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Purpose: To assess whether forming general behavioral intentions and implementing intentions through action plans promotes weight loss and is moderated by weight loss goals and self-efficacy., Design: A quasi-experimental study comparing change in body mass index (BMI) for 15 months between a behavioral intentions condition (BIC), an implementation intentions condition (IIC), and a comparison condition (CC)., Setting: Ten-week weight loss program delivered in weekly group meetings at community medical centers., Subjects: Six hundred thirty-two attendants at the weight loss program (80% of program attendants participated in the study)., Intervention: Weight loss program focused on lifestyle changes, augmented by two experimental conditions (vs. a comparison condition): BIC, intended use of weight loss techniques; IIC, intended use and detailed plans for two techniques. Phone follow-up was conducted 3 and 12 months later., Main Outcome: BMI during the program (computed on the basis of weight and height measured on a mechanical medical scale). Experimental manipulations included exposure to list of techniques (BIC/IIC) and structured planning form (IIC); independent variables were assessed with questionnaires (eating self-efficacy, weight loss goal, demographics)., Analysis: Linear mixed models estimating changes in BMI and their interactions with the planning interventions, goals, and self-efficacy., Results: Participants in the BIC and IIC lost 40% more weight during the 10-week program than those in the CC (1.10 and 1.11 BMI points compared with .79; ts < -2.76, ps < .01). Weight loss goals interacted with implementation intentions (t = 2.98, p < .01). Self-efficacy was unrelated to weight loss. No differences were found between conditions at 3 and 12 months after the program., Conclusion: Findings revealed that forming implementation intentions promotes weight loss within a weekly program at a field setting and that its effectiveness depends on initial high goals.

Aims: To identify socioeconomic status and gender inequalities in long and short-term Medical Nutrition Therapy among Israeli adult patients with diabetes., Methods: An analysis of data was performed on 90,900 patients over the age of 18 who were registered as patients with diabetes mellitus in Maccabi Healthcare Service Register which is the second largest health maintenance organization in Israel. Socioeconomic Rank for each patient was determined from the Israel Central Bureau of Statistics by geographical area of residence. Medical Nutrition Therapy was defined by the number of visits with registered dietitians. Short-term therapy was defined as one visit and long term therapy as two or more visits during the previous two years. Newly diagnosed patients were compared with veteran patients., Results: Only 25.8% of the patients with diabetes received nutrition therapy during the previous two years. Newly diagnosed patients received therapy more frequently than veterans. We found that long term therapy was positively dependent on socioeconomic rank. Women under the age of seventy five had a higher chance of receiving therapy compared to men., Conclusions: A nationwide nutritional counseling service is available and accessible to all patients with diabetes. However, the patients with higher socioeconomic rank have a higher rate of persistence with long-term nutritional therapy., (Copyright © 2013 Elsevier Ireland Ltd. All rights reserved.)

Objective: Immigration from Third World countries to the developed world is characterized by modification of lifestyle and acculturation to local customs. This study investigated changes in nutritional status and eating behaviors in female Ethiopian immigrants in Israel., Methods: Personal interviews, two 24-h dietary recalls, and anthropometric measurements were carried out in a random sample of 53 women 32 ± 6 y of age., Results: After living in Israel for an average of 14 y, body mass index was similar to the general Israeli population, with 42% of participants with a body mass index greater than 24.9 kg/m², including 11% categorized as obese. This is in stark contrast to the body mass index measured at arrival in Israel (∼19-20 kg/m²). Less than optimal consumption of dietary fiber, calcium, folate, and B12 was documented. Analysis by food groups showed that intake of dairy products, fruits, and vegetables was negligible, whereas simple sugar intakes were high. The women continued to prepare traditional Ethiopian foods but also incorporated local, less healthy foods into their diets. Compared with the high energy expenditure in rural Ethiopia, participants reported minimal physical activity in Israel., Conclusions: This immigrant community is at high risk for developing nutrition-related chronic diseases. Culturally sensitive nutrition education programs are urgently needed., (Copyright © 2012 Elsevier Inc. All rights reserved.)

