The Agatston Urban Nutrition Initiative: working to reverse the obesity epidemic through academically based community service

The Agatston Urban Nutrition Initiative (AUNI) presents a fruitful partnership between faculty and students at a premier research university and members of the surrounding community aimed at addressing the problem of childhood obesity. AUNI uses a problem-solving approach to learning by focusing course activities, including service-learning, on understanding and mitigating the obesity culture.

An exploratory investigation of dietary intake and weight in human immunodeficiency virus-seropositive individuals in Accra, Ghana

In Africa, the human immunodeficiency virus and acquired immunodeficiency syndrome (HIV/AIDS) complex is commonly referred to as "slim disease" because, as the disease progresses, food intake and metabolism are altered, leading to visible body weight loss. In this descriptive, cross-sectional pilot study, 50 HIV-seropositive adults attending the Korle Bu Teaching Hospital in Accra, Ghana, were interviewed during the late spring of 2003. Demographics, medical HIV history and current status of their HIV disease, food safety, and food security information were collected. One 24-hour dietary recall was completed, height and weight were measured, and body mass index (BMI) was calculated for each participant. Results show that women participants had a higher mean BMI and maintained it through disease progression compared with men (P<0.02). The majority of the participants cited cost as a barrier in purchasing adequate amounts of food (92%). Fruit and vegetable intake was low overall (<three servings/day). The foods contributing most to daily energy intake were fried fish, white rice, kenkey, white bread, and fufu. In fighting the global HIV/AIDS epidemic, registered dietitians must consider barriers to achieving optimal nutritional status in a cultural context to enhance feasibility and ensure the effectiveness of dietary interventions.

Obesity: the integrated roles of environment and genetics

Obesity represents one of the most serious global health issues with approximately 310 million people presently affected. It develops because of a mismatch between energy intake and expenditure that results from behavior (feeding behavior and time spent active) and physiology (resting metabolism and expenditure when active). Both of these traits are affected by environmental and genetic factors. The dramatic increase in the numbers of obese people in Western societies reflects mostly changing environmental factors and is linked to reduced activity and perhaps also increased food intake. However, in all societies and subpopulations, there are both obese and nonobese subjects. These differences are primarily a consequence of genetic factors as is revealed by the high heritability for body mass index. Most researchers agree that energy balance and, hence, body weight are regulated phenomena. There is some disagreement about exactly how this regulation occurs. However, a common model is the "lipostatic" regulation system, whereby our energy stores generate signals that are compared with targets encoded in the brain, and differences between these drive our food intake levels, activity patterns, and resting and active metabolisms. Considerable advances were made in the last decade in understanding the molecular basis of this lipostatic system. Some obese people have high body weight because they have broken lipostats, but these are a rare minority. This suggests that for the majority of obese people, the lipostat is set at an inappropriately high level. When combined with exposure to an environment where there is ready availability of food at low energy costs to obtain it, obesity develops. The evolutionary background to how such a system might have evolved involves the evolution of social behavior, the harnessing of fire, and the development of weapons that effectively freed humans from the risks of predation. The lipostatic model not only explains why some people become obese whereas others do not, but also allows us to understand why energy-controlled diets do not work. Drug-based solutions to the obesity problem that work with the lipostat, rather than against it, are presently under development and will probably be in regular use within 5-10 y. However, several lines of evidence including genetic mapping studies of quantitative trait loci associated with obesity suggest that our present understanding of the regulatory system is still rudimentary. In particular, we know nothing about how the target body weight in the brain is encoded. As our understanding in this field advances, new drug targets are likely to emerge and allow us to treat this crippling disorder.

Secular trend in the development of fatness during childhood and adolescence

This study examined the development of fatness, as indexed by skinfold thickness, in healthy Caucasian children and adolescents residing in the same location in Canada in the 1960s and the 1990s. The data comes from two longitudinal studies, conducted approximately 30 years apart, of children aged 8-16 years. The first study (1964-1973) annually measured 207 males and 140 females. The second investigation (1991-1997) repeatedly measured 113 males and 115 females. Identical measurement tools and protocols were used for height, body mass, and skinfolds. Maturational age was estimated as a measure in years from age of peak height velocity. Males from the second investigation matured significantly (P < 0.05) earlier. Multilevel regression modeling was utilized to determine developmental curves for the individuals within the two populations. When differences in height, body mass, and maturity were controlled, skinfold thicknesses of the males and females in the second study were significantly greater (P < 0.05) than age- and sex-matched peers in the first study. This was not seen in models of the BMI. The results suggest that when maturity and size were controlled, the fatness of children and adolescents increased over 30 years.

Obesity-related knowledge, attitudes, and behaviors in obese and non-obese urban Philadelphia female adolescents

OBJECTIVES

To examine relationships between knowledge, attitudinal and behavioral factors, and obesity and to determine how these factors influence obesity status in west Philadelphia female adolescents.

RESEARCH METHODS AND PROCEDURES

A matched-pairs study was conducted with 32 stature- and age-matched pairs of obese (body mass index and triceps skinfold > or =95th percentile of National Health and Nutrition Examination Survey I) and non-obese (body mass index and triceps skinfold between the 15th and 85th percentiles of National Health and Nutrition Examination Survey I) female African American adolescents (aged 11 to 15 years), selected from a school-based study sample, based on obesity status and matching criteria. Adolescents were compared on the following measures: physical activity, inactivity, dietary intake, eating attitudes, health behavior knowledge, body image, self-esteem, and maturation status. Differences between obese and non-obese females were tested using paired t tests and Wilcoxon matched-pairs signed-rank tests.

