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Obesity and diabetes have emerged as an increasing threat to public health, and the consumption of added sugar can contribute to their development. Though nutritional content information can positively influence consumption behavior, added sugar is not currently required to be disclosed in all countries. However, a growing proportion of the world’s population has access to mobile devices, which allow for the development of digital solutions to support health-related decisions and behaviors. To test whether advances in computational science can be leveraged to develop an accurate and scalable model to estimate the added sugar content of foods based on their nutrient profile, we collected comprehensive nutritional information, including information on added sugar content, for 69,769 foods. Eighty percent of this data was used to train a gradient boosted tree model to estimate added sugar content, while 20% of it was held out to assess the predictive accuracy of the model. The performance of the resulting model showed 93.25% explained variance per default portion size (84.32% per 100 kcal). The mean absolute error of the estimate was 0.84 g per default portion size (0.81 g per 100 kcal). This model can therefore be used to deliver accurate estimates of added sugar through digital devices in countries where the information is not disclosed on packaged foods, thus enabling consumers to be aware of the added sugar content of a wide variety of foods.

OBJECTIVE: Obesity is a chronic disease that disproportionately affects individuals from nonmajority racial/ethnic groups in the United States. Research shows that individuals from minority racial/ethnic backgrounds consider it important to have access to providers from diverse backgrounds. Health care providers and scientists from minority racial/ethnic groups are more likely than their non-Hispanic White counterparts to treat or conduct research on patients from underrepresented groups. The objective of this study was to characterize the racial/ethnic diversity of nutrition- and obesity-focused professional organizations in the United States. METHODS: This study assessed race/ethnicity data from several obesity-focused national organizations including The Obesity Society, the Academy of Nutrition and Dietetics (AND), the American Society for Nutrition, and the American Board of Obesity Medicine (ABOM). Each organization was queried via emailed survey to provide data on racial/ethnic representation among their membership in the past 5 years and among elected presidents from 2010 to 2020. RESULTS: Two of the three professional societies queried did not systematically track race/ethnicity data at the time of query. Limited tracking data available from AND show underrepresentation of Black (2.6%), Asian (3.9%), Latinx (3.1%), Native Hawaiian or Pacific Islander (1.3%), or indigenous (American Indian or Alaskan Native: 0.3%) individuals compared with the US population. Underrepresentation of racial/ethnic minorities was also reported for ABOM diplomates (Black: 6.0%, Latinx: 5.0%, Native American: 0.2%). Only AND reported having racial/ethnic diversity (20%) among the organization’s presidents within the previous decade (2010–2020). CONCLUSIONS: Findings suggest that (1) standardized tracking of race and ethnicity data is needed to fully assess diversity, equity, and inclusion, and (2) work is needed to increase the diversity of membership and leadership at the presidential level within obesity- and nutrition-focused professional organizations. A diverse cadre of obesity- and nutrition-focused health care professionals is needed to further improve nutrition-related health outcomes, including obesity, cardiovascular disease, diabetes, and undernutrition, in this country.

* Abbreviations: HRQoL — : health-related quality of life MVPA — : moderate-vigorous physical activity The public health, medical, and research community has increased focus on childhood obesity over the past few decades and for good reason. Obesity prevalence is at an all-time high,1 and rates of severe obesity continue to increase.2 Activity, both sedentary and physical, are key contributors to the development and treatment of obesity.3–5 Increasing physical activity while decreasing sedentary activity is an obvious goal in improving the weight and health of children. Unfortunately, the majority of children in the United States are not receiving the recommended amounts of physical activity and surpassing suggested limits on sedentary activity.6 Because there are finite hours in a day, increasing time spent on 1 activity will require doing less of another (ie, replacing one activity with another). In the case of activity, it is assumed that increased time spent engaged in physical activity is always beneficial, without the recognition that it may detract from other important life and health components (eg, sleep and school work). Exploring how individuals allocate their time may provide insight into how one can increase time spent in a beneficial behavior (eg, exercise), without stealing that time from an activity that is also beneficial (eg, sleep). In their study, Ng et al7 approached this topic through the lens of time and in relation … Address correspondence to Michelle I. Cardel, PhD, MS, RD, Department of Health Outcomes and Biomedical Informatics, College of Medicine, University of Florida, 2197 Mowry Rd, Gainesville, FL 32607. E-mail: mcardel{at}ufl.edu

