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Background/objective Maintenance interventions inherently require BMI improvement to maintain. This overlooks individuals initially unresponsive to obesity interventions. Staged pediatric clinical treatment guidelines were adapted to the school setting to develop an escalated treatment option for individuals initially unresponsive. This staged randomized controlled trial examined differences between escalated treatment (Take CHARGE!) and a maintenance program (PE Planners). Take CHARGE was hypothesized to have greater improvements in BMI as a percentage of the 95th BMI Percentile (%BMIp95) than PE Planners. Subjects/methods From 2018 to 2020, 171 middle and high schoolers (BMI Percentile ≥ 85) were recruited from a Houston school district to participate in a staged obesity intervention in their physical education (PE) class. After receiving a semester-long intensive lifestyle intervention (ILI) with established efficacy, all participants were randomized to Take CHARGE (n = 85) or PE Planners (n = 86). Take CHARGE escalated the behavioral treatment of obesity received in ILI with more frequent individual sessions, additional opportunities for parental and school staff involvement, and increased mentorship from trained college students. PE Planners allowed participants to decide how they wanted to be active in PE class. Mixed linear modeling examined %BMIp95 overtime between groups. This trial was registered at ClinicalTrials.gov (#NCT04362280). Results Participants were 13.63 ± 1.32 years old; 59% were female, and 85% were Hispanic. Among those initially unresponsive to ILI, Take CHARGE had significantly greater decreases in %BMIp95 than PE Planners (β = −0.01, p

BACKGROUND Moderate-to-vigorous physical activity (MVPA) declines during adolescence, particularly among girls. In this randomized control trial, we examined MVPA in a physical activity intervention compared to physical education (PE) class as usual (TAU), stratified by sex and weight classification. Standardized BMI (zBMI) overtime was also examined. METHODS Hispanic-American middle school students (N = 193) were recruited from a school district in Houston, Texas. Participants were randomized to either a circuit-based physical activity intervention or TAU (PE class as usual). MVPA was assessed using accelerometry at baseline and 6 months. Repeated measures ANCOVA were conducted to examine changes in MVPA, overall and stratified by sex and weight classification. This procedure was repeated for zBMI. RESULTS Participants were 12.10 ± 0.63 years old and 53% were girls. Overall those in intervention increased weekday MVPA more than TAU (F(1,190) = 7.03, p

Fear of falling is a critical component in fall prevention approaches; however, it is often overlooked in the majority of fall prevention exercises. Alternative fall prevention approaches that take fear of falling into account are necessary. This article discusses fall prevention activities that are feasible for individuals with limited mobility who have an increased fear of falling. Health care providers should consider the degree to which a patient has a fear of falling and recommend activities that fit most to their patient’s comfort level.

Background Indices of multimorbidity and deficit accumulation (ie, frailty indices) have been proposed as markers of biological aging. If true, changes in these indices over time should predict downstream changes in cognition and physical function, and mortality. Methods We examined associations that 8-year changes in (i) a multimorbidity index comprised of 9 chronic diseases and (ii) a frailty index (FI) based on deficit accumulation in functional, behavioral, and clinical characteristics had with subsequent measures of cognitive and physical function over 10 years. We drew data from 3 842 participants in the Action for Health in Diabetes clinical trial. They were aged 45–76 years at baseline and at risk for accelerated biological aging due to overweight/obesity and type 2 diabetes mellitus. Results A total of 1 501 (39%) of the cohort had 8-year increases of 1 among the 9 diseases tracked in the multimorbidity index and 868 (23%) had increases of ≥2. Those with greatest increases in multimorbidity tended to be older individuals, males, and non-Hispanic Whites. Greater FI increases tended to occur among individuals who were older, non-Hispanic White, heavier, and who had more baseline morbidities. Changes in multimorbidity and FI were moderately correlated (r = 0.26; p < .001). Increases in both multimorbidity and FI were associated with subsequently poorer composite cognitive function and 400-m walk speed and increased risk for death (all p < .001). Conclusions Accelerated biological aging, as captured by multimorbidity and frailty indices, predicts subsequent reduced function and mortality. Whether intensive lifestyle interventions generally targeting multimorbidity and FI reduce risks for downstream outcomes remains to be seen. Clinical Trials Registration Number: NCT00017953

