Obesity intervention among African-American children and adolescents

Better health indicators of FitSpirit participants meeting 24-h movement guidelines for Canadian children and youth

This study aims to determine the proportion of girls who meet the recommendations for moderate-to-vigorous physical activity (MVPA), screen time and sleep duration among FitSpirit participants and evaluate the associations of these recommendations with perceived health-related quality of life (QOL), perceived health, physical activity (PA), self-efficacy and body mass index. Cross-sectional analyses of FitSpirit data were performed. All variables were collected through an online questionnaire. The proportion of girls meeting all recommendations was 2.2%, while 72.5% met either one or two and 25.4% met none. A greater percentage of girls with ≥3 years in FitSpirit met MVPA and sleep recommendations combined when compared with fewer years (12.9% vs. 1.7% with 1 year; vs. 10.1% with 2 years; p < 0.05). Meeting the combinations of MVPA and screen time (β = 0.19, 95% CI = 0.40, 1.68), MVPA and sleep (β = 0.20, 95% CI = 0.27, 1.04) and all three combined (β = 0.17, 95% CI = 0.33, 1.71) was the most significant predictors of better perceived QOL. Respecting MVPA recommendations predicted a better perceived health (β = 0.18, 95% CI = 0.18, 0.87) while girls who slept as recommended had a better PA-related self-efficacy (β = 0.23, 95% CI = 0.51, 2.11). Not meeting any recommendation was associated with inferior PA-related self-efficacy (β = -0.32, 95% CI = -3.03, -1.21). Lastly, meeting MVPA and sleep recommendations was significantly associated with lower body mass index z-scores (β = -0.14, 95% CI = -1.16, -0.11). There was a small percentage of girls following all of the recommendations. Furthermore, meeting individual and combined recommendations was associated with better perceived QOL and health, PA self-efficacy as well as healthier body mass index z-score.

HIV Prevention Programming for Older African American Women: The Impact of a Faith-Based and Behavioral Science Partnership on Depressive Symptoms

Objective

The current study sought to test the effect of an HIV prevention intervention on depressive symptoms in a sample of older African American women.

Design Setting and Participants

A pretest-posttest randomized control group design was conducted in a mega-church in Los Angeles with a sample of 62 older African American women, aged ≥50 years, 29 of whom were randomly assigned to the experimental condition and 33 to the comparison/control condition.

Measures

A measure of psychological wellbeing (CES-D) was utilized to test the effect of the four-session group intervention vs the one-session informational group intervention on change in depressive symptoms from pretest to posttest. Demographic characteristics included: measures of age in years; relationship and employment statuses (coded 1 for yes, 0 for no); and educational attainment.

Results

Participation in the study was associated with a significant improvement in the women's psychological wellbeing from baseline to time 2; ie, decreased depressive symptoms. This change was greater for women in the four-session experimental group than for those in the one-session comparison group, due in part to a marginally significant interaction between time and experimental conditions.

Conclusions

This study demonstrates the utility of faith-based/behavioral-scientist partnerships in HIV programming. Findings contribute to the evidence on interventions that might reduce depressive symptoms and HIV risk among older African American women.

Obese Peers' Influence on Students' BMI: Heterogeneity in Race and Sex

Objectives

In this study, we investigate peer influence on obesity, with a focus on race and sex.

Methods

We conducted econometric analysis of longitudinal health data of 277,566 public school students, ages 5-13 years.

Results

A percentage point increase in the proportion of obese students within the same grade increased a student's BMI z-scores by about 4 one-thousandths of a standard deviation. On racial peers, the standard deviation increase in BMI z-score is 3.9 one-thousandths for Hispanics or Caucasians and 4.9 one-thousandths for African Americans. Influence of obese peers is nearly identical for boys and girls.

Conclusions

Such a small magnitude of obese peers' estimate suggests that classroom peers do not play a substantial role in weight gain or loss in elementary schools.

Increasing Physical Activity in Black Women: Results from a Randomized Trial Conducted in Faith-Based Settings

Objective

The Learning and Developing Individual Exercise Skills (L.A.D.I.E.S.) for a Better Life study compared a faith-integrated (FI) and a secular (SEC) intervention for increasing physical activity with a self-guided (SG) control group among African American women.

