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Objective To evaluate whether food planning behaviors mediate the relationship between a reported weight loss attempt and the home food environment (HFE). Design Secondary data analysis of 4 home visits, included collecting an objective home food inventory of the HFE and self-reported food planning behaviors. Participants There were 196 participants (mean age, 44.4 years; 83.7% female). Main Outcome Measures The percentage of obesogenic foods and fruits and vegetables (FV). Analysis Four regression analyses to test mediation. Results Meal planning and grocery list use did not explain the relationship between a weight loss attempt and obesogenic foods or FV in the home (P > 0.05). Post hoc analyses that examined participants with a body mass index of >25, >28, and >30 found that a weight loss attempt was associated with fewer obesogenic foods. In contrast, mediation analyses with planning behaviors and associations with FV in the home were nonsignificant (P > 0.05). Conclusions and Implications Obesity was more indicative of the HFE than making a weight loss attempt. A weight loss attempt was not associated with food planning behaviors, which may be used for multiple reasons, including organization and time management. Future studies should evaluate individual differences in strategies to create a healthy HFE in the context of a weight loss attempt.

Background Low balance confidence is a prevalent yet overlooked issue among people who use lower limb prostheses (LLP) that can diminish community integration and quality of life. There is a critical need to develop rehabilitation programs that specifically target balance confidence in people who use LLP. Previous research has shown that multicomponent interventions including cognitive-behavioral therapy (CBT) techniques and exercise are feasible and effective for improving balance confidence in older adults. Therefore, a cognitive behavioral–physical therapy (CBPT) intervention was developed to target balance confidence and increase community integration in people who use LLP. Methods/design This randomized control trial will recruit 60 people who use LLP with low balance confidence. Participants will be randomized to the CBPT intervention condition or control condition. Discussion The trial is designed to test the effects of the CBPT intervention on balance confidence and functional mobility in lower limb prosthesis users by examining self-reported and objective measures of community integration and quality of life. The trial will also examine the relationship between changes in balance confidence and changes in community integration following participation in CBPT intervention. Additionally, through participant feedback, researchers will identify opportunities to improve intervention efficacy. Trial registration ClinicalTrials.gov, NCT03411148. Registration date: January 26, 2018.

Objectives Active fantasy sports is a type of active video game (AVG) developed using principles from self-determination theory and the trans-contextual motivation model. The game leverages elements of a popular, previously sedentary game -- traditional fantasy sports -- but incorporates and encourages physical activity (PA) of participants ("fantasy team owners"). Early proof-of-concept stage research demonstrated potential for active fantasy sports to increase PA in adults ( Moller et al., 2014 ). However, more formative research identifying factors that influence enjoyment of active fantasy sports and PA goal achievement could improve efficacy and inform the development of alternative AVGs. Design Three active fantasy sports leagues were organized and data from the three leagues were combined to examine intervention and social factors that predicted enjoyment and PA goal achievement. Method Participants (N = 33, 15.2% female, M-Age = 34.0 years) wore an accelerometer to track PA and completed self-report measures about their experience upon league conclusion (league duration ranged from 16 to 17 weeks). Results Findings revealed that average steps significantly increased during the first six weeks of the intervention and then significantly decreased during subsequent weeks. Frequency of checking the league website was associated with greater PA goal achievement. Greater frequency of checking the accelerometer website and the league website were also associated with greater league enjoyment. Conclusions Promoting greater frequency of using the league and accelerometer websites is important to achieving greater impact on PA and league enjoyment through active fantasy sports. Future studies of active fantasy sports leagues could use randomized controlled trial and multiphase optimization strategy designs to vary game components in order to test which components sustain intrinsic motivation and increase PA. Lessons may be further applied to the development of other AVGs, especially those that build on established and popular sedentary video games.

Background: Among adults with diabetes, 19-34% will develop a diabetic foot ulcer (DFU), which increases amputation risk and health care costs, and worsens quality of life. Regular physical activity, when increased gradually, may help prevent DFUs. In this mixed-methods study, we examined the feasibility of a low-intensity, technology-based behavioral intervention to increase activity in adults at risk for DFUs. Method: Participants at risk for a DFU (n = 12; 66% female; mean age = 59.9 years) received four in-person exercise and behavioral counseling sessions over 2-3 weeks, supplemented with use of an activity monitor (to track steps) and text messages (to reinforce behavioral strategies) for an added 8 weeks. Pre- and postintervention assessments of accelerometer measured activity, daily mobility, and glycemic control (A1C) were completed. Treatment acceptability was assessed by questionnaire and via key informant interview. Results: The program appears feasible since all but one participant attended all four sessions, all used the activity monitor and all responded to text messages. Treatment acceptability (scale: 1 = very dissatisfied, 5 = extremely satisfied) was high; average item ratings were 4.79 (SD = 0.24). Participants increased their steps by an average of 881.89 steps/day ( d = 0.66). A1C decreased on average by 0.33% ( d = 0.23). Daily mobility did not change. Interview results suggest that participants perceived benefits from the intervention. Participant recommended improvements included providing more physical activity information, addressing pain, and intervention delivery in a podiatry clinic. Conclusion: Individuals at risk for a DFU might benefit from a minimally intensive, technology-based intervention to increase their physical activity. Future research comparing the intervention to usual care is warranted.

Most obesity prevalence data rely on self-report, which typically differs when compared to objectively measured height, weight, and body mass index (BMI). Given that Latino men have high rates of obesity in the United States and demonstrate greater misreporting compared to Caucasian men, examining the factors that contribute to misreporting among Latino men is warranted. This study examined BMI, Latino ethnic background (Mexican or Puerto Rican), and social desirability in relation to misreporting of BMI, as defined as the discrepancy between self-reported and measured height and weight, in Latino men. Participants were 203 adult Mexican and Puerto Rican men, average age 39.41 years, who participated in a larger study. Participants self-reported their weight and height, had their weight and height objectively measured, and completed a measure of social desirability. Measured BMI was the strongest predictor of misreporting BMI, such that the greater the participants’ BMI, the greater the discrepancy in BMI ( p < .001). Misreporting of BMI did not vary based on ethnic background, and measured BMI did not moderate the relationship between social desirability and misreporting of BMI. When normative error was distinguished from misreporting in post-hoc analyses, results showed that only 34.5% of participants demonstrated misreporting. Findings highlight the importance of identifying normative error when examining misreporting in order to improve the accuracy of self-reported BMI data. Future research on misreporting for Latino men should include weight awareness, acculturation, and length of U.S. residency as these variables may be related to self-reported weight and height.

