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This study sought to understand the process and strategies to recover from regain among weight loss maintainers.Participants in WeightWatchers (WW; n = 2457) had lost ≥9 kg for ≥1 year and were grouped based on self-reported weight change after maximum loss: sustained maintenance ("Stable"), ups and downs ("Gain-Lose"), and regain ("Gain"). The groups were compared on weight control strategies, and the Gain-Lose and Gain groups reported on attempts to reverse weight regain.Mean weight loss was 28.5 kg and duration of ≥9 kg loss was 3.5 years. During this time, 48% reported weight stability, and the remaining reported some regain (Gain-Lose, 29% or Gain, 23%). Among Gain and Gain-Lose, action to lose regained weight occurred after gaining4 kg. Compared with Gain, Gain-Lose sustained reengagement efforts longer (16 vs. 10 weeks) and had better dietary choices (3.4 vs. 3.2), self-monitoring (2.9 vs. 2.7), and psychological coping (2.5 vs. 2.4) scores. Among Gain-Lose, the most successful (2.3 kg vs.2.3 kg regain) initiated weight loss efforts after less regain (2.3 vs. 4.5 kg).Reengaging with weight loss after regains may be most successful if focused on diet, self-monitoring, and psychological coping and initiated with less regain.

We sought to examine the extent to which body mass index (BMI) was available in electronic health records for Florida Medicaid recipients aged 5 to 18 years taking Second-Generation Antipsychotics (SGAP). We also sought to illustrate how clinical data can be used to identify children most at-risk for SGAP-induced weight gain, which cannot be done using process-focused measures.Electronic health record (EHR) data and Medicaid claims were linked from 2013 to 2019. We quantified sociodemographic differences between children with and without pre- and post-BMI values. We developed a linear regression model of post-BMI to examine pre-post changes in BMI among 4 groups: 1) BH/SGAP+ children had behavioral health conditions and were taking SGAP; 2) BH/SGAP- children had behavioral health conditions without taking SGAP; 3) children with asthma; and 4) healthy children.Of 363,360 EHR-Medicaid linked children, 18,726 were BH/SGAP+. Roughly 4% of linked children and 8% of BH/SGAP+ children had both pre and post values of BMI required to assess quality of SGAP monitoring. The percentage varied with gender and race-ethnicity. The RMeeting the 2030 Centers for Medicare and Medicaid Services goal of digital monitoring of quality of care will require continuing expansion of clinical encounter data capture to provide the data needed for digital quality monitoring. Using linked EHR and claims data allows identifying children at higher risk for SGAP-induced weight gain.

The coronavirus pandemic revealed long-standing, unaddressed fissures in our systems, including dramatic gender inequities in science, technology, engineering, mathematics and medicine (STEMM) fields. Women have disproportionately carried the burden of child care and other caregiving responsibilities during the pandemic, and there are strong indications that the pandemic will likely exacerbate pre-existing disparities in the pipeline of women in STEMM and in leadership positions. Based on a literature review, our own experiences and the experiences of our colleagues, we review promising strategies that have been implemented by funding bodies, journals, professional societies, and colleges/universities as well as additional strategies that might be helpful for these entities to implement in order to move forward with policies in place that address gender inequities and rebuild our institutional systems better. At this moment in time, institutions should collect data on metrics such as recruitment, retention, tenure/promotion, funding, professional society membership, awards/honors, and scientific publishing. These data will be essential in determining the impact of policies on women in STEMM to ensure they are having the intended effect as well as what future actions might be necessary in an iterative process.

This study aimed to identify major themes of a large cohort experiencing long-term weight-loss maintenance who answered open-ended questions about weight-loss triggers, current motivations, strategies, and experiences.Machine learning and topic modeling were used to analyze responses to six open-ended questions among 6,139 WW International, Inc., (formerly Weight Watchers) members with weight-loss maintenance; inclusion criteria included ≥9.1-kg loss with weight-loss maintenance for ≥1 year.Participants (mean age = 53.6 years; 94.3% White; mean BMI = 27.8 kg/mFuture weight-maintenance research should include more diverse populations and investigate weight-loss maintenance as a journey with highs and lows, perseverance in the face of setbacks, sustained tracking, and making changes in medical status more salient during the weight-maintenance journey.

Obesity and diabetes have emerged as an increasing threat to public health, and the consumption of added sugar can contribute to their development. Though nutritional content information can positively influence consumption behavior, added sugar is not currently required to be disclosed in all countries. However, a growing proportion of the world’s population has access to mobile devices, which allow for the development of digital solutions to support health-related decisions and behaviors. To test whether advances in computational science can be leveraged to develop an accurate and scalable model to estimate the added sugar content of foods based on their nutrient profile, we collected comprehensive nutritional information, including information on added sugar content, for 69,769 foods. Eighty percent of this data was used to train a gradient boosted tree model to estimate added sugar content, while 20% of it was held out to assess the predictive accuracy of the model. The performance of the resulting model showed 93.25% explained variance per default portion size (84.32% per 100 kcal). The mean absolute error of the estimate was 0.84 g per default portion size (0.81 g per 100 kcal). This model can therefore be used to deliver accurate estimates of added sugar through digital devices in countries where the information is not disclosed on packaged foods, thus enabling consumers to be aware of the added sugar content of a wide variety of foods.

