P01 The efficacy of GLP-1 receptor agonists for the management of postprandial hyperinsulinaemic hypoglycaemia following bariatric surgery: A systematic review and narrative synthesisLlewellyn D, Logan Ellis H, Aylwin S, Oštarijaš E, Green S, Sheridan W, le Roux C, Miras A, Patel A, Vincent R, Dimitriadis G King’s College Hospital NHS Foundation Trust

Postprandial hyperinsulinaemic hypoglycaemia with neuroglycopenia is an increasingly recognised complication of Roux-en-Y gastric bypass (RYGB) and gastric sleeve surgery and may detrimentally affect patient quality of life. One likely causal factor is gut hormone Glucagon Like Peptide-1 (GLP-1), which has an exagerated rise following ingestion of carbohydrates in patients who have had bariatric surgery. We sought to assess the role of GLP-1RA in managing postprandial hypoglycaemia following bariatric surgery.

Medical Literature Analysis and Retrieval System Online (MEDLINE), Excerpta Medica (EMBASE), Cochrane Central Register of Controlled Trials (CENTRAL), ClinicalTrials.gov, and SCOPUS databases were systematically and critically appraised for all peer reviewed publications that suitably fulfilled the inclusion criteria established a priori. The protocol for this systematic review was developed according to the Preferred Reporting Items for Systematic review and Meta-Analysis Protocols. It followed methods outlined in The Cochrane Handbook for Systematic Reviews of Interventions and is registered with PROSPERO (ID CRD420212716429).

Our search produced only 6 articles that met the criteria for inclusion into this qualitative synthesis. Of the published articles, there was a cohort study of 5 patients, two case reports and 3 randomised controlled trials (RCTs). Two of these RCTs were crossover studies. Due to significant heterogeneity, pooling the data into a meta-analysis was not possible.

Postprandial hyperinsulinaemic hypoglycaemia remains a notoriously difficult to manage metabolic complication of bariatric surgery. In this first systematic review, we present evidence suggesting that use of GLP-1RAs does not lead to an increase of hypoglycaemic episodes and although this approach may appear counterintuitive, our findings suggest that GLP-1RAs could reduce the number of postprandial hypoglycaemic episodes and improve glycaemic variability.

Disclosures: None

P02 Increasing the number of referrals to the NHS Digital Weight Management Programme at a single GP centre - results from a two cycle auditSangha MS, Mehta N University College London

The prevalence of people living with obesity is expected to reach 40% by 2035, the cost to the NHS is expected to reach ~£9.7billion by 2050. Primary care services can provide opportunities to help these patients. In the Herts CCG, NHS Digital Weight Management Service (NHS DWMS) offer free weight loss programmes for people with type 1/2 diabetes and/or hypertension with a body mass index (BMI) > 30, with each referral entitling the practice to £11.50. This study investigated the number of referrals made to NHS DWMS in a single GP centre and aimed to improve this using an electronic patient records pop-up and warning sign that would alert clinicians of patient eligibility for referral when reviewing electronic patient records prior, or during, consultations. From 27/12/21 to 20/02/22 (8 weeks) 325 eligible patients had GP appointments with only 19 (5.84%) being referred. After the electronic records pop-up was created, 63 of 354 patients (17.8%) were referred. This equates to the practice being entitled to an average of ~£90.56 a week (from ~£27.31 a week prior to pop-up intervention). It was also noted that referrals were more likely to be made for patients living with hypertension than patients living with diabetes (cycle 1: 7% and 2% respectively, cycle 2: 20% and 9% respectively). In our centre, a pop-up and warning system increases the number of eligible patients referred to NHS DWMS.

Disclosures: None

P03 Anti-hypertrophic and Anti-inflammatory effects of Palmitoleic Acid in Adipose Tissue of Obese Mice with Repercussions in LiverSimã JJ, Cruz MM, Armelin-Correa L, Alonso-Vale MIC Federal University of Sã Paulo - UNIFESP, Brazil.

Our research has provided important evidence concerning the effects of palmitoleic acid, a natural omega-7 fatty acid (n7), which is abundant in plant, on metabolic disorders triggered by obesity. Considering the impact of obesity and related diseases on human health, studies focused on understanding the action of new agents that can modulate a healthy expansion of white adipose tissue (WAT) and treat related diseases are of relevance. Herein, we will show recent findings in WAT where n7 promoted metabolic changes and partially prevented in WAT the increase of gene expression that are triggered by obesity, suggesting that Obese+n7 animals do not require the same magnitude of metabolic adaptation to cope with energy demand from the high fat diet (HFD). Additionally, after 8 weeks of HFD-induced obesity in mice, we also observed that n7 had a beneficial effect on the changes trigged by HFD, attenuating the increase of lipids in liver, the body mass gain and reversing visceral adipocyte hypertrophy. However, n7 did not reverse the increase in WAT depot mass, suggesting greater hyperplasia in WAT of animals treated with n7. To further investigated, we used 3T3-L1 cell line, well characterized for adipogenesis studies. N7 increased proliferation, differentiation and the expression of Ppar-Î32 and Cebpa, the master regulators of adipogenesis, as well as the expression of its target genes that encodes proteins necessary for the maintenance of the adipocyte phenotype. Finally, n7 decreased the expression of pro-inflammatory genes in adipose-derived stromal vascular fraction (SVF). Taken together, n7 modulates functional capabilities of SVF cells during the process of inflammation induced by HFD, and our data reinforces that there is a cross-talk between adipocytes and adipose-derived stromal cells to promoting n7 anti-hypertrophic and anti-inflammatory synergistic effects in obese mice. These results elucidate new agent and cellular targets to promote WAT healthy expansion.

Disclosures: None

P04 Acceptance Commitment Therapy for Weight Loss: Insights from the clients- A Qualitative studyAyva S, Edwards S MoreLife UK

Rates of people living with obesity and overweight are rising in England (The King’sfund, 2021). It affects around one in every four adults (NHS, 2022). MoreLife UK delivers tailor-made, evidence-based, grounded in psychological and behaviour change theory health improvement programmes to individuals and families in area range of locations across the UK. We implemented a curriculum update in 2020 and expanded our intervention with elements of Acceptance and Commitment Therapy (ACT) tools and techniques.