Design/Setting/Participants

L.A.D.I.E.S. was a cluster randomized, controlled trial. Churches (n=31) were randomized and women within each church (n=12 - 15) received the same intervention.

Interventions

FI and SEC participants received 24 group-based sessions, delivered over 10 months. SG participants received printed materials to review independently for 10 months. Participants were followed for 12-months post-intervention to assess long-term intervention impact.

Main Outcome Measures

Data on participant characteristics, physical activity, and intervention-related constructs were collected at baseline, 10 months, and 22 months.

Results

Intervention session attendance was greater for FI compared with SEC participants (15.7 + 5.7 vs 12.4 + 7.3 sessions, respectively, P<.01). After 10 months, FI and SEC participants significantly increased daily walking (+1,451 and +1,107 steps/day, respectively) compared with SG participants (-128 steps/day). Increases were maintained after 22 months in the FI group compared with the SG group (+1092 vs. +336 daily steps, P<.01). Between-group changes in accelerometer-assessed physical activity were not statistically significant at any time point.

Conclusions

The FI intervention is a feasible strategy for short- and long-term increases in physical activity among African American women. Additional dissemination and evaluation of the strategy could be useful for reducing chronic disease in this high-risk population.

Cardiovascular Health in African Americans: A Scientific Statement From the American Heart Association

BACKGROUND AND PURPOSE

Population-wide reductions in cardiovascular disease incidence and mortality have not been shared equally by African Americans. The burden of cardiovascular disease in the African American community remains high and is a primary cause of disparities in life expectancy between African Americans and whites. The objectives of the present scientific statement are to describe cardiovascular health in African Americans and to highlight unique considerations for disease prevention and management.

METHOD

The primary sources of information were identified with PubMed/Medline and online sources from the Centers for Disease Control and Prevention.

RESULTS

The higher prevalence of traditional cardiovascular risk factors (eg, hypertension, diabetes mellitus, obesity, and atherosclerotic cardiovascular risk) underlies the relatively earlier age of onset of cardiovascular diseases among African Americans. Hypertension in particular is highly prevalent among African Americans and contributes directly to the notable disparities in stroke, heart failure, and peripheral artery disease among African Americans. Despite the availability of effective pharmacotherapies and indications for some tailored pharmacotherapies for African Americans (eg, heart failure medications), disease management is less effective among African Americans, yielding higher mortality. Explanations for these persistent disparities in cardiovascular disease are multifactorial and span from the individual level to the social environment.

CONCLUSIONS

The strategies needed to promote equity in the cardiovascular health of African Americans require input from a broad set of stakeholders, including clinicians and researchers from across multiple disciplines.

Obesity among Black Adolescent Girls: Genetic, Psychosocial, and Cultural Influences

This article focuses on the causes, consequences, and prevention of obesity among a subgroup of the American population, Black adolescent girls. Using an ecological perspective on obesity among Black adolescent girls, including feminist-womanist perspectives and historical and medical sociological perspectives, the authors discuss genetic, psychosocial, and cultural factors that may influence the propensity of Black adolescent girls’ susceptibility to obesity and to diabetes, one of the major complications of obesity. Prevention strategies, including individual and structural interventions, are illuminated.

Knowledge is (not) power: healthy eating and physical activity for African-American women

African-American women are more likely to be overweight or obese as compared to other ethnic groups. The purpose of this Qualitative Interpretive Meta-Synthesis (QIMS) was to explore the experiences that African-American women encounter when trying to eat healthily and maintain physical activity to inform practice and research. The QIMS included studies from various disciplines to understand the experiences of African-American women with eating healthily and being physically active. Five themes were identified: family; structured support; translating knowledge into behavior modifications; barriers to physical activity; and God is my healer. These themes enhance understanding of what African-American women know, their support system(s), and how cultural barriers impact nutrition and physical activity.

