P01 Navigating weight management discussions in real-world GP- patient primary care consultations: A qualitative exploratory study in Australian general practiceKimberley Norman1, Neha Giri1, Divya Ramachadran1, Nilakshi Gunatillaka1, Kellie West1, Elizabeth Sturgiss1 1Monash University

The highly individualised experience of living with obesity, coupled with the challenge for GPs to deliver healthcare messages in non-stigmatising ways, makes the role of a GP in obesity management complex. This study aimed to explore discussion strategies used in real-world GP-patient consultations when discussing obesity. Secondary data analysis of Australia’s first, and only, Digital Library of naturally occurring video recorded consultations was used. Forty-seven consultations and patient post-consultation satisfaction surveys were analysed using descriptive content analysis with seventeen consultations discussing weight eligible for in-depth analysis. A multi-disciplinary research team, including lived experience experts and practicing GPs conducted the analysis. 15/17 discussions about health in relation to weight were GP initiated and 2/17 were patient initiated. 14 used a structured approach (all GP initiated), while 3 used an opportunistic approach to weight (one GP and two patient initiated). GPs routinely asked for consent to discuss weight as part of their routine care, or gave space for the patient to decline discussion. Weight was always positioned as a factor in relation to another presenting health concern of the patient and was discussed in positive, encouraging ways that were relative to each individual patient’s health context. All patients reported in a post-consultation survey that they felt listened to and respected during consultations. This study of naturally occurring GP-patient consultations highlighted the intricacies of ways the topic of weight was approached in consultations. GPs navigated weight discussions in a way that attempted to minimise potential damage to the therapeutic relationship and related weight to health concerns relevant to each patient. While there was no overt discourse or behaviour from patients to indicate obesity stigma was present in these consultations, potentially stigma could have been internalised or perceived by patients. With the majority of weight discussions initiated by GPs in structured ways in these consultations, future research could look to develop specific evidence based non-stigmatising ‘weight’ discussion prompters for GPs to refer to in their practice for flexible consistency with the range of patients seen. Such prompters could support GPs to discuss weight in consultations and ensure potential covert stigma is minimised.

Declarations: None

P05 Lifestyle and BMI affect young people’s blood pressure: a mixed methods studyTrang Hong Khoa1, Bui Cong Minh1, Tran Xuan Quynh1, Nguyen Chien Thang1, To Minh Thien1, Vo Minh Dung Ngan1, Vo Tran Phuong Tuong1 1Can Tho University of Medicine and Pharmacy

In clinical practice blood pressure is a vital sign easily affected by various factors. Control of the non-pathological factors is necessary to ensure the accuracy of blood pressure. Measurement technique, movement state, and Body Mass Index (BMI) might strongly correlate with blood pressure. This study ssessed the association between blood pressure and BMI using linear regression and survey the knowledge and attitude about nutrition and physical exercise. It combined cross-sectional descriptive and questionnaire methods in 310 students 20–25 years old at Can Tho University of Medicine and Pharmacy, Vietnam. The history of hypertension and hypotension is 1.3% and 1.6%, respectively, with 0.3% using medication to regulate blood pressure. The BMI is 13.6–33.9 kg/m2. The systolic blood pressure (SBP) and diastolic blood pressure (DBP) are significantly different between the left and right upper limbs (p < 0.001). The SBP of the left upper limb increases in movement state by 14.6 ± 9.8 mmHg (p < 0.001, 95%CI: 15.7–13.5). The DBP of the left upper limb decreases in movement state by 1.7 ± 7.6 mmHg (p < 0.001, 95%CI: 0.8–2.5). The SBP and DBP relate to BMI through the following equation: SBP = 71.41 + 1.8x BMI (R2 = 0.21, p < 0.05), DBP = 52.02 + 0.81 x BMI (R2 = 0.09, p < 0.05). The rates of unknown harm associated with laking breakfast and regular physical exercise are 3.9% and 3.2%, respectively. 8.1% feel it is challenging to have three main dishes daily, and 6.5% feel it is difficult to have regular exercises. There is an association between BMI and SBP, DBP, in which, lack of knowledge about diet and exercise increases BMI.

Declarations: None

P06 Feasibility and preliminary efficacy of N-Acetylcysteine for loss of control eating: an open label studyMuthmainah Muthmainah1, Diana Sketriene1, Roberta Anversa1, Andrea Gogos1, Priya Sumithran2, Robyn Brown1 1University of Melbourne, Australia, 2Monash University, Australia

Loss of control eating negatively impacts outcomes of obesity treatment. However, there are a lack of effective medications for this maladaptive eating behaviour. N-acetylcysteine (NAC) has been shown to restore glutamatergic dysfunction in the brain and reduce several compulsive behaviours. We evaluated the feasibility and preliminary efficacy of NAC for loss of control eating. A single site open label study involving community residents in greater Melbourne was conducted between January and October 2023. A total of 30 participants with loss of control eating were enroled in the study. Participants received oral NAC medication (2400 mg/day) for 12 weeks. Treatment outcomes were assessed using both retrospective questionnaires and ecological momentary assessment (EMA). The primary outcome was feasibility including recruitment rate, retention rate at week 12, and adherence to medication. The secondary outcome was change in loss of control eating from baseline to week 12. Changes in drivers of eating behaviour as a result of NAC treatment were also explored. Recruitment rate was 3.8 participants per month; retention rate was 90% and medication adherence was 93%. Participants reported significant reduction in the frequency and severity of loss of control eating after NAC treatment. Participants showed less food craving, emotional eating, and pre-occupation with food at the end of week 12. Our data show that delivering a 12-week NAC intervention in people with loss of control eating and conducting behavioural assessments using EMA is feasible. This pilot study provides a rationale for conducting a randomised controlled trial to determine the efficacy of NAC for compulsive eating.

Declarations: PS has co-authored manuscripts with medical writing assistance provided by Novo Nordisk and Eli Lilly. The other authors declare none.

