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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. [ABSTRACT FROM AUTHOR]

Recent identification of the early-onset obese-asthma phenotype has spurred exploration of ways to promote effective, long-term management behaviors for children with this comorbid presentation. Few studies have examined the needs of children with both asthma and obesity and little is known about optimal management options for this unique population. Therefore, the authors aimed to review, critique, and synthesize existing published research on health-management programs designed for children with comorbid asthma and obesity in order to describe the state of the science and recommend next steps in creating pediatric management programs. Articles selected for a full-text review were pediatric-focused, included children with both asthma and obesity diagnoses, and discussed the implementation and evaluation of a management program or the evaluation of a management behavior. Fifteen articles were selected for review based on the inclusion criteria. Studies that included current evidence-based elements had better results than those that did not include such elements. Based on this review, it is recommended that researchers use theory based, multicomponent, multimodal, family-focused, behaviorally-based interventions that address systems-level influences, social determinates of health, and children's developmental needs over time. Additionally, there is a need for studies with sample sizes adequate for power analyses that include the youngest children with asthma and obesity. The need for effective programs for pediatric obese-asthma phenotype management creates the opportunity for nursing-led research and interventions to foster long-term health promotion for affected children and families. • Identification of the early-onset obese-asthma phenotype necessitates promotion of long-term management for these children. • Researchers should use theory based interventions to address children with obese-asthma phenotype's self-management. • Studies that include current evidence-based elements have better results than those that did not include such elements. [ABSTRACT FROM AUTHOR]

Background Scientifically sound methods for investigating dietary consumption patterns from self-serve salad bars are needed to inform school policies and programs. Objective To examine the reliability and validity of digital imagery for determining starting portions and plate waste of self-serve salad bar vegetables (which have variable starting portions) compared with manual weights. Design/methods In a laboratory setting, 30 mock salads with 73 vegetables were made, and consumption was simulated. Each component (initial and removed portion) was weighed; photographs of weighed reference portions and pre- and post-consumption mock salads were taken. Seven trained independent raters visually assessed images to estimate starting portions to the nearest ¼ cup and percentage consumed in 20% increments. These values were converted to grams for comparison with weighed values. Statistical analyses Intraclass correlations between weighed and digital imagery–assessed portions and plate waste were used to assess interrater reliability and validity. Pearson’s correlations between weights and digital imagery assessments were also examined. Paired samples t tests were used to evaluate mean differences (in grams) between digital imagery–assessed portions and measured weights. Results Interrater reliabilities were excellent for starting portions and plate waste with digital imagery. For accuracy, intraclass correlations were moderate, with lower accuracy for determining starting portions of leafy greens compared with other vegetables. However, accuracy of digital imagery–assessed plate waste was excellent. Digital imagery assessments were not significantly different from measured weights for estimating overall vegetable starting portions or waste; however, digital imagery assessments slightly underestimated starting portions (by 3.5 g) and waste (by 2.1 g) of leafy greens. Conclusions This investigation provides preliminary support for use of digital imagery in estimating starting portions and plate waste from school salad bars. Results might inform methods used in empirical investigations of dietary intake in schools with self-serve salad bars. [ABSTRACT FROM AUTHOR]

Timing of energy intake, a temporal dietary pattern, may enhance health. Eating a greater amount of energy earlier and a smaller amount of energy later in the day, a behavioral circadian rhythm, may assist with chronoenhancement. Chronoenhancement seeks to enhance entrainment (synchronization) of biological and behavioral circadian rhythms. In humans, research reports that eating a greater amount of energy early and a smaller amount of energy later in the day increases dietary induced thermogenesis, improves cardiometabolic outcomes, and enhances weight loss. However, little human research has examined if this eating pattern enhances regularity of biological circadian rhythm. In a randomized controlled 8-week pilot study, the influence of energy distribution timing on weight loss and regularity of sleep onset and wake times (marker for biological circadian rhythm) was examined. Within an hypocaloric, three-meal prescription, participants ( n  = 8) were assigned to either: 1) Morning: 50%, 30%, and 20% of kcal at breakfast, lunch, and dinner, respectively; or 2) Evening: 20%, 30%, and 50% of kcal at breakfast, lunch, and dinner, respectively. Percent weight loss and regularity of sleep onset and wake times were significantly ( p  < 0.05) greater for Morning than Evening. To enhance understanding of the influence of energy distribution timing on health, longer studies conducted in free-living participants, with dietary intake assessed using time-stamped methods, that include measures of the circadian timing system are needed. This small review is based upon a symposium presentation at the Society of the Study of Ingestive Behavior in 2017. [ABSTRACT FROM AUTHOR]

Background: Reliance on self-reported dietary intake methods is a commonly cited research limitation, and dietary misreporting is a particular problem in children and adolescents. Objective indicators of dietary intake, such as dietary biomarkers, are needed to overcome this research limitation. The added sugar (AS) biomarker δ13C, which measures the relative abundance of 13C to 12C, has demonstrated preliminary validity in adults.Objective: The purpose of this investigation was to determine the comparative validity, test-retest reliability, and sensitivity of the δ13C biomarker to detect AS and sugar-sweetened beverage (SSB) intake using fingerstick blood samples in children and adolescents.Methods: Children (aged 6-11 y, n = 126, 56% male, mean ± SD age: 9 ± 2 y) and adolescents (aged 12-18 y, n = 200, 44% male, mean ± SD age: 15 ± 2 y) completed 4 testing sessions within a 3-wk period. Participants' height, weight, demographic characteristics, and health history were determined at the first session; 24-h recalls were obtained at each visit and fingerstick blood samples were collected at visits 1 and 3. Samples were analyzed for δ13C value using natural abundance stable isotope mass spectrometry. δ13C value was compared with dietary outcomes in the full sample, and in child and adolescent subgroups. t Tests and correlational analyses were used to assess biomarker validity and reliability, whereas logistic regression and area under the receiver-operator characteristic curve (AUC) were used to evaluate sensitivity.Results: Reported mean ± SD AS consumption was 82.2 ± 35.8 g/d and 329 ± 143 kcal/d, and SSB consumption was 222 ± 243 mL/d and 98 ± 103 kcal/d. Mean δ13C value was -19.65 ± 0.69‰, and was lower in children than in adolescents (-19.80 ± 0.67‰ compared with -19.56 ± 0.67‰, P = 0.002). δ13C values were similar across sessions (visit 1: -19.66 ± 0.68‰; visit 3: -19.64 ± 0.68‰; r = 0.99, P < 0.001) and were associated (P < 0.001) with intake of total AS (grams, kilocalories: r = 0.29) and SSB (milliliters, kilocalories: r = 0.35). The biomarker was able to better discriminate between high and low SSB consumers than high and low AS consumers, as demonstrated by the AUC (0.75 and 0.62, respectively).Conclusions: The δ13C biomarker is a promising, minimally invasive, objective biomarker of SSB intake in children and adolescents. Further evaluation using controlled feeding designs is warranted. Registered at clinicaltrials.gov as NCT02455388. [ABSTRACT FROM AUTHOR]

