A two-year randomized trial of obesity treatment in primary care practice.

BACKGROUND: Calls for primary care providers (PCPs) to offer obese patients behavioral weight-loss counseling have not been accompanied by adequate guidance on how such care could be delivered. This randomized trial compared weight loss during a 2-year period in response to three lifestyle interventions, all delivered by PCPs in collaboration with auxiliary health professionals (lifestyle coaches) in their practices. METHODS: We randomly assigned 390 obese adults in six primary care practices to one of three types of intervention: usual care, consisting of quarterly PCP visits that included education about weight management; brief lifestyle counseling, consisting of quarterly PCP visits combined with brief monthly sessions with lifestyle coaches who instructed participants about behavioral weight control; or enhanced brief lifestyle counseling, which provided the same care as described for the previous intervention but included meal replacements or weight-loss medication (orlistat or sibutramine), chosen by the participants in consultation with the PCPs, to potentially increase weight loss. RESULTS: Of the 390 participants, 86% completed the 2-year trial, at which time, the mean (±SE) weight loss with usual care, brief lifestyle counseling, and enhanced brief lifestyle counseling was 1.7±0.7, 2.9±0.7, and 4.6±0.7 kg, respectively. Initial weight decreased at least 5% in 21.5%, 26.0%, and 34.9% of the participants in the three groups, respectively. Enhanced lifestyle counseling was superior to usual care on both these measures of success (P=0.003 and P=0.02, respectively), with no other significant differences among the groups. The benefits of enhanced lifestyle counseling remained even after participants given sibutramine were excluded from the analyses. There were no significant differences between the intervention groups in the occurrence of serious adverse events. CONCLUSIONS: Enhanced weight-loss counseling helps about one third of obese patients achieve long-term, clinically meaningful weight loss. (Funded by the National Heart, Lung, and Blood Institute; POWER-UP ClinicalTrials.gov number, NCT00826774.).

Achieving a healthy home food environment: perspectives on parents' nutrition education needs when living with food insecurity.

Purpose: The familial food environment is influenced by many factors, including food insecurity, food accessibility, and foods accepted by the family. These factors can facilitate or hinder caregivers' ability to support a healthy home food environment. The aim of this research was to explore the barriers to, perspectives on, and nutrition education needs identified by food-insecure parents which would then inform a community-based nutrition education program. Methods: A qualitative study used focus group data that were recorded, transcribed verbatim, and analyzed using a constant comparison approach to categorize the emerging themes. Results: Emergent themes: (1) Cooking confidence deficit; (2) Healthy meal preparation barriers; (3) Healthy meal acceptance barriers; (4) Meal planning, management, and adaptability. These themes suggest that supporting a healthy home food environment is connected to both food knowledge and competencies, known as food literacy. Conclusion: Food literacy competency should be assessed before nutrition education program implementation within community settings.

Unveiling Lived Experiences: Exploring the Health and Lifestyle Effects of COVID-19 on Healthcare Workers.

The COVID-19 pandemic brought about significant life disruptions among healthcare workers (HCWs), including changes in weight, eating habits, and physical activity. This qualitative study sought to evaluate the initial and longitudinal effects of health habits among HCWs throughout the pandemic. Data were collected through Qualtrics surveys at three points over a 2-year period with questions asking participants (n = 234) to describe whether they experienced changes in weight, eating behaviors, and physical activity and why they believe these changes occurred. The open-ended responses were analyzed following the summative content analysis approach. Four key themes emerged: (1) problematic eating patterns and habits, (2) disruptions in physical activity, (3) alterations in work environment and schedule, and (4) declines in mental health. Respondent reflections highlight the immediate and long-term pandemic-related effects on weight status for some, attributed to alterations in routines and health habits. Other HCWs reported a "reset" or indicated their habits may have been initially disrupted but normalized or improved over the 2-year time span. Findings underscore the need for strategies that support the physical and mental health of healthcare workers.

Empowering Community Leadership: Perspectives of Peer Mentors Facilitating a Food Pantry-Based Nutrition Education Program.

Peer Mentors (PMs) are valuable health educators within food-insecure communities; however, little is known about PMs' perspectives and experiences after serving in their peer mentor role. Therefore, this qualitative study explored PMs' (n = 10) perceptions and analyzed data using thematic analysis based on descriptive phenomenology. Four themes emerged: (1) Successes and Struggles in Sharing Nutrition Knowledge; (2) Establishing a Conducive Learning Environment; (3) The Peer Mentor and Mentee Connection: Impact of Shared Experiences; (4) Empowerment of the Peer Mentor Experience. PMs have many advantages; however, more research is needed to evaluate the sustainability and efficacy of PMs within food-insecure communities.

