Home environment and psychosocial predictors of obesity status among community-residing men and women

The lived experience of food insecurity among adults with obesity: a quantitative and qualitative systematic review

BACKGROUND

Food insecurity and obesity are increasing both globally and in the UK. In this review we systematically assess the lived experiences of people with obesity who are food insecure and often turn to food banks.

METHODS

We systematically searched electronic databases from January 2007 until October 2022. Data from eligible studies were extracted and the studies assessed for quality. Thematic analysis and narrative synthesis approach was used to analyse the extracted data.

RESULTS

Six themes were identified among 25 included studies, including: the financial cost of food; psychological aspects related to food insecurity; geographical access and the food environment; food practices in the home; experience of food assistance; and parental-child relationships. The cost of healthy food and psychological factors were identified as key driving factors of the relationship between food insecurity and obesity. Psychological factors such as depression, low self-esteem and stress played an important part in the lived experience of people with obesity and food insecurity.

CONCLUSION

The food environment provides context in which food decisions are made, therefore, systems change is necessary to ensure families can afford the food that enables a healthy diet. For clinicians, identification, and attention to the impact of food insecurity on people with obesity are important.

Utilisation of the health belief model to study the behavioural intentions relating to obesity management among university students: a cross-sectional study

BACKGROUND

Overweight and obesity are excessive fat accumulations linked with many health problems, including heart diseases, type 2 diabetes and cancer. Multiple studies have demonstrated that beliefs about overweight, obesity and self-efficacy play essential roles in the success of interventions for obesity management.

OBJECTIVES

This study aimed to identify the perceptions of university students of overweight and obesity using the health belief model (HBM) and to analyse their association with the body mass index (BMI) categories of the students.

DESIGN

A cross-sectional questionnaire-based study and a multistage sampling technique were used to ensure the recruitment of students from selected colleges of Jazan University-Saudi Arabia.

SETTING

Six colleges of Jazan University were randomly selected to ensure equal representation of health sciences, sciences and humanities colleges.

PARTICIPANTS

A total of 579 students completed an online survey between January and April 2023.

PRIMARY AND SECONDARY OUTCOME MEASURES

The primary outcome measures were demographic characteristics and HBM constructs. Secondary outcome measures were behavioural intentions relating to obesity management.

RESULTS

This study demonstrated that gender and self-reported family history of obesity were significantly correlated with the BMI categories of the students (p <0.001). Students in the underweight category showed the highest mean score for perceived severity (3.62 ±0.08). Perceived self-efficacy in exercise and diet was significantly associated with BMI categories, with adjusted ORs of 2.82 (2.10 to 3.79) and 1.51 (1.09 to 2.09), respectively. Perceived barriers to healthy eating and regular physical activity were significantly related to the behavioural intentions of obesity management. Multivariate logistic regression showed that perceived severity, perceived cues to action, perceived barriers and self-efficacy in dieting and exercise were significant predictors of behavioural intentions for the management of obesity.

CONCLUSION

This study underscores the need for tailored health promotion strategies that consider the perceptions and beliefs of people about the management of obesity.

A hamster model for stress-induced weight gain

This review addresses the translational relevance of animal models of stress and their effects on body weight. In humans, stress, whether chronic or acute, has often been associated with increased food intake and weight gain. In view of the current obesity epidemic, this phenomenon is especially relevant. Such observations contrast with reports with commonly used laboratory animals, especially rats and mice. In these species, it is common to find individuals gaining less weight under stress, even with potent social stressors. However, there are laboratory species that present increased appetite and weight gain under stress, such as golden hamsters. Furthermore, these animals also include metabolic and behavioral similarities with humans, including hoarding behavior which is also enhanced under stress. Consequently, we propose that our comparative perspective provides useful insights for future research on the development of obesity in humans as a consequence of chronic stress exposure.

Different Dimensions of the Home Food Environment May Be Associated with the Body Mass Index of Older Adults: A Cross-Sectional Survey Conducted in Beijing, China

OBJECTIVE

The objective of this study was to evaluate the home food environment of the elderly in Beijing and analyze its association with the body mass index (BMI) of the elderly, as well as to provide recommendations for improving the home food environment for the elderly.