IntroductionCommunity clinics often face pragmatic barriers, hindering program initiation and replication of controlled research trial results. Mentoring is a potential strategy to overcome these barriers. We piloted an in-person and telehealth mentoring strategy to implement the Telehealth-supported, Integrated Community Health Workers (CHWs), Medication-access, group visit Education (TIME) program in a community clinic.Research design and methodsParticipants (n=55) were low-income Latino(a)s with type 2 diabetes. The study occurred in two, 6-month phases. Phase I provided proof-of-concept and an observational experience for the clinic team; participants (n=37) were randomized to the intervention (TIME) or control (usual care), and the research team conducted TIME while the clinic team observed. Phase II provided mentorship to implement TIME, and the research team mentored the clinic team as they conducted TIME for a new single-arm cohort of participants (n=18) with no previous exposure to the program. Analyses included baseline to 6-month comparisons of diabetes outcomes (primary outcome: hemoglobin A1c (HbA1c)): phase I intervention versus control, phase II (within group), and research-run (phase I intervention) versus clinic-run (phase II) arms. We also evaluated baseline to 6-month CHW knowledge changes.ResultsPhase I: compared with the control, intervention participants had superior baseline to 6-month improvements for HbA1c (mean change: intervention: −0.73% vs control: 0.08%, p=0.016), weight (p=0.044), target HbA1c (p=0.035), hypoglycemia (p=0.021), medication non-adherence (p=0.0003), and five of six American Diabetes Association (ADA) measures (pConclusionsA novel, mentored approach to implement TIME into a community clinic resulted in improved diabetes outcomes. Larger studies of longer duration are needed to fully evaluate the potential of mentoring community clinics.

Health care professionals represent a population at high risk for poor health. Although this may be counterintuitive given their expertise in health, the high stress and long hours of many medical work environments present challenges for health care professionals to engage in healthy lifestyle behaviors. This is extremely problematic for the health and well-being of both health care professionals and the patients they treat. Medical settings are encouraged to implement interventions that intervene at both the enviornmental and personal level to help faciliate behavior change among health care providers.

The use of screen media has significantly increased and several lifestyle consequences have occurred following this change. Screen media exposure is more common among younger age children. Multiple factors may be the reason for this; however, their use is likely reinforced. Parents seek support from screen media devices, which can help calm and occupy their children in a matter of minutes. However, resorting to electronic devices for instant relief is likely to persist due to both negative and positive reinforcement. Reinforcing screen media in this way will make the use of screen devices inextricable for parents and their children. Explaining the issue clearly and coming up with feasible solutions will help minimize the negative health effects of prolonged screen use, the general desirability of screen media devices, and also improve (and increase) healthy screen time habits in children.

Carbon stored in harvested wood products (HWPs) can affect national greenhouse gas (GHG) inventories, in which the production and end use of HWPs play a key role. The Intergovernmental Panel on Climate Change (IPCC) provides guidance on HWP carbon accounting, which is sensitive to future developments of socioeconomic factors including population, income, and trade. We estimated the carbon stored within HWPs from 1961 to 2065 for 180 countries following IPCC carbon-accounting guidelines, consistent with Food and Agriculture Organization of the United Nations (FAOSTAT) historical data and plausible futures outlined by the shared socioeconomic pathways. We found that the global HWP pool was a net annual sink of 335 Mt of CO(2) equivalent (CO(2)e)⋅y(−1) in 2015, offsetting substantial amounts of industrial processes within some countries, and as much as 441 Mt of CO(2)e⋅y(−1) by 2030 under certain socioeconomic developments. Furthermore, there is a considerable sequestration gap (71 Mt of CO(2)e⋅y(−1) of unaccounted carbon storage in 2015 and 120 Mt of CO(2)e⋅y(−1) by 2065) under current IPCC Good Practice Guidance, as traded feedstock is ineligible for national GHG inventories. However, even under favorable socioeconomic conditions, and when accounting for the sequestration gap, carbon stored annually in HWPs is

This study evaluated the feasibility and effects of the Families Understanding Nutrition and Physically Active Lifestyles (FUNPALs) Playgroup on toddler (12–36-month-old) diet and activity behaviors. Parent–toddler dyads were recruited from disadvantaged communities and randomly assigned to receive 10-weekly sessions of the FUNPALs Playgroup (n = 24) or dose-matched health education control group (n = 26). FUNPALs Playgroups involved physical and snack activities, delivery of health information, and positive parenting coaching. The control group involved group health education for parents only. Process outcomes (e.g., retention rate, fidelity) and focus groups determined feasibility and perceived effects. To evaluate preliminary effects, validated measures of toddler diet (food frequency questionnaire and a carotenoid biomarker), physical activity (PA, accelerometers), general and feeding parenting (self-report surveys), and home environment (phone interview) were collected pre and post. The sample comprised parents (84% female) who self-identified as Hispanic/Latino (38%) and/or African American (32%). Retention was high (78%). Parents from both groups enjoyed the program and perceived improvements in their children’s health behaviors. Objective measures demonstrated improvement with large effects (η2 = 0.29) in toddler diet (p &lt, 0.001) but not PA (p = 0.099). In conclusion, the FUNPALs Playgroup is feasible and may improve toddler eating behaviors.

Medical professionals’ healthy eating and physical activity behaviors are likely to wane as other life events and everyday pressures increase. This is vital because as health behaviors decrease, the likelihood that this topic is addressed with patients also decreases. Increased training to improve health care providers’ knowledge about lifestyle behaviors may be inadequate to actually bring about a healthier lifestyle. The area of personal identity and value formation may shed light on a significant barrier in this area. Developing health care professionals who have values consistent with a healthy diet and physical activity, instead of just being informed about it, would increase the likelihood that healthy behavior changes are discussed with patients. Strategies to encourage value formation around healthy lifestyles among medical professionals are discussed.

