Improved Nutritional Knowledge in the Obese Adult Population Modifies Eating Habits and Serum and Anthropometric Markers

Weight Loss Programs: Why Do They Fail? A Multidimensional Approach for Obesity Management

PURPOSE OF REVIEW

Despite the prevalence of weight loss programs, their success rates remain discouraging, with around half of individuals regaining lost weight within two years. The primary objective of this review is to explore the factors contributing to the failure of weight loss programs and to provide insights into effective weight management strategies.

RECENT FINDINGS

Factors contributing to the failure of weight loss programs include the impracticality of restrictive diets, potential metabolic impacts, limited focus on lifestyle changes, genetic predispositions, psychological influences, socioeconomic status, and medical conditions. A holistic approach considering these factors is crucial for safe and sustainable weight loss. Key findings indicate the importance of holistic approaches to weight management, including lifestyle modifications, medical interventions, and behavioral and psychological strategies. Effective weight loss strategies emphasize low-calorie, nutrient-rich diets, regular physical activity, and interventions tailored to individual needs. Combining multiple approaches offers the best chance of successful weight management and improved health outcomes. This review provides insights into the complexities of obesity management and the factors contributing to the failure of weight loss programs. It highlights the necessity of adopting a holistic approach that addresses dietary habits, physical activity, genetic factors, psychological well-being, and socioeconomic influences. Recommendations include implementing lifestyle modifications, medical interventions when necessary, and integrating behavioral and psychological support to achieve sustainable weight loss and mitigate the global health challenge posed by obesity.

Assessing the Performance of a Nutrition Knowledge Questionnaire With a Low Socioeconomic Status Population Using Rasch Analysis

Parents and preschool teachers play a key role in shaping children's dietary behaviors. Knowledge of nutrition and healthy dietary choices is a key component to improve dietary habits and reduce the prevalence of obesity and associated co-morbidities. Using valid and reliable instruments is necessary for accurate assessment of knowledge to tailor interventions and measure effectiveness specific to the population of interest. The objectives of this paper are to (1) identify potential gaps in the baseline nutrition knowledge among parents and teachers using a previously validated questionnaire prior to a preschool obesity prevention intervention; and (2) assess the instrument's reliability and construct validity for a low socioeconomic status population using a post hoc Rasch analysis. Participants included 177 parents and 75 teachers who participated in a Head Start intervention study. Knowledge scores, instrument reliability, and item fit and difficulty were assessed using a Rasch analysis; t-tests were used to determine differences in scores between parents and teachers. Parents answered 38% of questions correctly while teachers correctly answered 46% of the questions. Adequate item fit and reliability were indicated for Sections 1 and 2 of the Nutrition Knowledge Questionnaire (NKQ). Section 3 demonstrated less adequate reliability. The items were found to adequately and reliably define the unidimensional measures of the three components of knowledge represented in this instrument, providing evidence of construct validity. However, Rasch measures indicated the NKQ overall was difficult for participants. Recommendations for improving the instrument for nutrition education/intervention and research practice areas related to obesity and obesity-related conditions are addressed.

Mindful Eating, Nutrition Knowledge, and Weight Status among Medical Students: Implications for Health and Counseling Practices

Academic stress and transitioning to young adulthood can lead medical students to develop inadequate eating habits, affecting both their physical and mental well-being and potentially compromising their ability to offer effective preventive counseling to future patients. The primary objective of this study is to analyze the levels of mindful eating and nutrition knowledge in Romanian medical students and their associations with various sociodemographic variables. Additionally, we explore the relationship between mindful eating and nutrition knowledge while accounting for sociodemographic factors and examine the impact of these factors on excess weight. Significant predictors of excess weight include high weight gain in the past year (OR = 15.8), the mindful eating questionnaire (MEQ) score (OR = 0.131), male gender (OR = 2.5), and being in the clinical years of medical school (OR = 2.2). While nutrition knowledge levels do not directly impact weight status, they share a 4% common variance with mindfulness in multivariate analysis. Notably, high weight gain is independent of the levels of mindful eating, but univariate testing links it to disinhibition and emotional response, components of mindfulness. Mindful eating stands out as independently associated with both nutrition knowledge and excess weight among medical students. Thus, interventions to address obesity should consider incorporating mindfulness training to enhance food intake awareness and improve weight management outcomes in Romanian medical students.

