Search

Background: State-of-the-art behavioral weight loss treatment (SBT) can lead to clinically meaningful weight loss, but only 30-60% achieve this goal. Developing adaptive interventions that change based on individual progress could increase the number of people who benefit.Purpose: Conduct a Sequential Multiple Assignment Randomized Trial (SMART) to determine the optimal time to identify SBT suboptimal responders and whether it is better to switch to portion-controlled meals (PCM) or acceptance-based treatment (ABT).Method: The BestFIT trial enrolled 468 adults with obesity who started SBT and were randomized to treatment response assessment at Session 3 (Early TRA) or 7 (Late TRA). Suboptimal responders were re-randomized to PCM or ABT. Responders continued SBT. Primary outcomes were weight change at 6 and 18 months.Results: PCM participants lost more weight at 6 months (-18.4 lbs, 95% CI -20.5, -16.2) than ABT participants (-15.7 lbs, 95% CI: -18.0, -13.4), but this difference was not statistically significant (-2.7 lbs, 95% CI: -5.8, 0.5, p = .09). PCM and ABT participant 18 month weight loss did not differ. Early and Late TRA participants had similar weight losses (p = .96), however, Early TRA PCM participants lost more weight than Late TRA PCM participants (p = .03).Conclusions: Results suggest adaptive intervention sequences that warrant further research (e.g., identify suboptimal responders at Session 3, use PCMs as second-stage treatment). Utilizing the SMART methodology to develop an adaptive weight loss intervention that would outperform gold standard SBT in a randomized controlled trial is an important next step, but may require additional optimization work.Clinical Trial Information: ClinicalTrials.gov identifier; NCT02368002. [ABSTRACT FROM AUTHOR]

Objectives. To evaluate a multicomponent obesity prevention intervention among diverse, low-income preschoolers. Methods. Parent–child dyads (n = 534) were randomized to the Now Everybody Together for Amazing and Healthful Kids (NET-Works) intervention or usual care in Minneapolis, MN (2012–2017). The intervention consisted of home visits, parenting classes, and telephone check-ins. The primary outcomes were adjusted 24- and 36-month body mass index (BMI). Results. Compared with usual care, the NET-Works intervention showed no significant difference in BMI change at 24 (–0.12 kg/m2; 95% confidence interval [CI] = −0.44, 0.19) or 36 months (–0.19 kg/m2; 95% CI = −0.64, 0.26). Energy intake was significantly lower in the NET-Works group at 24 (–90 kcal/day; 95% CI = −164, −16) and 36 months (–101 kcal/day; 95% CI = −164, −37). Television viewing was significantly lower in the NET-Works group at 24 (rate ratio = 0.84; 95% CI = 0.75, 0.93) and 36 months (rate ratio = 0.88; 95% CI = 0.78, 0.99). Children with baseline overweight or obesity had lower BMI in the NET-Works group than those in usual care at 36 months (–0.71 kg/m2; 95% CI = −1.30, −0.12). Hispanic children had lower BMI in the NET-Works group than those in usual care at 36 months (–0.59 kg/m2; 95% CI = −1.14, −0.04). Conclusions. In secondary analyses, NET-Works significantly reduced BMI over 3 years among Hispanic children and children with baseline overweight or obesity. Trial Registration: ClinicalTrials.gov Identifier: NCT01606891. [ABSTRACT FROM AUTHOR]

Summary: Background and Objectives: The NET‐Works trial (2012–2018) randomized 534 children ages 2–4 years at baseline and their caregivers to either a 3‐year multicomponent obesity prevention intervention or a control group. This research examined treatment effects on body mass index and other outcomes at 66 months. Methods: Parent–child dyads (n = 338) who agreed to participate in a 66 month measurement visit were measured for child BMI, physical activity, diet, and cardiometabolic risk factor variables. Results: At 66 months, no significant treatment effects were observed on BMI (Effect = −0.38; 95% CI = −1.13, 0.37). Subgroup results were consistent with the NET‐Works 36 month results. Children with overweight at baseline in the intervention group gained significantly less BMI versus children with overweight in the control group (Effect = −1.28; 95% CI = −2.48, −0.07). Among Hispanic children, those in the intervention gained significantly less BMI than those in the control group (Effect = −1.04; 95% CI = −1.97, −0.11). Conclusions: Evidence suggests that early intervention with children at highest risk for obesity, using community‐based, multicomponent, multisetting interventions, may be effective in reducing excess weight gain and obesity among certain subgroups of children. The intervention appeared to be effective in slowing BMI gain 66 months after randomization among children who were already overweight at ages 2–4 years and among children of Hispanic ethnicity. [ABSTRACT FROM AUTHOR]

Objective: Depression among pregnant women is a prevalent public health problem associated with poor maternal and offspring development. Behavioral activation (BA) is a scalable intervention aligned with pregnant women's preference for nonpharmacological depression care. This is the first test of the effectiveness of BA for depression among pregnant women, which aimed to evaluate the effectiveness of BA as compared with treatment as usual (TAU). Method: Pregnant women (mean age = 28.75 years; SD = 5.67) with depression symptoms were randomly assigned to BA (n = 86) or TAU (n = 77). Exclusion criteria included known bipolar or psychotic disorder or immediate self-harm risk. Follow-up assessment occurred 5 and 10 weeks postrandomization and 3 months postpartum using self-report measures of primary and secondary outcomes and putative targets. Results: Compared with TAU, BA was associated with significantly lower depressive symptoms (d = 0.34, p = .04) and higher remission (56.3% vs. 30.3%, p = .003). BA also demonstrated significant advantage on anxiety and perceived stress. Participants attended most BA sessions and reported high satisfaction. Participants in BA reported significantly higher levels of activation (d = 0.69, p < .0002) and environmental reward (d = 0.54, p < .003) than those who received TAU, and early change in both of these putative targets significantly mediated subsequent depression outcomes. Conclusions: BA is effective for pregnant women, offering significant depression, anxiety, and stress benefits, with mediation analyses supporting the importance of putative targets of activation and environmental reward. [ABSTRACT FROM AUTHOR]

This narrative review summarizes the literature regarding community-supported agriculture (CSA) with a focus on its use as a dietary and health improvement strategy. CSA members are typically women, white, highly educated, and affluent. The majority of members are motivated to participate in CSA by a concern for the environment and a desire for locally grown, high-quality, and organic produce. Numerous studies have provided evidence of the economic, community, environmental, and food quality related benefits of CSAs. A substantial body of literature has also explored the CSA member experience and has found that members are generally very satisfied, but membership turnover rates are often high. Research regarding the association between dietary intake and health is more limited and mostly descriptive in nature. CSA members often report increased consumption and variety of fruits and vegetables, changes in the household food environment, and changes in meal patterns. A small number of anecdotal reports also support the association between CSA participation and improved health status. However, there is a dearth of experimental research in this area, and results of these studies are mixed. Future research opportunities include longitudinal studies to evaluate repeat CSA participation and the long-term sustainability of CSA-related dietary and health changes. In addition, research is needed to address some of the methodologic limitations of the current research with regard to survey tools, generalizability of results, self-reporting bias, and CSA member support. [ABSTRACT FROM AUTHOR]