P08 The effects of a home-based resistance training programme on body composition and muscle function during weight loss in people living with overweight or obesity: a randomised controlled pilot trialAhmad Binmahfoz1, Emma Dunning1, Lynsey Johnston1, Cindy M Gray1, Stuart Gray1 1University of Glasgow

Obesity continues to grow as a public health concern and is associated with an increased risk of morbidity and mortality, and an increase in health and social care costs. Although dietary interventions can be effective at reducing body mass and improving cardiovascular risk factors, they also result in undesirable loss of lean tissue, highlighting the need for strategies that preserve muscle mass during weight loss. The aim of this randomised controlled trial was to investigate the effects of a home-based resistance training exercise programme on body composition and muscle function in people living with overweight or obesity undergoing dietary weight loss. Participants (n = 48) from Glasgow were randomly assigned to either a diet-induced weight loss group (WL) or a diet plus home-based resistance training exercise group (RT + WL) for 12-weeks. Measures of body composition, muscle strength, and physical function were assessed at baseline and post-intervention. There was no effect of the resistance exercise training programme (all p > .05) on body mass index (RT + WL: mean change (Δ)-0.87, 95% CI: -1.33, -0.41; WL: Δ-1, 95% CI: -1.61, -0.39), body mass (RT + WL: Δ-2.45, 95% CI: -3.77, -1.13; WL: Δ-2.83, 95% CI: -4.63, -1.03), fat mass (RT + WL: Δ-1.23, 95%CI: -2.48, 0.02; WL: Δ-1.94 95% CI: -3.59, -0.29), fat free mass (RT + WL: Δ-1.22, 95% CI: -2.41, -0.03; WL Δ-0.88, 95%CI: -1.62, -0.14) or muscle thickness (RT + WL: Δ-0.075, 95% CI: -1.3, 1.15; WL: Δ-0.74, 95% CI: -1.75, 0.27) during weight loss. However, resistance training during weight loss resulted in higher grip strength (RT + WL: Δ2.65, 95% CI: 0.44, 4.86; WL: Δ-0.26, 95% CI: -2.04, 1.51:p = 0.046), maximal voluntary contraction force (RT + WL:Δ23.61, 95% CI: 3.39, 43.84 WL: Δ-11.95, 95% CI: -35.37, 11.48;p = 0.019), and sit-to-stand test scores (RT + WL:Δ5.9, 95% CI: 4.27, 7.53 WL: Δ1.47, 95% CI: 0.13, 2.82; p < 0.001). These findings suggest that incorporating home-based resistance training into weight loss programmes can preserve, or even enhance, muscle function without negatively impacting the effectiveness of dietary weight loss interventions. The study highlights the potential of accessible, home-based resistance exercises in mitigating muscle function losses during weight loss in people living with overweight or obesity.

Declarations: None

P09 Validation and Efficacy of a Lifestyle Intervention Multidisciplinary AI-Based Weight Loss and Weight Maintenance Digital PlatformSarfraz Khokhar1, John Holden2 1Rasimo Systems, USA, 2University of Illinois, USA

Lifestyle adjustment is a key component of weight management strategies as a standalone measure or complementing pharmacological or surgical therapies. Artificial intelligence, along with digital technologies, can offer individualised approaches to enable people to lose and maintain weight loss through lifestyle intervention. In this 2-phase study spanning 24 weeks each, our objective was to validate and quantify the efficacy of an AI-based lifestyle intervention digital platform implementing a multidisciplinary approach for weight loss and weight maintenance. During the first phase, the platform was tested by 391 participants (58% women) with a broad range of BMI (20–78 kg/m2) aiming to lose weight in a multinational field trial. The focus of the second phase was weight loss maintenance. The digital platform consisted of a mobile app, an internet-connected scale, and a discipline of artificial intelligence called Expert system to provide individualised guidance, education, motivation, accountability, psychosocial coaching, and community support. The participants were on low calorie diet based on their metabolic rate. We divided the participants into seven subgroups: Overweight category, Obesity I, Obesity II, Obesity III, Obesity IV, Obesity V, and Obesity VI based on their BMI. After first phase completion, the participants achieved mean weight loss of 13.9% of their initial body weight, standard deviation (SD) = 4.4, 95% Confidence Interval: 13.4–14.3%, and p value < 0.00001. Individually, subgroups achieved 12.5–15.6% mean weight loss. Almost all (98.7%) participants lost at least 5% of body weight, 75% lost at least 10%, 43% at least 15%, and 9% at least 20%. During weight maintenance phase of 24 weeks, overall, 95.78% of participants maintained their weight with mean Additional Weight Loss (AWL) of 2.48%, with SD = 1.58, 95% confidence interval: 2.27–2.68%, p value < 0.00001. Individually, all participant who were in Overweight category maintained their weight with mean AWL of 1.72%. Among the remaining subgroups, 93.54 to 97.22% participant maintained their weight. Our study concludes that using an AI-assisted lifestyle intervention, with user-friendly and personalised features, people with all level of obesity can lose and maintain their weight. Such interventions not only can help maintain the weight loss but also can contribute to additional weight loss.

Declarations: None

P10 Encouraging healthy weight for adults living with learning disabilities: supporting the role of carersKaren D Coulman1, Justine Womack2, Carly Atkinson3, Briony Caffrey4, Alison Tavaré5, Nicola Powell6, Roz Erskine-Gray7, Amanda Owen-Smith1 1University of Bristol, 2Office for Health Improvement and Disparities, UK, 3Gloucestershire Hospitals NHS Foundation Trust, 4Cornwall Partnership NHS Foundation, 5Health Innovation West of England, UK, 6NHS England South West, 7Parent Carer representative

