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Providing interventions that facilitate improvement of dietary intake and other health behaviors can improve nutrition-related outcomes in adults with overweight or obesity. Medical nutrition therapy (MNT) behavioral interventions require expertise from registered dietitian nutritionists or international equivalents (dietitians), which no other health care provider can provide for adults with obesity. Current evidence supports the role of MNT behavioral interventions for adults with overweight or obesity as an effective treatment option, when appropriate for and desired by the client. This Academy of Nutrition and Dietetics Position Paper describes potential benefits and concerns regarding dietitian-provided MNT behavioral interventions for adults with overweight and obesity and informs dietitians about implications for practice. This Position Paper is supported by a systematic review examining effectiveness of MNT interventions provided by dietitians and by an evidence-based practice guideline. It is the position of the Academy of Nutrition and Dietetics that MNT behavioral interventions for adults (aged 18 years and older) with overweight or obesity should be a treatment option, when appropriate and desired by the client, to improve cardiometabolic, quality of life, and anthropometric outcomes. Dietitians providing MNT recognize the complex contributors to overweight and obesity, and thus individualize interventions, based on a shared decision-making process, and deliver interventions in an inclusive, compassionate, and client-centered manner. Interventions should include collaboration with an interprofessional team when needed. Dietitians strive to increase health equity and reduce health disparities by advocating and providing opportunities for increased access to effective nutrition care services. This position remains in effect until December 31, 2031., (Copyright © 2024 Academy of Nutrition and Dietetics. Published by Elsevier Inc. All rights reserved.)

Background: Obesity is associated with a multitude of comorbidities and considerable health care costs., Objective: The objective of this review was to examine the efficacy of weight management interventions provided by a registered dietitian or international equivalent (referred to as "dietitian")., Methods: This systematic review and meta-analysis of randomized controlled trials (RCTs) examined the effect of weight management interventions provided by a dietitian, compared with usual care or no intervention, on several cardiometabolic outcomes and quality of life in adults with overweight or obesity. MEDLINE, Embase, PsycINFO, Cochrane CENTRAL, Cochrane Database of Systematic Reviews, and CINAHL databases were searched for eligible RCTs published between January 2008 and January 2021 in the English language. Meta-analyses were conducted using a random-effects model, publication bias was assessed using funnel plots and Egger's statistics, and heterogeneity was assessed by interpreting I 2 values. Efficacy of intervention components, such as telehealth or group contacts, were explored in sub-group analyses. Version 2 of the risk-of-bias tool for RCTs was used to assess risk of bias. The Grading of Recommendations Assessment, Development and Evaluation method was used to determine certainty of evidence., Results: This systematic review included 62 RCTs. Compared with control conditions, weight management interventions provided by a dietitian resulted in improved body mass index (mean difference [MD] -1.5; 95% CI -1.74 to -1.26; moderate evidence certainty); percent weight loss (MD -4.01%; 95% CI -5.26% to -2.75%; high evidence certainty); waist circumference (MD -3.45 cm; 95% CI -4.39 to -2.51 cm; high evidence certainty); blood pressure (MD -3.04 mm Hg; 95% CI -5.10 to -0.98 mm Hg and MD -1.99 mm Hg; 95% CI -3.02 to -0.96 mm Hg for systolic blood pressure and diastolic blood pressure, respectively; moderate and low evidence certainty); and quality of life using the 36-Item Short Form Survey (MD 5.84; 95% CI 2.27 to 9.41 and 2.39; 95% CI 1.55 to 3.23 for physical and mental quality of life, respectively; low and moderate evidence certainty)., Conclusions: For adults with overweight or obesity, weight management interventions provided by a dietitian are efficacious for improving several examined cardiometabolic outcomes and quality of life., (Copyright © 2023 Academy of Nutrition and Dietetics. Published by Elsevier Inc. All rights reserved.)

