Faculty of Health Sciences; 2Faculty of Education, Universiti
Kebangsaan Malaysia, Kuala Lumpur, Malaysia
INTRODUCTION: Physical activity (PA), sedentary behaviour (SB) and
sleep are inter-related 24-h movement behaviours that are important
for growth and well-being of children. Suboptimal time use of daily
movement behaviour has been associated with adiposity, but little is
known on the activity profiles of Asian children. This study aims to
compare 24-h movement behaviour profiles by weight status in a sam-
ple of Malaysian schoolchildren aged 7 to 12 years who participated
in the South East Asian Nutrition Survey II (SEANUTS II) Malaysia.
MATERIALS AND METHODS: A sample of 436 children (mean age
9.7 ± 1.6 years, 56% males) wore tri-axial accelerometers GENEActiv
on their non-dominant wrists for a week, which captured their time
spent in four-part movement behaviours (light PA, moderate-to-
vigorous PA, SB, sleep) for at least 3 days, including a weekend day.
Based on measured body weight and standing height, body mass
index-for-age was calculated and used to classify children into obese
(n = 66) and non-obese groups (n = 370).
RESULTS: On average, children spent 251 min (17% of 24-h day) in
light PA, 72 min (5%) on moderate-to-vigorous PA, 646 min (45%) for
SB, and 471 min (33%) sleeping daily. Compared to non-obese chil-
dren, children who are living with obesity spent significantly less time
sleeping (449 ± 70 vs. 475 ± 64 min/day, p < 0.01), but more time in
1467789x, 2022, S2, Downloaded from https://onlinelibrary.wiley.com/doi/10.1111/obr.13503 by CAPES, Wiley Online Library on [16/12/2023]. See the Terms and Conditions (https://onlinelibrary.wiley.com/terms-and-conditions) on Wiley Online Library for rules of use; OA articles are governed by the applicable Creative Commons License
99 of 222
SB (667 ± 85 vs. 642 ± 84 min/day, p < 0.05). Time spent in light and
moderate-to-vigorous PA was similar across the two weight groups.
CONCLUSION: Based on accelerometer-based measures, there are
differences in the 24-h movement behaviour profiles between
Malaysian children with obesity and those without, specifically time
spent sleeping and in SB. Our findings highlight the discrepancy of
time-use in daily activities of children and suggest further exploration
of movement behaviour composition of children in relation to health
outcomes.
DISCLOSURE OF INTEREST: None declared.
P220 | Are current methods to estimate sleep
confusing the link between sleep and
obesity?
K. Meredith-Jones1; J. Haszard2; T. Stewart3; S. Duncan3;
B. Galland4; R. Taylor1
1
Medicine; 2Biostatistics Centre, University of Otago, Dunedin; 3Human
Potential Centre, Auckland University of Technology, Auckland;
4
Women's and Children's Health, University of Otago, Dunedin,
New Zealand
INTRODUCTION: A large body of evidence has emerged implicating
characteristics of children's sleep such as short duration, timing, poor
quality and high variability with a wide range of adverse health out-
comes including obesity. However, limited data have assessed agree-
ment with the gold standard polysomnography (PSG), or evaluated
whether agreement changes between devices or sites of wear
(e.g., wrist vs waist). Furthermore, differences between current scor-
ing algorithms for actigraphy are not known and further complicate
the efforts to better standardize use of actigraphy as a measure of
sleep. The aims of this study were to compare estimates of sleep–
wake times determined by two actigraphs worn at four different sites
to polysomnography (PSG) using different sleep–wake algorithms.
MATERIALS AND METHODS: 135 children (8–16 years) with no his-
tory of sleep disturbance wore two types of accelerometers
(ActiGraph GT3X+, Axivity AX3) at three sites (left hip, non-dominant
wrist, lower back) for 24 h. Data were processed using the count-
scaled, Sadeh, Cole-Kripke Tudor-Locke and Van Hees algorithms.
PSG data were collected using an in-home Type 2 device. PSG-
actigraphy epoch sensitivity (sleep agreement) and specificity (wake
agreement) were determined and sleep outcomes compared for timing
(onset and offset), quantity [sleep period time (SPT) and total sleep
time (TST)], and quality metrics [sleep efficiency and waking after
sleep onset (WASO)].
RESULTS: Mean values, mean differences, and ICCs for sleep variables
comparing PSG with actigraphy for the sample of children will be pre-
sented across wear site and sleep–wake algorithm. Bland–Altman
plots to visualize the level of agreement between GT3X+ and AX3 for
TST and WASO with the mean biases estimated for each algorithm
and site of wear will be discussed. Finally, sensitivity, specificity, and

100 of 222
accuracy of epoch-by-epoch comparisons between the actigraphy and
PSG data at each site and across algorithms will be presented.
CONCLUSION: Choice of actigraphy scoring algorithm and site of
wear can influence the mean bias and level of agreement in sleep–
wake estimates.
DISCLOSURE OF INTEREST: None declared.
P221 | Health literacy and behaviour among
pregnant women with obesity
M. Meldgaard
Department of Public Health, Aarhus University, Aarhus, Denmark
INTRODUCTION: Worldwide, obesity is increasing among pregnant
women, affecting the health of mother and baby. Obesity may be
associated with inadequate health literacy, a central competence
when navigating health information and services in antenatal care.
The aim of the study was to explore the health literacy concept from
women's point of view.
MATERIALS AND METHODS: An inductive, qualitative study with
interpretive description as the overall methodology. Data collection
proceeded through 10 semi-structured interviews. Informants con-
sisted of pregnant women with a prepregnancy BMI ≥ 25 kg/m2,
attending antenatal care in the midwifery clinic at Aarhus University
Hospital in the Central Denmark Region.
RESULTS: Health professionals deliver general, understandable health
information to pregnant women with a prepregnancy BMI ≥ 25 kg/
m2, but transformation of knowledge into specific healthy behavior
presents a challenge. Navigation in booking systems and available dig-
ital services presents a struggle to the women, but apps can be helpful
to accommodate navigation. Navigation may require adequate
eHealth Literacy. Conflicting information from health professionals,
social media, family etc. is a challenge for the women, and requires a
broad skillset to critically evaluate and solve.
CONCLUSION: Adequate health literacy is necessary for pregnant
women with a prepregnancy BMI > 25 kg/m2 receiving antenatal care
to (i) translate general health information into personalised healthy
behaviour, (ii) access and navigate complex and digitalised systems,
and (iii) critically evaluate conflicting information. Person-centered dif-
ferentiation in the organisation of antenatal care may benefit vulnera-
ble pregnant women with inadequate health literacy.
DISCLOSURE OF INTEREST: None declared.
1467789x, 2022, S2, Downloaded from https://onlinelibrary.wiley.com/doi/10.1111/obr.13503 by CAPES, Wiley Online Library on [16/12/2023]. See the Terms and Conditions (https://onlinelibrary.wiley.com/terms-and-conditions) on Wiley Online Library for rules of use; OA articles are governed by the applicable Creative Commons License
SUPPLEMENT ARTICLE
P223 | Impact of COVID-19 on lifestyle
behaviours of women 6 months following a
hypertensive disorder of pregnancy: A BP2
sub-study
M. L. Gow1,2,3; C. Rossiter1; M. Thomas1; L. Yang3; J. Roche4;
E. Hayes5; A. Canty6; L. Roberts2,3; A. Henry2,3,7 BP2 Steering
Committee
1
The University of Sydney; 2University of NSW; 3St George Hospital;
4
Royal Hospital for Women; 5Royal Prince Alfred Hospital; 6Liverpool
Hospital; 7The George Institute, Sydney, Australia
INTRODUCTION: Maintaining a healthy weight and lifestyle follow-
ing a hypertensive disorder of pregnancy is crucial for preventing
future cardiovascular disease. However, the COVID-19 pandemic
introduced unprecedented barriers to adopting healthy lifestyle
behaviours. The aim of this study was to determine how the COVID-
19 pandemic affected the diet and physical activity behaviours of
women 6 months following a hypertensive disorder of pregnancy.
MATERIALS AND METHODS: This sub-study represents a cross sec-
tional analysis of baseline data, collected at 6-months postpartum
from March 2019–February 2022, as part of the Blood Pressure Post-
partum study which recruited women following a hypertensive disor-
der of pregnancy from six Sydney metropolitan hospitals. Dates of
COVID-19 lockdowns for Sydney, Australia were collected from gov-
ernment websites. Diet (vegetable, fruit, alcohol, take away intake)
and physical activity (walking, vigorous activity, strength training fre-
quency and duration) were assessed using the self-report NSW Popu-
lation Health Survey. Outcome data were compared between women
who completed surveys ‘In Lockdown’ versus ‘Not in Lockdown’ as
well as ‘Prior to any Lockdown’ versus ‘During or Following any
Lockdown’.
RESULTS: Data were available for 506 participants; 84 women com-
pleted the study surveys during lockdown, and 149 completed the
surveys prior to any lockdown. Diet and physical activity did not differ
among women who completed the survey ‘In Lockdown’ versus ‘Not
in Lockdown’. ‘Prior to any Lockdown’ participants were more likely
to do any walking (95% versus 89%, p = 0.017), any vigorous activity
(43% versus 30%, p = 0.006) or any strength training (44% versus
33%, p = 0.024), spent more time doing vigorous activity (p = 0.003)
and strength training (p = 0.047) and were more likely to drink alcohol
at least monthly (54% versus 38%, p < 0.001) compared with ‘During
or Following any Lockdown’.
CONCLUSION: Our findings suggest that the confinements of lock-
down did not influence the diet and physical activity behaviours of
women 6 months following a hypertensive disorder of pregnancy.
However, physical activity levels were reduced following the emer-
gence of COVID-19, suggesting targeted efforts may be necessary to
entice postpartum women to reengage with exercise.
DISCLOSURE OF INTEREST: None declared.

SUPPLEMENT ARTICLE
P225 | Reducing postpartum weight
retention through lifestyle management:
Preferred intervention characteristics by
postpartum women
S. Lim1; M. Savaglio2; H. Skouteris2; L. Moran3
1 1
Health Systems and Equity, Eastern Health Clinical School, Monash
2
University, Boxhill; Health and Social Care Unit, Monash University,
Melbourne; 3Monash Centre of Health Research and Implementation,
Monash University, Clayton, Australia
INTRODUCTION: Postpartum weight retention is a significant con-
tributor to weight gain and obesity in women of reproductive age.
Achieving and maintaining a healthy lifestyle during this period could
be challenging. This study aimed to describe the preferences of post-
partum women on lifestyle intervention characteristics according to
the Template for Intervention Description and Replication (TIDieR)
framework.
MATERIALS AND METHODS: Women who have given birth within
the last 2 years and living with the child were recruited through con-
venience sampling to complete an interview (30–40 min) via Zoom.
Informed consent was obtained at the start of the interviews. Inter-
views were audio-recorded and transcribed using a professional tran-
scription service. All interview transcripts were coded by one author
(MS), with a 10% subset independently coded by other authors (SL,
LM). Thematic analysis was conducted using an open coding
approach. The main themes were subsequently mapped to the TIDieR
domains (Who, What, When, Where, How, How much, How often).
RESULTS: Sixteen themes were mapped against the seven TIDieR
domains. Postpartum women perceived lifestyle as a holistic balance
between diet, exercise, sleep and social connections. They preferred
interventions that addressed the health concerns of mothers and
infants. They preferred interventions that involve partners and peer
groups, include activities for both mother and babies, provide
accountability as well as practical strategies around childcare, cleaning
and cooking. Convenience and flexibility are key considerations in
delivery methods, with benefits and limitations stated for in-person
and online versions. Most suggested weekly to fortnightly sessions to
build a routine, with each session lasting 30–60 min depending on the
nature of the activities. Most women prefer lifestyle advice between
3 to 6 months of birth before returning to work. Maternal child health
nurses or mothers' groups were seen as an appropriate source to
receive lifestyle advice. Most expected the intervention to be deliv-
ered without cost to participants as with other community programs,
at a child-friendly venue.
CONCLUSION: Postpartum women are interested in receiving life-
style advice within the first 6 months after birth. Interventions should
target health holistically for both mothers and babies, provide practi-
cal strategies, at a weekly to fortnightly frequency, using convenience
and flexible delivery mode.
DISCLOSURE OF INTEREST: None declared.
1467789x, 2022, S2, Downloaded from https://onlinelibrary.wiley.com/doi/10.1111/obr.13503 by CAPES, Wiley Online Library on [16/12/2023]. See the Terms and Conditions (https://onlinelibrary.wiley.com/terms-and-conditions) on Wiley Online Library for rules of use; OA articles are governed by the applicable Creative Commons License
101 of 222
P226 | The use of mobile-based ecological
momentary assessment (mEMA)
methodology to assess dietary intake and
context in young people: A systematic review
S. Jia1; B. Battaglia2; L. Lee2; S. Partridge1; M. Allman-Farinelli2
Engagement and Co-Design Research Hub; 2Charles Perkins Centre,
Sydney Nursing School, The University of Sydney, Sydney, Australia
INTRODUCTION: Understanding food consumption behaviours and
meal patterns during young adulthood is critical to developing effec-
tive interventions to promote better nutrition and prevent obesity.
Mobile-based ecological momentary assessment (mEMA) which
involves the use of technology to sample data in real-time, may offer
valuable situational context surrounding eating and drinking occa-
sions. To date, it remains unclear whether mEMA is suitable as
method to measure dietary intake and related contextual factors in
young people. The aim of this systematic review was to assess the
methodological features of mEMA in dietary studies conducted in
young people aged between 16–30 years and synthesise findings on
its feasibility, acceptability, and validity.
MATERIALS AND METHODS: Five electronic databases (MEDLINE,
PsycINFO, CINAHL, Embase and Scopus) were searched from January
2008 to September 2021. The systematic review was conducted in
adherence to the Preferred Reporting Items for Systematic Review
and Meta-Analysis (PRISMA) guidelines.
RESULTS: Forty-six articles from 39 independent studies were
included. Fourteen studies comprehensively examined intake of foods,
food groups and beverages and seven studies examined intake of
high-fat foods only. Food consumption behaviours were observed in
34 of 39 studies. Nearly 70% (27/39) of all studies used a signal-
contingent (timed notification as a prompt) sampling approach to
gather data from participants. Smartphone apps were the predomi-
nant delivery mode (67%, 26/39), most studies monitored participants
over a period of 4–7 days (51%, 20/39) and delivered 4–6 prompts a
day (59%, 23/39). Compliance rates were reported to be over 80% in
20 studies. A low proportion of studies (4/39) validated mEMA
against a gold standard dietary assessment method, many (17/39)
instead used a validated questionnaire based on previous research.
CONCLUSION: This review demonstrates a wide variation in mEMA
methodology for diet-related research. Monitoring and assessing die-
tary behaviours in real-time using mobile technology could be a feasi-
ble and acceptable method for studying young people if balanced
with an appropriate sampling approach, monitoring period and prompt
frequency. It is recommended that future studies should include a val-
idation component of the mEMA method against dietary data collec-
tion instruments with higher quality reporting to strengthen the
evidence for its use in further research. Such novel methods are
essential for monitoring food and drink consumption, to understand
ways to empower individuals to stay healthy and work towards objec-
tives of national obesity strategies.
DISCLOSURE OF INTEREST: None declared.

102 of 222
P227 | Sleep patterns and obesity according
to income and education level in Korean
elderly
Y.-H. Kim1; B. D. Han2
1
Department of Family medicine; 2Korea University College of Medicine,
Korea University Anam Hospital, Seoul, Korea, Republic Of
INTRODUCTION: Obesity is a major health risk factor, and the
association between sleep duration and the prevalence of obesity
is well known. Socioeconomic status is also associated with obesity
prevalence and recently, there are some studies about sleep pat-
tern and obesity. Therefore, we investigated the sleep mismatch
and obesity according to economic and educational status in
Korean elderly population.
MATERIALS AND METHODS: Data from the Korean National Health
and Nutrition Examination Survey (KNHANES), which was conducted
between 2016 and 2017. The analysis in this study was confined to a
total of 3611 respondents over the age of 60 years. Sleep mismatch
was defined when sleep duration in the weekend was longer than
during weekdays and sleep mismatch was classified as <60 min,
60–120 min, and ≥120 min. Sleep duration, educational and economic
status was also surveyed. Multiple logistic regression analysis was per-
formed to obtain odds ratio (OR) for obesity after adjusting for signifi-
cant confounding variables.
RESULTS: A total of 3611 participants (1566 was men and 2045
women) were enrolled in the study. After adjusting for all covariates,
women with sleep mismatch 60–120 min showed increased OR for
obesity (OR = 2.02) and women with the lowest educational level
showed increased OR for obesity and underweight (OR = 1.63 and
3.05, respectively) in the lowest income level (Q1) compared to
women without sleep mismatch. However, there was no relationship
between sleep mismatch and obesity prevalence in women with other
economic and educational status. Also there was no relationship
between sleep mismatch and obesity in men according to socioeco-
nomic status.
CONCLUSION: Sleep mismatch is associated with obesity especially
in Korean elderly women with low income or low educational level.
DISCLOSURE OF INTEREST: None declared.
1467789x, 2022, S2, Downloaded from https://onlinelibrary.wiley.com/doi/10.1111/obr.13503 by CAPES, Wiley Online Library on [16/12/2023]. See the Terms and Conditions (https://onlinelibrary.wiley.com/terms-and-conditions) on Wiley Online Library for rules of use; OA articles are governed by the applicable Creative Commons License
SUPPLEMENT ARTICLE
P228 | Assessing the scalability of evidence-
based healthy eating and physical activity
programs in early childhood education and
care services across Australia
A. Grady1,2,3,4,5; S. L. Yoong6; J. Jackson1; M. Lum1
1
School of Medicine and Public Health, University of Newcastle,
Newcastle; 2Population Health, Hunter New England Local Health
District, Wallsend; 3Public Health, Hunter Medical Research Institute,
New Lambton Heights; 4National Centre of Implementation Science;
5
Priority Research Centre for Health Behaviour, University of Newcastle,
Newcastle; 6Health Sciences, Swimburne University of Technology,
Melbourne, Australia
INTRODUCTION: As early childhood education and care (ECEC) ser-
vices provide access to a substantial proportion of young children,
there has been considerable public health and research investment
placed on the development and implementation of effective
childcare-based obesity prevention programs at scale. However, few
interventions have been scaled up to reach the population, and of
these, systematic review evidence shows that on average these inter-
ventions retain only 50% of their proven efficacy. To maximise their
public health impact, interventions need not only be effective but also
consider a range of scalability factors, such as the expertise and
resources required to deliver the intervention outside of the research
environment, the potential reach, cost, end-user infrastructure, and fit
within the local context. This study aimed to describe perceptions
regarding the scalability of evidence-based healthy eating and physical
activity programs amongst randomly selected national sample of
Australian childcare services.
MATERIALS AND METHODS: A cross-sectional online or telephone
survey is being conducted with a random sample of ECEC services
across Australia. A bespoke measure of 15 items on a 5-point Likert
scale (strongly disagree–strongly agree) based on the 10 domains of
the Intervention Scalability Assessment Tool was developed to assess
end-user perceptions regarding the scalability of six evidence-based
healthy eating (e.g., training educators to support child healthy eating),
and seven evidence-based physical activity (e.g., providing sufficient
opportunities for child physical activity) programs. Descriptive statis-
tics will be used to describe the survey respondents and the perceived
scalability of each evidence-based healthy eating and physical activity
program.
RESULTS: Overall, 480 childcare services have completed the survey
to date (50% consent rate). Preliminary analyses indicate the
evidence-based healthy eating and physical activity programs
assessed received a mean scalability score of 40.14, ranging 37.77–
43.01 (maximum score of 50). Study completion is anticipated May
2022.
CONCLUSION: The findings of this study will provide insight into
the perceived scalability of evidence-based healthy eating and
physical activity interventions in the ECEC setting across Australia.
Such findings will help to identify where government investments

SUPPLEMENT ARTICLE
and implementation efforts are best placed to ensure the success-
ful scale up of evidence-based obesity prevention interventions in
the setting.
DISCLOSURE OF INTEREST: None declared.
P229 | A pilot trial assessing a workplace
health promotion program to engage school
staff in physical activity and healthy eating
behaviours
A. Hall1,2,3,4; B. Murawski2,3,4; L. Wolfenden1,2,3,4;
R. Sutherland1,2,3,4; C. Lecathelinais1,2,3,4; N. McCarthy1,2,3,4;
A. Shoesmith1,2,3,4; C. Lane1,2,3,4; S. Yoong1,2,4,5; K. Reilly1,2,3,4;
K. Hope1; R. Hodder1,2,4,6; N. Nathan1,2,4,6
1
Hunter New England Population Health, Wallsend; 2School of Medicine
and Public Health, University of Newcastle, Newcastle; 3Hunter Medical
Research Institute, New Lambton; 4Priority Research Centre for Health
Behaviour, University of Newcastle, Newcastle; 5School of Health
Sciences, Swinburne University of Technology, Hawthorn; 6Hunter
Medical Research Institute, Wallsend, Australia
INTRODUCTION: Poor nutrition and inadequate physical activity are
two of the main risk factors for overweight and obesity. Workplace
interventions provide an ideal opportunity to target these risk factors.
In a school setting there are numerous existing healthy eating and
physical activity programs that are delivered to students that could
incorporate participation of school staff. We aimed to improve
teacher's engagement in physical activity and healthy eating by sup-
porting the implementation of existing student health promotion pro-
grams to include adult school staff.
MATERIALS AND METHODS: This was a pilot study conducted as
cluster randomised controlled trial. Following baseline data collection
18 primary schools were randomised to receive either the Schools
Working to Improve Staff Health (SWISH) intervention (n = 9), or to a
waitlist control (n = 9). Schools randomised to SWISH received a
multi-component intervention that supported teachers to participate
in existing student health promotion programs. Teacher's physical
activity was assessed via wrist-worn accelerometers, and their daily
consumption of fruit and vegetables via a self-report survey. Differ-
ences in teacher physical activity and diet outcomes at follow-up were
compared using generalised linear mixed models.
RESULTS: 276 teachers provided self-report survey data and 289 pro-
vided accelerometer data. Teachers who received SWISH had higher
odds of participating in classroom physical activity (OR: 1.78; 95% CI:
0.20, 15.77) and fruit and veg breaks (OR: 2.89; 95% CI: 0.28, 29.60).
Compared to teachers in the control condition those who received
SWISH reported higher odds of consuming fruit (OR: 1.04; 95% CI:
0.09, 11.76) and vegetables (OR: 1.77; 95% CI: 0.16, 19.07) in line
with guideline recommendations. However, none of these differences
were statistically significant. Limited impact on physical activity out-
comes was observed.
1467789x, 2022, S2, Downloaded from https://onlinelibrary.wiley.com/doi/10.1111/obr.13503 by CAPES, Wiley Online Library on [16/12/2023]. See the Terms and Conditions (https://onlinelibrary.wiley.com/terms-and-conditions) on Wiley Online Library for rules of use; OA articles are governed by the applicable Creative Commons License
103 of 222
CONCLUSION: This pilot illustrates SWISH as a potentially simple,
acceptable and feasible intervention to address school's staff's health
behaviours, particularly diet outcomes. A larger trial to explore the
impact of SWISH is required.
DISCLOSURE OF INTEREST: A. Hall: None declared, B. Murawski:
None declared, L. Wolfenden: None declared, R. Sutherland: None
declared, C. Lecathelinais: None declared, N. McCarthy: None
declared, A. Shoesmith: None declared, C. Lane: None declared,
S. Yoong: None declared, K. Reilly: None declared, K. Hope: None
declared, R. Hodder: None declared, N. Nathan Grant/Research sup-
port with: jointly funded by the Teachers Health Foundation and
Hunter New England Population Health.
P230 | Differential effects of diet and
physical activity interventions in pregnancy
to prevent gestational diabetes mellitus and
reduce gestational weight gain by level of
maternal adiposity: A protocol for an
Individual Patient Data (IPD) meta-analysis
A. Boath1; L. Vale1; L. Hayes1; J. Allotey2; N. Heslehurst1
1
Population Health Sciences Institute, Newcastle University, Newcastle
Upon Tyne; 2Institute of Applied Health Research, University of
Birmingham, Birmingham, UK
INTRODUCTION: Maternal overweight and obesity prevalence is
increasing globally, as are associated adverse pregnancy outcomes
(e.g., gestational diabetes (GDM) and excessive gestational weight
gain (GWG)). Both GDM and GWG can have immediate, long-term
and intergenerational effects. Weight management interventions in
pregnancy, with diet and physical activity components, have typically
been delivered universally, or targeted towards all women above a
certain BMI. Interventions have been largely ineffective at preventing
GDM but have been consistently effective at reducing GWG,
although effect sizes are variable. Effectiveness may increase with
better targeting using alternative measures of adiposity to BMI
(e.g., waist circumference). We aim to evaluate if the effectiveness of
weight management interventions for the prevention of GDM and
reduction of GWG differs for women identified as having high adipos-
ity based on alternative (to BMI) measures.
MATERIALS AND METHODS: The International Weight Management
in Pregnancy (i-WIP) Collaborative Network has a living database of IPD
from randomised trials of diet and/or physical activity interventions in
pregnancy. Our analyses will use IPD systematically identified up to
March 2021. IPD on maternal adiposity measures (e.g., waist circumfer-
ence) collected prior to 20 weeks' gestation, GDM diagnosis and GWG
will be analysed. Following data harmonisation, a two-stage random
effects meta-analysis will be used for GWG and GDM. Summary inter-
vention effects with 95% confidence intervals will be derived along with
treatment co-variate interactions. Between-study heterogeneity will be
summarised by I2 and tau2 statistics. Potential sources of bias will be

104 of 222
evaluated. The nature and pattern of missing data will be explored, and
appropriate imputation methods adopted if assumptions are met.
RESULTS: Results have the potential to influence how weight man-
agement interventions in pregnancy are targeted. It may be better to
select women based upon alternative adiposity measures rather than
BMI alone.
CONCLUSION: To our knowledge, this is the first evaluation of
weight management interventions based upon adiposity measures. If
adiposity is found to be important in targeting interventions in preg-
nancy, this could be extrapolated for weight management interven-
tions in the preconception, interpregnancy and postnatal periods. The
work also forms the basis for extending analyses to estimate the cost-
effectiveness of using adiposity measures to target interventions for
the prevention of GDM and reduction of GWG.
DISCLOSURE OF INTEREST: None declared.
P231 | A systematic review of behavioural
early childhood obesity prevention trials—
Forming the TOPCHILD Collaboration
A. L. Seidler1; B. Johnson2; M. Aberoumand1; J. Williams1; R. Golley2;
S. Libesman1; A. Barba1; L. Askie1; L. Baur3; K. Hunter1 on behalf
of the TOPCHILD Collaboration
1
NHMRC Clinical Trials Centre, University of Sydney, Sydney; 2Caring
Futures Institute, Flinders University, Adelaide; 3Child and Adolescent
Health, University of Sydney, Sydney, Australia
INTRODUCTION: Childhood obesity rates are high, so prevention
should start early. There is a gap in understanding what type of child-
hood obesity prevention interventions is effective. We aimed to bring
together all planned, ongoing and completed interventions addressing
early childhood obesity prevention in a global alliance, and map their
key characteristics, target behaviours and effectiveness.
MATERIALS AND METHODS: We conducted a systematic review,
searching medical databases (e.g., Medline, EMBASE) and clinical trial
registries (ClinicalTrials.gov, WHO ICTRP) for RCTs evaluating beha-
vioural interventions aimed at preventing obesity and starting before
the first year of life. All eligible trials were invited to join the Trans-
forming Obesity Prevention for CHILDren (TOPCHILD) Collaboration
and asked to share their intervention materials and individual partici-
pant data. We mapped characteristics of all trials that have joined
TOPCHILD, including their location, delivery features, target behav-
iours and effectiveness.
RESULTS: We identified 76 trials (55 completed, 19 ongoing) with a
total of 54,901 infant-parent dyads (participants). Of those, 48 trials
(with 40,197 participants) have joined the TOPCHILD Collaboration to
date, representing 63% of trials and 73% of eligible participants. TOP-
CHILD trials are set in 15 countries, including 4 middle and 11 high
income countries. To date, 35 TOPCHILD trials have been completed
(31,185 participants). Around half (16; 55%) included an infant
weight-related outcome as their primary outcome. Intervention
1467789x, 2022, S2, Downloaded from https://onlinelibrary.wiley.com/doi/10.1111/obr.13503 by CAPES, Wiley Online Library on [16/12/2023]. See the Terms and Conditions (https://onlinelibrary.wiley.com/terms-and-conditions) on Wiley Online Library for rules of use; OA articles are governed by the applicable Creative Commons License
SUPPLEMENT ARTICLE
effectiveness varied, data on effectiveness for weight-related out-
comes was available for 26 trials, 7 of these (27%) detected a statisti-
cally significant improvement. Many trials alone were statistically
underpowered to detect differences in weight-related outcomes.
Interventions varied in content and delivery features and targeted a
range of behaviours. Within the 35 trials there were 41 active inter-
vention arms, 31 of those (75%) targeted infant feeding practices
(breast- and formula feeding), 36(88%) food provision feeding prac-
tices, 24 (59%) movement practices, and 7 (17%) sleep health
practices.
CONCLUSION: There is a plethora of trials in early childhood obesity
prevention, but they are heterogeneous in geographical location, tar-
get behaviours, outcomes, and effectiveness. The TOPCHILD Collabo-
ration brings together 48 trials with over 40,000 participants, to
understand which interventions work, how and for which populations.
This improved understanding of the landscape of early obesity pre-
vention trials will enable better planning and adaptation of programs,
to implement effective programs into policy and practice.
DISCLOSURE OF INTEREST: None declared.
P232 | Describing the delivery features used
in early child obesity prevention
interventions within the TOPCHILD
Collaboration
B. J. Johnson1; S. Shaw1; H. I. Lau1; R. Golley1; K. Hunter2;
P. Chadwick3; A. L. Seidler2 On behalf of the Transforming Obesity
Prevention for CHILDren (TOPCHILD) Collaboration
1
Caring Futures Institute, Flinders University, Adelaide; 2NHMRC Clinical
Trials Centre, The University of Sydney, Sydney, Australia; 3University
College London, London, UK
INTRODUCTION: Over the past two decades numerous early obesity
prevention interventions have been designed and tested. Interventions
use different approaches and features to deliver intervention content.
Understanding the features of how such interventions are delivered
(i.e., delivery features) provides a first step towards examining interven-
tion effectiveness by different approaches, to inform design of future
interventions. This project aimed to determine which delivery features
are commonly used in early child obesity prevention interventions, and
to identify any novel, untapped delivery features.
MATERIALS AND METHODS: Annual systematic searches were per-
formed in Epub Ahead of Print/MEDLINE, Embase, Cochrane
(CENTRAL), CINAHL, PsycINFO, as well as clinical trial registries from
2020–2021. Eligible randomised controlled trials of behavioural child
obesity prevention interventions commencing antenatally or in the
first year after birth were invited to join the Transforming Obesity in
CHILDren (TOPCHILD) Collaboration. Delivery features (e.g., why,
what, when, where, by whom, how an intervention is delivered) were
coded into categories using a standardised codebook, in duplicate by
independent coders. Consensus was achieved through discussion

SUPPLEMENT ARTICLE
between coders or with the senior reviewer. Narrative syntheses
were performed to summarise delivery features.
RESULTS: Thirty-five completed studies involving 41 active interven-
tions joined the TOPCHILD Collaboration as of March 2022. Prelimi-
nary findings revealed the most commonly used feature categories
were providing written materials (n = 29 intervention arms), didactic
sessions (n = 39), face-to-face delivery (n = 32), home setting
(n = 25), and monthly or greater frequency of contact (n = 26). There
was large variation in the underpinning theory and who delivered
interventions, with nursing/midwifery professionals (n = 15) being
the most commonly reported. Few interventions described features of
tailoring (n = 14) and modifications (n = 2), or used mobile applica-
tions (n = 2) or less than weekly frequency of contact (n = 1).
CONCLUSION: This project provides the first comprehensive, system-
atic examination of delivery features used in early child obesity pre-
vention interventions. While there were some common features
across majority of interventions, such as the materials or procedures
used, there was in general large variation in features such as the
underpinning theory, who delivers the intervention and mode of deliv-
ery and intervention dose. We have also identified untapped delivery
features in early child obesity prevention interventions to be investi-
gated in future research.
DISCLOSURE OF INTEREST: None declared.
P233 | Optimising a physical activity policy
implementation strategy via sequential
randomised and controlled trials: The PACE
case study
C. Lane; L. Wolfenden; A. Hall; A. Shoesmith; N. Nathan
University of Newcastle, Newcastle, Australia
INTRODUCTION: The implementation of school-based physical activ-
ity policies mandated by many jurisdictions internationally is poor.
Thus, the potential benefits of such policies for childhood obesity
reductions and other related health outcomes are seldom realised.
The multi-strategy Physically Active Children in Education (PACE) inter-
vention effectively increases schools' implementation of such policies;
however it may be improved to ensure successful translation from the
research setting to real-world contexts. Here, we describe the novel
approach we have used to optimise PACE for delivery at-scale.
MATERIALS AND METHODS: In the field of public health, optimisation
processes (cyclical and data-driven) are increasingly recognised for their
potential to improve interventions and maximise health impacts. The
intent of optimisation is to identify an intervention that is as effective as
possible within the resource constraints of end-users (delivery providers
and/or target setting). We employed a two-stage optimisation process
to improve PACE, inclusive of three sequential randomised and con-
trolled trials (RCTs) conducted in primary schools in NSW, Australia.
Areas for incremental improvements were identified using assessments
1467789x, 2022, S2, Downloaded from https://onlinelibrary.wiley.com/doi/10.1111/obr.13503 by CAPES, Wiley Online Library on [16/12/2023]. See the Terms and Conditions (https://onlinelibrary.wiley.com/terms-and-conditions) on Wiley Online Library for rules of use; OA articles are governed by the applicable Creative Commons License
105 of 222
of intervention effectiveness, costs, and implementation indicators, as
well as ongoing consultation with stakeholders and end-users.
RESULTS: Stage One optimisation of PACE comprised two RCTs: a
2017 pilot study in 12 schools and a 2018 hybrid implementation-
effectiveness study in 61 schools. This stage established the feasibility
and preliminary effectiveness of PACE for improving schools' policy
compliance and students participation in physical activity. An economic
evaluation showed an acceptable incremental cost-effectiveness ratio to
achieve policy implementation, and highlighted more costly PACE strate-
gies. Data were collectively used to inform adaptations made to reduce
in-person contact from external support personnel. Stage Two optimisa-
tion comprised a 2019 noninferiority RCT in 48 schools to empirically
evaluate the adapted PACE intervention. Findings showed that adapted
PACE minimised the relative cost of delivery without losing its meaning-
ful effect on policy implementation.
CONCLUSION: The optimisation of PACE is the first of its kind to
employ sequential RCTs to improve an implementation strategy. This
approach was well-suited to our research setting and it may set prece-
dence for optimisation research undertaken in similar contexts. The
resultant ‘optimised’ PACE intervention is an effective, cost-efficient
model with scalable modes of delivery. This case study provides
important information for researchers and policy makers seeking to
improve the impact of health interventions.
DISCLOSURE OF INTEREST: None declared.
P234 | Effectiveness of food systems' policies
and interventions on nutrition, climate
change and inequalities—A scoping review
C. Burgaz1,2; V. Gorasso1; S. Vandevijvere1 INFORMAS
1 2
Epidemiology and Public Health, Sciensano; Department of
Environmental Sciences, Université libre de Bruxelles (ULB), Brussels,
Belgium
INTRODUCTION: By 2050 the global population is projected to be
close to 10 billion. Thus, a pressing question is how to act at policy
level to meet the demand for nutritious food, providing healthy and
accessible diets for all, without impairing biodiversity, natural sources
and the environment. We conducted a scoping review to identify the
effectiveness of food systems policies or interventions on nutritional,
environmental and equity outcomes.
MATERIALS AND METHODS: A literature search was conducted in
2021 across four databases, adhering to PRISMA guidelines. A total of
196 reviews met the inclusion criteria and were included in the analy-
sis. The selected reviews were extracted and classified according to
the 10 subdomains within food systems, prior-defined through the
information taken from a broad compilation of 33 international policy
reports. Quality assessment was performed, and key information for
each review was extracted and summarised in a narrative synthesis.
RESULTS: The majority of the types of interventions studied reported
to be effective in addressing at least one outcome. For food supply

106 of 222
chain interventions, the most reported outcome was undernutrition;
while for food environment interventions, the most reported out-
comes were diet quality and overweight/obesity. The most important
interventions with triple duty potential were sustainable agriculture
practices and school food programmes. Other strategies such as
front-of-pack labelling, reformulation, in-store nudging interventions,
taxes and subsidies have shown to have double duty potential across
outcomes (mainly obesity prevention and environmental sustainabil-
ity). Overall, initiatives which combined two or more strategies were
found to be the most effective to improve nutrition outcomes. The
overall quality of the reviews was low and important gaps remain, in
particular related to the impact of food loss/waste, trade, packaging
and distribution, or restrictions on unhealthy food marketing on all
the outcomes. The outcomes the least studied were environmental
sustainability and women's empowerment.
CONCLUSION: Current evidence available is limited and heteroge-
neous across policy interventions. Many interventions reported to be
effective in achieving healthy diets and/or preventing obesity/NCDs.
Policies combining health and sustainability objectives are few and
mainly for the information type (labelling) or at schools (provision). To
the best of our knowledge, this is the first scoping review evaluating
effectiveness of food system policies on the double burden of malnu-
trition and the environment.
DISCLOSURE OF INTEREST: None declared.
P235 | Preliminary results of an online
lifestyle intervention during the COVID-19
pandemic on the BMI z-score of Mexican
schoolchildren: Outcome assessor-blinded
pilot randomized controlled trial
1 1
D. L. Ramírez Rivera ; T. Martínez Contreras ; A. Ruelas ; 1 Torres Strait Islander communities:
J. Esparza Romero2; T. Quizán Plata1; M. M. Haby1;
R. G. Díaz Zavala1
1
Department of Chemical and Biological Sciences, University of Sonora;
2
Department of Public Nutrition and Health, Research Center for Food
and Development A. C, Hermosillo, Sonora, Mexico
INTRODUCTION: The COVID-19 pandemic has been a risky period
for childhood obesity, due to the increase in unhealthy behaviors.
Online interventions could promote healthy habits. To our knowledge,
there are no randomized controlled trials aimed at preventing child-
hood obesity during the pandemic. The aim of this study was to evalu-
ate the effect of an online childhood obesity prevention program on
the BMI z-score of Mexican schoolchildren at 4 months during the
COVID-19 pandemic.
MATERIALS AND METHODS: A pilot randomized controlled trial of
4 months was conducted. Schoolchildren from an elementary school
in Northern Mexico were invited to participate. The intervention was
implemented from March through July 2021, children were taking
their normal school classes online. The study protocol was approved
1467789x, 2022, S2, Downloaded from https://onlinelibrary.wiley.com/doi/10.1111/obr.13503 by CAPES, Wiley Online Library on [16/12/2023]. See the Terms and Conditions (https://onlinelibrary.wiley.com/terms-and-conditions) on Wiley Online Library for rules of use; OA articles are governed by the applicable Creative Commons License
SUPPLEMENT ARTICLE
by the Research Ethics Committee of the University of Sonora
Department of Nursing (EPM-003-2020) and registered in Clinical Tri-
als (NCT04772859). All interested participants provided the written
informed consent and assent. Children were included if they had
internet and an electronic device. The intervention group had 3 online
sessions of nutrition and physical activity (60 min per session; 30 min
per area) per week during the 4-month intervention, and parents were
given nutrition information. The control group received one digital
brochure with recommendations for a healthy lifestyle. The primary
outcome was the BMI z-score and the secondary outcomes were:
waist circumference, relative fat mass, physical activity and sedentary
activities, diet, quality of life and nutrition knowledge. An independent
t-test for two samples or Mann–Whitney U was used to analyze the
difference in the change of the BMI z-score and secondary outcomes
between groups.
RESULTS: From 54 schoolchildren who started the study, 87% com-
pleted it. Children attended a mean of 22 of the 48 sessions (46%).
Intention-to-treat analysis at 4 months, showed no significant differ-
ence between groups in the BMI z-score change ( 0.02, 95% CI
0.19 to 0.15). However, the intervention group significantly
improved their quality of life score (7.00, 95% CI 0.40 to 13.6) and
fruit consumption.
CONCLUSION: This study showed that an online lifestyle intervention
implemented during the COVID-19 pandemic did not affect the BMI z-
score of schoolchildren, but improved other secondary variables. More
studies are required to evaluate the effect of these interventions in the
pandemic, and strategies to increase attendance are also needed.
DISCLOSURE OF INTEREST: None declared.
P236 | A strategy for discounting healthy
foods and drinks in remote Aboriginal and
Participant use and satisfaction
E. Tonkin1; E. McMahon2; A. Gunther2; E. Chan3; C. Deen4;
C. Brown4; E. Stubbs3; A. Bowden4; K. Cullerton1; A. Lee1;
D. Leonard4; C. Mah5; B. Fredericks1; J. Pauli3; J. Brimblecombe6;
M. Ferguson1
1
The University of Queensland, Brisbane; 2Menzies School of Health
Research, Darwin; 3Central Australian Aboriginal Congress, Alice Springs;
4
Apunipima Cape York Health Council, Cairns, Australia; 5Dalhousie
University, Halifax, Canada; 6Monash University, Clayton, Australia
INTRODUCTION: People living in remote Aboriginal and Torres Strait
Islander communities experience a disproportionate burden of prevent-
able chronic disease, in large part due to dietary factors underpinned by
inequity. The cost of a healthy diet in remote communities can be >30%
greater than the cost in major cities. A co-designed economic interven-
tion in the form of a discount to reduce the cost of healthy foods and
drinks in remote community stores was trialled. Here we describe partici-
pant use of, and satisfaction with, this strategy.

SUPPLEMENT ARTICLE
MATERIALS AND METHODS: A controlled before-and-after design
over a 6-month study period in 8 communities was used. All Aboriginal
and/or Torres Strait Islander pregnant and breastfeeding women, and
carers of children aged 6 months to 5 years were eligible for a discount
card, which provided 30% discount on healthy foods and drinks to a
capped value of $80, $100 or $120 each fortnight depending on the
number of eligible family members (1, 2 or 3+ respectively). Cards were
scanned at the register at time of purchase to redeem discount immedi-
ately. Promotional material and shelf stickers identified eligible foods.
Card purchases were tracked using store sales data. Participant satisfac-
tion was determined by a survey at study end. Data exploring strategy
implementation were collected from community advisors and store
managers.
RESULTS: Sales data from all 175 card holders showed strategy
uptake was very low; 60% used their card at least once, and 4% of the
allocated discount was used. Six (3%) participants reached 100%, and
24 (14%) reached 50% of their fortnightly allocation at least once. Sat-
isfaction surveys were completed with 114 (65%) participants, 82%
reported they found the card useful, and 82% and 57% reported they
purchased more and different foods (respectively) due to the discount.
Forgetting to use the card was the greatest barrier to use reported by
card users and non-users, followed by losing the card. Some imple-
mentation and population movement factors were reported by
community advisors and store staff to have potentially impacted par-
ticipants' opportunity to use their cards.
CONCLUSION: While considered by most participants to be useful,
this strategy for discounting healthy foods and drinks was not able to
be highly utilised. Future economic interventions could overcome the
card-use barriers identified here through consideration of a
population-wide approach in populations subjected to high food costs
and associated diet-related disease.
DISCLOSURE OF INTEREST: None declared.
P237 | The impact of COVID19 and ‘shocks’
on a whole of community childhood obesity
prevention trial in Australia
J. Whelan; M. Hillenaar; P. Fraser; M. Jackson; S. Allender; C. Bell;
C. Strugnell
Institute of Health Transformation, Deakin University, Geelong, Australia
INTRODUCTION: Childhood obesity impacts at least one in four chil-
dren across Australia. Large funded trials provide vital data for
researchers and practitioners to learn what works in preventing children
from experiencing an unhealthy weight. Over recent years, Australia, like
most countries, has experienced worsening climate events, particularly
bushfires, floods and droughts. The communities in this study were
emerging from a bushfire crisis as the COVID19 pandemic began. This
study sought to explore the impact of the pandemic and of natural disas-
ters on the capacity of stakeholders to maintain a vision that promotes
the health of children in a time of unprecedented crisis.
1467789x, 2022, S2, Downloaded from https://onlinelibrary.wiley.com/doi/10.1111/obr.13503 by CAPES, Wiley Online Library on [16/12/2023]. See the Terms and Conditions (https://onlinelibrary.wiley.com/terms-and-conditions) on Wiley Online Library for rules of use; OA articles are governed by the applicable Creative Commons License
107 of 222
MATERIALS AND METHODS: A case study design was used to
gather information from nine focus groups (online - Nov 2021–Feb
2022). Participants were recruited from diverse fields including local
government, health promotion, community health, health services, pri-
mary care partnerships, state government representatives and sports
and recreation facilities. A focus group schedule was developed based
on Durlak and Dupre's factors affecting the implementation process.
Participants reflected on how the COVID19 pandemic and recent nat-
ural disasters had impacted their capacity to implement a large-scale
funded trial. Focus groups were recorded, transcribed and themed in
NVivo to the interview schedule and emergent themes.
RESULTS: We held nine focus groups across five local government
areas with a total of 29 key stakeholders. The cross-sector represen-
tation we aimed for was achieved with all groups contributing to the
focus group discussions. Key themes included the pivoting of staff to
a COVID response, thereby being directly taken from their promotion
role to a ‘test and trace’ role. Of the staff who remained, they
reported a community who was no longer engaged with childrens
health in the manner it had been prioritised prior to COVID. Emphasis
had shifted to mental health and food security and to the family unit.
Where prevention work could be moved online this was initially seen
as a positive with engagement from people who had been more diffi-
cult to reach previously, however this was not sustained as the pan-
demic wore on. Invariably fatigue from multiple stakeholders was
reported due to the constant re-engagement that was attempted.
Stakeholders reflected on positive outcomes, most importantly an
observed strengthened sense of ‘care for others’ and a united ‘sense
of purpose’.
CONCLUSION: Shocks in the system are inevitable. COVID19 pro-
vides an ongoing opportunity to learn how to future-proof prevention
and our funded trials though adaptation and thinking and acting at a
very broad systems level for prevention. As one stakeholder observed
‘the importance of health is visible now’.
DISCLOSURE OF INTEREST: None declared.
P239 | Testing the Public Health
12 framework using a community-based
systems thinking obesity prevention case
study
K. A. Bolton1,2; J. Whelan2; A. Brown2; P. Fraser2; C. Bell2;
C. Strugnell2; S. Allender2
1
Institute for Physical Activity and Nutrition; 2Global Obesity Centre,
Institute for Health Transformation, Deakin University, Geelong, Australia
INTRODUCTION: There has been little guidance regarding the best
places to leverage in the complex problem of childhood obesity.
Recently, the Meadows 12 places to act in a system was translated
into language familiar to public health practitioners, termed Public
Health 12 (PH12). The aim of this study was to test the PH12 using
an action register that documented actions from a community-driven

108 of 222
systems approach to childhood obesity prevention in regional
Victoria, Australia.
MATERIALS AND METHODS: The action register contained informa-
tion as recorded by the project officer 2015–2019. This included: area
(e.g., active transport), variable of intervention focus (e.g., school envi-
ronment), action description (e.g., school bike bus), start date, status,
outputs, reach. An external reviewer with public health expertise allo-
cated each action into one of the 12 PH12 levels (ranging from level
1 (most effective): that is, the ability to continually adapt collective
fundamental beliefs leading to widespread change in the way things
are, to solve multiple complex problems; to level 12 (least effective):
to increase/decrease one isolated part of the system that already
exists in the community). Blinded double coding was conducted by an
original co-author of PH12, and the wider research team helped
achieve consensus for any coding disagreements.
RESULTS: The majority of actions was in levels 8–12 and largely con-
sisted of one-off isolated events. In 2015–2017, 106 actions were
registered. Of these, 16% were level 8, 25% level 10, 4% level 11 and
55% level 12. In 2018–2019, of the 96 actions implemented, 1% was
level 4, 5% level 8, 30% level 10, 7% level 11 and 56% level 12. The
highest level of action (level 4) was a local health service which imple-
mented a suite of level 5–12 actions in a “Going Green for Wellbeing”
initiative. Most common level 8 actions were policy-related, for exam-
ple, water only policies in basketball stadiums, healthy food policies.
The most common level 10 actions were active transport infrastruc-
ture (bike/walking school bus), regular breakfast clubs, establishment
of community/kitchen gardens and installation of drinking fountains.
The most common level 12 actions were one-off events such as
themed days at schools, workshops, forums, expos.
CONCLUSION: Coding community actions revealed a gap in action in
levels 1 to 7—leverage points which have been suggested to be more
effective at achieving and sustaining change in a system. In the future,
PH12 can help stakeholders identify gaps in planning, prioritising
and implementing actions—that is, identifying PH12 levels where
no action is planned and prioritising resources for actions to fill
those gaps.
DISCLOSURE OF INTEREST: None declared.
P240 | Community-wide clinical obesity
management implementation
1 2 3
L. D. Whigham ; N. V. Dhurandhar ; R. Dhurandhar ;
E. Dhurandhar3; A. N. Nathan4; H. W. Turnipseed5; A. M. Toney1
1
Center for Community Health Impact, The University of Texas Health
2
Science Center at Houston, El Paso; Department of Nutritional Sciences,
3 4
Texas Tech University; Obthera, Lubbock; Center for Community
Health Impact, Consultant; 5University of Texas at El Paso, El Paso, USA
INTRODUCTION: Individualized obesity management is studied and
practiced in clinical settings. Whereas, at the community level, obesity
is addressed through modification of environmental factors
1467789x, 2022, S2, Downloaded from https://onlinelibrary.wiley.com/doi/10.1111/obr.13503 by CAPES, Wiley Online Library on [16/12/2023]. See the Terms and Conditions (https://onlinelibrary.wiley.com/terms-and-conditions) on Wiley Online Library for rules of use; OA articles are governed by the applicable Creative Commons License
SUPPLEMENT ARTICLE
(e.g., physical activity opportunities, healthy food access). To synergize
the two approaches, here we describe our community-driven
approach to develop and deploy clinical management of obesity at a
community-wide scale.
MATERIALS AND METHODS: Through an iterative participatory pro-
cess focused on primary care providers (PCPs), we first developed a
comprehensive course that delivered training specific to obesity man-
agement for multidisciplinary clinic teams. Next, one-year follow-up
with course participants identified the need for and the development
of supplemental tools to facilitate practical implementation of course
content. Tools included a clinical decision support system software to
guide PCPs through a treatment algorithm and an online weight loss
diet planning program for patients. Using domains from the Consoli-
dated Framework for Implementation Research (CFIR), implementa-
tion was evaluated across varying clinical and community settings.
RESULTS: Preliminary results indicate that primary implementation
strengths and facilitators of program include evidence strength, rela-
tive advantage, and ease of use. For barriers to implementation, ‘time
limitation’ was consistent across sites. This barrier was related to
overall obesity treatment, not specific to the program design. Other
barriers varied by site including readiness for implementation and
inner setting domain (organizational culture and priorities). Preliminary
implementation has been successful at sites where latter barriers were
absent. Ongoing work is addressing strategies to mitigate time limita-
tion barrier and assess impact on health outcomes and cost-
effectiveness.
CONCLUSION: Widespread availability of evidence-based obesity
management at a community level has potential to significantly impact
obesity prevalence. Use of participatory methods to include commu-
nity PCPs in driving the development and deployment of a compre-
hensive obesity management program has led to successful
implementation of training and treatment components of the
program.
DISCLOSURE OF INTEREST: None declared.
P241 | Learning health systems: An approach
to optimise the impact of obesity prevention
initiatives
L. Wolfenden1,2,3,4; K. Lee4,5; C. Barnes1,2,3; N. Nathan1,2,3;
R. Sutherland1,2; C. Bialek1; A. Bauman4,5; M. Crane4,5
1
School of Medicine and Public Health, University of Newcastle,
Callaghan; 2Hunter New England Population Health, Wallsend; 3Hunter
Medical Research Institute, New Lambton; 4The Australian Prevention
Partnership Centre, The Sax Institute, Ultimo; 5Sydney School of Public
Health, Charles Perkins Centre, University of Sydney, Sydney, Australia
INTRODUCTION: Systematic reviews of well over 100 randomised
trials report the effects of interventions to prevent obesity are mar-
ginal and have not increased over time. More coordinated approaches
to research production are required to generate new knowledge

SUPPLEMENT ARTICLE
capable of achieving rapid incremental improvements in intervention
effectiveness. Learning health systems represent one such approach
and involve the use of data-driven processes to support iteration and
ongoing improvement in the effectiveness (or efficiency) of interven-
tions. The aim of this study is to describe the need for and potential
impact of applying learning health systems to the prevention of
obesity.
MATERIALS AND METHODS: We report the findings of 3 studies.
First, a study of 90 evidence-based healthy eating, physical activity and
obesity prevention interventions identified via a systematic search of
academic literature that were subsequently delivered in real world (non-
research) conditions. The study documented the period they had been
delivered and any modifications that had occurred over time. Second, a
qualitative study of managers of Australian (non) government prevention
agencies where deductive techniques were applied to identify and
describe factors that may impede learning health system approaches to
obesity prevention. The third is a case study of a school-based obesity
prevention initiative in Australia, where the application of learning health
systems were applied to optimise its effectiveness by a local health ser-
vice across a series of sequential randomised trials.
RESULTS: We found, internationally, most obesity prevention inter-
ventions are delivered to the community for prolonged periods with-
out modification. For example, 88% of school-based obesity
prevention programs were delivered for over a decade with less than
a third being modified over that time. We found no evidence of itera-
tive or continuous improvement processes. Prevention agency staff
reported a range of barriers to modifying interventions to enhance
their effects, including a lack of intervention flexibility and short term
funding cycles. Despite its challenges a school-based case study pro-
vides evidence of how the application of learning health system prin-
ciples can both substantively and rapidly increase intervention
effectiveness and reduce relative costs.
CONCLUSION: The adoption learning health system approaches to
the prevention of obesity represents a significant departure from cur-
rent practice of agencies responsible for obesity prevention. Nonethe-
less, its application has the potential to transform the impact of
obesity prevention initiatives.
DISCLOSURE OF INTEREST: None declared.
1467789x, 2022, S2, Downloaded from https://onlinelibrary.wiley.com/doi/10.1111/obr.13503 by CAPES, Wiley Online Library on [16/12/2023]. See the Terms and Conditions (https://onlinelibrary.wiley.com/terms-and-conditions) on Wiley Online Library for rules of use; OA articles are governed by the applicable Creative Commons License
109 of 222
P242 | Consumer willingness to pay for
healthier food and beverage products: A
systematic review
M. H. S. Alsubhi; M. Blake; T. Nguyen; I. Majmudar; M. Moodie;
J. Ananthapavan
School of Health and Social Development, Deakin University, Melbourne,
Australia
INTRODUCTION: Food retail strategies to improve the healthiness of
food and beverage options in supermarkets and grocery stores may
increase purchasing of healthy options and improve diets. Consumer
perspectives are important to retailers' and therefore customers' per-
ceptions of and demand for healthier food retail environments are
important determinants of the successful implementation and mainte-
nance of retail interventions.
MATERIALS AND METHODS: We performed a systematic review of
peer-reviewed literature to explore whether consumers are willing to
pay (WTP) more for healthier foods compared to conventional alter-
natives and to determine the key factors that may influence their will-
ingness to pay for healthier food and beverages in retail settings.
RESULTS: Twenty out of the 23 experiments included in this review
(87%) found consumers would pay a +5.6% to +91.5% (mean
+24.7%) price premium for healthier foods. Studies consistently
found a positive willingness to pay for meals and snacks with reduced
fat (+5.6% to +91.5%) and with wholegrains or additional fruit and
vegetables (+7.3% to +74.7%). While willingness to pay for meals and
snacks with reduced salt ( 33% to +34%) and for products with a
combination of low fat and sugar, or salt ( 41% to +40.5%) showed
mixed results. Adults over 60 years, females, those living with obesity,
and consumers who aim to maintain a healthy lifestyle were more
likely to pay a price premium for healthy food and beverages, whereas
younger consumers, consumers with normal weight and consumers
with higher levels of education were less likely to pay higher prices
for healthier items.
CONCLUSION: The results of this review contribute to our under-
standing of consumer preferences for healthier products and provide
information to retailers on consumer surplus associated with the pro-
vision of healthier food alternatives. This evidence may provide food
retailers with the incentives required to implement healthier food
retail environments.
DISCLOSURE OF INTEREST: None declared.

110 of 222
P244 | A systematic review of reviews
assessing the effectiveness of obesity
prevention interventions
N. Imad1,2; H. Turon2; A. Grady2,3; R. Wyse3; H. Almond4;
A. Leonard2; L. Wolfenden2; S. Keenan1; S. Yoong1,2
1 2
Swinburne University of Technology, VIC; Hunter New England Local
3 4
Health District; University of Newcastle, NSW; University of Tasmania,
TAS, Australia
INTRODUCTION: High body mass index has been identified as a risk
factor for many non-communicable diseases and thus imposes signifi-
cant morbidity and mortality on the population. To address this, many
interventions to prevent excessive weight gain have been developed
and their effects synthesised in systematic reviews. To maximise the
investment in obesity prevention programs from governments inter-
nationally, an overview of systematic reviews can benefit policy
makers and healthcare decision makers by assessing and consolidating
the findings of systematic reviews and meta-analyses. Therefore, the
aim of this review is to provide an overview of the current evidence-
base by synthesising the effectiveness and cost-effectiveness of obe-
sity prevention interventions in children and adults.
MATERIALS AND METHODS: This overview of reviews was con-
ducted in line with best practice guidance from the Joanna Briggs Insti-
tute and the Cochrane Handbook. A search of peer reviewed literature
was run in 5 databases including only publications from 2010–2021, as
we were interested in including the most contemporary evidence. Sys-
tematic reviews were included if they examined the effectiveness of
obesity prevention interventions and assessed body mass index. Data
extraction was undertaken by 1 reviewer and then checked by a sec-
ond independent reviewer. Risk of bias was assessed using the Joanna
Briggs Institute critical appraisal checklist for systematic reviews. Inter-
ventions were categorised according to the Institute of Medicine Accel-
erating Progress in Obesity Prevention Report.
RESULTS: A total of 8371 records were identified through electronic
database searching. We screened 6787 records after removal of dupli-
cates and included 132 studies plus 17 from other sources. Included
studies focused on children (aged between 0–18) (n = 114), on adults
only (n = 21) and on both (n = 14). This consisted of 76 diet and
physical activity behavioural interventions, 23 diet-only interventions,
17 physical activity-only interventions, 10 policy interventions, 9 com-
munity/parental involvement interventions, while the remaining
14 studies focused on varied interventions.
CONCLUSION: This review of reviews will identify and synthesise the
effectiveness of obesity prevention interventions in various settings
and populations to provide a summary of the overall literature. Find-
ings from this review will identify where sufficient evidence exists for
programs that warrant implementation, and highlight gaps in the evi-
dence base. This will help to inform future planning and development
of obesity prevention interventions delivered in many settings.
DISCLOSURE OF INTEREST: None declared.
1467789x, 2022, S2, Downloaded from https://onlinelibrary.wiley.com/doi/10.1111/obr.13503 by CAPES, Wiley Online Library on [16/12/2023]. See the Terms and Conditions (https://onlinelibrary.wiley.com/terms-and-conditions) on Wiley Online Library for rules of use; OA articles are governed by the applicable Creative Commons License
SUPPLEMENT ARTICLE
P245 | Estimating the impact of school-based
education and restriction on television
advertising to prevent childhood obesity in
Thailand
P. Hunchangsith1; L. Aminde2; L. Veerman2; W. Ngam-a-roon1
1
Institute for Population and Social Research, Mahidol University,
Nakhon Pathom, Thailand; 2School of Medicine and Dentistry, Griffith
University, Gold Coast campus, Queensland, Australia
INTRODUCTION: The prevalence of overweight in children aged 6–
14 years in Thailand has significantly increased, doubling from 5.8% to
13.9% between 1995 and 2014. The aim of this study was to estimate
how many cases of childhood overweight and obesity could be pre-
vented by implementing school-based education programs and
restriction on television (TV) advertising.
MATERIALS AND METHODS: A mathematical model was developed
to estimate the impact of two interventions: a school-based education
program to reduce consumption of carbonated drinks and restriction
of unhealthy food and beverages advertising on TV. Sex-specific body
mass index (BMI) for Thai children aged 6–12 years were calculated
using weight and height data from the National Health Examination
Survey Round V in 2014. We used a lognormal distribution to fit the
BMI data and modelled a shift in the distribution to quantify the
impact of the interventions. The prevalence of overweight and obesity
was then estimated by age and sex using BMI cut-offs from the Inter-
national Obesity Task Force.
For the school-based education intervention, the mean BMI
reduction 0.1 kg/m2 in children was adopted from an English cluster
randomized controlled trial. For the intervention restricting TV adver-
tising of unhealthy food and beverages high in fat, sugar and salt
(HFSS), the mean BMI reduction was calculated from change in energy
intake (in Kilocalories) per minute exposed to these advertisements,
followed by change in weight and then BMI. This required the follow-
ing data: (1) minutes per day that Thai children spent watching HFSS
food advertisements, (2) kilocalorie effect per minute exposed to TV
advertisements from meta-analysis, and (3) adjustment for real world
and mealtime compensation.
RESULTS: Restricting TV advertising of unhealthy food and beverages
reduced BMI on average by 0.32 kg/m2. The school-based education
intervention was estimated to reduce overall prevalence of childhood
overweight and obesity by 3.5% (3.2% in male, 3.8% in female), lower-
ing the number of cases with overweight and obesity from 1.10 mil-
lion to 1.06 million. Restriction on TV advertising reduced overall
prevalence of childhood overweight and obesity by 11% (10.0% in
male, 12.3% in female), lowering the number of cases with overweight
and obesity from 1.10 million to 0.98 million.
CONCLUSION: Both interventions were estimated to significantly
reduce childhood overweight and obesity in Thailand, although
restricting TV advertising of unhealthy food and beverages could have
a much bigger impact. Intervention effects alone are insufficient for
decision-making. Hence, cost-effectiveness analysis is needed to

SUPPLEMENT ARTICLE
inform policy makers on the allocation of limited resources for child-
hood obesity prevention in Thailand.
DISCLOSURE OF INTEREST: P. Hunchangsith Grant/Research sup-
port with: Thai Health Foundation, L. Aminde: None declared,
L. Veerman: None declared, W. Ngam-a-roon: None declared.
P246 | Scaling up a healthy lunchbox program
SWAP IT - which strategies are core and cost
effective?
R. Sutherland1,2,3,4; J. Jones1,3,4,5; A. Brown1,3,4,5; C. Barnes3,4,5;
N. Nathan1,3,4,5; C. Lecathelinais1; L. Janssen5; L. Wolfenden1,3,4,5
1
Hunter New England Population Health, Hunter New England Local
Health District, Wallsend; 2School of Health and wellbeing, University of
Newcastle; 3Hunter Medical Research Institute (HMRI); 4Priority
Research Centre Health Behaviour, University of Newcastle; 5University
of Newcastle, School of Health and Wellbeing, Newcastle, Australia
INTRODUCTION: There was no significant difference between groups
in the mean discretionary energy packed in the lunchbox ( 20.7 kJ,
p = 0.81), mean energy from everyday foods (30.2 kJ, p = 0.67), or total
energy packed in the lunchbox (9.9 kJ, p = 0.91). The mean cost per stu-
dent was $6.02 for the full intervention and $0.07 for the modified
version.
MATERIALS AND METHODS: A cluster RCT was undertaken with
10 primary schools in New South Wales, Australia. Schools were ran-
domised to receive the full SWAP IT program (4 strategies) or a modi-
fied version consisting of the most scalable program components
including the electronic parent messages. Mean energy (kilojoules [kJ])
content of discretionary lunchbox foods and drinks packed in lunch-
boxes, was measured via lunchbox observation using a validated
school food checklist at baseline and six-month follow-up. Secondary
outcomes included mean lunchbox energy (kJ) from everyday foods
and mean total lunchbox energy (kJ) packed in lunchboxes. Data were
analysed via hierarchical linear regression models controlling for clus-
tering, socioeconomic status and remoteness. Program cost per stu-
dent (dollar $AUD) were also measured across both groups.
RESULTS: There was no significant difference between groups in the
mean discretionary energy packed in the lunchbox ( 20.7 kJ, p = 0.81),
mean energy from everyday foods (30.2 kJ, p = 0.67), or total energy
packed in the lunchbox (9.9 kJ, p = 0.91). The mean cost per student
was $6.02 for the full intervention and $0.07 for the modified version.
CONCLUSION: Given there was no differential outcomes between
groups, the modified SWAP IT program provides a highly scalable and
cost-efficient alternative to the full SWAP IT program model.
DISCLOSURE OF INTEREST: R. Sutherland Grant/Research support
with: NSW Health Translational Research Grant, J. Jones: None
declared, A. Brown: None declared, C. Barnes: None declared,
N. Nathan: None declared, C. Lecathelinais: None declared,
L. Janssen: None declared, L. Wolfenden: None declared.
1467789x, 2022, S2, Downloaded from https://onlinelibrary.wiley.com/doi/10.1111/obr.13503 by CAPES, Wiley Online Library on [16/12/2023]. See the Terms and Conditions (https://onlinelibrary.wiley.com/terms-and-conditions) on Wiley Online Library for rules of use; OA articles are governed by the applicable Creative Commons License
111 of 222
P247 | Health economic modelling of early
childhood obesity prevention to inform policy
A. Hayes1; A. Killedar1; H. Tran2; J. Carrello1; V. Brown3
1
School of Public Health, University of Sydney, Camperdown; 2Institute
for Health Transformation, Deakin University; 3Institute for Health
Transformation, University of Sydney, Melbourne, Australia
INTRODUCTION: Childhood obesity is a significant public health con-
cern, and much effort has been invested in interventions aimed at
reducing this burden. An important factor for policy decisions and
resourcing of early prevention is whether programs or policies are
cost-effective, that is, whether they represent good value for money.
One of the challenges in evaluating early obesity prevention is that
the costs and benefits are likely to be observed later in childhood,
beyond the timeframe of an intervention. Here, we demonstrate the
evaluation of four obesity prevention interventions that capture long-
term impacts using novel modelling methods.
MATERIALS AND METHODS: In this presentation we summarise the
development of the Early Prevention of Obesity in Childhood
(EPOCH) model, a health economic model for economic evaluation of
obesity prevention in childhood and a companion model (EQ-EPOCH)
that estimates outcomes by socioeconomic groups. We used these
models to project BMI, overweight and obesity, QALYS and direct
healthcare costs from early to late childhood as a result of interven-
tions targeting breastfeeding, sleep, a combination of sleep, diet and
physical activity and an intervention in community Early Childhood
Education and Care. The probability of these interventions and inter-
vention scenarios being cost-effective over 10 years was estimated.
RESULTS: Based on a cost-effectiveness threshold of $50 k/QALY
gained and taking uncertainty into account, we found that the proba-
bility of cost-effectiveness of the sleep, community early childhood,
and combination interventions were 74%, 64% and 23%, respectively.
Cost-effectiveness varied by socioeconomic position (SEP): in the
sleep intervention, the probability of cost effectiveness was highest in
low and medium SEP groups (92–100%) and lower in the highest SEP
group (79%). Whole-of-population interventions to increase breast-
feeding were less cost-effective than those targeted at mothers who
did not intend to breastfeed, but had similar cost-effectiveness among
higher and lower SEP groups.
CONCLUSION: The use of common model framework for estimating
cost-effectiveness facilitates comparability, is able to predict equity
impacts and can provide policy guidance for targeting interventions to
populations that need it most.
DISCLOSURE OF INTEREST: None declared.

112 of 222
P248 | Identifying the effective components
of school-based obesity prevention
interventions: An exploratory analysis
R. Hodder 1,2,3,4 1,2,3,4
; K. O'Brien 1,2,3,4
; S. Lorien
; L. Wolfenden
1
Hunter New England Population Health; 2College of Health Medicine
and Wellbeing; 3National Centre of Implementation Science, University of
Newcastle; 4Hunter Medical Research Institute, Newcastle, Australia
INTRODUCTION: Childhood overweight and obesity is increasingly
prevalent, can persist into adulthood and influence lifelong health tra-
jectories. Complex, multicomponent, school-based obesity prevention
interventions are both common and heterogeneous, highlighting a
need to assess the effectiveness of individual intervention compo-
nents. An exploratory analysis was conducted of school-based ran-
domised controlled trials (RCTs) included in a recent systematic
review of obesity prevention interventions in children aged 6–
18 years to examine the impact of intervention components.
MATERIALS AND METHODS: Interventions of included studies were
coded to identify discrete intervention components by two indepen-
dent coders using a consensus approach. Subgroup meta-analyses of
studies were conducted by intervention component to determine
their potential effectiveness.
RESULTS: Of the 195 studies included in the systematic review,
140 studies (183,063 participants) were coded and included in sub-
group analysis conducted by intervention component. Results from
the subgroup analysis found interventions that incorporated 10 partic-
ular healthy eating (e.g., interactive healthy eating programs) and
physical activity (e.g., increased time or intensity) components have a
positive effect on child weight.
CONCLUSION: This exploratory analysis provides important guidance
to policymakers regarding which intervention components should be
prioritised in future school-based obesity prevention programs.
DISCLOSURE OF INTEREST: None declared.
P249 | Process of developing an interactive
web-based Healthy Beginnings program for
preventing obesity in the first years of life
S. Taki1; L. Baur2; C. Rissel2; D. Jawad1; B. Markides1; R. Calvo3;
R. Jones4; M. Hammersley4; N. Ahmadpour3; L. Buchanan5;
P. Phongsavan2; L. M. Wen1
1 1
Population Health Research and Evaluation Hub, Sydney Local Health
2 3
District; School of Public Health; The University of Sydney, Sydney;
4
University of Wollongong, Wollongong; 5Sydney Local Health District,
Sydney, Australia
INTRODUCTION: The Healthy Beginnings Trial was the world's first
RCT to test the effectiveness of an early obesity intervention in the first
2 years of life delivered through home visits. Subsequently, it has been
1467789x, 2022, S2, Downloaded from https://onlinelibrary.wiley.com/doi/10.1111/obr.13503 by CAPES, Wiley Online Library on [16/12/2023]. See the Terms and Conditions (https://onlinelibrary.wiley.com/terms-and-conditions) on Wiley Online Library for rules of use; OA articles are governed by the applicable Creative Commons License
SUPPLEMENT ARTICLE
scaled up and translated into various delivery modes. There is emerg-
ing evidence of digital interventions promoting healthy lifestyles but
few studies have focussed on the pregnancy to 12 months age
group. This study aims to translate and develop the Healthy Begin-
1,2,3,4
nings program through an interactive web-based platform with the
broader purpose which involves testing the feasibility of this platform.
MATERIALS AND METHODS: This study involved a number of studies
to develop the interactive Healthy Beginnings web-based program using
qualitative and quantitative approaches. (1a) Systematic assessment of
websites targeting healthy lifestyle behaviours for the first year of life;
(1b) National-wide online survey exploring parents internet usage for
support on health information on child health behaviours (N = 500);
(1c) Four co-design workshops with consumers (N = 20, pregnant
women and parents/carers of young children) to explore preferences for
design features of the Healthy Beginnings web-based platform and test-
ing; and (1d) Co-design crowdsourcing study- Facebook Group for con-
sumers via a private Healthy Beginnings Facebook group to regularly
interact with and receive feedback from the intended end-users of the
Healthy Beginnings web-based platform.
RESULTS: Of the sub-studies listed, study 1a is completed and study
1b to1d are currently underway and the results will be available to
share upon the conference date. On the results of study 1a, 450 web-
sites were screened and 66 were included based on the selection cri-
teria and were evaluated. Very few websites had a high quality rating,
while the majority scored adequate due to the lack of information
coverage, readability levels higher than the recommended (grade 8)
and a lack of cultural considerations.
CONCLUSION: Based on the sub-studies conducted, it is evident that
there is a need to develop an interactive web-based program that
could support families with healthy behaviours in the first 2000 days.
Although these sub-studies are intended to inform the build of the
Healthy Beginnings interactive web-based platform it will also inform
service-providers and researcher working with families in the first
2000 days of elements that should be considered when developing
digital based platforms.
DISCLOSURE OF INTEREST: None declared.
P250 | Implementing routine paediatric
height/length and weight screening and
weight management advice by clinicians: An
evaluation
S. Krstic1; F. Southcombe1; E. Denney-Wilson2; S. Dennis3
Growing Healthy Kid Service, SWSLHD P & CH; 2School of Nursing;
3
Faculty of Medicine and Health, University of Sydney, Sydney, Australia
INTRODUCTION: To evaluate strategies implemented to increase
routine height and weight screening, advice and referral for children
and young people (CYP) in South Western Sydney Local Health Dis-
trict (SWSLHD).

