Friday 10 February 2023

Treats: a helpful reward, or to be approached with care?

Posted by Anita Attala, Lead Adult Weight Management Dietitian from Northumbria Healthcare NHS Foundation Trust, and research team from Teesside University

We all like to have a ‘treat’ and to give ‘treats’ to others. Indeed, the use of food, and in particular what we in public health call ‘high fat, sugar, and salt’ containing foods or ‘HFSS’, are often chosen as rewards. The notion of food cultures is certainly a social anthropological (study of humans) concept, with an example being the use of food in positive reinforcement; using ‘treat’/HFSS foods to reward children in particular. Taken at ‘face-value’ such treats may appear harmless, however repeated use of HFSS in this way has been shown to physiologically influence the human food reward system, and impact on our ability to regulate how much food we eat. This, together with other detrimental impacts, has led to advice not to regularly use food as a reward. Research has also shown that using food rewards in adults can hinder healthy weight management, especially from a psychological perspective.

But what exactly is a ‘treat’? Why do we feel the need to ‘treat’ someone? Are ‘treats’ always a positive experience or can they be used in a detrimental or harmful way?

While working in a forensic service I saw patients gain weight, and often gain this weight very rapidly. I also noted that some staff seemed frustrated and concerned about the weight gain some patients experienced. However, I also noticed that HFSS food was frequently used as part of patient care. This sparked my interest in wanting to understand this apparent conflict.

Forensic services provide care for people with a severe mental illness or learning disability, who have committed a crime but are too vulnerable to be in prison. For example, they are high risk either to themselves or the public, and therefore are unable to live in the community. People in these environments are often here for a long time and are reported to die 15-20 years prematurely, often from avoidable diseases. There are often restrictions imposed on the person and their environment. These restrictions will depend on the level of security required and the risk posed by the patient, and can be directed by the Ministry of Justice. An example of a restriction might be the person is not able to leave the ward.

Limited research seems to have been undertaken around the use of HFSS food ‘treats’ for adults, let alone adults who are in hospital. Yet, it is something many of us seem primed to do – bring (HFSS) food to someone when they’re ill.

The word ‘treat’ conjures up a particular thought of food – which is often high in calories, high fat and high in sugar. What you view as a ‘treat’ and how to ‘treat’ can often have been learnt in childhood and can differ from person to person. But, while it is entirely possible to have a non-food ‘treat’, it’s often harder to think of one and can be more difficult to provide while in hospital (particularly one with restrictions such as forensic wards).

You could argue that ‘treats’, by definition, can only be a ‘treat’ if you don’t consume them on a regular basis. As research shows, regular behaviours of any kind, can soon develop into habits.

Wanting to learn more about the use of ‘treats’ to show care and kindness, particularly in a hospital setting, I applied for research funding from my Trust (Cumbria, Northumberland, Tyne and Wear NHS Foundation Trust). Also, in 2020, I was successful in obtaining a clinical academic internship with Health Education England (HEE) and the National Institute for Health and Care Research (NIHR). Both awards enabled me to research the use of treats in forensic inpatient care settings.

Using this funding, I decided to focus on whether ‘treats’ were being used to prompt a particular behaviour from a person, while in inpatient care settings; whether these ‘treats’ impacted on a person’s weight and physical health; and why treats were chosen and if it was related to ideas of care and kindness. Certainly, from my observations this is what seemed to be happening - often perhaps unconsciously – but this research allowed us to evidence what may be happening.

What we found

Our research into treats in the health care sector has now been published. It found that treats were used for a number of reasons including:
  • Being an affordable way to reward someone
  • An incentive to encourage patients to participate in activities, and
  • A way to express love/care for someone.
Of course, food as a bonding mechanism is not a new phenomenon, and the idea of certain foods providing comfort is well-established.

It’s entirely possible to have ‘treats’ as part of a healthy balanced diet, and that the origin of using HFSS as treats may be from a place of nurture, but the advice is that food treats should be infrequent and limited in quantity. While it would appear ‘easy’ to say that those working in institutions, like in NHS care services, need to be mindful of how food is being used, our research findings suggest that it may take a much bigger system/cultural change to reduce the use of HFSS as treats in services. I think the idea of a ‘positive food culture’ is useful here. One where the focus is on preserving and nurturing good health and wellbeing through the use of healthy, positive, food behaviours, attitudes and values.


Anita Attala, Lead Adult Weight Management Dietitian from Cumbria, Northumberland, Tyne & Wear NHS Foundation Trust, and postgraduate student from Teesside University.