ACT is an evidence-based third-wave therapy technique and has proven records of helping people with various mental health issues. The main aim of ACT is to help people live rich and meaningful lives (Hayes, 2019). ACT has been shown to facilitate longer-term behaviour changes compared with other techniques (Lillis, 2007; Heather et al., 2012; Fletcher, 2012; Reijonen, 2018; Fard et al., 2016; Forman et al., 2019).

This study aims to understand which ACT elements are perceived as helpful for weight management clients to lose weight and maintain their weight loss and how they facilitated their weight loss and management.

We will conduct two focus groups and four individual interviews with our clients to identify the unique contribution of ACT to the weight management programme. A focus group with the service practitioners to learn about their insights regarding the ACT elements of the programme and how these elements facilitate behaviour change and weight loss in their clients has already been undertaken. We will conduct a thematic analysis to identify patterns in the qualitative data.

We conducted a focus group with 6 of our practitioners. They believe that the values exercise, experiential avoidance, and urge surfing are helpful concepts of ACT. Results from the client feedback will follow.

Disclosures: None

P05 Implementing a Guided Self-help Intervention for the management of Binge Eating prior to a Specialist Weight Management ProgrammeEdwards S, Gately P, Hill A, Traviss-Turner G Leeds Beckett University

Binge eating is common in those living with obesity. NICE (2000) recommends Guided Self-Help (GSH) as a first line treatment for binge eating. However, services for binge eating are not widely available in the UK and many people experiencing binge eating are referred to weight management services. Binge eating poses a barrier to engagement with weight management and longer-term weight loss. The current service evaluation was a pilot to assess the preliminary effectiveness of delivering a brief, evidence-based GSH intervention for binge eating to adults, prior to them engaging in a standard NHS Tier 3 weight management service.

Service users were screened for binge eating using the Binge Eating Scale (BES). Those with a score ≥ 27 were invited to take part in the GSH intervention prior to engaging with the standard weight management programme. The intervention was based on cognitive behavioural principles. It comprised 7 sessions over 12 weeks and was supported by practitioners who had received appropriate training. 33 participants were found to be suitable, 22 started the programme, 9 dropped out and 13 have completed to date.

11 of the 13 participants who completed the GSH intervention reduced binge eating. Six had ceased binge eating altogether. The mean BES score pre-intervention was 34.3 (SD = 6.0) and post-intervention 20.6 (SD = 9.8). Of the 13 completers, 12 went on to engage in the standard weight management programme.

Commissioning psychological GSH support to address binge eating prior to engaging in Tier 3 weight management services shows promise. The intervention resulted in a reduction in mean BES scores representing a change from ‘severe binge eating’ to ‘mild or moderate binge eating’. This approach may reduce the pressure on eating disorder services and provide a more efficient pathway for those who wish to address both binge eating and complex obesity.

Disclosures: Paul Gately and Sophie Edwards are employed by MoreLife, the service commissioned to deliver the service

P06 Outcomes at One Year in a Community Tier 3 Weight Management ServiceEdwards S, Gately P, Costelloe E Leeds Beckett University

Obesity continues to be a major issue in the UK. Tier 3 weight management services are commissioned by the NHS to support those with complex obesity and are often delivered in secondary care settings. Current literature indicates that Tier 3 services have a short- to mid- range improvement on weight and health for service users, but there is limited data on outcomes beyond six months. This service evaluation looks at the outcomes at one year for service users who have completed this community-based Tier 3 weight management programme.

Service users are referred by healthcare professionals and have a BMI > 35 with comorbidities or >40 with or without comorbidities. The multidisciplinary team include a psychologist, dietitian and exercise professional who assess and advice on those with complex needs. The programme is made up of 12 weekly, group-based sessions which include lifestyle education and psychological support. These sessions are followed by nine monthly sessions that seek to support ongoing behaviour change. Weight and psychological measures (PHQ-9 for depression symptoms and GAD-7 for anxiety symptoms) are collected at referral, and at 12 months.

Between April 2020 and March 2021, 55 clients completed the 12-month programme. Mean weight loss was 8.82kg (SD = 8.39) or 6.79% (SD = 6.27) of their original weight. 39 of the 55 (71%) lost over 3% of their original weight and (63%) of the 55 lost over 5% of their original weight. Mean reduction in PHQ-9 scores was 3.36 (SD = 4.18) and mean reduction in GAD-7 scores was 2.49 (SD = 4.41).

Tier 3 weight management services utilising a psychological, group-based approach can lead to significant improvements in both weight and mental health outcomes at one year. Services can be successfully delivered in community settings which may reduce costs associate with secondary care services and improve access for those who have challenges travelling.

Disclosures: All authors are employed by MoreLife, the provider commissioned to deliver this service

P07 How is the NHS Low-Calorie Diet Programme expected to produce behavioural change to support diabetes remission: An examination of underpinning theoryEvans TSm Hawkes RE, Keyworth C, Newson L, Radley D, Hill A, Matu J, Ells LJ Leeds Beckett University, University of Manchester, University of Leeds, Liverpool John Moores University

In 2020, the National Health Service Low-Calorie Diet Programme (NHS-LCD) was launched, piloting a Total Diet Replacement intervention with behaviour change support for people living with Type 2 Diabetes and excess weight. Four independent service providers were commissioned to design and deliver theoretically grounded programmes in localities across England.

To (1) develop a logic model detailing how the NHS-LCD programme is expected to produce changes in health behaviour, and (2) analyse and evaluate the use of behaviour change theory in providers’ NHS-LCD Programme designs.

A documentary review was conducted. Information was extracted from the NHS-LCD service specification documents on how the programme expected to produce outcomes. The Theory Coding Scheme was used to analyse theory use in providers’ programme designs documents.

The NHS-LCD logic model included techniques aimed at enhancing positive outcome expectations of programme participation and beliefs about social approval of behaviour change to facilitate programme uptake and behaviour change intentions. This was followed by techniques aimed at shaping knowledge and enhancing the ability of participants to self-regulate their health behaviours, alongside a supportive social environment and person-centred approach.

