56. Empowering people to ward off diabetes
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CORDIScovery podcast- Episode #56 - Empowering people to ward off diabetes.
This is an AI transcription.
00:00:16:05 - 00:00:44:14
Abigail Acton
Hello and welcome to this episode of CORDIScovery with me, Abigail Acton. Obesity and being overweight is affecting children in the EU and worldwide at epidemic levels. In some countries, nearly 40% of children are impacted. An adolescent who is overweight has a high chance of becoming an obese adult, increasing their risk of a range of health related problems from type two diabetes, hypertension and coronary disease to the impact on mental health of people and their quality of life.
00:00:44:16 - 00:01:21:19
Abigail Acton
Policies aimed at reducing childhood obesity are challenging to implement and compliance can be irregular. So would involving adolescents in the process of developing the policies that are designed to help them make a difference? The International Diabetes Federation projects the number of people in the EU with the condition will rise to over 72 million by 2050. One warning flag for type two diabetes is gestational diabetes, the most common pregnancy complication women experience. Once again, can involving the group concerned in the decision making enable people to reduce their risk of maternal obesity?
00:01:21:21 - 00:01:46:04
Abigail Acton
Making the right choices is easier when healthier alternatives to the foods, which can have a negative impact on health, are available. So have we really made full use of sweeteners? And if not, why not? What benefits might they offer? Being overweight and having diabetes are major health challenges that can not only impact someone's quality of life, but are also putting a very real strain on health services that are, in many countries, thinly stretched already.
00:01:46:08 - 00:01:53:20
Abigail Acton
So what light can our three guests shine on these and other important questions?
00:01:53:22 - 00:02:15:03
Abigail Acton
All three have been supported by EU research and innovation funding. So here to share some of their findings are Knut-Inge Klepp, special adviser at the Norwegian Institute of Public Health and professor in public health nutrition at the University of Oslo. He's interested in health promotion among children and adolescents, and how to engage with young people in a way that makes a real difference.
00:02:15:06 - 00:02:16:04
Abigail Acton
Welcome, Knut-Inge.
00:02:16:09 - 00:02:17:12
Knut-Inge Klepp
Thank you.
00:02:17:14 - 00:02:40:18
Abigail Acton
Sharleen O’Reilly is a registered dietitian and professor of human nutrition at the University College Dublin in Ireland. Her research focuses on trying to improve women and children's health by preventing chronic diseases like heart disease or diabetes, through behavior change and health promotion. Hello, Sharleen. Welcome. And then we have Jason Halford, a professor of psychology at the University of Leeds.
00:02:40:20 - 00:02:49:04
Abigail Acton
Jason is interested in obesity, eating behavior and appetite. He is on the board of the European Coalition for People Living with obesity. Hi, Jason.
00:02:49:06 - 00:02:50:02
Jason Halford
Good morning.
00:02:50:04 - 00:03:08:00
Abigail Acton
Good morning to you. I'm going to turn to Knut-Inge first. CO-CREATE aimed to reduce childhood obesity and its co-morbidities by working with adolescents to create, inform and disseminate obesity preventative evidence based policies. Knut-Inge, what was the thinking behind the project? What problem were you looking to resolve?
00:03:08:02 - 00:03:36:03
Knut-Inge Klepp
Well, we thought that we really should listen to the young people to see what they think are the good solutions. So we know that adolescent time period, the teenage years is an incredible, interesting period of human life, where you go from being a child highly dependent on your parents and families to become an adult, making your own more independent decisions, and you acquire a lot of habits that you might take with you for the rest of your life.
00:03:36:05 - 00:03:44:07
Knut-Inge Klepp
So what was their perspective? and what could we learn? I mean, after all, they are the experts on their own life and the environment they're living in.
00:03:44:10 - 00:03:53:20
Abigail Acton
Absolutely. Has this been done much before? Because I've not really heard of many studies that have been trying to bring in younger people into this kind of process.
00:03:53:22 - 00:04:14:02
Knut-Inge Klepp
There has been some work that dates back looking at, for example, peer education, but very often then the young people were asked to deliver a message that had been created by adults. So it is more recently that we really want to listen to see what is that the young people bring to the table, what are their perspectives.
00:04:14:04 - 00:04:25:01
Abigail Acton
Right. No, absolutely. So tell me a little bit about the way that you conducted this research. Where did that participating kids come from and how did the project reach out and involve them, please? What did you actually do practically?
00:04:25:05 - 00:04:51:14
Knut-Inge Klepp
Yeah. So we worked in five European countries England, the Netherlands, Poland, Portugal and Norway, countries that are quite different. But in all of the countries, we see that there is a social gradient in that. We see difference in overweight and obesity rates depending on the socio economic background, the wealth and education of families. So we really wanted to include the variety of children from all kind of backgrounds.
00:04:51:16 - 00:05:19:12
Knut-Inge Klepp
So one way of doing that was going through the schools, schools located in different neighborhoods. But we also worked with the youth groups in Norway. For example, we have a youth organization named Plus, which is the youth organization of Save the Children, an organization run by and for young people in Portugal. They worked with the scout movement then recruited, young people from there.
00:05:19:14 - 00:05:44:00
Knut-Inge Klepp
And then, we sat down with the groups to see, what did they think where the causes of unhealthy eating and inactivity in their local environment. Identifying what we called the other drivers of obesity then, but not focusing so much on the disease, so overweight in itself, but more on eating and physical activity patterns.
00:05:44:00 - 00:06:01:02
Abigail Acton
Right. Exactly. Kind of the causes that would perhaps lead down that path, as you say, the lifestyle choices that could be laid down at that age, which might then actually, you know, benefit throughout the whole person's life. What the kids enthusiastic? Did you find that they wanted to party? I mean, they I can imagine maybe initially a little shy, but did they get into it?
00:06:01:06 - 00:06:36:07
Knut-Inge Klepp
Yeah, they did get into it. But of course, we thought we were the one who decided that we were going to focus on overweight and obesity, because that's what we had gotten funding to work on. But this is something that engage them. Quite a bit. One thing that came up that we hadn't thought so much about back when we started this work is the issue of mental health that in all countries that came up as one of the key elements that they wanted to discuss and thought that had a big impact on both eating habits of young people and an engagement of physical activity.
00:06:36:07 - 00:06:39:01
Knut-Inge Klepp
So that was really interesting to observe.
00:06:39:03 - 00:06:57:03
Abigail Acton
Yeah, it makes perfect sense once it's been pointed out, but it might not be the first thing you think of until it was pointed out. Yeah, it's an interesting insight. And, can you tell us some of the findings, in other words, did they come up with intriguing notions of how to do messaging or what might be effective?
00:06:57:03 - 00:06:58:09
Abigail Acton
What did they tell you?
00:06:58:11 - 00:07:10:04
Knut-Inge Klepp
Yes. So, as soon as they had decided, you know, what did they think were the drivers of the courses, then, so what is the solution? And we collected more than 100 really strong ideas.
00:07:10:08 - 00:07:11:13
Abigail Acton
Oh, excellent.
00:07:11:15 - 00:07:29:22
Knut-Inge Klepp
And, we were able to enlarge that in different ways. But that ranged from, for example, having more healthy or even cheaper food in the school setting, being active, able to be physically active, having active transportation to and from school in a safe manner.
00:07:29:24 - 00:07:31:11
Abigail Acton
What sort of... like safe bicycling?
00:07:31:11 - 00:07:59:23
Knut-Inge Klepp
Yeah. For example, and also, walking and also being able to engage in physical activity, free of, not having to pay, off the school, because the often high cost included in activity. But they also looked at more what we would call a policy, aspect at the national level, for example, how to reduce the digital marketing pressure that young people are experiencing.
00:07:59:24 - 00:08:10:17
Abigail Acton
I was wondering if maybe they'd raised that. Maybe what sort of advertising at certain times and not at other times and stuff like that. Yeah, It must have all felt the pressure to buy stuff.
00:08:10:20 - 00:08:39:11
Knut-Inge Klepp
Yeah, exactly. So we felt that they then both were pointing at the things that they could do themselves, but also being empowered in the way that they could argue for political changes. And we created dialog tools then where they could sit down with adults, they could represent businesses or other policy and decision makers and argue in favor of their proposals in a safe manner.