Background Eleven recommendations, based on systematic reviews, were developed for the Evidence Analysis Library’s prevention of type 2 diabetes project. Two recommendations, medical nutrition therapy (MNT) and weight loss, were rated strong. Objective Present the basis of systematic reviews for MNT and weight loss recommendations. Methods Literature searches using Medline were conducted to identify studies that met eligibility criteria. The MNT literature search covered a time span of 1995 to 2012, the weight loss literature search covered 2008 to 2012 due to inclusion of a Cochrane Review meta-analysis of randomized controlled trials (RCTs) published in 2008. Eligibility criteria for inclusion of articles included original research using higher-quality study designs (ie, RCTs, case control, cohort, crossover, and nonrandomized trials) with participants aged >18 years and meeting prediabetes or metabolic syndrome diagnostic criteria. MNT was defined as individualized and delivered by a registered dietitian nutritionist or international equivalent and length of weight loss interventions was ≥3 months. Main outcome measures Two-hour postprandial blood glucose level, glycated hemoglobin level, albumin-to-creatinine ratio (metabolic syndrome samples only), fasting blood glucose level, high-density lipoprotein cholesterol level, systolic and diastolic blood pressure, triglyceride levels, urinary albumin excretion rate (metabolic syndrome samples only), waist circumference (WC), and waist-to-hip ratio were evaluated. Results For MNT, 11 publications were included, with all 11 using an RCT study design and 10 including participants with prediabetes. A majority of publications reported significant improvements in glycemic outcomes, WC, and blood pressure. For weight loss, 28 publications were identified, with one meta-analysis (only included RCTs) and 20 publications using an RCT study design, with the meta-analysis and 10 RCTs including participants with prediabetes. A majority of publications reported significant improvements in glycemic outcomes, triglyceride level, WC, and blood pressure. Conclusions Systematic reviews provided strong evidence that MNT and weight loss alter clinical parameters in ways that should reduce the risk of developing type 2 diabetes. [ABSTRACT FROM AUTHOR]

This article is the 12th installment in a statistical series exploring the importance of research design, epidemiologic methods, and statistical analysis as applied to nutrition and dietetics research. The purpose of this series is to assist registered dietitian nutritionists in interpreting nutrition research and aid nutrition researchers in applying scientific principles to produce high-quality nutrition research. This article focuses on the use of crossover designs in nutrition and dietetics research. The purpose is to distinguish the crossover design from the randomized clinical trial, define important terms, illustrate a 2×2 crossover design, discuss potential confounding variables in the crossover design, describe the analysis and interpretation of crossover data, present sample size considerations, provide examples of the use of the crossover design in nutrition and dietetics, and discuss additional considerations when the independent variable has more than two levels. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

Background When a hypocaloric, low-fat diet is prescribed, intake of currently consumed foods can decrease, foods naturally low in fat and/or added sugar may increase, or fat- or sugar-modified foods may increase. Objective To examine food group intake change and its relation to reductions in energy and fat intake and weight during a lifestyle intervention. Design Secondary cohort analysis. Participants One hundred sixty-nine participants (aged 52.0±8.6 years, body mass index 34.9±4.5, 92% white, 97.6% non-Hispanic, and 56.8% women) with complete data at 0 and 6 months collected in a research setting. Main outcome measures From three 24-hour telephone dietary recalls, 165 food groups from Nutrition Data System for Research software were coded into 25 larger food groups assessing intake of higher-fat and/or added-sugar food groups vs naturally lower-fat and/or added-sugar food groups and into 17 larger food groups assessing intake of nonmodified vs fat- and/or sugar-modified food groups. Statistical analyses performed Repeated measures analyses of covariance (intervention group: covariate) assessed changes from 0 to 6 months. Hierarchical regressions examined changes in food group intake and changes in energy intake, percent energy from fat intake, and weight from 0 to 6 months. Results Significant reductions ( P <0.05) in intake of high-fat and/or high-added-sugar food groups (Higher-Fat Dairy; Higher-Fat Eggs; Higher-Fat Fats; Higher-Fat Fruit; Higher-Fat Meat; Nonmodified Higher-Fat Fats, Oils, and Sweets; Nonmodified Higher-Fat Sugar-Sweetened Fats, Oils, and Sweets; Nonmodified Regular-Fat Dairy; and Nonmodified Regular-Fat Sugar-Sweetened Dairy) occurred. Decreases in the Higher-Fat Meat group were significantly ( P <0.05) related to decreases in energy intake, percent energy from fat intake, and weight. Conclusions When a hypocaloric, low-fat diet is prescribed, reductions in high-fat and/or high-added-sugar food groups occur. Targeting reductions in high-fat meats may improve outcomes. [ABSTRACT FROM AUTHOR]

Background This investigation examined whether exposure to greater active videogame variety increases moderate- to vigorous-intensity physical activity (MVPA). Methods Twenty-three participants (age = 22.7 ± 4.2 yrs; body mass index = 23.5 ± 3.0 kg/m 2 ; self-reported MVPA = 298.7 ± 116.7 min/wk; 62.2% female; 73.9% Caucasian) participated in VARIETY (4 different active videogames during 4, 15-min bouts) and NON-VARIETY (only 1 active videogame during 4, 15-min bouts) counterbalanced sessions. VARIETY provided a different active videogame in each bout. NON-VARIETY provided participants their most highly liked active videogame in each bout. The Sensewear Mini Armband objectively assessed MVPA. Results For MVPA minutes, a session × bout (p < 0.05) interaction occurred. In NON-VARIETY, bouts 2, 3, and 4 had significantly (p < 0.05) fewer minutes than bout 1, with no decrease occurring in VARIETY. In bout 4, VARIETY had significantly (p < 0.05) more minutes than NON-VARIETY. A main effect of session (p < 0.05) occurred for MVPA minutes and energy expenditure, with VARIETY achieving greater amounts (31.8 ± 14.3 min vs. 27.6 ± 16.9 min; 186.1 ± 96.8 kcal vs. 171.2 ± 102.8 kcal). Conclusions Exposure to greater activity variety within a session increased MVPA. Future research should examine exposure to a variety of activities over a longer time frame with participants of differing lifestyles in free-living environments. [ABSTRACT FROM AUTHOR]

It is the position of the Academy of Nutrition and Dietetics that successful treatment of overweight and obesity in adults requires adoption and maintenance of lifestyle behaviors contributing to both dietary intake and physical activity. These behaviors are influenced by many factors; therefore, interventions incorporating more than one level of the socioecological model and addressing several key factors in each level may be more successful than interventions targeting any one level and factor alone. Registered dietitian nutritionists, as part of a multidisciplinary team, need to be current and skilled in weight management to effectively assist and lead efforts that can reduce the obesity epidemic. Using the Academy of Nutrition and Dietetics’ Evidence Analysis Process and Evidence Analysis Library, this position paper presents the current data and recommendations for the treatment of overweight and obesity in adults. Evidence on intrapersonal influences, such as dietary approaches, lifestyle intervention, pharmacotherapy, and surgery, is provided. Factors related to treatment, such as intensity of treatment and technology, are reviewed. Community-level interventions that strengthen existing community assets and capacity and public policy to create environments that support healthy energy balance behaviors are also discussed. [ABSTRACT FROM AUTHOR]