METHODS

This study was conducted in Beijing, China, in 2019. The participants were 1764 elderly individuals aged 65 to 80, recruited from 12 communities through a multistage stratified random sampling method. The study involved the use of questionnaire surveys to gather data on participants' demographics, the availability of various foods in their households, and their living conditions. Socioeconomic status (SES) was evaluated based on their educational level, occupation, and income level. Height and weight measurements were taken to calculate BMI. We conducted both univariate analysis and multiple linear regression analysis to evaluate the relationship between the home food environment and BMI.

RESULTS

A total of 1800 questionnaires were distributed, of which 1775 were retrieved, resulting in a questionnaire recovery rate of 98.6%. Among these, 1764 questionnaires were deemed valid, corresponding to a questionnaire validity rate of 99.4%. The participants had a mean age of 69.7 ± 4.3 years old, over 40% of whom were overweight or obese. In terms of low-energy/high-nutrient-density foods, the most readily available items were fresh vegetables (95.6%), followed by coarse grains (94.1%), fresh fruits (90.4%), and dairy products (83.6%). Among high-energy/low-nutrient-density foods, preserved foods were the most available (51.9%), followed by salted snacks (40.6%), sugary beverages (28.2%), and fried foods (9.4%). Approximately 7.3% of participants lived alone. Elderly individuals with higher SES had a lower BMI compared to those with medium to low SES (25.9 vs. 26.5, 25.9 vs. 26.4, p < 0.05). Those living alone had a higher BMI than those who did not (27.2 vs. 26.2, p = 0.001). After controlling for potential confounding variables, older adults with high SES exhibited a BMI reduction of 0.356 kg/m2 (p = 0.001), whereas those living alone exhibited an increase in BMI of 1.155 kg/m2 (p < 0.001). The presence of preserved foods at home was linked to a BMI increase of 0.442 kg/m2 (p = 0.008).

CONCLUSION

This study underscores the significant impact of family SES, living conditions, and the availability of preserved foods on the BMI of elderly individuals.

Overlapping and distinct relationships between hedonic hunger, uncontrolled eating, food craving, and the obesogenic home food environment during and after a 12-month behavioral weight loss program

Hedonic hunger, reward-driven eating outside of biological need, is a newer construct in eating behavior research. During behavioral weight loss (BWL), greater improvements in hedonic hunger are associated with higher weight loss, but it remains unclear if hedonic hunger predicts weight loss independent of more well-established, similar constructs (uncontrolled eating and food craving). Research also is needed to understand how hedonic hunger interacts with contextual factors (e.g., obesogenic food environment) during weight loss. Adults (N = 283) in a 12-month randomized controlled trial of BWL were weighed at 0, 12, and 24 months, and completed questionnaires assessing hedonic hunger, food craving, uncontrolled eating, and the home food environment. All variables improved at 12 and 24 months. Decreases in hedonic hunger at 12 months were associated with higher concurrent weight loss, but not when accounting for improvements in craving and uncontrolled eating. At 24 months, reduction in craving was a stronger predictor of weight loss than hedonic hunger, but improvement in hedonic hunger was a stronger predictor of weight loss than change in uncontrolled eating. Changes to the obesogenic home food environment failed to predict weight loss, regardless of levels of hedonic hunger. This study adds novel information on the individual and contextual factors associated with short- and long-term weight control, which can help refine conceptual models and treatment strategies.

The perceived role of food and eating among turkish women with obesity: A qualitative analysis

The studies show the link between Body Mass Index (BMI) and higher food responsiveness despite negative physical, social, and psychological outcomes. The descriptive studies examining what makes individuals with higher BMI values more likely to respond to food are limited, while there is none in the Turkish sample. This study aims to understand the subjective relationship of women with obesity/overweight related to food in Turkish culture. Turkish adult women (aged 22-54) who have BMI higher than 25 (overweight/obesity) participated in semi-structured interviews focusing on how they relate to food and obesity. Participants were reached through Ankara Etlik Zübeyde Hanım Obstetrics and Gynecology Hospital Obesity outpatient service. Audio-recorded interviews were analyzed predominantly inductively by thematic analysis principles. Analysis of these interviews reflected three main themes: (1) the act of eating: "I don't know why I eat when I'm full", (2) being overweight: "I am the kind of person who constantly tries to lose weight", and (3) sources of distress. The results indicated the dynamic relationship between the desire to eat, chronic stress, perceived unavailability of close ones, and low sense of self-worth among adult women with obesity/overweight. The other indication is the effect of culture in shaping the relationship dynamics, the sources of distress, and the eating patterns in developing and maintaining obesity.