Weight bias reduction intervention among nurse practitioner students using simulation-based experiences.

ABSTRACT: Few nurse practitioner (NP) programs include obesity and weight bias education in their curriculum. However, NPs will likely provide care for people living with obesity, many of whom have been discriminated against based on their weight by previous providers, and many NP students may feel unprepared to navigate weight management competently. This pilot study included a weight bias reduction (WBR) intervention, which included a simulation-based experience (SBE) with a standardized participant (SP) and educational activities embedded within the NP curriculum. Nineteen NP students participated in this pilot study, but only seven students had matching data for preintervention to postintervention scores. There were no statistically significant differences in preintervention and postintervention Attitudes Toward Obese Persons (ATOP) or Beliefs About Obese Persons (BAOP) scores. Despite this small sample size and not achieving statistical significance, SBE-SP holds promise to depict realistic patient encounters to improve NPs' attitudes and beliefs toward persons with obesity and to reduce weight bias. Therefore, incorporating SBE-SP may be a feasible component of the NP curriculum.

A Study of United States Registered Dietitian Nutritionists during COVID-19: From Impact to Adaptation.

The COVID-19 pandemic introduced an unprecedented health crisis, requiring many Registered Dietitian Nutritionists (RDNs) to expand their duties and services, while other RDNs faced unemployment, reduced hours, and changes to their work environment. This study evaluated whether the pandemic impacted RDNs' weight, eating behaviors, and psychological factors, and whether professional training as an RDN was perceived as a protective factor in maintaining healthy habits. A 57-item, cross-sectional, online questionnaire including open-ended questions was distributed to RDNs residing in the United States. Over two months (January 2021 to February 2021), 477 RDNs completed the questionnaire. Among RDNs, 68.5% reported no weight change, 21.4% reported weight gain greater than 5 pounds, and 10.3% reported weight loss greater than 5 pounds. Approximately 75% (n = 360) reported their RDN professional training equipped them with the skills needed to maintain healthy eating behaviors. Reduced physical activity and mental health were the top qualitative themes that emerged regarding reasons for weight change. These findings suggest that RDN professional practice skills may have conferred some personal health benefits, as evidenced by smaller weight gains, the maintenance of healthy habits, and fewer reporting psychological effects relative to the general population and other health professionals, thereby limiting the impact of pandemic-induced work and life disruptions.

Development of a weight bias reduction intervention for third-year nursing students.

To explore whether case-based learning will enhance a weight bias reduction (WBR) programme among nursing students to improve their attitudes and beliefs towards persons with obesity. A cluster-randomized controlled trial (CRT) among 13 medical-surgical clinical practicum groups consisting of six to eight third-year baccalaureate nursing students was conducted to compare a WBR training enhanced by case-based learning (WBR-I, n = 7) with a standard WBR control group (n = 6). All participants completed the Attitudes Towards Obese Persons (ATOP) and Beliefs About Obese Persons (BAOP) questionnaires before the randomized assignment and at the end of the 14-week semester. The BAOP scores of participants in the WBR-I group were significantly improved compared to controls (26.68 ± 7.85 and 22.93 ± 2.80, respectively; F = 18.23; p = .001 (<.01) indicating improved beliefs about the controllability of obesity. There were no significant changes to attitudes about individuals with obesity, as indicated by the ATOP scores. The findings of this pilot study suggest that a more intensive WBR programme that includes case-based learning scenarios that elicit critical thinking coupled with a standard WBR programme may reduce some aspects of weight bias.

A Year in the Life of U.S. Frontline Health Care Workers: Impact of COVID-19 on Weight Change, Physical Activity, Lifestyle Habits, and Psychological Factors.