Outside-of-school time obesity prevention and treatment interventions in African American youth

Outside-of-school time (OST; i.e. before/after-school hours, summer time), theory-based interventions are potential strategies for addressing increased obesity among African American youth. This review assessed interventions across multiple settings that took place during OST among African American youth aged 5-18 years old. Seven databases were searched for studies published prior to October 2013; 28 prevention and treatment interventions that assessed weight or related behaviours as a primary or secondary outcome were identified. Overall, these studies reported heterogeneous intervention length, theoretical frameworks, methodological quality, outcomes, cultural adaption and community engagement; the latter two attributes have been identified as potentially important intervention strategies when working with African Americans. Although not always significant, generally, outcomes were in the desired direction. When examining programmes by time of intervention (i.e. after-school, summer time, time not specified or multiple time periods), much of the variability remained, but some similarities emerged. After-school studies generally had a positive impact on physical activity, fruit/vegetable consumption and caloric intake, or body composition. The single summer time intervention showed a trend towards reduced body mass index. Overall findings suggest that after-school and summer programmes, alone or perhaps in combination, offer potential benefits for African American youth and could favourably influence diet and physical activity behaviour.

Race/ethnicity, education, and treatment parameters as moderators and predictors of outcome in binge eating disorder

OBJECTIVE

Binge eating disorder (BED) is prevalent among individuals from minority racial/ethnic groups and among individuals with lower levels of education, yet the efficacy of psychosocial treatments for these groups has not been examined in adequately powered analyses. This study investigated the relative variance in treatment retention and posttreatment symptom levels accounted for by demographic, clinical, and treatment variables as moderators and predictors of outcome.

METHOD

Data were aggregated from 11 randomized, controlled trials of psychosocial treatments for BED conducted at treatment sites across the United States. Participants were N = 1,073 individuals meeting criteria for BED including n = 946 Caucasian, n = 79 African American, and n = 48 Hispanic/Latino participants. Approximately 86% had some higher education; 85% were female. Multilevel regression analyses examined moderators and predictors of treatment retention, Eating Disorder Examination (EDE) global score, frequency of objective bulimic episodes (OBEs), and OBE remission.

RESULTS

Moderator analyses of race/ethnicity and education were nonsignificant. Predictor analyses revealed African Americans were more likely to drop out of treatment than Caucasians, and lower level of education predicted greater posttreatment OBEs. African Americans showed a small but significantly greater reduction in EDE global score relative to Caucasians. Self-help treatment administered in a group showed negative outcomes relative to other treatment types, and longer treatment was associated with better outcome.

CONCLUSIONS

Observed lower treatment retention among African Americans and lesser treatment effects for individuals with lower levels of educational attainment are serious issues requiring attention. Reduced benefit was observed for shorter treatment length and self-help administered in groups.

Early life opportunities for prevention of diabetes in low and middle income countries

BACKGROUND

The global burden of diabetes and other non-communicable diseases is rising dramatically worldwide and is causing a double poor health burden in low- and middle-income countries. Early life influences play an important part in this scenario because maternal lifestyle and conditions such as gestational diabetes and obesity affect the risk of diabetes in the next generation. This indicates important periods during the lifecourse when interventions could have powerful affects in reducing incidence of non-communicable diseases. However, interventions to promote diet and lifestyle in prospective parents before conception have not received sufficient attention, especially in low- and middle-income countries undergoing socio-economic transition.

DISCUSSION

Interventions to produce weight loss in adults or to reduce weight gain in pregnancy have had limited success and might be too late to produce the largest effects on the health of the child and his/her later risk of non-communicable diseases. A very important factor in the prevention of the developmental component of diabetes risk is the physiological state in which the parents enter pregnancy. We argue that the most promising strategy to improve prospective parents' body composition and lifestyle is the promotion of health literacy in adolescents. Multiple but integrated forms of community-based interventions that focus on nutrition, physical activity, family planning, breastfeeding and infant feeding practices are needed. They need to address the wider social economic context in which adolescents live and to be linked with existing public health programmes in sexual and reproductive health and maternal and child health initiatives.

SUMMARY

Interventions aimed at ensuring a healthy body composition, diet and lifestyle before pregnancy offer a most effective solution in many settings, especially in low- and middle-income countries undergoing socio-economic transition. Preparing a mother, her partner and her future child for "the 1000 days", whether from planned or unplanned conception would break the cycle of risk and demonstrate benefit in the shortest possible time. Such interventions will be particularly important in adolescents and young women in disadvantaged groups and can improve the physiological status of the fetus as well as reduce the prevalence of pregnancy conditions such as gestational diabetes mellitus which both predispose to non-communicables diseases in both the mother and her child. Pre-conception interventions require equipping prospective parents with the necessary knowledge and skills to make healthy lifestyle choices for themselves and their children. Addressing the promotion of such health literacy in parents-to-be in low- and middle-income countries requires a wider social perspective. It requires a range of multisectoral agencies to work together and could be linked to the issues of women's empowerment, to reproductive health, to communicable disease prevention and to the Millennium Development Goals 4 and 5.