Home availability of ultraprocessed foods in families who prepare meals at home

ABSTRACT Objective This study characterized the degree of processing of the food items available at home and the routine of shopping for food in families with children and/or teenagers and whose meals are usually prepared at home. Methods Mixed methods (interview, questionnaires, and food inventory). Interview’s transcripts were submitted to thematic analysis and the foods identified in the inventory were classified according to the degree of processing and analyzed for their availability and access in the home food environment. Results Results revealed the high availability of ultra-processed foods; that the supermarket was the main source of food acquisition; and that purchasing food is part of an organized routine where time and control of expenses are the most valued aspects. Conclusion Actions which focus on planning and executing the acquisition of unprocessed and minimally processed foods are needed to promote greater availability and increased intake of such foods, so that the composition of homemade meals may be in line with what is recommended by the national dietary guidelines.

Beyond the clinical walls: registered dietitian nutritionists providing medical nutrition therapy in the home setting

BACKGROUD/OBJECTIVES

Registered dietitian nutritionists (RDN) are providers of medical nutrition therapy (MNT) to address health and chronic disease. Traditionally, RDNs have provided care in healthcare facilities including hospitals and private care facilities. The purpose of this study was to determine how RDN individualized MNT in the home impacted nutrition, physical activity, and food security.

SUBJECTS/METHODS

This is a secondary data analysis. The mean age of the participants (n = 1,007) was 51.6 years old with a mean body mass index (BMI) of 34.1 kg/m². Individualized MNT visits were delivered by an RDN in the home setting from January to December 2019. Participants were referred by healthcare professionals or self-referred. Participants had MNT benefits covered by their health insurance plan (43.3% Medicaid; 39.8% private insurance; 7.9% Medicare, 9% other). Health outcomes related to nutrition care were measured. Outcomes included self-reported consumption of nutrition factors and physical activity. Our secondary outcome focused on food security. The changes in weight, BMI, physical activity, and nutrition factors were analyzed by a linear regression model or linear mixed model, adjusting for age, sex, baseline value, and number of appointments. Food security was summarized in a 2 by 2 contingency table.

RESULTS

Baseline values had significantly negative impacts for all changes and number of appointments was significant in the changes for weight and BMI. Increases in physical activity were significant for both female and male participants, 10.4 and 12.6 minutes per day, respectively, while the changes in weight and BMI were not. Regarding dietary factors, the consumption total servings per day of vegetables (0.13) and water (3.35) significantly increased, while the consumption of total servings of whole grain (−0.27), fruit (−0.32), dairy (−0.80) and fish (−0.81) significantly decreased. About 24% (of overall population) and 45% (of Medicaid population) reported improvements in food security.

CONCLUSIONS

This study found that home visits were a useful setting for MNT delivered by RDNs. There is a strong need for individualized counseling to meet the participants' needs and personal goals.

Predicting Obesity in Adults Using Machine Learning Techniques: An Analysis of Indonesian Basic Health Research 2018

Obesity is strongly associated with multiple risk factors. It is significantly contributing to an increased risk of chronic disease morbidity and mortality worldwide. There are various challenges to better understand the association between risk factors and the occurrence of obesity. The traditional regression approach limits analysis to a small number of predictors and imposes assumptions of independence and linearity. Machine Learning (ML) methods are an alternative that provide information with a unique approach to the application stage of data analysis on obesity. This study aims to assess the ability of ML methods, namely Logistic Regression, Classification and Regression Trees (CART), and Naïve Bayes to identify the presence of obesity using publicly available health data, using a novel approach with sophisticated ML methods to predict obesity as an attempt to go beyond traditional prediction models, and to compare the performance of three different methods. Meanwhile, the main objective of this study is to establish a set of risk factors for obesity in adults among the available study variables. Furthermore, we address data imbalance using Synthetic Minority Oversampling Technique (SMOTE) to predict obesity status based on risk factors available in the dataset. This study indicates that the Logistic Regression method shows the highest performance. Nevertheless, kappa coefficients show only moderate concordance between predicted and measured obesity. Location, marital status, age groups, education, sweet drinks, fatty/oily foods, grilled foods, preserved foods, seasoning powders, soft/carbonated drinks, alcoholic drinks, mental emotional disorders, diagnosed hypertension, physical activity, smoking, and fruit and vegetables consumptions are significant in predicting obesity status in adults. Identifying these risk factors could inform health authorities in designing or modifying existing policies for better controlling chronic diseases especially in relation to risk factors associated with obesity. Moreover, applying ML methods on publicly available health data, such as Indonesian Basic Health Research (RISKESDAS) is a promising strategy to fill the gap for a more robust understanding of the associations of multiple risk factors in predicting health outcomes.

