Dr Aaron Lett, Imperial College London; Dr Chris McLeod, Loughborough University; Dr Sarah Sauchell, University of Bristol and Dr Sion Parry, University of Oxford
Widespread problems of obesity, food insecurity and diet-related ill health require a dramatic change in our food environment, but how can research help to tackle these issues? In this guest blog, nutrition and eating behaviour researchers from top UK universities identify priorities for future appetite research with a focus on overweight and obesity.
Food reformulation and innovation to influence healthy and sustainable diets
Food reformulation is a route to providing foods that may be lower in energy and nutrients we should be eating less of (e.g. saturated fats, sugars and salt) but that can still be convenient, appealing and affordable. Effective reformulation, however, is more complex than simply removing or reducing such target nutrients from food and drink products. There are significant barriers including ingredient and food-specific technical challenges that need to be overcome without adversely impacting shelf life and sensory appeal or indeed having potentially unintended adverse health effects: for example, if reducing the sugars content is compensated for by an increase in saturated fat.
The popular demand for ‘clean label’ also offers a reformulation challenge for businesses, with consumers looking for few ingredients, that they perceive as ‘natural’ and avoiding ingredients such as low calorie sweeteners. Furthermore, consumer demand, corporate responsibility or government pressure may all be instrumental in incentivising food manufacturers to reformulate products.
Versatile multifunctional ingredients, innovative strategies that encourage long term repeat purchases, as well as insights into consumer purchasing behaviour are needed to help ensure that reformulated foods have a positive health impact and are commercially viable. Fundamentally such foods need to be designed around, and validated to improve human health.
Use of ‘Big data’ to develop understanding of drivers of appetite and food choice
‘Big data’ refers to large datasets which can be analysed to identify patterns and trends in complex behaviours (e.g. data from smartphones, wearable devices and social media). Although in obesity research big data can help to better understand drivers of appetite and food choice, to date its potential remains largely untapped.
To harness the true functionality of big data, we need to reduce the risk of collecting imprecise or inaccurate data and prevent the potential of flawed information being used in the implementation of interventions and policies. Smartphones and wearable devices offer great potential for collecting big data, but this method may only tap into more affluent sectors, so the results may not be generalisable to lower socioeconomic status population groups. Long term relationships need to be established with companies (e.g. supermarkets) that have access to big data e.g. scanned consumer purchase data, with the challenges of obtaining permission to use such company data for research purposes overcome. Finally, research will need to integrate a wide range of data; from small studies examining individual food choice behaviour or hormone secretion, to larger datasets examining social contributors to obesity (e.g. increased prevalence of fast food availability).
Big data may be ‘the future’ in many research fields. However, in appetite and obesity research, further groundwork is needed to ensure that findings are beneficial, timely, do not exacerbate inequalities and are ethically sound.
One diet does not fit all – bridging the gap between appetite research and obesity services
Whilst food reformulation and big data can help tackle obesity and gain insight on a larger scale, we must also acknowledge individual variability in responses to weight management interventions and the need for interindividual differences to be reflected in quality obesity services.
To guide personalised care we need to improve collaboration between researchers and healthcare teams. Novel insights into appetite regulation generated from big data, clinical research and patient experience can be used within healthcare teams to individualise treatment plans. We should also aim for an integrated model of care where every patient in a wide range of clinics can be a research participant, with better coordinated UK-wide trial systems that facilitate approval, recruitment, data collection and access to data sets. NHS commissioners could play a key role in helping researchers trial novel interventions within existing care protocols, and in finding ways to make data collected in clinics readily available for research. They can also reinforce the importance of evaluating quality of life and overall health, which are essential for long term weight management.
Having systems that allow an understanding of what is effective for patients with similar profiles including genetic composition, endocrine function (e.g. insulin resistance), psychological barriers to behaviour change (e.g. vulnerability to external stressors) and immediate social environment will open doors to personalising obesity treatment.
Supporting behaviour change - environmental drivers of obesity and food choices
Overall, we should move towards a ‘whole systems approach,’ which aims to integrate all the various stakeholders within a system (e.g. patients, public health workers, local businesses etc.) to collectively tackle obesity. For this kind of strategy to be successful, infrastructure and resources must be in place across the UK. This may include lifestyle weight management programmes, appropriately trained healthcare professionals who are aware of, and can make referrals to, weight management programmes, community groups that can offer additional peer support, and more widespread restrictions around food advertising.
The challenges of adopting this approach are numerous. Some local authorities, for instance, use quicker, more simple ‘sticking plaster’-type solutions; an example of which can be seen for the nation’s other nutrition crisis, food poverty, where food banks are the preferred management strategy rather than addressing underlying causes. Developing tools to measure system changes may help overcome some of these barriers. Demonstrating that we can accurately monitor how new strategies involving multiple stakeholders impact behaviour and how this may help to tackle obesity will provide evidence of the potential benefits of using this approach for local governments and funders. We must also investigate ways to effectively engage stakeholders (e.g. via social networking sites) to ensure inclusivity.
Cross-discipline, collaborative research is key to driving change in this area. This blog provides a brief summary of a Medical Research Council-funded virtual workshop (Aug 2020), that brought together researchers, clinicians and industry stakeholders to discuss how appetite and obesity research can help tackle obesity issues. If you are interested in finding out more about the workshop, please email the workshop organisers Professor Alex Johnstone (email@example.com) and Dr Adrian Brown (firstname.lastname@example.org).