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Background. The repeated loss and regain of body weight, referred to as weight cycling, may be associated with negative health complications. Given today's obesity epidemic and related interventions to address obesity, it is increasingly important to understand contexts and factors associated with weight loss maintenance. This study examined BMI among individuals who had previously participated in a 12-week, evidence-based, nationally disseminated nutrition and physical activity program designed for overweight and obese middle-aged and older women. Methods. Data were collected using follow-up surveys. Complete height and weight data were available for baseline, 12-week program completion (post-program) and follow-up (approximately 3 years later) for 154 women (response rate = 27.5%; BMI characteristics did not differ between responders and nonresponders). Results. Mean BMI decreased significantly from baseline to post-program (-0.5, P < 0.001) and post-program to follow-up (-0.7, P < 0.001). Seventy-five percent of survey respondents maintained or decreased BMI post-program to follow-up. Self-efficacy and social support for healthy eating behaviors (but not physical activity) were associated with BMI maintenance or additional weight loss. Conclusions. These findings support the durability of weight loss following participation in a relatively short-term intervention.

This cluster-randomized trial was designed to determine the efficacy of a 6-month exercise-nutritional supplement program (ENP) on physical function and nutritional status for older adults and the feasibility of implementing this program in a senior living setting. Twenty senior-living facilities were randomized to either a 3 day per week group-based ENP led by a trained facility staff member or a health education program (SAP). Participants (N = 121) completed a short physical performance battery, 400-m walk, handgrip strength test, and mini-nutrition assessment. 25-hydroxyvitamin D [25(OH)D], insulin-like growth-factor 1 (IGF-1), and activity level were also measured. The ENP did not significantly improve physical function or nutritional status compared with the SAP. Compared with baseline, participants in the ENP engaged in 39 min less physical activity per week at 6 months. Several facility characteristics hindered implementation of the ENP. This study highlights the complexity of implementing an evidence-based program in a field setting. [ABSTRACT FROM AUTHOR]

Objective: To better understand how the public defines 'healthy' foods and to determine whether the public considers sustainability, implicitly and explicitly, in the context of healthy eating. Design: We conducted a content analysis of public comments submitted to the US FDA in 2016 and 2017 in response to an invitation for feedback on use of the term 'healthy' on food labels. The analysis explored the ways in which commenters' definitions of 'healthy' aligned with the 2015–2020 Dietary Guidelines for Americans and whether their definitions considered sustainability. Setting: The US Government's Regulations.gov website. Participants: All 1125 unique comments from individuals and organisations. Results: Commenters' definitions of 'healthy' generally mirrored the recommendations that the Dietary Guidelines for Americans put forth to promote a 'healthy eating pattern'. Commenters emphasised the healthfulness of fruit, vegetables, whole grains, fish and other minimally processed foods and the need to limit added sugars, sodium, saturated and trans fats and other ingredients sometimes added during processing. One-third of comments (n 374) incorporated at least one dimension of sustainability, mainly the environmental dimension. Commenters who mentioned environmental considerations primarily expressed concerns about synthetic chemicals and genetic modification. Less than 20 % of comments discussed social or economic dimensions of sustainability, and less than 3 % of comments (n 30) used the word 'sustainability' explicitly. Conclusions: This novel analysis provides new information about the public's perceptions of 'healthy' foods relative to nutrition and sustainability considerations. The findings can be used to advance policy discussions regarding nutrition labelling and guidance. [ABSTRACT FROM AUTHOR]

Background: Cardiovascular disease is the leading cause of death in the United States and places substantial burden on the health care system. Rural populations, especially women, have considerably higher rates of cardiovascular disease, influenced by poverty, environmental factors, access to health care, and social and cultural attitudes and norms.Methods/design: This community-based study will be a two-arm randomized controlled efficacy trial comparing a multi-level, community program (Strong Hearts, Healthy Communities) with a minimal intervention control program (Strong Hearts, Healthy Women). Strong Hearts, Healthy Communities was developed by integrating content from three evidence-based programs and was informed by extensive formative research (e.g. community assessments, focus groups, and key informant interviews). Classes will meet twice weekly for one hour for 24 weeks and focus on individual-level skill building and behavior change; social and civic engagement are also core programmatic elements. Strong Hearts, Healthy Women will meet monthly for hour-long sessions over the 24 weeks covering similar content in a general, condensed format. Overweight, sedentary women 40 years of age and older from rural, medically underserved communities (12 in Montana and 4 in New York) will be recruited; sites, pair-matched based on rurality, will be randomized to full or minimal intervention. Data will be collected at baseline, midpoint, intervention completion, and six-month, one-year, and eighteen months post-intervention. The primary outcome is change in body weight; secondary outcomes include physiologic, anthropometric, behavioral, and psychosocial variables. In the full intervention, engagement of participants' friends and family members in partnered activities and community events is an intervention target, hypothesizing that there will be a reciprocal influence of physical activity and diet behavior between participants and their social network. Family members and/or friends will be invited to complete baseline and follow-up questionnaires about their health behaviors and environment, height and weight, and attitudes and beliefs.Discussion: Strong Hearts, Healthy Communities aims to reduce cardiovascular disease morbidity and mortality, improve quality of life, and reduce cardiovascular disease-related health care burden in underserved rural communities. If successful, the long-term goal is for the program to be nationally disseminated, providing a feasible model to reduce cardiovascular disease in rural settings.Trial Registration: ClinicalTrials.gov Identifier: NCT02499731 Registered on July 1, 2015. [ABSTRACT FROM AUTHOR]