The Impact of Sustainability Courses: Are They Effective in Improving Diet Quality and Anthropometric Indices?

There are studies on the effect of general nutrition education on diet quality and anthropometric measurements, while studies showing the effectiveness of sustainable nutrition education, which also addresses the effect of food on the environment, are quite limited. This study aimed to investigate the effects of sustainable nutrition education on diet quality, anthropometric measurements, and the carbon footprint (CFP) and water footprint (WFP) of diet. A total of 160 university students received 1 h of sustainable nutrition education for 6 weeks. Before, at the end of, and 2 months after the courses, 24 h food consumption records were taken to assess diet quality and CFP and WFP values of diet, and Mediterranean diet (MedDiet) and Healthy Eating Index (HEI)-2020 scores were evaluated. The results of the study showed that sustainable nutrition education increased MedDiet score by 1.86 points and HEI-2020 score by 7.38 points. This education program also decreased body weight, body mass index (BMI), fat mass, and neck circumference. Sustainability education has a positive impact on calcium, potassium, and magnesium intakes, a negative impact on vitamin B12 and zinc intakes, and no effect on total protein intake. Education resulted in a 22% reduction in CFP and a 10% reduction in WFP.

Impact of Medical School on the Relationship between Nutritional Knowledge and Sleep Quality-A Longitudinal Study of Students at Wroclaw Medical University in Poland

The aim of this study was to investigate the impact of the first year of medical school on the relationship between nutritional knowledge and sleep. To achieve this, first-year medical students at Wroclaw Medical University were invited to participate in the study during both the initial and final months of their first academic year. The study included 570 students in the initial period and 705 in the latter. The research questionnaire comprised the KomPAN, assessing nutritional knowledge, and the Pittsburgh Sleep Quality Index (PSQI), evaluating sleep quality. The majority of students demonstrated at least sufficient nutritional knowledge, while approximately two-thirds of students experienced poor sleep in both periods. Notably, sleep quality further deteriorated in the second period (PSQI total score: 6.86 vs. 7.38, p = 0.0157). This change was influenced mainly by a decrease in sleep duration and an increase in the use of sleep medications (both p < 0.0001). The significant difference in overall sleep quality between different nutritional knowledge levels emerged only in the second semester, where students with the highest nutritional knowledge slept the best, while those with the lowest slept the worst (p = 0.0001). Crucially, in both periods, the use of sleep medications was highest among individuals with insufficient nutritional knowledge. Throughout the academic year, the usage increased for all except those with the highest nutritional knowledge, who exhibited the best sleep (p < 0.0001). The escalating use of sleep medications among medical students warrants greater attention, and leveraging the relationship between nutritional knowledge and sleep could prove beneficial, as positive habits in one domain may positively influence the other.

Nutrition knowledge assessment tools for older adults and their carers: a scoping review

Poor nutritional intake is common among older adults. Given that nutrition knowledge is an important determinant of eating behaviour and nutritional status, understanding areas of inadequate knowledge can guide educational interventions to reduce risk of nutritional deficiencies and promote healthy ageing. This review investigated tools assessing general nutritional knowledge of older adults and their carers. Following the Joanna Briggs for Scoping Reviews guidelines, 4 databases (MEDLINE, CINAHL, Global Health and Embase) and grey literature were searched. Studies of any type containing general nutrition knowledge assessment tools for older adults or their carers were included. In total, 6934 articles were identified, of which 24 met the eligibility criteria, and 23 unique nutrition knowledge assessment tools were included. Of these tools, 14 were original, 6 were modified from other tools and 3 used dietary-related responses from national dietary survey questions. 6 tools were developed for carers (mostly nurses) and 17 tools for older adults. Tools had between 4 and 110 items. The most common topics for general nutrition knowledge questions were related to nutrients and roles, food sources of nutrients, and diet-disease relationships. 8 tools were developed prior to 2000. Most studies did not specify or assess psychometric properties of the tool, with only 9 (38 %) and 6 (26 %) studies testing for reliability and validity, respectively, and only 1 tool was considered reliable. Additional research for the development of reliable and validated tools or the validation of existing tools to assess nutrition knowledge of older adults and their carers is needed across different healthcare settings.