SUPPLEMENT ARTICLE
MATERIALS AND METHODS: A questionnaire was sent to all Health
Care Professionals (HCPs) who had undertaken online or face-to-face
training between December 2018 and June 2020 in SWSLHD
(n = 840). The questionnaire collected data on experiences of routine
height and weight screening and the effectiveness of strategies used
in the implementation.
RESULTS: Of the 840 questionnaires sent, 87 were undeliverable, of the
remaining 753, 285 were returned (38% response rate). More than half
(53%, 151/285) of participants were nurses. Most HCPs agreed that
there was a need for routine screening and reported that education,
training, and access to resources were the most helpful implementation
strategies. Most HCPs were confident in performing routine screening
but were less confident in raising the issue of weight with (CYP) and
their families. Barriers for implementation were lack of time, equipment,
appropriate clinical setting, along with HCPs' perceptions and beliefs
about obesity.
CONCLUSION: Routine screening is the first step in identifying CYP
at risk of overweight and obesity, but many HCP found it challenging
to incorporate into daily practice. Multifaceted strategies are needed
to increase routine screening across diverse health care settings so
that CYP get timely and appropriate intervention.
DISCLOSURE OF INTEREST: None declared.
P251 | A systematic review of early
childhood education and care based nutrition
interventions on child diet and weight
outcomes
S. L. Yoong1,2; M. Lum3; A. Grady3; L. Wolfenden3; N. Pearson2;
4 4 3 5
J. Jackson ; S. Mcrabb ; C. Barnes ; T. McDonnell ; A. Hall ; 4
J. Jones 2
1
Swinburne University of Technology, John Street, Hawthorn, Vic, 3122;
2 V. Gorasso1,2; I. Moyersoen1; S. Vandevijvere1; D. De Smedt2;
Hunter New England Population Health, Wallsend, NSW; 3School of
Medicine and Public Health; 4University of Newcastle, Callaghan, NSW,
2308, Australia; 5School of Nursing, Midwifery and Health Systems,
University College Dublin, Dublin, Ireland
INTRODUCTION: Dietary risk factors are the primary causes of death
and disability primarily due to their association with chronic diseases,
including obesity. As dietary behaviour tracks from childhood into
adulthood, interventions to improve child diet are recommended to
reduce population burden. Early childhood and education care (ECEC)
centres including long daycare, preschools, kindergartens and family
day care have been identified as an important setting to deliver
healthy eating intervention as they provide broad reach to young chil-
dren for prolonged periods, at a fundamental developmental period.
The impact of such interventions on child health however, remains
largely unknown. This systematic review therefore seeks to synthesis
the impact of ECEC-based healthy eating intervention on child dietary
and weight outcomes.
1467789x, 2022, S2, Downloaded from https://onlinelibrary.wiley.com/doi/10.1111/obr.13503 by CAPES, Wiley Online Library on [16/12/2023]. See the Terms and Conditions (https://onlinelibrary.wiley.com/terms-and-conditions) on Wiley Online Library for rules of use; OA articles are governed by the applicable Creative Commons License
113 of 222
MATERIALS AND METHODS: This systematic review was under-
taken consistent with methods outlined in the Cochrane Handbook.
Studies were eligible for inclusion if they were a randomised con-
trolled trial (RCT) examining the impact of a healthy eating interven-
tion on child dietary outcomes and/or weight. An electronic search
was undertaken in eight electronic databases and supplemented with
grey literature searches in February 2022. Two authors undertook all
screening and data extraction as well as risk of bias assessment using
the Cochrane Risk of Bias Tool. A random-effects meta-analysis was
undertaken where there were two or more comparable outcomes.
RESULTS: A total of 58 publications describing findings from
52 unique studies were included. Preliminary pooled analysis from
14 RCTs found a positive effect on child consumption of fruit and
vegetables and overall diet quality (n = 4). Meta-analysis of 9 studies
however found limited impact on sugar sweetened beverage con-
sumption and water consumption (n = 4 studies, SMD: 0.07[95% CI
0.06, 0.20]). There was limited impact on child BMI however a
promising effect on child weight was observed.
CONCLUSION: This review found positive effects of healthy inter-
ventions delivered in ECEC centres on some child dietary outcomes
and potentially weight status. These findings support the inclusion of
ECEC centres as priority settings for delivery of nutrition interven-
tions in chronic disease and obesity prevention policies nationally and
internationally. Future studies identifying priority interventions for
these settings and assessing strategies to support population wide
implementation of these interventions are warranted.
DISCLOSURE OF INTEREST: None declared.
P252 | The economic burden of obesity and
overweight in Belgium: Direct and indirect
costs
B. Devleesschauwer1
1
Epidemiology and public health, Sciensano, Brussels; 2Public Health and
Primary Care, Ghent University, Ghent, Belgium
INTRODUCTION: According to the Belgian health interview survey
(BHIS) 2013, 35% and 14% of the Belgian adults were affected
respectively by overweight and obesity. Considering the importance
of this risk factor this study investigates the burden of overweight
and obesity on healthcare and absenteeism costs in Belgium, as well
as to what extent the prevalence of chronic conditions affects this
burden.
MATERIALS AND METHODS: Healthcare and absenteeism cost were
estimated using national health status data from BHIS 2013 linked
with individual health insurance costs (2013–2017). Average yearly
healthcare costs and cost of absenteeism were reported for the adult
population by body mass index (BMI) categories. Costs were adjusted
by age, gender, educational level and physical inactivity. The attribut-
able cost of excess weight and contribution of 23 chronic conditions

114 of 222
to the incremental cost of overweight and obesity was estimated
using the method of recycled prediction.
RESULTS: Average healthcare expenses for adults with overweight
and obesity were significantly higher than the one observed in adults
with normal weight. The total yearly healthcare cost of overweight
and obesity in Belgium was estimated at around €3 billion (€581 and
€854 per capita for people with overweight and obesity respectively).
The comorbidities identified to be the main drivers for the incremental
healthcare costs were hypertension, serious gloom and depression,
and stomach ulcer. The mean incremental cost of absenteeism for
people with overweight was €261 per capita but did not statistically
differ from the cost of the people with normal weight. For people with
obesity, the same cost increases significantly to €2045 per capita. The
annual total incremental costs due to absenteeism were estimated at
more than €3.5 billion for people with a BMI ≥ 25. Hypertension and
low back pain were the most important drivers of the incremental cost
of absenteeism, followed by osteoarthritis and stroke.
CONCLUSION: The mean annual incremental cost of overweight and
obesity in Belgium is concerning and stresses the need for nutrition
and physical activity policy actions aiming to prevent the raise of the
proportion of people with excess weight. This study can be used as a
baseline to evaluate the potential savings and health benefits of obe-
sity prevention interventions.
DISCLOSURE OF INTEREST: None declared.
P253 | What is important to measure in early
childhood obesity prevention interventions?
The core outcome set for early intervention
trials to prevent obesity in children
V. Brown1,2; on behalf of the COS EPOCH working group
1 W. K. H. Mok; B. K. Poh; L. H. Wee; A. T. Ruzita
Institute for Health Transformation, Deakin University, Melbourne;
2 Centre for Community Health Studies (ReaCH), Faculty of Health
Centre for Research Excellence in Translating the Early Prevention of
Obesity in CHildhood, Sydney, Australia
INTRODUCTION: Core Outcome Sets (COS) are agreed minimum sets
of outcomes recommended for measurement in studies in specific health
areas. Development of COS can facilitate evidence comparison and syn-
thesis and provides crucial information on the outcomes that are consid-
ered most important from the perspectives of different stakeholders.
This study presents results from the development of a COS for random-
ised controlled trials evaluating the Early Prevention of Obesity in CHil-
dren aged from birth to five years (COS-EPOCH).
MATERIALS AND METHODS: COS development involved a literature
review (n = 161 studies), eDelphi study (n = 206 participants) and a final
consensus meeting (n = 9 participants). Participants in the eDelphi and
consensus meeting included parents/caregivers, funders, researchers,
health professionals and community stakeholders. Outcomes identified
in the literature review were rated by stakeholders in the e-Delphi sur-
vey to identify outcomes considered not important, critically important,
or ‘no consensus’ for inclusion in the COS. Following the eDelphi, the
1467789x, 2022, S2, Downloaded from https://onlinelibrary.wiley.com/doi/10.1111/obr.13503 by CAPES, Wiley Online Library on [16/12/2023]. See the Terms and Conditions (https://onlinelibrary.wiley.com/terms-and-conditions) on Wiley Online Library for rules of use; OA articles are governed by the applicable Creative Commons License
SUPPLEMENT ARTICLE
consensus meeting brought together stakeholders to vote and reach final
consensus on outcomes to be included in the COS.
RESULTS: Differences in stakeholder perceptions of the importance
of outcomes were evident. Ultimately, 22 outcomes were included in
the COS-EPOCH: child diet quality, child dietary intake, child fruit and
vegetable intake, child non-core food intake, child non-core beverage
intake, child meal patterns, child weight-based anthropometry, child
screentime, child time spent sedentary, child physical activity, infant
tummy time, child sleep duration, parent/caregiver physical activity
parenting practices, parent/caregiver sleep parenting practices, par-
ent/caregiver nutrition parenting practices, food environment, house-
hold food security, family meal environment, sedentary behaviour or
physical activity home environment, early education and care environ-
ment, child wellbeing, economic evaluation.
CONCLUSION: Study results provide important insights into the early
childhood obesity prevention intervention outcomes considered criti-
cal by a range of stakeholders. Findings should be used to inform
future intervention development and evaluation. More work is
planned to investigate recommended measurement methods for
COS-EPOCH outcomes. Together, these projects will standardise
guidance on the measurement and reporting of outcomes from early
childhood obesity prevention interventions. This will facilitate evi-
dence comparison and synthesis and maximise the value of data col-
lected across trials, leading to better understanding of which
interventions work, how and for whom.
DISCLOSURE OF INTEREST: None declared.
P254 | Sustainability of childhood obesity
interventions in Malaysia: A mix-method
study
Sciences, Universiti Kebangsaan Malaysia, Selangor, Malaysia
INTRODUCTION: School-based intervention is crucial to promote
active lifestyles and behaviour changes to overcome childhood obe-
sity; however, the sustainability of obesity interventions remains a
challenge. This presentation will report a post-intervention follow-up
study on students who participated in three school-based childhood
obesity interventions to explore the extent of sustainability and deter-
minants related to active lifestyles and behaviour changes.
MATERIALS AND METHODS: This follow-up study involved partici-
pants of Juara Sihat (age 12–14 years; n = 52), C.E.R.G.A.S (age 16–
17 years; n = 55), and GReat-Child (age 12 years; n = 31), which was
conducted in primary and secondary schools in Kuala Lumpur and its
suburbs. This study comprised both quantitative and qualitative com-
ponents conducted 1 year after completion of the interventions. The
quantitative study utilized a self-administered questionnaire to com-
pare knowledge, attitude and practice (KAP), and anthropometric
outcomes between baseline and sustainability follow-up for all three

SUPPLEMENT ARTICLE
interventions. The qualitative study involved face-to-face in-depth
interviews among 47 adolescents who participated in Juara Sihat
and C.E.R.G.A.S programmes to explore determinants that promote
and barriers related to the sustainability of the interventions. Quali-
tative data were transcribed verbatim and analysed using Nvivo
version 12.
RESULTS: The quantitative sustainability follow-up results indicate
that BMI-for-age z-score and body fat percentage decreased signifi-
cantly among C.E.R.G.A.S participants. In contrast, waist circumfer-
ence and physical activity level increased among the Juara Sihat
programme participants. Knowledge and practice scores for healthy
eating and physical activity increased significantly in all three inter-
ventions. Themes identified from the qualitative studies included:
(i) promoting determinants—knowledge, self-awareness, self-image,
parental and family support and accessibility of facilities; and
(ii) barriers—knowledge inconsistency, self-attitude, peer influence,
social pressure, and environmental factors.
CONCLUSION: This study demonstrated sustained intervention
effects on knowledge and practice, as well as on the influencing fac-
tors. Sustainability factors and elements that encourage behaviour
modifications are essential to ensure the long-term effectiveness of
childhood obesity interventions.
DISCLOSURE OF INTEREST: None declared.
P255 | Exploring the overall effect of FTO
genotype on BMI after childhood obesity
interventions and effect difference by
ethnicity: A systematic review and meta-
analysis
Z. Liu; J. Chen; W.-C. Xiao; H.-J. Wang
Peking University, Beijing, China
INTRODUCTION: FTO gene has shown a strong association with obe-
sity traits. However, previous studies exploring the effect of FTO on
children's body mass index (BMI) reduction through lifestyle interven-
tions have been limited in sample size. No systematic review of such
kind has been conducted. Moreover, whether the genetic effect dif-
fers by ethnicity remains unclear.
MATERIALS AND METHODS: We systematically searched MEDLINE,
CENTRAL, and Embase databases from inception to December 2021
according to a prospectively registered protocol (PROSPERO
CRD42022312177). We included lifestyle-based obesity interventions in
children, with 3 studies in 1660 children from China and 8 studies in
3141 children from Europe [Germany (n = 5), Brazil (n = 1), and Danish
(n = 1), and Spanish (n = 1)]. A random-effects meta-analysis was con-
ducted to summarize the effect of FTO genotype [rs9939609 (or a
proxy)] on BMI Z score in both Chinese and Europeans, after adjusting
for age, sex, and baseline outcome values by using an additive genetic
model; then we explored whether the association varied by ethnicity.
1467789x, 2022, S2, Downloaded from https://onlinelibrary.wiley.com/doi/10.1111/obr.13503 by CAPES, Wiley Online Library on [16/12/2023]. See the Terms and Conditions (https://onlinelibrary.wiley.com/terms-and-conditions) on Wiley Online Library for rules of use; OA articles are governed by the applicable Creative Commons License
115 of 222
RESULTS: The overall effect of FTO genotype on BMI Z score after
childhood obesity interventions was not statistically significant
(P = 0.13), but subgroup analyses showed that the effect differed by
ethnicity (P = 0.01). Among children in China, differential changes in
BMI Z score in response to obesity interventions were not signifi-
cantly different between FTO genotypes (pooled mean difference
from baseline to end of the trial: 0.03; 95% CI: 0.02, 0.08; P = 0.59).
Among children in European, carriage of the FTO [rs9939609 (or a
proxy)] minor allele was associated with a greater reduction in BMI Z
score (pooled mean difference from baseline to end of the trial: -0.06;
95% CI: 0.11, 0.01; P < 0.01).
CONCLUSION: We observed that European children carrying the FTO
minor allele may benefit more from obesity interventions in improving
BMI Z score, whereas Chinese children appeared to respond equally
well to lifestyle interventions for obesity prevention.
DISCLOSURE OF INTEREST: None declared.
P257 | Obesity induces TET2 dysfunction and
accelerates DNMT3A clonal haematopoiesis
leading to macrophage tissue infiltration
C. Bertuzzo Veiga1,2; P. K. Morgan1; M. K. S. Lee1; M. Herold3;
M. Watt2; D. Dragoljevic1; A. Murphy1
1
Division of Immunometabolism, Baker Heart and Diabetes Institute;
2
Department of Anatomy and Physiology; 3Walter and Eliza Hall Institute
of Medical Research, The University of Melbourne, Melbourne, Australia
INTRODUCTION: Obesity is one of the most prevalent diseases glob-
ally, which can lead to type 2 diabetes (T2D) and cardiovascular dis-
ease (CVD). Recent studies have shown that patients with CVD as
well as obesity are strong candidates for acquiring haematological
dysfunction composed of somastic mutations (SM) in the blood, a new
condition called clonal haematopoiesis of indeterminate potential
(CHIP). CHIP is characterized by the acquisition of SM (mostly in the
genes DNMT3A and TET2) in bone marrow (BM) haematopoietic stem
and progenitor cells (HSPCs), which can be detected in blood (diag-
nostically > 2% mutated cells). Co-mutation of DNMT3A and TET2
results in myeloproliferative disorders. Notably, a longitudinal study
identified that individuals with obesity have accelerated DNMT3A
mutations, however the mechanism linking CHIP in patients with obe-
sity remain unknown. Importantly, AMPK directly phosphorylates
TET2 to promote hydroxymethylation of DNA (5-hmC). In the setting
of metabolic disorders, AMPK activity is reduced and therefore fails
to activate TET2, preventing the hydroxymethylation of key genes,
effectively repressing them. With this knowledge, we hypothesized
that obesity accelerates the clonal outgrowth of DNMT3A CHIP by
inducing TET2 dysfunction thereby promoting further metabolic
complications.
MATERIALS AND METHODS: We performed a competitive BM
transplant (cBMT) to mimic human CHIP. Irradiated WT mice received
90% CD45.1/2 WT and 10% CD45.2 Dnmt3a /+
or Dnmt3a+/+ BM

116 of 222
cells. After BM reconstitution mice were fed a high fat diet (diet
induce obesity model; DIO) or a chow diet for 16 weeks. EchoMRI
mouse body composition and oral glucose tolerance test (OGTT) were
performed at the end of 16 weeks. Immune cells from blood, BM,
liver, and adipose tissue were analysed using flow cytometry.
RESULTS: When exploring physiological and haematological parame-
/+
ters, we observed that the mutant obese mice (Dnmt3a -DIO) pre-
sented pronounced obesity and impaired glucose metabolism
compared to their respective controls. These mice also exhibited
enhanced myelopoiesis, leading to clonal outgrowth of monocytes in
the circulation which consequently induced increase of different mac-
rophage populations in the adipose tissue and liver. In parallel,
/+
Dnmt3a -DIO mice presented TET2 dysfunction in BM HSPCs.
CONCLUSION: Collectively, our data demonstrates that obesity
directly induces TET2 dysfunction in BM HSPCs and increases
DNMT3A clonal outgrowth towards monocytes. This was associated
with an accelerated decline in whole body metabolism. Thus, these
findings will be key in identifying potential therapy approaches in
CHIP and obesity.
DISCLOSURE OF INTEREST: None declared.
P259 | Transcriptomic analysis of hepatic
steatosis and type 2 diabetes mice in
response to a novel therapeutic drug
G.-H. Kim1,2,3; Y. S. Chang4; J.-H. Shin5; S.-H. Hong1,2
1
Research Center for Bioconvergence Analysis, Korea Basic Science
Institute, Cheongju; 2Department of Bio-Analytical Science, University of
Science and Technology; 3Graduate School of Analytical Science and
Technology, Chungnam National University; 4College of Medicine,
Konyang University; 5College of Medicine, Chungnam National
University, Daejeon, Korea, Republic Of
INTRODUCTION: Cytochrome P450 4A (CYP4A) is a fatty acid hydrox-
ylase, which is involved in the metabolism of fatty acids. Ectopic accumu-
lation of fatty acid induces lipid peroxidation through CYP4A and forms
reactive oxygen species (ROS). Recently, there are a number of studied
for CYP4A related with liver disease, especially for the pathogenesis of
T2DM and NAFLD. Our research team discovered CYP4A inhibitor
which directly bound to CYP4A. However, the underlying mechanism of
CYP4A inhibitor remains undefined. Therefore, we tried to uncover the
mode of action for CYP4A inhibitor to understand how it works or which
actions are required for therapeutic efficacy.
MATERIALS AND METHODS: To comprehensively identify genes
associated with CYP4A inhibitor treatment, we performed transcriptomic
analysis (RNA-seq) in the liver collected from high fat diet (HFD) induced
mice model. A computational analysis was performed to get differently
expressed genes (DEG) to evaluate the comparative transcriptomic
approach between HFD treated with vehicle or CYP4A inhibitor.
RESULTS: We demonstrate a transcriptome-based molecular discrimina-
tion between HFD treated vehicle or CYP4A inhibitor. We found 210
1467789x, 2022, S2, Downloaded from https://onlinelibrary.wiley.com/doi/10.1111/obr.13503 by CAPES, Wiley Online Library on [16/12/2023]. See the Terms and Conditions (https://onlinelibrary.wiley.com/terms-and-conditions) on Wiley Online Library for rules of use; OA articles are governed by the applicable Creative Commons License
SUPPLEMENT ARTICLE
up-regulated and 256 down-regulated genes in HFD treated with CYP4A
inhibitor. Through Ingenuity Pathway Analysis (IPA) and gene ontology
(GO) analysis, we showed that CYP4A inhibitor regulated statistically sig-
nificant mechanism for the development of T2DM and liver injury.
CONCLUSION: Inhibition of CYP4A is novel target for the treatment
of hepatic steatosis and the development of T2DM. We screened var-
ious differently expressed genes along with predicted signaling path-
ways. Our findings provide a transcriptomic approach of the
mechanism for CYP4A inhibitor, highlight important signaling pathway
to treat liver injury and T2DM.
DISCLOSURE OF INTEREST: None declared.
P260 | Faecal microbial composition,
metabolic profiling and transcriptomics in
Australian men with or without metabolic
dysregulation
K. M. Hatton-Jones1; N. West1,2; P.-Y. Chen1; A. Cripps2; A. Cox1,2
1
School of Pharmacy and Medical Science; 2Menzies Health Institute
Queensland, Griffith University, Gold Coast, Australia
INTRODUCTION: The contributions of the gut microbiota and inflam-
matory signalling in metabolic disease development and obesity progres-
sion are still not fully characterised in humans. Differences in immune-
signalling, metabolism, and compositional changes to the gut microbiome
were explored in the current study to further our understanding of the
potential roles of metabolic and inflammatory signalling and the gut
microbiota in contributing to metabolic dysregulation in obesity.
MATERIALS AND METHODS: This study compared faecal microbial
composition, metabolic and inflammatory profiles, and targeted whole-
blood transcriptomics in healthy men (n = 15; 41.8 ± 12.2 years; BMI:
22.9 ± 1.3 kg/m2) and men with obesity and evidence of metabolic
dysregulation (MetDys: n = 14; 46.4 ± 9.7 years; BMI: 35.2
± 3.2 kg/m2). Blood samples were collected for metabolic and inflam-
matory assessment, and the whole-blood profiling of 742 inflammatory
and metabolic genes using Nanostring Technologies nCounter® analy-
sis system. Faecal samples were collected for microbial composition
profiling using 16 s rRNA gene sequencing. Metabolic and inflamma-
tory profiles were determined using a combination of circulating
metabolites, proteins, and transcriptomics.
RESULTS: The MetDys group exhibited evidence of metabolic and
immune dysregulation as evidenced by higher levels of leptin (~6.5 fold;
P < .0001), C-peptide (~2 fold; P < .0001), CRP (~2.25 fold; P = .02), and
lipopolysaccharide binding protein (~2 fold; P < 0.0001), and lower levels
of adipsin (~1.2 fold; P = .01) and ghrelin (~1.8 fold; P = 0.05). Targeted
gene expression profiling in whole blood revealed lower expression of
CXRC6 (~0.5 fold; P = .002) and higher expression of CAMP (~2 fold;
P = .01), LTF (~3 fold; P = .01), and LCN2 (~2.5 fold; P = .01) in the
MetDys group. Only modest differences in faecal microbial diversity and
composition were noted, with a trend for a higher relative abundance of
Bacteriodetes (6% higher; P = .06) in the MetDys group.

SUPPLEMENT ARTICLE
CONCLUSION: Differences in soluble inflammatory markers and
whole-blood expression of inflammatory genes were identified. The
findings suggest a systemic shift in inflammatory signalling that
may be contributing to the dysregulation of metabolic hormones in
the progression of metabolic disease in obesity. Evidence of
increased intestinal permeability in the MetDys group, in the
absence of clear differences in gut microbial composition, suggest
other non-microbial factors may also play a role in regulating gut
and inflammatory markers in obesity-associated metabolic disease.
DISCLOSURE OF INTEREST: None declared.
P262 | Are changes in adiposity and gut
microbiota composition related to individual
differences in macronutrient intake in rats
fed a ‘cafeteria-style’ diet?
M. Kendig1,2; S.-J. Leigh1,3; K. Hasebe1; R. F. Westbrook4; M. Morris1
1
School of Medical Sciences, UNSW Sydney; 2School of Life Sciences,
University of Technology, Sydney, Australia; 3APC Microbiome Ireland,
University of Cork, Cork, Ireland; 4School of Psychology, UNSW Sydney,
Sydney, Australia
INTRODUCTION: Chronic consumption of diets high in fat and/or sugar
is strongly linked to the risk of obesity and associated metabolic impair-
ment, as well as changes in cognition and the composition of the gut
microbiome. Fat and sugar are each implicated in these effects, but these
nutrients often occur together in food items and their consumption var-
ies widely between individuals, and within an individual over time.
MATERIALS AND METHODS: Here we examined whether changes
in adiposity and gut microbiota composition were related to individual
differences in consumption of a varied, palatable cafeteria diet (CAF).
Thirty adult male Sprague–Dawley rats were housed individually with
free access to chow and water (CON, n = 15) or chow, water, 10%
sucrose and a range of high-fat, high-sugar foods, which varied daily
(CAF, n = 15) for 7 weeks. Food intake was measured daily during
weeks 1 and 4, and twice weekly otherwise. Place recognition mem-
ory, whole body adiposity and plasma hormones were measured in
weeks 3 and 6, with faecal samples collected in weeks 0, 3 and 6 for
microbiome analyses.
RESULTS: Cafeteria diet exposure significantly increased energy intake,
weight gain and fat mass, and impaired place recognition memory rela-
tive to group CON at both 3 and 6 weeks. Contrary to expectations, ana-
lyses of differences in food selection and macronutrient intake within
group CAF found that the cognitive and metabolic impairments were
not reliably predicted by total energy intake or energy derived from fat,
sugar, or protein. Analyses of the gut microbiota will be discussed.
CONCLUSION: Results suggest that diet-induced impairments in adi-
posity are not driven by a single nutrient or eating pattern.
DISCLOSURE OF INTEREST: None declared.
1467789x, 2022, S2, Downloaded from https://onlinelibrary.wiley.com/doi/10.1111/obr.13503 by CAPES, Wiley Online Library on [16/12/2023]. See the Terms and Conditions (https://onlinelibrary.wiley.com/terms-and-conditions) on Wiley Online Library for rules of use; OA articles are governed by the applicable Creative Commons License
117 of 222
P264 | Early immune and metabolic
transcriptional changes in bariatric surgery: A
prospective human study
N. West1; N. Wylie2; R. Ramsey3; R. Moss2; K. Hatton-Jones3;
J. Sinclair3; A. Cripps4; A. Cox1
1
School of Pharmacy and Medical Sciences and Menzies Health Institute
QLD, Griffith University, Parklands; 2Toowoomba Weight Loss Surgery,
Toowoomba; 3School of Pharmacy and Medical Sciences; 4School of
Medicine and Dentistry, Griffith University, Parklands, Australia
INTRODUCTION: Chronic inflammation is a characteristic of obesity
and is proposed to contribute to metabolic dysregulation. Large improve-
ments in metabolic health following bariatric surgery occur in the short
to medium term (1–4 weeks) but little information on changes in immu-
nometabolism in this period are known. This study examined the time
course of changes in immunometabolism in the 12 weeks following bar-
iatric surgery utilising “Omics” approaches.
MATERIALS AND METHODS: A prospective longitudinal study of
individuals undergoing bariatric surgery was undertaken. Blood sam-
ples were collected from patients prior to pre-surgical caloric restric-
tion, the day before surgery, then 4 weeks and 12 weeks' post-
surgery. Whole blood inflammatory transcriptional changes were mea-
sured with the 770 gene NanoString PanCancer Immune Profiling
Panel (NanoString, Seattle, USA) and whole blood metabolic transcrip-
tional changes were measured with the 770 gene Human Metabolic
Pathways Panel (NanoString, Seattle, CA, USA) along with changes in
clinical measures of inflammation (leucocyte subsets and CRP) and
metabolism (HbA1C).
RESULTS: The largest changes in clinical measures of inflammation, in
particular white cell count, neutrophil count and CRP, occurred fol-
lowing pre-surgical caloric restriction compared to 4 weeks and
12 weeks post-surgery. Using a threshold of >2-fold change, the
greatest changes in immune gene expression were from pre-surgical
caloric restriction to the day before surgery. Gene set enrichment
analysis indicated that pre-surgical caloric restriction was associated
with increased expression of cell cycle and complement pathways but
reduced expression of senescence, Toll-Like Receptor, and T-cell and
B-cell functional pathways compared to 4 weeks or 12 weeks post-
surgery. Gene set enrichment analysis indicated broad increases in
immune cell metabolic pathway expression, particularly in mTOR, P53
and mitochondrial respiration following pre-surgical caloric restriction
but decreases in mTOR, AMPK, PI3K and epigenetic regulation at
12 weeks post-surgery.
CONCLUSION: Temporal differences in immunometabolic transcrip-
tional changes in whole blood were observed in relation to bariatric
surgery. Pre-surgical caloric restriction was associated with increased
activity in the innate immune system but reduced activity in the adap-
tive immune system, largely independent of changes in body mass.
Immune metabolic transcriptional activity displayed more uniform
changes across the study period and was related to changes in body

118 of 222
mass and diet. This study provides unique insight into immunometa-
bolism in obesity related disease.
DISCLOSURE OF INTEREST: None declared.
P266 | Asiatic acid attenuates kidney injury in
high-fat diet-induced obese mice
W. Sangartit1; U. Kukongviriyapan1; K. Senaphan2; G. Jan-On3
1
Physiology, Faculty of Medicine; 2Faculty of Veterinary Medicine, Khon
Kaen University, Khon Kaen; 3Chulabhorn International College of
Medicine, Thammasat University, Patumthani, Thailand
INTRODUCTION: Obesity is associated with several risk factors con-
tributing to kidney injury and chronic kidney disease (CKD). Activation
of the intrarenal renin-angiotensin system (RAS)/transforming growth
factor-β1 (TGF-β1)/nicotinamide adenine dinucleotide phosphate oxi-
dase 4 (NOX4) pathway is recently considered an underlying mecha-
nism of obesity-induced kidney injury. We aimed to explore the
effects of Asiatic acid (AA), a strong antioxidant on the RAS/TGF-β
-NOX4-mediated kidney injury in high-fat diet (HFD)-fed mice.
MATERIALS AND METHODS: Eight-week-old C57BL/6J mice were
assigned into 4 groups; (1) control fed with a regular diet (RD),
(2) HFD (60% of total calories from fat), (3) HFD supplemented with
1
AA 10 mg
kg per day, and (4) HFD supplemented with AA
1
20 mg
kg per day. AA was intragastrically administered for 4 weeks
starting after 8 weeks of HFD induction. During the experimental
period, the metabolic changes of those mice were monitored. At the
end of the experiment, glomerular ultrastructure and the expressions
of RAS/TGF-β1-NOX4 were investigated.
RESULTS: HFD-fed mice exhibited obesity accompanied by kidney
injury including increased urinary albumin to creatinine ratio (ACR),
mesangial expansion, and podocyte effacement (p < 0.01 vs. control).
The expression of renal TGF-β1, and NOX4 were also significantly
increased in comparison with the controls (p < 0.05). Moreover, HFD-
fed mice showed an upregulation of intra-renal angiotensin-
converting enzyme (ACE) and angiotensin II type 1 receptor (AT1R)
(p < 0.05 vs. controls). Supplementation with AA alleviated these
alterations and restored renal function of HFD-fed mice in a dose-
dependent manner.
CONCLUSION: AA mitigates kidney injury in HFD-induced obese mice
through suppression of RAS/TGF-β1-NOX4. Furthermore, it also allevi-
ated an impaired insulin sensitivity, dyslipidemia, and increased blood
pressure.
DISCLOSURE OF INTEREST: None declared.
1467789x, 2022, S2, Downloaded from https://onlinelibrary.wiley.com/doi/10.1111/obr.13503 by CAPES, Wiley Online Library on [16/12/2023]. See the Terms and Conditions (https://onlinelibrary.wiley.com/terms-and-conditions) on Wiley Online Library for rules of use; OA articles are governed by the applicable Creative Commons License
SUPPLEMENT ARTICLE
P267 | C-phycocianin extract using a greener
approach from Spirulina presents an anti-
obesity characteristic in mice treated with
hyperlipidic diet
A. Francisco da Silva Neto1; C. Fratelli2; Y. A. M. Ferreira2;
C. Oller do Nascimento1; M. M. Telles1; A. R. C. Braga2;
L. M. Oyama3
1
Physiology, Universidade Federal de São Paulo, Sao Paulo; 2Universidade
Federal de São Paulo, Santos; 3Universidade Federal de São Paulo, Sao
Paulo, Brazil
INTRODUCTION: The use of nutraceutical, food rich in bioactive
compounds with metabolic benefit effects have been used as a sup-
porting tool to control the metabolic alteration observed in people
affected by obesity. The Spirulina is a filamentous cyanobacterium
known by nutraceutical, hypolipidemic, hypoglycaemic and anti-
hypertensive qualities and it is rich in C-phycocianin, which have anti-
oxidant, antitumoral, anti-inflammatory and anti-obesogenic and
hepatoprotection activities. Aiming the correct way to explore the
Spirulina, the extraction protocol of C-phycocianin used in this study
was a “green method,” make use of water as solvent.
MATERIALS AND METHODS: Swiss mice were distributed into three
groups: (1) ND: normolipidic diet receiving saline by gavage; (2) SB:
high-fat diet receiving 500 mg/body weight per day of Spirulina bio-
mass; (3) CFC: high-fat diet receiving c-phycocyanin rich extract
500 mg/body weight per day obtained from the extraction without
chemicals, only water as a solvent, a greener approach. The food
intake was monitored daily, and the animals were weighed weekly.
After 12 weeks of treatment an oral glucose tolerance test (OGTT)
was performed and the animals were sacrificed.
RESULTS: The administration of Spirulina biomass for 12 weeks asso-
ciated with a high-fat diet increased the delta weight of the animals,
absolute liver weight and absolute and relative weight of inguinal
white adipose tissue compared to ND and CFC. Also, the SB group
showed glucose intolerance as compared to the ND group, while the
CFC group was similar to ND group. In order to verify possible mecha-
nism used by c-phycocyanin to normalize the glucose tolerance, AKT
total protein was quantified in the retroperitoneal white adipose tis-
sue by Western blotting but there is no difference among groups.
CONCLUSION: These results demonstrated that whole Spirulina bio-
mass did not present an anti-obesity characteristic. On the other
hand, the c-phycocyanin rich extract obtained from Spirulina biomass
using a greener approach was able to prevent obesity decreasing
white adipose depot weight and improving glucose intolerance, inde-
pendent of AKT content in the retroperitoneal white adipose tissue.
DISCLOSURE OF INTEREST: None declared.

SUPPLEMENT ARTICLE
P269 | Relationship between insulin
resistance biomarkers and visceral adipose
tissue in military personnel
P. F. Ferreira; M. Sena; S. Da Rosa; A. Silva; M. Fortes
Brazilian Army Research Institute of Physical Fitness, Brazilian Army, Rio
de Janeiro, Brazil
INTRODUCTION: Visceral adipose tissue (VAT) is considered a risk fac-
tor for metabolic syndrome (MS), since it has strong association with
insulin resistance (IR), leading to the development of chronic non-
communicable diseases (CNCDs). It should be noted that, due to the
association between IR, MS and CNCDs, there is a growing interest in
the development of techniques for evaluation and laboratory diagnosis
of IR at a lower cost. In this context, the triglyceride and high-density
lipoprotein (TRIG/HDL-c) and triglyceride and glucose (TyG) indexes
stand out. In this scenario, the objective of this work was to evaluate the
association between VAT, performed through X-ray emission absorpti-
ometry (DXA), and the TRIG/HDL-c and TyG indexes in Brazilian Army
soldiers.
MATERIALS AND METHODS: Cross-sectional study composed of
194 military personnel (38.0 ± 6.2 years) divided into two groups: 51 sub-
jects with MS risk factors (MS) and 143 subjects without MS risk factors
1467789x, 2022, S2, Downloaded from https://onlinelibrary.wiley.com/doi/10.1111/obr.13503 by CAPES, Wiley Online Library on [16/12/2023]. See the Terms and Conditions (https://onlinelibrary.wiley.com/terms-and-conditions) on Wiley Online Library for rules of use; OA articles are governed by the applicable Creative Commons License
119 of 222
(NMS). Blood collection was performed after a 12-h fasting for the analy-
sis of the following biomarkers: glucose, TRIG and HDL-c, using the
automated biochemical analyzer BT 3000 (Wiener Lab®). The VAT was
measured using the DXA equipment, iLunar model from GE Healthcare.
Data normality was confirmed by the Kolmogorov–Smirnov test, thus, in
descriptive statistics, mean and standard deviation were used for the var-
iable with normal distribution (VAT and TyG) and median for variables
with non-normal distribution (TRIG/HDL-c). In inferential statistics, Stu-
dent's and Mann Whitney's tests, regarding the variable distribution,
were used to evaluate the differences of the means/medians between
the two groups. For the analysis of the association between VAT and
TyG was used the Pearson's correlation and for VAT and TRIG/HDL-c
variables was used the Spearman's correlation.
RESULTS: Significant differences between the means were observed
between MS and NMS groups in TRIG/HDL-c (MS: 2.33 and NMS: 1.37;
p < 0.001), TyG (MS: 4.67 ± 0.24 and NMS: 4.44 ± 0.23; p < 0.001) and
VAT (MS: 15.20 ± 6.42 and NMS: 7.74 ± 5.51; p < 0.001). The VAT
showed significant positive correlation with the TRIG/HDL-c and TyG
indexes (r = 0.365 and r = 0.435, respectively; p < 0.001).
CONCLUSION: Individuals with MS risk factors are closer to develop-
ing IR and CNCDs. The studied indexes showed a positive correlation
with VAT in the studies group, which gives evidence of the possibility
of using them as a low-cost alternative for the assessment of IR.
DISCLOSURE OF INTEREST: None declared.

120 of 222
P270 | Role of SOAT1 in regulating
intracellular cholesterol redistribution during
adipogenesis
Q. Liu; Y. Zhu
The Hong Kong Polytechnic University, Hong Kong, Hong Kong
INTRODUCTION: Cholesterol homeostasis is critical to maintain adi-
pocyte function during obesity progression, however, the role of cho-
lesteryl esterification in adipocytes remains elusive. Sterol O-
acyltransferase 1 (SOAT1) is the dominant enzyme to synthesize cho-
lesteryl ester from free cholesterol in adipocytes. Previously, we
found that inhibiting SOATs attenuated adipogenesis in 3 T3-L1 cell
line, however, the underlying mechanism remains largely unknown.
MATERIALS AND METHODS: Stromal vascular fraction derived from
white adipose tissue, human preadipocytes, and murine 3 T3-L1 cell
line were cell models. Lentirvirus-mediated shRNA and Cre recombi-
nant adenovirus were applied to examine the role of SOAT1 in adipo-
cytes in vitro. RNA-seq, lipidomics, and various biochemical assays
were conducted to explore the underlying mechanism and potential
physiological significance.
RESULTS: We found that SOAT1 expression had been largely induced
in obese mice and mouse adipocytes differentiated from SVF. Addi-
tionally, both SOAT1 knockdown in 3 T3-L1 cells and SOAT1 knockout
in primary murine preadipocytes reduced lipid accumulation by 70%
after six days of differentiation. Regarding the regulatory role of cho-
lesterol in lipid droplet development in adipocytes, SOAT1 knockdown
also led to an increasement in intracellular cholesterol content and
inhibited sterol regulatory element-binding protein-2 maturation as
well as the expressions of its downstream genes involved in choles-
terol uptake. Furthermore, SOAT1 knockdown in preadipocytes atten-
uated the induction of plasma membrane cholesterol content during
adipogenesis, while cholesterol repletion with methyl-β-cyclodextrin
restored the expression of genes involved in cholesterol uptake and
adipogenesis in SOAT1-knockdown adipocytes.
CONCLUSION: In summary, our results reveal that SOAT1 is impor-
tant for adipogenesis via regulating intracellular cholesterol redistribu-
tion and highlight the potential role of cholesteryl esterification in
adipose tissue expansion.
DISCLOSURE OF INTEREST: None Declared.
1467789x, 2022, S2, Downloaded from https://onlinelibrary.wiley.com/doi/10.1111/obr.13503 by CAPES, Wiley Online Library on [16/12/2023]. See the Terms and Conditions (https://onlinelibrary.wiley.com/terms-and-conditions) on Wiley Online Library for rules of use; OA articles are governed by the applicable Creative Commons License
SUPPLEMENT ARTICLE
P271 | Characterising a new and improved
mouse model of diet-induced metabolic
syndrome
V. Tran; H. Brettle; H. Diep; Q. Nhu Dinh; C. G. Sobey;
G. R. Drummond; A. Vinh; M. Jelinic
Microbiology, Anatomy, Physiology and Pharmacology, Centre for
Cardiovascular Biology and Disease Research, La Trobe University,
Melbourne, Australia
INTRODUCTION: Metabolic syndrome (MetS) is a complex multifacto-
rial disease that increases the risk for cardiovascular disease and/or
death by 2- to 3-fold. Perivascular adipose tissue (PVAT – a continuous
layer with the adventitia of blood vessels) is a recognized regulator of
vascular function. However, in disease states such as MetS, the PVAT
promotes vascular dysfunction and acts as a reservoir for immune cell
accumulation. Sexual dimorphisms associated with PVAT pathophysiol-
ogy are poorly understood. This may be partly due to a lack of reliable
animal models that accurately reflect MetS parameters. We recently
developed a new mouse model of diet-induced MetS where metabolic
disturbances are comparable in both sexes. Using this new model of
MetS, we characterised the aortic PVAT immune cell profile and deter-
mined the influence of PVAT on vascular function in males and females.
MATERIALS AND METHODS: Six-week-old male and female
C57BL/6 mice were fed either a high-fat diet (43% kcal in food) with
high sugar and salt in their drinking water (10% high fructose corn
syrup and 0.9% NaCl; HFSS), or normal control diet (NCD) for
10 weeks. Physiological parameters were measured weekly and fort-
nightly. At end point, blood and aortic immune cell populations were
characterised using flow cytometry. Endothelium-dependent relaxa-
tion to acetylcholine in mouse abdominal aorta rings (with and with-
out PVAT) was measured using wire myography.
RESULTS: Compared to NCD, male and female HFSS-fed mice exhib-
ited increased cumulative weight gain, fasting blood glucose and sys-
tolic blood pressure (P < 0.05, n = 34–41), all of which are clinical
characteristics of MetS. In males fed a HFSS diet, aortic pro-
inflammatory monocytes (Ly6Chi+) and neutrophils (Ly6G+) were sig-
nificantly increased (P < 0.05 vs. HFSS-fed female). Wire myography
data indicated that PVAT blunted endothelium-dependent relaxation
in HFSS-fed males (P < 0.05 vs. NCD male) but enhanced
endothelium-dependent relaxation in HFSS females.
CONCLUSION: We developed the HFSS model - a clinically relevant
mouse model of diet-induced MetS. Despite comparable metabolic
disturbances in both sexes, aortic inflammation was only observed in
males. Moreover, MetS altered PVAT and vascular function in both
sexes, but with contrasting effects. These data highlight the sexual
dimorphisms in PVAT in the setting of MetS and support the impor-
tance of PVAT as a major regulator of vascular health.
DISCLOSURE OF INTEREST: None Declared.

SUPPLEMENT ARTICLE
P273 | Enablers and barriers to implementing
obesity assessments in clinical practice: A
rapid mixed methods systematic review
1 1 1 1
E. Atlantis ; R. Chimoriya ; C. Seifu ; K. Peters ; G. Murphy ; 1 Declared, P. Fahey: None Declared.
2 1 1
B. Carr ; D. Lim ; P. Fahey
1
Western Sydney University, Penrith, Australia; 2The University of
Sydney, Sydney, Australia
INTRODUCTION: This systematic review aims to improve our knowl-
edge of enablers and barriers to implementing obesity related anthro-
pometric assessments in clinical practice.
MATERIALS AND METHODS: We searched Medline, Embase, and
CINAHL databases for potentially relevant articles to 25th November
2021. We considered: quantitative studies that reported patient fac-
tors associated with obesity assessments in clinical practice (general
practice or primary care); and qualitative studies that reported views
of health care professionals about enablers and barriers to their imple-
mentation. We used random-effects meta-analysis to pool ratios for
categorical predictors reported in ≥three studies expressed as pooled
Risk Ratio (RR) with 95% Confidence Interval (CI), applied heteroge-
neous specific inverse variance weights, and investigated statistical
heterogeneity (I2), publication bias (Egger's test), and sensitivity ana-
lyses. We used reflexive thematic analysis for qualitative data and
applied a convergent integrated approach to synthesis.
RESULTS: We reviewed 22 quantitative (observational) and three
qualitative studies published between 2004 and 2020. All had ≥50%
of the quality items for risk of bias assessments. Obesity assessment
in clinical practice was positively associated with patient factors:
2
female sex (RR 1.28, 95%CI:1.10,1.50, I 99.8%, mostly UK and US
studies), socio-economic deprivation (RR 1.21, 95%CI:1.18,1.24, I2
73.9%, UK studies), non-White race/ethnicity (RR 1.27,
95%CI:1.03,1.57, I2 99.6%), and comorbidities (RR 2.11,
2
95%CI:1.60,2.79, I 99.6%, consistent across most countries). Obesity
assessment was also most common in the heaviest body mass index
group (RR 1.55, 95%CI:0.99,2.45, I2 99.6%). Views of health care pro-
fessionals were positive about obesity assessments when linked to
patient health (convergent with meta-analysis for comorbidities) and if
part of routine practice, but negative about their role, training, time,
resources, and incentives in the health care system.
CONCLUSION: Our evidence synthesis revealed several important
enablers and barriers to obesity assessments that should inform
health care professionals and relevant stakeholders to encourage
adherence to clinical practice guideline recommendations.
DISCLOSURE OF INTEREST: E. Atlantis Grant / Research support
with: EA was the Founding President, and now serves as the Secre-
tary, of the National Association of Clinical Obesity Services
(NACOS). He has received honoraria from Novo Nordisk for speaking
and participating at meetings. He has received unrestricted research
funding from Novo Nordisk and iNova on behalf of NACOS.,
R. Chimoriya Grant / Research support with: RC received payments
for his contributions through casual employment contracts at Western
1467789x, 2022, S2, Downloaded from https://onlinelibrary.wiley.com/doi/10.1111/obr.13503 by CAPES, Wiley Online Library on [16/12/2023]. See the Terms and Conditions (https://onlinelibrary.wiley.com/terms-and-conditions) on Wiley Online Library for rules of use; OA articles are governed by the applicable Creative Commons License
121 of 222
Sydney University., C. Seifu Grant/Research support with: CNS
received payments for her contributions through casual employment
contracts at Western Sydney University., K. Peters: None Declared,
G. Murphy: None Declared, B. Carr: None Declared, D. Lim: None
P276 | The best obesity indicators for
metabolic syndrome: The comparison of
discrimination power among body mass
index, waist circumference, waist-height ratio
B. T. Kim1; S.-H. Lee2; J.-W. Kim3
1
Family practice and Community health, Ajou University School of
Medicine, Suwon; 2Family Medicine, Seongnam Citizens Medical Center,
Seongnam, South Korea; 3Family Medicine, Uijeongbu Eulji Medical
Center, Uijeongbu, 4Family Medicine, Korea University College of
Medicine, Seoul, Korea, Republic Of
INTRODUCTION: Previous studies have reported that waist-to-
height ratio (WHtR) is a better predictor of cardiovascular risk than
body mass index (BMI) and waist circumference (WC); however, a
recent report questioned the predictive superiority of WHtR over
BMI and WC. The aim of this study was to identify the best anthropo-
metric predictor among three indicators of metabolic syndrome (MS).
MATERIALS AND METHODS: We analyzed 6,160 subjects from the
second year of the 4th Korea National Health and Nutrition Examina-
tion Survey(4th KNHANES). We carried out receiver-operating char-
acteristic analysis and compared area under the curves (AUCs) of BMI,
WC, and WHtR.
RESULTS: Across all ages, the AUC of WHtR was the largest among
obesity indicators (men:0.813, women:0.844), suggesting it was most
able to predict MS. However, after adjustment for age, WC became
the strongest predictor for MS (men:0.834, women:0.876) among
them. After age stratification of the study population (19–39 yrs,
40–64 yrs, ≥65 yrs), the three obesity indices had similar predictive
power in young women. In young and middle-aged men, and middle-
and old-aged women, WC and WHtR were equivalent in their predic-
tive ability but significantly higher than BMI.
CONCLUSION: Therefore, the superiority of WHtR over WC as a
predictor of MS may be overestimated, likely due to the inverse rela-
tionship between age and height.
DISCLOSURE OF INTEREST: None Declared.
 1467789x, 2022, S2, Downloaded from https://onlinelibrary.wiley.com/doi/10.1111/obr.13503 by CAPES, Wiley Online Library on [16/12/2023]. See the Terms and Conditions (https://onlinelibrary.wiley.com/terms-and-conditions) on Wiley Online Library for rules of use; OA articles are governed by the applicable Creative Commons License
122 of 222 SUPPLEMENT ARTICLE

P278 | Obesity has a protective effect against 2006 to Dec. 2014 were reviewed for exclusion criteria such as thy-
fragility fracture in older postmenopausal roid illnesses, malignancy or use of drugs that affect normal bone

women but not in early menopause:
Retrospective cohort study, Ajou bone love
database (ABLD)
J. Shin1; S. Lee1; K. Y. Kim1; Y. Choi2; O. Noh3; Y. Chung2; B.-T. Kim1
1
Department of Family Practice and Community Health; 2Department of
Endocrinology and Metabolism; 3Department of Radiation Oncology,
Ajou University School of Medicine, Suwon, Korea, Republic Of
INTRODUCTION: The fracture risk in postmenopausal women, esti-
mated from bone mineral density (BMD) is under the influence of vari-
ous factors such as age, ethnicity, and body mass index (BMI). Obesity
is known to correlate well with increased bone mass and decreased
fragility fracture. It is not clear that the beneficial effect of BMI on
osteoporosis is similar throughout postmenopausal period for age
plays crucial role in decreased bone mass and increased fracture
probability.
We analyzed the influence of age and BMI on BMD and fracture
rate in Korean postmenopausal women, using Ajou Bone Love Data
(ABLD).
MATERIALS AND METHODS: Electronic medical record (EMR) of
23,524 women ≥ 50 years old who had BMD measurement from Jan.
metabolism. 17,432 women were included in the analysis. Their first
fracture occurrence till Dec. 2021 was identified. Subjects were
grouped into age groups of 50–59 years, 60–69 years, 70–79 years,
and 80 and over. BMI groups were underweight, median, overweight,
and obese. Osteoporosis prevalence and fracture rate was calculated
in each age and BMI groups.
RESULTS: The prevalence of osteoporosis was 9.6%, 26.9%, 51.3%,
and 77.3% for age groups 50s, 60s, 70s, and 80 and over, respectively.
Fracture rate in each age groups were 2.6%, 4.9%, 8.9%, and 22.2%.
Osteoporosis prevalence in BMI groups were 55.3%, 26.3%, 20.2%,
17.6% for underweight, median, overweight, and obese, respectively.
Fracture rate in each group was 11.2%, 5.1%, 4.8%, 5.2%.
CONCLUSION: Increased weight is beneficial against osteoporosis in
advanced age, especially above 70 years, while being overweight or
obese provides no protection during early menopause years. Worsen-
ing with age, being underweight predisposes one more vulnerable to
fracture in all age ranges than the other weight categories. Therefore,
we conclude that putting more weight in senior years is beneficial for
BMD, and loseing weight under normal BMI range is critical of
increased fragile fracture risk which worsens with age.
DISCLOSURE OF INTEREST: None Declared.

TABLE 1 Demographics.

Average (min-max)
Number of subjects 17,432
Age (years) 60.8 (50–95.6)
Height (cm) 154.7 (117–175.9)
Weight (kg) 57.7 (24.8–110)
BMI 24.1 (12.3–44.1)
L1-L4 T-score 1.2 ( 7.4–4.9)
L1-L4 BMD 0.99 (0.26–1.91)
 1467789x, 2022, S2, Downloaded from https://onlinelibrary.wiley.com/doi/10.1111/obr.13503 by CAPES, Wiley Online Library on [16/12/2023]. See the Terms and Conditions (https://onlinelibrary.wiley.com/terms-and-conditions) on Wiley Online Library for rules of use; OA articles are governed by the applicable Creative Commons License
SUPPLEMENT ARTICLE 123 of 222

P279 | Clustering and combining patterns of proportion of these metabolic diseases. Additionally, NAFLD
metabolic diseases, and associated factors of accounted for the largest proportion of single metabolic diseases

non-alcoholic fatty liver disease among a
nationally representative sample of Korean
young adults
S. H. Kim
Department of Family Medicine, Wonkwang University Sanbon Hospital,
Wonkwang University School of Medicine, Gunpo, Korea, Republic Of
INTRODUCTION: Metabolic diseases, which are risk factors and lead-
ing diseases of cardiovascular disease (CVD) have been increasing in
Korean young adults. However, the recent prevalence of these meta-
bolic diseases and risk factors for nonalcoholic fatty liver disease
(NAFLD) in this population are not well known. Therefore, combining
patterns of metabolic diseases and associated factors of NAFLD were
investigated in Korean young adults.
MATERIALS AND METHODS: In the Korea National Health and
Nutrition Examination Survey (2017–2019), 4,230 adults aged 19–
39 years (1,913 men and 2,317 women) participated. NAFLD was
evaluated using the Hepatic steatosis index (HSI). The clustering pat-
terns of NAFLD, hypertension, diabetes mellitus, hypercholesterol-
emia, and hyper triglyceride were assessed using frequency analysis.
Univariate analysis and multivariable logistic regressions were used to
investigate the associated factors of NAFLD.
RESULTS: Total prevalence of NAFLD, hypertension, diabetes melli-
tus, hypercholesterolemia, and hyper triglyceride was 28.2%. The
prevalence of NAFLD was 16.2%, accounting for the highest
(49.6%). Among the participants with metabolic diseases, about 33%
had multiple metabolic diseases (≥2 diseases).
Factors showing significant association with NAFLD were males,
obesity, and excessive carbohydrate intake. Among them, obesity was
most significantly related to NAFLD.
CONCLUSION: Recently, the prevalence of metabolic diseases in
Korean young adults was almost 28%. The proportion of patients with
multiple metabolic diseases was relatively high. To prevent CVD, it is
necessary to pay more attention to lifestyle management and treat-
ment of obesity in young adults.
DISCLOSURE OF INTEREST: None Declared.
P281 | Association between body
composition parameters and metabolic
syndrome in postmenopausal women
Y. Jeong; S. G. Park; Y. Eun
Department of Family Medicine, Yeouido St. Mary's Hospital, College of
Medicine, The Catholic University of Korea, Seoul, Korea, Republic Of
INTRODUCTION: During menopause, women go through an increase
in total and central obesity, and this has been linked with a number of
metabolic complications. Metabolic syndrome is associated with obe-
sity, and BMI is widely used to evaluate obesity. However, BMI does
not sufficiently reflect the subject's body composition. To compensate
for the limitations of BMI, several parameters related to body

Crude Model 1 Model 2

BMI
Lowest 1 1 1
Middle 5.150 (2.296–11.553) 5.080 (2.248–11.478) 5.671 (2.336–13.770)
Highest 20.939 (9.596–45.689) 22.674(10.251–50.152) 25.049 (10.476–59.893)
FMR
Lowest 1 1 1
Middle 2.612 (1.356–5.033) 2.569 (1.328–4.968) 2.600 (1.294–5.223)
Highest 8.831 (4.747–16.430) 8.614 (4.609–16.099) 7.634 (3.906–14.924)
VFA
Lowest 1 1 1
Middle 3.107 (1.494–6.463) 3.083 (1.480–6.424) 3.557 (1.586–7.978)
Highest 14.983 (7.505–29.914) 14.587 (7.157–29.730) 16.410 (7.345–36.660)
SVR
Lowest 1 1 1
Middle 0.396 (0.243–0.645) 0.416 (0.251–0.690) 0.464 (0.266–0.807)
Highest 0.150 (0.082–0.272) 0.162 (0.086–0.304) 0.180 (0.091–0.354)

124 of 222
composition have been proposed. The purpose of this study is to
identify the associations of body composition factors with metabolic
syndrome in postmenopausal women.
MATERIALS AND METHODS: A total of 455 postmenopausal women
who visited the Health Promotion Center of St.Vincent's Hospital from
2009 to 2018 were analyzed. We used bioelectrical impedance analysis
to evaluate BMI, fat-to-muscle ratio (FMR), visceral fat area (VFA), and
skeletal muscle-to-visceral fat area ratio (SVR). Metabolic syndrome was
defined according to the revised National Cholesterol Education Program
Adult Treatment Panel III (NCEP ATP III). Multivariate logistic regression
analysis was done with the tertile groups for each potential indicator.
The Area under the receiver operating characteristic curve (AUC) was
used to assess the accuracy of each predictive distribution model.
RESULTS: All parameters showed statistically significant association
with metabolic syndrome in multivariate logistic regression analysis.
This association was strongest in the highest tertile and was main-
tained after adjusting for potential confounding covariates (p < 0.05).
Furthermore, all parameters showed high predictive power for meta-
bolic syndrome in the predictive distribution model, and BMI showed
the highest AUC (BMI 0.79, FMR 0.75, VFA 0.78, SVR 0.70).
CONCLUSION: All parameters in this study showed significant associa-
tion and high predictive power with metabolic syndrome. Especially, BMI
had high predictive power despite its limitations in reflecting body com-
position. Therefore, BMI, FMR, VFA, and SVR are expected to be useful
clinical indicators for metabolic syndrome in postmenopausal women.
DISCLOSURE OF INTEREST: None Declared.
P282 | Implementing a Liraglutide pathway
into a specialist weight management service
S. Edwards; A. Halsall; P. Gately
Leeds Beckett University, Leeds, UK
INTRODUCTION: The ‘National Institute for Health and Care Excel-
lence’ (NICE) guidelines are evidence-based recommendations for health
and care in England. In October 2020, NICE mandated Liraglutide as a
new treatment option available on the NHS in England for adults living
with obesity and additional risk factors, alongside a reduced-calorie diet
and increased physical activity. Liraglutide is a glucagon-like peptide-1
receptor agonist (GLP-1RA) that is provided as subcutaneous injection at
a dose of 3.0 mg/day. As a commissioned Tier 3 weight management
service operating across 10 districts in the UK there was a necessity to
respond by implementing a medical pathway into our service.
MATERIALS AND METHODS: Phase one of the set-up consisted of
the internal stakeholders, including the clinical leadership team and
senior management team, forecasting the required members of the
multidisciplinary team for implementation and factoring in the associ-
ated costings. Phase two involved engagement and negotiation with
the external stakeholders such as Clinical Commissioners and Novo
Nordisk. Simultaneously there was a need to manage the expectations
of the clients demands for Liraglutide in the service. Thus,
1467789x, 2022, S2, Downloaded from https://onlinelibrary.wiley.com/doi/10.1111/obr.13503 by CAPES, Wiley Online Library on [16/12/2023]. See the Terms and Conditions (https://onlinelibrary.wiley.com/terms-and-conditions) on Wiley Online Library for rules of use; OA articles are governed by the applicable Creative Commons License
SUPPLEMENT ARTICLE
conclusively embedding the pathway into our service and screening
for client's eligibility against NICE criteria.
RESULTS: NICE guidance urged a response from clinical commissioning
groups and commissioned Tier 3 services to action these guidelines
within three months of publication. However little instruction on how to
implement these recommendations was provided. Some of the issues
we encountered and have subsequently resolved included: negotiating
the resources needed for the pathway with each locality and securing
the funding, managing prescriptions plus associated storage issues and
obtaining blood results required for screening purposes.
CONCLUSION: A Liraglutide Pathway has now been integrated into
our Tier 3 services and we are able to offer this to clients deemed eli-
gible by NICE. Clients can access this medication for a maximum of
two years if they demonstrate an initial weight loss of more than 5%.
This provides eligible clients with a treatment option that deals with
the biological determinants of obesity and increases the chance of sig-
nificant weight-loss and a reduction in associated comorbidities.
DISCLOSURE OF INTEREST: S. Edwards Employee of: MoreLife,
A. Halsall Employee of: MoreLife, P. Gately Employee of: MoreLife.
P283 | Disclosing metabolic signatures after
different bariatric surgery procedures
through glycemic profiling – A cross-sectional
single-center cohort study
C. B. Lobato1,2,3,4; S. S. Pereira1,2,5; M. Guimarães1,2,5,6;
B. Hartmann3; A. M. Pereira6; M. Nora6; J. J. Holst3;
M. P. Monteiro1,2,5
1
Endocrine & Metabolic Research - Unit for Multidisciplinary Research in
Biomedicine UMIB, School of Medicine and Biomedical Sciences ICBAS-
University of Porto; 2ITR - Laboratory for Integrative and Translational
Research in Population Health, Porto, Portugal; 3Department of
Biomedical Sciences and Novo Nordisk Foundation Center for Basic
Metabolic Research, Faculty of Health and Medical Sciences, University
of Copenhagen; 4Department of Endocrinology, Hvidovre Hospital,
University of Copenhagen, Copenhagen, Denmark; 5Department of
Anatomy, School of Medicine and Biomedical Sciences ICBAS- University
of Porto, Porto; 6Department of General Surgery, Centro Hospitalar de
Entre o Douro e Vouga, Santa Maria da Feira, Portugal
INTRODUCTION: Entero-endocrine system plays a major role in bar-
iatric surgery metabolic gains. Yet, it might be involved in complica-
tions as post-bariatric hypoglycemia. The aim of this work was to
explore how hormone dynamics and ambulatory glycemic profiles
relate in individuals submitted to various bariatric procedures.
MATERIALS AND METHODS: Individuals, without prior diabetes diag-
nosis, who underwent bariatric surgery for obesity treatment were allo-
cated into 4 surgical groups: standard Roux-en-Y gastric bypass (C-
RYGB, n = 10); long biliopancreatic limb RYGB variant (M-RYGB,
n = 14); biliopancreatic diversion with duodenal switch (BPD-DS, n = 7)
and single anastomosis duodeno-ileal bypass with sleeve gastrectomy

SUPPLEMENT ARTICLE
(SADI-S, n = 9). Glucose and hormone dynamics were assessed on a liq-
uid mixed-meal tolerance test (MMTT) and Flash Glucose Monitoring
(FGM) for 14 days under free-living conditions. BMI, age and sex-
matched non-operated subjects underwent FGM to be used as controls
(n = 8). The incremental area under the curve for postprandial excursions
were calculated. Statistical significance was fixed at p < 0.05. Spearman
correlations were valued if R > 0.60 (p < 0.01).
RESULTS: Subjects who underwent bariatric surgery displayed
greater time in hypoglycemia and hyperglycemia, lesser Time in Range
(TIR, 3.9–7.8mM), and greater rate and magnitude of glucose fluctua-
tions, as compared to non-operated controls.
Among patients submitted to surgery, those who underwent RYGB
had greater postprandial glucose excursions on MMTT and greater rates
and amplitude of glucose excursions and day-to-day glucose variability
on FGM, when compared to those submitted to BPD-DS or SADI-S.
Heart rate (HR) and glucose excursions preceded and correlated with
GLP-1, insulin and C-peptide during the MMTT. A strong positive correla-
tion between HR, glucose, GLP-1 and C-peptide and the rate of glucose
changes on FGM (MAG change) were strongly and positively correlated.
FIGURE: Mean Absolute Glucose change (MAG change) through flash
glucose monitoring (FGM) of participants submitted to standard Roux-
en-Y gastric bypass (C-RYGB), long biliopancreatic limb RYGB (M-RYGB),
single-anastomosis bypass duodeno-ileal with sleeve gastrectomy (SADI-
S) and biliopancreatic diversion with duodenal switch (BPD-DS), and
matched non-operated controls (Control) (A) and its correlation with
C-peptide incremental area under the curve from baseline to peak levels
during a meal test (r = 0.604, p < 0.01) (B).
1467789x, 2022, S2, Downloaded from https://onlinelibrary.wiley.com/doi/10.1111/obr.13503 by CAPES, Wiley Online Library on [16/12/2023]. See the Terms and Conditions (https://onlinelibrary.wiley.com/terms-and-conditions) on Wiley Online Library for rules of use; OA articles are governed by the applicable Creative Commons License
125 of 222
CONCLUSION: Glycemic variability is higher after bariatric surgery,
varies after different procedures, and is accompanied by distinct
entero-pancreatic hormone responses.
This study was funded by FCT (PTDC/MEC-CIR/3615/2021,
UIDB/00215/2020, UIDP/00215/2020, and LA/P/0064/2020). This
work was supported by a research grant from the Danish Diabetes
Academy (grant-ID PhD013–20), which is funded by the Novo Nor-
disk Foundation, grant nr. NNF17SA0031406; and by a grant from
the “la Caixa” Foundation (ID 100010434, code LCF/BQ/
EU21/11890081).
DISCLOSURE OF INTEREST: None Declared.
P284 | Addressing the gap in healthcare:
Physical health-related lifestyle intervention
for mental-metabolic health Management in
Mental Illness
C. Lum1; D. Higgins2; C. Finneran1; R. Chen1
1
Diabetes Department, St Vincent's Hospital Sydney; 2Diabetes
Department, St Vincent's Sydney, Sydney, Australia
INTRODUCTION: Patients living with severe mental illness often
struggle to navigate health systems and find it difficult to make
healthy dietary and lifestyle choices. These individuals have a signifi-
cantly higher risk of developing metabolic disorders such as obesity,
pre-diabetes, diabetes, and metabolic syndrome. St Vincent's Hospital
Sydney (SVHS) has developed a “Metabolic-Mental Health” (MMH)
team, comprising an endocrinologist, dietitian, exercise physiologist,
diabetes educator and mental health nurse. The aim of this team was
to increase accessibility to health, dietary and lifestyle education and
to support patients in facilitating behaviour change. A marked positive
difference in weight, BMI and central adiposity was noted among
patients who attended the MMH service as compared to patients
who did not engage with the service.
MATERIALS AND METHODS: Based on NSW Health metabolic
monitoring guidelines, mental health staff screen all patients managed
under the service. Patients who meet criteria such as metabolic syn-
drome or related components, or any patient on clozapine, are
referred to the MMH service. The MMH team review metabolic data
(anthropometry, demographics, and pathology) prior to consulting
each patient to allow personalised education and management. Refer-
rals are organised where required. There is a strong emphasis on life-
style intervention (diet and physical activity). A case study has been
selected to reflect improvements in metabolic outcomes, through
engagement with this novel service.
RESULTS: Since June 2020, the team has assessed over 300 patients.
The majority had obesity, pre-diabetes, or type 2 diabetes. Over 40%
had metabolic syndrome, 61.9% dyslipidaemia, over 60% had schizo-
phrenia. Diets were rich in energy-dense food and drinks, sodium, and
saturated fats, and low in fibre and wholegrains. 70% reported no

126 of 222
physical activity. The risk of obesity may be increased by medications,
poor health literacy, poor dietary choices, and inactivity.
Our service has enabled prompt management of metabolic risk fac-
tors in these individuals, including diabetes-related education where
required, personalised lifestyle intervention and pharmacological ther-
apy. Lifestyle interventions and medications e.g. metformin may be
effective in attenuating adverse metabolic changes. The case illustrates
the potential effectiveness of multidisciplinary metabolic care.
CONCLUSION: The data indicates that a patient-centred, physical-
health clinic utilising an integrated multidisciplinary metabolic health
team is effective. Ongoing support facilitates behaviour and lifestyle
changes leading to improvements in weight, abdominal circumference,
and metabolic risk factors, thus mitigating adverse physical health
outcomes.
DISCLOSURE OF INTEREST: None Declared.
1467789x, 2022, S2, Downloaded from https://onlinelibrary.wiley.com/doi/10.1111/obr.13503 by CAPES, Wiley Online Library on [16/12/2023]. See the Terms and Conditions (https://onlinelibrary.wiley.com/terms-and-conditions) on Wiley Online Library for rules of use; OA articles are governed by the applicable Creative Commons License
SUPPLEMENT ARTICLE
P285 | Characteristics of self-managed
weight loss in Australian adults
D. Ramachandran1; A. Li2; T. Gill1
1
The Boden Initiative, Charles Perkins Centre, The University of Sydney,
Camperdown, Australia; 2The University of Melbourne, Melbourne,
Australia
INTRODUCTION: Access and availability to professional weight man-
agement services in Australia is severely limited. While many adults
with weight problems ‘self-manage’ weight-loss, there is little known
about this phenomenon. This study aimed to: a) describe the charac-
teristics of people who self-manage b) examine if successful (c) define
changes in food consumption and physical activity (d) identify clusters
and compare weight outcomes among them.
 1467789x, 2022, S2, Downloaded from https://onlinelibrary.wiley.com/doi/10.1111/obr.13503 by CAPES, Wiley Online Library on [16/12/2023]. See the Terms and Conditions (https://onlinelibrary.wiley.com/terms-and-conditions) on Wiley Online Library for rules of use; OA articles are governed by the applicable Creative Commons License
SUPPLEMENT ARTICLE 127 of 222

MATERIALS AND METHODS: Australian adults attempting to self-
manage their weight loss were recruited through Facebook advertise-
ments between Jan - Mar 2020 to complete an online survey. A
12-week follow-up survey was sent to each participant who com-
pleted the baseline survey. Data were collected on demographics,
height and weight, weight history, health status, diet, physical activity,
weight loss strategies, psychosocial factors. Descriptive statistics were
calculated on; changes in -weight, diet, and physical activity; clusters
(using two-step cluster analysis) and weight outcomes. Statistical anal-
ysis was done on SPSS at a priori 95% CI.
RESULTS: 205 participants completed the initial survey and 102 com-
pleted the follow-up. Participants were skewed towards female
(87.3%), married (72.5%), English-speaking (85.3%). Most (88%) had
overweight (23%) or obesity (65%), and were completely ‘unassisted’
(85%). 53% reported CHD, 27.5% with diagnosed depression. Mean
weight loss was 2.07 kg (SD 4.89; p ≤ 0.001) at follow-up. 32.4% were
‘successful’ (= > 3%) and clinically significant in 18.6 (= > 5%.) 47%
showed no change, whereas 9.8% gained weight. Small but significant
behavioural change incuded reduction in fruit (.96, t = 1.7; p = 0.09);
cakes, pies, biscuits (.79, t = 1.89; p = 0.06); takeaways (.27, t = 2.06;
p = 0.04); and SSBs (.95, t = 2.49; p = 0.01). Mean total physical
activity increased by 13 mins (not significant). Four clusters were
identified: ‘older, ill and stressed’ (29.9%), ‘younger healthy, but poor
and stressed’ (28.9%), ‘wealthy but ill and stressed’ (26.8%) and
‘wealth relaxed and healthy’ (14.4%). Cluster 4 ‘wealthy relaxed and
healthy’ had the highest proportion of successful weight losers
(42.9%), whereas Cluster 2 ‘younger healthy, but poor and stressed’
had least success (28.6).
CONCLUSION: In this sample of those who self-manage their weight
loss, a third were successful in losing weight and a fifth achieved clini-
cally significant weight loss despite the unique adverse effects of
COVID-19 on their weight loss journeys. These results were achieved
without professional intervention making further study of self-
management of weight important as there is significant stress on cur-
rent obesity management services.
DISCLOSURE OF INTEREST: None Declared.
P286 | Cost-effectiveness analysis of
recruitment strategies in a diabetes
prevention trial conducted across two sites in
Sydney, Australia
E. Bessell1; T. Markovic1,2; I. Caterson1,2; C. Hendy1; J. Burk1;
T. Picone1; N. Fuller1
1
Charles Perkins Centre, The University of Sydney; 2Metabolism &
Obesity Service, Royal Prince Alfred Hospital, Sydney, Australia
INTRODUCTION: Intervention trials for weight loss and preventive
health require large samples and community-based recruitment.
Recruitment can be expensive so the most cost-effective methods

TABLE 1 Contribution, overall cost, and cost per participant for each recruitment approach

Description Total cost Contacts Randomiseda Cost per participant Contributionb

Traditional media strategies: $115,846 1,102 170 (15%) $681 42.4%
Radio advertisement campaigns on 4 radio stations $40,000 412 140 (34%) $286 34.9%
Advertisements in 7 local newspapers $15,846 177 12 (7%) $1,320 3.0%
Interest/awareness pieces in 6 magazines 33 7 (21%) 1.7%
Television news coverage (3x) $60,000 329 6 (2%) $10,000 1.5%
Other/not further specified 151 5 (3%) 1.2%
Healthcare strategies: $81,973 314 57 (18%) $1,438 14.2%
Medical practice, flyer/poster in waiting room or GP referral 214 48 (22%) 12.0%
Pharmacy, flyer/poster or referral from staff 100 9 (9%) 2.2%
Online media strategies: 259 22 (8%) 5.5%
Online mentions, news articles, editorials 127 19 (15%) 4.7%
Online news advertisements $8,280 132 3 (2%) $2,760 0.7%
Hospital- and university-based advertising and recruitment 122 15 (12%) 3.7%
Word of mouth 146 14 (10%) 3.5%
Recruitment stalls and presentations at events 126 11 (9%) 2.7%
Social media (indirect from other organisations) 79 7 (9%) 1.7%
Not specified 2,350 105 (4%) 26.2%
c
$218,501 4,498 401 (9%) $545 100%
a
% of contacts randomised to the trial.
b
% contribution to total number of participants.
c
Includes $12,403 of indirect costs.

128 of 222
must be identified. We analysed the cost-effectiveness of recruitment
methods used in a randomised placebo-controlled supplement trial in
adults with prediabetes and overweight or obesity conducted in Syd-
ney, Australia.
MATERIALS AND METHODS: Recruitment strategies included
advertising on local radio stations and in local newspapers, television
news coverage, online advertising and editorials, advertising in and
referral from primary care settings, university- and hospital-based
advertising, and attending or hosting local events. For each strategy,
the number of expressions of interest and randomised participants
were collated. The percentage contribution from each strategy, overall
cost, and cost per participant were calculated.
RESULTS: Advertising on local radio stations was the most cost-
effective strategy, followed by advertising in and referral from primary
care settings. The least cost-effective strategy was television news
coverage as this was not targeted to the Sydney-based audience.
CONCLUSION: Recruitment methods should be location-specific and
appropriate for the target population, with priority given to low-effort
high-yield strategies. Trial investigators should seek opportunities for
free advertising.
DISCLOSURE OF INTEREST: E. Bessell: None Declared, T. Markovic
Shareholder of: Eli Lilly, Consultant for: Australian Nestle Health Ser-
vice, I. Caterson: None Declared, C. Hendy: None Declared, J. Burk:
None Declared, T. Picone: None Declared, N. Fuller Grant/Research
support with: Australian Eggs Corporation, Consultant for: Novo Nor-
disk, Paid Instructor for: Ausmed Education; Australian Eggs
Corporation.
1467789x, 2022, S2, Downloaded from https://onlinelibrary.wiley.com/doi/10.1111/obr.13503 by CAPES, Wiley Online Library on [16/12/2023]. See the Terms and Conditions (https://onlinelibrary.wiley.com/terms-and-conditions) on Wiley Online Library for rules of use; OA articles are governed by the applicable Creative Commons License
SUPPLEMENT ARTICLE
P287 | A sequential feeding trial of coconut
oil versus palm oil on blood lipids in healthy
adults
H. Swarnamali1; P. Ranasinghe2; R. Jayawardena3
1
Health and Wellness Unit; 2Depatment of Pharmacology; 3Department
of Physiology, Faculty of Medicine, University of Colombo, Colombo,
Sri Lanka
INTRODUCTION: Although the traditional South Asian diet is low in
fat content, the high incidence of CVDs in contrast to western coun-
tries is, therefore, correlate with high saturated fat intake. Though
coconut and palm oils are the most popular fat sources among South
Asians, a comparison of the effect of daily consumption of coconut
and palm oils on cardiovascular risk has not been clinically studied
recently.
MATERIALS AND METHODS: Ethical clearance was obtained
(Reference No: EC-19-046) from the ethics review committee of the
Faculty of Medicine, University of Colombo. The study was registered
in the clinical trial registry of Sri Lankan Medical Association:
SLCTR/2019/034. The study was carried out as a sequential feeding
clinical trial with 40 healthy adults dividing into two feeding periods
of 8 weeks each. Participants were provided palm oil for the first
feeding period followed by coconut oil with a 16-week washout
period in between. The outcomes measured were the difference in
serum low-density lipoprotein cholesterol (LDL-C), total and high-
density lipoprotein cholesterol (TC and HDL-C), TC/HDL-C ratio, tri-
glycerides (TG), very low-density lipoprotein cholesterol (VLDL-C),
fasting plasma glucose (FPG), and liver enzymes. Dietary intake and
physical activity levels were assessed as potential confounding
variables.
 1467789x, 2022, S2, Downloaded from https://onlinelibrary.wiley.com/doi/10.1111/obr.13503 by CAPES, Wiley Online Library on [16/12/2023]. See the Terms and Conditions (https://onlinelibrary.wiley.com/terms-and-conditions) on Wiley Online Library for rules of use; OA articles are governed by the applicable Creative Commons License
SUPPLEMENT ARTICLE 129 of 222

TABLE 1 Summary of comparison between treatments

Mean (±SD) difference (final - initial) p value

Biochemical parameter Palm oil Coconut oil
LDL-C (mg/dL) 3.65 (±18.60) 1.05 (±20.96) 0.623
Total cholesterol (TC) (mg/dL) 21.32 (±18.19) 8.16 (±23.84) < 0.001
HDL cholesterol (HDL-C) (mg/dL) 0.38 (±4.91) 0.51 (±6.81) 0.919
TC/HDL-C 0.49 (±0.57) 0.15 (±0.64) < 0.001
VLDL-C (mg/dL) 3.08 (±9.33) 0.25 (±8.21) 0.059
Triglycerides (mg/dL) 15.38 (±46.65) 1.27 (±41.04) 0.059
Alanine aminotransferase (U/L) 3.76 (±32.05) 1.00 (±12.68) 0.656
Aspartate aminotransferase (U/L) 0.00 (±15.81) 0.35 (±6.75) 0.610
Fasting Plasma Glucose (mg/dL) 1.16 (±9.63) 3.05 (±7.21) 0.017

Mean (±SD) differences (n = 37) of the respective treatment groups were subjected to paired sample t-test and Wilcoxon Signed Rank test (p < 0.05).

RESULTS: Serum LDL-C was not significantly different between the
two treatment oils (p = 0.623). Similarly, HDL-C (p = 0.919), VLDL-C
(p = 0.059), TG (p = 0.059) also did not show any statistically signifi-
cant difference, TC and TC/HDL-C ratios were significantly different
(p < 0.001) between the two treatment phases. FPG was significantly
different (p = 0.017) between the two treatment phases (Table 1).
CONCLUSION: Intake of palm oil consumption improved serum TC,
TC: HDL-C, and FPG in healthy adults in comparison to coconut oil.
No significant difference was observed in LDL-C, HDL-C, TG,
VLDL-C, ALT, and AST between coconut and palm oil.
DISCLOSURE OF INTEREST: None Declared.
P288 | Eating disorder risk during weight
management in adults with overweight or
obesity: A systematic review with meta-
analysis
H. Jebeile1; S. Libesman2; A. L. Seidler2; C. McMaster1; H. Melville1;
T. Low-Wah1; G. Dammery3; K. Hunter2; S. Garnett1,4; L. Baur1;
N. Lister1
1
Children's Hospital Westmead Clinical School, The University of Sydney,
Westmead, Australia; 2NHMRC Clinical Trials Centre; 3InsideOut
Institute for Eating Disorders, The University of Sydney, Sydney; 4Kids
Research, The Children's Hospital at Westmead, Westmead, Australia
INTRODUCTION: Dieting is an established risk factor for eating dis-
orders and the onset of binge eating. Dietary change is also a core
strategy of weight management interventions. It is important to
understand the impact of these interventions on eating disorder risk.
This systematic review aimed to examine the change in eating disor-
der risk and binge eating during behavioural weight management
interventions.
MATERIALS AND METHODS: Four databases (e.g. Medline, PSY-
CInfo) were searched to August 2020 to identify weight management
interventions conducted in adults with overweight/obesity and mea-
suring eating disorder risk or binge eating at pre- and post-
intervention or follow-up. Included studies were synthesised narra-
tively to describe change in risk scores, eating disorder diagnoses and
disordered eating behaviours. Meta-analyses, using random effects,
were conducted to examine within group change in risk. US Academy
Nutrition and Dietetics Quality Criteria Checklist: Primary Research
was used to assess quality (positive, neutral or negative rating).
RESULTS: Of 7,371 studies screened, 43 met inclusion criteria
(n = 4,984, mean age 22.1 to 59.9 years); 28 positive and 15 neutral
quality ratings. Interventions ranged from 4 weeks to 18 months with
follow-up of 24 weeks to 36 months post-intervention. All studies
reported no change or a reduction in eating disorder risk and binge
eating scores post-intervention and at latest follow-up. No studies
reported a statistically significant increase in risk scores. There was a
within group reduction in eating disorder risk (16 intervention arms;
standardised mean difference = 0.28; 95% CI: 0.39, 0.17; I2
53.1%) and binge eating (36 intervention arms; 0.70; 0.84, 0.56;
I2 78.7%) post-intervention, both maintained at follow-up. Ten studies
reported a reduction in prevalence or episodes of binge eating, and
one reported a reduction in the number of participants with binge eat-
ing disorder (BED). Three studies reported the onset of binge eating
and one study each the emergence of BED or compensatory behav-
iours in a subset of participants (2.3–6.5%).
CONCLUSION: For most adults, behavioural weight management
interventions do not increase eating disorder risk or binge eating,
indeed, a reduction is seen post-intervention and at follow-up. A small
subset of participants may experience the onset of binge eating or
compensatory behaviours. In practice, monitoring for the emergence
of disordered eating behaviours in at-risk individuals may help ensure
the safety of these interventions.
DISCLOSURE OF INTEREST: None Declared.

130 of 222
P289 | Investigating levels of weight bias
internalisation in young adults (18-25y)
I. Young1; N. Crino; K. Steinbeck2; H. O'Connor; H. Parker1
1
Faculty of Medicine and Health, School of Health Sciences; 2Faculty of
Medicine and Health, Specialty of Child and Adolescent Health, Clinical
School at The Children's Hospital Westmead, The University of Sydney,
Sydney, Australia
INTRODUCTION: Weight bias internalisation (WBI) is the internalisa-
tion of negative stereotypes and attitudes directed towards individ-
uals with obesity, and results in self-devaluation based on weight.
Whilst it is known to impact up to 40% of individuals with overweight
and obesity, with higher levels being shown in females and with
increased BMI, its impact in the rest of the population and in particu-
lar young adults is not yet known. This study aimed to determine
levels of WBI in young adults (18-25y) and explore any associations
with gender and perceived weight status in this group.
MATERIALS AND METHODS: Young adults (18–25) completed the
Weight Bias Internalisation Scale – Modified, provided demographic
information, and were asked to categorise themselves as being either
“healthy weight”, “overweight” or “underweight”. Participant BMI was
calculated from their reported height and weight and their actual BMI
category was compared to their perceived category.
RESULTS: A total of n = 193 young adults (18-25y) were recruited,
with a mean age, weight and BMI being 21 ± 2y, 67.73 ± 14.1 kg and
2
23.3 ± 4.2 kg/m respectively. 70.9% of completers identified as
being female with 28.5% being male and one participant selecting
“other” as their gender. Mean WBI was in line with the 55-60th
(females) and 60-65th (males) percentiles compared to populations
with overweight and obesity. WBI was significantly correlated with
BMI (r2 = 0.292, p < 0.001), however when comparing genders, it was
found that this relationship remained significant for females only
(r = 0.376, p < 0.001). 23.3% of respondents incorrectly identified
2
their weight category, with males tending to underestimate their
weight. Comparatively, females tended to overestimate their weight
with WBI having no impact on the likelihood of a participant being
able to correctly categorise their BMI status.
CONCLUSION: This study highlights the presence of WBI in young
adults of mostly a healthy BMI. This may lead to negative health out-
comes linked to WBI which have thus far only been shown in popula-
tions with overweight and obesity. As a result, there may be a need
for interventions helping young adults of all weight ranges to cope
with negative weight stigma and prevent the negative mental and
physical health impacts associated with its internalisation.
DISCLOSURE OF INTEREST: None Declared.
1467789x, 2022, S2, Downloaded from https://onlinelibrary.wiley.com/doi/10.1111/obr.13503 by CAPES, Wiley Online Library on [16/12/2023]. See the Terms and Conditions (https://onlinelibrary.wiley.com/terms-and-conditions) on Wiley Online Library for rules of use; OA articles are governed by the applicable Creative Commons License
SUPPLEMENT ARTICLE
P290 | The fracture risk according to body
mass index in Korean postmenopausal
women: A Nationwide cohort study
Y. Hur1; J.-W. Kim2,3; Y. Huh2
1
Department of Family Medicine, Inje University, Seoul, South Korea;
2
Department of Family Medicine, Uijeongbu Eulji Medical Center, Eulji
University, Uijeongbu; 3Department of Family Medicine, Korea University,
Seoul, Korea, Republic Of
INTRODUCTION: Obesity is generally associated with lower fracture
risk and protective of bone health. But several recent studies suggest
that obesity may be a risk factor for fracture. This study was aimed to
investigate the association of body mass index with osteoporosis out-
comes in Korean postmenopausal women.
MATERIALS AND METHODS: This study included 113,754 partici-
pants as 66-years-old postmenopausal women who had undergone a
health examination provided by the Korean National Health Insurance
Service (NHIS) from 2009 to 2012. The participants were investigated
until the end of 2019. The hazard ratios (HRs) and 95% confidence
intervals (CIs) for study outcomes were calculated using multivariable
Cox proportional hazard regression analysis.
RESULTS: Within the follow-up, the incidence rate (incidence per
1000person-years) of osteoporosis, all fracture, spine fracture and hip
fracture was 127.11, 17.83, 9.87 and 1.63 obese individuals with
BMI ≥ 30 kg/m2. After adjusting for confounding variables, the HRs
of osteoporosis (HR:1.085, CI:1.049–1.233) and spine fracture
(HR:1.136 CI:1.031–1.251) significantly increased among individuals
with BMI ≥ 30 kg/m2, compared to those with normal body weight. In
contrary, the HRs of all fracture (HR:1.215 CI: 1.083–1.364) and hip
fracture (HR: 2.037, CI:1.473–2.817) significantly increased among
individuals with BMI < 18.5 kg/m2, compared to those with normal
body weight.
CONCLUSION: The increase of BMI was significantly associated with
decreased total osteoporotic fracture risk. However, contrary to
expectations, elderly women with obesity had a higher risk of post-
menopausal osteoporosis than those who are normal weight. In old
age, osteoporosis and fractures affect mortality and are important fac-
tor for quality of life. Therefore evaluation and management of bone
density are important in elderly patients with obesity after menopause
in clinic.
DISCLOSURE OF INTEREST: None Declared.