ObjectiveApproximately one-third of children in the USA are either overweight or obese. Understanding the perceptions of children is an important factor in reversing this trend.DesignAn online survey was conducted with children to capture their perceptions of weight, overweight, nutrition, physical activity and related socio-behavioural factors.SettingWithin the USA.SubjectsUS children (n 1224) aged 8–18 years.ResultsTwenty-seven per cent of children reported being overweight; 47·1 % of children overestimated the rate of overweight/obesity among US children. A higher percentage of self-classified overweight children (81·9 %) worried about weight than did self-classified under/normal weight children (31·1 %). Most children (91·1 %) felt that it was important to not be overweight, for both health-related and social-related reasons. The majority of children believed that if someone their age is overweight they will likely be overweight in adulthood (93·1 %); get an illness such as diabetes or heart disease in adulthood (90·2 %); not be able to play sports well (84·5 %); and be teased or made fun of in school (87·8 %). Children focused more on food/drink than physical activity as reasons for overweight at their age. Self-classified overweight children were more likely to have spoken with someone about their weight over the last year than self-classified under/normal weight children.ConclusionsChildren demonstrated good understanding of issues regarding weight, overweight, nutrition, physical activity and related socio-behavioural factors. Their perceptions are important and can be helpful in crafting solutions that will resonate with children. [ABSTRACT FROM AUTHOR]

Background. This study tested the hypothesis that a home-based exercise program would improve functional performance in elderly people. Methods. We conducted a 6-month, single-blinded, randomized controlled trial. 72 community dwelling men and women (aged ≥ 70 years) with self-reported and laboratory-based functional impairment were recruited for the study. Participants were randomly assigned to either a home-based progressive strength, balance, and general physical activity intervention or an attention-control group that received home-based nutrition education. Functional performance was measured in the laboratory using the Physical Performance Test (PPT) and the Established Populations for Epidemiologic Studies of the Elderly (EPESE) short physical performance battery. Physiologic capacity was measured by strength (one repetition maximum), dynamic balance (tandem walk), gait speed (2-meter walk), and cardiovascular endurance (6-minute walk). Results. 70 participants (97%) completed the 6-month trial. Compliance with study interventions within each group ranged from 75% in controls to 82% in exercisers. PPT increased by 6.1 ± 13.4% in exercisers and decreased by 2.8 ± 13.6% in controls (p = .02). EPESE improved by 26.2 ± 37.5% in exercisers and decreased by 1.2 ± 22.1% in controls (p = .001). Dynamic balance improved by 33.8 &plusms; 14.4% in exercisers versus 11.5 ± 23.7% in controls (p = .0002). There were no differences between groups in the change in strength, gait speed, or cardiovascular endurance. Conclusions. Minimally supervised exercise is safe and can improve functional performance in elderly individuals. The improvements in functional performance occurred along with improvements in balance but without a significant change in muscle strength or endurance. [ABSTRACT FROM AUTHOR]

Objective To increase fruit, vegetable, and calcium-rich food consumption in community-dwelling, functionally impaired elderly.Design Six-month, home-based nutrition intervention study.Subjects Seventy men and women older than age 69 years were randomized to either a nutrition education intervention (n=38) or a control group that received an exercise intervention (n=32).Intervention Nutrition education was designed to increase fruit, vegetable, and calcium-rich food consumption.Main Outcome Measures Food intake was assessed by a food frequency questionnaire. Fasting blood measures of nutrients and carotenoids were performed.Statistical Analysis Two-group randomized controlled trial with pre-test and post-test design and intention-to-treat analysis. Analysis of covariance to was used to assess differences between the two groups. Baseline and change partial correlation coefficients were performed between intake and blood nutrient levels. Paired t tests were conducted to test within-group changes.Results Compared with the exercise group, subjects in nutrition group increased their self-reported intake of fruits by 1.1±0.2 (mean±SEM) servings per day (2.8 to 3.9, P=.01), vegetables 1.1±0.2 servings per day (2.3 to 3.4, P=.001), and milk/dairy 0.9±0.2 servings per day (3.0 to 3.9, P=.001). There was an increase in the dietary intake of α-carotene and β-carotene in the nutrition group and this correlated with the increase in blood concentrations of α-carotene and β-carotene (P≤.02; r=0.33 and r=0.33, respectively).Conclusion The results of this study suggest that it is possible to improve the dietary intake of community dwelling elders to include more fruits, vegetables, and calcium-rich foods. Recommendations for increasing consumption of fruits, vegetables, and calcium-rich foods should be specific and individualized to meet the dietary pattern and lifestyle of the individual. Compliance should be encouraged with record keeping as well as through continuous monitoring and positive reinforcement. J Am Diet Assoc. 2002;102:1421-1422. [Copyright &y& Elsevier]