Obesity is a multifactorial disease that disproportionally affects diverse racial and ethnic groups. Structural racism influences racial inequities in obesity prevalence through environmental factors, such as racism and discrimination, socioeconomic status, increased levels of stress, and bias in the health care delivery system. Researchers, clinicians, and policy makers must work to address the environmental and systematic barriers that contribute to health inequities in the United States. Specifically, clinicians should quantitatively and qualitatively assess environmental and social factors and proactively engage in patient-centered care to tailor available treatments based on identified needs and experiences.

The Eating Disorders In weight-related Therapy (EDIT) Collaboration brings together data from randomised controlled trials of behavioural weight management interventions to identify individual participant risk factors and intervention strategies that contribute to eating disorder risk. We present a protocol for a systematic review and individual participant data (IPD) meta-analysis which aims to identify participants at risk of developing eating disorders, or related symptoms, during or after weight management interventions conducted in adolescents or adults with overweight or obesity. We systematically searched four databases up to March 2022 and clinical trials registries to May 2022 to identify randomised controlled trials of weight management interventions conducted in adolescents or adults with overweight or obesity that measured eating disorder risk at pre- and post-intervention or follow-up. Authors from eligible trials have been invited to share their deidentified IPD. Two IPD meta-analyses will be conducted. The first IPD meta-analysis aims to examine participant level factors associated with a change in eating disorder scores during and following a weight management intervention. To do this we will examine baseline variables that predict change in eating disorder risk within intervention arms. The second IPD meta-analysis aims to assess whether there are participant level factors that predict whether participation in an intervention is more or less likely than no intervention to lead to a change in eating disorder risk. To do this, we will examine if there are differences in predictors of eating disorder risk between intervention and no-treatment control arms. The primary outcome will be a standardised mean difference in global eating disorder score from baseline to immediately post-intervention and at 6- and 12-months follow-up. Identifying participant level risk factors predicting eating disorder risk will inform screening and monitoring protocols to allow early identification and intervention for those at risk.

BACKGROUND Digital behavioral weight loss programs are scalable, effective, and provide an opportunity to personalize intervention components. However, more research is needed to test the acceptability and efficacy of personalized digital behavioral weight loss interventions. OBJECTIVE In a 6-month single-arm trial, we examined weight loss, acceptability, and secondary outcomes of a virtual commercial weight loss program (WeightWatchers (WW)). This digital program included a personalized weight loss program based on sex, age, height, weight, and personal food preferences as well as synchronous (e.g., virtual workshops and individual weekly check-ins) and asynchronous elements (e.g., mobile app and virtual group). In addition to a personalized daily and weekly PersonalPoints target, the program provided users with personalized lists of ≥300 ZeroPoint foods which are foods that do not need to be weighed, measured or tracked. METHODS We conducted a pre-post evaluation of this 6-month digitally-delivered and personalized WW weight management program on weight loss, participation, satisfaction, fruit and vegetable intake, physical activity, sleep quality, hunger, food cravings, quality of life, self-compassion, and well-being at 3- and 6-months. RESULTS Participants (N=153) were 70% female, 42.5% identified as being from a minoritized racial and/or ethnic group (mean age=41.09; SD = 13.78) and had a mean BMI of 31.8 (SD = 5.0). Participants lost an average of -4.25% (SD = 3.93) weight loss from baseline to 3 months and -5.05% (SD = 5.59) weight loss from baseline to 6 months. At 6 months, the percentage of participants who experienced 3%, 5% or 10% or greater weight loss was 63.4%, 51% and 14.4% respectively. The mean percent of weeks participants engaged in one or more aspects of the program was 87.53% (SD = 23.40) at 3 months and 77.67% (SD = 28.69) at 6 months. Over two-thirds of participants rated satisfaction highly. Significant improvements were observed in fruit and vegetable intake, physical activity, sleep quality, hunger, food cravings, quality of life, and well-being (Ps CONCLUSIONS This personalized, digital and scalable behavioral weight management program resulted in clinically significant weight loss and improvements in behavioral and psychosocial outcomes. Future research should compare personalized digital weight loss programs to generic programs on weight loss, participation, and acceptability. CLINICALTRIAL Clinicaltrials.gov NCT04032389; https://clinicaltrials.gov/ct2/show/NCT04032389.

Little is known about parent and adolescent motivations for engaging in weight communication.To assess parent and adolescent motivations for engaging in, or avoiding, weight communication, and whether these reasons differed across sex, race/ethnicity, weight, and engagement in weight management.Independent samples of parents (N = 1936) and unrelated adolescents (N = 2032) completed questionnaires assessing their agreement with different reasons they engage in, or avoid, parent-adolescent weight communication, using 7-point Likert scales (strongly-disagree to strongly-agree).Parents, irrespective of sex, race/ethnicity, and child's weight status, expressed stronger motivations for engaging in weight communication in order for their child to feel good about his/her weight and body size compared to being motivated because a health professional raised their child's weight as a concern. Adolescent motivations for weight communication with parents stemmed from health concerns and worry about their weight; avoidance stemmed from feeling embarrassed, upset, or not wanting to obsess about weight. Differences emerged across sex and race/ethnicity but were most pronounced by weight status and weight management.Parents and adolescents have different motivations for engaging in or avoiding weight communication. Protecting adolescents' emotional wellbeing and body esteem are viewed as reasons for both engaging in or avoiding weight communication.

