In nutritional research, the sensations of appetite have mostly been studied as a physiological phenomenon. However, in order to understand the significance of appetite for everyday eating habits, it is pertinent to include the social dimension. In a qualitative interview study, using qualitative semi-structured in-depth interviews, we investigated how appetite was experienced and handled in the context of everyday life among 20 men and women. This report examines how qualitative dimensions of appetite are experienced and conceptualised in everyday life. Achieving what was described as proper satiety was found to be of decisive importance for daily eating habits. The experience of being full up, the duration of satiety and the sensuous pleasure of eating were all found to be central dimensions of proper satiety, the definition of which varied according to different social contexts. Whether one ate one's fill in the company of others, alone, at work or in one's spare time turned out to be of decisive importance. A more elaborate understanding of the social dimensions of appetite may help to improve endeavours to prevent overweight and obesity.
To examine successful Canadian nursing and health promotion intervention programmes for childhood obesity prevention during gestation and infancy, an integrative review was performed of the literature from 1980 to September 2005. The following databases were used: PubMed; Cochrane Database of Systematic Reviews; Cochrane Controlled Trials Register; Database of Abstracts of Reviews of Effects; ACP Journal Club; MEDLINE; EMBASE; CINAHL; Web of Science; Scopus; Sociological Abstracts; Sport Discus; PsycInfo; ERIC and HealthStar. MeSH headings included: infancy (0-24 months), gestation, gestational diabetes, nutrition, prenatal care, pregnancy, health education, pregnancy outcome, dietary services with limits of Canadian, term birth. Of 2028 articles found, six Canadian childhood obesity prevention programmes implemented during gestation and/or infancy were found; three addressed gestational diabetes with five targeting low-income Canadian urban and/or Aboriginal populations. No intervention programmes specifically aimed to prevent childhood obesity during gestation or infancy. This paucity suggests that such a programme would be innovative and much needed in an effort to stem the alarming increase in obesity in children and adults. Any attempts either to develop new approaches or to replicate interventions used with obese adults or even older children need careful evaluation and pilot testing prior to sustained use within the perinatal period.
A number of studies have shown that dieting and body dissatisfaction are highly frequent among adolescents. We here describe the relationship between dieting and body dissatisfaction in 4,952 children selected from the 11, 13 and 15 year age cohorts of the Norwegian national sample in the multinational WHO survey "Health Behavior in School Children". Body dissatisfaction was defined as the subjective experience of being a bit or much too fat and, using this definition, about 20% of the boys reported body dissatisfaction and 7% that they were on a diet. About 37% of the girls reported body dissatisfaction and 15% that they were on a diet. Within the age cohorts, respectively 22%, 30% and 32% reported body dissatisfaction, whereas about 40% overall indicated no body dissatisfaction. Being on a diet was reported by 8% of the 11-year olds, and subsequently increased to 10% (13 years) and 14% (15 years). Multiple regression analysis showed that body dissatisfaction explained 33% of the variance in dieting behaviour, and that the overall effect of gender and age was small. Dieting and body dissatisfaction should therefore be recognised as being equally important among boys, and be counteracted within the framework of a health promotion strategy aimed at the general adolescent population.
The transfer of evidence from research into clinical practice is made almost impossible by enormous volume of literature on any topic. Consolidated evidence into guidelines is not very helpful as there are usually 50 guidelines existing on common clinical topics. Clinicians need assistance in identifying the best available evidence. This paper describes two strategies to transfer research evidence into clinical practice.
The Guideline Advisory Committee (GAC) in Ontario has assessed all available guidelines on 70 clinical topics using a validated and transparent process involving community-based physicians as assessors. A single best guideline is selected and a summary of its evidence-based recommendations are produced for easy use by practitioners (http://www.gacguidelines.ca). The Critically Appraised Practice Reflection Exercise (CAPRE) programme takes the best available evidence on 40 common practice problems, presents a summary for clinician and patient, has a strategy for physician and patient to find common ground in applying the evidence and has the practitioner to carry out a reflection exercise to gain continuing education credits (http://www.capre.ca). Distribution of these strategies in practice-based research networks is a further step in making research more relevant to practice.
