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PURPOSE OF REVIEW: The purpose of this review was to investigate and synthesize psychosocial outcomes from pharmacotherapy experimental trials for weight loss among adolescents with obesity. RECENT FINDINGS: There is a paucity of research regarding pharmacological interventions for adolescents with obesity. These studies have typically reported reductions in weight, and side effects have been inconsistently described. Overall, medication seems to be a safe and effective obesity treatment modality for adolescents with obesity. SUMMARY: Six articles were included in this review. Studies varied in medication type, medication dosing, lifestyle components, psychosocial measures, measurement intervals, and psychosocial outcomes. All studies found a reduction in weight and/or BMI. Studies were often underpowered to detect differences in psychosocial variables, which were always considered secondary or exploratory outcomes. Future research should include psychosocial outcomes as a primary endpoint of pharmacological interventions for adolescent obesity. Ultimately, the treatment of the complex disease of obesity deserves to be assessed through multiple health domains extending beyond weight reduction.

BACKGROUND The COVID-19 pandemic has had a widespread impact on attendance in biomedical research and health care visits. OBJECTIVE This study aimed to identify when and how American adults might feel comfortable about resuming in-person research and health care visits. METHODS Cross-sectional questionnaire data were collected from 135 adults (age: median 48 years; women: n=113, 83.7%; White participants: n=92, 68.2%) who were engaged in health-related research. RESULTS More than half of the respondents (65/122, 53.3%) felt that the COVID-19 pandemic positively affected their desire to participate in research. Although 73.6% (95/129) of respondents also indicated a willingness to attend in-person health care visits while Centers for Disease Control and Prevention (CDC) guidelines are implemented, 85.8% (109/127) indicated a willingness to attend in-person, outdoor visits, and 92.2% (118/128) reported a willingness to attend drive-through visits (with CDC guidelines implemented during both visit types). Videoconferencing was the most preferred format for intervention visits; however, adults over the age of 65 years preferred this format less than younger adults (P=.001). CONCLUSIONS Researchers and clinicians should continue to provide opportunities for continuing the conduction of remote-based interventions while enforcing CDC guidelines during in-person visits.

Bariatric surgery effectively treats severe obesity and metabolic diseases. However, individual outcomes vary depending on sustainable lifestyle change. Little is known about lifestyle patterns after bariatric surgery among the US population.To compare the level of physical activity and eating behavior among postbariatric surgery patients, individuals eligible for surgery, and those with normal weight.A cross-sectional study using nationally representative survey data from National Health and Nutrition Examination Survey 2015-2018. Respondents included for analysis were age 18 years or older, and categorized by individuals with normal weight, individuals who received bariatric surgery, and individuals clinically eligible for bariatric surgery. Analyses were performed from February to October 2021.Self-reported measures were used to assess physical activity (moderate-to-vigorous physical activity [MVPA], sedentary activity, and whether PA guidelines were met) and eating behaviors (total energy intake and Healthy Eating Index [HEI]-2015 diet quality scores).Of 4659 study participants (mean [SD] age, 46.1 [18.6] years; 2638 [weighted percentage, 58.8%] women; 1114 [weighted percentage, 12.7%] Black, 1570 [weighted percentage, 68.6%] White), 132 (3.7%) reported that they had undergone any bariatric surgery. Median (IQR) time since surgery was 7 (3-10) years. After propensity-score weighting, individuals who underwent bariatric surgery reported more time spent in MVPA than those eligible for surgery (147.9 min/wk vs 97.4 min/wk). Among respondents with normal weight, 45.6% (95% CI, 40.8% to 52.4%) reported meeting PA guidelines, almost 2 times higher than those in the bariatric surgery (23.1%; 95% CI, 13.8% to 32.4%) or in the surgery-eligible group (20.3%; 95% CI, 15.6% to 25.1%). Propensity-score weighted overall HEI was higher for individuals with normal weight (54.4; 95% CI, 53.0 to 55.9) than those who underwent bariatric surgery (50.0; 95% CI, 47.2 to 52.9) or were eligible for the surgery (48.0; 95% CI, 46.0 to 50.0). Across all HEI components, mean scores were similar between the bariatric surgery and surgery-eligible groups. Total energy intake was the lowest among those who underwent bariatric surgery (1746 kcal/d; 95% CI, 1554 to 1937 kcal/d), followed by those with normal weight (1943 kcal/d; 95% CI, 1873 to 2013 kcal/d) and those eligible for bariatric surgery (2040 kcal/d; 1953 to 2128 kcal/d).In this cross-sectional study, individuals who underwent bariatric surgery had beneficial lifestyle patterns compared with those eligible for surgery; however, these improvements seemed suboptimal based on the current guidelines. Efforts are needed to incorporate benefits of physical activity and a healthy, balanced diet in postbariatric care.

Research suggests that many parents make comments about their child’s weight, which is associated with negative adolescent health outcomes. Gaps in this literature include an underrepresentation of fathers, limited knowledge regarding positive versus negative parental weight comments and differences across race/ethnicity, and adolescent preferences for parental weight communication. The present study addressed these research gaps through a comprehensive investigation of two diverse samples of U.S. parents (n = 1936) and adolescents (n = 2032), who completed questionnaires about their experiences and perspectives of parental weight communication. Positive weight comments from parents were more frequent than negative comments, though both were commonly reported across sex, race/ethnicity, and weight status. In general, boys, fathers, Latino/a parents and adolescents, and adolescents with a high BMI and/or engaged in weight management reported more frequent parental weight-talk. Parent–adolescent weight communication occurred both in-person and digitally, and across daily life contexts. Although the majority of parents communicated positive messages of body diversity and respect, 44% and 63% of adolescents said they never want their mothers and fathers, respectively, to talk about their weight. Adolescents were offered circumstances that would increase their comfort level in having these conversations. Findings have implications for health professionals working with families to promote supportive health communication at home.

Background Behavioral obesity interventions using an acceptance‐based therapy (ABT) approach have demonstrated efficacy for adults, yet feasibility and acceptability of tailoring an ABT intervention for adolescents remains unknown. Objective This study assessed the feasibility and acceptability of an ABT healthy lifestyle intervention among diverse adolescent cisgender girls with overweight/obesity (OW/OB). Methods Adolescent cisgender girls aged 14–19 with a BMI of ≥85th percentile‐for‐sex‐and‐age were recruited for participation in a single‐arm feasibility study. The primary outcomes were recruitment and retention while the secondary outcome was change in BMI Z‐score over the 6‐month intervention. Exploratory outcomes included obesity‐related factors, health‐related behaviors, and psychological factors. Results Recruitment goals were achieved; 13 adolescents (>60% racial/ethnic minorities) participated in the intervention, and 11 completed the intervention (85% retention). In completers (n = 11), a mean decrease in BMI Z‐score of −0.15 (SD = 0.34, Cohen's d = −0.44) was observed. Improvements were also noted for change in percentage of 95th percentile (d = −0.35), percent body fat (d = −0.35), quality of life (d = 0.71), psychological flexibility (d = −0.86), and depression (d = −0.86). Conclusions These preliminary findings suggest an ABT healthy lifestyle intervention tailored for adolescent cisgender girls with OW/OB may be an acceptable treatment that could lead to improvements in BMI Z‐score, obesity‐related measures, and psychological outcomes.