Background: Behavioral lifestyle interventions are the foundation of adolescent obesity treatment. Tailoring an intervention using adolescent stakeholder engagement during the development process could improve intervention effectiveness. Methods: Adolescents with overweight/obesity ages 14–19 (n = 41) participated in 11 sex-specific focus groups (girls = 6, boys = 5) and were asked their preferences regarding who should lead the intervention and be involved, what the messaging of the program should be, how to make the program engaging and maintain participation, and how to best measure nutrition intake and activity. Transcripts were coded and analyzed for emergent themes. Results: Mean age was 16.0 ± 1.8 years and participants were racially/ethnically diverse. Adolescents preferred interventions that avoid a focus on “weight loss,” and instead emphasize “healthy lifestyle,” which represents a more comprehensive goal of targeting physical and mental well-being. Most participants indicated preferences for a relatable instructor with prior weight loss experience. Both sexes preferred optional parental involvement, as some parents were described as helpful, while others were perceived as a hindrance to success. Boys and girls identified incentives, engaging activities, and electronic communication as core components for engagement and retention, with girls emphasizing socialization and building relationships. Sex differences in preferences were observed. Girls had more concerns about intervention participation and preferred interventions to be sex stratified. Conclusions: Behavioral interventions to treat adolescent obesity should focus messaging/content on healthy lifestyles, rather than weight loss, and be sex stratified. Development and implementation of future behavioral interventions for adolescent obesity should consider tailoring to adolescent preferences when possible to improve feasibility, acceptability, and effectiveness.

Background: Due to the COVID-19 pandemic, most faculty in science, technology, engineering, mathematics, and medicine (STEMM) began working from home, including many who were simultaneously caring ...

Research findings suggest parent weight-talk is associated with negative health outcomes among youth, and weight must be discussed with caution. Yet, it remains unclear the extent to which different approaches to weight-talk affect different health-related outcomes. The objective of this systematic review is to characterize varying parent weight-talk approaches with respect to adolescent health-related and psychosocial outcomes and to identify methodological shortcomings in this body of literature. Included articles were published between January 2010 and January 2020, included adolescents ages 11–18, addressed weight-talk between parents and adolescents, and excluded clinical populations (e.g., eating disorder diagnosis, bariatric and/or diabetic population). A systematic search of three databases and a hand search of two peer-reviewed journals resulted in 16 articles meeting inclusion criteria. While findings remain preliminary, the research indicates that overall health-based conversations are more productive and cause less harmful consequences than overt conversations about adolescent weight. The findings also demonstrate that research lacks dyadic data between parents and adolescents for weight-talk, fathers are underrepresented in this research, and adolescent preferences/perceptions of comments and discussions with parents remain unknown. More research is needed to examine different types of weight-talk between parents and adolescents and health outcomes associated with engaging in such conversations and/or comments.

The 2016 U.S. presidential election was a major source of stress among many adults. Psychosocial stress can manifest physiologically in elevated blood pressure (BP). Little is known regarding the association of macro-level sociopolitical events with BP changes at the population-level. This study sought to characterize population-level changes in BP following the 2016 U.S. presidential election.Using 2015-2018 National Health and Nutrition Examination Survey, we included participants aged ≥18 years during the same periods prior to (May to October 2015/2016) and after (May to October 2017/2018) the election. Survey-weighted data were analyzed to compare population-level systolic BP (SBP) and diastolic BP (DBP) pre- and post-election, stratified by race/ethnicity. Sex differences were also investigated.We observed significant increases in SBP among non-Hispanic (NH) Asian participants (+3.4 mmHg; p = .046), but not among other racial/ethnic participants. DBP increased among NH Black participants (+2.3 mmHg; p = .049) and Mexican American participants (+2.9 mmHg; p = .007), but not among other racial/ethnic participants. These changes appeared attributable to differential BP changes by sex.At the population-level, variable changes in BP were observed by race/ethnicity following the 2016 U.S. presidential election, possibly driven by SBP elevations among women.

To examine how the teach-back, interactive communication loop between patient and provider, is utilized and its role in diabetes care delivery.This was a cross-sectional analysis of the Medical Expenditure Panel Survey (MEPS) 2011-2016. The study sample included US adults aged 18 or older with diabetes. Survey-design adjusted analyses were used to examine patterns of teach-back utilization across patient socioeconomic/clinical characteristics, patient-provider interactions, and diabetes care education.Analysis of 2901 US adults with diabetes showed that 25.0 % reported patient teach-back experience during their visit to care. Compared with patients without teach-back, those with teach-back experience had higher scores on interaction quality with their providers (composite score: 90.8 vs. 55.8, P .001). Those with teach-back were also more to receive additional advice on diet and exercise from providers (67.0 % vs. 60.9 %, P = 0.03) and to report that they were confident in diabetes self-care management (75.7 % vs. 70.3 %, P =0.03).Teach-back communication appears to be effective in patient-provider interaction and diabetes care education, leading to higher confidence in self-care management.Despite its potential, the utilization of teach-back communication is suboptimal. More effort is needed to promote effective use of teach-back communication in routine diabetes care.