Objective: To investigate the use of community-supported agriculture (CSA) as an employer-based health promotion intervention.Design: Quasi-experimental study using a convenience sample of employees at three employers.Setting: Participants and controls from three Minnesota employers completed baseline and follow-up health assessments and surveys about their experiences with CSA.Subjects: A total of 324 participants purchased a CSA share and were eligible for study inclusion. Study participants were matched by age, sex, employer and occupation to a non-randomized control group of individuals who did not purchase a CSA share but completed health assessments during the same time frame as the study participants.Results: The majority of participants were female, white, middle-aged and highly educated. The most common reason for purchasing a CSA share was a desire for fresh food, and the majority of participants were satisfied with their experience. Participants reported a significant increase in the number of vegetables present in the household and the frequency of family meals. The frequency of eating out decreased significantly, especially at fast-food restaurants. Participants also reported an increase in the amount and variety of produce consumed. However, health assessment data did not show significant changes in dietary intake, health status or BMI.Conclusions: CSA participation was associated with improvement in some aspects of the household environment and dietary behaviours. Further research is needed to determine whether employer-based CSA interventions may also lead to improvements in dietary intake and health. [ABSTRACT FROM AUTHOR]

Behavioral weight loss programs help people achieve clinically meaningful weight losses (8–10% of starting body weight). Despite data showing that only half of participants achieve this goal, a “one size fits all” approach is normative. This weight loss intervention science gap calls for adaptive interventions that provide the “right treatment at the right time for the right person.” Sequential Multiple Assignment Randomized Trials (SMART), use experimental design principles to answer questions for building adaptive interventions including whether, how, or when to alter treatment intensity, type, or delivery. This paper describes the rationale and design of the BestFIT study, a SMART designed to evaluate the optimal timing for intervening with sub-optimal responders to weight loss treatment and relative efficacy of two treatments that address self-regulation challenges which impede weight loss: 1) augmenting treatment with portion-controlled meals (PCM) which decrease the need for self-regulation; and 2) switching to acceptance-based behavior treatment (ABT) which boosts capacity for self-regulation. The primary aim is to evaluate the benefit of changing treatment with PCM versus ABT. The secondary aim is to evaluate the best time to intervene with sub-optimal responders. BestFIT results will lead to the empirically-supported construction of an adaptive intervention that will optimize weight loss outcomes and associated health benefits. [ABSTRACT FROM AUTHOR]

Abstract: Obesity prevention in children offers a unique window of opportunity to establish healthful eating and physical activity behaviors to maintain a healthful body weight and avoid the adverse proximal and distal long-term health consequences of obesity. Given that obesity is the result of a complex interaction between biological, behavioral, family-based, and community environmental factors, intervention at multiple levels and across multiple settings is critical for both short- and long-term effectiveness. The Minnesota NET-Works (Now Everybody Together for Amazing and Healthful Kids) study is one of four obesity prevention and/or treatment trials that are part of the Childhood Obesity Prevention and Treatment (COPTR) Consortium. The goal of the NET-Works study is to evaluate an intervention that integrates home, community, primary care and neighborhood strategies to promote healthful eating, activity patterns, and body weight among low income, racially/ethnically diverse preschool-age children. Critical to the success of this intervention is the creation of linkages among the settings to support parents in making home environment and parenting behavior changes to foster healthful child growth. Five hundred racially/ethnically diverse, two–four year old children and their parent or primary caregiver will be randomized to the multi-component intervention or to a usual care comparison group for a three-year period. This paper describes the study design, measurement and intervention protocols, and statistical analysis plan for the NET-Works trial. [Copyright &y& Elsevier]

Abstract: Pediatric primary care is an important setting in which to address obesity prevention, yet relatively few interventions have been evaluated and even fewer have been shown to be effective. The development and evaluation of cost-effective approaches to obesity prevention that leverage opportunities of direct access to families in the pediatric primary care setting, overcome barriers to implementation in busy practice settings, and facilitate sustained involvement of parents is an important public health priority. The goal of the Healthy Homes/Healthy Kids (HHHK 5–10) randomized controlled trial is to evaluate the efficacy of a relatively low-cost primary care-based obesity prevention intervention aimed at 5 to 10year old children who are at risk for obesity. Four hundred twenty one parent/child dyads were recruited and randomized to either the obesity prevention arm or a Contact Control condition that focuses on safety and injury prevention. The HHHK 5–10 obesity prevention intervention combines brief counseling with a pediatric primary care provider during routine well child visits and follow-up telephone coaching that supports parents in making home environmental changes to support healthful eating, activity patterns, and body weight. The Contact Control condition combines the same provider counseling with telephone coaching focused on safety and injury prevention messages. This manuscript describes the study design and baseline characteristics of participants enrolled in the HHHK 5–10 trial. [Copyright &y& Elsevier]

Objective: The Keep It Off trial evaluated the efficacy of a phone-based weight loss maintenance intervention among adults who had recently lost weight in Minnesota (2007-2010).Methods: 419 adults who had recently lost ≥ 10% of their body weight were randomized to the "Guided" or "Self-Directed" intervention. Guided participants received a 10 session workbook, 10 biweekly, eight monthly and six bimonthly phone coaching calls, bimonthly weight graphs and tailored letters based on self-reported weights. Self-Directed participants received the workbook and two calls. Primary outcomes are weight change and maintenance (regain of <2.5% of baseline body weight).Results: Mixed model repeated-measures analysis examining weight change revealed a significant time by treatment group interaction (p<0.0085). Guided participants regained significantly less weight than the Self-Directed participants at 12 and 24 months. The odds of 24 month maintenance were 1.37 (95% CI: 0.97-2.03) times greater in the Guided than in the Self-Directed group. When maintenance rates were compared across all follow-ups, there was a consistently higher maintenance rate for Guided participants (HR 1.31, 95% CI: 1.12-1.54).Conclusions: A sustained, supportive phone- and mail-based intervention promotes weight loss maintenance relative to a brief intervention for participants who have recently lost weight. [ABSTRACT FROM AUTHOR]

Abstract: Objective: The Keep It Off trial evaluated the efficacy of a phone-based weight loss maintenance intervention among adults who had recently lost weight in Minnesota (2007–2010). Methods: 419 adults who had recently lost ≥10% of their body weight were randomized to the “Guided” or “Self-Directed” intervention. Guided participants received a 10 session workbook, 10 biweekly, eight monthly and six bimonthly phone coaching calls, bimonthly weight graphs and tailored letters based on self-reported weights. Self-Directed participants received the workbook and two calls. Primary outcomes are weight change and maintenance (regain of <2.5% of baseline body weight). Results: Mixed model repeated-measures analysis examining weight change revealed a significant time by treatment group interaction (p<0.0085). Guided participants regained significantly less weight than the Self-Directed participants at 12 and 24months. The odds of 24month maintenance were 1.37 (95% CI: 0.97–2.03) times greater in the Guided than in the Self-Directed group. When maintenance rates were compared across all follow-ups, there was a consistently higher maintenance rate for Guided participants (HR 1.31, 95% CI: 1.12–1.54). Conclusions: A sustained, supportive phone- and mail-based intervention promotes weight loss maintenance relative to a brief intervention for participants who have recently lost weight. [Copyright &y& Elsevier]

