WAVE: a pocket guide for a brief nutrition dialogue in primary care

Youth WAVE Screener

Purpose

This study evaluated the feasibility of using the youth Weight, Activity, Variety, and Excess (WAVE) screener in a classroom setting for assessing student weight control intentions and the extent to which they used the WAVE strategies to control their weight.

Methods

The Youth WAVE Screener was administered to fifth-grade students in an inner-city school located in the Bronx, New York. The study was conducted in part to increase student awareness of snack foods and sugary beverages in relation to weight.

Results

Of the 169 students who completed the survey, 45.5% (n = 77) were trying to lose weight. Students who were trying to lose weight were more likely to have low-fat dairy products, less likely to have sugary beverages, and less likely to eat junk foods than those who were not trying to lose weight. Students who reported exercising 3 times weekly were more likely to report healthier dietary patterns and less sedentary behaviors than were students who exercise less often. Feedback and dialogue with fifth graders addressed the relationship between TV viewing and eating behavior, advertisement, availability, and preferences of fruits and vegetables.

Conclusions

The Youth WAVE Screener can be used to quickly identify children who are concerned about their weight as well as those with dietary and physical activity patterns that may increase the risk of obesity. Diabetes educators can use this screener to start a dialogue with children about their weight-related behaviors.

Binge eating and emotional eating behaviors among adolescents and young adults with bipolar disorder

BACKGROUND

This study investigates nutritional behavior among adolescents and young adults with bipolar disorder (BP) in comparison to those without history of major psychiatric disorder.

METHODS

131 participants (82 BP, 49 controls) with a mean age of 16.11 ± 1.61 years were included. The self-reported Quick Weight, Activity, Variety & Excess (WAVE) Screener was used to assess dietary habits, yielding a total nutritional score as well as Excess, Variety, and Household Food Insecurity subscale scores. Specifically, the Variety subscale was used to measure daily consumption of essential nutrients; the Excess subscale measured unhealthy eating behaviors such as binge eating and excessive intake of fat and sugar; and the Household Food Insecurity subscale was used to detect food insecurity. Within-group analysis was conducted on participants with BP to identify correlates of unhealthy diet.

RESULTS

BP participants scored significantly lower than controls on the WAVE (t=2.62, p=0.010), specifically the Excess subscale (t=3.26, p=0.001). This was related to higher prevalence of binge eating and emotional eating behaviors among participants with BP compared to controls. Within-group analyses showed that self-reported emotional dysregulation/impulsivity was associated with maladaptive nutritional behaviors (t=3.38, p=0.035).

LIMITATIONS

Cross-sectional design. Within-group analyses were underpowered. Diet quality was measured using a brief self-report screener.

CONCLUSION

Adolescents and young adults with BP have poorer nutritional behaviors compared to controls, and this difference is related to stress-induced eating. This demonstrates the need to screen for stress-induced eating and to intervene when needed in order to optimize nutritional behaviors among adolescents and young adults with BP.

Development and evaluation of the nutrition component of the Rapid Eating and Activity Assessment for Patients (REAP): a new tool for primary care providers

OBJECTIVES

1. To describe the development of a dietary assessment tool (Rapid Eating and Activity Assessment for Patients [REAP]) that quickly assesses a patient's diet and physical activity and facilitates brief counselling by a primary care provider, and 2. To describe the evaluation of the REAP in terms of its reliability, validity, and ease of use by primary care providers.

DESIGN, SETTING AND PARTICIPANTS

The evaluation of REAP included: 1) an implementation feasibility study conducted with 61 medical students and practicing physicians in practice settings at various medical schools; 2) a calibration study with 44 Brown University Medical School students; 3) cognitive assessment testing with 31 consumers in Rhode Island; and 4) a reliability and calibration study of the revised tool with 94 consumers in Rhode Island and Massachusetts.

RESULTS

The feasibility study revealed moderately high rankings on usefulness, ease, practicality, and helpfulness. The calibration studies demonstrated that REAP has excellent test-retest reliability (r = 0.86, P < .0001), is correlated with the Healthy Eating Index score (r = 0.49, P = .0007), and is significantly associated with intake of most nutrients studied.

CONCLUSIONS AND IMPLICATIONS

REAP has adequate reliability and validity to be used in primary care practices for nutrition assessment and counselling, and is also user-friendly for providers.

Lessons learned from nutrition curricular enhancements

The Nutrition Academic Award funded 21 US medical schools to develop, implement, evaluate, and disseminate nutrition curricula for medical students, residents, and physicians in practice over a 5-y period. This article summarizes some of the important lessons learned from this process and offers guidance and strategies for long-term success of nutrition curricular enhancements. Medical educators need to continue to develop, implement, evaluate, and disseminate nutrition curricula with and without funding. By using the lessons learned and the products developed by the Nutrition Academic Award schools, educators will be in a position to enhance their medical curriculum.

Science-Based Solutions to Obesity: What are the Roles of Academia, Government, Industry, and Health Care? Proceedings of a symposium, Boston, Massachusetts, USA, March 10-11, 2004 and Anaheim, California, USA, October 2, 2004

The complexity of the obesity epidemic requires the cooperation of key stakeholders in this effort. No one sector, academia, government, industry, or health care, has been successful in combating this disease to date. On March 10-11, 2004, The Harvard Medical School Division of Nutrition hosted the symposium "Science-Based Solutions to Obesity: What is the Role of Academia, Government, Industry, and Health care?" as a platform to address the role of these stakeholders, both individually and collectively, in combating the nation's epidemic of obesity. The proceedings from the symposium, included in this supplement, discuss the following: the science of obesity-related topics such as genetics, protein and weight loss, portion size, energy density, and behavior; the need for more aggressive government policies; industry's role in using research and development capabilities to promote healthier, portion-controlled products; and how to translate nutrition information from medical doctors to patients.

