Helen Croker - Academia.edu (original) (raw)

Papers by Helen Croker

Asia-Pacific Journal of Clinical Oncology

International journal of obesity (2005), Jan 20, 2014

Background:Despite a wealth of experimental studies on weight bias, little is known about weight ... more Background:Despite a wealth of experimental studies on weight bias, little is known about weight discrimination at the population level. This study examined the prevalence and socio-demographic correlates of perceived weight discrimination in a large population-based sample of older adults.Methods:Data were from 5307 adults in the English Longitudinal Study of Ageing; a population-based cohort of men and women aged ⩾50 years. Weight discrimination was reported for five domains (less respect/courtesy; treated as less clever; poorer treatment in medical settings; poorer service in restaurants/stores; threatened/harassed) at wave 5 (2010-2011). Height and weight were measured at wave 4 (2008-2009). We used logistic regression to test the odds of weight discrimination in relation to weight status, age, sex, wealth, education and marital status.Results:Perceived weight discrimination in any domain was reported by 4.6% of participants, ranging from 0.8% in the normal-weight participants t...

Obesity Reviews, 2011

Excessive pregnancy weight gain is associated with adverse maternal and child health outcomes. In... more Excessive pregnancy weight gain is associated with adverse maternal and child health outcomes. Intervention developers have assumed that adopting a healthier diet and increasing physical activity in pregnancy can limit weight gain, but evaluations of such interventions have yielded mixed results. Recent reviews of this literature have not identified defining characteristics of effective interventions. We systematically reviewed 10 published controlled trials of interventions that aimed to reduce gestational weight gain through changes in diet or physical activity. Characteristics of the sample, intervention content and delivery, and methodology were categorized. Meta-analysis showed that, overall, diet and physical activity change was effective in reducing gestational weight gain, but there was considerable heterogeneity in outcomes. Our analysis points to sample characteristics and aspects of intervention design, content, delivery and evaluation which differ between studies and may explain variation in effectiveness. Failure to evaluate changes in behaviour or its psychological determinants, and under-reporting of intervention content, may obscure identification of the processes by which weight change is effected. This limits our ability to discern active intervention ingredients. We suggest that behaviour-based gestational weight gain reduction interventions be more systematically designed, evaluated and reported to build on insights from behavioural science.

Eating and Weight Disorders - Studies on Anorexia, Bulimia and Obesity, 2011

There is evidence that black women are more satisfied with their body size despite higher rates o... more There is evidence that black women are more satisfied with their body size despite higher rates of overweight. One possible mechanism is differential exposure to ultrathin images. We hypothesized that models in magazines aimed at black women are not as thin as models in materials aimed at the general population. Pictures of women from magazines aimed at black women and magazines aimed at the general population were compared (N=51). Female raters (21 white, 21 black) matched pictures to one of four drawings depicting very thin to normal-weight women. The mean body size of pictures from black magazines was significantly higher than for general magazines (p<0.001, d=0.89); 85% of pictures from general magazines were in the two thinnest size categories compared with 46% of pictures from black magazines. Media aimed at black women are less likely to use extremely slim models, which could contribute to or reflect a greater range of acceptable body sizes.

BMC Public Health, 2012

Background: Primary care is the first port of call for advice about weight control. There is henc... more Background: Primary care is the first port of call for advice about weight control. There is hence a need for simple, effective interventions that can be delivered without specialist skills. We have developed such an intervention; the 10 Top Tips (10TT). This intervention was effective with respect to weight loss in a volunteer population, but has yet to be tested in primary care. The aim of this trial is therefore to test the effectiveness of the 10TT intervention in primary care, incorporating clinical outcomes and health economic analyses. Methods/Design: The trial is a two-arm, individually-randomised, controlled trial in obese (BMI ≥ 30) adults (n = 520) in primary care, comparing weight loss in patients receiving the 10TT intervention with weight loss in a control group of patients receiving usual care. The intervention is based on habit formation theory, using written materials to take people through a set of simple weight control behaviours with strategies to make them habitual; an approach that could make it more successful than others in establishing long-term behaviour change. Patients will be recruited from 14 General Practices across England. Randomisation will be through telephoning a central randomisation service using a computer-generated list of random numbers. Patients are followed up at 3, 6, 12, 18 and 24 months. The primary outcome is weight loss at 3 months, with assessment by a health professional who is blind to group allocation. Other follow-ups will be un-blinded. We will examine whether weight loss is maintained up to 24 months. We will also assess changes in the automaticity of the 10TT target behaviours and improvement in clinical markers for potential co-morbidities. Finally, we will undertake a full economic evaluation to establish cost-effectiveness in the NHS context. Discussion: If proven to be effective when delivered through primary care, 10TT could make a highly cost-effective contribution to improvements in population health.