Relative to other racial/ethnic groups in the United States, Hispanic American (HA) youth have higher rates of overweight and obesity. Previous work suggests that low perceived social status (SS) promotes excess caloric intake and, thereby, development of obesity. Psychological resilience may play a role in reducing adverse eating behaviors and risk for obesity. The objective of this study was to investigate whether resilience (as measured by the Connor Davidson Resilience Scale) interacts with experimentally manipulated SS to affect dietary intake among HA adolescents (N = 132). Using a rigged game of Monopoly (Hasbro, Inc.), participants were randomized to a high or low SS condition. Following the Monopoly game, participants consumed an ad libitum lunch and their dietary intake was assessed. There was a significant interaction between resilience and experimentally manipulated SS for total energy intake (p = 0.006), percent energy needs consumed (p = 0.005), and sugar intake (p = 0.004). For the high SS condition, for each increase in resilience score, total energy intake decreased by 7.165 ± 2.866 kcal (p = 0.014) and percent energy needs consumed decreased by 0.394 ± 0.153 (p = 0.011). In the low SS condition, sugar intake increased by 0.621 ± 0.240 g for each increase in resilience score (p = 0.011). After correction for multiple comparisons, the aforementioned interactions, but not simple slopes, were statistically significant.

Objective This study aimed to examine the impact of coronavirus disease 2019 (COVID-19) on current research participants' mental health outcomes, ability to adhere to behavioral intervention recommendations, and desire to participate in research. Methods A quantitative/qualitative cross-sectional survey was used among adults currently enrolled in health-related research (N = 250; 85% women; > 50% currently enrolled in behavioral weight loss intervention). Results COVID-19 was perceived as a severe threat by most (62.3%). Related to COVID-19, 29.6% of participants reported moderate/severe symptoms of anxiety/depression, and 68.4% reported moderate/severe posttraumatic stress disorder (PTSD) symptomatology, with women more likely to demonstrate moderate/severe anxiety/depression (P = 0.047) and PTSD symptomatology (P = 0.028) relative to men. Those with moderate/severe levels of anxiety/depression (P = 0.0154) and distress (P = 0.0330) were more likely to report a decreased desire to participate in research. Among those in behavioral interventions, individuals perceiving COVID-19 as a moderate/severe threat or experiencing moderate/severe depression or PTSD symptomatology were 4 to 19 times more likely to report that COVID-19 affected their ability to adhere to behavioral recommendations. Qualitative analysis identified four themes describing COVID-19's impact on research experiences: transition, remote intervention delivery, ability to adhere to program goals, and research participation interest. Conclusions These data suggest that participants engaged in health-related research perceive COVID-19 as a significant threat, affecting mental health, desire to participate in research, and ability to adhere to intervention recommendations.