Overweight and obesity affect most adults living in the United States and are causally linked to several adverse health outcomes. Registered dietitian nutritionists or international equivalents (dietitians) collaborate with each client and other health care professionals to meet client-centered goals, informed by the best available evidence, and translated through a lens of clinical expertise and client circumstances and preferences. Since the last iteration of the Academy of Nutrition and Dietetics guideline on adult weight management in 2014, considerable research has been conducted and circumstances confronting dietitians have evolved. Thus, updated guidance is needed. The objective of this evidence-based practice guideline is to provide recommendations for dietitians who deliver medical nutrition therapy behavioral interventions for adults (18 years and older) with overweight and obesity to improve cardiometabolic outcomes, quality of life, and weight outcomes, when appropriate for and desired by the client. Recommendations in this guideline highlight the importance of considering complex contributors to overweight and obesity and individualizing interventions to client-centered goals based on specific needs and preferences and shared decision making. The described recommendations have the potential to increase access to care and decrease costs through utilization of telehealth and group counseling as effective delivery methods, and to address other barriers to overweight and obesity management interventions. It is essential for dietitians to collaborate with clients and interprofessional health care teams to provide high-quality medical nutrition therapy interventions using the nutrition care process to promote attainment of client-centered outcomes for adults with overweight or obesity., (Copyright © 2023 Academy of Nutrition and Dietetics. Published by Elsevier Inc. All rights reserved.)

Although many studies have relied on parental responses concerning children's school-meal participation, few studies have evaluated parental response accuracy. We investigated misclassification of fourth-grade children's participation in school-meal programs based on parental responses relative to administrative daily records using cross-sectional study data collected for 3 school years (2004-05, 2005-06, and 2006-07) for 1,100 fourth-grade children (87% black; 52% girls) from 18 schools total in one district. Parents reported children's usual school-meal participation on paper consent forms. The district provided administrative daily records of individual children's school-meal participation. Researchers measured children's weight and height. "Usual participation" in breakfast/lunch was defined as ≥50% of days. Parental responses misclassified 16.3%, 12.8%, 19.8%, and 4.7% of children for participation in breakfast, classroom breakfast, cafeteria breakfast, and lunch, respectively. Parental responses misclassified more children for participation in cafeteria than classroom breakfast (P=0.0008); usual-participant misclassification probabilities were less than nonusual-participant misclassification probabilities for classroom breakfast, cafeteria breakfast, and lunch (P<0.0001 for each) (two-proportion z tests). Parental responses concerning children's participation were more accurate for lunch than breakfast; parents overstated breakfast participation (both classroom and cafeteria) and lunch participation. Breakfast participation misclassification was not related to body mass index (P=0.41), sex (P=0.40), age (P=0.63), or socioeconomic status (P=0.21) (multicategory logistic regression controlling for school year, breakfast location, and school). Relying on parental responses concerning children's school-meal participation may hamper researchers' abilities to detect relationships that have policy implications for the child nutrition community. The use of administrative daily records of children's school-meal participation is recommended., (Copyright © 2014 Academy of Nutrition and Dietetics. Published by Elsevier Inc. All rights reserved.)

Data from four cross-sectional studies involving fourth-grade children were analyzed to investigate the relationship between participation in school-provided meals and body mass index (BMI), and the effect observed energy intake has on that relationship. Participation and BMI data were available on 1,535 children (51% black; 51% girls) for 4 school years (fall 1999 to spring 2003; one study per school year) at 13 schools total. Direct meal observations were available for a subset of 342 children (54% black; 50% girls) for one to three breakfasts and one to three lunches per child for a total of 1,264 school meals (50% breakfast). Participation in breakfast, lunch, and combined (both meals on the same day) was determined from nametag records compiled for meal observations for each study. Weight and height were measured. A marginal regression model was fit with BMI as the dependent variable; independent variables were breakfast participation, lunch participation, combined participation, sex, age, race, and study. For the subset of children, observed energy intake at breakfast, lunch, and combined was included in additional analyses. Participation in breakfast, lunch, and combined was not significantly associated with BMI regardless of whether analyses included observed energy intake (P values >0.181). The relationship between observed energy intake at breakfast and lunch, separately and combined, with BMI was positive (P values <0.01). In conclusion, these results do not support a relationship between school-meal participation and BMI but do support a relationship between observed energy intake at school meals and BMI during fourth grade., (Copyright © 2012 Academy of Nutrition and Dietetics. Published by Elsevier Inc. All rights reserved.)