Application and type of behaviour change theory within providers’ programme designs varied: One provider explicitly linked theory to programme content; two providers linked 63% and 70% of intervention techniques to theory; and there was limited underpinning theory identified in the programme design documents for one of the providers.

The nature and extent of theory use underpinning the NHS-LCD varied greatly amongst service providers, with some but not all intervention techniques explicitly linked to theory. How this relates to outcomes across providers should be evaluated. It is recommended that explicit theory use in programme design and evidence of its implementation becomes a requirement of future NHS commissioning processes.

Disclosures: None

P08 A qualitative study exploring participant experience of Obstetric Weight Management (OWM)Shiplee GB Leeds Beckett University

Excess weight in obstetric populations is associated with negative health outcomes for both mother and child. OWM is defined as weight management for women in varied stages of childbearing. Stages may include preconception, peri-natal or postnatal. To date, there is little consensus and limited research. This research project explores participant experience of OWM, with the wider goal of developing recommendations for improving OWM approaches and provision.

OWM is an increasing public health challenge in line with the global issue of increasing excess weight in populations. Excess weight in childbearing is highly associated with increased risk of unplanned pregnancy loss and prevalence of short- and long-term negative health outcomes for both mother and baby. With some social groups being at more risk than others. National and local efforts in the UK to support women reduce and manage excess weight to promote healthier pregnancies, have been considered ineffective. This is partly based on growing statistics of miscarriage and still birth and the prevalence of gestational diabetes. Previous research specifies participation in local services supporting OWM is poor. Suggesting accessibility and negative associations with health care professionals are factors in low engagement rates.

This ongoing research project adopts qualitative research methods. Six months of fieldwork was conducted, based on a unique combination of focus groups and individual interviews with both ‘real women and families’ and health professionals. While practitioner ethnography was used to capture the researcher’s, professional experiences based on observations of appointments with service users and reflections on professional meetings. An analysis of the data is underway highlighting preliminary findings. Contributing to a set of recommendations and considerations for services aiming to effectively support women and families with excess weight.

Disclosures: None

P09 Re:Mission ‘An evaluation of the NHS Low Calorie Diet Programme’ early learningElls LJ, Homer C, Radley D, Drew K, Brown T, Marwood J, Logue J, Watson P, Jones S, Clare K Leeds Beckett University

The NHS long term plan made a commitment to test a Low Calorie Diet (achieved via a total Diet Replacement programme) for people living with, or at risk of, obesity and type 2 diabetes. Ten pilot sites were initially recruited to test the NHS Low Calorie Diet programme, delivered using one of three different behaviour change support models: one to one, group or digital. As NHS England are collecting and analysing quantitative process and clinical impact data, an additional qualitative and economic evaluation was required.

To deliver a coproduced, comprehensive qualitative and economic evaluation of the NHS Low Calorie Diet pilot, that will be integrated with the NHSE quantitative analyses, to provide an enhanced understanding of the long-term cost-effectiveness of the programme and its implementation, equity, transferability and normalisation across broad and diverse populations.

Methods: A comprehensive mixed method evaluation, underpinned by a realist approach to determine what works, for whom, in what context, and why, delivered through a series of five interlinked work packages.

Early learning from the first year of the programme mobilisation and implementation will be presented, which will provide an overview of delivery context, qualitative findings from mobilisation staff, primary care and service provider interviews and focus groups, and emerging insights from a service user survey.

The evaluation findings are providing real time insights to inform ongoing service development and future procurement activity.

Disclosures: None

P10 Supporting Weight Management during COVID-19 (SWiM-C): a randomised controlled trial of an ACT-based interventionMueller J, Richards R, Jones RA, Whittle F, Woolston J, Stubbings M, Sharp SJ, Griffin SJ, Bostock J, Hughes CA, Hill AJ, Ahern AL University of Cambridge

We evaluated the effect of a web-based, acceptance-based guided self-help intervention which aims to prevent weight gain in adults with overweight or obesity during the COVID-19 pandemic (SWiM-C: Supporting Weight Management during COVID-19).

We randomised 388 participants (≥18 years, BMI ≥ 25kg/m2) to the SWiM-C intervention (n = 192) or a control group (n = 196). SWiM-C is based on acceptance and commitment therapy (ACT) and is delivered remotely via an online web platform (12 weekly modules) and contact via telephone and email with a trained, non-specialist coach. The control group received a leaflet on weight management and wellbeing during the pandemic. Participants completed online questionnaires at baseline, 4 months, and 12 months. The primary outcome was change in self-reported weight from baseline to 12 months; secondary outcomes were eating behaviour, experiential avoidance, mental health, wellbeing and physical activity.

At 12 months, the adjusted difference in weight between the SWiM-C group and the control group participants was -0.81kg (95% confidence interval [CI]: -2.24 to 0.61kg). SWiM-C participants reported a greater reduction in experiential avoidance (-2.45, 95% CI: -4.75 to -0.15), uncontrolled eating (-3.36, 95% CI: -5.66 to -1.06), and emotional eating (-4.14, 95% CI: -7.25 to -1.02), and an increase in physical activity (8.96, 95% CI: 0.29 to 17.62) compared to the control group. No differences in mental health or wellbeing were observed at 12 months.

Whilst the effect of the SWiM-C intervention on weight was inconclusive, SWiM-C improved eating behaviours, physical activity and psychological flexibility. These variables have been previously identified as determinants of successful weight management. Further refinement of the intervention is necessary to ensure meaningful effects on weight prior to implementation in practice.

Disclosures: FW, JW, MS, SJS and JB report no conflicts of interest. AJH has consulted for Slimming World. CAH reports payment or honoraria from Ethicon, NovoNordisk and International Medical Press for lectures, presentations, speakers bureaus, manuscript writing or educational events. JM and RR are Trustees for the Association of the Study of Obesity (unpaid roles). ALA and SJG are the chief investigators on two publicly funded (MRC, NIHR) trials where the intervention is provided by WW (formerly Weight Watchers) at no cost outside the submitted work.