00:08:39:16 - 00:08:51:07
Abigail Acton
Oh, that's excellent. So it wasn't just a sort of theoretical concept. It was also giving them that voice really. And did any of these little kind of meetings go ahead where they were sitting down and talking to people who could make changes?
00:08:51:09 - 00:09:02:03
Knut-Inge Klepp
Yes. We had quite a few of them. This happened during the pandemic. So when we had planned to do this all in a physical setting in a room, we had to do it more digitally.
00:09:02:03 - 00:09:04:03
Abigail Acton
Yeah, we all had to learn how to do that.
00:09:04:08 - 00:09:17:05
Knut-Inge Klepp
Yeah. And it had some cost, but it also had some advantages in that we could bring together, young people from different countries and different settings. So that made the discussions more richer than we had anticipated.
00:09:17:07 - 00:09:23:05
Abigail Acton
There also might have been a feeling of less pressure for the younger ones not actually physically being in a room full of strange adults.
00:09:23:05 - 00:09:23:14
Knut-Inge Klepp
Yeah.
00:09:23:16 - 00:09:26:05
Abigail Acton
They might have felt more secure just chatting from their living rooms.
00:09:26:07 - 00:09:45:05
Knut-Inge Klepp
Yes, definitely. And at the same time, we really tried to set these dialog forums up in such a way that there should be a majority of young people, that they should be able to present themself in a way that made everyone stock more on equal footing. So it was safe, for them to participate.
00:09:45:09 - 00:09:51:18
Abigail Acton
Excellent. That's really excellent. Thank you. What do you think is the key thing that you want to take away from this project? What's the one message that's most important?
00:09:51:21 - 00:10:11:05
Knut-Inge Klepp
Well, it is the importance of listening to young people. They are the experts on their own situation. And I think also we see in this changing world the context that young people grow up in is also changing extremely fast. So we can't just rely on previous experience. We had to talk to people here and now.
00:10:11:11 - 00:10:19:13
Abigail Acton
Yeah. Have a rapid response. Yeah. Excellent. If you were building on the work that you've done so far, what would be the thing that you would do next?
00:10:19:15 - 00:10:42:10
Knut-Inge Klepp
Maybe, to be able to work in a local context and take it even further to follow up with local politicians, not only in the planning phase and the conceptual phase that we did for a long, for the most part, but also to see, well, if implemented, what impact is this going to have? So to bring in the young voice in all aspects of the policy change process?
00:10:42:12 - 00:10:46:05
Abigail Acton
Yeah, that makes sense. Jason, you have a question or an observation?
00:10:46:07 - 00:11:17:09
Jason Halford
It's really interesting data. And this idea of co-production I think is really good. I think you one of the first projects I've seen to do this really well in the obesity space. I focus on adolescents as well, who tend to fall between the stool of adults, child support. Did you get any feelings from the project about how supported adolescents living with obesity felt in their national health care systems, or how much blame or shame they felt, and whether that had an impact on how they engaged?
00:11:17:11 - 00:11:39:15
Knut-Inge Klepp
Yes, that's a really good, question, Jason. As I said, mental health was such an important aspect. And of course, the stigma issue was kind of something that came up right away in these discussions. We did not particularly work with, children, adolescents that were obese. And we didn't ask them about their weight or didn't even observe it.
00:11:39:15 - 00:11:50:14
Knut-Inge Klepp
They were kind of blinded to that. We want their concepts on focusing more on primary prevention, but it is clearly something that the young people are aware of.
00:11:50:16 - 00:12:13:17
Abigail Acton
Excellent. Thank you very much Knut-Inge. That was really well explained. I'm going to turn to Sharleen now. Sharleen, IMPACT DIABETES B2B, which has Bump2Baby, aimed to identify those most at risk from developing gestational diabetes and to provide them with personalized coaching delivered via a smartphone app to empower the target group to make healthy decisions that would improve pregnancy and postpartum outcomes.
00:12:13:21 - 00:12:19:04
Abigail Acton
So can you tell us a little bit about the risk of gestational diabetes and its impact, please, Sharleen?
00:12:19:06 - 00:12:25:12
Sharleen O’Reilly
Yeah, absolutely. I suppose, to make it feel a little bit more real, I'm going to kind of paint a picture.
00:12:25:16 - 00:12:26:06
Abigail Acton
Please do.
00:12:26:07 - 00:12:54:05
Sharleen O’Reilly
And so let's imagine a woman, we call her Sarah. You know, she's delighted since she's expecting her first baby. She's in her early 30s. And when she comes in for her first appointment, she's in the overweight category of her body mass index, which in essence, is the average woman that attends maternity services across Ireland, England, the rest of Europe and pretty much worldwide.
00:12:54:07 - 00:13:20:23
Sharleen O’Reilly
But, you know, Sarah doesn't actually realize that the pregnancy will actually tell her a little bit about her metabolism. So, I mean, pregnancy is like a stress test, for future health. And so if a woman develops gestational diabetes during her pregnancy, it's not just about the blood sugar is that she's going to have to manage during those final few months.
00:13:21:00 - 00:13:54:15
Sharleen O’Reilly
It's actually a signal that without further support, she's actually at a much greater chance, so about 1 in 2, of developing type two diabetes within the next 5 to 10 years, and is the single strongest predictor we have within women of developing type two diabetes. So it's actually not just about Sarah, though at this point I wanted to raise, you know, when you have a pregnancy affected by gestational diabetes, her child is growing up in her womb in an environment that has raised blood sugars.
00:13:54:15 - 00:14:21:17
Sharleen O’Reilly
And what we know is that affects also the baby's metabolism. So it sort of preprograms the baby to be at higher risk of developing obesity and also type two diabetes. So in essence, what we're seeing is a slow onset of an event during life, and like Knut was saying, it's another transformative period in someone's life to be pregnant. And we can see that the risk is being passed from generation to generation.
00:14:21:19 - 00:14:42:15
Sharleen O’Reilly
And it's a really big global concern. So we know that about 1 in 8 women in Ireland experience gestational diabetes. But actually globally it's higher. So about 1 in 6. It's the most common complication a woman can experience while pregnant. And you know that's going to affect loads of babies across the world.
00:14:42:19 - 00:14:56:19
Abigail Acton
Yeah. And on an ongoing basis. Absolutely. Perhaps even a lifetime basis. Yes. Clearly very important. There must be work obviously, being done already on the whole notion of trying to prevent gestational diabetes. But how did your project differ, your approach?
00:14:56:21 - 00:15:17:13
Sharleen O’Reilly
Yeah. Well, I suppose one of the key things is that pregnancy offers us this incredible window of opportunity. It's a time when a woman is open to making changes to their health. They're in high contact with the health service, maybe for the first time in their lives, and they actually know that their changes are going to impact the health of their child.
00:15:17:13 - 00:15:42:21
Sharleen O’Reilly
So they're invested in behavior change. And so you probably are thinking, sure, isn't there loads of preventative things being offered to women during pregnancy anyway because of this fact? But actually, yes. Yes and no, is the answer. So we know that they get excellent antenatal care in the countries in particular that we worked with. But what we also know is that the advice is generally nonspecific.
00:15:43:02 - 00:16:07:01
Sharleen O’Reilly
Clinics are dealing with large numbers of women and it's hard to provide. And so there's a gap with the traditional supports that are being provided in that they're not personalized. And it's typically, you know, a relationship that's relatively short term. And so once the woman is discharged from the maternity services, it's the time that actually the mum might actually need the most help.
00:16:07:03 - 00:16:29:03
Sharleen O’Reilly
And yet the service isn't there to support them at time. And, you know, when you think about poor Sarah, she's at home, she's got a baby and she has to look after, she's exhausted and she's not sleeping. She's trying to recover from potentially yet, you know, a big event in terms of her health and giving birth. And then she's also trying to learn how to breastfeed.
00:16:29:04 - 00:16:46:06
Sharleen O’Reilly
So it's a really hard time for a mum to actually, you know, be told that, you know, during pregnancy, they're at risk of developing this chronic disease, but they're in this chaotic period of their lives where there's a lot of demands being made to them and their health usually comes last.
00:16:46:08 - 00:17:00:21
Abigail Acton
Absolutely. You paint a very vivid picture there. I can just imagine that the temptation is simply to reach for the easiest food to hand, because you just do not want. You don't have the bandwidth to use it. Yeah, totally. No, I see what you mean. So what did the project set out to do to try and turn that around?