A framework to evaluate the cultural appropriateness of intervention research

Marked racial disparities exist in the prevalence, mortality, and treatment of asthma, between African American and White children and adolescents, despite increases in intervention trials to improve asthma outcomes. Yet, interventions to improve African American children's health must be culturally appropriate. To date, limited frameworks are available to decide whether an intervention tested with a targeted minority population employs a culturally appropriate design. In this article, we applied Bernal, Bonilla, and Bellido's ecological validity model to examine the cultural appropriateness of 12 randomized controlled trials of asthma self-management interventions published from 2000 to 2010. Most frequently met criteria were culturally appropriate methods of development and/or adaptation of interventions and inclusion of theoretical models. Least often met criteria were incorporating metaphors pertinent to participants and application of the language dimension. Based on this analysis, it is clear that an overarching framework is needed to guide the development of culturally targeted interventions.

Nourishing Our Understanding of Role Modeling to Improve Support and Health (NOURISH): design and methods

Pediatric overweight is associated with numerous physical and psychological health risks, and overweight children are at significant risk for obesity in adulthood. African-American children are at particularly high risk for obesity and related health complications. However, this racial group has traditionally had limited access to obesity treatment and relatively few studies have included sufficient numbers of lower-SES, African American participants. Further, although parental involvement in treatment for pediatric overweight has been found to be beneficial, few studies have examined the efficacy of offering treatment exclusively to parents, a potentially cost-effective approach which could benefit the entire family. This pilot project will evaluate the efficacy of an intensive parenting intervention, (NOURISH; Nourishing Our Understanding of Role modeling to Improve Support and Health), targeting racially diverse parents of overweight children (ages 6-11). NOURISH addresses several urgent research priorities by targeting the underserved and addressing the significant disparity in obesity treatment services. Parents meeting study criteria (having a child between the ages of 6 and 11 with a BMI ≥ the 85th percentile) will be offered participation in the randomized trial comparing NOURISH with a control group. We hypothesize that children whose parents participate in NOURISH will manifest greater decreases in BMI, and greater improvements in dietary intake, and quality of life compared to children whose parents do not participate. This study is designed explicitly to gather preliminary feasibility, acceptability, and effectiveness data to inform a subsequent larger randomized controlled trial.

Representation of ideal figure size in Ebony magazine: a content analysis

Studies examining trends over time in mainstream magazines observe decreases in women's figure size, and increases in figure exposure and amount of diet/exercise content. Little is known, however, regarding the content of African American magazines. Utilizing methods from classic studies, this investigation examined content in Ebony, a magazine with wide African American readership, from 1969 to 2008. We included the full content of N=462 issues, with a total of N=539 cover images of women, of which N=208 were full-body shots. Analyses indicated a curvilinear relationship between time and figure exposure, with a recent trend toward more full-body shots, similar to mainstream magazines. Contrary to previous studies, however, the majority of figures across time were average size, and a curvilinear relationship between time and diet/exercise content showed peak content in the early 1990s. Results are considered in context of research indicating African American women show less body dissatisfaction than other racial/ethnic groups.

Research partnership with underserved African-American communities to improve the health of older persons with disability: a pilot qualitative study

BACKGROUND AND AIMS

Underserved ethnic minorities are often under-represented in clinical investigations, often in the context of poor relationships between academic institutions and their minority communities. The aim of this study was to investigate an African-American community's perceptions about the barriers that hinder participation in research studies and, more broadly, on the status of institution/community relationships.

METHODS

We conducted a pilot qualitative study, based on semi- structured interviews of leaders of African-American communities in Winston-Salem, North Carolina. Relevant themes were abstracted from the interviews by a standardized iterative process.