Jo Smith, Consultant Dietitian (Clinical Academic) from Tees, Esk and Wear Valleys NHS Foundation Trust, and PhD student from Teesside University

Amelia Lake, Fuse Associate Director and Professor of Public Health Nutrition from Teesside University

Dr Emma Giles, co deputy-lead of the Fuse Behaviour Change Theme and Associate Professor Public Health from Teessside University

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  4. Attala A, Smith J, Lake AA, Giles E. Investigating ‘treat culture’ in a secure care service: a study of inpatient NHS staff on their views and opinions on weight gain and treat giving for patients in a forensic secure care service. J Hum Nutr Diet 2023; 1-13.
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Friday 3 February 2023

Welcome to your Wrapped, Fuse Open Science Blog

Posted by Mark Welford, Fuse Communications Manager, Teesside University

If you use Spotify (other streaming platforms are available) then you will no doubt have received your own personalised ‘Wrapped 2022’. A helpful (if somewhat creepy!) summary of your annual listening habits in one eye-searing psychedelically coloured package. Apparently, my most listened to song in 2022 was Baby Shark - I have a 3 year old.

Around this time of year I do a similar (if slightly less garish) job of pulling together the top 5 Fuse blog posts from the previous year.

But this year is a little different.

It’s award season and this year the blogs listed below were in the running for a coveted gong. Not at the GRAMMYs, Oscars, Emmys, BAFTAs, or BRITs but the (much more prestigious) first ever Fuse Awards!

Earlier this week (30 January), the post with the most views was crowned best blog of 2022 with the author awarded a shiny trophy at our ceremony in Durham *link may contain SPOILERS*.

So without further ado, here is the full list of the runners and writers in reverse order, culminating with the post that received the most views...

Posted by Tim Townshend, Professor of Urban Design for Health, Newcastle University

“...primarily designing around the needs of the private car - rather than humans - has been a disaster.”

Prof Townshend explores how we can plan for a healthier future by intervening in the built environment. From the 'toxic high street', to the green (and blue) spaces in our cities that encourage physical activity and social interaction, positive for physical health and mental wellbeing.

Posted: 13 May 2022

4. Science, and the art of communication

Posted by Louis Goffe, Research Associate, NIHR Policy Research Unit in Behavioural Science

"...building the evidence-base isn’t enough, we all need to work on at least one aspect of the artistic craft of research promotion."

COVID19 has brought into sharp focus that health promotion takes more than good science, there is an art to the delivery. In this post, Louis explores vaccine misinformation, the infodemic, involving the public and advocacy.

Posted: 28 January 2022

3. What support do children and young people actually want when their parents use drugs and alcohol?

Posted by Cassey Muir, Fuse & NIHR School for Public health Research (SPHR) funded PhD Researcher from Newcastle University and Kira Terry, Lived Experience Expert.

“No-one has ever asked me about how I feel in any of this.”

Fuse PhD student Cassey shares her research aiming to understand the experiences, perceived impacts and coping strategies of young people whose parents use substances. The post ends with Kira’s thoughts about contributing to the project as a Lived Experience Research Advisor.

Posted: 9 December 2022

2. Is a picture truly worth a thousand words?

Posted by Emma Adams, NIHR ARC NENC Mental Health Fellow at Newcastle University, and Experts by Experience from Fulfilling Lives Newcastle Gateshead & #HealthNow Newcastle

Find out how Emma and her Experts by Experience worked together to develop striking visuals to share what they had learned from a study exploring access to community based mental health and substance use support during the COVID-19 pandemic for individuals experiencing homelessness and those providing support.

Posted: 25 March 2022

And in at number one our award winner...

1. Universal Credit experiences and research co-production

Posted by David Black, Fuse Public Partner and Expert by Experience. Introduction by Mandy Cheetham, Research Fellow in the Applied Research Collaboration North East and North Cumbria (ARC NENC), Northumbria University

“In the past I'd always found the process of seeking
 help from the unemployment benefit system to be
 relatively easy, but Universal Credit was a disaster
 for me.”

Ever wondered how you could help shape research as a member of the public? In this Fuse blog, David shares his personal experiences of claiming benefits and how this has informed research to assess the impact of Universal Credit.

Posted: 11 March 2022

Below is a photo of David (second from the right) along with the other Fuse Award winners. Congratulations to all! 

Catch up with all the award winners using #FuseAwards23 or see the event programme on the Fuse website for all those shortlisted.

Join Fuse to be in with a shout of winning a coveted Fuse Award in 2024!