00:17:00:21 - 00:17:04:05
Abigail Acton
Tell me a little bit more about what you actually wanted to achieve and how it went.
00:17:04:10 - 00:17:28:07
Sharleen O’Reilly
Yeah. So two, three things differently, I suppose. The first was using a smartphone. And so women we already know are very high users. It's a high penetration of smartphones within this population. Women are already checking their phone several times a day. And so the support is going to them, at a time when they want it. So if it was a 3 a.m., you're off trying to breastfeed.
00:17:28:07 - 00:17:32:08
Sharleen O’Reilly
You can actually use a smartphone then. Or maybe during your lunch break.
00:17:32:08 - 00:17:36:07
Abigail Acton
Who would you reach out to at that time? Would it be like your peer group?
00:17:36:08 - 00:17:59:18
Sharleen O’Reilly
Yeah, well actually the application, Bump2Baby and Me, was able to allow the mum to either access a library of personalized resources, which includes like many videos and, you know, plain language information sheets about the information that she might need at that time. Or she could send a message to her health coach so she would record a video message if she wanted to.
00:17:59:18 - 00:18:07:16
Sharleen O’Reilly
And plenty of women did, or send a text message, you know, full of emojis, like crying face, you know, and...
00:18:07:16 - 00:18:13:10
Abigail Acton
Oh dear! And I guess, did they have health coaches then? Was that someone who was on the other end of the message?
00:18:13:16 - 00:18:38:01
Sharleen O’Reilly
Yeah. So, the women had, health coaches that were trained, health care professionals. We also upskill them in their health coaching. And so it meant that you had a resource that you contacted and had live phone calls with through video, so not really phone calls, through the app. And they had them at scheduled time.
00:18:38:01 - 00:19:01:17
Sharleen O’Reilly
So they had them at the start of the pregnancy, and they had them in the postpartum period, when they were trying to find their feet in that window, as well as if the mum developed gestational diabetes, she had an additional video call to see if she had any concerns about how her goals might need to change with the advice that she was receiving within her health care system about her diabetes.
00:19:01:17 - 00:19:13:19
Abigail Acton
So then we're talking about something that was very much more personalized, more accessible, and I guess maybe in a way also very cost effective, because did you find that you could produce this kind of service for a reasonable amount?
00:19:13:19 - 00:19:47:00
Sharleen O’Reilly
Yeah. So in essence, we were able to scale out the coaching. So a coach had a number of women. Liva Healthcaree is a small to medium sized enterprise that supports the Bump2Baby and Me app, and they're based in Denmark and the UK. And so they in essence helped us treat our platform that they've established and use within the NHS for providing health coaching, so that we had a trusted platform that the women could come into and one health coach could manage around 150 mums.
00:19:47:01 - 00:19:48:10
Abigail Acton
Perfect. That sounds very efficient.
00:19:48:13 - 00:20:11:02
Sharleen O’Reilly
Yeah it is. And you know, they can work through their coaching sessions as they need to, but also provide asynchronous contacts. So the women were emailed back, like with videos. And from the health coach on, I can see you, you're working on this skill now, so okay, have you thought about this? That's great that you sent me that picture of your dinner yesterday.
00:20:11:04 - 00:20:14:14
Sharleen O’Reilly
You know, your plate should be roughly half vegetables, you know?
00:20:14:16 - 00:20:27:00
Abigail Acton
Yeah. So basically very personalized, very much like having your hand held at a particularly difficult time. It sounds like excellent research. Well done. Superb. Does anyone have any observations or comments to make to Sharleen? Yes, Knut-Inge.
00:20:27:02 - 00:20:46:00
Knut-Inge Klepp
Yeah. Thank you. This is a really important and exciting work going on. I was just wondering if you see any potential for bringing this young, connecting these young women in any way, to have them support each other or also contribute to further year round research.
00:20:46:04 - 00:21:10:02
Sharleen O’Reilly
Yeah, absolutely. We did actually have a in-built forum so that the women could connect with one another. What we found, though, because the program, in terms of the intervention, ran over such a long period of time - so they were being coached for 18 months - and that's practically unheard of in the health coaching space, it's typically about six months.
00:21:10:04 - 00:21:42:21
Sharleen O’Reilly
What we found was because women were joining at different periods of time, creating those sort of vital connections that they would have with the peer to peer network was a little bit more tricky this time around, because we thought that they would connect more with one another. But what we found was because there was women coming in at different points of their pregnancy, there wasn't that nature of connection, in terms of "we're all starting this at the same time", but we have been funded to do a new version of the project.
00:21:42:22 - 00:21:43:15
Abigail Acton
Oh, excellent.
00:21:43:15 - 00:21:45:15
Sharleen O’Reilly
Which is called Baby and Me Plus.
00:21:45:15 - 00:21:48:03
Abigail Acton
Excellent. Bravo, you!
00:21:48:05 - 00:22:18:16
Sharleen O’Reilly
Yeah. So that project, is also funded through the European Horizon Partnerships. We're using new countries. So we're delivering the app in four different languages this time, as opposed to three in English, one in Spanish. And the women will be coming through at the same time. So we think that the usage of that forum to peer to peer support is actually going to be improved this time around, because the women will be feeling like the women are more like them.
00:22:18:16 - 00:22:20:19
Abigail Acton
Yeah, it's more of a cohesive group.
00:22:20:19 - 00:22:36:03
Sharleen O’Reilly
We know that it's really important because, women learn best, as you said yourself. They're their own experts. And they bring their own lived experience to each and every encounter that they have for the health care professional.
00:22:36:03 - 00:22:56:01
Abigail Acton
That's a really exciting development, Sharleen. Fabulous. Bravo! It's a compliment to your hard work so far. I'm going to turn to Jason now. Jason, identifying and addressing the barriers to the use of sweeteners was one of the aim of the SWEET project. Along with examining the risks and the benefits of replacing sugar generally. So can you tell us what interested you about the role in the nature of sweeteners?
00:22:56:03 - 00:22:59:06
Abigail Acton
Why do you feel they have an important, of an important role to play?
00:22:59:12 - 00:23:23:02
Jason Halford
Well, we know that, sugar has a role in the obesity problems that we're suffering in Europe with many adults in Europe, living with obesity or living with overweight. And we know it contributes it to the high density of calories. We know that sugar in sweetened beverages does not impact an appetite leading to overconsumption. And we also know that sugar is very rewarding.
00:23:23:08 - 00:24:09:15
Jason Halford
It's very rewarding to, again, driving over consumption. And that's for a long period of time, many companies had looked at sweeteners as a way of replacing sugars, largely in drinks and beverages rather than foods, although increasingly in food applications as well. But I think still long term uncertainties really. You can see a lot of concern, both in the academic research community, but also more broadly in the public, as well, because while experimental studies and even long term trials suggest that sweeteners, or at least certain sweeteners, can bring us benefits in terms of appetite control and weight management, there is a large body of observational and epidemiological data that
00:24:09:15 - 00:24:17:04
Jason Halford
suggest that consumption can be associated with obesity. Adverse cardiometabolic effects is a problem that.
00:24:17:08 - 00:24:24:21
Abigail Acton
That's very interesting, Jason. Associated with obesity. Could you be able to just very briefly explain what the connection might be? I mean, if that sounds counterintuitive, somehow.
00:24:24:24 - 00:24:27:01
Jason Halford
It does sound counterintuitive.
00:24:27:03 - 00:24:49:14
Jason Halford
And some people have argued to the notion of reverse causality: is the obesity what's driving the sweetener consumption rather than the sweetener consumption driving the obesity? And observational studies have a power of large numbers of people. They're great. You can look across at population living in the real world. But a lot of it also relies on self-report measures as well and dietary data.
00:24:49:14 - 00:25:22:02
Jason Halford
Self-reported dietary data can be problematic, but there are ways around that. You could do urine tests for certain sweeteners, not all sweeteners you can test for biologically, but there are ways around to addressing that sort of problem. So we were really interested in digging down on this, and we wanted to see whether actually replacing dietary struggle with the traditional and new low calorie or no calorie sweeteners, but also things called sweetener enhancers as well could act as safe, effective tools to address obesity and these related pathologies.