OBJECTIVES: The “traffic light diet” (TLD; or “stop light diet” among other names) categorizes foods into ‘green’, ‘yellow’, or ‘red’ groups to consume without restriction, in moderation, or minimally, respectively. It is often a component of childhood interventions targeting weight-related outcomes. The Academy of Nutrition and Dietetics Evidence Analysis Library assigned TLDs Grade I evidence in 2006 for pediatric weight management, but none of the studies reviewed tested the TLD in isolation. We conducted a review of the effect of TLDs on obesity-related outcomes in children and definitions among different implementations of TLDs. METHODS: We searched PubMed up to September 2019 for interventions using the TLD with obesity-related anthropometric outcomes. Studies were screened in duplicate, and treatment characteristics extracted. Additional studies were identified by screening references. Using a convenience sample of texts from the original TLD creators, Indiana University vending, a new pediatric weight loss app, and an online resource, we assessed how definitions of TLDs compare. RESULTS: Our search identified 386 abstracts, 5 of which were interventions that included the TLD and weight-related outcomes. Three of these were randomized controlled trials, and none studied the TLD in isolation outside of multicomponent interventions. We then focused on 4 foundational TLD articles that were repeatedly cited. One of these isolated the TLD from the multicomponent intervention but found no statistical effect of the diet or interaction of diet with other factors for weight-related outcomes. In the sample of TLD implementations, substantial differences were apparent in how foods were classified among green, yellow, and red groups, such as avocados, nuts, figs/fig cookies, and peanut butter. CONCLUSIONS: There is insufficient evidence supporting TLDs as a unique, isolatable factor in improving weight-related outcomes in children. This does not necessarily mean that TLDs are ineffective, as they have been incorporated into successful interventions. A standardization of TLD definitions (consistently categorizing foods and whether the term ‘TLD’ is meant to include other components of an intensive lifestyle intervention) is needed to make comparisons of effectiveness going forward. FUNDING SOURCES: The authors received no funding for this specific work.

Despite significant progress in recent decades, the recruitment, advancement, and promotion of women in academia remain low. Women represent a large portion of the talent pool in academia, and receive >50% of all PhDs, but this has not yet translated into sustained representation in faculty and leadership positions. Research indicates that women encounter numerous “chutes” that remove them from academia or provide setbacks to promotion at all stages of their careers. These include the perception that women are less competent and their outputs of lesser quality, implicit bias in teaching evaluations and grant funding decisions, and lower citation rates. This review aims to (1) synthesize the “chutes” that impede the careers of women faculty, and (2) provide feasible recommendations, or “ladders” for addressing these issues at all career levels. Enacting policies that function as “ladders” rather than “chutes” for academic women is essential to even the playing field, achieve gender equity, and foster economic, societal, and cultural benefits of academia.

Purpose To assess independent associations between objective socioeconomic status (OSS) and subjective social status (SSS) with metabolic syndrome (MetS) severity and indicators among African American (AA) adults in the Jackson Heart Study (JHS) at baseline (2000–2004) and eight-year follow-up (2009–2013). Methods Participants included 1724 AA adults from the JHS cohort (64.4 % women; mean age 53.4 ± 11.8). Associations of OSS (annual household income and school years completed) and SSS (measured with MacArthur Scales) with sex- and race/ethnic-specific MetS severity Z-score were examined after adjustment for demographics and MetS risk factors (i.e., nutrition, physical activity, smoking status, alcohol consumption, and depressive symptoms) at baseline and eight-year follow-up. Principal results Independent of OSS, demographic, psychosocial, and lifestyle factors, individuals with lower US-society SSS had more severe MetS at baseline. A significant interaction existed between sex and US-society SSS such that women with lower perceived social status had more severe MetS severity at baseline, and for every one unit increase in US-society SSS, MetS severity Z-score is estimated to decrease by 0.04. Components of MetS driving the relationship between US-society SSS and MetS severity at baseline were the inverse associations of SSS with glucose levels and the positive associations of SSS with HDL-C. Physical activity was independently associated with MetS severity at baseline, but not at eight-year follow-up. Major conclusions Though subjective and objective measures of social status are independently associated with cardiometabolic risk factors and MetS severity among AA adults, SSS may be a stronger predictor of MetS severity than OSS, particularly among women. SSS should be considered in conjunction with OSS when exploring social determinants of cardiometabolic health.