Background Little is known about diet quality with a reduced-energy, low-fat, partial meal replacement plan, especially in individuals with type 2 diabetes. The Action for Health in Diabetes (Look AHEAD) trial implemented a partial meal replacement plan in the Intensive Lifestyle Intervention. Objective To compare dietary intake and percent meeting fat-related and food group dietary recommendations in Intensive Lifestyle Intervention and Diabetes Support and Education groups at 12 months. Design A randomized controlled trial comparing Intensive Lifestyle Intervention with Diabetes Support and Education at 0 and 12 months. Participants/setting From 16 US sites, the first 50% of participants (aged 45 to 76 years, overweight or obese, with type 2 diabetes) were invited to complete dietary assessments. Complete 0- and 12-month dietary assessments (collected between 2001 and 2004) were available for 2,397 participants (46.6% of total participants), with 1,186 randomized to Diabetes Support and Education group and 1,211 randomized to Intensive Lifestyle Intervention group. Main outcome measures A food frequency questionnaire assessed intake: energy; percent energy from protein, fat, carbohydrate, polyunsaturated fatty acids, and saturated fats; trans -fatty acids; cholesterol; fiber; weekly meal replacements; and daily servings from food groups from the Food Guide Pyramid. Statistical analyses performed Mixed-factor analyses of covariance, using Proc MIXED with a repeated statement, with age, sex, race/ethnicity, education, and income controlled. Unadjusted χ 2 tests compared percent meeting fat-related and food group recommendations at 12 months. Results At 12 months, Intensive Lifestyle Intervention participants had a significantly lower fat and cholesterol intake and greater fiber intake than Diabetes Support and Education participants. Intensive Lifestyle Intervention participants consumed more servings per day of fruits; vegetables; and milk, yogurt, and cheese; and fewer servings per day of fats, oils, and sweets than Diabetes Support and Education participants. A greater percentage of Intensive Lifestyle Intervention participants than Diabetes Support and Education participants met fat-related and most food group recommendations. Within Intensive Lifestyle Intervention, a greater percentage of participants consuming two or more meal replacements per day than participants consuming less than one meal replacement per day met most fat-related and food group recommendations. Conclusions The partial meal replacement plan consumed by Intensive Lifestyle Intervention participants was related to superior diet quality. [ABSTRACT FROM AUTHOR]

Single-serving packages (SSPs) may assist people in reducing consumption. Because overweight/obese individuals and individuals practicing dietary restraint may be more responsive to external food cues regarding an amount of food to consume, we examined whether weight and restraint status influence the relationship between package size and consumption. It was hypothesized that SSPs would reduce intake in overweight/obese individuals and individuals practicing dietary restraint compared with standard packages (STPs). Using a 2×2×2 (unrestrained/restrained×normal weight/overweight×SSP/STP) between-subjects design, 64 participants (aged 23.7±3.3 years; 81.3% white; 46.9% female), from June to October 2011, were randomly assigned to receive 20 oz pretzels packaged in SSPs or STPs, and were instructed to eat the pretzels ad libitum for 4 days. Each condition in the design contained eight participants. Total grams consumed was determined by subtracting postconsumption from preconsumption weight of packages provided. Using an analysis of variance for total grams of pretzels consumed, there was a significant interaction (P=0.01) between package size and weight status. Overweight/obese participants in the SSP condition ate fewer grams of pretzels than overweight/obese participants in the STP condition (107.0±101.9 g vs 204.4±144.9; P<0.05). No effect of restraint was found on consumption. For overweight/obese individuals, fewer pretzels were consumed when packaged in SSPs compared with STPs. Thus, replacing STPs with SSPs may assist with reducing consumption in some overweight/obese individuals. [ABSTRACT FROM AUTHOR]

The more time adults spend being sedentary, the greater the risk of obesity. The effect of reducing television (TV) watching, a prominent sedentary behavior, on weight loss has not been tested in an adult standard behavioral obesity intervention, and the mechanisms by which reducing TV watching influences energy balance behaviors are not well understood. Two, 8-week, pilot, randomized controlled trials were conducted examining the effect of a reduced TV watching prescription on energy balance behaviors and weight loss within an adult standard behavioral obesity intervention. In the first study, participants (n = 24) were randomized into one of two conditions: (a) reduce energy intake and increase moderate to vigorous physical activity (MVPA) (INCREASE PA); or (b) reduce energy intake and decrease TV watching (DECREASE TV). As findings from the first pilot study did not show an increase in MVPA in the DECREASE TV group, the second study was designed to examine the effect of adding a reduced TV prescription to a standard intervention to optimize outcomes. In Pilot Study 2, participants (n = 28) were randomized to INCREASE PA or to INCREASE PA + DECREASE TV. Outcomes included objectively measured TV watching and MVPA, self-reported light physical activity (LPA-Pilot Study 2 only), self-reported dietary intake while watching TV, and weight. Conditions with TV watching prescriptions significantly reduced TV watching. Both studies showed medium to large effect sizes for conditions with TV watching prescriptions to show greater reductions in dietary intake while watching TV. Pilot Study 1 found a trend for an increase in MVPA in INCREASE PA and Pilot Study 2 found significant increases in MVPA in both conditions. Pilot Study 2 found a significant increase in LPA in the INCREASE PA + DECREASE TV. Results indicate adding a TV watching prescription to a standard obesity intervention did not enhance increases in MVPA, but may assist with reducing dietary intake while TV watching and increasing LPA. Future research should examine the effect of reducing TV watching during obesity treatment over a longer time frame in a larger sample. [ABSTRACT FROM AUTHOR]

Abstract: Objective: To examine the independent effects of physical activity (PA) intensity and choice of PA intensity when comparing affective response to and relative preference for self-selected-intensity versus imposed higher intensity PA. Design: Within-subjects experiment. Methods: Twenty-nine healthy, low-active women completed four PA bouts over two sessions. The first session consisted of a one-third mile self-selected-intensity treadmill walk during which the speed was recorded, but was not visible to the participants. The second session consisted of three, counterbalanced, one-third mile treadmill conditions: (a) self-selected intensity, (b) same intensity as recorded for the first-session-self-selected-intensity walk, but with the intensity imposed by the experimenter (i.e., yoked-self-selected intensity), and (c) intensity set at 20% higher than the first-session-self-selected-intensity walk (imposed higher intensity). Acute affective valence (pleasure/displeasure) was recorded prior to, during, and following each walking bout. Preference for each walking intensity was assessed using a behavioral-choice paradigm. Results: Contrary to hypotheses, there was no effect of condition on acute affective valence. However, consistent with hypotheses, there was a linear trend, F(1, 22) = 11.00, p = .003, indicating preference in descending order from self-selected-intensity to yoked-self-selected-intensity to imposed higher intensity PA. Conclusions: Both choice over the intensity and a lower intensity per se contributed to greater preference for self-selected-intensity over imposed higher intensity PA among healthy low-active women; however, there was no evidence to support the notion that affective response to PA mediated this relationship. [Copyright &y& Elsevier]