00:25:22:04 - 00:25:38:11
Jason Halford
And we're also interested in the impact of switching from sugar to sweeteners. In terms of environmental sustainability: Would there be benefits? Would it be detrimental? We had to model that on a lifecycle basis. With each of these ingredients that we're looking at against sugar.
00:25:38:13 - 00:26:02:20
Abigail Acton
It sounds very in-depth and complex, but not in a bad way. I mean intriguing project, multi strand. You will be looking at lots of different things. If we consider two of those because that's the time span unfortunately that we have, if we talk about safety and if we talk about public perceptions. So first of all, safety I mean like many people I've heard sort of vague sort of rumors that some sweeteners might not be so good for you and so on.
00:26:03:00 - 00:26:06:16
Abigail Acton
What did you find out with regards to the safety of using sweeteners?
00:26:06:18 - 00:26:33:24
Jason Halford
We examined safety in everything we did, and we had numerous studies, both acute and medium term. But we conducted a one year multicenter trial across Europe evaluating replacing sugar with low calorie sweeteners versus just standard, reduced sugar advice. And we looked at it in a weight loss and weight maintenance sort of paradigm. And we measured body weight, body fat mass and body fat mass distribution, gut microbiota composition -
00:26:33:24 - 00:26:59:14
because there's been some issues around that, and whether the changes the sweeteners produce are beneficial or not - cardiometabolic risk factors, glucose and insulin, and we looked also safety markers, including allergenicity, which interesting we looked at through cravings and food preferences, because there is a belief in some circles, scientific circles, that actually sweeteners encourage the consumption of sweet flavors, which again, would boost sugar consumption as well.
00:26:59:14 - 00:27:05:03
Jason Halford
So undo all that good work. And we also looked at adverse events such as GI symptoms and headaches.
00:27:05:03 - 00:27:06:22
Abigail Acton
Hang on a second. What is a GI symptom?
00:27:06:23 - 00:27:15:02
Gastrointestinal system. Some of these things are broken down the gut and that can cause some discomfort if you're moving or changing your diet as well.
00:27:15:05 - 00:27:17:17
Abigail Acton
And what sort of findings did you did you come up with?
00:27:17:19 - 00:27:43:03
Jason Halford
Well, actually, in terms of using the sweeteners, they maintained more weight loss, about 7.2kg compared with the control, which was the advice group, which managed to maintain 5.6kg at one year. But the difference between those two are clinically significant and in the favour of sweeteners. And so replacing dietary sugar could be a safe and effective tool in terms of combating obesity and its pathologies.
00:27:43:08 - 00:27:52:22
Jason Halford
But also sweetener consumption per se did not negatively impact cardiometabolic health or cause harmful microbial gut patterns.
00:27:53:01 - 00:28:21:17
Abigail Acton
So we're saying that there was an idea that maybe sweeteners could damage the cardiometabolic health. And in fact, it was shown that they didn't by your study. That's excellent. Okay. And if I was to move on to the public perception concept, because, you know, as a scientist, you can establish this, you can conduct research. But we all are coming from one fundamental point, which is that we have to get the members of the community that we are trying to help on board and motivated.
00:28:21:19 - 00:28:25:08
Abigail Acton
So what did you find with regards to the public perception?
00:28:25:10 - 00:28:46:15
Jason Halford
Well, I mean, there are some interesting results if you look nation by nation; they're very different in attitudes to both sweeteners, but also the credibility of scientific advice around sweeteners. Consumers don't always trust the scientific advice and so don't hold it in high regard. And another interesting thing is gender and age-related splits, which were completely different in different countries as well.
00:28:46:17 - 00:29:09:19
Jason Halford
But we did find across the piece that consumers were looking for ways to, reduce sugar intake. And they were considering, sweeteners as a potential tool for weight management, particularly this idea of reducing their sugar cravings, which people found a big issue when switching from sugar to non-sugar products. But often particularly, I think, because of experience or previous experience.
00:29:09:21 - 00:29:34:02
Jason Halford
So, with some of the older products out there, they were often considered less tasty or sweet than their sugar-sweetened counterparts. Sometimes there was that chemical taste associated with them as well, and that was a real barrier to the consumer experience of swapping from sugar to sweeteners. And I think consumers had higher, more positive perceptions of plant-based or what they considered natural sweeteners.
00:29:34:02 - 00:29:35:10
Abigail Acton
Yes, I can imagine.
00:29:35:10 - 00:29:49:03
Jason Halford
It could have been things like stevia. Even though stevia is produced in a factory. It's perceived as natural compared with what people would term artificial sweeteners. And that term 'artificial' is, again, a real area.
00:29:49:03 - 00:30:02:06
Abigail Acton
It's huge turnoff. Yeah. I mean, after all, stevia is a plant and sugar is a plant. So hey. Yeah. Thank you Jason. That's very interesting. Fascinating research. Thank you. Does anyone have any observations to make to Jason? Yeah. Sharleen.
00:30:02:08 - 00:30:35:24
Sharleen O’Reilly
Yes. It's super research and I'm quite interested in the impact of sweeteners during pregnancy. So did you look at any of that. Because there is good evidence to say that different sweeteners have differential impacts, potential animal pregnancies. And we don't have clear data from what I understand in children. But we can also see their sex specific impacts, which is kind of weird, but, very true for animal models, I don't know, did you see anything in your project or was anybody looking at that?
00:30:36:01 - 00:30:54:24
We didn't. I think we weren't using pregnant women. I think that was one of the exclusion criteria, although often we were recruiting families because we also wanted to look at this in children. But it turned out we were also doing this in the pandemic, and it was hard enough to get the adults to come into the laboratory. It was difficult across the countries we were doing it.
00:30:55:05 - 00:31:20:10
Jason Halford
Things were particularly strict in the Netherlands and in Copenhagen, perhaps less strict in Greece. There were differential things, so we didn't look at that and certainly, yes, these things are tested in models which look at their potential, deleterious or dangerous effects. And they're not allowed in the market. That said, it's an important point that each of these things is a different chemical.
00:31:20:10 - 00:31:36:19
Jason Halford
So to bag them all together, you know, I think often people just say sweeteners, all sweeteners, and it's all one thing. And there're very diverse amounts of these things; and new ones are coming forward, and it's very important that we keep on top of the testing for this.
00:31:36:21 - 00:31:53:23
Abigail Acton
Absolutely. Because the market must be absolutely massive for this sort of thing. Listen, the three of you have been really interesting today. And I love the way that you're coming at it from slightly different angles. But basically we are just talking about empowerment here one way or another. So thank you very much for your research and thank you for sharing your time with me this morning.
00:31:54:00 - 00:31:54:09
Sharleen O’Reilly
Thank you,
00:31:54:12 - 00:31:56:00
Jason Halford
Thank you very much.
00:31:56:02 - 00:31:56:10
Jason Halford
00:31:56:12 - 00:31:57:00
Knut-Inge Klepp
Thank you.
00:31:57:04 - 00:32:00:04
Abigail Acton
Bye bye!
00:32:00:06 - 00:32:22:10
Abigail Acton
If you've enjoyed this podcast, follow us on Spotify or Apple and check out the podcast homepage on the CORDIS website. Subscribe to make sure the hottest research and EU funded science isn't passing you by. And if you're enjoying listening, why not spread the word? We've talked about robotic harvesters so dexterous that they can pluck ripe grapes off vines without bruising.
00:32:22:12 - 00:32:41:15
Abigail Acton
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00:32:41:17 - 00:32:48:19
Abigail Acton
We're always happy to hear from you. Drop us a line editorial@cordis.europa.eu. Until next time.
This is an AI transcription.
00:00:16:05 - 00:00:44:14
Abigail Acton
Hello and welcome to this episode of CORDIScovery with me, Abigail Acton. Obesity and being overweight is affecting children in the EU and worldwide at epidemic levels. In some countries, nearly 40% of children are impacted. An adolescent who is overweight has a high chance of becoming an obese adult, increasing their risk of a range of health related problems from type two diabetes, hypertension and coronary disease to the impact on mental health of people and their quality of life.