RESULTS

Physical activity, inactivity, and perception of ideal body size emerged as the most important contributory factors to obesity status. There were no statistically significant matched-pair differences in macronutrient and micronutrient intakes, self-esteem, eating attitudes, health behavior knowledge, or maturation status of these adolescents. Obese adolescents had significantly lower levels of physical activity, higher inactivity, and a larger perception of ideal body size than non-obese adolescents.

DISCUSSION

Knowledge and attitudinal factors (with the exception of perception of ideal body size) had far less association with obesity than activity-related behavioral factors. These findings suggest that future intervention strategies should pay particular attention to physical activity, inactivity, and body image attitudes.

Anthropometric changes in urban Sardinian children 7 to 10 years between 1975-1976 and 1996

This study is a comparison of several anthropometric variables in school children of the same age (7-10 years) and sex measured in two primary schools in Cagliari (Sardinia, Italy) at an interval of 20 years (1996 vs. 1975-1976). For both males and females of each age-class, there are significant differences in the following dimensions: weight, stature, estimated lower limb length, biacromial breadth, xiphoid chest circumference, xiphoid chest depth, and bicristal breadth, and also in relative sitting height, cephalic index, and facial index. The means of the relative sitting height, cephalic, and facial indexes are higher in the children measured in 1975-1976 than in those measured in 1996. There are no significant differences in sitting height and arm length. In addition, the estimated BMIs of the 1975-1976 sample are, on average, lower than those of the 1996 sample. The results suggest that urban Sardinian children sampled in 1996 are generally taller, heavier, and larger and have a longer head and wider face than their peers of 20 years earlier. The increase in stature is due more to an increase in lower limb length than in sitting height. Am J. Hum. Biol. 12:782-791, 2000. Copyright 2000 Wiley-Liss, Inc.

Food consumption, activity, and overweight among elementary school children in an Appalachian Kentucky community

In the U.S., child overweight is on the rise and is implicated in later adult chronic illness. Given that overweight is hardly tractable, prevention as compared to treatment is seen as a better alternative for lowering the risk of long-term health consequences. To increase the success of prevention efforts, many argue that programs must be "culturally sensitive and targeted toward specific populations at greater risk. However, there exists a limited understanding of how overweight is distributed across the landscape, among and within populations and groups. This paper reports the prevalence of overweight among 54 school children in a rural, Appalachian community with a high rate of poverty, and it compares boys to girls. Thirty-seven percent of boys and 10.3% of girls are overweight, based on the 90th percentile body mass index (BMI). Analysis of food intake indicates a pattern of food consumption that is high in fatty and sugary foods and low in fruit and vegetable consumption. Analysis of activity indicates that children report more low-intensity activity than high; that overweight children report more episodes of video/computer play compared to nonoverweight children; and that boys spend more time than girls in front of the computer/television screen.

Anthropometric measurement error and the assessment of nutritional status

Anthropometry involves the external measurement of morphological traits of human beings. It has a widespread and important place in nutritional assessment, and while the literature on anthropometric measurement and its interpretation is enormous, the extent to which measurement error can influence both measurement and interpretation of nutritional status is little considered. In this article, different types of anthropometric measurement error are reviewed, ways of estimating measurement error are critically evaluated, guidelines for acceptable error presented, and ways in which measures of error can be used to improve the interpretation of anthropometric nutritional status discussed. Possible errors are of two sorts; those that are associated with: (1) repeated measures giving the same value (unreliability, imprecision, undependability); and (2) measurements departing from true values (inaccuracy, bias). Imprecision is due largely to observer error, and is the most commonly used measure of anthropometric measurement error. This can be estimated by carrying out repeated anthropometric measures on the same subjects and calculating one or more of the following: technical error of measurement (TEM); percentage TEM, coefficient of reliability (R), and intraclass correlation coefficient. The first three of these measures are mathematically interrelated. Targets for training in anthropometry are at present far from perfect, and further work is needed in developing appropriate protocols for nutritional anthropometry training. Acceptable levels of measurement error are difficult to ascertain because TEM is age dependent, and the value is also related to the anthropometric characteristics of the group of population under investigation. R > 0.95 should be sought where possible, and reference values of maximum acceptable TEM at set levels of R using published data from the combined National Health and Nutrition Examination Surveys I and II (Frisancho, 1990) are given. There is a clear hierarchy in the precision of different nutritional anthropometric measures, with weight and height being most precise. Waist and hip circumference show strong between-observer differences, and should, where possible, be carried out by one observer. Skinfolds can be associated with such large measurement error that interpretation is problematic. Ways are described in which measurement error can be used to assess the probability that differences in anthropometric measures across time within individuals are due to factors other than imprecision. Anthropometry is an important tool for nutritional assessment, and the techniques reported here should allow increased precision of measurement, and improved interpretation of anthropometric data.

Child growth and nutritional status in a high-poverty community in eastern Kentucky

The research reported in this paper examines the relationship between household socioeconomic measures, child growth, and nutritional status in a community in eastern Kentucky with a high rate of poverty. It is based on the premise that child growth and nutritional status reflect the social circumstances in which they occur. 21.6% of the children exhibited low height (<15th percentile of National Center for Health Statistics [NCHS] reference values), with 13% of the girls exhibiting stunting (<5th percentile). Thirty-three percent of the children exhibited overweight, and 13% exhibited obesity (>85th percentile and >95th percentile of National Health and Nutrition Examination Survey [NHANES] reference values, respectively); 21.4% of boys were obese, compared to 8.7% of girls. Analysis of variance indicated that child stature is best explained by the father's education level interacting with employment status, and by the mother's employment status interacting with household poverty level. Weight is best explained by the mother's employment status. However, the relationships among socioeconomic measures and growth outcomes differed by gender of the child. These issues are discussed in light of the anthropology literature and the situation in Bridges County, Kentucky where the research took place.