Abstract: Long-term weight-loss maintenance is notoriously difficult to achieve and promote. As the novelty of weight loss treatment fades, enthusiasm for diet and exercise tends to wane in the maintenance phase. Given the recognition of obesity as a chronic disorder requiring continued engagement in weight-control behaviors, there is a need to identify cost-effective and supportive therapies that can sustain motivation. In this paper, we describe the study design and baseline characteristics of participants enrolled in a trial to evaluate a program (Keep It Off) developed specifically for weight-loss maintenance using therapeutic phone contact with recent weight losers throughout the period in which they are at highest risk for weight regain. In the Keep It Off randomized clinical trial we are evaluating this phone-based intervention that focuses on key weight-loss maintenance behaviors followed by continued self-monitoring, reporting of weight, feedback, and outreach in members of a Minnesota managed-care organization. The goal of the intervention is to flatten the typical relapse curve. Moreover, data from this trial will inform our understanding of weight-loss maintenance, including predictors and behaviors that increase the likelihood of success over the long term. [Copyright &y& Elsevier]

Objectives: To assess the correlates of parental classification of adolescent weight status. Methods: Measured adolescent weight status was compared to parent self-report perception data (n=374 dyads) using multivariate analyses with interactions to identify characteristics associated with inaccurate parent classification of adolescent weight status. Results: Adolescent weight status was underestimated by 31% of parents. College-educated parents were more likely to underestimate the weight of their male adolescents (OR=1.95) and overweight adolescents (OR=4.0). Non-college-educated parents were 8.92 times as likely to misclassify overweight adolescents, regardless of the sex of the child. Conclusions: Parental perception may play a role in supporting adolescent's healthy weight-related behaviors. [ABSTRACT FROM AUTHOR]

Abstract: Objective: To evaluate the efficacy at 6-, 12-, and 24-month follow-up of Keep Active Minnesota (KAM), a telephone and mail-based intervention designed to promote physical activity (PA) maintenance among currently active adults age 50 to 70. Method: Participants who reported having recently increased their MVPA to a minimum of 2d/wk, 30min/bout, (N =1049) were recruited in 2004 and 2005 from one large managed care organization in Minnesota, and randomly assigned to either treatment (KAM; N =523), or Usual Care (UC; N =526) with PA assessed using the CHAMPS questionnaire, and expressed as kcal/wk energy expenditure. Results: We find a sustained, significant benefit of the intervention at 6, 12 and 24months. kcal/wk expenditure in moderate or vigorous activities was higher at 6 (p <.03, Cohen''s d 6m =.16), 12 (p <.04, d 12m =.13) and 24months (p <.01, d 24m =.16) for KAM participants, compared to UC participants. Conclusions: The KAM telephone- and mail-based PA maintenance intervention was effective at maintaining PA in both the short-term (6months) and longer-term (12 and 24months) relative to usual care. [Copyright &y& Elsevier]

Purpose. To address the translational research question regarding the optimal intervention "dose" to produce the most cost-effective rate of weight loss, we conducted the Drop It At Last (DIAL) study. Design. DIAL is a 6-month pilot randomized trial to examine the efficacy of phone-based weight loss programs with varying levels of treatment contact (10 vs. 20 sessions) in comparison to self-directed treatment. Setting. Participants were recruited from the community via mailings and advertisement. Subjects. Participants were 63 adults with a body mass index between 30 and 39 kg/m². Intervention. Participants received a standard set of print materials and were randomized to either: (1) self-directed treatment; (2) 10 phone coaching sessions; or (3) 20 phone coaching sessions. Measures. Measured height, weight, and psychosocial and weight-related self-monitoring measures were collected at baseline and follow-up. Analysis. General linear models were used to examine 6-month treatment group differences in weight loss and in psychosocial and behavioral measures. Results. Weight losses were -2.3, -3.2, and -4.9 kg in the self-directed, 10-session, and 20- session groups, respectively (p < .21). Participants who completed 10 or more sessions lost more weight (-5.1 kg) compared to those completed four or fewer sessions (- .3 kg, p < .04). Conclusion. Phone-based weight loss program participation is associated with modest weight loss. The optimal dose and timing of intervention warrant further study. [ABSTRACT FROM AUTHOR]

Objective: To examine the effect of self-weighing frequency on weight change and body satisfaction. Design: Observational study based on findings from a 6-month randomized controlled telephone-based weight loss trial. Data collected at baseline and 6 months. Setting: Metropolitan community-based sample. Participants: Sixty-three obese adults. Mean age 49.5 years, 82% percent white, and 79% female. Mean body mass index at baseline was 34.2 kg/m2. Main Outcome Measures: Change in weight and body satisfaction. Analysis: General linear model regression was used to assess the effect of self-weighing on outcomes of interest. Statistical significance was set at a level .05. Treatment group and baseline values of dependent variables included as covariates in all analyses. Results: Participants who increased their frequency of self-weighing over the 6-month period demonstrated significantly better weight loss outcomes than those who maintained or decreased their frequency of self-weighing (-6.8 kg vs -3.1 kg, F = 8.59, p .006). There were no significant associations between self-weighing frequency and body satisfaction at 6 months (F 0.55, P .58). Conclusions and Implications: These findings support frequent self-weighing for weight control. There appears to be little or no effect of self-weighing on body satisfaction. Future research should replicate these findings across a larger, more diverse population of overweight adults. [ABSTRACT FROM AUTHOR]

Background. Previous research has shown significant associations between depression and substance use and eating disordered behaviors. However, no research to date has described associations between depressive symptoms and nutritional intake or physical activity among adolescents in a nonclinical, population-based sample.Methods. Classroom surveys were completed by 4,734 ethnically diverse, middle- and high school students. Based on their depressive symptom scores, males and females were categorized with low-, moderate-, or high-depressive symptom status. Linear models were used to examine eating and health behavior variables by depressive symptom groups.Results. Depressive symptoms were positively associated with health-compromising attitudes such as perceived barriers to healthy eating and weight concerns, and health-compromising behaviors such as unhealthy weight-control behaviors and substance use, including caffeine. Depressive symptoms were negatively associated with health-promoting behaviors such as eating breakfast, lunch, and dinner. However, most associations between depressive symptoms and dietary micronutrients were not statistically significant. Health-promoting moderate-to-vigorous physical activity was negatively associated with depressive symptoms among males.Conclusions. Adolescents who report depressive symptoms are at risk for other health-compromising attitudes and behaviors and are also less likely to engage in health-promoting behaviors. Depressive symptoms may be an underlying trait in the expression of health behaviors among adolescents. [Copyright &y& Elsevier]

Background. This paper presents reliability and validity analyses of physical activity-related psychosocial questionnaires completed by 8- to 10-year-old African-American girls at baseline and follow-up assessments of pilot intervention studies in the Girls health Enrichment Multi-site Study (GEMS).Methods. Two hundred ten girls participated in the GEMS 12-week pilot studies and had their height and weight measured, wore an accelerometer for 3 days and completed a measure of their usual physical activity (PA) at baseline and after the 12-week intervention. Subgroups of girls also completed physical activity-related psychosocial measures at these two time points including: (a) self-concept; (b) self-efficacy; (c) outcome expectancies; and d) preferences. Principal components analysis was conducted on the psychosocial measures obtained at baseline. Cronbach''s alpha and test–retest reliability were computed. Convergent validity was assessed by correlating the baseline psychosocial measures with baseline physical activity measures and body mass index (BMI).Results. The following sub-scales were derived: Activity Preference, Positive Expectancies and Negative Expectancies for physical activity. Physical Performance Self-Concept and Self-Efficacy for physical activity were kept as single dimensional scales. Sub-scales, derived from principal components analyses, were Activity Preference, Positive Expectancies, and Negative Expectancies for physical activity. Internal consistency estimates for the various scales were substantial to excellent (0.67–0.85), while test–retest reliability estimates were fair to moderate (0.22–0.56). Correlations between the PA psychosocial sub-scales and measured levels of activity measures showed evidence of convergent validity for the Activity Preference sub-scale, although social desirability may have influenced the significant associations observed.Conclusions. The Activity Preference was a fairly reliable and valid measure. Further studies are needed to examine the utility of activity-related psychosocial measures in interventions to increase physical activity among preadolescent African-American girls. [Copyright &y& Elsevier]