00:00:44:16 - 00:01:21:19
Abigail Acton
Policies aimed at reducing childhood obesity are challenging to implement and compliance can be irregular. So would involving adolescents in the process of developing the policies that are designed to help them make a difference? The International Diabetes Federation projects the number of people in the EU with the condition will rise to over 72 million by 2050. One warning flag for type two diabetes is gestational diabetes, the most common pregnancy complication women experience. Once again, can involving the group concerned in the decision making enable people to reduce their risk of maternal obesity?
00:01:21:21 - 00:01:46:04
Abigail Acton
Making the right choices is easier when healthier alternatives to the foods, which can have a negative impact on health, are available. So have we really made full use of sweeteners? And if not, why not? What benefits might they offer? Being overweight and having diabetes are major health challenges that can not only impact someone's quality of life, but are also putting a very real strain on health services that are, in many countries, thinly stretched already.
00:01:46:08 - 00:01:53:20
Abigail Acton
So what light can our three guests shine on these and other important questions?
00:01:53:22 - 00:02:15:03
Abigail Acton
All three have been supported by EU research and innovation funding. So here to share some of their findings are Knut-Inge Klepp, special adviser at the Norwegian Institute of Public Health and professor in public health nutrition at the University of Oslo. He's interested in health promotion among children and adolescents, and how to engage with young people in a way that makes a real difference.
00:02:15:06 - 00:02:16:04
Abigail Acton
Welcome, Knut-Inge.
00:02:16:09 - 00:02:17:12
Knut-Inge Klepp
Thank you.
00:02:17:14 - 00:02:40:18
Abigail Acton
Sharleen O’Reilly is a registered dietitian and professor of human nutrition at the University College Dublin in Ireland. Her research focuses on trying to improve women and children's health by preventing chronic diseases like heart disease or diabetes, through behavior change and health promotion. Hello, Sharleen. Welcome. And then we have Jason Halford, a professor of psychology at the University of Leeds.
00:02:40:20 - 00:02:49:04
Abigail Acton
Jason is interested in obesity, eating behavior and appetite. He is on the board of the European Coalition for People Living with obesity. Hi, Jason.
00:02:49:06 - 00:02:50:02
Jason Halford
Good morning.
00:02:50:04 - 00:03:08:00
Abigail Acton
Good morning to you. I'm going to turn to Knut-Inge first. CO-CREATE aimed to reduce childhood obesity and its co-morbidities by working with adolescents to create, inform and disseminate obesity preventative evidence based policies. Knut-Inge, what was the thinking behind the project? What problem were you looking to resolve?
00:03:08:02 - 00:03:36:03
Knut-Inge Klepp
Well, we thought that we really should listen to the young people to see what they think are the good solutions. So we know that adolescent time period, the teenage years is an incredible, interesting period of human life, where you go from being a child highly dependent on your parents and families to become an adult, making your own more independent decisions, and you acquire a lot of habits that you might take with you for the rest of your life.
00:03:36:05 - 00:03:44:07
Knut-Inge Klepp
So what was their perspective? and what could we learn? I mean, after all, they are the experts on their own life and the environment they're living in.
00:03:44:10 - 00:03:53:20
Abigail Acton
Absolutely. Has this been done much before? Because I've not really heard of many studies that have been trying to bring in younger people into this kind of process.
00:03:53:22 - 00:04:14:02
Knut-Inge Klepp
There has been some work that dates back looking at, for example, peer education, but very often then the young people were asked to deliver a message that had been created by adults. So it is more recently that we really want to listen to see what is that the young people bring to the table, what are their perspectives.
00:04:14:04 - 00:04:25:01
Abigail Acton
Right. No, absolutely. So tell me a little bit about the way that you conducted this research. Where did that participating kids come from and how did the project reach out and involve them, please? What did you actually do practically?
00:04:25:05 - 00:04:51:14
Knut-Inge Klepp
Yeah. So we worked in five European countries England, the Netherlands, Poland, Portugal and Norway, countries that are quite different. But in all of the countries, we see that there is a social gradient in that. We see difference in overweight and obesity rates depending on the socio economic background, the wealth and education of families. So we really wanted to include the variety of children from all kind of backgrounds.
00:04:51:16 - 00:05:19:12
Knut-Inge Klepp
So one way of doing that was going through the schools, schools located in different neighborhoods. But we also worked with the youth groups in Norway. For example, we have a youth organization named Plus, which is the youth organization of Save the Children, an organization run by and for young people in Portugal. They worked with the scout movement then recruited, young people from there.
00:05:19:14 - 00:05:44:00
Knut-Inge Klepp
And then, we sat down with the groups to see, what did they think where the causes of unhealthy eating and inactivity in their local environment. Identifying what we called the other drivers of obesity then, but not focusing so much on the disease, so overweight in itself, but more on eating and physical activity patterns.
00:05:44:00 - 00:06:01:02
Abigail Acton
Right. Exactly. Kind of the causes that would perhaps lead down that path, as you say, the lifestyle choices that could be laid down at that age, which might then actually, you know, benefit throughout the whole person's life. What the kids enthusiastic? Did you find that they wanted to party? I mean, they I can imagine maybe initially a little shy, but did they get into it?
00:06:01:06 - 00:06:36:07
Knut-Inge Klepp
Yeah, they did get into it. But of course, we thought we were the one who decided that we were going to focus on overweight and obesity, because that's what we had gotten funding to work on. But this is something that engage them. Quite a bit. One thing that came up that we hadn't thought so much about back when we started this work is the issue of mental health that in all countries that came up as one of the key elements that they wanted to discuss and thought that had a big impact on both eating habits of young people and an engagement of physical activity.
00:06:36:07 - 00:06:39:01
Knut-Inge Klepp
So that was really interesting to observe.
00:06:39:03 - 00:06:57:03
Abigail Acton
Yeah, it makes perfect sense once it's been pointed out, but it might not be the first thing you think of until it was pointed out. Yeah, it's an interesting insight. And, can you tell us some of the findings, in other words, did they come up with intriguing notions of how to do messaging or what might be effective?
00:06:57:03 - 00:06:58:09
Abigail Acton
What did they tell you?
00:06:58:11 - 00:07:10:04
Knut-Inge Klepp
Yes. So, as soon as they had decided, you know, what did they think were the drivers of the courses, then, so what is the solution? And we collected more than 100 really strong ideas.
00:07:10:08 - 00:07:11:13
Abigail Acton
Oh, excellent.
00:07:11:15 - 00:07:29:22
Knut-Inge Klepp
And, we were able to enlarge that in different ways. But that ranged from, for example, having more healthy or even cheaper food in the school setting, being active, able to be physically active, having active transportation to and from school in a safe manner.
00:07:29:24 - 00:07:31:11
Abigail Acton
What sort of... like safe bicycling?
00:07:31:11 - 00:07:59:23
Knut-Inge Klepp
Yeah. For example, and also, walking and also being able to engage in physical activity, free of, not having to pay, off the school, because the often high cost included in activity. But they also looked at more what we would call a policy, aspect at the national level, for example, how to reduce the digital marketing pressure that young people are experiencing.
00:07:59:24 - 00:08:10:17
Abigail Acton
I was wondering if maybe they'd raised that. Maybe what sort of advertising at certain times and not at other times and stuff like that. Yeah, It must have all felt the pressure to buy stuff.
00:08:10:20 - 00:08:39:11
Knut-Inge Klepp
Yeah, exactly. So we felt that they then both were pointing at the things that they could do themselves, but also being empowered in the way that they could argue for political changes. And we created dialog tools then where they could sit down with adults, they could represent businesses or other policy and decision makers and argue in favor of their proposals in a safe manner.
00:08:39:16 - 00:08:51:07
Abigail Acton
Oh, that's excellent. So it wasn't just a sort of theoretical concept. It was also giving them that voice really. And did any of these little kind of meetings go ahead where they were sitting down and talking to people who could make changes?
00:08:51:09 - 00:09:02:03
Knut-Inge Klepp
Yes. We had quite a few of them. This happened during the pandemic. So when we had planned to do this all in a physical setting in a room, we had to do it more digitally.
00:09:02:03 - 00:09:04:03
Abigail Acton
Yeah, we all had to learn how to do that.
00:09:04:08 - 00:09:17:05
Knut-Inge Klepp
Yeah. And it had some cost, but it also had some advantages in that we could bring together, young people from different countries and different settings. So that made the discussions more richer than we had anticipated.