P11 The association between goal setting and weight loss outcomes: an observational analysis of real-world dataWren G, Koutoukidis D, Scragg J, Whitman M, Jebb SA University of Oxford

Goal setting may aid health-related behaviour change. The present study aimed to investigate the association between two measures of goals setting (percent weight loss goal and weight loss motivation) and weight change during a digital programme for weight loss, in a real-world setting.

This is a prospective longitudinal analysis of 36,794 UK adults with a BMI of ≥25 kg/m2, who participated in a 12-week digital behavioural programme for weight loss. The outcome was weight change at 24wks, assessed using mixed-model repeated-measures analyses to explore the effect of goal setting adjusted for known confounders. We also examined whether engagement acted as a mediator in the association between goals and weight loss.

Of the 36,794 participants who had weight readings at baseline, 13.1% (n = 4,818) reported weight at 24wks including a disproportionately high number of participants who were older and had lower baseline body mass index (p < 0.001). Most participants set goals of 5-10% of their initial body weight (64.3%), but weight loss at 24wks was greater for those who set goals of >10% compared to 5-10% (mean: 5.21kg; 95% CI: 5.01, 5.41; p < 0.001). There was no significant difference between goals of 5-10% and <5%. Appearance was most frequently reported as a motivational factor (40.1%) compared to health (27.6%), fitness (13.8%) or self-efficacy (18.5%), but at 24wks, health and fitness were associated with greater weight losses than appearance (mean: 1.40kg; 95% CI: 1.15, 1.65 and mean: 0.38kg; 95% CI: 0.05, 0.70, respectively). Engagement with programme components was a significant independent predictor of weight loss but not a mediator of the effect of goals on weight loss.

Setting larger goals and being motivated for health or fitness reasons were associated with greater weight loss. Randomised controlled trials of setting these types of goals are needed to confirm causality.

Disclosures: None

P12 Effects of long-term consumption of n-6 PUFA rich diet on the rat hypothalamic proteomeTelles MM, Pedroso AP, Forcelini Machado MM, da Silva Júlio V, Oyama LM, Tashima AK, Ribeiro EB Universidade Federal de Sao Paulo (UNIFESP)

The unbalanced consumption of polyunsaturated fatty acids (PUFAs) with high omega-6 (n-6)/omega-3 (n-3) ratio, characteristic of the Western diet, has been associated to inflammation and non-communicable chronic diseases. Indeed, n-6 PUFA has been reported to be more obesogenic and diabetogenic than other sources of fat or carbohydrates. Thus, the present study aimed to investigate the impact of long-term consumption of soybean oil-enriched hyperlipidic diet on the hypothalamic proteome of rats. 2-mo-old Wistar male rats were divided into 2 groups according to the 8-week diet protocol: HFD group, fed with the soybean oil-enriched high fat diet; Control group, fed with a standard chow diet (C). Food/caloric intake were evaluated weekly. Concluding the diet protocol, rats were euthanized, and hypothalami were removed and frozen at -80ºC until processing. Total protein content was extracted from hipothalami samples, and further analyzed by nanoLC-MS/MS. All the differentially expressed proteins were submitted to pathway analysis. Our results showed that the long-term consumption of soybean-enriched hyperlipidic diet modified hypothalamic proteins related to glucose metabolism, cytoskeleton remodeling, calcium signaling, Unfolded Proteins Response, endocytosis, exocytosis, and glutamate metabolism. Considering that most of the proteins altered were recognized to be involved in neurodegenerative processes, present findings suggest a potential harmful effect of the long-term consumption of soybean oil-enriched high fat diet. Therefore, further studies are needed to better comprehend the harmful potential of the overconsumption of n-6 PUFA on the pathogenesis of neurodegeneration.

Disclosures: None

P13 Ginkgo biloba extract modulates hippocampal signaling pathways related to the regulation of feeding behavior in ovariectomized ratsMachado MMF, Banin RM, Thomaz FM, de Andrade IS, Hirata BKS, Ribeiro EB, Telles MM Universidade Federal de Sao Paulo (UNIFESP)

Several studies have demonstrated that menopause contributes to the triggering of energy homeostasis disturbances, especially affecting feeding behavior, and thus favoring the development of obesity. However, even being observed improvement in these conditions after hormonal replacement therapy (HRT), alarming side effects are associated with this treatment, limiting its use by women with a history of breast cancer and cardiovascular disease. We have previously observed that Ginkgo biloba Extract (GbE) attenuated ovariectomy-related obesity, improving the hypophagic response of serotonin in the hypothalamus, and reducing serum leptin levels. Moreover, several anti-obesogenic properties of GbE were reported in diet-induced obese male rats, as well as its stimulatory effect on gene expression of hypothalamic anorexigenic effectors in normal male rats. Therefore, the present study investigated the effects GbE supplementation on hippocampal protein levels of 5-HT1A and 5-HT1B serotonin receptors, serotonin transporter (5-HTT), and leptin receptor (LepR) in ovariectomized rats. 2-month-old Wistar female rats were ovariectomized (OVX) or Sham-operated. After 2 months, daily oral gavages were performed once a day with 500 mg.kg−1 of GbE or vehicle for 14 days. GbE restored ovariectomy-induced decrease of 5-HT1A, and 5-HT1B protein levels in the hippocampus. Moreover, LepR hippocampal levels increased after GbE treatment, reaching similar levels of Sham rats. No changes were identified in 5-HTT levels. In summary, the present findings indicated that GbE improved the effectiveness of pivotal mechanisms involved in hippocampal generation of the negative feedback of food intake that were impaired by ovariectomy. Thus, GbE might be useful to alleviate disturbances related to energy homeostasis in menopause, which may also favor the improvement of body profile. Further studies are warranted to better understand the therapeutic potential of GbE in menopause.

Disclosures: None

P14 A Systematic Review Of Physical Activity and Nutritional Interventions for The Management of Normal Weight and Overweight ObesityJacob E, Avery A University of Nottingham

Normal Weight Obesity (NWO) is a highly prevalent, unclearly defined condition associated with increased cardiometabolic risk, and there are no systematic reviews conducted on its management. Overweight (BMI 25kg/m2 to < 30kg/m2) also has sparse research findings.

