Week 5 RF-Novel ways to support the prevention of illnesses associated with weight gain

Question 1

What is weight gain associated with?

Answer 1

 Weight gain is a health risk!

Weight gain is associated with long-term physical health conditions such as:
 Cardiovascular diseases (heart failure, stroke, etc.)
 Various cancers (pancreatic, bowel, liver, thyroid, etc.)
 Osteoarthritis (pain in your joints and bones)
 High blood pressure
 Breathing problems such as sleep apnoea and asthma
 Type 2 diabetes.

Question 2

What is Type 2 Diabetes?

Answer 2

 Type 2 diabetes (T2D) is a consequence of the body’s ineffective use of insulin (World
Health Organization, 2014).
-This causes the level of sugar (glucose) in the blood to become too high.

 T2D can cause symptoms like excessive thirst, needing to pee a lot, and tiredness.
-Over time, it can increase your risk of serious problems with your eyes, heart, and
nerves.

It’s a lifelong condition that requires regular self-management and may require:
 Changes to diet
 Regular check-ups
 Medication

Question 3

What is the Type 2 Diabetes Prevalence?

Answer 3

 T2D is an international public health concern; global incidence was at 462 million in 2017 (Khan et al., 2020).

 Furthermore, increasing numbers of people are at risk for T2D.

 US diabetes prevalence increased 128% between 1988 and 2008 (National Center for Health Statistics, 2015).

 Here in the UK, it is estimated that 5 million people are at high risk of developing T2D in England alone (PHE, 2018).

 But given that physical inactivity and excess body weight play a significant role in the development of type 2 diabetes…

 (Most people with type 2 diabetes are
overweight or obese; Eckel et al., 2011)

Question 4

What risk factors for T2D are ‘nonmodifiable’?

Answer 4

 Genetics (more likely to develop T2D if a close family member such as a parent did).

 Ethnicity (Black and South Asian more at risk due to cultural factors; health inequalities).

 Age (older adults at higher risk)

 But other ‘modifiable’ factors, including weight status, can be influenced via prevention efforts.

Question 5

What can reduce the risk of T2D?

Answer 5

Behavioural and environmental changes to:
 Diet
 Exercise
 Smoking behaviours
 Alcohol intake
 Weight more generally

 Can reduce the risk for T2D

Question 6

What Prevention methods have been implemented to reduce T2D?

Answer 6

 Following international evidence, NHS England launched the NHS Diabetes Prevention Programme (NHS-DPP) in 2016.

 A behavioural intervention for adults in England who have elevated blood glucose levels, (i.e., non-diabetic hyperglycaemia) to slow or stop their progression to developing Type 2 diabetes.

 The NHS-DPP is the largest diabetes prevention programme globally to achieve universal national coverage.

 But it’s not without its limitations.

Question 7

What does T2D prevention require?

Answer 7

 Behaviour change is important BUT…

 T2D prevention also requires the individual to navigate emotional challenges and dysfunction (Yates et al., 2019).

 (as well as associated health‐related cognitions linked to motivation, beliefs, and
attitudes; Stetson et al., 2017).

 Which can complicate an individual’s capacity for behaviour modification!

 Furthermore, the likes of goal setting is poorly utilised by the NHS DPP (Diabetes Prevention Programme) (Hawkes et al., 2021).

 Too regimented? Not enough focus on supporting people’s own goals for their health? i.e., tells them to lose weight but not a true way of how for the individual.

Question 8

What are some threats to positive emotional health?

Answer 8

Aspects of diabetes prevention that might affect your emotional health include a variety of things such as:
 The threat of a long-term physical illness
 Early symptoms (though not everyone at risk experiences symptoms!)
 Relationships with the health-care team
 Perceived or real progression of the disease
 Day-to-day prevention efforts (e.g., changes to lifestyle, etc.)
 Misinformation
 Stigma

Question 9

How is the current quality of recognising emotional health?

Answer 9

 Fortunately, the importance of diabetes emotional support is slowly being recognised.

 However, there is still a focus on reducing co-morbid mental illness rather than facilitating total mental health (which is common throughout psychology).

 We’re not taking into consideration the
individual’s well-being, their opportunities to thrive (not just survive), or how they may set positive long-term goals.

Question 10

What is the role and impact of positive affect?

Answer 10

 Positive affect (i.e., positive emotion) supports coping and wellbeing by providing the mental space for individuals to develop and invest in necessary psychological, intellectual, and social resources that they can later draw on in times of need (Fredrickson, 2001; 2004).