Healthcare workers (HCWs) experienced significantly higher burdens and life demands due to the COVID-19 pandemic. This study sought to assess the longitudinal effects among HCWs throughout the pandemic. Qualtrics surveys collected self-reported data on weight changes, eating patterns, physical activity (PA), and psychological factors with data organized by timepoints prior to the pandemic (PP0­prior to March 2020), baseline (M0­January 2021), month 6 (M6­July 2021), and month 12 (M12­January 2022). Eating patterns were negatively impacted at the M0, with reported increases in snacking/grazing (69.7%), fast food/take-out consumption (57.8%), and alcohol (48.8%). However, by M6 and M12 there were no statistically significant differences in eating patterns, suggesting that eating patterns normalized over time. Mean weight increased from PP0 to M0 by 2.99 pounds (p < 0.001, n = 226) and from PP0 to M6 by 2.12 pounds (p < 0.027, n = 146), though the difference in mean weight from PP0 to M12 was not statistically significant (n = 122). PA counts decreased from 8.00 sessions per week PP0 to 6.80 by M0 (p = 0.005) before jumping to 12.00 at M6 (p < 0.001) and 10.67 at M12 (p < 0.001). Psychological factors comparing M0 to M12 found statistically significant differences for depression (p-value = 0.018) and anxiety (p-value = 0.001), meaning depression and anxiety were initially increased but improved by M12. Additionally, higher scores on depression and insomnia scales were associated with lower PA levels. These overall results imply that the COVID-19 pandemic had immediate effects on the eating patterns, weight changes, PA, and psychological factors of HCWs; however, routines and lifestyle habits appeared to have normalized one year later.

Reflective journaling of nursing students on weight bias.

BACKGROUND: Self-reflection, combined with clinical experience, has been shown to enhance clinical and didactic knowledge among undergraduate nursing students. Reflective journaling is a valuable educational tool that builds critical thinking skills and raises self-awareness through the purposeful inspection of beliefs and attitudes. However, there are little data available on reflective journaling during clinical education exploring weight bias as part of a weight sensitivity training program. OBJECTIVES: The study aimed to explore the use of reflective journals as a tool to raise self-awareness and self-reflection of weight bias as part of a weight sensitivity training program. SETTINGS: The project was conducted at a four-year pre-licensure baccalaureate nursing program with third-year clinical students in a private Catholic university in southeastern Pennsylvania, USA. PARTICIPANTS: All third-year students enrolled in a medical-surgical clinical practicum were eligible to participate from August to December 2017. DESIGN & METHODS: For this qualitative study, data were collected during the 15-week medical-surgical clinical practicum, in which students completed five journal entries. De-identified data were analyzed using thematic analysis. RESULTS: A total of 98 students, 18 years of age and older consented, and 280 journal entries were analyzed. Four themes emerged from a majority of the journal entries: 1) increased self-awareness of personal weight bias; 2) acknowledgment of obesity as a chronic disease and not a choice; 3) insufficient resources or training may perpetuate weight bias; and 4) opportunity for weight sensitivity training to improve patient care. CONCLUSIONS: Through reflective journaling, nursing students were able to periodically self-reflect on their personal weight bias as it pertained to caring for patients with obesity. This introspective self-reflection as part of a weight sensitivity training may lead to not only improving clinical competencies in patient care but also in reducing weight bias in clinical practicum.

Nursing students' perspectives on observed weight bias in healthcare settings: A qualitative study.

BACKGROUND: Weight bias continues to be problematic within the healthcare setting among practicing healthcare providers (HCPs). These HCPs serve as influential role models for nursing students when immersed in the clinical environment. However, if HCPs are demonstrating bias toward patients with obesity, this may influence nursing students' beliefs and practices. AIMS: This study aimed to explore nursing students' reflections of observed weight bias within the healthcare setting. MATERIALS & METHODS: A descriptive qualitative study design was used involving reflective journaling and qualitative content analysis. Two cohorts of third-year baccalaureate nursing students (n = 197) participated in weight sensitivity training and submitted reflective journals over one academic semester. RESULTS: Reports of weight bias were categorized into three themes-(1) Direct Impact: Observed Implicit and Explicit Provider Weight Bias; (2) Indirect Impact: Weight Bias Due to Skills, Equipment, or Staffing/Environmental Deficits; and (3) Reactions toward HCP Weight Bias: Conflict Between Weight Bias Training and Real-World Healthcare Experiences. DISCUSSION: Weight bias was observed in some HCPs within the healthcare setting. Student reflections explored weight bias and the opposing messages between weight sensitivity training and real-world practices. CONCLUSION: Preventing bias through continuing education for HCPs is crucial to provide compassionate care and instill ethical values in the next generation nurses.

Learning environment and evidence among professionals and students satisfaction (LEAPS), experienced during the COVID-19 pandemic.