Objective: This study examined the differential impact of Hurricane Harvey on adolescent standardized Body Mass Index (zBMI), physical activity, diet, and perceived stress. Methods: Prior to Hurricane Harvey, 175 ethnic minority adolescents were recruited from an independent school district in Houston. Height and weight were directly measured. The School Physical Activity and Nutrition Questionnaire assessed diet and physical activity. Stress was assessed with the Perceived Stress Scale. High hurricane impact was classified as at least 1 affirmative response to house damage, rescue, displacement, or going without food, water, or medicine. Repeated measures such as ANCOVA models were developed to assess differences in zBMI, physical activity, diet, and stress between the hurricane impact groups. Regression models were used to assess stress as a mediator of the hurricane impact and zBMI change relationship. Results: Students who were highly impacted by the hurricane had a greater decrease in zBMI than those less impacted from pre-hurricane to 15 weeks post-hurricane (95% CI 0.02 to 0.25, p Conclusion: The decrease in zBMI among highly impacted students warrants further monitoring. Perceived stress, immediately following the hurricane, impacted student growth months later.

Background: Diabetes is a major contributor to morbidity and mortality. Community Health Workers (CHWs) have been instrumental in improving patient outcomes. However, CHW training largely focuses on general diabetes concepts rather than medications. Providing accessible, diabetes medication training for CHWs has the potential to increase patient understanding, personalized care, and adherence, thereby improving outcomes. Objective: To evaluate the impact of a telehealth-based diabetes medication training for CHWs on patient outcomes as measured by HbA1c changes. Methods: We provided a 12-month weekly, telehealth (videoconference) medication training for CHWs who led 6-month diabetes programs for low-income Latino(a)s in community clinics. We measured participant HbA1c (primary outcome), blood pressure, and body mass index (BMI) changes. We evaluated CHW knowledge via two pre/post-tests: medication adverse events/side effects (TEST-1, months 1&ndash, 6) and dosing, titration, and emergencies (TEST-2, months 7&ndash, 12). We assessed CHW training application by their ability to identify patient, provider, and healthcare system medication barriers. Results: Participants&rsquo, (n = 55) HbA1c improved (9.0% (75 mmol/mol) to 7.8% (62 mmol/mol) (p = 0.001)). Blood pressure and BMI changes were not significant. CHWs improved their knowledge: TEST-1: 10.5-18.2/20.0 (p = 0.002), TEST-2: 10.3&ndash, 17.3/19.0 (p = 0.0019). CHWs identified 984 patients (n = 610), providers (n = 151), and healthcare systems (n = 223) medication barriers during the 12-month training. Conclusions: Providing a telehealth-based, diabetes medication training program for CHWs allowed a personalized approach to identify barriers to care at several levels, which was associated with significant participant HbA1c reductions and improved CHW knowledge. This is a promising cost-effective, culturally sensitive strategy to improve diabetes care. Larger longitudinal evaluations are needed to fully understand the impact of CHW medication training.

OBJECTIVE Early response to obesity intervention consistently predicts long-term BMI reductions. However, little is known about how changes in weight at other times in an intervention may impact long-term outcomes. This study examined the relationship between weight-related changes that occurred early and later during an intervention and the association between these changes with overall outcomes. METHODS A secondary analysis of a school-based obesity intervention with replicated efficacy among Hispanic middle school students was conducted (n = 174). Linear regression models were developed in which first and second semester changes in BMI represented as a percentage of the 95th BMI percentile (%BMIp95) were separately used to predict overall %BMIp95 outcomes. First semester changes in %BMIp95 were used to predict subsequent %BMIp95 change (i.e., second semester). RESULTS Changes in %BMIp95 during both the first and second semesters were independently associated with overall changes from baseline (e.g., at 24 months: first semester, β = 0.59, P

The increase of the prevalence of type-2 diabetes as a consequence of overweight and obesity has stimulated public health authorities worldwide to develop strategies for its risk management and prevention. Among them, a reduction on the content of sugar in sugar-sweetened foods and beverages has been suggested, which led the food industry to replace partially sucrose with food additives, such as low- and no-calorie sweeteners (LNCS). As a consequence, there has been an increase of their consumption, which has made regulatory agencies to evaluate their exposure and possible consequences. At the same time, speculations about adverse effects, such as carcinogenicity, preterm delivery and metabolic changes involving appetite, weight increase and glucose intolerance, have been published. This scenario led ILSI Brasil to organize a meeting to update scientific knowledge on the safety of LNCS and to promote discussions among academia, regulatory bodies and food industries to clarify currently controversial information. The results of this initiative are presented in this review. It is suggested that LNCS, when used according to recommendations provided by scientific committees and regulatory authorities are considered safe. Further studies are required to evaluate the current level of exposure in general population and specific ones as children.

