Anna Peeters

Introduction: Understanding the lived experience of people with overweight or obesity is essential to ensure that interventions are free from weight stigma, avoid adverse consequences including eating disorder pathology, increase engagement, and promote culturally sensitive approaches to care. We aimed to synthesize published review evidence of the lived experience of people living with overweight and obesity engaging in weight management interventions. Methods: Database searches using defined inclusion criteria were undertaken in Ovid MEDLINE, APA PsycINFO via EBSCOHost, CINAHL Complete via EBSCOHost, and Cochrane Library. After screening and data extraction, thematic synthesis was undertaken using the Copilot large language model and verified by a researcher who had detailed knowledge of all included reviews. Results: The database searches identified 4183 studies, with 38 reviews meeting the inclusion criteria. Supportive networks (including familial, social, healthcare, and employment) were key to initiation, engagement and maintenance of weight loss across all age groups and interventions. Intervention design and delivery approaches that were accessible, individually tailored, collaborative, age‐appropriate, culturally sensitive, and free from judgment and stigma were key to sustained engagement with programs. Conclusions: This umbrella review identified emotional, healthcare, cultural, and societal implications for the weight stigma and bias described by participants in the current literature. By actively working to reduce weight bias and stigma in clinical practice, research, and guideline development, healthcare professionals, and academics can foster more equitable and effective weight management interventions that prioritize the long‐term health of people living with overweight or obesity.

Background: No studies have examined how price increases on unhealthy drinks in university vending machines impact customer purchasing or vendor financial implications. Vending machines often display prices only upon product selection, hindering consumers’ price evaluation. Objective: To assess the independent and combined effects of (i) a 20% price increase on unhealthy drinks, and (ii) prominent labels displaying the price below each product, on the healthiness of customer purchases and revenue in university vending machines. Design: Two-year 2 × 2 factorial cluster randomized controlled trial (March 2020 to February 2022). Machines were clustered by proximity. Itemised weekly sales data were collected for 33 weeks pre-trial and 103 weeks during the trial. Six-monthly audits assessed treatment maintenance. Participants/setting: Sixty vending machines across four campuses of a university in Victoria, Australia, with 59 machines analyzed. Intervention: Machine groups were randomly allocated to four conditions: (i) 20% price increase on unhealthy drinks (‘Price Increase Only’); (ii) prominent labels displaying the price below each product (‘Price Label Only’); (iii) ‘Price Increase + Price Label’; and (iv) no price increase or labels (‘Control’). Main outcome measures: The primary outcome was the change from pre-trial mean of volume percentage of unhealthy drinks sold per machine per week. Secondary outcomes included volume percentage of healthier drinks sold per week and revenue. Statistical analyses: Sales data were analysed using linear mixed models with machine cluster and machine as random effects; and fixed effects for price, label, price × label, pre-trial mean outcome, teaching period, COVID-19 lockdowns, and season. Results: Mean volume percentage of unhealthy drink sales was higher for the ‘Price Label Only’ compared to ‘Control’ condition (6.34 percentage points, 95%CI: 1.85, 10.82), percentage of unhealthy drink units sold, and energy and total sugar content of drinks sold, and lower for volume and unit percentage of unhealthy drink sales. No other significant differences were observed for the primary or secondary outcomes. Conclusions: This study in university vending machines found no impact of a 20% unhealthy drink price increase, and an increase in volume sales of unhealthy drinks in response to prominent price labelling only. Trial registration: Australian New Zealand Clinical Trials Registry Number: ACTRN12620000206921 (prospectively registered 20 February 2020).

Objectives: To gather staff feedback from small-to-medium Australian community food retail outlets on a Healthy Retail Toolkit and provide recommendations to inform future resource development to better support retailers to implement healthy food retail policies. Type of program: Co-design of a Healthy Retail Toolkit (the ‘Toolkit’) by a working group of food retailers, public health practitioners and researchers. The Toolkit consisted of six ‘steps for success’ for retailers implementing healthy changes to their food offerings and promotions, alongside troubleshooting tips and case studies of successful adoption of healthy food retail practices in similar food retail outlets. Methods: Interviews and focus groups were conducted with food outlet managers, owners, front-of-house and back-of-house staff within hospitals, tertiary education, and sport and recreation facilities in Victoria, Australia. Interviewees were asked to reflect on the Toolkit usability. A two-phase thematic analysis approach synthesised (i) responses according to the six Toolkit ‘steps for success’; and (ii) general recommendations for the development of resources for retailers implementing healthy food and drink initiatives. Results: Ten retailers participated in interviews or focus groups and provided feedback to improve the format and content of the Toolkit. Retailers valued the step-by-step approach of the ‘steps for success’. Highlighting implementation support services was helpful for those retailers who required additional tailored support. The use of links and direction to further support allowed the Toolkit to remain succinct and avoided making implementation appear overwhelming. Participants reflected on the importance of accessible and lay language, as well as using formatting, infographics and diagrams to break up text-heavy sections. They requested increased focus on the ‘business case’ for change, such as aligning to healthy consumer trends, and further troubleshooting tips and case studies to make the Toolkit brief and practical. Lessons learnt: Recommendations to inform future resource development for retailers included (1) describe the ‘business case’ for retailers to shift to healthier food and drink options; (2) provide step-by-step guidance on implementation stages; (3) address common challenges; (4) provide case studies, practical support, tools and templates; and (5) get feedback on tool content and format from your target audience.

