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C O N FE RE N C E R E P O R T

DOI: 10.1111/nbu.12012

The British Nutrition Foundations 45th Anniversary Conference: Behaviour change in relation to healthier lifestyles
V. Wells,* L. Wyness, S. Coe
*University of Westminster, London, UK (Placement Student at the British Nutrition Foundation, 2012); British Nutrition Foundation, London, UK

Royal College of Physicians, Regents Park, London, 26 June 2012

On 26 June 2012, the British Nutrition Foundation (BNF) held its 45th anniversary conference in London to discuss and debate how to inuence positive behaviour change in diet and lifestyle habits. The conference was attended by 140 delegates including representatives from the food industry and public health groups, as well as academics and students. The conference was chaired by Professor Judy Buttriss, BNF Director General; Ms Gill Fine, Consultant Public Health Nutritionist; and Mr Roy Ballam, BNF Education Programme Manager. Professor Alan Shenkin, BNFs Honorary President began by welcoming Her Royal Highness The Princess Royal to the conference. Her Royal Highness opened the conference with her keynote address acknowledging the very difcult territory of behaviour change. She highlighted the increasing prevalence of overweight and obesity and the decrease in physical activity levels across the UK over recent decades. She continued by saying there is a wealth of evidence to show that changing peoples behaviour can have a major impact on improving their health, but the precise reasons why people behave the way they do and what can motivate them to change their diet and lifestyle choices needs to be better understood in order to change behaviour. Professor Susan Michie, from University College London, gave the rst conference presentation on Eating and physical activity behaviour: a framework for interventions. Professor Michie discussed the thinking behind the COM-B System, which characterises behaviour (B) as an interaction between three necessary

Correspondence: Dr. Laura Wyness, Senior Nutrition Scientist, British Nutrition Foundation, Imperial House, 15-19 Kingsway, London WC2B 6UN, UK. E-mail: l.wyness@nutrition.org.uk

conditions: whether a person has the psychological or physical ability to enact the behaviour (Capability, C), that they have the physical and social environment that enables the behaviour (Opportunity, O), and the reective and automatic mechanisms that activate or inhibit behaviour (Motivation, M). Behaviour depends on the interaction between these three conditions. Professor Michie explained that a framework for designing interventions to change behaviour needed to have the following criteria: comprehensive coverage, coherence and clear linkage to a model of behaviour. Importantly, the framework must be useable and useful to policy makers, service planners and intervention designers. This led to the development of a new framework named the Behaviour Change Wheel (BCW). The BCW was derived from a systematic review of 19 previous frameworks and positions the COM-B model at the hub of a wheel, with nine separate intervention functions and seven policy categories (Michie et al. 2011a). Behaviour change techniques are the active ingredients within interventions that are designed to change behaviour. They are observable, replicable and irreducible components of an intervention, which can be used alone or usually in combination with other behaviour change techniques. Professor Michie has published a taxonomy of behaviour change techniques used in interventions (Abraham & Michie 2008) and is currently working on a study in which 93 behaviour change techniques have been identied (Michie et al. 2011b). Identication of behaviour change techniques is possible through analysis of data in systematic reviews, which can determine the technique or combination of techniques that is most effective. For example, Professor Michie and colleagues found that self-monitoring was an effective behaviour change technique across many intervention types, and that interventions that combined this with other self-regulatory techniques were twice as effective as those that did not include either (Michie et al. 2009).

