Population-based prevention of obesity: the need for comprehensive promotion of healthful eating, physical activity, and energy balance: a scientific statement from American Heart Association Council on Epidemiology and Prevention, Interdisciplinary Committee for Prevention (formerly the expert panel on population and prevention science)

Variation in prevalence of gestational diabetes mellitus among hospital discharges for obstetric delivery across 23 states in the United States

OBJECTIVE

To examine variability in diagnosed gestational diabetes mellitus (GDM) prevalence at delivery by race/ethnicity and state.

RESEARCH DESIGN AND METHODS

We used data from the Healthcare Cost and Utilization Project State Inpatient Databases for 23 states of the United States with available race/ethnicity data for 2008 to examine age-adjusted and race-adjusted rates of GDM by state. We used multilevel analysis to examine factors that explain the variability in GDM between states.

RESULTS

Age-adjusted and race-adjusted GDM rates (per 100 deliveries) varied widely between states, ranging from 3.47 in Utah to 7.15 in Rhode Island. Eighty-six percent of the variability in GDM between states was explained as follows: 14.7% by age; 11.8% by race/ethnicity; 5.9% by insurance; and 2.9% by interaction between race/ethnicity and insurance at the individual level; 17.6% by hospital level factors; 27.4% by the proportion of obese women in the state; 4.3% by the proportion of Hispanic women aged 15-44 years in the state; and 1.5% by the proportion of white non-Hispanic women aged 15-44 years in the state.

CONCLUSIONS

Our results suggest that GDM rates differ by state, with this variation attributable to differences in obesity at the population level (or "at the state level"), age, race/ethnicity, hospital, and insurance.

Genome-wide meta-analysis identifies 11 new loci for anthropometric traits and provides insights into genetic architecture

Approaches exploiting trait distribution extremes may be used to identify loci associated with common traits, but it is unknown whether these loci are generalizable to the broader population. In a genome-wide search for loci associated with the upper versus the lower 5th percentiles of body mass index, height and waist-to-hip ratio, as well as clinical classes of obesity, including up to 263,407 individuals of European ancestry, we identified 4 new loci (IGFBP4, H6PD, RSRC1 and PPP2R2A) influencing height detected in the distribution tails and 7 new loci (HNF4G, RPTOR, GNAT2, MRPS33P4, ADCY9, HS6ST3 and ZZZ3) for clinical classes of obesity. Further, we find a large overlap in genetic structure and the distribution of variants between traits based on extremes and the general population and little etiological heterogeneity between obesity subgroups.

Obesity has few effects on future psychosocial functioning of adolescents

We reexamine the effects of obesity on a wide range (n=17) of indicators of functioning drawn from five broad domains: interpersonal problems, psychological problems, suicidal behaviors, academic performance, and psychiatric disorders. Evidence on this question is mixed. Data are analyzed from a large community sample of adolescents 11-17 at baseline (n=4175) who were followed up a year later (n=3134). Using measured height and weight, overweight was defined as 95th>BMI≤85th percentile and obese as BMI >95th percentile. At baseline, obesity was associated with increased odds only for any mood disorder and poor perceived mental health. For boys, there were no significant associations, but girls had higher odds of problems at school, poor perceived mental health, and mood disorders. Results from the two-wave cohort reveal obesity increased future risk only for poor perceived mental health. For boys, the same pattern was observed, but for girls there were no significant associations. Overall, we found that weight status had few deleterious effects on adolescent social functioning, in multivariate, prospective analyses. If there is an effect of obesity on functioning, it may operate through mediators such as body image.

Service learning in a pediatric weight management program to address childhood obesity

This paper describes an inter-professional service learning collaboration and reflects benefits and considerations when incorporating a family-oriented approach in the community-based pediatric weight management program. Because obesity has tremendous consequences on a nation's health and economy, a pediatrician in a community health network has utilized an inter-professional team to implement a pediatric weight management program targeting children between the ages of 8 and 15 years. The team incorporates a culturally sensitive curriculum using a family-oriented approach for obesity prevention and intervention. Physicians, registered dietitians, occupational therapists, nurse practitioners, and mental health professionals assist participants in adopting a healthier lifestyle by addressing physical and psychosocial issues related to obesity, developing a nutrition plan, making healthier food choices, and finding fun ways to be more physically active. Graduate occupational therapy students work closely with the team members to assist delivery of interactive activities and behavior intervention.

Quality of life in overweight and obese young Chinese children: a mixed-method study

BACKGROUND

Obesity among young children in Hong Kong has become a public health problem. This study explored associations between Chinese parent reported children's quality of life (QoL), socio-demographics and young children's weight status from 27 preschool settings.

METHODS

A mixed-method approach, including quantitative and qualitative tools, was employed for this cross-sectional study. Quantitative data were collected from 336 Chinese parents of children aged 2-7 years. Paediatric Quality of Life Inventory 4.0 (PedsQL, v 4.0) and a questionnaire about parents' socio-demographics were used. In-depth interviews with mothers, teachers and children from a larger sample were the basis of 10 case studies. Quantitative data were analysed using chi-square analysis, one-way ANOVA and logistic regression. Qualitative data were analysed according to a multi-level framework that established linkages with quantitative data.

RESULTS

The children's Body Mass Index (BMI) ranged from 11.3 to 28.0 kg/m(2) and was classified into four weight groups. ANOVAs showed that the normal-weight children had significantly higher PedsQL scores in Physical Functioning than obese children (mean difference = 14.19, p < .0083) and significantly higher scores in School Functioning than overweight children (mean difference = 10.15, p < .0083). Results of logistic regression showed that relative to normal-weight children, obese children had a 2-5 times higher odds of showing problems in Physical, Social Functioning and School Performance. Overweight children had 2 times higher odds of problems in Social Functioning, and underweight children had a 2 times higher odds of problems in Physical Functioning. Children's age (χ(2) = 21.71, df = 3, p < 0.01), and housing (χ(2) = 33.00, df = 9, p < 0.01) were associated with their weight. The case studies further act as a supplement to the quantitative data that children showed emotional problems across different abnormal weight statues; and the association between children's weight status and well-being might be affected by multiple childcare arrangements and familial immigration status.

CONCLUSIONS

This study is one of only a few studies that have examined parents', teachers' and young children's own perceptions of the children's quality of life across different weight statuses. The results are discussed in terms of their implications for intervention.

Program Obesity Zero (POZ)--a community-based intervention to address overweight primary-school children from five Portuguese municipalities

OBJECTIVE

Results of the WHO European Childhood Obesity Surveillance Initiative indicated that on average one out of four primary-school children is overweight or obese. Portugal presented one of the highest prevalences of obesity. Childhood obesity prevention and treatment should be a top priority. The aim of the present study was to evaluate the effectiveness of Program Obesity Zero (POZ), a multi-component, community-, family- and school-based childhood obesity intervention.

DESIGN

Parents and children attended four individual nutrition and physical activity counselling sessions, a one-day healthy cooking workshop and two school extracurricular sessions of nutrition education. Waist circumference, BMI, physical activity level, sedentary behaviours, and nutrition and physical activity knowledge, attitudes and behaviour were assessed at baseline and after 6 months. Diet was assessed using two 24 h recalls, at baseline and at 6 months.

