This present paper reviews the reliability and validity of visual analogue scales (VAS) in terms of (1) their ability to predict feeding behaviour, (2) their sensitivity to experimental manipulations, and (3) their reproducibility. VAS correlate with, but do not reliably predict, energy intake to the extent that they could be used as a proxy of energy intake. They do predict meal initiation in subjects eating their normal diets in their normal environment. Under laboratory conditions, subjectively rated motivation to eat using VAS is sensitive to experimental manipulations and has been found to be reproducible in relation to those experimental regimens. Other work has found them not to be reproducible in relation to repeated protocols. On balance, it would appear, in as much as it is possible to quantify, that VAS exhibit a good degree of within-subject reliability and validity in that they predict with reasonable certainty, meal initiation and amount eaten, and are sensitive to experimental manipulations. This reliability and validity appears more pronounced under the controlled (but more arti®cial) conditions of the laboratory where the signal : noise ratio in experiments appears to be elevated relative to real life. It appears that VAS are best used in within-subject, repeated-measures designs where the effect of different treatments can be compared under similar circumstances. They are best used in conjunction with other measures (e.g. feeding behaviour, changes in plasma metabolites) rather than as proxies for these variables. New hand-held electronic appetite rating systems (EARS) have been developed to increase reliability of data capture and decrease investigator workload. Recent studies have compared these with traditional pen and paper (P&P) VAS. The EARS have been found to be sensitive to experimental manipulations and reproducible relative to P&P. However, subjects appear to exhibit a signi®cantly more constrained use of the scale when using the EARS relative to the P&P. For this reason it is recommended that the two techniques are not used interchangeably.Visual analogue scales: Electronic appetite rating systems: Appetite: Hunger A speci®c advantage of studying the behaviour of human subjects (relative to animals) is that human subjects can be asked a number of questions relating to their motivation, sensations and attitudes. Psychologists and clinicians have long used subjective feelings of bodily sensations or functions to help in research investigations and patient management. Such assessments have been carried out in diverse conditions to examine a variety of`functions': quality of life (Hunt et al. 1981), pain (Ohnhaus & Alder, 1975;Downie et al. 1978), sex, libido, depression, anxiety (Keys et al. 1950, nausea and appetite (Hill & Blundell, 1982). Freyd (1923) has pointed out that such ratings are the only practical equivalents of objective measurements for many types of psychological phenomena, especially introspective or verbally reported data.Attempting to understand the role of food and ...

This project audited attendance and weight loss in a primary care/commercial weight management partnership scheme in patients who participated over 6 months. 4754 adult patients (575 men, 4179 women) were referred to Slimming World for 24 weekly sessions. Data were analysed using individual weekly weight records. Mean (standard deviation, SD) body mass index (BMI) change was -3.3 kg m(-2) (2.2), weight change -8.9 kg (6.0), percent weight change -8.6% (5.3) and number of sessions attended 21.3 (3.2) of 24. For patients attending at least 20 of 24 sessions (n = 3626 or 76.3%), mean (SD) BMI change was -3.6 kg m(-2) (2.2), weight change -9.6 kg (6.1), percent weight change -9.3% (5.3). Weight loss was greater in men than women (P < 0.001). 74.5% of all patients enrolled, and 79.3% of patients attending 20 or more sessions achieved at least 5% weight loss. 37.3% of the whole population lost ≥10% of their weight. Weight gain was prevented in 96.3% of all patients referred. Referral to a commercial organization for community-based lifestyle intervention is a practical option for longer-term National Health Service weight management strategies.

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and 4 Slimming World, Alfreton DE55 4UEThis analysis examined the association between restrained eating behaviour and weight loss maintenance in 1428 participants of a slimming organisation who had been members for a mean°SD 16°16 months. They had lost 13.8%°9.2 % of their initial weight and were trying to maintain, or increase, their weight loss during a subsequent 6-month study period.Data were collected as part of the DiOGenes study (1) . Ethical approval was given by the University of Surrey Ethics Committee. Adults were recruited between August 2006 and July 2008 from Slimming World at group meetings and by email. Subjects completed questionnaires at two time points, measurement 1 (M1) at the start of the study and nominally six months later (measurement 2 (M2)). Participants' weights (using calibrated scales) were taken from group records for M1, M2, six months before (measurement 0) and when they initially enrolled. Participants were free to continue following the weight-loss programme as they wished during this study, and there was no intervention other than completing the questionnaires.Cognitive restraint of eating or dietary restraint, disinhibition and susceptibility to hunger were measured using the Three Factor Eating Questionnaire (2) . Dietary restraint is not a single construct, but can be split into flexible and rigid restraint. These two components of restraint were assessed by validated questionnaire (3) . Linear regression analysis was used to identify the associations between questionnaire responses and weight change (as a percentage of M1 weight) over the study period. Participants who reported having low levels of disinhibition at the first measurement had more positive weight gains during the following six months. This only explained a small proportion of the variance in weight loss maintenance. Cognitive restraint and its components were not strongly associated with weight loss maintenance.

3Slimming World, Alfreton DE55 4UEDemographic factors are important correlates of predisposition to obesity but much less is known about how they relate to weight loss and its maintenance. This analysis examined the demographic predictors of weight loss maintenance (WLM) in 1428 participants of a slimming organisation, who had been members for a mean°SD of 16°16 months, had lost 13.8%°9.2 % weight and were trying to maintain, or increase, their weight loss during a subsequent 6 month study period.Data were collected as part of the DiOGenes study (1) . Ethical approval was given by the University of Surrey Ethics Committee. Adults were recruited between August 2006 and July 2008 from Slimming World at group meetings and by email. Participants' weights (using calibrated scales) were taken from group records at four time points, measurement 1 (M1) at the start of the study period, nominally six months later (measurement 2 (M2)), six months before M1 and when they initially enrolled with Slimming World. Participants were free to continue following the weight-loss programme as they wished during this study, and there was no intervention other than completing the questionnaires. Participants completed a general screening questionnaire at M1 relating to age, gender, marital status, education level achieved, employment status, number of adults and children in the household, monetary expenditure on food, number of siblings, weight history, weight history of parents and siblings, medical history (whether a doctor had told them they have had obesity, diabetes, cancer, high blood pressure, high cholesterol, heart disease or stroke), medical history of parents and siblings, alcohol intake, smoking status, and birth weight. Linear regression analysis was used to identify the associations between questionnaire responses and weight change (as % M1 weight) over the 6 month study period. Mean age was 46.8 years for women, 50.8 years for men; 95 % were women.There was no association between age, sex, marital status or family structure and subsequent WLM. Heavier people lost a greater percentage of their weight during the study period than did lighter people (p < 0.001), presumably because they had more to lose. People who were unemployed and "other" lost considerably more weight during the study than those who were employed, or not working for other reasons. However, there were only 37 and 58 people in these first two groups respectively. The percentage of respondents who reported being told by a doctor they had medical conditions was as follows: high blood pressure 30 %, high cholesterol 16 % and obesity 36 %. Fewer than 5 % of respondents answered yes for the other conditions. Being told by their GP that they were obese, either currently or in the past, significantly correlated with respondents' WLM (p = 0.007). All significant associations explained a very small percentage of the variance in WLM. No other demographic variables were associated with WLM. In this study demographic measures were used as baseline indicators of subse...