SUPPLEMENT ARTICLE
P291 | Perspectives of clinicians and patients
on how to facilitate transition from tertiary
metabolic health services to community-
based maintenance care for adults living with
obesity
K. A. Mcbride1; G. Alsutany1; J. Termaat1; K. Williams2
1
School of Medicine, Western Sydney University; 2Nepean Family
Metabolic Health Service, Nepean Hospital, Penrith, Australia
INTRODUCTION: Tertiary services are in high demand as the number
of people living with clinically severe obesity in Australia increases.
Once they have achieved predetermined health goals, patients need
to be transitioned to appropriate community-based care to urgently
free up capacity. This situation has been further exacerbated by
COVID. Maintenance of any successful treatment via tertiary obesity
services is therefore becoming increasingly important to reduce rates
of relapse back to these services.
MATERIALS AND METHODS: This qualitative project explored what
is needed in community-based care to help positively support individ-
uals living with obesity maintain their health gains. Through one-on-
one interviews and focus groups, guided by an interview schedule,
with patients as well as staff from several metabolic health services in
Sydney, we explored how clinic patients can maintain their health in a
community-setting.
RESULTS: We interviewed 22 patients and 13 of their clinicians
between July 2020 and April 2022. A lack of appropriate and consis-
tent clinical support within the community was identified by both the
patients and clinicians. Most clinicians we spoke to, who included
endocrinologists, psychologists, dieticians and nurses agreed general
practice was key to maintenance care. Lack of general practice under-
standing around how to appropriately manage and support patients
living with obesity, lack of bariatric equipment and limited Medicare
supported allied health appointments were all seen as being signifi-
cant barriers to individuals with obesity being appropriately supported
beyond their clinics. Patients reported being highly reluctant to transi-
tion out of these services and lose contact, yet simultaneously were
reluctant to engage with community-based healthcare, due to limited
clinical and social support, limited bariatric equipment, being subject
to demeaning and embarrassing clinical interactions, lack of care coor-
dination and feeling stigmatised due to their size. Clinicians also felt
social prescribing to well-organised support groups outside of the
clinic was needed to mitigate social isolation and stigma, with patients
also agreeing peer support groups have potential to provide important
supplementary support to individuals with obesity outside of the
clinic.
CONCLUSION: Integrated, community-based and affordable models
of care are needed now to allow tertiary obesity services to discharge
their patients safely. Currently, individuals aiming to maintain their
weight are likely to struggle in the context of existing community care
provisions. Intervention to improve the appropriateness of
1467789x, 2022, S2, Downloaded from https://onlinelibrary.wiley.com/doi/10.1111/obr.13503 by CAPES, Wiley Online Library on [16/12/2023]. See the Terms and Conditions (https://onlinelibrary.wiley.com/terms-and-conditions) on Wiley Online Library for rules of use; OA articles are governed by the applicable Creative Commons License
131 of 222
community-based services, including general practice, must urgently
be undertaken.
DISCLOSURE OF INTEREST: None Declared.
P292 | Very low carbohydrate high fat
weight-loss diets for the management of
diabetes and cardiometabolic disease risks: A
systematic review update on recent evidence
L. J. Ross1; J. Musial2; R. Hay2; A. Cawte2; A. Byrne2
1
Nutrition and Dietetics, Queensland University of Technology; 2Nutrition
and Dietetics, Royal Brisbane Hospital, Brisbane, Australia
INTRODUCTION: Very-low-carbohydrate-high-fat (VLCHF) diets are
increasingly being used for weight loss in diabetes management, but
concerns exist regarding long-term glycaemic control and
cardiometabolic risk.
AIM: a systematic literature review of recent randomised controlled
trials (RCT) conducting VLCHF diet interventions in diabetes/at-risk
populations.
MATERIALS AND METHODS: Four online databases (Ovid Medline,
The Cochrane Library, CINAHL, Embase), were searched from
October 2018 to December 2020 for RCT interventions of ≥3 months
duration that met adherence to pre-defined macronutrient intakes:
VLCHF ≤25%E carbohydrate (CHO), ≥35%E fat; compared to low fat
(LF) controls: >45%E CHO, ≤30%E fat and glycaemic and CVD risk
outcomes. This is an update of the previous review conducted from
2009 to 2018 and registered with PROSPERO (CRD42018108281)
and published in Nutrition and Dietetics (Ross L et al Nut Diet 2020;
78:41–56).
RESULTS: 1402 articles were retrieved; 94 full-text articles were
screened; and eight articles were included for review, from: Taiwan,
Israel, Iran, USA, Denmark and Australia (3 studies). Participants
(n = 606) were adults with diabetes type 2 (5 studies), diabetes type
1 (1 study), abdominal obesity (1 study), or an obesity-related disease
(1 study). Interventions included education sessions (individual and/or
group) and regular ongoing support from health professionals (includ-
ing dietitians). Three of six studies reported greater weight-loss in
VLCHF groups, the remainder reported similar significant weight-loss.
One study reported greater reduction in hepatic fat in the VLCHF
group. Three of four studies reported greater improvements in glycae-
mic control in VLCHF groups, the remaining study reported similar
glycaemic improvements. Two of these studies also reported greater
reductions in anti-glycaemic medications in VLCHF groups; one study
reported less hypoglycaemia in the VLCHF group. Six of seven studies
reporting cardiometabolic risk factors found beneficial or no detrimen-
tal effects. One study reported nutrition biomarkers within normal
ranges at baseline did not change significantly for either group after
2 years.
CONCLUSION: The studies included in the update confirm the find-
ings of the previous review that VLCHF and LF diets have at least

132 of 222
comparable benefits for weight-loss without detrimental effects on
cardiometabolic risk markers. New evidence on VLCHF diets also sug-
gests benefits for glycaemic control and no change to nutritional risk
markers.
DISCLOSURE OF INTEREST: None Declared.
P293 | Identifying factors which influence
eating disorder risk during obesity treatment:
A consultation survey
1 1 2 3
N. B. Lister ; C. McMaster ; B. Johnson ; A. L. Seidler ; K. Hunter ; 3
4 5 1
S. Garnett ; S. Paxton ; L. Baur ; H. Jebeile 1
1
Children's Hospital Westmead Clinical School, University of Sydney,
Sydney; 2Caring Futures Institute, Flinders University, Adelaide, Australia;
3
NHMRC Clinical Trials Centre, University of Sydney; 4Kids Research, The
Children's Hospital at Westmead, Sydney; 5School of Psychology and
Public Health, La Trobe University, Melbourne, Australia
INTRODUCTION: Disordered eating behaviors (DEBs) and eating dis-
orders (EDs) are more common among individuals with overweight or
obesity compared to those of lower weight. Systematic reviews show
DEBs and ED risk generally improve during obesity treatment, but
some individuals have worsening ED risk. This study aimed to under-
stand clinician, researcher and consumer views regarding individual
characteristics and intervention strategies which may influence ED
risk during obesity treatment.
MATERIALS AND METHODS: An online survey (Qualtrics) consisted
of four sections: (1) participant demographics; (2) individual risk fac-
tors; (3) intervention strategies; and (4) delivery features. Questions
were based on current literature, expert consultation, and the TIDieR
checklist for intervention reporting. Individual factors were rated on a
5-point Likert scale from 1 = very unlikely to be relevant to 5 = very
likely to be relevant. Intervention strategies were rated on a 5-point
Likert scale from 1 = very likely to decrease risk of an ED to 5 = very
likely to increase risk of an ED. Delivery features were rated as either
“important” or “unimportant” to ED risk. Participants were recruited
internationally through obesity, ED and discipline-specific professional
and consumer organizations as well as social media.
RESULTS: Eighty-three participants completed the survey, the major-
ity of whom identified as clinicians (n = 59, 71%). Participants
reported a lived experience of overweight and/or obesity (n = 53,
64%) and one or more ED diagnoses (n = 72, 87%). Individual factors
most frequently rated as being very relevant to ED risk included his-
tory of an ED, weight-based teasing/stigma, weight bias internaliza-
tion, body dissatisfaction and history of ED treatment. Intervention
strategies most frequently rated as increasing ED risk included inter-
mittent fasting, very low energy diets and group weighing, and those
most frequently rated as decreasing ED risk included intuitive eating,
strategies to address DEBs and exploration of DEB underlying
causes/drivers. Delivery features considered most important were
who delivered the intervention (profession, training, qualifications),
1467789x, 2022, S2, Downloaded from https://onlinelibrary.wiley.com/doi/10.1111/obr.13503 by CAPES, Wiley Online Library on [16/12/2023]. See the Terms and Conditions (https://onlinelibrary.wiley.com/terms-and-conditions) on Wiley Online Library for rules of use; OA articles are governed by the applicable Creative Commons License
SUPPLEMENT ARTICLE
support offered during the intervention (frequency, duration) and tar-
get population (individual vs family-based).
CONCLUSION: This study provides insight into the views of clini-
cians, researchers and consumers regarding ED risk during treatment
for obesity. The interaction between individual characteristics and
intervention strategies identified as relevant for ED risk should be
examined in future research and considered in clinical practice.
DISCLOSURE OF INTEREST: None Declared.
P294 | Obesity in renal failure patients is
common and is associated with a decreased
likelihood of renal transplantation
N. Barakati1; S. Price1; S. Fourlanos1; S.-J. Tan2; P. Hughes2;
R. Masterson2; B. Sobey2; J. Wentworth1
1
Endocrinology; 2Nephrology, Royal Melbourne Hospital, Melbourne,
Australia
INTRODUCTION: Although clinical guidelines state that obesity does
not contra-indicate renal transplantation, it is broadly acknowledged
that transplant surgery is technically more difficult in patients with
obesity and some studies suggest obesity increases the risk of graft
failure.
MATERIALS AND METHODS: To determine the prevalence of obe-
sity in our patients with End Stage Renal Disease (ESRD) and its
potential impact on renal transplantation we analysed data collected
from adult patients who had never been transplanted previously and
commenced dialysis at Royal Melbourne Hospital between 2017 and
2021 (N = 515). Obesity was defined as a body mass index (BMI)
greater than 30 kg/m2.
RESULTS: One hundred and sixty patients (31%) were affected by
obesity when they started dialysis, of whom 47 (9%) had class II obe-
sity (BMI 35 to 40 kg/m2) and 21 (4%) had class III obesity
(BMI > 40 kg/m2). Patients with obesity were as likely as patients
with BMI < 30 to be referred for renal transplant assessment
(90 (56%) c.f. 185 (52%); p = 0.3921) but less likely to have received a
renal transplant by March 2022 (30 (19%) c.f. 107 (30%); p = 0.0070).
CONCLUSION: We conclude that obesity is common in patients com-
mencing dialysis and is associated with a lower likelihood of receiving
a renal transplant. Weight change in individuals with renal failure is
multifactorial and also may reflect the severity of their chronic dis-
eases. Further studies are being performed to determine if and how
obesity decreases the likelihood of renal transplantation and the
impact of weight loss therapies on transplantation and other clinical
outcomes.
DISCLOSURE OF INTEREST: None Declared.

SUPPLEMENT ARTICLE
P296 | Comparison of the effects of COVID-
19 lockdowns in 2020 and 2021 on food
purchasing and consumption, lifestyle
behaviours and psychological distress: A
survey of tertiary weight loss clinic patients
K. Sim1,2; J. Franklin1,3; G. Maston1; E. Manson1; H. Nelthorpe1;
1,2,3 1,2,3
T. Markovic ; S. Hocking
1
Metabolism & Obesity Service, Sydney Local Health District; 2Boden
Initiative, Charles Perkin Centre, The University of Sydney; 3Faculty of
Medicine and Health, The University of Sydney, Sydney, Australia
INTRODUCTION: People with obesity have been particularly vulnera-
ble to COVID-19 lockdown measures. The New South Wales Govern-
ment implemented two state-wide lockdowns in 2020 and 2021. The
aim was to compare the effects of these lockdowns on health and life-
style factors among patients with obesity.
MATERIALS AND METHODS: A specifically designed online survey
and the Depression Anxiety Stress Scale (DASS-21) were adminis-
tered to patients scheduled for a tertiary weight management service
appointment between June–August 2020 and September–October
2021. Ethics was obtained (X20–0152).
RESULTS: A total of 223 patients responded to the first lockdown sur-
vey and 270 to the second. Patient demographics were similar for both
groups. Compared to the first lockdown, 64% reported finding the sec-
ond lockdown comparatively harder despite 93% having received at
least one vaccination dose and reporting identical rates of COVID-19
(1.4%). Almost all (92%) reported weight changes in the first survey
compared with 71% in the second. Food purchasing behaviour was
similar during both lockdowns: 51% vs 33% reported buying more in
fear of running out, 28% vs 36% bought food to cope with emotions
and 26% vs 31%, ate more takeaway during the first lockdown com-
pared to the second. Food consumption and reasons for eating were
also similar. Exercise was similar during both lockdowns: most reported
doing some exercise during the first and second lockdown (64% vs
62%). Of those, 57% vs 61% reported a reduction in exercise, and 18%
vs 20% reported an increase. There were no statistical differences in
DASS-21 scores or severity distribution between the two lockdowns.
The majority of patients reported normal levels of anxiety (59% vs
55%) and stress (70% vs 61%), 50% vs 58% reported mild-extreme
1467789x, 2022, S2, Downloaded from https://onlinelibrary.wiley.com/doi/10.1111/obr.13503 by CAPES, Wiley Online Library on [16/12/2023]. See the Terms and Conditions (https://onlinelibrary.wiley.com/terms-and-conditions) on Wiley Online Library for rules of use; OA articles are governed by the applicable Creative Commons License
133 of 222
depression scores, approximately 20% of patients reported severe to
extreme levels of depression and/or anxiety, and 13% vs 17% reported
severe to extreme stress levels during the first and second lockdown.
CONCLUSION: Patients with obesity experienced high levels of emo-
tional distress during both COVID-19 lockdowns. Despite reporting
greater hardship during the second lockdown, food purchasing, con-
sumption and lifestyle behaviours were similar.
DISCLOSURE OF INTEREST: None Declared.
P297 | Combined patterns of obesity and
metabolic phenotype and their association
with risk of cardiovascular disease
S.-J. Park; Y. Eun
family medicine, Yeouido St. Mary's Hospital, college of Medicine, The
Catholic University of Korea, Seoul, Korea, Republic Of
INTRODUCTION: Obesity defined by body mass index (BMI), does
not reflect the degree of excess fat or metabolic abnormalities. To
understand traits associated with CVD risk, we investigated whether
the combined patterns of obesity/metabolic phenotype were associ-
ated with cardiovascular disease (CVD) risk in Korean adults.
MATERIALS AND METHODS: We used data from the Korean
National Health and Nutrition Examination Survey, a cross-sectional
survey of Korean civilians, conducted in 2015 and 2016, and data on
a total of 8,022 participants were analyzed. Obesity/metabolic pheno-
types were divided into four groups depending on metabolic syn-
drome and BMI: metabolically healthy normal weight (MHNW),
metabolically healthy obesity (MHO), metabolically abnormal but nor-
mal weight (MANW), and metabolically abnormal obesity (MAO). The
Framingham cardiovascular risk score (FRS) was used to determine
10-yr CVD risk, classified FRS ≥ 10% as moderate-high risk and
FRS ≥ 20% as high risk.
RESULTS: The odds ratios (ORs) of moderate-high CVD risk were
1.22 (1.01–1.48) in MHO, 3.89 (3.26–4.65) in MANW, and 2.67
(2.24–3.18) in MAO after adjusting for alcohol consumption, physical
activity, and glomerular filtration rate levels. The high CVD risk was
positively associated with MANW (adjusted OR = 3.93 [3.06–5.09])
and MAO (adjusted OR = 2.35 [1.87–2.97]), but not with MHO, com-
pared to the MHNW control group.
 1467789x, 2022, S2, Downloaded from https://onlinelibrary.wiley.com/doi/10.1111/obr.13503 by CAPES, Wiley Online Library on [16/12/2023]. See the Terms and Conditions (https://onlinelibrary.wiley.com/terms-and-conditions) on Wiley Online Library for rules of use; OA articles are governed by the applicable Creative Commons License
134 of 222 SUPPLEMENT ARTICLE

Table. Association between cardiovascular disease risk and obesity/metabolic phenotypes.

CVD risk MHNW MHO MANW MAO P value P for trend

Model 1
Moderate-high Reference 1.39 (1.15–1.67) 5.83 (4.95–6.87) 4.49 (3.88–5.21) < 0.001 < 0.001
High Reference 1.33 (0.98–1.82) 6.58 (5.21–8.31) 4.50 (3.70–5.48) < 0.001 < 0.001
Model 2
Moderate-high Reference 1.33 (1.10–1.61) 5.11 (4.33–6.03) 3.87 (3.33–4.49) < 0.001 < 0.001
High Reference 1.27 (0.92–1.73) 5.62 (4.42–7.15) 3.75 (3.07–4.59) < 0.001 < 0.001
Model 3
Moderate-high Reference 1.22 (1.01–1.48) 3.89 (3.26–4.65) 2.67 (2.24–3.18) < 0.001 < 0.001
High Reference 1.12 (0.80–1.55) 3.93 (3.06–5.09) 2.35 (1.87–2.97) < 0.001 < 0.001

Values are expressed as odds ratio (95% confidence interval). Moderate-high CVD risk; FRS ≥ 10%, High CVD risk; FRS ≥ 20%. Model 1 unadjusted. Model
2 adjustment for drinking, physical activity and dyslipidemia. Model 3 adjusted for Model 2 + estimated glomerular filtration rate (eGFR), and fasting blood
glucose. CVD; cardiovascular disease, FRS; Framingham cardiovascular risk score, MANW; metabolically abnormal, but normal weight, MAO; metabolically
abnormal obesity, MHO; metabolically healthy obesity, MHNW; metabolically healthy normal weight.

CONCLUSION: When comparing CVD risk by the combined patterns
of obesity/metabolic phenotype, the groups with metabolic abnormal-
ities were at high CVD risk regardless of obesity.
DISCLOSURE OF INTEREST: None Declared.
P298 | Investigating the impact of binge
eating and food addiction on weight loss
outcomes in patients with obesity attending a
tertiary weight management clinic
J. Franklin1,2; K. Sim1,3; E. Manson1; S. Hocking1,2,3; J. Swinbourne1;
H. Nelthorpe1; G. Loughnan1; T. Markovic1,2,3
1
Metabolism & Obesity Service, Royal Prince Alfred Hospital; 2Faculty of
Medicine and Health; 3Boden Initiative, Charles Perkins Centre, The
University of Sydney, Sydney, Australia
obtained from SLHD Governance body X16–0335 & HREC/16/
RPAH/459.
RESULTS: Of 132 individuals, 18% had BE only, 7% had FA only, 32%
had both BE and FA (BE+FA) and 43% had neither (NO-BE/FA).
There was no difference in mean attendance across groups
(BE 7.1 months, FA 5.7 months, BE+FA 8.0 months and NO-BE/FA
7.1 months). At 12-months, the completers lost on average 4.8%
(SD 9.8%) of their body weight and the ITT group lost 3.1% (SD 6.8%).
There was a trend for the BE+FA group for both completers (2.4%)
and ITT (2.1%) to lose the least amount of weight, followed by NO-
BE/FA (2.7 and 2.5%), FA only (11.0 and 2.9%) and BE only (11.9 and
6.2%). BE+FA (p = 0.017) and NO-BE/FA (p = 0.022) lost statistically
significantly less weight than the BE only group.
CONCLUSION: FA and BE did not appear to affect attendance. How-
ever, the combination of BE and FA may have an effect on
weight loss.
DISCLOSURE OF INTEREST: None Declared.

INTRODUCTION: Binge eating ([BE], eating a large quantity of food

with a loss of control and distress) affects up to 30% of individuals
seeking obesity treatment. Despite being aware of the negative con-
sequences, a compulsion to eat is often reported and termed “food
addiction” (FA). Individuals with combined BE and FA have worse psy-
chosocial pathology and eating behaviours compared with those with
BE or FA alone or neither condition. We aimed to investigate whether
the presence of BE or FA affects weight loss and duration of atten-
dance at the Metabolism & Obesity Service (MOS), an Australian ter-
tiary weight management service.
MATERIALS AND METHODS: A retrospective cohort of patients
attending MOS between June 2016–September 2019 was identified.
The presence of BE and FA was identified at baseline using the BE
scale (score >18) and Yale FA scale. Bodyweight was measured at
1, 2, 3, 6, 9 and 12 months and MOS monthly attendance was calcu-
lated (0–12 months). Weight loss data was analysed using completers
(attended MOS for 12 months) and intention to treat (ITT). Ethics was
P299 | Qualitative comparison of parents'
feeding strategies with children of different
fussiness levels
A. Burnett1; C. G. Russell2; K. Lacy2; T. Worsley2; A. Spence2
1
School of Exercise and Nutrition Sciences, Deakin University; 2Institute
for Physical Activity and Nutrition (IPAN), School of Exercise and
Nutrition Sciences, Deakin University, Burwood, Australia
INTRODUCTION: Parental feeding practices and strategies used dur-
ing mealtimes can influence a child's dietary intake, which have impor-
tant effects on their weight status. However, previous studies have
focused on general feeding practices determined by existing question-
naires, rather than parents' perceptions reported in their own words.
Additionally, previous research has not measured how parents

SUPPLEMENT ARTICLE
respond in certain situations, e.g., when their child is being fussy, and
compared whether these differ depending on the child's trait level of
fussiness.
MATERIALS AND METHODS: In 2018/2019, 1,504 mothers of
young children (aged 2–5 years) in Australia completed an online sur-
vey including a measure of fussiness from the Children's Eating
Behaviour Questionnaire (categorised into low and high fussiness by
cut point XX) and an open-ended question (What are the strategies
you use when your child is being fussy or refusing to eat?). Thematic
analysis was conducted using NVivo. Themes were examined to
determine if there were differences in parent feeding strategies by
child fussiness levels.
RESULTS: The findings show that parents reported preventative
(e.g., meal involvement, eating together as a family, hiding vegetables
in meals, offering a variety or choice of foods, and offering liked
foods) and/or reactive (e.g., encouragement, offering alternatives,
rewards for eating, asking the child to try the food, discussing health
benefits of the food, and trusting the child's hunger) strategies in
response to child's fussy eating behaviours.
There were differences in several of the themes between children
of high (42%) and low (58%) fussiness. For example, more parents
with children of high fussiness (58%) reported using rewards for eat-
ing as a strategy, whereas more parents with children of low fussiness
(65%) reported eating together as a family as a strategy.
CONCLUSION: Parents reported a mixture of strategies known to
have both positive and negative impacts on children's dietary intakes.
Parents with children of higher fussiness levels spontaneously
reported more strategies associated with unhealthier child dietary
intake. Future interventions aimed at supporting parents to best
respond to their child's eating behaviours, especially children with
high levels of fussiness, to facilitate healthy dietary intake.
DISCLOSURE OF INTEREST: None Declared.
P301 | Perceptions on healthy eating among
iTaukei women and men in Viti Levu, Fiji: An
intersectional interpretation
B. L. McKenzie1; G. Waqa2; A. Hart1; A. Moala Silatolu2; A. Palagyi1;
R. Norton1; R. McLean3; J. Webster1
1
The George Institute for Global Health, Sydney, Australia; 2Fiji National
University, Suva, Fiji; 3University of Otago, Dunedin, New Zealand
INTRODUCTION: Pacific Island countries experience some of the
highest rates of non-communicable disease (NCD) globally. A main
contributor to this burden is a transition from traditional plant- and
seafood-based diets to a westernised diet high in fat, salt, and sugar.
Fiji is a Pacific Island country with a population of around 900,000
people. Most of the Fijian population identifies as Indigenous iTaukei
Fijian (57%) or Indo-Fijian (Fijians with South Asian heritage, 38%).
There are ethnic disparities in the burden of NCD, iTaukei men have a
higher risk of death from cardiovascular disease than iTaukei women,
1467789x, 2022, S2, Downloaded from https://onlinelibrary.wiley.com/doi/10.1111/obr.13503 by CAPES, Wiley Online Library on [16/12/2023]. See the Terms and Conditions (https://onlinelibrary.wiley.com/terms-and-conditions) on Wiley Online Library for rules of use; OA articles are governed by the applicable Creative Commons License
135 of 222
and Indo-Fijian women and men. Further, NCD risk factors differ by
gender: 22% of men live with obesity compared to 42% of women.
This study sought to investigate perceptions around healthy eating
within the iTaukei population of Fiji, and to determine the implications
of findings for policies to prevent diet-related disease equitably.
MATERIALS AND METHODS: Six focus groups were conducted with
women and men, separately, across four villages in Central Division,
Viti Levu, Fiji in December 2019. Discussions were conducted in
Fijian and English, and were recorded, transcribed, translated, and the-
matically analysed. Themes were mapped to an intersectionality
framework to aid interpretation, and to evaluate how different equity
and power dynamics influenced participants' perceived ability to con-
sume a healthy diet.
RESULTS: Twenty-two women and 24 men participated in discus-
sions. Seven overarching themes were identified: generational
changes in food behaviour; gendered beliefs around food and food
provision; cultural and religious obligations; the impact of environ-
ment change on food availability; the importance and value of food;
food preferences; and knowledge. Participants identified that it was
the “duty” of women to prepare food for their families, though some
women reflected on this responsibility being unbalanced with many
women now in the formal workforce. Intergenerational changes in
food preferences and practices were highlighted, with a perception
that previous generations were healthier. Power dynamics and exter-
nal factors, such as environmental changes, were identified by women
and men as crucial influencers on their ability to eat a healthy diet.
CONCLUSION: Embedded traditional perceptions of gendered roles
relating to nutrition were misaligned with other societal and environ-
mental changes. Non-gender factors such as power dynamics and
environmental change influenced diet, highlighting the importance of
viewing nutrition-related issues through an intersectional lens to
inform equitable food policy in Fiji for the reduction of diet-related
disease.
DISCLOSURE OF INTEREST: None Declared.
P302 | Assessing the promotional strategies
for unhealthy foods and non-alcoholic
beverages in retail food outlets in rural and
urban settings in Kenya
C. H. Karugu1; M. Wanjohi1; S. Mugo1; M. Holdsworth2;
V. Ojiambo1; A. Laar3; S. Vandevijvere4; G. Asiki1
1
Health and Systems for Health Department, African Population and
Health Research Centre, Nairobi, Kenya; 2NUTRIPASS Unit: IRD-Univ,
French National Research Institute for Sustainable Development (IRD),
Montpellier, France; 3University of Ghana, Accra, Ghana; 4Sciensano,
Service of lifestyle and chronic diseases, Belgium, Brussels, Belgium
INTRODUCTION: The nutrition transition observed in Low and Mid-
dle income countries is largely a consequence of changes in the food
environments fuelled by globalization, urbanization and marketing of

136 of 222
unhealthy foods. We assessed the food promotional strategies used
to market foods in retail food stores, and estimated the proportions of
foods advertised by each strategy.
MATERIALS AND METHODS: This was a cross-sectional study con-
ducted in 115 food retail stores distributed in three Kenyan counties
(Nairobi-urban, Mombasa-urban, and Baringo-rural) between August
2021 and October 2021. We used a structured questionnaire adapted
from the INFORMAS protocol. The descriptive statistics were used to
show the proportions of the foods marketed using various promo-
tional strategies. The NOVA classification was used to classify the
foods advertised into unprocessed or minimally processed food, pro-
cessed culinary ingredients, processed foods, and ultra-processed
foods.
RESULTS: The majority of the advertisements were in Nairobi County
(n = 663, 71.0%) a metropolitan city followed by Baringo, (n = 155,
16.6%), a predominantly rural county and Mombasa (n = 116, 12.4%)
a coastal urban tourist city in Kenya. The major advertisement strate-
gies used were; the size of advertisement, type of advertisement, and
contents of the advertisement, number of food product types, promo-
tional characters and premium offers. Majority of the foods advertised
were ultra-processed foods (60.3%), followed by unprocessed/
minimally processed (31.9%), processed culinary ingredient (7.70%),
and processed foods (0.11%). Of all foods promoted using large sized
advertisements, 58.9% were ultra-processed foods, for medium sized
advertisements (85.5%) were ultra-processed, while among small sized
advertisements only 35.8% were ultra-processed. Of all ultra-
processed foods, 67.5% were advertised using store merchandising,
while 42.4% of these foods were advertised using posters and ban-
ners. Most (60.4%) ultra-processed foods were advertised as a single
product-type advertisement. Further, the ultra-processed foods
accounted for 55.85% of the cartoon and company owned characters
promotional strategy.
CONCLUSION: In all promotional strategies, ultra-processed foods
were the most common foods advertised. The high level of promotion
of the ultra-processed foods, which are unhealthy foods may contrib-
ute to consumption of unhealthy foods which will lead to a rise in
obesity and NCDs in Kenya. Policies and actions are needed to regu-
late the marketing of unhealthy foods in retail outlets.
DISCLOSURE OF INTEREST: None Declared.
1467789x, 2022, S2, Downloaded from https://onlinelibrary.wiley.com/doi/10.1111/obr.13503 by CAPES, Wiley Online Library on [16/12/2023]. See the Terms and Conditions (https://onlinelibrary.wiley.com/terms-and-conditions) on Wiley Online Library for rules of use; OA articles are governed by the applicable Creative Commons License
SUPPLEMENT ARTICLE
P303 | Interactivity, quality, and content of
websites promoting health Behaviours during
infancy: A six-year update of the systematic
assessment
D. Jawad1,2,3; H.-L. Cheng4,5; L. M. Wen1,2,3,5; C. Rissel1,6;
L. Baur1,3,7; S. Mihrshahi8; S. Taki1,2,3,5
1
Faculty of Health and Medicine, The University of Sydney; 2Health
Promotion Unit, Sydney Local Health District; 3NHMRC Centre of
Research Excellence in the Early Prevention of Obesity in Childhood;
4
Susan Wakil School of Nursing and Midwifery, Faculty of Medicine and
Health, The University of Sydney; 5Sydney Institute for Women, Children
and their Families, Sydney Local Health District, Sydney; 6College of
Medicine and Public Health, Flinders University, Darwin; 7Specialty of
Child and Adolescent Health, Sydney Medical School, The University of
Sydney; 8Department of Health Sciences, Faculty of Medicine, Macquarie
University, Sydney, Australia
INTRODUCTION: As of 2021, 89% of the Australian population are
active internet users. Although the internet is widely used, there are
concerns about the quality, accuracy, and credibility of health-related
websites. A 2015 systematic assessment of infant feeding websites
and apps available in Australia found that 61% of websites were of
poor quality and readability with minimal coverage of infant feeding
topics and lack of author credibility.
MATERIALS AND METHODS: Similar methods to the 2015 assess-
ment were used. Key words related to infant milk feeding behaviours,
solid feeding, active play, screen time and sleep were used to identify
websites targeting infant health behaviours on Safari Google search
engine. The websites were evaluated between July 2021 and
February 2022 and assessed for information content based on the
Australian Infant Feeding Guidelines and National Physical Activity
Recommendations. Suitability, quality, interactivity, and readability of
information were evaluated using validated tools.
RESULTS: Of the 450 websites screened, 66 were included based on
the selection criteria and evaluated. Overall, the quality of websites
was mostly adequate. Media- related sources, Non-Governmental
Organisations, hospital, and privately owned websites had the highest
median quality scores. The information covered within the websites
was predominantly poor. Suitability of health information was mostly
rated adequate for literacy demand, layout, and motivation of readers.
The median readability score for the websites was grade 8.5 which is
higher than the Government recommendations (< grade 8). Only 14%
of websites presented information that addressed culture in texts or
images.
CONCLUSION: Quality, content, readability, and interactivity of web-
sites promoting health behaviours during infancy ranged between
poor to adequate. Since the 2015 systematic assessment, there was a
slight improvement in quality of websites but no difference in the
SAM rating and readability of information. There is a need for
researchers and healthcare providers to leverage innovative web-
based platforms to provide culturally competent evidence-based

SUPPLEMENT ARTICLE
information based on Government guidelines that are accessible to
those with limited English proficiency.
DISCLOSURE OF INTEREST: None Declared.
P304 | The role of sweet food preferences in
appetite and eating behaviours in the context
of weight-loss in women
D. O'connor; P. Oustric; N. Casanova; K. Beaulieu; M. Hopkins;
C. Gibbons; G. Finlayson
School of Psychology, University of Leeds, Leeds, UK
INTRODUCTION: In the last 50 years, obesity rates have increased
globally alongside the increased availability of highly palatable foods.
Those with a preference for sweet food display increased energy intake,
placing them at greater risk of developing obesity. However, sweet food
preferences require further study, to illuminate potential barriers to suc-
cessful weight-loss. The following study aimed to investigate three areas;
i) the stability of sweet taste preferences, ii) the relationship between
baseline sweet food preferences and eating behaviour traits and iii) to
compare differences in sweet food preferences following completion of
two differing dietary weight-loss protocols.
MATERIALS AND METHODS: 46 women with overweight or obesity
(mean±SD BMI: 29.17 ± 2.4 kg/m2, age: 35 ± 10 years) were random-
ised to follow one of two dietary protocols (intermittent energy
restriction, IER or continuous energy restriction, CER) for 12 weeks or
until 5% weight-loss was achieved. Participants attended the lab at
baseline, week 2 and post-intervention. Participants completed fasted
body composition (air displacement plethysmography), food prefer-
ence (Leeds Food Preference Questionnaire) – in fasted, fed and post-
meal states, and serial appetite (VAS) assessment along eating behav-
iour questionnaires (Three-Factor Eating Questionnaire: TFEQ and
Binge Eating Scale; BES). Eating behaviour assessment included an ad
libitum test meal 3 hrs after a standardised breakfast. 48 lean partici-
pants (BMI: 21.7 ± 1.8 kg/m2, age: 35 ± 10 years) were also recruited
to provide a baseline measures day control comparison.
RESULTS: The stability of sweet food preferences (n = 94) demon-
strated a high degree of variability across a single day (r = .374–.515,
p < .001), dependent on nutritional state, but a high degree of stability
across a period of weeks (n = 37) during weight-loss (r = .792–.872,
p < .001). Correlations were noted between implicit wanting for sweet
foods at baseline and the change in disinhibition (r = .320, p < .005)
and restraint (r = .361, p < .005) during weight loss. Explicit wanting
for sweet foods was also correlated with changes in BES score
(r = .365, p < .005) and restraint (r = .361, p < .005) during weight
loss. No difference in sweet food preferences (p = .340–.974), nor in
ad libitum energy intake (p = .059–.614) existed between IER and
CER at any time point.
CONCLUSION: Sweet food preference was demonstrated to be a
highly stable individual trait during a period of weight-loss in women
with overweight or obesity. This preference displays associations with
1467789x, 2022, S2, Downloaded from https://onlinelibrary.wiley.com/doi/10.1111/obr.13503 by CAPES, Wiley Online Library on [16/12/2023]. See the Terms and Conditions (https://onlinelibrary.wiley.com/terms-and-conditions) on Wiley Online Library for rules of use; OA articles are governed by the applicable Creative Commons License
137 of 222
changes in behavioural traits during a dietary induced weight-loss
intervention, although there were no differences in outcomes based
on type of diet protocol.
CLINICALTRIALS.GOV IDENTIFIER: NCT03447600.
DISCLOSURE OF INTEREST: None Declared.
P305 | Sugar reduction program in remote
community stores: Retrospective evaluation
of implementation and impact on sugar
E. J. McMahon1; H. Romaniuk2; L. Orellana2; J. Brimblecombe3
1
Wellbeing & Preventable Chronic Disease Division, Menzies School of
Health Research, Darwin; 2Faculty of Health, Deakin University, Geelong,
Australia; 3Monash University, Clayton, Australia
INTRODUCTION: From 2017, Outback Stores (OBS), a
Commonwealth-entity providing fee-for-service management to
Australian remote community stores governed by community represen-
tatives (Store Directors), ran a sugar reduction program. Strategies that
restricted availability of sugary products were presented to Store
Directors for their consideration as policy for their store. This retro-
spective evaluation assessed implementation and impact on sugar sold.
MATERIALS AND METHODS: Store Director meeting minutes were
used to identify which of the 32 stores had agreed to implement at
least one sugar reduction strategy in the evaluation period (Jul
2016-Dec 2019). Point of sale data were collected for all products
sold by each store in Jul 2016-Dec 2019 and used to examine strat-
egy implementation (soft drink unit size reduction; restricting days/
times when specific sugary food/drinks were available). A multilevel
linear interrupted time series model was fitted with 1 breakpoint at
the start of the intervention (defined as when first strategy was
agreed to) to assess effect on the primary outcome, free sugars per
MJ energy from all food & drink (mg/MJ), using weekly sales data for
52 weeks pre- and post- intervention start (excluding one store that
did not have 52 weeks pre-intervention data).
RESULTS: Twenty stores (62.5%) agreed to at least one sugar reduc-
tion strategy in the evaluation period, with most agreeing to more
than one strategy in 1–2 meetings. Soft drink unit size reduction was
the most common strategy and was well implemented (19/20 stores
replaced one or more soft drink products with smaller unit sizes; one
store completely removed all sizes of the most popular soft drink).
Other strategies were agreed to by fewer stores later in the study
period, with considerable variation in which products were restricted
and when, and were less well implemented. Free sugars sold
decreased each week on average by 6.57 mg/MJ (95%CI -12.1 to
1.05 mg/MJ) pre-intervention and by 15.7 mg/MJ (95%CI -21.8 to
9.65 mg/MJ) post-intervention; with a significant additional weekly
reduction in sales of free sugar post- compared to pre-intervention of
9.15 mg/MJ (95%CI -14.7 to 3.56 mg/MJ, p = 0.001).
CONCLUSION: Most stores implemented sugar reduction policies
indicating Store Director and OBS commitment to sugar reduction in

138 of 222
their stores. Soft drink unit size reduction was the most common and
consistently implemented which may be due to ease of the strategy
to implement/maintain and/or perceived acceptability to the commu-
nity. There is evidence that the sugar reduction program accelerated
the modest sugar reduction occurring prior to implementation. This
evaluation shows the merit of presenting strategies to Store Directors
for their consideration as policy for their store.
DISCLOSURE OF INTEREST: None Declared.
P307 | Provision of free healthy lunches in
Australian primary schools: Parents'
perceptions of barriers
G. Aydin; C. Margerison; A. Worsley; A. Booth
School of Exercise and Nutrition Sciences, Deakin University, Melbourne,
Australia
INTRODUCTION: Globally, many primary school-aged children have
nutritionally deficient diets. Schools can be regarded as important
venues for health promotion as children spend a significant amount of
time and consume at least one meal a day at schools. Free school
lunch provision has the potential to contribute to the nutrition status
of school children and address food insecurity in socioeconomically
disadvantaged students. Although free or subsidised school lunches
are provided in some countries, most Australian children rely on
home-packed lunches. Exploring key stakeholder views is critical for
any future program aiming to initiate free lunch provision at
Australian primary schools. As parents are one of the key stakeholders
of nutrition promotion among children, the objective of the study was
to explore Australian primary school parents' views of the provision of
free lunches at schools, in particular the barriers to it.
MATERIALS AND METHODS: An online nationwide cross-sectional
survey with closed and open-ended questions was conducted in
Australia between March and April 2021. Descriptive statistics were
calculated for the survey responses using SPSS software. Open-ended
responses were analysed using Leximancer content analysis software.
RESULTS: 787 parents responded to the survey questions
(Mage = 40 years, 95% female, 72% university degree). Fifty-three per
cent of parents agreed with the statement ‘well-balanced, healthy
free school lunches should be provided at school to all students.’
whereas 30% were neutral and 16% disagreed. The parents who
opposed the proposal had reservations regarding the healthiness of
the lunches. Some parents felt that it was parents' or children's
responsibility to prepare lunches, not schools. Several parents were in
favour of equity, not equality; they believed these lunches should only
be provided to children in need. Lastly, some opposing parents had
concerns because of the cultural diversity of children at schools, high
incidence of allergies and potential cost to taxpayers.
CONCLUSION: Exploration of parents' views is crucial as their sup-
port is imperative for any future initiative aiming to provide free
school lunches in Australian primary schools. Although more than
1467789x, 2022, S2, Downloaded from https://onlinelibrary.wiley.com/doi/10.1111/obr.13503 by CAPES, Wiley Online Library on [16/12/2023]. See the Terms and Conditions (https://onlinelibrary.wiley.com/terms-and-conditions) on Wiley Online Library for rules of use; OA articles are governed by the applicable Creative Commons License
SUPPLEMENT ARTICLE
50% of parents expressed their support for free lunches at primary
schools, the concerns of parents who disagreed should be addressed.
These findings can provide directions for future health promotion pro-
grams at primary schools.
DISCLOSURE OF INTEREST: None Declared.
P308 | Evidence for the protein leverage
hypothesis in young children prone to
obesity: A cohort analysis from the ‘healthy
start’ study
H. Zhang1,2; A. M. Senior3,4; C. Saner5,6,7; N. J. Olsen1; S. C. Larsen1;
D. Raubenheimer3,4; S. Simpson3,4; B. Lilienthal Heitmann1,2,3
1
Research Unit for Dietary Studies, The Parker Institute, Bispebjerg and
Frederiksberg Hospital; 2Section for General Practice, Department of
Public Health, University of Copenhagen, Copenhagen, Denmark;
3
Charles Perkins Centre; 4School of Life and Environmental Sciences,
University of Sydney, Sydney, Australia; 5Division of Pediatric
Endocrinology, Diabetology and Metabolism, Department of Pediatrics,
Bern University Hospital; 6Department of Biomedical Research, University
of Bern, Bern, Switzerland; 7Murdoch Children's Research Institute, The
Royal Children's Hospital, Parkville, Australia
INTRODUCTION: The protein leverage hypothesis (PLH) proposes
that the rise in obesity has been caused partly by a shift towards diets
with reduced protein energy/non-protein energy ratios relative to the
set point for protein intake, which is strictly regulated in people. Evi-
dence for the PLH comes from studies in animals and adult humans,
while studies in children are few. Thus, the aim is to test the PLH in
young children prone to obesity.
MATERIALS AND METHODS: Data were from the ‘Healthy Start’
intervention study of young children prone to obesity. Dietary infor-
mation was measured by a 4-day dietary record. Body mass index
(BMI) z scores, fat mass percentage (FM%), waist-height (WHtR) and
hip-height ratio (HHtR) were measured by trained health profes-
sionals. The strength of leverage (L coefficient) for protein was tested
by fitting the power function to the relationship between energy
intake and protein (%). The energy composition of dietary macronutri-
ents (%) with total energy intake and each anthropometric was pre-
sented using the Nutritional Geometry, visualized through response
surfaces, and analyzed through mixture models.
RESULTS: A total of 553 individuals aged 2–6 years were included
and followed for 1.3 years. At baseline, total energy intake (Mean
[SD]) was 4.8 (1.0) MJ/day, energy proportion from protein (%) was
15.7 (2.3) %, carbohydrate (%) 54.8 (4.7) %, and fat (%) 29.5 (4.5) %. In
the fully adjusted model at baseline, there was an inverse relationship
between dietary protein (%) and total energy intake, which followed a
power function (L coefficient 0.19; P < 0.01). Notably, a diet lower
in protein (%) at baseline was associated with a subsequent increase
in BMI z scores, WHtR, and HHtR after 1.3-year follow-up, in support
of the PLH.

SUPPLEMENT ARTICLE
CONCLUSION: Evidence for the PLH was firstly found in young chil-
dren prone to obesity, showing that children with dietary protein
diluted by carbohydrate or fat had higher energy intake, later weight
gain and adiposity risk over 1.3 years.
DISCLOSURE OF INTEREST: None Declared.
P309 | Barriers and factors influencing whole
grain intake in southeast Asian countries:
Protocol of a scoping review
H. C. Koo1; U. Danaselvam1; C. S. Siau2; M. N. A. Mohd Sanip1
1
Tunku Abdul Rahman University College; 2Universiti Kebangsaan
Malaysia, Kuala Lumpur, Malaysia
INTRODUCTION: A number of developing countries in Southeast
Asia are facing the burden of obesity problem. Whole grains may
assist in decreasing such risk. However, whole grain intake in South-
east Asia countries still fall below the recommended level. Under-
standing the barriers and factors influencing whole grain consumption
may improve its consumption among the populations. Subsequently
reduce the prevalence of obesity. The present scoping review aims to
summarize the barriers and factors influencing whole grain consump-
tion across Southeast Asia.
MATERIALS AND METHODS: Methodology framework from Arksey
and O'Malley will be adopted in the present review. Electronic data-
bases e.g. PubMed/MEDLINE, ProQuest, Science Direct, Scopus and
Springer Journal Collection, as well as keywords will be searched for
identifying relevant studies. Besides, a hand search will be conducted
using the reference lists of selected journals, for additional relevant
studies. Inclusion criteria including (1) journals published in English;
(2) from year 2011 onwards; (3) conducted in all age groups of South-
east Asian populations and; (4) relevant to barriers and factors
influencing whole grain intake. Two investigators will screen the eligi-
ble titles, abstracts and full journals independently. Third investigator
will be included for any disagreement. An iterative approach for chart-
ing, collating, summarizing and reporting the data will be taken.
PRISMA 2020 abstract checklist, flowchart and review checklist will
be adopted.
RESULTS: Although research ethical approval is not required for this
proposed review, as the review does not involve human or animal par-
ticipants, the proposal was submitted for approval to the Tunku Abdul
Rahman University College Ethics Committee, and provisional
approval was received (TARUC/EC/2020/08–3). Summary tables will
be presented to demonstrate the barriers and factors influencing
whole grain intake in Southeast Asian countries, including Malaysia,
Singapore, Philippines, Indonesia, Thailand, Vietnam, Brunei, Laos,
Cambodia, Myanmar and East Timor.
CONCLUSION: It is a novel approach to summarize the barriers and
factors influencing whole grain consumption among Southeast Asian
populations. We anticipate the outcomes of the review will provide a
comprehensive summary regarding the barriers and factors
1467789x, 2022, S2, Downloaded from https://onlinelibrary.wiley.com/doi/10.1111/obr.13503 by CAPES, Wiley Online Library on [16/12/2023]. See the Terms and Conditions (https://onlinelibrary.wiley.com/terms-and-conditions) on Wiley Online Library for rules of use; OA articles are governed by the applicable Creative Commons License
139 of 222
influencing whole grain intake in Southeast Asia, and deliver key infor-
mation to government, policy makers and health professionals to
develop and deliver an evidence-based intervention, to improve
whole grain consumption in the region, subsequently reduce the prev-
alence of obesity.
DISCLOSURE OF INTEREST: None Declared.
P310 | Energy dense nutrient poor [EDNP]
food consumption patterns of young
Australian adults
K. T. Kombanda1; A. Worsley2; A. Booth1; C. Margerison1
1
Institute for Physical Activity and Nutrition, School of Exercise and
Nutrition Sciences; 2School of Exercise and Nutrition Sciences, Deakin
University, Geelong, Australia
INTRODUCTION: Young Australian adult's [18–30 years] diets are
characterized by high consumption of Energy Dense and Nutrient
Poor [EDNP] foods [commonly referred to as discretionary foods] and
low consumption of fruit and vegetables. Diets rich in energy density,
sugars, saturated fats and low in fiber have been associated with
increased risk of developing obesity. However, less research has
focused on examining young adults' EDNP food consumption patterns
in Australia. The aim of this research was to examine young Australian
adults' food consumption patterns and to study the association with
demographic characteristics.
MATERIALS AND METHODS: An online 27-item food-frequency
questionnaire focusing on EDNP foods was developed and adminis-
tered to 115 young Australian adults aged between 18 to 30 years
residing in Australia. Food consumption patterns were assessed by K-
means cluster analysis. Subsequently, the Fisher–Freeman–Halton
Exact test was used to test differences between the clusters in the
following respondent demographics: financial situation, gender, living
arrangement, education status, employment status, student status,
maternal education status and paternal education status. Data analysis
was conducted using IBM SPSS statistics [version 27].
RESULTS: A two-cluster solution was sought for the frequency of
consumption of EDNP foods. Cluster 1 exhibited the highest fre-
quency of EDNP food consumption when compared to cluster 2 which
showed the lowest frequency of consumption for all EDNP foods.
The two clusters differed greatly regarding the consumption of cakes
and muffins. There were significant differences between the clusters
in employment status [p = 0.02] and student status [p = 0.00]
(Fisher–Freeman–Halton Exact test).
CONCLUSION: Cluster analysis identified two major food consump-
tion patterns [high versus low consumption] based on the frequency
of consumption of EDNP foods among a sample of young Australian
adults. Findings suggest the need to particularly consider young
Australian adults' employment status and student status when design-
ing effective nutrition promotion strategies to improve young
Australian adults' EDNP food behaviours. This may in turn help to
 1467789x, 2022, S2, Downloaded from https://onlinelibrary.wiley.com/doi/10.1111/obr.13503 by CAPES, Wiley Online Library on [16/12/2023]. See the Terms and Conditions (https://onlinelibrary.wiley.com/terms-and-conditions) on Wiley Online Library for rules of use; OA articles are governed by the applicable Creative Commons License
140 of 222 SUPPLEMENT ARTICLE

reduce young Australian adults' increased risk of developing chronic T A B L E 1 Comparison between OLS, SA (lag/error) and GWR
diseases including obesity. models of fitness (n = 640), India, NFHS, 2015–16

DISCLOSURE OF INTEREST: None Declared. Parameters OLS SL SE GWR

Stunting

P312 | Identifying geographical heterogeneity Adjusted R2 0.610 0.675 0.729 0.734

of under-five child nutritional status in Indian AIC 4160.4 4090.4 4086.5 4026.5

districts AIC reduction — 70.0 73.9 133.9

Wasting
M. Biswas Adjusted R2 0.265 0.349 0.397 0.499

Center for the Study of Regional Development, Jawaharlal Nehru AIC 4235.3 4149.2 4151.0 4060.3
University, New Delhi, India AIC reduction — 86.1 84.3 175.0
Underweight
Adjusted R2 0.689 0.752 0.774 0.809
INTRODUCTION: Though nutritional deficiency affects all age groups AIC 4224.9 4153.3 4089.9 4080.9
at any stage of life, under-five children are often more vulnerable and AIC reduction — 71.6 135.0 144.0
susceptible to higher risk. India has substantially reduced the burden
of under-five child malnutrition over the last two decades. Despite
this, it is still gigantic and differs remarkably across districts, while the
demographic and socio-economic groups are most affected by it. This
paper aimed to decrypt the place-specific spatial dependence and het- CONCLUSION: This nationwide study confirmed that the spatial
erogeneity in associations between district-level nutritional status dependencies and heterogeneities in the district-level nutritional sta-
(stunting, wasting and underweight) and its considered correlates tus indicators were strongly explained by a multitude of factors and
using a geocoded database for all 640 Indian districts. thus can help policymakers in formulating effective nutrition-specific
MATERIALS AND METHODS: Unit level data was drawn from theat- programmatic interventions to speed up the coverage of under-five
est fourth wave of the National Family Health Survey, 2015–16 (the malnutrition status in most priority districts and geographical hot
Indian equivalent of Demographic Health Survey (DHS), and, there- spots across India.
fore, did not require any ethical approval for conducting this specific DISCLOSURE OF INTEREST: None Declared.
study. Univariate Moran's I and LISA statistics were used to confirm
the spatial clustering and dependence in under-five nutritional status.
P313 | Do primary school lunchboxes meet
The Ordinary Least Square (OLS), Geographically Weighted Regres-
national dietary guidelines
sion (GWR), Spatial (lag/error) models were employed to examine the
effects of correlates on the district-level nutritional status.
N. Hudson1,2,3; A. Brown1,2,3,4,5; R. Sutherland1,2,3,4,5; L. Janssen1;
RESULTS: The mean (Moran's I) district-level stunting, wasting and
C. Desmet1; R. Reynolds1,2,3; A. Chooi6; J. Jones1; F. Stacey1;
underweight were 38% (0.634), 21% (0.488) and 36% (0.721), respec-
C. Lecathelinais1,2,3,4; L. Wolfenden1,2,3,4,5
tively. The GWR results disclosed that the spatial heterogeneity in
1
relationships between district-level nutritional status and its driving Hunter New England Population Health, Wallsend, Newcastle; 2Hunter

forces were strongly location-based, altering their direction, magni- Medical Research Institute, New Lambton, Newcastle; 3School of

tude and strength across districts. Overall, the localized model per- Medicine and Public Health; 4Priority Research Centre for Health

formed better, and best fit the data than the OLS and spatial Behaviour; 5National Centre for Implementation Science, University of

(lag/error) models. Newcastle, Callaghan, Newcastle; 6Hunter New England Health,

Newcastle, Australia

INTRODUCTION: Children spend a significant proportion of their life

at school and most who attend Australian primary schools bring a
packed lunch. Therefore, lunchbox foods may have a substantial
impact on nutrition and health outcomes. This study compared food
group serves packed in primary school lunchboxes to the Australian
Dietary Guidelines, to determine associations between adherence to
guidelines and school or child characteristics.
MATERIALS AND METHODS: A cross-sectional study conducted in
44 primary schools across three local health districts of New South

SUPPLEMENT ARTICLE
Wales photographed and analysed student lunchboxes using a vali-
dated audit tool, to determine fruit, vegetable, dairy/alternative and
discretionary serves packed. results were compared to the Australian
Dietary Guidelines for children, based on the proportion that students
should be consuming whilst at school. Mixed models analyses were
conducted, with adjustments for potential clustering, to investigate
associations between the food groups and sex, socio economic status
(SES), school sector and year level (K-2/3–6).
RESULTS: Fruit was packed in 83.9% (n = 3,812) of the 4,542 lunch-
boxes analysed. Only 19.7% (n = 894) contained vegetables, with
1.9% (n = 85) meeting recommendations (1.5 serves). Similarly, 22.1%
(n = 1,003) contained dairy/alternatives, with 19.0% (n = 864) meet-
ing recommendations (0.5–1 serve). Whilst, 86.4% (n = 3,924) con-
tained at least one discretionary food, with 67.8% (n = 3,080)
exceeding the maximum recommendation (1 serve). Males (p = 0.04),
students in years 3–6 (p = 0.01) and those from low SES areas
(p = 0.05) exceeded this recommendation by significantly more.
Younger students had significantly higher dairy/alternatives
(p < 0.001) and fruit provision (p < 0.001).
CONCLUSION: School lunchboxes are not meeting the current rec-
ommendations. Most concerning is the low provision of vegetables
and dairy/alternatives, and the likelihood that excessive discretionary
foods are displacing core foods, particularly in males, students in years
3–6 and those from low SES areas. Programs seeking to improve the
nutritional quality of lunchboxes may benefit from exploring barriers
to packing specific food groups, and reducing enablers to packing dis-
cretionary foods, particularly in the higher risk groups, to develop
more targeted programs.
DISCLOSURE OF INTEREST: None Declared.
P317 | Poor quality of diet among younger
adults with overweight and obesity in Korea
S. Y. Kang1; Y. I. Hur2
1
International Healthcare Center, Asan Medical Center; 2Department of
Family Medicine, Seoul Paik Hospital, Inje University College of Medicine,
Seoul, Korea, Republic Of
INTRODUCTION: Diet quality is important for the prevention and
management of obesity. We aimed to investigate the quality of diet
according to age groups in adults with overweight and obesity in
Korea.
MATERIALS AND METHODS: We analyzed 8,637 adults with over-
weight and obesity (4,280 men and 4,357 women) in the KNHANES
2016 to 2019. Participants were aged ≥ 19 years, and their BMIs were
≥ 23.0 kg/m2. Diet quality was evaluated by the Korean Healthy Eat-
ing Index (KHEI), and poor quality of diet was defined as the lowest
quartile of each items of the KHEI. Age group (years) was categorized
as follows: 19–34, 35–49, 50–64, and ≥ 65. The odds ratios (ORs) and
confidence intervals (CIs) for poor quality of diet in each age group in
1467789x, 2022, S2, Downloaded from https://onlinelibrary.wiley.com/doi/10.1111/obr.13503 by CAPES, Wiley Online Library on [16/12/2023]. See the Terms and Conditions (https://onlinelibrary.wiley.com/terms-and-conditions) on Wiley Online Library for rules of use; OA articles are governed by the applicable Creative Commons License
141 of 222
comparison to those aged ≥ 65 years were calculated by multivariate
logistic regression analysis.
RESULTS: The mean total KHEI scores in men with overweight and
obesity aged ≥ 65 years, 50–64 years, 35–49 years, and 19–34 years
were 66.8 (0.5), 64.9 (0.4), 59.7 (0.4), and 55.7 (0.5), respectively;
whereas, the scores in women with overweight and obesity were 67.6
(0.4), 66.8 (0.4), 62.9 (0.5), and 56.3 (0.6), respectively (p for trend <
0.001) In both men and women, the adjusted ORs and CIs for poor
quality of diet were higher in younger age groups, specifically in the
following components of the KHEI: having breakfast, mixed grains
intake, total fruits intake, fresh fruits intake, total vegetable intake,
vegetable intake excluding Kimchi and pickled vegetables, % of energy
from saturated fatty acids, % of energy from sweets and beverages,
and energy intake.
CONCLUSION: Nutritional therapy should be emphasized more in
younger adults. In particular, appropriate amount of mixed grain,
fruits, and vegetable intake should be encouraged, and intake of fat,
sweets, and beverages should be decreased.
DISCLOSURE OF INTEREST: None Declared.
P318 | Evaluation of a healthy food and drink
policy in 13 recreation centres: An
observational study
S. Naughton1; H. Romaniuk2; A. Peeters1; A. Chung3; L. Orellana2;
A. Jerebine4; T. Boelsen-Robinson1
1
Insitute for Health Transformation; 2Biostatistics Unit, Deakin
University, Geelong, Australia; 3School of Public Health and Preventive
Medicine, Monash University, Melbourne; 4School of Health and Social
Development, Deakin University, Geelong, Australia
INTRODUCTION: A community organisation in Victoria, Australia
introduced a comprehensive healthy food and drink policy in its
aquatic and recreation centre food outlets to create a healthier food
environment for members and staff. This study reports the impact of
the policy on the healthiness of customer purchases and food and
drink sales.
MATERIALS AND METHODS: Six years of monthly point-of-sale
data (number of items and sales value) was available from 13 partici-
pating centres. The nutritional content of items was used to catego-
rise them as ‘red’ (limit), ‘amber’ (choose carefully), or ‘green’ (best
choices) using Victorian state government guidelines. The policy man-
dated the proportions of ‘red (<10%)’ and ‘green (>50%)’ menu items.
Three 2-year periods were considered: prior to, during, and post, pol-
icy implementation. Primary outcomes, calculated separately for food
and drinks, were monthly total sales ($) and percentage of total vol-
ume (litres/kg) sold of ‘red’, ‘amber’,’green’ items. Secondary out-
comes were energy density (kJ/g), percentage of total volume of
sugar, fat, saturated fat, and sodium. Comparison between the pre-
and post-implementation periods was the focus. An interrupted time
series analysis was performed for each outcome for each centre.

142 of 222
Random effects meta-analysis was used to estimate the overall initia-
tive effect: for sales the relative percentage difference (post-pre-
sales)/pre-sales; absolute percentage difference for other outcomes.
RESULTS: The policy did not affect food sales ( 3.2% (95% confi-
dence interval (CI) -20.8%,14.5%)), though drink sales declined by
27.3% (95% CI -37.3%, 17.3%). ‘Red’ food sales declined by
14.7% (95% CI -21.6%, 7.7%), ‘amber’ increased (11.0; 95% CI
5.5%,16.4%), with no change in ‘green’ food sales (3.3% [95% CI
-1.4%, 8.0%]). ‘Red’ drinks declined by 37.1% (95% CI -43.2%,
31.0%), while both ‘amber’ (8.8%; 95% CI 3.6%, 14.1%), and ‘green’
(28.0%; 95% CI 22.9%, 33.2%) increased. The energy density of foods
sold declined by 1.39 kJ/g (95% CI -2.51 kJ/g, 0.28 kJ/g) and the
food sugar content decreased by 4.94% (95% CI -8.14%, 1.74%).
Similarly, the energy density of drinks sold declined by 0.32 kJ/ml
(95% CI -0.42 kJ/ml, 0.23 kJ/ml) and the drink sugar content
declined by 2.01% (95% CI -2.47%, 1.55%).
CONCLUSION: This analysis showed that the implementation of a
comprehensive healthy food and drink policy can result in a shift to
healthier purchases and reduction in sugar purchased. Sales revenue
from foods did not decline. Healthy food retail policies can create sus-
tained shifts towards healthier purchases and have the potential to
improve population diets.
DISCLOSURE OF INTEREST: None Declared.
P321 | A cluster randomized controlled trial
of a choice architecture intervention,
embedded in an online canteen, to increase
the purchase of healthier recess items from
high-school canteens
T. Delaney1,2,3,4; L. Wolfenden1; H. Lamont1; C. Lecathelinais2;
R. Sutherland1; S. L. Yoong5; R. Wyse1
1
Public Health and Medicine, University of Newcastle, Newcastle;
2
Population Health, Hunter New England Local Health District, Wallsend;
3
Hunter Medical Research Institute; 4Priority Research Centre for Health
Behaviour, University of Newcastle, Newcastle; 5Health Sciences,
Swinburne University of Technology, Melbourne, Australia
INTRODUCTION: High school canteens are a key setting for public
health nutrition intervention. Across Australia, there has been a rapid
uptake of ‘online canteens’ which enable students to pre-order and
pay for menu items via the web or mobile app. Online canteens pro-
vide ideal infrastructure to support the purchase of healthier items via
the use of choice architecture strategies. Despite this, no trial has
tested the efficacy of choice architecture strategies within an online
canteen on improving the nutritional quality of high school student
purchases at recess.
The aim of this research was to assess the impact of embedding
choice architecture strategies into an online canteen (including menu
labelling, prompts, item positioning, and feedback) on the nutritional
1467789x, 2022, S2, Downloaded from https://onlinelibrary.wiley.com/doi/10.1111/obr.13503 by CAPES, Wiley Online Library on [16/12/2023]. See the Terms and Conditions (https://onlinelibrary.wiley.com/terms-and-conditions) on Wiley Online Library for rules of use; OA articles are governed by the applicable Creative Commons License
SUPPLEMENT ARTICLE
quality of school canteen recess purchases of high school students
(aged 12–19 years).
MATERIALS AND METHODS: A cluster randomized controlled trial
was conducted with 6 high schools in one Australian state. Schools
were randomized to receive either the choice architecture interven-
tion, or usual online ordering. Nutrient quality was assessed using rou-
tine data collected by the online canteen. Primary outcomes were the
proportion of ‘Everyday’, ‘Occasional’, and ‘Should Not Be Sold’ items
purchased, categorized using the state healthy canteen policy. Linear
mixed models were used to assess outcomes.
RESULTS: A total of 161 eligible students from 6 schools were
included in the analysis. There were no between group differences
over time for the intervention group in the mean percentage of online
recess items per student that were ‘Everyday’ (8.0%; [95% CI - 6.0,
22.1]; P = 0.26), ‘Occasional’ ( 8.0%; [95% CI - 20.6, 4.3]; P = 0.20)
or ‘Should Not Be Sold’ (0.7%; [95% CI - 9.4, 10.7]; P < 0.9).
CONCLUSION: While in the expected direction, statistical tests did
not identify any significant between-group differences over time in
‘Everyday’, ‘Occasional’ or ‘Should Not Be Sold’ items purchased at
recess, suggesting that a choice architecture intervention has limited
effects on increasing the purchase of healthier recess items from
high-school canteens. Further research is warranted, to confirm this
finding including a larger sample size and other ordering periods
(lunch).
DISCLOSURE OF INTEREST: None Declared.
P322 | Re-inventing food and nutrition
resources for young children through co-
design
T. Gunawardena; C. Dix; B. Murawski; J. Palmer; N. Billich; H. Truby
School of Human Movement and Nutrition Sciences, University of
Queensland, Brisbane, Australia
INTRODUCTION: Children who are above a healthy weight are likely
to carry this body habitus and related co-morbidities into adulthood
(Simmonds et al Obes Rev 2016; 17 (2) 95–107). This tracking high-
lights the need to focus more efforts into preventative action in the
early years of life.
As the formation of healthy dietary habits at home and within child-
care environments can determine a child's lifelong attitudes and behav-
iours towards food (Jackson et al Int. J. Environ. Res 2021; 18,838), the
development of healthy eating habits sits not only with parents, but with
the Early Childhood Education and Care (ECEC) sector.
Preliminary review undertaken by our team highlighted the gaps
within current nutrition resources for young children, including a lack
of engaging, problem-solving and user-centric resources. Cultural
adaptations and meal preparation resources for disadvantaged com-
munities were also limited.
MATERIALS AND METHODS: Co-design is an innovative outcome-
focused process, incorporating the end user throughout development.

SUPPLEMENT ARTICLE
This approach can lead to collaborative, user-centric resource devel-
opment, allowing effective integration into practice. By implementing
Design Thinking approaches, a range of ECEC sector personnel,
including child care centre directors and chef, completed a virtual con-
sumer panel where facilitated conversations were used to garner their
experiences of accessing and using currently available tools and
resources relating to food and nutrition. These data will be analysed
using Design Thinking processes, including Empathy Mapping. Follow-
ing this collaborative and iterative process, resource prototypes will
be presented for user-testing to assess relevance and user acceptance
prior to finalisation.
RESULTS: The initial ECEC consumer panels identified a lack of credi-
ble, easy to find, freely accessible nutrition resources and professional
development opportunities for the ECEC sector. Educators also
reported managing a small proportion of children with atypical eating
behaviours, missed developmental eating milestones, and outlined
challenges with parental communication and support. Specific points
such as their difficulties in translating current resources into their
practice were identified and issues of trust and credibility of the
source of the resources were also important. Credible resources
informed by co-design, and time-appropriate professional develop-
ment opportunities, could support the ECEC sector to provide
improved nutrition and food for children.
CONCLUSION: Design Thinking framework use in the development
of nutrition resources, allows user input in all elements of resource
development. This ensures resources are tailored to the specific needs
of the group in a preferable format. This may support improved nutri-
tion provision in the ECEC sector.
DISCLOSURE OF INTEREST: T. Gunawardena Grant / Research sup-
port with: Australian Government Department of Health: Public
Health and Chronic Disease Program - Early Childhood Nutrition,
C. Dix Grant / Research support with: Australian Government Depart-
ment of Health: Public Health and Chronic Disease Program - Early
Childhood Nutrition, B. Murawski Grant / Research support with:
Australian Government Department of Health: Public Health and
Chronic Disease Program - Early Childhood Nutrition, J. Palmer Grant
/ Research support with: Australian Government Department of
Health: Public Health and Chronic Disease Program - Early Childhood
Nutrition, N. Billich Grant / Research support with: Australian Govern-
ment Department of Health: Public Health and Chronic Disease Pro-
gram - Early Childhood Nutrition, H. Truby Grant/Research support
with: Australian Government Department of Health: Public Health
and Chronic Disease Program - Early Childhood Nutrition.
1467789x, 2022, S2, Downloaded from https://onlinelibrary.wiley.com/doi/10.1111/obr.13503 by CAPES, Wiley Online Library on [16/12/2023]. See the Terms and Conditions (https://onlinelibrary.wiley.com/terms-and-conditions) on Wiley Online Library for rules of use; OA articles are governed by the applicable Creative Commons License
143 of 222
P323 | Household food security status and
obesity in Kuantan, Pahang., Malaysia
R. Mat Ya; W. A. Bakar
Nutrition Sciences, International Islamic University Malaysia, Kuantan,
Malaysia
INTRODUCTION: Food insecurity has become one of the concerning
issues in public health. It exists whenever people are unable to always
access to sufficient food to maintain an active and healthy life. The
purpose of this paper was to investigate household food security sta-
tus and its relationship with obesity in Kuantan, Pahang.
MATERIALS AND METHODS: This cross-sectional study was con-
ducted in Kuantan, Pahang among 110 mothers age 19–49 years using a
set of questionnaires. Food security status were classified using the Food
Insecurity Experience Scale (FIES) questionnaire while height and weight
were measured to calculate Body Mass Index (BMI).
RESULTS: The result indicates that 54% households were food secure
while 46% experienced food insecurity. Out of the food insecure
group, 38.7% were mild food insecure, 6.4% were moderate food
insecure and 0.9% fell into severe food insecure group. Food insecu-
rity was found to be associated with household income [Adj OR:
19.33 (95% CI;2.41, 154.95; p-value = 0.005], mother's working sta-
tus [Adj OR: 3.92 (95% CI; 1.40, 10.97; p-value = 0.009] and mother's
marital status [Adj OR: 11.68 (95% CI; 1.17, 115.97; p-
value = 0.036)]. This study found that mean BMI was significantly
associated with household food insecurity (p-value = 0.025). The
result shows that BMI increases as the severity level of food insecu-
rity increases.
CONCLUSION: This study shows that the prevalence of food insecu-
rity and its associated factors including obesity is a major concern in
this area. The results warrant the need for further inquiry to explore
the complex interaction of food insecurity and obesity in order to
advocate the best intervention.
DISCLOSURE OF INTEREST: None Declared.
P324 | Public support for policy interventions
addressing high sugars intake in Australia: A
population-based study
A. Gupta1; K. D. Raine2; P. Moynihan3; M. A. Peres4
1
Global Obesity Centre (GLOBE), Institute for Health Transformation,
Deakin University, Burwood, Australia; 2School of Public Health,
University of Alberta, Edmonton, Canada; 3Adelaide Dental School,
University of Adelaide, Adelaide, Australia; 4Oral Health ACP, Duke-NUS
Medical School, Singapore, Singapore
INTRODUCTION: High sugars intake is a significant contributor an
unhealthy diet. Numerous public health policies exist to address
unhealthy diets; however, policy adoption and implementation

144 of 222
remains low globally. Thus, to help encourage policy adoption and
implementation, the current study aimed to assess the level of public
support for a range of public health policy interventions addressing
high sugars intake in Australia and describe the characteristics of the
population.
MATERIALS AND METHODS: Cross-sectional population-based data
for 4,040 Australian adults aged 15 + years representative of the
Australian population was sourced from Australian National Dental
Telephone Interview Survey. Public support for six public health policy
interventions (1. sugar-sweetened beverage taxation, 2. ‘unhealthy’
food and beverage taxation, 3. zoning and 4. restriction of ‘junk’ food
and sugar-sweetened beverage respectively near schools, in vending
machines at schools and 5. public places; and 6. prohibiting advertising
and promotion of ‘unhealthy’ food and beverages to children below
16 years) was measured on a five-point Likert scale (strongly support
to strongly oppose). Proportions of public support for policies were
assessed across sociodemographic characteristics of the Australian
adult population.
RESULTS: Overall the support for all interventions was high. Highest
support was observed for policies targeting children (78% supported
restricting sugars-sweetened beverages from vending machines in
schools, 75% supported prohibiting advertising and promotion of
‘unhealthy’ food and beverages to children under the age of 16 and,
64% supported zoning to restrict the supply of ‘junk’ food near
schools), and the lower support for those that imposed taxes
(e.g., 54% supported ‘unhealthy’ food and beverage taxation). Youn-
ger adults were generally less likely to express support for any policy
initiative, while participants with tertiary level of education were more
likely to support for any policy initiative. Women were more likely to
support the public health strategies targeting children specifically.
CONCLUSION: Overall, there is a strong national public support for
public health policies addressing high sugars intake in Australia. The
adoption and implementation of policies targeting children are most
favoured by the population and is a good starting point for policy-
makers to address unhealthy diets. More advocacy is warranted to
demonstrate the benefits of introducing other policies such as restric-
tions and taxation to increase public support and acceptability.
DISCLOSURE OF INTEREST: None Declared.
P325 | A cross-sectional study assessing the
implementation of early childhood education
and care-based obesity prevention practices
in NSW, Australia
A. Renda1; S. Yoong2; A. Grady1; M. Lum1; K. Reilly1
1
University of Newcastle, Newcastle; 2Swinburne University, Melbourne,
Australia
INTRODUCTION: Healthy eating and physical activity practices, poli-
cies, and programmes to reduce childhood obesity in Early Childhood
Education and Care (ECEC) services exist, however they are not
1467789x, 2022, S2, Downloaded from https://onlinelibrary.wiley.com/doi/10.1111/obr.13503 by CAPES, Wiley Online Library on [16/12/2023]. See the Terms and Conditions (https://onlinelibrary.wiley.com/terms-and-conditions) on Wiley Online Library for rules of use; OA articles are governed by the applicable Creative Commons License
SUPPLEMENT ARTICLE
routinely implemented. In 2013, only 27% of New South Wales
(NSW) ECEC services surveyed were implementing all six healthy eat-
ing and physical activity practices assessed in the setting (Yoong et al
J Paediatr Child Health 2016; 52[7], 765–770). However, the current
rate of implementation of these programs is unknown. This study aims
to measure the level of implementation of specific obesity prevention
practices, policies, and programs in ECEC services in NSW, Australia.
MATERIALS AND METHODS: A cross-sectional online and tele-
phone survey is being conducted with ECEC services (October 2021
– ongoing). ECEC services contact details were obtained from a pub-
licly available register, with a random sample of potential services
invited to participate via email and phone. The implementation of sev-
enteen evidence-based and recommended healthy eating and physical
activity practices is being assessed, such as, providing healthy eating
education and activities to children outside mealtimes and providing
sufficient opportunities for child physical activity. To measure the
level of practice implementation, services will be dichotomised into
“not meeting” and “meeting”. Descriptive and inferential statistics will
be used to report the level of implementation and potential associa-
tions between this outcome and services' characteristics such as type
of service, location, and size.
RESULTS: A total of 1,026 services were invited to participate, with
data collection ongoing. The current consent rate is 38%, of which
19% are preschools and 81% are long day care services. Preliminary
results show that of the 8 physical activity practices assessed, less
than 25% of services are implementing two practices, one is met by
25–50% of services, two by 50–75%, and three by >75% of services.
Of the 9 healthy eating practices, four are met by 25–50% of services,
three by 50–75% and two by >75% of services.
CONCLUSION: This cross-sectional study will assess the level of
implementation of obesity prevention practices, programs and policies
in ECEC services, and will provide important information on where
efforts to support implementation is needed.
DISCLOSURE OF INTEREST: None Declared.
P327 | Lessons learnt in using the FOOD EPI
tool for benchmarking food environment
policies amidst disruptions by the COVID‐19
pandemic in Uganda
B. Atwine1; M. Guloba1; T. Odokonyero2; T. Akurut1; G. Asiki3
1
Microeconomics; 2Sectoral, Economic Policy Research Centre, Kampala,
Uganda; 3APHRC, Nairobi, Kenya
INTRODUCTION: The Food Environment Policy index (Food EPI), fol-
lows the INFORMAS methodology for benchmarking public policies
and actions for healthy food environment and requires adaptation to
meet local country context. Uganda is one of the pioneer countries to
implement the FOOD EPI tool with a modification to include double
duty indicators (a total of 55 indicators) and during a pandemic

SUPPLEMENT ARTICLE
situation. Here, we document our experiences and lessons learnt in
implementing the FOOD EPI tool in Uganda.
MATERIALS AND METHODS: Between April 2020 and March 2022,
the team of researchers at EPRC was engaged in adapting and using
the Food EPI tool for benchmarking through six steps (training, adap-
tation, desk review, evidence validation workshop, rating and prioriti-
sation workshop and report writing). We have documented our
experiences and lessons through the entire process. Most of the expe-
riences are captured from documents such as meeting minutes,
reports submitted to APHRC and the funder and individual observa-
tions of researchers.
RESULTS: The initial implementation of activities was disrupted by
the COVID‐19 pandemic, thus most activities were conducted virtu-
ally (training of the teams via zoom, project launch, validation). The
team had to quickly adapt to a “new normal” modality of work which
entailed biweekly virtual meetings to receive technical support from
INFORMAS experts. The research project launch was important as an
entry point for developing rapport or relationships with government
officials and experts. This was also important for continuity through-
out the project cycle. During policy review, we learnt that not all rele-
vant documents are available online, therefore, a call for information
through writing to government offices to identify physical copies of
documents was important. Visits to government offices that were
mapped to the various policy domains yielded access to several docu-
ments. We also found that it is important to follow other informal
sources of information such as news items, policy and government
programme events, pronouncements by leadership to access current
actions. Government Ministries, Departments and Agencies (MDAs)
may be slow to respond to document requests and therefore require
constant reminders. Constant reminders through phone calls were
also important in ensuring participation in workshops. Finally, working
in a team with specific task allocation by FOOD EPI domain was
helpful.
CONCLUSION: These experiences and lessons can inform the pro-
cess of FOOD EPI benchmarking in low and middle income countries
with unique challenges such as access to online information as well as
emergency situations as pandemics in any country.
DISCLOSURE OF INTEREST: None Declared.
P328 | A review of efforts to advance equity
and community voices in food and obesity
prevention policy
C. Zorbas1; J. Browne2; R. Christidis2; P. Nagorcka-Smith2;
A. Brown2; S. Allender2; A. Peeters1; K. Backholer2
1
Global Obesity Centre, Institute for Health Transformation, Deakin
University, Melbourne; 2Global Obesity Centre, Institute for Health
Transformation, Deakin University, Geelong, Australia
INTRODUCTION: Overweight, obesity and dietary risks are socially
patterned. People who experience the most social disadvantage also
1467789x, 2022, S2, Downloaded from https://onlinelibrary.wiley.com/doi/10.1111/obr.13503 by CAPES, Wiley Online Library on [16/12/2023]. See the Terms and Conditions (https://onlinelibrary.wiley.com/terms-and-conditions) on Wiley Online Library for rules of use; OA articles are governed by the applicable Creative Commons License
145 of 222
experience the worst health outcomes. Current policy to prevent
weight gain and promote healthy diets largely underrepresent voices
from these groups. We aimed to systematically scope the literature to
understand how people with lived experience of social disadvantage
can participate in food and obesity prevention policy processes.
MATERIALS AND METHODS: A systematic scoping review was con-
ducted by applying five concepts (‘social disadvantage’, ‘lived experi-
ence’, ‘citizen participation’, ‘food/obesity’, and ‘policy’) across four
academic and grey databases. Studies that actively engaged people
with lived experience of social disadvantage in policy processes to
promote healthy diets or prevent obesity were included. Studies that
focused on individual behaviour change policies were excluded. Study
characteristics were extracted, and thematic analysis was conducted
to understand key factors affecting the participation of people who
experience disadvantage in food and obesity prevention policy
processes.
RESULTS: Twenty-four studies were included. The majority were con-
ducted in the United States of America (n = 16), with most studies
including people with ethnic minority backgrounds (n = 10) or resi-
dents living in rural (n = 8) or low socioeconomic (n = 7) areas. Half
of the studies used some form of community-based participatory
research. Five interconnected themes were identified to describe how
the voices of people experiencing disadvantage could be incorporated
in policy processes (mostly through policy advocacy and to a lesser
extent, to drive policy change). Themes indicated the need to: 1)
develop cross-institutional partnerships with community organisations
that meaningfully reach and engage priority groups; 2) be guided by
shared values and passion for community wellbeing; 3) create equita-
ble governance structures and cultures, which include a commitment
to co-learning; 4) invest in building community capacity (through train-
ing, leadership opportunities, and shared ownership over initiatives);
and 5) use culturally appropriate methods to capture and elevate com-
munity voices in ways that enable ongoing dialogue in policy
processes.
CONCLUSION: Multi-sectoral efforts, underpinned by genuine and
meaningful participation of people experiencing social disadvantage,
will be required to create more equitable food systems. These efforts
have been limited in the real-world to date and should continue to be
explored.
DISCLOSURE OF INTEREST: None Declared.