Methodologies for assessing the household food availability in the context of food (in)security: a systematic review

This article aims to identify the methods used to assess household food availability in studies on food and nutritional security and to discuss its methodological aspects. Systematic review elaborated according to the PRISMA method. We searched at PubMed; Scielo and Lilacs databases, and studies that used methods of assessing the availability of food at home were included. In the end, 19 papers composed the review. Food availability was predominantly assessed for a seven days period and from a single data measurement. Other variables were also observed in the studies, such as socio-demographic data and expenditure on food. Among the limitations to assess the food availability at home, we can highlight the difficulty in measuring the food distribution among family members and the lack of information on the variability of this availability. Such assessment can be improved by investigating the strengths and weaknesses of the instruments for greater detail and accuracy of the information. We recommend the development and validation of specific instruments capable of effectively measure the food availability at the household level.

Randomized controlled trials of self-monitoring interventions with or without incentives for diet and exercise among individuals with overweight or obesity: Psychological and behavioural effects

OBJECTIVES

To test the effects of three behavioural interventions (daily monetary incentives + self-monitoring, delayed lump sum monetary incentives + self-monitoring, and self-monitoring only) on psychological constructs and fruit and vegetable consumption or physical activity behaviour change among a sample of adults with overweight or obesity.

DESIGN

A pair of 3-arm longitudinal randomized controlled trials compared daily monetary incentives + self-monitoring, delayed lump sum monetary incentives + self-monitoring, and self-monitoring only interventions for either fruit and vegetable consumption or physical activity.

METHODS

Individuals reporting elevated weight status and insufficient engagement in one of the target behaviours were randomly assigned to one of three 3-week interventions. All three interventions involved daily self-monitoring of the behaviour, and two provided monetary incentives contingent upon reported behaviour. Participants completed measures of psychological constructs and reported behaviour at baseline, the end of the intervention, and two and four weeks post-intervention.

RESULTS

Participants across all three intervention conditions demonstrated increased engagement in the target behaviour from pre- to post-intervention and reported behaviour remained above baseline levels at both follow-up time points. Increases in reported behaviour during the intervention were associated with increases in self-efficacy, and this enhanced self-efficacy prospectively predicted sustained reported behaviour at follow-up. However, contrary to hypotheses, the incentive interventions including self-monitoring were not more efficacious than self-monitoring alone, and increased reported behaviour was not associated with enhancements in attitudes.

CONCLUSIONS

Self-monitoring interventions can aid behaviour change efforts, and behavioural practice during these interventions can increase self-efficacy. However, among adults with overweight or obesity who are seeking behaviour change interventions, incentive-based self-monitoring approaches may not be superior to self-monitoring alone in driving behaviour change and maintenance.

Reward-related eating, self-regulation, and weight change in pregnancy and postpartum: the Pregnancy Eating Attributes Study (PEAS)

Background/Objectives.

Reward-related eating is hypothesized to underlie risk for weight gain in obesogenic environments, but its role is unknown during pregnancy and postpartum when weight change is normative, but excess weight gain and weight retention are common. This study examined associations of self-reported reward-related eating, self-regulation, and the home food environment with excessive gestational weight gain (GWG) and postpartum weight change.

Subjects/Methods.

Participants in the Pregnancy Eating Attributes Study observational cohort were enrolled at ≤12 weeks pregnancy and followed through one-year postpartum (458 recruited; 367 retained through delivery). Participants completed four measures of reward-related eating – Modified Yale Food Addiction Scale, Power of Food Scale, Multiple Choice Procedure, and a Reinforcing Value of Food Questionnaire; two measures of self-regulation – Barratt Impulsiveness Scale and Delay of Gratification Inventory; and a Home Food Inventory. Measured weight and skinfolds were obtained. Multinomial logistic and multiple linear regression analyses estimated associations of reward-related eating, self-regulation, and home food environment with excessive GWG, gestational fat gain, postpartum weight change, and percent of GWG retained.