Adults with learning disabilities (LDs) die 20 years earlier than the general adult population and heart disease is one of the main causes of avoidable deaths. Adults with LDs have a higher prevalence of obesity, a key risk factor for heart disease. Adults with LDs often need support from carers to engage with and maintain healthy behaviours, however, a lack of appropriate training for carers has been identified. This research aims to develop free e-learning for carers on supporting healthy weight in people with LDs. Methods include three stages: 1) Identification and content analysis of key printed and online resources used by professionals to promote healthy weight in people with LDs, 2) Qualitative interviews with managers, clinical leads, and commissioners working in relevant health and social care settings (n = 14) to identify key barriers and enablers for carers in supporting healthy weight in people with LDs, to inform the training content, 3) Qualitative interviews with paid and unpaid carers to discuss and refine draft training content (in progress). Here we present key findings from thematic analysis of stage 2. The importance of the carer as a role model with ‘a lot of power’ in the relationship was highlighted. Key carer related challenges in promoting healthy weight in people with LDs included workforce pressures, their own views, confidence, and skills related to healthy behaviours and cooking, ‘misplaced knowledge’ around weight and what is achievable, the use of food as a reward and perceived tensions in supporting choice alongside promoting healthier behaviours. ‘Mainstream’ weight management services were difficult for adults with LDs to access as they were not commissioned or set-up to meet their needs. Some examples of innovative practice were described, such as joint education of both carers and people with LDs. A need to upskill carers on the basics of healthy eating and physical activity and supporting specific challenges in the LDs population was identified. Training content is currently being developed with carers (stage 3). Adults with LDs are involved in co-creating lived experience videos to support the training content, which is expected to be nationally available by early 2025.

Declarations: CA is a Trustee of the Caroline Walker Trust.The other authors have none.

P11 Obesity Trends in England: An age-period-cohort approach to studying long-term trends in adiposity measuresLaura A Gray1, Magdalena Opazo Breton2 1University of Sheffield, 2University of Nottingham

Obesity prevalence in England, and across the world, has been increasing in recent years and continues to do so. Obesity is often defined using established body mass index (BMI) thresholds but BMI cannot differentiate between muscle mass and fat mass. Waist measurement, allows central obesity and the distribution of fat mass to be assessed. This is arguably a better predictor of obesity-related harm than a weight-based measure. Recently, the National Institute of Health and Care Excellence (NICE) has recommended using waist-to-height ratio (WHtR) as well as BMI to identify and assess obesity. This study aims to determine whether trends in obesity differ when using BMI or WHtR definitions. We use the Health Survey for England and analyse individuals between the ages of 16 and 85 years, using data from 1997-2019, enabling us to investigate cohorts born between 1909-2003. Individuals are considered to be living with obesity, or not, using established thresholds for each measure. We investigate simple trends in the prevalence of obesity across time, and illustrate age-trajectories for 5-year birth cohorts, using WHtR and BMI obesity definitions. Next, we estimate an age-period-cohort (APC) model for each of the obesity definitions, to disentangle the effects of aging, from contextual factors and generational effects. The prevalence of obesity increases over time after accounting for age and cohort, when using each of the definitions. The prevalence of obesity using WHtR increases considerably with age across the lifespan. In contrast to the prevalence of obesity using BMI decreases after 65 years. The prevalence is similar across birth cohorts for both measures. There are no significant differences between males and females in the prevalence of obesity using either measure. Our results are broadly similar across WHtR and BMI. However, whereas the prevalence of obesity falls after the age of 65 years when using BMI, this is not the case when using WHtR. This could mean that WhtR might better identify obesity in older individuals. Our results could have important policy implications, both for how to measure obesity-related risks and for policymakers in identifying appropriate ages and cohorts for intervention.

Declarations: None

P12 Behavioural Weight Management Interventions in Asian countries: A Systematic Review and Meta-Analysis of Randomised Controlled TrialsNurul Afiedia Roslim1, Sufen Zhu2, Min Gao2, Charlotte Lee2, Jadine Scragg2, Michaela Noreik3, Aryati Ahmad1, Jamie Hartman Boyce4, Susan Jebb2 1Universiti Sultan Zainal Abidin, 2University of Oxford, 3University of Applied Sciences, Krefeld, Germany, 4University of Massachusetts Amherst

Obesity is a growing global health problem due to serious implications on individual’s health outcome. Behavioural weight management interventions (BWMIs) can reduce health risks associated with excess weight. However, the effects have yet to be established in Asian countries. This review aimed to examine the effectiveness of BWMIs for adults with a body mass index ≥23.0 kg/m2 in Asian countries. Seven electronic databases were searched from 1946 to the end of March 2024 for randomised controlled trials (RCTs) of BMWI programmes conducted in South Asian, East Asian and Southeast Asian countries. Two researchers independently identified eligible studies, extracted data and assessed risk of bias using the Cochrane risk of bias tool. Meta-analysis was conducted using random effects models, and a pooled mean difference for body weight at baseline to 12 months and 24 months was calculated. Out of 6713 identified studies, a total of 13 RCTs (2585 participants) met the inclusion criteria and were included in this review. Ten studies were judged at high risk of bias, whilst two studies were judged with ‘some concern’ and one was judged as ‘low risk’. The mean difference for weight change at 12 months was −0.99 kg (95% confidence interval −1.75 to 0.22, I2 = 79%, p = 0.01) and −3.16 kg (−3.71 to −2.62, I2 = 0%, p < 0.001) at 24 months (two studies, n = 668) favouring the intervention group. In a subgroup analyses, studies that incorporated both diet and exercise (mean difference: −1.67 kg; p = 0.0008), tailored (mean difference: −1.49 kg; p = 0.04) and individual (mean difference: −1.25 kg; p = 0.010) approach showed greater weight changes than other kind of approach. Besides, studies with participants aged >53 years, healthy, predominantly female (>50%) and from lower-income countries reported greater weight changes than their counterparts (p < 0.05). Findings demonstrated that tailored BWMIs are effective in tackling excess weight problems in adults in Asian countries. These discoveries offer valuable insights for healthcare practitioners and researchers, adding in the development of BWMIs to combat obesity and its associated health risks in the future.