146 of 222
P330 | Benchmarking the healthiness, equity
and environmental sustainability of
Australian university food environments
D. Mann; S. Naughton; S. O'Halloran; G. Sacks
Global Obesity Centre, Deakin University, Melbourne, Australia
INTRODUCTION: Globally, there is increasing interest in monitoring
actions to create healthy, equitable and environmentally sustainable
food environments. University campuses are complex food environ-
ments catering to diverse communities, and represent promising set-
tings for developing strategies to transform food environments. To
date, there have only been a small number of assessments of the
healthiness of campus food environments. This study aimed to pro-
vide a comprehensive assessment of university food environments in
Australia by applying the University Food Environment Assessment
(Uni-Food) tool in a convenience sample of universities in 2021/2022.
MATERIALS AND METHODS: Universities were recruited via a
snowball sampling technique. The previously published and validated
Uni-Food tool was used to assess each university on three compo-
nents: 1) university systems and governance; 2) campus facilities and
environments; and 3) food retail outlets. Universities received an
overall score out of 100, reflecting the extent of implementation of
best practice (0–25%: very little; 25–50%: low; 50–75%: medium; and
75–100%: high). Each audited university was provided with an indi-
vidual report with tailored recommendations.
RESULTS: As of April 2022, six universities had conducted an audit of
their university food environment. Overall scores for each university
ranged between ‘very little’ to ‘medium’ implementation of best prac-
tice. Preliminary results indicate that there is some diversity in univer-
sity food environments, but most institutions lack comprehensive
policies and strategies relating to the availability, labelling, accessibil-
ity, and affordability of healthy and environmentally sustainable foods.
Most universities did not have a policy to restrict the availability and
promotion of unhealthy and unsustainable foods and beverages, and
those which did failed to meet best practice guidelines. Key strengths
identified across all universities included their strong sustainable pro-
cesses relating to energy and water use, and their representation of
students on key working groups related to the promotion the funda-
mental aspects of campus food environments.
CONCLUSION: Current Australian university campuses fall short of
best practice guidelines for comprehensive food environments. Fur-
ther benchmarking of university food environments is likely to help to
increase the accountability of the tertiary education sector for creat-
ing healthy, equitable and environmentally sustainable food environ-
ments; whilst supporting universities in identifying areas for action.
DISCLOSURE OF INTEREST: None Declared.
1467789x, 2022, S2, Downloaded from https://onlinelibrary.wiley.com/doi/10.1111/obr.13503 by CAPES, Wiley Online Library on [16/12/2023]. See the Terms and Conditions (https://onlinelibrary.wiley.com/terms-and-conditions) on Wiley Online Library for rules of use; OA articles are governed by the applicable Creative Commons License
SUPPLEMENT ARTICLE
P331 | Philippine food retail amidst COVID-
19 pandemic: A thematic analysis
E. Borazon1; V. Marquez2; C. N. Rachmi3; S. M. Jamil4; S. Phulkerd5;
A.-M. Thow6; H. Trevena; B. K. Poh4
1
International Graduate Program of Education and Human Development,
National Sun Yat-sen Unviersity, Kaohsiung City, Taiwan, Province of
China; 2School of Economics, University of the Philippines-Diliman,
Quezon City, Philippines; 3Reconstra Utama Integra, Jakarta, Indonesia;
4
Centre for Community Health Studies (ReaCH), Faculty of Health
Sciences, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia;
5
Institute for Population and Social Research, Mahidol University,
Nakhon Pathom, Thailand; 6Menzies Centre for Health Policy and
Economics
INTRODUCTION: The COVID-19 pandemic has caused disruptions in
food supply chains and food processing, changes in economic activi-
ties, and reduced access to food alongside changes in food purchasing
patterns. The several pandemic waves have transformed the food
retailers' business models, paving the way for better resilience and
recovery. Thus, this study aims to characterize the Philippine food
retail landscape during the COVID-19 pandemic with the ultimate
goal of documenting pathways to recovery and resilience.
MATERIALS AND METHODS: Published news articles from top three
news sites (ABS-CBN News, GMA Network, and Philippine Daily
Inquirer) based on the Reuters Institute ranking and government web-
sites were utilized as sources of data published from March to
December 2020. A total of 240 articles were gathered and 93 articles
were deemed unique after filtering for redundancies and relevance.
The study narrowed down with the search terms COVID AND food
retail, COVID AND market, COVID AND food supply, and COVID
AND food. Data collected were qualitatively analyzed using Leximan-
cer software utilizing a machine learning technique. A PESTEL
(Political, Economic, Social, Technological, Environmental, and Legal)
analysis was also conducted to analyze the macro-environment fac-
tors within the food retail system during the COVID-19 pandemic.
RESULTS: Results show that seven main themes emerge: lockdown,
food, pandemic, market, access, digital, and cash. The PESTEL analysis
reveal that: (1) Satellite palengkes proved to be a novel solution
among the populated cities of the National Capital Region; (2) Despite
the economic recession, the Philippine food retail industry was
observed to be thriving; (3) Social efforts from the private sector sig-
nificantly aided Filipinos in these trying times; and (4) Food related
enterprises managed to survive by immersing in the online platform
and omni-channel retailing.
CONCLUSION: These results indicate that although the Philippine
food retail has thrived amidst the crisis, potential improvements can
be done through better food retail policies.
DISCLOSURE OF INTEREST: None Declared.

SUPPLEMENT ARTICLE
P332 | A pathway towards the adoption of
fiscal policies to promote food systems
outcomes in the Pacific Islands
E. Reeve1; A. M. Thow2; A. Ravuvu3
1
Institute for Health Transformation, Deakin University, Melbourne;
2 1
Menzies Centre for Health Policy, University of Sydney, Sydney,
3
Australia; Public Health Division, The Pacific Community, Suva, Fiji
INTRODUCTION: Food taxes have been promoted for NCD preven-
tion, and taxes are increasingly being considered to incentivize pro-
duction and consumption of more sustainable food options. Pacific
Island countries have been early adopters of SSB taxes, and are dem-
onstrating interest in Food taxes. Food taxes especially feasible option
in a post-covid recovery, as they offer potential to raise more signifi-
cant revenue than SSB taxes. As an example, Tonga has implemented
taxes on a range of fatty meats, and is looking to expand the tax to a
range of other foods linked to diet-related NCDs. However, food
taxes can be challenging to design and administer, including in Pacific
Island Countries and Territories. Major points that countries must
address include documenting relevant consumption, demonstrating
potential impact, and addressing the requirements of policy processes.
MATERIALS AND METHODS: This study built on the framework for
fiscal policies outlined in Thow et al (Bull World Health Organ 2018)
to develop a systematic resource for countries considering extending
SSB taxes towards other foods in order to address different food sys-
tems outcomes in the context of a post-covid recovery. It drew from
global literature around policy considerations for broad based food
taxes to examine how they are/may be addressed in the Pacific con-
text. The study synthesized policy, trade and consumption data being
generated through the Pacific Islands Food Systems project to address
remaining questions around food taxation in the Pacific.
RESULTS: Despite a significant proportion of Pacific Island Countries
having adopted SSB taxes, and a number of countries demonstrating
interest in broad-based food taxes, only two countries had moved to
adopt food taxes. We systematically presented a number of
approaches suited to the identification of foods most likely to reduce
NCDs or promote positive environmental outcomes, nuanced to the
Pacific context. We demonstrated the way that trade and consump-
tion data can be utilized to generate evidence for food-based taxes,
and the mechanisms and rates that could be used to apply them. We
outlined areas of potential incoherence between food taxes, trade
commitments, and agricultural subsidies and grants, and explored
administrative options for countries to address these.
CONCLUSION: Food taxes could be highly beneficial for addressing a
number of food systems outcomes in Pacific Island Countries in the
post-covid recovery. Our analysis offers a much-needed resource for
countries by addressing both evidence and policy design concerns.
DISCLOSURE OF INTEREST: None Declared.
1467789x, 2022, S2, Downloaded from https://onlinelibrary.wiley.com/doi/10.1111/obr.13503 by CAPES, Wiley Online Library on [16/12/2023]. See the Terms and Conditions (https://onlinelibrary.wiley.com/terms-and-conditions) on Wiley Online Library for rules of use; OA articles are governed by the applicable Creative Commons License
147 of 222
P334 | Diabetes incidence among individuals
with different weight status: A systematic
review and meta-analysis of prospective
cohort studies
H.-J. Yu1; M. Ho1; X. Liu1; J. Yang2; P. H. Chau1; D. Y. T. Fong1
School of Nursing, Li Ka Shing Faculty of Medicine, The university of
Hong Kong, Hong Kong, Hong Kong; 2Shenzhen Second People's Hospital,
Shenzhen, China
INTRODUCTION: It is known that diabetes prevalence is higher
among individuals with overweight/obesity than those with normal
weight. Diabetes incidence is a more reliable metric to indicate its
related disease burden, however, there is no meta-analysis to estimate
the diabetes incidence by weight status. This meta-analysis aimed to
estimate the diabetes incidence among adults with underweight, nor-
mal weight, and overweight/obesity.
MATERIALS AND METHODS: PubMed, Embase, Web of Science,
and Cochrane Library were searched from inception to November
13, 2020. Prospective cohort studies with a sample size over 1,000
and follow-up duration over 12-month, and reporting diabetes inci-
dence by baseline body mass index (BMI) categories in adults were
included. Weight status was defined by the ethnic-specific BMI classi-
fication. All analyses were performed using the random-effects
models with inverse variance weighting. Subgroup analysis was used
to explore the potential effects of sex, age, country income, region,
weight assessment, and diabetes ascertainment methods on the esti-
mated diabetes incidence. The study protocol was registered with
PROSPERO (CRD42020215957).
RESULTS: A total of 84 studies involving 3,363,948 adults at baseline
from 20 countries were included. The pooled incidences of diabetes
in adults underweight, normal weight, and overweight/obesity were
5
1 (95% CI: 3
1–8
3, I2 = 98
8%, n = 12 studies), 2
7 (95% CI: 2
2–
3
3, I2 = 99
6%, n = 64 studies), and 10
3 (95% CI: 9
1–11
6,
I2 = 99
7%, n = 81 studies) per 1,000 person-years, respectively.
Regardless of weight status, males and older adults have a higher
pooled incidence of diabetes. Diabetes incidence in low- and middle-
income countries (LMICs) was lower than the high-income countries
(HICs) among adults with underweight (2.0 vs. 7.6 per 1,000 person-
years). However, diabetes incidence in LMICs was higher than HICs
among adults with normal weight (6
5 vs. 2
1 per 1,000 person-years)
and overweight/obesity (14
3 vs. 9
3 per 1,000 person-years). Diabe-
tes incidence in the Western Pacific region and South-East Asian
region was higher than that in the American and European regions.
Furthermore, diabetes incidence among studies using self-reported
weight status was higher than those using objectively measured
weight status, and so does the comparison between self-reported and
objectively measured diabetes.
CONCLUSION: The diabetes incidence among adults varied by
weight status. High diabetes incidence among adults with normal and

148 of 222
overweight/obesity is a public health concern, particularly in the
LMICs and non-western countries.
DISCLOSURE OF INTEREST: None Declared.
P335 | Cost-effectiveness analysis of the
Western Australian Livelighter® mass media
campaign
J. Ananthapavan1; H. N. Q. Tran1; B. Morley2; E. Hart3;
K. Kennington3; J. Stevens-Cutler3; S. J. Bowe4; P. Crosland1;
M. Moodie1
1
Deakin Health Economics, Deakin University; 2Cancer Council Victoria,
Melbourne; 3Cancer Council Western Australia, Perth; 4Deakin
University, Melbourne, Australia
INTRODUCTION: Mass media campaigns have been recommended
as a key component of a comprehensive public health approach to
address overweight and obesity. The Western Australian
(WA) LiveLighter® campaign, funded by the WA Department of
Health, has implemented a series of mass media advertising cam-
paigns that aim to encourage the maintenance of a healthy weight
through healthy lifestyle behaviours. LiveLighter® commenced in
2012 and up until 2020 there had been seven television-led phases of
the campaign delivered in WA over 22 campaign periods (referred to
as waves). This study aimed to assess the cost-effectiveness of the
LiveLighter® campaign in preventing obesity-related ill health in the
WA population from the health sector perspective.
MATERIALS AND METHODS: The impact of an average LiveLighter®
campaign delivered in three waves over 12 months was assessed for
the WA population aged 25–49 years. Campaign effectiveness was
estimated from a meta-analysis of campaign cohort studies that sur-
veyed a representative sample of the WA population on discretionary
food (sweet food and sugary drinks) consumption one month prior
and one month after campaign airing. The intervention effect on dis-
cretionary food consumption was assumed to last for the duration of
the campaign. Campaign costs were derived from campaign invoices
and interviews with Cancer Council WA staff, and adjusted to A
$2017 values. The long-term health (measured as health-adjusted life
years [HALYs]) and health care cost-savings resulting from reduced
obesity-related diseases as a consequence of reduced discretionary
food consumption were modelled over the lifetime of the target pop-
ulation using a validated multi-state lifetable Markov model. This
model simulates the impact of changes in body mass index (BMI) on
the incidence, prevalence, mortality and morbidity of nine obesity-
related diseases.
RESULTS: The meta-analysis indicated a reduction in the consump-
tion of sugary drinks by 0.78 serves per week and sweet food by 0.28
serves per week. The 12 month intervention was estimated to cost
approximately A$2.46 million (M) and resulted in an estimated reduc-
tion in average weight of 0.58 kg, 204 HALYs gained (95%CI: 103;
334) and healthcare cost-savings of A$3.17 M over the lifetime of the
1467789x, 2022, S2, Downloaded from https://onlinelibrary.wiley.com/doi/10.1111/obr.13503 by CAPES, Wiley Online Library on [16/12/2023]. See the Terms and Conditions (https://onlinelibrary.wiley.com/terms-and-conditions) on Wiley Online Library for rules of use; OA articles are governed by the applicable Creative Commons License
SUPPLEMENT ARTICLE
study population. The mean incremental cost-effectiveness ratio
showed that LiveLighter® was dominant (cost-saving and health pro-
moting). The intervention remained cost-effective in all the sensitivity
analyses conducted.
CONCLUSION: The LiveLighter® campaign is likely to represent very
good value-for-money as an obesity prevention intervention in WA.
DISCLOSURE OF INTEREST: J. Ananthapavan Consultant for: JA was
funded by Cancer Council WA to conduct the project, H. N. Q. Tran
Consultant for: HNQT was funded by Cancer Council WA to conduct
the project, B. Morley Employee of: BM is employed by Cancer Coun-
cil Victoria, E. Hart Employee of: EH is employed by Cancer Council
Western Australia, K. Kennington Employee of: KK was employed by
Cancer Council Western Australia, J. Stevens-Cutler Employee of:
JS-C is employed by Cancer Council Western Australia, S. J. Bowe:
None Declared, P. Crosland: None Declared, M. Moodie Consultant
for: MM was funded by Cancer Council WA to conduct the project.
P336 | Brands off our kids: Developing an
advocacy platform to protect children from
unhealthy food marketing
K. Hickey; J. Martin; A. Schmidtke
Obesity Policy Coalition, Melbourne, Australia
INTRODUCTION: In 2021 the Obesity Policy Coalition (OPC)
released a platform to protect children from unhealthy food market-
ing: Brands off our kids. This platform set out the following four key
actions for government to take to give Australian children a childhood
free from unhealthy food marketing:
• Ensure TV, radio and cinemas are free from unhealthy food market-
ing from 6 am to 9:30 pm
• Prevent processed food companies from targeting children
• Ensure public spaces and events are free from unhealthy food
marketing
• Protect children from digital marketing of unhealthy food
The platform also set out key results from surveys demonstrating
strong public support for government action, as well as the features
required for effective regulation.
MATERIALS AND METHODS: This presentation will outline the four
key actions, detail why and how the OPC developed this platform and
explain its role and influence in advocating for change.
This presentation will discuss:
• the OPC's history in advocacy to protect children from unhealthy
food marketing
• the shift from a focus on failing industry codes to a focus on our
recommendations for change
• the approach taken in developing this new platform, including the
use of survey data and values-based messaging

SUPPLEMENT ARTICLE
• the advocacy strategy that accompanied the platform, including
organisational and public support
RESULTS: This presentation will discuss the reach and impact of the
platform and how it has been used to support advocacy by OPC.
This includes:
• The support from other public health organisations – more than
35 health organisations signed on in support of the platform
• The support from individuals – around 250 individual signatories
• Media coverage and social media engagement
• Wide distribution to politicians at federal and State/Territory level
• Engagement and meetings with politicians to discuss and present
the platform
• Use as a tool to assess new industry code on food and beverage
marketing
• Use in further advocacy work including on National Obesity
Strategy
CONCLUSION: This presentation will explore both the detail of the
OPC's Brands off our kids platform and the strategy behind it and pro-
vide an insight into how a platform of this type can support and
strengthen public health advocacy and influence policy change.
DISCLOSURE OF INTEREST: None Declared.
P340 | Planning for improved public health in
obesogenic environments: Gaps and overlaps
in the Western Australian regulatory
frameworks
M. Blake
Law School, University of Western Australia, Perth, Australia
INTRODUCTION: Recent research led by the Telethon Kids Institute
has highlighted the disproportionate distribution of fast-food chains in
those suburbs experiencing lower socio-economic status. This data
highlights the need for improved governance of planning decisions to
protect the health of those most vulnerable to the predatory practices
of the fast-food industry. This project identifies those aspects of the
regulatory frameworks relevant to planning decisions concerning the
location of unhealthy food and drink outlets. This exposes a landscape
populated by overlap, inconsistency and gaps in governance and the
need for regulatory reform.
MATERIALS AND METHODS: The first part of the methodology is
desk-based research which unpacks the legal provisions and the
policy directives which determine the outcome of planning applica-
tions concerning the location of fast-food outlets. The Public
Health Act 2016 (WA), the statutory duties under this and key pro-
visions concerning local Public Health Plans made pursuant to that
Act are explored. The Planning and Development Act 2005(WA),
relevant statutory powers and Local Planning Schemes created
1467789x, 2022, S2, Downloaded from https://onlinelibrary.wiley.com/doi/10.1111/obr.13503 by CAPES, Wiley Online Library on [16/12/2023]. See the Terms and Conditions (https://onlinelibrary.wiley.com/terms-and-conditions) on Wiley Online Library for rules of use; OA articles are governed by the applicable Creative Commons License
149 of 222
under the Act are similarly interrogated, in particular specific
clauses under the relevant regulations. The project then examines
avenues for influencing and challenging planning decisions, includ-
ing judicial review, and community objections. The second part of
the methodology involves the interviewing of relevant local govern-
ment experts in an effort to identify key ‘on the ground’ chal-
lenges to effecting planning outcomes which better protect local
communities from the proliferation of fast food outlets.
RESULTS: The research exposes deficiencies in the regulatory land-
scape which reduce the ability to effectively influence and chal-
lenge planning applications for fast food outlets. These include the
language and terminology found in the legislation and regulations,
and limitations in the criteria applicable to Local Planning Schemes,
and Development Approval Conditions. The research also identifies
inherent limitations in prescriptions around zoning tables which
could impact positively on the reduction of fast food outlets. The
interview data indicates obstacles to good communication across
different local government departments impeding the creation of a
culture supportive of enhancing good governance around planning
decisions.
CONCLUSION: The presentation will offer some possible avenues for
addressing the current gaps and obstacles within the regulatory land-
scape. These include specific amendments to the key legislative provi-
sions as well as more effective education of decision-makers around
identifying and balancing public interest considerations in the
decision-making process.
DISCLOSURE OF INTEREST: None Declared.
P341 | Food and beverage industry influence
on nutrition policy development and
implementation in the Philippines: A
qualitative case study
O. Huse1; P. Baker2; P. Zambrano3; G. Sacks4; E. Reeve1; A. Peeters4;
C. Bell1; K. Backholer1
1
Global Obesity Centre, Institute For Health Transformation, Deakin
University, Geelong, Australia; 2Institute for Physical Activity and
Nutrition, Deakin University, Melbourne, Australia; 3Alive and Thrive,
South East Asia, Manila, Philippines; 4Global Obesity Centre, Institute For
Health Transformation, Deakin University, Melbourne, Australia
INTRODUCTION: Increasing global evidence demonstrates that the
food and beverage industry influences the development and imple-
mentation of food and nutrition policies in ways that maximise their
interests, often at the expense of public health. However, few studies
have sought to understand how this occurs in lower-middle income
countries. This research aimed to describe how the food and beverage
industry influences food- and nutrition-related policy development
and implementation processes in the Philippines, a lower-middle
income country in East Asia.

150 of 222
MATERIALS AND METHODS: A qualitative case-study design was
used. Semi-structured key informant interviews were conducted with
nine representatives from the Philippines government and key
(health-related) NGOs closely involved with nutrition policy making in
the Philippines. Interview schedules and data analysis were guided by
existing theories relating to corporate power, corporate political activ-
ities, corporate messaging, and corporate objectives.
RESULTS: The food and beverage industry in the Philippines builds its
power and influence by occupying key positions, forming coalitions,
operationalizing its extensive resources, and swaying constituents to
support industry objectives. Industry engages in a range of tactics
aimed at influencing policy development and implementation, includ-
ing contacting policy makers directly, promoting ‘substitute’ policies
(such as self-regulation and other voluntary actions), presenting evi-
dence and data that they have generated themselves, and offering
gifts and financial incentives to government agencies and individuals.
Industry frames globally recommended policies as having unintended
negative impacts and being ineffective at improving health. As a result
of its influence, the food and beverage industry seeks to delay, pre-
vent, water-down and circumvent implementation of globally recom-
mended food and nutrition policies.
CONCLUSION: In the Philippines, the food and beverage industry
engages in highly overt activities designed to influence food and nutri-
tion policy processes in their favour. Their influence on policy pro-
cesses may be addressed through increased transparency, mandatory
declarations of conflict of interest, and strong political will to align
proposed policies with best practice.
DISCLOSURE OF INTEREST: None Declared.
P342 | Locations and types of food
Marketing in Recreation and Sport Facilities
in Canada
M. Warken1; E. Hobin2; S. Kirk3; D. L. Olstad4; H. Vatanparast5;
K. Raine6; R. Prowse1
1
Memorial University of Newfoundland, St. John's; 2Public Health
3 4
Ontario, Toronto; Dalhousie University, Halifax; University of Calgary,
Calgary, Canada; 5University of Saskatchewan, Saskatoon, Canada;
6
University of Alberta, Edmonton, Canada
INTRODUCTION: The World Health Organization recommends
restricting unhealthy food and beverage marketing in children's set-
tings, including recreation and sport facilities (RSF). Policy discussions
regarding restricting unhealthy food marketing to children in Canada
often lack attention to RSF due to perceived need for industry spon-
sors to fund sports. This study assessed the nature and extent of food
marketing in a diverse sample of RSF across Canada.
MATERIALS AND METHODS: A cross-sectional assessment was
completed Feb-Apr 2022 in a random sample of RSF from four strata
(urban-ice; urban-non-ice; rural-ice; rural-non-ice) within a day's travel
from the most populated urban centres in nine Canadian provinces.
1467789x, 2022, S2, Downloaded from https://onlinelibrary.wiley.com/doi/10.1111/obr.13503 by CAPES, Wiley Online Library on [16/12/2023]. See the Terms and Conditions (https://onlinelibrary.wiley.com/terms-and-conditions) on Wiley Online Library for rules of use; OA articles are governed by the applicable Creative Commons License
SUPPLEMENT ARTICLE
Eligible RSF were indoor, had 1 + area for ice hockey, soccer, or
swimming, and offered programming for children under 18 years.
Audits were completed by trained research assistants using the vali-
dated and reliable Food and beverage Marketing Assessment Tool for
Settings (FoodMATS). The FoodMATS includes 37 items for which
raters systematically record the presence/absence of food marketing,
the product/brand marketed, techniques used (child-appeal/sports-
related) and the advertisement's size.
RESULTS: Of 271 RSF contacted, 86 agreed to participate (67% of
responses; 144 did not responded; 41 declined/ineligible). Data have
been collected for 31 RSF (urban-ice [n = 8], urban-non-ice [n = 11],
rural-ice [n = 4], rural non-ice [n = 8]) to date. Almost all (94%) RSF
had 1 + instances of food marketing. 933 food marketing instances
were recorded of which 48% were large, 11% were child-appealing,
and 6% were sports-related. The median number of food marketing
instances was 22 (IQR: 9,40) per RSF. The majority of food marketing
instances were found in concessions (n = 322,35%) (e.g. product
placement at checkout [n = 157], on menus [n = 38]) and on vending
machines (n = 299,32%), while 24% were found in sports areas
(n = 225) (e.g. on ice/field/walls of playing areas [n = 143], in specta-
tor areas [n = 43], on scoreboards/clocks [n = 27]). There were
92 sports areas, including ice rinks [n = 27], weight/cardio rooms
[n = 16], gymnasiums [n = 16], pools [n = 11], running tracks
[n = 10], and fields [n = 5]. Almost half (43%) of all sports areas had
food marketing, and food marketing was most common in ice rinks
(85%), fields (60%), and gymnasiums (44%).
CONCLUSION: RSF expose children to multiple instances of food
marketing. Excluding sport settings from policy restricting food mar-
keting to children allows food marketers to reach children. Future
analysis will explore the nature and extent of food marketing by facil-
ity type and the relationship between observable food marketing
instances and food industry sponsor financial donations.
DISCLOSURE OF INTEREST: None Declared.
P343 | Local government perspectives on
strengthening equity in local healthy eating
policies
S. Schultz; C. Zorbas; A. Peeters; K. Backholer
Global Obesity Centre, Institute for Health Transformation, Deakin
University, Melbourne, Australia
INTRODUCTION: Inequities in healthy eating and diet-related dis-
eases are unfair, avoidable and a critical public health priority. Govern-
ments play an important role in addressing unhealthy diets, yet there
is a lack of evidence of effective equity-oriented policy action that
addresses the determinants of healthy eating inequities. With their
close connection to community, local governments are well placed to
act upon the determinants of healthy eating via their healthy eating
policies and programs. This study aims to understand how local gov-
ernments consider equity in the development, prioritisation and

SUPPLEMENT ARTICLE
implementation of healthy eating policies and programs, and identify
potential barriers and enablers to strengthening an equity focus.
MATERIALS AND METHODS: Semi-structured interviews will be
conducted between May and July 2022 with participants from 16–20
local governments in Victoria, Australia. Participants will be those
involved in the development and/or implementation of healthy eating
policies. A purposive sample of participants from urban and regional
local government areas, as well as areas of lower and higher socioeco-
nomic disadvantage will be recruited. The interview guide will be
informed by VicHealth's Fair Foundations Framework for Health
Equity and the Consolidated Framework for Implementation
Research. An inductive thematic analysis will be conducted to inter-
pret the data.
RESULTS: Thematic analysis will be completed by August 2022. Key
themes describing how local governments currently consider equity in
healthy eating policies and programs will be presented. Barriers and
enablers to strengthening local government's equity focus when
developing, prioritising and implementing local healthy eating policies
and programs will also be reported. Preliminary discussions with local
government stakeholders suggest these may include perceived com-
plexity of equity and lack of supportive institutional structures, pro-
cesses and tools.
CONCLUSION: Ongoing research is needed to support local govern-
ment efforts to develop and implement equitable healthy eating poli-
cies in the real-world. Our novel findings on the perspectives of local
government representatives will help inform the development of an
equity tool to support local governments strengthen equity outcomes
of their healthy eating policies and programs.
DISCLOSURE OF INTEREST: None Declared.
P344 | Developing and piloting a toolkit to
evaluate commercial food retail
environments
S. Barquera1; M. White1; X. Zarate1; A. P. Bonner1; C. Nieto1;
 n Flández2; L. Tolentino1
K. Leo
1
Health and Nutrition Research Center, NATIONAL INSTITUTE OF
PUBLIC HEALTH (INSP), MEXICO, Cuernavaca, Mexico; 2United Nations
Children's Fund (UNICEF) LACRO, Ancon, Panama
INTRODUCTION: Food retailers use diverse marketing strategies to
sell and position products, influencing consumers' purchasing deci-
sions. Ultra-processed foods high in calories, sugar, fat, and sodium,
which are associated with obesity and diet related diseases, are pro-
moted more often than unprocessed and minimally foods, increasing
their appeal to customers. This creates an unhealthy store environ-
ment which can be difficult to evaluate. Our objective was to design
and pilot a Toolkit with a methodology to determine the presence and
extent of marketing strategies among basic (healthy) and non-basic
(less healthy) food groups in stores.
1467789x, 2022, S2, Downloaded from https://onlinelibrary.wiley.com/doi/10.1111/obr.13503 by CAPES, Wiley Online Library on [16/12/2023]. See the Terms and Conditions (https://onlinelibrary.wiley.com/terms-and-conditions) on Wiley Online Library for rules of use; OA articles are governed by the applicable Creative Commons License
151 of 222
MATERIALS AND METHODS: To develop the Toolkit, a systematic
review was carried out on the effect of in-store marketing strategies
on food purchases, a survey of food retailers, and a literature search
to identify existing instruments. The methodology was piloted in six
supermarkets located in urban and high-traffic areas in five Latin
American countries in December 2020. Data was collected using Goo-
gle Forms. The final Toolkit included 16 general indicators across six
domains, offering three different approaches (limited, basic, or
expanded) for resource availability. The in-store observations took
1.5 hours to complete on average. Food groups were categorized as
basic (healthy) and non-basic (less healthy).
RESULTS: Results were homogenous in the six stores. Regarding the
availability domain, all stores had a moderate to high variety across
food groups, with acceptable perceived quality of fruits and vegeta-
bles. Considering the promotional domain, banners and product dis-
plays were the most frequently utilized strategies. The food groups
with the greatest number of product displays throughout the stores
were regular soda and sweet snacks (candies, chocolates and cookies).
With respect to the price domain, discounts were the preferred type
of strategy and were used most for sweet snacks. In the product
domain, the most commonly used child-targeted strategy was cartoon
characters. Breakfast cereals, candies, chocolates, and cookies used
the greatest number of strategies, with at least 3 types (cartoons,
games/prizes, location on bottom shelf). Diet soda was the only food
group with no child-directed strategies.
CONCLUSION: The Toolkit highlights differences in the magnitude of
promotions between healthy and less healthy food groups, showing
that the latter are promoted with more types of price, promotion,
product, and placement strategies. The toolkit is quick and easy to
apply, which is ideal for researchers with limited resources. It can be
used to generate country-specific evidence and support the need for
marketing regulations to ultra-processed foods to make food environ-
ments more conducive to healthy choices.
DISCLOSURE OF INTEREST: S. Barquera Grant / Research support
with: UNICEF LACRO, M. White Grant / Research support with: UNI-
CEF LACRO, X. Zarate Grant / Research support with: UNICEF
LACRO, A. P. Bonner Grant / Research support with: UNICEF LACRO,
C. Nieto Grant / Research support with: Bloomberg Philanthropies,
n Flández Consultant for: UNICEF LACRO, L. Tolentino Grant/
K. Leo
Research support with: Bloomberg Philanthropies.
P345 | Transformations in retail food sector
in East Asia
T. Scapin; S. Dean; B. Wood; G. Sacks; A. Cameron
Global Obesity Centre (GLOBE), Deakin University, Burwood, Australia
INTRODUCTION: The important influence of the retail food environ-
ment on food choices and diets is increasingly recognised. Large and
modern retail chains use highly sophisticated tactics to influence pur-
chasing behaviour, manipulating product assortment, price-setting

152 of 222
and marketing tactics, often to promote highly processed, unhealthy
foods and beverages. Economic development and demographic
changes in East Asia have resulted in changes in both the retail mix
and purchases of unhealthy food products. Despite the ongoing nutri-
tion transition in the region, few studies have described the retail food
transformations taking place. The aim of this study was to map recent
changes in the food retail sector in East Asia.
MATERIALS AND METHODS: Time-series data related to the food
retail market in six East Asian countries (China, Indonesia, Malaysia,
Philippines, Thailand, and Vietnam) were obtained from the Euromoni-
tor International Passport Database. Data from the past 14 years
(2007–2021) on the number of food outlets, selling space and market
value were summarised for ‘modern’ (supermarkets, hypermarkets,
convenience stores) and ‘traditional’ grocery retailers (small indepen-
dent stores, wet markets, food stalls). E-commerce trends were also
investigated by looking at changes on online sales of fast-food
restaurants.
RESULTS: Our findings revealed a rapid change in the retail food sec-
tor in East Asia over time. Although traditional retailers are still pre-
dominant in the countries analysed, their number of outlets, selling
space and market share has decreased markedly in the past 14 years,
with the COVID-19 pandemic greatly impacting the traditional sector.
The reduction in the number of traditional outlets over the last two
years (2019–2021) was 242% higher than the sum of the reduction in
the twelve years before the pandemic. In contrast, the modern gro-
cery retailing sector has experienced a continuous expansion over the
past 14 years, with an increase of 298% in the number of convenience
stores and a 102% increase in the number of supermarkets and no
shrinkage due the COVID-19 pandemic. An emergent trend in the
region is the increasing online sales from fast-food restaurants, which
have been increasing markedly since 2007 and more predominantly
after 2020 with the beginning of the COVID-19 pandemic. In
Malaysia, for example, almost 70% of sales from major fast-food res-
taurants were made through online channels in 2021.
CONCLUSION: This study forms an important basis for understand-
ing the changing retail food sector in East Asia, with clear differences
between traditional and modern retailers, and the emergence of
online food retail. These findings can be used to inform efforts to pro-
mote a healthy retail food sector in the region.
DISCLOSURE OF INTEREST: None Declared.
P346 | Measuring urban food environments:
An analysis of density of modern trade food
retail in Bangkok, Thailand
T. Sakulsri1; N. Thongcharoenchupong1; S. Phulkerd1; C. N. Rachmi;
M. J. Sameeha2; E. Q. Borazon3; A.-M. Thow4; H. Trevena4;
B. K. Poh2
1
Institute for Population and Social Research, Mahidol University,
Nakhonpathom, Thailand; 2Faculty of Health Sciences, Universiti
Kebangsaan Malaysia, Kuala Lumpur, Malaysia; 3College of Social
Sciences, National Sun Yat-sen University, Kaohsiung, City, Taiwan,
1467789x, 2022, S2, Downloaded from https://onlinelibrary.wiley.com/doi/10.1111/obr.13503 by CAPES, Wiley Online Library on [16/12/2023]. See the Terms and Conditions (https://onlinelibrary.wiley.com/terms-and-conditions) on Wiley Online Library for rules of use; OA articles are governed by the applicable Creative Commons License
SUPPLEMENT ARTICLE
Province of, China; 4Menzies Centre for Health Policy and Economics,
University of Sydney, Sydney, Australia
INTRODUCTION: The prevalence of overweight and obesity has
been increasing worldwide. Retail food environment plays an impor-
tant role in shaping overweight and obesity risks as it drives access to
types of food consumers purchase and consume. The aim of the study
was to apply Geographic Information System to analyse density of
modern trade food retailers, to better understand retail food environ-
ments in Bangkok which is the most populated city in Thailand and
dominates urbanization of the country.
MATERIALS AND METHODS: This studied applied a geographic
approach for the analysis of current density of modern trade food
retailers in Bangkok Thailand. Existing data and information were
derived from various organizations of Thailand. GIS software was
used as a tool to explore the density of modern trade food retailers in
urban Thailand.
RESULTS: Bangkok had a total area of 1,568.70 km2 per 5,696,409
population. The population density per unit area was 3,631 people
per km2. There were 3,951 modern food retail establishments. The
density of food retailers was 2.52 stores per km2. By Bangkok district,
the highest density of the modern food retail establishments was
observed in the inner city area of Bangkok which is filled up with
housing estates and public institutions such as offices and schools.
The top three districts with the highest density were Pom Prap Sattru
Phai, Bang Rak and Ratchathewi districts, at 18.13, 16.43 and 16.13
establishments per km2, respectively. Convenience stores including
Express and Mini Mart which sell a range of food and beverage prod-
ucts had the highest number of stores compared to other modern
trade formats in Bangkok. This is followed by supermarket format,
department store format and hypermarket format, respectively. Most
convenience stores were found being located almost all over the
streets and corners in commercial and office areas in Bangkok.
CONCLUSION: The findings suggest that establishing urban planning
policies that explicitly support healthy food access or encouraging
healthy food retailers, such as convenience stores and supermarkets is
needed. This should include in-store intervention to create more shelf
space used for fresh and healthy food products in all food retail
formats.
DISCLOSURE OF INTEREST: None Declared.

SUPPLEMENT ARTICLE
P348 | Early pregnancy adiposity, gestational
diabetes and weight gain: A conceptual
model and external validation
A. Boath1; L. Vale1; L. Hayes1; J. Allotey2; N. Heslehurst1
1
Population Health Sciences Institute, Newcastle University,
NEWCASTLE UPON TYNE; 2Institute of Applied Health Research,
University of Birmingham, Birmingham, UK
INTRODUCTION: The causal pathways linking early pregnancy adi-
posity to gestational diabetes (GDM) and weight gain (GWG) are not
well understood. Exploring this may lead to a better understanding of
how adiposity in pregnancy is related to GDM and GWG. This may
inform antenatal screening approaches to identify women for inter-
ventions to reduce GDM and GWG. We aimed to develop and vali-
date a conceptual model of the relationship between early pregnancy
adiposity, GDM and GWG.
MATERIALS AND METHODS: Development of the conceptual model
involved a literature review of epidemiological evidence, diet and
physical activity interventions, mechanistic evidence and current clini-
cal care pathways in the UK. These were synthesised to produce an
initial model. Leading international experts from a broad range of
backgrounds participated in 1 of 2 virtual expert panels. Nominal
group technique was used in the conversations around refining the
model. An iterative approach was taken with feedback from panel
1 being presented to panel 2.
RESULTS: An initial draft model was produced to represent estab-
lished relationships between early pregnancy adiposity status and key
features of GDM (insulin resistance and beta cell dysfunction) and
GWG. The potential impact of interventions on these relationships
were added to the model. The model also showed the range of imme-
diate and long-term maternal and child outcomes. Panel 1 was
attended by 7 experts, panel 2 by 8. Panel 1 suggested additional
adverse outcomes, including psychological impact on women of a
GDM diagnosis and the effect of GDM and excess GWG on offspring
neurodevelopment. Panel 1 also suggested that insulin resistance and
beta-cell dysfunction should be modelled as two separate pathways
implicated in GDM. Both panels suggested that epidemiological risk
factors be more explicit in the model; with further risk factors such as
maternal height, sleep and stress included.
CONCLUSION: The model provides a novel framework linking early
pregnancy adiposity to GDM and GWG. It highlights the complex and
multi-factorial nature of GDM and GWG, the multiple factors associ-
ated with excessive GWG and GDM development, and additional
related adverse outcomes. Understanding how diet and physical activ-
ity interventions could act, in relation to early pregnancy adiposity,
forms a mechanistic basis for further analytical exploration. For exam-
ple, showing how adverse outcomes focused on in trials and meta-
analyses extend into an economic evaluation model providing infor-
mation to service commissioners on how interventions may cost-
effective based upon a woman's adiposity.
DISCLOSURE OF INTEREST: None Declared.
1467789x, 2022, S2, Downloaded from https://onlinelibrary.wiley.com/doi/10.1111/obr.13503 by CAPES, Wiley Online Library on [16/12/2023]. See the Terms and Conditions (https://onlinelibrary.wiley.com/terms-and-conditions) on Wiley Online Library for rules of use; OA articles are governed by the applicable Creative Commons License
153 of 222
P349 | Investigating the existing evidence for
the effectiveness and cost-effectiveness of
targeting of weight management
interventions in early pregnancy on
alternative methods of adiposity to body
mass index
A. Boath1; L. Vale1; L. Hayes1; J. Allotey2; N. Heslehurst1
1
Population Health Sciences Institute, Newcastle University,
NEWCASTLE UPON TYNE; 2Institute of Applied Health Research,
University of Birmingham, Birmingham, UK
INTRODUCTION: Weight management interventions in pregnancy
aim to reduce adverse pregnancy outcomes or minimise gestational
weight gain (GWG). Body mass index (BMI) is usually used to select
pregnant women for weight management interventions. BMI is subop-
timal at predicting individual risk and alternative measures, such as
early pregnancy waist circumference, may inform better targeting of
interventions and improve cost-effectiveness. We aimed to identify
weight management interventions in pregnancy that had been tar-
geted based upon adiposity measures, alternative to BMI, and if any
economic evaluations had been conducted.
MATERIALS AND METHODS: Systematic literature searches were
conducted in March 2021 to identify trials that had selected pregnant
women for intervention using adiposity measures, other than BMI.
Searches of clinical trial registries were conducted in April 2021. To
identify economic evaluations, systematic literature searches were
undertaken in March 2022.
RESULTS: Systematic literature searches to identify weight manage-
ment interventions in pregnancy targeted based upon alternative
methods of adiposity did not identify any studies. Additionally,
searches of clinical trials registries returned no trials basing weight
management interventions targeted using alternative methods of adi-
posity. No relevant economic evaluations were identified.
CONCLUSION: The lack of available evidence on the effectiveness
and cost-effectiveness of targeting weight management interventions
using early pregnancy adiposity illustrates an evidence gap and oppor-
tunity for further research. Addressing this gap is important given the
high prevalence of maternal overweight or obesity, and the poor per-
formance of assessing individual risk by BMI. Although no studies were
identified directly evaluating the use of these measures for targeting
interventions some trials did record these measures in their datasets.
This provides an opportunity to use individual patient data (IPD) meta-
analysis to explore if targeting weight management interventions using
these measures might be more effective than using BMI. This would
facilitate estimation of the cost-effectiveness of using alternative adi-
posity measures by incorporating data into a decision model.
DISCLOSURE OF INTEREST: None Declared.

154 of 222
P350 | Optimising health in preconception,
pregnancy and postpartum (HiPPP): The
OptimalMe program. Baseline preconception
health and lifestyle behaviours; and post-
intervention behaviour change and
engagement outcomes. A mixed-method
study
B. R. Brammall; C. Harrison; R. Garad; H. Teede
Monash Centre for Research and Implementation, Monash University,
Clayton, Australia
INTRODUCTION: Reproductive aged women are high-risk for acceler-
ated weight gain and obesity development, with pregnancy recognised
as a critical contributory life-phase. Healthy lifestyle interventions dur-
ing the preconception and antenatal periods improve maternal and
infant health outcomes. Yet, interventions from preconception-
through-to-postpartum, and translation and implementation into real-
world healthcare settings remains limited. OptimalMe is a randomised,
hybrid implementation effectiveness study of an evidence based
healthy lifestyle intervention. Here, we report baseline preconception
health and lifestyle behaviours, acceptability of the intervention during
preconception and self-reported behaviour change.
MATERIALS AND METHODS: 380 women planning a pregnancy
within one year of enrollment were recruited. Women received access
to an online portal with preconception health and lifestyle modules, goal
setting and behaviour change tools, monthly SMS messages, and two
coaching sessions (randomised to zoom or phone) prior to pregnancy.
RESULTS: Uptake of coaching sessions was 89% for session one and
66% for session two. Women had a mean (SD) age of 31.7 (4.4) years
and, at baseline, a self-reported BMI of 25.8 (6.1). Most (n = 302/354,
85.3%) were planning their first, or second (n = 41/354, 11.6%) preg-
nancy. Post-intervention n = 155/181, 85.6% of women reported
engagement with a GP for preconception care and (182/207, 87.9%)
improved lifestyle behaviour, since starting OptimalMe. Direct pre-and-
post comparison of individual participant data showed that of 287 points
of potential change (up-to-date cervical cancer screening, elimination of
high risk behaviours, uptake of preconception supplements and
improved weighing habits) 128 (44.6%) points of change were achieved.
Health coaching sessions were found to improve accountability and con-
fidence; yet further personalisation and support was desired. Engage-
ment with zoom and phone sessions was comparable (87% and 86%
respectively, session one, and 64% and 67% for session two) and both
methods were well accepted and increased women's accountability.
CONCLUSION: A low intensity digital health and lifestyle program
with embedded health coaching can improve uptake of preconception
care and lead to self-reported behaviour change. Key features included
increased accountability, non prescriptive simple health and lifestyle
messages, small changes to behaviour, self-weighing, and delivery
including online modules, phone/zoom coaching, and SMS reminders.
DISCLOSURE OF INTEREST: None Declared.
1467789x, 2022, S2, Downloaded from https://onlinelibrary.wiley.com/doi/10.1111/obr.13503 by CAPES, Wiley Online Library on [16/12/2023]. See the Terms and Conditions (https://onlinelibrary.wiley.com/terms-and-conditions) on Wiley Online Library for rules of use; OA articles are governed by the applicable Creative Commons License
SUPPLEMENT ARTICLE
P351 | A scoping review of double and triple-
duty actions designed to address the global
syndemic of obesity, undernutrition and
climate change in childhood
C. Venegas Hargous1,2; C. Strugnell1; L. Orellana3; S. Allender1;
C. Corvalan4; C. Bell1,2
1
Global Obesity Centre, Institute for Health Transformation, Faculty of
Health; 2School of Medicine, Faculty of Health; 3Biostatistics Unit,
Faculty of Health, Deakin University, Geelong, Australia; 4Public Nutrition
Unit, Institute of Nutrition and Food Technology, University of Chile,
Santiago, Chile
INTRODUCTION: Obesity, undernutrition, and climate change consti-
tute a global syndemic that disproportionately affects vulnerable
populations, including children. Actions that simultaneously address
these pandemics are urgently needed to avoid further health, eco-
nomic, and environmental consequences. Compiled evidence on dou-
ble or triple-duty interventions (targeting two or the three pandemics
simultaneously) is lacking.
MATERIALS AND METHODS: We summarized data on the design,
implementation and evaluation of interventions designed or adapted
to be double or triple-duty and their effects in childhood. Six data-
bases were searched (January 2015–March 2021) using terms related
to ‘children’, ‘interventions’, ‘nutrition’, ‘physical activity’, and ‘climate
change’.
RESULTS: The search yielded 15,475 articles after duplicates were
removed. Data were extracted from 43 studies, 6 of which were ran-
domized controlled trials (RCTs). In total, we found 33 triple-duty,
8 double-duty, and 2 single-duty actions that were assessed to see if
they did no harm to other forms of malnutrition or the environment.
Most actions were policies, programs or regulations targeting the food
system in the school setting. Evidence of community engagement was
reported in 53% of studies. Out of the 43 interventions, 31 measured
outcomes related to at least 2 components of the global syndemic.
Dietary intake and food-related attitudes were the most common
nutrition/physical activity-related outcomes while greenhouse gas
emissions and food waste were the most measured climate change-
related outcomes. Overall, 19 interventions (3 RCTs) showed positive
double or triple-duty effects. Modelling studies indicate that strength-
ening the environmental sustainability of dietary guidelines is a cost-
effective triple duty action.
CONCLUSION: This review found promising double and triple-duty
actions for addressing the global syndemic in childhood. Highest qual-
ity studies point to food-related policy actions and multicomponent
interventions that expose children to healthy and environmentally
sustainable foods. Future research should ensure consistency in the
type of outcomes measured to enable comparison with published
studies and prioritise the evaluation of double and triple-duty effects.
DISCLOSURE OF INTEREST: None Declared.

SUPPLEMENT ARTICLE
P352 | Evaluating the cost-effectiveness of
an implementation intervention that
improves teachers' provision of school day
physical activity
C. Lane1; N. Nathan1; P. Reeves2; R. Sutherland1; L. Wolfenden1;
1 1
A. Shoesmith ; A. Hall
1
University of Newcastle, Newcastle; 2Hunter Medical Research Institute,
New Lambton Heights, Australia
INTRODUCTION: School-based physical activity interventions are an
effective and cost-effective approach for addressing a modifiable risk
factor of childhood obesity. Implementation strategies may be used to
support schools' to implement such evidence-based practices required
for health benefits. However there are few economic evaluations of
public health implementation interventions, leaving little understand-
ing of the investment required to achieve implementation of
evidence-based physical activity practices. To address this evidence
gap, we conducted a trial-based cost-effectiveness analysis of a multi-
strategy intervention (Physically Active Children in Education [PACE])
that support schools' implementation of a mandatory state physical
activity policy.
MATERIALS AND METHODS: A prospective, trial-based cost-
effectiveness analysis from the perspective of the health service pro-
vider tasked with intervention delivery. Data were used from a ran-
domised and controlled trial conducted in 61 primary schools in New
South Wales (NSW), Australia. Schools were randomised to receive
PACE or a wait-list control group. Strategies included centralised tech-
nical assistance, ongoing consultation, principal's mandated change,
identifying and preparing in-school champions, educational outreach
visits and provision of educational materials. Effectiveness was mea-
sured as the difference in the mean change in weekly minutes of
physical activity implemented by classroom teachers, recorded in a
daily log book at baseline and 12-month follow-up. Incremental cost-
effectiveness ratios (ICERs) were calculated as the incremental cost of
delivering PACE (reported in $AUD, 2018) divided by the estimated
intervention effect.
RESULTS: PACE cost the health service provider a total of $35,692
(95% Uncertainty Interval [UI]: $32,380, $38,331) to deliver; and an
average cost of $1,151 (95%UI: $1,045, $1236) per school. The ICER
was $29 (95%UI: $17, $64) for every additional minute of weekly
physical activity implemented per school.
CONCLUSION: PACE was deemed to be a cost-effective intervention
for increasing school implementation of a policy mandate. This out-
come was interpreted with consideration to (i) previous investments
by the health service provider to support schools compliance with
other obesity related programs and (ii) existing funding and infrastruc-
ture that is available, lessening the required investment. The study
findings provide a greater understanding of the investment required
to achieve implementation of an evidence-based practice.
DISCLOSURE OF INTEREST: None Declared.
1467789x, 2022, S2, Downloaded from https://onlinelibrary.wiley.com/doi/10.1111/obr.13503 by CAPES, Wiley Online Library on [16/12/2023]. See the Terms and Conditions (https://onlinelibrary.wiley.com/terms-and-conditions) on Wiley Online Library for rules of use; OA articles are governed by the applicable Creative Commons License
155 of 222
P353 | The effect of school-based
implementation interventions on measures of
child nutrition, physical activity and BMI: A
systematic review
C. Barnes1,2,3,4; S. McCrabb1,2,3,4; K. O'Brien1,2,3,4; R. Hodder1,2,3,4;
R. Sutherland1,2,3,4; S. L. Yoong1,2,3,4,5; N. Nathan1,2,3,4;
F. Tzelpis1,2,3,4; C. Williams1,2,3,4; E. Nolan3; K. Ng6,7;
L. Wolfenden1,2,3,4
1
Priority Research Centre for Health Behaviour; 2School of Medicine and
Public Health, University of Newcastle, Newcastle; 3Hunter Medical
Research Institute, New Lambton, Australia; 4Hunter New England
Population Health, Wallsend; 5Swinburne University of Technology,
Melbourne, Australia; 6Physical Activity for Health Cluster, Department
of Physical Education and Sport Sciences, University of Limerick, Limerick,
Ireland; 7School of Educational Sciences and Psychology, University of
Eastern Finland, Kuopio, Finland
INTRODUCTION: Best-practice guidelines have been developed
acknowledging the potential for school-based settings to influence
child nutrition and physical activity behaviours. While these guidelines
recommend schools adopt a range of policies and practices, research
suggests that schools fail to routinely implement them in practice. This
review aimed to examine the effectiveness of implementation strate-
gies in: improving the implementation of school-based interventions
to address student diet and physical activity; and improving measures
of student diet, physical activity and BMI.
MATERIALS AND METHODS: This review employed methods con-
sistent with the Cochrane Handbook for Systematic reviews. Any trial
with a parallel control group that compared a strategy to implement
school-based policies or practices to address diet, physical activity or
obesity to no intervention, usual practice or a different implementa-
tion strategy was eligible for inclusion. A search of electronic data-
bases and other sources was conducted until April 2021 to identify
any relevant trials. Citation screening, data extraction and risk of bias
assessment was performed in pairs. For randomised trials, we con-
ducted meta-analyses of implementation and student outcomes using
a random-effects model.
RESULTS: Seventeen studies examined nutrition interventions,
12 studies examined physical activity and four examined a combina-
tion of nutrition and physical activity. Meta-analyses indicated that
relative to control, strategies improved the implementation of nutri-
tion (SMD 0.74, 95%CI 0.44, 1.04; 10 studies), physical activity (SMD
1.53, 95%CI 0.78, 2.28; 6 studies), and combined nutrition and physi-
cal activity interventions (SMD 0.41, 95%CI 0.09, 0.74; 3 studies). Rel-
ative to control, the use of implementation strategies to support
intervention implementation may result in a slight improvement on
measures of student diet (SMD 0.08; 95%CI 0.02, 0.14; 11 studies),
physical activity (SMD 0.09; 95% CI -0.02, 0.19; 9 studies) and BMI
(SMD -0.02; 95%CI: 0.05, 0.02; 8 studies).
CONCLUSION: Findings of the review indicate that whilst strategies
are effective improving the implementation of school-based nutrition

156 of 222
and physical activity policies and practices, such improvements in
implementation only lead to slight improvements in measures of stu-
dent diet, physical activity and BMI.
DISCLOSURE OF INTEREST: None Declared.
P354 | Lifestyle modification program is
effective for weight loss, but for whom?
1 1
E. You ; K. Cocotis ; K. Hider 2
1 2
Prevention and Health Promotion; Evaluation, Evidence & Quality,
Diabetes Victoria, Melbourne, Australia
INTRODUCTION: Evidence suggests that lifestyle modification pro-
grams have the great potential to help individuals living with over-
weight or obesity to achieve weight loss. However, the evidence is
inconclusive regarding who are more likely to achieve weight loss.
The Life! program is one of the largest lifestyle modification programs
in Australia. The program offers group-based intervention sessions
(hereafter Life! Group Course) for individuals at risk of type 2 diabetes
and/or cardiovascular disease (CVD). One of the main program goals
is to help participants achieve at least a 5% weight loss. The objectives
of this research were to: 1) investigate the effects of the Life! Group
Course on improving participants' weight and 2) explore whether par-
ticipants with specific characteristics were more likely to achieve the
weight loss goal.
MATERIALS AND METHODS: The Life! Group Course has been
offering a one-on-one Introductory Session (baseline) and five group-
based intervention sessions to participants within six months.
Community-based individuals (age≥18 years old) at risk of type 2 dia-
betes and/or CVD are eligible to participate. This research included
participants attending the Life! Group Course in the 2020–21 financial
year. Information on participants' characteristics was collected at
baseline while their weight data were gathered at baseline and six
months. Paired t test was performed to compare participants' weight
between baseline and Session 5. Logistic regression was conducted to
explore the association between participants' characteristics and their
achievement of the weight loss goal.
RESULTS: Throughout 2020–21, 2,588 individuals were enrolled into
the Life! Group Course, with 819 completing Session 5 at the end of
the financial year. Of 592 participants with valid weight data at both
baseline and six months, there was an average weight loss of 2.4 kg
(95% CI: 2.7 kg to 2.0 kg; p < 0.001). At six months, 21.8%
(n = 132) of the participants achieved a 5% weight loss. Regression
analysis identified that participants living in disadvantaged Local Gov-
ernment Areas (LGAs) (95% CI: 0.342–0.979; p = 0.041) and having a
higher risk score (measured by the Australian Type 2 Diabetes Risk
Assessment tool) (95% CI: 1.016–1.134; p = 0.011) were more likely
to achieve the weight loss goal.
CONCLUSION: The research findings demonstrate that the Life!
Group Couse is effective in improving participants' weight over six
months. Strategies are needed to explore how the program can help
1467789x, 2022, S2, Downloaded from https://onlinelibrary.wiley.com/doi/10.1111/obr.13503 by CAPES, Wiley Online Library on [16/12/2023]. See the Terms and Conditions (https://onlinelibrary.wiley.com/terms-and-conditions) on Wiley Online Library for rules of use; OA articles are governed by the applicable Creative Commons License
SUPPLEMENT ARTICLE
more participants to achieve the weight loss goal. Moreover, further
investigation is needed to understand why participants living in disad-
vantaged LGAs and at higher risk of type 2 diabetes and/or CVD at
baseline are more likely to achieve the weight loss goal over six
months.
DISCLOSURE OF INTEREST: None Declared.
P355 | Effect of nutritional counseling and
physical activity on overweight and obese in-
school adolescents in two local government
areas of south-East Nigeria
E. Ajuogu1; U. C. Madubueze2; I. Akamike2; I. Okedo-Alex2;
L. Ogbonnaya2
1
Community Medicine and Public Health, Federal University of
Technology, Owerri, Owerri, Imo State, Nigeria; 2Community Medicine
and Public Health, Alex-Ekwueme Federal University Teaching Hospital,
Abakaliki (AE-FUTHA), Abakaliki, Ebonyi State, Nigeria
INTRODUCTION: Overweight and obesity are issues of public health.
This study aims to identify the effect of nutritional counselling and
physical activities on over-weight and obese adolescents.
MATERIALS AND METHODS: This was a quasi-experimental study
among In-school adolescents in South-East Nigeria. A multistage sam-
pling technique was used to select respondents. Baseline anthropo-
metric, physical activity, dietary and sleeping pattern data were
collected. Sixty adolescents with BMI of ≥25 kg/m2 were recruited
for the intervention and control site respectively. The interventions
were a) increase in physical activity; hours of sleep; consumption of
fruits and vegetables; b) reduction in screen time and sedentary
behavior for a period of 5 months. A self-administered questionnaire
was used to collect data. Lifestyle and BMI changes at the end of the
study were compared with baseline. Statistical Package for Social Sci-
ences version 20 was used for data analysis. Means, standard devia-
tion, and proportions were calculated. Test statistics used were Paired
t-test and Wilcoxon tests, Level of significance was set at α ≤ 0.05.
RESULTS: Mean age of participants was 13.77 ± 1.96 years, while
mean BMI was 21.29 ± 3.75 kg/m2. Prevalence of overweight and
obesity were 5.6% and 19.0% respectively. The interventions led to
increase in physical activity, fruits and vegetables consumption;
decrease in screen time, sedentary activities, and consumption of
snacks and sweetened beverages, p < 0.05. The mean BMI of the
intervention group reduced by 0.38 kg/m2 and increased by 0.09 kg/
m2 in the control group. The proportion of overweight adolescents in
the intervention arm also reduced by 0.3% compared to the baseline.
Gender, private school, high socioeconomic class, high level of seden-
tary activities, skipping of breakfast and consumption of snacks were
predictors of obesity and over-weight. Being sufficiently active 0.12
(0.08–0.16) and regular consumption of vegetables 0.65(0.45–0.10)
had protective effects.

SUPPLEMENT ARTICLE
CONCLUSION: Introduction of physical activities, reduction of seden-
tary lifestyle, increase in consumption of fruits and vegetables were
effective in reducing the mean BMI and the proportion of overweight
and obese ‘in-school’ adolescents. It is recommended that schools
and family-based interventions be co-opted into schools' curriculum
to improve BMI among these adolescents.
DISCLOSURE OF INTEREST: None Declared.
P356 | The story of project ECHO(R) in
Queensland, Australia
J. Walker1; J. Munro2; L. Raethke2; R. Littlewood2
1
School of Human Movement and Nutrition Sciences, The University of
2
Queensland; Health and Wellbeing Queensland, Queensland
Government, Brisbane, Australia
INTRODUCTION: Health and Wellbeing Queensland (HWQld) was
established in 2019 as an independent statutory body of the Queens-
land Government. As a health promotion agency, HWQld initiates and
supports multiple state-wide prevention activities. Project ECHO® is a
virtual knowledge sharing model that expands the capability of health
and other professionals by engaging interactive conversational com-
munities of practice. In 2020, HWQld became a Project ECHO® hub
to assist with building the prevention capacity of the Queensland
®
workforce. This is the first time that Project ECHO has been used in
a prevention sense in Australia rather than for treatment purposes.
We aimed to describe the journey taken and understand the scope of
impact.
MATERIALS AND METHODS: Prior to the development of specific
Project ECHO® series, HWQld engaged with external partners to
understand the need for certain topics, and the types of professionals
who would engage and benefit. From this emerged a partnership
model which includes universities to support research activities and
curriculum content and non-government organisations to provide
consumer insight and support curriculum content. All series were
developed by subject matter experts from HWQld, in combination
with partner organisations.
RESULTS: The first series in 2020 focused on Childhood Overweight
and Obesity. Content included assessment and intervention aspects
and medical and psychosocial morbidities. Participants were health
professionals; specialists, general practitioners, nurses, dietitians,
occupational therapists, physiotherapists and psychologists. In 2021,
three new topics were piloted. Creating a healthier remote food stores
environment featured content such as application of the four P's (prod-
uct, placement, promotion and price). Participants included commu-
nity nutritionists, dietitians and policymakers. Example content for
Tuckshop Menu Planning included reviewing menus and designing and
marketing new menus, and participants were tuckshop conveners.
Early Childhood Nutrition featured content such as first foods and
picky eating, and participants included early childhood workers. Over-
all 179 participants from QLD, NSW, NT and WA participated, and
1467789x, 2022, S2, Downloaded from https://onlinelibrary.wiley.com/doi/10.1111/obr.13503 by CAPES, Wiley Online Library on [16/12/2023]. See the Terms and Conditions (https://onlinelibrary.wiley.com/terms-and-conditions) on Wiley Online Library for rules of use; OA articles are governed by the applicable Creative Commons License
157 of 222
positive feedback was evident. Research activities are ongoing and
will enable a greater understanding of the changes in practice, confi-
dence, attitudes and knowledge of participants.
CONCLUSION: By using the Project ECHO® model, HWQld has been
successful in building the prevention capacity of health and other pro-
fessionals across multiple states. Application of the model outside of
traditional clinical health service delivery has been effective. Future
series findings combined with research output will provide the
evidence-base for widespread integration of this model into preven-
tion activities across Australia.
DISCLOSURE OF INTEREST: None Declared.
P357 | School-based nutrition interventions
in children aged 6 to 18 years: An umbrella
review of systematic reviews
K. O'Brien1,2,3,4,5; C. Barnes1,2,3,4; S. Yoong1,2,3,4,5,6; E. Campbell1,2,3,4;
R. Wyse1,2,4; T. Delaney1,2,3,4; A. Brown1,2,3,4,5; F. Stacey2,3,4;
L. Davies3; S. Lorien1,2,3,4,5; R. Hodder1,2,3,4,5
1
College of Health Medicine and Wellbeing; 2Priority Research Centre in
Health and Behaviour, University of Newcastle; 3Hunter New England
Population Health; 4Hunter Medical Research Institute; 5National Centre
of Implementation Science, University of Newcastle, Newcastle; 6School
of Health Sciences, Swinburne University of Technology, Hawthorn,
Australia
INTRODUCTION: Suboptimal diet is a leading preventable risk factor
for non-communicable diseases, including obesity. Global data indi-
cates that children and adolescents do not meet dietary intake recom-
mendations. Schools are identified as a key setting to influence
children and adolescent's healthy eating. In order to identify which
school-based nutrition interventions should be prioritised for invest-
ment, policymakers and practitioners require high quality synthesis of
all available research evidence from the most robust trials. This
umbrella review sought to synthesis the evidence from systematic
reviews for the effectiveness of school-based nutrition interventions
on the dietary intake of children aged 6 to 18 years.
MATERIALS AND METHODS: Systematic reviews of randomised
controlled trials of school-based nutrition interventions which aimed
to improve children's dietary intake were included. We undertook a
narrative synthesis of reviews, organising the results of the reviews by
intervention type and dietary intake outcome. The types of interven-
tions synthesised in each review were categorised according to one or
all of the three of the World Health Organisation Health Promoting
Schools (HPS) framework domains: nutrition education; food environ-
ment; all three HPS framework domains (i.e. all primary studies had to
include education, environment and partnerships); and other.
RESULTS: Intervention approaches reported to be effective on at
least one dietary intake outcome included nutrition education, food
environment, those based on all three domains of the HPS framework
and eHealth interventions.

158 of 222
CONCLUSION: School-based nutrition interventions can have a posi-
tive effect on dietary intake of children aged 6 to 18 years and contin-
ued investment in school-based nutrition interventions to improve
student diets are warranted. Implications for future research will be
discussed.
DISCLOSURE OF INTEREST: None Declared.
P358 | Harmonising outcomes across early
childhood obesity prevention trials: A scoping
review and case study
K. E. Hunter1; B. Johnson2; R. Golley2; V. Brown3; A. L. Seidler1
The TOPCHILD Collaboration
1
NHMRC Clinical Trials Centre, University of Sydney, Sydney; 2Caring
Futures Institute, Flinders University, Adelaide, Australia; 3Deakin Health
Economics, Deakin University, Geelong, Australia
INTRODUCTION: The TOPCHILD Collaboration brings together early
obesity prevention trialists from around the world to undertake an
individual participant data meta-analysis. Combining data in this field
is challenging because there is no agreed standardised set of out-
comes (‘Core outcome sets’, COS), and thus there is great variation in
outcomes collected. We sought to scope and harmonise outcome col-
lection within TOPCHILD. The overall aim is to facilitate synthesis of
outcome data, thereby reducing research waste and improving the
power of combined analyses.
MATERIALS AND METHODS: We conducted a scoping review con-
sisting of: 1) systematic search of databases and trials registers to
identify eligible trials (randomised, evaluating behavioural interven-
tions commencing antenatally or ≤1 year of age) and literature on out-
come harmonisation; 2) data extraction of main outcome domains,
measures and tools used in TOPCHILD trials; 3) a survey among inves-
tigators of planned/ongoing TOPCHILD trials; and 4) discussion with
an expert panel of methodologists, dietitians and clinical trialists.
RESULTS: We identified 76 eligible trials, with a sample size of 54,901.
Of these, 19 were planned/ongoing and therefore had potential to add
or modify outcomes collected. We identified large variation in outcomes
collected and measures used. For example, dietary intake outcomes ran-
ged from overall energy intake to servings or quantities of specific items,
such as fruit. Furthermore, measurement tools varied from study-specific
food frequency questionnaires to 24-hour dietary recall. Of the ongoing
trials that completed the survey (n = 7/19), all collected anthropometric
and infant feeding outcomes, while fewer collected outcomes related to
sleep (n = 3, 43%) and sedentary behaviours (n = 2, 29%). Commonly
collected and important outcomes were grouped into domains by the
expert panel. Within these domains, key outcomes and suggested mea-
sures were derived, based on the scoping review (Table).
CONCLUSION: In the absence of a COS, this table will be useful to
inform design of new trials in this area. We encourage trialists to use
it to align their research efforts by harmonising outcomes where pos-
sible. This will maximise the use of data collected by enabling better
1467789x, 2022, S2, Downloaded from https://onlinelibrary.wiley.com/doi/10.1111/obr.13503 by CAPES, Wiley Online Library on [16/12/2023]. See the Terms and Conditions (https://onlinelibrary.wiley.com/terms-and-conditions) on Wiley Online Library for rules of use; OA articles are governed by the applicable Creative Commons License
SUPPLEMENT ARTICLE
Table. Key outcome domains and measures for the TOPCHILD
Collaboration.
Domain Example outcomes
Child dietary intake energy intake, fruit consumption
Infant feeding breastfeeding duration, age at
introduction of solids
Child movement device assessed physical activity, screen
time
Child sleep day/night-time sleep duration
Parent feeding practices parent feeding style
incorporation into the existing evidence base. Importantly, COS and
core outcome measures (COM) are under development, and these will
further advance harmonisation efforts.
DISCLOSURE OF INTEREST: None Declared.
P359 | Approach-avoidance training
effectiveness: Reduction on approach bias for
unhealthy food, weight and food liking in
people with excess weight.
L. Solier; R. González; A. Caracuel; R. Vilar
Mind, Brain and Behavior Research Center, University of Granada,
Granada, Spain
INTRODUCTION: Obesity is partly driven by unhealthy food choices
related to approach bias for unhealthy food. The present study aims
to reduce that bias in people with overweight and obesity by using
approach-avoidance training (AAT), study its association with reported
food liking, and explore weight loss two weeks after the training.
MATERIALS AND METHODS: One hundred and twelve participants
(108 females) with excess weight (BMI 25–40 kg/m2) were recruited
via social media. Participants were randomly assigned to 3 groups:
verum AAT (n = 38); sham AAT (n = 40); and control (n = 34). AAT
was completed daily for 1 week (at least 5 minutes per day) using the
Tilt Taskâ. In this app, participants in the verum AAT group must zoom
in or zoom out a food image according to its format (vertical or hori-
zontal, counterbalanced) using their smartphone device (90% of
healthy food images appear in the format to be approached). For the
sham training, the approach-avoidance ratio of the healthy and
unhealthy food images was 50%. The control group did not receive
any cognitive training. An approach bias index was obtained with the
sham version of the Tilt Task before and after the 1-week-training,
whereas weight (from a pharmacy digital scale), and unhealthy food
liking (score on a visual analog scale) were obtained before and two
weeks after the training.
RESULTS: Two mixed-model ANOVA were used to test effects on
approach bias for unhealthy food and on weight change with a
3 (group: verum ATT, sham ATT and control) x 2 (time: pre and post)

SUPPLEMENT ARTICLE
design. Results showed a significant interaction both for the approach
bias for unhealthy food [F (3,109) = 6.338, p = .002)], and weight
change [F (3,75) = 4.687, p = .012]. Post-hoc analysis showed no sta-
tistical differences between the groups on the approach bias for
unhealthy food, but medians and visual inspection of the graphic indi-
cated a decrease of the bias on the verum AAT group, a smaller
decrease for the sham group, and an increase for the control group.
Post-hoc ANOVA showed a smaller weight reduction on the control
group with respect to the verum and sham AAT groups. A lineal
regression model showed that changes on the approach bias for
unhealthy food predicted changes in unhealthy food liking (R2 = .051;
p = .050).
CONCLUSION: We showed that one week AAT reduced approach
bias for unhealthy food in people with excess weight that predicted
changes in linking for this kind of food. Furthermore, verum and pla-
cebo AAT groups showed weight loss two weeks later. Possibly, our
placebo training is not such, and future research should explore this.
In short, AAT could prove an important target for obesity treatments.
DISCLOSURE OF INTEREST: None Declared.
P361 | Climate change action in community-
based obesity prevention interventions: A
scoping review
N. Ward; M. Moodie; M. Nichols; V. Brown
Institute of Health Transformation, Deakin University, Melbourne,
Australia
INTRODUCTION: Obesity and climate change have common drivers.
Changes to transport, food production and an abundance of ultra-
processed foods have simultaneously resulted in significant detrimen-
tal effects on global obesity rates and climate change. To disrupt the
trajectory of the syndemic, interventions must address both obesity
and climate change drivers.
Community-based interventions (CBIs) are a cost-effective strat-
egy in reducing childhood obesity rates and have the potential to
simultaneously achieve positive environmental outcomes. However,
the effect of community-based obesity prevention interventions on
climate change has not been explored. Furthermore, it is unknown
how many existing obesity CBIs comprise elements of climate change
interventions.
MATERIALS AND METHODS: The 153 studies included in a recently
published Cochrane Systematic Review of interventions for prevent-
ing obesity in children were searched to identify CBIs including
school-aged children (5–17 years). To be classified as community-
based, interventions needed to have active participation in at least
two community settings.
The Cochrane review search was then updated to April 2022, to
identify any additional studies since the previous search.
Included studies were examined for the frequency and type of
strategies likely to have components that benefit climate change.
1467789x, 2022, S2, Downloaded from https://onlinelibrary.wiley.com/doi/10.1111/obr.13503 by CAPES, Wiley Online Library on [16/12/2023]. See the Terms and Conditions (https://onlinelibrary.wiley.com/terms-and-conditions) on Wiley Online Library for rules of use; OA articles are governed by the applicable Creative Commons License
159 of 222
RESULTS: Fourteen studies were identified that met the study inclu-
sion criteria. Most studies (n = 12), had two intervention settings with
school and home being the most common. Two studies included three
settings: school, community and home. Of the 14 interventions, all
but one had elements that potentially act as dual driver of obesity and
climate change.
The most common dual drivers were reducing screen time (6 stud-
ies) and intake of sugar sweetened beverages (SSB) (6 studies). Two of
the SSB interventions actively encouraged SSB be replaced with
water. Despite 92% of the studies containing climate change action
components the link to climate change was rarely explicit.
CONCLUSION: CBIs have the potential to include and promote obesity
and climate change action as there is substantial overlap in the drivers.
Whilst the majority of CBIs for obesity prevention included elements of
climate change intervention, this was neither explicit or deliberate. The
full positive effects of the interventions on communities was not mea-
sured and therefore not fully realised. To be successful in reducing obe-
sity and improving climate change community-based interventions must
incorporate dual actions. Incorporating both obesity and climate change
as intentional objectives in interventions may increase community
acceptability and participation as well as intervention cost effectiveness.
DISCLOSURE OF INTEREST: None Declared.
P362 | Development of an adolescent obesity
intervention programme through curriculum
involvement at high schools in the City of
Tshwane
N. A. Ngwenya1; T. Ramukumba1; T. Sivhabu2
1
Adelaide Tambo School of Nursing; 2Tshwane University of Technology,
Pretoria, South Africa
INTRODUCTION: Obesity is a global health concern that is not lim-
ited to the adult population. There is a growing prevalence among
children from different parts of the world regardless of the age group
or gender with prevalence rate at 100%. The health consequences of
obesity are severe and may significantly influence the quality of life of
those suffering from this health condition. Contributing factors to
obesity include lack of sleep, stress, metabolic disorders and chronic
inflammation. More so, lifestyle modifications particularly among
urban dwellers that often depend on “junk” food rather eating healthy
food may contribute to the incidence of obesity. School-based inter-
ventions are identified as a way to address the increasing rates of
childhood obesity through the increase of physical activity and edu-
cating them about healthy food choices. The increase of adolescent
obesity is attributed to the increased intake of energy-dense foods
that are high in fat; increase in physical inactivity due to the increas-
ingly sedentary nature of many forms of work, changing modes of
transportation, and increasing urbanization. The enhancement accept-
ability and feasibility school-based efforts should be designed to work
 1467789x, 2022, S2, Downloaded from https://onlinelibrary.wiley.com/doi/10.1111/obr.13503 by CAPES, Wiley Online Library on [16/12/2023]. See the Terms and Conditions (https://onlinelibrary.wiley.com/terms-and-conditions) on Wiley Online Library for rules of use; OA articles are governed by the applicable Creative Commons License
160 of 222 SUPPLEMENT ARTICLE

within the school infrastructure with flexibility in timing of the inter-
vention and personnel involvement.
The purpose of the study was to explore the content of the cur-
riculum and the teachers' views to develop intervention programme
for adolescent obesity in the high school curriculum.
MATERIALS AND METHODS: Delphi technique was used to develop
the intervention programme with the curriculum expects. The
research strategy for the study was exploratory and descriptive
research designs. The population included the curriculum specialist
from the district offices and universities. Snowball sampling was used
to sample the curriculum specialists. Content analysis using Tesch's
open induction analysis was utilised. Trustworthiness included data
co-coding by an independent co-coder and confirmation of themes.
RESULTS: Results from the questionnaire were categorized and ana-
lyse to develop an intervention programme for adolescent obesity in
the high school curriculum.
CONCLUSION: The study will allow the introduction of intervention
of obesity within the education environment through a High school
Curriculum to reduce the prevalence of adolescent obesity.
DISCLOSURE OF INTEREST: None Declared.
P363 | Efficacy of a low-calorie meal
replacement for weight loss in night shift
workers with obesity: A randomized
controlled trial
P. Sooriyaarachchi1; R. Jayawardena2; T. Pavey1; N. King1
1
School of Exercise and Nutrition Sciences, Queensland University of
Technology, Brisbane, Australia; 2Department of Physiology, Faculty of
Medicine, University of Colombo, Colombo, Sri Lanka
INTRODUCTION: Shift work is growing in modern society and it is
necessary to ensure the continuity of essential services. Shift work is
associated with a number of chronic health conditions including obe-
sity. Obesity is a major risk factor for increased morbidity and mortal-
ity. Weight reduction in patients with obesity lowers the risk for
cardiovascular disease, diabetes, certain cancers, and mortality.
Achieving a negative energy balance by providing low-calorie meal
replacement is a widely used strategy for weight management. This
study aims to evaluate the impact of a low-calorie meal replacement
on body weight and other anthropometric parameters of shift workers
with obesity.
MATERIALS AND METHODS: This trial was conducted in parallel,
randomized controlled design for a period of 4 weeks. A total of
50 shift workers with body mass index over 25 kg/m2 were recruited
after assessing their eligibility. Participants were randomly assigned to
the intervention group (IG) and the control group (CG) on a 1:1 ratio.
The IG (N = 25) was provided with a low-calorie (~200 kcal) meal
replacement shake for dinner, and the CG (N = 25) was advised to
continue their habitual diets. Anthropometric parameters including
body weight, height, waist (WC) and hip circumference (HC) were
measured at the baseline and repeated after 4 weeks. The indepen-
dent sample t-test was used to make comparisons between groups.
Effects with P < 0.05 were considered significant.
RESULTS: A sample of 49 participants (IG: 24, CG: 25) completed the
study. IG and CG were not significantly different for mean age (35.28
± 10.39 vs 36.72 ± 12.86, P = 0.665) or for any of the parameters
measured at baseline including body weight (80.18 ± 15.47 vs 77.50
± 15.57; 0.545), WC (99.91 ± 11.73 vs 97.01 ± 12.13; 0.395), HC
(105.67 ± 8.58 vs 105.27 ± 8.27; 0.867) and waist/hip ratio (0.95
± 0.07 vs 0.92 ± 0.07; 0.205). The participants in the IG exhibited a
significant reduction in average body weight, WC and waist/hip ratio
at the end of 4 weeks (Table 1). But there was no significant change in
the HC between the groups.
CONCLUSION: Intake of a low-calorie meal replacement shake for
dinner has significantly reduced the body weight, WC and waist/hip
ratio of shift workers with obesity. Interventions based on dietary
modification could be considered an effective method in weight
management.
DISCLOSURE OF INTEREST: None Declared.

Table 1: Anthropometric parameters before and after the intervention.