American Journal of Clinical Nutrition, 2013

Background: As dietary gatekeepers for young children, parents are often the proximal target of f... more Background: As dietary gatekeepers for young children, parents are often the proximal target of family-based dietary interventions.

Journal of Smoking Cessation 2 68 72, 2007

In International Journal of Obesity Nature Publishing Group, May 1, 2007

The Lancet Diabetes & Endocrinology, 2015

Background Behavioural interventions might improve clinical outcomes in pregnant women who are ob... more Background Behavioural interventions might improve clinical outcomes in pregnant women who are obese. We aimed to investigate whether a complex intervention addressing diet and physical activity could reduce the incidence of gestational diabetes and large-for-gestational-age infants.

Archives of Disease in Childhood - Fetal and Neonatal Edition, 2011

ObjectivesTo develop a lifestyle intervention to improve pregnancy outcome in obese pregnancies.M... more ObjectivesTo develop a lifestyle intervention to improve pregnancy outcome in obese pregnancies.MethodsIn accord with UK MRC guidelines a phased approach towards development of an randomised controlled trials (RCT) was adopted by a multidisciplinary team. This included Phase I literature review and protocol development; Phase II pilot RCT to assess behavioural change and practicality; Phase III (multicentre RCT; primary outcomes; maternal

BMC Pregnancy & Childbirth, 2015

International journal of obesity (2005), 2005

To assess the accuracy of parents' perceptions of their 3 to 5 y old children's weight st... more To assess the accuracy of parents' perceptions of their 3 to 5 y old children's weight status in a large UK sample. Parental perception and concern about child weight, demographic variables, and children's height and weight were obtained for 564 parent-child dyads. Only 1.9% of parents of overweight children and 17.1% of parents of obese children described their child as overweight. The odds of parents perceiving the child as overweight were increased for overweight (2.7; 95% CI 0.4, 16.5) and obese (28.5; 7.1, 115.4) compared with normal weight children, but were not associated with parental weight or with any demographic factors. Although few parents perceived their overweight children as overweight, more (66.2%) expressed concern about their overweight child becoming overweight in the future. Odds of concern were progressively higher for overweight (2.5; 1.6, 3.9) and obese children (4.6; 2.2, 9.7), and were also higher for parents who were themselves overweight (1.9;...

BMC public health, Jan 3, 2014

Small-scale evaluations suggest that the provision of feedback to parents about their child's... more Small-scale evaluations suggest that the provision of feedback to parents about their child's weight status may improve recognition of overweight, but the effects on lifestyle behaviour are unclear and there are concerns that informing parents that their child is overweight may have harmful effects. The aims of this study were to describe the benefits and harms of providing weight feedback to parents as part of a national school-based weight-screening programme in England. We conducted a pre-post survey of 1,844 parents of children aged 4-5 and 10-11 years who received weight feedback as part of the 2010-2011 National Child Measurement Programme. Questionnaires assessed general knowledge about the health risks associated with child overweight, parental recognition of overweight and the associated health risks in their child, child lifestyle behaviour, child self-esteem and weight-related teasing, parental experience of the feedback, and parental help-seeking behaviour. Differenc...