Introduction: Post-marketing data on weight-loss medications in free living population are a necessary adjunct to data from clinical trials., Materials and Methods: We conducted a population-based analysis of first-time medication users based on HMO pharmacy purchasing data serving > one million adults., Results: During 5 years, usage of orlistat and sibutramine more than doubled and rates were higher during the months May-Aug. As compared to non-users (n = 1,038,828), annual weight-loss drug users (n = 7175) had higher women proportion, body-mass-index (BMI), bariatric surgery history, and usage of diabetes, depression, and cardiovascular medications (p < 0.001 for all). Among users, men had higher BMI (34.4 kg/m(2) vs. 32.5 kg/m(2)), prevalence of diabetes (25.4% vs. 10.7%) and heart disease (14.2% vs. 3.5%) than women. Mean duration of purchasing weight-loss medications was 2.1 months for orlistat and 2.9 months for sibutramine. Fewer than 2% completed 12 months of weight-loss medication therapy. Among the 25% who continued to purchase at least 4 months, BMI (sub-group analysis) reduced from 33.02 kg/m(2) to 32.04 kg/m(2) (p < 0.001). In a multivariate model, long-term adherence (≥ 4 months) to weight-loss medications was associated with use of sibutramine vs. orlistat (OR = 2.08; 95%CI: 1.76-2.45), and prevalence of diabetes (OR = 1.20; 95%CI: 1.01-1.25). Age, gender, and baseline BMI were not associated with long-term adherence., Conclusions: Usage of weight-loss drugs is higher among diabetes patients. However, the poor adherence to therapy is substantially below levels reported in clinical trials., (Copyright © 2011 Elsevier Ireland Ltd. All rights reserved.)

Background: Clinical trials that have assessed the best approach for treating under-nutrition in old age are scarce., Objective: To determine the impact of an intensive nutritional intervention program led by a dietitian on the health and nutritional status of malnourished community dwelling older adults., Methods: Sixty-eight eligible participants (age<75) were randomly assigned to a Dietetic Intervention Treatment (DIT), an intensive nutritional intervention led by a dietitian, or a Medical Treatment (MT), a physician-led standard care group, with an educational booklet regarding dietary requirements and recommendations for older adults. An additional 59 eligible participants who were unable to participate in the randomization were included as a non-randomized "untreated nutrition" group (UNG)., Results: Over the 6-month follow-up, the DIT group showed significant improvement in cognitive function (from 25.8±4.5 to 26.8±4, p=0.04), and depression score (from 7.3±3.9 to 5.4±3.9, p=0.04) compared with the change in the other 2 groups. The DIT group showed a significant improvement in intake of carbohydrates (+15% vs. +1% in the MT and +3% in the UNG), protein (+8% vs. +2% in the MT and -3% in the UNG), vitamin B6 (+20% vs. +7% in the MT and +8% in the UNG), and vitamin B1 (+22% vs. +11% in the MT and 0% in the UNG). The DIT group had a significantly lower cost of physician visits than the other 2 groups ($172.1±232.0 vs. $417.2±368.0 in the MT and $428.1±382.3 in the UNG, p=0.005)., Conclusion: Intensive dietary intervention was moderately effective in lowering cost of services used and improving medical and nutritional status among community dwelling older adults.