OBJECTIVES: Fermentable carbohydrate is universally recognized as the major dietary risk factor for dental caries. We assessed the broader relationship between diet quality and dental caries in a diverse Latinx adult population. METHODS: In a cross-sectional probability sample, 14,517 dentate men and women in the Hispanic Community Health Study/Study of Latinos (HCHS/SOL) received a dental examination and completed two 24-hours dietary recalls and a food propensity questionnaire. The 2010 Alternative Healthy Eating Index (AHEI) assessed diet quality and the National Cancer Institute method predicted usual intake of the 11 dietary components that comprise the AHEI. Dental caries experience was quantified using the decayed, missing and filled surfaces (DMFS) index. Covariates included sociodemographic and anthropometric characteristics. Survey multivariable-adjusted linear regression models quantified the relationship of 2010 AHEI score, and its 11 components, with DMFS. RESULTS: In multivariable-adjusted models, each 10-unit increase in diet quality score was associated with 2.5 fewer (95% confidence interval: −3.4, −1.6) DMFS. The relationship was pronounced among foreign-born individuals, who com-prised three-quarters of the sample, irrespective of their length of US residence, but was not apparent among U.S.-born individuals. Greater intake of sugar-sweetened beverage and fruit juice was positively associated with dental caries, whereas vegetables (excluding potatoes); whole grains; and omega-3 fats were inversely associated with dental caries, independent of covariates and the other dietary components (all P < 0.05). CONCLUSIONS: An association between diet quality and dental caries was restricted to foreign-born Latinix and was not limited to the adverse impact of sugar-sweetened drinks.

OBJECTIVES: Intake of n-3 polyunsaturated fatty acids (PUFAs) has been reported to provide various benefits for patients with metabolic syndrome (MetS), such as reducing blood pressure and improving blood lipids, but results are inconsistent. This study aimed to investigate the effect of n-3 PUFA intake on components of MetS. METHODS: We searched PubMed, Scopus, Web of Sciences, and Cochrane databases up to June 2018 for randomized trials at least 30 days long comparing n-3 PUFAs with a control in patients diagnosed with MetS (PROSPERO registration ID: CRD42017072332). The outcomes include body mass index, systolic and diastolic blood pressure, triglyceride, high-density lipoprotein cholesterol, and fasting blood glucose. Mean differences post-intervention or mean change from baseline were combined using random-effects models; confirmation of within-study effect sizes is ongoing. RESULTS: A total of 14 trials were identified. The pooled results showed n-3 PUFA intake reduced systolic blood pressure by 3.92 mmHg (95%CI: –6.89, –0.96, P-value = 0.009, I2 = 34%, 9 trials) and diastolic blood pressure by 2.81 mmHg (95%CI: –4.26, –1.36, P-value = 0.0001, I2 = 15%, 8 trials). Body mass index was lower in the n-3 PUFA group by 3.19 kg/m2 (95%CI: –6.16, –0.22, P-value = 0.04, I2 = 97%, 7 trials) compared to the control group. Triglyceride levels in n-3 PUFA groups were significantly lower than the control when pooling trials with post intervention data only (–33.13 mg/dL, 95%CI: –49.44, –16.81, P-value