Public Health Nutrition, 2012

Objective: Misperception of social norms may result in normalising unhealthy behaviours. The pres... more Objective: Misperception of social norms may result in normalising unhealthy behaviours. The present study tested the hypothesis that parents overestimate both the frequency of unhealthy snacking in pre-school children other than their own (descriptive norms) and its acceptability to other parents (injunctive norms). Design: A cross-sectional, self-report community survey. Questions assessed the frequency with which respondents' own child ate unhealthy snacks and their beliefs about the appropriate frequency for children to snack. Perceived descriptive norms were assessed by asking parents to estimate how often other 2-4 year-old children in their area ate snacks. Perceived injunctive norms were assessed by asking them about other parents' beliefs regarding the appropriate frequency for snacks. Misperceptions were assessed from (i) the difference between the prevalence of daily snacking and parents' perceived prevalence and (ii) the difference between acceptability of daily snacking and parents' beliefs about its acceptability to others. Setting: Pre-schools and children's centres in one borough of London, UK. Subjects: Parents (n 432) of children age 2-4 years. Results: On average, parents believed that more than half of 'other' children had snacks at least daily, while prevalence data indicated this occurred in only 10 % of families. The same discrepancy was observed for perceived injunctive norms: parents overestimated other parents' acceptance of frequent snacking, with two-thirds of parents having a self v. others discrepancy. Conclusions: Misperceptions were identified for descriptive and injunctive norms for children's snacking. Accurate information could create less permissive norms and motivate parents to limit their child's intake of unhealthy snacks.

Psychological Science, 2011

Parents commonly use rewards to encourage children to eat healthfully, but this practice remains ... more Parents commonly use rewards to encourage children to eat healthfully, but this practice remains controversial because rewards are suspected of undermining children's intrinsic motivation. A cluster-randomized trial examined children's acceptance of a disliked vegetable over 12 daily taste exposures. These exposures were paired with a tangible reward, a social reward, or no reward, and the findings were compared with the results from a no-treatment control condition. Liking and intake of the vegetable were assessed in a free-choice consumption task at preintervention, postintervention, 1 month after intervention, and 3 months after intervention. Liking increased more in the three intervention conditions than in the control condition, and there were no significant differences between the intervention conditions. These effects were maintained at follow-up. Children in both reward conditions increased consumption, and these effects were maintained for 3 months; however, the effects of exposure with no reward became nonsignificant by 3 months. These results indicate that external rewards do not necessarily produce negative effects and may be useful in promoting healthful eating.

Proceedings of the Nutrition Society, 2005

Obesity is a serious and increasing health issue. Approximately two-thirds of adults in the UK ar... more Obesity is a serious and increasing health issue. Approximately two-thirds of adults in the UK are now overweight or obese. Recent public health reports firmly reinforce the importance of engaging individuals to look after their health, including their weight. They also spell out the need for individuals to be supported more actively, on many levels, to enable this 'engagement'. Meanwhile, national surveys indicate that approximately two-thirds of adults are concerned about weight control, with one-third actively trying to lose weight. This finding is hardly surprising considering current weight statistics, plus the plethora of popular diets on offer. Weight-loss methods include diet clubs, diet books, exercise, meal replacements, advice from healthcare professionals and following a self-styled diet. Obesity is a multi-factorial problem, and losing weight and, in particular, maintaining weight loss is difficult and often elusive. It is argued that the modern obesogenic or 'toxic' environment has essentially taken body-weight control from an instinctive 'survival' process to one that needs sustained cognitive and skillbased control. The evidence suggests that health professionals can help individuals achieve longer-term weight control by supporting them in making sustainable lifestyle changes using a range of behavioural techniques. These techniques include: assessing readiness to change; self-monitoring; realistic goal setting; dietary change; increased physical activity; stimulus control; cognitive restructuring; relapse management; establishing ongoing support. Consistently working in a client-centred way is also being increasingly advocated and incorporated into practice to help motivate and encourage, rather than hinder, the individual's progress.

Preventive Medicine, 2014

Objective: Providing parents with information about their child's overweight status (feedback) co... more Objective: Providing parents with information about their child's overweight status (feedback) could prompt them to make lifestyle changes for their children. We assessed whether parents of overweight children intend to or change behaviours following feedback, and examined predictors of these transitions.