Due to changing recommendations for fruit and vegetable (F/V) intake, public health and private organizations recognized the need to revise communications and programs that promote F/V consumption. This article describes formative research conducted in 2005 to develop a new identity for the 5 A Day Program, updated to the Fruits & Veggies--More Matters program. The objective was to re-brand the 5 A Day Program's campaign message to be adaptable, sustainable, and compelling, while leveraging the program's existing message dissemination infrastructure. Formative research included interviews with representatives from government, nonprofit organizations, and industry, and consumer perspectives from interviews, focus groups, and an online survey. Public health and private organizations agreed that a compelling emotional benefit was needed to motivate consumers to eat more F/V and that messaging needed to be used consistently among national, state, and local programs. Interviews and focus groups targeted mothers who believed they and their families were getting enough F/V, knew they could eat more, but needed to be convinced why they should do so. The most effective messages appealed to mothers' emotional needs to be responsible, leveraged functional intrinsic values of F/V, did not try to quantify "enough," and focused on small steps. When the Fruits & Veggies-More Matters slogan and graphic were viewed together, the majority (62%) said it increased their interest in eating more F/V. The Fruits & Veggies-More Matters brand offers numerous opportunities for promoting F/V consumption through this public health initiative., (Copyright © 2011 American Dietetic Association. Published by Elsevier Inc. All rights reserved.)

Children's dietary intake is a key variable in evaluations of school-based interventions. Current methods for assessing children's intake, such as 24-hour recalls and meal observations, are time- and resource-intensive. As part of a study to evaluate the impact of farm-to-school programs, the school lunch recall was developed from a need for a valid and efficient tool to assess school lunch intake among large samples of children. A self-administered paper-and-pencil questionnaire, the school lunch recall prompts for school lunch items by asking children whether they chose a menu item, how much of it they ate, how much they liked it, and whether they would choose it again. The school lunch recall was validated during summer school in 2008 with 18 third- to fifth-grade students (8 to 11 years old) in a North Carolina elementary school. For 4 consecutive days, trained observers recorded foods and amounts students ate during school lunch. Students completed the school lunch recall immediately after lunch. Thirty-seven total observation school lunch recall sets were analyzed. Comparison of school lunch recalls against observations indicated high accuracy, with means of 6% for omission rate (items observed but unreported), 10% for intrusion rate (items unobserved but reported), and 0.63 servings for total inaccuracy (a measure that combines errors for reporting items and amounts). For amounts, accuracy was high for matches (0.06 and 0.01 servings for absolute and arithmetic differences, respectively) but lower for omissions (0.47 servings) and intrusions (0.54 servings). In this pilot study, the school lunch recall was a valid, efficient tool for assessing school lunch intake for a small sample of third- to fifth-grade students., (Copyright © 2011 American Dietetic Association. Published by Elsevier Inc. All rights reserved.)

Background: Accurate information about children's intake is crucial for national nutrition policy and for research and clinical activities. To analyze accuracy for reporting energy and nutrients, most validation studies utilize the "conventional approach," which was not designed to capture errors of reported foods and amounts. The "reporting-error-sensitive approach" captures errors of reported foods and amounts., Objective: To extend results to energy and macronutrients for a validation study concerning retention interval (elapsed time between to-be-reported meals and the interview) and accuracy for reporting school-meal intake, the conventional and reporting-error-sensitive approaches were compared. DESIGN AND PARTICIPANTS/SETTING: Fourth-grade children (n=374) were observed eating two school meals, and interviewed to obtain a 24-hour recall using one of six interview conditions from crossing two target periods (prior 24 hours and previous day) with three interview times (morning, afternoon, and evening). Data were collected in one district during three school years (2004-2005, 2005-2006, and 2006-2007)., Main Outcome Measures: Report rates (reported/observed), correspondence rates (correctly reported/observed), and inflation ratios (intruded/observed) were calculated for energy and macronutrients., Statistical Analyses Performed: For each outcome measure, mixed-model analysis of variance was conducted with target period, interview time, their interaction, and sex in the model; results were adjusted for school year and interviewer., Results: With the conventional approach, report rates for energy and macronutrients did not differ by target period, interview time, their interaction, or sex. With the reporting-error-sensitive approach, correspondence rates for energy and macronutrients differed by target period (four P values <0.0001) and the target period by interview-time interaction (four P values <0.0001); inflation ratios for energy and macronutrients differed by target period (four P values <0.0001), and inflation ratios for energy and carbohydrate differed by the target period by interview-time interaction (both P values <0.005)., Conclusions: Shortening the retention interval of dietary recalls increases accuracy for reporting energy and macronutrients. For validation studies, it is best to obtain reference information from a method that provides details about foods and amounts consumed and to use an analytic approach that captures errors of reported foods and amounts., (2010 American Dietetic Association. Published by Elsevier Inc. All rights reserved.)