Background. Reliability and validity were established for weight concern measures completed by 8–10-year-old African-American girls participating in a pilot obesity prevention program.Methods. Two hundred ten girls and parents participated in the program. Girls completed subscales of the McKnight Risk Factor Survey (MRFS) and body silhouette ratings, had height, weight, and body fat measured, wore accelerometers for 3 days, and completed two dietary recalls. Principal components analysis, internal consistency, and test–retest reliability were computed for weight concerns and body image measures along with convergent validity with body mass index (BMI), percent body fat (PBF), physical activity, and dietary intake.Results. A Moderate Weight Control Behaviors (MWCB) subscale was derived from the MRFS. Overconcern with Weight and Shape (OWS) was a stand-alone scale. Internal consistency estimates for the scales were substantial ranging from 0.71 to 0.84. Test–retest reliabilities were moderate (0.45–0.58). OWS, MWCB, body silhouette rating, and body size discrepancy were positively associated with BMI and PBF. The “like to look” silhouette rating was negatively associated with PBF.Conclusions. Weight concern measures had reasonable levels of internal consistency and promising validity, but only moderate test–retest reliability among preadolescent African-American girls. Refinement and further validation of weight concern measures in this population are warranted. [Copyright &y& Elsevier]

Background. Valid and reliable physical activity checklists are needed to assess effectiveness of interventions. This study tested the validity and reliability of the Girls health Enrichment Multi-site Studies (GEMS) Activity Questionnaire.Methods. Two-hundred and ten African-American girls completed the GEMS Activity Questionnaire (GAQ), a checklist of 28 physical and 7 sedentary activities, including TV viewing, inquiring whether performed on the previous day (“yesterday”), and whether usually performed (“usual”). The girls wore an accelerometer (used as the criterion for validity) for three consecutive days at baseline and after a 12-week pilot intervention. Data from 172 girls at baseline and follow-up were usable for this report.Results. Girls were (mean ± SD) 8.8 ± 0.8 years old with a BMI of 22.3 ± 5.9 kg/m2. The intraclass correlation (ICC) examining reliability for the accelerometer across 3 days at baseline for the combined group was fair (ICC = 0.33, P < 0.21). The test–retest reliability coefficient for the 18-item MET-weighted GAQ yesterday scores for the comparison group of girls was 0.57 (P < 0.001). At baseline and follow-up, nonsignificant correlations were observed between 3-day accelerometer counts/minute and GAQ 18-item usual score for both comparison and intervention groups. A significant correlation was found between change in accelerometer minutes of moderate-to-vigorous activity (MVPA) between 12 noon and 6 PM and change in GAQ physical activities in the comparison girls (R = 0.35, P < 0.01). The TV-usual score was correlated with 3-day accelerometer counts/minute (R = −0.19, P = 0.02) at baseline for the total sample.Conclusions. Correlations between the GAQ and accelerometer were low, indicating low validity. Although the GAQ may be helpful in describing types of physical activities performed, it needs further development to improve its psychometric properties. [Copyright &y& Elsevier]

Objective: Card-sorting tasks for assessing food and activity preferences and patterns among African American girls were developed. Associations among food preference and intake frequency, activity preference and frequency, and body mass index were examined.Design: Participants completed newly developed card-sorting tasks assessing food and activity preferences and patterns. Height and weight were measured.Subjects/setting: Ninety-six 8- to 10-year-old African American girls from schools and community centers in Minneapolis-St. Paul.Main outcome measures: Preference and frequency data for 64 foods/beverages and 34 activities.Statistical analyses: Frequencies for food and activity preference and frequency categories were computed. Pearson correlations among food and activity preference, frequency, and body mass index were computed.Results: High-sugar (eg, fruit drinks, soda) and/or high-fat (eg, ice cream, cookies) foods were among the most popular and frequently consumed. Ninety-six percent of girls liked fruit drinks, with 35% consuming them “almost every day.” Less-structured activities such as biking, games, jump rope, and dance were most popular. Biking was preferred by 85% of girls, with 48% biking “almost every day.” Food preference and frequency categories were moderately correlated (r=0.30 to 0.58), as were activity preference and frequency (r=0.37 to 0.49).Applications: The card-sorting tasks are useful tools for assessing food and activity preferences and patterns in girls. Obesity prevention programs for African American girls should include preferred activities such as dance, jump rope, and active play. Programs may also benefit from a focus on replacing high fat/high sugar snacks and sweetened beverages with low-fat, lower-calorie snacks and beverages (eg, fruit, vegetables, water). [Copyright &y& Elsevier]

Presents a study which investigated the perceived function of eating for women with bulimia nervosa. Function of binge eating as an avoidance coping response; Methodology; Results; Discussion.

Focuses on a study which identified the determinants of exercise behavior. Differentiating between exercise adoption, maintenance ,and relapse; Personal characteristics associated with physical activity; Environmental factors.

Provides information on a study which described health beliefs, weight concern, dieting practices and weight-loss program preferences of American Indian women residing in urban setting. Methods and procedures; Results and discussion; Applications.

Objectives: This study examines motivations for yoga and identifies unique motivational profiles among a sample of young adult yoga practitioners. This study further determines how young adult yoga practitioners' motivational profiles associate with physical health behaviors and psychological factors. Subjects/Setting: Survey data were drawn from the fourth wave of a large, population-based study (Project EAT-IV; Eating and Activity in Teens and Young Adults). Design: Latent class analysis (LCA) was used to identify motivational profiles among Project EAT-IV participants practicing yoga (n = 297; mean age: 30.8--1.7 years; 79.7% female). Cross-sectional associations between latent motivational profiles, physical health behaviors, and psychological factors were determined with unadjusted and adjusted (gender, race/ethnicity, and body mass index) general linear models. Results: Across motivational profiles, most young adult yoga practitioners were motivated by enhanced fitness and stress reduction/relaxation. Additional motivations for yoga clustered by appearance (desire to change body appearance or weight) or mindfulness (desire to increase present moment awareness) underpinnings. The LCA characterized motivational profiles as ''Low Appearance, Low Mindfulness'' (Class 1; n = 77), ''Low Appearance, High Mindfulness'' (Class 2; n = 48), ''High Appearance, Low Mindfulness'' (Class 3; n = 79), and ''High Appearance, High Mindfulness'' (Class 4; n = 93). Having a profile with high mindfulness and low appearance motivations (Class 2) was associated with higher body satisfaction in comparison to the other classes (p < 0.001). Relative to Class 2, those with low mindfulness motivations (Class 1; Class 3) reported less total physical activity (p = 0.002) and those with high appearance motivations (Class 3; Class 4) reported higher compulsive exercise scores (p = 0.002). Conclusions: In this sample, high mindfulness and low appearance motivations for yoga appeared optimal for physical and psychological health. Cross-sectional findings suggest that young adult yoga practitioners' mindbody health may be supported by motivational underpinnings that emphasize yoga's internal (mindfulness) rather than external (appearance) benefits. [ABSTRACT FROM AUTHOR]