00:09:17:07 - 00:09:23:05
Abigail Acton
There also might have been a feeling of less pressure for the younger ones not actually physically being in a room full of strange adults.
00:09:23:05 - 00:09:23:14
Knut-Inge Klepp
Yeah.
00:09:23:16 - 00:09:26:05
Abigail Acton
They might have felt more secure just chatting from their living rooms.
00:09:26:07 - 00:09:45:05
Knut-Inge Klepp
Yes, definitely. And at the same time, we really tried to set these dialog forums up in such a way that there should be a majority of young people, that they should be able to present themself in a way that made everyone stock more on equal footing. So it was safe, for them to participate.
00:09:45:09 - 00:09:51:18
Abigail Acton
Excellent. That's really excellent. Thank you. What do you think is the key thing that you want to take away from this project? What's the one message that's most important?
00:09:51:21 - 00:10:11:05
Knut-Inge Klepp
Well, it is the importance of listening to young people. They are the experts on their own situation. And I think also we see in this changing world the context that young people grow up in is also changing extremely fast. So we can't just rely on previous experience. We had to talk to people here and now.
00:10:11:11 - 00:10:19:13
Abigail Acton
Yeah. Have a rapid response. Yeah. Excellent. If you were building on the work that you've done so far, what would be the thing that you would do next?
00:10:19:15 - 00:10:42:10
Knut-Inge Klepp
Maybe, to be able to work in a local context and take it even further to follow up with local politicians, not only in the planning phase and the conceptual phase that we did for a long, for the most part, but also to see, well, if implemented, what impact is this going to have? So to bring in the young voice in all aspects of the policy change process?
00:10:42:12 - 00:10:46:05
Abigail Acton
Yeah, that makes sense. Jason, you have a question or an observation?
00:10:46:07 - 00:11:17:09
Jason Halford
It's really interesting data. And this idea of co-production I think is really good. I think you one of the first projects I've seen to do this really well in the obesity space. I focus on adolescents as well, who tend to fall between the stool of adults, child support. Did you get any feelings from the project about how supported adolescents living with obesity felt in their national health care systems, or how much blame or shame they felt, and whether that had an impact on how they engaged?
00:11:17:11 - 00:11:39:15
Knut-Inge Klepp
Yes, that's a really good, question, Jason. As I said, mental health was such an important aspect. And of course, the stigma issue was kind of something that came up right away in these discussions. We did not particularly work with, children, adolescents that were obese. And we didn't ask them about their weight or didn't even observe it.
00:11:39:15 - 00:11:50:14
Knut-Inge Klepp
They were kind of blinded to that. We want their concepts on focusing more on primary prevention, but it is clearly something that the young people are aware of.
00:11:50:16 - 00:12:13:17
Abigail Acton
Excellent. Thank you very much Knut-Inge. That was really well explained. I'm going to turn to Sharleen now. Sharleen, IMPACT DIABETES B2B, which has Bump2Baby, aimed to identify those most at risk from developing gestational diabetes and to provide them with personalized coaching delivered via a smartphone app to empower the target group to make healthy decisions that would improve pregnancy and postpartum outcomes.
00:12:13:21 - 00:12:19:04
Abigail Acton
So can you tell us a little bit about the risk of gestational diabetes and its impact, please, Sharleen?
00:12:19:06 - 00:12:25:12
Sharleen O’Reilly
Yeah, absolutely. I suppose, to make it feel a little bit more real, I'm going to kind of paint a picture.
00:12:25:16 - 00:12:26:06
Abigail Acton
Please do.
00:12:26:07 - 00:12:54:05
Sharleen O’Reilly
And so let's imagine a woman, we call her Sarah. You know, she's delighted since she's expecting her first baby. She's in her early 30s. And when she comes in for her first appointment, she's in the overweight category of her body mass index, which in essence, is the average woman that attends maternity services across Ireland, England, the rest of Europe and pretty much worldwide.
00:12:54:07 - 00:13:20:23
Sharleen O’Reilly
But, you know, Sarah doesn't actually realize that the pregnancy will actually tell her a little bit about her metabolism. So, I mean, pregnancy is like a stress test, for future health. And so if a woman develops gestational diabetes during her pregnancy, it's not just about the blood sugar is that she's going to have to manage during those final few months.
00:13:21:00 - 00:13:54:15
Sharleen O’Reilly
It's actually a signal that without further support, she's actually at a much greater chance, so about 1 in 2, of developing type two diabetes within the next 5 to 10 years, and is the single strongest predictor we have within women of developing type two diabetes. So it's actually not just about Sarah, though at this point I wanted to raise, you know, when you have a pregnancy affected by gestational diabetes, her child is growing up in her womb in an environment that has raised blood sugars.
00:13:54:15 - 00:14:21:17
Sharleen O’Reilly
And what we know is that affects also the baby's metabolism. So it sort of preprograms the baby to be at higher risk of developing obesity and also type two diabetes. So in essence, what we're seeing is a slow onset of an event during life, and like Knut was saying, it's another transformative period in someone's life to be pregnant. And we can see that the risk is being passed from generation to generation.
00:14:21:19 - 00:14:42:15
Sharleen O’Reilly
And it's a really big global concern. So we know that about 1 in 8 women in Ireland experience gestational diabetes. But actually globally it's higher. So about 1 in 6. It's the most common complication a woman can experience while pregnant. And you know that's going to affect loads of babies across the world.
00:14:42:19 - 00:14:56:19
Abigail Acton
Yeah. And on an ongoing basis. Absolutely. Perhaps even a lifetime basis. Yes. Clearly very important. There must be work obviously, being done already on the whole notion of trying to prevent gestational diabetes. But how did your project differ, your approach?
00:14:56:21 - 00:15:17:13
Sharleen O’Reilly
Yeah. Well, I suppose one of the key things is that pregnancy offers us this incredible window of opportunity. It's a time when a woman is open to making changes to their health. They're in high contact with the health service, maybe for the first time in their lives, and they actually know that their changes are going to impact the health of their child.
00:15:17:13 - 00:15:42:21
Sharleen O’Reilly
So they're invested in behavior change. And so you probably are thinking, sure, isn't there loads of preventative things being offered to women during pregnancy anyway because of this fact? But actually, yes. Yes and no, is the answer. So we know that they get excellent antenatal care in the countries in particular that we worked with. But what we also know is that the advice is generally nonspecific.
00:15:43:02 - 00:16:07:01
Sharleen O’Reilly
Clinics are dealing with large numbers of women and it's hard to provide. And so there's a gap with the traditional supports that are being provided in that they're not personalized. And it's typically, you know, a relationship that's relatively short term. And so once the woman is discharged from the maternity services, it's the time that actually the mum might actually need the most help.
00:16:07:03 - 00:16:29:03
Sharleen O’Reilly
And yet the service isn't there to support them at time. And, you know, when you think about poor Sarah, she's at home, she's got a baby and she has to look after, she's exhausted and she's not sleeping. She's trying to recover from potentially yet, you know, a big event in terms of her health and giving birth. And then she's also trying to learn how to breastfeed.
00:16:29:04 - 00:16:46:06
Sharleen O’Reilly
So it's a really hard time for a mum to actually, you know, be told that, you know, during pregnancy, they're at risk of developing this chronic disease, but they're in this chaotic period of their lives where there's a lot of demands being made to them and their health usually comes last.
00:16:46:08 - 00:17:00:21
Abigail Acton
Absolutely. You paint a very vivid picture there. I can just imagine that the temptation is simply to reach for the easiest food to hand, because you just do not want. You don't have the bandwidth to use it. Yeah, totally. No, I see what you mean. So what did the project set out to do to try and turn that around?
00:17:00:21 - 00:17:04:05
Abigail Acton
Tell me a little bit more about what you actually wanted to achieve and how it went.
00:17:04:10 - 00:17:28:07
Sharleen O’Reilly
Yeah. So two, three things differently, I suppose. The first was using a smartphone. And so women we already know are very high users. It's a high penetration of smartphones within this population. Women are already checking their phone several times a day. And so the support is going to them, at a time when they want it. So if it was a 3 a.m., you're off trying to breastfeed.
00:17:28:07 - 00:17:32:08
Sharleen O’Reilly
You can actually use a smartphone then. Or maybe during your lunch break.
00:17:32:08 - 00:17:36:07
Abigail Acton
Who would you reach out to at that time? Would it be like your peer group?