OBJECTIVE This randomized trial experimentally manipulated social status to assess effects on acute eating behavior and 24-hour energy balance. METHODS Participants (n = 133 Hispanics; age 15-21 years; 60.2% females) were randomized to low social status ("LOW") or high social status ("HIGH") conditions in a rigged game of Monopoly (Hasbro, Inc.). Acute energy intake in a lunchtime meal was measured by food scales. Twenty-four-hour energy balance was assessed via summation of resting metabolic rate (metabolic cart), physical activity energy expenditure (accelerometer), thermic effect of food, and subtraction of twenty-four-hour energy intake (food diary). RESULTS In the total sample, no significant differences were observed by study condition at lunchtime. LOW females consumed a greater percent of lunchtime daily energy needs (37.5%) relative to HIGH females (34.3%); however, this difference was not statistically significant (P = 0.291). In males, however, LOW consumed significantly less (36.5%) of their daily energy needs relative to HIGH males (45.8%; P = 0.001). For 24-hour energy balance, sex differences were nearly significant (P = 0.057; LOW females: surplus +200 kcal; HIGH males: surplus +445 kcal). Food-insecure individuals consumed a nearly significant greater lunchtime percent daily energy than those with food security (40.7% vs. 36.3%; P = 0.0797). CONCLUSIONS The data demonstrate differential acute and 24-hour eating behavior responses between Hispanic male and female adolescents in experimentally manipulated conditions of low social status.

Objective This study aimed to examine the impact of coronavirus disease 2019 (COVID-19) on current research participants' mental health outcomes, ability to adhere to behavioral intervention recommendations, and desire to participate in research. Methods A quantitative/qualitative cross-sectional survey was used among adults currently enrolled in health-related research (N = 250; 85% women; > 50% currently enrolled in behavioral weight loss intervention). Results COVID-19 was perceived as a severe threat by most (62.3%). Related to COVID-19, 29.6% of participants reported moderate/severe symptoms of anxiety/depression, and 68.4% reported moderate/severe posttraumatic stress disorder (PTSD) symptomatology, with women more likely to demonstrate moderate/severe anxiety/depression (P = 0.047) and PTSD symptomatology (P = 0.028) relative to men. Those with moderate/severe levels of anxiety/depression (P = 0.0154) and distress (P = 0.0330) were more likely to report a decreased desire to participate in research. Among those in behavioral interventions, individuals perceiving COVID-19 as a moderate/severe threat or experiencing moderate/severe depression or PTSD symptomatology were 4 to 19 times more likely to report that COVID-19 affected their ability to adhere to behavioral recommendations. Qualitative analysis identified four themes describing COVID-19's impact on research experiences: transition, remote intervention delivery, ability to adhere to program goals, and research participation interest. Conclusions These data suggest that participants engaged in health-related research perceive COVID-19 as a significant threat, affecting mental health, desire to participate in research, and ability to adhere to intervention recommendations.

Background Metabolic syndrome (MetS) is a risk factor for the development of cardiovascular disease and type 2 diabetes. Although the development of MetS is attributed to known lifestyle factors, perceived discrimination may also contribute to MetS development and severity. Purpose We examined the associations of perceived discrimination with MetS severity among African American adults at baseline and 8-year follow-up. Methods Three thousand eight hundred and seventy participants (mean age 53.8 ± 13.0; 63.1% female) without diabetes and no missing MetS severity scores at baseline were included. Each self-reported measure of discrimination at baseline (everyday, lifetime, and burden of lifetime) was classified into tertiles (low, medium, high). After adjustment for demographics and MetS risk factors, associations of discrimination were examined with a sex- and race/ethnicity-specific MetS severity Z-score. We employed a mixed model approach that allowed for the assessment of an overall association between reported discrimination at baseline and MetS severity, and for the possible change over time. Results Sex and age differences were observed in experiences with discrimination, such that men reported higher levels of all aspects of discrimination relative to women. Everyday discrimination decreased with age, whereas lifetime discrimination increased with age (p < .05). Independent of lifestyle and demographic factors, everyday and lifetime discrimination were significantly associated with MetS severity (p = .003 and p = .017, respectively) and the associations remained constant over the 8 years (i.e., no interaction with time). Conclusions Our results suggest that, in a large community-based sample of African Americans, discrimination is a salient psychosocial risk factor for severity of MetS.

Summary Objective Effectiveness of behavioural obesity treatments in adolescents is modest. Thus, incorporating participant feedback may lead to improvement of intervention acceptability. This qualitative study's objective was to assess perceived barriers/facilitators to weight loss and healthy lifestyles among diverse adolescents with overweight/obesity (OW/OB). Methods Adolescents ages 14–19 with BMI ≥ 85th percentile participated in focus groups and identified perceived barriers/facilitators to weight loss and healthy lifestyles. Results Ten sex‐stratified focus groups (n = 41; n = 13 males, n = 28 females) were conducted in 2018 and 2019. Females reported experiencing weight struggles, whereas males often stated no struggles with weight, despite all participants meeting criterion for OW/OB. Barriers included eating behaviours, family members and internal motivation, with additional barriers of physical activity, friends, time and support cited in females. Facilitators included parental, familial and peer support of healthy eating and exercise, modelling behaviours, internal motivation and organized sports. Two additional findings regarding adolescents' perceived barriers/facilitators include substantial overlap and sex differences of perceived barriers/facilitators. Conclusions Adolescent males and females with OW/OB experience weight status differently, affecting their perceived barriers/facilitators to weight loss and healthy lifestyles. Tailoring weight management interventions to the unique needs of adolescent females versus adolescent males has the potential to improve intervention quality and effectiveness.

OBJECTIVES: The “traffic light diet” (TLD; or “stop light diet” among other names) categorizes foods into ‘green’, ‘yellow’, or ‘red’ groups to consume without restriction, in moderation, or minimally, respectively. It is often a component of childhood interventions targeting weight-related outcomes. The Academy of Nutrition and Dietetics Evidence Analysis Library assigned TLDs Grade I evidence in 2006 for pediatric weight management, but none of the studies reviewed tested the TLD in isolation. We conducted a review of the effect of TLDs on obesity-related outcomes in children and definitions among different implementations of TLDs. METHODS: We searched PubMed up to September 2019 for interventions using the TLD with obesity-related anthropometric outcomes. Studies were screened in duplicate, and treatment characteristics extracted. Additional studies were identified by screening references. Using a convenience sample of texts from the original TLD creators, Indiana University vending, a new pediatric weight loss app, and an online resource, we assessed how definitions of TLDs compare. RESULTS: Our search identified 386 abstracts, 5 of which were interventions that included the TLD and weight-related outcomes. Three of these were randomized controlled trials, and none studied the TLD in isolation outside of multicomponent interventions. We then focused on 4 foundational TLD articles that were repeatedly cited. One of these isolated the TLD from the multicomponent intervention but found no statistical effect of the diet or interaction of diet with other factors for weight-related outcomes. In the sample of TLD implementations, substantial differences were apparent in how foods were classified among green, yellow, and red groups, such as avocados, nuts, figs/fig cookies, and peanut butter. CONCLUSIONS: There is insufficient evidence supporting TLDs as a unique, isolatable factor in improving weight-related outcomes in children. This does not necessarily mean that TLDs are ineffective, as they have been incorporated into successful interventions. A standardization of TLD definitions (consistently categorizing foods and whether the term ‘TLD’ is meant to include other components of an intensive lifestyle intervention) is needed to make comparisons of effectiveness going forward. FUNDING SOURCES: The authors received no funding for this specific work.