CG (n = 25) IG (n = 24)
P-value
Parameters Baseline End % change Baseline End
Weight 77.50 ± 15.57 77.78 ± 15.90 0.31 ± 1.25 80.77 ± 15.50 79.42 ± 15.07 1.63 ± 1.68 <0.001
WC 97.01 ± 12.13 97.21 ± 11.95 0.26 ± 2.90 100.48 ± 11.62 97.60 ± 10.88 2.71 ± 4.52 0.008
HC 105.27 ± 8.27 106.07 ± 7.93 0.82 ± 2.45 105.93 ± 8.66 105.96 ± 8.57 0.05 ± 2.23 0.256
Waist/hip 0.92 ± 0.07 0.92 ± 0.07 0.52 ± 3.07 0.95 ± 0.07 0.92 ± 0.08 2.75 ± 4.43 0.046

SUPPLEMENT ARTICLE
P364 | Perinatal support for breastfeeding
using mHealth: Impact on breastfeeding
knowledge, intention, confidence and
attitudes
R. Laws1; H. Cheng2; B. Markides1; C. Rossiter2; K. Kuswara1;
E. Denney-Wilson2
1
Institute for Physical Activity and Nutrition, Deakin University, Geelong,
Australia; 2Susan Wakil School of Nursing and Midwifery, University of
Sydney, Sydney, Australia
INTRODUCTION: Breastfeeding is a known early life protective fac-
tor for obesity and has important benefits for mothers and babies.
Breastfeeding outcomes are shaped by knowledge, attitudes, confi-
dence and intentions during pregnancy. Although popular, breastfeed-
ing apps are often poor quality; their impact on breastfeeding
outcomes is unknown. This study aimed to: 1) explore the feasibility
of the My Baby Now app in providing perinatal breastfeeding support;
2) examine the preliminary impact on breastfeeding knowledge, atti-
tudes, confidence and intentions.
MATERIALS AND METHODS: A mixed method pre-post pilot study
was conducted in 2021. Participants were women 20–30 weeks ges-
tation recruited via social media and offered access to the My Baby
Now app. Breastfeeding knowledge and intentions were collected at
baseline (T1) and 36–38 weeks gestation (T2); attitudes and confi-
dence were collected at baseline, T2 and T3 (8–12 weeks postpar-
tum). App engagement was measured via app analytics using a
previously validated engagement index. Qualitative interviews were
conducted with a purposeful sample following T3.
RESULTS: A total of 266 participants were recruited, 169 (63.5%)
completed T2, 157 (59%) completed T3. Mothers without university
education perceived the app to be higher quality, more useful and
impactful than university educated mothers. There were significant
increases from baseline to T2 in the proportion of participants cor-
rectly identifying exclusive breastfeeding recommendations (59.6% v
66.5%, P < 0.001) and with intentions to exclusively breastfeed (76.6
v 80.9, P < 0.001). There were also significant increases in breastfeed-
ing attitude and confidence scores from baseline to T2 and from base-
line to T3. In linear regression models, after controlling for covariates,
app engagement during pregnancy significantly predicted changes in
breastfeeding attitudes from baseline to postpartum amongst partici-
pants without a university education. App engagement did not predict
changes in breastfeeding knowledge, confidence or intentions.
CONCLUSION: The My Baby Now app provides an acceptable source
of breastfeeding support, particularly for women without university
education. This study provides preliminary evidence of the beneficial
impact of the app on breastfeeding attitudes amongst participants
without a university education. There was no impact of app usage on
breastfeeding knowledge, confidence or intentions during pregnancy.
Further research using a randomised controlled study design is
needed to examine the effectiveness of mHealth interventions in
1467789x, 2022, S2, Downloaded from https://onlinelibrary.wiley.com/doi/10.1111/obr.13503 by CAPES, Wiley Online Library on [16/12/2023]. See the Terms and Conditions (https://onlinelibrary.wiley.com/terms-and-conditions) on Wiley Online Library for rules of use; OA articles are governed by the applicable Creative Commons License
161 of 222
influencing breastfeeding outcomes, particularly amongst women with
lower levels of education.
DISCLOSURE OF INTEREST: None Declared.
P365 | Can a school nutrition intervention
have an impact on a child's whole day total
energy intake?
R. Sutherland1,2,3,4; J. Jones1,3,4,5; A. Brown1,3,4,5; C. Barnes3,4,5;
N. Nathan1,3,4,5; C. Lecathelinais1; L. Janssen5; L. Wolfenden1,3,4,5
1
Hunter New England Population Health, Hunter New England Local
Health District, Wallsend; 2School of Health and wellbeing, University of
Newcastle; 3Hunter Medical Research Institute (HMRI); 4Priority
Research Centre Health Behaviour, University of Newcastle; 5School of
Health and Wellbeing, University of Newcastle, Newcastle, Australia
INTRODUCTION: SWAP IT is an effective mHealth lunchbox inter-
vention supporting parents to SWAP discretionary lunchbox foods
with foods aligned with Australian Dietary Guidelines. SWAP IT tar-
gets parent barriers to packing healthy lunchboxes through 4 strate-
gies: 1) school nutrition policy, 2) curriculum resources, 3)
10 electronic messages delivered directly to parent's mobile phones,
and 4) parent resources (drink bottles, ice-brick and resource booklet).
Despite showing significant effects on child BMI and the nutritional
quality of foods packed/consumed from lunchboxes, little is known
about whether students compensate by overconsuming energy out-
side of the school day. This exploratory study aims to identify if the
benefits of SWAP IT reach beyond the school day by impacting on
student total daily energy intake (kj), and determine if student charac-
teristics are associated with a reduction in total daily energy.
MATERIALS AND METHODS: A cluster RCT was undertaken with
32 primary schools in New South Wales, Australia. Schools were ran-
domised to receive the mHealth SWAP IT program or waitlist control.
Mean total daily energy (kJ), proportion of energy from core and non-
core foods were measured in Years 5 and 6 students completing the
Australian Child and Adolescent Eating Survey at baseline and six-
month follow-up. Associations between student characteristics (sex,
socioeconomic status (SES), geographic location) explored if any
impact was universal or limited to subgroups of student population.
Data were analysed via hierarchical linear regression models control-
ling for clustering, SES and remoteness.
RESULTS: Of the 583 students in Year 5 and 6, 60%, completed the
online survey. There was a significant difference between groups in
the mean total daily energy intake ( 820.8 kJ, p = 0.04). However, no
significant difference in the percentage of energy from core ( 1.09%,,
p = 0.44) and non-core foods (1.09%,, p = 0.44) was found. There
were no significant associations between student characteristics and a
reduction in total energy intake.
CONCLUSION: This exploratory study provides some evidence that
behavioural changes made by parents in improving the nutritional
quality of foods packed in lunchboxes may be transferrable beyond

162 of 222
the school lunchbox to other meals outside of school. The barriers
addressed in the school lunchbox intervention may be consistently
faced by parents in the provision of healthy food choices across the
entire day.
DISCLOSURE OF INTEREST: None Declared.
P366 | Systematic review of childhood
obesity prevention interventions in children
aged 6–18 years
R. Hodder1,2,3,4; K. O'Brien1,2,3,4; S. Lorien1,2,3,4; L. Wolfenden1,2,3,4;
T. Moore5,6; A. Hall1,2,3,4; S. Yoong1,2,3,4,7; C. Summerbell8,9
1 P367 | First 1,000 days interventions in
Hunter New England Population Health; 2College of Health Medicine
and Wellbeing; 3National Centre of Implementation Science, University of
4 5
Newcastle; Hunter Medical Research Institute, Newcastle; The National
Institute for Health Research Applied Research Collaboration West (NIHR
ARC West), University Hospitals Bristol National Health Service
Foundation Trust, Bristol, Australia; 6Population Health Sciences, Bristol
Medical School, University of Bristol, Bristol, UK; 7School of Health
Sciences, Swinburne University of Technology, Hawthorn, Australia;
8
Department of Sport and Exercise Sciences, Durham University,
9
Durham; Fuse: the NIHR Centre for Translational Research in Public
Health, Durham, Newcastle, Northumbria, Sunderland and Teesside, UK
INTRODUCTION: Childhood obesity remains a global public health
priority due to the enormous burden it generates. Recent surveillance
data suggests there has been a sharp increase in the prevalence of
childhood obesity during the COVID-19 pandemic. The Cochrane
review of childhood obesity prevention interventions (0–18 years)
updated to 2015 is the most comprehensive review of randomised
controlled trials (RCTs) on this topic. However the burgeoning number
of high quality studies published since 2015 have not been synthe-
sised. This systematic review sought to assess the effectiveness,
adverse effects and cost-effectiveness of obesity prevention interven-
tions on the weight of children aged 6–18 years and identify interven-
tion characteristics associated with effectiveness.
MATERIALS AND METHODS: An update of the Cochrane systematic
review of obesity prevention interventions restricted to children aged
6–18 years was conducted (search up to March 2021). Any RCT of a
school-based intervention targeting diet and/or physical activity to
prevent obesity in children aged 6–18 years were included. Trial
effects were synthesised via meta-analyses using random-effects
models.
RESULTS: Meta-analysis of 140 of 195 included studies (183,063 par-
ticipants) found a very small positive effect on body mass index (BMI)
for school-based studies (SMD -0
03, 95%CI -0
06,-0
01; trials = 94;
participants = 131,496; moderate certainty evidence) but not after-
school programs, community or home-based studies. Subgroup analy-
sis by age (6–12 years; 13–18 years) found no differential effects.
Meta-regression found no study characteristics (including setting,
income level) associated with intervention effect. Ten of 53 studies
assessing adverse effects reported presence of an adverse event.
1467789x, 2022, S2, Downloaded from https://onlinelibrary.wiley.com/doi/10.1111/obr.13503 by CAPES, Wiley Online Library on [16/12/2023]. See the Terms and Conditions (https://onlinelibrary.wiley.com/terms-and-conditions) on Wiley Online Library for rules of use; OA articles are governed by the applicable Creative Commons License
SUPPLEMENT ARTICLE
Insufficient data was available to draw conclusions on cost-
effectiveness.
CONCLUSION: This updated synthesis of obesity prevention inter-
ventions for children aged 6–18 years, found a small beneficial impact
on child BMI for school-based obesity prevention interventions only.
A more comprehensive assessment of interventions is required to
identify mechanisms of effective interventions to inform future obe-
sity prevention public health policy, which may be particularly salient
for COVID-19 recovery planning.
DISCLOSURE OF INTEREST: None Declared.
socioeconomically disadvantaged families to
improve energy balance-related behaviors or
prevent obesity: A systematic review
S. Lioret1; F. Harrar1; D. Boccia2; K. Hesketh3; K. Campbell3;
K. Kuswara3; C. van Baaren1; S. Maritano4; C. Pizzi4; M.-A. Charles1;
B. Heude1; R. Law3
1
CRESS, INSERM, Paris, France; 2London School of Hygiene & Tropical
Medicine, Epidemiology and Population Health, London, UK; 3Institute for
Physical Activity and Nutrition, Deakin University, Geelong, Australia;
4
Cancer Epidemiology Unit, Department of Medical Sciences, University
of Turin and CPO-Piemonte, Turin, Italy
INTRODUCTION: Social inequalities in energy balance-related behav-
iors (EBRBs) and obesity risk start from infancy, calling for early public
health action. This systematic review examined effectiveness of inter-
ventions implemented during pregnancy and up to 2 years of age to
improve EBRBs or prevent obesity in children from socioeconomically
disadvantaged families.
MATERIALS AND METHODS: Screening of the 8,517 references
retrieved from PubMed/MEDLINE, EMBASE, CINAHL, PsycINFO,
and Scopus databases from 1990 to 2021 was undertaken by two
authors. Data extraction and internal and external validity assessment
were undertaken by one author and cross checked by another. Find-
ings were synthesized narratively.
RESULTS: We found 24 distinct interventions, reported in 33 articles.
Overall, despite their heterogeneity and variability in internal and
external validity, there was some evidence of beneficial impact of
interventions on obesity risk, as well as its associated EBRBs, e.g.:
responsive feeding practices, dietary intake, TV viewing, movement
behaviors and sleep routines. The most effective interventions aimed
at promoting breastfeeding were those started antenatally; this held
true for the prevention of obesity, provided the intervention contin-
ued for at least 2 years postnatally and was multi-behavioral. Effective
interventions were more likely to target first-time mothers. Profes-
sional delivery agents, multidisciplinary teams and groups of peers,
were more often involved in successful interventions. However, those
implemented among ethnic/racial minorities had some impact on
feeding practices and dietary intake (but not on the prevention of

SUPPLEMENT ARTICLE
obesity) when delivered by lay agents. Co-creation with stakeholders,
including recipients, and adhesion to theoretical frameworks, were
additional ingredients for more pragmatic, inclusive, non-judgmental,
and effective programs.
CONCLUSION: The growing body of evidence on obesity prevention
interventions targeted at socioeconomically disadvantaged families is
promising for reducing early inequalities in obesity risk. Future inter-
ventions should however further consider inclusion of structural com-
ponents to facilitate behavior change, along with higher quality
designs and longer follow-ups. More thorough process evaluation
linked to trial outcomes is also needed for the replication and scaling-
up of effective programs.
DISCLOSURE OF INTEREST: None Declared.
P368 | Supporting mothers with infant
feeding, sleep and active play through a
telephone-based intervention: Qualitative
evaluation of the 4 year healthy beginnings
program
S. Taki; K. Kuswara; L. M. Wen
Population Health Research & Evaluation Hub, Sydney Local Health
District, Australia
INTRODUCTION: Many risk factors for childhood obesity are estab-
lished in the first 2000 days. Healthy Beginnings is an established
evidence-based program in Sydney, Australia, led by child health
nurses to promote and support best-practice infant feeding, sleep and
physical activity. This study aimed to assess the participants experi-
ences with a four year intervention led by nurses and delivered by
telephone support combined with SMS and mailed intervention (con-
taining healthy eating, physical activity and screen time information).
MATERIALS AND METHODS: The Healthy Beginnings telephone
based program included two phases. Phase 1 (2017): 1155 women in
their 3rd trimester were recruited and randomised into either a
6-staged- nurse-led telephone support sessions plus mailed booklets
arm, SMS plus mailed booklets arm, or usual care arm. Phase 2 (2019):
Participants from phase 1 were re-invited to participate in a continued
program supporting their children at 2–4 years. Of the participants
who consented (n = 662), they were re-randomised into two groups,
mothers in the intervention group received three staged, nurse-led
telephone support sessions plus SMS messages and mailed interven-
tion booklets and there was a usual care arm. Participants were pur-
posely selected and invited to participate in a qualitative telephone
interview based on intervention group (1. Intervention-intervention,
2. Control-intervention, 3. Intervention-control) and demographic
characteristics. The interviews were guided by the Behaviour Change
Wheel, exploring the influence that the intervention had on child
feeding, sleep and physical activity behaviours, experiences with the
delivery mode and differences experienced in phase 1 and 2.
1467789x, 2022, S2, Downloaded from https://onlinelibrary.wiley.com/doi/10.1111/obr.13503 by CAPES, Wiley Online Library on [16/12/2023]. See the Terms and Conditions (https://onlinelibrary.wiley.com/terms-and-conditions) on Wiley Online Library for rules of use; OA articles are governed by the applicable Creative Commons License
163 of 222
RESULTS: A total of 28 interviews were completed, approximately
10 participants from each of the 3 intervention groups. Analysis
highlighted positive factors, particularly with the nurse-led telephone
support as mothers felt they were receiving personalised advice which
also helped empower mothers with addressing challenges mothers
experienced, while the SMS's offered convenience in receiving infor-
mation. Although the majority of mothers did not notice a difference
in intervention between phase 1 and 2, many suggested that the sup-
port in the first 2 years of life was needed more that 2 to 4 years.
Having a variety of delivery modes (telephone, SMS, booklets) was
suggested to be acceptable as it catered for mothers various needs.
CONCLUSION: The Healthy Beginnings program shows potential for
continued deliver and scale up. These findings have demonstrated the
acceptability of receiving support on child health behaviours in the
first 2000 days through various modes of delivery, but also the impor-
tance of receiving tailored support.
DISCLOSURE OF INTEREST: None Declared.
P369 | Embedding obesity prevention within
maternity care. A ten-year journey of
knowledge creation and translation research
in practice
S. De Jersey1,2; T. Guthrie1,2; M. Hoch3; L. Callaway2,4;
N. Meloncelli2,5
1
Nutrition and Foodservices, Royal Brisbane and Women's Hospital;
2
Faculty of Medicine, University of Queensland; 3Excercise and Nutrition
Science, Queensland University of Technology; 4Women's and Newborn
Services, Royal Brisbane and Women's Hospital; 5Allied Health, Metro
North Health, Brisbane, Australia
INTRODUCTION: Excess gestational weight gain (GWG) is experi-
enced by 50 to 75% of women in developed countries and is indepen-
dently associated with future obesity in mothers and their offspring.
Provision of maternity care that optimises healthy GWG is recom-
mended in clinical practice guidelines, however, is rarely provided.
The aim of this study was to describe the staged implementation of
service changes to support healthy GWG through low and high inten-
sity interventions within routine maternity care.
MATERIALS AND METHODS: A pre-post implementation study
design was used to examine the impact of three phases of service-
wide changes between 2009 and 2019 at a metropolitan public hospi-
tal in Australia. The PRECEDE-PROCEED model of health program
planning guided the planning and evaluation with implementation sci-
ence principles underpinning changes. A baseline assessment included
a prospective observational cohort, and medical record audit. Phase
1 and 2 involved addressing identified barriers through staff training,
weight monitoring on a personalised pregnancy weight gain chart
(PWGC) and brief advice (low intensity). Phase 3 introduced an
enhanced dietetic service for high-risk women (high intensity). These
interventions were not compared but complementary. Expert

164 of 222
Recommendations for Implementing Change strategies were used at
each phase. Questionnaires assessed advice women received and
GWG was audited.
RESULTS: Thirty-five discrete implementation strategies were used.
Eleven were used across all three phases including facilitation, asses-
sing readiness and identify barriers and facilitators, building a coali-
tion, and mandating change. Dietetic referrals for women with a
BMI ≥ 25 kg/m2 increased from baseline 1% to 13% in Phase
3. Between baseline, Phase 1 and Phase 2, the advice women
received from midwives on recommended GWG improved signifi-
cantly. Women with three or more weights recorded on a PWGC
were less likely to have excess GWG (33% vs 50% p = 0.028).
Women attending dietetic care decreased consumption of discretion-
ary food and sedentary time (all p < 0.05) and increased diet quality
and weekly physical activity.
CONCLUSION: It is feasible to implement changes within routine
antenatal care to support evidence-based obesity prevention. Tar-
geted implementation strategies can enhance care delivery and impact
on behavioural outcomes.
DISCLOSURE OF INTEREST: S. De Jersey Grant / Research support
with: Metro North Health Clinican Research Fellowship, T. Guthrie
Grant / Research support with: Royal Brisbane and Women's Hospital
PhD Scholarship, M. Hoch: None Declared, L. Callaway: None
Declared, N. Meloncelli Grant/Research support with: Advance
Queensland Clinical Fellowship.
P370 | Developing systems-informed tools to
support the implementation of healthy food
retail
T. Bowling1; M. Blake2; A. Brown1; A. Gupta2; C. Vargas2;
1 3 2
J. Whelan ; M. Christian ; A. Peeters ; T. Boelsen-Robinson 2
1
Global Obesity Centre, Institute for Health Transformation, Deakin
University, Geelong, Australia; 2Global Obesity Centre, Institute for
Health Transformation, Deakin University; 3Nutrition Dietics & Food,
Monash University, Melbourne, Australia
INTRODUCTION: Ensuring healthy choices in food retail environ-
ments is an important step in enabling healthy diets and obesity pre-
vention efforts. Potential models of healthy food retail interventions
including government mandated policies, voluntary guidelines, and
interventions implemented in partnership with researchers or health
promotion bodies that rely heavily on the support of health promotion
practitioners (HPPs). Building the capacity of HPPs to create healthier
food environments by engaging with, understanding, and supporting
retailers is a key next step in addressing unhealthy diets.
The Systems Thinking Approach to Retail Transformation (START
map) is a theoretical framework derived from the experience of HPPs
and retailers to identify critical levers for organisations to shift to
healthier food retail. How the concepts and functionality of this
framework can be utilised is currently unknown. This research aims to
1467789x, 2022, S2, Downloaded from https://onlinelibrary.wiley.com/doi/10.1111/obr.13503 by CAPES, Wiley Online Library on [16/12/2023]. See the Terms and Conditions (https://onlinelibrary.wiley.com/terms-and-conditions) on Wiley Online Library for rules of use; OA articles are governed by the applicable Creative Commons License
SUPPLEMENT ARTICLE
explore public health stakeholders' perceptions of usefulness of trans-
lating the START map into practical tools for retailer engagement and
program planning.
MATERIALS AND METHODS: Two consecutive workshops will be
conducted in April–May 2022 with approximately 20–30 stakeholders
involved in the design, implementation, or evaluation of healthy food
retail interventions. Workshops will explore if, how, and in what con-
text stakeholders would use the START map within their work, frame-
work interpretation, and what translational tool format would be most
useful to end users. Workshops will be delivered through a combina-
tion of training sessions in the concepts and tools of systems thinking
and interactive group work where these skills and knowledge will be
applied.
RESULTS: Results will tell us how stakeholders would use the START
map in planning, implementing, resourcing, and adapting healthy food
retail change and how this evidence-informed framework could be
translated into a useful tool to support implementation. This study will
also expose HPPs to the application of systems thinking within
healthy food retail interventions an essential skill in dealing with com-
plex commercial food retail environments.
CONCLUSION: This study will provide key insights into how to trans-
late the START map and broader theoretical concepts, into practical
and accessible tools to plan, implement, resource, and adapt healthy
food retail policies and initiatives.
ACKNOWLEDGMENTS: This study was funded by a Institute for
Health Transformation Partnership Funding Grant from Deakin Uni-
versity, and a Prevention Centre, Capacity building and research
translation grant.
DISCLOSURE OF INTEREST: None Declared.
P371 | Health impact assessment of
interventions preventing excess weight in
Belgium: prioritization of interventions using
qualitative and quantitative data
V. Gorasso1,2; B. Devleesschauwer1; D. De Smedt2; S. Vandevijvere1
1
Epidemiology and public health, Sciensano, Brussels, Belgium; 2Public
Health and Primary Care, Ghent University, Ghent, Belgium
INTRODUCTION: According to the 2018 Belgian health examination
survey, more than 50% of the adult population was living with over-
weight or obesity. In Belgium, about 25% of adults do not eat vegeta-
bles daily, 45% do not eat fruit daily and one third of daily energy
intake is derived from ultra-processed food. Belgian adults are also
less physically active compared to the European average. Hence, there
is a need for a national action plan for preventing the raise in the pro-
portion of people with overweight and obesity. The WaIST project
aims to provide proactive policy support for generating evidence-
based recommendations accounting for health gains and cost savings
including stakeholders' implementation considerations.
 1467789x, 2022, S2, Downloaded from https://onlinelibrary.wiley.com/doi/10.1111/obr.13503 by CAPES, Wiley Online Library on [16/12/2023]. See the Terms and Conditions (https://onlinelibrary.wiley.com/terms-and-conditions) on Wiley Online Library for rules of use; OA articles are governed by the applicable Creative Commons License
SUPPLEMENT ARTICLE 165 of 222

MATERIALS AND METHODS: The process for the selection of the
interventions to be included in the model was based on scientific evi-
dence of effectiveness, international recommendations and input from
Belgian stakeholders. Most recurrent relevant policy recommenda-
tions from international reports regarding food environment and
physical activity (PA) promotion were included. We also selected
interventions based on their effectiveness in modelling studies and
real-world evaluations. Federal and regional authorities, general prac-
titioner and patients organizations were consulted via an online sur-
vey and a structured meeting. They were asked to rate existing
policies in Belgium based on their perceived effectiveness and com-
prehensiveness, and to rank macro policy areas by feasibility and
importance for the Belgian context.
RESULTS: According to international recommendations, we priori-
tized restricting marketing to children, as well as supporting income
programs for poor and vulnerable groups (e.g. vouchers) for the pur-
chase of healthy food and setting nutrition standards in schools. Exist-
ing health impact assessment models showed a high effectiveness of
menu labelling, financial incentives for weight loss by health insurers
and sugar-sweetened beverage taxes. The latter was also found to be
effective in real-world applications. Stakeholders evaluated the cur-
rently existing Nutriscore in Belgium to be both comprehensive and
effective. School-based programmes, including nutritional and PA
standards, and improvement of the nutritional quality of the supply
chain were ranked high in terms of importance and feasibility.
CONCLUSION: The most relevant interventions for international rec-
ommendations, modelling studies and real-world evaluations and Bel-
gian stakeholders will be included in the forthcoming health impact
model. Combining qualitative and quantitative methods for interven-
tion selection allowed to consider different aspects of the implemen-
tation of health intervention (e.g. effectiveness, feasibility in the
Belgian context).
DISCLOSURE OF INTEREST: None Declared.
P372 | Estimated impacts on consumption
and obesity from the implementation of the
sugar-sweetened beverages tax in Thailand
W. Ngam-A-Roon1; P. Hunchangsith1; L. Veerman2; L. Aminde2
1
Institute for Population and Social Research, Mahidol university, Nakhon
Pathom, Thailand; 2School of Medicine and Dentistry, Gold Coast,
Australia
INTRODUCTION: The prevalence of obesity is increasing among the
population of Thailand. Taxing sugar-sweetened beverages (SSB) is
recommended by the World Health Organization (WHO) to reduce
obesity. Thailand implemented an SSB tax in 2017, with tax levels ris-
ing every two years, to support reaching the global non-
communicable disease targets by 2025. The aim of the study was to
estimate the impact of SSB taxation on SSB consumption and the
number of persons with obesity.
MATERIALS AND METHODS: This study used mathematical model-
ing to estimate the daily energy consumption from SSB in relation to
the four phases of the tax that is being implemented in Thailand. SSB
comprised of carbonated drinks, energy drinks, and ready-to-drink
(RTD) coffee and tea with added sugar. Reductions in average con-
sumption were estimated using price elasticity estimates. Reductions
in average BMI were calculated by using energy balance equations.
BMI was modelled as lognormal distributions. Estimates were made
by 5-year age group and sex. Data were mostly from Thai health sur-
veys and Euromonitor Passport. Changes in SSB consumption and
obesity prevalence are reported.
RESULTS: As tax levels increased, SSB consumption was projected to
decrease from phase 1 to phase 4 in all categories of drinks. The larg-
est reduction was seen in carbonated drinks (11%), and the smallest
reduction was for RTD tea (3%) (Table: Consumption changes). The
prevalence of obesity 1 and obesity 2 in men decreased by approxi-

Table: Consumption changes and numbers of persons with obesity 1 and 2.

Consumption changes

Male (Liter/day/person) Female (Liter/day/person)

SSB categories Phase 1 Phase 4 Phase 1 Phase 4

Carbonated drinks 0.2872 0.2547 0.2817 0.2496
Energy drinks 0.0660 0.0608 0.0655 0.0603
RTD coffee 0.1344 0.1251 0.1335 0.1248
RTD tea 0.1690 0.1638 0.1686 0.1633
Numbers of persons with obesity 1 and 2
Obesity Level Male Female
(WHO Asian-BMI classification) Phase 1 Phase 4 Phase 1 Phase 4
Obesity 1 (BMI ≥ 25–29.9) 8,610,277 8,164,669 9,316,286 9,120,638
Obesity 2 (BMI ≥ 30) 2,038,892 1,827,163 5,049,221 4,736,576

166 of 222
mately 5.2% and 10.4%, compared with 2.1% and 6.2% in women,
respectively (Table: Numbers of persons with obesity 1 and 2).
CONCLUSION: Taxation can help to reduce SSB consumption and
the number of persons living with obesity among the Thai population.
Men benefit more than women. The Thai SSB tax should be imple-
mented in full, along with other measures to improve diets and
increase physical activity.
DISCLOSURE OF INTEREST: W. Ngam-A-Roon Grant/Research sup-
port with: Thai Health Foundation, P. Hunchangsith: None Declared,
L. Veerman: None Declared, L. Aminde: None Declared.
P373 | Effects of a multifaceted intervention
on accelerometer-measured physical activity
in primary school children and effect
difference by potential moderators: a nested
study in the DECIDE-Children study
1 1 2 3 1 4
Z. Liu ; Z.-H. Yue ; L.-M. Wen ; J. Zhao ; S. Zhou ; A.-Y. Gao ;
F. Zhang5; H.-J. Wang1
1
Peking University, Beijing, China; 2The University of Sydney, Sydney,
Australia; 3The University of Auckland, Auckland, 1023, New Zealand;
4
Dongcheng Primary and Secondary School Health Care Center;
5
Mentougou Primary and Secondary School Health Care Center, Beijing,
China
INTRODUCTION: Interventions are urgently needed to effectively
improve physical activity in children. This study aimed to assess the
effects of a multifaceted intervention on accelerometer-measured
physical activity of primary school children.
MATERIALS AND METHODS: This was a nested study in the
DECIDE-Children study, a cluster-randomized controlled trial con-
ducted from September 2018 to June 2019 (Liu et al JAMA Pediatr
2022;176:e214375). In this study, we selected 4 schools from the
intervention group (119 children) and 4 schools from the control
group (99 children) in Beijing, one of three study sites in the DECIDE-
Children study. The intervention focused on both children and their
family and school context to facilitate children's behavioral improve-
ment for obesity prevention. The outcome was objectively measured
physical activity using the accelerometer. Its measures included inten-
sity and amounts of physical activity within the whole day or within
specific periods of a day (weekday/weekend day, in school/out of
school). Linear mixed models allowing for the school-clustering effect
were used to estimate the effect size of the intervention. We also
examined potential moderators of the intervention effects including
sex, age, body mass index status at baseline, physical activity at base-
line, and accelerometer compliance.
RESULTS: Children in the intervention group spent more time on the
in-school moderate-to-vigorous physical activity (MVPA) compared
with the control group (adjusted mean difference: 0.54 minutes/hour,
95% confidence interval: 0.13 to 0.94, P = 0.012), but the interven-
tion did not improve physical activity within the whole weekday or
1467789x, 2022, S2, Downloaded from https://onlinelibrary.wiley.com/doi/10.1111/obr.13503 by CAPES, Wiley Online Library on [16/12/2023]. See the Terms and Conditions (https://onlinelibrary.wiley.com/terms-and-conditions) on Wiley Online Library for rules of use; OA articles are governed by the applicable Creative Commons License
SUPPLEMENT ARTICLE
weekend day (P > 0.05). There was no difference in the effect size
across most of the moderators except for age, as younger children
appeared to benefit more from the intervention in the improvement
of in-school MVPA (Pinteraction = 0.035). No between-group differ-
ences were observed in out-of-school physical activity (P > 0.05).
CONCLUSION: The childhood obesity intervention effectively
increased MVPA during in-school hours but did not improve out-of-
school physical activity. Children's age appeared to be associated with
the effect size of the intervention.
DISCLOSURE OF INTEREST: None Declared.
P374 | Association between physical activity
and self-regulation in early childhood – A
systematic review
A. F. L. D'cruz1; N. D'Souza1; C. Smith1; K. Downing1; E. Sciberras2;
K. Hesketh1
1
Institute of Physical Activity and Nutrition/Faculty of Health; 2Center
for Social and Early Emotional Development/Faculty of health, Deakin
University, Melboune, Australia
INTRODUCTION: Early childhood (0–5 years) is a central period for
the development of physical activity and self-regulation, both of
which have been identified as important predictors of paediatric obe-
sity. Children with lower levels of physical activity and those with
poorer self-regulation skills are more likely to be identified as having
overweight/at risk for overweight in early childhood. There is growing
evidence that physical activity and self-regulation are interrelated,
however, this remains unclear in young children. The current review
systematically summarised associations between physical activity and
self-regulation in early childhood and explored the directionality of
associations.
MATERIALS AND METHODS: Searches were run in seven electronic
databases (APA PsycINFO, SPORTS Discuss, CINHAL, MEDLINE
Complete, Embase, Global Health) in December 2021. Inclusion cri-
teria were published in English, measuring both physical activity and
self-regulation, and early childhood population (mean age ≤5 years).
RESULTS: Thirty-seven papers met the inclusion criteria, of which
only four investigated all three domains of self-regulation (beha-
vioural, cognitive, and emotional). Overall, findings were inconclusive;
17 studies reported weak to moderate positive associations between
physical activity and self-regulation, 3 studies reported inverse associ-
ations, 10 reported mixed associations, and 7 reported no associa-
tions. Physical activity and behavioural self-regulation were most
consistently positively associated, with 6 of 9 studies reporting a posi-
tive association. Less consistent were associations with cognitive and
emotional self-regulation. Only one study explored potential bi-
directional associations between physical activity and self-regulation,
reporting a positive bidirectional association between the two. Associ-
ations were also found to be moderated by child sex in three studies.
Two studies suggested that associations varied based on the amount

SUPPLEMENT ARTICLE
of time spent in total physical activity, however, there was no consen-
sus on the beneficial threshold for physical activity.
CONCLUSION: This review suggests a beneficial association between
young children's physical activity and both behavioural self-regulation
and broader self-regulation. Less consistent associations between
physical activity and cognitive and emotional domains were observed.
There is some suggestion the association may be bidirectional, and
that physical activity dose and sex potentially confound the associa-
tion. Investigation in future studies may help clarify such
phenomenon.
DISCLOSURE OF INTEREST: None Declared.
P375 | Features, motivators and goals
associated with weight loss in the ACTION
Chile survey
A. Cuevas1; R. Alonso1; A. Rendon2; E. Barros3; F. Pardo4
1
Center for Advanced Metabolic Medicine and Nutrition. Universidad
Finis Terrae, School of Medicine, Santiago, Chile; 2Novo Nordisk,
Copenhagen, Denmark; 3Novo Nordisk, Santiago; 4Center for Biomedical
Research, Universidad de Valparaiso, Valparaiso, Chile
INTRODUCTION: Despite the high prevalence of obesity in Chile,
people with obesity (PwO) often receive “suboptimal” care due to
clinical barriers, perceptions, and behaviours towards obesity. Achiev-
ing significant weight loss is often a struggle for many PwO.
MATERIALS AND METHODS: Using data collected in Chile for the
ACTION-IO survey (NCT03584191), we aimed to identify features,
motivators, and goals in people with obesity (PwO) who reported
>10% body weight loss over the past 3 years (n = 1,000).
RESULTS: Prevalence of PwO who reported <5, 5–10 and >10%
weight loss was 60.9, 21.9 and 17,2%, respectively. Those whith
>10% body weight loss (>10%BWL) reported higher levels of educa-
tion, discussing more about weight with a health care provider (HCP)
over the last 5 years, and more frequently that their conversation with
an HCP was very/extremely helpful than those who lost <10% body
weight (p < 0.05). The >10%BWL group less frequently reports “to be
more fit/better shape” as a motivator than those who lost < 10%
body weight (p < 0.05), while to have a general health concern, and
support from family and friends appear to be important motivators in
this group (p ns). “To live a longer life” appears to be an important
weight management goal to achieve (p ns) in the >10%BWL group.
“To lose a pre-specified % of body weight”, “improve my physical,
mental health and well-being” and “improve my lifestyle” are goals
more frequently set with an HCP in the >10%BWL group (p < 0.05).
Moreover, the >10%BWL group reports discussing more about weight
with an obesity specialist (p < 0.05) and having tried or currently try-
ing prescription weight loss medication than those who report < 5%
body weight loss (p < 0.05).
CONCLUSION: PwO who reported losing >10% body weight in Chile
more frequently discussed about weight with HCPs, obesity
1467789x, 2022, S2, Downloaded from https://onlinelibrary.wiley.com/doi/10.1111/obr.13503 by CAPES, Wiley Online Library on [16/12/2023]. See the Terms and Conditions (https://onlinelibrary.wiley.com/terms-and-conditions) on Wiley Online Library for rules of use; OA articles are governed by the applicable Creative Commons License
167 of 222
specialists, and found these conversations helpful, while being moti-
vated by improving overall health rather than physical shape, set clear
goals with their HCP, and more frequently used prescription weight
loss medication. This identifies clear features associated with clinically
significant weight loss, that involve a personal concern about health
and active involvement and support from HCPs that could improve
results in the standard of care for all PwO.
DISCLOSURE OF INTEREST: A. Cuevas Grant/Research support
with: Investigator ACTION-IO study. Fee honorarium, R. Alonso
Employee of: medical director Novo Nordisk, A. Rendon Employee of:
medical director Novo Nordisk, E. Barros Employee of: Medical Sci-
ence Liaison-Obesity Novo Nordisk, F. Pardo: None Declared.
P376 | Improvements in mental health,
disability, and quality of life following
internet-delivered cognitive behaviour
therapy in adults with high weight and
chronic health conditions
A. Heriseanu1; E. Karin1; J. Walker2; M. Gandy1; M. Bisby1; A. Scott1;
J. Dudeney1; A. Fisher1; N. Titov2; B. Dear1
1
eCentreClinic; 2MindSpot Clinic, Macquarie University, Sydney, Australia
INTRODUCTION: There is growing evidence that psychological treat-
ment, especially cognitive behavioural therapy (CBT), can improve
functioning, and reduce psychological distress in persons with chronic
health conditions, such as diabetes, cardiovascular disease, and
chronic pain. High weight is commonly associated with chronic health
conditions, yet there has been little work investigating whether high
weight has an impact on response to psychological interventions in
this population. Therefore, the current study examined the associa-
tions between BMI and clinical outcomes (depression, anxiety, disabil-
ity, quality of life and satisfaction with life) following a transdiagnostic
psychological intervention.
MATERIALS AND METHODS: The intervention was an 8-week
internet-delivered CBT program that aimed to promote emotional
wellbeing and adjustment to chronic illness in adults with chronic
health conditions (N = 239; mean age = 48.59, SD = 13.78; mean
BMI = 30.44, SD = 8.33; 87% female). The influence of BMI category
at baseline on treatment outcomes at post-treatment and 3-month
follow-up was examined using generalized estimating equations. We
also examined whether BMI and the self-rated health impact of partic-
ipant weight changed as a result of treatment, even though these
were not specifically targeted in this intervention.
RESULTS: Improvements in all outcomes were observed across BMI
categories, and a significant effect of BMI category was also observed,
such that the improvements reported by persons with obesity or
overweight were, on average, larger than those within a healthy
weight range. We did not observe any significant changes in partici-
pants' BMI, or in the self-rated impact of their weight on their health.

168 of 222
CONCLUSION: This suggests that persons with high weight and
chronic health conditions benefit from iCBT programs targeting psy-
chological distress. However, future research integrating behaviour
change information specific to lifestyle factors may be necessary to
achieve changes in weight and in its perceived impact on health.
DISCLOSURE OF INTEREST: None Declared.
P377 | Exploring system dynamics of
community engagement in obesity
prevention
A. D. Brown1; C. Bell2; J. Hayward1; J. Kuhlberg3; G. Brown4;
S. Allender1
1
Global Obesity Centre, Institute for Health Transformation; 2School of
3
Medicine, Deakin University, Geelong, Australia; System Stars, Chapel
Hill, USA; 4Centre for Social Impact, University of New South Wales,
Sydney, Australia
INTRODUCTION: While there are case studies of community-led
approaches to obesity prevention supported by systems science in
the literature, much remains unknown about how to evaluate commu-
nity engagement in obesity prevention and how to use systems sci-
ence to enhance engagement. System dynamics modelling, one
method from systems science, is well suited to provide practical
insights about community engagement. System dynamics modelling
focuses on hypothesised causal relationships between multiple vari-
ables separated by time and space. It also focuses on variables that
form feedback loops, where one variable causes a change in a series
of variables, which ultimately feedback and cause a change in that ini-
tial variable, leading to exponential growth or goal-seeking behaviour.
These perspectives allow for a consideration of the complexity of
community engagement, defined by multiple variables changing over
time with counterintuitive behaviour resulting from their relationships.
This study aims to build a quantified system dynamics model repre-
senting a dynamic theory of the drivers of community engagement in
obesity prevention to generate new theoretical and practical insights.
MATERIALS AND METHODS: This study's system dynamics model-
ling will draw on key stakeholder interviews to form an initial
hypothesised system structure of community engagement processes.
The stakeholders are practitioners working across Victoria, Australia
on community-based approaches to obesity prevention. A systematic
review of measures of community engagement in obesity prevention
will inform the model and contextualise practitioners' observations.
The model will be further strengthened with available organisational
datasets that measure community engagement in projects over time.
Stakeholders will be engaged throughout the modelling process to
promote understanding of the model as it develops and support the
model's relevance to practice.
RESULTS: The study aims to build a model that reflects the insights
shared by practitioners, presenting a theory of how community
engagement may change over time in a project given specific starting
1467789x, 2022, S2, Downloaded from https://onlinelibrary.wiley.com/doi/10.1111/obr.13503 by CAPES, Wiley Online Library on [16/12/2023]. See the Terms and Conditions (https://onlinelibrary.wiley.com/terms-and-conditions) on Wiley Online Library for rules of use; OA articles are governed by the applicable Creative Commons License
SUPPLEMENT ARTICLE
conditions, boundaries of the project, and system structure. The
model will be accompanied by an interactive interface that will allow
practitioners to consider which parts of systems structure may be
most important at different points in time when trying to work with
community on obesity prevention. Results will be available at the
conference.
CONCLUSION: Community-led approaches supported by systems
science are promising for obesity prevention. This study will demon-
strate how a system sciences method, system dynamics modelling,
can generate useful insights for practitioners working with
community.
DISCLOSURE OF INTEREST: None Declared.
P378 | Are we ‘being, having or living with’
overweight?: Combating stigma with the
development of communication guidelines on
obesity for a public health organisation
A. Finch1; G. Myers1; W. Watson2; C. Hughes2; A. Sartori1
1
Cancer Council WA, Perth; 2Cancer Council NSW, Sydney, Australia
INTRODUCTION: As part of Cancer Council's cancer prevention
activities we talk about body weight as a risk factor that can be modi-
fied through individual behaviour change and policy/environmental
changes. However, obesity and body weight can be difficult issues to
talk about. They're sensitive topics, the causes of weight gain are
complex, and changing body weight is not an achievable goal for many
people. Additionally, the way that we communicate on obesity con-
tributes to cultural norms around body weight, including weight
stigma, and is therefore important to get right.
To facilitate consistent communication on the issue of body
weight in a range of media (e.g. media releases, policy briefs, website
information etc) we developed a bespoke set of guidelines for Cancer
Council Australia and state branches.
MATERIALS AND METHODS: We investigated existing communica-
tion guidelines for various health issues, and consulted with stake-
holders from public health, consumer groups, and communication
professionals.
RESULTS: We will share the Cancer Council ‘Guidelines for communi-
cations on body weight and health’ which includes:
• Background on the link between weight and health
• The impact of weight stigma.
• Information on the role of the environment.
• Practical advice on specific language and phrases to use when talk-
ing about weight and health.
• Anti-weight-stigma advocacy tools.
CONCLUSION: The creation of a set of guidelines with involvement
from many stakeholders has resulted in a tool that is fit-for-purpose,

SUPPLEMENT ARTICLE
practical and accepted by all relevant users. We hope that this will
lead to:
• Consistent use of sensitive and inclusive language that does not
contribute to weight stigma.
• Greater awareness of the impact of weight stigma.
• Greater focus on collective policy action for obesity prevention.
• Appreciation from multidisciplinary professionals that the language
we use around weight and health matters
DISCLOSURE OF INTEREST: None Declared.
P379 | Factors associated with reported need
of weight loss support among adults with
overweight or obesity
A. Molarius1,2; J. Karlsson3
1
Centre for Clinical Research, Region Värmland; 2Department of Public
Health Sciences, Karlstad University, Karlstad; 3University Health Care
Research Center, Örebro University, Örebro, Sweden
INTRODUCTION: Evidence-based methods to lose weight are impor-
tant to tackle increasing obesity trends in adult populations but long-
term results of weight loss attempts are discouraging. The aim of this
study was to investigate factors associated with reported need of
weight loss support among adults with overweight or obesity.
MATERIALS AND METHODS: The study includes 8,182 persons with
overweight or obesity (BMI > =25 kg/m2) aged 30–69 years answer-
ing a survey questionnaire sent to a random population sample in five
counties in Sweden in 2017. Subjects were divided into two groups:
those who do not want to lose weight or who want to lose weight but
do not need support (n = 6,720) and those who want to lose weight
and need support (n = 1,462). Multivariate odds ratios for needing
weight loss support were calculated for gender, age, educational level,
economic difficulties, social support, physical activity, obesity, and
several health problems.
RESULTS: In total, 79% of the subjects with overweight and 94% of
the subjects with obesity wanted to lose weight, and 18% reported
needing weight loss support. The factors most strongly associated
with reported need of weight loss support were obesity, female gen-
der, lack of social support, and depression (with odds ratios between
2 and 4). Physical inactivity, economic difficulties, hypertension, and
musculoskeletal pain had a moderate association. Age, educational
level, and diabetes were not independently associated with reported
need of weight loss support. Obesity, lack of social support, and
depression had the strongest associations also when analyzed sepa-
rately in men and women.
CONCLUSION: Reported need of weight loss support is more com-
mon among women than among men and strongly associated with
obesity, lack of social support, and depression in both genders. These
1467789x, 2022, S2, Downloaded from https://onlinelibrary.wiley.com/doi/10.1111/obr.13503 by CAPES, Wiley Online Library on [16/12/2023]. See the Terms and Conditions (https://onlinelibrary.wiley.com/terms-and-conditions) on Wiley Online Library for rules of use; OA articles are governed by the applicable Creative Commons License
169 of 222
factors are important for planning preventive and weight-control mea-
sures among adults with overweight or obesity.
DISCLOSURE OF INTEREST: None Declared.
P380 | Psychological intervention for
bariatric patients during Covid-19 lockdown a
comparison between patients undergoing
surgery pre-pandemic and during pandemic
lockdowns
A. M. Ristanto; K. Burke
Psychology, Central Queensland University, Cairns, Australia
INTRODUCTION: Elective surgeries were postponed due to the
COVID-19 pandemic, resulting in several patients waiting for bariatric
surgery, lengthening the time to surgery, and prolonging the pre-
surgery stage while undertaking periods of being locked down. Psy-
chological issues have been found in locked down populations, with
eating patterns changing, psychological issues exacerbated and vul-
nerable populations at greater risk. The effect of psychological inter-
vention on wellbeing for Bariatric Surgery Patients during Covid-19
lockdown is being examined in this study. It was hypothesized that
patients who underwent bariatric surgery and recovery prior to the
pandemic would have better wellbeing scores compared to those who
underwent surgery or were waiting for surgery during the pandemic.
It also aims to look at the number and type of psychological interven-
tion between the two groups.
MATERIALS AND METHODS: Participants are to be recruited via an
anonymous online survey from bariatric surgery support groups. Data
will be analysed using SPSS statistical software. Method: 198 persons
who have either undergone bariatric surgery (gastric sleeve, roux-
en-Y gastric bypass, laparoscopic adjustable gastric banding) or are
waiting for surgery are to be recruited by an anonymous online sur-
vey, a percentage of whom may have undergone psychological
counselling. The SF36 which assess physical and mental well-being
and the DASS-21 which measures depression, anxiety and stress will
be used.
RESULTS: (Study in currently in progress with results due in August/
September 2022). Type of surgery undergone will be determined for
each participant, number of psychological intervention sessions
attended and time since surgery will be recorded to determine if there
is any difference between wellbeing scores across the groups. The
groups will consist of gastric sleeve surgery (vertical sleeve gastrec-
tomy), roux-en-Y gastric bypass, laparoscopic adjustable gastric band-
ing, who will be examined to see if counselling had any impact on
wellbeing scores pre and post pandemic and to see if the pre-
pandemic groups had higher wellbeing scores.
CONCLUSION: The study aims to test the hypothesis of better well-
being for patients during the pandemic if they attend psychological
counselling and to compare those who had surgery during the pan-
demic to those who underwent surgery prior to the pandemic with

170 of 222
the hypothesis being those who underwent surgery prior to pandemic
will have better wellbeing scores.
DISCLOSURE OF INTEREST: None Declared.
P381 | Effect of gender and age on attitudes
about weight loss, worry about weight and
weight loss attempts among adolescents
living with obesity: Subanalysis from the
ACTION teens global study
B. Bin-Abbas1; L. A. Baur2; A. Bereket3; W. Chen4;
F. Fernández-Aranda5; N. Garibay Nieto6; J. C. Halford7;
 pez Siguero8; C. Maffeis9; V. Mooney10; C. K. Osorto11;
J. P. Lo
R. Reynoso12; Y.-J. Rhie13; M. Toro-Ramos14
1
King Faisal Specialist Hospital and Research Center, Riyadh,
Saudi Arabia; 2Children's Hospital Westmead Clinical School, The
University of Sydney, Westmead, Australia; 3Marmara University School
4
of Medicine, Istanbul, Turkey; Children's Hospital, China Medical
University, Taichung, Taiwan, Province of China; 5University Hospital of
Bellvitge-IDIBELL and CIBEROBN, Barcelona, Spain; 6Hospital General de
México “Dr. Eduardo Liceaga”, Mexico City, Mexico; 7University of Leeds,
8 9
Leeds, UK; Regional University Hospital, Málaga, Spain; University of
Verona, Verona, Italy; 10The European Coalition for People Living with
Obesity, Dublin, Ireland; 11Novo Nordisk A/S, Copenhagen, Denmark;
12
Novo Nordisk Health Care AG, Zürich, Switzerland; 13Korea University
14
College of Medicine, Seoul, Korea, Republic Of; IPS Universitaria,
Medellin, Colombia
INTRODUCTION: This subanalysis of the ACTION Teens study aimed
to assess the effect of adolescent gender/age on attitudes about
weight loss (WL), worry about weight and WL attempts among ado-
lescents living with obesity (ALwO).
MATERIALS AND METHODS: The global, cross-sectional ACTION
Teens survey (NCT05013359) assessed perceptions, attitudes, behav-
iours and barriers to effective obesity care among ALwO (aged 12–
<18 years [y]; N = 5,275), caregivers (CGs) of ALwO (N = 5,389) and
healthcare professionals who treat ALwO (N = 2,323). Results
reported here were stratified by ALwO gender/age. Proportions were
compared with a Z-test; significant differences (p < 0.05) are
reported.
RESULTS: Overall, 2,971 (56%) ALwO were male (aged 12–13 y:
n = 938; 14–15 y: n = 829; 16–17 y: n = 1,204) and 2,304 (44%)
female (aged 12–13 y: n = 549; 14–15 y: n = 650; 16–17 y:
n = 1,105). While 65% of ALwO felt WL was completely their respon-
sibility (male vs female: 63 vs 68%; p < 0.05), only 37% of CGs felt
WL was completely their ALwO's responsibility. More female ALwO
were extremely/very worried about their weight than males (46 vs
31%; p < 0.05); the proportion that was extremely/very worried
peaked at 14–15 y for both males (12–13 y: 22%, 14–15 y: 37%, 16–
17 y: 34%; p < 0.05 for 12–13 vs 14–15 y and 12–13 vs 16–17 y)
and females (12–13 y: 43%, 14–15 y: 56%, 16–17 y: 41%; p < 0.05
1467789x, 2022, S2, Downloaded from https://onlinelibrary.wiley.com/doi/10.1111/obr.13503 by CAPES, Wiley Online Library on [16/12/2023]. See the Terms and Conditions (https://onlinelibrary.wiley.com/terms-and-conditions) on Wiley Online Library for rules of use; OA articles are governed by the applicable Creative Commons License
SUPPLEMENT ARTICLE
for 12–13 vs 14–15 y and 14–15 vs 16–17 y). Overall, 58% of ALwO
reported making a WL attempt in the past year, while only 41% of
CGs responded similarly for their ALwO. Compared with male ALwO,
more females made a WL attempt in the past year (65 vs 53%;
p < 0.05) and indicated they were extremely/very likely to make a WL
attempt within 6 months (44 vs 34%; p < 0.05); the proportion that
was extremely/very likely to make a WL attempt peaked at 14–15 y
for both males (12–13 y: 25%, 14–15 y: 40%, 16–17 y: 36%; p < 0.05
for 12–13 vs 14–15 y and 12–13 vs 16–17 y) and females (12–13 y:
43%, 14–15 y: 54%, 16–17 y: 38%; p < 0.05 for all age group
comparisons).
CONCLUSION: Compared with other age groups, more ALwO aged
14–15 y (particularly females) were extremely/very worried about
their weight and extremely/very likely to make a future WL attempt.
DISCLOSURE OF INTEREST: B. Bin-Abbas Consultant for: Novo Nor-
disk, L. A. Baur Consultant for: Novo Nordisk, Speakers bureau with:
Novo Nordisk, A. Bereket Consultant for: Novo Nordisk, Speakers
bureau with: Novo Nordisk, W. Chen Consultant for: Novo Nordisk,
F. Fernández-Aranda Grant / Research support with: Novo Nordisk,
Consultant for: Novo Nordisk, Paid Instructor for: Wiley, Speakers
bureau with: ICOMES conference, Novo Nordisk, N. Garibay Nieto
Consultant for: Novo Nordisk, Speakers bureau with: Eli Lilly, Merck
Serono, J. C. Halford Consultant for: Boehringer Ingelheim, Dupont,
 pez Siguero Consultant for: Novo Nordisk,
Novo Nordisk, J. P. Lo
C. Maffeis Consultant for: Eli Lilly, Novo Nordisk, Roche, Speakers
bureau with: Aboca, Eli Lilly, Novo Nordisk, V. Mooney Consultant
for: Boehringer Ingelheim, Novo Nordisk, Paid Instructor for: Novo
Nordisk, Speakers bureau with: Ethicon, Novo Nordisk, C. K. Osorto
Shareholder of: Novo Nordisk, Employee of: Novo Nordisk,
R. Reynoso Shareholder of: Novo Nordisk, Employee of: Novo Nor-
disk, Y.-J. Rhie Consultant for: Novo Nordisk, M. Toro-Ramos Grant/
Research support with: Novo Nordisk, Consultant for: Novo Nordisk,
Paid Instructor for: Novo Nordisk, Speakers bureau with: Novo Nor-
disk, Sandoz.
P382 | Evaluation of the Western Australian
SHIFT guide which aims to change the
narrative on obesity
C. E. Pulker; K. Law
Community and Population Health, East Metropolitan Health Service,
Perth, Australia
INTRODUCTION: People with obesity often experience weight bias
and stigma, facing multiple forms of prejudice and discrimination. The
Western Australian (WA) Department of Health Healthy Weight
Action Plan and the East Metropolitan Health Service (EMHS) Obesity
Prevention Strategy identified addressing the impact of weight stigma
as a priority. The aim was to develop a locally relevant, practical guide
to support WA health system communications staff to work in a non-
stigmatising manner when reporting on obesity.

SUPPLEMENT ARTICLE
MATERIALS AND METHODS: A review of the literature was con-
ducted to summarise the impact of weight stigma on people living
with obesity. Existing guides on communicating about obesity were
reviewed to inform content. WA health system communications staff
were involved throughout the development process, to ensure the
guide was relevant to their context. Regular feedback was received
during the development process via consultation, which was consoli-
dated to inform subsequent changes. The SHIFT guide was launched
by the WA Department of Health in November 2020. Evaluation of
the reach and impact of the SHIFT guide among stakeholders was
conducted In February 2022. The online survey was informed by the
RE-AIM framework and approved as an EMHS Quality Activity (Ref:
46286).
RESULTS: Nine survey responses were received from people working
in health services, government and non-government organisations.
The SHIFT guide had been read by all nine respondents; and shared
with a network of 141 people and organisations. Almost all (7/9) had
applied the principles of the SHIFT guide in their work, including:
(1) using person-first and weight neutral language; (2) choosing non-
stigmatising images; and (3) referring to the checklist of eight things
to consider when reporting on obesity. The SHIFT guide had been
adapted for training GPs, country health service staff, and student die-
titians; presented to community groups and the Danish Children's
Healthy Weight Alliance; and a slide deck and pre-recorded presenta-
tion prepared. To maintain ongoing effectiveness, ensuring contribu-
tion from people with lived experience and creating a staff training
programme were recommended.
CONCLUSION: Communications professionals have the power and
agency to change public perceptions of obesity. Involving them in the
co-development of the SHIFT guide ensured their needs were met
and produced a guide which exemplified the values recommended.
The SHIFT guide has been widely used within the WA health system
to raise awareness of the impact of weight stigma and to shift the lan-
guage and images used when communicating about obesity.
DISCLOSURE OF INTEREST: None Declared.
P383 | Associations between parents'
physical activity and their physical activity-
specific parenting confidence
C. Smith1; K. Hesketh1; J. Hnatiuk1; S. Paudel Subedi1; S. Crawford2
1
Institute for Physical Activity and Nutrition, Deakin University, Burwood;
2
Judith Lumley Centre, La Trobe University, Bundoora, Australia
INTRODUCTION: Previous research suggests that children are more
active when their parents promote physical activity. Parents who are
more active themselves may be more confident in their parenting
around physical activity, however this has not been previously investi-
gated. This study aimed to investigate associations between parental
levels of physical activity and their physical activity-specific parenting
confidence.
1467789x, 2022, S2, Downloaded from https://onlinelibrary.wiley.com/doi/10.1111/obr.13503 by CAPES, Wiley Online Library on [16/12/2023]. See the Terms and Conditions (https://onlinelibrary.wiley.com/terms-and-conditions) on Wiley Online Library for rules of use; OA articles are governed by the applicable Creative Commons License
171 of 222
MATERIALS AND METHODS: Baseline data from 827 parents of
2 year olds (743 mothers, 84 fathers; mean age 35 years) in the Let us
Grow randomised controlled trial were utilised. Parents' physical
activity was assessed using ActiGraph GT3X + accelerometers, worn
continuously for eight days with data collected in 5-second epochs.
Validated accelerometer cut-points of ≥1952 counts per minute
determined time spent in moderate- to vigorous-intensity physical
activity (MVPA) per week. Physical activity-specific parenting confi-
dence was assessed by a previously developed four-item scale with
responses on a 5-point Likert scale (1 = not at all confident to
5 = extremely confident) summed to create a score with a range of
1–20. Linear regression analyses were used to examine the associa-
tion between exposures and outcomes.
RESULTS: Average weekly MVPA was 85 mins for mothers and
94 mins for fathers, with 3% of mothers and 8% of fathers meeting
guidelines of 150 mins per week. Physical activity-specific parenting
confidence was similar for mothers and fathers, with mean confidence
scores of 14.4 and 14.2 respectively. Independent t tests indicated
mothers and fathers had similar physical activity-specific parenting
confidence, for individual items and total score. Simple linear regres-
sion indicated MVPA was positively associated with parenting confi-
dence scores for mothers (p = 0.005) but not fathers (p = 0.875). For
mothers, a 10 min increase in weekly MVPA was associated with a
0.1 increase in parenting confidence.
CONCLUSION: This study suggests that supporting mothers of young
children to increase their own physical activity could lead to an
increase in physical activity-specific parenting confidence. Although a
low percentage of parents are meeting physical activity guidelines,
fathers appear to be slightly more active than mothers, but parenting
confidence levels are similar. With a small sample of fathers in this
study, future research focusing on fathers would be beneficial to
increasing understanding of associations between physical activity
and parenting confidence in this under-researched group.
DISCLOSURE OF INTEREST: None Declared.
P384 | Severe obesity landscape in Canada:
Worsening trends from 2005 through 2018
E. Lytvyak; S. Straube; R. Modi; K. Lee
University of Alberta, Edmonton, Canada
INTRODUCTION: Obesity is a progressive, multifactorial, chronic dis-
ease with high risks of relapse and recurrence. Adiposity-related com-
plications, all-cause and premature mortality that are more prevalent
among people living with severe obesity necessitate urgent public
health and medical community attention. Our study described and
analyzed national temporal severe obesity trends in the Canadian
adult population from 2005 through 2018.
MATERIALS AND METHODS: A consecutive cross-sectional study
using data from seven sequential Canadian Community Health Survey
cycles (CCHS2005 – CCHS2017–18), the largest Canadian survey

172 of 222
F I G U R E 1 Trends in severe obesity prevalence among adults, by
sex, Canada, from 2005 to 2017–18 (asterisk denote statistically
significant increasing trend; p < 0.001).
focused on health and health determinants, was conducted. We
included data from Canadians ≥18 y.o. with self-reported body mass
index (BMI). To yield BMI estimates maximally in line with measured
ones, sex-specific validated correction equations were applied to self-
reported BMI to produce adjusted BMI. Severe obesity was defined
as adjusted BMI ≥ 40.00 kg/m . Temporal trends in prevalence were
2
analyzed using Pearson's chi-squared test with Bonferroni's p-value
adjustment, and Cochran-Armitage test of trend.
RESULTS: Data from 746,408 (403,582 females and 342,826 males)
CCHS participants were included. Severe obesity prevalence in
Canada rose significantly between 2005 and 2017–18, from 6.3% to
9.2%, representing increases of 2.9 percentage-points (absolute) and
46.0% (relative to the baseline) (p < 0.001). Increases were observed
across both sexes, all age groups, and all Canadian provinces/
territories (p < 0.001). While the relative increase in severe obesity
prevalence over 14 years was more pronounced among males com-
pared to females (51.7% vs. 43.3%, respectively), the absolute
increases were comparable (2.9 vs. 3.0 percentage-points). In 2017–
18, severe obesity prevalence was higher among females than males
(9.6% vs. 8.8%; p < 0.001) (Figure 1). Age-wise, in 2017–18, Canadian
adults in their 50s had the highest severe obesity prevalence of
11.2%, followed by those in their 40s and 60s (10.5% each), while
those who were 18–19 y.o. had the lowest (2.7%).
CONCLUSION: Almost 1 in 10 Canadian adults now lives with severe
obesity, representing the highest-ever prevalence. Due to the variety
and complexity of contributing factors, severe obesity does not have
an easy solution. Comprehensive lifestyle modification, pharmacologi-
cal and surgical treatment modalities need to be considered. Targeting
1467789x, 2022, S2, Downloaded from https://onlinelibrary.wiley.com/doi/10.1111/obr.13503 by CAPES, Wiley Online Library on [16/12/2023]. See the Terms and Conditions (https://onlinelibrary.wiley.com/terms-and-conditions) on Wiley Online Library for rules of use; OA articles are governed by the applicable Creative Commons License
SUPPLEMENT ARTICLE
obesogenic environments through evidence-based improvements in
our built and food environments together with community-based pro-
grams and health policies aimed at modifying behavioural, environ-
mental and social determinants contributing to severe obesity is also
needed. Our study of the recent trends in severe obesity prevalence
highlights the urgent need for managing severe obesity at the individ-
ual and population levels.
DISCLOSURE OF INTEREST: None Declared.
P385 | The lived experience of patients with
obesity at a metropolitan public health
service
F. Pazsa1; C. Said2; K. Haines1; D. Hitch1; S. Eloise1; M. Shackell1
1
Western Health, St Albans, United Kingdom; 2Physiotherapy, The
University of Melbourne, Parkville, Australia
INTRODUCTION: The aim of this study was to explore the lived
experience of hospitalised patients with obesity, with the overall
objective of utilising this information to drive service improvements
for this increasing patient population.
MATERIALS AND METHODS: Qualitative design was implemented.
Data was collected via ten semi-structured interviews. Interpretative
Phenomenological Analysis (IPA) was used to analyse the data and
identify key themes. Previously hospitalised patients with obesity
were included.
RESULTS: A comprehensive data set was produced, that simulta-
neously supported existing clinical opinion and provided new insight
into what is important from the patient perspective. Three main
themes emerged as important factors to hospitalised patients with
obesity: meeting physical care needs; interpersonal interactions and
psychosocial impact.
CONCLUSION: Timely provision of appropriate equipment and con-
sideration of the design of infrastructure to support the care of this
cohort should be considered. Education around specialised manual
handling and understanding the psychosocial complexities of being
obese should be addressed. An emphasis on basic principles of care
provision to enhance interpersonal interactions, along with improved
understanding of the impact of weight bias and obesity stigma in
healthcare are also supported. Preparing healthcare professionals to
support weight loss is another key recommendation. The themes
identified in this study provide direction for future research to work
towards improved models of care for this patient population in this
setting and beyond.
DISCLOSURE OF INTEREST: None Declared.

SUPPLEMENT ARTICLE
P386 | A qualitative study exploring
participant experience of obstetric weight
management (OWM)
S. Edwards; P. Gately; G. Shiplee
Leeds Beckett University, Leeds, UK
INTRODUCTION: OWM is defined as weight management for
women in varied stages of childbearing. Stages may include precon-
ception, peri-natal or postnatal. OWM is an increasing public health
challenge in line with the global issue of obesity prevalence. Excess
weight in childbearing is highly associated with increased risk of
unplanned pregnancy loss and prevalence of short- and long-term
negative health outcomes for both mother and baby. With some
social groups being at more risk than others. Efforts in the UK to sup-
port women reduce and manage excess weight to promote healthier
pregnancies, have been considered ineffective. This research explores
participant experience of OWM, with the wider goal of developing
recommendations for improving OWM approaches and provision.
MATERIALS AND METHODS: The research project adopts qualita-
tive research methods. Six months of fieldwork was conducted, based
on a unique combination of focus groups and individual interviews
with both ‘real women and families’ and health professionals
(e.g., health psychologists). While practitioner ethnography was used
to capture the researcher's, professional experiences of OWM prac-
tice. Thematic and narrative analysis is currently underway.
RESULTS: Preliminary findings support barriers to engagement, sup-
ported by previous research. Such as, a prevalence of unplanned preg-
nancy loss and impacts on mental health and operational structural
inefficiencies. Findings also suggest the pandemic had an adverse
impact on this population, adding to the multiple barriers to behaviour
change, already present.
CONCLUSION: Innovative intervention development should consider
a flexible and individual approach to weight management support. Ini-
tial recommendations focus on ensuring facilitators are aware of the
complex biopsychosocial impact of childbearing and how this effects a
successful weight management journey.
DISCLOSURE OF INTEREST: S. Edwards Employee of: MoreLife,
P. Gately Employee of: MoreLife, G. Shiplee Employee of: MoreLife.
1467789x, 2022, S2, Downloaded from https://onlinelibrary.wiley.com/doi/10.1111/obr.13503 by CAPES, Wiley Online Library on [16/12/2023]. See the Terms and Conditions (https://onlinelibrary.wiley.com/terms-and-conditions) on Wiley Online Library for rules of use; OA articles are governed by the applicable Creative Commons License
173 of 222
P387 | Informing a best-practice bottle and
formula feeding preventative intervention: A
systematic qualitative review of carer
perspectives on overweight, obesity and
early childhood caries in infants and young
children
H. J. Cheng1; L. Baur2; A. Arora3; E. Denney-Wilson1
1
Susan Wakil School of Nursing and Midwifery; 2Sydney Medical School,
The University of Sydney, Camperdown, Australia; 3School of Science and
Health, Western Sydney University, Campbelltown, Australia
INTRODUCTION: Formula and bottle feeding can increase risk of
overweight, obesity and early childhood caries (ECC) in infants and
young children. Overfeeding and continual exposure of teeth to sugar
are etiological factors of overweight, obesity and ECC, through behav-
iours that include: continuous feeding in response to crying and
unsettledness, excessive formula feeding, and the addition of cario-
genic carbohydrous foods to bottles. Carer beliefs, such as preference
for heavy infants and lesser importance of primary teeth compared to
permanent teeth, may be barriers to uptake of obesity and ECC pre-
vention messages. Creating targeted messages on best-practice for-
mula feeding, bottle feeding and transitioning from bottles to cups,
may be more effective and engaging. This systematic qualitative
review, conducted following PRISMA guidelines, aimed to identify
carer perspectives on overweight, obesity and ECC in infants and
young children, in order to inform focus group research and a pilot
intervention study.
MATERIALS AND METHODS: Databases CINAHL, Medline and
EMBASE, were searched in August 2021 for original qualitative
research on parent and carer perspectives and beliefs on overweight,
obesity and ECC in infants and young children. Studies were limited
to parents and carers of infants and children aged 0–6 years. Findings
were analysed and synthesised using thematic analysis informed by
the COM-B Model. Critical appraisal will be undertaken using the
CASP Qualitative Checklist.
RESULTS: 100 publications were found: 57 focused on overweight
and obesity, 43 focused on ECC. Most participants were carers of
children diagnosed with or at increased risk of overweight, obesity
and ECC. Key themes identified as barriers to uptake of overweight,
obesity and ECC-protective behaviours include: preference for larger
infants with perceived good feeding and activity over concerns on
increased infant weight; lack of understanding of increased ECC risk
in permanent teeth following ECC in primary teeth; and beliefs sur-
rounding child feeding, including child deprivation by avoiding obeso-
genic and cariogenic foods, use of food or infant formula for discipline
or settling crying, and interpretation and response to hunger, appetite
and satiety signals. Findings also indicated knowledge gaps on impact
of overweight, obesity and ECC on child health.
CONCLUSION: Carer perspectives will provide insight for focus
group research and co-design of a pilot intervention study. Tailoring

174 of 222
intervention strategies with behaviour change theory to address carer
priorities for child health can support uptake of obesity and ECC pre-
vention messages.
DISCLOSURE OF INTEREST: None Declared.
P388 | Effect of gender and age on
perception of overall health and worry about
the impact of weight on future health among
adolescents living with obesity and
caregivers: Subanalysis from the ACTION
teens global study
L. A. Baur1; A. Bereket2; B. Bin-Abbas3; W. Chen4;
F. Fernández-Aranda5; N. Garibay Nieto6; J. C. Halford7;
 pez Siguero8; C. Maffeis9; V. Mooney10; C. K. Osorto11;
J. P. Lo
R. Reynoso12; Y.-J. Rhie13; M. Toro-Ramos14
1
Children's Hospital Westmead Clinical School, The University of Sydney,
2
Westmead, Australia; Marmara University School of Medicine, Istanbul,
Turkey; 3King Faisal Specialist Hospital and Research Center, Riyadh,
Saudi Arabia; 4Children's Hospital, China Medical University, Taichung,
5
Taiwan, Province of China; University Hospital of Bellvitge-IDIBELL and
CIBEROBN, Barcelona, Spain; Hospital General de México “Dr. Eduardo
6  pez Siguero Consultant for: Novo Nordisk,
Liceaga”, Mexico City, Mexico; 7University of Leeds, Leeds, UK; 8Regional
University Hospital, Málaga, Spain; 9University of Verona, Verona, Italy;
10
The European Coalition for People Living with Obesity, Dublin, Ireland;
11 12
Novo Nordisk A/S, Copenhagen, Denmark; Novo Nordisk Health Care
AG, Zürich, Switzerland; 13Korea University College of Medicine, Seoul,
Korea, Republic Of; 14IPS Universitaria, Medellin, Colombia
INTRODUCTION: This subanalysis of the ACTION Teens study aimed
to assess the effect of adolescent gender/age on perceptions of
health and worry about the impact of weight on future health among
adolescents living with obesity (ALwO) and caregivers (CGs) of ALwO.
MATERIALS AND METHODS: The global, cross-sectional ACTION
Teens survey (NCT05013359) assessed perceptions, attitudes, behav-
iours and barriers to effective obesity care among ALwO (aged 12–
<18 years [y]; N = 5,275), CGs (N = 5,389) and healthcare profes-
sionals who treat ALwO (N = 2,323). Results reported here were
stratified by ALwO gender/age. Proportions were compared with a Z-
test; significant differences (p < 0.05) are reported.
RESULTS: Overall, 2,971 (56%) ALwO were male (aged 12–13 y:
n = 938; 14–15 y: n = 829; 16–17 y: n = 1,204) and 2,304 (44%)
female (aged 12–13 y: n = 549; 14–15 y: n = 650; 16–17 y:
n = 1,105). Fewer female ALwO perceived their overall health as
excellent/very good than males (29 vs 39%; p < 0.05) and a greater
proportion of females worried ‘a lot’ about their weight affecting their
future health than males (43 vs 32%; p < 0.05). Compared with ALwO
aged 12–13 y, fewer ALwO aged 14–15 and 16–17 y perceived their
overall health to be excellent/very good (males: 54 vs 41 and 27%;
p < 0.05 for both; females: 35 vs 29 and 27%; p < 0.05 for both). The
proportion of ALwO that worried ‘a lot’ about weight affecting their
1467789x, 2022, S2, Downloaded from https://onlinelibrary.wiley.com/doi/10.1111/obr.13503 by CAPES, Wiley Online Library on [16/12/2023]. See the Terms and Conditions (https://onlinelibrary.wiley.com/terms-and-conditions) on Wiley Online Library for rules of use; OA articles are governed by the applicable Creative Commons License
SUPPLEMENT ARTICLE
future health peaked at 14–15 y for both males (12–13 y: 26%, 14–
15 y: 36%, 16–17 y: 32%; p < 0.05 for 12–13 vs 14–15 y and 12–13
vs 16–17 y) and females (12–13 y: 40%, 14–15 y: 49%, 16–17 y:
41%; p < 0.05 for 12–13 vs 14–15 y and 14–15 vs 16–17 y). Among
CGs of male (n = 3,276) and female (n = 2,113) ALwO, more CGs of
males perceived their ALwO's health as excellent/very good (52 vs
46%; p < 0.05), while fewer CGs of males worried ‘a lot’ that their
ALwO's weight could affect their future health (35 vs 40%; p < 0.05).
CONCLUSION: Female ALwO were less likely to consider themselves
to be in excellent/very good health and were more worried about
their weight affecting health than male ALwO. For both genders,
ALwO aged 14–15 y were most worried about the impact of their
weight on future health.
DISCLOSURE OF INTEREST: L. A. Baur Consultant for: Novo Nor-
disk, Speakers bureau with: Novo Nordisk, A. Bereket Consultant for:
Novo Nordisk, Speakers bureau with: Novo Nordisk, B. Bin-Abbas
Consultant for: Novo Nordisk, W. Chen Consultant for: Novo Nordisk,
F. Fernández-Aranda Grant / Research support with: Novo Nordisk,
Consultant for: Novo Nordisk, Paid Instructor for: Wiley, Speakers
bureau with: ICOMES conference, Novo Nordisk, N. Garibay Nieto
Consultant for: Novo Nordisk, Speakers bureau with: Eli Lilly, Merck
Serono, J. C. Halford Consultant for: Boehringer Ingelheim, Dupont,
Novo Nordisk, J. P. Lo
C. Maffeis Consultant for: Eli Lilly, Novo Nordisk, Roche, Speakers
bureau with: Aboca, Eli Lilly, Novo Nordisk, V. Mooney Consultant
for: Boehringer Ingelheim, Novo Nordisk, Paid Instructor for: Novo
Nordisk, Speakers bureau with: Ethicon, Novo Nordisk, C. K. Osorto
Shareholder of: Novo Nordisk, Employee of: Novo Nordisk,
R. Reynoso Shareholder of: Novo Nordisk, Employee of: Novo Nor-
disk, Y.-J. Rhie Consultant for: Novo Nordisk, M. Toro-Ramos Grant/
Research support with: Novo Nordisk, Consultant for: Novo Nordisk,
Paid Instructor for: Novo Nordisk, Speakers bureau with: Novo Nor-
disk, Sandoz.
P389 | Prevalence of weight excess in two
neighboring indigenous populations in Brazil
with different periods of social changes
L. F. C. Viola1; R. S. Moisés1; L. F. Franco1; J. P. Vieira-Filho1;
A. L. Dal Fabbro2; L. J. Franco2
1
Federal University of São Paulo, São Paulo, Brazil; 2University of São
Paulo, Ribeirão Preto, Brazil
INTRODUCTION: Currently, data on the prevalence of weight excess
(WE) in Brazilian indigenous populations are limited. Social changes
from contact with Brazilian society have led to modifications in food
consumption patterns and physical activity levels. The Xavante and
Bororo Indians are two neighboring indigenous communities that had
permanent contact with our society since 1956 and 1902, respec-
tively, which led to important changes in their traditional diet and a

SUPPLEMENT ARTICLE
more prevalent sedentary lifestyle. Both belong to the same linguistic
group and are historically rival populations.
MATERIALS AND METHODS: The objective of our work is to evalu-
ate the prevalence of WE in two neighboring indigenous populations,
which had permanent contact and at different velocities of social
changes with the Brazilian population. Our work was carried out with
932 Xavante Indians of the São Marcos and Sangradouro reservations
and 152 Bororo Indians of the Meruri reservation, both in the state of
Mato Grosso, Brazil. The diagnosis of WE was confirmed by a body
mass index ≥ 25 kg/m2. Waist circumference (WC) was measured at
the midpoint between the lowest rib and the upper border of the
anterior superior iliac crest, with the individual in the standing posi-
tion. Continuous data were expressed as proportions, means, and
standard deviations.
RESULTS: The prevalence of WE in Bororo Indians was 70.4% (95%
CI 62.5–77.5), with 75.7% (95% CI 63.9–85.1) in women and 65.8%
(95% CI 54.5–75.9) in men. In Xavante Indians, the prevalence was
81.5% (95% CI 78.9–83.9), with 81.9% (95% CI 78.1–85.2) in women
and 81.2% (95% CI 77.3–84.6) in men. Regarding age, the prevalence
of WE in Xavante and Bororo was 88.9% (95% CI 85.9–91.5%) and
66.7% (95% CI 55.8–76.5) in the 18–39 years age-group; 91.9% (95%
CI 87.3–95.2) and 79.6% (95% CI 65.7–89.8) in the 40–59 years age-
group; and 49.2% (95% CI 41.9–56.5) and 62.5% (95% CI 35.4–84.8)
in the age-group over 60 years, respectively. Mean (± sd) WC for
women and men for Xavante Indians were 98.6 cm ± 11.1 vs 95.9 cm
± 10.4 (p < 0.01), respectively; and for Bororo Indians, it was 97.5 cm
± 11.8 vs 91.3 cm ± 11. 6 (p < 0.01), respectively.
CONCLUSION: The prevalence of WE in Xavante and Bororo Indians
was much higher than that in the general Brazilian population (55.4%).
This results from an intense change in their way of life, which
occurred in a very short period of time in the Xavante population, and
may explain the higher prevalence of WE when compared to the Bor-
oro population.
DISCLOSURE OF INTEREST: None Declared.
P391 | Plant-based diet quality and socio-
demographics and weight status among
Brazilian adults: The Brazilian nutrition and
health study (EBANS)
A. C. Leme1; R. M. Fisberg2; G. Gomez3; G. Ferrari4; A. P. Del'Arco5;
I. Kovalsky6; M. Fisberg7 ELANS group
1
Center for Excellence in Nutrition and Feeding Difficulties, PENSI
Institute, Sabará Children's Hospital, José Luiz Egydio Setúbal, São Paulo,
Brazil; 2Nutrition, School of Public Health, University of São Paulo, Sao
Paulo, Brazil; 3Universidad Costa Rica, San Jose, Costa Rica; 4Escuela de
Ciencias de la Actividad Física, el Deporte y la Salud, Universidad de
Santiago de Chile (USACH), Santiago, Chile; 5Pediatrics, Federal
University of Sao Paulo, Sao Paulo, Brazil; 6Medicine, Pontifical Catholic
1467789x, 2022, S2, Downloaded from https://onlinelibrary.wiley.com/doi/10.1111/obr.13503 by CAPES, Wiley Online Library on [16/12/2023]. See the Terms and Conditions (https://onlinelibrary.wiley.com/terms-and-conditions) on Wiley Online Library for rules of use; OA articles are governed by the applicable Creative Commons License
175 of 222
University of Argentina, Buenos Aires, Argentina; 7Center for Excellence
in Nutrition and Feeding Difficulties, PENSI Institute, Sabará Children's
Hospital, José Luiz Egydio Setúbal, Sao Paulo, Brazil
INTRODUCTION: Consumption of plant-based foods is increasing
worldwide, but the reasons may vary. There is evidence to support
the socio-demographic and weight status and plant-based diets, how-
ever, data from low- and middle-income countries, including Brazil is
still scarce. The aim was to assess the quality of plant-based vs. animal
foods in relation to the socio-demographic and weight status in a
Brazilian cross-sectional study.
MATERIALS AND METHODS: Data was from a population-based
cross-sectional study (Brazilian Study of Nutrition and Health – EBANS).
The EBANS was part of the Latin American Study of Nutrition and
Health (ELANS) a multi-centric study with 8 Latin American countries.
Dietary intake was collected using two 24 h dietary records. The diet
quality was evaluated using the adapted version of the Comprehensive
Diet Quality Index (cDQI) which assesses the quality of 17 foods based
on healthfulness, and separately scored the quality of 11 plant-based
foods in a plant-based Diet Quality Index (pDQI) and 6 animal foods in
animal-based Diet Quality Index (aDQI). Socio-demographic and weight
status were evaluated to verify possible associations with the indexes.
Descriptive statistics and linear regressions were calculated, considering
a 5% level of significance (p < 0.05).
RESULTS: The mean total score for the pDQI was 40.66 (out of 55)
(95%CI 40.69, 40.85), aDQI was 13.83/30 (95%CI 13.73, 13.92), and
for cDQI was 56.67/85 (95%CI 52.25, 56.10). Lower scores for the
pDQI were observed for adolescents (ß = 2.83; 95%CI -3.70,
1.95) and young adults (ß = 1.27; 95%CI -1.96, 0.56), being sin-
gle or living alone (ß = -0.73, 95%CI -1.10, 0.35), being white (ß = -
0.53; 95%CI -0.92, 0.14), being normal-weight (ß = 0.69, 95%CI
-1.17, 0.20) and overweight (ß = -0.65, 95%CI -1.14, 0.15) as
compared to their counterparts. Male participants (ß = 0.21, 95%CI
-0.40, 0.03) and those pursuing less than high-school degree
(ß = 0.42, 95%CI -0.76, 0.08) showed lower scores for aDQI.
CONCLUSION: Despite the intake of plant-based diets in the
Brazilian population, some of these components were not healthy
(e.g., sugar-sweetened beverages, refined grains, and sweets and
deserts). Adolescents and young adults, single/living alone, and people
living with overweight showed lower scores for pDQI. Future public
health policies and behavioral-change strategies should focus on
healthy and unhealthy plant-based food components.
DISCLOSURE OF INTEREST: None Declared.
 1467789x, 2022, S2, Downloaded from https://onlinelibrary.wiley.com/doi/10.1111/obr.13503 by CAPES, Wiley Online Library on [16/12/2023]. See the Terms and Conditions (https://onlinelibrary.wiley.com/terms-and-conditions) on Wiley Online Library for rules of use; OA articles are governed by the applicable Creative Commons License
176 of 222 SUPPLEMENT ARTICLE

P392 | Review on obesity management P393 | Content analysis of #postpartumbody

framework: The significance of psychological images posted to Instagram
and Behavioural theories in research and
clinical approaches M. L. Gow1,2; H. Jebeile1,3; N. Lister1,3; H. Roth4; H. Skouteris5;
H. Bergmeier5
M. Md-Yasin1; F. Ariffin2; H. Abd Hamid2; A. N. Mohd Yusof3; 1
Children's Hospital Westmead Clinical School, The University of Sydney,
4 5
K. Yusof ; A. Bulgiba Westmead, Australia; 2School of Women's and Children's Health,
1
Primary Care Medicine Department, Faculty of Medicine Universiti University of NSW, Sydney; 3The Institute of Endocrinology and Diabetes,
Teknologi MARA ( UiTM), Faculty of Medicine Universiti Teknologi MARA The Children's Hospital at Westmead, Westmead, Australia; 4Faculty of
2
( UiTM) Sg Buloh Campus Selangor, MALAYSIA; Primary Care Medicine Health, University of Technology Sydney, Sydney; 5Health and Social
Department, Faculty of Medicine Universiti Teknologi MARA ( UiTM), Care Unit, School of Public Health and Preventive Medicine, Monash
Primary Care Medicine Department, Faculty of Medicine Universiti University, Melbourne, Australia
Teknologi MARA (UiTM) Sg Buloh Campus Selangor, MALAYSIA;
3
Department of Medical Ethics and Law, Faculty of Medicine Universiti
INTRODUCTION: Instagram use is associated with negative impacts
Teknologi MARA, Selangor, Malaysia; 4Cardiology Department, Faculty of
on mood and body satisfaction in young women. This study 1)
Medicine Universiti Teknologi MARA (UiTM), Faculty of Medicine
describes the content of images on Instagram tagged with #postpar-
Universiti Teknologi MARA (UiTM) Sg Buloh Campus Selangor MALAYSIA,
tumbody and; 2) compares images from ‘Top’ posts with ‘Recent’
Selangor; 5Julius Centre University Malaya (JCUM), University of Malaya,
posts to determine engaging content.
Kuala Lumpur, MALAYSIA, Faculty of Medicine, University of Malaya,
MATERIALS AND METHODS: 600 images tagged with #postpartum-
Kuala Lumpur, MALAYSIA, Kuala Lumpur, Malaysia
body (300 ‘Top’ and 300 ‘Recent’) were systematically captured from
Instagram and coded using a predefined framework. Images of women
INTRODUCTION: Various theories and frameworks are developed were coded for adiposity, muscularity, pose and attire. Chi-square
for obesity management, which poses a challenge to stakeholders in tests were used to compare ‘Top’ and ‘Recent’ posts.
selecting the most appropriate framework for clinical management RESULTS: Most (n = 409) images were of a woman who generally
and research design. The aim of this article is to review the frame- had low/average adiposity (91%) and little-to-none/some visible mus-
works and theories used in obesity management research. cle definition (93%). Most women (52%) were posing in a non-specific
MATERIALS AND METHODS: This is a systematic literature search manner, 5% were posing to accentuate a postpartum body feature
that was conducted at baseline from February 2012 to February 2013 and 40% were wearing fitness attire. Compared with ‘Recent’, ‘Top’
to identify and evaluate all concepts, frameworks, and theories used posts were less likely to be text-focused (p < 0.001), photos of food
in obesity management published between 1986 and 2013. The sec- (p < 0.001) or linked to a product/program (p < 0.001).
ond systematic search of literatures were conducted to identify any CONCLUSION: Images of women on Instagram tagged with #postpar-
articles on “systematic or narrative review on obesity management tumbody do not reflect the actual population of women in the post-
framework or model” published between 2013–2021 to look for partum period, but rather present an ‘idealised’ version which may
updates. The databases used were Pubmed/Medline and CINAHL. contribute to body dissatisfaction. Conveying health information on
RESULTS: Baseline outcome showed, out of 276 articles related to obe- Instagram may be necessary to interrupt potentially harmful content.
sity management framework, 194 obesity management frameworks DISCLOSURE OF INTEREST: None Declared.
were identified. 32 frameworks were used repetitively in more than 1 lit-
erature and the topmost frequently used frameworks were Social Cogni-
tive Theory, Cognitive Behavioural Theory, Transtheoretical Model, Self-
Efficacy Theory and Theory of Planned Behaviour. Up to date there is
no systematic or narrative review on obesity management framework or
model article published. Hence, the novelty of this review.
CONCLUSION: Majority of the frameworks were used for interven-
tional studies and based on psychological and behavioural theories.
The most common domain is related to “person factors” which is cru-
cial in determining change within the person. This review acts as a
platform for framework or model used in obesity management.
DISCLOSURE OF INTEREST: None Declared.