00:17:36:08 - 00:17:59:18
Sharleen O’Reilly
Yeah, well actually the application, Bump2Baby and Me, was able to allow the mum to either access a library of personalized resources, which includes like many videos and, you know, plain language information sheets about the information that she might need at that time. Or she could send a message to her health coach so she would record a video message if she wanted to.
00:17:59:18 - 00:18:07:16
Sharleen O’Reilly
And plenty of women did, or send a text message, you know, full of emojis, like crying face, you know, and...
00:18:07:16 - 00:18:13:10
Abigail Acton
Oh dear! And I guess, did they have health coaches then? Was that someone who was on the other end of the message?
00:18:13:16 - 00:18:38:01
Sharleen O’Reilly
Yeah. So, the women had, health coaches that were trained, health care professionals. We also upskill them in their health coaching. And so it meant that you had a resource that you contacted and had live phone calls with through video, so not really phone calls, through the app. And they had them at scheduled time.
00:18:38:01 - 00:19:01:17
Sharleen O’Reilly
So they had them at the start of the pregnancy, and they had them in the postpartum period, when they were trying to find their feet in that window, as well as if the mum developed gestational diabetes, she had an additional video call to see if she had any concerns about how her goals might need to change with the advice that she was receiving within her health care system about her diabetes.
00:19:01:17 - 00:19:13:19
Abigail Acton
So then we're talking about something that was very much more personalized, more accessible, and I guess maybe in a way also very cost effective, because did you find that you could produce this kind of service for a reasonable amount?
00:19:13:19 - 00:19:47:00
Sharleen O’Reilly
Yeah. So in essence, we were able to scale out the coaching. So a coach had a number of women. Liva Healthcaree is a small to medium sized enterprise that supports the Bump2Baby and Me app, and they're based in Denmark and the UK. And so they in essence helped us treat our platform that they've established and use within the NHS for providing health coaching, so that we had a trusted platform that the women could come into and one health coach could manage around 150 mums.
00:19:47:01 - 00:19:48:10
Abigail Acton
Perfect. That sounds very efficient.
00:19:48:13 - 00:20:11:02
Sharleen O’Reilly
Yeah it is. And you know, they can work through their coaching sessions as they need to, but also provide asynchronous contacts. So the women were emailed back, like with videos. And from the health coach on, I can see you, you're working on this skill now, so okay, have you thought about this? That's great that you sent me that picture of your dinner yesterday.
00:20:11:04 - 00:20:14:14
Sharleen O’Reilly
You know, your plate should be roughly half vegetables, you know?
00:20:14:16 - 00:20:27:00
Abigail Acton
Yeah. So basically very personalized, very much like having your hand held at a particularly difficult time. It sounds like excellent research. Well done. Superb. Does anyone have any observations or comments to make to Sharleen? Yes, Knut-Inge.
00:20:27:02 - 00:20:46:00
Knut-Inge Klepp
Yeah. Thank you. This is a really important and exciting work going on. I was just wondering if you see any potential for bringing this young, connecting these young women in any way, to have them support each other or also contribute to further year round research.
00:20:46:04 - 00:21:10:02
Sharleen O’Reilly
Yeah, absolutely. We did actually have a in-built forum so that the women could connect with one another. What we found, though, because the program, in terms of the intervention, ran over such a long period of time - so they were being coached for 18 months - and that's practically unheard of in the health coaching space, it's typically about six months.
00:21:10:04 - 00:21:42:21
Sharleen O’Reilly
What we found was because women were joining at different periods of time, creating those sort of vital connections that they would have with the peer to peer network was a little bit more tricky this time around, because we thought that they would connect more with one another. But what we found was because there was women coming in at different points of their pregnancy, there wasn't that nature of connection, in terms of "we're all starting this at the same time", but we have been funded to do a new version of the project.
00:21:42:22 - 00:21:43:15
Abigail Acton
Oh, excellent.
00:21:43:15 - 00:21:45:15
Sharleen O’Reilly
Which is called Baby and Me Plus.
00:21:45:15 - 00:21:48:03
Abigail Acton
Excellent. Bravo, you!
00:21:48:05 - 00:22:18:16
Sharleen O’Reilly
Yeah. So that project, is also funded through the European Horizon Partnerships. We're using new countries. So we're delivering the app in four different languages this time, as opposed to three in English, one in Spanish. And the women will be coming through at the same time. So we think that the usage of that forum to peer to peer support is actually going to be improved this time around, because the women will be feeling like the women are more like them.
00:22:18:16 - 00:22:20:19
Abigail Acton
Yeah, it's more of a cohesive group.
00:22:20:19 - 00:22:36:03
Sharleen O’Reilly
We know that it's really important because, women learn best, as you said yourself. They're their own experts. And they bring their own lived experience to each and every encounter that they have for the health care professional.
00:22:36:03 - 00:22:56:01
Abigail Acton
That's a really exciting development, Sharleen. Fabulous. Bravo! It's a compliment to your hard work so far. I'm going to turn to Jason now. Jason, identifying and addressing the barriers to the use of sweeteners was one of the aim of the SWEET project. Along with examining the risks and the benefits of replacing sugar generally. So can you tell us what interested you about the role in the nature of sweeteners?
00:22:56:03 - 00:22:59:06
Abigail Acton
Why do you feel they have an important, of an important role to play?
00:22:59:12 - 00:23:23:02
Jason Halford
Well, we know that, sugar has a role in the obesity problems that we're suffering in Europe with many adults in Europe, living with obesity or living with overweight. And we know it contributes it to the high density of calories. We know that sugar in sweetened beverages does not impact an appetite leading to overconsumption. And we also know that sugar is very rewarding.
00:23:23:08 - 00:24:09:15
Jason Halford
It's very rewarding to, again, driving over consumption. And that's for a long period of time, many companies had looked at sweeteners as a way of replacing sugars, largely in drinks and beverages rather than foods, although increasingly in food applications as well. But I think still long term uncertainties really. You can see a lot of concern, both in the academic research community, but also more broadly in the public, as well, because while experimental studies and even long term trials suggest that sweeteners, or at least certain sweeteners, can bring us benefits in terms of appetite control and weight management, there is a large body of observational and epidemiological data that
00:24:09:15 - 00:24:17:04
Jason Halford
suggest that consumption can be associated with obesity. Adverse cardiometabolic effects is a problem that.
00:24:17:08 - 00:24:24:21
Abigail Acton
That's very interesting, Jason. Associated with obesity. Could you be able to just very briefly explain what the connection might be? I mean, if that sounds counterintuitive, somehow.
00:24:24:24 - 00:24:27:01
Jason Halford
It does sound counterintuitive.
00:24:27:03 - 00:24:49:14
Jason Halford
And some people have argued to the notion of reverse causality: is the obesity what's driving the sweetener consumption rather than the sweetener consumption driving the obesity? And observational studies have a power of large numbers of people. They're great. You can look across at population living in the real world. But a lot of it also relies on self-report measures as well and dietary data.
00:24:49:14 - 00:25:22:02
Jason Halford
Self-reported dietary data can be problematic, but there are ways around that. You could do urine tests for certain sweeteners, not all sweeteners you can test for biologically, but there are ways around to addressing that sort of problem. So we were really interested in digging down on this, and we wanted to see whether actually replacing dietary struggle with the traditional and new low calorie or no calorie sweeteners, but also things called sweetener enhancers as well could act as safe, effective tools to address obesity and these related pathologies.
00:25:22:04 - 00:25:38:11
Jason Halford
And we're also interested in the impact of switching from sugar to sweeteners. In terms of environmental sustainability: Would there be benefits? Would it be detrimental? We had to model that on a lifecycle basis. With each of these ingredients that we're looking at against sugar.
00:25:38:13 - 00:26:02:20
Abigail Acton
It sounds very in-depth and complex, but not in a bad way. I mean intriguing project, multi strand. You will be looking at lots of different things. If we consider two of those because that's the time span unfortunately that we have, if we talk about safety and if we talk about public perceptions. So first of all, safety I mean like many people I've heard sort of vague sort of rumors that some sweeteners might not be so good for you and so on.
00:26:03:00 - 00:26:06:16
Abigail Acton
What did you find out with regards to the safety of using sweeteners?