Abstract: Background: Sedentary behavior (SB), independent of physical activity, represents a significant health risk. We previously used objective measures to demonstrate that bariatric surgery candidates engage in high levels of SB overall, but supplementing these measures with subjective reports would provide information about time allocated to different forms of SB. The aim of this study was to examine self-reported time spent performing specific types of SB and discrepancy between self-reported and objectively measured estimates of total sedentary time in bariatric surgery candidates. Methods: A total of 52 bariatric surgery candidates (87% female; age = 46.2±9.1 years; body mass index [BMI] = 45.3±6.7) completed the 9-item Sedentary Behavior Questionnaire (SBQ) as a subjective measure of SB and wore the SenseWear Armband (SWA; SenseWear, Pittsburgh, PA) as an objective measure. Paired samples t tests and the intraclass correlation coefficient (ICC) assessed measurement discrepancy. Results: Television-viewing was the most frequently performed type of SB (2.7±1.6 hours per day), followed by paper/computer work (1.9±1.8 hours per day), driving/riding in automobile (1.2±1.1 hours per day), and sitting/talking on telephone (1.1±1.2 hours per day). On average, the SBQ and SWA produced similar estimates of daily sedentary time (hours per day) at the group level (9.6±4.8 versus 9.3±1.9; mean difference = –.34±4.6; P = .59), although agreement between the measures at the individual level was poor (mean absolute value of difference = 3.8±2.8 hours per day; ICC = .22; P = .06). Conclusion: Television-viewing was the single SB in which participants most frequently engaged and thus may be an important modifiable target for reducing total sedentary time in bariatric surgery candidates. The SBQ and SWA can be used similarly to describe SB levels in this patient population at the group level; however, ability of these measures to produce comparable estimates of sedentary time for any individual patient is limited. [Copyright &y& Elsevier]

Abstract: Dietary goals specific for lowering energy density (ED) may promote a nutrient-dense diet and weight loss. This pilot study examined the effects of ED-based diet prescriptions on diet quality and weight loss during a 3-month behavior-based obesity intervention conducted in a research setting. Forty-four adults with overweight/obesity (age 52.1±7.6 years, body mass index [BMI; calculated as kg/m2] 34.8±4.8, 81.8% women, and 93.2% white) were recruited between December 2009 and March 2010 and randomly assigned to: Low ED (consume ≥10 foods ≤1.0 kcal/g dietary ED and ≤2 foods ≥3.0 kcal/g dietary ED per day (n=15); Low-Energy, Low-Fat (1,200 to 1,500 kcal/day, ≤30% energy from fat (n=15); or Low-ED, Low-Energy, Low-Fat (n=14). Participants received 12 weekly group sessions led by a research interventionist. Dietary intake (measured by 3-day food records), self-reported physical activity, and weight were measured at baseline and 3 months. Intent-to-treat analyses showed all conditions reduced dietary ED and energy intake (P<0.001). Low-ED and Low-ED, Low-Energy, Low-Fat interventions increased fruit consumption (P<0.05). All conditions increased self-reported physical activity (P<0.001), with no difference between conditions. Although participants in all conditions lost weight (P<0.001), those in the Low-ED condition lost more (P<0.05) than those in the Low-ED, Low-Energy, Low-Fat condition (Low-ED −20.5±7.0 lb, Low-Energy, Low-Fat −16.9±10.1 lb, and Low-ED, Low-Energy, Low-Fat −12.5± 6.5 lb). A diet prescription that lowered ED increased fruit intake and enhanced weight loss compared with other weight loss prescriptions. [Copyright &y& Elsevier]

Abstract: Due to the high prevalence of overweight and obesity, developing strategies to improve weight loss and weight loss maintenance is imperative. One dietary environmental variable that has received little attention in being targeted in an intervention to assist with obesity treatment is dietary variety. Experimental research has consistently shown that greater dietary variety increases consumption, with the effect of variety on consumption hypothesized to be a consequence of the differential experience of the more varied sensory properties of food under those conditions with greater dietary variety. As reduced energy intake is required for weight loss, limiting variety, particularly in food groups that are high in energy-density and low in nutrient-density, may assist with reducing energy intake and improving weight loss. A series of investigations, both observational and experimental, were conducted to examine if limiting variety in an energy-dense, non-nutrient-dense food group, snack foods (i.e., cookies, chips), assisted with reducing energy intake of the food group and improving weight loss. Results of the investigations suggest that a prescription for limiting variety in a food group can be implemented during obesity treatment, limiting variety is associated with the occurrence of monotony, and that reducing food group variety is related to decreased consumption of that food group. Future research is needed to ascertain the long-term effect of prescriptions targeting dietary variety on weight loss and weight loss maintenance. [Copyright &y& Elsevier]

Background: Genome-wide association studies (GWAS) have identified consistent associations with obesity. However, the mechanisms remain unclear. Objective: The objective was to determine the association between obesity susceptibility loci and dietary intake. Design: The association of GWAS-identified obesity risk alleles (FTO, MC4R, SH2B1, BDNF, INSIC2, TNNI3K, N1SCH-STAB1, MTIF3, MAP2K5, QPCTUG1PR, and PPARC) with dietary intake, measured through food-frequency questionnaires, was investigated in 2075 participants from the Look AHEAD (Action for Health in Diabetes) clinical trial. We adjusted for age, sex, population stratification, and study site. Results: Obesity risk alleles at FTO rsl421085 significantly predicted more eating episodes per day (P = 0.001)-an effect that persisted after adjustment for body weight (P = 0.004). Risk variants within BDNF were significantly associated with more servings from the dairy product and the meat, eggs, nuts, and beans food groups (P ≤ 0.004). The risk allele at SH2B1 rs4788099 was significantly associated with more servings of dairy products (P = 0.001), whereas the risk allele at TNN13K rsl514176 was significantly associated with a lower percentage of energy from protein (P = 0.002). Conclusion: These findings suggest that obesity risk loci may affect the pattern and content of food consumption among overweight or obese individuals with type 2 diabetes. The Look AHEAD Genetic Ancillary Study was registered at clinicaltrials.gov as NCT01270763 and the Look AHEAD study as NCT00017953. [ABSTRACT FROM AUTHOR]

Background: Dietary variety is a factor that influences consumption but has received little attention in obesity treatment. Objective: This study examined the effect of limiting the variety of different non-nutrient-dense, energy-dense foods (NND-EDFs) (ie, chips, ice cream, cookies) on dietary intake and weight loss during an 18-mo lifestyle intervention. Design: Two hundred two adults aged 51.3 ± 9.5 y with a BMI (in kg/m2) 34.9 ± 4.3 (57.8% women, 92.2% white) were randomly assigned to 1 of 2 interventions: Lifestyle (1200-1500 kcal/d, ≤30% of energy as fat; n = 101) or Lifestyle + limited variety (LV) (limit variety of NND-EDFs, ie, 2 choices; n = 101). Both interventions involved 48 group sessions. Dietary intake, NND-EDF hedonics, NND-EDF variety in the home, and weight were assessed at 0, 6, 12, and 18 mo. Results: Intent-to-treat analyses showed that the Lifestyle+LV group consumed less variety (P < 0.01) and energy daily (P < 0.05) from NND-EDFs than did the Lifestyle group at 6, 12, and 18 mo. The Lifestyle+LV group consumed less total energy daily (P < 0.05) at 6 mo than did the Lifestyle group. The Lifestyle+LV group reported less (P < 0.05) NND-EDF variety in the home at 6 and 18 mo than did the Lifestyle group. The hedonics of one chosen NND-EDF decreased more (P < 0.05) in the Lifestyle+LV group. Despite these effects, no difference in percentage weight loss occurred at 18 mo (Lifestyle+LV: -9.9 ± 7.6%; Lifestyle: -9.6 ± 9.2%). Conclusions: Limitations in dietary variety decreased intakes in the targeted area but did not affect weight loss. Limiting variety in more areas may be needed to improve weight loss and weight-loss maintenance. This trial was registered at clinicaltrials.gov as NCT01096719. [ABSTRACT FROM AUTHOR]