Objective The objective of this study was to evaluate the effect of skipping breakfast on body composition and cardiometabolic risk factors. Methods This study conducted a systematic review and meta-analysis of randomized controlled trials (RCTs) evaluating breakfast skipping compared with breakfast consumption. Inclusion criteria included age ≥ 18, intervention duration ≥ 4 weeks, ≥ 7 participants per group, and ≥ 1 body composition measure. Random-effects meta-analyses of the effect of breakfast skipping on body composition and cardiometabolic risk factors were performed. Results Seven RCTs (n = 425 participants) with an average duration of 8.6 weeks were included. Compared with breakfast consumption, breakfast skipping significantly reduced body weight (weighted mean difference [WMD] = -0.54 kg [95% CI: -1.05 to -0.03], P = 0.04, I2 = 21.4%). Percent body fat was reported in 5 studies and was not significantly different between breakfast skippers and consumers. Three studies reported on low-density lipoprotein cholesterol (LDL), which was increased in breakfast skippers as compared with breakfast consumers (WMD = 9.24 mg/dL [95% CI: 2.18 to 16.30], P = 0.01). Breakfast skipping did not lead to significant differences in blood pressure, total cholesterol, high-density lipoprotein (HDL) cholesterol, triglycerides, C-reactive protein, insulin, fasting glucose, leptin, homeostatic model assessment of insulin resistance, or ghrelin. Conclusions Breakfast skipping may have a modest impact on weight loss and may increase LDL in the short term. Further studies are needed to provide additional insight into the effects of breakfast skipping.

Background Hunger and food cravings predict poor outcomes in lifestyle interventions for weight management. For this reason, flexible weight management programs, as opposed to restrictive weight management programs, are needed. WW (formerly Weight Watchers)—a widely available, commercial weight management and wellness program—includes an approach that allows participants to obtain a personalized zero-point food (ZPF) list, which includes foods that do not need to be weighed, measured, or tracked. With over 300 potential options, ZPFs can include fruits, vegetables, legumes, whole grains, nonfat dairy, and lean sources of protein. Participants are assigned an individualized daily and weekly point target and can use ZPFs to help budget their points throughout the day, which can nudge participants toward a healthier overall dietary pattern. Objective In a 6-month, single-arm trial, we examined the efficacy of WW when delivered via multimodal digital tools, including a mobile app for assisting with point tracking, weekly virtual workshops, weekly 5-minute wellness check-ins, and a Facebook group in which participants could socialize and support each other. Methods The outcomes included weight change from baseline, as measured by the Bluetooth scales provided to each participant; hunger (visual analogue scale); food cravings (Food Craving Inventory); the intake of fruits and vegetables (The Five Factor Screener); physical activity (Global Physical Activity Questionnaire); and overall well-being (WHO-5 Well-Being Index). Results Of the 153 participants, 70% were female, and 66% were White. Participants’ mean age was 41.09 (SD 13.78) years, and they had a mean BMI of 31.8 (SD 5.0) kg/m2. Retention was high, as 91.5% provided 6-month follow-up data. Participants lost an average of 5.1% of body weight from baseline to 6 months (mean −4.4, SD 4.87 kg; P Conclusions This program, which used a less restrictive method of food tracking and provided personalized ZPFs, resulted in significant weight loss and an increase in fruits, vegetables, and exercise, while also reducing hunger and food cravings. Future research should compare the effectiveness of these approaches to traditional programs that require the self-monitoring of all foods and beverages. Trial Registration ClinicalTrials.gov NCT04302389; https://clinicaltrials.gov/ct2/show/NCT04302389 Conflicts of Interest None declared.

Background Generally, adherence to diet and physical activity in behavioral weight management programs predicts weight loss. Moreover, meeting attendance and platform or app use predict weight loss. Many weight-loss–prediction studies primarily use regression. However, little is known about the levels of adherence to specific web-based weight management program tools as well as behavioral and psychosocial variables that predict significant weight loss using machine-learning approaches. Objective In this paper, we aimed to examine variables that can predict clinically significant weight loss (≥5%) in a multimodal commercial digital weight management program, including levels of adherence to intervention tools and changes in behavioral and psychosocial states using machine-learning approaches. Methods We performed secondary analyses using data from a one-arm trial online WW (formerly Weight Watchers) weight-loss intervention program, lasting 6 months, that recruited US adults with a BMI range of 25-45 kg/m2. We used a WW Bluetooth scale and digital intervention tools such as mobile app for point tracking, weekly virtual workshops, weekly wellness check-ins and a Facebook group, and changes in psychosocial and behavioral variables (ie, food craving, Pittsburgh sleep quality index, diet, hunger, and physical activity). Using the receiver operating characteristics (ROC) curve, we identified the predictors of significant weight loss, as well as the associated cut points (CP) and area-under-curve (AUC) values for each variable. We further used a classification tree to confirm the importance of these predictors and assessed the out-of-sample prediction accuracies using 5-fold cross-validation. Results Participants (N=153) were 70% female and 66% White, with a mean age of 41.09 (SD 13.78) years, and had a mean BMI of 31.8 kg/m2 (SD 5.0). Approximately 51% of participants lost ≥5% weight. Using ROC curve, food tracking (CP≥9.4%; AUC=0.744; P Conclusions ROC curve and classification tree provided consistent results of predictors of clinically significant weight loss (ie, food tracking, increase in self-weighing, workshop attendance, and wellness check-in attendance). Our study extends the weight management literature by using machine-learning approaches to identify significant weight loss predictors and specific levels of these predictors needed to achieve clinically significant weight loss. Conflicts of Interest None declared.