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Professor Michie emphasised that the mode of delivery of behaviour change interventions also needs to be considered. There are numerous ways of delivering interventions and new technologies offer huge potential by being more mobile and current. She reminded the audience that when reading about interventions, there is often a description regarding mode of delivery, yet very little detail regarding the precise content of the intervention. When deciding upon the mode of delivery, factors to consider include, evidence of effectiveness, local relevance, practicability, affordability, and acceptability to the public and health professionals and sometimes even political acceptance. Professor Michie concluded that to address behaviour change, the starting point is to rstly understand the problem, followed by the target behaviour and then the context in which it exists, while drawing on the theories of behaviour. Appropriate behaviour change techniques then need to be identied and the full range of effective strategies to use considered. Only then can interventions be successfully implemented. For more information, please see Atkins & Michie, pp. 305 in this issue. Dr Melvyn Hillsdon, from the University of Exeter, spoke about promoting behaviour change in relation to physical activity at an individual level. He focused on giving a avour of motivational interviewing techniques and their role in behaviour change. Dr Hillsdon outlined common assumptions as to why people do not change from undesirable behaviours towards healthier ones. Firstly, they may not see their behaviour as being particularly problematic and as these unhealthy behaviours, such as being physically inactive, become more common in wider society, the behaviour then seems acceptable to those concerned. Also people may not be aware of what the current physical activity guidelines are, how to meet these guidelines or may not even care about following them (Miller 2004). Secondly, even when interventions are delivered specically to inform, educate and make people care, only small changes in behaviour can be seen and these are typically only sustained over short time periods. One alternative view explaining why these interventions do not lead to more sustainable changes in behaviour is unresolved ambivalence (i.e. having mixed feelings) in peoples own minds regarding the need for change. From a negative perspective, people often think of physical activity as hard work, tedious and boring. Hence, a person may accept that their current level of activity raises concerns about their future health, but they may also recognise the things they like about their current behaviour and what they would need to lose or give up in order to increase their physical activity. When

a person is ambivalent, or in two minds, they may think a lot about the changes they should make, but never get round to taking action. Motivational interviewing aims to unlock this ambivalence. Dr Hillsdon explained that research has shown that the way in which ambivalence is dealt with in a face-to-face consultation between a practitioner and their client actually changes how a person behaves during that consultation. Studies have shown that what people actually say out loud in a consultation can predict how they will behave in the future. The more the client talks about why they should change and what they might gain from change, rather than talking about the barriers to change, the more they seem to put these changes into practice. Furthermore, motivational interviewing is collaborative (i.e. the practitioner and the client need to work together). The relationship should be one of acceptance (client) and compassion (practitioner). Dr Hillsdon explained that motivational interviewing has two key components: a relationship component that focuses on the quality of the relationship between the practitioner and client; and, a technical component that focuses on the actual process involved. These two are dependent on each other (e.g. using the correct technical process without establishing a good relationship is not effective and does not lead to much behaviour change). Dr Hillsdon also highlighted that a key factor for the practitioner is to be empathic, to try to see things from the clients perspective. Studies have shown empathetic practitioners to encourage greater changes in behaviour than non-empathetic practitioners. Motivational interviewing uses specic language and communication skills to encourage the client to do most of the talking. Dr Hillsdon reminded the audience that many clients have well versed responses to defend themselves against the behaviour being encouraged by practitioners (i.e. typically beginning their sentences with a yes, but). The client needs to feel at ease and willing to talk about their behaviour. Practitioners should use open ended questions, demonstrate reective listening (i.e. reecting on what the client has said) and provide a summary of what the client has said. A powerful point in the interview is asking the client what it will take for them to take action. This is the important transition from talking to doing discussing change expectations and identifying opportunities for change. This should lead onto a specic plan of action with tangible goals. One example of a suitable way forward is to suggest going through a diary together for the next month. This should involve discussing likely eventualities for behaviour change, for example, asking when is the rst time you think you will take more physical exercise and if so

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what time in the day? What do you need to do to make arrangements for this? What might get in the way? What can you do if that happens? This can help the client to feel engaged because they will have a plan that they are actually leading. Dr Hillsdon nished by highlighting that there is support available in the form of the UK Department of Healths Lets Get Moving (Foster et al. 2009) physical activity care pathway (available at www.dh.gov.uk/ health/2012/03/lets-get-moving/). This is a resource that integrates motivational interviewing tools and can be used by either practitioners or clients. Dr James Stubbs from Slimming World discussed behaviour change in relation to weight control. He highlighted that there are numerous approaches to weight management, ranging from simple diets to bariatric surgery, but that all approaches involve changes in both diet and activity behaviour. Overall, weight-loss interventions themselves have changed over the years, having increased in duration, intensity and the amount of social support, all of which have had positive effects on weight outcomes. The complexity of weight-loss interventions, as well as the number of behavioural change techniques applied has also increased, which may be counterproductive because of the potential to overload some individuals. Any energy-controlled diet will reduce weight provided there is a caloric decit, but the problem with drastic diets is that they can induce binge eating or lead to rapid weight regain after dieting. Furthermore, regardless of media stories of the success of fad diets, it is well known that the most successful diets are those that promote steady weight loss and combine components of different dietary approaches. Typically, studies have shown that a low fat, higher protein and lower energy density diet that is palatable enough to maintain over a long period is the best way to control weight (Stubbs et al. 2010). Evidence suggests that reducing energy intake is more effective for promoting weight loss than increasing physical activity. One plausible explanation for this is that the capacity for habitually sedentary overweight people to partake in high levels of activity and to increase their energy expenditure on a day-to-day basis is limited. Dr Stubbs emphasised, however, that physical activity is very important for weight-loss maintenance and that those who maintain weight loss have typically increased physical activity levels, are more active and spend less time being sedentary than the general population. Dr Stubbs then discussed the transition from weight loss to weight-loss maintenance. He referred to studies