Declarations: None

P13 The Longitudinal Association of Body Weight Misclassification in Adolescence with Body Fat and Waist Circumference in AdulthoodAbdulaziz D. Alouf Aloufi12 1The University of Queensland, 2Ministry of Health, Saudi Araia

This study examines the longitudinal association between adolescent body weight misclassification and body fat and waist circumference during adulthood. A Birth cohort study was used, data collected at 14 and 30 years after birth. To determine misclassification, we compared perceived with measured body weight data. Analyses examines means and mean differences of body fat percentages and waist circumference level across weight misclassification groups. Early life and adolescent covariates were included in the data analyses. Children of all consecutive public obstetrical patients delivered at a major obstetrical hospital in Brisbane, Australia. Participants were (n = 1002) those with measured and perceived body weight at 14-year follow-up as well as actual measure of adult body fat and waist circumference at 30-year follow-up. Adolescent body weight underestimation was significantly associated with an increase in body fat percentages and waist circumference in adulthood compared to those who correctly estimated their body weight for males and females. In mean difference analyses, adolescent males and females who underestimated their body weight were found to have significantly higher body fat and waist circumference means than those who correctly estimate their body weight in both unadjusted and adjusted comparisons. Males who, as adolescent, overestimated their body weight have higher body fat and waist circumference means when they reach adulthood. Weight underestimation in adolescence predicts increased body fat and waist circumference during adulthood. Increase awareness of weight misclassification and actual body weight might contribute to better control of weight gain.

Declarations: None

P14 Local health service leads and commercial provider staff experiences of the NHS Low Calorie Diet programme pilot: a qualitative explorationLouisa Ells1, Kevin Drew1, Susan Jones2, Catherine Homer3, Tamara Brown1, Duncan Radley1, Patricia Watson2, Charlotte Freeman1, Karina Kinsella1, Maria Maynard1, Chirag Bakhai4 1Leeds Beckett University, 2Teesside University, 3Sheffield Hallam University, 4Churchfield Medical Centre, Bedfordshire, UK

The NHS-Low-Calorie-Diet pilot programme was established to support people living with Type-2-Diabetes to lose weight and improve their glycaemic control using total diet replacement alongside behaviour change support. The Re:Mission study was commissioned to provide a comprehensive qualitative and economic evaluation. Here we present key insights on the barriers and facilitators to equitable mobilisation from the perspective of local health service leads, and implementation and equity from the service providers’ perspective. Twenty semi-structured interviews were completed with locality leads, and thirteen focus groups were conducted with commercial providers across the first two-years of the programme. Interviews with locality leads explored several topics of interest, including referrals, training, communication, incentivisation, governance and engagement. Focus groups with commercial providers were grounded on Normalisation Process Theory, with the addition of topics on equity and person-centredness. Seven core themes were identified from the locality leads: COVID-19 and primary care capacity and engagement; methods of communication; approaches to training; approaches to incentivisation; approaches to referrals; barriers to referrals; and the importance of collaboration. Our findings demonstrate the large variation and differences in the approaches taken when delivering the programme across ten geographically and demographically distinct pilot sites, and lack of a consistent approach or strategy to mobilisation and delivery support for the programme. From the providers’ perspective, the programme was found to fulfil the requirements for normalisation. However, barriers were identified in engaging some GP practices and receiving sufficient referrals, as well as supporting some service users through challenges to remain engaged. There was also variation in communication and training between provider sites. Health inequalities remain a significant challenge during mobilisation, but health service leads with responsibility for programme planning and organisation can contribute to tackling this challenge by adopting an equity perspective from the start. The programme was most workable when supported by effective primary care engagement, training, and internal and external communication. Limitations in relation to programme specifications (e.g., eligibility criteria, service specification) and local commissioning decisions (e.g., pattern of roll out, incentivisation of general practice) were identified and could be addressed in the national specification and through sharing insights from pilot sites.

Declarations: CB is a primary care advisor to the national diabetes programme for NHS England and NHS Improvement.

P15 Acceptance of novel bean-based meals in diverse primary school settings; a real-world observational studyNatasha Bayes1, John Ingram2, Charlotte A. Hardman1 1University of Liverpool, 2University of Oxford

Beans are nutrient powerhouses, offering plant-based protein, fibre, vitamins and minerals, which can contribute to healthy dietary patterns and potentially reduce risk of obesity and other diet-related chronic health conditions. They are also affordable and environmentally sustainable food sources. The ‘BeanMeals’ research project uses novel UK-grown beans for food system transformation by developing healthy and sustainable bean-based meals. The current study explored how to promote acceptance and consumption of newly-introduced bean-based lunchtime meals in six primary schools in Leicestershire, alongside school staff training and children’s food system educational activities. School cooks, midday supervisors and Year 5 class teachers engaged in training to prepare the beans and to nurture children’s positive experiences and exposure to the beans, and Year 5 children participated in bean-based educational activities (234 children across the six schools, aged 9-10 years). Lunchtime observations were conducted at each school (39 observations in total across the six schools from February to July 2023) to measure overall uptake, consumption and liking of the bean-meals using pre-post meal photos and liking ratings collected from Year 4 and 5 children (N = 132). Findings suggest that the schools offered the beans in numerous composite meals (e.g., cottage pie, curry, chilli, pizza) and sides (e.g., baked beans), with visible (e.g., beans identifiable in curry) and invisible (e.g., beans blitzed into pasta/pizza sauce) offerings provided within mostly vegetarian dishes. The most frequently presented meals were bean-pizza (provided at 17% of meal observations) and baked beans (at 19% of meal observations). There were variations in children choosing (uptake), consuming and liking of the different bean-based meals, with bean-pizza generally being most popular and well-liked. However, across all of the meals and observations, children on average consumed 71% (standard deviation (SD) = 37%) of their bean-meal with an average liking rating of 3.7 (SD = 1.3) on a 5-point rating scale (1 Super Yuck – 5 Super Yum). Collectively, the findings offer insights into school acceptance, opportunities and barriers to offering novel UK-grown bean-based meals into school lunchtime food. These insights will help the future implementation of healthy, affordable and sustainable foods to children lunchtime school food.

Declarations: CAH declares research funding from the American Beverage Association (paid to institution), primary supervision on a PhD studentship funded by Coca-Cola, and personal honoraria from International Sweeteners Association and International Food Information Council for work unrelated to the submitted abstract. NB and JI reports no conflicts of interest.