Objective: To investigate whether school-meal observations influenced children's 24-hour dietary recalls., Study Design and Setting: Over three school years, 555 randomly selected fourth-grade children were interviewed to obtain a 24-hour dietary recall; before being interviewed, 374 children were observed eating two school meals (breakfast, lunch), and 181 children were not observed. Within observation-status groups (observed, unobserved), children were randomized within sex to one of six combinations from two target periods (prior 24 hours, previous day) crossed with three interview times (morning, afternoon, evening)., Results: For each of the five variables (interview length, meals/snacks, meal components, items, kilocalories), naïve and adjusted equivalence tests rejected that observation-status groups were different, indicating that school-meal observations did not influence children's 24-hour dietary recalls. There was a target-period effect on length (P<0.0001) (longer for prior-24-hour recalls), a school year effect on length (P=0.0002) (longer for third year), and a target period-interview time interaction on items (P=0.0110) and kilocalories (P=0.0047) (both smaller for previous-day recalls in the afternoon than prior-24-hour recalls in the afternoon and previous-day recalls in the evening), indicating that variables were sufficiently sensitive and psychometrically reliable., Conclusion: Conclusions about 24-hour dietary recalls by fourth-grade children observed eating school meals in validation studies are generalizable to 24-hour dietary recalls by comparable but unobserved children in nonvalidation studies.

Background: For a 24-hour dietary recall, two possible target periods are the prior 24 hours (24 hours immediately preceding the interview time) and previous day (midnight to midnight of the day before the interview), and three possible interview times are morning, afternoon, and evening. Target period and interview time determine the retention interval (elapsed time between to-be-reported meals and the interview), which, along with intervening meals, can influence reporting accuracy., Objective: The effects of target period and interview time on children's accuracy for reporting school meals during 24-hour dietary recalls were investigated. DESIGN AND SUBJECTS/SETTING: During the 2004-2005, 2005-2006, and 2006-2007 school years in Columbia, SC, each of 374 randomly selected fourth-grade children (96% African American) was observed eating two consecutive school meals (breakfast and lunch) and interviewed to obtain a 24-hour dietary recall using one of six conditions defined by crossing two target periods with three interview times. Each condition had 62 or 64 children (half boys)., Main Outcome Measures: Accuracy for reporting school meals was quantified by calculating rates for omissions (food items observed eaten but unreported) and intrusions (food items reported eaten but unobserved); a measure of total inaccuracy combined errors for reporting food items and amounts., Statistical Analyses Performed: For each accuracy measure, analysis of variance was conducted with target period, interview time, their interaction, sex, interviewer, and school year in the model., Results: There was a target-period effect and a target-period by interview-time interaction on omission rates, intrusion rates, and total inaccuracy (six P values <0.004). For prior-24-hour recalls compared to previous-day recalls, and for prior-24-hour recalls in the afternoon and evening compared to previous-day recalls in the afternoon and evening, omission rates were better by one third, intrusion rates were better by one half, and total inaccuracy was better by one third., Conclusions: To enhance children's dietary recall accuracy, target periods and interview times that minimize the retention interval should be chosen.

Background: Intrusions in dietary recalls may originate in confusion of episodic memories manifested as temporal dating errors., Objective: Data from a validation study (concerning reporting accuracy over multiple recalls) and school foodservice production records were used to investigate origins of intrusions in school meals in children's 24-hour recalls. DESIGN/SUBJECTS/SETTING: During the 1999-2000 school year, 104 fourth-grade children were observed eating school meals on 1 to 3 nonconsecutive days separated by >or=25 days, and interviewed about the previous day's intake in the morning on the day after each observation day., Statistical Analyses Performed: For breakfast and lunch separately, logistic regression was used to investigate the effect of time (ie, days) before the interview day on the probability that intrusions referred to items available in the school foodservice environment. Exploratory analyses were conducted for breakfast options observed and/or reported eaten., Results: For interviews in which reported meals met criteria to be considered school meals and that contained intrusions, of 634 and 699 items reported eaten at breakfast and lunch, respectively, 394 and 331 were intrusions. Availability in the school foodservice environment of items referred to by intrusions in reports of lunch, but not breakfast, decreased as days increased before the interview day (P=0.031 and P=0.285, respectively). Concerning breakfast, children observed eating a cold option (ie, ready-to-eat cereal, milk, juice, crackers [graham or animal]) almost always reported a cold option, whereas children observed eating a hot option (ie, non-ready-to-eat cereal entrée [eg, sausage biscuit], milk, and fruit or juice) reported a cold option in approximately 50% of interviews., Conclusions: In children's 24-hour recalls, confusion of episodic memories contributes to intrusions in school lunch, and generic dietary information (eg, cold option items available daily) or confusion of episodic memories may contribute to intrusions in school breakfast. Understanding the origins of intrusions may help in developing interview methods to decrease the occurrence of intrusions.