AbstractDietary supplement use is increasingly more popular in the United States. Although dietary supplements are not intended to replace intakes from foods, many formulations contain multiple nutrients at levels equivalent to or greater than their corresponding dietary recommendations. Nutrient doses are often justified by expected benefits. Women in the peri- and early postmenopausal stages are becoming the most frequent users of dietary supplements, so consideration of reported dietary intakes by women in this age range (45–60 years) is important for determining appropriate levels of supplementation. Dietary intakes at the 5th percentile among women in this age group meet 20–80% of the recommended intakes for individual nutrients. Therefore, for most nutrients, the difference between recommended dietary intakes and actual intakes reported by the 5th percentile represents an adequate level of supplementation. Exceptions to this strategy exist, which relate to evidence of deficiency in the US, the bioavailability of certain nutrients, and putative health benefits not considered in existing dietary recommendations. For some nutrients, there is an overall lack of scientific evidence that supplementation is required at all. [ABSTRACT FROM AUTHOR]

Presents a chart on calcium-rich foods. Dairy products; Soy and other beans; Fruits and vegetables.

Presents a guide to various soybean products. Types of soybean products; Nutritional contents.

Rural midlife and older women have high rates of cardiovascular disease (CVD) risk factors and lower access to healthy living resources. The Strong Hearts, Healthy Communities (SHHC) intervention, tailored to the needs of rural women, demonstrated effectiveness on many outcomes. The purpose of the Strong Hearts for New York (SHNY) study is to evaluate the efficacy of an enhanced version of the curriculum (SHHC-2.0). SHNY is a randomized controlled efficacy intervention, comparing participants receiving the SHHC-2.0 curriculum with a delayed intervention control group. SHHC, informed by formative research, includes core elements from three evidence-based programs. Changes based on extensive outcome and process evaluation data were made to create SHHC-2.0. Classes will meet twice weekly for 24 weeks and include individual, social, and environmental components. Overweight women age 40 and over will be recruited from 11 rural, medically underserved communities in New York; data will be collected at baseline and 12, 24, 36, and 48 weeks across individual, social, and environmental levels. Primary outcome is body weight. Secondary outcomes include Simple 7 (composite CVD risk score), anthropometric, physiologic, biochemical, physical activity, and dietary intake measures; healthy eating and exercise self-efficacy and attitudes; and self-efficacy of the social network of participants. The aims of this study are to evaluate the efficacy of the enhanced SHHC-2.0 program for participants, changes among participants' social networks, and the difference in outcomes when participants are and are not provided with technological tools (Fitbit and body composition scale). [ABSTRACT FROM AUTHOR]

Health-promoting behaviors for childhood obesity prevention are needed across multiple environments where children spend time, including out-of-school time (OST). Therefore Healthy Kids Out of School (HKOS) developed intervention strategies to promote three evidence-based principles (Drink Right, Move More, Snack Smart) for obesity prevention in OST. The strategies were developed with stakeholder input, disseminated, and evaluated (2012-2015) in two volunteer-led OST organizations, Boy Scouts of America (BSA) and 4-H, across three US states using the RE-AIM (Reach, Effectiveness, Adoption, Implementation, Maintenance) framework. Mixed methods were used involving surveys, key informant interviews, and organizational-level data collection. Sixty out of 81 (74.1%) BSA districts and 4-H counties reaching 84,590 children (72% of children participating in BSA and 4-H in three states) adopted the strategies. 530 surveys completed by local OST leaders at baseline and 294 at follow-up showed the percentage of programs offering healthy beverages and opportunities for physical activity increased from baseline to follow-up (beverages 26% baseline, 35% follow-up, odds ratio (OR) 1.53; physical activity 31% baseline, 45% follow-up, OR 1.79; all p < 0.05). The increasing trend for healthy snacks was statistically non-significant (p = 0.09). Leaders interviewed reported the strategies were easy to implement, a good fit with their program, facilitated success, and they expected to maintain the changes. Integration of HKOS customized materials (BSA patch and 4-H pin) on BSA and 4-H national websites is a broader indicator of maintenance. Intervention strategies developed with stakeholder input and disseminated with training can effectively facilitate healthy environments for children, and have potential for national scale. [ABSTRACT FROM AUTHOR]

The article offers information on a study in which parents' perspectives about nutrition and physical activity (PA) during out-of-school time (OST). It mentions that 600 parents with a school-aged child participated in programs from selected OST organizations. It adds that about two thirds of parents agreed that OST programs should promote healthy environments for children, whereas one third agreed that parents alone should be responsible for children's nutrition and PA.