SUPPLEMENT ARTICLE
P394 | The experience of living with obesity
for adults in Asian countries: A scoping
review of qualitative studies
N. A. Yunus1,2; G. Russell3; R. Muhamad2; T. L. Chai1;
M. A. F. Ahmad Zawawi4; E. Sturgiss1
1
School of Primary and Allied Health Care, Monash University Peninsular
Campus, Victoria, Australia; 2Department of Family Medicine, School of
Medical Sciences, Universiti Sains Malaysia, Kubang Kerian, Kelantan,
3
Malaysia; Department of General Practice, School of Public Health and
4
Preventive Medicine, Monash University, Victoria, Australia; Section 19
Health Clinic, Petaling Health Department, Shah Alam, Selangor,
Malaysia
INTRODUCTION: Patients' diverse experiences of living with obesity
are influenced by their varied social, cultural and biological back-
grounds. The lived experience of adults with obesity has often been
focused on in western countries, yet little is known about the lived
experience within the Asian socio-cultural context. This review aims
to identify and synthesise the qualitative evidence that explores the
lived experience of adults with obesity in Asian countries.
MATERIALS AND METHODS: Guided by the Joanna Briggs Institute
(JBI) approach, we systematically searched five databases (Medline,
Embase, PsychINFO, CINAHL and Scopus) for studies involving adults
with obesity in Asian countries that explored the concept of the lived
experience including the meaning of living with obesity, day-to-day
experience, people's feelings about their big body, and how living with
a big body affects people's lives. Studies exploring obesity with a spe-
cific health condition or evaluating a specific intervention were
excluded. Eligible studies published until June 2021 and full text avail-
able in English were included. Two reviewers screened titles/abstracts
and full texts. Findings were extracted and analysed using descriptive
qualitative content analysis and discussed among all co-authors.
RESULTS: A total of 16,764 articles were retrieved, with 136 screened
for full-text and 11 included for review. Articles were published
between 2012 and 2021; seven were published from 2018 onwards.
Various qualitative research designs were employed, but many did not
describe or justify their specific qualitative approach. Experience
around bariatric surgery was the most commonly explored concept,
with many newer studies focused on patients' experiences of adap-
tion to life after bariatric surgery. Preliminary analysis identified three
categories of lived experience: 1) cultural norms shaped the lived
experience of adults with obesity, 2) the influence of obesity on the
social relationship, and 3) coping with life challenges.
CONCLUSION: The lived experiences of adults with obesity in Asian
countries are strongly influenced by their social-cultural background and
have a high impact on their social relationships. However, studies on
adults' lived experience with obesity in Asian countries are scant and
report a limited description of the qualitative approach and findings.
Future research should fully report the qualitative methods to provide
contextual information on the ontology and epistemology of the study.
1467789x, 2022, S2, Downloaded from https://onlinelibrary.wiley.com/doi/10.1111/obr.13503 by CAPES, Wiley Online Library on [16/12/2023]. See the Terms and Conditions (https://onlinelibrary.wiley.com/terms-and-conditions) on Wiley Online Library for rules of use; OA articles are governed by the applicable Creative Commons License
177 of 222
The influence of the socio-cultural background on people's lived experi-
ence with obesity, particularly in Asia, should be explored further.
DISCLOSURE OF INTEREST: None Declared.
P395 | Management of Eating Disorders for
people with higher weight: Clinical practice
guidelines
A. F. Ralph1; L. Brennan2; S. Byrne3; B. Caldwell4; J. Farmer5;
L. M. Hart6; G. A. Heruc7; S. Maguire8; M. K. Piya9; J. Quin5;
S. K. Trobe10; A. Wallis11; A. Williams-Tchen5; P. Hay12
1
National Eating Disorders Collaboration, Sydney; 2School of Psychology
and Public Health, La Trobe University, Wodonga, Australia; 3Department
of Psychology, University of Western Australia, Perth; 4Eating Disorders
Victoria; 5Lived Experience Advocate; 6Centre for Mental Health,
Melbourne School of Population and Global Health, University of
Melbourne, Melbourne; 7Eating disorders and Nutrition Research Group
(ENRG), School of Medicine, Western Sydney University; 8InsideOut
Institute for Eating Disorders, The University of Sydney; 9School of
Medicine, Western Sydney University, Sydney; 10National Eating
Disorders Collaboation, Melbourne; 11Sydney Children's Hospitals
Network, The Children's Hospital Westmead; 12Eating Disorders and
Body Image (EDBI), Translational Health Research Institute, School of
Medicine, Sydney, Australia
INTRODUCTION: The prevalence of eating disorders is high in people
with higher weight, particularly those presenting for weight-loss and with
metabolic co-morbidities. Despite this, there is little to guide clinicians in
the management of eating disorders in this population. The aim of this
guideline is to synthesise the current best practice approaches to the
management of eating disorders in people with higher weight and make
evidence-based clinical practice recommendations.
MATERIALS AND METHODS: The National Eating Disorders Collabo-
ration Steering Committee auspiced a Development Group for Clinical
Practice Guidelines of the treatment of eating disorders for people with
higher weight. The Development Group followed the ‘Guidelines for
Guidelines’ process outlined by the National Health and Medical
Research Council.
The development group included people with clinical and/or aca-
demic expertise and/or lived experience. The guideline has undergone
extensive peer review and consultation over an 18-month period
involving reviews by key stakeholders, including experts and organisa-
tions with clinical, academic and/or lived experience.
RESULTS: Twenty-one clinical recommendations are made and
graded according to the National Health and Medical Research Coun-
cil evidence grades. Strong recommendations were supported for psy-
chological treatment as a first-line treatment approach adults (with
bulimia nervosa or binge eating disorder), adolescents and children.
Clinical considerations such as weight stigma, interprofessional collab-
orative practice and cultural considerations are also discussed.

178 of 222
CONCLUSION: This guideline fills an important gap in the need to
better understand and care for people experiencing eating disorders
who also have higher weight. The guideline acknowledges deficits in
knowledge and consequently the reliance on consensus and lower
levels of evidence for many recommendations, and the need for
research particularly evaluating weight-neutral and other more recent
approaches in this field.
DISCLOSURE OF INTEREST: A. F. Ralph: None Declared, L. Brennan:
None Declared, S. Byrne: None Declared, B. Caldwell: None Declared,
J. Farmer: None Declared, L. M. Hart: None Declared, G. A. Heruc: None
Declared, S. Maguire: None Declared, M. K. Piya: None Declared,
J. Quin: None Declared, S. K. Trobe: None Declared, A. Wallis: None
Declared, A. Williams-Tchen: None Declared, P. Hay Consultant for:
Takeda pharmaceuticals.
P396 | Combining indigenous knowledge
with group model building systems mapping
methods to build community capacity and
promote solutions that take into account
underlying social inequities
P. McKelvie-Sebileau1,2; D. Rees3; D. Tipene-Leach2; E. D'Souza4;
B. Swinburn1; S. Gerritsen1
1
University of Auckland, Auckland, New Zealand; 2Eastern Institute of
3 4
Technology, Taradale; Synergia Ltd; Auckland University of Technology,
Auckland, New Zealand
INTRODUCTION: Children's nutrition is highly influenced by
community-level deprivation and disparities in health outcomes con-
tinue to increase. Childhood obesity in New Zealand (NZ) is no excep-
tion with children living in the most deprived neighbourhoods 2.5
times more likely to have obesity than children in the least deprived
neighbourhoods (NZ Health Survey 2020/21). Public health initiatives
incorporating systems thinking can engage communities to develop
new knowledge and increase commitments to health improvement at
the community level, yet few studies describe the use of these
methods when working with Indigenous communities.
MATERIALS AND METHODS: We applied the formal structure of
Group Model Building (GMB) workshops, embedded within an Indige-
nous worldview to engage a high deprivation, high Indigenous population
regional community in NZ to improve children's nutrition. Three GMB
workshops were held to create systems maps of the drivers and feed-
back loops of poor nutrition in the community. M
aori Indigenous knowl-
edge (matauranga) and approaches (tikanga) were prioritized to ensure
cultural safety of participants and to encourage identification of interven-
tions that take into account social and cultural environmental factors.
RESULTS: 19 youth and 26 adult stakeholders participated. The youth
visual map comprised of 13 reinforcing causal loops (CLD) and the adult
map comprised of 10 reinforcing and 1 balancing CLD. While the adult-
constructed map focused more on the influence of societal factors such
as cost of housing, financial literacy in communities, and social security,
1467789x, 2022, S2, Downloaded from https://onlinelibrary.wiley.com/doi/10.1111/obr.13503 by CAPES, Wiley Online Library on [16/12/2023]. See the Terms and Conditions (https://onlinelibrary.wiley.com/terms-and-conditions) on Wiley Online Library for rules of use; OA articles are governed by the applicable Creative Commons License
SUPPLEMENT ARTICLE
the youth-constructed map placed more emphasis on individual-
environment factors such as the influence of marketing by the fast-food
industry and mental wellbeing. Both systems maps included cultural iden-
tity and Indigenous knowledge as factors influencing community nutri-
tional patterns. Ten prioritized community-proposed interventions were
identified such as increasing cultural connections in schools and the fea-
sibility and likely impact for change of each intervention was rated.
CONCLUSION: Systems mapping with youth and adults provides
important insights into understandings and perceptions of drivers of
poor nutrition which can assist future interventions. The combination
of community-based system dynamics methods of Group Model
Building and a matauranga M
aori worldview is a novel Indigenous sys-
tems approach that engages participants and highlights cultural and
family issues in the systems maps, acknowledging the ongoing impact
of historical colonization in our communities.
DISCLOSURE OF INTEREST: None Declared.
P397 | How do youth really use their digital
devices? Insights from the bedtime and
electronic devices (BED) study
S.-R. Wickham1; B. Brosnan1; K. Meredith-Jones1; B. Galland2;
J. Haszard3; R. Taylor1
1
Medicine; 2Women and Childrens Health; 3Biostatistics, University of
Otago, Dunedin, New Zealand
INTRODUCTION: Not getting enough sleep increases the risk of obe-
sity in children and adolescents. One of the major factors thought to
delay the onset of sleep is the use of electronic devices before bed.
However, current measurement of screen use is limited to crude
questionnaires which are likely unable to accurately quantify screen
use, determine if passive or more interactive behaviours matter, or
assess multitasking or multiple device use, all thought to be important.
The aim of this study was to investigate how youth use digital devices
before bed using video footage.
MATERIALS AND METHODS: Data from the Bedtime and Electronic
Devices (BED) study was used, which recruited 85 children aged 11–
14 years, and measured device use from 3 hours before bed until they
got up in the morning, on four nights (weekdays and weekends) over
the course of one week. Device use was measured using wearable
cameras (Patrol Eyes SC-DV7 Ultra camera on a chest harness facing
outwards) prior to sleep and a stationary camera (same camera with
infrared mode) mounted on a tripod in the bedroom overnight. Foot-
age will be coded using a coding schedule shown to reliably (Cohen's
k ≥ 0.8) discriminate between ten different types of screen behaviours
including social media, browsing the internet, watching, and gaming.
RESULTS: Video examples will be presented illustrating several
aspects of device use in this population that are unlikely to be cap-
tured by questionnaires, such as: 1) the highly individualistic nature of
screen use in children, 2) the speed at which children interact with
their devices and switch between different devices and behaviours, 3)

SUPPLEMENT ARTICLE
the ubiquity of multitasking both within and across devices, and 4) the
frequency of phone notifications. Being able to measure such behav-
iours is important for improving our understanding of screen use in
general, and particularly in relation to device use prior to sleep.
CONCLUSION: The impact of screen time on health is of interest to a
variety of fields, but our measurement of screen time is currently
poor. This novel video footage can objectively illustrate the complex
and dynamic way youth interact with digital media, which is highly
variable, incredibly rapid, and very difficult to measure by question-
naire. Future analyses will quantify the different screen behaviours
and determine how each is related to subsequent sleep in an effort to
explain why short sleep increases the risk of obesity in children.
DISCLOSURE OF INTEREST: None Declared.
P399 | Bayesian network modelling to
identify on-ramps to childhood obesity
W. Zhu1; R. Marchant2; R. Morris1; L. Baur1,3; S. Simpson1; S. Cripps2
1
The University of Sydney; 2CSIRO; 3The Children's Hospital at
Westmead, Sydney, Australia
INTRODUCTION: When tackling complex public health challenges
such as childhood obesity, interventions focused on immediate
causes, such as poor diet and physical inactivity, have had limited suc-
cess, largely because upstream root causes remain unresolved. A pri-
ority is to develop new modelling frameworks to map the causal
structure of complex chronic disease networks, allowing disease “on-
ramps” to be identified and targeted.
MATERIALS AND METHODS: We employed Bayesian Network anal-
ysis on data from The Longitudinal Study of Australian Children to
conduct a causal analysis of the network of factors leading to child-
hood obesity. We used the structure of these networks, known as
Directed Acyclic Graphs (DAGs), to track over time the nature and
direction of dependencies leading to childhood obesity. We per-
formed inferences based on the posterior distribution of the DAGs,
estimated using Partition Markov chain Monte Carlo.
RESULTS: For each time point, socio-economic status sat centrally in
the DAG structure, implying that socio-economic status drives the
network structure. When socio-economic status was missing from a
dataset[lo1], parental high school level became the central node for
the network. For children under age 8y, the most influential direct
causal factors explaining child body mass index were birth weight and
parents' body mass index. After age 8y, free time activity became an
important driver of obesity, while the upstream factors influencing
free time activity for boys compared with girls were different.
CONCLUSION: Childhood obesity was largely a function of socio-
economic status, which manifested via numerous downstream factors.
Parental high school levels entangle with socio-economic status,
hence an on-ramp to childhood obesity. The strong and independent
causal relationship between birth weight and childhood body mass
index suggests a biological link. Our study implies that interventions
1467789x, 2022, S2, Downloaded from https://onlinelibrary.wiley.com/doi/10.1111/obr.13503 by CAPES, Wiley Online Library on [16/12/2023]. See the Terms and Conditions (https://onlinelibrary.wiley.com/terms-and-conditions) on Wiley Online Library for rules of use; OA articles are governed by the applicable Creative Commons License
179 of 222
targeted at increasing high school completion rates may be effective
in reducing childhood obesity prevalence.
DISCLOSURE OF INTEREST: None Declared.
P400 | Poor dental utilisation in those with
clinically severe obesity - a neglected issue
with solutions needed
Z. Malik1; W. Sohn1; S. Nanayakkara1; K. Williams2,3
1
School of Dentistry, Faculty of Medicine and Health, The University of
Sydney, NSW, Australia; 2Nepean Blue Mountains Family Metabolic
Health Service (NBMFMHS), Nepean Blue Mountains Local Health
District, Kingswood; 3Charles Perkins Centre-Nepean, The University of
Sydney, NSW, Australia
INTRODUCTION: Some studies report poor oral health in people with
obesity when compared to the background population. Data linking
body mass index (BMI) and dental utilisation with oral and general
health, quality of life, wellbeing and mental health are lacking. This
study aimed to explore the relationship between BMI and these
parameters in individuals attending a hospital-based obesity service.
MATERIALS AND METHODS: This study was a single-site project.
Ethics approval was gained from the Nepean Blue Mountains Local
Health District Human Research Ethics Committee (project number:
2018/ETH00353). Adult patients of a hospital-based obesity service
in Greater Western Sydney with clinically severe obesity were invited
to participate in a self-administered survey cross sectional study,
which collected data on dental utilisation, dental anxiety and oral
health related quality of life (OHRQoL). Data on general health was
obtained from the participants' medical records.
RESULTS: Of the 82 individuals who consented to participate,
81 (98.8%) completed the study questionnaire and 74 (91.3%)
answered additional screening questions relating to their general well-
being and mental health. Of participants, 50 (61.7%) reported that
their last dental visit was more than one year ago and 24 (29.6%) par-
ticipants reported high levels of dental anxiety. There were fair to high
levels of OHRQoL (IQR 4.5–20.5). Screening questions suggested low
general wellbeing and poor mental health in this patient cohort.
Within this group, BMI was not significantly correlated with any of
the variables of dental utilisation, dental anxiety, OHRQoL, wellbeing
or mental health (p > 0.05). There was a negative correlation between
dental anxiety and dental utilisation (p < 0.05).
CONCLUSION: Patients with clinically severe obesity reported poor
dental utilisation and high levels of dental anxiety. The study high-
lights the frequency of medical complications, lack of wellbeing and
poor mental health which were evident in this cohort and which may
complicate dental management.
DISCLOSURE OF INTEREST: Z. Malik: None Declared, W. Sohn: None
Declared, S. Nanayakkara: None Declared, K. Williams Grant/Research
support with: Novo Nordisk, Pfizer and Lilly outside the submitted work,
Paid Instructor for: Clinical Lead and Manager of the Nepean Blue Moun-
tains Family Metabolic Health Service.

180 of 222
LBP01 | Association of serum leptin with
obesity associated type 2 diabetes
S. Akter1; H. Akhter2; H. S. Chaudhury3; L. Ali4
1
Department of Biochemistry and Molecular Biology, School of Medicine,
Kyung Hee University, Seoul, Republic of Korea; 2Biomedical and
Toxicological Research Institute, Bangladesh Council of Scientific and
Industrial Research, Dhaka, Bangladesh; 3Department of Biochemistry,
International Medical College Hospital, Tongi, Bangladesh; 4Pothikrit
Institute of Health Studies, Dhaka, Bangladesh
INTRODUCTION: Leptin is a multifunctional peptide hormone which
may be implicated in the pathogenesis of obesity associated comor-
bidities like type 2 diabetes by influencing insulin secretion or sensi-
tivity. Therefore, the present study was designed to analyze insulin
secretory defect in relation to leptin level in obese subjects.
MATERIALS AND METHODS: A cross‐sectional analytical study
included forty‐one (41) obese subjects and eighty (80) age‐matched
healthy control. Anthropometric and biochemical parameters were
measured following standard procedures. Circulating fasting insulin
and leptin level were assayed by enzyme‐linked immunoassay (ELISA).
Beta‐cell function (HOMA%B) and insulin sensitivity (HOMA%S) were
calculated by the HOMA‐CIGMA software.
RESULTS: The obese subjects showed significantly higher serum lep-
tin level [13.63 (0.65–55.31) versus 4.92 (0.65–42.84), p = 0.001],
fasting insulin [50.72 (14.99–149.77) versus 34.28 (12.41–169.12), p
= 0.014)], SBP (112.68 ± 10.13 versus 107.75 ± 10.40, p < 0.01), DBP
(76.46 ± 6.73 versus 71.75 ± 8.68, p < 0.01), and serum TG [156(50–
681) versus 115 (49–600), p < 0.01) compared with healthy controls.
The serum leptin level was positively correlated with BMI, triceps,
subscapular skinfold thickness, waist circumferences, body fat per-
centages, fat mass, fasting insulin, HOMA%B, phase I and phase II
insulin secretion and negatively with serum creatinine, uric acid, and
HOMA%S. In binary logistic regression, leptin independently predict
obesity by adjusting confounding variables.
CONCLUSION: The study conclude that serum leptin level was asso-
ciated with pathogenesis of obesity related type 2 diabetes. The
results need to be confirmed in larger datasets.
DISCLOSURE OF INTEREST: None declared.
LBP02 | Withdrawn
LBP03 | Withdrawn
LBP04 | Withdrawn
1467789x, 2022, S2, Downloaded from https://onlinelibrary.wiley.com/doi/10.1111/obr.13503 by CAPES, Wiley Online Library on [16/12/2023]. See the Terms and Conditions (https://onlinelibrary.wiley.com/terms-and-conditions) on Wiley Online Library for rules of use; OA articles are governed by the applicable Creative Commons License
SUPPLEMENT ARTICLE
LBP05 | The programming effects of maternal
obesity on offspring are exacerbated by adult
exposure to a high‐fat, high‐sugar “Cafeteria”
diet
A. Tajaddini; M. D. Kendig; K. Hasebe; M. Billah; M. J. Morris
School of Medical Sciences, UNSW, Sydney, New South Wales, Australia
INTRODUCTION: Maternal obesity has well‐established effects on
offspring health, increasing the risk of complications in childhood.
However, whether offspring born to mothers with obesity are more
susceptible to unhealthy diet exposure later in life needs further
investigation. Therefore, we assessed the effects of maternal expo-
sure to a high‐fat, high‐sugar ‘cafeteria (Caf) diet on food intake and
metabolic measures in adult offspring fed chow or Caf diet.
MATERIALS AND METHODS: Adult female Sprague Dawley rats
were fed standard chow (n = 10) or Caf (n = 15) diet during prepreg-
nancy, gestation, and lactation. On PND 20, male and female offspring
were weaned onto chow diet until 9 weeks of age, when siblings from
chow and Caf dams either continued on chow or switched to Caf diet
(1‐2/sex/litter) for five more weeks.
RESULTS: Caf diet accelerated premating weight gain, but during ges-
tation, chow and Caf dams gained weight comparably. During lacta-
tion, the Caf group lost weight thus body weights of the diet groups
converged at weaning. During lactation, Caf fed dams consumed
greater amounts of fat, but approximately 35% less protein than chow
fed dams. Caf fed dams had greater brown adipose tissue (BAT) and
retroperitoneal (RP) fat mass, as well as higher blood glucose and
plasma leptin levels at the end of lactation. Liver glutathione peroxi-
dase (GPx) was increased in Caf versus control fed dams; there were
no differences in liver triglyceride, superoxide dismutase (SOD), and
catalase (CAT) levels. Male and female offspring from Caf‐fed dams
were smaller at birth. Maternal Caf diet was associated with higher
levels of glucose and leptin in both sexes at weaning, with no effect
on insulin. Liver triglyceride content was also increased in offspring of
Caf dams with no significant differences in liver antioxidant enzymes.
At 3 and 7 weeks of age, fat mass was higher in offspring of Caf fed
dams, despite no differences in body weight relative to chow
offspring. After switching to Caf diet at 9 weeks, offspring born to Caf
fed dams exhibited elevated body weight and fat mass, with more
pronounced effects in females. At 14 weeks, males from Caf‐fed dams
exhibited increased body weight and adiposity relative to offspring
from chow dams. In females, only RP fat mass was increased.
CONCLUSION: Overall, our findings suggest that maternal obesity
induced by Caf diet produces a programming effect on offspring in
both sexes characterized by elevated adiposity in early life, despite
similar body weights. Data suggest a latent vulnerability to obesogenic
diet exposure in offspring born to Caf‐fed dams. Current work is
exploring hepatic gene changes induced by maternal obesity using
RNA sequencing in young and adult offspring.
DISCLOSURE OF INTEREST: None declared.

SUPPLEMENT ARTICLE
LBP06 | Effect of dietary fiber intake on the
incidence of type 2 diabetes: Evidence from
Melbourne collaborative cohort study
(MCCS)
R. Kabthymer1; M. N. Karim2; A. Hodge3,4; B. Decourten1,5
1
Medicine; 2School of Public Health, Monash University, Melbourne,
3 2
Victoria, Australia; Cancer Epidemiology Division, Cancer Council
Victoria, Melbourne, Victoria, Australia; 4Centre for Epidemiology and
Biostatistics, Melbourne School of Population and Global Health,
University of Melbourne, Melbourne, Victoria, Australia; 5School of
Health and Biomedical Sciences, RMIT University, Melbourne, Victoria,
Australia
INTRODUCTION: Healthy diet is a cornerstone of prevention of type
2 diabetes. With growing evidence on the roles of different fiber
types on health, we aimed to assess the effects of total dietary and
different fiber types on the risk of diabetes.
MATERIALS AND METHODS: The Melbourne Collaborative Cohort
Study (MCCS) enrolled 41,513 participants 40‐69 years of age from
1990 to 1994. The first and second follow‐ups were conducted in
1994–1998 and 2003–2007. Self‐reported diabetes incidence was
recorded at both follow‐ups. We analyzed data from 39,185 partici-
pants with a mean of 13.8 years of follow‐up. The relationships
between dietary fiber intake (total, fruit, vegetable, and cereal fiber)
and the incidence of diabetes were assessed using Poisson regression,
adjusted for dietary, lifestyle obesity, socioeconomic, and other possi-
ble confounders. Fiber intakes were categorized into quintiles.
RESULTS: Total fiber intake was not associated with diabetes risk.
Higher intakes of cereal fiber (p for trend=0.003 but not fruit (p for
trend=0.3) and vegetable (p for trend =0.5) fiber intakes were protec-
tive against diabetes. For cereal fiber, quintile 5 versus quintile 1
showed a 19% reduction in diabetes risk IRR=0.81 (95% CI: 0.72‐
0.96). For fruit fiber, only the second quintile showed association, only
quintile 2 versus quintile 1 showed a 16% risk reduction IRR=0.84
(95% CI: 0.73‐0.96).
CONCLUSION: Intakes of cereal fiber and to a lesser extent fruit fiber
may reduce the risk of diabetes, while total fiber showed no associa-
tion. These results suggest that more specific recommendations
regarding dietary fiber intake may be needed to prevent diabetes. In
addition, results imply the need for further study on the specialized
effects of different fiber types on health problems.
DISCLOSURE OF INTEREST: None declared.
1467789x, 2022, S2, Downloaded from https://onlinelibrary.wiley.com/doi/10.1111/obr.13503 by CAPES, Wiley Online Library on [16/12/2023]. See the Terms and Conditions (https://onlinelibrary.wiley.com/terms-and-conditions) on Wiley Online Library for rules of use; OA articles are governed by the applicable Creative Commons License
181 of 222
LBP07 | Exploration of diet, physical activity,
health knowledge, and the cardiometabolic
profile of young adults with intellectual
disability
C. Zwack1,2; E. Lambert1; G. Lambert1; R. McDonald1
1
Swinburne University of Technology, Melbourne, Victoria, Australia;
University of Sydney, Sydney, New South Wales, Australia
INTRODUCTION: People with intellectual disability (ID) face numer-
ous health inequities, and despite increased awareness initiatives over
recent decades, their health status remains poor. The discrepancies in
health manifest in health care access, reduced life expectancy,
increased prevalence of chronic health conditions, and unmet health
needs. Young adults with ID seem to be at high risk of having adverse
health outcomes and recent figures indicated they are four times
more likely to experience premature mortality than those without ID.
Recent studies in this cohort have revealed that young adults with ID
demonstrate an increased prevalence of subclinical and environmental
factors related to CVD development. To further develop a clear
understanding of their cardiometabolic profile, this exploratory study
aims to determine the prevalence of modifiable risk factors, such as
physical activity, diet and associated health knowledge in adults with
ID aged 18–45 years.
MATERIALS AND METHODS: We investigated the association
between modifiable risk factors and cardiometabolic health profile in
adults with ID (n = 39) aged 18–45 years and compared them controls
without ID (n = 38). Cardiometabolic health was assessed through
clinical evaluation of traditional parameters (e.g. blood pressure, BMI,
waist circumference, fasting glucose) and assessment of physical
activity levels, diet, and associated health knowledge using self‐report,
the Food Choice Questionnaire and modified Nutrition and Activity
Knowledge Survey (NAKS), respectively.
RESULTS: We found that young adults with ID have an increased
obesity (mean body mass index; ID group: 32.9 ± 8.6 vs. control
group: 26.2 ± 5.5, P = 0.001) are engaging in less physical activity than
the age‐matched general population (total activity minutes per week;
ID group: 172.2 ± 148.9 vs. control group: 416.4 ± 277.1, P < 0.001),
and overall have unhealthier diets. Additionally, knowledge about
nutrition and physical activity appears to be an important predictor of
cardiometabolic risk in this population. Multiple regression analysis
with all participants showed that total NAKS score significantly
predicted participants with ID (β = −1.680, p = 0.015), Hba1c levels
(β = 0.137, p = 0.029), waist circumference (β = 0.030, p = 0.034), and
fasting glucose levels (β = −1.426, p = 0.004).
CONCLUSION: Issues identified in this study include obesity and the
factors relating to the condition, including low levels of activity and
unhealthy diet. Other concerns are metabolic risk factors including
impaired glycaemic control and elevated heart rate, highlighting that
these may be important clinical measures for assessing cardiometa-
bolic risk in young adults with IDs. Further exploration into the devel-
opment and implementation of a health promotion program specific

182 of 222
for young people with ID will be of great benefit to their cardiometa-
bolic health outcomes.
DISCLOSURE OF INTEREST: None declared.
LBP08 | Withdrawn
LBP09 | Withdrawn
LBP10 | The acute effects of self‐myofascial
release on fundamental physical activity
movement patterns
I. M. Brown; D. K. Cancado; B. L. Chase; E. H. Nakachi; J. D. Reece
Brigham Young University Hawaii, Laie, Hawaii, USA
INTRODUCTION: Flexibility improves physical activity movement
patterns, but the acute effects of self‐myofascial release (SMR) on
these movement patterns are less known. The aim of this study was
to determine the acute effects of SMR on movements required for
daily living.
MATERIALS AND METHODS: This study was a cross‐over design
(n = 30) with a convenient random sample, equally representing
females and males. The order of treatments was randomly assigned
with a one week washout period between treatments. Each treatment
was preceded by a five minute dynamic warm up, followed by a pre‐
test of movement patterns, treatment, and then posttest. Movement
patterns were defined by using the Functional Movement Screen
(FMS) composite score and range of motion for the lower trunk
muscles including both the sit and reach (SR) box test and the Glute
Ham Developer (GHD) back extension test. The treatment SMR used
a high‐density foam roller and the control treatment was static
stretching (cSS). Each treatment lasted 5 min and included a total of
five different movements.
RESULTS: Paired samples t‐test revealed that SMR had an acute
significant improvement on FMS (MD 1.32 ± 1.19, P < 0.001,
d = 1.10), SR (2.88 ± 4.21, P < 0.001, d = 0.68), and GHD (9.57 ± 8.04,
P < 0.001, d = 1.19) scores. Paired samples t‐test revealed that cSS
only had an acute significant improvement in FMS (MD 0.52 ± 0.79,
P = 0.001, d = 0.65), SR (2.36 ± 3.59, P = 0.001, d = 0.66) but not
GHD (1.31 ± 7.98, P = 0.376, d = 0.16) scores.
CONCLUSION: The current study demonstrates that SMR appears to
have a positive acute effect on everyday movement patterns and can
be an alternative to static stretching. Future studies may investigate
the training effect of SMR on levels of physical activity and mobility
patterns.
DISCLOSURE OF INTEREST: None declared.
1467789x, 2022, S2, Downloaded from https://onlinelibrary.wiley.com/doi/10.1111/obr.13503 by CAPES, Wiley Online Library on [16/12/2023]. See the Terms and Conditions (https://onlinelibrary.wiley.com/terms-and-conditions) on Wiley Online Library for rules of use; OA articles are governed by the applicable Creative Commons License
SUPPLEMENT ARTICLE
LBP11 | Withdrawn
LBP12 | A feasibility study of a moderately
reduced‐carbohydrate intervention designed
to prevent gestational diabetes
M. Michalopoulou1,2; S. A. Jebb1,2; L. Mackillop3,4; P. Dyson2,5;
J. E. Hirst3,4; N. M. Astbury1,2
1
Nuffield Department of Primary Care Health Sciences, University of
Oxford, Oxford, UK; 2Oxford Biomedical Research Centre, National
Institute for Health Research (NIHR), Oxford, UK; 3Nuffield Department
of Women’s and Reproductive Health, University of Oxford, Oxford, UK;
4
Oxford University Hospitals NHS Foundation Trust, Oxford, UK; 5Oxford
Centre for Diabetes Endocrinology and Metabolism (OCDEM), University
of Oxford, Oxford, UK
INTRODUCTION: Carrying or gaining excessive weight during
pregnancy increases the chances of developing gestational diabetes
mellitus (GDM). Low‐carbohydrate diets have shown promise for
blood glucose and weight control in people with type 2 diabetes, but
there is no evidence to support their use in pregnancy. Here we
report preliminary results from a feasibility trial of a moderately
reduced‐carbohydrate intervention, designed to prevent GDM.
MATERIALS AND METHODS: Fifty‐one individuals who were
pregnant <20 weeks' gestation, with body mass index ≥30 kg/m2, and
a negative baseline oral glucose tolerance test (OGTT), were random-
ized 2:1 to a moderately reduced‐carbohydrate intervention or control
(usual care). The dietary plan aimed to provide 130–150 g carbohy-
drate/day based on 3R's: Refrain from sugary foods and drinks,
Reduce portions of starchy carbohydrates, and Replace refined star-
chy carbohydrates with unrefined varieties and sugary foods/drinks,
with low/no‐sugar alternatives. The program combined a 30‐min
consultation with a healthcare professional, with structured written
information, supplemented by up to six 10‐ to 15‐min telephone ses-
sions for support as needed. The feasibility outcomes were as follows:
(1) adoption of the reduced‐carbohydrate advice by the intervention
group and (2) retention of participants, assessed by completion of a
second OGTT at 24–28 weeks' gestation. Secondary outcomes
intended to provide preliminary evidence of potential effectiveness
included gestational weight gain and blood glucose control.
RESULTS: Fifty of 51 participants attended the follow‐up OGTT.
Carbohydrate intake at follow‐up was 188 g/day (95% CI, 159 to 217)
in the intervention and 200 g/day (95% CI, 160 to 240) in the control
group, a difference of −28 and −20 g/day from baseline, respectively.
Mean (±SD) weight gain in the intervention group from baseline to
follow‐up was 2.8 kg (±2.7), compared with 4.4 kg (±3.0) in the control
group. Mean (±SD) fasting plasma glucose was 4.4 mmol/L (±0.4) in
both groups at baseline and was unchanged at follow‐up (4.6 mmol/L
(±0.4) and 4.5 mmol/L (±0.5) in intervention and control, respectively).
Mean (±SD) 2‐h glucose was 5.4 mmol/L (±1.2) and 5.1 mmol/L (±1.0)

SUPPLEMENT ARTICLE
at baseline and 5.9 mmol/L (±1.3) and 5.8 mmol/L (±1.3) at follow‐up
in intervention and control groups, respectively.
CONCLUSION: Retention of participants was high suggesting the
study design is feasible, but the reduction in carbohydrate intake was
small, and did not meet pre‐specified progression criteria, limiting the
likelihood of achieving the desired goal to prevent GDM.
DISCLOSURE OF INTEREST: M. Michalopoulou: None Declared, S.
A. Jebb: None Declared, L. Mackillop Employee of: LM is a part‐time
employee of EMIS Group plc., P. Dyson: None Declared, J. E. Hirst:
None Declared, N. M. Astbury: None Declared
LBP13 | Withdrawn
1467789x, 2022, S2, Downloaded from https://onlinelibrary.wiley.com/doi/10.1111/obr.13503 by CAPES, Wiley Online Library on [16/12/2023]. See the Terms and Conditions (https://onlinelibrary.wiley.com/terms-and-conditions) on Wiley Online Library for rules of use; OA articles are governed by the applicable Creative Commons License
183 of 222
LBP14 | The exploitation of crowd‐sourcing
for collecting new branded food data in
Slovenia using VešKajJeš mobile application
A. Kušar1; I. Pravst1,2,3; E. Hafner1; M. Hribar1; K. Žmitek1,3;
B. Blažica4; B. Koroušić Seljak5
1
Nutrition institute, Tržaška cesta 40, SI‐1000 Ljubljana, Ljubljana,
Slovenia; 2Biotechnical Faculty, University of Ljubljana, Jamnikarjeva
101, SI‐1000 Ljubljana, Ljubljana, Slovenia; 3VIST–Faculty of Applied
Sciences, Gerbičeva cesta 51A, SI‐1000 Ljubljana, Ljubljana, Slovenia;
4
Jožef Stefan Institute, Ljubljana, Slovenia; 5Jožef Stefan Institute,
Jamova cesta 39, SI‐1000, Ljubljana, Slovenia
INTRODUCTION: Branded foods databases are very valuable both
for nutrition research and policymakers—also enabling monitoring
changes in the food supply. However, compilation of such datasets is
challenging due to rapid changes in the food supply. In Slovenia, we
use a standardized approach for collection of data in food stores,
while in 2019 we also started with crowd‐sourcing method, using
VešKajJeš (VKJ) mobile application. Our objective was to exploit the

184 of 222
potential of crowd‐sourcing by comparing datasets compiled with
both approaches.
MATERIALS AND METHODS: Two datasets were used [1]: CLAS
(Food Composition and Labelling Information System) dataset with
branded food composition data, collected in Slovenian food stores in
2020, and VKJ dataset, collected with the use of crowdsourcing with
the mobile app VKJ (2019–2020). Comparisons were conducted for
selected food categories that are especially important for reformula-
tion strategies (soft drinks; breakfast cereals and yoghurt products),
and this abstract focused in energy value. Wilcoxon's test was used to
check for differences between datasets; significance was set at p <
0.05.
RESULTS: The CLAS dataset from food monitoring study (n = 3,077)
was notably larger than VKJ crowd‐sourcing dataset (n = 709). In Bev-
erages, we observed some significant differences for the subcategories
of nectars (p = 0.003) and soft drinks (p = 0.015), while no significant
differences were observed in category Breakfast cereals. In Beverages,
median energy value was 33.7 kJ/100 ml for both datasets. The dif-
ference in median energy value in Breakfast cereals was minor (387.1
vs. 388.1 kJ/100g for VKJ and CLAS, respectively). Yoghurts was the
only food category in our comparison, where a significant difference
was observed between both datasets on the level of main food cate-
gory, with slightly higher median energy value observed in the crowd‐
sourced VKJ dataset (84.6 vs. 82.5 kJ/100g). Subcategory analyses
showed that differences originate particularly from flavored yoghurts
and yoghurt imitates.
CONCLUSION: Considering that both datasets were collected on the
same market and in comparable time‐period, the observed differences
are originating from the used approach for data collection. While stan-
dard food supply study in food stores collected data for all the avail-
able products, regardless of their market‐share, crowd‐sourcing more
likely results in more popular products, with higher market share. Nev-
ertheless, crowd‐sourcing was shown as a very useful method to sup-
plement branded food datasets.
Funding: EU Horizon 2020 Project “FNS‐Cloud“(GA 863059) and
SRA national research program P3‐0395.
REFERENCES:
[1] Pravst I et al. Front. Nutr. 2022; 8:798576.
DISCLOSURE OF INTEREST: None declared.
1467789x, 2022, S2, Downloaded from https://onlinelibrary.wiley.com/doi/10.1111/obr.13503 by CAPES, Wiley Online Library on [16/12/2023]. See the Terms and Conditions (https://onlinelibrary.wiley.com/terms-and-conditions) on Wiley Online Library for rules of use; OA articles are governed by the applicable Creative Commons License
SUPPLEMENT ARTICLE
LBP15 | Diet quality and 21‐year cumulative
healthcare claims and charges associations
among Australian women
J. Baldwin; E. Clarke; C. Collins
The University of Newcastle, Callaghan, Australia
INTRODUCTION: Understanding the associations between diet qual-
ity and healthcare use can help influence healthcare policy and public
health priorities. However, few studies have explored the relationship
between diet quality and healthcare use and charges over time.
Therefore, the aim was to investigate the relationship between (1)
baseline diet quality and (2) change in diet quality over time, with 21‐
year cumulative Medicare claims and charges.
MATERIALS AND METHODS: Data from Survey 3 (2001) and Survey
7 (2013) of the 1946‐1951 cohort of the Australian Longitudinal
Study on Women's Health (ALSWH) were analyzed (n = 8228). Diet
quality was assessed using the Australian Recommended Food Score
(ARFS). ARFS scores range from 0–74, with higher scores indicating
higher diet quality. Twenty‐one year cumulative Medicare Benefits
Schedule data were reported by baseline ARFS quintile and category
of diet quality change. Linear regression analyses, adjusted for area of
residence, socioeconomic status, lifestyle factors, and private health
insurance status were conducted.
RESULTS: Baseline higher vegetable intakes were associated with
fewer 21‐year Medicare claims (β = −4.9, 95%CI −7.4, −2.5) and
charges (β = ‐$AU315.40, 95%CI ‐$AU506.60, ‐$AU124.20) for all
women. Higher dairy subscale scores at baseline were associated with
higher Medicare claims (β = 16.3, 95%CI 10.3, 22.4) and charges (β =
$AU1,165.20, 95%CI $AU695.10, $AU1,635.30) for all women.
Women whose diet quality worsened over time (change of ≤ −4
points) made more claims and had high charges compared with those
whose diet quality remained stable; median [Q1, Q3] 413 [277, 588]
claims $AU27,073 [$AU16,723, $AU42,134], compared with 387
[259, 559] claims and $AU25,686 [$AU15,201, $AU40,309]. When
examining changes in ARFS and ARFS subscales as a predictor of 21‐
year cumulative healthcare claim, for each 10‐unit increase in ARFS
over time, 12 fewer healthcare claims were made. Additionally, each
point increases in vegetable and dairy subscale scores were associated
significantly fewer claims.
CONCLUSION: Women whose diet quality worsened over time had
significantly more healthcare claims and higher charges over 21 years.
DISCLOSURE OF INTEREST: None declared.
 1467789x, 2022, S2, Downloaded from https://onlinelibrary.wiley.com/doi/10.1111/obr.13503 by CAPES, Wiley Online Library on [16/12/2023]. See the Terms and Conditions (https://onlinelibrary.wiley.com/terms-and-conditions) on Wiley Online Library for rules of use; OA articles are governed by the applicable Creative Commons License
SUPPLEMENT ARTICLE 185 of 222

LBP16 | Evaluation of alignment between TABLE: Agreement and correlation between nutri‐score and health
nutri‐score and health star rating front‐of‐ star rating

package labeling based on Slovenian food

supply % of agreement
(offer/sales‐ Cohen's Spearman
E. Hafner 1,2 3
; A. Kušar ; I. Pravst 2,3,4 Main category weighted) kappa rho

1 TOTAL (n = 17,226) 70/81 0.62 0.87

Nutrition Institute, Ljubljana, Slovenia; 2Biotechnical Faculty, University
3
of Ljubljana, Jamnikarjeva, 101 1000Ljubljana, Slovenia; Nutrition Beverages (n = 1822) 94/98 0.91 0.98

Institute, Tržaška cesta, 40 1000Ljubljana, Slovenia; 4VIST–Faculty of Bread & bakery 82/85 0.74 0.93
products (n = 2304)
Applied Sciences, Gerbičeva cesta 51A 1000, Ljubljana, Slovenia
Cereal & cereal 69/79 0.57 0.86
products (n = 547)
INTRODUCTION: Front‐of‐package nutrition labeling (FOPNL) is rec- Confectionery 80/72 0.63 0.76
ognized as an efficient tool that can support reformulation and health- (n = 2283)
ier food choices. A very interesting type of FOPNLs is rating schemes. Convenience foods 68/53 0.56 0.87
Our objective was to compare two market‐implemented schemes— (n = 750)
European Nutri‐Score (NS) and Australian Health Star Rating (HSR), Dairy and imitates 53/70 0.42 0.64
using Slovenian branded food dataset. (n = 3203)

MATERIALS AND METHODS: A total of 17,226 prepacked foods Edible oils and 35/22 0.22 0.63
emulsions (n = 587)
and drinks from the 2020 Slovenian food supply were profiled with
Fish and fish products 55/58 0.41 0.81
NS and HSR. To enable comparison with NS, 10 HSR grades were
(n = 577)
divided into five. We profiled food products with both rating schemes
Fruit and vegetables 67/81 0.57 0.84
to provide grade‐proportions. Products were assigned as healthier
(n = 1452)
when classified to NS A or B; or HSR ≥3.5*. Alignment between both
Meat and meat 71/73 0.57 0.85
profiles was assessed with agreement (% of agreement and Cohen's products (n = 1890)
Kappa) and correlation (Spearman rho). Using 12‐month nationwide
Snack foods (n = 604) 75/68 0.62 0.82
sales‐data, we also employed sales‐weighing, to account for market‐
Sauces and spreads 71/76 0.62 0.83
share differences. (n = 1207)
RESULTS: Results show that both profiles have high ability to discrim-
inate products based on their nutritional composition. NS and HSR
assessed 22% and 33% of Slovenian food supply as healthy, respec- CONCLUSION: Overall, NS and HSR are highly compliant FOPNLs
tively. Agreement between NS and HSR was strong (70%, κ = 0.62) with a few divergences in some subcategories. We observed that
with a very strong correlation (rho = 0.87). Profiles were most aligned even though they do not always grade products equally high, the
within food categories Beverages and Bread & bakery products with trend of ranking is mostly similar.
almost perfect agreement and correlation, while less aligned for Dairy Funding: EU Horizon 2020 Project “FNS‐Cloud“(GA 863059),
& imitates and Edible oils & emulsions. Disagreements were visible SRA national research program P3‐0395.
especially for subcategories of Cheese (8%, κ = 0.01, rho = 0.38) and DISCLOSURE OF INTEREST: None declared.
Cooking oils (27%, κ = 0.11, rho = 0.40). We observed that in most cat-
egories, correlation was higher than agreement. Sales‐weighting
LBP17 | Mongolian schoolchildren's
showed that offer in the food supply does not always reflect the sales.
overweight related their unhealthy eating and
Agreement between profiles after sales‐weighting in most cases
increased but was decreased for Confectionery, Convenience foods, Edi-
physical activity: Results of the Mongolian
ble oils & emulsions and Snack foods.
school‐based health survey

E. Dashzeveg; Suvd Batbaatar

Department for Nutrition Research, National Center For Public Health of

Mongolia, Ulaanbaatar, Mongolia

INTRODUCTION: Three times nationwide school‐based cross‐sec-

tional study aimed to assess overweight and obese of schoolchildren
aged 10–18 years. Adolescents aged between 10 and 18 constituted
about 20% of the total population of Mongolia.

186 of 222
MATERIALS AND METHODS: The participants were randomly
selected using two‐stage cluster sampling technique. Data were col-
lected through standardized questionnaires and anthropometric mea-
surements. In total, 60 schools from Ulaanbaatar city and 21 aimags
were selected to participate in the survey. Nearly, over 5000 (female:
51.7%, male: 48.3%) schoolchildren, aged 12–18 years, took part in
the study.
RESULTS: Nearly a quarter of students (18.1%) have overweight,
4.2% of them have obese in 2020. By the age group, the prevalence
of overweight was higher (26.4%) among schoolchildren when they
were 12 years old or younger. Overall, 13.5% of students between
aged 13 and 15 years have overweight, and this result was 11.2%
among students aged over 16 years. Comparing in 2010 (overweight
9.1%), overweight was raised two times among schoolchildren in
Mongolia.
However, of all students, 20.8% of total participants were physi-
cally active 60 min per day. This percentage was gradually decreasing
among students aged 13–15 years at 19.4% and 16 years or older at
18.6%, respectively. While student, 38.3% of the participants reported
in sitting activity and they prefer to having watch TV, play game at
home rather than driving in a bicycle and other physical activity. In
addition, sugar consumption was higher among schoolchildren. The
percentage of sugary and carbonated drinks was 41.8%, and con-
sumption of food with sugar was 63.9% every day for them.
CONCLUSION: In Mongolia, until now, most approaches have
focused on changing behavior of individuals on diet and exercises
through the training and advise, and it seems that these strategies
have limited results on the growing overweight in Mongolia.
REFERENCES: Formation of favorable environment for development,
training, education and informatization of children in Mongolia, Ulaan-
baatar, page 3‐10, 2004.
WHO, Adolescent pregnancy, MPS notes, Volume 1, №1, Oct
2008
Statistics, National Statistical office of Mongolia, UB, 2013
Global School based Student Health Survey manual, WHO, CDC,
2001
Program on the adolescent health and development”, “Improve-
ment on living conditions of Mongolian adolescents” project, Ulaan-
baatar, page 336‐338, 2003,
Mongolian steps survey on the prevalence of non‐communicable
diseases and injury risk factors, 2009
Survey report on “Schoolchildren’s health”, on “Schoolchildren’s
health and training overload time regime and assessment of hygiene”
project, MEDS, MOH, page 82‐95, 2009
Lecturer in Sociology, Government Pre‐University College, Kavi-
tal. Tq: Manvi. Dt:Raichur. Karnataka The International Journal of
Indian Psychology: Volume: 01|Issue: 03|ISSN 2348‐5396 © 2014
DISCLOSURE OF INTEREST: None declared.
1467789x, 2022, S2, Downloaded from https://onlinelibrary.wiley.com/doi/10.1111/obr.13503 by CAPES, Wiley Online Library on [16/12/2023]. See the Terms and Conditions (https://onlinelibrary.wiley.com/terms-and-conditions) on Wiley Online Library for rules of use; OA articles are governed by the applicable Creative Commons License
SUPPLEMENT ARTICLE
LBP18 | Early childhood obesity prevention in
primary healthcare: A protocol of a needs
assessment
E. T. House1,2; E. Kerr3; E. Denney‐Wilson2,4,5; S. Taki1,2,3;
S. Vlahos6; A. Fili6; K. Willcocks6; C. Rossiter4; H. Cheng2,4;
L. Baur1,2,7; L. M. Wen1,2,3,5
1
School of Public Health, The Faculty of Medicine and Health, Sydney,
New South Wales, Australia; 2NHMRC Centre of Research Excellence in
Translating Early Prevention of Obesity in Childhood (EPOCH‐Translate
CRE), The University of Sydney, Sydney, New South Wales, Australia;
3
Health Promotion Unit, Population Health Research & Evaluation Hub,
Sydney Local Health District, Sydney, New South Wales, Australia;
4
Susan Wakil School of Nursing and Midwifery, Faculty of Medicine and
Health, The University of Sydney, Sydney, New South Wales, Australia;
5
Sydney Institute for Women, Children and Their Families, Sydney Local
Health District, Sydney; 6PO Box 241, Karitane, Villawood, Sydney, New
South Wales, Australia; 7Discipline of Child and Adolescent Health,
Sydney Medical School, The University of Sydney, Sydney, New South
Wales, Australia
INTRODUCTION: Risk factors for childhood obesity emerge in the
first 2000 days of life. Primary healthcare professionals (PHPs) are
ideally placed to support obesity prevention efforts, due to their fre-
quent contact with young children and their parents. Connecting the
Dots (CTD) is a national early childhood nutrition promotion program
led by Karitane in partnership with the Healthy Beginnings team at
Sydney Local Health District. CTD will deliver online early childhood
nutrition education to parents/carers and health professionals. This
study will aim to identify professional development needs of PHPs
providing care to children aged 0–5 years and seek their feedback on
proposed training material for the CTD program.
MATERIALS AND METHODS: A 20‐item online survey, adapted from
previous research, will be distributed to Australian PHPs providing
care to children aged 0–5 years. The survey will be promoted on social
media and circulated via professional networks. The survey will exam-
ine PHPs' practice, self‐efficacy, knowledge, and attitudes related to
early childhood nutrition and obesity prevention, and their training
needs. A purposively selected sample of the survey participants who
expressed an interest will be invited to participate in a semistructured
interview to further explore their childhood nutrition professional
development needs, barriers to obesity prevention in practice and
feedback on proposed training material. Data will be collected in RED-
Cap and descriptive analysis of quantitative data will be conducted in
SPSS. Qualitative data will be analyzed thematically, and barriers and
facilitators to the implementation of obesity prevention in routine
care will be coded using the Behaviour Change Wheel.
RESULTS: Preliminary results of this project will be available in Octo-
ber 2022. Findings will be used to inform the design of the CTD pro-
fessional development program.

SUPPLEMENT ARTICLE
CONCLUSION: This study provides an important opportunity to
embed an evidence‐based obesity prevention intervention in primary
healthcare.
DISCLOSURE OF INTEREST: None declared.
LBP19 | Withdrawn
LBP20 | The translation, validation, and
reliability of a chrononutrition assessment
tool for Malaysian population
G. Y. Chong1; S. K. Nachatar Singh2; R. Abd Talib3; S. L. Loy4;
W. Y. Siah5; H. Y. Tan1; S. S. Harjit Singh6; R. Binti Abdullah5;
5 1
H. Binti Mahmud ; H. C. Koo
1
Faculty of Applied Sciences, Tunku Abdul Rahman University College;
2 3
Faculty of Applied Sciences, UCSI University; Centre for Community
Health Studies, The National University of Malaysia, Kuala Lumpur,
Malaysia; 4Duke‐NUS Medical School, Singapore, Singapore; 5Klinik
Kesihatan Batu Berendam, Melaka; 6Hospital Serdang, Selangor,
Malaysia
INTRODUCTION: Chrononutrition, the study about the relationships
between food administration, body's circadian rhythms, and health
risks, has now become a potential strategy in nutrition therapy for
chronic diseases. But there are few convenient tools available to
access chrononutrition characteristics and adapt to Malaysians, a pop-
ulation facing high risk of metabolic diseases. Hence, this study aimed
to translate the chrononutrition profile questionnaire into Malay ver-
sion (CPQ‐M) and determine its validity and reliability.
MATERIALS AND METHODS: This study was a cross‐sectional study
involving 202 Malaysian respondents aged 18 years and older who
have completed the online survey. Nine bilanguages native speakers
were involved in the forward and backward translations, followed by
content validity, which involved seven multidisciplinary team mem-
bers and validity by 10 target participants. A total of 93 respondents
repeated CPQ‐M after 14 days, to accomplish the test–retest reliabil-
ity. The researcher performed an exploratory factor analysis (EFA)
with varimax rotation to determine the validity of the construct. Cron-
bach's alpha coefficient (CAC) and intraclass correlation coefficient
(ICC) were used to identify internal consistency and test–retest
reliability.
RESULTS: This study obtained a good content validity in CPQ‐M with
a content validation index (CVI) of 0.86 from experts. The EFA of
CPQ‐M showed a six‐dimensional model (60.06% of the variance). A
total of 17 elements revealed good to excellent test–retest reliability
(ICC = 0.82–0.97), except night eating on a weekly average with a
moderate ICC of 0.65. Good internal consistency of CPQ‐M was
found, with Cronbach's alpha 0.75.
1467789x, 2022, S2, Downloaded from https://onlinelibrary.wiley.com/doi/10.1111/obr.13503 by CAPES, Wiley Online Library on [16/12/2023]. See the Terms and Conditions (https://onlinelibrary.wiley.com/terms-and-conditions) on Wiley Online Library for rules of use; OA articles are governed by the applicable Creative Commons License
187 of 222
CONCLUSION: The CPQ‐M is a valid and reliable tool to assess
chrononutrition characteristics among Malaysian adults.
Acknowledgments: The researchers wish to thank the Ministry of
Higher Education of Malaysia for providing support under the Funda-
mental Research Grant Scheme (FRGS) (FRGS/1/2021/SKK06/
TARUC/02/1) that has helped this research.
DISCLOSURE OF INTEREST: None declared.
LBP21 | WHO and Asian classification of
obesity and its relationships with diabetes
among the Malaysian adults: Findings from a
nationally representative cross‐sectional
study
G. P. Lim1; L. K. Tan2; H. C. Koo3; C. C. Kee2; M. A. Omar2
1
Monash University Malaysia, Bandar Sunway, Malaysia; 2National
Institutes of Health, Shah Alam, Malaysia; 3Tunku Abdul Rahman
University College, Kuala Lumpur, Malaysia
INTRODUCTION: Obesity is one of the independent risk factors for
diabetes. Nonetheless, this was mainly reported in the prevalent dia-
betes cases where WHO cut‐off was employed for obesity classifica-
tion. The ethnicity‐specific cut‐off for obesity classification has gained
attention particularly in the Asian population and facilitated in the
identification of obesity‐related health condition, including diabetes.
This study aimed to investigate the relationship between obesity and
undiagnosed diabetes among Malaysian adults, using the WHO and
Asian cut‐off point for obesity classification.
MATERIALS AND METHODS: We analyzed the data from 13,989
Malaysian adults who participated in the National Health Morbidity
and Survey 2015. General obesity was defined as BMI ≥30 and ≥25
based on WHO and Asian cut‐off points, respectively. Central obesity
was defined by WHO as waist circumference >102 cm for male and
>88 cm for female, whereas the Asian cut‐off points are >90 cm for
male and >80 cm for female. Undiagnosed diabetes was identified
when the respondent was not known to have diabetes and had a fast-
ing capillary blood glucose ≥6.1 mmol/L. Multiple logistic regression
was employed to determine the relationships between general and
central obesity with undiagnosed diabetes after adjusting for sociode-
mographic characteristics, lifestyle risk factors and other health
conditions.
RESULTS: The mean age (±SE) of our study population was 36.77
(±0.18) with the overall prevalence of undiagnosed diabetes of 9.6%.
Our data demonstrated that the prevalence of general obesity (WHO,
16.4%, 95%CI: 15.6–17.3 and Asian, 44.7%, 95%CI: 43.4–45.9) and
central obesity (WHO, 18.4%, 95%CI: 17.5–19.5 and Asian, 41.9%,
95%CI: 40.6–43.3) were significantly different when comparing
between the WHO (p < 0.001) and Asian cut‐off (p < 0.001) for obe-
sity classification. Further association analysis demonstrated that gen-
eral obesity is associated with undiagnosed diabetes using both WHO
(adjusted OR: 1.54, 95%CI: 1.27–1.87) and Asian (adjusted OR: 1.47,

188 of 222
95%CI: 1.22–1.76) BMI cut‐off points, after adjusted for confounders.
Likewise, we also observed significant association between central
obesity and undiagnosed diabetes in both cut‐off points (WHO,
adjusted OR: 1.59, 95%CI: 1.32–1.93 and Asian, adjusted OR: 1.40,
95%CI: 1.17–1.67), after adjusted for confounders.
CONCLUSION: Our findings demonstrated that general obesity and
central obesity were associated with undiagnosed diabetes among the
Malaysian adults. Furthermore, higher prevalence of obesity observed
when Asian BMI cut‐off point was employed in this present study was
in line with the findings from other Asian Pacific populations that indi-
cates the needs to use ethnicity‐specific obesity classification in clini-
cal settings to identify obesity and prevent progression to obesity‐
related health conditions.
DISCLOSURE OF INTEREST: None declared.
LBP22 | Daily energy contribution of
ultraprocessed foods using 4‐day mobile food
records: Temporal eating patterns in
Australian adults
J. D. Healy1; S. S. Dhaliwal2,3,4,5; C. M. Pollard2,6,7; C. J. Boushey8;
C. Shoneye1; A. Harray9; C. Whitton1; D. A. Kerr2,6
1
Curtin University; 2Curtin Health Innovation Research Institute, Perth,
Australia, Western Australia, Australia; 3Duke‐NUS Medical School,
National University of Singapore, Singapore, Singapore; 4Institute for
Research in Molecular Medicine (INFORMM), Universiti Sains Malaysia,
Pulau Pinang, Malaysia; 5Singapore University of Social Sciences,
Singapore, Singapore; 6Curtin School of Population Health, Curtin
University, Perth, Western Australia, Australia; 7Enable Institute Curtin
University, Perth, Western Australia, Australia; 8Epidemiology Program,
University of Hawaii Cancer Center, Honolulu, Hawaii, USA; 9Telethon
Kids Institute, Perth, Western Australia, Australia
INTRODUCTION: Ultra‐processed food (UPF) consumption has been
associated with excess energy intake (EI), obesity, and non‐communi-
cable disease. Eating occasions where large EI occur also contribute to
excess EI. Image‐based mobile food records (mFR) capture the specific
time food is eaten, improving eating occasion assessments away from
traditional recall estimates or meal labels such as “breakfast.” Tempo-
ral eating patterns are associated with increased risk of obesity, yet lit-
tle is known about UPF consumption across the day.
Aim: The aim of this study is to identify temporal patterns associated
with energy consumed from UPFs using 4‐day mobile food records
(4dFR) among adults.
MATERIALS AND METHODS: The 4dFR data from two population‐
based intervention studies, Study 1 (243, 18–30 years old, mean (m)
BMI 24.3 ± 5.4 kg/m2) and Study 2 (146, 30–65 years old, m BMI
31.40 ± 3.98 kg/m2), were assessed for associations between age,
BMI, and gender with temporal patterns of UPF EI. To examine tem-
poral patterns, time was taken from the image capture data, and UPF
were identified using a standard food assessment method. UPF
1467789x, 2022, S2, Downloaded from https://onlinelibrary.wiley.com/doi/10.1111/obr.13503 by CAPES, Wiley Online Library on [16/12/2023]. See the Terms and Conditions (https://onlinelibrary.wiley.com/terms-and-conditions) on Wiley Online Library for rules of use; OA articles are governed by the applicable Creative Commons License
SUPPLEMENT ARTICLE
classification was made using the NOVA system and EI based on the
AUS‐NUT 2011‐13 database. The percent of UPF EI contribution to
total energy intake (TEI) over 24 h was calculated.
RESULTS: The sample characteristics were Study 1 (66% female, m
24.3 ± 3.4 years) and Study 2 (66% female, m 49.24 ± 9.7 years). An
independent samples t‐test was performed to compare the UPFs
energy percentage of TEI between Study 1 (m = 48.8% ± 15.59) and
Study 2 (m = 36.12% ± 15.10), with a significant difference (p < 0.001)
in UPF energy percentage of TEI between the two study groups. The
proportion of daily EI from UPFs shows different temporal patterns
between the two study groups (Table 1). Peak EI from UPFs in both
groups was greatest between 6–8 p.m., then 12–2 p.m. and for Study
1, 6–9 a.m. These peaks accounted for 56.5% (Study 1) and 63.2%
(Study 2) of UPF EI with more UPF EI in the peaks for older Study 2
participants compared with a gradual increase in younger Study 1
participants.
T A B L E 1 Peak intake of the percent of UPF energy intake as a
proportion of daily energy intake in adults from Study 1 (n = 243) and
Study 2 (n = 146) studies
Time of 6–9 a. 9–12 12–3 3–6 6–8 8 p.m.–
day (h) m. p.m. p.m. p.m. p.m. 6 a.m.
Study 1 14.5% 12.4% 20.4% 14.7% 21.6% 10.4%
Study 2 3.9% 13.8% 27.2% 16.6% 32.1% 6.5%
CONCLUSION: The results show that the temporal pattern of UPF EI
starts earlier and gradually increases over 24 h in those under 30
years (Study 1) compared with peak UPF EI at two main meal times in
those over 30 years (Study 2) living with a higher BMI. Temporal pat-
terns of UPF EI show that the hyper palatable promoted UPFs are
mainly eaten in mealtimes and contribute to energy intake across the
day. The timing of consumption is important information in develop-
ing dietary advice for public health interventions addressing obesity.
DISCLOSURE OF INTEREST: None declared.
LBP23 | Malaysian whole grain cookbook: A
nutrition promotion resource for the
community
D. Ugunesh1; K. Hui Chin1; C. S. Siau2; M. N. A. Mohd Sanip3
1
Faculty of Applied Sciences, Tunku Abdul Rahman University College,
Kuala Lumpur, Malaysia; 2Faculty of Health Sciences, Universiti
Kebangsaan Malaysia, Bangi, Malaysia; 3Faculty of Social Science and
Humanities, Tunku Abdul Rahman University College, Kuala Lumpur,
Malaysia
INTRODUCTION: The prevalence of obesity is dramatically higher in
economically developed regions but is now rising significantly world-
wide, especially in Malaysia. Dietary habits play a vital role in the
pathogenesis of obesity. In spite of that, researchers have attributed

SUPPLEMENT ARTICLE
that whole grain consumption is associated with a reduced risk of
noncommunicable diseases, which subsequently reduces the rates of
obesity among the population. Hence, this study aimed to develop a
whole grain‐based cookbook as a nutrition resource tool tailored spe-
cifically to the requirements and taste buds of Malaysian adults.
MATERIALS AND METHODS: Malaysian traditional recipes were
reviewed, selected, and refined from multiple reliable cookbook
sources, both online and in print. Sensory evaluation was conducted
among consumers to access the acceptance of the created localized
whole grain dishes.
RESULTS: The developed whole grain cookbook named “Malaysia's
Whole Grain Delicacies” contains a total of 25 localized whole grain‐
based recipes. The recipe contents and nutritional information's were
carefully evaluated and finalized by a panel of chefs, nutritionists, and
dieticians, respectively. The cookbook features simple instructions
with the recipe images attached, respectively; nutritional information
provided for each recipe; a professional's suggestion of healthy life-
style tips; usage of available and accessible whole grain ingredients;
affordable ingredients; production of nutrient‐dense foods for each
category (breakfast, lunch, snack, dinner, and kids meal); and the rec-
ipes developed on the basis of stapled multicultural foods available in
Malaysia such as “Nasi Lemak”, “Chapati” and “Nasi Biryani”. The rec-
ipes were well acknowledged by both the panel of experts and
consumers.
CONCLUSION: This is the first paper to outline the process under-
taken to develop a localized whole grain‐based recipe cookbook as a
nutrition resource tool in Malaysia. This knowledge may aid other
researchers in developing nation‐specific cookbooks and or resources
tool such as e‐books adapted to their own local needs.
DISCLOSURE OF INTEREST: None declared.
1467789x, 2022, S2, Downloaded from https://onlinelibrary.wiley.com/doi/10.1111/obr.13503 by CAPES, Wiley Online Library on [16/12/2023]. See the Terms and Conditions (https://onlinelibrary.wiley.com/terms-and-conditions) on Wiley Online Library for rules of use; OA articles are governed by the applicable Creative Commons License
189 of 222
LBP24 | The correlation between the snack
intake of Filipino children from Geronimo
Street, Sampaloc, Manila, Philippines in
relation to their body mass index
L. O. P. Lopez; S. R. K. Chua; A. J. M. Gonzales
Department of Food Science and Nutrition, University of the Philippines
Diliman, Quezon, Philippines
INTRODUCTION: The study on the correlation between snack intake
and body mass index (BMI) was conducted among 6–12 year old chil-
dren under the Tulong sa Kapwa Kapatid (2KK) foundation in Geron-
imo St., Sampaloc last 2018. It aims to determine the relationship
between the energy contribution of snacks in a child's diet to a child's
BMI.
MATERIALS AND METHODS: The children's weight and height were
measured to calculate for their BMI, while a 24 h food recall was done
in order to measure meal against snack intake. Further interviews
regarding family food preferences and snacking habits of children
were also conducted with guardians.
RESULTS: A multiple regression analysis of the predictor variable—
energy contribution of snacks—to the outcome variable, BMI, along
with confounding variables such as age, gender, monthly per capita
food expenditure and income, and physical activity resulted in a p‐
value of 0.007489, showing that there is a moderate correlation
between the energy contribution of snacks to the child's BMI. A cor-
relation coefficient of 0.45 also revealed that although the data are
scattered, there exists positive correlation between the two main vari-
ables being studied.
CONCLUSION: Based on these results, the study concludes that
there exists a correlation between a school‐age child’s snack intake
and their BMI. Hence, the amount of snacks that a child eats may

190 of 222
indicate their BMI in the sense that the larger the amount of energy
contributed by snacks consumed relative to meals, the larger the pos-
sibility of the child having a higher BMI.
DISCLOSURE OF INTEREST: None declared.
LBP25 | The use of online and app‐based
food delivery services in the era of COVID‐
19 pandemic and its associated factors
L. M. Dana1,2; Z. Talati1; B. Morley3; M. O'Connor1; G. Myers4;
A. Sartori5; C. Pollard1,6
1
School of Population Health, Curtin University, Perth, Western Australia,
Australia; 2Forrest Research Foundation, University of Western Australia,
3
Perth, Western Australia, Australia; Centre for Behavioural Research in
4
Cancer, Cancer Council Victoria, Melbourne, Australia; Nutrition;
5 M. Ahmed; G. Hu; J. Lee; A. Batalla; M. L'Abbe
Obesity Prevention, Cancer Council Western Australia, Perth, Western
6 Department of Nutritional Sciences, University of Toronto, Toronto,
Australia, Australia; Public Health Advocacy Institute, Perth, Western
Australia, Australia
INTRODUCTION: Online and app‐based meal delivery services
(OMDS) are rapidly growing worldwide, and the Australian market is
projected to be worth AUD$ 3.17 billion by 2027, with an expected
annual growth rate of 8.12% between 2022 and 2027. Previous
research found that OMDS platforms may contribute to overweight
and obesity due to their ease of use and the proportion of unhealthy
foods in their most popular meals, up to 86%. Despite this, little is
known about the population subgroups most likely to use these ser-
vices, why they use them, or the impact that the COVID‐19 restric-
tions had on their use. To address this knowledge gap, this study
assessed the extent of OMDS usage among Australian adults and fac-
tors associated with their use, including the impact of the COVID‐19
pandemic.
MATERIALS AND METHODS: An online survey of n = 3000 Austra-
lians aged 18+ years was conducted between May 19 and June 3,
2022. The sample was nationally representative in terms of age, gen-
der, and location. Multivariate regression analyses were conducted to
identify factors associated with OMDS use. The study was approved
by a university Human Research Ethics Committee.
RESULTS: Sixty‐five percent of respondents had used OMDS at some
time, 44% used OMDS at least once monthly, and 26% used them at
least once a week. Fifty‐five percent of OMDS users reported that
their frequency of use had increased as a result of the COVID‐19 pan-
demic and 32% started using these services since COVID‐19 began in
2020. Younger respondents (Coef.= −0.01 for 1 year increase in age;
p < 0.001), those residing in a share house (Coef. = 1.40; p = 0.007),
high income earners (Coef. = 0.43; p < 0.001), and people who have
been in COVID‐19 quarantine during the past 3 months (Coef. = 0.82;
p = 0.003) were more likely to use OMDS in the 3 months prior to the
survey. In terms of lifestyle behaviors, binge drinkers (Coef. = 0.90; p
< 0.001), current smokers (Coef. = 1.31; p < 0.001), and frequent fast
food (Coef. = 2.12; p < 0.001) and sugary drink (Coef. = 0.17; p =
1467789x, 2022, S2, Downloaded from https://onlinelibrary.wiley.com/doi/10.1111/obr.13503 by CAPES, Wiley Online Library on [16/12/2023]. See the Terms and Conditions (https://onlinelibrary.wiley.com/terms-and-conditions) on Wiley Online Library for rules of use; OA articles are governed by the applicable Creative Commons License
SUPPLEMENT ARTICLE
0.003) consumers and people who consumed fewer serves of vegeta-
bles per day (Coef. = −0.18; p = 0.039) were more likely to use
OMDS.
CONCLUSION: The prevalence and frequency of use of OMDS are
high among Australian adults and have increased since the onset of
the COVID‐19 pandemic. Given the rapid growth of OMDS use and
its association with the lifestyle behaviors linked to overweight and
obesity among people who use these services, the current research
provides essential insights to inform targeting of public health inter-
ventions and policies related to online meal ordering platforms.
DISCLOSURE OF INTEREST: None declared.
LBP26 | Nutritional quality of Canadian pre‐
packaged food supply
Ontario, Canada
INTRODUCTION: Food supply that delivers energy‐dense products
with high‐levels of sodium, saturated fat and sugar, is a major risk fac-
tor for noncommunicable diseases (1). Monitoring the food supply can
document the extent of the problem and allow for novel policy
actions to address it (1). Nutrient profiling (NP) is a method to rank
foods according to their nutritional composition and is used for public
health initiatives such as front‐of‐pack labeling, taxation, educating
consumers, advertising regulations, or guiding reformulation (2). These
initiatives have the potential to facilitate Canadians towards improv-
ing the nutritional quality of their diets. The objective was to assess
the nutritional quality of the Canadian packaged food supply using a
nutrient profiling tool that is specifically designed to assess the eligi-
bility of products that can carry claims and indicate healthfulness.
MATERIALS AND METHODS: Using the University of Toronto Food
Label Information Program (FLIP) database 2020 (n = 42,762) (3), the
nutritional scores, ranging from −15 (most healthy) to +80 (less
healthy), for packaged foods and beverages were derived using the
Food Standards of Australia and New Zealand‐ Nutrient Profiling
Scoring Criterion (FSANZ‐NPSC) (4). The FSANZ‐NPSC systems
assigns points for ‘nutrients to limit’ (calories, saturated fat, sodium,
and total sugar) and deducts points for “nutrients and components to
encourage” (dietary fiber; protein; and fruit, vegetable, nut, and
legume (FVNL) content).
RESULTS: Overall, almost half (49%) of the Canadian pre‐packaged
food products were considered as “healthy” and eligible to carry a
health claim. The average FSANZ‐NPSC score was 7, suggesting a
“moderately” low nutritional quality of the food supply. About 11% of
bakery products and 5% of sugars and sweets categories were identi-
fied the less healthy and not eligible to carry a claim, whereas the cat-
egories cereals and grains, beverages, fruits and vegetables were
identified as “healthy.” Products in combination dishes, dairy, and

SUPPLEMENT ARTICLE
soups had a similar percentage of products scoring as less healthy and
healthy.
CONCLUSION: This study highlights the priority categories for refor-
mulation to improve the nutritional quality of packaged food and bev-
erages in Canada. FSANZ‐NPSC considers the contribution of both
nutrients and food components, thus allowing for assessing the nutri-
tional quality of food supply beyond that of nutrients only and that
may also align with dietary guidelines.
REFERENCES:
[1] Neal et al. Obes Revs 2013; Suppl 1: 49‐58.
[2] WHO. Nutrient Profiling. https://apps.who.int/nutrition/topics/
profiling/en/index.html
[3] Ahmed et al. Front Nutr 2022; 8:825050.
[4] The Food Standards of Australia and New Zealand Nutrient Profil-
ing Scoring Criterion. https://www.foodstandards.gov.au/industry/
labelling/Pages/Consumer-guide-to-NPSC.aspx
DISCLOSURE OF INTEREST: None declared.
LBP27 | Evaluation of WhatsApp‐based
counseling and body composition
measurement to enrich knowledge about
healthy diet and weight management among
middle‐aged Hong Kong Chinese women: A
randomized controlled trial
M. Lin1; L. Yang1; C. Hao2; Y. J. Xie1,3
1 M. Kuroiwa1; S. Fuse‐Hamaoka1; R. Tanaka1; T. Endo2; T. Naito1;
School of Nursing, Faculty of Health and Social Science, The Hong Kong
Polytechnic University, Hong Kong; 2School of Public Health, Sun Yat‐sen
University, Guangzhou, China; 3Research Center for Chinese Medicine
Innovation, The Hong Kong Polytechnic University, Hong Kong, China
INTRODUCTION: Healthy diet and weight management are impor-
tant to personal lifestyle. However, many people are not aware of it
due to poor understanding of the relevant knowledge. We aimed to
examine the effectiveness of an integrated counseling and body com-
position assessment intervention on enhancing healthy diet and
weight management related knowledge among middle‐aged Hong
Kong Chinese women.
MATERIALS AND METHODS: The prospective two‐arm randomized
controlled trial was conducted among 173 Hong Kong Chinese
women aged 45−65 years. They were randomly assigned to interven-
tion group (n = 82) or control group (n = 91). Participants assigned to
intervention group received body composition measurement using
the InBody 270 device at baseline, along with an immediate consulta-
tion (5−10 min) based on their measurements. During 3‐month inter-
vention period, they were also provided with weekly personalized
nutrition and weight management counseling (15 min each time) from
a dietitian through WhatsApp. People in control group received the
body composition measurement and brief counseling after measure-
ment only. The knowledge level was evaluated by a self‐designed 15‐
1467789x, 2022, S2, Downloaded from https://onlinelibrary.wiley.com/doi/10.1111/obr.13503 by CAPES, Wiley Online Library on [16/12/2023]. See the Terms and Conditions (https://onlinelibrary.wiley.com/terms-and-conditions) on Wiley Online Library for rules of use; OA articles are governed by the applicable Creative Commons License
191 of 222
item questionnaire before and after the intervention. The scores of
the questionnaire ranged from 15 to 75, higher score indicated more
correct in knowledge assessment.
RESULTS: The average age of the participants was 56.5 ± 4.9 (range:
45−65 year) years. After 3‐month intervention, the overall knowledge
score was increased among 53.7% participants in the intervention
group and 36.0% in the control group, respectively. Compared with
baseline, the score significantly increased from 53.6 (SD: 4.24) to 55.1
(SD: 4.59) in the intervention group (p < 0.05). Such increase was
higher than control group, the difference of the score changes was
1.52 + 1.01 between groups (p < 0.05). Regarding to single knowledge
items, significant improvements were found about “obesity is a risk
factor for cancer” (37.3% vs. 25.3%, p < 0.05), “people should do a
certain amount of exercise every day” (22.4% vs. 14.7%, p < 0.05),
and “the bottom of the food pyramid is carbohydrates” (34.3% vs.
24.0%, p < 0.05).
CONCLUSION: A 3‐month WhatsApp‐based tailored health counsel-
ing and body composition assessment program had moderate effect
in improving healthy eating and weight management knowledge for
middle‐aged Hong Kong Chinese women.
DISCLOSURE OF INTEREST: None declared.
LBP28 | Relationship between brown adipose
tissue density in healthy children and
abnormalities during pregnancy and
nutritional status during infancy
R. Kime1; Y. Kurosawa1; T. Hamaoka1
1
Department of Sports Medicine for Health Promotion, Tokyo Medical
University, Tokyo, Japan; 2Faculty of Science and Technology, Meijo
University, Aichi, Japan
INTRODUCTION: The importance of brown adipose tissue (BAT) in
healthy children is well‐recognized. The group with obesity has a sig-
nificantly lower BAT density (BAT‐d) than the group without obesity,
even in those aged ≤5 years. Thus, as a parameter of BAT‐d is nega-
tively correlated with body adiposity over a wide age range, even from
early children.
The purpose of this study was to evaluate BAT‐d and the factors
influencing this density in this population group.
MATERIALS AND METHODS: This study was conducted during
December 2019 to April 2020. A total of 152 participants (79 girls
and 73 boys), 1 to 4 years of age, were recruited. Near‐infrared time‐
resolved spectroscopy, a relatively new methodology, was used to
monitor BAT‐d. As an index of BAT‐d, we measured the tissue total
hemoglobin concentration in the supraclavicular region, adjusted
according to the subcutaneous adipose tissue thickness ([total‐Hb‐
Adj]sup). In addition, abnormalities during pregnancy and nutritional
status during infancy were evaluated as potential factors influencing
BAT‐d. A univariate analysis was conducted to identify factors (sex,