One way in which to modify food purchases is to change prices through tax policy, subsidy policy, or both. We reviewed the growing body of experimental research conducted in the laboratory and in the Held that investigates the following: the extent to which price changes influence purchases of targeted and nontargeted foods, total energy, or macronutrients purchased; the interaction of price changes with adjunctive interventions; and moderators of sensitivity to price changes. After a brief overview of economic principles and observa-tional research that addresses these issues, we present a targeted re-view of experimental research. Experimental research suggests that price changes modify purchases of targeted foods, but research on the overall nutritional quality of purchases is mixed because of substi-tution effects. There is mixed support for combining price changes with adjunctive interventions, and there are no replicated findings on moderators to price sensitivity in experiments. Additional focused research is needed to better inform food policy development with the aim of improving eating behavior and preventing obesity. [ABSTRACT FROM AUTHOR]

Abstract: Underreporting in self-reported dietary intake has been linked to dietary restraint (DR) and social desirability (SD), however few investigations have examined the influence of both DR and SD on reporting accuracy and used objective, rather than estimated, measures to determine dietary reporting accuracy. This study investigated accuracy of reporting consumption of a laboratory meal during a 24-hour dietary recall (24HR) in 38 healthy, college-aged, normal-weight women, categorized as high or low in DR and SD. Participants consumed a lunch of four foods (sandwich wrap, chips, fruit, and ice cream) in a laboratory and completed a telephone 24HR the following day. Accuracy of reported energy intake of the meal=((reported energy intake−measured energy intake)/measured energy intake)×100 [positive numbers=overreporting]. Overreporting of energy intake occurred in all groups (overall accuracy rate=43.1±49.9%). SD-high as compared to SD-low more accurately reported energy intake of chips (19.8±56.2% vs. 117.1±141.3%, p<0.05) and ice cream (17.2±78.2% vs. 71.6±82.7%, p<0.05). SD-high as compared to SD-low more accurately reported overall energy intake (29.8±48.2% vs. 58.0±48.8%, p<0.05). To improve accuracy of dietary assessment, future research should investigate factors contributing to inaccuracies in dietary reporting and the best methodology to use to determine dietary reporting accuracy. [Copyright &y& Elsevier]

Abstract: Background: The reported effects of bariatric surgery on food cravings have been inconsistent. Moreover, research has been largely limited to sweet cravings, and no study has examined whether surgery patients'' cravings differ from those of normal weight (NW) controls. Our objective was to use an empirically validated instrument to examine changes in bariatric surgery patients'' frequency of food cravings and consumption of craved foods from before to 3 and 6 months after surgery and to compare surgery patients'' frequency of food cravings to those of NW controls. The setting was private hospitals and research center in the United States. Methods: Bariatric surgery patients (n = 32) and NW controls (n = 20) completed the Food Cravings Inventory and had their height and weight measured. Results: Before surgery, the patients reported more overall cravings and cravings for high fat and fast foods and a greater consumption of craved high-fat foods than the NW controls. From before to 3 and 6 months after surgery, the patients had significant reductions in overall cravings for, and consumption of, craved foods, with specific effects for sweets and fast food; however, surgery had virtually no effect on the cravings for high-fat foods. Moreover, high-fat and fast food cravings did not reduce to normative levels. The postoperative patients were less likely to consume craved sweets than NW controls, and the patients'' postoperative weight loss was largely unrelated to food cravings. Conclusion: Bariatric surgery is associated with significant reductions in food cravings and consumption of craved foods, with the exception of high-fat foods. Despite these decreases, patients'' cravings do not fully reduce to “normative” levels and are not associated with postoperative weight loss. [Copyright &y& Elsevier]

Abstract: Research shows a positive relationship between dietary energy density (ED) and body mass index (BMI), but dietary ED of weight loss maintainers is unknown. This preliminary investigation was a secondary data analysis that compared self-reported dietary ED and food group servings consumed in overweight adults (OW: BMI=27–45kg/m2), normal weight adults (NW: BMI=19–24.9kg/m2), and weight loss maintainers (WLM: current BMI=19–24.9kg/m2 [lost≥10% of maximum body weight and maintained loss for ≥5years]) participating in 2 studies, with data collected from July 2006 to March 2007. Three 24-h phone dietary recalls from 287 participants (OW=97, NW=85, WLM=105) assessed self-reported dietary intake. ED (kcal/g) was calculated by three methods (food+all beverages except water [F+AB], food+caloric beverages [F+CB], and food only [FO]). Differences in self-reported consumption of dietary ED, food group servings, energy, grams of food/beverages, fat, and fiber were assessed using one-way MANCOVA, adjusting for age, sex, and weekly energy expenditure from self-reported physical activity. ED, calculated by all three methods, was significantly lower in WLM than in NW or OW (FO: WLM=1.39±0.45kcal/g; NW=1.60±0.43kcal/g; OW=1.83±0.42kcal/g). Self-reported daily servings of vegetables and whole grains consumed were significantly higher in WLM compared to NW and OW (vegetables: WLM=4.9±3.1 servings/day; NW=3.9±2.0 servings/day; OW=3.4±1.7 servings/day; whole grains: WLM=2.2±1.8 servings/day; NW=1.4±1.2 servings/day; OW=1.3±1.3 servings/day). WLM self-reported consuming significantly less energy from fat and more fiber than the other two groups. Self-reported energy intake per day was significantly lower in WLM than OW, and WLM self-reported consuming significantly more grams of food/beverages per day than OW. These preliminary findings suggest that consuming a diet lower in ED, characterized by greater intake of vegetables and whole grains, may aid with weight loss maintenance and should be further tested in prospective randomized controlled trials. [Copyright &y& Elsevier]

Abstract: Many factors influence children''s dietary intake, including children''s and parents'' food hedonics (liking), and parent intake. This secondary data analysis studied the relationship between child and parent liking, and parent intake and child intake of fruits, vegetables, low-fat dairy, snack foods, and sweetened beverages in 4- to 9-year-old overweight/obese (body mass index ≥85th percentile) children presenting for obesity treatment (September 2005 to September 2007) in Providence, RI. One hundred thirty-five parent-child pairs, with complete baseline dietary (3-day food record) and food group hedonic data were included. Hedonic ratings were mean ratings using a 5-point Likert scale (lower scores represented greater liking of a food group). Children were aged 7.2±1.6 years, 63.0% girls, 12.6% African American, and 17.8% Hispanic, with a mean body mass index z score of 2.3±0.6. Total servings consumed by children over 3 days were: fruits 2.7±3.2, vegetables 3.4±2.5, low-fat dairy 2.4±2.1, snack foods 5.9±4.2, and sweetened beverages 2.7±3.1. After demographic and anthropometric variables were controlled, parent intake was positively related (P<0.05) to child intake of all food groups except sweetened beverages. Child liking was only significantly (P<0.05) related to child intake of vegetables. In young children with obesity/overweight, parent intake was consistently related to child intake. Changing parent intake may be important in helping to change the dietary intake of young children with overweight/obesity. [Copyright &y& Elsevier]