that suggest that common weight control behaviours associated with weight loss are not necessarily the same as the behaviours associated with successful weight-loss maintenance. This suggests that weight loss and weightloss maintenance involve two clusters of overlapping behaviours, which are, to some extent, shared, but also involve different behaviours (Sciamanna et al. 2011). Dr Stubbs then went on to describe the physiological adaptations that take place in the body following weight loss, which tend to promote weight regain. For example, the decrease in fat mass triggers hormone cascades, that are likely to increase food intake by stimulating appetite and food-based reward systems. Weight loss also reduces the basal metabolic rate and increases muscular efciency, both of which result in a decrease in energy expenditure. This tends to result in individuals being pulled back to the weight at which they started (i.e. before weight loss). Therefore, successful weightloss maintainers have to exercise more to maintain their energy expenditure and to control their appetite, so that they eat less and remain vigilant to catch small slips before they turn into relapses. This is relative to their behaviour before they lost weight and also to people of the same body weight who have never lost weight. Dr Stubbs referred to the National Weight Control Registry in the United States that recruits successful weight-loss maintainers. Requirements to be on the registry include a weight loss of at least 13.6 kg (the average is 30 kg) maintained for at least 1 year. Within the registry, records show precisely how weight loss is maintained by the individual and the behaviours employed are ranked into a league table. Cutting back on calories and being more active top the league table, but a whole range of other behaviours that differ between individuals are deployed (Klem et al. 1997, 2000; Wyatt et al. 2002; Phelan et al. 2003, 2006; Wing & Phelan 2005; Raynor et al. 2006; Catenacci et al. 2008). Among these behaviours, self-monitoring of weight and eating breakfast are important, as well as limiting certain foods, being consistent, but exible with eating patterns and catching small slips before big relapses. Maintaining personal wellbeing and psychosocial support are also critical for weight-loss maintenance. Regular physical activity at a high level and avoiding being hungry are also important factors. In his closing summary, Dr Stubbs stated that weight loss is a difcult journey where energy-controlled diets appear to be more important earlier on in the process, with physical activity being essential to weight-loss maintenance. Long-term personal self-management is required to progress from weight loss to habitual weight-loss maintenance. The risk of weight gain is

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decreased by maintaining a new pattern of behaviours after weight loss. Dr Stubbs concluded by saying that an environment that supports, facilitates and nurtures behaviour change gives people the capability, opportunity and motivation to navigate to a healthy weight. To view an e-Seminar recording Dr Stubbs presentation, see tinyurl.com/BNF-behaviour-change. For more information, also see Stubbs and Lavin (pp. 522) in this issue. Dr Paul Chadwick, from University College London provided an overview of factors that inuence food choice and dietary behaviour patterns. Although nutritional awareness is currently very prominent, functional nutritional literacy (i.e. being able to read and understand nutrition information) is generally low, particularly for socially disenfranchised groups. Dr Chadwick stated that although scientic understanding of the relationship between diet and health is growing, 62.8% of UK adults are overweight or obese (DH 2012). It is therefore reasonable to question whether efforts to educate individuals are missing something. He went on to describe the inuences on food choice, stating that they start very early in life and can be mapped by a series of discrete developmental phases, each with their own challenges where children rst begin to learn to accept the adult diet and acquire their own taste preferences. For some children, there are few opportunities to develop a liking for nutrient-rich foods. Liking of a food is proportionally related to the degree of exposure and generally most parents try giving new foods three times to a child, whereas 1015 tastes may be actually required to inuence liking. Food liking is a major determinant of food and drink consumption at all ages. Dr Chadwick explained that for most children, food preferences remain malleable and there is some evidence that this remains the case into adulthood. He emphasised that exposure is very important and the malleability of childrens food preferences depends largely on the family and the willingness and ability of the primary caregiver to provide and enforce healthy food consumption. The primary caregiver has been termed the nutritional gatekeeper. Evidence suggests that these nutritional gatekeepers are responsible for 72% of food decisions within a household (Wansink 2006). Dr Chadwick described the phenomenology of food choice and explained that adults typically make over 200 food-based decisions per day. People are, however, only consciously aware of 14.4 of these decisions, on average (Wansink & Sobal 2007). There is a category of research called mindless eating, which refers to the fact that a signicant proportion of human decision-making about food choice is largely beyond routine conscious