Nearly one-fifth of the pediatric population in the United States has obesity. Comprehensive behavioral interventions, with at least 26 contact hours, are the recommended treatment for pediatric obesity; however, there are various barriers to implementing treatment. This Perspective applies the Exploration, Preparation, Implementation, and Sustainment (EPIS) framework to address barriers to implementing multidisciplinary pediatric weight management clinics and identify potential solutions and areas for additional research. Lack of insurance coverage and reimbursement, high operating costs, and limited access to stage 4 care clinics with sufficient capacity were among the main barriers identified. Clinicians, researchers, and patient advocates are encouraged to facilitate conversations with insurance companies and hospital and clinic administrators, increase telehealth adoption, request training to improve competency and self-efficacy discussing and implementing obesity care, and advocate for more stage 4 clinics.

(This article has been accepted for publication in Current Developments in Nutrition published by Oxford University Press.) Traffic light labeling (TLL) of foods is a strategy often included in multicomponent behavioral interventions (MBI) for childhood obesity. TLLs categorize foods as ‘green’ (no restrictions); ‘yellow’ (moderation); and ‘red’ (consume minimally). The body of research investigating the effects of TLL conflates the labeling itself with MBIs that include TLL as one component. For instance, the Academy of Nutrition and Dietetics’ Evidence Analysis Library gave traffic light diets Grade I evidence for pediatric weight management. Yet, whether the term traffic light diet referenced TLL in isolation or as part of an MBI was ambiguous. Herein we evaluate the evidence supporting TLL for childhood obesity as a standalone treatment and identify areas requiring further research. No articles from a PubMed search for TLL and weight-related outcomes tested TLL in isolation. One article was identified through reference lists that tested TLL mostly in isolation, which observed no significant differences between groups. TLL definitions and categorizations vary across studies and contexts, using average calories in categories of foods, energy density, or specific ingredients to determine labeling. Systematic reviews generally conclude TLL-based approaches affect food selection and consumption, but none studied obesity-related outcomes. We believe the evidence supports that: 1) there is a lack of standardization regarding TLL food classifications; 2) the term “traffic light diet” is inconsistently used to mean intensive lifestyle programs or TLL itself; and 3) there is insufficient evidence to understand the effects of TLL as an isolatable factor for childhood obesity. Importantly, limited evidence about TLL does not mean it is ineffective; TLL has been incorporated into successful childhood obesity intervention programs, but the unique causal contribution of TLL remains uncertain. Standardized definitions of traffic light labels for categorizing foods and trials with TLL alone are needed to test direct impacts of TLL on obesity-related outcomes.

BACKGROUND Low objective socioeconomic status (SES) and subjective social status (SSS), one's perceived social rank, are associated with obesity. This association may be due, in part, to social status-related differences in energy expenditure. Experimental studies are needed to assess the extent to which SES and SSS relate to energy expenditure. OBJECTIVE Assess the effects of experimentally manipulated social status and SSS on moderate-to-vigorous physical activity (MVPA) and sedentary behaviour. METHODS One hundred thirty-three Hispanic adolescents aged 15-21 were randomized to a high or low social status position, facilitated through a rigged game of Monopoly™. SSS was assessed with MacArthur Scales. Post-manipulation 24-h MVPA and sedentary behaviour were assessed via accelerometry. Analyses were conducted with general linear regression models. RESULTS Experimentally manipulated social status did not significantly affect the total time spent in MVPA or sedentary behaviour; however, identifying as low SSS was significantly associated with less MVPA (p = 0.0060; 18.76 min less). CONCLUSIONS Tewnty-four-hour MVPA and sedentary behaviour are not affected by an acute experimental manipulation of social status. However, low SSS, independent of SES, was associated with clinically significant differences in MVPA. SSS may be a better predictor of MVPA than SES among Hispanic adolescents, potentially influencing obesity, and other health-related outcomes.

Background The association of race/ethnicity with childhood-onset systemic lupus erythematosus (cSLE) outcomes has been well described, with non-White individuals experiencing a more severe disease phenotype including increased damage accrual and higher rates of renal involvement. However, there are limited data regarding patient-reported outcomes (PROs) across race and ethnic groups in cSLE. This study assesses the association of race/ethnicity with Patient-Reported Outcomes Measurement Information System (PROMIS®) in cSLE patients at enrollment in the Childhood Arthritis and Rheumatology Research Alliance (CARRA) Registry. Methods The CARRA Registry is a convenience cohort of pediatric patients with rheumatic disease including cSLE primarily from North America. This study included cSLE patients enrolled in the CARRA registry within two years from cSLE diagnosis who met ≥ 4/11 ACR classification criteria for lupus. Baseline demographics, laboratory, and disease features as well as PROs were obtained. Analysis of variance (ANOVA) was used to assess the difference in the PROMIS summary T-score means across races/ethnicities. Relationships between SLEDAI and PRO scores were analyzed using Pearson’s correlation coefficients. Multivariable linear regression analysis was used to examine the association of race and ethnicity with PROMIS scores at baseline. P-values Results 588 cSLE patients met inclusion criteria: 84% were female, 24.2% non-Hispanic White, 23% African American, and 19% Hispanic. The mean age at diagnosis was 13.2 years (SD 3.1). Household income and highest parental education varied by race/ethnic group, as did frequency of rash, leukopenia, and positive anti-Sm antibody (table 1). The cohort had low-moderate baseline disease activity, with a mean SLEDAI of 6.14 (SD 6.8). There was no difference in disease activity across races/ethnicities in one-way ANOVA analysis. The overall PROMIS PHG-7 mean T-score was 38.6 (SD 6.4), more than 1 SD below the general population mean of 50. The mean Pain Interference T-score of 54 (SD 10) was slightly above, and the Physical Function Mobility mean T-score of 47.5 (SD 10.13) was slightly below the population mean of 50. There was a negative moderate correlation between PROMIS Pain Interference and Physical Function Mobility (Pearson correlation coefficient: −0.52). There was no association between race/ethnicity and PROMIS scores in multivariable linear regression analysis. Conclusions In this large multiethnic CARRA pediatric lupus cohort, global health (PGH-7), pain interference, and physical function mobility as measured by PROMIS did not vary across races/ethnicities. The relatively low baseline disease activity may explain this lack of association. Long-term follow-up data is needed to assess for associations between PROs and race/ethnicity over time.