Abstract: Objective: The objective of this study was to test the hypothesis that community-based environmental change intervention prevents undesirable weight gain in children. Method: The method used in this study was a two-year, non-randomized, controlled trial (2003–2005) using community-based participatory methodology in three diverse cities in Massachusetts: one intervention and two socio-demographically-matched control communities (pooled for analysis). Children (n=1028), with a mean age=7.61+1.04years participated. Interventions were made to improve energy balance by increasing physical activity options and availability of healthful foods (Year 1). To firmly secure sustainability, the study team supported policies and shifted intervention work to community members (Year 2). Results: Change in body mass index z-score (BMIz) was assessed by multiple regression, accounting for clustering within communities and adjusting for baseline covariates. Sex-specific overweight/obesity prevalence, incidence and remission were assessed. Over the two-year period, BMIz of children in the intervention community decreased by −0.06 [p=0.005, 95% confidence interval: −0.08 to −0.04] compared to controls. Prevalence of overweight/obesity decreased in males (OR=0.61, p=0.01) and females (OR=0.78, p=0.01) and remission increased in males (OR 3.18, p=0.03) and females (OR 1.93, p=0.03) in intervention compared to controls. Conclusion: Results demonstrate promise for preventing childhood obesity using a sustainable multi-level community-based model and reinforce the need for wide-reaching environmental and policy interventions. [Copyright &y& Elsevier]

Objective A narrow range of food choices may lead to dietary inadequacies, a particular concern in elderly people. We hypothesized that consumption of a more diverse diet would predict better nutritional status in frail elderly persons.Subjects Subjects included 98 frail nursing home residents (36 men, 62 women), mean age 87.1±5.5 (72 to 98) years.Methods 3-day dietary variety scores ranging from 23 to 48 and fruit and vegetable variety scores ranging from 5 to 20 were calculated from weighed 3-day food records as the number of different food or fruit and vegetable choices consumed. A higher score indicates a more varied diet. Nutritional status was assessed by weight, height, body mass index (BMI), skinfold thickness, circumference measures, calculated mean arm muscle area, total body water, computerized tomography of the thigh, and total body potassium, as well as nutritional analysis, biochemical measures, and subject medical history.Statistical methods Univariate regression analyses were performed to investigate the relationship between clinical and nutrition variables. Multiple linear regressions were used to develop models relating dietary variety scores to possible etiologic factors as well as indicators of nutritional status. Models were controlled for age, BMI, and energy intake when appropriate.Results Mean dietary variety score was 35.2±4.5, and mean fruit and vegetable variety score was 11.3±3.0. Higher dietary variety score was associated with higher energy intake (β=20.5, P<.001) and both high dietary variety score and fruit and vegetable variety score were positively associated with intake for many nutrients (P≤.05). High dietary variety score was related to high fruit and vegetable variety score and total intake of fruits and vegetables. In men, higher dietary variety score and fruit and vegetable variety score were associated with higher high-density lipoprotein (β=1.02), lower very-low-density lipoprotein (β=-3.58) and triglycerol (β=-3.51), and higher blood folate (β=4.72) concentrations in women (P≤.05). In women, high dietary variety score was associated with higher BMI (β=0.34, P<.001) and higher total body potassium (β=1.30, P=.02); high fruit and vegetable variety score was associated with higher BMI (β=0.41), mid-arm circumference (β=0.34), and mid-arm muscle area (β=2.94) (P≤.03). Dietary variety score was higher (mean 37.6±5.38 vs 34.6±4.14) in those who received assistance with feeding (β=2.67, P=.01). History of cancer (β=-2.04) and gastrointenstinal cancer (β=-3.54) were associated with low dietary variety score (P≤.05).Conclusions The results of this study suggest that a highly varied diet in elderly nursing home residents is associated with better nutritional status as assessed by nutrient intake, biochemical measures, and body composition measures. Dietary variety score is a straightforward tool for screening and identifying people at nutritional risk, as well as a mechanism for monitoring response to nutritional, medical, and environmental interventions. Preventive measures to improve dietary variety, as measured by the dietary variety score, should be evaluated and introduced before nutrition and health complications arise. J Am Diet Assoc. 2002;102:1096–1104. [Copyright &y& Elsevier]