Obesity is highly prevalent and disabling, especially in individuals with severe mental illness including bipolar disorders (BD). The brain is a target organ for both obesity and BD. Yet, we do not understand how cortical brain alterations in BD and obesity interact.

We obtained body mass index (BMI) and MRI-derived regional cortical thickness, surface area from 1231 BD and 1601 control individuals from 13 countries within the ENIGMA-BD Working Group. We jointly modeled the statistical effects of BD and BMI on brain structure using mixed effects and tested for interaction and mediation. We also investigated the impact of medications on the BMI-related associations.

BMI and BD additively impacted the structure of many of the same brain regions. Both BMI and BD were negatively associated with cortical thickness, but not surface area. In most regions the number of jointly used psychiatric medication classes remained associated with lower cortical thickness when controlling for BMI. In a single region, fusiform gyrus, about a third of the negative association between number of jointly used psychiatric medications and cortical thickness was mediated by association between the number of medications and higher BMI.

We confirmed consistent associations between higher BMI and lower cortical thickness, but not surface area, across the cerebral mantle, in regions which were also associated with BD. Higher BMI in people with BD indicated more pronounced brain alterations. BMI is important for understanding the neuroanatomical changes in BD and the effects of psychiatric medications on the brain.

Engagement with members is an important issue for the Royal College of Psychiatrists (RCPsych) and an area for ongoing development. This is an issue that extends to Psychiatry trainees and the Psychiatric Trainees’ Committee (PTC) has adopted increasing engagement as one of its key aims. Divisional representatives in different areas of the UK had noted that trainees had limited knowledge of the PTC or its roles and projects both within the College and local areas. To improve this it was decided to pilot a project that established a social media platform for trainees to improve communication between the PTC, it's representatives and trainees. It was decided that Workplace (a professional version of Facebook) would be used. This had already been established in the Severn Deanery.

Northern Ireland (NI) and the East of England (EoE) deaneries were selected as pilot areas for the project. Preparation for the project included collaboration with trainees from the Severn deanery and meeting with the RCPsych Digital team. A scoping questionnaire was circulated to trainees in each deanery.

Following this, two closed groups were initiated on Workplace in August 2019 for Northern Ireland and East of England trainees.

Results from the survey sent prior to the social media pages being established indicated there was appetite among trainees for the project. The pages were established in July 2019. The pilot project was promoted by representatives.

In the initial phases, approximately 40% of trainees signed up. Information regarding college and local events, committee meeting updates and training opportunities was disseminated on the platform. There was evidence of early use by trainees outside of the representative group.

This however was not sustained and gradually use of the platform reduced over the pilot period, both in postings and membership. A further questionnaire circulated in July 2020 highlighted trainees’ concerns relating to the platform, including concerns around data protection and a high number of notifications associated with the Workplace medium. The ultimate impact on engagement was also felt to be minimal.

Following feedback and increasing usage costs by Workplace, it was decided not to continue with a nationwide role out of the project. COVID-19 has seen the successful use of platforms such as Microsoft Teams and these may be considered in the future, given their integration with existing trust systems.

Globally, over 1.97 billion adults and 338 million children and adolescents are living with overweight and obesity, increasing the risk of numerous co-morbidities, including at least 12 cancers(1). WCRF/AICR conducted a literature review of diet and physical activity as determinants of weight gain, overweight and obesity in adults and children. We also introduce a novel evidence-based policy framework for promoting physical activity, and linked database, currently in development as part of the EU-funded CO-CREATE project on child and adolescent obesity prevention.

Evidence on diet and physical activity as determinants and risk of weight gain, overweight and obesity was systematically extracted from existing reviews and a systematic search for recent meta-analyses, then collated and analysed. The WCRF Continuous Update Project Expert Panel drew conclusions about which exposures influence risk of weight gain, overweight and obesity, using pre-defined criteria that included evidence of biological plausibility.

The Panel identified strong evidence that several diet and physical activity related exposures influence the risk of weight gain, overweight and obesity in adults and children (see table 1). Separate conclusions were drawn for adults and children in relation to screen time, considered a marker of sedentary time.

However, the Panel noted that as exposures tend to cluster, physiologically interact and share common biological mechanisms, they should not be regarded as absolutely ‘singular'but an integrated concept of interrelated exposures within a pattern of lifestyle. Table 1.

Risk of weight gain, overweight and obesity

For full list of footnotes, see Energy Balance and Body Fatness report(1).

Healthy dietary patterns help prevent excess weight gain. Achieving such patterns requires attention to the broader economic, environmental and social factors that influence and constrain people's behaviour. The findings of this report support the need for evidence-based public health policy to help create health-enabling environments, particularly for children and adolescents. The WCRF International MOVING framework(2) presents a package of policies to promote physical activity, which alongside wider public health policy can help address the multiple drivers of overweight and obesity.