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Obesity and type 2 diabetes disproportionately impact U.S. racial and ethnic minority communities and low-income populations. Improvements in implementing efficacious interventions to reduce the incidence of type 2 diabetes are underway (i.e., the National Diabetes Prevention Program), but challenges in effectively scaling-up successful interventions and reaching at-risk populations remain. In October 2017, the National Institutes of Health convened a workshop to understand how to (1) address socioeconomic and other environmental conditions that perpetuate disparities in the burden of obesity and type 2 diabetes; (2) design effective prevention and treatment strategies that are accessible, feasible, culturally relevant, and acceptable to diverse population groups; and (3) achieve sustainable health improvement approaches in communities with the greatest burden of these diseases. Common features of guiding frameworks to understand and address disparities and promote health equity were described. Promising research directions were identified in numerous areas, including study design, methodology, and core metrics; program implementation and scalability; the integration of medical care and social services; strategies to enhance patient empowerment; and understanding and addressing the impact of psychosocial stress on disease onset and progression in addition to factors that support resiliency and health.

Background: The prevalence of obesity among children continues to rise. Individual-focused health education efforts have been minimally successful in producing the necessary changes to curb this epidemic. Purpose: The purpose of this study was to examine the relationships between neighborhood characteristics, grocery store availability and accessibility, and parent-reported fruit and vegetable intake and/or weight status. Methods: Data was collected from 797 preadolescent children (ages 6-11) participating in an obesity prevention study. Individual-level variables were daily fruit and vegetable intake and body mass index. Social and physical environment variables included percent of poverty within neighborhoods (census tracts) and mapped grocery store locations. Bivariate analyses were performed to explore relationships. Results: Most (78%) children (mean age=8.1) failed to meet fruit and vegetable recommendations, and 37% were overweight. Nearly 50% of high poverty neighborhoods had no grocery stores within their boundaries. Children in high poverty neighborhoods consumed fewer servings of fruits and vegetables (t = 4.03, p less than 0.001) than children in low poverty neighborhoods. Discussion: This study demonstrates some associations between neighborhood characteristics, grocery store availability, and child fruit and vegetable intake. Translation to Health Education Practice: Health educators should consider how the social and physical environment may hinder positive health behaviors. (Contains 1 figure and 3 tables.)

Objective: There is a broad array of health equity policy actions that may be important for addressing social determinants of obesity. The objective of this study was to identify local policy actions most salient for addressing health equity among practitioners, policymakers, and researchers active in obesity. Methods: We surveyed 195 participants in August-November 2020, including US public health practitioners, local policymakers, and researchers active in obesity policy or health equity. We asked them to select the most important health equity policy actions and rate them for potential impact and feasibility. Results: Living wage and access to early education scored highly across 3 dimensions of importance, potential impact, and feasibility among 3 of the 4 groups -- local public service employees and policymakers, academics, and others. Local public service employees and policymakers also rated expanded childcare and job/skills training programs highly across all 3 dimensions. Respondents rated policy actions higher for potential impact than feasibility. Conclusions: We present novel, timely findings for prioritizing health equity policy actions for addressing obesity at the local level. Several policy actions not typically considered in obesity research were identified as salient by groups relevant to local obesity policymaking. [ABSTRACT FROM AUTHOR]

Objective: Obesity increases the risk for pregnancy complications and maternal hyperglycemia. The Institute of Medicine developed guidelines for gestational weight gain (GWG) targets for women with overweight/obesity, but it is unclear whether exceeding these targets has adverse effects on maternal glucose metabolism.Methods: Insulin sensitivity (assessed using the Matsuda Insulin Sensitivity Index), β-cell function (assessed as insulin secretion rate in relation to plasma glucose), and plasma insulin clearance rate were evaluated using a frequently sampled oral glucose tolerance test at 15 and 35 weeks of gestation in 184 socioeconomically disadvantaged African American women with overweight/obesity.Results: Insulin sensitivity decreased, whereas β-cell function and insulin clearance increased from 15 to 35 weeks of gestation in the entire group. Compared with women who achieved the recommended GWG, excessive GWG was associated with a greater decrease in insulin sensitivity between 15 and 35 weeks. β-cell function and plasma insulin clearance were not affected by excessive GWG.Conclusions: These data demonstrate that gaining more weight during pregnancy than recommended by the Institute of Medicine is associated with functional effects on glucose metabolism. [ABSTRACT FROM AUTHOR]

Background: Given sparse knowledge on dissemination, this study sought to explore key benefits, barriers and contextual factors that are perceived to be important to the adoption and implementation of the "Community Guide's" evidence-based physical activity recommendations. Design: We conducted case studies in two states where extensive adoption and implementation of the Guide's recommendations have occurred and in two states where widespread dissemination has lagged. Interviews (n = 76) were semi-structured and included both quantitative and qualitative methods. Participant perceptions from the following areas were examined: (i) priority of physical activity, (ii) awareness of and ability to define the term "evidence-based approaches" and (iii) awareness, adoption, facilitators, benefits, challenges and barriers to Guide adoption. Results: Key enabling factors among high capacity states included: funds and direction from the Centers for Disease Control and Prevention; leadership support; capable staff; and successful partnerships and collaborations. Restraining forces among low capacity states included: the Guide recommendations being too new; participants being too new to current job; lack of time and training on how to use the Guide recommendations; limited funds and other resources and lack of leadership. Conclusion: To be effective, we must gain an understanding of contextual factors when designing for dissemination.

Objective: To describe the frequency of inappropriate feeding practices used by parents of preschoolers and the impact on a child's preference for and intake of fruits and vegetables (FV). Design: Cross-sectional analysis of baseline data from a telephone interview. Setting: A community-based program in rural southeastern Missouri. Participants: 1555 rural parents participating in the High 5 for Kids project. The mean age of parents was 28.9 years, the mean age for children was 38.0 months, and 52.1% of children were male. Variables Measured: Demographic characteristics; intake and preferences for FV; inappropriate child feeding practices. Analysis: Inappropriate feeding practices, preferences for and intake of FV were examined using Kruskal-Wallis tests and Spearman's correlations. Logistic regression was used to assess the relationships between FV intake and preference and inappropriate feeding practices. Results: An increasing number of inappropriate feeding practices negatively impacted FV preference of children but positively impacted FV intake. Conclusions and Implications: This study documents the public health need to develop programs that guide and advise rural parents on information about how children develop patterns of intake, and how to foster children's preferences and acceptance of healthful food.

Objective: To identify regional, organizational, and personal characteristics that predict awareness and adoption of a dietary curriculum training and CD among educators. Methods: A cross-sectional study of educators (n=675) representing 48 states report program awareness and factors that influenced adoption. Results: Among those surveyed, 354 educators were aware (52%) of the CD and 192 educators adopted it (54%). Adopters were nearly 8 times more likely to identify training time and nearly 7 times more likely to identify CD training method as influencing adoption. Conclusion: Although regional and organizational characteristics are predictors of awareness, these variables were less likely to predict adoption of such programs.