Background and Objectives: The purpose of this study is to examine the patterns of patient teach-back experience (also known as “interactive communication loop”) and determine its association with risk for diabetic complications and hospitalization, and health expenditures among individuals with diabetes. Methods: A retrospective cohort study of 2901 US adults aged 18 years or older with a confirmed diagnosis of diabetes was conducted using data from the 2011 to 2016 Longitudinal Medical Expenditure Panel Survey. Survey-design adjusted multivariable models were used to examine whether having patient teach-back experience at the baseline year (Year 1) is associated with development of diabetic complications, hospitalization, and health expenditure at follow-up year (Year 2). Health expenditures were adjusted for inflation and expressed in 2017 US dollars. All adjusted models included patient sociodemographic and clinical characteristics. Results: Analyses found that patients with teach-back experience were less likely to develop diabetic complications (adjusted odds ratio [AOR], 0.70; 95% CI, 0.52–0.96) and be admitted to the hospital due to diabetic complications (AOR, 0.51; 95% CI, 0.29–0.88) at 1-year followup. Patients having teach-back experience also had a significantly smaller increase in total expenditures of $1920 compared with those not having teach-back of $3639 (a differential change of −$1579; 95% CI, −$1717 to −$1443; P Conclusions: Teach-back could be an effective communication strategy that has potential to improve health outcomes, resulting in savings in diabetes care.

Despite significant progress in recent decades, the recruitment, advancement, and promotion of women in academia remain low. Women represent a large portion of the talent pool in academia, and receive >50% of all PhDs, but this has not yet translated into sustained representation in faculty and leadership positions. Research indicates that women encounter numerous “chutes” that remove them from academia or provide setbacks to promotion at all stages of their careers. These include the perception that women are less competent and their outputs of lesser quality, implicit bias in teaching evaluations and grant funding decisions, and lower citation rates. This review aims to (1) synthesize the “chutes” that impede the careers of women faculty, and (2) provide feasible recommendations, or “ladders” for addressing these issues at all career levels. Enacting policies that function as “ladders” rather than “chutes” for academic women is essential to even the playing field, achieve gender equity, and foster economic, societal, and cultural benefits of academia.

Purpose To assess independent associations between objective socioeconomic status (OSS) and subjective social status (SSS) with metabolic syndrome (MetS) severity and indicators among African American (AA) adults in the Jackson Heart Study (JHS) at baseline (2000–2004) and eight-year follow-up (2009–2013). Methods Participants included 1724 AA adults from the JHS cohort (64.4 % women; mean age 53.4 ± 11.8). Associations of OSS (annual household income and school years completed) and SSS (measured with MacArthur Scales) with sex- and race/ethnic-specific MetS severity Z-score were examined after adjustment for demographics and MetS risk factors (i.e., nutrition, physical activity, smoking status, alcohol consumption, and depressive symptoms) at baseline and eight-year follow-up. Principal results Independent of OSS, demographic, psychosocial, and lifestyle factors, individuals with lower US-society SSS had more severe MetS at baseline. A significant interaction existed between sex and US-society SSS such that women with lower perceived social status had more severe MetS severity at baseline, and for every one unit increase in US-society SSS, MetS severity Z-score is estimated to decrease by 0.04. Components of MetS driving the relationship between US-society SSS and MetS severity at baseline were the inverse associations of SSS with glucose levels and the positive associations of SSS with HDL-C. Physical activity was independently associated with MetS severity at baseline, but not at eight-year follow-up. Major conclusions Though subjective and objective measures of social status are independently associated with cardiometabolic risk factors and MetS severity among AA adults, SSS may be a stronger predictor of MetS severity than OSS, particularly among women. SSS should be considered in conjunction with OSS when exploring social determinants of cardiometabolic health.

Introduction: Subjective social status (SSS) is inversely related to allostatic load (AL) markers, but little is known in Hispanics/Latinos. We assessed the hypotheses that SSS would be inversely associated with total AL and subsystem scores, regardless of objective socioeconomic status (OSS). Methods: Data were from baseline of the HCHS/SOL (n = 12,722, aged 18-74y). We assessed SSS using a 10-step ladder. Participants identified on which step they stood in relation to other people in the U.S. Higher scores indicated higher SSS (range: 1-10). Participants self-reported OSS as household income, educational attainment, and employment status. AL was comprised of 16 physiological markers from the parasympathetic (n=2; heart rate variability), inflammation (n=2; C-reactive protein, white blood cell), metabolic (anthropometrics, lipids, glucose, insulin resistance; n=8), and cardiopulmonary (blood and pulse pressures, resting heart rate, lung function; n=4) subsystems. Each marker was assigned a score of 1 if the value exceeded clinical cut-offs (or high-risk quartiles) or the participant reported taking medication to alter the marker. Otherwise, the marker was assigned a score of 0. Scores were summed across the 16 markers to create an AL score (0-16), with higher scores indicating higher AL. Scores were then dichotomized as high (vs. low) if scores were ≥ AL and subsystem medians. Multivariate-adjusted, survey-weighted linear and logistic regression models tested the association of SSS with AL and subsystem scores. Results: Sample means (95% CI) for SSS and AL were 4.4 (4.3-4.5) and 4.2 (4.1-4.3), respectively. A one-step increase on the SSS ladder was associated with lower AL ((β(SE): -0.1(0.02), p=0.003) and metabolic system (-0.04(0.01), p=0.001) scores. After adjusting for OSS, the association between SSS and AL was attenuated (-0.03(0.02), p=0.09), but remained significant for metabolic system scores (-0.03(0.01), p=0.01). When modeling dichotomized AL, a one-step increase was associated with lower odds of high AL (Odds Ratio (OR); 95% Confidence Intervals (CI): 0.94 (0.91-0.98), p=0.001), high parasympathetic system (0.96 (0.93-1.00), p=0.03), and high metabolic system (0.95 (0.92-0.98)) scores. After adjusting for OSS, higher SSS remained associated with lower odds of high AL (0.95 (0.92-0.99), p=0.01) and high metabolic system (0.96 (0.92-0.99), p=0.01) scores, but the association between SSS and lower parasympathetic subsystem scores was attenuated (0.97 (0.94-1.00), p=0.08). SSS was not associated with inflammation or cardiopulmonary subsystems. Conclusions: Among Hispanics/Latinos living in the U.S, OSS attenuated the relationship between SSS and AL. SSS may be influencing AL through the metabolic system, and could provide unique psychological and biobehavioral targets for reducing metabolic risk disparities among Hispanics/Latinos living in the U.S.

OBJECTIVES: Fermentable carbohydrate is universally recognized as the major dietary risk factor for dental caries. We assessed the broader relationship between diet quality and dental caries in a diverse Latinx adult population. METHODS: In a cross-sectional probability sample, 14,517 dentate men and women in the Hispanic Community Health Study/Study of Latinos (HCHS/SOL) received a dental examination and completed two 24-hours dietary recalls and a food propensity questionnaire. The 2010 Alternative Healthy Eating Index (AHEI) assessed diet quality and the National Cancer Institute method predicted usual intake of the 11 dietary components that comprise the AHEI. Dental caries experience was quantified using the decayed, missing and filled surfaces (DMFS) index. Covariates included sociodemographic and anthropometric characteristics. Survey multivariable-adjusted linear regression models quantified the relationship of 2010 AHEI score, and its 11 components, with DMFS. RESULTS: In multivariable-adjusted models, each 10-unit increase in diet quality score was associated with 2.5 fewer (95% confidence interval: −3.4, −1.6) DMFS. The relationship was pronounced among foreign-born individuals, who com-prised three-quarters of the sample, irrespective of their length of US residence, but was not apparent among U.S.-born individuals. Greater intake of sugar-sweetened beverage and fruit juice was positively associated with dental caries, whereas vegetables (excluding potatoes); whole grains; and omega-3 fats were inversely associated with dental caries, independent of covariates and the other dietary components (all P < 0.05). CONCLUSIONS: An association between diet quality and dental caries was restricted to foreign-born Latinix and was not limited to the adverse impact of sugar-sweetened drinks.