Introduction: Ideal timing for elective delivery of infants with single ventricle heart disease, balancing benefits of fetal growth with risk of fetal demise, remains unclear. Improved understanding of fetal growth in late gestation and postnatal outcomes related to gestational age (GA) may improve insight. Hypothesis: Patients with single ventricle heart disease and aortic hypoplasia have decreased fetal growth velocity in late gestation, but longer gestation results in improved outcomes. Methods: This was a retrospective cohort analysis of patients in phase 2 of the National Pediatric Cardiology Quality Improvement Collaborative database from 2016-2019 who were anticipated to need stage 1 palliation (S1P) and had a GA of > 36 weeks. Birth weight (BW) and BW z-scores were compared across GA to normative values. Outcome measures of survival to stage 2 palliation (S2P), post-S1P length of stay, and duration of mechanical ventilation were compared by GA. Results: The cohort included 1290 infants. There was an increase in mean BW with increasing GA (2.83 kg at 36-37 weeks, 3.15 kg at 38 weeks, 3.33 kg at 39 weeks, 3.40 kg at > 40 weeks; p > 40 weeks; p > 40 weeks; p=0.0001). Among 1083 survivors to discharge or S2P if not discharged, there was no difference in post S1P length of hospitalization across GA (p=0.19). Infants who reached S2P readiness milestones were more likely to undergo S2P if born after longer gestation (p=0.0001). Conclusions: Infants with single ventricle heart disease and aortic hypoplasia have decreased growth velocity in late gestation, but growth continues. Infants born after longer gestation have improved outcomes with shorter duration of ventilation and greater likelihood of undergoing S2P.

Background Over a third of preadolescent children with overweight or obesity. The American Academy of Pediatrics (AAP) recommends pediatric providers help families make changes in eating and activity to improve body mass index (BMI). However, implementation is challenging given limited time and referral sources, and family burden to access in-person weight management programs. Purpose To describe the design of a National Heart Blood and Lung Institute sponsored cluster randomized controlled pediatric-based trial evaluating the effectiveness of the Fitline pediatric practice-based referral program to reduce BMI and improve diet and physical activity in children with overweight or obesity. Comparison will be made between brief provider intervention plus referral to (1) eight weekly nutritionist-delivered coaching calls with workbook to help families make AAP-recommended lifestyle changes (Fitline-Coaching), vs. (2) the same workbook in eight mailings without coaching (Fitline-Workbook). Methods Twenty practices are pair-matched and randomized to one of the two conditions; 494 parents and their children ages 8–12 with a BMI of ≥85th percentile are being recruited. The primary outcome is child BMI; secondary outcomes are child's diet and physical activity at baseline and 6- and 12-months post-baseline. Cost-effectiveness of the two interventions also will be examined. Conclusion This is the first randomized controlled trial to examine use of a centrally located telephonic coaching service to support families of children with overweight and obesity in making AAP-recommended lifestyle changes. If effective, the Fitline program will provide an innovative model for widespread dissemination, setting new standards for weight management care in pediatric practice. Trial registration: The ClinicalTrials.gov registration number is NCT03143660 .

The number of total joint arthroplasty (TJA) procedures done in patients with obesity is increasing in the United States.Compared with patients without obesity who undergo TJA, patients with obesity are at increased risk for numerous complications including periprosthetic joint infection and revisio

Active videogames (AVGs) could provide a novel approach to increasing physical activity and decreasing sedentary activity in children, but little is known about which children are likely to use AVGs. This study examined whether youth demographics, social support, and AVG engagement influence use of AVGs and physical activity.A diverse sample of youth participants (42.4% non-Hispanic white), aged 8-14 years (n = 85), who owned an AVG console, completed surveys, wore an activity monitor, and logged AVG use for 1 week. Regression analyses were used to examine variables associated with daily AVG minutes and to examine the relationship between daily AVG minutes and daily steps.Older and non-Hispanic white children played AVGs for fewer minutes per day (P's 0.03). Greater peer support for playing AVGs was associated with greater daily AVG minutes (P = 0.003). Daily AVG minutes were not associated with daily steps.Results suggest that younger children and children who do not identify as non-Hispanic white may be more open to playing AVGs. Targeting social support in AVG interventions may increase time spent playing AVGs.

OBJECTIVE Physical activity (PA) is important for adolescents with inflammatory bowel diseases (IBDs) given the increased risk of developing osteoporosis and the increased risk of IBD-related complications among those with IBD and obesity. Symptoms such as fatigue, abdominal pain, nausea, and frequent bowel movements can interfere with PA. Sports participation is an important source of PA for adolescents; however, the extent to which IBD interferes with sports participation is unstudied. The present study aimed to examine demographic, health-related, physical, and psychosocial correlates of perceived impairment in sports participation. METHOD Seventy-six adolescents (M[SD] = 14.5 [1.8] years, 45% girls) completed surveys of perceived impairment in sports participation, demographics, physical health, and psychosocial health. Physicians rated disease activity at enrolment. All participants were diagnosed with IBD for at least a year and prescribed a daily oral medication. RESULTS Nearly half of participants reported at least occasional interference in sports participation because of their IBD. Active disease (P = 0.014), older age (P = 0.006), and poorer disease-specific quality of life, and quality of life in physical health and psychosocial domains were associated with greater impairment in sports participation in bivariate analyses (P

The 2017 hypertension guidelines from the American College of Cardiology and American Heart Association provide little guidance regarding specific lifestyle and behavioral approaches to prevent and...