Effect of Nutrition Education on Health Science University Students to Improve Cardiometabolic Profile and Inflammatory Status

The inadequate lifestyle associated with university life may have a negative impact on various cardiometabolic factors. The aim of this study was to evaluate the effect of a one-year nutrition education course on cardiometabolic parameters in undergraduate health science students. During the 2021-22 academic year, 1.30 h nutrition sessions were conducted twice a week. Capillary blood samples were collected and centrifuged to measure cardiometabolic and inflammatory biomarkers in serum. The sample studied consisted of 49 students: 20.4% male and 79.6% female. The nutritional intervention resulted in changes in dietary patterns, with increased consumption of vegetables, nuts and legumes. After the course, females showed an increase in HDL-cholesterol levels (p = 0.007) and no change in LDL-cholesterol levels (p = 0.189). On the other hand, males showed significant changes in HDL-cholesterol (p = 0.001) and LDL-cholesterol (p = 0.043) levels. The atherogenic index was also significantly reduced (p < 0.001) in both males (p = 0.009) and females (p = 0.002). Differences were also observed in the increase in vitamin D levels in both males and females, although the magnitude of the increase was greater in the men (Δ = 7.94, p = 0.016 in men vs. Δ = 4.96, p = 0.001 in women). The monocyte-to-HDL ratio (MHR) showed a significant reduction, although these differences were only significant in males. Students with low vitamin D levels had higher LDL-cholesterol values (p = 0.01) and atherogenic index (p = 0.029). Adjusted linear regression analysis showed a significant association between post-course vitamin D MHR (β = -0.42, IC: -0.29, -0.06, p < 0.01). These findings suggest the importance of including nutrition education programs during the university stage for the prevention of long-term health problems.

Additional health education and nutrition management cause more weight loss than concurrent training in overweight young females

OBJECTIVE

This study aimed to compare the effect of concurrent training and the addition of health education and nutrition management on body composition and health-related outcomes.

METHODS

Twenty-four healthy overweight females (20.42 ± 1.02 years, body mass index [BMI] 25.83 ± 3.63 kg∙m^-2) were assigned to a concurrent training group (Exe, n = 12) or a concurrent training and health education group (Exe + Edu, n = 12). Both groups completed 8 weeks of concurrent training (6 days/week), whereas the Exe + Edu participants received additional health education and controlled daily energy intake within the basal metabolic rate. Body composition, serum glucose, lipids and related hormones were measured before and after intervention.

RESULTS

After intervention, the Exe group lost 2.47 kg (±2.46) of body mass, 2.44 kg (±1.71) of total fat mass (FM), corresponding to a body fat percentage (BF%) of 2.25%. Losses of body mass, total FM and BF% in the Exe + Edu group were -5.19 ± 1.87 kg, -4.42 ± 1.83 kg and -4.33 ± 2.39%, respectively. The Exe + Edu participants had significantly greater reductions of body mass, total FM, and trunk and leg FM relative to the Exe participants (p < 0.05). Serum glucose, lipids, insulin and progesterone levels were improved in both groups without group difference.

CONCLUSION

Concurrent training is an effective short-term training strategy for reducing FM and improving fasting glucose, blood lipids and related hormones. Furthermore, the combination of additional health education can achieve greater effects on weight loss and the reduction of total and regional FM, which may be a better obesity treatment method.

Unique genetic variants of lean nonalcoholic fatty liver disease: a retrospective cohort study