Results.

Excessive GWG was associated with food reinforcement intensity, but not with any other measure of reward-related eating, self-regulation, or home food environment. Greater gestational fat gain was associated only with higher Multiple Choice Procedure. Postpartum weight change and percent of GWG retained were associated with greater Delay of Gratification and obesogenic home food environment, but not with any measure of reward-related eating or with impulsivity.

Conclusions.

Findings do not support the hypothesis that self-reported reward-related eating is associated with weight outcomes in pregnancy and postpartum but indicate a relation of Delay of Gratification with postpartum weight retention. Further research using both surveys and objective measures of reward-related eating is needed to advance our understanding of the relation of reward-related eating with weight changes during this critical period of a woman’s life.

Association of Home Food Availability with Prediabetes and Diabetes among Adults in the United States

This study examined associations of home food availabilities with prediabetes and diabetes among 8929 adults (20–70 years) participating in 2007–2010 National Health and Nutrition Examination Surveys. Odds ratios (ORs) and 95% confidence intervals (95% CIs) were estimated by logistic regression. Relative to non-diabetic participants (individuals without diabetes or prediabetes), prediabetes participants were associated with lower availabilities of green vegetables (OR = 0.82; 95% CI = 0.73–0.91; p = 0.0006) and fat-free/low-fat milk (OR = 0.80, 95% CI = 0.65–0.89; p = 0.001) and higher sugary drink availability (OR = 1.24, 95% CI = 1.04–1.48; p = 0.02), adjusting for age, sex, and ethnicity (Model 1). The associations remained significant for vegetables (p = 0.005) and fat-free/low-fat milk (p = 0.02) adjusting for additional confounders (body mass index, education, Model 2). Adjusting for dietary components did not change the above results (in model 2) significantly. Participants with high healthy food availability scores had approximately 31% reduction (p = 0.003) in odds of prediabetes compared to those with low scores in Model 1. No associations were detected for diabetes except for fat-free/low-fat milk availability, for which an inverse association was observed in Model 1 (OR = 0.80, 95% CI = 0.65–0.99; p = 0.04). The results show prediabetes participants had lower availability of healthy foods and higher availability of unhealthy foods, suggesting the need to improve healthy food availability at home for this population.

Factors influencing weight management behavior among college students: An application of the Health Belief Model

BACKGROUND

Overweight and obesity have become a significant public health concern in both developing and developed countries. Due to the health implications of weight-reduction behaviors, it is important to explore the factors that predict their occurrence. Therefore, the present study was performed to examine factors affecting the behavioral intention of weight management as well as assess the predictive power of the Health Belief Model (HBM) for body mass index (BMI).

METHODS

This cross-sectional study was conducted among 336 female students recruited from dormitories of Tabriz University of Medical Sciences, using quota sampling technique. Data were collected by a structured questionnaire in seven parts (including perceived severity, perceived susceptibility, perceived benefit, perceived barrier, cue to action, self-efficacy in dieting and physical activity, and behavioral intention of weight management), based on the HBM. Structural equation modeling (SEM) was conducted to identify the relationship between HBM constructs and behavioral intention of weight management. Linear regression model was performed to test the ability of the HBM to predict students' BMIs.

RESULTS

Higher level of perceived threats (sum of perceived susceptibility and severity) (β = 0.41, P<0.001), perceived benefits (β = 0.19, P = 0.009), self-efficacy in exercise (β = 0.17, P = 0.001), and self-efficacy in dieting (β = 0.16, P = 0.025) scales was significantly related to greater behavioral intention of weight management. Moreover, perceived threat mediated the relationships between perceived cue to action, perceived benefits, self-efficacy in exercise, and weight management practices. The fit indices of the SEM model seemed acceptable. The final regression model explained approximately 40% of variance in BMI (P<0.001). Additionally, perceived severity, barrier, and self-efficacy in dietary life were the significant variables to predict students' BMIs.