SETTING

Five Portuguese municipalities and local communities.

SUBJECTS

Two hundred and sixty-six overweight children (BMI ≥ 85th percentile) aged 6-10 years, from low-income families in five Portuguese municipalities, were assigned to the intervention.

RESULTS

Children showed reductions in waist circumference (-2.0 cm; P < 0.0001), mean BMI (-0.7 kg/m2; P < 0.0001) and BMI-for-age percentile (-1.7; P < 0.0001) at 6 months. Overall, children's intake of fruit and vegetables was <400 g/d throughout the intervention. After 6 months, higher fibre consumption and an apparent decrease in sugary soft drinks intake to a quarter of that observed at baseline (mean intake: 198 ml/d at baseline), with improvements in physical activity levels and screen time <2 h/d, were also observed.

CONCLUSIONS

The findings suggested that POZ is a promising intervention programme, at municipality level, to tackle childhood overweight and obesity.

Retrospective chart review for obesity and associated interventions among rural Mexican-American adolescents accessing healthcare services

PURPOSE

To report a retrospective analysis of data routinely collected in the course of healthcare services at a rural health clinic and to assess obesity incidence and associated interventions among rural Mexican-American adolescents.

DATA SOURCES

Two hundred and twelve charts reviewed; 98 (46.2%) males and 114 (53.8%) females. Data extracted included Medicaid exams conducted at the clinic within 5 years. Equal overweight or obese (n = 105, 49.5%), versus normal BMI categorizations (n = 107, 50.5%) documented overall and by gender. Female obesity higher (25.4%) than national norms (17.4%); male rates (25.5%) were within national norm. Interventions provided by nurse practitioners (94%) for 34.8%-80% of overweight/obese had limited follow-up (4%). Obesity incidence markedly increased between 13 and 18 years of age without associated interventions; 51.4%-75.6% without interventions.

CONCLUSIONS

Obesity is a healthcare problem among rural Mexican-American adolescents accessing care at the rural health clinic. Obesity intervention and follow-up was suboptimal within this setting. Rural and ethnic minority adolescents experience health disparities concerning obesity prevalence and remote healthcare access.

IMPLICATIONS

Obesity prevention and treatment during adolescence is a national health priority given physiologic and psychological tolls on health and potential for obesity into adulthood. Obesity assessment and translation of evidence-based interventions for rural Mexican-American adolescents at rural health clinics is implicated.

Comparison of nutrition standards and other recommended procurement practices for improving institutional food offerings in Los Angeles County, 2010-2012

National, state, and local institutions that procure, distribute, sell, and/or serve food to employees, students, and the public are increasingly capitalizing on existing operational infrastructures to create healthier food environments. Integration of healthy nutrition standards and other recommended practices [e.g., energy (kilocalories) postings at point-of-purchase, portion size restrictions, product placement guidelines, and signage] into new or renewing food service and vending contracts codifies an institution's commitment to increasing the availability of healthful food options in their food service venues and vending machines. These procurement requirements, in turn, have the potential to positively influence consumers' food-purchasing behaviors. Although these strategies are becoming increasingly popular, much remains unknown about their context, the processes required to implement them effectively, and the factors that facilitate their sustainability, especially in such broad and diverse settings as schools, county government facilities, and cities. To contribute to this gap in information, we reviewed and compared nutrition standards and other best practices implemented recently in a large school district, in a large county government, and across 10 municipalities in Los Angeles County. We report lessons learned from these efforts.

Churches as targets for cardiovascular disease prevention: comparison of genes, nutrition, exercise, wellness and spiritual growth (GoodNEWS) and Dallas County populations

BACKGROUND

We compared cardiovascular (CV) risk factors (CVRFs) of community-based participatory research (CBPR) participants with the community population to better understand how CBPR participants relate to the population as a whole.

METHODS

GoodNEWS participants in 20 African-American churches in Dallas, Texas were compared with age/sex-matched African-Americans in the Dallas Heart Study (DHS), a probability-based sample of Dallas County residents. DHS characteristics were sample-weight adjusted to represent the Dallas County population.

RESULTS

Despite having more education (college education: 75 versus 51%, P< 0.0001), GoodNEWS participants were more obese (mean body mass index: 34 versus 31 kg/m(2), P< 0.001) and had more diabetes (23 versus 12%, P< 0.001) and hyperlipidemia (53 versus 14%, P< 0.001) compared with African-Americans in Dallas County. GoodNEWS participants had higher rates of treatment and control of most CVRFs (treated hyperlipidemia: 95 versus 64%, P< 0.001; controlled diabetes: 95 versus 21%, P< 0.001; controlled hypertension: 70 versus 52%, P= 0.003), were more physically active (233 versus 177 metabolic equivalent units-min/week, P< 0.0001) and less likely to smoke (10 versus 30%, P< 0.001).

CONCLUSIONS

Compared with African-Americans in Dallas County, CBPR participants in church congregations were more educated, physically active and had more treatment and control of most CVRFs. Surprisingly, this motivated population had a greater obesity burden, identifying them as a prime target for CBPR-focused obesity treatment.

Adherence to the Baltic Sea diet consumed in the Nordic countries is associated with lower abdominal obesity

Due to differences in food cultures, dietary quality measures, such as the Mediterranean Diet Score, may not be easily adopted by other countries. Recently, the Baltic Sea Diet Pyramid was developed to illustrate healthy choices for the diet consumed in the Nordic countries. We assessed whether the Baltic Sea Diet Score (BSDS) based on the Pyramid is associated with a decreased risk of obesity and abdominal obesity. The population-based cross-sectional study included 4720 Finns (25-74 years) from the National FINRISK 2007 study. Diet was assessed using a validated FFQ. The score included Nordic fruits and berries, vegetables, cereals, ratio of PUFA:SFA and trans-fatty acids, low-fat milk, fish, red and processed meat, total fat (percentage of energy), and alcohol. Height, weight and waist circumference (WC) were measured and BMI values were calculated. In a multivariable model, men in the highest v. lowest BSDS quintile were more likely to have normal WC (OR 0·48, 95 % CI 0·29, 0·80). In women, this association was similar but not significant (OR 0·65, 95 % CI 0·39, 1·09). The association appeared to be stronger in younger age groups (men: OR 0·23, 95 % CI 0·08, 0·62; women: OR 0·17, 95 % CI 0·05, 0·58) compared with older age groups. Nordic cereals and alcohol were found to be the most important BSDS components related to WC. No association was observed between the BSDS and BMI. The present study suggests that combination of Nordic foods, especially cereals and moderate alcohol consumption, is likely to be inversely associated with abdominal obesity.

Could the new body shape index predict the new onset of diabetes mellitus in the Chinese population?

BACKGROUND

Anthropometric measures could predict the new onset of diabetes mellitus (DM). Recently, a new anthropometric measure (a body shape index, ABSI) was developed, and ABSI could predict premature mortality, even better than WC and BMI. The main aims of the study were to assess the DM predictive power of ABSI based on the follow-up data over 15 years collected from a general Chinese population.