OBJECTIVES: Subjective and objective social status is associated with weight status, but this relationship differs by sex and the mechanisms remain unclear. METHODS: This randomized study in Hispanic adolescents investigated the effects of experimentally manipulated social status on ad libitum acute and 24-hour dietary intakes and stress-related outcomes as potential mechanisms through which social status affects weight. Participants (n = 133; ages 15–21; 60.2% girls; BMI ≥18.5 and ≤40 kg/m(2); 23.4% food insecure) consumed a standardized breakfast and then were randomized to a low (LOW) or high social status position (HIGH) in a rigged game of Monopoly™, in which the rules differed substantially by social status position. Following the game, the participants consumed an ad libitum lunchtime meal. Energy intake was assessed by pre- and post- food weighing. Stress-related markers were measured at baseline, before Monopoly™, after Monopoly™, and after lunch, with the exception of cortisol (measured before and after Monopoly™). RESULTS: There was a significant interaction between sex and experimentally manipulated social status (P = 0.0087), such that girls randomized to LOW consumed significantly more of their daily energy needs at the ad libitum lunchtime meal relative to those randomized to HIGH (37.5% vs. 34.3%, respectively). Individuals with food insecurity consumed a greater % of their daily energy needs at the lunchtime meal than those with food security, although the result was not quite statistically significant (40.7% vs. 36.3%, respectively; P = 0.08). In LOW, participants report decreased feelings of powerfulness following Monopoly™ (P = 0.0006). There were no significant differences between HIGH and LOW following Monopoly™ regarding perceived stress, cortisol, heart rate, or blood pressure. Social status condition was not related to 24-hour % of daily energy needs consumed. CONCLUSIONS: Our data suggest a causal link between experimentally manipulated low social status and increased acute energy intakes among Hispanic girls, potentially influenced by decreased feelings of powerfulness, which is independent of stress. Low social status may play a causal role in the development of obesity by promoting excess calorie consumption. Further research is needed to identify the biobehavioral mechanisms contributing to this phenomenon. FUNDING SOURCES: NIH. SUPPORTING TABLES, IMAGES AND/OR GRAPHS

Objectives Subjective social status (SSS) is known to be inversely associated with obesity. Our objective was to determine if SSS is associated with eating behaviors that would predispose to weight gain, specifically, with inadequate compensation for excess energy consumed during a single large meal. Therefore, we conducted a pilot study to determine the association of SSS with 24-h energy balance, 24-h and post-lunch energy intake, changes in body composition and changes in adjusted resting energy expenditure on days when a high-energy lunch was consumed in free-living human subjects. Method Female participants (7 normal weight and 10 overweight) consumed 60% of’ estimated 24-h energy requirements as a lunchtime meal in the laboratory for 14 days. Subjective social status was measured at baseline using the MacArthur Scale. Remote Food Photography Method was used to record food intake outside of the lab on days 1–2, 7–8, and 12–13. Associations of 24-h energy balance, 24-h and post-lunch energy intake, changes in adjusted resting energy expenditure and changes in percent body fat (measured by dual x-ray absorptiometry) with SSS were studied. Results Mean (standard deviation) age and BMI were 36.29 (8.25) years and 26.43 (2.32) kg/m2, respectively. Lower SSS was significantly associated with positive energy balance (p for trend 0.002), and higher post-lunch energy intake (p = 0.02) when controlled for age and initial body mass index. Conclusions Our pilot data show that lower SSS is associated with higher post-lunch energy intake, which is indicative of poor energy compensation following a large meal. Over a longer time period, this could result in fat mass gain. Studies that are of longer duration and well-powered are warranted to confirm our findings.

The focus of this commentary is Nettle et al.'s insurance hypothesis linking food insecurity to a high body mass index (BMI). We discuss how the relationship between race/ethnicity and obesity in the United States is consistent with this hypothesis, then present potential ways forward to elucidate the validity of this hypothesis in humans through rigorous controlled trials.