In much of lifestyle medicine, health-related quality of life (HRQoL) is a primary focus with the assumption that symptom reduction increases quality of life (QoL) in a more global sense. Lifestyle medicine research has shown that reducing symptoms increases the likelihood that QoL is improved. However, little information is available as to the impact of interventions when they are not effective in creating the desired healthy outcomes. It is possible that some lifestyle interventions have a negative impact on QoL, especially when a patient is not “successful” in reducing their symptomatology. Considering QoL from a broader perspective as an outcome in combination with traditional health outcomes may improve provider-patient rapport and empower patients to provide feedback on treatment, which, in turn, may improve overall treatment.

Background Research shows that elementary students gain weight over the summer. It is unknown if these findings apply to Hispanic adolescents. We evaluated school and summer standardized body mass index (zBMI) changes in Hispanic middle school students. Methods Hispanic middle school students were randomly assigned to a weight management program (N = 230) or control condition (N = 195). Paired sample t-tests compared zBMI change scores during the school year versus summer when not enrolled in a weight management program (eg, control group). We used 2 × 2 repeated measures analysis of variances to determine program group differences in zBMI scores across school versus summer periods separately for normal and overweight/obese students. Results In the control group, students' zBMI change scores decreased during the school year, but increased during summer for both normal weight and overweight/obese students. Program effects on zBMI indicated school year decreases and summer increases for both normal and overweight/obese students. However, zBMI scores did not differ by program status for normal weight students. Overweight/obese students in the program compared to the control group increased zBMI to a lesser extent over the summer. Conclusion For all students, zBMI increased during the summer. A school-based weight management program protected overweight/obese students against potentially greater summer weight gain.

Food choices and eating behaviors are influenced by a wide variety of factors. However, traditional dietary advice primarily addresses health-related reasons for eating. Lifestyle medicine outcomes may be improved by helping individuals become more aware of why they eat and support individuals to increase their skills in reconciling eating for health and nonhealth purposes. Intuitive eating aims to increase individuals’ awareness of why, what, and how much they eat through mindfulness. This framework and concepts such as flexible restraint can be used to teach individuals skills that may help them improve psychological well-being and manage their weight.

Education is ubiquitous with clinical care. However, not all education supports behavioral change. Education is a broad term that encompasses the process of obtaining general knowledge, personal awareness, and skills training. Although not sufficient, education is a necessary component for behavior change. This article outlines the role of education in behavior change and offers practical suggestions for how clinicians can provide education to their patients to help them change behavior.

A new chapter of an everlasting softwood lumber trade dispute between the U.S. and Canada begins with an imposition of the countervailing duty (CVD) and anti-dumping (AD) tariffs on Canadian softwood lumber supply to the U.S. By using a 20-region global softwood lumber trade model, we examine the regional welfare impacts of CVD and AD tariffs on U.S. imports of Canadian softwood lumber in both countries. We also evaluate the welfare implications of alternative restrictive trade policies relevant to the softwood lumber trade dispute. Simulation results from a mixed complementary problem model calibrated using positive mathematical programming reveal that a 26.75% CVD and AD tariff curtails Canadian lumber shipments to the U.S. by 4.9 million cubic meters (m 3 ), reduces Canada's market share in the U.S. by nearly 5%, and encourages the U.S. domestic lumber industry to produce an additional 2.6 million m 3 . The government tax revenue and the U.S. producers' gain clearly outweigh the loss incurred by U.S. consumers. However, Canadian producers have an economic incentive to voluntarily reduce their share of the U.S. market by voluntarily restricting exports and capturing quota rents. Additionally, the foreign exchange rate has the ability to alter the effects of protectionist policies.

Hispanics are disparately affected by diabetes. Treating socioeconomically disadvantaged Hispanics is challenging due to economic and cultural barriers. Health care providers must understand that cultural beliefs about medicine and disease may have an impact on how diabetes treatment is viewed. Concepts such as susto (fright), coraje (anger), and fatalismo (fatalism) are common cultural beliefs. If these beliefs are not well understood by the health care provider, recommendations for treatment are likely to be discarded. To dismantle cultural barriers between the patient and the health care provider, there are several strategies that a health care provider can implement. For instance, a health care provider must develop trust with the patient. The health care provider could also engage a family member or promotora or promotor (community health worker) in the conversation. Furthermore, if the cultural barriers are significant, the patient may be best served by receiving treatment from someone with a better understanding of his or her background. Thus, a referral may be appropriate.