00:26:06:18 - 00:26:33:24
Jason Halford
We examined safety in everything we did, and we had numerous studies, both acute and medium term. But we conducted a one year multicenter trial across Europe evaluating replacing sugar with low calorie sweeteners versus just standard, reduced sugar advice. And we looked at it in a weight loss and weight maintenance sort of paradigm. And we measured body weight, body fat mass and body fat mass distribution, gut microbiota composition -
00:26:33:24 - 00:26:59:14
because there's been some issues around that, and whether the changes the sweeteners produce are beneficial or not - cardiometabolic risk factors, glucose and insulin, and we looked also safety markers, including allergenicity, which interesting we looked at through cravings and food preferences, because there is a belief in some circles, scientific circles, that actually sweeteners encourage the consumption of sweet flavors, which again, would boost sugar consumption as well.
00:26:59:14 - 00:27:05:03
Jason Halford
So undo all that good work. And we also looked at adverse events such as GI symptoms and headaches.
00:27:05:03 - 00:27:06:22
Abigail Acton
Hang on a second. What is a GI symptom?
00:27:06:23 - 00:27:15:02
Gastrointestinal system. Some of these things are broken down the gut and that can cause some discomfort if you're moving or changing your diet as well.
00:27:15:05 - 00:27:17:17
Abigail Acton
And what sort of findings did you did you come up with?
00:27:17:19 - 00:27:43:03
Jason Halford
Well, actually, in terms of using the sweeteners, they maintained more weight loss, about 7.2kg compared with the control, which was the advice group, which managed to maintain 5.6kg at one year. But the difference between those two are clinically significant and in the favour of sweeteners. And so replacing dietary sugar could be a safe and effective tool in terms of combating obesity and its pathologies.
00:27:43:08 - 00:27:52:22
Jason Halford
But also sweetener consumption per se did not negatively impact cardiometabolic health or cause harmful microbial gut patterns.
00:27:53:01 - 00:28:21:17
Abigail Acton
So we're saying that there was an idea that maybe sweeteners could damage the cardiometabolic health. And in fact, it was shown that they didn't by your study. That's excellent. Okay. And if I was to move on to the public perception concept, because, you know, as a scientist, you can establish this, you can conduct research. But we all are coming from one fundamental point, which is that we have to get the members of the community that we are trying to help on board and motivated.
00:28:21:19 - 00:28:25:08
Abigail Acton
So what did you find with regards to the public perception?
00:28:25:10 - 00:28:46:15
Jason Halford
Well, I mean, there are some interesting results if you look nation by nation; they're very different in attitudes to both sweeteners, but also the credibility of scientific advice around sweeteners. Consumers don't always trust the scientific advice and so don't hold it in high regard. And another interesting thing is gender and age-related splits, which were completely different in different countries as well.
00:28:46:17 - 00:29:09:19
Jason Halford
But we did find across the piece that consumers were looking for ways to, reduce sugar intake. And they were considering, sweeteners as a potential tool for weight management, particularly this idea of reducing their sugar cravings, which people found a big issue when switching from sugar to non-sugar products. But often particularly, I think, because of experience or previous experience.
00:29:09:21 - 00:29:34:02
Jason Halford
So, with some of the older products out there, they were often considered less tasty or sweet than their sugar-sweetened counterparts. Sometimes there was that chemical taste associated with them as well, and that was a real barrier to the consumer experience of swapping from sugar to sweeteners. And I think consumers had higher, more positive perceptions of plant-based or what they considered natural sweeteners.
00:29:34:02 - 00:29:35:10
Abigail Acton
Yes, I can imagine.
00:29:35:10 - 00:29:49:03
Jason Halford
It could have been things like stevia. Even though stevia is produced in a factory. It's perceived as natural compared with what people would term artificial sweeteners. And that term 'artificial' is, again, a real area.
00:29:49:03 - 00:30:02:06
Abigail Acton
It's huge turnoff. Yeah. I mean, after all, stevia is a plant and sugar is a plant. So hey. Yeah. Thank you Jason. That's very interesting. Fascinating research. Thank you. Does anyone have any observations to make to Jason? Yeah. Sharleen.
00:30:02:08 - 00:30:35:24
Sharleen O’Reilly
Yes. It's super research and I'm quite interested in the impact of sweeteners during pregnancy. So did you look at any of that. Because there is good evidence to say that different sweeteners have differential impacts, potential animal pregnancies. And we don't have clear data from what I understand in children. But we can also see their sex specific impacts, which is kind of weird, but, very true for animal models, I don't know, did you see anything in your project or was anybody looking at that?
00:30:36:01 - 00:30:54:24
We didn't. I think we weren't using pregnant women. I think that was one of the exclusion criteria, although often we were recruiting families because we also wanted to look at this in children. But it turned out we were also doing this in the pandemic, and it was hard enough to get the adults to come into the laboratory. It was difficult across the countries we were doing it.
00:30:55:05 - 00:31:20:10
Jason Halford
Things were particularly strict in the Netherlands and in Copenhagen, perhaps less strict in Greece. There were differential things, so we didn't look at that and certainly, yes, these things are tested in models which look at their potential, deleterious or dangerous effects. And they're not allowed in the market. That said, it's an important point that each of these things is a different chemical.
00:31:20:10 - 00:31:36:19
Jason Halford
So to bag them all together, you know, I think often people just say sweeteners, all sweeteners, and it's all one thing. And there're very diverse amounts of these things; and new ones are coming forward, and it's very important that we keep on top of the testing for this.
00:31:36:21 - 00:31:53:23
Abigail Acton
Absolutely. Because the market must be absolutely massive for this sort of thing. Listen, the three of you have been really interesting today. And I love the way that you're coming at it from slightly different angles. But basically we are just talking about empowerment here one way or another. So thank you very much for your research and thank you for sharing your time with me this morning.
00:31:54:00 - 00:31:54:09
Sharleen O’Reilly
Thank you,
00:31:54:12 - 00:31:56:00
Jason Halford
Thank you very much.
00:31:56:02 - 00:31:56:10
Jason Halford
00:31:56:12 - 00:31:57:00
Knut-Inge Klepp
Thank you.
00:31:57:04 - 00:32:00:04
Abigail Acton
Bye bye!
00:32:00:06 - 00:32:22:10
Abigail Acton
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Abigail Acton
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Giving people the tools they need to make healthier food choices
Obesity and being overweight is impacting children in the EU, and worldwide, at epidemic levels: in some countries nearly 40 % of children are affected. The International Diabetes Federation(opens in new window) projects the number of people in the EU, with the condition, will rise to over 72 million by 2050. An adolescent who is overweight has a high chance of becoming an obese adult, increasing their risk of a range of health-related problems, from type 2 diabetes, hypertension and coronary disease to the impact on the mental health of people and their quality of life. Policies aimed at reducing childhood obesity are challenging to implement, and compliance can be irregular – so would involving adolescents in the process of developing the policies that are designed to help them, make a difference? One warning flag for type 2 diabetes is gestational diabetes, the most common pregnancy complication women experience. Once again, can involving the group concerned, in the decision-making, enable women to reduce their risk of maternal obesity? Making the right choices is easier when healthier alternatives to the foods which can have a negative impact on health, are available. Have we really made full use of sweeteners? If not, why? What benefits might they offer? So, what light can our three guests shine on these, and other important questions? All three have been supported by EU research and innovation funding. So, here to share some of their findings are: Knut-Inge Klepp(opens in new window), special advisor at the Norwegian Institute of Public Health(opens in new window) and professor in Public Health Nutrition at the University of Oslo(opens in new window). He is interested in health promotion among children and adolescents, and how to engage with young people in a way that makes a difference, an idea he explored through the CO-CREATE project. Sharleen O’Reilly(opens in new window), coordinator of the IMPACT DIABETES B2B project, is a registered dietitian and professor of Human Nutrition at University College Dublin(opens in new window), Ireland. Her research focuses on trying to improve women and children’s health by preventing chronic diseases, such as heart disease or diabetes, through behaviour change and health promotion. Jason Halford(opens in new window) is a professor of Psychology at the University of Leeds(opens in new window). Jason is interested in obesity, eating behaviour and appetite. He is on the board of the European Coalition for People living with Obesity and coordinated the SWEET project.
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Keywords
Countries
Ireland, Norway, United Kingdom