Systematically review physical activity and nutritional interventions for effectiveness and safety in the management of Normal Weight and Overweight Obesity (BMI < 30kg/m2 with a marker of raised body fat other than BMI).

Electronic databases were searched. Clinical trials including any physical activity or nutritional interventions, published between 2012-2022, evaluating body fat change were selected. Risk of bias was assessed.

Seven trials met inclusion criteria, including one single arm intervention, and six randomised controlled trials. A High Intensity Interval Training (HIIT) intervention with a high risk of bias had the largest effect on reducing body fat percentage (MD -5.18%, SD 0.14), with the next highest effects from high protein intake interventions (MD -3.70%, SD 1.47; MD -1.40%, SD 0.17). These three interventions also had the highest increase in lean mass. Two calorie restricted interventions had the highest mean weight loss (MD -3.10kg SD 0.87; MD -2.40kg, SD 0.25), but also had loss of lean mass/fat free mass, resulting in low reductions in body fat percentage (MD-1.10% SD 0.57; MD -1.26% SD 1.46). No serious adverse events were reported. There was considerable heterogeneity between studies.

There are physical activity and nutritional interventions that are effective for the management of normal weight and overweight obesity. There are numerous promising physical activity interventions. The most promising nutritional intervention is high protein intake and the least promising is energy restriction. More high quality, multi-intervention trials are urgently needed to assess effectiveness and safety of interventions, define target losses and the best tools to measure adiposity. Thanks to Rupesh Tailor for statistical assistance.

Disclosures: Dr Elizabeth Jacob is a Director of the company Dr Liya Jacob Ltd. Amanda Avery has a Consultant Role at Slimming World.

P15 A critique of obesity strategies published by the Scottish Government since devolutionSteiner T, Craig L University of Aberdeen

Overweight and obesity has remained a public health issue in Scotland for decades. Since devolution in 1998, Scottish Governments have released multiple strategies aimed at preventing obesity however rates have remained persistently high. It is fair to expect that a positive tangible impact would have been achieved by this point. This paper provides an evaluation of obesity strategies published in Scotland since devolution.

The study followed methods developed by Theis and White (2021) who previously carried out an evaluation of obesity strategies in England. Their comprehensive analytical framework in which policies within obesity strategies are coded by various themes was applied. Content analysis was completed by counting the frequencies of codes and the findings discussed using applied thematic analysis.

Scottish Governments have largely favoured low-intervention obesity policies. Policies generally lacked sufficient detail to explain how they would be implemented, and they also carried minimal levels of regulation to ensure delivery. Policies were found to be designed in a way that placed at least some level of responsibility on individuals in society. Finally, there was very little evidence of on-going learning and evaluation from strategy to strategy over time. However, the most recent obesity strategy did show signs of improved design.

Weak policy design and a lack of ongoing evaluation are likely to be key reasons behind the ineffectiveness of the strategies to reduce obesity rates. The Scottish Government must look to higher intervention policies, such as fiscal levers, if real improvement is to be achieved.

Disclosures: None

P16 Primary Care Network Holistic Nutritionist and Health Coach - Remote and Supermarket Based Consultations, Impact on Lifestyle and Weight: A Service EvaluationHaseler T, Nelson B, Maynard R, Mandicate K Camden Central PCN

Primary care networks (PCNs) can bring innovative lifestyle and weight interventions to local populations with efficiencies of scale, particularly given developments in digital and remote working. Presently, evidence on feasibility or impact to support these services is lacking. Central Camden PCN developed a local pilot holistic health coaching intervention, delivered remotely and at local supermarkets, tailored towards targeting obesity, and functional symptoms. The aim of this poster is to evaluate this service’s feasibility and impact.

Patients were referred by primary care professionals (PCPs) to a British association for Nutrition and Lifestyle Medicine certified therapist. Inclusion criteria included patient goals of weight loss, symptom control, or ‘other’. Four one-to-one consultations over four months were offered, including education on food-labels and shopping for healthy food at the patient’s supermarket. Biometric data and patient self-assessment questionnaires were collected at the first and fourth consultations.

From February 2020 to April 2022 213 referrals were received, 33 patients completed the programme, 107 did not book their first appointment, the remainder have not completed their appointments. Of 33 completers, 6 were referred for a primary indication of weight loss, 13 for functional bowel symptoms, and 14 for ‘other’. 20 completers were female (60.6%), and 22 were aged 18-34 years, mean age 34.7. 15 patients had BMI > 25 on referral (mean Weight=90.7kg), with a mean decrease after four consultations of -2.3kg (2.3%, p = 0.005). Beneficial changes with p < 0.05 were also seen in fruit and vegetable intake, symptomatic scores and BMI. Wellbeing and activity levels did not alter significantly.

This PCN-level service is effective in engaging PCPs in referrals, and benefitting completers’ diets, weight and symptoms. There is, however, inequity of access, with a predominantly young and female completer population, and a low rate of referral-to-completion conversion which requires further evaluation.

Disclosures: None

P17 Effectiveness of weight management interventions in adults delivered by primary care: A systematic review and meta-analysis of randomised controlled trialsMadigan CD, Graham HE, Sturgiss E, Kettle VE, Gokal K, Biddle G, Taylor GMJ, Daley AJ Loughborough University

To examine the effectiveness of behavioural weight management interventions for adults delivered by primary care.

A systematic review and meta-analysis of randomised controlled trials.

Randomised controlled trials of behavioural weight management interventions delivered by primary care relative to comparator groups with weight change measured at >12-month follow-up. Participants were adults with a body mass index >25 kg/m2.

Trials from a previous systematic review were extracted and a search was completed using the following databases: Cochrane Central Register of Controlled Trials, MEDLINE, PubMed and PsychINFO from 1st January 2018 to 19th August 2021.