OBJECTIVE The purpose of this study was to examine whether adults with obesity and metabolic syndrome who screen as high risk for obstructive sleep apnea (OSA) lose less weight as part of a weight loss intervention than those who screen as low risk. METHOD We conducted a secondary analysis of a randomized trial comparing 2 weight loss interventions consisting of dietary counseling for adults with obesity and metabolic syndrome. Participants were screened for sleep apnea using a validated screening questionnaire. Percent weight loss was calculated from weight measured at baseline and intervention end (12 months). Weight loss of 5% or greater was considered clinically significant. Multivariate linear and logistic regression models estimated the association between OSA screening status (high vs. low risk) and percent weight loss and clinically significant weight loss, adjusting for relevant covariates including body mass index and sleep duration. RESULTS Nearly half of participants (45.8%) screened as high risk for OSA. Participants who screened as high risk for OSA lost less weight (1.2% ± 4.2% vs. 4.2% ± 5.3%) and were less likely to lose 5% or greater (24.4% vs. 75.6%) than participants without OSA. CONCLUSION Among adults with obesity and metabolic syndrome, those at high risk for OSA lost less weight in response to a dietary counseling intervention than adults with low risk of OSA. Routine OSA screening should be considered as part of weight loss treatment programs. Additional research is needed to determine how to tailor weight loss treatment for those with high risk for OSA. (PsycINFO Database Record

BACKGROUND Given the dramatic increase in adolescent overweight and obesity, models are needed for implementing weight management treatment through readily accessible venues. We evaluated the acceptability and efficacy of a school-based intervention consisting of school nurse-delivered counseling and an afterschool exercise program in improving diet, activity, and body mass index (BMI) among overweight and obese adolescents. METHODS A pair-matched cluster-randomized controlled school-based trial was conducted in which 8 public high schools were randomized to either a 12-session school nurse-delivered cognitive-behavioral counseling intervention plus school-based after school exercise program, or 12-session nurse contact with weight management information (control). Overweight or obese adolescents (N = 126) completed anthropometric and behavioral assessments at baseline and 8-month follow-up. Main outcome measures included diet, activity, and BMI. Mixed effects regression models were conducted to examine differences at follow-up. RESULTS At follow-up, students in intervention compared with control schools were not different in BMI, percent body fat, and waist circumference. Students reported eating breakfast (adjusted mean difference 0.81 days; 95% confidence interval [CI] 0.11-1.52) on more days/week; there were no differences in other behaviors targeted by the intervention. CONCLUSIONS While a school-based intervention including counseling and access to an after-school exercise program is theoretically promising with public health potential, it was not effective in reducing BMI or key obesogenic behaviors. Our findings are important in highlighting that interventions targeted at the individual level are not likely to be sufficient in addressing the adolescent obesity epidemic without changes in social norms and the environment.

Obesity and a sedentary lifestyle are common challenges among individuals at risk of diabetic foot ulcers. While substantial research exists on physical activity interventions in adults with diabetes, those at greatest risk for foot ulceration were often excluded or not well represented. Both at-risk patients and their clinicians may be hesitant to increase physical activity because of their perception of diabetic foot ulcer risks. Physical activity is not contraindicated for those at risk of diabetic foot ulcer, yet patients at risk present with unique barriers to initiating increases in physical activity. This review focuses upon the physiological and psychological challenges of increasing physical activity and exercise in patients at risk of diabetic foot ulcers. Offloading, diabetic peripheral neuropathy, depression, pain, self-efficacy and social support, diabetic foot ulcer risk-specific beliefs and emotions, and research to date on exercise interventions in this population are all discussed. Additionally, recommendations for implementing and researching physical activity interventions for individuals at risk for diabetic foot ulcer are provided. Copyright © 2016 John Wiley & Sons, Ltd.

Objective: Social influences play an important role in shaping adolescents’ dietary and physical activity behaviors. We examined the role of perceived modeling and perceived social support from family and friends on diet and physical activity behaviors among overweight and obese adolescents participating in a weight management trial. Methods: Six high schools were randomized to a school-nurse delivered behavioral weight management intervention or an information attention-control. Data on perceived support and modeling of healthy eating and physical activity from family and friends and dietary and physical activity behaviors were obtained from participants (N=82) at baseline and 2- and 6-months follow-up. Results: Linear mixed models were used to examine associations between social factors at baseline and diet and physical behaviors at 6 months. Friend support was correlated with increased fruit and vegetable consumption (0.4 servings/day) and decreased added sugar intake (-14.2 grams/day) (p’s

Behavioral activation is an empirically supported treatment for depression, but much is unknown about factors associated with treatment response. The present study aimed to determine whether baseline levels and subsequent changes in psychosocial factors were associated with improvement in depression in women with comorbid obesity who received behavioral activation treatment for depression and a lifestyle intervention. Multilevel modeling was used to estimate the associations between psychosocial factors and change in depression scores during the first 10 weeks of treatment and associations between changes in psychosocial factors from baseline to 6-month follow-up and change in depression over the same time period. No baseline psychosocial factors were associated with depression improvement during treatment (p = 0.110–0.613). However, greater improvement in hedonic capacity (p = 0.001), environmental reward (p = 0.004), and social impairment (p = 0.012) were associated with greater reductions in depression over 6 months. Findings highlight the differential relationship specific psychosocial factors have with depression treatment outcomes.

Background Physical activity is important for youth with inflammatory bowel diseases (IBD), and sports participation is a common way in which youth are physically active. Yet, studies examining sports participation in youth with IBD and barriers to sports participation are lacking. This study examined the role of disease complications, body mass index (BMI), subjective physical health, and psychosocial functioning in influencing sports participation in a large sample of youth with IBD participating in the Crohn's and Colitis Foundation of America Partners (CCFA Partners) Kids and Teens Registry. Methods CCFA Partners Kids and Teens is an internet-based cohort study in which participants and their parents self-report demographics, disease characteristics, anthropometrics, and validated assessments of physical health, psychosocial functioning, and perceived impairment in sports participation. We performed a cross-sectional analysis of 450 cohort participants, age 12-17 years. Results Nearly two-thirds of the sample reported that their IBD resulted in some impairment in sports participation. IBD disease activity was associated with perceived impairment in sports participation. In a forward regression analysis controlling for disease activity, fatigue, pain, and past IBD-related surgery emerged as the most salient correlates of impairment in sports participation. Conclusions Disease activity and subjective physical health symptoms were the most salient correlates of impairment in sports participation. Whether these barriers interfere with physical activity more generally deserves further study, as does replication of these findings longitudinally. Ultimately, a greater understanding of potential barriers to sports participation may be useful for generating targeted physical activity recommendations for youth with IBD.