METHODS AND FINDINGS

The data were collected in 1992 and then again in 2007 from the same group of 711 individuals. Because 24 of them were diagnosed with DM in 1992, our analysis was eventually based on the usable data collected from the remaining 687 individuals (male: 58.1%). ABSI was defined as WC/(BMI(2/3)height(1/2)), expressing WC and height in m. After adjusting for confounders, increasing the population ABSI by one standard deviation would result in an increased HR of 41% (95%CI: 12%-77%), compared to 73% (95%CI: 37%-118%) for BMI and 96% (95%CI: 53%-150%) for WC. WC had the best discriminatory power for DM (AROC: 0.701, 95%CI: 0.641-0.760), followed by BMI (AROC: 0.668, 95%CI: 0.601-0.734) and ABSI (AROC: 0.647, 95%CI: 0.581-0.713).

CONCLUSIONS

ABSI could predict the new onset of DM in the Chinese population independently. Since the confidence intervals for the HR coefficients and AROCs overlapped, the predictive ability of ABSI for DM was not better than WC and BMI. The three measures had similar predictive abilities for DM. Further studies about ethnic specificities of ABSI are needed and warranted.

Multiple behavior interventions to prevent substance abuse and increase energy balance behaviors in middle school students

This study examined the effectiveness of two transtheoretical model-tailored, computer-delivered interventions designed to impact multiple substance use or energy balance behaviors in a middle school population recruited in schools. Twenty middle schools in Rhode Island including sixth grade students (N=4,158) were stratified and randomly assigned by school to either a substance use prevention (decreasing smoking and alcohol) or an energy balance (increasing physical activity, fruit and vegetable consumption, and limiting TV time) intervention group in 2007. Each intervention involved five in-class contacts over a 3-year period with assessments at 12, 24, and 36 months. Main outcomes were analyzed using random effects modeling. In the full energy balance group and in subsamples at risk and not at risk at baseline, strong effects were found for physical activity, healthy diet, and reducing TV time, for both categorical and continuous outcomes. Despite no direct treatment, the energy balance group also showed significantly lower smoking and alcohol use over time than the substance use prevention group. The energy balance intervention demonstrated strong effects across all behaviors over 3 years among middle school students. The substance use prevention intervention was less effective than the energy balance intervention in preventing both smoking and alcohol use over 3 years in middle school students. The lack of a true control group and unrepresented secular trends suggest the need for further study.

Implementing a community-based obesity prevention programme: experiences of stakeholders in the north east of England

Recent literature indicates the potential of community-based obesity prevention programmes in the endeavour to reduce the prevalence of obesity in developed nations. Considerable suggestion and advocacy come from theoretical standpoints and little is known on actual practical application of this type of multi-component health promotion programme. This article explores the experiences of 'implementation' by stakeholders of a large community-based obesity prevention programme, facilitated by a National Health Service Care Trust in the north-east of England, UK. Three stakeholder groups (senior health officials, public health workers and community members) who had administrated and experienced the programme since its conception in 2006 provide perspectives on the aspects of local delivery and receipt. Semi-structured interviews and focus groups were conducted with stakeholders (28 participants in total). The participants felt there were three broad aspects which shaped and constrained the delivery and receipt of the programme, namely partnership working, integration of services and quality issues. Data indicated that it had taken time to establish working partnerships between the multi-agencies involved in the community-based obesity programme. Strategic management would aid the processes of communication and collaboration between agencies and also the local community involved in the administration, delivery and participation of interventions in the programme. Secondly, the way in which the programme is justified and sustained will have to be reviewed, with the intention of using a suitable evaluative framework or tool for monitoring purposes.

Overweight and obesity prevention for adolescents: a cluster randomized controlled trial in a school setting

BACKGROUND

Given the increasing prevalence of obesity among youth over the past decade, prevention has become an international public health priority.

PURPOSE

To evaluate the 2-year effectiveness of three strategies aimed at preventing overweight and obesity among adolescents in a high school setting.

DESIGN

PRomotion de l'ALIMentation et de l'Activité Physique (PRALIMAP) is a school-based RCT. Each study high school was assigned to receive or not, over a 2-year period (Grades 10 and 11), each of three prevention strategies according to a 2 × 2 × 2 factorial school randomization. Data were collected in 2006-2009 and analyzed in 2009-2011.

SETTING/PARTICIPANTS

A total of 3538 adolescents (aged 15.6±0.7 years at baseline) in 24 public high schools in Lorraine (northeastern France) completed the PRALIMAP trial.

INTERVENTIONS

The prevention strategies were education (development of nutritional knowledge and skills); environment (creation of a favorable environment by improving availability of "healthy" dietary items and physical activity); and screening and care (detection of overweight/obesity and, if necessary, adapted care management).

MAIN OUTCOMES MEASURES

The main outcome of interest was BMI; BMI z-score and prevalence of overweight/obesity were considered as secondary outcomes.

RESULTS

Adolescents who completed the PRALIMAP trial were younger, less often suspected of having eating disorders and depression, and came from a higher socioeconomic class than those who did not. The 2-year change of outcomes was more favorable in the 12 screening and care high schools compared to the no-screening ones: a 0.11 lower increase in BMI (p=0.0303); a 0.04 greater decrease in BMI z-score (p=0.0173); and a 1.71% greater decrease in overweight/obesity prevalence (p=0.0386). Education and environment strategies were not more effective than no strategy intervention.

CONCLUSIONS

Although the screening and care strategy is an effective way to prevent, at 2 years, overweight and obesity among adolescents in a high school setting, its effects over and above no strategy intervention were small.

TRIAL REGISTRATION

This study is registered at www.clinicaltrials.govNCT00814554.

Beyond the "I" in the obesity epidemic: a review of social relational and network interventions on obesity

BACKGROUND

Recent research has shown the importance of networks in the spread of obesity. Yet, the translation of research on social networks and obesity into health promotion practice has been slow.

OBJECTIVES

To review the types of obesity interventions targeting social relational factors.

METHODS

Six databases were searched in January 2013. A Boolean search was employed with the following sets of terms: (1) social dimensions: social capital, cohesion, collective efficacy, support, social networks, or trust; (2) intervention type: intervention, experiment, program, trial, or policy; and (3) obesity in the title or abstract. Titles and abstracts were reviewed. Articles were included if they described an obesity intervention with the social relational component central. Articles were assessed on the social relational factor(s) addressed, social ecological level(s) targeted, the intervention's theoretical approach, and the conceptual placement of the social relational component in the intervention.

RESULTS

Database searches and final article screening yielded 30 articles. Findings suggested that (1) social support was most often targeted; (2) few interventions were beyond the individual level; (3) most interventions were framed on behaviour change theories; and (4) the social relational component tended to be conceptually ancillary to the intervention.

CONCLUSIONS

Theoretically and practically, social networks remain marginal to current interventions addressing obesity.

Effects of circuit-based exercise programs on the body composition of elderly obese women

Aim

The aim of this study was to investigate the impact of circuit-based exercise on the body composition in obese older women by focusing on physical exercise and body weight (BW) gain control in older people.