We investigated the prevalence and clinical metabolic characteristics of lean nonalcoholic fatty liver disease (NAFLD) in an elderly Chinese population and assessed the relevance of lipid markers and genetic variation. All 5,338 community subjects underwent detailed clinical and laboratory examinations and were divided into three groups: lean (Body mass index (BMI) < 23 kg/m², n = 2,012), overweight (BMI = 23-24.9 kg/m², n = 1,354), and obese (BMI ≥ 25 kg/m², n = 1,972). Single nucleotide polymorphisms were selected based on those reported in previous NAFLD or obesity genome-wide association studies. The frequencies of alleles and genotypes were calculated and statistically analyzed with Pearson's χ² tests. One-way ANCOVA was used to test the association between positive SNPs and metabolic parameters in lean NAFLD individuals. Our results showed that the C allele frequency of rs2279026, the G allele of rs2279028, the C allele of rs780093, and the C allele frequency of rs1260326 were higher in obese NAFLD than in lean NAFLD (P < 0.05). In addition, we observed an association between the CC of rs1421085, TT of rs3751812, AA of rs8050136, and AA of rs9939609 genotypes in the FTO gene and low-density lipoprotein levels (P < 0.05). In conclusion, our findings provide a unique perspective on the prevalence, genetic characteristics, and metabolic profile of NAFLD in older lean individuals in China. This is the first study to examine the association between genetic variants in the FTO, TFAP2B and GCKR genes and NAFLD in a cohort of lean individuals.

Nutrition and Food Literacy in the MENA Region: A Review to Inform Nutrition Research and Policy Makers

BACKGROUND

Improving food and nutrition literacy is fundamental to tackling the Middle East and North Africa (MENA) region's enormous challenges, including malnutrition and food insecurity. To direct initiatives, it is crucial to assess the region's food and nutrition literacy. Thus, we aimed to review studies on food/nutrition literacy status in the MENA countries and illuminate the region's research gaps in these areas, in terms of assessment, policy, and program implementation.

METHODS

PubMed and Google Scholar databases were searched between 18 December and 8 May 2022, to identify relevant articles published up to 2022 in the MENA region.

RESULTS

Twelve studies were included in this review. Lebanon, Palestine, and Iran are the only three MENA countries where nutrition and/or food literacy were assessed. People in these countries mostly had inadequate food and/or nutrition literacy levels, especially in the skills rather than the cognitive domain. Food and/or nutrition literacy showed associations with food habits, food-label use, food-consumption patterns, school performance, food security, dietary diversity, and nutrient adequacy. The MENA countries developed no policies or programs to address food and nutrition literacy.

CONCLUSION

This review is a wake-up call for researchers and policymakers to develop a robust approach to combat food and nutrition literacy concerns in the MENA region.

Front-of-pack (FOP) labelling systems to improve the quality of nutrition information to prevent obesity: NutrInform Battery vs Nutri-Score

Many systems for classifying food products to adequately predict lower all-cause morbidity and mortality have been proposed as front-of-pack (FOP) nutritional labels. Although the efforts and advances that these systems represent for public health must be appreciated, as scientists involved in nutrition research and belonging to diverse Italian nutrition scientific societies, we would like to draw stakeholders' attention to the fact that some FOP labels risk being not correctly informative to consumers' awareness of nutritional food quality. The European Commission has explicitly called for such a nutrition information system to be part of the European "strategy on nutrition, overweight and obesity-related issues" to "facilitate consumer understanding of the contribution or importance of the food to the energy and nutrient content of a diet". Some European countries have adopted the popular French proposal Nutri-Score. However, many critical limits and inadequacies have been identified in this system. As an alternative, we endorse a new enriched informative label-the NutrInform Battery-promoted by the Italian Ministry of Health and deeply studied by the Center for Study and Research on Obesity, Milan University. Therefore, the present position paper limits comparing these two FOP nutritional labels, focusing on the evidence suggesting that the NutrInform Battery can help consumers better than the Nutri-Score system to understand nutritional information, potentially improving dietary choices. LEVEL OF EVIDENCE: II. Evidence was obtained from well-designed controlled trials without randomization.

The use of social media to search for weight reduction information: Assessment of the perception among a sample of Saudi adults

Objective

To assess the patterns, prevalence, and perceptions of the benefits and risks of using social media as a source of weight loss information among Saudi adults.

Methods

In this cross-sectional study, convenient snowball sampling was used to recruit Saudi adults. A self-report questionnaire containing the following five sections was distributed: sociodemographic information, the pattern of social media use, use of social media to obtain weight loss information, perception of benefits, and perception of risks of using social media. A Chi-square test was used to identify differences according to participants' demographics.