Objective To identify biological and psychosocial factors associated with dropout in a multidisciplinary behavioral intervention in obese adolescents.Methods A total of 183 adolescents (15.4±1.6 years), pubertal (Tanner stage 3 or 4) and obese (34.7±4.0kg/m2), were enrolled in a 12-week behavioral intervention, which included clinical consultations (monthly), nutritional and psychological counseling (once a week), and supervised aerobic training (three times/week). The studied variables were weight, height, body mass index, body composition (skinfold), cardiorespiratory fitness (direct gas analysis), blood lipids and self-reported symptoms of eating disorders (bulimia, anorexia and binge eating), anxiety, depression, body image dissatisfaction and quality of life. Statistical analysis included binary logistic regression and independent t-tests.Results Of the adolescents, 73.7% adhered to the program. The greatest chance for dropout was observed among adolescents older than 15 years (odds ratio of 0.40; 95%CI: 0.15-0.98), with more anorexia symptoms (odds ratio of 0.35; 95%CI: 0.14-0.86) and hypercholesterolemia (odds ratio of 0.40; 95%CI: 0.16-0.91) at baseline.Conclusion Older adolescents, with more symptoms of eating disorders and total cholesterol have less chance to adhere to multidisciplinary treatments. Objetivo Identificar os fatores biológicos e psicossociais associados à desistência de uma intervenção multidisciplinar comportamental em adolescentes obesos.Métodos Foram selecionados para participar das 12 semanas de intervenção 183 adolescentes (15,4±1,6 anos), púberes (Tanner 3 ou 4) e obesos (34,7±4,0 kg/m2). A intervenção incluiu consultas clínicas (mensal), aconselhamento nutricional e psicológico (uma vez/semana), e treinamento aeróbio supervisionado (três vezes/semana). As variáveis estudadas foram peso, altura, índice de massa corporal, composição corporal (dobras cutâneas), aptidão cardiorrespiratória (análise direta de gases), perfil lipídico e sintomas autorrelatados de transtornos alimentares (bulimia, anorexia e compulsão alimentar), ansiedade, depressão, insatisfação com a imagem corporal e qualidade de vida. A análise estatística incluiu regressão logística binária e teste tde Student independente.Resultados Aderiram ao programa 73,7% dos adolescentes. A maior chance de desistência foi observada entre aqueles com mais de 15 anos (odds ratiode 0,40; IC95%: 0,15-0,98), com mais sintomas de anorexia (odds ratio de 0,35; IC95%: 0,14-0,86) e com hipercolesterolemia (odds ratio de 0,40; IC95%: 0,16-0,91) no início do estudo.Conclusão Adolescentes mais velhos, com mais sintomas de transtornos alimentares e de níveis de colesterol total, têm menor chance de aderir a tratamentos multidisciplinares.

Parental feeding practices have been associated with children's weight status, but results have been inconsistent across populations. Research is needed to elucidate the relationship between parental feeding practices and adiposity in diverse populations. The present study tested if: (1) parental feeding practices differed by race/ethnicity, (2) parental pressure to eat and parental restriction were associated with adiposity levels, and (3) to investigate the relationship between parental feeding practices and/or child adiposity with socioeconomic status (SES). Structural equations modeling was conducted to test the model in 267 children aged 7-12 years self-identified as African American (AA), European American (EA), or Hispanic American (HA) from economically diverse backgrounds. Dual energy X-ray absorptiometry and computed tomography scanning were used to determine body composition and abdominal fat distribution, respectively. Parental restriction was a significant predictor of child adiposity while parental pressure to eat had an inverse relationship with child adiposity. HA parents reported significantly higher levels of restriction and pressure to eat, whereas EA parents reported the lowest. SES was positively associated with child adiposity and inversely related to parental restriction and pressure to eat. Thus, parental feeding practices differ across racial/ethnic groups and SES and may contribute to population differences in child adiposity.

Objective The objective was to determine if calcium intake was associated with resting energy expenditure (REE) and body fat in children after accounting for ancestral genetic background. Study design Participants included 315 children. REE, body composition, and dietary calcium were assessed by indirect calorimetry, dual-energy x-ray absorptiometry, and 24-hour recalls, respectively. Structural equations modeling assessed the relationships among REE, calcium intake, and body fat. Results There were positive associations between calcium intake and REE (P < .01) and between REE and total body fat (P < .0001). There was indirect effect of calcium intake on total body fat (P < .01). There were positive associations between calcium intake and REE (P < .01), and a trend toward an association of calcium intake and total body fat (P = .065) among boys only, whereas the only significant relationship among girls was an association of REE on total body fat (P < .0001). Conclusions REE was associated with calcium intake and mediated a relationship between calcium intake and total body fat. These findings suggest calcium intake may play a role in fat accumulation and energy balance through its effects on REE, especially in boys. (J Pediatr 2010;157:473-8).