CONCLUSIONS

These findings suggest that health education programs based on the HBM needs to be integrated in preventive health programs and health interventions strategies to ensure adherence and well-being of the participants.

Mental Illness, Not Obesity Status, is Associated with Food Insecurity Among the Elderly in the Health and Retirement Study

OBJECTIVES

Food insecurity, limited or uncertain access to adequate nutrition, is an increasingly recognized determinant of health outcomes and is often associated with having obesity. It is unclear, however, if this association persists in elderly populations.

METHODS

We conducted a cross-sectional study of 2868 participants' aged 65+ years from the Health and Retirement Study. Multivariate logistic regression was used to assess associations between food insecurity and body mass index, demographic characteristics, psychiatric history, and medical history.

RESULTS

Participants with overweight/obesity had a higher prevalence of food insecurity than leaner counterparts, however, weight status was not a significant predictor of food insecurity after multivariate adjustment. Instead, mental illness, current smoking status, and non-White race were all independently associated with food insecurity.

DISCUSSION

Beyond financial status, health care providers are encouraged to use these characteristics to identify elderly patients that may be at risk of food insecurity.

Being Motivated by Nutrition Is Associated With Healthy Home Food Environment of Supplemental Nutrition Assistance Program (SNAP) Recipients

OBJECTIVE

To examine the relationship between food shopping motivating factors and the home food environment (HFE).

METHODS

Participants in the Supplemental Nutrition Assistance Program (n = 123) who were taking part in the Utah State Double-Up Food Bucks evaluation program were interviewed about their HFE, factors motivating shopping, and food security status. Composite HFE scores were derived from the Perceived Nutrition Environment Measure Survey questionnaire and food security score from the 6-item US Household Food Security Survey questionnaire. Analysis included multiple linear regression.

RESULTS

Mean age was 46 ± 16.1 years. Regression models showed significant associations of being motivated by nutrition, education, and food security with HFE (β = 4.70, P = .03; β = 1.44, P = .06; and β = 1.44, P = .06, respectively).

CONCLUSION AND IMPLICATIONS

In-store interventions to improve perceived nutrition importance among shoppers may be a useful tool to improve home food supplies. Further research is recommended examining the association between food shopping motivators and the HFE in a larger population.

Impact of a Healthy Weight Intervention Embedded Within a National Home Visiting Program on the Home Food Environment

Purpose: To determine whether a lifestyle intervention embedded within Parents as Teachers (PAT), a national child development and parenting home visiting program, helped families make food-related home environment changes.

Design: Secondary data analysis of a stratified randomized pragmatic trial. (Trial Registration: This study is registered at www.clinicaltrials.gov NCT01567033).

Setting: Participant homes in St. Louis, Missouri.

Subjects: Women (n = 179 with pre-post data, of 230 with baseline) participating in standard PAT, with overweight or obesity, and at least one preschool child with BMI percentile ≥60%.

Intervention: PAT + Healthy Eating and Active Living Taught at Home (HEALTH), embedded elements of the Diabetes Prevention Program within the standard PAT curriculum. PAT + HEALTH addressed specific behaviors that impact caloric intake (e.g., sugar-sweetened beverages), focusing on behavioral and environmental strategies. Consistent with PAT practice, the frequency, number, and focus (i.e., time spent on intervention components) of home visits were determined by the family's needs; dose structure was flexible [on average intervention: 23 (SD = 9), usual care: 13 (SD = 6) visits].

Measures: Food availability/accessibility and distractions in the home were assessed with items drawn largely from the HomeSTEAD Survey.

Analysis: Generalized estimating equations (GEEs) were used to test equality of changes between baseline and 24 months in the intervention and usual care groups.

Results: The only significant difference in the pattern of change between usual care and intervention was soda availability/accessibility (p = 0.013).

Conclusion: This embedded intervention successfully reduced availability/accessibility of sugar-sweetened beverages in the home. However, given the limited impact on other food-related home environment factors, future interventions could seek to more effectively intervene on all aspects of the home environment.

Food Insecurity and Obesity: Exploring the Role of Social Support

BACKGROUND

Women are disproportionately affected by both obesity and food insecurity. Food insecurity occurs when there is limited ability to acquire adequate foods. It is unknown whether social support can reduce the effect of food insecurity on increased obesity. This study seeks to determine whether social support modifies the relationship between food insecurity and obesity.