Data extraction and synthesis: Two reviewers independently identified eligible studies, extracted weight data, and assessed risk of bias using the Cochrane risk of bias tool. Meta-analyses were conducted with random effects models and a pooled mean difference for both weight (kg) and waist circumference (cm) were calculated.

Weight change from baseline to 12 months (primary), baseline to >24 months. Change in waist circumference was assessed at the same time points.

34 trials were included; 14 additional trials from the updated 2018 search. Twenty-seven trials (n = 8,000) were included in the primary outcome of weight change at 12-month follow-up. The mean difference between the intervention and comparator groups at 12 months was -2.3 kg (95% CI -3.0 to -1.6, I2 88%, p < 0.001), favouring the intervention group. At >24 months (13 trials, n = 5011) the mean difference was -1.8 kg (95% CI -2.8 to -0.8, I2 88%, p < 0.001) favouring the intervention. The mean difference in waist circumference was -2.5cm (18 trials, n = 5,288, 95% CI -3.2 to -1.8, I2 69%, P < 0.001) in favour of the intervention at 12 months.

Conclusions: Weight management interventions delivered in primary care are effective for weight loss and could be offered to help the public manage their weight.

Disclosures: None

P18 The effect of maternal comsumption of green tea extract, by rats, during pregnancy and lactation, promotes lower evolution in body weight and regulates the cytokine replication in female offspringAlves-Nakakura FC, Pontes LPP, Boldarine VT, Neto NIP, Feitoza AHS, Hachul ACL, Oller do Nascimento CM, Oyama LM Universidade Federal de São Paulo

The type of maternal diet during the pregnancy period has an impacting role on the health evolution and risk of diseases in the offspring’s adult life. Green tea has anti-obesity, antioxidant, anti-inflammatory and immunomodulatory properties. In this context, the aim of the study was to investigate the effects of maternal consumption of green tea extract during pregnancy and lactation on the evolution in body weight and inflammatory profile markers in female offspring. Three-month-old female Wistar rats, during the 1st day of pregnancy up to the 28th day of lactation, were divided in two groups: MW = mothers that received water and ME = mothers who received green tea extract (400mg/kg of weight body weight/day), both with a growth control diet. After lactation, on day 28 postpartum, one female pup from each mother was euthanized and they were divided into the following groups: OW = offspring of the mother who received water and OE = offspring of the mother who received green tea extract. Pups body weight gain, adipose tissue depot weight and inflammatory markers protein in the adipose tissue were evaluated. When compared to OW animals, the OE group showed lower body weight gain and mesenteric adipose tissue relative weight. The MyD88 protein content was increased in the mesenteric adipose tissue. The parametrial adipose tissue presented an increase in the content of cytokines IL-6, TNF-Î ± and IL-1Î2. In summary, the results emphasize that the lower evolution in the body weight and the elevation of inflammatory profile makers in newborn can have harmful consequences for the health of the female offspring in adult life.

Disclosures: None

P19 Effects of aerobic, resistance and concurrent training in the browning process in rats with obesity induced by hyperlipidic dietPontes LPP, Alves-Nakakura FC, Neto NIP, Boldarine VT, Maza PK, Avila F, Antunes HKM, Damaso AR, Oyama LM Universidade Federal de São Paulo

Physical training has been widely used as a non-drug clinical strategy in the treatment of obesity. The objective was to evaluate the effect of resistance, aerobic and concurrent training on markers of browning of white adipose tissue from rats with obesity induced by a high fat diet. The experiment lasted 16 weeks, with eight weeks of obesity induction and eight weeks of physical training and change diet to a normocaloric one in male Wistar rats. The groups were Sedentary control diet (CS/n = 8), Sedentary high fat diet (HS/n = 8), Aerobic exercise (AE/n = 8), Resistance exercise (RE/n = 8) and concurrent training (CE/ n = 8). Body mass, food intake and analysis of browning process markers FGF-21, Irisin, PGC1Î ± , PPARÎ3 and UCP1 in subcutaneous (SUB), retroperitoneal (RET) and mesenteric (MES) adipose tissue were evaluated. The minimum level of significance adopted was 5%. The trained groups had lower adiposity and delta mass compared to the HS group. Irisin in RET adipose tissue was higher in the RE group compared to the HS group; in the MES, the AE group was higher in relation to the CS group; in SUB, the RE group was higher when compared to the CS group. The concentrations of FGF21 in the RET and SUB in the RE group were higher than in the control groups, respectively. The concentration of PGC1Î ± was higher in the RE group of adipose tissue from the MES and SUB when compared with the control groups; PPARÎ3 was higher in the RE group in the MES when compared to the HS group, and UCP1 showed higher levels in the AE in relation to the HS group. In conclusion, both resistance and aerobic training were efficient in activating different biomarkers of the browning process. However, no important adaptations resulting from concurrent training were observed.

Disclosures: None

P20 Acceptance Commitment Therapy for Weight Loss: Insights from the clients- A Qualitative studySirin-Ayva, AB, Edwards, S MoreLife UK

Rates of people living with obesity and overweight are rising in England (The King’s fund, 2021). It affects around one in every four adults (NHS, 2022). MoreLife UK delivers tailor-made, evidence-based which are grounded in psychological, and behaviour change theory health improvement programmes to individuals and families in area range of locations across the UK. We implemented a curriculum update in 2020 and expanded our intervention with elements of Acceptance and Commitment Therapy (ACT) tools and techniques.

ACT is an evidence-based third-wave therapy technique and has proven records of helping people with various mental health issues. The main aim of ACT is to help people to live rich and meaningful life (Hayes, 2019). ACT has been shown to facilitate longer-term behaviour changes compared with other techniques (Lillis, 2007; Heather et al., 2012; Fletcher, 2012; Reijonen, 2018; Fard et al., 2016; Forman et al., 2019).

This study aims to understand which elements of ACT are perceived as helpful for weight management clients to lose weight and maintain their weight loss and how these elements facilitated their weight loss and management.

We will conduct two focus groups and four individual interviews with our clients to identify the unique contribution of ACT to the weight management programme. A focus group with the service practitioners to learn about their insights regarding the ACT elements of the programme and how these elements facilitate behaviour change and weight loss in their clients has already been undertaken. We will conduct a thematic analysis to identify patterns in the qualitative data.