Weight management through the childbearing years is important, yet few women have access to efficacious weight loss programs. Online social network-delivered programs may increase reach and thus impact. The aim of this study was to gauge interest in a Twitter-based weight loss intervention among women of childbearing age and the feasibility of recruitment via Twitter. We recruited English-speaking women aged 18-45 years (N = 63) from Twitter to complete an anonymous online survey including open-ended questions about program advantages and concerns. Forty percent of participants were obese and 83 % were trying to lose weight. Eighty-one percent were interested in a Twitter-delivered weight loss program. Interest was high in all subgroups (62-100 %). Participants (59 %) cited program advantages, including convenience, support/accountability, and privacy. Concerns (59 %) included questions about privacy, support/accountability, engagement, efficacy, and technology barriers. Research is needed to develop and evaluate social media-delivered interventions, and to develop methods for recruiting participants directly from Twitter.

Blogging is a form of online journaling that has been increasingly used to document an attempt in weight loss. Despite the prevalence of weight loss bloggers, few studies have examined this population. We examined characteristics of weight loss bloggers and their blogs, including blogging habits, reasons for blogging, like and dislikes of blogging, and associations between blogging activity and weight loss. Participants (N = 194, 92.3 % female, mean age = 35) were recruited from Twitter and Facebook to complete an online survey. Participants reported an average weight loss of 42.3 pounds since starting to blog about their weight loss attempt. Blogging duration significantly predicted greater weight loss during blogging (β = -3.65, t(185) = -2.97, p = .003). Findings suggest that bloggers are generally successful with their weight loss attempt. Future research should explore what determines weight loss success/failure in bloggers and whether individuals desiring to lose weight would benefit from blogging.

Background Few studies have compared diets to determine whether a program focused on 1 dietary change results in collateral effects on other untargeted healthy diet components. Objective To evaluate a diet focused on increased fiber consumption versus the multicomponent American Heart Association (AHA) dietary guidelines. Design Randomized, controlled trial from June 2009 to January 2014. (ClinicalTrials.gov: NCT00911885). Setting Worcester, Massachusetts. Participants 240 adults with the metabolic syndrome. Intervention Participants engaged in individual and group sessions. Measurements Primary outcome was weight change at 12 months. Results At 12 months, mean change in weight was -2.1 kg (95% CI, -2.9 to -1.3 kg) in the high-fiber diet group versus -2.7 kg (CI, -3.5 to -2.0 kg) in the AHA diet group. The mean between-group difference was 0.6 kg (CI, -0.5 to 1.7 kg). During the trial, 12 (9.9%) and 15 (12.6%) participants dropped out of the high-fiber and AHA diet groups, respectively (P = 0.55). Eight participants developed diabetes (hemoglobin A1c level ≥6.5%) during the trial: 7 in the high-fiber diet group and 1 in the AHA diet group (P = 0.066). Limitations Generalizability is unknown. Maintenance of weight loss after cessation of group sessions at 12 months was not assessed. Definitive conclusions cannot be made about dietary equivalence because the study was powered for superiority. Conclusion The more complex AHA diet may result in up to 1.7 kg more weight loss; however, a simplified approach to weight reduction emphasizing only increased fiber intake may be a reasonable alternative for persons with difficulty adhering to more complicated diet regimens. Primary funding source National Heart, Lung, and Blood Institute.

Dog walking may increase physical activity among dogs and their owners. Understanding barriers and facilitators to walking the dog is critical to developing interventions to increase dog walking. This study aimed to confirm previously identified barriers and facilitators of dog walking, and to identify unique factors that may be relevant to dog walking in cities with variable weather. This mixed methods study used focus groups to identify barriers and facilitators associated with dog walking and a survey to examine which factors were associated with dog walking. Focus group participants described barriers, such as lack of time, weather, lack of places to walk and the dog's bad behaviour. Facilitators included enjoyment, dog walking norms (defined as the participant's perception of how much the veterinarian, other dog owners, and their family think they should walk the dog), and socialisation opportunities. A hierarchical regression analysis of survey data revealed that the participant's perception of dog walking norms was associated with increased frequency and duration of dog walking, while weather, work and family commitment barriers were associated with a reduced frequency and duration of dog walking. Family, community and veterinarian dog walking norms, inclement weather, and lack of time due to work obligations emerged as important correlates of dog walking. Interventions that aim to increase physical activity by encouraging dog walking may benefit from incorporating strategies that address facilitators (family support) and barriers (time and weather) to walking the dog.

Objective Obesogenic factors are related to depressive symptoms in adolescence, though the exact mechanisms are still not fully understood. Sedentary behaviors (e.g., screen time) have been linked to depression, and are predicted by lower family meal frequency, suggesting they may play a mediational role between family meals and depressive symptoms. The current study sought to clarify the relationships among these variables. Methods A sample of 123 youth between the ages of eight and 14 years old ( M = 11.90, SD = 1.87) identifying predominantly as African American (33.3%) or Caucasian (36.7%) was examined. Regression analyses and Sobel tests with bootstraps were conducted to test the mediation model. In addition, analyses were conducted with the participants split by weight category (lean vs. overweight/obese) to examine for group differences. Results Preliminary evidence was found for a mediational relationship between family meal frequency and depressed mood, through sedentary screen time. However, no direct relationship was found from family meal frequency to depressed mood. In addition, the pattern of relationships was found to vary across weight categories. Conclusions Results suggest connections between eating behavior, sedentary screen time, and depression and support the possibility of forming family-based interventions to improve physical and mental health in youth. Further research is required to determine the role of weight status and to account for potential confounds.