METHODS

We conducted a cross-sectional study in a nationally representative sample of 4672 women aged ≥40 years using National Health and Nutrition Examination Survey (2003-2008). Individual food insecurity was assessed based on the U.S. Department of Agriculture 18-item validated household food security scale. Women were categorized as fully food secure (0 affirmative responses) or food insecure (1-10 affirmative responses). Obesity was defined as body mass index ≥30 kg/m2. Outcomes were analyzed by multivariable logistic regression.

RESULTS

Fourteen percent were food insecure. Women with food insecurity had 1.4 the odds of obesity as those who were fully food secure, adjusting for race/ethnicity and health status (95% confidence interval [CI] 1.22-1.62). Food-insecure women were 80% less likely to report strong social support than women who were fully food secure (95% CI 0.11-0.36). Social support as measured in this study did not modify the association between food insecurity and obesity.

CONCLUSIONS

Women reporting food insecurity reported lower levels of social support and were more likely to experience obesity. Interventions to reduce obesity in women who are food insecure must consider the limited resources available to these women.

Association of Individual and Neighborhood Factors with Home Food Availability: Evidence from the National Health and Nutrition Examination Survey

BACKGROUND

Accumulating evidence suggests the important role of the home food environment in an individual's dietary intake.

OBJECTIVE

This study examined the associations of individual and neighborhood-level factors with the availability of healthy and unhealthy foods in the home using a nationally representative sample from the 2007 to 2008 and 2009 to 2010 National Health and Nutrition Examination Surveys (NHANES).

DESIGN

A cross-sectional study design was used with NHANES merged with the 2000 census data. Food availability was measured through self-report questionnaire regarding the frequency of foods or drinks available in the home.

PARTICIPANTS

The analysis included 8,975 participants aged 19 to 65 years.

STATISTICAL ANALYSES PERFORMED

Associations of individual and neighborhood factors with home food availability (always or most of the time available) were assessed using logistic regression modeling accounting for NHANES' complex survey design and weights. Individual-level and neighborhood-level factors were simultaneously included in the analysis.

RESULTS

Family income-to-needs ratio was positively associated with the availability of dark green vegetables (odds ratio [OR]=1.07; 95% CI=1.00 to 1.13), fat-free or low-fat milk (OR=1.16; 95% CI=1.07 to 1.25), and salty snacks (OR=1.12; 95% CI=1.04 to 1.20) in the home. College graduates were more likely to have fruits (OR=1.96, 95% CI=1.48 to 2.60), vegetables (OR=1.48; 95% CI=1.16 to 1.88), and fat-free or low-fat milk (OR=1.81; 95% CI=1.55 to 2.12) and less likely to have salty snacks (OR=0.77; 95% CI=0.63 to 0.95) and sugary drinks (OR=0.46, 95% CI=0.37 to 0.57) available compared with non-college graduates. Tract socioeconomic status (SES) scores were positively associated with fruit (OR=1.15; 95% CI=1.02 to 1.29), vegetable (OR=1.14; 95% CI=1.03 to 1.26), and fat-free or low-fat milk (OR=1.25; 95% CI=1.10 to 1.42) availability. Urban residents were associated with greater availability of fruits (OR=1.47; 95% CI=1.05 to 2.08) and fat-free or low-fat milk (OR=1.33; 95% CI=1.02 to 1.73) in the home compared with rural residents. Food desert status was not associated with home food availability.

CONCLUSIONS

The results show that SES at both individual (education, income) and neighborhood level was linked to home food availability, suggesting a need to improve the home food environment for socioeconomically disadvantaged individuals and neighborhoods.

Obesity: Risk factors, complications, and strategies for sustainable long-term weight management

Background and Purpose

The aims of this article are to review the effects of obesity on health and well‐being and the evidence indicating they can be ameliorated by weight loss, and consider weight‐management strategies that may help patients achieve and maintain weight loss.

Methods

Narrative review based on literature searches of PubMed up to May 2016 with no date limits imposed. Search included terms such as “obesity,” “overweight,” “weight loss,” “comorbidity,” “diabetes,” cardiovascular,” “cancer,” “depression,” “management,” and “intervention.”