Objective: To compare reporting accuracy for breakfast and lunch in 2 studies., Design: Children were observed eating school meals and interviewed the following morning about the previous day. In Study 1, 104 children were each interviewed 1 to 3 times with >or=25 days separating any 2 interviews. In Study 2, 121 children were each interviewed once in forward (morning-to-evening) and once in reverse (evening-to-morning) order, with these interviews separated by >or=29 days., Setting: 12 schools., Participants: Fourth-grade children., Main Outcome Measures: For each meal, food-item variables (observed number, reported number, omission rate, intrusion rate, total inaccuracy) and kcal variables (observed, reported, correspondence rate, inflation ratio)., Analysis: General linear mixed models., Results: For each study, observed and reported numbers of items and kcal, and correspondence rate (reporting accuracy), were greater for lunch than for breakfast; omission rate, intrusion rate, and inflation ratio (measures of reporting error) were greater for breakfast than for lunch. In Study 1, for each meal over interviews, total inaccuracy decreased and correspondence rate increased. In Study 2, for each meal for boys for reverse and for girls for forward order, omission rate was lower and correspondence rate was higher., Conclusions and Implications: Breakfast was reported less accurately than lunch. Despite improvement over interviews (Study 1) and differences for order x sex (Study 2), reporting accuracy was low for breakfast and lunch.

Objective: Validation study data are used to illustrate that conclusions about children's reporting accuracy for energy and macronutrients over multiple interviews (ie, time) depend on the analytic approach for comparing reported and reference information-conventional, which disregards accuracy of reported items and amounts, or reporting-error-sensitive, which classifies reported items as matches (eaten) or intrusions (not eaten), and amounts as corresponding or overreported., Subjects and Design: Children were observed eating school meals on 1 day (n=12), or 2 (n=13) or 3 (n=79) nonconsecutive days separated by >or=25 days, and interviewed in the morning after each observation day about intake the previous day. Reference (observed) and reported information were transformed to energy and macronutrients (ie, protein, carbohydrate, and fat), and compared., Main Outcome Measures: For energy and each macronutrient: report rates (reported/reference), correspondence rates (genuine accuracy measures), and inflation ratios (error measures)., Statistical Analyses: Mixed-model analyses., Results: Using the conventional approach for analyzing energy and macronutrients, report rates did not vary systematically over interviews (all four P values >0.61). Using the reporting-error-sensitive approach for analyzing energy and macronutrients, correspondence rates increased over interviews (all four P values <0.04), indicating that reporting accuracy improved over time; inflation ratios decreased, although not significantly, over interviews, also suggesting that reporting accuracy improved over time. Correspondence rates were lower than report rates, indicating that reporting accuracy was worse than implied by conventional measures., Conclusions: When analyzed using the reporting-error-sensitive approach, children's dietary reporting accuracy for energy and macronutrients improved over time, but the conventional approach masked improvements and overestimated accuracy. The reporting-error-sensitive approach is recommended when analyzing data from validation studies of dietary reporting accuracy for energy and macronutrients.

This pilot study investigated body mass index (BMI; calculated as kg/m(2)), sex, interview protocol, and children's accuracy for reporting kilocalories. Forty 4th-grade children (20 low-BMI: >or=5th and <50th percentiles, 10 boys, 15 African American; 20 high-BMI: >or=85th percentile, 10 boys, 15 African American) were observed eating school meals (breakfast, lunch) and interviewed either that evening about the prior 24 hours or the next morning about the previous day, with 10 low-BMI (5 boys) and 10 high-BMI (5 boys) children per interview protocol. Five kilocalorie variables were analyzed using separate four-factor (BMI group, sex, race, interview protocol) analyses of variance. No effects were found for reported or matched kilocalories. More kilocalories were observed (P<0.02) and omitted (P<0.05) by high-BMI than low-BMI children. For intruded kilocalories, means were smaller (better) for high-BMI girls than high-BMI boys, but larger for low-BMI girls than low-BMI boys (interaction P<0.04); low-BMI girls intruded the most while high-BMI girls intruded the least. For interview protocol, omitted and intruded kilocalories were higher (worse), although not significantly so (P values <0.11), for interviews about the previous day than the prior 24 hours. These results illuminate relations of BMI, sex, interview protocol, and children's reporting accuracy, and are consistent with results concerning BMI and sex from studies with adults.