Diabetes is a complex and multifactorial disease affecting more than 415 million people worldwide. Excess adiposity and modifiable lifestyle factors, such as unhealthy dietary patterns and physical inactivity, can play a significant role in the development of type 2 diabetes. Interventions that implement changes to lifestyle behaviors, in addition to pharmacological treatment, may attenuate the development and worsening of diabetes. This narrative review delineates how standard behavioral interventions (SBTs), based in “first wave” behavioral therapies and “second wave” cognitive behavioral therapies, serve as the foundation of diabetes treatment by supporting effective lifestyle changes, including improving adherence to healthful behaviors, medication, and self-monitoring regimens. Moreover, “third wave” “acceptance-based therapies” (ABTs), which integrate techniques from acceptance and commitment therapy, are proposed as a potential novel treatment option for diabetes management. Further research and long-term, randomized controlled trials will clarify the feasibility, acceptability, and effectiveness of ABT for improving glucose control via enhancing medication adherence and promoting effective lifestyle changes in people with diabetes.

Objective Subjective social status (SSS), perceived rank in the social ladder, is associated with weight, but determinants of SSS in youth remain unknown. Relationships between youth SSS and income, food insecurity, parent SSS, and BMI change were investigated during an obesity intervention. Methods Data came from a family-centered, community-based obesity intervention for low-income families. Parent and youth SSS were assessed using a validated, age-appropriate SSS scale. Food insecurity and socioeconomic factors were assessed in parents; child and parent weight-related data were measured at baseline and post intervention. Results Participants included 110 primarily Hispanic (97%) low-income youth and their parents. Food insecurity was reported in 66.4% of families. Youth SSS was positively associated with parent SSS (P = 0.0014). In both parents and children, the association between income and SSS was moderated by food insecurity such that lower income was more strongly associated with lower SSS among food-insecure households (P = 0.0286 and P = 0.0327, respectively). Youth SSS was not associated with youth BMI reduction. Conclusions Youth SSS was not predictive of weight loss in this intervention. Intriguingly, the association between income and SSS was modified by food insecurity, suggesting that food insecurity shapes the contribution of socioeconomic factors to one's perceived social status.

Introduction With obesity rates and obesity-related healthcare costs increasing, policy makers must understand the scope of obesity across populations. Objective This study sought to characterize adult obesity using electronic health records (EHRs) available from a statewide clinical data research network, the OneFlorida Clinical Research Consortium, which contains claims and EHR data from over 12 million patients in Florida. The primary aim was to compare EHR-based Florida obesity rates with those rates obtained from the Behavioural Risk Factor Surveillance System (BRFSS). Methods Body mass index from OneFlorida patient data (2012-2016) was used to characterize obesity among adults 20-79 years old. Obesity rates from both OneFlorida and BRFSS (2013) were reported by demographics and by county. Results Among the 1,344,015 adults in OneFlorida with EHR data and who met inclusion criteria, the obesity rate was 37.1%. Women had higher obesity rates compared with men. Obesity rates varied within racial/ethnic groups, with the highest rate among African-Americans (45.7%). Obesity rates from OneFlorida were consistently higher than those found in BRFSS (overall 27.8%). Conclusions Utilizing clinical big data available through hospital system and health partner collaborations provides an important view of the extent of obesity. Although these data are available only from healthcare users, they are large in scope, directly measured and are available sooner than commonly used national data sources.

We investigated the relationship between adverse childhood experiences (ACEs) and children’s internalising symptoms and externalising problems in the Wales Adoption Cohort Study, a prospective longitudinal study that used case file records (n = 374) for a sample of British children adopted from care (M = 2 years, 55% male). Parents (n = 96) completed questionnaires at 3–5 months, 15–17 months, and 31–33 months post-placement. We hypothesised that: (1) children adopted from care would have experienced more ACEs than children in the general population; (2) the number of ACEs would be associated with higher internalising symptom and externalising problem scores; and (3) adoptive parental warmth would moderate the relationship between ACEs and post-placement internalising symptoms and externalising problems. Nearly half (42%) of the children experienced four or more ACEs. Internalising symptoms and externalising problems were significantly higher than the UK general population. The number of ACEs was associated with internalising symptoms 3 years post-adoptive placement but this relationship was moderated by adoptive parental warmth. This study profiles the experiences and characteristics of a national sample of adopted children and highlights the potential importance of parent warmth as a factor that ameliorates the impact of ACEs on poor child outcomes.

Bariatric surgery leads to clinically significant weight loss and improvements in cardiometabolic risk factors (1–3). However, population-based evidence evaluating the degree of improvements in cardiometabolic outcomes among those receiving bariatric surgery is limited. Using the National Health and Nutrition Examination Survey (NHANES) 2015–2018, we examined cardiometabolic risk factors among individuals who had undergone bariatric surgery, those eligible for but not receiving bariatric surgery, and normal-weight adults. This study included adults aged ≥18 years who responded to bariatric surgery questions during the NHANES 2015–2018 cycles. The NHANES uses a stratified multistage probability method to sample the nationally representative U.S. population (https://www.cdc.gov/nchs/nhanes/index.htm). We analyzed six cardiometabolic measures—systolic blood pressure (SBP), diastolic blood pressure (DBP), hemoglobin A1c (HbA1c), total cholesterol (TC), HDL cholesterol (HDL-C), and hs-CRP—measured in a mobile examination center. We used survey design–adjusted descriptive statistics to characterize the study population into three groups: 1 ) individuals with normal weight (BMI 18.5–24.9 kg/m2), 2 ) individuals reporting receipt of bariatric surgery, and 3 ) individuals medically eligible for bariatric surgery but reporting they had not received it. Surgery eligibility criteria include BMI ≥40 kg/m2 or …

Background There are racial/ethnic disparities in colorectal cancer (CRC) screening, including lower uptake rates among Hispanic Americans (HAs) and Asian Americans (AAs) relative to non-Hispanic white Americans. The objective of this study was to explore pathways associated with the use of health services and to characterize multifaceted associations with the uptake of CRC screening among HAs and AAs. Methods Data were obtained from the Medical Expenditure Panel Survey (2012-2013). Participants included HA (n = 3731) and AA (n = 1345) respondents ages 50 to 75 years who met CRC screening recommendations. A modified Andersen behavioral model was used to examine pathways that lead to CRC screening uptake, including predisposing characteristics (education, economic, and cultural factors), health insurance, health needs (perceived health status and several comorbidities), and health provider contextual factors (access to care, perceived quality of health services, and distrust in health care). Structural equation modeling was used to examine the models for HAs and AAs. Results In the HA model, cultural factors (standardized regression coefficient [β] = -0.04; P = .013) and distrust in health care (β = -0.05; P = .007) directly and negatively affected CRC screening. Similarly, cultural factors (β = -0.11; P = .002) negatively affected CRC screening in the AA model, but distrust in health care was not significant (P = .103). In both models, perceived quality of health services was positively associated with CRC screening uptake and mediated the negative association between cultural factors and CRC screening. Access to care was not associated with CRC screening. Conclusions Correlations between CRC screening and associated factors differ among HAs and AAs, suggesting a need for multilevel interventions tailored to race/ethnicity. The current findings suggest that facilitating access to care without improving perceived quality of health services may be ineffective for increasing the uptake of CRC screening among HAs and AAs. Cancer 2018;124:335-45. © 2017 American Cancer Society.