P16 A qualitative exploration of children’s acceptance of novel bean-based meals and educational activity in diverse primary school settingsNatasha Bayes1, John Ingram2, Charlotte A. Hardman1 1University of Liverpool, 2University of Oxford

The ‘BeanMeals’ project was implemented in six Leicestershire primary schools, using novel UK-grown beans to offer healthy and sustainable bean-based lunchtime meals. BeanMeals ran from February 2023-July 2023 and offered bean-based meals to children (whole school) alongside educational activities (Year 5 children) about beans. Towards the end of the project, 115 children participated in focus groups (40 Year 4 control group, 75 Year 5 intervention group). Thematic analysis generated two themes for the qualitative data: 1. Perceptions of the project, and 2. Impacts of the project on their knowledge about the food system and their eating behaviours. Perceptions theme: Children had various taste and texture preferences for the beans. Children generally preferred consuming the beans within a meal rather than in isolation, preferably within meals already liked and familiar to children. Children enjoyed the educational activities within the intervention). Children overall desired more taster-based experiences with beans rather than an offer of selecting the bean-based meals at lunchtime. Additionally, children with packed lunches expressed desire for more bean tasting opportunities than the limited opportunities they had in this current project, which taster-based experiences would afford more easily than just the bean-based school meal offer. Impact theme: In general, children recalled learnings about different beans, where they are grown, and the impact beans can health on health and environment. Familiarity, liking and willingness to taste the beans and bean-based meals varied across the children, however some children recognised the importance of being curious and willing to try new and unfamiliar foods to discover their likes/dislikes, and be willing to retry previously disliked foods to discover changing food preferences. Some children however maintained reluctance to try new foods. These findings show children’s receptivity to learning about topics related to health and wellbeing when they are fun/engaging, and children are generally willing to try novel foods when offered in stimulating ways. BeanMeals showed evidence of impact through building curiosity, familiarity and willingness to try new foods. Future interventions would benefit from longer exposure periods to increase the changes of positive eating behaviour outcomes such as more consistent liking and consumption of novel foods.

Declarations: CAH declares research funding from the American Beverage Association (paid to institution), primary supervision on a PhD studentship funded by Coca-Cola, and personal honoraria from International Sweeteners Association and International Food Information Council for work unrelated to the submitted abstract. NB and JI reports no conflicts of interest.

P17 Evidence-based optimisation of PROGROUP, a group-based intervention for people living with severe obesity: Understanding fidelity to delivery and the patient experienceLily Hawkins1, Dawn Swancutt2, Shokraneh Moghadam1, Rod Sheaff2, Jonathan Pinkney2, Mark Tarrant2, Jenny Lloyd1, & The PROGROUP Study Team2 1University of Exeter, 2University of Plymouth

Individuals referred to specialist weight management programmes face significant waiting times, possible worsening co-morbidities, and stigma. Group-based interventions offer a potentially efficient treatment option and provide numerous benefits for patients, such as support and a sense of shared social identity. The PROGROUP intervention aims to manage group processes and shared social identity to support behaviour change for people living with severe obesity. Data from the PROGROUP feasibility randomised controlled trial (fRCT) was used to assess fidelity of delivery to PROGROUP principles and patient experiences, to optimise the intervention and training in preparation for the definitive trial. Three specialist UK NHS weight management services participated in a feasibility trial, involving five facilitators and 94 patients with severe obesity (defined as BMI ≥40 kg/m2 or 35 kg/m2 with comorbidities). A mixed-methods realist process evaluation used data from 12 patient and five facilitator interviews, 35 hours of audio and six hours of video data of group sessions, two checklists, and a group processes questionnaire to assess fidelity of delivery and patients’ experience of the PROGROUP intervention. Evidence demonstrated that sessions were too content heavy and hindered flexible delivery in accordance with PROGROUP principles. Facilitators felt that some educational content was unnecessary for people living with severe obesity and content contributing to a positive group environment was sometimes overlooked due to time constraints. Patients reported that they valued the behavioural change and psychological-based activities of group sessions. In response to these findings, the intervention content and training programme were revised to ensure better balance between educational material and group activities, with greater emphasis placed on activities that supported group empowerment and ownership, as well as managing group processes within training. The success of group-based interventions relies on the facilitator addressing the group’s needs and creating conditions for a shared social identity and sense of ownership to develop. For patients with severe obesity, there was a desire for more focus on the psychological and behavioural aspects of living with severe obesity over educational content. Facilitator training aims to develop the skills of bringing the group together, using a format that is feasible and acceptable to healthcare staff.

Declarations: None

P18 The effectiveness of family-based weight loss interventions for weight loss/dietary and physical activity related behaviour change for mothers with overweight or obesity: Protocol for Systematic reviewMai Haiba123, David French1, Nia Coupe1, Michelle Harvie123 1University of Manchester, 2NIHR Manchester Biomedical Research Centre, 3Manchester University NHS Foundation Trust

Many mothers encounter challenges in maintaining a healthy weight associated with limited time and competing priorities of childcare responsibilities, full time work or study, catering for the dietary requests of their children and family which can have a negative impact on the home food environment and lack of social support from family members can also oppose weight loss efforts. Family interventions have demonstrated efficacy for managing weight/behaviour change amongst children with obesity. We are undertaking a systematic review to explore the role of family-based weight loss interventions targeting mothers with overweight or obesity and possible successful components to inform future interventions. We will search the following data bases : Embase, APA psych and EBSCO CINAHL. Studies included should be randomised control trials of family-based weight loss/behaviour change interventions targeting women who have caring responsibilities for children within the same household with a body mass index (BMI) of ≥25 kg/m², or ≥23 kg/m² for those from high-risk ethnic groups. The comparator group will be a weight loss/behaviour change intervention targeting parents only or any control (wait list/minimal intervention). Titles will be scanned by first reviewer then abstract scan will be conducted independently by the first and second reviewers followed by a full text screen. In case of disagreement, the opinion of a third or fourth reviewer will be sought. Data extraction will focus on weight outcomes of the mothers as the primary outcome, presented as weighted mean differences (WMD) with 95% confidence intervals. Secondary outcomes include weight outcomes for other family members, dietary and physical activity related behaviour change outcomes as well as outcomes related to family dynamics and relationships. A meta-analysis will be conducted following I square statistic test of heterogeneity ≤50%. The results would be utilised to inform the design of a family-based weight loss intervention for women at risk of breast cancer. The protocol is published on PROSPERO (CRD42024537118)