Summary: Objective: To prospectively evaluate the relationship between cumulative environmental stress and cardiometabolic risk in middle childhood, and to examine whether hair cortisol, a measure of hypothalamic pituitary adrenal‐axis activity, mediates this relationship. Methods: In a cohort of children from low‐income households (n = 320; 59% Hispanic, 23% Black, body mass index (BMI) percentile >50th at enrollment), environmental stressors including family and neighbourhood factors representing disadvantage/deprivation, and cortisol concentrations from hair samples, were measured over five timepoints beginning when children were 2–4 years old. Cardiometabolic risk factors (i.e., BMI, blood pressure, lipids, blood sugar, C‐reactive protein) were measured at the final timepoint when children were 7–11 years of age. Results: In adjusted logistic regression models, greater cumulative environmental stress was associated with a higher likelihood of elevated cardiometabolic risk in middle childhood (p = 0.01). Children from minoritized racial/ethnic groups had a higher prevalence of both stressors and cardiometabolic risk factors. Cumulative environmental stress was associated with higher hair cortisol concentrations (p < 0.01). However, hair cortisol was not directly associated with cardiometabolic risk factors and did not explain the association between environmental stress and cardiometabolic risk in causal mediation analysis. Conclusions: The influence of cumulative stress on cardiometabolic health can be observed in middle childhood and may contribute to cardiometabolic health disparities, highlighting the importance of public health interventions to mitigate disadvantage. [ABSTRACT FROM AUTHOR]

Summary: Background: Pediatric primary care is an important setting for addressing obesity prevention. Objective: The Healthy Homes/Healthy Kids 5‐10 randomized controlled trial evaluated the efficacy of an obesity prevention intervention integrating pediatric primary care provider counseling and parent‐targeted phone coaching. Methods: Children aged 5 to 10 years with a BMI between the 70th and 95th percentile and their parents were recruited from pediatric primary care clinics. Participants received well‐child visit provider counseling about obesity and safety/injury prevention and were then randomized to a 14‐session phone‐based obesity prevention (OP; n = 212) or safety and injury prevention contact control (CC; n = 209) intervention. The primary outcome was 12 and 24‐month child BMI percentile. Results: There was no overall significant treatment effect on child BMI percentile. Caloric intake was significantly lower among OP compared with CC participants at 12 months (P < .005). In planned subgroup analyses, OP condition girls had significantly lower BMI percentile (P < .05) and BMI z‐score (P < .02) at 12 and 24 months relative to CC girls and were less likely to be overweight (38.0% vs 53.0%, P < .01) or (obese 3.4% vs 8.8%, P < .10) at follow‐up. Conclusions and Relevance: An obesity prevention intervention integrating brief provider counseling and parent‐targeted phone counseling did not impact 12 and 24‐month BMI status overall but did have a significant impact on BMI in girls. [ABSTRACT FROM AUTHOR]

Severe obesity is a complex, chronic disease affecting nearly 9% of adolescents in the U.S. Although the current mainstay of treatment is lifestyle therapy, pediatric clinical practice guidelines recommend the addition of adjunct anti-obesity medication (AOM), such as phentermine and topiramate. However, guidance regarding when adjunct AOM should be started and how AOM should be used is unclear. Furthermore, an inherent limitation of current treatment guidelines is their "one-size-fits-all" approach, which does not account for the heterogeneous nature of obesity and high degree of patient variability in response to all interventions. This paper describes the study design and methods of a sequential multiple assignment randomized trial (SMART), "SMART Use of Medications for the Treatment of Adolescent Severe Obesity." The trial will examine 1) when to start AOM (specifically phentermine) in adolescents who are not responding to lifestyle therapy and 2) how to modify AOM when there is a sub-optimal response to the initial pharmacological intervention (specifically, for phentermine non-responders, is it better to add topiramate to phentermine or switch to topiramate monotherapy). Critically, participant characteristics that may differentially affect response to treatment will be assessed and evaluated as potential moderators of intervention efficacy. Data from this study will be used to inform the development of an adaptive intervention for the treatment of adolescent severe obesity that includes empirically-derived decision rules regarding when and how to use AOM. Future research will test this adaptive intervention against standard "one-size-fits-all" treatments. [ABSTRACT FROM AUTHOR]

Post-COVID-19 condition (also known as long COVID) is an emerging chronic illness potentially affecting millions of people. We aimed to evaluate whether outpatient COVID-19 treatment with metformin, ivermectin, or fluvoxamine soon after SARS-CoV-2 infection could reduce the risk of long COVID. We conducted a decentralised, randomised, quadruple-blind, parallel-group, phase 3 trial (COVID-OUT) at six sites in the USA. We included adults aged 30–85 years with overweight or obesity who had COVID-19 symptoms for fewer than 7 days and a documented SARS-CoV-2 positive PCR or antigen test within 3 days before enrolment. Participants were randomly assigned via 2 × 3 parallel factorial randomisation (1:1:1:1:1:1) to receive metformin plus ivermectin, metformin plus fluvoxamine, metformin plus placebo, ivermectin plus placebo, fluvoxamine plus placebo, or placebo plus placebo. Participants, investigators, care providers, and outcomes assessors were masked to study group assignment. The primary outcome was severe COVID-19 by day 14, and those data have been published previously. Because the trial was delivered remotely nationwide, the a priori primary sample was a modified intention-to-treat sample, meaning that participants who did not receive any dose of study treatment were excluded. Long COVID diagnosis by a medical provider was a prespecified, long-term secondary outcome. This trial is complete and is registered with ClinicalTrials.gov , NCT04510194. Between Dec 30, 2020, and Jan 28, 2022, 6602 people were assessed for eligibility and 1431 were enrolled and randomly assigned. Of 1323 participants who received a dose of study treatment and were included in the modified intention-to-treat population, 1126 consented for long-term follow-up and completed at least one survey after the assessment for long COVID at day 180 (564 received metformin and 562 received matched placebo; a subset of participants in the metformin vs placebo trial were also randomly assigned to receive ivermectin or fluvoxamine). 1074 (95%) of 1126 participants completed at least 9 months of follow-up. 632 (56·1%) of 1126 participants were female and 494 (43·9%) were male; 44 (7·0%) of 632 women were pregnant. The median age was 45 years (IQR 37–54) and median BMI was 29·8 kg/m2 (IQR 27·0–34·2). Overall, 93 (8·3%) of 1126 participants reported receipt of a long COVID diagnosis by day 300. The cumulative incidence of long COVID by day 300 was 6·3% (95% CI 4·2–8·2) in participants who received metformin and 10·4% (7·8–12·9) in those who received identical metformin placebo (hazard ratio [HR] 0·59, 95% CI 0·39–0·89; p=0·012). The metformin beneficial effect was consistent across prespecified subgroups. When metformin was started within 3 days of symptom onset, the HR was 0·37 (95% CI 0·15–0·95). There was no effect on cumulative incidence of long COVID with ivermectin (HR 0·99, 95% CI 0·59–1·64) or fluvoxamine (1·36, 0·78–2·34) compared with placebo. Outpatient treatment with metformin reduced long COVID incidence by about 41%, with an absolute reduction of 4·1%, compared with placebo. Metformin has clinical benefits when used as outpatient treatment for COVID-19 and is globally available, low-cost, and safe. Parsemus Foundation; Rainwater Charitable Foundation; Fast Grants; UnitedHealth Group Foundation; National Institute of Diabetes, Digestive and Kidney Diseases; National Institutes of Health; and National Center for Advancing Translational Sciences. [ABSTRACT FROM AUTHOR]