The COVID-19 pandemic required schools to transition courses to an online platform. This shift to Emergency Remote Teaching (ERT) created gaps in the literature about its impact on students. The purpose of this study was to test the relationship between learner and instructional attributes and learner satisfaction with ERT. A modified version of the Student Satisfaction Survey assessed learner and instructional attributes and learner satisfaction among a convenience sample of 12 graduate and 83 undergraduate nursing students. Open-ended questions assessed students' responses to their satisfaction with ERT. Multiple regression analysis was used to test associations of learner and instructional attributes with student satisfaction. Overall satisfaction with ERT was neutral with a mean of 2.76 on a 1 to 5 scale; students rated instructional attributes higher with a mean of 3.64. Instructional engagement/technology use (single factor) and learner technology competence were associated with student satisfaction, beta = 0.93(0.09), p<.001; beta = 0.24(0.09), p = .008, respectively. Between-class technology use and prior experience with online courses were not associated with student satisfaction, beta = -0.08(0.09), p = .379, beta = 0.26(0.15), p = .079, respectively. Qualitative findings revealed faculty engagement was a major determinant in learner satisfaction with ERT. Supporting faculty competence for the use of technology may increase learner satisfaction with ERT.

Successes and challenges of using a peer Mentor model for nutrition education within a food pantry: a qualitative study.

BACKGROUND: Delivering nutrition education within an emergency food pantry (EFP) provides an opportunity to reach many food insecure households and underserved populations. However, little is known about using a peer mentor model, "Community Cooks," as a modality to deliver nutrition education within this setting. This research aimed to identify the successes and challenges of using a peer mentor model within an EFP to better understand the best approaches to deliver nutrition education among community residents. METHODS: In spring 2018, semi-structured interviews were conducted with 11 peer mentors after they delivered a series of nutrition workshops to community members of the EFP. Interviews were audio-recorded and transcribed verbatim. Qualitative content analysis was used to analyze the data. RESULTS: All peer mentors were women over 40 years-of-age, were recruited from the EFP community; most were high school graduates and currently received some form of federal nutrition assistance. All peer mentors reported that the "Community Cooks" nutrition education program offered many benefits. Key successes of the program included serving in the role as a peer mentor was an empowering experience which gave them a sense of community, purpose, and camaraderie; 2) the nutrition education was appropriately tailored towards those living with food insecurity; 3) the recipes required minimal cooking skills and included low-cost easily accessible foods available at the EFP. Key challenges of the program were the lack of community member engagement in the nutrition education workshops. CONCLUSION: Challenges continue to exist when delivering nutrition education within a community EFP setting. While the use of peer mentors to deliver nutrition education messages is promising, more research is needed to quantify the impact of using a peer mentor model in underserved and food insecure communities.

Barriers to Healthy Eating in a Community That Relies on an Emergency Food Pantry.

OBJECTIVE: To explore perceived barriers to healthy eating within a food-insecure community that relies on an emergency food pantry. METHODS: A qualitative descriptive study was conducted using focus groups within an emergency food pantry located in southeastern Pennsylvania. Eleven female participants were recruited from the food pantry to serve as focus group participants and key community informants. Focus group transcripts were transcribed, coded, and analyzed using a constant comparative method. RESULTS: Four themes regarding perceived barriers to healthy eating were identified: (1) knowledge, (2) resources, (3) special dietary needs, and (4) culture and family influences. CONCLUSIONS AND IMPLICATIONS: Emergent themes from the focus groups identified the perceived barriers to healthy eating within a food-insecure community. These findings may be essential for informing the development of future nutrition education programs and for promoting health in low-income communities.

Weight Sensitivity Training Among Undergraduate Nursing Students.

BACKGROUND: A Curriculum Embedded Weight Sensitivity Training program (CeWebs) was integrated into an undergraduate nursing course to improve attitudes and beliefs toward individuals with obesity. METHOD: A one-group repeated measures study was conducted to compare students' pretest and posttest attitudes and beliefs using the Attitudes Toward Obese Persons (ATOP) and Beliefs About Obese Persons (BAOP) at the beginning and end of the semester. RESULTS: Comparison of pretraining and posttraining scores of 125 junior nursing students on ATOP (73.96 ± 15.02 and 84.59 ± 15.39, respectively) indicated a significant increase in scores (p < .01), which reflects more positive attitudes. Comparison of pretraining and posttraining BAOP scores (18.20 ± 6.84 and 22.22 ± 7.87, respectively) indicated a significant (p < .01) increase in scores, indicating beliefs that obesity is not controllable. CONCLUSION: These findings suggest that embedding weight sensitivity training into undergraduate nursing curricula may improve attitudes and beliefs toward patients with obesity. [J Nurs Educ. 2020;59(8):453-456.].

Reduced Eating Pace (RePace) Behavioral Intervention for Children Prone to or with Obesity: Does the Turtle Win the Race?