We conducted a focus group with 6 of our practitioners. They believe that the values of exercise, experiential avoidance, and urge surfing are helpful concepts of ACT. Results from the client feedback will follow.

Disclosures: None

P21 Ginkgo biloba extract supplementation differently alters fatty acid composition in neutral lipid classes of the liver in obese rats fed a high-fat dietJoyce EC 1, Hirata BKS 2, Machado MMF 2, Telles MM 2, Bueno AA 1 1University of Worcester, 2Federal University of So Paulo Brazil

Obesity can result in metabolic disturbances, chronic inflammation and disturbed tissue fatty acid (FA) composition. The liver is dynamically involved in lipid metabolism including fatty acid β-oxidation and de novo lipogenesis. Antioxidant and anti-inflammatory properties have been attributed to Ginkgo biloba (GbE) supplementation. We investigated whether GbE supplementation altered neutral lipid FA profiles of liver tissue in high-fat-diet (HFD)-induced obese rats.

2-month-old male Wistar rats, were fed from 2 to 4-months-old with a HFD (28% lard), followed by 14 days of supplementation with saline (HFD-S) or GbE (HFD-GbE) at 500mg/kg. As GbE supplemented rats ingested fewer calories, a pairfed (HFD-PF) group was also included. Rats were euthanized and liver tissue removed. Total lipids were Folch-extracted and neutral lipids separated chromatographically into triglycerides (TAG), cholesteryl esters (CE) and monoglyceride + diglycerides (MAG + DAG), methylated and analysed by gas chromatography.

Liver TAG ω3 metabolite levels increased for HFD-PF (↑33%) and HFD-GbE (↑55%) compared to HFD-S, decreasing the ω6/ω3 ratio to 14:1 in HFD-GbE compared to HFD-S (19:1, p = 0.001) and HFD-PF (17:1, p = 0.02). CE-monounsaturate FA levels increased in HFD-GbE compared to HFD-S (p = 0.0001) and HFD-PF (p = 0.002) while HFD-GbE polyunsaturate FA levels decreased compared to HFD-S (p = 0.0003) and HFD-PF (p = 0.02). The CE ω6/ω3 ratio increased to 8:1 (p = 0.01) following GbE treatment compared to 5:1 in both HFD-S and HFD-PF. MAG + DAG-saturated FA levels decreased in HFD-PF (p = 0.01) and HFD-GbE (p = 0.003) compared to HFD-S, while MUFA levels increased in HFD-PF (p = 0.01) and HFD-GbE (p = 0.001).

The combined changes in liver TAG, CE and MAG + DAG FA levels, suggest GbE supplementation may contribute to altered liver lipid metabolism, peripheral FA store mobilisation or changes in ω3 and ω6 inflammation mitigation conferring some protection against the deleterious effects of a high fat diet. Further studies are needed for better understand of the beneficial effect of GbE.

Disclosures: None

P22 A systematic review of the effect of digital game-based and influencer food and non-alcoholic beverage marketing on children and adolescentsEvans R, Maden M, Jones A, Christiansen P, Albadri S, Boyland E University of Liverpool

Videogame livestreaming platforms are an emerging form of digital media where individuals can watch gaming influencers play videogames. These platforms are popular with children and targeted by food and non-alcoholic beverage (hereafter: food) brands, yet few studies have examined the impact of their food marketing exposure on children. Studies assessing the impact of television food marketing on children’s beliefs and behaviours map onto a logical hierarchy of effects linking food promotions to weight outcomes via brand awareness, attitudes and preferences, purchase, and consumption. This novel systematic review examined evidence for a relationship between exposure to food marketing within digital game-based media and via influencers, and these outcomes in young people.

Studies in which digital game-based or influencer food marketing exposure was experimentally manipulated, and at least one of the hierarchy of effects outcomes measured, in young people (up to 18 years) were included. Thirteen electronic databases were searched. Experimental (quantitative or mixed-method) and observational studies were considered. The review was pre-registered in PROSPERO [CRD42020167360] and conducted in accordance with PRISMA guidelines.

Twenty-two studies were included. Meta-analyses indicated an effect of food marketing on attitudes and preferences, and consumption behaviours. Purchase and awareness outcomes were synthesised narratively. Most included studies had either some concerns or a low risk of bias.

Evidence suggests that there is a relationship between exposure to food marketing via influencers and digital gaming media, and several hierarchy of effects outcomes. Findings are the first to demonstrate this relationship collectively, which has implications for food marketing policy.

Disclosures: P.C. has received research funding from the American Beverage Association. All such funding is for work outside of the current review.

P23 Development and initial evaluation of a weight management programme tailored for people with serious mental illness: a non-randomised feasibility study with qualitative interviewsLee C, Piernas C, Waite F, Aveyard A University of Oxford

People with serious mental illness (SMI) have higher rates of obesity and premature mortality due to cardiovascular disease (CVD) than the general population. Trials show behavioural weight management programmes (BWMPs) can help people with SMI lose weight and reduce the burden of CVD. However diagnostic-specific barriers to uptake and engagement are reported. We aimed to develop and evaluate a standard BWMP tailored for people with SMI - called ‘Weight cHange for people with sErious mEntal iLlness (WHEEL).’

The development comprised: 1) 12 patient and public contributors with SMI; 2) a systematic review of qualitative studies to identify programme characteristics that promote uptake and engagement for SMI; 3) a systematic review of trials testing BWMPs to identify which characteristics lead to weight loss; and 4) coding the effective characteristics against a standard 12-week BWMP to identify opportunities for tailored support. Initial evaluation comprised: 5) a non-randomised study of feasibility (retention and n, % of programme sessions attended) and acceptability (qualitative interviews plus self-reported weight loss) at end-of-programme.