Purpose The purpose of the study was to evaluate the feasibility of integrating Community Health Workers (CHWs) as part of the team leading diabetes group visits. Methods This was a randomized controlled study that integrated CHWs as part of the team leading diabetes group visits for low-income Hispanic adults (n = 50). Group visits met for 3 hours each month for a 6-month duration. Main measures included baseline and 6-month clinical outcomes (ie, A1C, lipids), concordance with 8 standard of care guidelines (ie, screens for cervical, breast, and colon cancer) from the US Preventive Task Force and American Diabetes Association, and participant acceptability. Results Compared to control participants, the intervention group resulted in significantly better clinical outcomes or guideline concordance for the following areas: target A1C levels, retinal eye exams, diabetes foot exams, mammograms, and urine microalbumin. Significantly more individuals in the control group gained weight, whereas a greater number of participants in the intervention group lost weight. Intervention participants found the group visits highly acceptable. Conclusions Integrating CHWs as part a comprehensive diabetes group visit program is a feasible and effective system-level intervention to improve glycemic control and achieve guideline concordance.

We use a dynamic, global computable general equilibrium (CGE) model to capture the economic impacts of internet adoption, modeled through reduced demand in the newsprint and printing and writing paper (pulp and paper) industries. Global newsprint consumption is estimated to fall dramatically by 2030. We rely on estimates from another study that captures the change in global pulp and paper consumption using the global forest products model (GFPM), based on two scenarios: (i) full per capita internet adoption by 2100 and (ii) more rapid full internet adoption by 2050. We incorporate reductions in pulpwood consumption into a global multiregional dynamic CGE model to estimate economy-wide impacts in Canadian provinces, the United States, and the rest of the world. Results indicated that the year 2050 internet adoption scenario would result in a reduction in cumulative discounted gross domestic product (GDP) by as much as 17% in some regions of Canada, reduce GDP by 5.8% in the United States, and increase GDP by 3.3% in the rest of the world from 2006 to 2030. These findings highlight the costs of internet adoption, leaving net benefit analysis of adoption to future work.

The importance of international trade for the welfare of actors in the forest sector was estimated by comparing the current state of the world with a world in pure autarky with zero imports and exports of roundwood and manufactured wood products. The analysis was done with a comparative statics application of the Global Forest Products Model. The model was first calibrated to replicate observations in the base year 2013, and then solved under autarky conditions. The results showed much variation in the effects of international trade on production, consumption, and prices across countries and sub sectors. Globally international trade did have a positive effect on the economic welfare of the sector. This was due mostly to the positive effect on the surplus of consumers, and to a lesser extent on the increase in value added in forest industries. But value added profited manufacturers in developed countries much more than in developing. Furthermore, while wood producers in developed countries increased their profits with trade, those in developing countries incurred heavy losses that negated any incentive to invest in forest conservation, management and new plantations.

Increasing physical activity (PA) is a critical issue in improving overall health. Prior attempts by public health campaigns to promote PA through health-focused messaging have faced challenges. As PA and sedentary behaviors are developed during the early childhood period (ages 0 to 5 years), this stage represents a unique opportunity for clinicians to encourage activity at the family level. Clinicians should discuss the holistic benefits of PA, including the development of social skills and relationships, motor skills that could be applicable to sports later in life, and cognitive skills that could translate to academic achievements in school. For PA to occur in children, parents should also be engaged in and model the PA behaviors, increasing the likelihood of young children learning to be physically active.

Health promotion strategies typically include changing the environment, providing supervision to decrease the likelihood an unhealthy behavior will occur, and increasing skills to make decisions supporting health in environments in which such choices are challenging to make. The first two strategies are important in improving the environment to promote healthy decision making. However, the creation of restrictive environments has repeatedly shown to not support disease prevention in the long term. Restrictive environments do not support the development of skills to make healthy choices when restrictions are not in place. This is particularly true for children who are learning to navigate their environment and make health decisions. The creation of adaptive learning environments should be prioritized to help individuals develop the skills needed for long-term health promotion.

Summary Objective To compare depressive symptomatology as assessed by two frequently used measures, the Beck Depression Inventory (BDI‐1A) and Patient Health Questionnaire (PHQ‐9). Methods Investigators conducted a cross‐sectional secondary analysis of data collected as part of the follow‐up observational phase of the Look AHEAD study. Rates of agreement between the BDI‐1A and PHQ‐9 were calculated, and multivariable logistic regression was used to examine the relationship between differing depression category classifications and demographic factors (ie, age, sex, race/ethnicity) or comorbidities (ie, diabetes control, cardiovascular disease). Results A high level of agreement (κ = 0.47, 95% CI (0.43 to 0.50)) was found in the level of depressive symptomatology between the BDI‐1A and PHQ‐9. Differing classifications (minimal, mild, moderate, and severe) occurred in 16.8% of the sample. Higher scores on the somatic subscale of the BDI‐1A were significantly associated with disagreement as were having a history of cardiovascular disease, lower health‐related quality of life, and minority racial/ethnic classification. Conclusions Either the BDI‐1A or PHQ‐9 can be used to assess depressive symptomatology in adults with overweight/obesity and type 2 diabetes. However, further assessment should be considered in those with related somatic symptoms, decreased quality of life, and in racial/ethnic minority populations.