Summary While the inverse association between socioeconomic status (SES) and obesity in high gross domestic product countries is well established using observational data, the extent to which the association is due to a true causal effect of SES and, if so, the mechanisms of this effect remain incompletely known. To assess the influence of social status on obesity via energy intake, we randomized individuals to a higher or lower social status and observed subsequent energy intake. College students between the ages of 18 and 25 were randomized to social status and were operationalized as being a leader or follower in a partner activity as purportedly determined by a (bogus) test of leadership ability. Investigators were blinded to treatment assignment. Immediately after being told their leadership assignment, paired participants were provided with platters of food. Energy intake was objectively measured in kilocalories (kcal) consumed, and paired t-tests were used to test for significant differences in intake between leaders and followers. A total of 60 participants were included in the final analysis (males = 28, females = 32). Overall, no difference in energy intake was observed between leaders and followers, consuming an average of 575.3 and 579.8 kcal, respectively (diff = 4.5 kcal, P = 0.94). The null hypothesis of no effect of social status, operationalized as assignment to a leadership position in a small-group activity, on energy intake was not rejected.

The study aimed to assess for an association between the degree of severity of the metabolic syndrome and risk of type 2 diabetes beyond that conferred by the individual components of the metabolic syndrome.We assessed HRs for an Adult Treatment Panel III (ATP-III) metabolic syndrome score (ATP-III MetS) and a sex- and race-specific continuous metabolic syndrome severity z score related to incident diabetes over a median of 7.8 years of follow-up among participants of two observational cohorts, the Atherosclerosis Risk in Communities study (n = 10,957) and the Jackson Heart Study (n = 2137).The ATP-III MetS had an HR for incident diabetes of 4.36 (95% CI 3.83, 4.97), which was attenuated in models that included the individual metabolic syndrome components. By contrast, participants in the fourth quartile of metabolic syndrome severity (compared with the first quartile) had an HR of 17.4 (95% CI 12.6, 24.1) for future diabetes; in models that also included the individual metabolic syndrome components, this remained significant, with an HR of 3.69 (95% CI 2.42, 5.64). There was a race × metabolic syndrome interaction in these models such that HR was greater for black participants (5.30) than white participants (2.24). When the change in metabolic syndrome severity score was included in the hazard models, this conferred a further association, with changes in metabolic syndrome severity score of ≥0.5 having a HR of 2.66 compared with changes in metabolic syndrome severity score of ≤0.Use of a continuous sex- and race-specific metabolic syndrome severity z score provided an additional prediction of risk of diabetes beyond that of the individual metabolic syndrome components, suggesting an added risk conferred by the processes underlying the metabolic syndrome. Increases in this score over time were associated with further risk, supporting the potential clinical utility of following metabolic syndrome severity over time.

OBJECTIVES: Intake of n-3 polyunsaturated fatty acids (PUFAs) has been reported to provide various benefits for patients with metabolic syndrome (MetS), such as reducing blood pressure and improving blood lipids, but results are inconsistent. This study aimed to investigate the effect of n-3 PUFA intake on components of MetS. METHODS: We searched PubMed, Scopus, Web of Sciences, and Cochrane databases up to June 2018 for randomized trials at least 30 days long comparing n-3 PUFAs with a control in patients diagnosed with MetS (PROSPERO registration ID: CRD42017072332). The outcomes include body mass index, systolic and diastolic blood pressure, triglyceride, high-density lipoprotein cholesterol, and fasting blood glucose. Mean differences post-intervention or mean change from baseline were combined using random-effects models; confirmation of within-study effect sizes is ongoing. RESULTS: A total of 14 trials were identified. The pooled results showed n-3 PUFA intake reduced systolic blood pressure by 3.92 mmHg (95%CI: –6.89, –0.96, P-value = 0.009, I2 = 34%, 9 trials) and diastolic blood pressure by 2.81 mmHg (95%CI: –4.26, –1.36, P-value = 0.0001, I2 = 15%, 8 trials). Body mass index was lower in the n-3 PUFA group by 3.19 kg/m2 (95%CI: –6.16, –0.22, P-value = 0.04, I2 = 97%, 7 trials) compared to the control group. Triglyceride levels in n-3 PUFA groups were significantly lower than the control when pooling trials with post intervention data only (–33.13 mg/dL, 95%CI: –49.44, –16.81, P-value

OBJECTIVES: Subjective and objective social status is associated with weight status, but this relationship differs by sex and the mechanisms remain unclear. METHODS: This randomized study in Hispanic adolescents investigated the effects of experimentally manipulated social status on ad libitum acute and 24-hour dietary intakes and stress-related outcomes as potential mechanisms through which social status affects weight. Participants (n = 133; ages 15–21; 60.2% girls; BMI ≥18.5 and ≤40 kg/m(2); 23.4% food insecure) consumed a standardized breakfast and then were randomized to a low (LOW) or high social status position (HIGH) in a rigged game of Monopoly™, in which the rules differed substantially by social status position. Following the game, the participants consumed an ad libitum lunchtime meal. Energy intake was assessed by pre- and post- food weighing. Stress-related markers were measured at baseline, before Monopoly™, after Monopoly™, and after lunch, with the exception of cortisol (measured before and after Monopoly™). RESULTS: There was a significant interaction between sex and experimentally manipulated social status (P = 0.0087), such that girls randomized to LOW consumed significantly more of their daily energy needs at the ad libitum lunchtime meal relative to those randomized to HIGH (37.5% vs. 34.3%, respectively). Individuals with food insecurity consumed a greater % of their daily energy needs at the lunchtime meal than those with food security, although the result was not quite statistically significant (40.7% vs. 36.3%, respectively; P = 0.08). In LOW, participants report decreased feelings of powerfulness following Monopoly™ (P = 0.0006). There were no significant differences between HIGH and LOW following Monopoly™ regarding perceived stress, cortisol, heart rate, or blood pressure. Social status condition was not related to 24-hour % of daily energy needs consumed. CONCLUSIONS: Our data suggest a causal link between experimentally manipulated low social status and increased acute energy intakes among Hispanic girls, potentially influenced by decreased feelings of powerfulness, which is independent of stress. Low social status may play a causal role in the development of obesity by promoting excess calorie consumption. Further research is needed to identify the biobehavioral mechanisms contributing to this phenomenon. FUNDING SOURCES: NIH. SUPPORTING TABLES, IMAGES AND/OR GRAPHS

Subjective social status (SSS), perceived rank in the social ladder, is associated with weight, but determinants of SSS in youth remain unknown. Relationships between youth SSS and income, food insecurity, parent SSS, and BMI change were investigated during an obesity intervention.Data came from a family-centered, community-based obesity intervention for low-income families. Parent and youth SSS were assessed using a validated, age-appropriate SSS scale. Food insecurity and socioeconomic factors were assessed in parents; child and parent weight-related data were measured at baseline and post intervention.Participants included 110 primarily Hispanic (97%) low-income youth and their parents. Food insecurity was reported in 66.4% of families. Youth SSS was positively associated with parent SSS (P = 0.0014). In both parents and children, the association between income and SSS was moderated by food insecurity such that lower income was more strongly associated with lower SSS among food-insecure households (P = 0.0286 and P = 0.0327, respectively). Youth SSS was not associated with youth BMI reduction.Youth SSS was not predictive of weight loss in this intervention. Intriguingly, the association between income and SSS was modified by food insecurity, suggesting that food insecurity shapes the contribution of socioeconomic factors to one's perceived social status.