Abstract: The influence of dietary environmental factors on child weight status may be important in the battle against childhood obesity. Portion size and energy density are factors shown to impact entrée energy intake in children. However, the influence of these factors on child snack energy intake has not been studied. Thus, the aim of this study was to investigate the impact of portion size on intake of a lower energy-dense and higher energy-dense snack in preschool-aged children. A 2×2 crossover design (within-subject factors of portion size and energy density) was conducted on Wednesdays in a preschool setting on the University of Tennessee campus from October 2008 to November 2008. Seventeen children had complete data (age 3.8±0.6 years; 10 of 17 were female; 14 of 17 were white). Foods were applesauce (lower energy dense=0.43 kcal/g) and chocolate pudding (higher energy dense=1.19 kcal/g), and portion sizes were 150 g (small) and 300 g (large). Measures included anthropometrics, hunger, liking of foods, and caretakers'' child-feeding practices using validated instruments. Mixed factorial analyses of covariance, with order controlled, analyzed gram and energy snack intake across conditions. There was no significant main effect of energy density on snack intake, but the main effect of portion size on snack intake (small portion size 84.2±30.8 kcal, large portion size 99.0±52.5 kcal; P<0.05) was significant. Results indicate increased energy intake when snacks are offered in larger portion size, regardless of energy density. Snack portion size may be an environmental strategy that can reduce excessive energy intake in children. [Copyright &y& Elsevier]

Abstract: Larger portion sizes increase energy intake, yet it is unclear whether single-serving packages can reduce intake. This study examined the effects of providing breakfast foods in single-serving packages and nonportioned packages on energy intake of these foods during an 8-week behavioral weight-loss program. In fall 2005, 19 adults (mean body mass index [calculated as kg/m2]=31.8±4.0) were randomized to conditions that provided foods in single-serving packages (Single-Serving) or in nonportioned packages (Standard). Overall amounts and types of foods provided were consistent across conditions: cereal and peaches (weeks 1, 3, 5, and 7) and applesauce and cheese (weeks 2, 4, 6, and 8). Participants were instructed to eat one serving of each food for breakfast and not to consume the provided foods at other times. Mean daily energy intake of the provided foods was the primary dependent variable. The Single-Serving group ate less energy from the combined pairs of foods provided together as compared to Standard (cereal and peaches, 117.0±3.2 kcal/day vs 143.5±39.3 kcal/day; P<0.05 and applesauce and cheese, 174.2±13.5 kcal/day vs 199.0±29.4 kcal/day; P<0.05). This effect was a result of less energy consumed from cereal and applesauce in Single-Serving compared to Standard conditions (cereal, 80.2±2.9 kcal/day vs 106.3±22.9 kcal/day; P<0.01 and applesauce, 44.5±0.6 kcal/day vs 59.3±5.0 kcal/day; P<0.01), with no differences in energy consumption for peaches and cheese (P>0.10). This suggests that single-serving packages may help reduce energy intake at breakfast within the context of a behavioral weight-control program. [Copyright &y& Elsevier]

Abstract: Purpose: To investigate whether fast food consumption and breakfast skipping are associated with weight gain during the transition from adolescence to adulthood. Methods: A prospective study of 9919 adolescents participating in Waves II (age range 11–21 years) and III (age range 18–27 years) of the National Longitudinal Study of Adolescent Health. BMI z scores (zBMI) were computed using the 2000 Centers for Disease Control and Prevention growth charts. Multivariate regression models assessed the relationship between Wave II fast food and breakfast consumption and change in fast food and breakfast consumption between Waves II and III and weight gain during the transition to adulthood. Results: Marked increases in fast food consumption and decreases in breakfast consumption occurred over the 5-year interval. Greater days of fast food consumption at Wave II predicted increased zBMI at Wave III. Fewer days of breakfast consumption at Wave II and decreases in breakfast consumption between Waves II and III predicted increased zBMI at Wave III. Conclusions: Fast food consumption and breakfast skipping increased during the transition to adulthood, and both dietary behaviors are associated with increased weight gain from adolescence to adulthood. These behaviors may be appropriate targets for intervention during this important transition. [Copyright &y& Elsevier]

Abstract: Limiting meal variety decreases hedonic ratings of eaten foods more so than non-eaten foods, demonstrating sensory-specific satiety. Exposure to a food over time decreases the food''s hedonic ratings, indicating monotony. The effect of limiting food group variety over time on long-term sensory-specific satiety and monotony is unknown. Thirty overweight adults were randomized to one of two 8-week behavioral weight loss interventions. One condition limited snack food intake to one chosen snack food (reduced variety), while the other limited snack food intake to <1 serving/day (control), with no variety limit. In the reduced variety condition, hedonic ratings of the chosen snack food showed a decrease (p <.05) over time and decreased more (p <.05) than hedonic ratings of other snack foods. Weight loss (−7.4±5.8 lb) occurred in both conditions. Limiting food group variety over 8 weeks produced long-term sensory-specific satiety and monotony. Future research should examine if limiting food group variety over an extended time affects intake and could be used as a technique in weight loss interventions. [Copyright &y& Elsevier]

Background: Changes in sedentary behavior may be related to changes in energy intake. Objective: The purpose of this study was to investigate how experimental changes in the amount of sedentary behaviors influence energy intake. Design: Sixteen nonoverweight 12-16-y-old youth were studied in a within-subject crossover design with three 3-wk phases: baseline, increasing targeted sedentary behaviors by 25-50% (increase phase), and decreasing targeted sedentary behaviors by 25-50% (decrease phase). Repeated 24-h recalls were used to assess energy and macronutrient intakes during targeted sedentary behaviors. Accelerometers were used to assess activity levels. Results: Targeted sedentary behaviors increased by 81.5 min/d (45.8%) and decreased by 109.8 min/d (-61.2%) from baseline (both: P < 0.01). Girls increased sedentary behaviors significantly more than did boys (107.3 and 55.8 min/d, respectively; P < 0.01) in the increase phase. Energy intake decreased (-463.0 kcal/d; P < 0.01) when sedentary behaviors decreased: the decrease in fat intake was - 295.2 kcal/d (P<0.01). No significant changes in energy intake were observed when sedentary behaviors were increased. Youth also increased their activity by 102.4 activity counts min-1 d-1 (estimated at 113.1 kcal) when sedentary behaviors were decreased (P < 0.05). Conclusions: Decreasing sedentary behaviors can decrease energy intake in nonoverweight adolescent youth and should be considered an important component of interventions to prevent obesity and to regulate body weight. [ABSTRACT FROM AUTHOR]