Conclusions

Over one third of U.S. adults have obesity. Obesity is associated with a range of comorbidities, including diabetes, cardiovascular disease, obstructive sleep apnea, and cancer; however, modest weight loss in the 5%–10% range, and above, can significantly improve health‐related outcomes. Many individuals struggle to maintain weight loss, although strategies such as realistic goal‐setting and increased consultation frequency can greatly improve the success of weight‐management programs. Nurse practitioners have key roles in establishing weight‐loss targets, providing motivation and support, and implementing weight‐loss programs.

Implications for Practice

With their in‐depth understanding of the research in the field of obesity and weight management, nurse practitioners are well placed to effect meaningful changes in weight‐management strategies deployed in clinical practice.

A Different Weight Loss Experience: A Qualitative Study Exploring the Behavioral, Physical, and Psychosocial Changes Associated with Yoga That Promote Weight Loss

Yoga interventions improve obesity-related outcomes including body mass index (BMI), body weight, body fat, and waist circumference, yet it is unclear whether these improvements are due to increased physical activity, increased lean muscle mass, and/or changes in eating behaviors. The purpose of this study is to expand our understanding of the experience of losing weight through yoga. Methods. Semistructured interviews were qualitatively analyzed using a descriptive phenomenological approach. Results. Two distinct groups who had lost weight through yoga responded: those who were overweight and had repeatedly struggled in their attempts to lose weight (55%, n = 11) and those who were of normal weight and had lost weight unintentionally (45%, n = 9). Five themes emerged that differed slightly by group: shift toward healthy eating, impact of the yoga community/yoga culture, physical changes, psychological changes, and the belief that the yoga weight loss experience was different than past weight loss experiences. Conclusions. These findings imply that yoga could offer diverse behavioral, physical, and psychosocial effects that may make it a useful tool for weight loss. Role modeling and social support provided by the yoga community may contribute to weight loss, particularly for individuals struggling to lose weight.

The Relationship between Food Insecurity, Dietary Patterns, and Obesity

Food insecurity is a major public health concern, and refers to the uncertainty, lack of, or inability to acquire nutritious food in a safe and socially acceptable manner. Food insecurity has been associated with obesity and unhealthy dietary patterns, both of which can have negative health consequences. A review of the current literature revealed an adverse association between food insecurity and dietary patterns is well supported. The association between food insecurity and obesity is strongest for women, with results for men and children being mixed. Evidence for long-term effects is limited due to a lack of longitudinal studies. Results from interventional studies have mostly yielded mixed results, and it is presently unclear how to best help food insecure individuals improve diet and weight.

Social disparities in dietary habits among women: Geographic Research on Wellbeing (GROW) Study

OBJECTIVE

Relationships among race/ethnicity, individual socio-economic status (SES), neighbourhood SES and acculturation are complex. We sought to answer whether: (i) race/ethnicity, individual SES and neighbourhood SES have independent effects on women's fruit and vegetable consumption (FVC); (ii) SES modifies the effects of race/ethnicity on FVC; and (iii) nativity modifies the effect of Latina ethnicity on FVC.

DESIGN

Cross-sectional surveys from the population-based Geographic Research on Wellbeing (GROW) Study were linked with census-tract level data. FVC was indicated by (i) consuming fruits and vegetables less often than daily (LOWFV) and (ii) not having fruits and vegetables in the home very often. Other variables included age, marital status, race/ethnicity, country of birth, educational attainment, family income and longitudinal neighbourhood poverty (based on latent class growth models). Weighted logistic regression models accounting for the complex sample design were constructed.

SETTING

California, USA, 2012-2013.

SUBJECTS

Women (n 2669).

RESULTS

In adjusted models, race/ethnicity, education and income were independently associated with FVC, but not neighbourhood poverty. Women of colour, high-school graduates and women with incomes at 301-400 % of the federal poverty level were at higher odds of LOWFV compared with non-Hispanic Whites, college graduates and those with incomes >400 % of the federal poverty level. Little evidence for interactions between race/ethnicity and individual or neighbourhood SES was found; similar patterns were observed for immigrant and US-born Latinas.

CONCLUSIONS

Addressing the dietary needs of lower-SES communities requires multilevel interventions that simultaneously provide culturally tailored nutrition education and address the physical and economic accessibility of culturally acceptable fruits and vegetables.