BACKGROUND: The teach-back method, also known as the “show-me” method, has been endorsed by many medical and health care societies. However, limited investigation has been conducted regarding its association with patient outcomes. OBJECTIVES: To examine the association between patient teach-back experience and the risk of hospitalizations and length of hospital stay among patients with ambulatory care sensitive conditions (ACSCs). DESIGN: A matched cohort study. SETTING: Data from the 2011–2015 Longitudinal Medical Expenditure Panel Survey (panels 16–19). PARTICIPANTS: Three thousand nine hundred ninety-four US adults aged ≥ 18 years with any of 5 ACSCs (hypertension, type 2 diabetes, heart disease, asthma, and chronic obstructive pulmonary disease [COPD]). MEASUREMENTS: Hospital admissions (all-cause or ACSC-related) and the length of stay of the first admission were examined by teach-back during interaction with a health provider. RESULTS: Patients with teach-back experience were less likely to experience hospitalization for an ACSC-related condition (relative risk, 0.85; 95% CI, 0.71 to 0.99) and had a lower risk for a condition-related readmission (hazard ratio, 0.77; 95% CI, 0.60 to 0.99), compared with those without teach-back experience. The median length of hospital stay did not differ between patients with teach-back experience and those without teach-back experience (median 3 days [IQR 1 to 8 days] and median 3 days [IQR 0 to 8 days], respectively; P = 0.84). Subgroup analysis showed that the association of reported teach-back experience on the outcomes was relatively stable among those with hypertension, diabetes, and heart disease, but was not among those with asthma or COPD. LIMITATION: Teach-back exposure relied on patient self-reported information. CONCLUSIONS: Our findings suggest that patient teach-back method is associated with reduced risk of hospitalization for those with ACSCs, especially among patients with cardiovascular diseases and type 2 diabetes. Encouraging providers to utilize the teach-back method at every visit has the potential to further reduce hospitalizations for individuals with ACSCs. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (10.1007/s11606-019-05135-y) contains supplementary material, which is available to authorized users.

Low social status (SS) is a determinant of poor health status and is associated with increased disease burden. Obesity affects 20.6% of American adolescents, most of whom are from low-SS families. Contributors to the development of obesity among adolescents include sedentary behavior and low levels of physical activity. Environmental determinants—infrastructure, policy, and social relationships—influence engagement in physical activity and are affected by SS. Significant declines in physical activity have been documented during adolescence, and adolescents of low SS engage in significantly less physical activity per week than those with high SS. This article briefly reviews the literature on the relationship between SS and physical activity in adolescents and introduces a proposed biological mechanism that may explain that relationship. Characterizing the effects that SS can have on physical activity may help tailor clinical interventions and public health campaigns seeking to improve adolescent physical activity and weight management, thus increasing their effectiveness. This may be particularly beneficial for underserved populations.

Background The COVID-19 pandemic has had a widespread impact on attendance in biomedical research and health care visits. Objective This study aimed to identify when and how American adults might feel comfortable about resuming in-person research and health care visits. Methods Cross-sectional questionnaire data were collected from 135 adults (age: median 48 years; women: n=113, 83.7%; White participants: n=92, 68.2%) who were engaged in health-related research. Results More than half of the respondents (65/122, 53.3%) felt that the COVID-19 pandemic positively affected their desire to participate in research. Although 73.6% (95/129) of respondents also indicated a willingness to attend in-person health care visits while Centers for Disease Control and Prevention (CDC) guidelines are implemented, 85.8% (109/127) indicated a willingness to attend in-person, outdoor visits, and 92.2% (118/128) reported a willingness to attend drive-through visits (with CDC guidelines implemented during both visit types). Videoconferencing was the most preferred format for intervention visits; however, adults over the age of 65 years preferred this format less than younger adults (P=.001). Conclusions Researchers and clinicians should continue to provide opportunities for continuing the conduction of remote-based interventions while enforcing CDC guidelines during in-person visits.

OBJECTIVES: This study assessed the feasibility and acceptability of an ABT healthy lifestyle intervention among diverse adolescent cisgender girls with overweight/obesity (OW/OB). METHODS: Adolescent cisgender girls ages 14 to 19 with a BMI ≥ 85(th) percentile-for-sex-and-age were recruited for participation in a single-arm feasibility study. The primary outcomes were recruitment and retention while the secondary outcome was change in BMI Z-score over the 6-month intervention. Exploratory outcomes included obesity-related factors, health-related behaviors, and psychological factors. RESULTS: Recruitment goals were achieved; thirteen adolescents (>60% racial/ethnic minorities) participated in the intervention, and eleven completed the intervention (85% retention). In completers (n = 11), a mean decrease in BMI Z-score of −0.15 (SD = 0.34, Cohen's d = −0.44) was observed. Improvements were also noted for change in percentage of 95(th) percentile (d = −0.35), % body fat (d = −0.35), quality of life (d = 0.71), psychological flexibility (d = −0.86), and depression (d = −0.86). CONCLUSIONS: These preliminary findings suggest an ABT healthy lifestyle intervention tailored for adolescent cisgender girls with OW/OB may be an acceptable treatment that could lead to improvements in BMI Z-score, obesity-related measures, and psychological outcomes. FUNDING SOURCES: This work is supported by the National Center for Advancing Translational Sciences of the National Institutes of Health (NIH; UL1TR001427) and WellCare Health Plans, Inc. Dr. Cardel is also supported by the National Institutes of Health National Heart, Lung, and Blood Institute (K01HL141535 and R25HL126146).

Pediatric obesity, a significant public health concern, has been associated with adult premature mortality and the development of type 2 diabetes and cardiovascular disease. Evidence has suggested that the gut microbiota is associated with pediatric obesity. Establishment of the infant gut microbiome is dependent on a dynamic maternal-infant microbiota exchange during early life. The objective of this review is to describe maternal factors such as feeding practices and antibiotic use that may influence the infant gut microbiome and risk for obesity. The complex components in human milk have many nutritional benefits to the infant; however, the microbiome in human milk may be an important factor to help regulate the infant's weight. We discuss maternal antibiotics and the effects on breast milk as critical exposures that alter the infant's gut microbiome and influence the risk of pediatric obesity.

Objective To systematically assess the quality of online information related to weight loss that Spanish speakers in the U.S. are likely to access. Methods This study evaluated the accessibility and quality of information for websites that were identified from weight loss queries in Spanish and compared this with previously published results in English. The content was scored with respect to five dimensions: nutrition, physical activity, behavior, pharmacotherapy, and surgical recommendations. Results Sixty-six websites met eligibility criteria (21 commercial, 24 news/media, 10 blogs, 0 medical/government/university, 11 unclassified sites). Of 16 possible points, mean content quality score was 3.4 (SD = 2.0). Approximately 1.5% of sites scored greater than 8 (out of 12) on nutrition, physical activity, and behavior. Unsubstantiated claims were made on 94% of the websites. Content quality scores varied significantly by type of website (P

A retrospective study of kids’ meals purchased at Walt Disney World was conducted to determine acceptance rates for healthy sides and beverages. Purchase data from all 145 Walt Disney World restaurants were analyzed using a log-linear model and a Poisson regression. Across all restaurants, 47.9% and 66.3% of guests accepted healthy default sides and beverages, respectively. Acceptance rates of sides and beverages were higher at quick-service restaurants (49.4% and 67.8%, respectively) compared to table-service restaurants (40.3% and 45.6%, respectively). The healthy defaults reduced calories (21.4%), fat (43.9%), and sodium (43.4%) for kids’ meal sides and beverages. This study contributes by examining the use of kids’ meal healthy defaults in quick-service and table-service restaurant formats at the world’s largest theme park, a previously unstudied setting, and by providing the largest ever healthy default data set. The results suggest that healthy defaults can shift food and beverage selection patterns toward healthier options.