Purpose: This paper's aim is to identify whether community-level socioeconomic status (SES) predicts: screening test for pre-diabetes; actual diagnosis of pre-diabetes; or nutritional counseling., Design/methodology/approach: This is an analysis of 1,348,124 insured adults receiving medical care from Maccabi Healthcare Services (MHS) in 107 MHS clinics throughout Israel. The research population comprised 79 percent of the MHS members over 18 years of age in 2004-2006. Area level socioeconomic data were drawn from the Israel Central Bureau of Statistics SES index for every geographical area and each MHS clinic in the study was coded from: - 1.03 to 2.73 (- 1.03 indicating low SES and 2.73 + high SES) according to the SES index for the location. The fasting glucose laboratory test was used for analysis. Pre-diabetes diagnosis was based on a fasting glucose above 100 mg/dl. Nutritional counseling was defined by dietitian visits in the claims database., Findings: The percentage of insured individuals who underwent blood glucose testing during the study increased with age from 67 percent at ages 18-45 to92 percent for age 65 and over. The percentage of individuals diagnosed with pre-diabetes also increased with age, rising from 4 percent in the younger group to 14 percent in those aged 46-65 and to 14-16 percent of 65 and older. The percentage of individuals with pre-diabetes who visited a dietitian was 16-27 percent for those under 65 and 14-17 percent for those over 65 (males and females, respectively). Individuals living in lower socioeconomic areas were less likely to have blood tests. Among tested patients, the prevalence of pre-diabetes was higher in areas of lower SES and their dietitian visits were less frequent., Practical Implications: In lower SES index areas, there is a need for better identification and treatment of patients., Originality/value: The paper shows that a proactive approach is needed both to detect pre-diabetes and to encourage patients to receive nutritional treatment.

Physicians' knowledge and attitudes can profoundly impact the quality of nutritional care provided to older patients. We assessed physicians' knowledge and attitudes concerning nutritional care for older adults and its correlates. Questionnaires were mailed to 898 physicians in the second largest HMO in Israel: the response rate was 26.5%. Questionnaires assessed aspects of geriatric nutrition, such as food choices, functioning, and medical conditions. Results indicated highest knowledge of nutritional issues for family physicians and for those who were younger (<50 age) and female. Although 68% believed it is important for physicians to explain nutritional issues to older patients, this role was also deemed important for dietitians (83%) and nurses (59%). A variety of factors influencing geriatric nutrition, especially functional and medical conditions, were identified; likewise, nutrition was perceived as influencing various health conditions. Although the low response rate limits generalizability, it appears that physicians in this survey recognized the impact of proper nutrition health and take responsibility for explaining nutrition to their older patients.

Context: Teaching nutrition to medical students is constrained by limitations in curricular time and competition with other topics., Objectives: To identify time slots and teaching methods for incorporating nutrition into the medical school curriculum, determine students' nutritional knowledge following the program, and their perception of the effectiveness of the program., Methods: A nutritional workshop was added to the clinical experience weeks of second-year medical students. The first class included 66 students and the second class included 56 students. In order to fully acquaint the students with nutrition, four topics were included: nutritional policy, dietary assessment, nutritional recommendations, and obesity. Students were encouraged to actively participate in the program which included dietary intake interviews, debates regarding nutritional treatments, and actual practice in class. The main outcome measures were nutritional knowledge and evaluation of the program by the students., Findings: Over 90% of the students answered the knowledge questions correctly. The effectiveness of the training was graded (on a scale of 1-7) between 3.7-5.4 in the first year and 3.4-5.7 in the second year., Conclusions: The ten-hour nutritional workshops within the clinical weeks were well-received by second-year medical students. Using cases relevant to the students' age seems to enhance their interest in the program.