Issue Addressed: Local government (LG) facilities such as libraries, clubs and sport and recreation centres generally offer and promote nutritionally poor foods that may contribute to excess energy intake. It is unclear what effect exposure to a healthy food retail initiative may have on customer and staff support for such changes. This study investigated the association of a healthy drink intervention in LG‐owned sporting facilities on changes in (i) intervention LG attitudes and facility healthy food and drink provision, compared to control LGs; and (ii) intervention LG customer and staff support for the intervention.Methods: Eight Victorian LGs implemented a two‐year intervention to limit sugary drink availability in LG‐owned sporting facilities. At baseline (2018) and follow‐up (2020), attitudinal surveys were sent to intervention LG staff (baseline: n = 162; follow‐up: n = 183) and customers (baseline: n = 1079; follow‐up: n = 1188), and policy surveys were sent to all state LGs. Baseline and follow‐up responses, and policy survey responses between 8 intervention and 24 control LGs were compared using logistic regression.Results: Intervention LGs' baseline priorities for promoting healthy eating were higher than control LGs, with no change in priorities at follow‐up. Intervention LG staff and customers' belief that sporting facilities should promote healthy eating remained high between baseline (customers 79%; staff 76%) and follow‐up (customers 75%; staff: 73%).Conclusions: Facility staff and customers support interventions to align sporting facilities' healthy lifestyle message with healthier food environments.So What?: LG prioritisation of healthy eating appears to be a prerequisite for LG healthy drink policies.

Summary: Increasing the healthiness of food retail environments is an identified mechanism to help halt rising rates of diet‐related non‐communicable diseases. Previous studies on healthy food environment adoption report that retailers' perceptions of loss of profitability and higher food costs are often barriers to change. Despite this, actual changes to profitability and food costs have not been fully explored. This study aimed to systematically scope the evidence relating to changes to food costs or profitability when changes are made to increase the healthiness of food and drinks sold by food service retailers. Nine databases were searched, with studies included from settings that sold ready‐to‐consume items, with interventions to increase the healthiness of menus, and reporting food environment/nutrition outcomes, and cost/profit outcomes. Of the 12 studies included, the majority were conducted in the United States and in school settings. Most studies indicated that increasing the healthiness of food service retail environments resulted in neutral or favorable financial outcomes. Food costs and/or profit changes were most often monitored via simple accounting measures. While further research is needed to strengthen the evidence on financial outcomes of healthier food provision, this review indicates that some perceived barriers to change may not be warranted.

Background: Digital health literacy has emerged as a critical skill set to navigate the digital age. Objective: This review sought to broadly summarize the literature on associations between digital health literacy and (1) sociodemographic characteristics, (2) health resource use, and (3) health outcomes in the general population, patient groups, or parent or caregiver groups. Methods: A rapid review of literature published between January 2016 and May 2022 was conducted through a search of 4 web-based databases. Articles were included on the basis of the following keywords: “measured digital health literacy,” “digital literacy,” “ehealth literacy,” “e-health literacy,” “electronic health literacy,” or “internet health literacy” in adult populations; participants were from countries where English was the primary language; studies had to be cross-sectional, longitudinal, prospective, or retrospective, and published in English. Results: Thirty-six articles met the inclusion criteria. Evidence on the associations between digital health literacy and sociodemographic characteristics varied (27/36, 75% included studies), with higher education (16/21, 76.2% studies that examined the association) and younger age (12/21, 57.1% studies) tending to predict higher digital health literacy; however, other studies found no associations. No differences between genders were found across the majority of studies. Evidence across ethnic groups was too limited to draw conclusions; some studies showed that those from racial and ethnic minority groups had higher digital health literacy than White individuals, while other studies showed no associations. Higher digital health literacy was associated with digital health resource use in the majority of studies (20/36, 55.6%) that examined this relationship. In addition, higher digital health literacy was also associated with health outcomes across 3 areas (psychosocial outcomes; chronic disease and health management behaviors; and physical outcomes) across 17 included studies (17/36, 47.2%) that explored these relationships. However, not all studies on the relationship among digital health literacy and health resource use and health outcomes were in the expected direction. Conclusions: The review presents mixed results regarding the relationship between digital health literacy and sociodemographic characteristics, although studies broadly found that increased digital health literacy was positively associated with improved health outcomes and behaviors. Further investigations of digital health literacy on chronic disease outcomes are needed, particularly across diverse groups. Empowering individuals with the skills to critically access and appraise reliable health information on digital platforms and devices is critical, given emerging evidence that suggests that those with low digital health literacy seek health information from unreliable sources. Identifying cost-effective strategies to rapidly assess and enhance digital health literacy capacities across community settings thus warrants continued investigation.