Results

A total of 420 Saudi adults were included in the study. Most Saudi adults (43.3%) used social media for more than four hours a day, and 88.6% used WhatsApp. The prevalence of social media use for weight loss information was 89.2% among Saudi adults. Significant associations were found between the use of social media for weight loss information and age (<33 years old) and monthly income (<5000 Saudi Arabian Riyal) ( p ≤ 0.012). Of the participants, 71.7% believed that social media is “always” or “frequently” an easily acceptable way to obtain weight loss information. Moreover, 36% of Saudi adults believed that weight loss information on social media could be scientifically inaccurate, and 61% believed that it could be posted solely for marketing and financial purposes.

Conclusion

The findings of this study show that Saudi adults have a high prevalence of social media use to obtain weight loss information. The benefits and risks of using social media as a source of weight loss information were also perceived to be high among Saudi adults.

Effectiveness to promote weight loss maintenance and healthy lifestyle habits of a group educational intervention program in adults with obesity: IGOBE program

BACKGROUND

To achieve sustainable weight loss and healthy lifestyle changes is a huge challenge in the fight against obesity. The objective of this study was to evaluate the effectiveness to promote weight loss maintenance and healthy lifestyle habits of a group educational intervention program, Group Intervention in OBEsity (IGOBE), compared with a usual care therapy to lose weight.

METHODS

Patients with obesity (n = 437; 18.5% men, 18-77 years and 40.4 ± 6.7 kg/m²) were randomised into two groups to follow a prospective interventional real-life study: a control group (CG), treated with usual clinical practice, and an intervention group (IG), in which the patients participate in a group intervention program on healthy lifestyle habits with weekly sessions for six weeks, after which a re-evaluation was made at six months and at 12 months of follow-up. After finishing the study dropout rates were 44.6% in CG and 43.4% in IG. Anthropometric, dietetic habits and body composition data were analysed in both groups at the pre-intervention and post-interventions of the subjects by completer's analysis.

RESULTS

At 12 months of following IGOBE program, the IG achieved greater weight loss (-7.1% of the initial weight) than the CG, which exhibited a weight gain (3.0% of the initial weight). The body weight change induced in the IG was accompanied by a reduction in fat mass, particularly visceral fat and waist circumference. Relevantly, the IG adhered to a healthy dietary pattern and changed its eating habits, which correlated with the improvement in body weight.

CONCLUSIONS

Intensive educational group treatment that induces a change of eating habits and adherence to healthy dietary pattern is more effective in a long-term to counteract obesity traits than a standard treatment performed individually. The IGOBE program could be a cost-effective practice in the clinical management of obesity.

Dietary Changes, Motivators, and Barriers Affecting Diet and Physical Activity among Overweight and Obese: A Mixed Methods Approach

The aims of this study were to examine (1) effects of nutritional guidance and physical activity on dietary habits among overweight and obese after an intervention and one year after follow-up (quantitative study) and (2) barriers and motivators for changes in diet and physical activity (qualitative study). A total of 98 participants with a mean age of 46.8 ± 10.2 years were included and divided into a Training Group (TG) (n = 51) or a Nutritional Guidance and Training Group (NTG) (n = 47). At baseline, after 33 weeks, and one year after the intervention, participants answered a questionnaire. Interviews gave data to elicit motivations and challenges related to diet and exercise. A GLM repeated measures analysis was used to investigate differences and interactions between factors. Participants ate healthier after starting to exercise. After 33 weeks, the NTG ate significantly more vegetables (p = 0.026) and legumes (p < 0.01) than the TG. No significant differences were found one year after follow-up. General health was the most important motivator for changing diet and exercise. Barriers to changing diet were related to work, family, meal size, and participants' internal decisions to change habits. Barriers to exercise were holidays and time constraints. Planning purchases and regular exercise were important factors to achieve and maintain weight loss.