Quality control is an important aspect of a study because the quality of data collected provides a foundation for the conclusions drawn from the study. For studies that include interviews, establishing quality control for interviews is critical in ascertaining whether interviews are conducted according to protocol. Despite the importance of quality control for interviews, few studies adequately document the quality control procedures used during data collection. This article reviews quality control for interviews and describes methods and results of quality control for interviews from two of our studies regarding the accuracy of children's dietary recalls; the focus is on quality control regarding interviewer performance during the interview, and examples are provided from studies with children. For our two studies, every interview was audio recorded and transcribed. The audio recording and typed transcript from one interview conducted by each research dietitian either weekly or daily were randomly selected and reviewed by another research dietitian, who completed a standardized quality control for interviews checklist.Major strengths of the methods of quality control for interviews in our two studies include: (a) interviews obtained for data collection were randomly selected for quality control for interviews, and (b) quality control for interviews was assessed on a regular basis throughout data collection. The methods of quality control for interviews described may help researchers design appropriate methods of quality control for interviews for future studies.

This article (a) provides a general review of interobserver reliability (IOR) and (b) describes our method for assessing IOR for items and amounts consumed during school meals for a series of studies regarding the accuracy of fourth-grade children's dietary recalls validated with direct observation of school meals. A widely used validation method for dietary assessment is direct observation of meals. Although many studies utilize several people to conduct direct observations, few published studies indicate whether IOR was assessed. Assessment of IOR is necessary to determine that the information collected does not depend on who conducted the observation. Two strengths of our method for assessing IOR are that IOR was assessed regularly throughout the data collection period and that IOR was assessed for foods at the item and amount level instead of at the nutrient level. Adequate agreement among observers is essential to the reasoning behind using observation as a validation tool. Readers are encouraged to question the results of studies that fail to mention and/or to include the results for assessment of IOR when multiple people have conducted observations.

Purpose: This study evaluated the effect of recency on accuracy of fourth-graders' dietary reports., Methods: Each of 60 randomly selected children was observed eating school meals (breakfast, lunch) and interviewed to obtain a 24-hour dietary recall using one of six conditions generated by crossing two target periods (previous day, prior 24 hours) with three interview times (morning, afternoon, evening), with 10 children (5 males) per condition. Accuracy of the school meal portions of each recall was assessed by comparing reports to observations. Rates for omissions (items observed but not reported) and intrusions (items reported but not observed) were calculated to determine accuracy for reporting items. A measure of total inaccuracy combined errors for reporting items and amounts., Results: Using the prior 24 hours as the target period yielded better performance than did using the previous day: Omission rates were lower by about one-third, intrusion rates by about one-half, and total inaccuracy by about one-third (all p's<0.01). A marginally significant interaction of target period by interview time was found for omission rate (p=0.08), but not for intrusion rate (p=0.15) or for total inaccuracy (p=0.47)., Conclusions: This provides evidence that recency influences children's recall accuracy and demonstrates the importance of an awareness of principles of memory when designing what are essentially memory tests for epidemiologic studies.

We investigated telephone administration of the Children's Social Desirability (CSD) scale and our adaptation for children of the Social Desirability for Food scale (C-SDF). Each of 100 4th-graders completed 2 telephone interviews 28 days apart. CSD scores had adequate internal consistency and test-retest reliability, and a 14-item subset was identified that sufficiently measures the same construct. Our C-SDF scale performed less well in terms of internal consistency and test-retest reliability; factor analysis revealed 2 factors, 1 of which was moderately related to the CSD. The 14-item subset of the CSD scale may help researchers understand error in children's dietary reports.