Methods

Seventy older women (>60 years old) voluntarily took part in the study. Participants were randomized into six different groups according to body mass index (BMI): appropriate weight (AW) control (AWC) and trained (AWT) groups, overweight (OW) control (OWC) and trained (OWT) groups, and obesity (O) control (OC) and trained (OT) groups. The exercise program consisted of 50 minutes of exercise three times per week for 12 weeks. The exercises were alternated between upper and lower body using rest between sets for 40 seconds with intensity controlled by heart rate (70% of work). The contraction time established was 5 seconds to eccentric and concentric muscular action phase. The following anthropometric parameters were evaluated: height (m), body weight (BW, kg), body fat (BF, %), fat mass (FM, kg), lean mass (LM, kg), and BMI (kg/m²).

Results

The values (mean ± standard deviation [SD]) of relative changes to BW (−8.0% ± 0.8%), BF (−21.4% ± 2.1%), LM (3.0% ± 0.3%), and FM (−31.2% ± 3.0%) to the OT group were higher (P < 0.05) than in the AWT (BW: −2.0% ± 1.1%; BF: −4.6% ± 1.8%; FM: −7.0% ± 2.8%; LM: 0.2% ± 1.1%) and OWT (BW: −4.5% ± 1.0%; BF: −11.0% ± 2.2%; FM: −16.1% ± 3.2%; LM: −0.2% ± 1.0%) groups; additionally, no differences were found for C groups. While reduction (P < 0.03) in BMI according to absolute values was observed for all trained groups (AWT: 22 ± 1 versus 21 ± 1; OWT: 27 ± 1 versus 25 ± 1, OT: 34 ± 1 versus 30 ± 1) after training, no differences were found for C groups.

Conclusion

In summary, circuit-based exercise is an effective method for promoting reduction in anthropometrics parameters in obese older women.

Accuracy and reliability of direct observations of home-packed lunches in elementary schools by trained nutrition students

Increased attention has been directed toward the school food environment because children consume important contributions toward their daily food intake while at school. In Canada, most elementary school students bring a lunch to school and there are minimal data on the composition and consumption of these lunches. Dietary assessment of home-packed lunches is challenging compared with assessment of standardized school meals due to greater diversity of items, nonstandard portions, and opaque containers. We assessed accuracy and reliability of a food observation method whereby upper-year nutrition students (n=15) were trained to assess packed lunch contents and intake in elementary schools. Accuracy and reliability was assessed during 2010-2011 in three observational phases: sample lunches, volunteer-consumed lunches, and elementary school students' lunches (n=32). Observers accurately identified 96% and 95% of items in the sample and volunteer lunches, respectively. Similarly, they accurately reported portion sizes for 86% and 94% of the items in the sample and volunteer lunches, thus showing improvements in successive phases. Interobserver reliability for amount consumed, by portion size and macronutrient content, ranged from 0.79 to 0.88 in the volunteer-consumed lunches and 0.78 to 0.86 in the students' lunches, with a majority ≥0.80. It is noteworthy that the analyses for the amount consumed were conducted as absolute amounts with no allowances for discrepancies, which differs from other interobserver reliability assessments where as much as 25% discrepancy is considered agreement. Observers with prior nutrition knowledge assessed packed lunch contents and intake accurately and reliably by direct observation in an elementary school setting.

A cluster-randomised clinical trial comparing two cardiovascular health education strategies in a child population: the Savinghearts project

Background

This paper describes a methodology for comparing the effects of an eduentertainment strategy involving a music concert, and a participatory class experience involving the description and making of a healthy breakfast, as educational vehicles for delivering obesity-preventing/cardiovascular health messages to children aged 7–8 years.

Methods/design

This study will involve a cluster-randomised trial with blinded assessment. The study subjects will be children aged 7–8 years of both sexes attending public primary schools in the Madrid Region. The participating schools (n=30) will be randomly assigned to one of two groups: 1) Group MC, in which the children will attend a music concert that delivers obesity-preventing/cardiovascular health messages, or 2) Group HB, in which the children will attend a participatory class providing the same information but involving the description and making of a healthy breakfast. The main outcome measured will be the increase in the number of correct answers scored on a knowledge questionnaire and in an attitudes test administered before and after the above interventions. The secondary outcome recorded will be the reduction in BMI percentile among children deemed overweight/obese prior to the interventions. The required sample size (number of children) was calculated for a comparison of proportions with an α of 0.05 and a β of 0.20, assuming that the Group MC subjects would show values for the measured variables at least 10% higher than those recorded for the subjects of Group HB. Corrections were made for the design effect and assuming a loss to follow-up of 10%. The maximum sample size required will be 2107 children. Data will be analysed using summary measurements for each cluster, both for making estimates and for hypothesis testing. All analyses will be made on an intention-to-treat basis.

Discussion

The intervention providing the best results could be recommended as part of health education for young schoolchildren.

Trial registration

Clinicaltrials.gov: NCT01418872

Effect of gender on the association between weight status and health-related quality of life in adolescents

Background

Some studies have investigated the association between body mass index (BMI) and health-related quality of life (HRQoL) among adolescents, but their results have been discrepant and few paid attention to the role of gender. The present investigation aimed to assess the relationship between weight status and HRQoL in adolescents and to verify whether it was similar in boys and girls.

Methods

Five thousand two hundred and twenty six adolescents aged 14 to 18 years were included in the PRomotion de l’ALIMentation et de l’Activité Physique (PRALIMAP) trial, a 2x2x2 factorial cluster randomized trial performed in 24 high schools in France. Sociodemographic, anthropometric and HRQoL data were collected. BMI was categorized in four classes (thin, normal-weight, overweight, obese). Linear regression models were used to estimate the association between weight status and HRQoL, adjusting for confounders.

Results

The mean age of adolescents was 15.7±0.6 years and their mean BMI was 21.6 ±3.5 kg/m²; 55% were girls. Boys were more often overweight and obese than were girls (overweight: 15.6% vs 14.2%, obese: 4.8% vs 3.3%), and girls were more likely to be thin (5.5% vs 4.5%, p=0.0042). All HRQoL scores were higher for boys (p=<0.0001). Weight status was not associated with physical and social scores neither in boys nor in girls. Conversely, it was associated with mental score, but differently in girls than boys. As compared with normal-weight girls, thin girls had better mental HRQoL (β=+6.17, p=0.0010), and overweight and obese girls had lower mental HRQoL (β=−3.89 and β=−5.90, respectively, p<0.001). Mental HRQoL was lower for thin, overweight and obese boys than for normal-weight boys (β= −4.97, β= −1.68 and β= −3.17, respectively, p<0.0001).

Conclusions

Gender can modify the association between weight status and HRQoL in adolescents. Body image could be an important target of public health programs to improve subjective health during adolescence.

Fruits and vegetables intake and characteristics associated among adolescents from Southern Brazil

Background

Increased body weight has been associated with an unhealthy diet, low consumption of fruits and vegetables. Our objective was to investigate whether adolescents had low intake of fruits and vegetables, and whether gender, age and education could affect the feeding patterns.