Declarations: None

P19 A quality improvement project on the prescribing and monitoring of Orlistat in the management of obesity in primary careBarkatullah Sahibzada1 1NHS Dumfries and Galloway

Obesity is a significant risk factor for severe health conditions, including heart attacks and strokes. According to NICE and SIGN guidelines, orlistat can be considered as part of the obesity management plan for patients with a Body Mass Index (BMI) of at least 30 kg/m2, or 28 kg/m2 if additional risk factors are present. To continue Orlistat treatment, patients are required to achieve a minimum weight loss of 5% within three months of initiation. Regular follow-up appointments are essential to monitor the effectiveness of the treatment and ensure ongoing progress. This project included all 21 patients in the practice prescribed Orlistat. The primary aim was to ensure BMI checks before prescribing and to conduct 3-month and annual reviews. PDSA cycles were employed to introduce several improvements: a standardised prescribing flowchart, a recall system for scheduling reviews, and an integrated EMIS template for recording BMI and review dates, which automatically added patients to the recall system. Additionally, delivering educational sessions for staff and developing patient information leaflets helped raise awareness about the importance of monitoring and reviews in Orlistat treatment. Baseline data revealed that only 58% of patients were initiated on Orlistat appropriately, with just 38% having a 3-month review and 25% having an annual review. After implementing the changes, 8 patients were discontinued from Orlistat, 88% of whom had been using it inappropriately for over 6 years. The 3-month and annual review rates both improved to 80%. Overall, the project successfully increased appropriate prescribing and monitoring of Orlistat from 23% to 90% in five months. Staff education, coupled with a recall system integrated within the IT system and simple flowcharts, effectively reduced waste, enhanced compliance with national guidelines, and minimised patient harm.

Declarations: None

P20 The PROGROUP Randomised Controlled Trial reveals variability in provision, heterogeneity of design, and research readiness of UK Tier 3 servicesJeanette Sanders1, Wendy Ingram1, Dawn Swancutt1, Mark Tarrant1, Jonathan Pinkney1 1University of Plymouth

The PROGROUP study “How are treatment outcomes for people with severe obesity ImPROved by GROUP-based behavioural intervention?” investigates optimisation of behaviour change delivery in Specialist Weight Management Services (SWMS), effectiveness and cost-effectiveness. Implementing findings from an initial feasibility Randomised Controlled Trial (RCT), the full multicentre, individually randomised RCT involves facilitated group intervention (PROGROUP), based on social identity theory and principles of behaviour change, delivered in-person versus the comparator of Usual one-to-one Care (consistent with NICE CG189 principles). We describe current SWMS and their research readiness. Potentially eligible services were identified through; 15 Clinical Research Networks in England, and their equivalents in Wales, Scotland and Northern Ireland, Association for the Study of Obesity, the Getting-Right-First-Time (GRIFT) survey, and we undertook additional checks with NHS England, the British Dietetic Association and our own contact. 67 potential sites described as SWMS were identified 48 responded to approaches. Service leads were consulted for service descriptions and potential eligibility. All services expressed interest in the trial (100%). However, 83% of responders were excluded by multiple factors including; failure of service to meet an appropriate definition of SWMS; planning uncertainties and reconfigurations; recommissioning and decommissioning; insufficient size and referrals to meet recruitment targets; insufficient staffing; inability to accommodate in-person group sessions; primary reliance on virtual delivery; primary function as bariatric surgery triage services; existing group-based Usual Care; and inexperience with research. In the current RCT, seven SWMS are recruited, meeting eligibility criteria and in the process of opening. These sites have large capacity, clinical and research experience, and represent a mix of urban, rural, socioeconomic and population diversity. In conclusion, there is little research on behavioural intervention design and delivery with or without adjunctive pharmacology in the SWMS setting, and SWMS provision is highly variable. There is a need to identify the most effective intervention design and delivery. While there are some high quality research-ready SWMS, numbers with the experience and capacity to accommodate Health Service Research are very limited. There is a need to expand research activity and trials in SWMS.

Declarations: None

P22 Co-designing a weight-neutral health intervention in DenmarkCatharina Thiel Sandholdt1, Rasmus Køster-Rasmussen1, Lene Bomholt Meyer1, Ann-Kathrin Lindahl Christiansen1, Gu∂rún Ágústa Sigur∂ardóttir1, Emma Katrine Frøhlke Steinbo1, Frans Boch Waldorff1 1University of Copenhagen

Systematic evaluations find that weight loss-focused lifestyle interventions are mostly ineffective in achieving clinically meaningful long-term weight reduction or reduction in cardiovascular events or mortality. Furthermore, studies point towards that weight loss interventions may come with adverse consequences and contribute to weight stigma. More comprehensive approaches to health are therefore relevant to develop and explore and here weight-neutral health (WNH) can be a relevant framework. WNH promotes size diversity, intuitive eating, and enjoyable physical activity with no aim of weight reduction. This poster presents the co-design process for developing a weight-neutral health intervention (WIN) that will be tested for feasibility in 2025. The co-design development process followed the MRC framework for complex interventions and applied methods from Human-Centered Design to organise the process. Stakeholders in five municipalities, 15 professionals working with weight neutral health and 16 people with lived experience contributed through workshops, interviews, and informal dialogue. A novel approach to formative evaluation was introduced through a buddy letter system. Based on the process we have developed a group-based intervention with basic and optional activities. The intervention will aim to reduce weight-stigma, promote intuitive eating and increase body awareness and physical movement. A co-design process is a valuable approach for including relevant stakeholders in an intervention development. The process has qualified the intervention set-up and components. We look forward to present and discuss the development process on how we have developed the WNH-intervention.