The article discusses the authors' views about the impact of social media on public health research in America as of 2017, and it mentions hos public health researchers use social media tools to communicate their work and influence mass media coverage of public health-related issues by disseminating press releases. The Twitter, Facebook, and Instagram online social networking services are examined, along with efforts to combat misinformation about public health topics.

Objective The purpose of this study was to describe adults who use Twitter during a weight loss attempt and to compare the positive and negative social influences they experience from their offline friends, online friends, and family members. Materials and methods Participants (N=100, 80% female, mean age=37.65, SD=8.42) were recruited from Twitter. They completed a brief survey about their experiences discussing their weight loss attempt with their online and offline friends and provided responses to open-ended questions on the benefits and drawbacks of discussing weight on Twitter, Facebook, and weight-specific social networks. Results Participants rated their connections on Twitter and weight loss-specific social networks to be significantly greater sources of positive social influence for their weight loss (F(3)=3.47; p

OBJECTIVE To identify subgroups of adults with respect to weight loss motivations and assess factors associated with subgroup membership. METHOD A cross-sectional survey among 414 overweight/ obese employees in 12 Massachusetts high schools was conducted. Latent class analysis (LCA) defined distinct weight loss motivation classes. Multinomial logistic regression assessed participant characteristics with class membership. RESULTS Three classes emerged: improving health; improving health and looking/feeling better; and improving health, looking/feeling, better and improving personal/social life. Compared to class 1, class 2 was more likely to be female and younger and class 3 was more likely to be female, younger, have children at home, and perceive themselves as very over-weight. CONCLUSIONS Findings can inform targeted weight loss interventions.

Some adults with comorbid depression and obesity respond well to lifestyle interventions while others have poor outcomes. The objective of this study was to evaluate whether early-treatment weight loss progress predicts clinically significant 6-month weight loss among women with obesity and depression.We conducted a secondary analysis of data from 75 women with obesity and depression who received a standard lifestyle intervention. Relative risks (RRs) and 95% confidence intervals (CIs) for achieving ≥5% weight loss by 6 months were calculated based on whether they achieved ≥1 lb/week weight loss in weeks 2-8. Among those on target at week 3, we examined potential subsequent time points at which weight loss progress might identify additional individuals at risk for treatment failure.At week 2, women who averaged ≥1 lb/week loss were twice as likely to achieve 5% weight loss by 6 months than those who did not (RR=2.40; 95% CI: 2.32-4.29); weight loss at weeks 3-8 was similarly predictive (RRs=2.02-3.20). Examining weight loss progress at week 3 and subsequently at a time point during weeks 4-8, 52-67% of participants were not on target with their weight loss, and those on target were 2-3 times as likely to achieve 5% weight loss by 6 months (RRs=1.82-2.92).Weight loss progress as early as week 2 of treatment predicts weight loss outcomes for women with comorbid obesity and depression, which supports the feasibility of developing stepped care interventions that adjust treatment intensity based on early progress in this population.

Moderate-intensity physical activity is recommended for individuals with diabetes to control glucose and prevent diabetes-related complications. The extent to which a diabetes diagnosis motivates patients to increase physical activity is unclear. This study used data from the Women's Health Initiative Observational Study (baseline data collected from 1993 to 1998) to examine change in physical activity and sedentary behavior in women who reported a diabetes diagnosis compared with women who did not report diabetes during 7 yr of follow-up (up to 2005).Participants (n = 84,300) were postmenopausal women who did not report diabetes at baseline (mean ± SD; age = 63.49 ± 7.34 yr; body mass index = 26.98 ± 5.67 kg·m). Linear mixed-model analyses were conducted adjusting for study year, age, race/ethnicity, body mass index, education, family history of diabetes, physical functioning, pain, energy/fatigue, social functioning, depression, number of chronic diseases, and vigorous exercise at age 18 yr. Analyses were completed in August 2012.Participants who reported a diabetes diagnosis during follow-up were more likely to report increasing their total physical activity (P = 0.002), walking (P0.001), and number of physical activity episodes (P0.001) compared with participants who did not report a diabetes diagnosis. On average, participants reporting a diabetes diagnosis reported increasing their total physical activity by 0.49 MET·h·wk, their walking by 0.033 MET·h·wk, and their number of physical activity episodes by 0.19 MET·h·wk. No differences in reported sedentary behavior change were observed (P = 0.48).A diabetes diagnosis may prompt patients to increase physical activity. Healthcare professionals should consider how best to capitalize on this opportunity to encourage increased physical activity and maintenance.

Objective Obesity and depression are associated with somatic complaints that may complicate the measurement of depression in obese individuals. The Beck Depression Inventory-II (BDI-II) and the Hamilton Rating Scale for Depression (HRSD) are frequently used to measure depression severity. The BDI-II and HRSD's ability to measure depression severity may be compromised in those with obesity, to the extent that scores on their somatic items stem more from obesity than from depression. This study examined the: 1) internal consistency of the BDI-II and HRSD among obese women who varied in depressive symptomatology and 2) total and item-level change in the measures among participants who met the criteria for depression remission at 6-months. Methods Data were from a randomized controlled trial of obese women with depression who received either behavioral activation for depression followed by a lifestyle intervention or a lifestyle intervention with attention control. Results At screening (n = 355), internal consistency was strong for the BDI-II (α = 0.89), but moderate for the HRSD (α = 0.67). Among the participants who met the criteria for depression remission following treatment (n = 115), every BDI-II item showed significant change at 6-months. In contrast, three HRSD items did not significantly change: the anxiety—somatic (p = 0.063), somatic symptoms—gastrointestinal (p = 1.000) and loss of weight (p = 0.319) items. Conclusion The BDI-II may be more reliable and sensitive to change than the HRSD in obese women with comorbid depression. Intervention studies involving obese, depressed women should consider these findings in selecting depression outcome measures.