Asia-Pacific Journal of Clinical Oncology

International journal of obesity (2005), Jan 20, 2014

Background:Despite a wealth of experimental studies on weight bias, little is known about weight ... more Background:Despite a wealth of experimental studies on weight bias, little is known about weight discrimination at the population level. This study examined the prevalence and socio-demographic correlates of perceived weight discrimination in a large population-based sample of older adults.Methods:Data were from 5307 adults in the English Longitudinal Study of Ageing; a population-based cohort of men and women aged ⩾50 years. Weight discrimination was reported for five domains (less respect/courtesy; treated as less clever; poorer treatment in medical settings; poorer service in restaurants/stores; threatened/harassed) at wave 5 (2010-2011). Height and weight were measured at wave 4 (2008-2009). We used logistic regression to test the odds of weight discrimination in relation to weight status, age, sex, wealth, education and marital status.Results:Perceived weight discrimination in any domain was reported by 4.6% of participants, ranging from 0.8% in the normal-weight participants t...

Obesity Reviews, 2011

Excessive pregnancy weight gain is associated with adverse maternal and child health outcomes. In... more Excessive pregnancy weight gain is associated with adverse maternal and child health outcomes. Intervention developers have assumed that adopting a healthier diet and increasing physical activity in pregnancy can limit weight gain, but evaluations of such interventions have yielded mixed results. Recent reviews of this literature have not identified defining characteristics of effective interventions. We systematically reviewed 10 published controlled trials of interventions that aimed to reduce gestational weight gain through changes in diet or physical activity. Characteristics of the sample, intervention content and delivery, and methodology were categorized. Meta-analysis showed that, overall, diet and physical activity change was effective in reducing gestational weight gain, but there was considerable heterogeneity in outcomes. Our analysis points to sample characteristics and aspects of intervention design, content, delivery and evaluation which differ between studies and may explain variation in effectiveness. Failure to evaluate changes in behaviour or its psychological determinants, and under-reporting of intervention content, may obscure identification of the processes by which weight change is effected. This limits our ability to discern active intervention ingredients. We suggest that behaviour-based gestational weight gain reduction interventions be more systematically designed, evaluated and reported to build on insights from behavioural science.

Eating and Weight Disorders - Studies on Anorexia, Bulimia and Obesity, 2011

There is evidence that black women are more satisfied with their body size despite higher rates o... more There is evidence that black women are more satisfied with their body size despite higher rates of overweight. One possible mechanism is differential exposure to ultrathin images. We hypothesized that models in magazines aimed at black women are not as thin as models in materials aimed at the general population. Pictures of women from magazines aimed at black women and magazines aimed at the general population were compared (N=51). Female raters (21 white, 21 black) matched pictures to one of four drawings depicting very thin to normal-weight women. The mean body size of pictures from black magazines was significantly higher than for general magazines (p<0.001, d=0.89); 85% of pictures from general magazines were in the two thinnest size categories compared with 46% of pictures from black magazines. Media aimed at black women are less likely to use extremely slim models, which could contribute to or reflect a greater range of acceptable body sizes.

BMC Public Health, 2012

Background: Primary care is the first port of call for advice about weight control. There is henc... more Background: Primary care is the first port of call for advice about weight control. There is hence a need for simple, effective interventions that can be delivered without specialist skills. We have developed such an intervention; the 10 Top Tips (10TT). This intervention was effective with respect to weight loss in a volunteer population, but has yet to be tested in primary care. The aim of this trial is therefore to test the effectiveness of the 10TT intervention in primary care, incorporating clinical outcomes and health economic analyses. Methods/Design: The trial is a two-arm, individually-randomised, controlled trial in obese (BMI ≥ 30) adults (n = 520) in primary care, comparing weight loss in patients receiving the 10TT intervention with weight loss in a control group of patients receiving usual care. The intervention is based on habit formation theory, using written materials to take people through a set of simple weight control behaviours with strategies to make them habitual; an approach that could make it more successful than others in establishing long-term behaviour change. Patients will be recruited from 14 General Practices across England. Randomisation will be through telephoning a central randomisation service using a computer-generated list of random numbers. Patients are followed up at 3, 6, 12, 18 and 24 months. The primary outcome is weight loss at 3 months, with assessment by a health professional who is blind to group allocation. Other follow-ups will be un-blinded. We will examine whether weight loss is maintained up to 24 months. We will also assess changes in the automaticity of the 10TT target behaviours and improvement in clinical markers for potential co-morbidities. Finally, we will undertake a full economic evaluation to establish cost-effectiveness in the NHS context. Discussion: If proven to be effective when delivered through primary care, 10TT could make a highly cost-effective contribution to improvements in population health.