Background and Aims: The elderly are becoming a significant segment of the public receiving medical nutritional care in the community. Since dietitians are the professionals responsible for their nutritional care, the aim of this study was to assess dietitians' attitudes and correlates regarding elderly nutritional factors., Participants and Methods: Questionnaires were distributed at a dietitians' conference to 114 dietitians working in the second largest HMO in Israel. Ninety-five questionnaires were returned. The questionnaire assessed different aspects of elderly nutrition, such as factors affecting elderly nutrition, medical conditions influenced by nutrition, and the dietitian's role in modifying elderly nutritional habits., Results: Participants reported that between 25% and 50% of their patients were elderly. They believed that dietitians are the only health care professionals who should be giving nutritional advice to the elderly. The more experienced dietitians were willing to share nutritional treatment plans with the patients' physicians. The participants in this study believed that nutritional advice may influence the elderly to change their nutritional habits. They recognized the impact that nutrition can have on different health conditions and identified a variety of factors affecting elderly nutrition, especially functional and medical conditions., Conclusions: Overall, dietitians working in the community viewed themselves as the main professionals responsible for counseling the elderly on nutritional issues. Although dietitians perceived their knowledge and skills in this area as very good, the researchers identified a need for further education, especially regarding the possible influence of socio-demographic characteristics on dietary intake and the value of educating the elderly to read and understand nutrition labels.

Background: Nutrition has a critical effect on the infant's brain development during pregnancy and the first 18 months of life. Inappropriate diet can cause infant mortality. Research has shown that medical professionals lack the required knowledge regarding nutrition and that there are no suitable instructional programs on this subject for them., Objectives: To examine the knowledge and attitudes of gynecologists, pediatricians and nurses who work in mother and child health clinics of "Maccabi" Healthcare Services in Israel concerning infants' and pregnant women's nutrition and to compare these findings to the public's general knowledge., Methods: The study population consisted of gynecologists and pediatricians who work in "Maccabi" Healthcare Services throughout the country and all the nurses at the family healthy clinics. In addition, a sample of mothers attending six different family health clinics was recruited. Four structured questionnaires were created for each group in the study population (gynecologist, pediatricians, nurses and mothers). The questionnaires included questions that evaluated the knowledge and attitudes toward infants' nutrition., Results: The mothers showed high level of knowledge (67% correctly answered 3 or more of the 4 questions, compared to 51% of nurses, 27% or pediatricians, 38% of gynecologists, p < 0.01). The physicians showed a higher level of knowledge in the questions related to their specialty. When asked about the effect of nutritional instruction on the infants' health, the pediatricians answered correctly at a higher rate than the other study groups (74% of pediatricians answered correctly 3 out of 3 questions, compared to 60% of gynecologists, 47% nurses, p < 0.01). Professionals believe that they can train mothers on nutritional issues., Conclusions: Appointing a nutritionist to the mother and child clinics should be considered, as the professional caregivers of pregnant women and infants were found to be lacking in sufficient knowledge in certain aspects of nutrition for these populations.

Background: The world population is getting older and the percentage of elderly people (over 65 years old) in Israel (November 1999) is approaching 10%. Six percent of Maccabi Healthcare Services members are older adults. Elderly people are at risk for undernutrition due to chronic diseases, decreased physical and cognitive functioning. The present study aimed to assess the dietary intake of elderly people in Tel Aviv, members of Maccabi Healthcare Services, to evaluate their intake in relation to the recommendations, as well as to determine the association between the dietary intake and the use of medical care services., Methods: A random sample of people over 70 years old, members of Maccabi Healthcare Services, were randomly selected and interviewed for their dietary intake using food frequency questionnaire. Additional questions were asked regarding lifestyle, health status and use of health care services. The interviews were conducted by trained interviewers from the surveys department of Maccabi Healthcare Services., Results: One hundred and fifty eight people participated in the survey. Among them, 8% were consuming less than 800 calories per day and 33% less than 1200 calories per day. Over 40% of the participants had at least one chronic disease or condition and 19% had dental problems. Most of the participants (70%) visited their family physician at least once in the last 3 months, 71% visited at least one specialist in the last 6 months and 12% visited a dietitian. Over 90% of the interviewees eat 3 meals a day and over 50% participate in physical activity regularly. Significant negative association was shown between caloric intake and family physician office visits, No such association was shown for specialist office visits., Conclusions: Over 30% of the participants of this study have lower caloric intake. It seems that there is an increased need to improve the awareness of older people to the importance of nutrition for their health and quality of life. Larger and more detailed studies are needed to understand the scope of the problem.