Objective To assess dietary costs during a family-based pediatric obesity intervention.Design Families were randomized to one of two groups. Dietary and cost data were collected from a parent or child using three 24-hour recalls: at baseline, 6 months, and 12 months.Subjects Thirty-one families with an obese 8- to 12-year-old child entered treatment, with complete dietary data provided from 20 families.Intervention The 20-week behavior modification intervention emphasized increasing diet nutrient-density. Families attended group and individual sessions or group sessions.Main outcome measures Energy intake; percent of energy from protein, fat, and carbohydrate; servings and percent servings from food groups classified by nutrient density; and daily food costs.Statistical analyses performed Mixed analyses of variance, with group as the between-subject factor, and time as the within-subject factor.Results No significant effect of group was found in any analyses. Significant decreases in percent overweight were observed at 6 and 12 months for children (-10.0±8.7 and -8.0±10.3, respectively) (mean±standard deviation) and parents (-6.7±10.3 and -5.3±14.1). Energy intake for parents and children combined significantly decreased from baseline (1,881±462) to 6 months (1,412±284), and 1 year (1,338±444). Servings from low-nutrient-dense foods significantly decreased from baseline (34.7±16.2) to 6 months (16.0±8.6) and 1 year (18.6±9.2), causing a significant increase in diet nutrient density. Dietary cost did not change at 6 months, but significantly decreased from baseline to 1 year ($6.77±2.41 to $5.04±1.80). Cost per 1,000 kcal did not significantly change.Applications/Conclusions Adopting a lower-energy, nutrient-dense diet did not increase dietary costs over time. Consequently, cost should not be a barrier in the adoption of a healthful diet. J Am Diet Assoc. 2002;102:645–650, 655–656. [Copyright &y& Elsevier]

Abstract: Background: Greater exposure to an orosensory cue could increase habituation rate. This investigation examined salivary habituation during 10 lemon juice trials providing exposure via olfactory, gustatory, and combined systems. Methods: Healthy, normal-weight, unrestrained females (age=20.7±2.7year, body mass index [BMI]=22.2±1.5kg/m2, 70.0% white) were randomly assigned to 1 of 3 conditions: olfactory (SMELL: n=8), gustatory (TASTE: n=10), or olfactory+gustatory (SMELL+TASTE: n=9). All conditions completed 12, 2-minute, trials (trials 1–2: water [baseline]; trials 3–12: lemon juice), in which salivation was measured. In conditions with taste exposure, 0.05ml of the stimulus was placed on the tongue. In conditions with smell exposure, 4.0g of the stimulus was held 0.5in from the nose. Salivation was measured using dental rolls and mean salivation of every two trials was the dependent variable. Results: A mixed-factor ANCOVA, controlling for baseline differences between the conditions in lemon juice hedonics, found a significant (p<0.05) interaction of condition x trial. SMELL+TASTE significantly (p<0.05) increased salivation from baseline to lemon juice exposure, and decreased salivation by the last two mean trials. TASTE had a significant (p<0.05) increase in salivation from baseline to lemon juice, with no decrease. Conclusion: Repeated exposure to an orosensory cue by combined olfactory and gustatory systems produced a faster habituation rate than exposure by the gustatory system alone. Thus, food cues that combine exposure to the olfactory and gustatory systems may enhance satiation. [Copyright &y& Elsevier]

Although adolescents with obesity have heightened risk for eating pathology, the impact of differential parent involvement on eating pathology after obesity treatment is unknown. We examined differences in eating pathology in adolescents whose parents were randomized to distinct interventions within adolescent obesity treatment. Participants were 82 adolescent/parent dyads (adolescents: 63 % female; 55 % racial/ethnically marginalized) enrolled in TEENS+, a 4-month behavioral weight loss intervention. Parents were randomized to either a parent weight loss treatment (TEENS+PWL) or parent skills training (TEENS+PAC). Adolescents completed the Eating Disorder Examination-Questionnaire with Instructions (EDE-Q-I) and Child Depression Inventory (CDI) at baseline, 4 m, and 7 m. Group differences in eating pathology (global score; eating concern, weight concern, shape concern, restraint) and depression across time points were evaluated with linear mixed models. No significant differences were observed between TEENS+PAC and TEENS+PWL in eating pathology or depression, nor were there group by time interactions. Time point differences were observed for all EDE-Q-I and CDI outcomes, except eating concerns; pairwise contrasts revealed a variety of change patterns. Weight and shape concerns decreased from 0 to 4 m; observed reductions were maintained at 7 m. Restraint was highest at 4 m and decreased at 7 m but did not return to baseline. EDE-Q-I global scores significantly declined over time. Depression decreased over time, but a significant difference was only observed between 0 and 7 m. Neither parent intervention yields harm related to eating pathology in adolescents engaged in obesity treatment. Obesity treatment does not appear to have iatrogenic effects on eating pathology in adolescents. • Examined eating pathology among adolescents in obesity treatment. • Investigated differences between two distinct parent interventions. • Obesity treatment does not appear to have iatrogenic effects on eating pathology. • Both parent approaches offer protection against eating pathology. [ABSTRACT FROM AUTHOR]

Objective: To determine associations among objectively-measured nocturnal sleep time, bedtime and obesogenic behaviors, including dietary intake, timing of intake, and physical activity, in a diverse sample of school-aged children who presented for behavioral treatment to enhance sleep duration.Methods: Eighty-seven children (8-11 y, 66.7% female, zBMI: 0.86 ± 1.0) who self-reported sleeping <9.5 h/night were studied for one week using wrist actigraphy to estimate sleep; hip-worn accelerometers to measure physical activity; and 24 h dietary recalls to capture dietary intake and meal timing. Pearson and Spearman's rho correlations and linear regressions controlling for age, gender and race were used for statistical analyses.Results and Conclusion: Mean bedtime was 10:31 PM (±58.2 min) and mean nocturnal sleep time was 7.7 h (±37.5 min). Although later bedtime was associated with shorter sleep time (r = -0.61, p < 0.001), the two variables were differentially related to obesity risk factors. Later bedtime, but not sleep time, correlated with greater daily fat intake, later first meal of the day, and greater after-dinner intake (all p < 0.05). Nocturnal sleep time, but not bedtime, correlated with zBMI (p = 0.04). Both sleep time and later bedtime were associated with a later last meal of the day (all p < 0.05). Findings remained consistent after controlling for demographic factors. In short-sleeping school-aged children, bedtime may be more predictive of dietary obesity risk factors whereas sleep duration may be more predictive of zBMI. Results suggest that health providers should consider both bedtime and sleep duration for reducing obesity risk in children.Clinical Trial: Enhancing Sleep Duration: Effects on Children's Eating and Activity Behaviors, NCT03186508, https://clinicaltrials.gov/ct2/show/NCT03186508. [ABSTRACT FROM AUTHOR]