RESULTS

Interviewees identified barriers to participation of African- Americans in research, and suggested that existing barriers may be overcome with an innovative model of a community/institution relationship, which would include open communication and cooperation, mutually beneficial programs, holistic approaches to health and disease, participatory and balanced partnerships with communities, and the establishment of multiethnic advisory boards.

CONCLUSIONS

This study suggests strategies that public health researchers should consider to establish effective institution/community relationships, in order to enhance participation of underserved ethnic minorities in research studies, and to improve the health status of their most disabled and demanding seniors.

Psychological risk factors in headache

Headache is a chronic disease that occurs with varying frequency and results in varying levels of disability. To date, the majority of research and clinical focus has been on the role of biological factors in headache and headache-related disability. However, reliance on a purely biomedical model of headache does not account for all aspects of headache and associated disability. Using a biopsychosocial framework, the current manuscript expands the view of what factors influence headache by considering the role psychological (i.e., cognitive and affective) factors have in the development, course, and consequences of headache. The manuscript initially reviews evidence showing that neural circuits responsible for cognitive-affective phenomena are highly interconnected with the circuitry responsible for headache pain. The manuscript then reviews the influence cognitions (locus of control and self-efficacy) and negative affect (depression, anxiety, and anger) have on the development of headache attacks, perception of headache pain, adherence to prescribed treatment, headache treatment outcome, and headache-related disability. The manuscript concludes with a discussion of the clinical implications of considering psychological factors when treating headache.

Practitioner review: bridging the gap between research and clinical practice in pediatric obesity

BACKGROUND

Pediatric obesity is a significant public health concern, with rising prevalence rates in both developed and developing countries. This is of particular significance given that overweight children and adolescents are at increased risk for multiple medical comorbidities, as well as psychosocial and behavioral difficulties. The current review highlights findings from the empirical pediatric obesity treatment literature, with particular attention to diet, physical activity, and behavior interventions. Evaluation and treatment considerations relevant to working with overweight children and adolescents with psychiatric comorbidities are reviewed.

METHODS

Review of the relevant treatment literature, with a focus on randomized clinical trials, was conducted. Recommendations regarding treatment of children and adolescents with psychiatric comorbidities are based on relevant prospective studies of the relationship between weight status and psychological variables and studies with adult populations.

RESULTS

Well-established pediatric weight control interventions have been conducted in research settings. These studies provide a starting point, but are limited by homogeneous samples that may exclude participants with psychiatric comorbidities. Practitioners treating obese children and adolescents with psychiatric disorders are encouraged to assess individual, familial, and contextual variables specific to weight (e.g., motivation and existing support to change current eating and physical activity patterns, extent of weight-related conflict within family, impact of weight on current functioning) in order to prioritize treatment objectives.

CONCLUSIONS

The review concludes with a discussion of current empirical and practical challenges, including explicitly targeting obese children and adolescents with psychiatric concerns and determining appropriateness of pursuing weight control interventions in this population.

Weight and health status of inner city African American children: Perceptions of children and their parents

Poor socioeconomic status and African American (AA) ethnicity contribute to an increased risk of obesity for many inner city children. One hundred and forty six AA children and 108 AA parents attending an inner city health fair completed surveys regarding perceptions of their own (or their child's) weight and the impact of weight on health. The children were measured and their body mass indexes were calculated. Thirty-seven percent of the child respondents (n=52) were at risk of overweight or overweight; of these, 67% perceived themselves as normal weight, and 77% thought their weight was healthy. Weighing more was felt to be healthy by 17% of children and 29% of parents. Of 39 parents whose children were at risk of overweight or overweight, 68% felt their child's weight was normal and 80% thought it was healthy. These results suggest that inner city AA children and their parents often do not recognize being overweight or the health implications of being overweight.

Childhood obesity: a school-based approach to increase nutritional knowledge and activity levels

Although the incidence of childhood obesity is rising at an alarming rate, weight loss programs for children are few and often inaccessible for various reasons, including cost, transportation difficulties, and lack of parental involvement. School-based programs, offered free of charge, make weight management more accessible. School-based health centers have a unique opportunity to assure that schools stay in the forefront of obesity prevention and management. This article discusses one such program that was designed and implemented by the staff of a Louisiana school-based health center.