Declarations: None

P23 Body weight reduction in women treated with tirzepatide by menopausal stage: A post hoc analysis from the SURMOUNT programAndreea Ciudin Mihai1, Adam Stefanski2, Luis-Emilio García-Pérez2, Donna Mojdami2, Irina Jouravskaya2, Sirel Gurbuz2, Rebecca Taylor2, Julia P. Dunn2, Alun Lloyd Davies2 1Barcelona Campus Hospitalari, 2Eli Lilly and Company

In the SURMOUNT (SM) clinical trial programme, tirzepatide-treatment resulted in substantial and clinically meaningful bodyweight (BW) reductions in people living with overweight and obesity. This post-hoc analysis evaluated the effect of tirzepatide-treatment on BW in women according to menopause stage. Women with obesity (BMI ≥ 30 kg/m2) or overweight (BMI ≥ 27 kg/m2 with at least one weight-related comorbid condition, excluding type 1 or type 2 diabetes) from SM-1, -3 and -4 were randomised to tirzepatide (SM-1: 5, 10 or 15 mg; SM-3 and −4: maximum tolerated dose [MTD] of 10 or 15 mg) or placebo. The tirzepatide 15 mg or MTD treatment arms from each study were included in this analysis. Participants were categorised as having “pre-menopause” (aged < 45 yrs without any indication of menopause), “peri-menopause” (aged 40-54yrs with evidence for menopause but not satisfying criteria for post-menopause or 45–54 yrs with no evidence for menopause) or “post-menopause” (aged ≥ 40yrs with documented medical history indicating menopause/bilateral oophorectomy (BO)/follicle-stimulating hormone ≥40 mIU/mL without HRT/ ≥ 55 yrs without HRT, or BO). Premature or artificial menopause, or Mayer-Rokitansky-Küster-Hauser syndrome were excluded from this analysis, as was one participant <40 yrs with BO. Change in BW and waist circumference (WC) and the proportion of participants achieving weight reduction thresholds (≥5%, ≥10%, ≥15%, ≥20%, and ≥25%) were assessed at the primary endpoint of 72-weeks (SM-1 and -3) and 88-weeks (SM-4). Reductions from baseline in BW ranging from 22–29% and WC ranging from 15 to 26 cm were significant in all menopausal status subgroups with tirzepatide and were significantly greater vs placebo (p < 0.001 all). The proportion of participants who achieved BW loss ≥5% was 96–100% with tirzepatide vs 6–78% with placebo across subgroups. Furthermore, 63–89% and 37–74% of participants achieved BW loss ≥20% and ≥25% with tirzepatide, respectively. Overall, a significantly greater proportion of participants from all tirzepatide-treated subgroups exceeded all BW loss thresholds vs placebo. In this post hoc analysis, women living with obesity or overweight and without type 2 diabetes treated with tirzepatide demonstrated significant BW and WC reductions vs placebo, irrespective of stage of menopausal transition.

Declarations: ACM reports honoraria from AstraZeneca, Boehringer Ingelheim, Eli Lilly and Company, Esteve, and Novo Nordisk for scientific talks, advisory board sessions, attendance to congresses and is a member of the DMC for Boehringer Ingelheim clinical trials in obesity.

LEGP, AS, DM, RT, SG, ALD and JPD are employees and shareholders of Eli Lilly and Company.

P24 Early weight loss and reported gastrointestinal adverse events in tirzepatide-treated participants in the SURMOUNT 1-2 trialsAlexander Kokkinos1, Tina Thethi2, Dachuang Cao3, Adam Stefanski3, Clare Lee3, Lisa M. Neff3, Casey J. Mast3, Angel Rodriguez3, Amy Bartee3, Simon Coates4 1National and Kapodistrian University of Athens, 2AdventHealth, USA, 3Eli Lilly and Company

The objective of this analysis was to assess whether greater early weight loss was associated with higher incidences of nausea, vomiting, or diarrhoea (NVD) in participants treated with tirzepatide (TZP) in SURMOUNT-1 (SM-1) and SURMOUNT-2 (SM-2). Post hoc analyses included 1775 TZP-treated participants with obesity or overweight with at least one weight related complication in SM-1 and 609 TZP-treated participants with obesity or overweight and type 2 diabetes in SM-2. Participants were categorised as either early responders (≥5% weight reduction at Week-8) or non-early responders (<5% weight reduction at Week-8). Analyses used the efficacy estimand (randomised participants receiving ≥1 dose of study drug excluding off-treatment data). In SM-1, early responders (n = 1103;62.1%) achieved a significantly greater percent body weight reduction compared to non-early responders (n = 672;37.9%) from baseline to Week-8 (-7.9% vs. -3.1%, p < 0.001) and from baseline to Week-72 (-23.3% vs. -14.6%, p < 0.001). During Weeks 0-8, 24.2% of early responders reported mild, 6.4% moderate, and 0.5% severe NVD vs. non-early responders (17.9% mild, 4.5% moderate, and 0.9% severe NVD). The majority of NVD observed during SM-1 were mild to moderate in severity and were reported more frequently during the dose escalation period, with a gradual reduction in incidence in both groups over the course of the study. In SM-2, early responders (n = 247;40.6%) again achieved a significantly greater percent body weight reduction compared to non-early responders (n = 362;59.4%) from baseline to Week-8 (-7.1% vs. -2.5%, p < 0.001) and from baseline to Week-72 (-20.0% vs. -10.8%, p < 0.001). During Weeks 0-8, 17.4% of early responders reported mild, 4.5% moderate, and 0% severe NVD vs. non-early responders (13.3% mild, 2.5% moderate, and 0.8% severe NVD). Incidence and distribution of NVD in SM-2 was consistent with what was observed for SM-1. In SM-1 and SM-2, participants treated with TZP reported generally mild to moderate NVD more frequently during the first 8-weeks, regardless of the early weight loss category. The incidence of events decreased over the course of the studies and was in general comparable between early and non-early responders, suggesting no meaningful differences in gastrointestinal tolerability of TZP regardless of the early response or the weight reduction over time.

Declarations: Alexander Kokkinos reports having received research grants from Novo Nordisk, Pharmaserve Lilly, and ELPEN Pharma, serving on advisory boards for Novo Nordisk, Pharmaserve Lilly, Sanofi, and Boehringer-Ingelheim, as well as receiving honoraria for lectures from Novo Nordisk, Pharmaserve Lilly, Astra Zeneca, MSD, Sanofi, Bausch Health, Ethicon, Galenica Pharma, and Epsilon Health. Tina Thethi has worked with Novo Nordisk, Bayer and Elli Lilly. Dachuang Cao, Adam Stefanski, Clare Lee, Lisa Neff, Casey Mast, Angel Rodriguez, Amy Bartee are employees and shareholders of Eli Lilly and Company.