Caloric beverages may promote obesity by yielding energy without producing satiety, but prior laboratory and intervention studies are inconclusive. This study examined whether the diets of free-living overweight and obese women show evidence that calories from beverages are offset by reductions in solid food within individual eating occasions and across entire days. Eighty-two women weighed and recorded all consumed foods and beverages for seven days. Beverages were coded as high-calorie (≥ 0.165 kcal/g) or low-calorie (

Context Built environment-focused interventions and policies are recommended as sustainable approaches for promoting physical activity. Physical activity has not traditionally been considered in land use and transportation decision making. Effective collaboration with non-public health partners requires knowledge of their perceived barriers to such consideration. Objective This analysis sought to (a) establish prevalence estimates of selected barriers to the consideration of physical activity in community design and layout decisions and (b) describe how barrier reporting by public health officials differs from other municipal officials among a wide range of job functions and departments in a geographically diverse sample. Design A Web-based survey was conducted among municipal officials in 94 cities and towns with populations of at least 50 000 residents in 8 states. Participants A total of 453 municipal officials from public health, planning, transportation/public works, community and economic development, parks and recreation, city management, and municipal legislatures in 83 cities and towns responded to the survey. Main outcome measures Five barriers to consideration of physical activity in community design and layout were assessed. Results The most common barriers included lack of political will (23.5%), limited staff (20.4%), and lack of collaboration across municipal departments (16.2%). Fewer participants reported opposition from the business community or residents as barriers. Public health department personnel were more likely to report the barriers of limited staff and lack of collaboration across municipal departments than other professionals. They were also more likely to report lack of political will than city managers or mayors and municipal legislators. Conclusions Barriers to increasing consideration of physical activity in decision making about community design and layout are encouragingly low. Implications for public health practice include the need to strategically increase political will despite public health staffing constraints and perceived lack of collaboration with relevant departments such as planning and public works/transportation.

Objective Depression is associated with increased risk for obesity and worse weight loss treatment outcomes. The purpose of the present study was to test the hypothesis that delivering evidence-based behavior therapy for depression prior to a lifestyle weight loss intervention improves both weight loss and depression. Design In a randomized controlled trial, obese women with major depressive disorder (N=161, mean age=45.9 [SD: 10.8] years) were randomized to brief behavior therapy for depression treatment followed by a lifestyle intervention (BA) or a lifestyle intervention only (LI). Follow-up occurred at 6- and 12-months. Main outcome measures included weight loss and depression symptoms. Results Intention-to-treat analyses revealed both conditions lost significant weight, but no differences between conditions in weight change at 6-months (BA= −3.0%, SE= − 0.65%; LI=−3.7%, SE = 0.63%; p = 0.48) or 12-months (BA= −2.6%, SE= 0.77%; LI= −3.1%, SE=0.74%; p= 0.72). However, the BA condition evidenced significantly greater improvement in Beck Depression Inventory-II scores relative to the LI condition at both 6-months (BA mean change= −12.5, SD= 0.85; LI mean change= −9.2, SD=0.80, p= 0.005) and 12-months (BA mean change= −-12.6, SD= 0.97; LI mean change= −9.9, SD= 0.93; p = 0.045). Participants who experienced depression remission by 6-months (61.2%) lost greater weight (mean = −4.31%; SE=0.052) than those who did not (39.7%; mean= −2.47%, SE=0.53; p=.001). Conclusion Adding behavior therapy to a lifestyle intervention results in greater depression remission but does not improve weight loss within one year. Improvement in depression is associated with greater weight loss.

BACKGROUND Models are needed for implementing weight management interventions for adolescents through readily accessible venues. This study evaluated the feasibility and efficacy of a school nurse-delivered intervention in improving diet and activity and reducing body mass index (BMI) among overweight and obese adolescents. METHODS Six high schools were randomized to either a 6-session school nurse-delivered counseling intervention utilizing cognitive-behavioral techniques or nurse contact with provision of information. Eighty-four overweight or obese adolescents in grades 9 through 11 completed behavioral and physiological assessments at baseline and 2- and 6-month follow-ups. RESULTS At 2 months, intervention participants ate breakfast on more days/week (difference = 1.01 days; 95% CI: 0.11, 1.92), and had a lower intake of total sugar (difference = −45.79 g; 95% CI: −88.34, −3.24) and added sugar (difference = −51.35 g; 95% CI: −92.45, −10.26) compared to control participants. At 6 months, they were more likely to drink soda ≤ one time/day (OR 4.10; 95% CI: 1.19, 16.93) and eat at fast food restaurants ≤ one time/week (OR 4.62; 95% CI: 1.10, 23.76) compared to control participants. There were no significant differences in BMI, activity, or caloric intake. CONCLUSION A brief school nurse-delivered intervention was feasible, acceptable, and improved selected obesogenic behaviors, but not BMI.

OBJECTIVE To describe the development of measures of worksite descriptive social norms for weight loss, physical activity, and eating behaviors. METHODS Three surveys were tested in 844 public high school employees. Factor analysis, Cronbach alpha, and tests of association with other worksite social contextual measures and behaviors were performed. RESULTS Each survey demonstrated high internal consistency and was associated with measures of social support and behaviors. Confirmatory factor analysis supported the reliability of the weight-loss and eating-behavior norms surveys, but not the physical-activity norms survey. CONCLUSIONS The weight-loss and eating norms surveys are reliable, valid measures.

Adults with serious mental illness die more than 10 years earlier than the average American. Premature mortality is due to the high prevalence of preventable diseases including cardiovascular disease and diabetes. Poor lifestyle behaviors including lack of exercise and physical inactivity contribute to the epidemic levels of obesity, diabetes, and cardiovascular disease observed among adults with serious mental illness. Not surprisingly, people with serious mental illness are among the most costly consumers of health services due to increased visits for poorly managed mental and physical health. Recent studies have demonstrated that exercise interventions based on community mental health settings can significantly improve physical and mental health in people with serious mental illness. However, current funding regulations limit the ability of community mental health settings to offer exercise programming services to people with serious mental illness. Policy efforts are needed to improve the dissemination and sustainability of exercise programs for people with serious mental illness.