Methods

A population-based sample of adolescents, aged 12–19 years, were randomly selected in southern Brazil and included in this cross-sectional study. The total daily consumption of fruits, vegetables, rice and beans were investigated in standardized household interviews, using a food frequency questionnaire and questions, being categorized as five or more servings per day as the five-a-day diet. ANOVA, ANCOVA, and modified Poisson regression were used in the analysis.

Results

Adolescents (n = 568) were included, 49.5% boys, 14.3% had overweight and 8.8% obesity. Approximately 23% of participants consumed five daily servings of fruits and vegetables. It was observed that 36.7% of boys and 31.0% of girls consumed less than one serving of fruit per day, and 58.4% and 44.6%, respectively, consumed less than one serving of vegetables. The consumption of vegetables, fruits, and rice and beans were not independently associated with gender. Overweight was associated with higher intake of five-a-day, independently of confounding factors.

Conclusions

Adolescents from southern Brazil have lower frequency of consumption of five servings a day of fruits and vegetables combined.

The role of food culture and marketing activity in health disparities

Marketing activities have attracted increased attention from scholars interested in racial disparities in obesity prevalence, as well as the prevalence of other preventable conditions. Although reducing the marketing of nutritionally poor foods to racial/ethnic communities would represent a significant step forward in eliminating racial disparities in health, we focus instead on a critical-related question. What is the relationship between marketing activities, food culture, and health disparities? This commentary posits that food culture shapes the demand for food and the meaning attached to particular foods, preparation styles, and eating practices, while marketing activities shape the overall environment in which food choices are made. We build on prior research that explores the socio-cultural context in which marketing efforts are perceived and interpreted. We discuss each element of the marketing mix to highlight the complex relationship between food culture, marketing activities, and health disparities.

Community energy balance: a framework for contextualizing cultural influences on high risk of obesity in ethnic minority populations

INTRODUCTION

Increases in the availability, affordability, and promotion of high-calorie foods and beverages and decreased obligations for routine physical activity have fostered trends of increased obesity worldwide. In high-income, plural societies, above average obesity prevalence is often observed in ethnic minority communities, suggesting that obesity-promoting influences are more prevalent or potent in these communities.

METHODS

An interdisciplinary group of scholars engaged in multiple rounds of focused discussion and literature review to develop a Community Energy Balance Framework (CEB). The objective was to explore the nature of the excess obesity risk in African descent and other ethnic minority populations and identify related implications for planning and evaluating interventions to prevent obesity.

RESULTS

A key principle that emerged is that researchers and programmers working with ethnic minority communities should contextualize the food- and physical activity-related sociocultural perspectives of these communities, taking into account relevant historical, political, and structural contexts. This perspective underscores the fallacy of approaches that place the entire burden of change on the individual, particularly in circumstances of social disadvantage and rapid cultural shifts.

CONCLUSION

The CEB framework is proposed for use and further development to aid in understanding potential health-adverse effects of cultural-contextual stresses and accommodations to these stresses.

The effects of initial and subsequent adiposity status on diabetes mellitus

BACKGROUND

Obesity in adulthood is associated with increased risk for diabetes mellitus (DM). It is uncertain whether this risk is attenuated in adulthood who are overweight or obese initially but not obese subsequently.

METHODS AND RESULTS

The data were collected in 1992 and then again in 2007 from the same group of 687 participants (male: 58.1%, age: 48.1 ± 6.2 years).The participants were categorized into four groups on the basis of adiposity status in 1992 and 2007: group I included subjects with a normal BMI in 1992 and 2007; group II, those with a normal BMI in 1992 who were overweight or obese in 2007; group III, those who were overweight or obese in 1992 but normal BMI in 2007; and group IV, those who were overweight or obese in 1992 and 2007. With group I as reference, the HR is 0.818 for group II (95% CI: 0.341-1.962, p=0.653), 2.231 for group III (95% CI: 1.087-4.579, p=0.029) and 1.855 for group IV (95% CI: 1.049-3.279, p=0.034) after adjustment for confounders. It was not significantly different between groups I and II, as well as between groups III and IV.

CONCLUSION

In adulthood, becoming nonobese could not reverse the adverse effects of obesity on DM, as compared with the subjects who persist being overweight or obese. Keeping weight in the normal BMI range should be emphasized in the public for preventing DM.

Sodium intake and blood pressure among US children and adolescents

OBJECTIVE

To assess the association between usual dietary sodium intake and blood pressure among US children and adolescents, overall and by weight status.

METHODS

Children and adolescents aged 8 to 18 years (n = 6235) who participated in NHANES 2003-2008 comprised the sample. Subjects' usual sodium intake was estimated by using multiple 24-hour dietary recalls. Linear or logistic regression was used to examine association between sodium intake and blood pressure or risk for pre-high blood pressure and high blood pressure (pre-HBP/HPB).

RESULTS

Study subjects consumed an average of 3387 mg/day of sodium, and 37% were overweight/obese. Each 1000 mg per day sodium intake was associated with an increased SD score of 0.097 (95% confidence interval [CI] 0.006-0.188, ∼1.0 mm Hg) in systolic blood pressure (SBP) among all subjects and 0.141 (95% CI: -0.010 to 0.298, ∼1.5 mm Hg) increase among overweight/obese subjects. Mean adjusted SBP increased progressively with sodium intake quartile, from 106.2 mm Hg (95% CI: 105.1-107.3) to 108.8 mm Hg (95% CI: 107.5-110.1) overall (P = .010) and from 109.0 mm Hg (95% CI: 107.2-110.8) to 112.8 mm Hg (95% CI: 110.7-114.9; P = .037) among those overweight/obese. Adjusted odds ratios comparing risk for pre-HBP/HPB among subjects in the highest versus lowest sodium intake quartile were 2.0 (95% CI: 0.95-4.1, P = .062) overall and 3.5 (95% CI: 1.3-9.2, P = .013) among those overweight/obese. Sodium intake and weight status appeared to have synergistic effects on risk for pre-HBP/HPB (relative excess risk for interaction = 0.29 (95% CI: 0.01-0.90, P < .05).

CONCLUSIONS

Sodium intake is positively associated with SBP and risk for pre-HBP/HPB among US children and adolescents, and this association may be stronger among those who are overweight/obese.

Analysing falls in coronary heart disease mortality in the West Bank between 1998 and 2009

OBJECTIVES

To analyse coronary heart disease (CHD) mortality and risk factor trends in the West Bank, occupied Palestinian territory between 1998 and 2009.

DESIGN

Modelling study using CHD IMPACT model.

SETTING

The West Bank, occupied Palestinian territory.

PARTICIPANTS

Data on populations, mortality, patient groups and numbers, treatments and cardiovascular risk factor trends were obtained from national and local surveys, routine national and WHO statistics, and critically appraised. Data were then integrated and analysed using a previously validated CHD model.

PRIMARY AND SECONDARY OUTCOME MEASURES

CHD deaths prevented or postponed are the main outcome.

