Paulina Nowicka

Professor (Chair) in Food Studies, Nutrition and Dietetics, esp Communication of Dietetics

Obesity has been main focus of my research for over 20 years. My work integrates the medical and social sciences and has been conducted at Lund University, Yale, University of Oregon, Oxford University and Karolinska Institutet before joining Uppsala University. The projects I lead investigate what makes early family-based interventions effective and how lifestyle patterns develop across generations.

For complete list of my activities and funding, please see my CV.

The projects I lead are inspired by my experiences at the Childhood Obesity Unit at the Pediatric Hospital in Malmö, Sweden, where I worked for almost a decade as a clinician. In my doctoral thesis, in the discipline of Pediatrics (2009, Faculty of Medicine, Lund University, Sweden), I examined different methods of multidisciplinary treatment of obesity in children and adolescents, with particular attention to possibilities for family therapy. This is still the main focus of my team, together we develop and evaluate childhood obesity interventions, for example the More and Less Study and the More and Less Study Europe (part of the STOP project).

My postdoctoral education (2009-2014) included research at Yale University, USA (Yale Pediatric Obesity/Diabetes Research Program), University of Oregon, USA (Department of Psychology) and University of Oxford, UK (Institute of Social and Cultural Anthropology). I am associated with Unit for Biocultural Variation and Obesity at the University of Oxford .

I have served on numerous expert committees and boards such as Childhood Obesity Task Force of the European Association for the Study on Obesity (EASO), European Childhood Obesity Group (ECOG) and Swedish Association for the Study on Obesity (SFO) and the expert group for nutrition and publlic health at the National Food Agency.

I lecture about body weight, food and eating practices of children and adolescents, and I supervise students on the bachelor, master, doctoral and postdoctoral levels. I have supervised three doctoral students: Anna Ek, who defended her thesis "Early obesity: family-based risk factors and treatment interventions" in 2016, Karolin Bergman, who defended her thesis Negotiating healthy eating: Lay, stakeholder and government constructions of official dietary guidance in Sweden in 2019, and Maria Somaraki who defended her thesis Parent-child feeding dynamics and childhood obesity: The importance of foreign background and effects of early obesity treatment in 2020. I have been a postdoctoral mentor for Elin Lövestam who is now Associate Professor at Uppsala University, Pernilla Sandvik, who is now Associate Senior Lecturer at Uppsala University, and Anna Ek who is now senior researcher at Karolinska Institutet.

As many as 20% of children in Sweden develop overweight or obesity during childhood and adolescence. While obesity is difficult to treat in adolescence, early childhood presents a unique opportunity to provide effective treatment through lifestyle changes alone. However, the effects of treatment interventions early in life need to be further examined, paying particular attention to how parents can be best supported when implementing lifestyle changes for their families. To do so, I lead several projects using both quantitative and qualitative methods. A particular highlight is the More and Less Study, a randomized controlled trial aiming to test different treatment options for preschoolers with obesity. To further understand the broader context behind the development of eating habits in families with young children, my publications focus on obesity through the prism of social inequality, sense of coherence and intergenerational perspectives on body weight, food and eating. My research has been funded funded by Swedish Research Council, VINNOVA, EU HORIZON 2020, Swedish Medical Association, FORTE, the Jerring Foundation, among others.

Research on parental support

The More and Less Study was started in 2011 when I chose to carry out my postdoctoral research at the renowned research institute Oregon Social Learning Center (OSLC), in Eugene, Oregon, USA. The researchers at OSLC have long studied how and what kind of parenting promotes healthy development in children; their studies have informed many established parental support programs such as KOMET, Triple P and The incredible years. I got especially inspired by KEEP, a program developed by OSLC, which introduces parents in a systematic way to behaviors that strengthen a positive interaction with the child and facilitate changes in habits and routines. Together with my team, first at Karolinska Institutet and later at Uppsala University, I have developed the parental support program, The More and Less, which is specifically designed for families of preschoolers, 2–6 years old, with overweight or obesity.

What is More and Less

In the More and Less program, parents attend group sessions to learn about and try different tools that promote healthy habits in the family. Participants have said that meeting parents who are in the same situation is a highlight of the program. More and Less was first evaluated in a randomized controlled trial in collaboration with child health care and pediatric and adolescent medicine clinics in Stockholm 2012–2016. The study showed that More and Less was effective in improving several health outcomes in children 4–6 years old with obesity one year and four years after the program (Ek et al 2019, Ek et al 2022). As a next step, the program has been included in the EU project STOP (2018–2022) and has been evaluated in Spain, Romania and Sweden. In this study, families of children from the age of two and children with overweight were included.

Close dialogue with parents has been crucial for the development of the program, and we have conducted interviews with parents exploring their experiences of the program. This has led to several qualitative publications (Ek et al., Appetite 2020, Nowicka et al. 2022a, Nowicka et al. 2022b). Overall, the program has been described and evaluated in more than twenty scientific publications and two doctoral theses (Anna Ek, Karolinska Institutet 2016 and Maria Somaraki, Uppsala University 2019). Both the group leaders’ and parents’ manuals have been translated into five languages.

How the ML program works

• The More and Less program consists of 10 group meetings of 1.5 hours once a week. Each meeting is based on a specific theme.

• Parents and group leaders (two per group) discuss strategies and concrete tips, for example:

o how much food is adequate and how to limit the child's screen time.

o how habits can be changed and how parents can best encourage children to learn new, slightly more difficult things.

o how parents can deal with tantrums, why it is important to be able to say no, how conflict situations can be avoided, and other important aspects of parenting, for example, how to be a “fair” parent.

The aim of the program is to empower parents in adopting new parenting tools and supporting their child's health, healthy eating habits and physical activity. It's about finding solutions that suit each family.

The group meetings are led by two group leaders who have health care background and additional education in the More and Less program. The group leaders first train by leading a group under supervision and then lead groups independently. Each group consists of 6–10 families where both parents are invited, and groups can be held both digitally and face-to-face. In the case of face-to-face groups, childcare can be offered to those who need it.

All parents receive written materials related to each group meeting. These materials include many tips on healthy habits, portion sizes, drinks, cooking and exercise, as well as guidance on how to keep motivated, on both weekdays and weekends.

Ongoing research

We are currently evaluating long-term effects of obesity treatment started at the preschool age, using the data from the randomized controlled trial, the More and Less study. We do this with quantitative studies (with a focus on weight status, children's metabolic health and eating behavior and parents' psychosocial health) and qualitative studies, exploring the experiences of both children and parents. The doctoral student My Sjunnestrand specifically studies parents' experiences of weight talk and body image in children who have participated in treatment at the preschool age.

We are also evaluating the effects of the More and Less program implemented in Spain and Romania as part of the EU project STOP.

Finally, we have started a new study (led by Anna Ek and Markus Brissman at KI) which aims to adapt More and Less to families with children who have both obesity and ADHD. It is an unexplored group of children who have both diagnoses, which can have a major impact on the everyday lives of many families.