OBJECTIVE: Obesity is a chronic disease that disproportionately affects individuals from nonmajority racial/ethnic groups in the United States. Research shows that individuals from minority racial/ethnic backgrounds consider it important to have access to providers from diverse backgrounds. Health care providers and scientists from minority racial/ethnic groups are more likely than their non-Hispanic White counterparts to treat or conduct research on patients from underrepresented groups. The objective of this study was to characterize the racial/ethnic diversity of nutrition- and obesity-focused professional organizations in the United States. METHODS: This study assessed race/ethnicity data from several obesity-focused national organizations including The Obesity Society, the Academy of Nutrition and Dietetics (AND), the American Society for Nutrition, and the American Board of Obesity Medicine (ABOM). Each organization was queried via emailed survey to provide data on racial/ethnic representation among their membership in the past 5 years and among elected presidents from 2010 to 2020. RESULTS: Two of the three professional societies queried did not systematically track race/ethnicity data at the time of query. Limited tracking data available from AND show underrepresentation of Black (2.6%), Asian (3.9%), Latinx (3.1%), Native Hawaiian or Pacific Islander (1.3%), or indigenous (American Indian or Alaskan Native: 0.3%) individuals compared with the US population. Underrepresentation of racial/ethnic minorities was also reported for ABOM diplomates (Black: 6.0%, Latinx: 5.0%, Native American: 0.2%). Only AND reported having racial/ethnic diversity (20%) among the organization’s presidents within the previous decade (2010–2020). CONCLUSIONS: Findings suggest that (1) standardized tracking of race and ethnicity data is needed to fully assess diversity, equity, and inclusion, and (2) work is needed to increase the diversity of membership and leadership at the presidential level within obesity- and nutrition-focused professional organizations. A diverse cadre of obesity- and nutrition-focused health care professionals is needed to further improve nutrition-related health outcomes, including obesity, cardiovascular disease, diabetes, and undernutrition, in this country.

Background Obesity is a significant risk factor of several cancers that imposes a substantial economic burden on US healthcare that remains to be quantified. We estimated the excess costs and economic burden of obesity-related cancers in the United States. Methods From the Medical Expenditure Panel Survey (2008-2015) data, we identified 19 405 cancer survivors and 175 498 non-cancer individuals. We estimated annual health expenditures using generalized linear regression with log link and gamma distribution by cancer types (stratified by 11 obesity-related cancers and other cancer types), controlling for sociodemographic and clinical characteristics. All cost estimates were adjusted to 2015 USD value. Results The average annual total health expenditures were $21 503 (95% CI, $20 946-$22 061) for those with obesity-related cancer and $13 120 (95% CI, $12 920-$13 319) for those with other cancer types. There was a positive association between body mass index and health expenditures among cancer survivors: for each additional 5-unit increase in body mass index, the average predicted expenditures increase by $1503 among those with obesity-related cancer and by $722 among those with other cancers. With adjustments for sociodemographic and clinical characteristics, the mean incremental expenditures of treating obesity-related cancer were 2.1 times higher than those of other cancers ($4492 vs $2139) and more considerable among the non-elderly cancer population. Obesity-related cancers accounted for nearly 43.5% of total direct cancer care expenditures, estimated at $35.9 billion in 2015. Conclusion The economic burden of obesity-related cancer in the United States is substantial. Our findings suggest a need for the inclusion of comprehensive obesity prevention and treatment in cancer care.

We characterized the prevalence of obesity among Florida children 2–19 years old using electronic health records (EHRs). The obesity prevalence for 331,641 children was 16.9%. Obesity prevalence at 6–11 years (19.5%) and 12–19 years (18.9%) were approximately double the prevalence of obesity among children 2–5 years (9.9%). The highest prevalence of severe obesity occurred in rural Florida (21.7%) and non-Hispanic children with multiple races had the highest obesity prevalence (21.1%) across all racial/ethnic groups. Our results highlight EHR as a low-cost alternative to estimate the prevalence of obesity and severe obesity in Florida children, both overall and within subpopulations.