P25 Challenges in obesity management and psychosocial impact: a real-world perspective among people with obesity and their physiciansSwarna Khare1, Esther Artime12, Sarah Zimner-Rapuch3, Josefine Redig4, Caragh Flannery5, Victoria Higgins6, Andrea Leith6, Tamara Mensah6, Simon Coates7 1Eli Lilly and Company, Bracknell, UK, 2Eli Lilly and Company, Alcobendas, Spain, 3Eli Lilly and Company, Neuilly sur Seine, France, 4Eli Lilly and Company, Stockholm, Sweden, 5Eli Lilly and Company, Cork, Ireland, 6Adelphi Real World, Bollington, UK, 7Eli Lilly and Company, Basingstoke, UK

This study aims to explore People with obesity (PwO) and healthcare providers’/physicians’ (HCP) perceptions of unmet needs in obesity management and the psychosocial impact for PwO. Data were drawn from the Adelphi Real World Obesity Disease Specific Programme™, a real-world, cross-sectional survey of HCP and their consulting PwO, conducted in Brazil, Canada, China, Japan, Kingdom of Saudi Arabia (KSA) and United Arab Emirates between April-December 2022. HCP reported demographics, clinical characteristics, and weight management approaches for 3-8 consecutive qualifying PwO who completed a voluntary questionnaire providing demographics and psychosocial impact. Analyses were descriptive. Total of 431 HCP provided data on 2839 PwO. 55% of PwO were female (n = 1571), mean ± SD age 43 ± 13.5 years (n = 2837), BMI 33 ± 7.0 (n = 2837), from BMI 31 ± 4.3 in China (n = 801) to 36 ± 7.7 in Canada (n = 197), and 2 ± 1.8 comorbidities (n = 2839), from 2 ± 1.1 in KSA (n = 200) to 3 ± 2.2 in Canada (n = 199). Current weight management approaches included a diet (87%, n = 2479) and physical activity (74%, n = 2088) varying by country. HCP reported 4 ± 4.1 weight loss (WL) attempts for PwO in the last 3 years (n = 1780), with 26% having ≥5 attempts (n = 456) and slow WL journey for PwO (44%, n = 480), with ~20% of PwO never losing weight in Canada (n = 16), China (n = 94), and Japan (n = 39). 68% of their PwO had a weight target (n = 1937), with 99% not reaching it to date (n = 1925). HCP were not satisfied with current weight of PwO, believing that 74% could achieve a lower weight (n = 2093). 1,643 PwO provided self-reported data, (58% female, n = 950; mean ± SD age 41 ± 13.0 years, n = 1640). PwO reported struggling with weight for 64 ± 87.1 months (n = 1604) with 6 ± 4.9 WL attempts (n = 823). While 74% of PwO felt their HCP explained their weight management plan (n = 1193/1614), 43% said would like to learn more (n = 679/1582). 54% of PwO reported other people made them feel ashamed about their weight (n = 887), and 66% (n = 1083) and 53% (n = 873) reported bother or embarrassment about their weight. Despite numerous WL attempts, HCP reported that PwO had not reached WL goals, with most HCP not satisfied with the current weight of their consulting PwO. PwO-centered approaches are required to tackle this growing complex health issue.

Declarations: SK, EA, JR, SZR and CF are employees and minor stake/shareholders of Eli Lilly and Company. VH, AL and TM are employees of Adelphi Real World.

P26 Evolving behavioural intervention research for patients living with severe obesity: The PROGROUP feasibility trialDawn Swancutt1, Jenny Lloyd2, Rod Sheaff1, Joanne Hosking1, Wendy Ingram1, Jeanette Saunders1, Shokraneh Moghadam2, Lily Hawkins2, Laura Hollands1, Mark Tarrant1, Jonathan Pinkney1 1University of Plymouth, 2University of Exeter

The PROGROUP behaviour change feasibility study was designed in 2019, at a time when fewer evidence-based options were available for people living with severe obesity. Waiting lists to access Specialist Tier 3 weight management services were common and service delivery of behavioural interventions varied throughout the country. Since then, pressures on services have escalated, hence findings from this research have become even more important to the many thousands of patients awaiting care. One aim of this feasibility trial was to assess the ability to conduct trial processes in preparation for a definitive national trial of effectiveness. A feasibility Randomised Controlled Trial of PROGROUP versus usual care, with parallel process evaluation and economic evaluation, was conducted in 2022/23. Of 99 consented participants at three participating sites, 94 were individually randomised 1:1 to receive the PROGROUP programme (in groups) or usual care provided by the service. Delivery fidelity, patient recruitment and retention and trial processes were assessed using mixed methods data, including session attendance, fidelity checklists, in-person observations (n = 10), video and audio recordings of session delivery (n = 40), patient questionnaires (n = 250 weekly and n = 71 outcome measure questionnaires), interviews (n = 33) and patient weight. Patient satisfaction with PROGROUP was high, although this was contingent on regular and consistent attendance by group members. Anxiety during sessions was low and participants reported high levels of understanding how to perform strategies discussed during sessions. There was strong evidence that feeling safe, understood, and supported was key to patient engagement and that a shared social identity emerged which potentially contributed to behaviour change. Fifty-eight (62%) participants had weight measured at 6 months, and fifty-two at 12 months. Findings enabled us to re-visit the protocol and sample size and develop guidance for efficiently screening and approaching potential participants to maximise recruitment and retention. Learning from the facilitator training programme led to further refinement, including shortening its length, use of on-line self-directed learning and greater emphasis on group facilitation training. The trial was highly successful in identifying the key practical barriers and facilitators to running this study, and has enabled us to optimise and finetune the intervention and definitive trial plan.

Declarations: None

P27 A fat-rich preload before a carbohydrate-rich meal increases the peak postprandia