BACKGROUND Efficacious school-based interventions among ethnic minority youth are often intensive and difficult to disseminate. OBJECTIVE This parallel, open-label-randomized controlled trial aimed to compare changes in adolescent-standardized body mass index (zBMI) from a school-based obesity intervention given 0, 1, 3, or 5 days a week. METHODS Mexican-American youth (n = 243) with overweight or obesity were recruited from a Houston school district and randomized to receive an obesity intervention with established efficacy 0 (control), 1, 3, or 5 d/wk (respectively, equating to 0, 40, 120, or 200 min of contact each week). In each condition, 80% of intervention time was allocated to physical activity and 20% to nutrition, with behavioural modification overlaid throughout. zBMI was calculated from directly measured height and weight. A linear mixed model evaluated differences in zBMI over time between conditions. RESULTS Participants were 12.02 ± 0.57 years old with a zBMI of 1.80 ± 0.46 at baseline. Among those with complete data at 1 year (n = 203), a significant condition by time interaction was indicated (F = 9.42, P < .001). Those who received the intervention 3 or 5 d/wk had significantly greater decreases in zBMI than control (respectively, -0.19 zBMI units/y; 95% CI, -0.28 to -0.11; and -0.18 zBMI units/y; 95% CI, -0.27 to -0.10, both P < .001). No differences were found between 3 and 5 d/wk (95% CI, -0.09-0.08, P = .87). CONCLUSIONS The intervention provided 3 d/wk resulted in similar zBMI improvements as the intervention provided 5 d/wk. This information can be used to develop scalable school-based obesity interventions.

The prevention and treatment of lifestyle disease involves overlapping factors. Those at the highest risk for the development of lifestyle disease are also at the highest risk for poor treatment outcomes. Although behavioral treatment of lifestyle disease has demonstrated efficacy on average, considerable individual variation exists in treatment response. In clinical settings, individuals unresponsive to treatment are typically provided escalated care. Community-based care is designed to reach high-risk populations unlikely to seek medical care. However, in community settings escalated treatment options are not usually available for individuals unresponsive to treatment. Addressing this gap is imperative to improve health outcomes of high-risk populations and to identify individuals who may be resistant to behavioral lifestyle treatment.

One of the greatest challenges to lifestyle medicine is patient adherence. Lifestyle diseases inherently require lifetime prevention and treatment. Therefore, adherence to lifestyle medicine recommendations must also be long-term. Long-term adherence implies that a routine incorporating health recommendations has been developed. Instead of focusing on the immediacy of adherence in lifestyle changes, health care providers could consider helping patients develop a routine to slowly incorporate those changes. This perspective may enable greater long-term adherence to lifestyle change recommendations.

Chronic disease is challenging to treat because treatment often requires lifestyle behavior changes. In recent years the use of health and wellness coaches (HWC) has emerged as a way to support patients making behavioral changes. The use of HWCs has resulted in improved management of chronic disease for many patients. The success of HWCs is often thought to be due to the extended care they provide and the behavioral modification techniques they promote such as goal setting and self-monitoring. This article describes how HWC’s conformity to the current health care zeitgeist of personalized, holistic care may be another reason for their success.

Communication between health care providers and patients is important for behavioral treatment in lifestyle medicine. Ineffective communication can lead to patient dissatisfaction, demotivation, and discontinuation of treatment. It is important for health care providers to understand their biases, praise patients’ behaviors rather than health outcomes, and use language to prevent dichotomous thinking. These strategies may lead to sustained lifestyle behavior changes and better treatment outcomes among patients.

The Global Forest Products Model (GFPM) was applied to forecast the effect of increased per capita Internet adoption on the global paper products industry to 2030. Two scenarios were examined: (a) full per capita Internet adoption by 2100, and (b) more rapidly by 2050. Global newsprint consumption is estimated to be 34.2–37.1 million tonnes lower in 2030 than in the US Forest Service 2010 Resources Planning Act report, and the 2010 report from the Food and Agriculture Organization of the United Nations. Similarly, global printing and writing paper consumption is forecasted to be 76.7–87.1 million tonnes lower by 2030. By including controls for per capita Internet use in the demand equations for print based media, this article reflects the recent declines in global paper product consumption. Out-of-sample forecasts over a two-year period indicate global model prediction errors from 0 to 3%, depending on the product and exogenous assumptions. The results highlight the importance of considering market evolution in long-term global forecasting, and a failure to account for future rates of Internet adoption will result in an upward bias on paper product market forecasts.

Annually, nearly 500 gigatonnes of CO2 are exchanged between terrestrial ecosystems and the atmosphere, and this exchange is clearly affected by human activities related to the Earth's forests. Governments are therefore willing to draft legislation incentivizing forest activities that sequester carbon to combat climate change. In this review, we examine issues related to the creation of carbon offset credits through forest conservation, burning of wood biomass in lieu of fossil fuels, and intensive commercial management that accounts for all carbon fluxes, including postharvest. In doing so, we study the costs of monitoring, measuring, and contracting; the principal-agent problem; and questions related to life cycle analyses of CO2. We can only conclude that greater care is likely needed in the future to identify carbon offsets from forestry activities if these are to be traded in emissions markets.