Background. This study identifies Southeast Asian refugee parents’ and grandparents’ perceptions of the risk and protective factors for childhood obesity. Methods. We used a mixed methods approach (concept mapping) for data collection and analyses. Fifty-nine participants engaged in modified nominal group meetings where they generated statements about children’s weight status and structuring meetings where they sorted statements into piles based on similarity and rated statements on relative importance. Concept Systems ® software generated clusters of ideas, cluster ratings, and pattern matches. Results. Eleven clusters emerged. Participants rated “Healthy Food Changes Made within the School” and “Parent-related Physical Activity Factors” as most important, whereas “Neighborhood Built Features” was rated as the least important. Cambodian and Hmong participants agreed the most on cluster ratings of relative importance (r = 0.62). Conclusion. The study findings may be used to inform the development of culturally appropriate obesity prevention interventions for Southeast Asian refugee communities.

Purpose: Rural cancer survivors report poorer health-related quality of life (QOL) than those residing in urban areas and have been disproportionately impacted by COVID-19. This study explored associations between the perceived threat of COVID-19 and psychosocial distress due to COVID-19 on health-related QOL in rural cancer survivors residing in central Pennsylvania. Method: Previous participants (n=195) in the Partnering to Prevent and Control Cancer (PPCC) study who had a working email address were sent an email invitation to complete an online questionnaire. Of the 195 cancer survivors contacted, 90 (46.2%) have responded to the email invitation and completed the questionnaire to date. The questionnaire assessed sociodemographics, perceived threat of COVID-19, psychosocial distress related to COVID-19, and QOL (physical and social functioning, role limitations due to physical health and emotional problems, fatigue, emotional well-being, pain, and general health). Linear regression models were used to explore associations between COVID-19 perceived threat and psychosocial distress and QOL; all models were adjusted for age, body mass index (BMI), and education. Results: Rural cancer survivors who completed the online questionnaire were mostly women (70%), non-Hispanic white (97.8%), in their 60s (M age=60.4±13.9 years), with overweight (M BMI=29.0±7.6 kg/m2), and college graduates (67.8%). Most participants were breast (37.8%) or prostate (23.3%) cancer survivors, not currently receiving treatment (93.3%), and were more than 12 weeks but less than 5 years post-treatment (93.7%). Nearly half (41.1%) of participants rated their health as excellent or very good, and 17.8% rated their health as fair or poor. Generally, participants felt that COVID-19 was a threat to them, their city, school, community, or household (M score=17.2±3.4, scale: 5-20), but did not feel anxious, worried, or depressed due to the COVID-19 outbreak (M score=6.8±3.1, scale: 5-20). Although perceived threat was not associated with QOL, psychosocial distress related to COVID-19 was significantly associated with role limitations due to emotional problems (B=-3.958, SE=.993, p Conclusions: Although the perceived threat of COVID-19 was low among rural cancer survivors, participants reported elevated psychosocial distress related to COVID-19, which negatively impacted their mental but not physical health. These findings highlight the potential of the COVID-19 outbreak to exacerbate the persistent long-term adverse effects of cancer treatment on health-related QOL among rural cancer survivors. Psychosocial and behavioral interventions are critically needed to reduce COVID-19-related psychosocial distress among rural cancer survivors and to improve QOL and promote health equity among this vulnerable, underserved population. Citation Format: Scherezade K. Mama, Michelle Cardel, Kathryn H. Schmitz. Impact of COVID-19-related psychosocial distress on health-related quality of life in rural cancer survivors [abstract]. In: Proceedings of the AACR Virtual Meeting: COVID-19 and Cancer; 2020 Jul 20-22. Philadelphia (PA): AACR; Clin Cancer Res 2020;26(18_Suppl):Abstract nr S07-04.

Importance Obesity in adolescence has reached epidemic proportions around the world, with the prevalence of severe obesity increasing at least 4-fold over the last 35 years. Most youths with obesity carry their excess adiposity into adulthood, which places them at increased risk for developing obesity-driven complications, such as type 2 diabetes and cardiovascular disease, and negatively affects social and emotional health. Given that adolescence is a unique transition period marked by significant physiologic and developmental changes, obesity-related complications can also negatively affect adolescent growth and developmental trajectories. Observations Provision of evidence-based treatment options that are tailored and appropriate for the adolescent population is paramount, yet complex. The multifactorial etiology of obesity along with the significant changes that occur during the adolescent period increasingly complicate the treatment approach for adolescent obesity. Treatment practices discussed in this review include an overview of evidence supporting currently available behavioral, pharmacologic, surgical, and device interventions for obesity. However, it is important to note that these practices have not been effective at reducing adolescent obesity at the population level. Conclusions and relevance Because adolescent obesity requires lifelong treatment, effectively addressing this disease will require significant resources, scientific rigor, and the provision of access to quality care similar to other chronic health conditions. Effective and less invasive therapies, effective adjuncts, and comprehensive centers that offer specialized treatment are critical. This considerable need for increased attention to obesity care calls for dedicated resources in both education and research for treatment of obesity in youths.

OBJECTIVES: Obesity in adolescence has reached epidemic proportions around the world, with the prevalence of severe obesity increasing at least four-fold over the last 35 years. Provision of evidence-based treatment options that are tailored and relevant to the needs of adolescents is paramount, yet difficult to tailor because little is known regarding barriers and facilitators to adolescent weight loss. Thus, identification of barriers and facilitators to weight loss among adolescents with overweight/obesity (OW/OB) is needed. The objective of this qualitative study was to assess perceived barriers and facilitators to a healthy lifestyle and weight loss among adolescents with OW/OB. METHODS: Using 2018–2019 data from eleven focus groups among adolescents aged 14–19 with OW/OB (n = 41; n = 11 boys and n = 30 girls), a moderated, semi-structured focus group guide was used to identify perceived barriers and facilitators to a healthy lifestyle and weight loss. RESULTS: Adolescents reported time, access to healthful foods, food cravings, stress, and weight stigma/shaming as barriers to weight loss. Themes around internal and external psychosocial states (support, motivation) and behaviors including modeling, sports, and other physical activities were identified as both barriers and facilitators. Parents were recognized by teens as both helping and hindering weight loss, but overall teens felt their parents were more so facilitators than barriers, particularly as it related to modeling behaviors. Differences were noted by sex, among which girls reported experiencing weight struggles, whereas boys generally stated they did not struggle with weight, despite all participants meeting criterion for OW/OB. CONCLUSIONS: Adolescent boys and girls with OW/OB perceive their weight status differently and identify a variety of barriers and facilitators to a healthy lifestyle and weight loss. Tailoring adolescent weight management interventions to address these perceived barriers and facilitators, along with noted sex differences, has the potential to improve the quality and effectiveness of adolescent obesity interventions. FUNDING SOURCES: National Heart, Lung, and Blood Institute, National Institute of Health, WellCare Health Plans.

