Developing and evaluating behavioural interventions to reduce meat consumption

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Behavioural Medicine The proposed research explores the feasibility and effectiveness of a multicomponent e-intervention that aims to enhance adherence to meal replacement programmes among overweight and obese patients in primary care.More specifically, the project investigates whether an intervention combining meal replacement programmes with a phone application designed to help patients monitoring their weight loss and their adherence to the programme results in (1) higher adherence to the dietary regimen, (2) higher weight loss and (3) greater improvement of bio-markers associated with obesity-related morbidities compared to an intervention featuring meal replacement programmes only. If proven effective, this would be the first intervention within a primary care setting that may successfully contribute, at virtually no added cost, to the reduction of the health and economic burden of obesity.Being overweight or obese has been consistently associated with a number of severe health conditions such as type II diabetes(1-4), coronary heart disease(5-8), male impotence(9-12) and increased risk of breast(13-15) and colorectal cancer(16-18) alongside other adverse psychological outcomes(19-21). Every year obesity accounts for a worldwide loss of 35.8 million disability-adjusted life years(22) and the NHS expenditure associated with obesity related diseases is expected to reach 22.9 billion pounds per year by 2050(23). Because the awareness of the impact of obesity on health is suboptimal and due to the stigma attached to this condition(24-27), patients might lack the motivation or feel too embarrassed to actively seek the support of specialised healthcare institutions to normalise their weight. The role of primary care practices is therefore of fundamental importance to reduce the prevalence of obesity at population level. This is not only true because of patients' inherent preference for primary care interventions compared to other commercial options(28,29) but also because overweight and obese patients visiting primary care practices for routine check-ups or because of (supposedly) weight-unrelated conditions can opportunistically be offered weight loss interventions. Nevertheless, a systematic review of the literature indicated that, to date, primary care interventions have not been successful in normalising the BMI of overweight patients(22). This is possibly because such interventions took a cognitive approach, assuming that human behaviour is determined by rational choices, while psychological research consistently indicated that human behaviour is strongly influenced by environments and heuristics(30-34). Sporadic educational sessions aiming to increase patients' knowledge of the health risks associated with being overweight might therefore not be sufficient to foster clinically relevant weight loss in an obesogenic society. Instead more substantial interventions that successfully help patients with overcoming daily motivational, volitional and practical barriers to dietary changes are needed. Modern digital technology might be a valuable opportunity with which such interventions can be developed. The aim of this project is therefore to design a multicomponent intervention featuring digital technology that can feasibly be delivered in primary care practices and that is effective at increasing patients' adherence to prescribed meal replacement programmes and in achieving a clinically relevant BMI reduction while still being time and cost economic.MRC Skill Priority: Interdisciplinary skills (social/clinical interface)