Theoretically based behavioral interventions provide the most evidence for successful change; however, several issues should be considered when applying these interventions. For example, school-based obesity prevention programs can be used to teach children how to adopt healthy lifestyle behaviors from an early age. Ecological systems theory provides a framework to design, implement, and evaluate school-based obesity prevention programs. An ecological framework emphasizes that the characteristics within and between systems place children at risk for obesity. Although this developmental process is considered to occur continuously and simultaneously, in practice, we tend to consider the relationships to be unidirectional. Using a positive behavioral momentum approach in practice may assist in addressing these complexities.

Background Little is known about patterns in the transition from healthy weight to overweight or obesity during the elementary school years. This study examined whether there were distinct body mass index (BMI) trajectory groups among elementary school children, and predictors of trajectory group membership. Methods This is a secondary analysis of 1651 elementary school children with complete biannual longitudinal data from kindergarten to the beginning of 5th grade. Heights and weights were measured by trained school nurses using standard procedures at the beginning and end of each school year for 11 consecutive assessments. Group-based trajectory clustering and multinomial logit modeling were conducted. Results When using BMIz score, six trajectory groups were identified revealing substantial consistency in BMIz score across time. When using a categorical variable separating overweight/obese children (BMI ≥ 85%ile) from the rest, five developmental trajectories (persistently non-overweight/obese weight: 51.1 %; early-onset overweight/obese: 9.2 %; late-onset overweight/obese: 9.7 %; becoming healthy weight: 8.2 %; and chronically overweight/obese: 21.8 %) were identified. When using a categorical variable separating obese children (BMI ≥ 95%ile) from the rest, three trajectories (persistently non-obese: 74.1 %, becoming obese: 12.8 %; and chronically obese: 13.2 %) were identified. For both cutoffs (≥ BMI percentile 85 % or 95 %), girls were more likely than boys to be classified in the persistently non-overweight and/or obese group (odds ratios (OR) ranged from 0.53 to 0.67); and Hispanic children and non-Hispanic Black children were more likely to be chronically overweight and/or obese than non-Hispanic White children (OR ranged from 1.57 to 2.44). Hispanic children were also more likely to become obese (OR: 1.84) than non-Hispanic White children when ≥ BMI percentile 95 % was used. Conclusions Boys, Hispanic and non-Hispanic Black children were at higher risk of being overweight or obese throughout their elementary school years, supporting the need for obesity treatment. Post kindergarten and post second grade summer months were times when some children transitioned into overweight/obesity. It will be important to identify which behavioral factors (e.g., diet, physical activity, sedentary behaviors, and/or sleep) predisposed children to becoming overweight/obese, and whether these factors differ by time (Kindergarten versus second grade). If behavioral predisposing factors could be identified early, targeted obesity prevention should be offered.

European governments are rapidly turning to biomass to comply with the EU's legislated renewable energy targets for 2020 and 2030. To do so, EU member states will likely have to increase imports of biomass from timber rich regions, which will undoubtedly disrupt international wood product markets. In this study, a static global forest trade model of coniferous wood products is used to examine the effects of expanded demand for wood pellets in Europe to generate reliable electricity. Positive mathematical programming (PMP) is used to calibrate the model to 2012 bilateral trade flows. To assess the impact of increased wood-pellet demand on global forest products, we consider a scenario where EU demand for wood pellets doubles. Model results suggest increases in the world prices of industrial roundwood (1%), particleboard ($34/m 3 ), fibreboard ($30/m 3 ), pulp ($65/t) and pellets (71% to 128%), while the prices of sawnwood and plywood & veneer are projected to fall by $12/m 3 and $4/m 3 , respectively. The gains and losses are unevenly distributed between timber rich and timber poor regions; Russia, Canada and the U.S. experience large net welfare gains of $706 million, $544 million and $416 million, respectively, while Asia loses $1.8 billion. In the forest products sector, the gains outweigh losses with economic benefits increasing by some $4.9 billion, but this is a cost to the consumers of electricity and/or taxpayers in the regions implementing these renewable energy policies. The price of wood pellets is projected to rise between $107 and $154 per tonne. The findings highlight the need to account for the interconnections among softwood forest products globally.

The management of chronic disease is complex. For many diseases, the treatment for the disease may mimic disease symptoms. For example, exercise training is recommended as part of the treatment of chronic obstructive pulmonary disease (COPD). Individuals may confuse the physiological experiences related to exercise with COPD symptoms. This type of association between treatment and disease can cause anxiety. For health care practitioners to successfully motivate their patients to make the necessary behavior changes for disease treatment, anxiety must also be addressed.