192 of 222
age, gestational diabetes, hypertensive syndrome of pregnancy, preg-
nancy anemia, threatened miscarriage, nutrition at one month after
birth, and introduction of baby food at 6 months after birth) influenc-
ing the [total‐Hb‐Adj]sup; p < 0.25 was accepted for further multivari-
ate analyses (logistic regression analysis). The analyses were
performed using SPSS Statistics 28 (IBM Japan, Tokyo, Japan); p <
0.05 was considered statistically significant.
RESULTS: The average age of the participants was 2.28 ± 1.09 years,
and the average [total‐Hb‐Adj]sup was 89.8 ± 21.5 μM. The univariate
analysis showed that the occurrence of hypertensive syndrome of
pregnancy, pregnancy anemia, nutrition at one month after birth (p <
0.25), and introduction of baby food at 6 months after birth (p < 0.05)
were significantly correlated with [total‐Hb‐Adj]sup. However, the
logistic regression analysis showed that only the introduction of baby
food at 6 months after birth remained as a significant factor affecting
[total‐Hb‐Adj]sup (p = 0.079).
CONCLUSION: These results suggest that BAT‐d tends to be higher
if baby food is not started before 6 months of age. Postnatal dietary
status might influence BAT‐d in children 1 to 4 years of age.
DISCLOSURE OF INTEREST: None declared.
LBP29 | What's in South Australian
schoolchildren's lunchboxes? A snapshot of
food and packaging contents
N. Lalchandani1; C. Hume1; S. Crabb1; L. Giles1; J. Hendrikx2;
C. Miller3
1
School of Public Health, The University of Adelaide; 2KESAB
environmental solutions; 3Health Policy Centre, South Australian Health
and Medical Research Institute (SAHMRI), Adelaide, South Australia,
Australia
INTRODUCTION: The school food model in Australia relies predomi-
nantly on home‐packed lunches. Food and packaging contents of
school lunchboxes have not been studied together. This audit of
South Australian school children's lunchboxes aimed to examine the
types of food and beverages brought to school, what was wasted by
children, and what types of packaging items were involved.
MATERIALS AND METHODS: Children's lunchboxes were photo-
graphed before morning break and after lunch break. Contents were
coded into a novel audit tool designed using REDCap that provided a
snapshot of food and beverage items, approximate food waste, and
packaging.
RESULTS: A total of 14 preschools and nine primary schools in low (n
= 8), medium (n = 7), and high (n = 8) socioeconomic areas of the
Greater Adelaide region were part of this study. In total, contents of
673 lunchboxes were analyzed. Lunchboxes of preschool children
contained more “nude” food variety and primary school children had a
higher proportion of packaged discretionary foods. Lunchboxes of
preschool children contained more fruits (91.8% vs. 64.6%; χ2(1) =
73.2685, p ≤ 0.001), vegetables (35.6% vs. 15.9%; χ2(1) = 33.9625, p ≤
1467789x, 2022, S2, Downloaded from https://onlinelibrary.wiley.com/doi/10.1111/obr.13503 by CAPES, Wiley Online Library on [16/12/2023]. See the Terms and Conditions (https://onlinelibrary.wiley.com/terms-and-conditions) on Wiley Online Library for rules of use; OA articles are governed by the applicable Creative Commons License
SUPPLEMENT ARTICLE
0.001), and dairy items (45.3% vs. 18.9%; χ2(1) = 53.5680, p ≤ 0.001),
compared with primary school children's. Overall, there was a high
proportion of single‐use packaging in lunchboxes mainly due to snack
food items packed in soft plastic or silver lined wrappers. There was
also a considerable proportion of food waste, with vegetables being
wasted the most (50.6%) compared with snacks (25.2%).
CONCLUSION: This lunchbox audit study quantified and assessed
contents of school lunchboxes packed from home. Besides nutrition,
lunchboxes are also a source of avoidable packaging and food waste,
which suggests implications of lunchbox food choices for health and
environmental sustainability. Given the observed differences in quality
of lunchboxes between preschoolers' and primary schoolers', future
interventions can focus on primary school children to optimize the
health and environmental agenda in the context of their lunchboxes.
DISCLOSURE OF INTEREST: None declared.
LBP30 | The association between nut
consumption and sleep quality in adults by
body mass index: a cross‐sectional study with
data from the UK Biobank
B. Bizzozero‐Peroni; R. Fernández‐Rodríguez; E. Jiménez‐López;
I. A. Martínez‐Ortega; C. Pascual‐Morena; J. F. López‐Gil;
V. Martínez‐Vizcaíno; A. E. Mesas
Health and social research center, Faculty of nursing, University of
Castilla‐La Mancha, Universidad de Castilla‐La Mancha, Cuenca, Spain
INTRODUCTION: Nuts are a source of essential nutrients that are
related to sleep quality (1); however, few studies have assessed this
association (2). This study analyzed the relationship between nut con-
sumption and sleep quality in middle‐aged and older adults from the
United Kingdom (UK).
MATERIALS AND METHODS: This cross‐sectional study (Project
72061) was conducted using the UK Biobank (UKB) resource and
included 502,460 adults aged 37–73 years. Dietary data were
obtained from the Oxford WebQ questionnaire. Nut consumption
was defined as roasted/salted or unsalted nuts or peanuts, combined
into three categories: (i) no consumption (reference), (ii) >0 to 1 hand-
ful of 30 g per day (moderate), and (iii) >1 to 4 handfuls per day (high).
Sleep‐related variables (duration, insomnia, chronotype, snoring, and
sleepiness) were derived from the UKB touchscreen questionnaire
and characterized sleep quality as good or poor (3). Logistic regression
models with backwards stepwise selection of adjustment covariates
were performed. To assess interactions between the main covariates
(i.e., sex, age, physical activity, BMI, loneliness, and medical conditions)
and nut consumption on sleep quality, p‐values were calculated using
the log‐likelihood ratio test.
RESULTS: A total of 69,656 participants (mean age 56.2 ± 7.8 years,
55.3% women) were included in the analyses. Compared with non-
consumers (reference category = 1), those consuming nuts up to 1
handful per day were more frequently classified as having good sleep

SUPPLEMENT ARTICLE
quality (OR 1.05; 95% CI 1.02–1.09) in the fully adjusted analysis. No
association was observed for the highest category of nut consumption
(OR 1.00; 95% CI 0.91–1.09). An interaction was observed between
nut consumption and BMI on sleep quality (p = 0.026). In stratified
analyses, only adults with a BMI between 18.5 and 29.9 kg/m2 who
consumed a moderate frequency of nuts were significantly more likely
to have good sleep quality than nonconsumers (OR 1.07; 95% CI
1.03–1.11).
CONCLUSION: Moderate nut consumption (>0 to 1 handful per day)
was significantly associated with good sleep quality in UK adults with
normal weight or overweight status. In individuals with obesity, nut
consumption was not associated with sleep quality.
REFERENCES:
[1] Peuhkuri et al. Nutr Res. 2012; 32(5):309‐19.
[2] Mossavar‐Rhamani Y et al. J Sleep Res. 2017; 26(6):739‐46.
[3] Fan M et al. Eur Heart J. 2020; 41(11):1182‐9.
DISCLOSURE OF INTEREST: None declared.
LBP31 | Plant‐based dietary patterns and
mental health in the general population: A
systematic review.
R. Fernández‐Rodríguez; T. Villa‐Muñoz; M. Garrido‐Miguel;
M. Medrano; J. F. López‐Gil; B. Bizzozero‐Peroni; A. E. Mesas;
V. Martínez‐Vizcaíno
Health and social research center, Faculty of nursing, University of
Castilla‐La Mancha, Universidad de Castilla‐La Mancha, Cuenca, Spain
INTRODUCTION: Depression and anxiety are the most prevalent
mental health disorders worldwide.1 Plant‐based diets have been
recommended because of their cardiometabolic effects and environ-
2
mental sustainability. However, their effects on mental health are still
a debatable issue. Therefore, our aim was to examine and systemati-
cally synthesize the available evidence on the relationship between
plant‐based diets and mental health outcomes (i.e., depression, anxi-
ety, stress, mood state, and quality of life).
MATERIALS AND METHODS: Five databases (Medline, Scopus,
Cochrane Central, Web of Science, and EBSCOhost) were examined
from inception to March 22, 2022. The Cochrane handbook and the
PRISMA guideline were followed. We included randomized controlled
trials (RCTs) and longitudinal and cross‐sectional studies that included
participants ≥18 years, and with at least one intervention related to
plant‐based diets, that were defined as vegan and vegetarian (lacto‐
3
ovo‐vegetarian) . Those studies with outcomes related to depression,
anxiety, or mood state were included. The quality of studies was
assessed with the Cochrane Risk of Bias 2 (RoB2) for RCTs and with
the National Institute of Health (NIH) tool for observational studies.
RESULTS: From 996 retrieved studies, a total of 14 studies (n =
150,193) were included (eight cross‐sectional, five follow‐up and one
RCT. There were 13 studies in which depression was measured,
1467789x, 2022, S2, Downloaded from https://onlinelibrary.wiley.com/doi/10.1111/obr.13503 by CAPES, Wiley Online Library on [16/12/2023]. See the Terms and Conditions (https://onlinelibrary.wiley.com/terms-and-conditions) on Wiley Online Library for rules of use; OA articles are governed by the applicable Creative Commons License
193 of 222
showing benefits of plant‐based diets on eight. Regarding anxiety, five
out of seven studies showed positive results favoring plant‐based
diets. Finally, five out of six studies were related to positive results on
stress, mood state, and quality of life measures.
CONCLUSION: Plant‐based diets seem to have a positive impact on
diminishing symptomatology and depression risk, as well as these pat-
terns are related to lower scores on anxiety and stress scales. Long‐
term studies with a greater sample size following plant‐based diets
and categorizing between healthy and unhealthy plant‐based diets are
needed to draw more solid conclusions.
REFERENCES:
[1] Mental GBD, Collaborators. The Lancet Psychiatry 2022;9:137–50.
[2] Kahleova H et al. Nutrients. 2017;9(8):1–13.
[3] Craig WJ et al. Nutrients. 2021;1–29.
DISCLOSURE OF INTEREST: None declared.
LBP32 | Spending on diseases in Australia
attributable to potentially avoidable risk
factors
E. Bourke; V. Prescott; R. Bennetts
Australian Institute of Health and Welfare, Canberra, ACT, Australia
INTRODUCTION: The burden of disease due to potentially prevent-
able (modifiable) risk factors has been reported for several years by
the Australian Institute of Health and Welfare (AIHW) as part of the
Australian Burden of Disease Study (ABDS). The objective of this
study is to estimate health spending in 2018–2019 for burden of dis-
ease conditions that can be attributable to risk factors. This analysis
uses AIHW burden of disease data and AIHW disease expenditure
data to estimate the financial cost of the diseases that are due to risk
factors, to complement the information related to attributable disease
burden.
MATERIALS AND METHODS: Each risk factor‐disease combination
reported in the ABDS is included in this analysis. In the ABDS, the
burden of each condition due to a risk factor is estimated using the
relative risks determined through epidemiological investigation, popu-
lation age and size and the proportion of the population in each expo-
sure group. This risk distribution is compared with a “counterfactual,”
what would have occurred if exposure to the risk factor had been
avoided or had been reduced to its lowest level. Combining this infor-
mation gives a measure of the population attributable fraction (PAF)
of a disease that is due to a risk factor. The proportion the risk factor
contributes to a condition was adjusted to account for overlaps
between risk factors because each risk factor was calculated indepen-
dently. This adjustment was made using the joint effect calculation
and ensures that the burden allocated is not greater than actual
burden.
To estimate the health spending due a risk factor, total expendi-
ture for diseases by age and sex from the AIHW's disease expenditure

194 of 222
database are multiplied by the corresponding risk factor PAFs, to cal-
culate the percentage of the disease spending that is due to a risk
factor.
RESULTS: Estimates of health spending in 2018–2019 that could be
attributable to risk factors were calculated for close to 100 burden of
disease conditions and are presented at the national level. Results
from this analysis were published on the AIHW website in April 2022
in Health system spending per case of disease and for certain risk factors.
Spending on conditions due to obesity was higher than all other risk
factors at $4.3 billion, largely from costs of osteoarthritis ($1.1 billion),
type 2 diabetes ($568 million), and chronic kidney disease ($564 mil-
lion). This differs from burden estimates, where tobacco use was the
highest ranked risk factor.
CONCLUSION: Quantifying the impact of risk factors allows us to
assist evidence‐based decisions about where to direct efforts to pre-
vent disease and injury and to improve population health. As the mag-
nitude of costs associated with conditions can be quite different to
the burden, reporting both metrics in risk factor attributions provides
additional information about the impact to the health system due to
potentially avoidable health risks.
DISCLOSURE OF INTEREST: None declared.
LBP33 | Factors influencing food and
beverage industry's responses after the
implementation of sweetened beverage
excise duty (SBED) in Malaysia
1 1 2
G. Appannah ; Y. Y. Ng ; R. Don ; S. Shyam 2 measures to create healthy food retail
1
Department of Nutrition, Universiti Putra Malaysia, Serdang, Malaysia;
2
International Medical University, Bukit Jalil, Malaysia
INTRODUCTION: In 2019, Malaysia imposed an excise duty known
as Sweetened Beverage Excise Duty (SBED) of RM0.40 (0.1 United
States Dollar) per liter on SSBs to address the ever growing epidemic
of obesity and its associated chronic diseases. Following the imple-
mentation of the SBED, food and beverage industry and manufac-
turers were asked to reformulate their products as a way to mitigate
the sugar tax. Although vast majority of the food and beverage indus-
try have responded, that is, reformulation to the mandatory imple-
mentation of the SBED, their views and factors on these responses
were unclear.
MATERIALS AND METHODS: In this cross‐sectional study, a total of
40 food and beverage industry listed under the Federation of Malay-
sian Manufacturers (FMM) were invited to participate in this study. A
few factors including types of responses towards to the SBED, char-
acteristics of industry, pricing decision following SBED, fiscal policy
for health and the uses of the SBED revenue were assessed using a
self‐administered questionnaire by any higher management personnel
of the industry. Associations between characteristics of the industry,
pricing decision, fiscal policy for health, uses of revenue, and
1467789x, 2022, S2, Downloaded from https://onlinelibrary.wiley.com/doi/10.1111/obr.13503 by CAPES, Wiley Online Library on [16/12/2023]. See the Terms and Conditions (https://onlinelibrary.wiley.com/terms-and-conditions) on Wiley Online Library for rules of use; OA articles are governed by the applicable Creative Commons License
SUPPLEMENT ARTICLE
responses towards the SBED were assessed using logistic regression
analysis.
RESULTS: A total of 32 industry participated in this study and were
represented mainly by companies registered as Sdn. Bhd. (72%) and
with more than 50 employees (91%). Most industry reported that they
have reduced sugar content (84%) as a respond towards the imple-
mentation of the SBED followed by increased selling price (69%) and
decreased packaging size (50%). Findings from logistic regression anal-
ysis indicated that the food and beverage industries who reported an
impact on their untaxed beverages production were 12.6 times more
likely to have responded to all three SBED actions (OR = 12.6; 95%CI:
1.966,80.757; p < 0.05). Nonetheless, these impacts were rather posi-
tive, whereby an increased production of untaxed beverages was
reported (OR = 9.6; 95%CI: 1.378, 67.246; p < 0.05). Those industries
that have responded to all actions of SBED agreed that the revenue
of SBED should be used for improving agriculture areas (OR = 7.5;
95%CI: 1.288, 43.687; p < 0.05).
CONCLUSION: The findings of this study highlighted that all food
and beverage industry have responded to the implemented SBED in
Malaysia. Majority of them have attempted to reformulate sugar con-
tent in their products which is in line with the main objective of the
SBED implementation. The implementation of SBED has contributed
to the production of untaxed beverages and that the demand of mov-
ing away from taxed beverages was somewhat promising.
DISCLOSURE OF INTEREST: None declared.
LBP34 | The use of private regulatory
environments—A scoping review
J. Dancey1; J. Brimblecombe2; B. Reeve3; A. Jones4; M. Ferguson5
1
Faculty of Medicine, Nursing and Health Sciences and Buildings and
Property Division; 2Faculty of Medicine, Nursing and Health Sciences,
Monash University, Clayton, Victoria, Australia; 3The University of
Sydney Law School, The University of Sydney, Sydney, New South Wales,
Australia; 4Food Policy and Law, The George Institute, Sydney, New
South Wales, Australia; 5School of Public Health, The University of
Queensland, Brisbane, Queensland, Australia
INTRODUCTION: Significant changes to food retail environments are
required to prevent obesity and other diet‐related non‐communicable
diseases. Public and private regulation have been used to improve the
healthiness of food retail environments. Private regulation refers to
forms of regulation developed by private entities or organizations,
without state involvement. Research from the fields of regulatory
studies and public health law demonstrates that to be effective, pri-
vate regulation must be accompanied by adequate mechanisms for
monitoring, review and enforcement. We conducted a scoping review
to examine the use of private regulation to create healthy food retail
environments, how they were implemented, monitored, reviewed and
enforced, and the barriers to and enablers of their governance.

SUPPLEMENT ARTICLE
MATERIALS AND METHODS: Our scoping review protocol was
developed by our team of public health nutrition and public health law
researchers and informed by the Johanna Briggs Institute guidelines
for scoping reviews. We searched six databases with terms for popu-
lation (food retail), intervention (regulation), and outcome (healthy
food). Data were extracted on article demographics, type of regula-
tion, voluntary, or mandatory nature; regulatory processes regarding
implementation, monitoring, review, and enforcement; and the bar-
riers to and enablers of these regulatory processes. Evaluation of the
data drew on a framework developed by Reeve for evaluating and
strengthening the performance of public health law and regulation.
RESULTS: The 28 articles identified were published between 2011
and 2020, with 20 articles (71%) published from 2015 onwards. The
28 articles reported on 20 unique private regulatory initiatives to cre-
ate healthier food retail environments in six countries. Articles refer-
enced private regulatory measures in the form of programs, standards,
schemes, interventions, initiatives, policies, strategies, and guidelines
and cited a mix of voluntary (n = 13) and mandatory (n = 5) measures
or both (n = 2). All articles reported on some aspect of implementa-
tion, nine (32%) articles reported a form of monitoring, one article
(4%) reported on enforcement, and four (14%) articles reported on a
review process. Barriers and enablers to effective regulatory pro-
cesses were grouped into nine dominant themes including the regula-
tory substantive content, retailer, customer, operational, financial,
communication and choice issues, relationship management ,and
leadership.
CONCLUSION: To promote progress in this field, we recommend that
more attention be paid to reporting on the monitoring, review and
enforcement processes used to implement private regulation.
REFERENCES:
[1] Reeve et al. Ariz. J. Int'l & Comp L. 2018;35(No 1):61.
DISCLOSURE OF INTEREST: None declared.
LBP35 | The Queensland implementation
response to the National Obesity Strategy:
Building buy‐in through engagement
J. Nean1; E. Gale2; K. Clark1; C. Morrison1; M. Butcher3;
K. Bowmaker3; N. Herd3
1
Health and Wellbeing Queensland; 2Queensland Health, Brisbane; 3The
Social Deck, Sunshine Coast, Australia
INTRODUCTION: The National Obesity Strategy 2022–2032 (NOS)
was released in Australia in March 2022, following endorsement by
Commonwealth, state, and territory governments. The strategy pro-
vides a 10‐year national framework to prevent, reduce, and treat obe-
sity in Australia. Queensland's dedicated public health authority,
Health and Wellbeing Queensland (HWQld), is leading the state's
implementation of the NOS with the development of a Queensland
1467789x, 2022, S2, Downloaded from https://onlinelibrary.wiley.com/doi/10.1111/obr.13503 by CAPES, Wiley Online Library on [16/12/2023]. See the Terms and Conditions (https://onlinelibrary.wiley.com/terms-and-conditions) on Wiley Online Library for rules of use; OA articles are governed by the applicable Creative Commons License
195 of 222
Obesity Prevention Strategy and a foundational action plan (QOPS)
which is the first of multiyear action plans. This project aims to code-
velop a community informed QOPS that focuses on systems change
to address the complex public health issues of obesity, in an equitable
manner. HWQld is leading the way in Australia with their state's
response to the NOS, through a highly consultative and community
focussed approach that considers the diverse population and unique
challenges in Queensland.
MATERIALS AND METHODS: During June and July 2022, HWQld
delivered a first round of engagement activities with the assistance of
external engagement specialists, The Social Deck. Stakeholders from
across community and health sectors, government, and industry were
invited to participate in targeted workshops to identify priority actions
for Queensland, current initiatives to be leveraged, and bold new
actions to tackle the obesity crisis. A community survey was devel-
oped to collect insights from community members about their pre-
ferred priorities for action. A data‐driven, thematic analysis approach
was used in data collection and analysis to enable an in‐depth under-
standing of the key themes and subthemes that emerged from the
consultation with various stakeholder groups.
RESULTS: A total of six workshops (n = 95), a webinar (n = 126), and a
community survey (n = 757) were conducted. The engagement pro-
cess has enabled the development of partnerships, momentum, and
buy‐in across government and community to change the factors that
promote unhealthy weight gain and to support those living with over-
weight and obesity. Key themes that emerged included equity (espe-
cially food equity and food security), government leadership and
collaboration, local and community‐led solutions, and building capacity
and education to improve health literacy. These themes align with the
principles and three ambitions of the NOS: (1) creating supportive,
sustainable, and healthy environments; (2) empowering people to stay
healthy; and (3) access to early intervention and care.
CONCLUSION: The engagement process has highlighted a strong
desire from Queenslanders for change through bold new actions, with
equity at the heart. Findings will be used to inform the QOPS to sup-
port the state's implementation of the NOS. Subsequent consultations
will be undertaken with key stakeholders and community to ensure
that strategies and actions are practical, achievable, and meet the
needs of Queensland communities.
DISCLOSURE OF INTEREST: None declared.

196 of 222
LBP36 | Computational system dynamics
models could serve as advocacy tools for
policy to address the upstream causes of
childhood obesity
1 2 1 2 1
L. Crielaard ; A. Brown ; M. Nicolaou ; J. Hayward ; K. Stronks ;
S. Allender2
1
Public and Occupational Health, Amsterdam UMC location University of
Amsterdam, Amsterdam, Netherlands; 2Faculty of Health, Global Obesity
Centre (GLOBE), Institute for Health Transformation, Deakin University,
Geelong, Victoria, Australia
INTRODUCTION: The emerging system dynamics perspective on
childhood obesity postulates that upstream, environment‐level causes
can counterbalance downstream, individual‐level action. Still, advocat-
ing for upstream policy is challenging because the obesity policy
image is individualized. Computational system dynamics models
(SDMs) can simulate implications for BMI‐outcomes of both mental
models: individual‐level interventions, following the individualized pol-
icy image, and environment‐level interventions, following the system
dynamics perspective. Because SDMs were developed to test hypoth-
eses about mental models, they could serve as advocacy tools in shift-
ing the policy image from “individual responsibility” to “outcome of an
obesogenic environment.”
MATERIALS AND METHODS: We organized a workshop to, using
thematic analysis, assess whether community leaders, associated with
WHOSTOPS and experienced with the system dynamics perspective,
perceive an SDM with simulations comparing these mental models as
a useful advocacy tool. WHOSTOPS is a community‐research partner-
ship to establish community‐based whole‐of‐systems approaches to
childhood obesity in Victoria, Australia (Allender et al. Int J Environ
Res Public Health 2016 Nov 16;13(11):1143). The SDM, presented
via an interface, had been published previously and was informed by
local empirical data collected within WHOSTOPS (Crielaard et al.
Obes Rev 2020;21:e13044).
RESULTS: The SDM indicated that in the WHOSTOPS communities,
the reduction in community‐level BMI theoretically achievable by an
individual‐level intervention is diminished by 30% because the environ-
ment is unsupportive. The SDM's ability to simulate implications of dif-
ferent mental models, intuitive presentation of simulation RESULTS,
and incorporation of local empirical data caused the community leaders
to perceive it as a useful advocacy tool in shifting the policy image.
CONCLUSION: Community‐based whole‐of‐systems approaches
could integrate SDMs as advocacy tools for involved community
leaders to challenge mental models of potential contributing partners.
REFERENCES: (Allender et al. Int J Environ Res Public Health 2016
Nov 16;13(11):1143) (Crielaard et al. Obes Rev 2020;21:e13044)
DISCLOSURE OF INTEREST: None declared.
1467789x, 2022, S2, Downloaded from https://onlinelibrary.wiley.com/doi/10.1111/obr.13503 by CAPES, Wiley Online Library on [16/12/2023]. See the Terms and Conditions (https://onlinelibrary.wiley.com/terms-and-conditions) on Wiley Online Library for rules of use; OA articles are governed by the applicable Creative Commons License
SUPPLEMENT ARTICLE
LBP37 | Identifying attributes of
neighborhoods with higher risk of obesity: A
decision tree approach
M. Chandrabose; N. Hadgraft; N. Owen; T. Sugiyama
Healthy Cities Research Group, Centre for Urban Transitions, Swinburne
University of Technology, Melbourne, Australia
INTRODUCTION: Various contextual (environmental and socioeco-
nomic) attributes of neighborhoods where people live may influence
their obesity risk. Research has shown that neighborhood walkability,
greenness, urban sprawl, and area‐level socio‐economic status (SES)
are associated with obesity risk, by typically focusing on one exposure
measure. However, such investigation does not identify target areas
where more residents are likely to be at risk of obesity, since contex-
tual attributes may interact with each other in affecting obesity risk.
This study aimed to identify attributes of neighborhoods where resi-
dents have a higher obesity risk.
MATERIALS AND METHODS: We used data from 2041 metropolitan
residents in the 2011–2012 wave of the Australian Diabetes, Obesity
and Lifestyle Study (56% women, age range 36 to 77). Waist circum-
ference (WC) was used as the marker of obesity risk. The contextual
attributes used were neighborhood walkability (composite of residen-
tial density, street intersection density, and destination density),
neighborhood greenness (assessed from satellite images), the level of
urban sprawl (distance from residence to the nearest major city cen-
ter), and area‐level SES (a census‐based composite index correspond-
ing to the neighborhood). We used decision trees to identify
subgroups homogenous in terms of WC based on explanatory vari-
ables. The relative importance of explanatory variables in influencing
WC was also assessed. We also analyzed men and women separately.
RESULTS: The image shows the decision tree model for WC based on
contextual attributes. Residents in neighborhoods that are low in walk-
ability and in greenness, far from the city center, and low in SES were
likely to have greater waist circumference. In terms of relative impor-
tance, area‐level SES was the key discriminator (set at 100% for com-
parison), followed by greenness (65%), walkability (38%), and distance
to city center (34%). For men (not shown), WC subgroups were deter-
mined mainly by walkability (100%), distance to city center (73%),
greenness (65%), and area‐level SES (28%). In contrast, WC subgroups
for women were determined mainly by greenness (100%), area‐level
SES (89%), distance to the city center (61%), and walkability (45%).
CONCLUSION: This study identified subgroups that differed in the
risk of obesity based on contextual attributes. Obesity prevention
efforts may target neighborhoods that are low in walkability and in
greenness, far from the city center, and low in SES. Environmental ini-
tiatives improving greenness and walkability may help to reduce obe-
sity risk. The mechanisms underlying gender‐based differences in the
effects of contextual factors on obesity risk need to be investigated
to develop more‐targeted interventions for men and women.
DISCLOSURE OF INTEREST: None declared.

SUPPLEMENT ARTICLE
LBP38 | Fussy Eating Rescue, a mobile-web
app for responsive feeding practises among
parents of toddlers: a pilot randomized
controlled feasibility trial
B. Markides1; K. D. Hesketh2; R. Maddison2; R. Laws2;
E. Denney-Wilson3; K. J. Campbell2
1 15 subscribed to SMS notifications. 80% of parents agreed the app
Institute for Physical Activity and Nutrition, Deakin University,
2 was easy to use, 75% agreed it was well-organized with useful
Melbourne; Institute for Physical Activity and Nutrition, Deakin
3 content, and 75% said they would recommend it to others. While
University, Burwood; Susan Wakil School of Nursing and Midwifery, The
University of Sydney, Camperdown, Australia
INTRODUCTION: Fussy eating is a developmentally typical behav-
iour, generally presenting during toddlerhood. Up to half of parents of
young children have concerns about fussy eating, and concern may
mediate the use of nonresponsive feeding practises, such as coercive
or unstructured feeding and using food to reward eating. This random-
ized controlled pilot feasibility trial (ACTRN12621000925842) aimed
to evaluate feasibility and acceptability of Fussy Eating Rescue, a web
app for parents concerned about toddler fussy eating. Secondary aims
were to explore indications of its effect on parent feeding practises
and child eating behaviours.
MATERIALS AND METHODS: Fussy Eating Rescue features included:
(1) a Tracker, allowing parents to track repeated offers of food,
(2) Topics, covering fussy eating, feeding strategies, and general nutri-
tion, (3) Rescues, with quick lists and content, (4) Recipes, and
(5) SMS. Parents of toddlers (12 - 36 months) concerned about fussy
eating were recruited via Facebook and randomized to an intervention
group, receiving access to the app for 6 weeks, or wait-list control.
Outcomes were assessed at baseline and 6 weeks. Feasibility and
acceptability (assessed by participant retention rate, engagement, and
1467789x, 2022, S2, Downloaded from https://onlinelibrary.wiley.com/doi/10.1111/obr.13503 by CAPES, Wiley Online Library on [16/12/2023]. See the Terms and Conditions (https://onlinelibrary.wiley.com/terms-and-conditions) on Wiley Online Library for rules of use; OA articles are governed by the applicable Creative Commons License
197 of 222
app usability and satisfaction) were analysed descriptively. Secondary
outcomes (parent concern for fussy eating, self-efficacy, feeding
practices; child food fussiness, neophobia, and mealtime behaviours)
were examined with t-tests.
RESULTS: 57 participants completed the baseline survey, 51 partici-
pants (89%) were enrolled in the trial, and 42 completed the 6-week
survey (retention rate: 81%). 19/20 parents began using the app, and
70% agreed that it had helped their ability to manage fussy eating,
only 45% agreed it had improved their child’s eating and only 55%
said they would use the app again. Despite this, post-intervention
measures showed no significant changes in parent concern, self-
efficacy, or feeding practises, but did show significant decreases in
child food fussiness (p = .04, Cohen D = .40) and aggressive mealtime
behaviours (p = .01, Cohen D = .55). There were no differences at
baseline between intervention and control groups or in any baseline /
6-weeks comparisons for the control group.
CONCLUSION: Fussy Eating Rescue may be feasible way to engage
parents concerned for toddler fussy eating. As this pilot was not pow-
ered to detect differences in secondary outcomes, a larger trial is
needed to its efficacy.
DISCLOSURE OF INTEREST: None declared.

198 of 222
LBP39 | Returning to a healthy weight post
GDM: The potential for support from
mHealth
1 2 2
A. Roesler ; K. Butten ; M. Varnfield
1
Health & Biosecurity, CSIRO, Adelaide, South Australia, Australia;
2
Health & Biosecurity, CSIRO, Brisbane, Queensland, Australia
INTRODUCTION: Approximately 18% of pregnant women are
1
affected by GDM . The CSIRO AEHRC has a mobile health (mHealth)
platform (M♡THer) which has shown promise in the effective man-
agement of gestational diabetes (GDM) during pregnancy. The plat-
form's services currently finish at birth. However, women who have
experineced GDM are at increased risk of Type 2 diabetes and this is
associated with being overweight2. The aims of this research are to
understand the opportunities for mHealth for postpartum women
who have experienced GDM, particularly focusing on healthy weight
and reducing Type 2 diabetes risk.
MATERIALS AND METHODS: 1. A steering group committee that
includes women that have experienced GDM, health providers and
academics, has been formed to oversee and guide this research. 2.
The research involves the following data collection activities:
1. Interviews: Interview current and past users of the M♡THer plat-
form (including women who have experienced GDM and health
providers) to understand if and how the current platform could be
improved to support women in the postpartum period. This will
involve approximately 45 interviews that will be thematically
analyzed.
2. Survey and follow‐up interviews: A national survey of women who
have experienced GDM and their health providers. This survey will
assess if women are feeling supported in the postpartum period to
meet their weight and health goals. We specifically want to under-
stand the awareness and usage of mHealth programs during post-
partum and unmet needs. An estimated sample size of 400–700 is
expected with 30 follow‐up interviews.
3. The findings will be used to inform future development of the
M♡THer platform and its extension or connection with other
platforms.
4. Note that we may not capture all subpopulations through this
research, and further research will be required.
RESULTS: It is expected that:
• Extension of the M♡THer platform will be desired by some women
and clinicians currently using the platform.
• The end users would appreciate 1 health and well‐being platform
(such as M♡THer) to use during pregnancy and postpartum.
• Participants will want the mHealth platform to provide education
and reminders surrounding dietary intake tracking, carbohydrate
monitoring, mental well‐being tracking, weight monitoring, exercise
1467789x, 2022, S2, Downloaded from https://onlinelibrary.wiley.com/doi/10.1111/obr.13503 by CAPES, Wiley Online Library on [16/12/2023]. See the Terms and Conditions (https://onlinelibrary.wiley.com/terms-and-conditions) on Wiley Online Library for rules of use; OA articles are governed by the applicable Creative Commons License
SUPPLEMENT ARTICLE
reminders, blood pressure monitoring, sleep tracking, and blood
sugar measuring.
• A number of women will not be interested in mHealth, and other
avenues will be required to support them.
CONCLUSION: This research has just started, with data currently
being collected. There is much to understand about how mHealth can
best support women in the postpartum period, including how current
mHealth platforms are being used and what gaps exist. This research
will help us to better understand the mHealth needs of women who
have experienced GDM to obtain optimal weights and healthy
lifestyles.
REFERENCES:
[1] AIHW. Cat. no. CVD 85 2019.
[2] Guo et al JWH 2016. 25, 38‐49.
DISCLOSURE OF INTEREST: None declared.
LBP40 | Prevalence of Spanish adolescents
with disordered eating symptoms and its
associated factors from a socioecological
approach
J. F. López‐Gil1; R. Fernández‐Rodríguez1,2; A. E. Mesas1;
E. Jiménez‐López1; M. Garrido‐Miguel1; D. Victoria‐Montesinos3;
H. Gutiérrez‐Espinoza4; P. J. Tárraga‐López5
1
Health and social research center, Faculty of nursing, University of
Castilla‐La Mancha., Universidad de Castilla‐La Mancha; 2Health and
Social Research Center, Universidad de Castilla‐La Mancha, Cuenca,
Spain; 3Faculty of Health Sciences, San Antonio Catholic University of
Murcia (UCAM), Murcia, Spain, UCAM, Murcia, Spain; 4Escuela de
Fisioterapia, Universidad de las Américas, Quito, Ecuador., Universidad de
las Américas, Quito, Ecuador, Spain; 5Departamento de Ciencias Médicas,
Facultad de Medicina, Universidad Castilla‐La Mancha (UCLM), Albacete,
Spain, Universidad de Castilla‐La Mancha, Albacete, Spain
INTRODUCTION: Eating disorders are severe and potentially life‐
threatening illnesses affecting people through the life span, with a
specific influence on both the physical and psychological development
of the young population.1
MATERIALS AND METHODS: The aim of this study was twofold: (a)
to establish the prevalence of adolescents with disordered eating and
(b) to determine the factors associated with this prevalence in a repre-
sentative sample of Spanish adolescents. This cross‐sectional study
analyzed data from 741 adolescents (55.1% girls) from the Eating
Healthy and Daily Life Activities (EHDLA) study, which included a rep-
resentative sample of adolescents aged 12 to 17 years from the Valle
de Ricote (Region of Murcia, Spain). To determine the prevalence of
disordered eating, the Sick, Control, One stone, Fat, Food (SCOFF)
questionnaire was used. A socioecological approach was used to

SUPPLEMENT ARTICLE
identify individual‐, interpersonal‐ or organizational‐level factors asso-
ciated with disordered eating symptoms among adolescents.
RESULTS: The prevalence of disordered eating was 30.1%. This con-
dition was associated with female sex (OR = 2.60; CI 95%, 1.81–3.73),
immigrant status (OR = 2.22; CI 95%, 1.51–3.25), or excess weight
(OR = 2.74; CI 95%, 1.93–3.89). Furthermore, lower odds of having
disordered eating were found for each hour slept (OR = 0.81; CI 95%,
0.67–0.98).
CONCLUSION: Almost one‐third of the studied Spanish adolescents
had disordered eating, which could severely influence their general
health. Female sex, immigrant status, and excess weight are individual
aspects that may account for important disparities in the prevalence
of disordered eating symptoms among Spanish adolescents. Further-
more, future prospective studies should assess whether sleep duration
could help prevent disordered eating symptoms.
REFERENCES:
[1] Hornberger, L. L. et al. 147(1), e2020040279.
DISCLOSURE OF INTEREST: None declared.
LBP41 | Changes of food label viewing
behaviors in a healthy eating and weight
management counseling program: A
randomized controlled trial among middle‐
aged Hong Kong Chinese women
Y. J. Xie1,2; L. Tian2; Q. Zhou3; C. Hao4; Y. Gao5; D. D. Zhang6;
H. H. Wang4,7; A. Loke2; J. Qin2; L. Yang2
1
Research Center for Chinese Medicine Innovation; 2School of Nursing,
The Hong Kong Polytechnic University, Hong Kong, Hong Kong; 3School
of Public Health, Peking University, Beijing, China; 4School of Public
5
Health, Sun Yat‐Sen University, Guangzhou, China; Department of Sport,
Physical Education and Health, Hong Kong Baptist University, Hong
Kong; 6JC School of Public Health and Primary Care, Chinese University
of Hong Kong, Hong Kong, Hong Kong; 7College of Medicine and
Veterinary Medicine, The University of Edinburgh, Edinburgh, UK
INTRODUCTION: Proper usage of food labels plays an important role
in healthy eating. The purpose of this study was to exam the effec-
tiveness of a healthy eating and weight management counseling pro-
gram on food label viewing behaviors among middle‐aged Hong Kong
Chinese women.
MATERIALS AND METHODS: This was a two‐arm randomized con-
trolled trial. An integrated approach that consisted of a body composi-
tion measurement by the InBody 270, followed by an immediate
counseling after the measurement (5–10 min), and a dietitian‐guided
weekly WhatsApp‐based individualized counseling (15 minutes each
time), was implemented in the intervention group for 12 weeks. Par-
ticipants in the control group only received the body composition
measurement and a brief counseling after the measurement. A 4‐point
1467789x, 2022, S2, Downloaded from https://onlinelibrary.wiley.com/doi/10.1111/obr.13503 by CAPES, Wiley Online Library on [16/12/2023]. See the Terms and Conditions (https://onlinelibrary.wiley.com/terms-and-conditions) on Wiley Online Library for rules of use; OA articles are governed by the applicable Creative Commons License
199 of 222
Likert scale with four options including “Never”, “Rarely”, “Sometimes”,
and “Always” were used for measuring the frequency of food label
viewing behaviors. The participants were asked to recall the fre-
quency of viewing front‐of‐package nutrition labels when they pur-
chased packaged biscuits, bread, beverages, and canned food before
and after the intervention.
RESULTS: A total of 173 women aged 45 to 65 years were involved
in the analysis, with 82 in the intervention group and 91 in the control
group. The mean age was 56.5 ± 4.9 years. At baseline, the percent-
age of “sometimes/always view food labels” in the intervention group
was 62.2%, 47.6%, 65.9%, and 62.2% for the biscuits, bread, bever-
ages, and canned food, respectively. After 12 weeks intervention, the
overall percentage of viewing four food labels increased from 37.8%
to 55.0% (p < 0.05). Except the canned food, the percentage signifi-
cantly increased to 76.7%, 73.3%, and 80.0% for viewing the food
labels of biscuits, bread, and beverages, respectively (all p < 0.05).
Compared with control group, the increases were statistically signifi-
cant, with the corresponding odds ratio of 2.02 (95% CI: 1.06 to 3.83)
for biscuits, 1.95 (95% CI: 1.03 to 3.70) for bread, and 2.05 (95% CI:
1.07 to 3.91) for beverages, respectively.
CONCLUSION: The 12 weeks integrated nutrition related counseling
program could significantly improve the frequency of viewing food
labels in middle‐aged Hong Kong Chinese women.
DISCLOSURE OF INTEREST: None declared.
LBP43 | Association of Stearoyl CoA
Desaturase 1 Gene Polymorphism and
Enzyme Activity in Bangladeshi Type 2
Diabetic Patients
S. Akter1; M. Bhowmik2; M. Saiedullah3; H. S. Chaudhury4; L. Ali5
1
Kyung Hee University, Seoul, Korea, Republic Of; 2Bangladesh Reference
Institute for Chemical Measurements (BRiCM), Dhaka, 1205;
3
Department of Physiology and Molecular Biology, Bangladesh University
of Health Sciences, Dhaka, 1216; 4Department of Biochemistry,
International Medical College Hospital, Tongi, 1711; 5Pothikrit Institute
of Health Studies, Dhaka, 1000, Bangladesh
INTRODUCTION: Stearoyl‐CoA Desaturase 1 (SCD1), the rate limiting
enzyme for the biosynthesis of monounsaturated fatty acids, has been
altered SCD1 in a variety of metabolic diseases. Herein we evaluated
the genetic deviation of the SCD1 gene and its activity in association
with type 2 diabetes subjects in Bangladesh.
MATERIALS AND METHODS: A total of 45 T2DM subjects and 45
controls were recruited. Anthropometric and biochemical parameters
were measured by standard methods. Serum leptin and insulin were
measured by enzyme linked immunosorbent assay (ELISA). Plasma
free fatty acids were analyzed by gas‐liquid chromatography (GLC).
Stearoyl CoA desaturase 1 activity was calculated by plasma
palmitoleic/palmitic (C16:1/C16:0) ratio. Genomic blood DNA was
extracted and analyzed by the PCR‐RFLP method. Genetic
 1467789x, 2022, S2, Downloaded from https://onlinelibrary.wiley.com/doi/10.1111/obr.13503 by CAPES, Wiley Online Library on [16/12/2023]. See the Terms and Conditions (https://onlinelibrary.wiley.com/terms-and-conditions) on Wiley Online Library for rules of use; OA articles are governed by the applicable Creative Commons License
200 of 222 SUPPLEMENT ARTICLE

polymorphism of SCD1 gene was determined using Hardy‐Weinberg GDM Control

Equilibrium. n 49,232 n 170,335
RESULTS: The result showed significant differences in heterozygous Age 32.2 (5.5) 32.0 (5.5)
variants of SCD1 gene (T→C) between T2DM and control subjects BMI (kg/m ) 2
29.3 (0.05) 25.7 (0.03)
(p=0.004). BMI, WHR and blood glucose were found to significantly
Self‐reported ethnicity, n (%)
increase in rs7849 genotype. High frequencies of SCD1 gene rs7849
White 27,584 (56.0) 131,864 (77.4)
variant were observed in central obesity (16%), overweight (20%) and
Indian 3,902 (7.9) 6,098 (3.6)
body fat percentage (25%). Lower levels of SCD 1 activity was
Pakistani 3,902 (7.9) 6,098 (3.6)
observed in T2DM patients and it was positively correlated with
Bangladeshi 3,884 (7.9) 2,961 (1.7)
serum leptin levels (r=0.185, p=0.04).
CONCLUSION: The genetic variations in the SCD1 gene may influ- Other Asian 2,856 (5.8) 4,564 (2.7)

ence the functional activity in patients with T2DM, further popula- Caribbean 640 (1.3) 1,924 (1.1)

tion‐based study in patients with overweight and obesity is warranted Black African 2,751 (5.6) 6,973 (4.1)
to confirm the function of rs7849 variant in the pathophysiology of Chinese 786 (1.6) 1586 (0.9)
obesity associated T2DM in Bangladesh. Other 3026 (6.2) 8,503 (5.0)
DISCLOSURE OF INTEREST: None Declared

LBP44 | Exploring the LOng‐term Outcomes

following a PrEgancy affected by gestational
diabetes: ELOPE‐GDM project
N. M. Astbury1; L. Mackillop2; J. Hirst2; J. Hippisley‐Cox1; S. Jebb1
1
Nuffield Department of Primary Care Health Sciences; 2Nuffield
Department of Women's & Reproductive Health, University Of Oxford,
Oxford, United Kingdom
INTRODUCTION: Gestational diabetes mellitus (GDM) is defined as
glucose intolerance with onset during pregnancy and resolving after
birth. GDM is known to be associated with an increased risk of
adverse outcomes during pregnancy and birth, and there is consistent
evidence to suggest a strong association between GDM and progres-
sion to T2DM later in life. However, the risks of developing other
health conditions and the healthcare usage and costs of caring for
GDM women (beyond pregnancy) are not known. In this project we
will quantify the long‐term health risks of GDM and estimate the eco-
making‐up the control group. Women who received a diagnosis of
GDM had higher pre‐pregnancy BMI, and a greater proportion
reported to be Asian, African or Chinese backgrounds compared with
the control women. Analysis on clinical outcomes is currently in pro-
gress and preliminary results will be presented.
CONCLUSION: The results will provide information which is important
to women who are pregnant or planning pregnancy and their families, it
will inform the development of clinical guidelines and help commis-
sioners to judge the cost‐effectiveness of potential new pathways of
care which may help prevent and treat GDM more effectively.
DISCLOSURE OF INTEREST: None Declared
LBP45 | Relationships between waist and hip
circumference and 10‐year cardiovascular
disease risk: findings from the baseline data
of a Hong Kong women cohort
Y. J. Xie1,2; L. Tian1; Q. Sun3; L. Yang1; Y. Gao4; D. Zhang5; C. Hao6;

nomic and healthcare costs attributed to GDM. J. Qin1; A. Loke1

MATERIALS AND METHODS: Using QResearch database, we will
extract electronic primary care patient records linked with hospital
episode statistics (HES), of women with at least one singleton delivery
between 1 January 2000 and 7 August 2021. Exposure will be diagno-
sis of GDM in any pregnancy. Cases will be matched with up to four
control records of women who have never received a diagnosis of
GDM, matched on maternal age and delivery (+/‐ 3 mo). Women will
be followed‐up from the delivery until an outcome of interest, death or
transfer out of the practice that shares data. We will analyse the risk
GDM poses for a range of clinical conditions e.g type 2 diabetes, cardio-
vascular disease, depression, cancer. We will also extract information
on the total number and type of consultations, prescriptions, diagnostic
tests and treatments to estimate healthcare costs attributed to GDM.
RESULTS: We have identified records of 49,477 women with GDM,
and these were matched with 170,335 unique maternal records,
1
School of Nursing; 2Research Center for Chinese Medicine Innovation,
The Hong Kong Polytechnic University, Hong Kong, Hong Kong;
3
Department of Nutrition, Harvard School of Public Health, Boston,
United States; 4Department of Sport, Physical Education and Health,
Hong Kong Baptist University; 5JC School of Public Health and Primary
Care, Chinese University of Hong Kong, Hong Kong, Hong Kong; 6School
of Public Health, Sun Yat‐Sen University, Guangzhou, China
INTRODUCTION: Limited studies have investigated the threshold
effects of the associations between anthropometric parameters and
the risk of cardiovascular disease (CVD) in Asian female population.
The purpose of this study was to examine the associations of 10‐year
CVD risk with waist circumference (WC), hip circumference (HC) and

SUPPLEMENT ARTICLE
T A B L E 1 Regression analyses of the associations between
anthropometric parameters and FRS
threshold β (95% CI) β (95% CI)
value < threshold value ≥ threshold value
WC 88.0 cm 0.12 (0.11 to 0.15) 0.15 (0.03 to 0.25)
HC 102.3 cm ‐0.21 (‐0.25 to ‐0.17) ‐0.37 (‐0.50 to ‐0.24)
WHR 0.81 13.11 (7.93 to 18.28) 23.23 (18.88 to 27.59)
waist‐hip‐ratio (WHR) in a sample of Hong Kong Chinese women and
to explore the possible threshold effects.
MATERIALS AND METHODS: Data were extracted from a prospec-
tive cohort study that contained 4,222 Hong Kong women aged from
30 to 74 years and free of CVD at the baseline assessment during
2020 and 2021. In total 3,809 (90.22%) women who took physical
examinations (blood pressure, height, weight, WC and HC) and lipid
test (cholesterol, high density lipoprotein) were included in the analy-
sis. The demographics, disease status, lifestyle factors and other cov-
ariates were collected by questionnaires through face‐to‐face
interview. The 10‐year CVD risk was calculated by the laboratory‐
based Framingham 10‐year risk score (FRS). Multiple linear regression
model was adopted to exam the relationships between anthropomet-
ric variables and 10‐year CVD risk. Two‐piecewise linear regression
model was further used to explore the threshold effects, with the
threshold value automatically calculated by recursive algorithm.
RESULTS: The average age of the participants was 55.8±8.8 years.
The mean WC and HC was 78.9±9.4 cm and 94.7±6.7 cm, respec-
tively; 43.0% of the particpants had central obesity (WC≥80 cm). The
median of FRS was 0.05 (interquartile range: 0.03 to 0.08), 14.9% of
the participants had a high level of CVD risk (FRS ≥ 10%). After adjust-
ment of BMI, education level, occupation, physical activity and drink-
ing, 1‐cm increase in WC was associated with 0.13 (95% CI: 0.10 to
0.16) units increase in FRS; while 1‐cm increase in HC predicted ‐0.23
(95% CI: ‐0.27 to ‐0.20) units changes of FRS. The WHR was posi-
tively associated with FRS (β=19.50, 95% CI: 17.27 to 21.72). Thresh-
old effects existed in all three anthropometric parameters. The
regression coefficient was 13.11 (95% CI: 7.93 to 18.28) for
WHR<0.81 and 23.23 (95% CI: 18.88 to 27.59) for WHR≥0.81. Simi-
lar findings were observed for both WC and HC. Table 1 shows the
threshold values of WC and HC and the corresponding regression
coefficients.
CONCLUSION: Larger WC but smaller HC predicted the higher 10‐
year CVD risk in Hong Kong Chinese women. When the women's WC
and WHR excessed a threshold value, the 10‐year CVD risk was
aggravated.
DISCLOSURE OF INTEREST: None Declared
1467789x, 2022, S2, Downloaded from https://onlinelibrary.wiley.com/doi/10.1111/obr.13503 by CAPES, Wiley Online Library on [16/12/2023]. See the Terms and Conditions (https://onlinelibrary.wiley.com/terms-and-conditions) on Wiley Online Library for rules of use; OA articles are governed by the applicable Creative Commons License
201 of 222
LBP46 | The paradox of obesity with
European Working Group on Sarcopenia in
Older People (EWGSOP)‐2 criteria in a
healthy population– results of a cohort study
M. Shahraki Jazinaki1; M. R. Shadmand Foumani Moghadam2;
Z. Hosseini2; R. Rezvani1; A. Norouzy1
1
Nutrition, Mashhad University of Medical Sciences; 2Nutrition Sciences,
Varastegan Institute, mashhad, Iran, Islamic Republic Of
INTRODUCTION: Sarcopenia is defined as a progressive musculoskel-
etal disorder that results in progressive loss of muscle mass and its
consequences during aging. Sarcopenia is associated with an increase
in adverse outcomes such as falls, efficient reduction, weakness, and
mortality. On the other side, Obesity is a major problem with increas-
ing prevalence worldwide while the population is aging. The aim of
this study is to investigate the paradox of obesity in sarcopenia cri-
teria that can make diagnostic biases.
MATERIALS AND METHODS: To measure skeletal muscle mass
(SMM) and body mass index (BMI), the bioelectric impedance analyzer
(BIA) InBody‐270 was used. To calculate the skeletal muscle mass index
(SMMI), SMM was divided by the square of the height in meters based
on the European Working Group on Sarcopenia in Older People
(EWGSOP)‐2 guideline. Muscle strength was measured using a hydrau-
lic hand dynamometer according to the Roberts et al. methodology and
the 4‐m gait speed was used to evaluate muscle performance.
RESULTS: 766 healthy individuals aged 65.1±6.8 years (33% male)
with a mean BMI of 26.5±4.4 kg/m2 included. Nine percent, 37.1%,
37.99%, and 23.9% of the population were underweight, normal,
overweight, and obese. The comparison showed a significantly lower
SMMI (OR (95% CI)=0.155 (0.053‐0.46), P=0.001) in underweight
than normal while muscle strength and performance was independent.
The different for muscle strength was significant for overweight (OR
(95% CI)=0.918 (0.891‐0.95), P<0.001) and obesity (OR (95% CI)
=0.895 (0.864‐0.93), P=<0.001) in compare with normal. In addition
to muscle strength muscle performance (OR (95% CI)=7.462 (1.679‐
33.17), P=0.008) within people with obesity and SMMI in overweight
(OR (95% CI)=1.404 (1.153‐1.71), P=<0.001) in people with overweight
were significantly different in comparison with the normal group.
CONCLUSION: The result of the study shows sarcopenia can stay
undiagnosed in people with obesity despite affecting both its strength
and performance. A revision to the EWGSOP‐2 to adjust the impact
of obesity may be required.
DISCLOSURE OF INTEREST: None Declared

202 of 222
LBP47 | Withdrawn
LBP48 | Withdrawn
LBP49 | Healthy Kids Program: Using
telehealth to run multi‐disciplinary group
education for children and their families
D. Schefe; N. Ward; K. Mackay; R. Rafferty; D. Brewer
Darling Downs Health, Nutrition & Dietetics, Toowoomba Hospital,
Toowoomba, Australia
INTRODUCTION: Paediatric obesity is a significant concern. Children
affected by obesity are more likely to become adults affected by obe-
sity and have poorer physical and mental health. Within Queensland 1
in 4 (24%) children are living with overweight or obesity1. Healthy
Kids Program is a collaborative five‐month program that was devel-
oped in 2021 and piloted within Darling Downs Health by dietitians,
child health nurses, psychologists and exercise physiologists. The pro-
gram aims to improve health outcomes in childhood overweight and
obesity by focusing on lifestyle interventions including healthy eating,
exercise, sleep and mindfulness.
MATERIALS AND METHODS: The group targets children aged 2‐17
years and their families. Evaluation methods include the use of pre
and post surveys reporting on physical activity, screen time, sleep,
dietary intake, habits and behaviours and anthropometric measures.
RESULTS: Whilst the program had positive participant feedback there
was a significant participant attrition. It is well recognised that families
have many competing demands. Offering an alternative option to
access services is therefore vital to ensure the ability for continual
engagement and equity in rural health. The most recent cohort
(February to June 2022) was delivered via telehealth to improve access;
and more than half of the participants completed the program. This was
a significant improvement to the pilot cohort where only face‐to‐face
contact was offered, and a large dropout rate was observed. Positive
outcomes have continued to be reported, most notably an increase in
physical activity and reductions in take away food consumption,
however retention rates remain less than desirable.
CONCLUSION: Future cohorts will offer hybrid modes of delivery to
continue to increase access and improve the recruitment and reten-
tion of participants across vast geographical areas.
REFERENCES:
[1] Australian Institute of Health and Welfare, 2020, Overweight
and obesity among Australian children and adolescents, August,
Australian Government
DISCLOSURE OF INTEREST: None Declared.
1467789x, 2022, S2, Downloaded from https://onlinelibrary.wiley.com/doi/10.1111/obr.13503 by CAPES, Wiley Online Library on [16/12/2023]. See the Terms and Conditions (https://onlinelibrary.wiley.com/terms-and-conditions) on Wiley Online Library for rules of use; OA articles are governed by the applicable Creative Commons License
SUPPLEMENT ARTICLE
LBP51 | Association of abdominal obesity and
hematological parameters in South Korean
adults: Korean National Health and Nutrition
Examination Survey 2016‐2018
H. Mun; S. B. Pak
NHIMC, Seoul, Korea, Republic Of
INTRODUCTION: The prevalence of obesity in Korea has gradually
increased. Obesity is an accumulation of excessive adipose tissue that
secretes interleukin‐6 contributing to megakaryocytopoiesis. It is well
known that the blood platelets are produced through the process of
various differentiations in megakaryocytes. This study aims to investi-
gate the association between abdominal obesity and the hematologi-
cal parameters in Korean adults.
MATERIALS AND METHODS: The analysis was conducted with data
of 15,176 adults (6,639 males and 8,537 females) aged 19 years and
older selected from the 2016‐2018 Korea National Health and Nutri-
tion Examination Survey. The relationship between abdominal obesity
and hematological parameters was analyzed using multivariate logistic
regression after adjusting for variables such as age, status of smoking,
alcohol drinking, exercise, and history of diabetes.
RESULTS: The present study included 4,417 participants with abdom-
inal obesity and 10,759 without abdominal obesity. The value of
hematological parameters increased when both males and females
had abdominal obesity. The odd ratios (ORs) (95% confidence interval
[CI]) for the highest quartile of the platelet count in patients with
abdominal obesity were 1.427(1.201‐1.695) for males and 2.380
(2.020‐2.804) for females (P<0.001). The ORs(95% CI) for the highest
WBC count quartile in those with abdominal obesity were 2.280
(1.908‐2.725) for males and 3.939(3.325‐4.668) for females
(P<0.001).
Data expressed as odds ratio (95% CI) Values are from multivariate
logistic regression analysis; Adjusted for age, drinking, smoking, physi-
cal activity, and diabetes mellitus.
CONCLUSION: These findings suggested that abdominal obesity
was positively associated with hematological parameters in Korean
adults.
DISCLOSURE OF INTEREST: None Declared.
 1467789x, 2022, S2, Downloaded from https://onlinelibrary.wiley.com/doi/10.1111/obr.13503 by CAPES, Wiley Online Library on [16/12/2023]. See the Terms and Conditions (https://onlinelibrary.wiley.com/terms-and-conditions) on Wiley Online Library for rules of use; OA articles are governed by the applicable Creative Commons License
SUPPLEMENT ARTICLE 203 of 222

T A B L E 2 Odds ratio and 95% confidence intervals for analysis of covariance (ANCOVA) to compare adjusted mean HGS and
hematological parameters according to abdominal obesity
the multivariate logistic regression to calculate the odds ratios (ORs)
Abdominal and 95% confidence intervals (CIs) for low muscle strength according
Variable obesity Odds to the AIP quartiles.
(Reference: Q1) ratio (95% CI) P‐value RESULTS: The AIP value was significantly higher in obese group than
Platelets(×109/L) Q2(219‐255) 1.09(0.91‐1.29) 0.343
non‐obese group (0.43 vs 0.35, P<0.001). Mean handgrip strength of
Male
the highest AIP quartile was significantly lower than that of the lowest
Q3(255‐294) 1.29(1.09‐1.53) 0.003
AIP quartile in obese group (Q1: 21.59kg, Q4: 18.39, P<0.001), but
Q4(>294) 1.43(1.20‐1.69) < 0.001
the differences were statistically insignificant in non‐obese group. In
Female Q2(228‐268) 1.54(1.30‐1.83) < 0.001
obese group, the OR of low muscle strength was significantly greater
Q3(268‐308) 1.76(1.49‐2.07) < 0.001 in the highest AIP quartile than in the lower AIP quartiles (Q1: OR ref.,
Q4(>308) 2.38(2.02‐2.80) < 0.001 Q2: OR 2.136, Q3: OR 4.443, Q4: OR 4.580).
WBC (Thous/uL) Q2(5.46‐6.41) 1.40(1.16−1.67) < 0.001 CONCLUSION: Higher AIP value was associated with reduced hand-
Male grip strength in the elderly women with obesity. Clinicians should pay
Q3(6.41‐7.57) 1.78(1.48−2.14) < 0.001 attention to elderly women with low muscle strength and obesity for
Q4(>7.57) 2.28(1.90−2.72) < 0.001 increased cardiovascular disease risk.
Female Q2(4.82−5.72) 1.48(1.24‐1.76) < 0.001
Q3(5.72‐6.82) 2.13(1.81‐2.52) < 0.001 REFERENCES:
Q4(>6.82) 3.93(3.32‐4.66) < 0.001 Samper‐Ternent, R. et al. Rev Clin Gerontol 2012; 22 10‐34
RBC (Mil/uL) Q2 (4.76‐5.04) 1.39(1.18‐1.63) < 0.001 World Health Organization. Obesity and overweight fact sheet.
Male Available: https://www.who.int/news‐room/fact‐sheets/detail/obe-
Q3(5.04‐5.31) 1.54(1.30‐1.82) < 0.001 sity‐and‐overweight. Accessed: 9 June 2021.
Q4(>5.31) 2.41(2.02‐2.87) < 0.001 Malenfant, J.H. et al. J Glob Health Rep 2019; 3
Female Q2(4.16‐4.38) 1.31(1.11‐1.55) < 0.001 Kim, T.N. Journal of Obesity & Metabolic Syndrome 2018; 27 84‐92

Q3(4.38‐4.61) 1.84(1.55‐2.18) < 0.001

Macek, P. et al. Clinical Interventions in Aging 2020; 15 2301
Gaba A. et al. Eur J Nutr 2014; 53 167‐176
Q4(>4.61) 3.00(2.54‐3.54) < 0.001
Qianqian Gao et al. Clinical Nutrition 2021; 40 4633‐4641
Kim, I.H. J Korean Med Sci 2011; 26 250‐257
Zhu et al. Lipids in Health and Disease 2018; 17 37
Kwon, YN et al. J Bone Metab 2018; 25 53‐5
LBP52 | The Atherogenic Index of Plasma is Lim, J.W. et al. Korean J Fam Med. 2011; 32 128‐134
associated with Handgrip Strength in Elderly Hwang, B.K. et al. J Korean Med Sci 2012; 27 748‐755
Women with Obesity – A Nationwide Study Yang, Y.S. et al. Journal of Obesity & Metabolic Snydrome 2022; 31
in Korea 169‐177
Mathus‐Vliegen, Elisabeth M.H. J Clin Gastroenterol 2021; 46 533‐
H. L. Choi 544
Family Medicine, Samsung Medical Center, Seoul, Korea, Republic Of Rashid, Mitchell N. Prev Cardiol. 2033; 6 42‐47
Jing Wu et al. Front. Cardiovasc. Med. 8; 817441
Lee, Y.L. et al. Ann Geriatr Med Res eISSN 2508‐4798
INTRODUCTION: The worldwide obesity prevalence has increased
among the elderly. Age‐related changes of body composition include DISCLOSURE OF INTEREST: None Declared.
increase in body fat mass and decrease in muscle mass – leading to
sarcopenic obesity. These changes are more prominent in elderly
women than elderly men. This study aims to investigate whether the
handgrip strength (HGS) is associated with the atherogenic index of
plasma, a novel index for cardiovascular disease, among Korean
elderly women with obesity.
MATERIALS AND METHODS: We analyzed data of 1430 Korean
women age of > 65 years obtained from the seventh Korean National
Health and Nutritional Examination Survey (KNHNES). The elderly
women with BMI >25 were grouped into obese group. We catego-
rized the atherosclerotic index of plasma (AIP) values into quartiles
and defined low muscle strength as HGS less than 16.80kg. We used

204 of 222
LBP53 | Considerations of eating disorder risk
during treatment of obesity in children,
adolescents and adults
C. Kwok1; V. Forward2; C. McMaster1; N. Lister1; S. Garnett1,3;
1
H. Jebeile
1
Children's Hospital Westmead Clinical School, The University of Sydney,
Westmead; 2Nutrition and Dietetics Group, Charles Perkins Centre, The
University of Sydney, Sydney; 3Kids Research, The Children's Hospital at
Westmead, Westmead, Australia
INTRODUCTION: People with obesity are vulnerable to eating disor-
ders with several shared risk factors. It has been suggested that
screening for eating disorder risk be part of obesity assessment and
treatment. However, it is unclear what current practice entails. We
aimed to explore considerations of eating disorder risk during treat-
ment of obesity, including assessment and intervention strategies
used in clinical practice.
MATERIALS AND METHODS: An online (REDCap) cross‐sectional
survey was distributed to clinicians working with individuals who had
obesity in Australia through professional societies and social media.
The survey had three sections: 1. Characteristics of Obesity Clinician/
Practice, 2. Current Practice (including assessment and treatment
modification), 3. Attitudes. Data were summarised using descriptive
statistics and free‐text comments were independently coded in dupli-
cate to identify themes.
RESULTS: 59 clinicians completed the survey. Most were dietitians
(n=29, 49.2%), identified as female (n=45, 76.3%) and worked within a
public hospital (n=30, 40.8%) and/or private practice (n=29, 49.2%).
Overall, 84.7% (n=50) of clinicians reported assessing for eating disor-
der risk, with unstructured open‐ended questions (n=35, 59.3%) being
the most used assessment method. Most clinicians endorsed the
attitude that having a history of, or risk factors of an eating disorder
should not preclude a person from receiving obesity treatment but
emphasised the importance of modification of care including using a
patient‐centred approach involving a multidisciplinary team and pro-
moting healthy eating behaviours, with less emphasis on calorie restric-
tion or bariatric surgery. Management approaches did not differ for
those with eating disorder risk factors or a diagnosed eating disorder.
CONCLUSION: Most clinicians assessed for eating disorder risk and
modified treatment accordingly. Individualised care, balancing models
of care for eating disorders and obesity, standardised approach to
assessment and further access to appropriate eating disorder training
and services will be important in improving care of patients with
obesity.
DISCLOSURE OF INTEREST: None Declared.
1467789x, 2022, S2, Downloaded from https://onlinelibrary.wiley.com/doi/10.1111/obr.13503 by CAPES, Wiley Online Library on [16/12/2023]. See the Terms and Conditions (https://onlinelibrary.wiley.com/terms-and-conditions) on Wiley Online Library for rules of use; OA articles are governed by the applicable Creative Commons License
SUPPLEMENT ARTICLE
LBP54 | Association of carotid intima‐media
thickness with heart rate variability among
healthy adults in Korea
H. Bak; Y. Park
Family Medicine, Dong‐A university hospital, BUSAN, Korea, Republic Of
INTRODUCTION: Increased carotid intima‐media thickness (IMT) and
decreased standard deviation of normal‐to‐normal interval (SDNN)
are known risk factor for cardiovascular disease. This study investi-
gated this association in patients who visited a health promotion
center.
MATERIALS AND METHODS: We studied 4,981 participants who
visited the Health Promotion Center at a University Hospital between
March 2018 and February 2019. Carotid artery ultrasonography and
heart rate variability (HRV) test were measured in all patients. Sub-
jects were divided into normal and abnormal based on 0.9mm of
carotid IMT. To determine the correlation between carotid IMT
and HRV, scatter plots and Pearson correlation coefficients were
obtained. In addition, to determine the association of carotid IMT with
HRV, cardiovascular disease (CVD) risk factors (sex, age, obesity,
hypertension, diabetes mellitus, dyslipidemia, smoking) known to be
associated with increased carotid IMT and HRV parameters were set
as risk factors and multivariate logistic regression analysis was
performed.
RESULTS: Carotid IMT showed negative correlations with HRV
parameters (SDNN, RMSSD, TP, LF, and HF), and the only positive
correlation with LF/HF ratio. Increased carotid IMT was significantly
associated with SDNN reduction(<30msec) (odds ratio [OR], 1.19;
P=0.019;95% confidence interval [CI], 1.03‐1.38), RMSSD reduction
(<20msec) (OR, 1.22;P=0.013;95% CI, 1.04‐1.42). This association
was obtained after being adjusted for all CVD risk factors.
CONCLUSION: Increased carotid IMT and decreased SDNN, known
as CVD risk factors, are independently correlated.
REFERENCES:
1. Touboul PJ et al. Stroke 2005;36(8):1741‐1745.
2. Kitamura A et al. Stroke 2004;35(12):2788‐2794.
3. Dekker JM et al. Circulation 2000;102(11):1239‐1244.
4. Pereira VL et al. Front Physiol 2017;8:248 5.Eller NH et al. Int J
Behav Med 2006;13(3):201‐213
DISCLOSURE OF INTEREST: None Declared.
 1467789x, 2022, S2, Downloaded from https://onlinelibrary.wiley.com/doi/10.1111/obr.13503 by CAPES, Wiley Online Library on [16/12/2023]. See the Terms and Conditions (https://onlinelibrary.wiley.com/terms-and-conditions) on Wiley Online Library for rules of use; OA articles are governed by the applicable Creative Commons License
SUPPLEMENT ARTICLE 205 of 222

TABLE 4 Multivariable logistic regression analysis of SDNN, RMSSD for carotid IMT

Model 1 Model 2 Model 3

OR (95% CI) P‐value OR (95% CI) P‐value OR (95% CI) P‐value
SDNN 1.56 (1.36‐1.77) <0.001 1.19 (1.03‐1.38) 0.019
RMSSD 1.76 (1.53‐2.01) <0.001 1.22 (1.04‐1.42) 0.013

Model 1 are crude data.

Model 2 are adjusted sex, age, obesity, hypertension, diabetes, dyslipidemia, smoking and SDNN.
Model 3 are adjusted sex, age, obesity, hypertension, diabetes, dyslipidemia, smoking and RMSSD.
HRV, heart rate variability; IMT, intima‐media thickness; OR, odds ratio; CI, confidence interval; HR, heart rate; SDNN, standard deviation of NN (RR)
interval; RMSSD, root mean square of successive NN interval differences.
Odds ratios and P‐values were calculated using logistic regression.
 1467789x, 2022, S2, Downloaded from https://onlinelibrary.wiley.com/doi/10.1111/obr.13503 by CAPES, Wiley Online Library on [16/12/2023]. See the Terms and Conditions (https://onlinelibrary.wiley.com/terms-and-conditions) on Wiley Online Library for rules of use; OA articles are governed by the applicable Creative Commons License
206 of 222 SUPPLEMENT ARTICLE

LBP55 | Association between body dyslipidemia, there was no significant association between body com-
composition parameters and coronary artery position factors and coronary artery calcium.

calcium in postmenopausal women CONCLUSION: Although there was no significant relationship

J. W. Hwang; Y. Eun; S. G. Park
Yeouido St. Mary's Hospital, College of Medicine, The Catholic University
of Korea, Seoul, Korea, Republic Of
INTRODUCTION: Hormonal changes during menopause influence
body composition and could result in various metabolic diseases.
Metabolic abnormalities are the leading cause of coronary artery dis-
ease (CAD), which is the leading cause of death worldwide. Several
parameters have been studied as indicators for coronary atheroscle-
rosis and metabolic disorders, but the best tool for postmenopausal
women is yet to be found. Therefore, in this study, we aim to com-
pare and observe the association between various body composition
parameters and coronary artery calcium (CAC) in postmenopausal
women.
MATERIALS AND METHODS: A total of 455 postmenopausal
women who visited the Health Promotion Center of St.Vincent’s
Hospital from 2009 to 2018 were analyzed. We used bioelectrical
impedance analysis to evaluate BMI, fat‐to‐muscle ratio (FMR),
visceral fat area (VFA), and skeletal muscle‐to‐visceral fat area ratio
(SVR). Computed tomography imaging was used to ascertain the CAC
score. Multivariate logistic regression analysis was done with the
tertile groups for each potential indicator.
RESULTS: In logistic regression analysis, SVR showed a statistically
significant relationship with coronary artery calcium (p value of SVR
Q2< 0.007 and SVR Q3 <0.001). However, after adjusting for age,
systolic blood pressure, smoking, diabetes, hypertension, and
between body composition factors with CAC after adjusting for con-
founding factors, this study showed that SVR had a negative associa-
tion with coronary calcium in postmenopausal women. Additional
large‐scale studies are needed to confirm a definite association, and
research on other indicators for the prevention of coronary artery dis-
ease in postmenopausal women should be continued.
DISCLOSURE OF INTEREST: None Declared.
LBP56 | Exploring the physiological barriers
to weight management in women with
polycystic ovary syndrome: A scoping review
K. Nguo1; M. McGowan2; S. Cowan2; Z. Davidson1; S. Pirotta2;
A. Doredevic1; M. Hajishafiee3; H. Teede2; M. Carmichael4;
L. Moran2
1
Nutrition, Dietetics and Food; 2Monash Centre for Health Research and
Implementation (MCHRI), Monash University, Melbourne; 3Thompson
Institute, University of the Sunshine Coast; 4Allied Health and Human
Performance, University of South Australia, Adelaide, Australia
INTRODUCTION: Polycystic ovary syndrome (PCOS) is an endocrine
condition occurring in 8‐13% of reproductive‐aged women associated
with reproductive, metabolic and psychological dysfunction. Over-
weight and obesity are prevalent and can exacerbate the features of
PCOS. Lifestyle interventions to prevent weight gain or assist with
weight loss are first line strategies in PCOS management. The aim of

TABLE 1 Multivariate logistic analysis of body composition factors with coronary artery calcium scores

Crude Model 1 Model 2

BMI
Q1 1 1 1
Q2 1.350(0.806‐2.261) 1.272(0.721‐2.245) 1.021(0.562‐1.853)
Q3 0.955(0.558‐1.634) 0.944(0.524‐1.699) 0.576(0.299‐1.108)
SVR
Q1 1 1 1
Q2 0.498(0.299‐0.829) 0.827(0.471‐1.451) 0.986(0.548‐1.775)
Q3 0.371(0.217‐0.635) 0.797(0.434‐1.464) 1.001(0.523‐1.918)
VFA
Q1 1 1 1
Q2 1.067(0.610‐1.865) 0.907(0.496‐1.657) 0.815(0.433‐1.534)
Q3 2.000(1.186‐3.373) 1.065(0.590‐1.924) 0.713(0.373‐1.362)
FMR
Q1 1 1 1
Q2 0.954(0.555‐1.642) 0.872(0.483‐1.576) 0.686(0.366‐1.288)
Q3 1.493(0.892‐2.500) 1.320(0.748‐2.328) 1.011(0.553‐1.846)

SUPPLEMENT ARTICLE
this review is to explore the physiological factors affecting energy
homeostasis, which may impact weight gain, weight loss and weight
maintenance in PCOS and generate recommendations for future
research.
MATERIALS AND METHODS: A systematic literature search was
performed using MEDLINE, EMBASE, PsycInfo, AMED, CINAHL and
Cochrane Central Register of Controlled Trials to June 2022. Search
terms included physiological factors affecting energy intake (e.g. gas-
trointestinal appetite hormones, adipokines, subjective appetite, brain
responses measured by functional brain imaging (fMRI), neuropep-
tides) and energy expenditure (e.g. total energy expenditure (TEE),
resting energy expenditure (REE), metabolic flexibility) in women with
PCOS. Abstracts, non‐English language and reviews were excluded.
RESULTS: A total of n=55 energy intake and n=23 energy expendi-
ture papers were included. Energy intake papers included focused
specifically on studies assessing the impact of food, nutrient or sup-
plements on outcomes to better capture the accurate relationship
with energy homeostasis (papers with multiple outcomes were
counted as separate studies). Energy intake studies (n=91) were
grouped into the outcomes of gastrointestinal appetite hormones
(n=44), adipokines (n=35), subjective appetite (n=9), fMRI (n=3) and
neuropeptides (n=0). Energy expenditure studies (n=29) were grouped
into TEE (n=1), REE (n=15), meal induced thermogenesis (n=3), nutri-
ent oxidation (n=6) and metabolic flexibility (n=4). Across both energy
intake and expenditure papers, sixty percent of the studies compared
outcome responses in women with PCOS to a control group. Results
were inconsistent with 57% reporting no differences and 43% report-
ing altered responses in PCOS compared with controls, including
blunted appetite hormone responses, metabolic inflexibility and
reduced energy expenditure. An additional 456 papers were identified
with relevant outcomes, however outside the context of energy
homeostasis.
CONCLUSION: This comprehensive review has identified several pri-
orities for further research, firstly in primary studies where research is
limited such as TEE, fMRI and neuropeptides and secondly where sys-
tematic reviews and meta‐analyses could be conducted to synthesise
the current evidence including REE and gastrointestinal hormones.
Addressing these research gaps will contribute significantly in under-
standing the aetiology of weight management and obesity in women
with PCOS and assist with informing future interventions.
DISCLOSURE OF INTEREST: None Declared
1467789x, 2022, S2, Downloaded from https://onlinelibrary.wiley.com/doi/10.1111/obr.13503 by CAPES, Wiley Online Library on [16/12/2023]. See the Terms and Conditions (https://onlinelibrary.wiley.com/terms-and-conditions) on Wiley Online Library for rules of use; OA articles are governed by the applicable Creative Commons License
207 of 222
LBP57 | Addressing the Urgent Need in
Obesity Care and Management: A Consensus
in South and Southeast Asia
K. W. Tham1; M. Fojas2; T. Q. Nam3; B. J. Oldfield4 on behalf of
the Working Group on A Consensus on Obesity Care and
Management in South and Southeast Asia
1
Singapore Association for the Study of Obesity, Singapore, Singapore;
2
University of the Philippines College of Medicine, Manila, Philippines;
3
Ho Chi Minh City University Medical Center, Ho Chi Minh, Viet Nam;
4
Monash University, Melbourne, Australia
INTRODUCTION: In South and Southeast Asia (S‐SEA) the preva-
lence of obesity is predicted to double between 2010 and 2030. Chal-
lenges in obesity prevention, care and management in this region
include the unique nature of excess adiposity in the Asian phenotype,
the double burden of nutrition, cultural nuances and the inconsistent
quality of obesity care. To address these concerns, a panel of experts
in the field of obesity undertook to develop practical recommenda-
tions to underpin the clinical approach to, and management of, obesity
in this region.
MATERIALS AND METHODS: The panel consisted of 12 physicians
with expertise in managing obesity in children and adults from Bangla-
desh, Brunei, India, Indonesia, Malaysia, Philippines, Singapore, Sri
Lanka, Thailand, and Viet Nam and 2 experts from Australia who par-
ticipated equally in the process as external advisors. A set of clinical
questions were established that would help define optimal
approaches to the following: identification and staging of obesity,
obesity treatment (behavioral, psychological, pharmacologic, and sur-
gical options), weight maintenance after weight loss, weight stigma
and patient engagement. Forty‐two clinical recommendations were
voted upon by the panel of 14 experts, with consensus determined as
≥80% agreement among panelists.
RESULTS: Consensus was achieved on all 42 clinical recommenda-
tions. Country‐specific nuances were sought from experts from each
country in S‐SEA and were reflected in the final recommendations. A
number of aspects of obesity care and management unique to the S‐
SEA experience were identified and included: the distribution of adi-
posity in individuals and its adverse impact on Asians, particularly in
the determination of the diagnosis of obesity, the diversity of culture
influencing dietary habits and the molding of beliefs and attitudes of
both people with obesity and healthcare professionals towards obe-
sity and its management, the heterogeneity of healthcare systems and
of healthcare resources including public access to, and level of training
of, specialists in obesity care and treatment options. Beyond the goals
of improved diagnosis and management of obesity, the recommenda-
tions emphasized the pertinence of addressing psychological and
social aspects of obesity, the role of family and community, weight
bias and stigma and the use of respectful, appropriate language.
Finally, the panel acknowledged the urgent need to advocate for pub-
lic health measures to prevent obesity throughout the life course in
this region.