RESULTS

CHD death rates fell by 20% in the West Bank, between 1998 and 2009. Smoking prevalence was initially high in men, 51%, but decreased to 42%. Population blood pressure levels and total cholesterol levels also decreased. Conversely, body mass index rose by 1-2 kg/m(2) and diabetes increased by 2-8%. Population modelling suggested that more than two-thirds of the mortality fall was attributable to decreases in major risk factors, mainly total cholesterol, blood pressure and smoking. Approximately one-third of the CHD mortality decreases were attributable to treatments, particularly for secondary prevention and heart failure. However, the contributions from statins, surgery and angioplasty were consistently small.

CONCLUSIONS

CHD mortality fell by 20% between 1998 and 2009 in the West Bank. More than two-third of this fall was due to decreases in major risk factors, particularly total cholesterol and blood pressure. Our results clearly indicate that risk factor reductions in the general population compared save substantially more lives to specific treatments for individual patients. This emphasizes the importance of population-wide primary prevention strategies.

Population approaches to improve diet, physical activity, and smoking habits: a scientific statement from the American Heart Association

BACKGROUND

Poor lifestyle behaviors, including suboptimal diet, physical inactivity, and tobacco use, are leading causes of preventable diseases globally. Although even modest population shifts in risk substantially alter health outcomes, the optimal population-level approaches to improve lifestyle are not well established.

METHODS AND RESULTS

For this American Heart Association scientific statement, the writing group systematically reviewed and graded the current scientific evidence for effective population approaches to improve dietary habits, increase physical activity, and reduce tobacco use. Strategies were considered in 6 broad domains: (1) Media and educational campaigns; (2) labeling and consumer information; (3) taxation, subsidies, and other economic incentives; (4) school and workplace approaches; (5) local environmental changes; and (6) direct restrictions and mandates. The writing group also reviewed the potential contributions of healthcare systems and surveillance systems to behavior change efforts. Several specific population interventions that achieved a Class I or IIa recommendation with grade A or B evidence were identified, providing a set of specific evidence-based strategies that deserve close attention and prioritization for wider implementation. Effective interventions included specific approaches in all 6 domains evaluated for improving diet, increasing activity, and reducing tobacco use. The writing group also identified several specific interventions in each of these domains for which current evidence was less robust, as well as other inconsistencies and evidence gaps, informing the need for further rigorous and interdisciplinary approaches to evaluate population programs and policies.

CONCLUSIONS

This systematic review identified and graded the evidence for a range of population-based strategies to promote lifestyle change. The findings provide a framework for policy makers, advocacy groups, researchers, clinicians, communities, and other stakeholders to understand and implement the most effective approaches. New strategic initiatives and partnerships are needed to translate this evidence into action.

Choose to Move for Positive Living: physical activity program for obese women

The Choose to Move for + (Positive) Living program was implemented to increase physical activity among obese women. A holistic approach was used to promote stage of health behavior change, social support, and quality of life and reduce depression. Within 6 months, physical fitness improved and depressive symptoms decreased.

Serum omega-6 polyunsaturated fatty acids and the metabolic syndrome: a longitudinal population-based cohort study

The serum fatty acid composition reflects the dietary fatty acid composition from the past few days to several weeks. However, the role of serum omega-3 (from fish and fish oils) and omega-6 (from vegetable oils) polyunsaturated fatty acids (PUFAs) in the course of metabolic syndrome is poorly understood. At the Primary Health Care Unit in Pieksämäki, Finland, all subjects born in 1942, 1947, 1952, 1957, and 1962 (n = 1,294) were invited for health checkups in 1997-1998 and 2003-2004. Metabolic syndrome was defined by using the new, harmonized criteria. The serum omega-3 PUFAs, omega-6 PUFAs, and total fatty acids were analyzed by proton nuclear magnetic resonance spectroscopy. Altogether, data from both checkups were available for 665 subjects. After adjustment for age, sex, and baseline body mass index, the incidence of metabolic syndrome between the 2 checkups with a 6.4-year follow-up was inversely associated (P < 0.001) with the increased relative proportion of omega-6 PUFAs in serum lipids. Further adjustment for body mass index change, lipid medication, smoking, alcohol intake, and physical activity conveyed similar results. The authors did not find any significant associations between omega-3 PUFAs and the incidence of metabolic syndrome. Therefore, their results suggest that the change in the relative proportion of omega-6 PUFAs in serum lipids is inversely related to the incidence of metabolic syndrome.

Creating neighbourhood groupings based on built environment features to facilitate health promotion activities

OBJECTIVES

Detailed assessments of the built environment often resist data reduction and summarization. This project sought to develop a method of reducing built environment data to an extent that they can be effectively communicated to researchers and community stakeholders. We aim to help in an understanding of how these data can be used to create neighbourhood groupings based on built environment characteristics and how the process of discussing these neighbourhoods with community stakeholders can result in the development of community-informed health promotion interventions.

METHODS

We used the Irvine Minnesota Inventory (IMI) to assess 296 segments of a semi-rural community in Alberta. Expert raters "created" neighbourhoods by examining the data. Then, a consensus grouping was developed using cluster analysis, and the number of IMI variables to characterize the neighbourhoods was reduced by multiple discriminant function analysis.

RESULTS

The 296 segments were reduced to a consensus set of 10 neighbourhoods, which could be separated from each other by 9 functions constructed from 24 IMI variables. Biplots of these functions were an effective means of summarizing and presenting the results of the community assessment, and stimulated community action.

CONCLUSIONS

It is possible to use principled quantitative methods to reduce large amounts of information about the built environment into meaningful summaries. These summaries, or built environment neighbourhoods, were useful in catalyzing action with community stakeholders and led to the development of health-promoting built environment interventions.

Geographic differences in physical education and adolescent BMI: have legal mandates made a difference?

The school environment is an ideal setting for healthy weight programming with adolescents. The federal government has reinforced the importance of school-based health promotion. The current study examined the preliminary influence of the 2006 school wellness policy requirement of the Child Nutrition and WIC Reauthorization Act (CNWICRA) on adolescent Body Mass Index (BMI) and physical education participation. Nationally representative data from the 2003 and 2007 Youth Risk Behavior Surveillance Survey (YRBSS) were used. The authors examined BMI percentile and physical education participation based on survey year and geographic region. Results suggest a slight decrease in BMI with no changes in physical education participation. A main effect for geographic region was found for both physical education participation and BMI percentile, while a geographic region-by-survey year interaction was discovered when analyzing BMI percentiles. Results suggest a need for continued investigation and may inform future healthy weight programming and geographically tailored wellness policies.

"I'm ready to eat and grab whatever I can get": Determinants and patterns of African American men's eating practices

This article examines determinants and patterns of African American men's dietary practices. Thematic content analysis was used to analyze data from nine exploratory focus groups conducted with 83 urban, middle-aged and older African American men from southeast Michigan. The men distinguished between healthy and unhealthy foods and "meals" versus other instances of eating. Eating patterns and content differed depending on the meal, work and family schedules, food availability, and whether it was a weekday or weekend. When eating alone or outside the home, men prioritized convenience and preferences for tasty, unhealthy foods. Men often reported skipping breakfast or lunch and grabbing snacks or fast food during the day. They emphasized sharing dinner with their spouses and families-usually a home-cooked, "healthy" meal. On weekends, spouses often cooked less and men snacked and dined out more frequently. Sunday dinners involving favorite, unhealthy comfort foods were the highlight of men's eating practices. African American men tended not to follow healthy eating recommendations because of their busy lives, reliance on spouses to prepare food, and preferences for unhealthy foods. These findings suggest that healthy eating interventions must consider how the contexts of African American men's lives shape their eating practices.