Diabetes medical nutrition therapy: practical tips to improve outcomes

PURPOSE

To describe the evolving and expanding role of nurse practitioners (NPs) in providing diabetes medical nutrition therapy (MNT) as the United States faces epidemics of diabetes and obesity.

DATA SOURCES

Scientific literature and reports from the public health, diabetes, and nutrition fields.

CONCLUSIONS

Although clinically effective for both prevention and treatment of diabetes, MNT is often underutilized. The majority of people with diabetes are cared for by primary care providers; the role of NPs as primary care providers is evolving and expanding. NPs are recognized as leaders who creatively adapt to the rapidly changing health care delivery system.

IMPLICATIONS FOR PRACTICE

NPs can serve as role models by presenting accurate, basic nutrition messages, referring patients to registered dietitians for MNT, reinforcing nutrition and the importance of lifestyle change as primary treatments for their disease, and following up on their patients' progress with nutrition interventions.

REAP and WAVE: new tools to rapidly assess/discuss nutrition with patients

Dietary changes can be helpful in preventing or treating a variety of prevalent health problems. Physicians can be helpful in helping patients make positive dietary changes, be physically active and lose weight, but, for a variety of reasons, many physicians do little nutrition counseling. There is a need for brief, user-friendly tools to enable physicians to rapidly and accurately assess patients' diets and exercise habits as well as provide information to aid the physician in delivering effective nutrition counseling. The purpose of this paper is to discuss two new tools, WAVE and REAP, that have been developed by the Nutrition Academic Award to help physicians and other health care providers conduct nutrition assessment and counseling with their patients in a practical and effective manner. The WAVE acronym and tool is designed to encourage provider/patient dialogue about the pros and cons of the patients' current status related to Weight, Activity, Variety and Excess. The Rapid Eating and Activity Assessment for Patients (REAP) is a brief validated questionnaire that is designed to aid providers in performing a brief assessment of diet and physical activity. An accompanying Physician Key aids the provider in discussing the patient's answers and counseling them appropriately. REAP and WAVE can be helpful tools to facilitate nutrition assessment and counseling in the provider office. Depending on patients' health priorities and how much time is available, these tools can be used in a variety of ways to discuss nutrition with patients during a clinical encounter in 1-9 min.

Recent dietary guidelines to prevent and treat cardiovascular disease, diabetes, and obesity

Nutrition guidelines are emphasizing dietary patterns as primary and secondary prevention trials provide increasing evidence of the importance of lifestyle changes to prevent/control cardiovascular disease (CVD) risk factors such as diabetes and hypertension. Despite the increasing evidence that weight loss and modified dietary patterns are effective, there is considerable debate about the level of carbohydrate that will be most beneficial. Epidemiologic studies indicate that certain ethnic and racial minority groups have increased CVD risk with higher rates of obesity, hypertension, diabetes, and stroke. Immigrant and Native American populations have had a dramatic rise in obesity, diabetes, and ultimately CVD with acculturation, accompanied by a higher fat intake and decreased physical activity. Culturally tailored intervention approaches are being used to reduce risk. The lack of third-party payment still limits the availability of nutrition services. However, medical nutrition therapy is covered by Medicare for diabetes and pending legislation will extend coverage to CVD. Medical education researchers have developed tools such as the WAVE (Weight, Activity, Variety and Excess) pocket guide as a quick method to facilitate addressing referral for medical nutrition therapy that can be readily incorporated into practice settings.

Current literature in diabetes

In order to keep subscribers up-to-date with the latest developments in their field, John Wiley & Sons are providing a current awareness service in each issue of the journal. The bibliography contains newly published material in the field of diabetes/metabolism. Each bibliography is divided into 17 sections: 1 Books, Reviews & Symposia; 2 General; 3 Genetics; 4 Epidemiology; 5 Immunology; 6 Prediction; 7 Prevention; 8 INTERVENTION: a&rpar General; b&rpar Pharmacology; 9 Pathology: a&rpar General; b&rpar Cardiovascular; c&rpar Neurological; d&rpar Renal; 10 Endocrinology & Metabolism; 11 Nutrition; 12 Animal Studies; 13 Techniques. Within each section, articles are listed in alphabetical order with respect to author (9 Weeks journals - Search completed at 1st Aug 2001)

Translation of nutritional sciences into medical education: the Nutrition Academic Award Program

For the past 40 y the scientific community has decried the inadequacy of the training of physicians and other health professionals in the subject of human nutrition. In 1997 the National Heart, Lung, and Blood Institute developed the Nutrition Academic Award (NAA) Program, an initiative to improve nutrition training across a network of US medical schools. The purpose of this funding, which began in 1998, is to support the development and enhancement of nutrition curricula for medical students, residents, and practicing physicians to learn principles and practice skills in nutrition. The NAA recipients developed the Nutrition Curricular Guide for Training Physicians, a plan to incorporate clinical guidelines into physician practice skills, create educational and assessment practice tools, and evaluate curricula, materials, and teaching tools. Dissemination of NAA activities and materials will be facilitated by a national website, presentations and publications, and consultants and advisors from the NAA nutrition education programs. The NAA Program constitutes a major new effort to enhance nutrition knowledge and skills among health care providers and to effectively apply the science of human nutrition to clinical medicine. This article describes the purpose and aims of the NAA Program, the organizational structure of the network of recipients, a profile of the recipients and individual programs at 21 medical schools, the various strategies to overcome barriers in training physicians in human nutrition, and collaborative and dissemination efforts.