awareness. Environmental cues can directly inuence food consumption [e.g. the size of the bowl a person is eating from has been shown to inuence the amount of food consumed (Wansink & Sobal 2007)]. This could lead to people being unaware of how much they are eating and could explain why typically, personal accounts of eating behaviour are not usually accurate and it is common for people to report to healthcare professionals that they do not understand why they are overweight. This is commonly misinterpreted as denial. Dr Chadwick pointed out that the reality is that overconsumption of a small amount of calories over 10 years can result in a 10-point increase in body mass index. Given that many determinants of food choice are beyond conscious awareness, this might be a nonpathologising explanation for excessive weight gain. Much behaviour around food choice is habitual in nature and by denition outside our awareness, thereby making it almost impossible to control (Rothman et al. 2009). Habitual behaviour is more dependent on our environment than conscious control and this type of behaviour responds poorly to information-based interventions. Dr Chadwick suggested that generally, we may need to focus less on telling people what not to eat and more on helping and supporting people to acquire the desired response of avoiding overconsumption (e.g. re-structuring the environment in such a way as to provide cues for conscious recognition of the overconsumption of food). Nutritional interventions may be more successful if they incorporate an understanding of the development and maintenance of such processes. This may explain why multi-component interventions based on learning and self-regulation theory, such as the MEND programme (Mind, Exercise, Nutrition, Do it), are more successful than information provision in stimulating behaviour change. For more information, see Chadwick et al. pp. 3642 in this issue. The afternoon session included a variety of case studies on different aspects of behaviour change. The rst case study was provided by Professor Ken Fox, from the University of Bristol, who described the importance of partnerships between academia and commercial organisations as a means to encourage and increase physical activity for health enhancement and weight management. He outlined his own experiences of working on randomised controlled trials in collaboration with commercial companies. From his perspective, one of the advantages of working with a commercial weight-loss company was regular access (i.e. on a weekly basis) to a large overweight and obese population. When this organisation wanted to increase the emphasis on physical activity in

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their weight-loss programme, the challenges were to convince their members of the importance of physical activity for health and wellbeing, as well as to facilitate more positive attitudes towards physical activity amongst them; thereby providing a programme that would facilitate sustainable increases in physical activity. The materials used within the programme represented real people as models to inspire people to change behaviour, by highlighting the social (e.g. spending more time with family) and psychological benets of becoming more active, as well as the importance of increasing activity slowly and of selecting activities suited to ability. Professor Fox suggested that the use of real people as case studies is a more effective strategy to motivate the general public to be healthy rather than using elite athletes as role models. Professor Fox concluded by saying that academic and commercial partnerships can bring many advantages to research processes, including intervention design and delivery (i.e. can facilitate population access), enhanced communication and marketing resource capability, experienced knowledge of the population concerned, as well as experience of putting scientic evidence and theory into practical strategies that can be widely implemented in real world settings. Professor Paul Gately, from Leeds Metropolitan University and founder of MoreLife spoke about behaviour change for healthier lifestyles in children. Childhood obesity is recognised as a major public health challenge; however, interventions have had limited success. Professor Gately highlighted that there are 4.3 million overweight and obese children in the UK, and 140 000 of these children would be immediately eligible for surgery if they were adults. He argued that prevention is critical but that the risk of overweight and obesity for different groups needs to be considered before planning weight gain prevention and treatment interventions. To do this, one must rst track obesity from childhood to adulthood to determine the likelihood of obese children becoming obese adults. Data from longitudinal studies across a range of different countries has shown that between 6298% of obese children will become obese adults. Professor Gately highlighted a mismatch in the amount of money allocated to the prevention of obesity and the amount allocated to the treatment of childhood obesity by the UK government. For example, public spending from 2005 to 2010 was approximately 1 billion per annum on obesity prevention activities, such as school food and school sport programmes. During the same period, public spending on the treatment of childhood obesity was estimated at approximately 30