Relationship between sleep quality and quantity and weight loss in women participating in a weight-loss intervention trial

Evidence suggests that individuals who report fewer total hours of sleep are more likely to be overweight or obese. Few studies have prospectively evaluated weight-loss success in relation to reported sleep quality and quantity. This analysis sought to determine the association between sleep characteristics and weight loss in overweight or obese women enrolled in a randomized clinical trial of a weight-loss program. We hypothesized that in overweight/obese women, significant weight loss would be demonstrated more frequently in women who report a better Pittsburgh Sleep Quality Index (PSQI) Global Score or sleep >7 h/night as compared to women who report a worse PSQI score or sleep ≤7 h/night. Women of ages 45.5 ± 10.4 (mean ± SD) years and BMI of 33.9 ± 3.3 (n = 245) were randomized and completed PSQI at baseline and 6 months; 198 had weight change assessed through 24 months. At baseline, 52.7% reported PSQI scores above the clinical cutoff of 5. Better subjective sleep quality increased the likelihood of weight-loss success by 33% (relative risk (RR), 0.67; 95% confidence interval (CI), 0.52-0.86), as did sleeping >7 h/night. A worse Global Score at 6 months was associated with a 28% lower likelihood of continued successful weight loss at 18 months, but unassociated by 24 months. These results suggest that sleep quality and quantity may contribute to weight loss in intervention-based studies designed to promote weight control in overweight/obese adult women.

Prevention of weight gain following a worksite nutrition and exercise program: a randomized controlled trial

BACKGROUND

Many employers are now providing wellness programs to help employees make changes in diet and exercise behaviors. Improving health outcomes and reducing costs will depend on whether employees sustain lifestyle changes and maintain a healthy weight over time.

PURPOSE

To determine if a 9-month maintenance intervention immediately following a 10-week worksite exercise and nutrition program would prevent regain of the weight lost during the program.

DESIGN

RCT.

SETTING/PARTICIPANTS

In 2008, a total of 330 employees from 24 teams completed a 10-week exercise and nutrition program at a large hospital worksite and were randomized by team to maintenance or control (usual care) for 9 months.

INTERVENTION

Internet support with a website for goal-setting and self-monitoring of weight and exercise plus minimal personal support.

MAIN OUTCOME MEASURES

Weight loss, percentage weight loss, time spent in physical activity, and frequency of consumption of fruits/vegetables, fatty foods, and sugary foods at 1 year compared to baseline. One-year follow-up was completed in 2010, and data were analyzed in 2011.

RESULTS

At 1 year, 238 subjects (72%) completed follow-up assessments. Mean baseline BMI was 27.6 and did not differ between intervention and control. Compared to baseline, both groups lost weight during the 10-week program and maintained 65% of weight loss at 1 year (p<0.001). There was no difference in weight loss between groups at the end of the 10-week program (4.8 lbs vs 4.3 lbs, p=0.53 for group X time interaction) or end of maintenance at 1 year (3.4 lbs vs 2.5 lbs, p=0.40 for group X time interaction). All subjects had improvements in physical activity and nutrition (increased fruits/vegetables and decreased fat and sugar intake) at 1 year but did not differ by group.

CONCLUSIONS

An intensive 10-week team-based worksite exercise and nutrition program resulted in moderate weight loss and improvements in diet and exercise behaviors at 1 year, but an Internet-based maintenance program immediately following the 10-week program did not improve these outcomes.

TRIAL REGISTRATION

This study is registered at clinicaltrials.gov NCT00707577.

"Peers, parents and phones"--Swedish adolescents and health promotion

Many unhealthy behaviors are created during adolescence and follow the individual into adulthood. In addition, health behaviors often occur in clusters as those who are inactive are more likely to eat unhealthy food and smoke. This makes the early foundation of healthy behaviors vital. The aim was to describe and develop an understanding of adolescents' awareness and experiences concerning health promotion. Data was collected using focus groups with a total of 28 seventh graders and was analysed with latent qualitative content analysis. One main theme was identified; being competent, ambivalent and creative at the same time. The following three subthemes also emerged: being a digital native for better and for worse, knowing what is healthy, and sometimes doing it, and considering change and having ideas of how change could be supported. The main theme elucidates how the majority of students were informed and able but they did not always prioritize their health. The concept of health promotion relies upon the engagement of the individual; however, although the students had clear ideas about how they would like to change their own behaviors, they felt a need for support. Interestingly, the students were able to make several suggestions about the kind of support that would make a difference to their adoption to more healthy modes of living. They suggested information and communication technology (ICT), for example encouraging text messages (SMS), and social support, for example parents setting rules and peers inspiring them to adhere to a healthy behavior. The knowledge gained from this study echoes our view of inclusion and this could be helpful for those who encounter the challenge of promoting health among adolescents.

Differential associations between the food environment near schools and childhood overweight across race/ethnicity, gender, and grade

Epidemiologic studies have observed influences of the food environment near schools on children's overweight status but have not systematically assessed the associations by race, sex, and grade. The authors examined whether the associations between franchised fast food restaurant or convenience store density near schools and overweight varied by these factors using data for 926,018 children (31.3% white, 55.1% Hispanic, 5.7% black, and 8% Asian) in fifth, seventh, or ninth grade, nested in 6,362 schools. Cross-sectional data were from the 2007 California physical fitness test (also known as "Fitnessgram"), InfoUSA, the California Department of Education, and the 2000 US Census. In adjusted models, the overweight prevalence ratio comparing children in schools with 1 or more versus 0 fast food restaurants was 1.02 (95% confidence interval (CI): 1.01, 1.03), with a higher prevalence ratio among girls compared with boys. The association varied by student's race/ethnicity (P = 0.003): Among Hispanics, the prevalence ratio = 1.02 (95% CI: 1.01, 1.03); among blacks, the prevalence ratio = 1.03 (95% CI: 1.00, 1.06), but among Asians the prevalence ratio = 0.94 (95% CI: 0.91, 0.97). For each additional convenience store, the prevalence ratio was 1.01 (95% CI: 1.00, 1.01), with a higher prevalence ratio among fifth grade children. Nuanced understanding of the impact of food environments near schools by race/ethnicity, sex, and grade may help to elucidate the etiology of childhood overweight and related race/ethnic disparities.