Mobile health medication reminder apps may be a useful supplement to traditional adherence-promotion interventions for pediatric chronic illness populations because they can give real-time reminders and provide education and promote behavior modification (components known to enhance adherence in traditional interventions) in an engaging and developmentally acceptable way. Moreover, apps have the potential to be used by youth and parents, an important consideration given that shared involvement in condition management is associated with better adherence.This study evaluated the content and usability of existing medication reminder apps operating on the Apple platform.Two researchers coded 101 apps on 15 desirable reminder, educational, and behavioral modification features. Usability testing was conducted with the subset of apps (n = 8) that had the greatest number of content features using a validated measure.Apps contained an average of 4.21 of 15 content features, with medication reminder features being more common than either educational or behavioral modification features. Apps most commonly included a medication name storage feature (95%), a time-based reminder feature (87%), and a medication dosage storage feature (68%). Of the eight apps that had the highest number of content features, Mango Health, myRX Planner, and MediSafe evidenced the highest usability ratings. No apps identified were specifically designed for pediatric use.Most apps lacked content known to be useful in traditional pediatric adherence-promotion interventions. Greater attention to educational and behavioral modification features may enhance the usefulness of medication reminder apps for pediatric groups.Collaborations between behavioral medicine providers and app developers may improve the quality of medication reminder apps for use in pediatric populations.

Objective The Make Better Choices 1 trial demonstrated that participants with unhealthy diet and activity behaviors who were randomized to increase fruits/vegetables and decrease sedentary leisure achieved greater diet and activity improvement than those randomized to change other pairs of eating and activity behaviors. Participants randomized to decrease saturated fat and increase physical activity achieved the least diet-activity improvement. This study examined which psychological mechanisms mediated the effects of the study treatments on healthy behavior change. Methods Participants (n = 204) were randomized to 1 of 4 treatments: increase fruits/vegetables and physical activity; decrease saturated fat and sedentary leisure; decrease saturated fat and increase physical activity; increase fruits/vegetables and decrease sedentary leisure. Treatments provided 3 weeks of remote coaching supported by mobile decision support technology and financial incentives. Mediational analyses were performed to examine whether changes in positive and negative affect, and self-efficacy, stages of readiness to change, liking, craving and attentional bias for fruit/vegetable intake, saturated fat intake, physical activity, and sedentary leisure explained the impact of the treatments on diet-activity improvement. Results Greater diet-activity improvement in those randomized to increase fruits/vegetables and decrease sedentary leisure was mediated by increased self-efficacy (indirect effect estimate = 0.04; 95% bias corrected CI, 0.003-0.11). All treatments improved craving, stage of change and positive affect. Conclusion Accomplishing healthy lifestyle changes for 3 weeks improves positive affect, increases cravings for healthy foods and activities, and enhances readiness to make healthy behavior changes. Maximal diet and activity improvement occurs when interventions enhance self-efficacy to make multiple healthy behavior changes. (PsycINFO Database Record

OBJECTIVE To examine determinants of racial/ethnic differences in diabetes incidence among postmenopausal women participating in the Women’s Health Initiative. RESEARCH DESIGN AND METHODS Data on race/ethnicity, baseline diabetes prevalence, and incident diabetes were obtained from 158,833 women recruited from 1993–1998 and followed through August 2009. The relationship between race/ethnicity, other potential risk factors, and the risk of incident diabetes was estimated using Cox proportional hazards models from which hazard ratios (HRs) and 95% CIs were computed. RESULTS Participants were aged 63 years on average at baseline. The racial/ethnic distribution was 84.1% non-Hispanic white, 9.2% non-Hispanic black, 4.1% Hispanic, and 2.6% Asian. After an average of 10.4 years of follow-up, compared with whites and adjusting for potential confounders, the HRs for incident diabetes were 1.55 for blacks (95% CI 1.47–1.63), 1.67 for Hispanics (1.54–1.81), and 1.86 for Asians (1.68–2.06). Whites, blacks, and Hispanics with all factors (i.e., weight, physical activity, dietary quality, and smoking) in the low-risk category had 60, 69, and 63% lower risk for incident diabetes. Although contributions of different risk factors varied slightly by race/ethnicity, most findings were similar across groups, and women who had both a healthy weight and were in the highest tertile of physical activity had less than one-third the risk of diabetes compared with obese and inactive women. CONCLUSIONS Despite large racial/ethnic differences in diabetes incidence, most variability could be attributed to lifestyle factors. Our findings show that the majority of diabetes cases are preventable, and risk reduction strategies can be effectively applied to all racial/ethnic groups.

A shift from home-prepared to away-from-home and ready-to-eat foods has occurred in recent decades, which has implications for obesity and health. This study tested whether delay discounting, a facet of impulsivity reflecting sensitivity to immediate reward, is associated with the frequency of consumption and typical amount consumed of home-prepared, away-from-home, and ready-to-eat foods among overweight and obese women. Seventy-eight participants completed a binary choice task assessing discounting of delayed monetary rewards. Nutrient analysis of weighed food records characterized dietary intake over seven consecutive days. Foods were categorized as home-prepared, away-from-home, or ready-to-eat by a registered dietitian from information provided by participants. Delay discounting was not associated with the frequency of consuming home-prepared, away-from-home, and ready-to-eat foods as reflected in the percentages of recorded foods or total energy intake from each category. However, once consuming away-from-home and ready-to-eat foods (but not home-prepared foods), impulsive women consumed more energy than less impulsive women. Exploratory analyses indicated that more impulsive women chose away-from-home foods with a higher energy density (kcal/g). Impulsivity was associated with the quantity of away-from-home and ready-to-eat foods consumed, but not the frequency of their consumption. Home food preparation may be critical to weight control for impulsive individuals.

We assessed the validity of the emotional eating scale (EES) by examining whether the EES predicted food intake following two negative mood inductions. Participants underwent mood inductions for anxiety, anger and neutral mood, then received snack foods in a sham palatability test. EES anxiety, but not anger, predicted intake. Participants high on EES anxiety consumed more snacks during the anxiety mood induction, whereas participants low on EES anxiety consumed less snacks. Results suggest that EES anxiety is a predictor of anxiety-driven eating and may be used to assess emotional eating when direct observation of intake is not possible.