Given emerging adulthood is a period of increased independence, it is unclear how much contact emerging adults have with their parents, how this communication occurs, and how frequency of communication differs across sociodemographic characteristics. The main aim of this study was to examine communication patterns and modalities between emerging adults and their parents. Data are from an 8-year longitudinal, population-based study of socio-economically and racially/ethnically diverse adolescents followed into emerging adulthood (n = 1539; mean age = 22.1; 53.1% female). Latent profile analysis results supported a 5-class model, in which classes were characterized by patterns of frequency of communication with parents across different modalities. The most common communication modality included medium levels of engagement (i.e., few times/week), with both parents, and was in-person or via the phone (i.e., calls, text messages, email). Results differed by race/ethnicity. Findings from this exploratory study may be useful for supporting positive communication patterns between emerging adults and their parents and may inform what intervention delivery format (e.g., phone, social media-based, in-person) may be more effective for certain parent/emerging adult subgroups engaging in family-based interventions. Highlights: Emerging adults and their parents were communicating regularly, several times per week. Preferred communication modality was phone (i.e., texting, emailing, calling). The most common pattern of communication was medium engagement with both parents. Emerging adults who also had high connectedness with their mothers reported the most frequent communication. [ABSTRACT FROM AUTHOR]

Objective: Having frequent family dinners is associated with better diet quality in children; however, it is unknown whether the frequency of certain family meal types (i.e. dinner) is more strongly associated with better child weight and diet quality compared with other meal types (i.e. breakfast, lunch). Thus, the current study examined the frequency of eating breakfast, lunch or dinner family meals and associations with pre-school children's overall diet quality (HEI-2010) and BMI percentile.Design: Cross-sectional baseline data (2012-2014) from two randomized controlled childhood obesity prevention trials, NET-Works and GROW, were analysed together.Setting: Studies were carried out in community and in-home settings in urban areas of Minnesota and Tennessee, USA.Subjects: Parent-child (ages 2-5 years) pairs from Minnesota (n 222 non-Hispanics; n 312 Hispanics) and Tennessee (n 545 Hispanics; n 55 non-Hispanics) participated in the study.Results: Over 80 % of families ate breakfast or lunch family meals at least once per week. Over 65 % of families ate dinner family meals ≥5 times/week. Frequency of breakfast family meals and total weekly family meals were significantly associated with healthier diet quality for non-Hispanic pre-school children (P<0·05), but not for Hispanic children. Family meal frequency by meal type was not associated with BMI percentile for non-Hispanic or Hispanic pre-school children.Conclusions: Breakfast family meal frequency and total weekly family meal frequency were associated with healthier diet quality in non-Hispanic pre-school children but not in Hispanic children. Longitudinal research is needed to clarify the association between family meal type and child diet quality and BMI percentile. [ABSTRACT FROM AUTHOR]

Background: Efforts to recruit and retain participants in clinical trials are challenging, especially in studies that include minority or low-income children. To date, no studies have systematically examined recruitment and retention strategies and their effectiveness in working successfully with this population. We examined strategies employed to recruit or retain minority or low-income children in trials that included an obesity-related behavior modification component.Methods: First, completed home-, community-, and school-based trials involving minority or low-income children aged 2-17 years were identified in a search of the ClinicalTrials.gov registry. Second, a PubMed search of identified trials was conducted to locate publications pertinent to identified trials. Recruitment and retention rates were calculated for studies that included relevant information.Results: Our final analytic sample included 43 studies. Of these, 25 studies reported recruitment or retention strategies, with the amount of information varying from a single comment to several pages; 4 published no specific information on recruitment or retention; and 14 had no publications listed in PubMed. The vast majority (92 %) of the 25 studies reported retention rates of, on average, 86 %. Retention rates were lower in studies that: targeted solely Hispanics or African Americans (vs. mixed races of African Americans, whites, and others); involved children and parents (vs. children only); focused on overweight or obese children (vs. general children), lasted ≥1 year (vs. <1 year), were home or community-based (vs. school-based), included nutrition and physical activity intervention (vs. either intervention alone), had body mass index or other anthropometrics as primary outcome measures (vs. obesity-related behavior, insulin sensitivity, etc.). Retention rates did not vary based on child age, number of intervention sessions, or sample size.Conclusions: Variable amounts of information were provided on recruitment and retention strategies in obesity-related trials involving minority or low-income children. Although reported retention rates were fairly high, a lack of reporting limited the available information. More and consistent reporting and systematic cataloging of recruitment and retention methods are needed. In addition, qualitative and quantitative studies to inform evidence-based decisions in the selection of effective recruitment and retention strategies for trials including minority or low-income children are warranted. [ABSTRACT FROM AUTHOR]

Objectives: The current study aimed to identify features to include in online grocery stores to support healthful food purchasing by those striving to lose weight.Design: A Value Proposition Design approach was used to gain shopper insights, devise potential online grocery store features and obtain feedback on these features.Setting: Telephone interviews were conducted to gain insight into shoppers' needs and perceptions. Results were used by the research team to identify potential online grocery shopping features that may support healthful purchase decisions, and interviews were conducted with a different sample of shoppers to gather feedback on features.Participants: Insight (n 25) and feedback (n 25) interviews were conducted with convenience samples of adults trying to lose weight.Results: Participants were primarily female, white, college educated and with obesity or overweight. Online grocery features devised by the research team based on findings from the insight interviews included (1) shopping cart nutrition rating tool; (2) healthy meal planning tool; (3) interactive healthy eating inspiration aisle and (4) healthy shopping preference settings option. Findings from the feedback interviews indicated that the healthy meal planning tool, healthy shopping preference settings option and shopping cart nutrition rating tool features were positively rated by most participants.Conclusions: There are multiple features grocers should consider including in their online stores to attract and support customers striving to eat healthy for weight loss. [ABSTRACT FROM AUTHOR]

Objective. To examine the beliefs, attitudes and health-seeking behavior surrounding the use of traditional medicine among the Karen (refugees from Burma). Methods. Three focus groups and two key-informant interviews were conducted with the Karen along with observations by researchers. Results. The Karen continue to use elements of their traditional healthcare system after resettling in the U.S. Accessibility and perceived efficacy of treatments influence their health-seeking behavior. The participants discussed beliefs about health and healing, spirituality, and their experience as refugees. Implications for improving the quality of healthcare for the Karen and recommendations for further research are discussed. [ABSTRACT FROM AUTHOR]