OBJECTIVE: Rapid eating is a risk factor for childhood obesity but has not been a focus of intervention with young children. The short-term effects of a novel family-based treatment, "Reduced Eating Pace" (RePace), were tested on child eating speed and secondary outcomes. METHODS: Twenty-eight rapid eating children were randomized to RePace (n  = 14) or Delayed Usual Care Control (DUC) (n  = 14). RePace taught families a slower eating pace using psychoeducational and behavioral techniques, including silent vibrating devices that prompted 30-second "turtle bites." Outcomes included child "slowness in eating" assessed by parent-report questionnaire and observed eating in the laboratory (i.e., mouthfuls/minute and kilocalories/minute). Child BMI and other eating variables were secondary outcomes. RESULTS: Children in RePace compared with DUC showed increased "slowness in eating" (P  <  0.001), increased food enjoyment (P  = 0.04), and less BMI gain (P  = 0.02) after 8 weeks. There was no treatment effect for observed eating speed, although typicality of the laboratory test meal was an effect modifier in exploratory analyses. Specifically, RePace versus DUC showed attenuated increases in mouthfuls per minute over time among youth for whom the laboratory food amount was more typical of amounts served at home. CONCLUSIONS: Slower eating may be a novel target for family-based obesity prevention targeting high-risk children.

A Pilot Randomized Controlled Trial of a Technology-Based Approach for Preventing Excess Weight Gain during Pregnancy among Women with Overweight.

OBJECTIVE: Overweight/obesity and excess weight gain during pregnancy are associated with adverse maternal and neonatal outcomes. Few interventions have been effective in limiting gestational weight gain among women with overweight or obesity. This pilot, randomized clinical trial compared treatment as usual (TAU) to a lifestyle modification program delivered via phone for the prevention of excess gestational weight gain in women who had overweight or obesity. METHODS: Participants included 41 pregnant women with a body mass index (BMI) ≥ 25 kg/m2 (mean age = 28.7 ± 5.8 years; mean pre-gravid BMI = 31.2 ± 6.2 kg/m2; 54% black, 39% white). The intervention group (n = 20) received weekly telephone counseling sessions and used WiFi scales to monitor their weight from weeks 16 to 36 of pregnancy. We compared differences in weight and birth outcomes for the intervention vs. the TAU group (n = 21). RESULTS: The intervention and TAU groups did not differ with respect to: gestational weight gain (15.5 ± 5.3 vs. 13.3 ± 6.8 kg, respectively); proportion gaining above the 2009 Institute of Medicine recommended weight range (83 vs. 70%); and weight gain from pre-pregnancy weight to 6 weeks postpartum (4.8 ± 4.6 vs. 3.0 ± 5.5 kg). Other birth and health outcomes also did not differ. CONCLUSION: A telemedicine intervention designed to decrease logistical burden on participants was not more successful in reducing excessive weight gain during pregnancy as compared to TAU. Future studies should examine more intensive forms of remote treatment beginning earlier in pregnancy as well as interventions promoting a healthy weight prior to pregnancy.

Restricting Advertisements for High-Fat, High-Sugar Foods during Children's Television Programs: Attitudes in a US Population-Based Sample.

BACKGROUND: Children in the United States (US) are frequently exposed to advertisements for high-fat, high-sugar (HFHS) foods, which is linked to greater demand for and consumption of those foods. Restricting advertisements for HFHS foods may be a viable obesity prevention strategy-however, public support for policy change is unclear. METHODS: A secondary analysis of the 2012 Annenberg National Health Communication Survey was conducted. Respondents (N = 1838) were 53.2% female, mean age 50.0 ± 16.5 years. Race/ethnic composition was 76.8% white, 7.4% black, 9.2% Hispanic, and 6.6% other. The percentage of respondents supporting and opposing the regulation was calculated and logistic regression models identified predictors of support. Potential predictors included sociodemographic variables, attitudes towards other health regulations (e.g., smoking bans in public places), and various health behaviors (e.g., fruit and vegetable intake). RESULTS: A total of 56.3% of respondents supported or strongly supported advertisement restrictions, while only 8.2% strongly opposed. Approximately 20% had no opinion. Greatest support was found among respondents who supported smoking bans in public settings (OR = 4.3), who supported banning trans fats in restaurants (OR = 1.7), and who were older (OR = 1.7). CONCLUSION: The US adult population appears to have an appetite for restricting HFHS advertising to children, with more than half the populace supporting such a policy in 2012. This may be an opportune time to implement and rigorously evaluate such childhood obesity prevention strategies.