 Importantly, positive affect plays an especially adaptive role in health, as evidenced by its associations with both physical and mental health outcomes (Pressman et al., 2019).

Question 11

What is positive affect associated with?

Answer 11

Positive affect is associated with:
 an increase in physical activity (Baruth et al., 2011).

 improvements to eating behaviours
(Whitehead, 2017).

 and a lower likelihood of tobacco use (Niemiec et al., 2010).

 Positive affect may even protect against the effects of stress (Sewart et al., 2019) and
depression (Riskind et al., 2013).

 (which is important given the correlations between T2D and both stress & depression!).

Question 12

What is positive affect linked to with T2D?

Answer 12

In those identified to be at high risk of T2D, positive affect is:
 linked to improved glycaemic (blood sugar) control (Tsenkova et al., 2008); and
has been shown to protect against the
development of T2D among those with a
family history of the disease (Tsenkova et al., 2016).

 Providing direct evidence for clinical benefits!

Question 13

How can we facilitate positive affects?

Answer 13

 Importantly, positive affect can be facilitated to achieve these effects using ‘Positive Psychological Interventions’ (PPIs).

 (defined as intentional activities that aim to boost wellbeing, enhance positive
feelings, behaviours, or cognitions; Sin & Lyubomirsky, 2009).

 Such interventions have been shown to support behavioural and cognitive change in ways that promote well‐being and overall health.

 Positive psychology interventions are typically brief and self‐administered, and their effects are not limited by mental health status (Carr et al., 2020).

Question 14

Give examples of Positive Psych Interventions and diabetes care and its effectiveness?

Answer 14

 Gratitude and self‐affirmation tasks, combined with increased social support, improved physical activity and increased self management behaviours in young adults with type 1 diabetes (T1D) (Jaser et al., 2014).

 Similarly, a benefit‐finding task was associated with lower depressive symptoms, higher perceived coping
effectiveness, improvements in self‐management behaviours, higher positive affective reactions to stress and superior blood glucose levels in a similar population
with T1D (Tran et al., 2011).

 Meanwhile, an online intervention that taught positive affect skills reduced negative affect (i.e., negative emotions) and perceived stress in adults with T2D (Cohn
et al., 2014).

Question 15

Can we apply positive psychology with prevention?

Answer 15

 However, the scope of these positive psychology interventions could be broader and applied to support preventative strategies, not just self-management.

 (especially given that positive affect is more likely to support behavioural and cognitive change the earlier into the illness the intervention is provided; Pressman et al., 2019).

Question 16

What is the “Best Possible Self” Intervention?

Answer 16

 The ‘Best Possible Self’ (BPS) intervention is a disclosive writing exercise designed to help recipients set goals for a positive, imagined future (King, 2001).

There are associations between the BPS intervention and reductions in:
 Depressive symptoms,
 Pain & other physical illness symptoms,
 The number of visits to healthcare centres…

 Indicating benefits for physical and mental health among clinical populations and the general public alike (see Loveday et al., 2018).

Question 17

What did Gibson et al (2021) propose in relation to the BPS intervention?

Answer 17

 We proposed that the BPS intervention could be used for T2D prevention because it is brief, flexible, and well-evidenced across various contexts (Loveday et al., 2018).

 It could be easily administered, and we hoped it would make for an acceptable public health intervention.

 We’d previously used a modified version of the ‘best possible self’ (BPS) intervention to help adults with T1D and T2D set diabetes‐specific goals (Gibson et al., 2018).

 Amongst other results, this was shown to
improve perceptions of self‐care.

Question 18

What was Gibson et al’s (2021) study?

Answer 18

 As a first application of the intervention into the general public domain, we took an
explorative approach to investigate how people may engage with, and utilise, the ‘Best Possible Self’ intervention when used as a T2D prevention tool using a qualitative design guided by Braun and Clarke’s (2019) Reflexive Thematic Analyses.

A qualitative investigation can:
 provide rich data around intervention mechanisms, benefits and engagement (Gough & Deatrick, 2015).
 Provide insights into the contextual circumstances of implementing, delivering and evaluating interventions (Pope & Mays, 1995).

 The BPS intervention and user instructions were emailed to participants.

 Participants were encouraged to liaise directly (through their preferred communication medium: email, messaging or telephone) with the lead author to seek clarification and ask questions about the intervention before and during the intervention period.