Background: Research suggests that the interaction between biological susceptibility and environmental risk is complex and that further study of behavioral typologies related to obesity and associated behaviors is important to further elucidate the nature of obesity risk and how to approach it for intervention. The current investigation aims to identify phenotypical lifestyle patterns that might begin to unify our understanding of obesity and obesity related behaviors. Methods: Individuals who had recently lost substantial weight of their own initiative completed measures of intentional weight control behaviors and lifestyle behaviors associated with eating. These behaviors were factor analyzed and the resulting factors were examined in relation to BMI, recent weight loss, diet, and physical activity. Results: Four meaningful lifestyle and weight control behavioral factors were identified--regularity of meals, TV related viewing and eating, intentional strategies for weight control, and eating away from home. Greater meal regularity was associated with greater recent weight loss and greater fruit and vegetable intake. Greater TV related viewing and eating was associated with greater BMI and greater fat and sugar intake. More eating away from home was related to greater fat and sugar intake, lower fruit and vegetable intake, and less physical activity. Greater use of weight control strategies was most consistently related to better weight, diet, and physical activity outcomes. Conclusions: Compared to the individual behavior variables, the identified lifestyle patterns appeared to be more reliably related to diet, physical activity, and weight (both BMI and recent weight loss). These findings add to the growing body of literature identifying behavioral patterns related to obesity and the overall weight control strategy of eating less and exercising more. In future research it will be important to replicate these behavioral factors (over time and in other samples) and to examine how changes in these factors relate to weight loss and weight maintenance over time. [ABSTRACT FROM AUTHOR]

Objectives: To build upon state-of- the-art theory and empirical data to estimate the strength of multiple mediators of the efficacious Keep Active Minnesota (KAM) physical activity (PA) maintenance intervention. Methods: The total, direct, and indirect effects through which KAM helped randomized participants (KAM n=523; UC n=526) maintain moderate or vigorous PA (MVPA) for up to 2 years were estimated using structural equation modeling. Results: Multiple mediators explained half (β=.052, P=.13) of the effect of KAM on MVPA (β=.105, P=.004). Self-efficacy was the upstream variable in 2 endogenously mediated effects, and the self-concept mediator emerged as the strongest predictor of MVPA. Conclusions: KAM positively impacted self-efficacy, which was associated with PA enjoyment, integration into the self-concept, and PA maintenance. Successful long-term PA maintenance appears to be influenced by multiple small interrelated mediational pathways. Future research evaluating maintenance models should specify recursive relationships among mediators and outcomes. [ABSTRACT FROM AUTHOR]

The article provides information on a study which determined whether a free prepared meal and incentivized structured weight loss program leads to weight loss and weight loss maintenance in obese and overweight women. The study was conducted at U.S. institutions over a period of two years with follow-up between November 2007 and April 2010. Components of the behavioral goals are energy-reduced, nutritionally adequate diet and increased physical activity, among others. A discussion on the research findings is detailed.

Abstract: Objective. : We evaluate the 6-month efficacy of Keep Active Minnesota, a phone- and mail-based physical activity maintenance intervention designed for use with adults age 50 to 70 years who have increased their physical activity within the past year. Method. : Participants (N =1049) recruited in 2004 and 2005 from one large managed-care organization in Minnesota were randomly assigned to either treatment (N =523) or usual care (N =526) with physical activity assessed using the Community Healthy Activities Model Program for Seniors questionnaire, and expressed as kcal/week expenditures. Results. : Total physical activity at baseline was similar for treatment and usual care participants (p <0.44) as was moderate/vigorous physical activity (p <0.21). Maintenance of physical activity was higher among treatment participants whose mean 6-month change in total kcal/week energy expenditure was −91, compared to −683 for usual care participants (p <0.002). Mean 6-month change in kcal/week expenditure in moderate or vigorous activities was −49 for treatment participants, compared to −612 for usual care participants (p <0.001). Conclusions. : This phone- and mail-based physical activity maintenance intervention is efficacious at maintaining physical activity at 6 months. [Copyright &y& Elsevier]

Objectives. The goal of this study was to evaluate awareness of, agreement with, and implementation of the American Academy of Pediatrics (AAP) media use guidelines among pediatricians. Pediatricians' beliefs about several media effects were also measured, as was their own media use. Pediatricians were also asked about how often they make media recommendations as part of anticipatory guidance during well-child visits, as well as the perceived efficacy of and barriers to making such recommendations. Design. A cross-sectional survey mailed to all members of the Minnesota chapter of the AAP. Participants. A total of 365 pediatricians completed the survey. Measures. The 58-item survey assessed familiarity with, agreement with, and implementation of each of 3 AAP recommendations, to limit children's media time, to discourage television (TV) viewing among children <2 years of age, and to encourage alternative entertainment for children. Pediatricians were also asked about the perceived effectiveness of and barriers to guideline implementation. In addition, pediatricians were asked to report their own TV viewing habits and their opinions about how much media affect children's health and behavior. Results. Most pediatricians were familiar with and also agreed with the 3 AAP recommendations. Their agreement may stem from the fact that pediatricians almost universally believe that children's media use negatively affects children in many different areas, including children's aggressive behavior, eating habits, physical activity levels, risk for obesity, high-risk behaviors, and school performance. Pediatricians were most likely to have encouraged alternative entertainment and were least likely to have discouraged TV viewing for children <2 years of age. The majority of pediatricians provided all 3 recommendations to parents at least sometimes. Most pediatricians reported that their recommendations were at least a little effective when they did make them. The most... [ABSTRACT FROM AUTHOR]

Objective. This paper presents the reliability and validity of several diet-related psychosocial questionnaires.Methods. At baseline and 12 weeks follow-up, parents/caregivers of one hundred fifty 8- to 10-year-old African-American completed questionnaires on food preparation habits for their daughter, perceived home barriers to healthy eating, and fruit, juice, vegetable (FJV), low-fat and high-fat food availability. Girls completed a sweetened beverage preferences questionnaire and two 24-h dietary recalls to assess intake. Principal components analyses were conducted for two newly designed measures. Internal consistency was calculated and construct validity was assessed between the psychosocial scales and obesity-related dietary variables.Results. Low-fat and high-fat food preparation for daughters, and perceived home barriers to eating low-fat food and FJV subscales were derived from the new questionnaires. Internal consistency reliabilities were moderate (0.58) to substantial (0.80) across all new and existing scales. Test–retest reliabilities were moderate (0.44) to substantial (0.79). Girls'' intake of fat as a percentage of energy was positively related to parental high-fat food preparation for daughters (P < 0.01) and negatively related to parental low-fat food preparation practices for daughters (P < 0.05).Conclusions. Measures of family influences on FJV, fat, and sweetened beverage consumption were internally consistent with moderate to substantial stability. Scales for low-fat and high-fat food preparation practices for daughters achieved construct validity with fat consumption in the hypothesized direction. Family food preparation habits appear to be important targets for future interventions. [Copyright &y& Elsevier]

ABSTRACT. Objective. The primary aim of this study was to evaluate among health care professionals their attitudes, perceived barriers, perceived skill level, and training needs in the management of child and adolescent obesity. Methods. A national needs assessment consisting of a mailed questionnaire was conducted among a random sample of health care professionals. The survey was completed by 202 pediatricians, 293 pediatric nurse practitioners, and 444 registered dietitians. Results. The majority of all respondents felt that childhood obesity was a condition that needs treatment (75%-93%), and affects chronic disease risk (76%-89%) and future quality of life (83%-93%). The most frequent barriers were lack of parent involvement, lack of patient motivation, and lack of support services. Registered dietitians were less likely to identify barriers to treatment compared with pediatricians or pediatric nurse practitioners. The most common areas of self-perceived low proficiency were in the use of behavioral management strategies, guidance in parenting techniques, and addressing family conflicts. All 3 groups expressed high interest in additional training on obesity management of children and adolescents, especially in the area of behavioral management strategies and parenting techniques. Those practitioners with >10 years of practice reported the greatest interest in training. Conclusions. Pediatric practitioners view child and adolescent obesity with concern and feel that intervention is important. However, several important barriers interfere with treatment efforts and will need to be addressed. There is also a need for increased training opportunities related to obesity prevention and treatment. The results of this study provide directions and priorities for training, education, and advocacy efforts. Pediatrics 2002;110:210-214; child obesity, adolescent obesity, practitioners, treatment child barriers. [ABSTRACT FROM AUTHOR]