million (e.g. community programmes focused on children with a weight problem). Put in context, Professor Gately stated that if one in three children have a weight problem in the UK, then spending only 0.06% of the governments health budget on the treatment of childhood obesity was not appropriate. However, health professionals treating obesity should focus on the individual, as a one size ts all approach does not work, while they should also think beyond a 12-week intervention period and consider the huge variation in the needs of that individual. For more information, see Gately pp. 439 in this issue. Dr Victoria Burley, from the University of Leeds presented a case study on the development and testing of a mobile phone application for weight loss. UK data indicates that 93% of the population have or use a mobile phone (Ofcom 2011). The aim of this project was to develop, validate and investigate the feasibility and acceptability of a smartphone application (app) to support weight loss. The app, My Meal Mate, is based on the principle that self-monitoring of food and drink intake improves adherence to an energy intake goal. My Meal Mate enables users to set their own weight-loss goal and energy intake target on a daily basis but within safe and recommended targets based on gender, age and activity levels. The app estimates how many calories need to be consumed to lose weight within safe and recommended targets (Carter et al. 2012). Dr Burley presented the results of a pilot trial of the app. The trial involved 128 overweight and obese volunteers who were randomised to one of three 6-month weight management groups based on the principle of self-monitoring of food intake: My Meal Mate, an online weight-loss website or a paper food intake diary. Preliminary data suggested greater trial retention and a higher number of adherence days in the My Meal Mate group compared with the other two groups, as only three individuals dropped out of the My Meal Mate group compared with more than half of the volunteers in the online food diary and paper food diary groups. Also, over the 6-month trial period, My Meal Mate app users kept daily records of food intake for an average of three months compared to one month for the other two groups, therefore, adherence to the My Meal Mate app method was higher. This suggests more potential for feedback with a larger period of self-monitoring. Dr Burley concluded that the pilot trial suggests that My Meal Mate shows good potential as a convenient dietary assessment tool and further exploration through a full trial is warranted to test its efcacy in terms of generating weight loss. For more information, see Carter et al. pp. 804 in this issue.

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Dr Anne Haase, from the University of Bristol presented ndings from the TREAting Depression with physical activity trial (TREAD trial) (Chalder et al. 2012). Dr Hasse explained that the trial was set up following recent reviews that suggested that physical activity may have mood enhancing benets for those with depression. The intervention trial aimed to design and test the feasibility of a physical activity intervention for people with depression. The main research question was to determine whether physical activity in addition to standard care had any greater benet over that of usual care alone in reducing depressive symptoms. The randomised controlled trial was driven by patient preferences to ensure that they engaged with the physical activity and made plans for changing their behaviour using self-determination theory (i.e. promoting motivation through choice, condence and relatedness) (Ryan & Deci 2000) incorporating motivational interviewing (Vansteenkiste & Sheldon 2006) and behaviour change strategies to facilitate an increase in physical activity. There were three phases to the delivery of the intervention. Phase 1 was the intensive phase, where participants had frequent contact with a facilitator who provided behaviour change strategies through a motivational interviewing approach. Phase 2 was the patient-driven phase, which was negotiated between the facilitator and participant, and the nal exit phase was designed to help the patient to deal with any relapses and develop strategies to help regain condence and return to being physically active on a regular basis. The study did not nd that participants who were offered the physical activity intervention reported any improvements in mood or the symptoms of depression. However, participants within the intervention group signicantly increased and maintained their physical activity levels beyond the duration of the intervention. Furthermore, participants found the intervention highly acceptable and felt supported by their facilitators. A number of people felt that their mood had improved as a consequence of the increase in physical activity, although this was not detected medically. Dr Haase concluded that this theory-based motivational facilitation had successfully changed physical activity behaviours and could potentially be applied to other populations to improve physical health. Professor Paul Gilbert, from the University of Derby outlined the development of compassion-focused therapy for people with high levels of shame and selfcriticism, typically seen in those with severe depression who have relapsed while undergoing standard therapies. Shame and self-criticism are behavioural factors that are highly predictive of difculties in engaging with therapy.