American Journal of Clinical Nutrition, 2013

Background: As dietary gatekeepers for young children, parents are often the proximal target of f... more Background: As dietary gatekeepers for young children, parents are often the proximal target of family-based dietary interventions.

Journal of Smoking Cessation 2 68 72, 2007

In International Journal of Obesity Nature Publishing Group, May 1, 2007

The Lancet Diabetes & Endocrinology, 2015

Background Behavioural interventions might improve clinical outcomes in pregnant women who are ob... more Background Behavioural interventions might improve clinical outcomes in pregnant women who are obese. We aimed to investigate whether a complex intervention addressing diet and physical activity could reduce the incidence of gestational diabetes and large-for-gestational-age infants.

Archives of Disease in Childhood - Fetal and Neonatal Edition, 2011

ObjectivesTo develop a lifestyle intervention to improve pregnancy outcome in obese pregnancies.M... more ObjectivesTo develop a lifestyle intervention to improve pregnancy outcome in obese pregnancies.MethodsIn accord with UK MRC guidelines a phased approach towards development of an randomised controlled trials (RCT) was adopted by a multidisciplinary team. This included Phase I literature review and protocol development; Phase II pilot RCT to assess behavioural change and practicality; Phase III (multicentre RCT; primary outcomes; maternal

BMC Pregnancy & Childbirth, 2015

International journal of obesity (2005), 2005

To assess the accuracy of parents' perceptions of their 3 to 5 y old children's weight st... more To assess the accuracy of parents' perceptions of their 3 to 5 y old children's weight status in a large UK sample. Parental perception and concern about child weight, demographic variables, and children's height and weight were obtained for 564 parent-child dyads. Only 1.9% of parents of overweight children and 17.1% of parents of obese children described their child as overweight. The odds of parents perceiving the child as overweight were increased for overweight (2.7; 95% CI 0.4, 16.5) and obese (28.5; 7.1, 115.4) compared with normal weight children, but were not associated with parental weight or with any demographic factors. Although few parents perceived their overweight children as overweight, more (66.2%) expressed concern about their overweight child becoming overweight in the future. Odds of concern were progressively higher for overweight (2.5; 1.6, 3.9) and obese children (4.6; 2.2, 9.7), and were also higher for parents who were themselves overweight (1.9;...

BMC public health, Jan 3, 2014

Small-scale evaluations suggest that the provision of feedback to parents about their child's... more Small-scale evaluations suggest that the provision of feedback to parents about their child's weight status may improve recognition of overweight, but the effects on lifestyle behaviour are unclear and there are concerns that informing parents that their child is overweight may have harmful effects. The aims of this study were to describe the benefits and harms of providing weight feedback to parents as part of a national school-based weight-screening programme in England. We conducted a pre-post survey of 1,844 parents of children aged 4-5 and 10-11 years who received weight feedback as part of the 2010-2011 National Child Measurement Programme. Questionnaires assessed general knowledge about the health risks associated with child overweight, parental recognition of overweight and the associated health risks in their child, child lifestyle behaviour, child self-esteem and weight-related teasing, parental experience of the feedback, and parental help-seeking behaviour. Differenc...