 Following engagement with the intervention, a convenience sample of 12 females and 2 males - with a mean age of 30.7 years (SD: 12.7; range: 21–71 years) - submitted data.

 Participants completed the intervention at least once a week (taking approximately 10
mins to complete) for a minimum of 4 weeks and then submitted examples of their ‘best possible selves’.

 Participants were also then given the option to provide direct feedback about the intervention.

They were asked to consider:
 their engagement (e.g., how/when/where did you complete the intervention),
 application (how easy/difficult was it to do the intervention)
 acceptability (e.g., what did you (dis)like?) of the BPS intervention
 And to add any such reflective commentaries to their intervention submissions

Question 19

Give an example of the intervention instructions

Answer 19

Take a moment to think about your best possible self. Imagine that you are in excellent health and that you have been taking extra good care of your body. You are exercising regularly, and you are eating well. You have worked hard and succeeded at accomplishing all of your health-related goals. Imagine how it felt to achieve those goals and reflect on how positive it would feel to be this fit and healthy. Then, tell yourself the important things you realised or the critical steps you took to get there.
Now, please use the next 10 minutes to write continuously about what you imagined.

Question 20

What was found in Theme 1 Holistic Health?

Answer 20

A sense of interconnectedness:
 participants perceived different aspects of their health as complementary or otherwise
linked.

Forgiveness and self-care:
 health goals were seen as an ongoing journey and so it was important to take care of oneself along the way.

Social aspects of one’s best possible self:
 relationships were intrinsically linked to the notion of a ‘best possible self’ and
participants often desired healthier relationships or a more sociable future, either as a goal in and of itself or in service of other health goals.

Question 21

What was found in Theme 2 Control?

Answer 21

Identifying what works for you:
 Via engagement with the intervention, participants assessed their current health levels before identifying barriers and generating solutions (often unique, tailored, and ‘easier’ or ‘fun’ health behaviours).

Alternative goals:
 In service of ‘gaining control’ participants listed a number of seemingly non-health related goals, such as financial security and one’s appearance.

Technology as an aid:
 The intervention, especially the goal‐setting aspect, encouraged many participants to utilise technology to help implement their behaviour change and achieve and track their new identified
BPS.

Positive feelings generated by the BPS intervention:
 Goal achievement in particular facilitated feelings of happiness, though some participants noted the discrepancy between current and best possible future selves.

Question 22

How did Gibson et al (2021) interpret their findings?

Answer 22

Examinations of the accounts highlighted several ways in which individuals used the intervention to:
 conceptualise their health,
 set goals, and
 receive emotional benefits.

 While we did not focus the BPS intervention on specific T2D risk factors for behaviour change (e.g., improvements in physical activity, smoking behaviour or diet).

 it is an important finding that participants
incorporated these risk factors (at their choice) into their accounts.

 This intervention enabled people to seemingly person‐centre the intervention’s focus and identify their best possible selves in the context of positive health behaviours and outcomes.

 highlighting an underpinning motivation to achieve good health and well‐being.

Participants used the intervention to create a space where they could:
 reflect upon their current selves;
 identify barriers to their future selves; and
 develop thoughtful goals.
 Importantly, participants appeared to move from goal identification to implementation using additional resources, objective health markers, and a sense of well‐being identified by engagement with the intervention.

 In particular, this BPS intervention appeared to bridge the goal‐setting and implementation gap via psychological changes evident in ‘control’.

 although affective changes brought about by the intervention may also have played a
role.

Question 23

What do Gibson et al’s (2021) study mean for the future?

Answer 23

 Psychological and affective determinants of individual health behaviours are often missing from public health interventions.

 This is problematic given that individual variation in the needs and determinants of behaviours fluctuate.

 Therefore, any public health interventions that aim to target large population groups (such as the NHS DPP) must be flexibly aligned to individual determinants and support the behavioural and underpinning psychological and affective changes.

Question 24

How can we implement the BPS into practise?

Answer 24

 In the future, the BPS intervention could be made available as an online resource, integrated into existing public health interventions (such as the NHS DPP) or provided in‐person by a healthcare professional.

 Those wishing to implement our tailored
intervention for T2D prevention may use it as a brief psychological intervention in the same way that others have for addressing smoking and drinking behaviours.

 If the BPS intervention was delivered face-to-face as part of ongoing consultation, healthcare professionals might ask recipients to share their goals with them to develop a health plan together.