Results of go girls: a weight control program for overweight African-American adolescent females

OBJECTIVE

Go Girls was a church-based nutrition and physical activity program designed for overweight African-American (AA) adolescent females.

RESEARCH METHODS AND PROCEDURES

Ten predominantly middle-socioeconomic churches were randomized to either a high-intensity (20 to 26 sessions) or moderate-intensity (six sessions) culturally tailored behavioral group intervention delivered over 6 months. Each session included an experiential behavioral activity, approximately 30 minutes of physical activity, and preparation and tasting of healthy foods. In the high-intensity group, girls also received four to six telephone counseling calls. From the 10 churches, 123 girls completed baseline and 6-month post-test assessments. The primary outcome was BMI; secondary outcomes included waist and hip circumferences, percentage body fat estimated by bioimpedance, serum insulin, glucose, and lipids, and cardiovascular fitness at 6-month follow-up. Selected measures were also collected at 1-year follow-up.

RESULTS

At 6-month follow-up, the net difference between the high- and moderate-intensity groups was 0.5 BMI units. This difference was not statistically significant (p = 0.20). There were no significant group differences in secondary outcomes. Girls in the high-intensity condition, however, who attended more than three-quarters of the sessions had significantly lower BMI and percentage body fat relative to girls in the high-intensity group who attended fewer sessions. Findings at 1-year follow-up mirrored those at 6 months.

DISCUSSION

We concluded that the intervention was not effective in reducing adiposity, although there were some positive findings among high attenders. Despite the null result, the intervention was generally well received by participants. Future interventions may require greater dose and a more structured dietary change program.

Body mass index and breast cancer risk in African American women

PURPOSE

Studies of the relationship between body mass index (BMI) and breast cancer in African American women have been few. We conducted a case-control study to examine whether BMI is associated with risk of breast cancer in this population.

METHODS

Cases were 304 women diagnosed with breast cancer at the ages of 20 to 64 years. Controls were 305 women without a history of breast cancer. Telephone interviews were conducted to collect data on history of exposure to various factors at or before the date of diagnosis in cases or equivalent date in controls (reference date). Using logistic regression, we compared cases and controls in BMI at age 18, BMI at the reference date, and change in BMI between the two dates.

RESULTS

Using BMI at reference date, we found an odds ratio (OR) of 1.75 (95% confidence interval [CI], 1.02-3.02) and 2.32 (95% CI, 1.33-4.03) for women with BMI of 25 to 29.9 and 30 or higher, respectively, compared with women having BMI lower than 25. The corresponding OR estimates for BMI at age 18 were not significantly different from the unity. The average annual change in BMI between age 18 and date of diagnosis or reference date was associated with breast cancer risk, as shown that more BMI change tended to increase breast cancer risk compared with the baseline quartile of change. When data were analyzed by menopausal status, the association was found for both post-menopausal and pre-menopausal tumors for BMI at reference date but not for BMI at age 18. There was a higher risk for more annual BMI change compared with the baseline for both pre-menopausal and post-menopausal women.

CONCLUSION

Our results suggest that BMI at reference date and change in BMI were associated with increased risk of breast cancer in African American women, and the association might be found for both post-menopausal and pre-menopausal tumors.

Binge eating and psychological distress in ethnically diverse undergraduate men and women

Binge eating symptomatology affects African Americans and Caucasians at similar rates. Moreover, compared to anorexia nervosa (AN) and bulimia nervosa (BN), binge eating and BED are more evenly distributed across genders. Undergraduates are likely to be affected by binge eating, yet, relatively few studies have investigated this behavior and its correlates in college samples. This study examined the influence of alexithymia, depression, and anxiety on binge eating among ethnically diverse undergraduates. Results indicated that these variables significantly predicted eating symptomatology among Caucasian and African American women but not among Caucasian men. Further, among Caucasian women, depression was the only unique predictor of eating pathology. In contrast, anxiety was the only unique predictor of disordered eating in African American women. There were no differences between Caucasians and African Americans in severity of disordered eating symptomatology; however, in both ethnic groups, women reported greater eating pathology than men. Eating disorders of all types may be more prevalent among African American undergraduates than previously thought. These results highlight the need to study binge eating and its correlates in this traditionally underserved group.