Dietary quality is important for children’s growth and development. Poor dietary quality and maternal depression are prevalent among low-income, Hispanic families. Maternal depression likely influences child feeding before and during the meal. This secondary data analysis of an observational feeding study (2007–2008) examined how maternal depressive symptomology relates to dietary quality of dinner served to and consumed by Head Start preschoolers in Houston, TX (n = 82 mother-child dyads). A digital photography method assessed food served and consumed by the child at three separate dinner meals in families’ homes. Healthy Eating Index-2010 (HEI) was calculated and averaged across the three meals to measure dietary quality (possible range 0–100). Maternal depression was assessed by the Centers for Epidemiologic Depression Scale (CES-D, possible range 0–60). A series of linear regression models were developed, regressing the total CES-D score and all four CES-D subscales onto both the dietary quality of the meal served and consumed. Dinners served had a HEI of 45.70 ± 9.19 and dinners consumed had a HEI of 44.65 ± 7.34. Clinically significant depressive symptomology (CES-D ≥ 16) was reported by 28% of mothers. Maternal depressive symptomology and the dietary quality served were not related. Controlling for dietary quality served, total CES-D and somatic complaints subscale scores were associated with lower dietary quality consumed (respectively, β = −0.16, p

Objective/Background: To examine how demographic and injury characteristics identify satisfaction with life (SWL), and assess the differential effects of a wellness intervention by baseline SWL groups. Design: Baseline and longitudinal analysis of a randomized controlled pilot intervention using decision tree regression and linear mixed models. Setting: Community based. Participants: Seventy-two individuals with spinal cord injury (SCI) were randomized to an intervention group (n = 39) or control group (n = 33). Participants were aged 44.1 ± 13.0 years and 13.1 ± 10.6 years post-injury. Most participants were male (n = 50; 69.4%) and had paraplegia (n = 38; 52.7%). Participants were classified as high versus low SWL at baseline using a cutoff score of 20. Interventions: The intervention aimed to increase self-efficacy, and in turn, increase engagement in health-promoting behaviors related to SWL. Six 4-hour in-person workshops were conducted over a 3-month period led by experts and peer-mentors who were available for support. Outcome measure(s): Self-efficacy for health practices, secondary condition severity, health-promoting behaviors, perceived stress, and SWL. Results: At baseline, participants with low SWL were recently injured (

Infection with adenovirus 36 (Ad36) has been associated with risk of obesity in youth in some studies, but the seroprevalence of this virus has not been examined among all populations. As Hispanic-American youth are of greater risk for obesity than other American youth, we sought to determine the proportion of Ad36 seropositive (Ad36+) students in an urban middle school serving a Hispanic population. We further examined if Ad36+ students were more likely to have obesity, and if Ad36 serostatus impacted changes in weight status following a health intervention. We determined body mass index (BMI) at the beginning and end of a 16-week health intervention among 40 Hispanic-American middle-school students. Ad36 serostatus was determined by enzyme-linked immunsorbent assay (ELISA). Seventy percent of the students were Ad36+. Ad36+ and Ad36 seronegative (Ad36−) did not differ before or after the intervention in body weight measures. The odds of being classified as obese was 1.4 times greater among Ad36+ than Ad36− at baseline, and 2.4 times greater post-intervention, but these were not statistically significant. We report a high seroprevalence of Ad36 among a population of Hispanic-American students. Ad36 seropositivity was associated with a trend for a greater likelihood of having obesity, but did not impact response to a health intervention.

Physical activity is an important target for improving health and well-being among cancer survivors. Cancer clinicians are uniquely positioned to promote physical activity among survivors through follow-up visits for treatment planning and surveillance. Providers should prioritize assessment of guideline-concordant physical activity and facilitate achievement of physical activity guidelines through exercise prescription, goal setting, addressing barriers, and capitalizing on support systems.

The cornerstone to successful aging is maintaining a consistent physical activity routine and healthy diet. This is particular important for aging adults to preserve their independence. However, for low-income aging adults there are significant individual and environmental barriers that reduce their ability to maintain a healthy lifestyle. Understanding how environmental supports can be found in existing programs geared toward older adults is a way to insure long-term behavioral changes.

The number of putative causes of obesity continues to increase at a rapid rate. As science identifies novel causes of obesity, innovations in the treatment of obesity also evolve. These innovations have important implications for clinical practice; however, a gap exists between research and the clinical application of research. Practical considerations about how to address this gap between research and practice are discussed.

Parental engagement is an important component in lifestyle behavior change interventions for children as parents are uniquely positioned to establish a healthy environment and model healthy eating and physical activity habits for their children. Despite both mothers and fathers being important agents of behavioral change for their children, fathers are typically underrepresented in programming interventions. Physical activity may be an important strategy for fathers to become involved in lifestyle change with their children as, compared to mothers, fathers traditionally tend to be comfortable engaging in physical activity with their children.

Stress is a core issue to be addressed in lifestyle medicine. Not only does it influence disease directly (eg, cardiovascular disease), it also indirectly affects health by having a negative influence on other behaviors such as sleep and physical activity. The importance of stress is further highlighted by the fact that it is one of the most highly ranked health risks for employees globally. Practitioners are encouraged to attend to both significant life stressors and those that are encountered daily. Stress reduction strategies are further discussed.