The position statement is issued by The Obesity Society in response to published literature, as well as inquiries made to the Society by patients, providers, Society members, policy makers, and others regarding the efficacy of vaccines in persons with obesity against SARS‐CoV‐2, the virus that causes COVID‐19. The Obesity Society has critically evaluated data from published peer‐reviewed literature and briefing documents from Emergency Use Authorization applications submitted by Pfizer‐BioNTech, Moderna, and Johnson & Johnson. We conclude that these vaccines are highly efficacious, and their efficacy is not significantly different in people with and without obesity, based on scientific evidence available at the time of publication. The Obesity Society believes there is no definitive way to determine which of these three COVID‐19 vaccines is “best” for any weight subpopulation (because of differences in the trial design and outcome measures in the phase 3 trials, elapsed time between doses, and regional differences in the presence of SARS‐CoV‐2 variants [e.g., South Africa B.1.351 in Johnson & Johnson trial]). All three trials have demonstrated high efficacy against COVID‐19–associated hospitalization and death. Therefore, The Obesity Society encourages adults with obesity ≥18 years (≥16 years for Pfizer‐BioNTech) to undergo vaccination with any one of the currently available vaccines authorized for emergency use by the US Food and Drug Administration as soon as they are able.

Background: Contemporary data characterizing the utilization of metabolic and bariatric surgery (MBS) by type 2 diabetes mellitus (T2DM) status are limited. Methods: In this study, we analyzed data from patients 18-88 years of age eligible for MBS seen in the OneFlorida (https://onefloridaconsortium.org/) between 1/1/ 2012 to 12/31/2018. MBS eligibility was defined by any of the following criteria: (1) an encounter with a body mass index (BMI) ≥ 40 kg/m2; or (2) BMI ≥ 35 kg/m2 with at least one obesity-related comorbidity, including T2DM, hypertension, or hyperlipidemia. We compared patients’ characteristics stratified by T2DM status and whether they underwent common bariatric procedures including Roux-en-Y gastric bypass (RYGB), sleeve gastrectomy (SG), and adjustable gastric banding (AGB). We performed multivariable logistic regression to identify factors independently associated with receipt of MBS among diabetic patients. Results: Among 190,606 patients with T2DM, 4103 (2.2%) of them underwent BS. Patients with diabetes were more likely to receive RYGB than those without T2DM (47.6% vs. 37.7%). We also observed that patients without diabetes aged between 18-44 years had a higher rate of MBS utilization than patients in that age range with diabetes (58.7% vs. 37.4%). The logistic regression results showed that female, higher pre-surgical BMI, had pre-surgical hypertension were strong indicators associated with bariatric treatment among patients with diabetes. Conclusion: In this study, we observed that patients with obesity and T2DM still had relatively low rates of MBS. The observed differences in rates of MBS among different demographic subgroups could inform interventions that target reductions in these disparities. Disclosure G. Chen: None. W. T. Donahoo: None. M. Cardel: Consultant; Spouse/Partner; Weight Watchers International, Inc. A. Holgerson: None. A. L. Ayzengart: None. M. J. Gurka: None.

Introduction: Politics are a major source of stress and anxiety among U.S. adults, and the 2016 U.S. general election may have led to increased psychosocial stress among different racial/ethnic populations. Psychosocial stress can manifest physiologically in elevated blood pressure (BP). Yet, little is known regarding whether this response differs among racial/ethnic groups. We sought to characterize population-level changes in BP among non-Hispanic (NH) Whites, NH Blacks, and Mexican Americans before and after the 2016 U.S. general election. Methods: Using cross-sectional 2015-2018 National Health and Nutrition Examination Survey (NHANES) data, we included participants aged ≥20 years with ≥1 systolic BP (SBP) and diastolic BP (DBP) measurement during the examination periods just prior to and after the election. The pre-election period was from May 2016 to October 2016 and the post-election period was from November 2017 to April 2018. Survey-weighted data were analyzed to compare mean SBP and DBP pre- and post-election, stratified by race/ethnicity. Stratified analyses were also performed on hypertension status, defined as self-report, mean BP ≥140/90, or use of ≥1 antihypertensive drug. Results: We included 1,060 NH Whites, 720 NH Blacks, and 223 Mexican Americans during the pre-election period and 676 NH Whites, 564 NH Blacks, and 468 Mexican Americans during the post-election period. We observed a significant increase in SBP among Mexican Americans (mean±SEM, 118±0.5 mmHg [pre-election] vs. 121.7±0.7 mmHg [post-election], p=0.005), but not among NH Blacks (126.7±0.9 mmHg vs. 128.9±0.7 mmHg, p=0.083) nor NH Whites (123±0.6 mmHg vs. 124.8±1.4 mmHg, p=0.256). DBP increased among both Mexican Americans (69.5±0.5 mmHg vs. 72.6±1.1 mmHg, p=0.022) and NH Blacks (72.2±0.8 mmHg vs. 74.9±0.6 mmHg, p=0.012), but not among NH Whites (70.4±0.4 mmHg vs. 72.9±1.3 mmHg, p=0.075). These effects were largely attributable to BP changes among those with hypertension (pre-election: 414 NH Whites, 350 NH Blacks, 60 Mexican Americans; post-election: 330 NH Whites, 298 NH Blacks, 156 Mexican Americans), in whom there was an increase in SBP among NH Blacks (138.8±1.3 mmHg vs. 143.7±1.7 mmHg, p=0.032) and Mexican Americans (133.9±1.1 mmHg vs. 141.9±1.5 mmHg, p=0.0002); and an increase in DBP among NH Blacks (76.2±1.2 mmHg vs. 80.8±0.9 mmHg, p=0.005). No significant changes were observed in any racial/ethnic group without hypertension. Conclusions: At the population-level, NH Blacks and Mexican Americans had increases in BP following the 2016 U.S. general election, largely driven by BP elevations among those with hypertension. Patient-level data, especially linked with political affiliation, may provide additional insights into the psychosocial stress effect of major political events.