Professor Gilbert explained that as an evolutionary psychopathologist, his approach was to start with an understanding of how we have evolved, in order to understand peoples difculties in that context. People who are selfcritical and shame prone also struggle with setbacks and become emotionally dysregulated, many of whom struggle with their weight. Those working within this eld look to identify normal behaviour in abnormal environments (e.g. consuming more food than required and leading a sedentary lifestyle could be considered a normal response to our abnormal obesogenic environment in an evolutionary context). Professor Gilbert outlined his theory of emotional regulation whereby a threat response (which could include feelings of shame and self-criticism) could effectively take over the mind, making it very difcult to inuence positive behaviour change. This effect can be mitigated by evoking the compassionate system of emotional regulation within the individual, calming the threat response and allowing the individual to move beyond negative thoughts and to take positive action. Professor Gilbert explained how positive behaviour change can be facilitated using compassionate approaches. These included developing group support for encouragement for when things do not work out, developing compassion for the self and to develop a greater understanding of the motivational and emotional drivers behind behaviour change. The nal case study was presented by Mr Fred Turok, Chair of the Fitness Industry Association and Co-Chair of the Department of Healths Responsibility Deal Physical Activity Network. Mr Turoks presentation was on behaviour change and physical activity: exercise professionals delivering motivational interviews. Mr Turok highlighted that the fourth largest preventable cause of death is physical inactivity and that there are 5800 health and leisure facilities across the UK, meaning that almost 90% of the population live within two miles of a health and leisure facility. The Fitness Industry Association is a non-prot organisation and promotes the use of physical activity for the maintenance of a healthy lifestyle both in the prevention and management of disease. Mr Turok reported on the Fitness Industry Associations involvement in the Lets Get Moving programme, an evidence-based behaviour change programme to promote physical activity in primary care. The programme used both motivational interviewing and support from exercise commissioners. All participants increased their activity levels substantially and evaluation has shown that participants remained active for more than a year. Mr Turok also discussed the UK Department of Healths Responsibility Deal Physical Activity Network.

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Carter MC, Burley VJ, Nykjaer C et al. (2012) My Meal Mate (MMM): validation of the diet measures captured on a smartphone application to facilitate weight loss. British Journal of Nutrition 3: 18. Catenacci VA, Ogden LG, Stuht J et al. (2008) Physical activity patterns in the National Weight Control Registry. Obesity 16: 15361. Chalder M, Wiles NJ, Campbell J et al. (2012) A pragmatic randomised controlled trial to evaluate the cost-effectiveness of a physical activity intervention as a treatment for depression: the treating depression with physical activity (TREAD) trial. Health Technology Assessment 16: 1164. DH (Department of Health) (2012) Facts and gures on obesity. Available at: http://www.dh.gov.uk/health/2012/04/obesityfacts/ (accessed 29 November 2012). Foster J, Thompson K & Harkin J (2009) Lets Get Moving: Commission Guidance A New Physical Activity Care Pathway for the NHS. Department of Health: London. Klem ML, Wing RR, Lang W et al. (2000) Does weight loss maintenance become easier over time? Obesity Research 8: 43844. Klem ML, Wing RR, McGuire MT et al. (1997) A descriptive study of individuals successful at long-term maintenance of substantial weight loss. American Journal of Clinical Nutrition 66: 23946. Michie S, Abraham C, Whittington C et al. (2009) Effective techniques in healthy eating and physical activity interventions. Health Psychology 28: 690701. Michie S, Abraham C, Eccles MP et al. (2011a) Strengthening evaluation and implementation by specifying components of behaviour change uinterventions: a study protocol. Implementation Science 6: 10. Michie S, van Stralen MM & West R (2011b) The behaviour change wheel: a new method for characterising and designing behaviour change interventions. Implementation Science 6: 42. Miller WR (2004) Motivational interviewing in the service of health promotion. American Journal of Health Promotion 18: A1A10. Ofcom (The Ofce of Communications) (2011) Infrastructure Report: The rst communications infrastructure report. Available at http://stakeholders.ofcom.org.uk/binaries/research/telecomsesearch/bbspeeds2011/infrastructure-report.pdf (accessed 21 December 2012). Phelan S, Hill JO, Lang W et al. (2003) Recovery from relapse among successful weight maintainers. American Journal of Clinical Nutrition 78: 107984. Phelan S, Wyatt HR, Hill JO et al. (2006) Are eating and exercise habits of successful weight losers changing? Obesity 14: 7106. Raynor DA, Phelan S, Hill JO et al. (2006) Television viewing and long-term weight maintenance: results from the National Weight Control Registry. Obesity 14: 181624. Rothman AJ, Sheeran P & Wood W (2009) Reective and automatic processes in the initiation and maintenance of dietary change. Annals of Behavioural Medicine 38: S4S17. Ryan RM & Deci EL (2000) Self-development theory and the facilitation of intrinsic motivation, social development, and well-being. The American Psychologist 55: 6878. Sciamanna CN, Kiernan M, Rolls BJ et al. (2011) Practices associated with weight loss versus weight-loss maintenance results of a national survey. American Journal of Preventative Medicine 41: 15966.