208 of 222
CONCLUSION: The rise in obesity prevalence in S‐SEA necessitates
an improvement in the quality of care for those living with obesity in
the region. To address this need, a panel of 12 experts from 10 coun-
tries in S‐SEA with 2 external advisors established and agreed upon
42 clinical recommendations to be used by clinicians in the care and
management of obesity in children and adults across the region.
DISCLOSURE OF INTEREST: K. W. Tham Grant/Research support
with: Novo Nordisk, Consultant for: DKSH, Novo Nordisk, Speakers
bureau with: Astra Zeneca, DKSH, Novo Nordisk, M. Fojas Speakers
bureau with: Novo Nordisk, T. Q. Nam Consultant for: AstraZeneca,
Boehringer Ingelheim Viet Nam, Novo Nordisk, Sanofi, Speakers
bureau with: AstraZeneca, Boehringer Ingelheim, MSD, Merck Serono,
Novartis, Novo Nordisk, Sanofi, B. Oldfield Consultant for: Novo
Nordisk
LBP58 | Expert consensus on relevant risk
predictors for the occurrence of
cardiometabolic complications in pregnancy
S. Cowan1; S. Lang1; J. Enticott1; H. Teede1; R. Goldstein1; R. Wang2;
F. Taylor1; L. Moran1
1
Monash Centre for Health Research Implementation; 2Obstertrics &
Gynaecology, Monash University, Melbourne, Australia
INTRODUCTION: Obesity increases the risk of gestational diabetes
mellitus (GDM) and hypertensive disorders of pregnancy (HDP),
including de novo gestational hypertension and preeclampsia. Early
intervention with lifestyle treatment can prevent development or
lessen severity of GDM and HDP, and reduce long‐term risk of type 2
diabetes and cardiovascular disease. However, diagnosis of GDM and
HDP occurs in the second‐third trimester, and there is currently poor
identification of high‐risk women in early pregnancy. There is also no
risk prediction model encompassing both GDM and HDP complica-
tions. The aim of this e‐Delphi study was to reach an expert consen-
sus on key predictors for cardiometabolic complications (GDM and
HDP) in early pregnancy.
MATERIALS AND METHODS: A narrative review was used to iden-
tify existing risk prediction models for GDM and HDP (1). Predictors
used in these models were presented to key stakeholders (patient rep-
resentatives, researchers and clinicians) for prioritisation using a two‐
round modified Delphi method (two e‐surveys and one online consen-
sus meeting). A priori consensus criteria informed which predictors
were brought forward for discussion at the consensus meeting where
the list of predictors was finalised. Discussions focused on the impor-
tance (clinically relevant and statistically significant), feasibility (easily
and conveniently measured) and acceptability (suitable and appropri-
ate to collect) of predictors.
RESULTS: The narrative review identified 18 GDM and 15 HDP pre-
diction models. From these models 15 predictors were presented to
stakeholders in round 1. All 15 predictors were brought forward from
round 1 and eight additional predictors were nominated by
1467789x, 2022, S2, Downloaded from https://onlinelibrary.wiley.com/doi/10.1111/obr.13503 by CAPES, Wiley Online Library on [16/12/2023]. See the Terms and Conditions (https://onlinelibrary.wiley.com/terms-and-conditions) on Wiley Online Library for rules of use; OA articles are governed by the applicable Creative Commons License
SUPPLEMENT ARTICLE
stakeholders and discussed at the consensus meeting. Round 1 was
completed by 31 stakeholders, 45% (14/31) of whom completed
round 2. Twelve predictors were included in the final list, consisting of
10 maternal history predictors (age, body mass index, parity, ethnicity,
history hypertension, history diabetes, family history diabetes, history
polycystic ovary syndrome, history macrosomia, history chronic kid-
ney disease), one biochemical predictor (blood glucose) and one hae-
modynamic predictor (systolic blood pressure). Excluded predictors
were viewed as impractical to collect in the clinical setting due to vari-
ability of measurement (e.g. waist circumference) and training
required to ensure accuracy (e.g. uterine artery pulsatility index).
CONCLUSION: This final list of predictors will be used to develop a
risk prediction model for early pregnancy that facilitates timely inter-
vention. Incorporating clinical knowledge and consumer perspectives
in the early phase of predictor selection ensures that the risk predic-
tion model is clinically useful with good practical performance, gener-
ating a tool that can be more easily integrated into routine care.
REFERENCE:
1. Thong et al. J Cardiovasc Dev Dis 2022; 9 55.
DISCLOSURE OF INTEREST: None Declared
LBP59 | Old drug, new tricks: an RCT
repurposing dexamfetamine to treat obesity
N. Gauci1,2; H. Khalifa2; D. Lee1; D. Coulshed2,3; E. Hibbert2,3;
K. Foster‐Powell3; A. Poulton2,3
1
Nepean Lung and Sleep, Kingswood; 2The University of Sydney, Sydney;
3
Nepean Hospital, Penrith, Australia
INTRODUCTION: The principles of losing weight are easy to under-
stand but in practice, many people find it exceedingly difficult to
maintain a negative energy balance through a combination of diet and
exercise. This has led to an important role for medical and surgical
treatment for obesity. Drugs which suppress the appetite can be
expensive, with monthly treatment for anti‐obesity medications cost-
ing anywhere from $122 to $387. Dexamfetamine (DEX), which could
be a cheaper alternative, is considered a relative contraindication due
to its abuse potential. However, it is likely that the primary goal of
people seeking anti‐obesity medication is for help with losing weight,
rather than the intention to abuse drugs. Therefore, our aim is to test
whether in combination with diet and lifestyle, a 6 month period of
treatment with DEX is safe and more effective than placebo for treat-
ing obesity. In the longer term, DEX might be reconsidered as a viable
treatment option, particularly for people who are economically
disadvantaged.
MATERIALS AND METHODS: Double blind randomised placebo‐
controlled trial of 6 months treatment followed by 2 years observa-
tion, with 2 groups of 30 participants per group. Inclusion criteria: age
18‐70; BMI 25‐70; apnoea‐hypopnoea index of at least 15 events per

SUPPLEMENT ARTICLE
hour; medically stable. Exclusions include a history of drug abuse, con-
current treatment with psychotropic medication and medical contrain-
dications to stimulants. Participants are randomised 1:1 to either
immediate release DEX tablets or identical placebo tablets. The dose
is titrated, starting at 5mg/1 tablet twice daily, with weekly incremen-
tal dose increases of 5mg/1 tablet twice daily as tolerated, to a maxi-
mum of 30mg/6 tablets twice daily. Each participant is reviewed
weekly during titration followed by monthly review at maintenance.
Dosage adjustment is guided by clinical effects and ratings using the
amphetamine interview rating scale. The dose is back titrated over the
last month of treatment.
RESULTS: The study is in the final stages of recruitment. The data
remains blinded and is the combination of DEX and placebo groups.
51 subjects have been consented into the study (33 male, mean age
47 years). Mean weight loss at 6 months was 9.04 kg (95% CI 6.29 –
11.77, p<0.001). Twelve subjects reduced their body weight by 10%
or more. Two subjects reduced their body weight by more than 20%
(22.4 kg and 20.6 kg, respectively). None had drug craving on ceasing
medication, and there were no cardiac complications. Adverse psycho-
tropic effects (anger, irritability) limited the dose in 2 subjects (6%).
CONCLUSION: The mean weight loss in the combined cohort indi-
cates efficacy at an inexpensive cost of only $33/month for DEX at
full dose. DEX/placebo was well‐tolerated by most subjects, with no
evidence of abuse or dependence. The preliminary results of this
study suggest that DEX may merit further research as a cheaper alter-
native to newer appetite suppressant drugs.
DISCLOSURE OF INTEREST: None Declared.
LBP60 | Intermittent fasting versus calorie
restriction on blood pressure and the renin‐
angiotensin‐aldosterone system: A secondary
analysis of a randomised controlled trial in
adults at elevated risk of developing type 2
diabetes
R. Charrouf1,2; K. Liu1,2; X. T. Teong1,2; A. Hutchison1,2; H. Leonie1,2
1
SAHMRI; 2University of Adelaide, Adelaide, Australia
INTRODUCTION: Hypertension is strongly linked to overactivity of
the renin‐angiotensin‐aldosterone system (RAAS) in individuals with
obesity. Weight loss reduces blood pressure and dampens RAAS.
This study is a secondary analysis to compare the modality of
weight loss by early intermittent fasting (eIF) versus calorie restriction
(CR) on blood pressure and RAAS in adults at elevated risk of type 2
diabetes.
MATERIALS AND METHODS: This open‐label, multi‐arm, parallel‐
group sequential randomised controlled trial involved a 6‐month inter-
vention (NCT03689608) where participants were randomised to one
of three groups: eIF (30% of energy requirements before 12pm fol-
lowed by a 20‐hour fast on 3 non‐consecutive fasting days/week;
usual diet on non‐fasting days), CR (70% of energy requirements daily
1467789x, 2022, S2, Downloaded from https://onlinelibrary.wiley.com/doi/10.1111/obr.13503 by CAPES, Wiley Online Library on [16/12/2023]. See the Terms and Conditions (https://onlinelibrary.wiley.com/terms-and-conditions) on Wiley Online Library for rules of use; OA articles are governed by the applicable Creative Commons License
209 of 222
without time prescription), or standard care (SC, given a healthy life-
style booklet). This secondary analysis was limited to those not taking
antihypertensive medications (including angiotensin converting
enzyme (ACE) inhibitors, diuretics, beta blockers, vasodilators, renin
inhibitors, n=120, 58% female, age 58±10 years, BMI 33.7±4.1kg/m2).
Blood pressure and fasting levels of aldosterone and ACE were exam-
ined by ELISA at baseline and 24 weeks. One‐way analysis of covari-
ance was performed utilising SPSS, adjusted for baseline, sex, and
Australian type 2 diabetes (AUSD) risk score.
RESULTS: At 24 weeks body weight was reduced in eIF and CR as
compared to SC (both p<0.001), with no difference in body weight
between eIF and CR. Systolic blood pressure was reduced by eIF (‐9 ±
1 mmHg) versus SC (‐3 ± 2 mmHg, p=0.02), but there was no differ-
ence between eIF and CR (‐7 ± 2 mmHg, p=0.44) or between CR and
SC (p=0.42). Diastolic blood pressure was reduced by eIF (‐6 ± 1
mmHg) versus SC (‐2 ± 1 mmHg, p=0.05), but there was no difference
between eIF and CR(‐4 ± 1 mmHg, p=0.11), and the CR and SC group
(p=0.38). Aldosterone was not different between groups but ACE
levels were reduced in eIF vs CR only (p=0.01).
CONCLUSION: The study indicates that the modality of weight loss
did not differentially impact blood pressure, giving people with obe-
sity some flexibility around the intervention that best suits their
lifestyle.
REFERENCES:
Engeli et al. Hypertension 2004; 45(3): 356‐362
DISCLOSURE OF INTEREST: None Declared.
LBP61 | Withdrawn
LBP62 | Evaluation of a Northern Territory
Weight Management Clinic
S. Krishna1; D. Pammit‐Mellors2; K. Taylor3; K. Willson4;
D. MacKay1,5; A. Wood1,5
1
Department of Endocrinology; 2Diabetes Education Unit; 3Nutrition and
Dietetics; 4Department of General Medicine, Royal Darwin Hospital;
5
Menzies School of Health Research, Charles Darwin University, Darwin,
Australia
INTRODUCTION: There is a higher proportion of Aboriginal and
Torres Strait Islander people living with obesity and socioeconomic
disadvantage in Australia’s Northern Territory (NT) compared to the
rest of Australia. Whilst trial data supports the use of very low energy
diets (VLED) and pharmacotherapy for weight loss, real world evi-
dence is limited. We aimed to determine the impact of a new weight
management clinic in Darwin, NT, on the health of people living with
obesity.

210 of 222
MATERIALS AND METHODS: A prospective study including all cli-
ents attending the Top End Weight Management Clinic in Darwin
from its commencement in August 2021 to June 2022 was under-
taken with informed consent. Analysis of the 21 clients who com-
pleted 12 weeks of therapy was performed. The multidisciplinary
clinic caters for people aged 18 to 60 with body mass index (BMI) >30
2
kg/m and established obesity related complications. It involves an
individualised weight management plan, VLED with formulated meal
replacements, and pharmacological support if required. First‐line phar-
macotherapy is topiramate, phentermine, or a GLP‐1 receptor agonist.
Outcomes included percentage and absolute total body weight loss.
Paired t‐tests were used to compare weight and BMI between base-
line and after 12 weeks of therapy.
RESULTS: In the 10‐month period, 21 of 38 clients completed 12
weeks of therapy. Five (24%) identified as Aboriginal or Torres Strait
Islander. At enrolment, mean age was 42 years (SD 11.8), mean
weight was 147.8 kg (SD 41.9), and mean BMI 50.2 kg/m2 (SD 15.9).
At enrolment, 11 (52%) had established diabetes (1 type 1, and 10
type 2), 12 (57%) had obstructive sleep apnoea, and 10 (48%) had
musculoskeletal conditions. One or more pharmacological agents were
commenced for 10 clients (semaglutide n=4; topiramate n=3; phenter-
mine n=4). Topiramate was ceased for 2 clients due to side effects,
with no cessation of other pharmacotherapy.
After 12 weeks mean weight was 135.9 kg (SD 41.1) and mean
BMI 46.2 kg/m2 (SD 15.7). Mean change in body weight was ‐11.8%
(SD 9.5; p<0.001) with clients losing between ‐1.2% to 24.8% body-
weight. Absolute mean weight loss was 11.9 kg (SD 9.5) and mean
change in BMI was 4.0 kg/m2 (SD 2.95; p<0.001).
CONCLUSION: Among clients attending the first weight management
clinic in the NT, we report meaningful improvements in weight and
BMI. This evaluation demonstrates that a multidisciplinary approach
can result in short‐term weight loss with the potential for significant
health benefits in the long term.
DISCLOSURE OF INTEREST: None Declared
LBP63 | The relationship between sleep
duration and Insulin resistance in non‐
diabetic Korean adults
S. Park; C. Choi
Family Medicine, Seoul St. Mary’s Hospital, College of Medicine, The
Catholic University of Korea, Seoul, Korea, Republic Of
INTRODUCTION: As industrialization progresses in modern society,
sleep time is getting shorter. As a result, sleep time is reported to be
associated with chronic diseases such as metabolic syndrome and dia-
betes, and the importance of sleep is emphasized. Previous studies
have shown that inappropriate sleep time increases the prevalence of
diabetic and prediabetic stages. However, these studies have been
conducted in the West, and in the East, there is a relatively lack of
research on the correlation between sleep and insulin resistance.
1467789x, 2022, S2, Downloaded from https://onlinelibrary.wiley.com/doi/10.1111/obr.13503 by CAPES, Wiley Online Library on [16/12/2023]. See the Terms and Conditions (https://onlinelibrary.wiley.com/terms-and-conditions) on Wiley Online Library for rules of use; OA articles are governed by the applicable Creative Commons License
SUPPLEMENT ARTICLE
Recently, as westernization has been progressing in the East, it is nec-
essary to study the correlation between sleep time and insulin resis-
tance. The aim of this study is to examine the associations of sleep
duration with insulin resistance in patients without type 2 diabetes
using The Korean National Health and Nutrition Examination Survey.
MATERIALS AND METHODS: This cross‐sectional study included
7646 Korean adults (3402 men and 4244 women) 19 to 64 years of
age who participated in the Korean National Health and Nutrition
Examination Survey between 2019 and 2020. Subjects were catego-
rized into three groups based on self‐reported sleep duration (<7, 7,
or >7 h/d). We used homeostatic model assessment of insulin resis-
tance (HOMA‐IR) as indicators of insulin resistance. The association
between sleep duration and insulin resistance was investigated using
multivariable logistic regression analysis.
RESULTS: A total of 7646 adults aged 19‐64 years old were included
in this study. Short sleep duration (<7 hours) was associated with
increased odd ratios (ORs) for having high HOMA‐IR, compared with
normal sleep duration (OR=1.208, 95% confidence interval [CI]:
1.050–1.390, adjusted for age, gender, education, income, occupation,
marital status, smoking, drinking and physical activity).
CONCLUSION: Based on HOMA‐IR, short sleep duration was signifi-
cantly associated with insulin resistance in apparently Korean nondia-
betic adults. An inappropriate sleep duration was associated with
insulin resistance.
REFERENCES:
Pyykkönen et al. the PPP‐Botnia study. Annals of medicine 2014; 46:
324‐9
Chaput et al. Diabetologia 2007; 50: 2298‐304
DISCLOSURE OF INTEREST: None Declared.
LBP64 | Withdrawn
LBP65 | Subjects with NAFLD but without
obesity demonstrate lower risk of metabolic
syndrome than those with obesity but
without NAFLD: a multicenter cross-sectional
study
T. P. Chen1; H. H. Kao1; C. Y. Wang1; K. Y. Lai1; K. C. Yang2;
W. Y. Lin1
1
Department of family medicine, China medical university hospital,
Taichung; 2Department of Family Medicine, National Taiwan University,
Taipei, Taiwan, Province of China
INTRODUCTION: Nonalcoholic fatty liver disease (NAFLD) and obe-
sity are risk factors for metabolic syndrome (MetS). Interaction
between NAFLD and obesity might deteriorate the probability of

SUPPLEMENT ARTICLE
MetS. We aim to evaluate the impact of obesity on the risk of MetS in
subjects with NAFLD.
MATERIALS AND METHODS: A population‐based cross‐sectional
study was conducted in three different hospitals in Taiwan from 2015
to 2022. Anthropometric and biochemical measurements were col-
lected after 8‐hour fasting. NAFLD was diagnosed through abdominal
ultrasonography by trained doctors. Participants were divided into
two groups by body mass index (BMI) with a cutoff value of 25 kg/m2
and NAFLD status. The diagnostic criteria for MetS were based on
the National Cholesterol Education Program Adult Treatment Panel III
Criteria (NCEP‐ATP III), which was then modified for the Asia group.
The risk of MetS with the status of NAFLD and obesity was assessed
using a multiple logistic regression model.
RESULTS: 690 eligible participants were involved in the analysis, with
441 NAFLD without obesity and 249 with obesity but without
NAFLD. The mean age was 62.7 ± 16.7 years old. The prevalence of
MetS was 35.4% in the NAFLD group without obesity and 47.7% in
the group with obese but without NAFLD, respectively. The NAFLD
group without obesity demonstrates a lower percentage of abnormal
waist circumference and blood pressure than those with obesity but
without NAFLD (p<0.05). However, the ratio of abnormal triglyceride,
high‐density lipoprotein cholesterol (HDL‐C), and glucose were similar
between the two groups (p>0.05). The nonobese NAFLD group
demonstrates a lower risk of metabolic syndrome than the group with
obesity but without NAFLD (Odds ratio 0.68, 95% confidence interval
[CI]: 0.47‐0.97).
CONCLUSION: Both NAFLD and obesity increase the risk of MetS.
As risk factors, NAFLD reveals a lower risk of MetS compared with
obesity.
DISCLOSURE OF INTEREST: None Declared.
LBP66 | Withdrawn
1467789x, 2022, S2, Downloaded from https://onlinelibrary.wiley.com/doi/10.1111/obr.13503 by CAPES, Wiley Online Library on [16/12/2023]. See the Terms and Conditions (https://onlinelibrary.wiley.com/terms-and-conditions) on Wiley Online Library for rules of use; OA articles are governed by the applicable Creative Commons License
211 of 222
LBP67 | Obesity and cardiovascular diseases,
Cross‐sectional study in Saudi arabia “occurs”
M. Shams1; A. Alshaikh2; A. Alfadda3; A. Alshehri4; F. Al Sabaan5;
H. Mosli6; S. Khader7; R. Dahash8; S. Bukhari9; R. Aljawair10;
A. Al Qarni11; H. Alquraini12; M. Refaat1
1
Medical affairs, Novo Nordisk, Riyadh; 2Department of endocrinology,
Dr Sulaiman Fakeeh Hospital, Jeddah; 3Faculty of medicine, King Saud
University; 4Obesity Research Center, King Fahad Medical City;
5
Department of endocrinology, Security Forces Hospital, Riyadh; 6Faculty
of medicine, King Abdulaziz University Hospital, Jeddah; 7Department of
endocrinology, Dr Sulaiman Habeeb Hospital; 8Department of
endocrinology, National Guard Hospital, Riyadh; 9Department of
endocrinology, King Fahad Armed Forces Hospital, Jeddah; 10Department
of endocrinology, Dhahran Military Medical Complex, Dammam;
11
Department of endocrinology, King Abdulaziz Hospital, Ministry of
National Guard Health Affairs; 12Department of endocrinology, Almoosa
Specialized Hospital, Ihsaa, Saudi Arabia
INTRODUCTION: In 2020, more than one‐third of the global adult
population was overweight (body mass index [BMI] >25), of which
30% were complaining of obesity (BMI >30). The prevalence of obe-
sity in the Kingdom of Saudi Arabia (KSA) is estimated to rise to 92%
in men and 75% in women by 2050. Epidemiological studies have
identified obesity as a risk factor for chronic diseases, including the
risk for CVD events like dyslipidaemia, hypertension, and coronary
heart disease. Across the world, CVD is the leading cause of death
and disability, and it is projected that the death rate linked to CVDs
will reach 23 million by 2030. CVD‐related mortality alone accounts
for approximately 42% of all deaths in KSA. Our study aims to esti-
mate the prevalence of CVDs among people with obesity with or
without a history of T2D, in addition to assessing the burden of obe-
sity clinically and economically.
MATERIALS AND METHODS: This is a multi‐centre cross‐sectional,
observational study. The study will be comprised of two components:
(1) Cross‐sectional component to capture data on patient’s clinical
characteristics, data on demographics, lifestyle, QoL and productivity
(from patient questionnaires); (2) Retrospective component to capture
medical history (history of CVD from patients’ electronic medical
records “EMR”) and HCRU data. The study population will include
adults with obesity, either without a history of T2D (Cohort 1) or with
a history of T2D (Cohort 2). A minimum of 1142 people with obesity
(802 patients in Cohort 1 and 340 patients in Cohort 2) will be
recruited for the study. Data will capture data from (1) Patients’ EMR,
(2) Patient questionnaires, and (3) Local obesity burden model.
The study’s primary objective is to estimate the prevalence of
CVDs among people with obesity without a history of T2D. The sec-
ondary objectives of this study are to estimate the prevalence of CVD
among people with obesity and a history of T2D and all people with
obesity (including patients with or without a history of T2D). QoL,
HCRU, productivity among all people with obesity and the distribution
of obesity‐related complications according to age, sex, and BMI.

212 of 222
RESULTS: Study results will be reported in 2023.
CONCLUSION: OCCURS study will provide great insights towards
improving awareness, management, treatment, and support for people
with obesity and cardiometabolic risks.
REFERENCES:
Kilpi et al. Public Health Nutr. 2014;17(5):1078‐86.
Tiffany et al. Circulation. 2021;143:e984–e1010
Maedeh et al. BMC Public Health 21, 401 (2021)
DISCLOSURE OF INTEREST: M. Shams Shareholder of: Novo Nor-
disk, Employee of: Novo Nordisk, A. Alshaikh: None Declared, A.
Alfadda: None Declared, A. Alshehri: None Declared, F. Al Sabaan:
None Declared, H. Mosli: None Declared, S. Khader: None Declared,
R. Dahash: None Declared, S. Bukhari: None Declared, R. Aljawair:
None Declared, A. Al Qarni: None Declared, H. Alquraini: None
Declared, M. Refaat Employee of: Novo Nordisk
LBP68 | Recent knowledge of the impact of
antenatal probiotic supplementations on the
risk of obesity in offspring: A review of
literature
A. I. A. Thahir
Central Clinical School, The University of Sydney, Sydney, Australia
INTRODUCTION: Probiotic supplementations have a beneficial
impact on obesity in adults. However, there is an inconsistent result
on the effects of antenatal probiotics supplementation on pregnancy
outcomes in obese mothers, and there is a gap about the impact on
offspring obesity. This study will present the current knowledge in the
literature about recent studies of probiotics during pregnancy and
their impact on the risk of obesity in offspring.
MATERIALS AND METHODS: This study used a narrative review
approach conducted from June to July 2022. We used two databases
for the search, including Medline and EMBASE. Several key terms,
such as probiotics (probiotics or probiotic agent or synbiotics or syn-
biotics agent) and antenatal (antenatal or pregnancy or prenatal care
or maternal health services) and pregnancy outcomes (pregnancy out-
comes or birth weight or gestational age or birth length) were used.
Studies without these key terms in the title will be removed. We also
used Mendeley to remove duplicate records. Review or study protocol
articles were excluded. Of 267 records identified, we obtained 111 in
the screening stage.
RESULTS: Of the 111 studies, 40 are eligible for inclusion in this
review, consisting of 36 studies in humans and 4 in animals. From the
literature, we highlight the debate that probiotics given during preg-
nancy do not impact the development of obesity risk in the first years
of life. One study shows that probiotic intervention in infants might
protect against the risk of obesity in children under five. We also
found multiple benefits of antenatal probiotics on secondary
1467789x, 2022, S2, Downloaded from https://onlinelibrary.wiley.com/doi/10.1111/obr.13503 by CAPES, Wiley Online Library on [16/12/2023]. See the Terms and Conditions (https://onlinelibrary.wiley.com/terms-and-conditions) on Wiley Online Library for rules of use; OA articles are governed by the applicable Creative Commons License
SUPPLEMENT ARTICLE
outcomes, which can be indirectly associated with obesity in children,
such as gestational diabetes mellitus, inflammatory markers, and the
risk of preterm birth. Additionally, limited studies in low‐middle
income countries, although childhood obesity also increased in these
areas.
CONCLUSION: Probiotic intervention during pregnancy might not
have a direct association with childhood obesity. However, several
factors related to obesity, particularly maternal factors, may get bene-
fits. Thus, probiotic supplementation could be given with a focus on
frequency and duration.
DISCLOSURE OF INTEREST: None Declared.
LBP69 | The Effects of a Multi‐level
Intervention to Increase Physical Activity
among Preschool Children in Iran: A
Randomized Controlled Trial
A. Mehdizadeh Hakkak1; M. Khadem‐Rezayian2; M. A. Sardar3;
M. Nematy4
1
Department of Nutrition, Ghaem Hospital; 2Clinical Research
Development Unit; 3School od Medicine, Mashhad University of Medical
Sciences, Mashhad; 4Department of Nutrition, Mashhad University of
Medical Sciences, Mashhad, Iran, Islamic Republic Of
INTRODUCTION: Physical inactivity is a major contributor to child-
hood overweight and obesity. The aim of this study was to evaluate
the effects of a multi‐level, multi‐component intervention program on
the attractiveness of physical activity and subjective and objective
physical activity level in preschoolers.
MATERIALS AND METHODS: A sample of 202 preschool children
(aged 4‐6 years), recruited from four preschools in Mashhad, Iran were
included in a cluster randomized controlled trial. The Iran Healthy
Start (IHS) intervention consisting of six interlinked components was
conducted in the intervention preschools for five months. Primary
outcomes were children’s objective and subjective physical activity
level as well as the attractiveness of physical activity.
RESULTS: The intervention group experienced a significant increase
in their attraction to physical activity (81.1±7.4 to 83.4±8.5, p=0.008),
number of steps per day (5209±2298 to 5863±2596, p=0.004) and
duration of daily vigorous physical activity (35.6±26.5 min/day to
43.2±41.0, p=0.01). However, there were no significant changes in
sedentary and moderate physical activity. Between‐group analysis
revealed that the intervention was only successful in increasing the
objectively assessed physical activity level in the intervention group
(599.46±1684.75 steps vs. ‐1143.45±2000.98, p<0.001).
CONCLUSION: The Iran Healthy Start program could increase the
objectively measured physical activity (steps/day) among preschool
children.
DISCLOSURE OF INTEREST: None Declared.

SUPPLEMENT ARTICLE
LBP70 | A weight management program
tailored for people with mental illness: a non‐
randomised feasibility study with qualitative
interviews
C. Lee1; C. Piernas1; F. Waite2; P. Aveyard1
1
Nuffield Department of Primary Care Health Sciences; 2Department of
Psychiatry, University of Oxford, Oxford, United Kingdom
INTRODUCTION: Weight management programs can support people
with obesity to lose weight. However, people with severe mental ill-
ness (SMI) often fail to engage with this treatment option and
bespoke programs are rarely provided in practice. It is possible that
extra support could help people with SMI to engage in and benefit
from mainstream programs. We aimed to develop and test this
approach – which we called ‘Weight cHange for people with sEvere
mEntal iLlness (WHEEL).’
MATERIALS AND METHODS: Our development comprised: (1)
involving 12 patient and public representatives with SMI and obesity;
(2) a systematic review of qualitative studies to identify program char-
acteristics that promote uptake and engagement for people with SMI;
(3) a second systematic review of trials testing the effectiveness of
weight management programs to identify which characteristics lead
to weight loss; and (4) coding the effective characteristics against a
mainstream program to identify opportunities for extra support. Our
initial evaluation comprised: (5) a non‐randomised study of feasibility
(retention and n [%] of program sessions attended) and acceptability
(qualitative interviews plus self‐reported weight loss) at end‐of‐
program.
RESULTS: The program was a commercially‐provided weight manage-
ment program to be attended in‐person or online once a week for 12‐
weeks. It was augmented with a one‐off consultation (called 'Meet‐
Your‐Mentor') tailored for people with SMI and weekly mentor check‐
ins over telephone or email. Seventeen participants (mean age: 48·52
years; 47% with schizophrenia) enrolled in the feasibility study and 16
were followed‐up at 12‐weeks (95% retention). All participants
attended the consultation, 9/16 attended 50% of the weekly sessions,
and 12/16 responded to 50% of the weekly check‐ins. All participants
valued the therapeutic support and reported weight loss (mean
4·06kg, SD: 3·17). Anxious avoidance, however, remained a barrier to
joining the in‐person sessions.
CONCLUSION: A mainstream weight management program aug-
mented with brief education and low‐intensity support is potentially
feasible for healthcare systems to provide, acceptable to people with
SMI, and may lead to weight loss. These indicate findings are novel
and warrant a larger randomised controlled trial to asses the impact of
WHEEL on objective health outcomes.
DISCLOSURE OF INTEREST: None Declared.
1467789x, 2022, S2, Downloaded from https://onlinelibrary.wiley.com/doi/10.1111/obr.13503 by CAPES, Wiley Online Library on [16/12/2023]. See the Terms and Conditions (https://onlinelibrary.wiley.com/terms-and-conditions) on Wiley Online Library for rules of use; OA articles are governed by the applicable Creative Commons License
213 of 222
LBP71 | The effectiveness of 24 weeks
healthy eating and weight management
counselling on body composition among
middle‐aged Hong Kong Chinese women: a
randomized controlled trial
L. Tian1; Q. Zhou2; H. H. Wang3,4; Y. J. Xie1,5
1
School of Nursing, Hong Kong Polytechnic University, Hong Kong, Hong
Kong; 2School of Public Health, Peking University, Beijing; 3School of
Public Health, Sun Yat‐Sen University, Guangzhou, China; 4College of
Medicine and Veterinary Medicine, The University of Edinburgh,
Edinburgh, United Kingdom; 5Research Center for Chinese Medicine
Innovation, The Hong Kong Polytechnic University, Hong Kong, Hong
Kong
INTRODUCTION: The objective of this study was to examine the
effectiveness of a healthy eating and weight management counselling
programme on the changes of body composition in Hong Kong
women.
MATERIALS AND METHODS: A two‐arm randomized controlled trail
was implemented. A total of 173 eligible Hong Kong Chinese women
aged 45‐65 years were randomized to the intervention group (n=82)
and the control group (n=91). Participants in the intervention group
received a 24‐week integrated approach, which consisted of a body
composition measurement, an immediate 5‐10 minutes counselling
based on the measurement, and 15‐min weekly dietitian‐guided
WhatsApp‐based individualized counselling for 24 weeks. Participants
in the control group only received the body composition measure-
ment and a brief counselling after the measurement. Inbody 270 was
used to measure the body composition including body weight, body
fat mass (BFM) and body fat percentage (BFP). The changes in body
weight, BMI, BFM and BFP were analyzed before and after the inter-
vention by intention‐to‐treat (ITT) analysis.
RESULTS: At baseline, the average weight and BMI was 58.08 ±10.30
kg and 23.52±3.86 kg/m2, respectively. In total 49.13% of the partici-
pants were overweight or obesity. At week 24, participants in the
intervention group lost a mean body weight of 0.49 kg (95% CI: 0.14
to 0.84). They also lost 0.68 kg/m2 of BMI, 0.42 kg of BFM and 1.81%
of BFP, respectively (all p<0.05). The change in body weight was sig-
nificantly correlated with the change in BFM (Pearson r=0.75,
p<0.01). No significant changes were found in the control group. The
between‐group difference was observed significantly in BMI (‐0.24
kg/m2, 95% CI: ‐0.45 to ‐0.03, p<0.05) and BFP (‐0.63%, 95% CI: ‐
1.20% to ‐0.06%, p<0.05) but not body weight and BFM (both
P>0.05).
CONCLUSION: A 24‐week integrated nutrition counselling approach
could moderately reduce body weight in the middle‐aged Hong Kong
Chinese women, and the weight loss was related to the fat loss.
DISCLOSURE OF INTEREST: None Declared.

214 of 222
LBP72 | Parental care behaviors in the
management of childhood obesity: A
qualitative study
M. Razi; A. Nasiri
Department of Nursing, Birjand University of Medical Sciences, Birjand,
Iran, Islamic Republic Of
INTRODUCTION: Today, childhood obesity is one of the most impor-
tant health challenges in all countries, which increases the need for
preventive programs and effective treatment strategies. Since involv-
ing parents in strategies for child weight management is one of the
best actions, in‐depth examination of parents' experiences of care
behaviors during the management of child obesity is very important.
The present study aimed to explain parents’ experiences of care
behaviors and childhood obesity management.
MATERIALS AND METHODS: This qualitative study used purposive
sampling and semi‐structured interviews with 17 parents of obese
children aged 6‐12 years. The interviews were digitally recorded, tran-
scribed verbatim, and analyzed through conventional content analysis
based on Graneheim and Lundman method.
RESULTS: Three categories emerged from the obtained data: focus
on the situation, efforts towards systematic management and, rebuild-
ing and correcting wrong behaviors.
CONCLUSION: The study findings provide a deep understanding of
how childhood obesity is managed in the family, the most important
institution influencing the control of child obesity. Therefore, health
professionals can realize the weaknesses and strengths of family care
programs regarding childhood obesity, and design them effectively.
DISCLOSURE OF INTEREST: None Declared.
LBP73 | Engaging women with young
children in the development of a lifestyle
intervention to reduce postpartum weight
retention
M. Makama1; L. J. Moran1; B. Hill2; L. M. Redman3; S. Lim4;
H. Skouteris2,5
1
Monash Centre for Health Research and Implementation, Monash
University, Clayton; 2Health and Social Care Unit, School of Public Health
and Preventive Medicine, Monash University, Melbourne, Australia;
3
Pennington Biomedical Research Center, Louisiana State University,
Louisiana, United States; 4Health Systems and Equity, Eastern Health
Clinical School, Monash University, Box Hill, Australia; 5Warwick Business
School, Warwick University, Coventry, United Kingdom
INTRODUCTION: Postpartum weight retention is a major contributor
to obesity in women of childbearing age, resulting in long‐term health
consequences. Postpartum lifestyle interventions are known to be
effective in reducing postpartum weight retention and improving the
1467789x, 2022, S2, Downloaded from https://onlinelibrary.wiley.com/doi/10.1111/obr.13503 by CAPES, Wiley Online Library on [16/12/2023]. See the Terms and Conditions (https://onlinelibrary.wiley.com/terms-and-conditions) on Wiley Online Library for rules of use; OA articles are governed by the applicable Creative Commons License
SUPPLEMENT ARTICLE
overall health and wellbeing of mothers but have poor reach and
engagement. This study describes the process of engaging women
with young children in the development of a theory‐ and evidence‐
based intervention program to reduce postpartum weight retention
by improving program feasibility for adoption and acceptability among
postpartum women.
MATERIALS AND METHODS: The intervention was co‐developed
with input from a community group of mothers, previous literature
reviews, and an expert advisory group. Mothers who were members
of ‘Mothers of Preschoolers’ (MOPS) were invited to participate in a
focus group discussion and two co‐design workshop sessions. Thir-
teen women participated in a focus group discussion and 12 women
in each co‐design workshop.
RESULTS: The intervention ideas generated by the mothers include
inviting expert speakers e.g., dieticians, peer mentoring through inter-
est groups, having 1 – 2 mentors for the whole group, and incorporat-
ing a physical activity component into MOPS sessions. The advisory
group suggested leveraging the unique skills and prior experiences of
mothers within the group and developing a curriculum that mothers
can be trained to deliver.
CONCLUSION: An intervention designed to be implemented by
MOPS for its members and incorporated into their regular sessions is
feasible and acceptable to mothers of young children.
DISCLOSURE OF INTEREST: None Declared.
LBP74 | Connecting people from CALD
backgrounds with a health practitioner – the
Health Navigation and Multicultural Living
Well Program
H. Do1; N. Chen1; E. Pe1; K. Lekkas1; H. Vidgen2; K. Davidson2;
G. Oryem1; T. Gingell2
1
Ethnic Communities Council of Queensland; 2Faculty of Health,
Queensland University of Technology, Brisbane, Australia
INTRODUCTION: The Health Navigation and Multicultural Living
Well Program aimed to bridge the gap between healthcare service
providers and people from six Culturally and Linguistically Diverse
(CALD) backgrounds with a chronic disease diagnosis or identified as
being medium to high risk. Clients received three sessions with Multi-
cultural Health Workers (MHW). The sessions were tailored to the cli-
ent’s needs with regard to topic and modality, including time, place
(mean 12 days) and delivery method (adapted during the pandemic).
The Program was conducted by the Ethnic Communities Council of
Queensland (ECCQ) who aimed to match MHW to the language and
cultural identity of clients. Funding was provided through the Bris-
bane North Primary Health Network.
MATERIALS AND METHODS: The Program was comprehensively
evaluated. Clients’ demographics, anthropometry, pre‐post self‐
reported health behaviours, AUSDRISK scores and program satisfaction

SUPPLEMENT ARTICLE
were collected by ECCQ as were MHW‐level data. ECCQ and BNPHN
interviews were conducted by QUT post‐program implementation.
RESULTS: In 2019‐22, 227 people completed the Program. Clients
were from 40 different ethnic groups, born in 12 different countries
and reported speaking 24 different languages. The three sessions
were conducted over a mean of 12 days (median 14 days, range 8‐96
days). Attendance to all sessions was 100%. Following the program
97% reported that the consume more fruit and vegetables and 87%
indicated they are doing more physical activity. 63% of clients with
obesity and 45% of clients with overweight decreased their BMI. 85
clients in the AUSDRISK undiagnosed/high risk category (initially
n=133) decreased their score. 60% of 91 clients who were initially in
the increased risk AUSDRISK category (n=91) decreased their score at
the final screening.
MHW reported increased capacity to support clients with chronic
disease and its associated risk factors. Both BNPHN and ECCQ valued
their partnerships, reported an enhanced working relationship as a
result of the program which led to other collaboration opportunities.
Connecting and working with a range of general practices was recog-
nised as a challenge and an area that the Program could had been bet-
ter supported with. The flexibility of the program was identified as a
strength by clients, MHW and funders.
CONCLUSION: The critical success factors that contributed to the
program success were being flexible and client centred, delivered by
the peak CALD agency and having a support from the funder. These
core components should be maintained should the Program contin-
ued. Areas for enhancement include improving communication and
engagement with general practitioners, funding to embed the program
into routine service provision and an independent evaluation of long
term outcomes.
DISCLOSURE OF INTEREST: None Declared.
LBP75 | Brief schema therapy for individuals
with obesity and a history of trauma: A pilot
case series
S. Hayes1,2; E. Smith1
1
Psychology, Western Sydney University, Bankstown; 2Psychology,
Australian Institute for Human Wellness, Kogarah, Australia
INTRODUCTION: With rates of obesity, reaching global epidemic
proportions, more targeted interventions are needed to reduce the
societal impact of this condition. Limited interventions target the
underlying mechanisms that result in the development and mainte-
nance of obesity. Childhood trauma and lifetime adversity have often
been associated with adult obesity and therefore the current study
aims to develop an intervention that incorporates both the underlying
mechanisms and the consequential behaviours. This pilot case series
examined the feasibility of a brief Schema Therapy in improving treat-
ment outcomes in individuals with obesity and a history of trauma. It
1467789x, 2022, S2, Downloaded from https://onlinelibrary.wiley.com/doi/10.1111/obr.13503 by CAPES, Wiley Online Library on [16/12/2023]. See the Terms and Conditions (https://onlinelibrary.wiley.com/terms-and-conditions) on Wiley Online Library for rules of use; OA articles are governed by the applicable Creative Commons License
215 of 222
was hypothesised that this intervention would improve mental well-
being, reduce disordered eating and potentially reduce BMI.
MATERIALS AND METHODS: Six participants were recruited to
complete a 12 week schema therapy program with a focus on the
impact of trauma and maladaptive eating behaviours. Participants
were required to complete measures on childhood trauma, eating
behaviours, schemas, emotion regulation, well‐being and psychologi-
cal stress pre and post intervention. Their weight was also measured
weekly.
RESULTS: Despite one drop‐out, results found majority of
participants reporting an increase in overall well‐being, self‐compas-
sion and emotion regulation, and a decrease in disordered eating
pathology, psychological stress and maladaptive schemas/modes.
Majority also reported weight loss and/or a reduction in hip/waist
circumference.
CONCLUSION: It is evident that Schema Therapy may be effective in
addressing the relationship between traumatic experiences and its
relationship to eating, thus producing more positive eating behaviours
and beliefs which in turn lead to potential for longer term weight loss.
DISCLOSURE OF INTEREST: None Declared.
LBP76 | Association of maternal BMI and
Gestational Weight Gain (GWG) with
offspring anthropometry, cord blood DNA
methylations, adipokine levels and the effect
of life style modification on growth during
infancy: a randomized control trial ‐ Study
protocol
V. D. Kiridana1; N. S. Kalupahana2; C. J. Rathnayaka3;
S. B. Tennekoon4; P. Wickramasingha5; G. U. Vidanapathirana1;
R. Karunathilake1; N. S. Wimalaratne2; J. A. Weerakkody2
1
Department of Paediatrics, Faculty of Medicine; 2Department of
Physiology, Faculty of Medicine; 3Department of Obstetrics &
Gynaecology, Faculty of Medicine; 4Department of Community Medicine,
Faculty of Medicine, University of Peradeniya, Sri Lanka; 5Department of
Paediatrics, Faculty of Medicine, University of Colombo, Sri Lanka, Kandy,
Sri Lanka
INTRODUCTION: Prevention of childhood obesity needs focus on
primary and primordial prevention. The aim of our study is to identify
the role of maternal obesity on offspring adiposity and the effect of
lifestyle modification on infant weight gain.
MATERIALS AND METHODS: Study component 1 is a prospective
cohort study of 1537 mother‐infant pairs. Mothers are categorised
into low, normal and high BMI according to preconceptual BMI.
Anthropometric measurements including skinfold thickness of new
born are obtained. Cord blood samples are collected from 100
mothers from each BMI category for DNA methylation and adipokine
assays. Infants are followed up for 3 years to assess growth trajectory
and adiposity. Study component 2 is a clinical trial where infants are

216 of 222
recruited for intervention and control groups under the categories of
small, appropriate and large for gestational age from each maternal
BMI group depending on the proportion in the study cohort. Interven-
tion is based on a modified framework of the Infant and Young Child
Feeding guideline of the WHO that comprises of advice on feeding,
activity and screen time.
During follow up, weight gain trajectory is assessed on WHO
recommended growth charts and specific advises are given accord-
ingly. In the study component 2, rapid weight gain is assessed as the
primary outcome, defined as weight gain >+0.67 SD during the first
year of life. Association of maternal BMI and birthweight with the
weight gain trajectory is analyzed as secondary outcomes. Other
adverse events like underweight or poor weight gain are assessed.
RESULTS: Interim analysis of 1050 pregnant women revealed 33.7%
(n=355) prevalence of high maternal BMI. Out of the 738 mothers
who have already delivered, 506 mother‐infant pairs showed a signifi-
cant positive correlation between both maternal BMI and gestational
weight gain (GWG) with infant birthweight (P<0.05, Spearman r=0.11
and P<0.05, Spearman r=0.12 respectively). However, neither the spe-
cific categories of maternal BMI nor the GWG show a statistically sig-
nificant association with newborn’s weight (Chi sq‐4.77,df‐6,p>0.5
and ANOVA,df‐2.0,p>0.05 respectively).
CONCLUSION: On completion, our study is expected to identify the
association of maternal obesity with offspring anthropometry, cord
blood DNA methylations and adipokines. It would elucidate the effec-
tiveness of lifestyle modification on preventing rapid postnatal weight
gain. This would be the first Sri Lankan study to investigate the role of
early life exposures on epigenetic changes and the first clinical trial on
early life behavioural interventions on prevention of childhood obe-
sity. Results of the interim analysis conclude high prevalence of
maternal obesity and positive association of maternal BMI and GWG
with offspring adiposity.
DISCLOSURE OF INTEREST: None Declared.
LBP78 | Effectiveness And Sustainability of A
Hybrid Weight Reduction Program For
Employees In Malaysia During The COVID‐
19 Pandemic
Z. A. Manaf; A. F. Mat Ludin; S. Shahar; S. M. Abdul Basir
Centre for Healthy Aging and Wellness, Faculty of Health Sciences,
National University of Malaysia, Kuala Lumpur, Malaysia
INTRODUCTION: Effort to reduce weight is challenging especially
during the COVID‐19 home confinement period when access to food
is often unlimited while physical activity is restricted. This study aims
to compare the effectiveness and sustainability of a hybrid structured
weight management programme (Mind‐SLIMSHAPE™) with a conven-
tional face‐to‐face dietary counselling program (CDP) among
employees affected by obesity.
1467789x, 2022, S2, Downloaded from https://onlinelibrary.wiley.com/doi/10.1111/obr.13503 by CAPES, Wiley Online Library on [16/12/2023]. See the Terms and Conditions (https://onlinelibrary.wiley.com/terms-and-conditions) on Wiley Online Library for rules of use; OA articles are governed by the applicable Creative Commons License
SUPPLEMENT ARTICLE
MATERIALS AND METHODS: 162 employees affected by over-
weight and obesity were recruited in a quasi‐experimental study. The
participants were divided into two groups (intervention group, n = 83,
and control group, n = 79). Participants in the intervention group
received the 6‐month weekly programme including talks, demonstra-
tions, interactive activities, hands‐on activities, and exercise sessions.
The control group received a routine face‐to‐face weight manage-
ment consultation from a dietitian. Anthropometric and dietary intake
data were determined at baseline, month‐6, and during follow‐up at
month‐14.
RESULTS: Out of 83 Mind‐SLIMSHAPE™ participants, 26.5% (n=22)
have achieved a minimum weight loss of 5% in 6 months compared
to the CDP group (3.0%). Participants from the Mind‐SLIMSHAPE™
group had a higher weight reduction by 3.3% (‐2.77 ± 4.35 kg),
BMI by 3.3% (‐1.08 ± 1.70 kg/m2), WC by 9.7% (‐10.0 ± 7.8 cm)
and BF by 2.8% (‐1.15 ± 2.67%) as compared to the CDP group
which had 0.5% weight loss (‐0.42 ± 2.71 kg), 0.6% (‐0.21 ± 1.06
kg/m2) BMI reduction, 1.9% (‐1.92 ± 5.31 cm) WC reduction and
0.5% (‐0.17 ± 2.12%) BF loss. A significant group‐by‐time interac-
tion was found for the weight (p=0.001), BMI (p=0.002), body fat
(BF) percentage (p=0.030), and waist circumference (WC) (p<0.001)
with changes favouring Mind‐SLIMSHAPE™ over CDP in 6 months.
At month‐14, a significant interaction effect on the weight
(p =.038), BF (p=.014), and WC (p<.001). Participants with weight
loss of less than 5% from baseline were six times more likely to
regain weight at month‐14.
CONCLUSION: A hybrid weight reduction program Mind‐SLIM-
SHAPE™ is effective in promoting weight loss and prevent
substantial weight gain during pandemic COVID‐19. This mode of
intervention has potential to be adopted during pandemic and
endemic era.
REFERENCES:
(Robinson et al. Appetite 2020; 156, 104853)
(World Health Organization. Global Action Plan for the Prevention
and Control of Noncommunicable Diseases 2013‐2020; WHO:2013)
(Abdul Basir et al. Nutrients 2022; 14: 3140)
DISCLOSURE OF INTEREST: None Declared.
 1467789x, 2022, S2, Downloaded from https://onlinelibrary.wiley.com/doi/10.1111/obr.13503 by CAPES, Wiley Online Library on [16/12/2023]. See the Terms and Conditions (https://onlinelibrary.wiley.com/terms-and-conditions) on Wiley Online Library for rules of use; OA articles are governed by the applicable Creative Commons License
SUPPLEMENT ARTICLE 217 of 222

LBP80 | Motivators for and barriers to that there are multiple barriers to weight loss. The greatest weight
successful weight loss: a survey of people loss barriers for PwO as compared to HCPs were lack of exercise

with obesity and healthcare professionals in (63% vs 71%), unhealthy eating habits (60% vs 67%), preference for
unhealthy food (57% vs 66%) and lack of motivation (55% vs 65%).
the Asia‐Pacific region
Only about half of PwO (46%) and HCPs (51%) strongly agreed that
genetics was a barrier to weight loss.
A. Boonyavarakul1; A. Ahmed2; M. Mercado Garcia3;
CONCLUSION: For PwO, feeling physically better, more fit, and more
B. M. Guajardo Guzman4; T. Q. Nam5; N. A. Nicodemus Jr6;
7 8 3 9 confident were their top weight loss motivators. Although HCPs
Z. Nor Hanipah ; F. Pathan ; J. G. Uranga Romano ; S. Soegondo ;
largely agreed with PwO, they perceived general health concerns and
K. W. Tham10; E. L. Tolentino Jr11; A. G. Unnikrishnan12;
specific medical diagnoses to be greater motivators for weight loss
B. Oldfield13
than did PwO. HCPs and PwO also generally agreed that lack of exer-
1
Division of Endocrinology, Department of Internal Medicine,
cise and unhealthy eating habits were the top barriers to successful
Phramongkutklao Hospital, Bangkok, Thailand; 2The Aga Khan University
weight loss, but HCPs viewed lack of motivation as a greater barrier
Hospital, Karachi, Pakistan; 3Novo Nordisk, Dubai, United Arab Emirates;
than did PwO themselves. Awareness of the importance of biological
4
Novo Nordisk, Kuala Lumpur, Malaysia; 5University Medical Center at
factors as barriers to obesity management were similarly low among
Ho Chi Minh City, Ho Chi Minh City, Viet Nam; 6University of the
both PwO and HCPs.
Philippines‐College of Medicine, Manila, Philippines; 7Department of
DISCLOSURE OF INTEREST: A. Boonyavarakul: None Declared, A.
Surgery, Faculty of Medicine and Health Sciences, Universiti Putra
Ahmed: None Declared, M. Mercado Garcia Shareholder of: Novo
Malaysia, Selangor, Malaysia; 8Department of Endocrinology, Ibrahim
Nordisk, Employee of: Novo Nordisk, B. M. Guajardo Guzman
Memorial Diabetes Center, Dhaka, Bangladesh; 9Indonesia Diabetes
Employee of: Novo Nordisk, T. Q. Nam Paid Instructor for: Novo
Institute, Diabetes Connection & Care, Eka Hospitals, Jakarta, Indonesia;
Nordisk, Eli Lilly, Boehringer Ingelheim, Merck KgaA, Astra Zeneca,
10
National Healthcare Group, Singapore, Singapore; 11Ateneo School of
Novartis, N. A. Nicodemus Jr. Consultant for: Novo Nordisk, Astra
Medicine and Public Health, Pasig, Metro Manila, Philippines;
Zeneca, Merck, Speakers bureau with: Novo Nordisk, Astra Zeneca,
12
Chellaram Diabetes Institute, Bavdhan, Pune, India; 13Monash
Merck, Z. Nor Hanipah Consultant for: Novo Nordisk, F. Pathan:
University, Clayton, Australia
None Declared, J. G. Uranga Romano Shareholder of: Novo Nordisk,
Employee of: Novo Nordisk, S. Soegondo Consultant for: Sanofi,
Novo Nordisk, Eli Lilly, MSD, Astra Zeneca, Abbott, Pfizer, Boehrin-
INTRODUCTION: Over past decades, the scientific understanding of ger Ingelheim, Merck Indonesia, Speakers bureau with: Sanofi, Novo
obesity has led to obesity being increasingly recognized as a chronic Nordisk, Eli Lilly, MSD, Astra Zeneca, Abbott, Pfizer, Boehringer
disease requiring long‐term management. However, barriers exist to Ingelheim, Merck Indonesia, K. W. Tham Consultant for: Novo Nor-
the optimal management of obesity. This study examines perceptions disk (COI), Speakers bureau with: Novo Nordisk (COI), DKSH, E. L.
of motivators and barriers to weight loss from the perspectives of Tolentino, Jr.: None Declared, A. G. Unnikrishnan Consultant for:
people with obesity (PwO) and healthcare professionals (HCPs) in Novo Nordisk, Sanofi, AstraZeneca, MSD, Boehringer‐Ingelheim,
Asia‐Pacific countries. Speakers bureau with: Novo Nordisk, Sanofi, AstraZeneca, MSD,
MATERIALS AND METHODS: A cross‐sectional study (ACTION Boehringer‐Ingelheim, B. Oldfield Consultant for: Novo Nordisk,
APAC) was conducted in nine countries in the Asia‐Pacific region: Speakers bureau with: Novo Nordisk
Bangladesh, India, Indonesia, Malaysia, Pakistan, Philippines,
Singapore, Thailand and Vietnam. A total of 10,429 PwO and 1,901
LBP81 | Withdrawn
HCPs took an online survey. Obesity was defined as body mass index
(BMI) ≥25 kg/m2, except in Singapore, where BMI of ≥27 kg/m2 was
used.
RESULTS: Both PwO and HCPs had similar perceptions regarding
weight loss motivators. Motivators for PwO included wanting to be fit
(34%), feel better physically (34%), be more confident (31%), or to fit
into a smaller clothing size (23%). Other motivators were general
health concerns (23%) and encouragement from family or friends
(21%). Only 4% of PwO said they had no desire to lose weight; 74%
of PwO report having made at least one serious weight loss attempt
in their adult life, with an average of three attempts. According to
HCPs, patients’ weight loss motivators included wanting to feel better
physically (42%), general health concerns (40%), wanting to be more
confident (37%), a specific medical event or diagnosis (36%), and
wanting to be more fit (34%). Both PwO and HCPs strongly agreed

218 of 222
LBP82 | Obesity and its management in the
Asia‐Pacific region from the perspective of
people with obesity and healthcare
professionals: key findings from a large,
multinational survey
K. W. Tham1; A. Ahmed2; A. Boonyavarakul3; M. Mercado Garcia4;
B. M. Guajardo Guzman5; T. Q. Nam6; N. A. Nicodemus Jr7;
Z. Nor Hanipah8; F. Pathan9; J. G. Uranga Romano4; S. Soegondo10;
E. L. Tolentino Jr11; A. G. Unnikrishnan12; B. Oldfield13
1
National Healthcare Group, Singapore, Singapore; 2The Aga Khan
University Hospital, Karachi, Pakistan; 3Division of Endocrinology,
Department of Internal Medicine, Phramongkutklao Hospital, Bangkok,
Thailand; 4Novo Nordisk, Dubai, United Arab Emirates; 5Novo Nordisk,
Kuala Lumpur, Malaysia; 6University Medical Center at Ho Chi Minh City,
Ho Chi Minh City, Viet Nam; 7University of the Philippines‐College of
Medicine, Manila, Philippines; 8Department of Surgery, Faculty of
Medicine and Health Sciences, Universiti Putra Malaysia, Selangor,
Malaysia; 9Department of Endocrinology, Ibrahim Memorial Diabetes
Center, Dhaka, Bangladesh; 10Indonesia Diabetes Institute, Diabetes
Connection & Care, Eka Hospitals, Jakarta, Indonesia; 11Ateneo School of
Medicine and Public Health, Pasig, Metro Manila, Philippines;
12
Chellaram Diabetes Institute, Bavdhan, Pune, India; 13Monash
University, Clayton, Australia
INTRODUCTION: Obesity is an escalating public health concern in
the Asia‐Pacific region. This ACTION APAC study examined percep-
tions, attitudes, and behaviors surrounding obesity and its manage-
ment in the region.
MATERIALS AND METHODS: A cross‐sectional online survey was
conducted with 10,429 people with obesity (PwO) and 1,901 health-
care professionals (HCPs) in Bangladesh, India, Indonesia, Malaysia,
Pakistan, Philippines, Singapore, Thailand, and Vietnam. The definition
of obesity used for Singapore differed from other countries (body
mass index [BMI] ≥27 kg/m2 vs BMI ≥25 kg/m2 in all other countries).
RESULTS: The majority of PwO (68%) and HCPs (84%) recognized
obesity as a chronic disease; however, they also believed that weight
loss is solely the responsibility of the PwO (63% and 41%, respec-
tively). Less than half (43%) of PwO discussed their weight with an
HCP in the past 5 years, and they were more likely to get information
on weight management from non‐medical sources including the Inter-
net (49%), smartphone apps (39%), and family/friends (35%), than
from an HCP (30%). When asked about their weight loss goals, PwO
reported setting a weight loss goal of 23% of their current body
weight. HCPs reported discussing weight with only 56% of their
patients who have obesity. Although the majority of HCPs (72%)
recorded obesity as a diagnosis in their patients’ medical charts at
least most of the time, they only informed 60% of their patients of
their obesity diagnosis, on average. Some HCPs (5%) said they never
mention obesity as a diagnosis to their patients. Weight management
methods were infrequently discussed by HCPs with their patients.
1467789x, 2022, S2, Downloaded from https://onlinelibrary.wiley.com/doi/10.1111/obr.13503 by CAPES, Wiley Online Library on [16/12/2023]. See the Terms and Conditions (https://onlinelibrary.wiley.com/terms-and-conditions) on Wiley Online Library for rules of use; OA articles are governed by the applicable Creative Commons License
SUPPLEMENT ARTICLE
HCPs estimated that they recommend general improvements in eating
habits and increased physical activity to 20% of their patients, pre-
scription weight loss medications to 11%, and weight loss surgery to
only 8% of their patients, on average.
CONCLUSION: Obesity is regarded as a chronic disease by most
PwO and HCP in the Asia‐Pacific. Despite this, misconception and
inadequate knowledge about obesity and its management is prevalent
among PwO, leading to them not receiving adequate medical guidance
and setting substantial weight loss targets. Most HCPs are not regu-
larly discussing the diagnosis of obesity and management options with
their patients despite diagnosing them with obesity.
DISCLOSURE OF INTEREST: K. W. Tham Consultant for: Novo Nor-
disk (COI), Speakers bureau with: Novo Nordisk (COI), DKSH, A.
Ahmed: None Declared, A. Boonyavarakul: None Declared, M. Mer-
cado Garcia Shareholder of: Novo Nordisk, Employee of: Novo Nor-
disk, B. M. Guajardo Guzman Employee of: Novo Nordisk, T. Q. Nam
Paid Instructor for: Novo Nordisk, Eli Lilly, Boehringer Ingelheim,
Merck KgaA, Astra Zeneca, Novartis, N. A. Nicodemus Jr. Consultant
for: Novo Nordisk, Astra Zeneca, Merck, Speakers bureau with: Novo
Nordisk, Astra Zeneca, Merck, Z. Nor Hanipah Consultant for: Novo
Nordisk, F. Pathan: None Declared, J. G. Uranga Romano Shareholder
of: Novo Nordisk, Employee of: Novo Nordisk, S. Soegondo Consul-
tant for: Sanofi, Novo Nordisk, Eli Lilly, MSD, Astra Zeneca, Abbott,
Pfizer, Boehringer Ingelheim, Merck Indonesia, Speakers bureau with:
Sanofi, Novo Nordisk, Eli Lilly, MSD, Astra Zeneca, Abbott, Pfizer,
Boehringer Ingelheim, Merck Indonesia, E. L. Tolentino, Jr.: None
Declared, A. G. Unnikrishnan Consultant for: Novo Nordisk, Sanofi,
AstraZeneca, MSD, Boehringer‐Ingelheim, Speakers bureau with:
Novo Nordisk, Sanofi, AstraZeneca, MSD, Boehringer‐Ingelheim, B.
Oldfield Consultant for: Novo Nordisk, Speakers bureau with: Novo
Nordisk
LBP83 | Perceived barriers to managing
childhood obesity: A qualitative study
M. Razi; A. Nasiri
Department of Nursing, Birjand University of Medical Sciences, Birjand,
Iran, Islamic Republic Of
INTRODUCTION: Obesity is increasing rapidly in all developed,
industrialized, and developing countries(1). Obesity affects people's
health and its effects are multiplied when it starts in childhood(2‐4).
Therefore, its prevention and management in childhood is very impor-
tant. However, childhood obesity management faces many obstacles
and problems. The present study aimed to conduct the perceived bar-
riers to managing childhood obesity
MATERIALS AND METHODS: This study used qualitative descriptive
approach, purposeful sampling, as well as in‐depth, unstructured, and
face‐to‐face interviews with 16 mothers, 1 father, 4 children and 2
elementary teachers, 1 health instructor, 1 physical education instruc-
tor and 2 nutritionist to collect data. The interviews were digitally

SUPPLEMENT ARTICLE
TABLE 2 Categories and Subcategories
Categories Subcategories
Lifestyle change following Sedentary life
corona Disturbed sleep‐wake rhythm
pattern
Tendency to Overeating
Escape from the reality of Denial of obesity
obesity normalization of obesity
negligence Lack of proper follow‐up by the
school
duality in management in family
Compromising under the
compassion
recorded, transcribed verbatim, and analyzed using Graneheim and
Lundman(5) conventional content analysis approach.
RESULTS: In total, 30 interviews were conducted with 27 partici-
pants. The mean age of the participants was reported as 39 years for
parents, 10 years for children, 48 years for Teachers and coaches.
Most of parents were employed. Data analysis led to the emergence
of primary codes, which were eventually divided into 3 categories and
8 subcategories. The main categories included lifestyle change follow-
ing corona, escape from the reality of obesity, and negligence, which
will be described in detail below (Table 2).
CONCLUSION: Childhood obesity management is challenging. Exam-
ining the issues and problems from the point of view of those who are
effective in the management of childhood obesity can help health care
systems plan practical interventions.
REFERENCES:
1. Nittari G, et al. Clin Ter. 2019;170(3):e223‐30.
2. Flynn J. T. Pediatr Nephrol. 2013;28(7):1059‐66.
3. Pulgaron ER, et al. Curr Diab Rep. 2014;14(8):508.
4. Tasca GA, et al. Pers Individ. 2009;47(6):662‐7.
5. Graneheim UH, et al. Nurse Educ Today. 2004;24(2):105‐12.
DISCLOSURE OF INTEREST: None Declared
LBP85 | How and why people eat the way
they do: A qualitative study with rural
Australians
N. Van Dyke
Mitchell Institute, Victoria University, Melbourne, Australia
INTRODUCTION: There is evidence that most people have a reason-
able awareness of connections between healthier foods and better
health, and a broad understanding regarding types of food that
enhance or detract from health. A variety of studies, however, find
that merely enhancing knowledge and shifting attitudes has little
1467789x, 2022, S2, Downloaded from https://onlinelibrary.wiley.com/doi/10.1111/obr.13503 by CAPES, Wiley Online Library on [16/12/2023]. See the Terms and Conditions (https://onlinelibrary.wiley.com/terms-and-conditions) on Wiley Online Library for rules of use; OA articles are governed by the applicable Creative Commons License
219 of 222
impact on behaviour. Increasing evidence suggests that public health
and health‐promotion interventions with a theoretical basis are more
effective than those lacking such a foundation. Andreasen’s
Social Marketing Model (Andreasen 1995) posits that a primary
focus for behaviour change is on learning what people want and need
rather than trying to persuade them to adopt particular behaviours or
goals.
The aim of this study was to use a qualitative methodology to
explore the process by which people make eating decisions in order
to inform approaches to public health recommendations and policy in
this area.
MATERIALS AND METHODS: Three, two‐hour group discussions
were conducted with a total of 23 participants living in a non‐metro-
politan area of Victoria, Australia: (1) young women, aged 18‐24, with
no children; (2) women aged 35‐45 with primary school aged children;
and (3) men, aged 35‐50, living with a partner and with pre‐ or primary
school aged children.
Topics included Influences on eating decisions, eating patterns,
feelings around eating, enjoyment of food/eating, and considerations
around healthfulness of food.
Discussions were transcribed and thematically analysed using a
grounded theory approach.
RESULTS: Seven main themes were identified, most with several sub‐
themes. These were: personal factors (perceived conflict between food
preferences and ‘healthy eating’; hormone cycles; weather and seasons),
family factors (time and convenience; choice is not always entirely up to
the individual; age of children; price and budgets), work and work places,
social factors (location of eating; social and physical activities), planning
and preparation, patterns of meals, (timing of meals; standard and vari-
able meals – weekend vs. weekday; breakfast vs. lunch vs. dinner), and
perceptions of own eating.
CONCLUSION: Although decisions regarding when, what, and how
much to eat are determined in part by taste preferences and health
considerations, they are also heavily influenced by a host of other
factors, including other household members’ preferences, family
activities, and workplace and time constraints, as well as convenience
and price. It seems that people want to eat healthier, or at least know
they should eat healthier, but it’s all just too hard. We therefore argue
that a key to improving people’s eating behaviours is to make it easy to
eat more healthfully, or at least not much harder than eating poorly.
REFERENCES:
Andreasen, A.R. (1995). Marketing Social Change: Changing Behavior
to Promote Health, Social Development, and the Environment.
San Francisco: Jossey‐Bass.
DISCLOSURE OF INTEREST: None Declared.

220 of 222
LBP86 | Further investigations into adverse
life experiences and eating disorder
pathology and weight outcomes
S. Hayes1,2; E. Smith1
1
Psychology, Western Sydney University, Bankstown; 2Psychology,
Australian Institute for Human Wellness, Kogarah, Australia
INTRODUCTION: It has been well established that traumatic experi-
ences, especially those that happen in childhood, will significantly
increase the risk of disordered eating pathology and obesity. The cur-
rent study aimed to further develop an understanding of how the
experiences of trauma across the lifespan, including more vast range
of experiences, are associated with eating disorder pathology and
weight outcomes.
MATERIALS AND METHODS: A total of 624 participants from Amer-
ica and Australia between the age of 18 to 72 years old were
recruited to complete an online survey on emotion regulation, psycho-
logical distress, coping strategies, adverse childhood and life experi-
ences, eating disorder pathology, and BMI.
RESULTS: Any experience of adverse childhood or life experiences
was significantly associated with some forms of disordered eating
pathology and BMI; however higher cumulative experiences of
adverse childhood or life experiences was significantly associated with
even greater levels of disordered eating pathology and BMI.
CONCLUSION: This study further supports the notion that childhood
trauma significantly increases disordered eating pathology and BMI
long term, however it also provided evidence that even more minor
adverse life experiences can also result in higher rates of disordered
eating pathology and BMI. Future research should consider a wide
range of adverse life experiences when developing treatment for
those with disordered eating pathology, poor coping strategies and
obesity.
DISCLOSURE OF INTEREST: None Declared.
LBP87 | How complications of obesity
uniquely affect patients preferences for
weight loss treatments: a systematic review
S. Cooney1; H. Craig2; C. le Roux2
1
Nephrology, Beaumont Hospital; 2Diabetes Complications Research
Centre, University College Dublin, Dublin, Ireland
INTRODUCTION: The large number of complications of obesity has
increased the prevalence of multimorbid patients living with complex
chronic diseases. We aimed to synthesise how multimorbidity affects
patient preference for weight loss treatments, and determine which
factors influence these choices. Although a growing number of these
patients exist, qualitative data is scarce. A synthesis of findings from
1467789x, 2022, S2, Downloaded from https://onlinelibrary.wiley.com/doi/10.1111/obr.13503 by CAPES, Wiley Online Library on [16/12/2023]. See the Terms and Conditions (https://onlinelibrary.wiley.com/terms-and-conditions) on Wiley Online Library for rules of use; OA articles are governed by the applicable Creative Commons License
SUPPLEMENT ARTICLE
several papers could achieve greater conceptual understanding than a
single study.
MATERIALS AND METHODS: We performed a systematic review of
qualitative studies about patients with obesity complications choices
regarding weight loss treatments, and thematic synthesis of the find-
ings from these studies. Data sources included Pubmed, CINAHL,
Embase, Psycinfo and grey literature. Thematic synthesis was per-
formed using the Thomas and Harden method involving initial line by
line coding of primary studies and then the development of further
descriptive and analytical themes.
RESULTS: A total of 1,013 qualitative studies were screened and 7
studies were included. The core analytical themes identified as central
to patient preference resounded in all papers: hope and fear. These
hopes and fears affected patients’ choices in three main ways‐ fear of
complications leading to a desire for treatment and hopes and fears
surrounding the treatments themselves, as well as treatment out-
comes affecting their inclination towards a particular therapy. Of note,
the presence of obesity complications was a motivating factor for
seeking treatment, and affected the treatment options patients would
consider‐ being more open to medical or surgical pathways.
CONCLUSION: Presence of complications has a definite effect on
patients’ motivation for treatment and preference for treatment type.
This highlights the importance of further research into this rapidly
expanding area, given the current dearth of research and the growing
number of people this applies to.
DISCLOSURE OF INTEREST: None Declared.
LBP88 | Associations between weight self‐
stigma and healthful behaviours among
Australian adults with type 2 diabetes
S. Manallack1,2; E. Holloway1,2; F. Pouwer1,3,4; J. Speight1,2,3;
E. Holmes‐Truscott1,2
1
School of Psychology, Deakin University, Geelong; 2Australian Centre for
Behavioural Research in Diabetes, Diabetes Victoria, Melbourne,
Australia; 3Department of Psychology, University of Southern Denmark;
4
Steno Diabetes Center Odense, Odense, Denmark
INTRODUCTION: People who perceive or experience weight stigma
engage less in health enhancing behaviours. Higher self‐efficacy, self‐
esteem, and social support are associated with increased engagement,
and may protect against the negative impact of stigmatisation. Self‐
stigma occurs when an individual internalises stigma, for example,
judging, blaming and/or shaming themselves. We aimed to examine
associations between weight self‐stigma and healthful behaviours
(healthy diet and physical activity), and potential moderating effects
of self‐esteem, diabetes self‐efficacy, and diabetes social support,
among Australian adults with insulin‐treated (IT) and non‐insulin‐trea-
ted (NIT) type 2 diabetes (T2D).
MATERIALS AND METHODS: Data were from the second Diabetes
MILES–Australia (MILES‐2) cross‐sectional online survey. Participants

SUPPLEMENT ARTICLE
were recruited mainly via the national diabetes registry. Participants
with T2D who reported concern about overweight (N=726; IT: 48%;
age: 60.2±9.6 years; women: 50%), were invited to complete the
Weight Self‐Stigma Questionnaire (WSSQ, total score, subscales:
self‐devaluation, fear of enacted stigma). Participants also completed
measures of diabetes self‐care (SDSCA, subscales: diet, exercise), self‐
esteem (RSES), diabetes self‐efficacy (CIDS), diabetes social support
(DSS), and self‐reported demographic and clinical characteristics. Linear
regression analyses tested associations between WSSQ and SDSCA
subscales and interaction effects, adjusting for demographic and clinical
variables. Outcomes were compared by treatment type (IT vs NIT).
RESULTS: Weight self‐stigma was apparent in both groups (IT: 36.5
+9.6; NIT: 36.0+9.7; range 12‐60). Those with IT‐T2D reported
greater fear of enacted stigma than those with NIT‐T2D (Mdiff=0.9,
p=.001). No differences were observed in weight self‐stigma total or
self‐devaluation. For both groups, weight self‐stigma was negatively
associated with self‐esteem (r=‐.5), diabetes self‐efficacy (r=‐.4), and
diabetes social support (r=‐.3; all p<.01). Weight self‐stigma total was
associated with diet in both groups (β=‐0.3), and with exercise in
those with NIT‐T2D only (β=‐0.2; all p<.001). No significant interac-
tion effects were observed for the moderators.
CONCLUSION: This study provides novel evidence that weight self‐
stigma is associated with suboptimal diet and physical activity among
Australian adults with T2D who report concern about overweight.
Further research is needed to examine the psychosocial, behavioural,
and long‐term health impacts of weight self‐stigma among adults with
T2D.
DISCLOSURE OF INTEREST: None Declared.
LBP89 | Parental perceptions associated with
childhood obesity in urban Vietnam
T. Mai1; C. Q. Tran2; S. Nambiar1; J. C. Van der Pols1; D. Gallegos1
1
School of Exercise and Nutrition Sciences, QUT, Brisbane, Australia;
2
Nutrition, Pham Ngoc Thach Medical University, Ho Chi Minh City, Viet
Nam
INTRODUCTION: Childhood overweight and obesity are rapidly
increasing in urban Vietnam. This public health issue is attributable to
a number of complex determinants. In this study, we examined factors
related to parental self‐efficacy and perceptions of their child’s weight
status for associations with childhood obesity in Ho Chi Minh City,
Vietnam.
MATERIALS AND METHODS: Four primary schools in different
socioeconomic status areas in Ho Chi Minh City, Vietnam were ran-
domly selected to recruit 221 children 9‐11 years old for the study.
Weights and heights were measured twice using standardized
1467789x, 2022, S2, Downloaded from https://onlinelibrary.wiley.com/doi/10.1111/obr.13503 by CAPES, Wiley Online Library on [16/12/2023]. See the Terms and Conditions (https://onlinelibrary.wiley.com/terms-and-conditions) on Wiley Online Library for rules of use; OA articles are governed by the applicable Creative Commons License
221 of 222
methods. Children with BMI Z‐score > 2 SD was considered as obese.
Parents completed a self‐reported questionnaire about factors rele-
vant to childhood overweight and obesity. Parental perception of their
child’s weight status was measured by one text‐based question and
one image‐based question showing sex‐specific body sizes for Asian
children. A 14‐item questionnaire (α = 0.949 and ICC = 0.90 (0.77‐
0.95)) was used to evaluate parents‘self‐reported efficacy in influenc-
ing their child’s eating behaviours and physical activity. Chi‐squared
test was used to examine group differences between children with
obesity and non‐obesity, and logistic regression was used to examine
the possible association between those factors and obesity. Two‐
sided P‐value < 0.05 was considered statistically significant.
RESULTS: More than a half of parents (57‐61%) underestimated their
child’s weight status. The overall prevalence of children with obesity
was 31.7%, whereas 9.1% of parents perceived their child was obese.
Parents were more likely to correctly identify their child as being
obese by using an image‐based question than by using a text‐based
question (24.1% vs. 11.9%) although the overal correctly estimation
of child’s weight status was similar for both questions (38% and 40%,
respectively). Children with parents who correctly estimated their
weight status had a lower odds of obesity than those with parents
who underestimated their weight status (OR = 0.52 (0.28‐0.98), p =
0.042). The self‐efficacy score of parents with a child with obesity (85
points) was lower than the score of parents with a child with a healthy
weight and underweight (96 points) or overweight child (102 points).
For each point increase in the total parent’s self‐efficacy score, the
odds of being obese were OR=0.99 (0.98‐1.00), p = 0.022).
CONCLUSION: Findings from this study indicated that parents highly
underestimated their child’s weight status. Given the rapid nutrition
transition where parents have been previously focused on ensuring
their children are not underweight, there appears to be scope for re‐
educating parents regarding the impacts of weight status on children’s
health with the focus on parental perception of the child’s weight sta-
tus and their self‐efficacy in influence on children‘s dietary practices
and physical activities.
DISCLOSURE OF INTEREST: None Declared.

222 of 222
LBP90 | Perceptions on obesity management
among people with obesity and healthcare
professionals in the Asia‐Pacific region
1 2 3 4
T. Q. Nam ; A. Ahmed ; A. Boonyavarakul ; M. Mercado Garcia ;
B. M. Guajardo Guzman5; N. A. Nicodemus Jr6; Z. Nor Hanipah7;
F. Pathan8; J. G. Uranga Romano4; S. Soegondo9; K. W. Tham10;
11 12 13
E. L. Tolentino Jr ; A. G. Unnikrishnan ; B. Oldfield
1
University Medical Center at Ho Chi Minh City, Ho Chi Minh City, Viet
Nam; 2The Aga Khan University Hospital, Karachi, Pakistan; 3Division of
Endocrinology, Department of Internal Medicine, Bangkok, Thailand;
4
Novo Nordisk, Dubai, United Arab Emirates; 5Novo Nordisk, Kuala
Lumpur, Malaysia; 6University of the Philippines‐College of Medicine,
Manila, Philippines; 7Department of Surgery, Faculty of Medicine and
Health Sciences, Universiti Putra Malaysia, Selangor, Malaysia;
8
Department of Endocrinology, Ibrahim Memorial Diabetes Center,
Dhaka, Bangladesh; 9Indonesia Diabetes Institute, Diabetes Connection &
Care, Eka Hospitals, Jakarta, Indonesia; 10National Healthcare Group,
Singapore, Singapore; 11Ateneo School of Medicine and Public Health,
Pasig, Metro Manila, Philippines; 12Chellaram Diabetes Institute,
Bavdhan, Pune, India; 13Monash University, Clayton, Australia
INTRODUCTION: Obesity is an epidemic health problem globally and
more so in the Asia‐Pacific region. Therefore, the aim of this study
was to explore perceptions and attitudes towards obesity and its man-
agement among people with obesity (PwO) and healthcare profes-
sionals (HCPs) in Asia‐Pacific countries.
MATERIALS AND METHODS: A cross‐sectional population‐based
survey was conducted in Bangladesh, India, Indonesia, Malaysia, Paki-
stan, Philippines, Singapore, Thailand, and Vietnam. A total of 10,429
PwO and 1,901 HCPs took part in this online survey. Obesity was
defined as body mass index (BMI) ≥25 kg/m2, except in Singapore,
where BMI of ≥27 kg/m2 was used.
RESULTS: PwO and HCPs had different perspectives regarding the
healthcare system and obesity management approaches. Most HCPs
(85%) believed the healthcare system is a good resource for weight
loss, but only 63% of PwO had a similar perception. PwO (63%) were
also less likely than HCPs (87%) to agree that the treatment of obesity
1467789x, 2022, S2, Downloaded from https://onlinelibrary.wiley.com/doi/10.1111/obr.13503 by CAPES, Wiley Online Library on [16/12/2023]. See the Terms and Conditions (https://onlinelibrary.wiley.com/terms-and-conditions) on Wiley Online Library for rules of use; OA articles are governed by the applicable Creative Commons License
SUPPLEMENT ARTICLE
should be a team effort involving different HCPs and that the cost of
obesity therapy is a barrier to weight loss (58% vs 76%). Many PwO
(50%) and HCPs (62%) agreed there were good prescription weight
loss medications options currently available, but they were concerned
about the side effects of these medications (63% and 69%, respec-
tively). A majority of PwO would rather lose weight on their own than
depend on medication (65%) or have weight loss surgery (68%). Like-
wise, a substantial proportion of HCPs believed their patients would
rather lose weight on their own than take prescription weight loss
medications (55%). Additionally, most HCPs (71%) preferred to recom-
mend lifestyle therapy than weight loss surgery to their patients with
obesity.
CONCLUSION: HCPs have a more positive perception of the health-
care system and multidisciplinary team approach regarding obesity
management as compared with PwO. However, both HCPs and PwO
prefer lifestyle intervention than other treatment modalities such as
prescription weight loss medications and bariatric surgery. PwO and
HCPs may benefit from further awareness and education on obesity
management and treatment options.
DISCLOSURE OF INTEREST: T. Q. Nam Paid Instructor for: Novo
Nordisk, Eli Lilly, Boehringer Ingelheim, Merck KgaA, Astra Zeneca,
Novartis, A. Ahmed: None Declared, A. Boonyavarakul: None
Declared, M. Mercado Garcia Shareholder of: Novo Nordisk,
Employee of: Novo Nordisk, B. M. Guajardo Guzman Employee of:
Novo Nordisk, N. A. Nicodemus Jr. Consultant for: Novo Nordisk,
Astra Zeneca, Merck, Speakers bureau with: Novo Nordisk, Astra
Zeneca, Merck, Z. Nor Hanipah Consultant for: Novo Nordisk, F.
Pathan: None Declared, J. G. Uranga Romano Shareholder of: Novo
Nordisk, Employee of: Novo Nordisk, S. Soegondo Consultant for:
Sanofi, Novo Nordisk, Eli Lilly, MSD, Astra Zeneca, Abbott, Pfizer,
Boehringer Ingelheim, Merck Indonesia, Speakers bureau with: Sanofi,
Novo Nordisk, Eli Lilly, MSD, Astra Zeneca, Abbott, Pfizer, Boehringer
Ingelheim, Merck Indonesia, K. W. Tham Consultant for: Novo Nor-
disk (COI), Speakers bureau with: Novo Nordisk (COI), DKSH, E. L.
Tolentino, Jr.: None Declared, A. G. Unnikrishnan Consultant for:
Novo Nordisk, Sanofi, AstraZeneca, MSD, Boehringer‐Ingelheim,
Speakers bureau with: Novo Nordisk, Sanofi, AstraZeneca, MSD,
Boehringer‐Ingelheim, B. Oldfield Consultant for: Novo Nordisk,
Speakers bureau with: Novo Nordisk