The GAC website has more than 100,000 'hits' per month and 4500 identified regular users from Canada and the world. The numbers are steadily increasing. The CAPRE programme has not been formally evaluated but over 150 clinicians have used the programme with patients. With a national launch, the programme there between 60,000 and 80,000 hits per week with 100 physicians completing the programme for continuing medical education (CME) credits in the first month. Physicians report that their patients are very pleased with their physician using the latest evidence to address their problem. This is true even if the patient does not agree to follow the evidence-based recommendations. Using these programmes in practice-based research, networks should further promote making research more relevant to practice.
Transferring research-based evidence into clinical practice has many challenges. Two programmes developed to address these challenges are described. Although not fully evaluated, there is some evidence of success.
To provide insight into Canadian dietitians' attitudes and practices regarding obesity and weight management.
Cross-sectional mail survey of a stratified random sample of members of Canadian dietetic associations.
A total of 514 dietitians (74% of those surveyed), 350 (69%) of whom actively counselled overweight/obese clients.
Participants received a questionnaire to assess dietitians' attitudes regarding obesity and overweight, views regarding their role in weight management, counselling practices, and the criteria used to judge success. Demographic variables were collected.
Most dietitians believed that obesity contributes to morbidity and mortality, and that small weight losses produced important health benefits. However, 80% agreed that health indicators other than weight loss should be the focus of obesity management, and 55% specifically recommended that clients not weigh themselves. Instead, weight management was promoted by recommending healthy eating and increased physical activity. Three-quarters agreed that they are the profession best trained to manage obesity but two-thirds believed their time would be better spent preventing rather than managing obesity. Dietitians most valued education received from on-the-job support and mentoring from other dietitians. Participants reported wanting to learn more about motivational and behavioural modification counselling techniques.
Canadian dietitians follow a lifestyle approach to weight management. Studies are required to formally assess the effectiveness of various aspects of this approach.
We examined interprofessional (IP) attitudes and relationships within an emergent network, the Canadian Obesity Network (CON), using semi-structured individual interviews with 13 members of the CON. CON is a newly formed network of obesity researchers, health professionals, and other stakeholders whose vision is to reduce the mental, physical, and economic burden of obesity on Canadians. Analysis of participant contributions led to a "Who?, What?, When?, Where?, Why?, and How?" framework of IP practice and obesity. Results indicate that a wide range of professionals are ready (who?), the issue is apparent (what?), the context is multi-located (where?), the timing is right (when?), and there is general consensus that IP practice (how?) is the only way to go to effectively tackle the obesity issue (why?). Recommendations and suggestions for future studies of IP practice in the context of both networks and obesity are made.
OBJECTIVE: This study presents an overview of national nutrition action plans in the member states of the European Union (EU), before its enlargement in 2004. In addition, their compliance with key recommendations of the World Health Organization, as documented in the First Action Plan for Food and Nutrition Policy and the Global Strategy on Diet, Physical Activity and Health, has tentatively been evaluated on the basis of the policy documents published. DESIGN: Literature review of publicly available policy national plans on nutrition and physical activity. SETTING: Member states of the EU before enlargement in May 2004. RESULTS: The development of national nutrition action plans is gaining momentum. Six of the 15 EU member states - namely, Sweden, Finland, Denmark, France, The Netherlands and the UK - have an operational nutrition policy and four of them have published an elaborated description of their nutrition policy in English. By the end of 2004, another four countries are expected to have their plan finalised. The available nutrition action plans generally seem to comply with international recommendations, although large variations are observed between the member states in terms of terminology, nutritional recommendations, institutional framework, nutritional scope, social groups targeted and monitoring and evaluation structures. CONCLUSIONS: Although the importance of nutritional surveillance, a comprehensive approach to nutritional problems and stakeholder involvement is recognised by the action plans, the justification for it is vaguely described. This paper advocates for proper evaluation and documentation of interventions in public health nutrition and nutrition policies.