Objective The aim of this study is to compare the associations of mood and anxiety disorders (12 months and past diagnosis) with obesity among ethnically diverse adults. Methods Data from Caucasians, African American, and Latinos in the National Comorbidity Survey Replication (NCS-R), National Latino and Asian American Study (NLAAS), and National Study of American Life (NSAL) were analyzed (n = 17,445). Multivariate logistic regression models tested the associations between 12 month and past diagnosis of mood and anxiety disorders with obesity (body mass index ≥ 30 kg/m2). Results Approximately 52% of the sample was female and 24% obese. Among Caucasians, 12-month mood disorder (OR = 1.30, 95% CI = 1.05, 1.62), past diagnosis of mood disorder (OR = 1.37, 95% CI = 1.11, 1.69) and 12-month anxiety disorder (OR = 1.40, 95% CI = 1.02, 1.68) were associated with greater likelihood of obesity. Among African Americans, past year anxiety disorder (OR = 1.63, 95% CI = 0.92, 1.67) was associated with greater likelihood of obesity, and a trend toward an association between 12 month mood disorder (OR = 1.24, 95% CI = 0.92, 1.67) and obesity was observed. Similarly among Latinos, past year anxiety disorder (OR = 1.45, 95% CI = 1.00, 1.99) was associated with greater likelihood of obesity, and a trend toward an association between 12-month mood disorder (OR = 1.26, 95% CI = 0.94, 2.01) was observed. Tests of statistical interaction to assess heterogeneity of the associations of mood and anxiety disorders with obesity, comparing African Americans and Latinos to Caucasians, suggest differences in the association of past diagnosis of mood disorder with obesity (P Conclusions Results suggest similar associations between 12-month mood and anxiety disorders with obesity across groups.

Although mortality rates from cardiovascular disease (CVD) declined by 26% from 1995 to 2005,1 it remains the leading cause of death for US adults. The American Heart Association (AHA) set a 2020 impact goal to “improve the cardiovascular health of all Americans by 20% while reducing deaths from CVD and stroke by 20%.”2 To this end, the AHA recommended prevention as a first-line strategy and identified “life's simple seven,”3 lifestyle behaviors and risk factors described in Table 1, which, if appropriately followed or adhered to, will improve cardiovascular health.2 View this table: Table 1. Summary of Life's Simple Seven Goals From the AHA Adherence refers to the extent to which patient behaviors align with clinical recommendations.4 The prevention behaviors offered by the AHA can be categorized as follows: (1) lifestyle behaviors, (2) screening, and (3) medication use. Lifestyle behaviors include a healthy diet, maintaining a healthy weight, engaging in physical activity, and not smoking. Screenings include those for blood pressure, lipid levels, and diabetes mellitus. Medication use refers to over-the-counter medications such as aspirin and prescription medications such as lipid-lowering agents and antihypertensive medications. Adherence to preventive therapies is suboptimal. For example, only 5% of adults engage in the recommended amount of physical activity.5 In comparison, about 43% of adults with a history of CVD or equivalent CVD risk take statins6 and 57% of adults 25 years old had their cholesterol tested at least once in the past 5 years.7 High-risk lifestyle behaviors are most prevalent in populations with limited income and education, ethnic/racial minority populations, and in low-income communities.8,9 The challenge is even more complicated because having multiple risk factors is common.10 A 2001 National Health Interview Survey reported a clustering of smoking, obesity, physical inactivity, and excessive alcohol intake (41% …

Current approaches to dietary counseling for obesity are heavily rooted in the notion of “personal choice” Typically, patients receive education about dietary contributions to energy balance and are then encouraged to make dietary choices (e.g., food selections, portion sizes) consistent with weight loss. Yet even highly motivated and nutritionally-informed patients often struggle to refrain from highly palatable, energy-dense foods available in the modern environment, and ultimately, only a small percentage of individuals achieve sustained weight loss through dietary modification (1–4). Failed attempts at weight control are frustrating to patients and providers alike. Studies show that both parties frequently attribute obesity to poor “personal choices” or insufficient “willpower” on the part of the patient (5,6). For example, a sample of British dietitians ranked “lack of willpower” as more important to the development of obesity than genetic factors (7), even though adult body mass is 55–75% heritable (8,9). The suggestion that individuals become or remain obese due to their unhealthy personal choices, or a lack of willpower to make healthy choices, is stigmatizing to patients and unlikely to motivate patients to lose weight (10). De-emphasizing the role of personal choice in dietary counseling for obesity would reduce stigma, but doing so carries the risk of undermining patients’ perceived control over their weight loss success. The goal of this commentary is to help dietitians negotiate this dilemma by presenting a scientifically-informed framework that views the personal choices relevant to obesity counseling in terms of three neurobehavioral processes. We argue that applying this framework in dietary counseling can both minimize patient stigma and preserve patients’ sense of empowerment.

Emotional eating appears to contribute to weight gain, but the characteristics that make one vulnerable to emotional eating remain unclear. The present study examined whether two negative affect response styles, rumination and distraction, influenced palatable food intake following an anger mood induction in normal weight and obese adults. We hypothesized that higher rumination and lower distraction would be associated with greater vulnerability to anger-induced eating, particularly among obese individuals. Sixty-one participants (74% female, mean age = 34.6) underwent neutral and anger mood inductions in counterbalanced order. Directly following each mood induction, participants were provided with 2,400 kcals of highly palatable snack foods in the context of a laboratory taste test. Results revealed that distraction influenced energy intake following the mood induction for obese but not normal weight individuals. Obese participants who reported greater use of distraction strategies consumed fewer calories than those reporting less use of distraction strategies. These findings were independent of subjective hunger levels, individual differences in mood responses and trait anger, and other factors. Rumination did not account for changes in energy intake among obese or normal weight participants. Among obese individuals, the tendency to utilize fewer negative affect distraction strategies appears to be associated with vulnerability to eating in response to anger. Future research should determine whether coping skills training can reduce emotional eating tendencies.