* Abbreviations: HRQoL — : health-related quality of life MVPA — : moderate-vigorous physical activity The public health, medical, and research community has increased focus on childhood obesity over the past few decades and for good reason. Obesity prevalence is at an all-time high,1 and rates of severe obesity continue to increase.2 Activity, both sedentary and physical, are key contributors to the development and treatment of obesity.3–5 Increasing physical activity while decreasing sedentary activity is an obvious goal in improving the weight and health of children. Unfortunately, the majority of children in the United States are not receiving the recommended amounts of physical activity and surpassing suggested limits on sedentary activity.6 Because there are finite hours in a day, increasing time spent on 1 activity will require doing less of another (ie, replacing one activity with another). In the case of activity, it is assumed that increased time spent engaged in physical activity is always beneficial, without the recognition that it may detract from other important life and health components (eg, sleep and school work). Exploring how individuals allocate their time may provide insight into how one can increase time spent in a beneficial behavior (eg, exercise), without stealing that time from an activity that is also beneficial (eg, sleep). In their study, Ng et al7 approached this topic through the lens of time and in relation … Address correspondence to Michelle I. Cardel, PhD, MS, RD, Department of Health Outcomes and Biomedical Informatics, College of Medicine, University of Florida, 2197 Mowry Rd, Gainesville, FL 32607. E-mail: mcardel{at}ufl.edu

Background Mobile fruit and vegetable (F&V) markets may be a promising strategy to improve F&V intake among low-income and racial/ethnic minority groups. However, challenges remain in terms of maximizing the reach and utilization of such markets. Therefore, this study identifies perceived barriers to and facilitators of utilizing a mobile F&V market among residents who lived in low-income housing that received the markets. Specifically, this article reports the results of the follow-up acceptability study of the “Live Well, Viva Bien” (LWVB) intervention. Method We conducted concept mapping with residents in housing communities that received the Fresh to You (FTY) markets. Participants generated, sorted, and rated statements concerning barriers to and facilitators of market use. We compared the rating data by residents’ level of market utilization and created a map representing how statements clustered into conceptual themes. Results We retained 66 unique participant-generated statements. Eight thematic clusters emerged; four pertained to barriers: financial/promotion, produce-related, scheduling/knowledge, and logistic/awareness barriers, and four related to facilitators: produce/staffing, promotion, accessibility, and multilevel market facilitators. There was a strong correlation in ratings between participants who more frequently versus less frequently shopped at the markets ( r = 0.94). Conclusions Participants identified financial barriers, market promotion, ease of market accessibility, produce variety and quality, and staffing as key factors influencing FTY market use. This study highlights the importance of identifying the perceived barriers to and facilitators of mobile F&V market use among target populations to inform future efforts to scale up such approaches.

Relative to other racial/ethnic groups in the United States, Hispanic American (HA) youth have higher rates of overweight and obesity. Previous work suggests that low perceived social status (SS) promotes excess caloric intake and, thereby, development of obesity. Psychological resilience may play a role in reducing adverse eating behaviors and risk for obesity. The objective of this study was to investigate whether resilience (as measured by the Connor Davidson Resilience Scale) interacts with experimentally manipulated SS to affect dietary intake among HA adolescents (N = 132). Using a rigged game of Monopoly (Hasbro, Inc.), participants were randomized to a high or low SS condition. Following the Monopoly game, participants consumed an ad libitum lunch and their dietary intake was assessed. There was a significant interaction between resilience and experimentally manipulated SS for total energy intake (p = 0.006), percent energy needs consumed (p = 0.005), and sugar intake (p = 0.004). For the high SS condition, for each increase in resilience score, total energy intake decreased by 7.165 ± 2.866 kcal (p = 0.014) and percent energy needs consumed decreased by 0.394 ± 0.153 (p = 0.011). In the low SS condition, sugar intake increased by 0.621 ± 0.240 g for each increase in resilience score (p = 0.011). After correction for multiple comparisons, the aforementioned interactions, but not simple slopes, were statistically significant.

Obesity affects 158 million youth worldwide and is associated with psychosocial comorbidity. This review describes weight management options utilized by adolescents, including both self-directed weight loss and medically supervised obesity treatment interventions, and associated psychosocial impacts. A majority of adolescents with obesity attempt to manage weight on their own, primarily through attempting weight loss, sometimes with supplement use. Approaches such as these are associated with a degree of risk, disordered eating behaviors, and further weight gain. In contrast, medically supervised multicomponent interventions are associated with improved psychosocial health, including quality of life, self-esteem, and body image, and reduced symptoms of depression, anxiety, and eating disorders. Few studies utilizing antiobesity pharmacotherapy have reported psychosocial outcomes, and trials of bariatric surgery show some early improvements with a need for sustained psychological support following surgery. Greater access to medically supervised treatment services is required to facilitate obesity care for adolescents. Early data on psychosocial health and obesity treatment offer promising outcomes; however, larger randomized controlled trials and longer-term data are needed. Future research should include both physiological and psychosocial outcomes to assess impact of interventions on the holistic health of adolescents with obesity.