Public Health Nutrition, 2012

Objective: Misperception of social norms may result in normalising unhealthy behaviours. The pres... more Objective: Misperception of social norms may result in normalising unhealthy behaviours. The present study tested the hypothesis that parents overestimate both the frequency of unhealthy snacking in pre-school children other than their own (descriptive norms) and its acceptability to other parents (injunctive norms). Design: A cross-sectional, self-report community survey. Questions assessed the frequency with which respondents' own child ate unhealthy snacks and their beliefs about the appropriate frequency for children to snack. Perceived descriptive norms were assessed by asking parents to estimate how often other 2-4 year-old children in their area ate snacks. Perceived injunctive norms were assessed by asking them about other parents' beliefs regarding the appropriate frequency for snacks. Misperceptions were assessed from (i) the difference between the prevalence of daily snacking and parents' perceived prevalence and (ii) the difference between acceptability of daily snacking and parents' beliefs about its acceptability to others. Setting: Pre-schools and children's centres in one borough of London, UK. Subjects: Parents (n 432) of children age 2-4 years. Results: On average, parents believed that more than half of 'other' children had snacks at least daily, while prevalence data indicated this occurred in only 10 % of families. The same discrepancy was observed for perceived injunctive norms: parents overestimated other parents' acceptance of frequent snacking, with two-thirds of parents having a self v. others discrepancy. Conclusions: Misperceptions were identified for descriptive and injunctive norms for children's snacking. Accurate information could create less permissive norms and motivate parents to limit their child's intake of unhealthy snacks.

Psychological Science, 2011

Parents commonly use rewards to encourage children to eat healthfully, but this practice remains ... more Parents commonly use rewards to encourage children to eat healthfully, but this practice remains controversial because rewards are suspected of undermining children's intrinsic motivation. A cluster-randomized trial examined children's acceptance of a disliked vegetable over 12 daily taste exposures. These exposures were paired with a tangible reward, a social reward, or no reward, and the findings were compared with the results from a no-treatment control condition. Liking and intake of the vegetable were assessed in a free-choice consumption task at preintervention, postintervention, 1 month after intervention, and 3 months after intervention. Liking increased more in the three intervention conditions than in the control condition, and there were no significant differences between the intervention conditions. These effects were maintained at follow-up. Children in both reward conditions increased consumption, and these effects were maintained for 3 months; however, the effects of exposure with no reward became nonsignificant by 3 months. These results indicate that external rewards do not necessarily produce negative effects and may be useful in promoting healthful eating.

Proceedings of the Nutrition Society, 2005

Obesity is a serious and increasing health issue. Approximately two-thirds of adults in the UK ar... more Obesity is a serious and increasing health issue. Approximately two-thirds of adults in the UK are now overweight or obese. Recent public health reports firmly reinforce the importance of engaging individuals to look after their health, including their weight. They also spell out the need for individuals to be supported more actively, on many levels, to enable this 'engagement'. Meanwhile, national surveys indicate that approximately two-thirds of adults are concerned about weight control, with one-third actively trying to lose weight. This finding is hardly surprising considering current weight statistics, plus the plethora of popular diets on offer. Weight-loss methods include diet clubs, diet books, exercise, meal replacements, advice from healthcare professionals and following a self-styled diet. Obesity is a multi-factorial problem, and losing weight and, in particular, maintaining weight loss is difficult and often elusive. It is argued that the modern obesogenic or 'toxic' environment has essentially taken body-weight control from an instinctive 'survival' process to one that needs sustained cognitive and skillbased control. The evidence suggests that health professionals can help individuals achieve longer-term weight control by supporting them in making sustainable lifestyle changes using a range of behavioural techniques. These techniques include: assessing readiness to change; self-monitoring; realistic goal setting; dietary change; increased physical activity; stimulus control; cognitive restructuring; relapse management; establishing ongoing support. Consistently working in a client-centred way is also being increasingly advocated and incorporated into practice to help motivate and encourage, rather than hinder, the individual's progress.

Preventive Medicine, 2014

Objective: Providing parents with information about their child's overweight status (feedback) co... more Objective: Providing parents with information about their child's overweight status (feedback) could prompt them to make lifestyle changes for their children. We assessed whether parents of overweight children intend to or change behaviours following feedback, and examined predictors of these transitions.