Objective: To investigate the accuracy of children's dietary recalls of school breakfast and school lunch validated with observations and obtained during in-person versus telephone interviews., Design: Each child was observed eating school breakfast and school lunch and was interviewed that evening about that day's intake., Setting: Ten elementary schools., Participants: A sample of fourth-graders was randomly selected within race (black, white) and gender strata, observed, and interviewed in person (n = 33) or by telephone (n = 36)., Main Outcomes Measured: Rates for omissions (items observed but not reported) and intrusions (items reported but not observed) were calculated to determine accuracy for reporting items. A measure of total inaccuracy was calculated to determine inaccuracy for reporting items and amounts combined., Analysis: Analysis of variance; chi-square., Results: Interview type (in person, telephone) did not significantly affect recall accuracy. For omission rate, intrusion rate, and total inaccuracy, means were 34%, 19%, and 4.6 servings for in-person recalls and 32%, 16%, and 4.3 servings for telephone recalls of school breakfast and school lunch., Conclusions and Implications: The accuracy of children's recalls of school breakfast and school lunch is not significantly different whether obtained in person or by telephone. Whether interviewed in person or by telephone, children reported only 67% of items observed; furthermore, 17% of items reported were not observed.

Objective: To use data from observations and interviews to document fourth-graders' preferences for, and consumption of, fruits compared to vegetables available as part of school lunches., Design: Observations and interviews were conducted for studies regarding the impact of time interval between eating and reporting on the accuracy of children's school lunch recalls., Subjects/settings: Children were recruited from up to 4 schools in one district during 3 school years; 63% agreed to participate. Randomly selected children (n = 237) were each observed eating school lunch once and were interviewed (regarding items eaten and preferences for items eaten) within 11/2 hours or the next morning., Main Outcome Measures: Observed consumption of servings of items available as part of school lunch was recorded as none, taste, little bit, half, most, and all. Response options for preferences for items available as part of school lunch were liked not at all, a little, and a lot., Statistical Analyses Performed: Mixed-model analysis of variance., Results: Preferences were higher for fruits than vegetables. As preferences increased, consumption increased (P <.0001). Consumption of fruits compared to vegetables was similar after adjusting for preferences., Implications: Research is needed to understand how to increase children's preferences for vegetables as a means of increasing consumption.

Objective: To explore fourth-graders' school breakfast participation by gender and race (black, white) and examine the extent to which parents' responses to "Does this child usually eat school breakfast?" reflected their children's participation., Design: Parents answered "yes" or "no" to the questions printed on consent forms. Observers documented which children participated in school breakfast on 26 to 51 randomly selected days per school during 24 weeks in the 1999-2000 school year., Subjects: 357 children recruited from all 22 fourth-grade classes from 6 schools in 1 public school district., Variables Measured: Participation rate, participation rate grouping [usually participated (>or=50% of days observed), did not usually participate (< 50% of days observed)]., Statistical Analyses Performed: Komolgorov-Smirnov tests, McNemar's test., Results: Median participation rate was 37.5% overall. Distribution of participation rates differed significantly by race (K-S test, P <.001) but not gender. There was a significant difference in the percentage of parents who said "yes" or "no" compared to children's usual participation grouping (McNemar test, P <.001). Of parents who said "yes," 66% of children usually participated; of parents who said "no," 92% of children did not usually participate., Implications: Children, not parents, must be the source for learning about what children eat at school.

Objective: To determine the accuracy and consistency of fourth-graders' school breakfast and school lunch recalls obtained during 24-hour recalls and compared with observed intake., Design: Children were interviewed using a multiple-pass protocol at school the morning after being observed eating school breakfast and school lunch., Subjects: 104 children stratified by ethnicity (African-American, white) and gender were randomly selected and interviewed up to 3 times each with 4 to 14 weeks between each interview., Statistical Analysis: Match, omission, and intrusion rates to determine accuracy of reporting items; arithmetic and/or absolute differences to determine accuracy for reporting amounts; total inaccuracy to determine inaccuracy for reporting items and amounts combined; intraclass correlation coefficients (ICC) to determine consistency., Results: Means were 51% for omission rate, 39% for intrusion rate, and 7.1 servings for total inaccuracy. Total inaccuracy decreased significantly from the first to the third recall (P=0.006). The ICC was 0.29 for total inaccuracy and 0.15 for omission rate. For all meal components except bread/grain and beverage, there were more omissions than intrusions. Mean arithmetic and absolute differences per serving in amount reported for matches were -0.08 and 0.24, respectively. Mean amounts per serving of omissions and intrusions were 0.86 and 0.80, respectively., Applications/conclusions: The low accuracy and low consistency of children's recalls from this study raise concerns regarding the current uses of dietary recalls obtained from children. To improve the accuracy and consistency of children's dietary recalls, validation studies are needed to determine the best way(s) to interview children.