Reflections on obesity-related health behaviors over time and suggestions for health promotion programs from African American women

African American (AA) women have the highest rate of obesity in the United States. To date, there are mixed findings on AA women's perception on obesity and their perceived changes in health behaviors over time that may have contributed to obesity. Therefore, the aims of this current qualitative descriptive study were to explore: 1) AA women's perception on obesity and perceived changes in health behaviors related to obesity through their reflection on life; 2) AA women's perceived facilitators and barriers to maintaining healthy behaviors; and 3) AA women's suggestions for future health promotion programs to manage obesity. Semi-structured interviews with ended questions were conducted with 21 AA women. Luborsky's method for thematic analysis was used to analyze data. Three main themes with subthemes were identified. First main theme was the AA culture that served as a facilitator and barrier to maintaining healthy lifestyle from childhood to young adulthood. Second main theme was gradual changes in their healthy lifestyle due to social and physical environment from young adulthood to middle adulthood. Third main theme was AA women's various suggestions for future health promotion programs. This study found obesity to be a multifactorial phenomenon that is a result of complex interaction of culture, environment, and social networks. Therefore, clinicians need to address the issue of obesity from a holistic perspective for AA women to actively engage with their primary health care. Future health promotion programs should incorporate culturally tailored lifestyle components and increase knowledge on healthy lifestyle against obesity through community-based programs.

Effects of Diet Control and Telemedicine-Based Resistance Exercise Intervention on Patients with Obesity and Knee Osteoarthritis: A Randomized Control Trial

This study investigated the effects of home-based nutritional and telemedicine-based resistance exercise interventions on improving body composition, blood biochemistry, and lower-limb functional performance. In total, 66 obese patients with mild-to-moderate knee osteoarthritis were randomly divided into a diet control group (D), elastic band resistance exercise group (E), and diet control plus elastic band exercise group (D + E). Each group was supervised by a clinical dietitian and follow-up was conducted via telephone calls or a communication application to track the participants’ progress. After 12 weeks of intervention, the D (p < 0.001) and D + E (p < 0.001) groups achieved significant weight loss. The D + E group exhibited a significant reduction in body fat relative to the D (p = 0.019) and E (p = 0.012) groups. Compared with the D (p = 0.002) and E (p = 0.019) groups, the D + E group achieved significant improvements in the timed up-and-go test and Western Ontario and McMaster Universities Osteoarthritis total scale. The D + E group experienced significant improvements in total cholesterol (p = 0.001), low-density lipoprotein cholesterol (p = 0.01), and triglyceride levels (p = 0.007) relative to other groups. In conclusion, individual diet control intervention combined with telemedicine-based resistance exercise intervention significantly improved the body composition, blood biochemistry, and lower-limb functional performance of the investigated population with comorbid conditions.

5q35 duplication presents with psychiatric and undergrowth phenotypes mediated by NSD1 overexpression and mTOR signaling downregulation

PURPOSE

Nuclear receptor binding SET domain protein 1, NSD1, encodes a histone methyltransferase H3K36. NSD1 is responsible for the phenotype of the reciprocal 5q35.2q35.3 microdeletion-microduplication syndromes. We expand the phenotype and demonstrate the functional role of NSD1 in microduplication 5q35 syndrome.

METHODS

Through an international collaboration, we report nine new patients, contributing to the emerging phenotype, highlighting psychiatric phenotypes in older affected individuals. Focusing specifically on the undergrowth phenotype, we have modeled the effects of Mes-4/NSD overexpression in Drosophila melanogaster.

RESULTS

The individuals (including a family) from diverse backgrounds with duplications ranging in size from 0.6 to 4.5 Mb, have a consistent undergrowth phenotype. Mes-4 overexpression in the developing wing causes undergrowth, increased H3K36 methylation, and increased apoptosis. We demonstrate that altering the levels of insulin receptor (IR) rescues the apoptosis and the wing undergrowth phenotype, suggesting changes in mTOR pathway signaling. Leucine supplementation rescued Mes-4/NSD induced cell death, demonstrating decreased mTOR signaling caused by NSD1.

CONCLUSION

Given that we show mTOR inhibition as a likely mechanism and amelioration of the phenotype by leucine supplementation in a fly model, we suggest further studies should evaluate the therapeutic potential of leucine or branched chain amino acids as an adjunct possible treatment to ameliorate human growth and psychiatric phenotypes and propose inclusion of 5q35-microduplication as part of the differential diagnosis for children and adults with delayed bone age, short stature, microcephaly, developmental delay, and psychiatric phenotypes.