Abstract: Purpose: To determine whether baseline intake or initial changes in intake of fruits (F), vegetables (V), snack foods (SF), and reduced-calorie snack foods (RCSF) during standard behavioral weight loss treatment predict BMI reductions among overweight adolescents. Given conflicting messages between child and adult weight loss interventions, the role of RCSF in adolescent weight control was of particular interest. Methods: Seventy-two adolescents, 13–16years old, participating in a 16-week behavioral weight loss trial with diet records at baseline and 4weeks were included. Height and weight were measured at 0 and 16weeks. Frequency of intake of F, V, SF, and RCSF were obtained from 7-day food records at 0 and 4weeks. Results: Male gender, higher initial frequency of intake of V and increased frequency of intake of F and RCSF over the first 4weeks of treatment accounted for 43% of the variance in BMI reduction at 16weeks (p <.001). Conclusions: Early changes in eating habits, including increased frequency of intake of F and RCSF may promote greater adolescent BMI reductions. [ABSTRACT FROM AUTHOR]

Stimuli that promote eating in the absence of the physiological need for food are pervasive and can facilitate excessive energy intake. The practices of mindful eating (ME) and intuitive eating (IE) have been developed to minimize external drivers of energy intake by helping individuals emphasize the sensory properties of foods and internal indicators of hunger and fullness. To enhance understanding about the effect of ME and IE interventions on dietary intake, this systematic review included randomized trials of ME and IE interventions that examined dietary intake, defined as energy intake or diet quality, in adults of varying weight status without a diagnosis of an eating disorder. The selection of literature followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses systematic review process, in which PubMed, CINAHL (Cumulative Index to Nursing and Allied Health Literature), and PsycINFO databases were searched for studies published between January 1980 and November 2019. Studies were included if they met the following criteria: randomized trial design in which 1 arm was an intervention with an ME or IE component and there was at least 1 control or active comparison arm; enrolled participants were of a healthy weight or with overweight or obesity and reported not having an eating disorder (ie, anorexia, bulimia nervosa, or binge eating disorder) or other health conditions in which dietary restrictions were applied; were at least 18 years of age; and outcomes of energy intake or diet quality were reported at baseline and post intervention. The modified Downs and Black checklist was used to assess risk of bias for each study that met inclusion criteria. A total of 13 studies, including 8 investigating ME interventions and 5 investigating IE interventions, represented in 14 articles, were included in the review. Seven of the 9 articles reporting on energy intake did not find significant group differences. Eight of the 12 articles reporting on diet quality did not find significant group differences. The mean bias assessment score was 13.6 out of 28, indicating poor quality. Little evidence suggests that ME and IE interventions influence energy intake or diet quality. To draw strong conclusions about the effect of ME and IE on dietary intake, future research using study designs of high rigor are needed. [ABSTRACT FROM AUTHOR]

Body-borne sensors may be useful in assessing eating behaviors and have the potential to overcome some of the limitations of self-report instruments. The Bite Counter is a new commercial device, worn on the wrist that purports to track the number of bites taken per day. It contains a tri-axial accelerometer that detects an upward, arcing motion from the table to the mouth, known as a wrist roll. Purpose: To examine the validity of the Bite Counter device for measuring bites in individuals while consuming various foods and beverages. Methods: 15 adults (23-58years old) wore the device on the wrist of their dominant hand. They were presented with a meal consisting of foods/beverages, each consumed with different utensils: meat (knife and fork), side items (fork), soup (spoon), pizza (hands), can of soda (hands), and a smoothie (straw). Each food or drink was consumed by itself, in consecutive order. A researcher observed them through a one-way mirror and counted the number of bites taken. Results: The percentage of actual bites taken varied as follows: Meat (127%), side items (82.6%), soup (60.2%), pizza (87.3%), soda (81.7%), and smoothie (57.7%). The overall mean was 81.2% of bites taken. Conclusion: The results indicate that the Bite Counter holds promise for being able to count the number of hand-to-mouth movements. In general, it underestimated hand-to-mouth movements, but some types of hand movements caused overestimation of bites. Future studies should be undertaken to improve the sensitivity and specificity of the Bite Counter device. [ABSTRACT FROM AUTHOR]

Produce prescription (FVRx) programs have been established to support the consumption of fruits and vegetables (FVs), particularly among individuals at risk for diet-related chronic disease or food insecurity, through referral by a healthcare provider. To date, published literature on prescription programs solely focused on FVs has not been synthesized. To examine the impact of FVRx programs on FV intake, cardiovascular risk factors and food security in children and adults. A systematic review with searches across five databases were completed. All records were uploaded into Covidence, a systematic review management software. Duplicates were removed and selection of studies was determined based on review of title/abstract and subsequent review of full-text articles by two independent reviewers. Disagreements were resolved by consensus with a third reviewer. Eligibility criteria included studies published in the US, in English between August 2012-2022. Eligible studies had to include exposure to a FVRx program (enrolled participants with or at risk for a diet-related chronic disease or food insecurity, referral by a healthcare provider, and use of a monetary prescription redeemed at a farmers' market or grocery store) and an outcome of FV intake, cardiovascular risk factors, and/or food security. Reported outcome data was extracted from eligible articles and synthesized. Across studies, findings were summarized for each outcome. A total of 949 records were identified and 248 duplicates were removed. Of the 701 titles/abstracts reviewed, 47 were identified for full text review. Twenty studies were selected for inclusion. Fifteen studies reported FV intake, 12 analyzed changes and 7 studies found a significant increase in FV intake. Cardiovascular risk factors outcomes were reported for HbA1c (n=7), blood pressure (n=8) and cholesterol (n=2) with mixed findings. Of the 7 studies that reported food security outcomes, 4 analyzed changes with all reporting improvements in food security. There is evidence to support FVRx programs improve food security with mixed findings for FV intake and cardiovascular risk factors. NIH [ABSTRACT FROM AUTHOR]

Obesity is associated with a multitude of comorbidities and considerable health care costs. 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"). 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. 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). 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. [Display omitted] [ABSTRACT FROM AUTHOR]

Although many people try to lose weight, a large proportion of individuals do not achieve clinically significant weight loss. Nonresponse and relapse rates in lifestyle interventions are largely explained by challenges in avoiding or resisting temptation in the context of omnipresent food access. Innovative enhancement strategies are needed to help individuals manage temptation in evidence-based lifestyle interventions. This prospective, four-parallel-arm, randomized controlled trial tests the efficacy of two weight management enhancement strategies on weight and dietary outcomes among individuals with overweight or obesity: (1) an environmental control strategy combining modification of the home food environment and grocery delivery (AVOID) and (2) an impulse control strategy involving daily, gamified inhibitory control training (RESIST). Women and men (n = 500) with overweight or obesity (Body Mass Index between 25 and 40.0 kg/m2) will be enrolled in a 12-month commercial weight-loss program (WW, formerly Weight Watchers©) and randomly assigned to one of four conditions: (1) WW alone, (2) WW + AVOID, (3) WW + RESIST, or (4) WW + AVOID + RESIST. Anthropometric, dietary, cognitive, and household food environment assessments will be conducted in English or Spanish at enrollment and at 6- and 12-month follow-up. This research addresses the pragmatic question of how to best optimize behavior change: Should we modify the choice environment, strengthen individuals' self-regulation, or both, to maximize behavior change? This work can inform the development of enhancement strategies to promote adherence to lifestyle recommendations and other impulse control challenges. • Novel design compares environmental changes and cognitive training for weight loss. • Evaluating ripple effects on household members can inform weight loss strategies. • Gamification principles sustain training frequency, duration and adherence. [ABSTRACT FROM AUTHOR]