The programme developed was a weekly BWMP delivered by a commercial company. It was augmented with a one-off educational session geared towards people with SMI and weekly mentor check-ins. Seventeen participants (mean age: 48·52 years; 47% with schizophrenia) enrolled in the feasibility study and 16 were followed-up at 12-weeks (95% retention). All participants attended the educational session, 9/16 attended 50% of the weekly BWMP sessions, and 12/16 responded to 50% of the weekly check-ins. All participants reported weight loss (mean 4·06kg, SD: 3·17) and valued the novel education and therapeutic support. However anxious avoidance remained a barrier to joining the BWMP.

This study showed initial evidence that a standard BWMP augmented with brief education and low-intensity support is feasible, acceptable, and may lead to weight loss in people with SMI.

Disclosures: None

P24 Sources of information and support preferred by people living with obesity (PLWO) in the ACTION-IO study UKHughes C, Ahern A, Halford JCG, McGowan B, Kasetty H, Vincent A, Parretti H University of East Anglia, University of Cambridge, University of Leeds, Guys & St Thomas’ NHS Trust; Novo Nordisk UK

To explore the preferred sources of information and support for PLWO in the ACTION-IO study UK.

The ACTION-IO online survey was completed by PLWO (body mass index ≥30 kg/m2 based on self-reported height and weight) in 11 countries to investigate the perceptions, attitudes, behaviours and potential barriers to effective obesity care. We analysed data from the UK subset (N = 1500). Where appropriate, comparisons with global ACTION-IO data are reported.

81% of PLWO had discussed or would consider discussing weight with their healthcare professional (HCP). Only 21% who had discussed found it helpful, or very helpful; 69% acted on HCP advice, but only 39% thought they were somewhat successful; 26% of HCPs did not provide any suggestions. Improving diet and physical activity were the most frequent weight-management strategies. Few PLWO reported visiting an obesity specialist, using pharmacotherapy or bariatric surgery. The most frequent sources of information about managing weight were Internet (31%), family and friends (27%) and weight-loss programmes (26%). Only 23% cited HCPs (29% in the global study). The top three factors for improving weight loss were: HCPs providing weight-loss solutions directly to PLWO (70%), providing solutions to help HCPs treat PLWO (51%) and reducing misinformation about obesity (40%). About a third mentioned reducing stigma, changing HCP judgemental views and increasing recognition of obesity as a disease.

In the UK primary care, HCPs are the gateway to NHS weight-management services. PLWO were prepared to discuss weight with their HCP, but many did not find this helpful and wanted solutions delivered directly to patients. Treatment effectiveness might be improved by better education of HCPs, increased referral to specialist services, improved Internet- and media-based patient information resources, and offering PLWO direct access to effective weight-management interventions.

Disclosures: CH: Consultancy for Alva Health, Novo Nordisk; honoraria from Ethicon, Johnson & Johnson, Novo Nordisk and research grants from NIHR. AA: Scientific advisory board for Weight Watchers; Principal Investigator in two trials where Weight Watchers donated the intervention (no cost); research grants from the Medical Research Council and NIHR Programme Grants for Applied Research. JCGH: The University of Leeds has received consultancy income from Novo Nordisk and Dupont; all monies used to fund research. BMG: Consultancy and honoraria for Ipsen, Novo Nordisk; advisory for Lilly, Novo Nordisk; research grants from Novo Nordisk; shareholder Reset Health. HK: Novo Nordisk employee. AV: No conflicts of interest to declare. HP: Honoraria from Novo Nordisk and Johnson & Johnson; research grants from NIHR, UEA Health and Social Care Partners, PHE and OHID.

P25 Does using planning policy to restrict new takeaways reduce childhood overweight, obesity and inequalities?: A quasi-experimental analysis of Gateshead’s Supplementary Planning Document between 2015-2020Xiang H, Albani V, Goffe L, Nasima A, Lake AA, Wildman J, Brown H Newcastle University

North-East England has a high prevalence of childhood obesity, with 29.1% of children in year 6 obese in 2020/21. Local authorities are responsible for improving population health but have limited budgets and capacity. Gateshead introduced supplementary planning guidelines in 2015 that banned any new takeaways in the local authority. Our previous research found that this policy led to a reduction in the density and proportion of fast-food outlets. However, its impact on health was unknown.

In this study, we investigate changes in the density and proportion of takeaways by area deprivation and if this has led to decreases in inequalities in childhood overweight and obesity prevalence.

We used Middle Super Output Layer (MSOA) data on childhood overweight and obesity from the National Child Measurement Programme from 2011-2020. We used food outlet data from the Food Standard Agency Food Hygiene Rating Scheme for 2012-2020 and data on Index of Multiple Deprivation 2015 from Office of National Statistics. We employ a quasi-experimental method, a difference-in-difference approach, to compare changes in childhood overweight and obesity rates between Gateshead and five other local authorities in the North-East of England which did not have planning guidance restricting new takeaways.

We only found a significant reduction of 2.7% (95% CI: -5.3% to -0.2%) in year 6 overweight in the second most deprived quartile of MSOAs in Gateshead compared with local authorities which did not adopt any planning policy. This may be because of heterogeneity in the number of takeaways in each decile of deprivation.

Limiting new takeaways through planning policy may have helped contribute to reducing health inequalities in childhood weight in Gateshead. As planning policy is dynamic it is important to consider how this evidence may help other local authorities tackle obesity.

Disclosures: None

P26 Spillover effects from early childhood, dietary obesity prevention strategies: A rapid reviewMarr C, Breeze P, Caton S University of Sheffield

Interventions targeting early childhood obesity are often-family based, as such they have the potential to not only impact upon the target participants but also on other family members. Changes in outcomes for those not directly targeted in an intervention can be referred to as spillover effects. The aim of this rapid review was to explore the spillover effects from early childhood, dietary-based obesity prevention strategies. Medline, Web of Science and Psycinfo were searched in July 2020. 12 studies met the inclusion criteria and were included in the review. In most of the studies (n = 11) the intervention targeted multiple health behaviours incorporating dietary components. Spillover effects were only captured for parents of children enrolled in an obesity prevention intervention. Dietary outcomes were the most frequently explored spillover effect, followed by weight based outcomes. There were significant positive effects of early childhood obesity prevention strategies on parental fruit and vegetable intake. Results