The Network encourages businesses to take responsibility for the health of their employees, customers and communities through the promotion of physical activity. Mr Turok concluded by calling for the audience to get more involved and to use the marketing expertise and balance sheets of local and national businesses to help deliver high-calibre exercise programmes and behaviour change and that healthcare professionals need to change their behaviour to take advantage of what businesses have to offer in order to work together in the future. Lastly, at the end of the conference, all of the speakers were invited to give a short, but lively panel discussion. To view the discussion, see www.nutrition.org. uk/nutritionscience/behaviour/behaviour-discussion. Ms Gill Fine then closed the conference by thanking all of the participants for an interesting and engaging day. She said the issue regarding industry and researchers ability to work together for the public good has been debated for many years. With this in mind, Ms Fine implored nutrition students to think carefully about their involvement with any type of partnership, stating that effective partnerships are the way forward, but that there is a need to include clear parameters to ensure they result in public good. For further information relating to this conference, including several of the presentations please see tinyurl.com/BNF-behaviour-change.

Acknowledgements
The British Nutrition Foundation (BNF) wishes to thank Slimming World for the nancial support that has enabled the cost of this event to be subsidised for delegates. Contributions to the administrative support for the conference have also been made by BNFs Sustaining Member Companies: the Agriculture and Horticulture Development Board, Associated British Foods Grocery Group, Coca-Cola Great Britain and Ireland, Danone Waters and Dairies UK Ltd., DuPont Nutrition and Health Division, J Sainsbury Plc, Kellogg Company of Great Britain Ltd., Kraft Foods UK Ltd., Nestl UK Ltd., PepsiCo UK Ltd., Tate & Lyle Sugars and Unilever plc.

Conict of interest
The authors have no conict of interest to disclose.

References
Abraham C & Michie S (2008) A taxonomy of behaviour change techniques used in interventions. Health Psychology 27: 37987.

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Stubbs J, Whybrow S & Lavin J (2010) Dietary and lifestyle measures to enhance satiety and weight control. Nutrition Bulletin 35: 11325. Vansteenkiste M & Sheldon KM (2006) Theres nothing more practical than a good theory: integrating motivational interviewing ad self-determination theory. British Journal of Clinical Psychology 45: 6382. Wansink B (2006) Nutritional gatekeepers and the 72% solution. Journal of American Dietetic Association 106: 13247.

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Wansink B & Sobal J (2007) Mindless eating: the 200 daily food decisions we overlook. Environment and Behavior 39: 10623. Wing RR & Phelan S (2005) Long-term weight loss maintenance. American Journal of Clinical Nutrition 82: 222S5S. Wyatt HR, Grunwald GK, Mosca CL et al. (2002) Long-term weight loss and breakfast in subjects in the National Weight Control Registry. Obesity Research 10: 7882.

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