Eating behaviors, including unhealthy snacking or excessive snacking leading to excess calorie consumption, may contribute to obesity among adolescents. Socioeconomic status (SES) also significantly influences eating behaviors, and low SES is associated with increased risk for obesity. However, little is known regarding the relationship between snacking behavior and SES among adolescents and how this may contribute to obesity-related outcomes. The primary objective of this scoping review was to review the literature to assess and characterize the relationship between SES and snacking in adolescents. The secondary objective was to assess weight-related outcomes and their relation to snacking habits. Included articles were published between January 2000 and May 2019; written in English, Portuguese, or Spanish; and focused on adolescents (13–17 years). In total, 14 bibliographic databases were searched, and seven studies met the inclusion criteria. Preliminary evidence from the seven included studies suggests a weak but potential link between SES and snacking. Additionally, these dietary patterns seemed to differ by sex and income type of country. Finally, only three of the included studies addressed weight-related outcomes, but the overall available evidence suggests that snacking does not significantly affect weight-related outcomes. Due to the small number of included studies, results should be interpreted with caution.

SUMMARY: BACKGROUND: In adults, the Taq1a polymorphism (rs1800497) near the D2 receptor (DRD2) gene is associated with body mass index and binge eating and is more prevalent among non-Hispanic Blacks (NHB) and Hispanic-Americans (HA) relative to non-Hispanic Whites (NHW). We hypothesize Taq1a polymorphism (rs1800497) risk alleles contribute to paediatric racial/ethnic differences in obesity phenotypes. OBJECTIVES: This study aims to characterize the relationship between the Taq1a polymorphism (rs1800497), diet and adiposity in a multi-ethnic cohort of 286 children (98 NHB, 76 HA and 112 NHW), ages 7–12. METHODS: Dual-energy X-ray absorptiometry, computed tomography scans and two 24-h dietary recalls assessed body composition, fat distribution and dietary intakes, respectively. RESULTS: Children with two Taq1a risk alleles (NHB = 50.0%, HA = 43.3%, NHW = 6.7%) reported a 20% increase in total energy intake (P = 0.0034) and percent of calories from sugar consumed (P = 0.0077) than did children with less than two risk alleles. Children with two Taq1a risk alleles demonstrated significantly higher total body fat (P = 0.0145), body fat percentage (P = 0.0377), intra-abdominal adiposity (P = 0.0459), subcutaneous abdominal adiposity (P = 0.0213) and total abdominal adiposity (P = 0.0209) than did children with one or no Taq1a risk alleles. CONCLUSIONS: Our results suggest that having two Taq1a risk alleles is associated with an increase in reported calorie and sugar consumption and is a potential risk factor for early development of excess adiposity in multi-ethnic children. These results need to be confirmed in a larger sample.

Objectives Subjective social status (SSS) is known to be inversely associated with obesity. Our objective was to determine if SSS is associated with eating behaviors that would predispose to weight gain, specifically, with inadequate compensation for excess energy consumed during a single large meal. Therefore, we conducted a pilot study to determine the association of SSS with 24-h energy balance, 24-h and post-lunch energy intake, changes in body composition and changes in adjusted resting energy expenditure on days when a high-energy lunch was consumed in free-living human subjects. Method Female participants (7 normal weight and 10 overweight) consumed 60% of’ estimated 24-h energy requirements as a lunchtime meal in the laboratory for 14 days. Subjective social status was measured at baseline using the MacArthur Scale. Remote Food Photography Method was used to record food intake outside of the lab on days 1–2, 7–8, and 12–13. Associations of 24-h energy balance, 24-h and post-lunch energy intake, changes in adjusted resting energy expenditure and changes in percent body fat (measured by dual x-ray absorptiometry) with SSS were studied. Results Mean (standard deviation) age and BMI were 36.29 (8.25) years and 26.43 (2.32) kg/m2, respectively. Lower SSS was significantly associated with positive energy balance (p for trend 0.002), and higher post-lunch energy intake (p = 0.02) when controlled for age and initial body mass index. Conclusions Our pilot data show that lower SSS is associated with higher post-lunch energy intake, which is indicative of poor energy compensation following a large meal. Over a longer time period, this could result in fat mass gain. Studies that are of longer duration and well-powered are warranted to confirm our findings.

Background We examined whether neighborhood-, friend-, and family- norms and social support for consumption and purchase of fruits and vegetables (F&V) were associated with F&V intake among low-income residents in subsidized housing communities. We examined baseline data from a study ancillary to the Live Well/Viva Bien intervention. Participants included 290 residents in four low-income subsidized housing sites who were ≥ 18 years of age, English and/or Spanish speaking, and without medical conditions that prevented consumption of F&V. Methods Linear regression models examined associations of norms and social support with F&V intake after adjustments for sociodemographic characteristics. Results In the analysis, neighborhood social support for F&V was associated with a 0.31 cup increase in F&V intake (95% CI = 0.05, 0.57). The family norm for eating F&V and family social support for eating F&V were associated with a 0.32 cup (95% CI = 0.13, 0.52) and 0.42 cup (95% CI = 0.19, 0.64) increase in F&V intake, respectively. Conclusions To our knowledge, no other studies have examined neighborhood, family, and peer norms and social support simultaneously and in relation to F&V intake. These findings may inform neighborhood interventions and community-level policies to reduce neighborhood disparities in F&V consumption.

Objective To evaluate the effects of water versus beverages sweetened with non-nutritive sweeteners (NNS) on body weight in subjects enrolled in a year-long behavioral weight loss treatment program. Methods The study used a randomized equivalence design with NNS or water beverages as the main factor in a trial among 303 weight-stable people with overweight and obesity. All participants participated in a weight loss program plus assignment to consume 24 ounces (710 ml) of water or NNS beverages daily for 1 year. Results NNS and water treatments were non-equivalent, with NNS treatment showing greater weight loss at the end of 1 year. At 1 year subjects receiving water had maintained a 2.45 ± 5.59 kg weight loss while those receiving NNS beverages maintained a loss of 6.21 ± 7.65 kg (P < 0.001 for difference). Conclusions Water and NNS beverages were not equivalent for weight loss and maintenance during a 1-year behavioral treatment program. NNS beverages were superior for weight loss and weight maintenance in a population consisting of regular users of NNS beverages who either maintained or discontinued consumption of these beverages and consumed water during a structured weight loss program. These results suggest that NNS beverages can be an effective tool for weight loss and maintenance within the context of a weight management program.

Little is known about how the intensity of aerobic training influences appetite-regulating hormones in obese adolescents. Our goal was to assess the effect of low and high intensity aerobic trainings on food intake and appetite-regulating hormones in obese adolescents. Forty three obese adolescents (age: 13–18y, BMI: 34.48 ± 3.94 kg/m2) were randomized into high intensity training (HIT; n = 20) or low intensity training (LIT; n = 23) groups for 12 weeks. All participants also received the same nutritional, psychological and clinical counseling. Pre- and postintervention energy intake (EI) and circulating levels of insulin, leptin, peptide YY3–36 (PYY3–36) and ghrelin were measured. Adolescents in the HIT showed a reduction in total EI and an increase in PYY3–36 (p < .05). Aerobic exercise training performed at ventilatory threshold 1 intensity, reduced EI and augmented PYY3–36 in obese adolescents, compared with LIT. The data suggest that HIT and LIT have differential effects in the regulation of appetite signals and subsequent EI in obese adolescents.