Bariatric surgery: an IDF statement for obese Type 2 diabetes

The International Diabetes Federation Taskforce on Epidemiology and Prevention of Diabetes convened a consensus working group of diabetologists, endocrinologists, surgeons and public health experts to review the appropriate role of surgery and other gastrointestinal interventions in the treatment and prevention of Type 2 diabetes. The specific goals were: to develop practical recommendations for clinicians on patient selection; to identify barriers to surgical access and suggest interventions for health policy changes that ensure equitable access to surgery when indicated; and to identify priorities for research. Bariatric surgery can significantly improve glycaemic control in severely obese patients with Type 2 diabetes. It is an effective, safe and cost-effective therapy for obese Type 2 diabetes. Surgery can be considered an appropriate treatment for people with Type 2 diabetes and obesity not achieving recommended treatment targets with medical therapies, especially in the presence of other major co-morbidities. The procedures must be performed within accepted guidelines and require appropriate multidisciplinary assessment for the procedure, comprehensive patient education and ongoing care, as well as safe and standardized surgical procedures. National guidelines for bariatric surgery need to be developed for people with Type 2 diabetes and a BMI of 35 kg/m² or more.

General characteristics and risk factors of cardiovascular disease among interstate bus drivers

Workers in the transportation industry are at greater risk of an incorrect diet and sedentary behavior. The aim of our study was to characterize a population of professional bus drivers with regard to clinical and demographic variables, lipid profile, and the presence of cardiovascular risk factors. Data from 659 interstate bus drivers collected retrospectively, including anthropometric characteristics, systolic and diastolic blood pressure, lipid profile, fasting blood glucose, meatoscopy, and audiometry. All participants were male, with a mean age of 41.7 ± 6.9 years, weight of 81.4 ± 3.3 kg, and BMI 27.2 ± 3.3 Kg/m²; the mean abdominal and neck circumferences were 94.4 ± 8.6 cm and 38.9 ± 2.2  cm; 38.2% of the sample was considered hypertensive; mean HDL cholesterol was 47.9 ± 9.5 mg/dL, mean triglyceride level was 146.3 ± 87.9 mg/dL, and fasting glucose was above 100 mg/dL in 249 subjects (39.1%). Drivers exhibited reduced audiometric hearing at 4-8 kHz, being all sensorineural hearing loss. The clinical characterization of a young male population of interstate bus drivers revealed a high frequency of cardiovascular risk factors, as obesity, hypertension, hyperlipidemia, and hyperglycemia, as well as contributing functional characteristics, such as a low-intensity activity, sedentary behavior, long duration in a sitting position, and high-calorie diet, which lead to excessive weight gain and associated comorbidities.

A qualitative study of leadership characteristics among women who catalyze positive community change

BACKGROUND

Leadership is critical to making changes at multiple levels of the social ecological model, including the environmental and policy levels, and will therefore likely contribute to solutions to the obesity epidemic and other public health issues. The literature describing the relative leadership styles and strengths of women versus men is mixed and virtually all research comes from sectors outside of public health. The purpose of this qualitative study is to identify specific leadership skills and characteristics in women who have successfully created change predominantly within the food and physical activity environments in their communities and beyond. The second purpose of this study is to understand best practices for training and nurturing women leaders, to maximize their effectiveness in creating social change.

METHODS

Key informant interviews were conducted with 16 women leaders in the public health sector from November 2008 through February 2010. The sample represented a broad spectrum of leaders from across the United States, identified through web searches and through networks of academic and professional colleagues. Most were working on improving the food and physical activity environments within their communities. Questions were designed to determine leaders' career path, motivation, characteristics, definition of success, and challenges. The initial coding framework was based on the questioning structure. Using a grounded theory approach, additional themes were added to the framework as they emerged. The NVivo program was used to help code the data.

RESULTS

Respondents possessed a vision, a strong drive to carry it out, and an ability to mobilize others around the vision. Their definitions of success most often included changing the lives of others in a sustainable way. Persistence and communications skills were important to their success. The mentoring they received was critical. Challenges included fundraising and drifting from their original mission.

CONCLUSIONS

These findings may be used to help develop or inform a model of women's leadership in public health and to improve the training and nurturance of leaders who promote health in their communities and beyond.

Potential nutritional and economic effects of replacing juice with fruit in the diets of children in the United States

OBJECTIVE

To estimate the nutritional and economic effects of substituting whole fruit for juice in the diets of children in the United States.

DESIGN

Secondary analyses using the 2001-2004 National Health and Nutrition Examination Survey and a national food prices database. Energy intakes, nutrient intakes, and diet costs were estimated before and after fruit juices were completely replaced with fruit in 3 models that emphasized fruits that were fresh, inexpensive, and widely consumed and in a fourth model that partially replaced juice with fruit, capping juice at recommended levels.

SETTING

A nationwide, representative sample of children in the United States.

PARTICIPANTS

A total of 7023 children aged 3 to 18 years.

MAIN EXPOSURES

Systematic complete or partial replacement of juice with fruit.

MAIN OUTCOME MEASURES

Difference in energy intakes, nutrient intakes, and diet costs between observed and modeled diets.

RESULTS

For children who consumed juice, replacement of all juice servings with fresh, whole fruit led to a projected reduction in dietary energy of 233 kJ/d (-2.6% difference [95% CI, -5.1% to -0.1%]), an increase in fiber of 4.3 g/d (31.1% difference [95% CI, 26.4%-35.9%]), and an increase in diet cost of $0.54/d (13.3% difference [95% CI, 8.8%-17.8%]).

CONCLUSIONS

Substitution of juice with fresh fruit has the potential to reduce energy intake and improve the adequacy of fiber intake in children's diets. This would likely increase costs for schools, childcare providers, and families. These cost effects could be minimized by selecting processed fruits, but fewer nutritional gains would be achieved.

What a man wants: understanding the challenges and motivations to physical activity participation and healthy eating in middle-aged Australian men

Little attention has been paid to the physical activity (PA) and nutrition behaviors of middle-aged men; thus, the aim of this study was to gather information and gain insight into the PA and nutrition behaviors of these men. Six focus group sessions were undertaken with middle-aged men (N = 30) from regional Australia to explore the challenges and motivations to PA participation and healthy eating. Men had a good understanding of PA and nutrition; however, this was sometimes confounded by inconsistent media messages. Work commitments and family responsibilities were barriers to PA, while poor cooking skills and abilities were barriers to healthy eating. Disease prevention, weight management, and being a good role model were motivators for PA and healthy eating. By understanding what a man wants, PA and nutrition interventions can be designed and delivered to meet the needs of this hard-to-reach population.

The impact of an intervention taught by trained teachers on childhood overweight

The purpose of this study was to assess the effects of a six-months’ nutrition program, delivered and taught by classroom teachers with in-service nutrition training, on the prevention of overweight and obesity among children in grades 1 to 4. In this randomized trial, four hundred and sixty four children from seven elementary schools were allocated to a nutrition educational program delivered by their own teachers. Intervened teachers had 12 sessions of three hours each with the researchers throughout six months, according to the topics nutrition and healthy eating, the importance of drinking water and healthy cooking activities. After each session, teachers were encouraged to develop activities in class focused on the learned topics. Sociodemographic, anthropometric, dietary, and physical activity assessments were performed at baseline and at the end of the intervention. In the intervention group the increase in Body Mass Index (BMI) z-score was significantly lower than in the control group (p = 0.009); fewer proportion of children became overweight in the intervened group compared with the control (5.6% vs. 18.4%; p = 0.037). Our study provides further support to decrease the overweight epidemic, involving classroom teachers in a training program and making them dedicated interventionists.