This research investigated three levels of family variables—general family dysfunction, family eating attitudes and behaviors, and negative familial communication regarding physical appearance and encouragement to diet—as predictors of the severity of bulimic symptomatology in a sample of 345 undergraduate women. Participants completed The Bulimia Test—Revised (Thelen, Farmer, Wonderlich, & Smith, 1991), the Family Environment Scale (Moos & Moos, 1984), and the Family Eating Attitude and Behavior Scale (Hogen, 1988) and rated the frequency with which family members made negative statements regarding their physical appearance and the need to diet. A hierarchical multiple regression analysis indicated that all three levels of family variables accounted for significant proportions of the variance in bulimic symptomatology. When the contribution of other variables to the regression equation was controlled, negative family communications, external control of food intake, and rules related to family mealtimes remained as significant predictors. These results illustrate the importance of investigating the relative contribution of different classes of familial variables to our understanding of bulimia nervosa and suggest important foci for the prevention of eating problems and eating disorders among young women. [ABSTRACT FROM AUTHOR]

Applying the Behavior Change Technique Taxonomy has the potential to facilitate identification of effective childhood obesity intervention components. This article evaluates the feasibility of coding Childhood Obesity Prevention and Treatment Consortium interventions and compares reliability between external taxonomy-familiar coders and internal intervention-familiar coders. After training, coder pairs independently coded prespecified portions of intervention materials. An adjudication process was used to explore coding discrepancies. Reliability between internal and external coders was moderate (prevalence and bias-adjusted kappa.38 to.55). Reliability for specific target behaviors varied with substantial agreement for physical activity (.63 to.76) and moderate for dietary intake (.44 to.63). Applying the taxonomy to these interventions was feasible, but agreement was modest. Coding discrepancies highlight the importance of refining coding to capture the complexities of childhood obesity interventions, which often engage multiple recipients (e.g., parents and/or children) and address multiple behaviors (e.g., diet, physical activity, screen time). [ABSTRACT FROM AUTHOR]

This study prospectively examined the relationship of home yard-size to objectively measured physical activity over three years among a cohort of 531 low-income pre-school-aged children. An adjusted total-effect association of 12.72 additional minutes per week of moderate/vigorous physical activity (MVPA) was observed for each additional hectare of yard-size. The direct-effect association, adjusting for previous year MVPA, was not statistically significant. This study provides evidence that the private or semi-private space around the house may impact children's' physical activity. Public health and urban planning practitioners should consider these results to identify built environment solutions for improving MVPA among low-income minority children. [ABSTRACT FROM AUTHOR]

Background: The majority of participants in weight loss trials are non-Hispanic White women, while men and women of color are underrepresented. This study presents data obtained from non-targeted and targeted recruitment approaches in a trial of behavioral weight loss programs to (1) describe the yields from each approach and (2) compare the demographics, weight control histories, and study involvement of samples recruited by each approach.Methods: Data for this observational study include source of recruitment, demographic information, weight loss experiences (e.g., lifetime weight loss, current weight loss behaviors), and completion of the 6-month assessment visit.Results: Men comprised 14.2% of participants who responded to non-targeted recruitment efforts, while targeted efforts yielded 50.4% men. Similarly, people of color comprised 12.8% of those who responded to non-targeted approaches, whereas targeted recruitment methods yielded 47.2% people of color. Men recruited through targeted methods were younger (p = 0.01) than men recruited through non-targeted means but were otherwise similar. Women of color recruited through targeted methods reported use of fewer weight loss strategies relative to women of color recruited through non-targeted means (p = 0.006) but were otherwise similar. There were no differences by recruitment method on retention to the study.Conclusions: Using targeted recruitment methods increased the ethnic and gender diversity of the recruited sample without reducing study retention. This targeting also increased the enrollment of women with less weight loss experience who may not have otherwise sought out a weight loss program. Developing and implementing a targeted recruitment plan should be considered early in the clinical trial development process.Trial Registration: Clinicaltrials.gov, NCT02368002. Registered on 20 February 2015. [ABSTRACT FROM AUTHOR]

Introduction: Determining the population-based scope and stability of eating, activity, and weight-related problems is critical to inform interventions. This study examines: (1) the prevalence of eating, activity, and weight-related problems likely to influence health; and (2) the trajectories for having at least one of these problems during the transition from adolescence to adulthood.Methods: Project EAT I-IV (Eating and Activity in Teens and Young Adults) collected longitudinal survey data from 858 females and 597 males at four waves, approximately every 5 years, from 1998 to 2016, during the transition from adolescence to adulthood. Analyses were conducted in 2017-2018. Measures included high fast-food intake (≥3 times/week), low physical activity (<150 minutes/week), unhealthy weight control, body dissatisfaction, and obesity status.Results: Among females, the prevalence of having at least one eating, activity, or weight-related problems was 78.1% at Wave 1 (adolescence) and 82.3% at Wave 4 (adulthood); in males, the prevalence was 60.1% at Wave 1 and 69.2% at Wave 4. Of all outcomes assessed, unhealthy weight control behaviors had the highest prevalence in both genders. The stability of having at least one problem was high; 60.2% of females and 34.1% of males had at least one problematic outcome at all four waves.Conclusions: The majority of young people have some type of eating, activity, or weight-related problem at all stages from adolescence to adulthood. Findings indicate a need for wide-reaching interventions that address a broad spectrum of eating, activity, and weight-related problems prior to and throughout this developmental period. [ABSTRACT FROM AUTHOR]

OBJECTIVES: Although blood pressure (BP) is routinely measured in outpatient visits, elevated BP and hypertension are often not recognized. We evaluated whether an electronic health record-linked clinical decision support (CDS) tool could improve the recognition and management of hypertension in adolescents. METHODS: We randomly assigned 20 primary care clinics within an integrated care system to CDS or usual care. At intervention sites, the CDS displayed BPs and percentiles, identified incident hypertension on the basis of current or previous BPs, and offered tailored order sets. The recognition of hypertension was identified by an automated review of diagnoses and problem lists and a manual review of clinical notes, antihypertensive medication prescriptions, and diagnostic testing. Generalized linear mixed models were used to test the effect of the intervention. RESULTS: Among 31 579 patients 10 to 17 years old with a clinic visit over a 2-year period, 522 (1.7%) had incident hypertension. Within 6 months of meeting criteria, providers recognized hypertension in 54.9% of patients in CDS clinics and 21.3% of patients in usual care (P ≤ .001). Clinical recognition was most often achieved through visit diagnoses or documentation in the clinical note. Within 6 months of developing incident hypertension, 17.1% of CDS subjects were referred to dieticians or weight loss or exercise programs, and 9.4% had additional hypertension workup versus 3.9% and 4.2%, respectively (P = .001 and .046, respectively). Only 1% of patients were prescribed an antihypertensive medication within 6 months of developing hypertension. CONCLUSIONS: The CDS had a significant, beneficial effect on the recognition of hypertension, with a moderate increase in guideline-adherent management. [ABSTRACT FROM AUTHOR]