The need for more inclusive measurement to advance equity in eating disorders prevention.

Eating disorder (ED) research and practice have been shaped by prevailing stereotypes about who EDs are most likely to affect. Subsequently, the field has prioritized the needs and concerns of affluent, cisgender, heterosexual, white girls and women to the exclusion of others, especially people marginalized based on their race, ethnicity, sexual orientation, and/or gender identity. However, EDs exist across diverse groups and actually occur with elevated prevalence in several marginalized groups. Growing research points to differences in the drivers of EDs in such groups (e.g. desire to attain the curvy rather than thin ideal; dietary restraint due to food insecurity rather than weight/shape concerns), yet tools typically used for screening and intervention evaluation do not capture eating pathology driven by such factors. In this commentary, we describe gaps in existing ED assessment tools and argue these gaps likely underestimate EDs among marginalized groups, bias who is invited, participates in, and benefits from ED prevention programs, and obscure potential group differences in the efficacy of such programs. We also discuss the potential of these ramifications to exacerbate inequities in EDs. Finally, we outline recommendations to overcome existing gaps in measurement and, consequently, advance equity in the realm of ED prevention.

Impact of changes to the Child and Adult Care Food Program on children's dietary intake in family child care homes.

OBJECTIVE: To estimate the impact of recent changes to the Child and Adult Care Food Program (CACFP) meal pattern on young children's diets in family child care homes (FCCHs) serving racially/ethnically diverse children. DESIGN: In a natural experimental study of thirteen CACFP-participating FCCHs, we used digital photographs taken of children's plates before and after meals matched with menus to measure children's dietary intake both prior to implementation of the new meal patterns (summer/fall of 2017) and again 1 year later (summer/fall of 2018). Generalised estimating equations tested for change in intake of fruits, vegetables, whole grains, 100 % juice, grain-based desserts, meat/meat alternates and milk, adjusting for clustering of observations within providers. SETTING: FCCHs in Boston, MA, USA. PARTICIPANTS: Three- to 5-year-old children attending FCCHs. RESULTS: We observed 107 meals consumed by twenty-eight children at the thirteen FCCHs across an average of 2·5 (sd 1·3) d before the CACFP policy change, and 239 meals consumed by thirty-nine children across 3·8 d (sd 1·4) 1 year later. During lunch, fruit intake increased by about a third of a serving (+0·38 serving, 95 % CI 0·04, 0·73, P = 0·03), and whole grain intake increased by a half serving (+0·50 serving, 95 % CI 0·19, 0·82, P = 0·002). No changes were seen in other meal components. CONCLUSION: Young children's dietary intake in CACFP-participating FCCHs improved following the CACFP meal pattern change, particularly for fruits and whole grains, which were targets of the new policy. Additional research should examine impacts of the changes in other child care settings, age groups and locales.

Childhood food insufficiency and adulthood cardiometabolic health conditions among a population-based sample of older adults in Puerto Rico.

Childhood food insufficiency negatively influences physical and psychosocial health in children, but less is known about long-term health implications. This study aimed to elucidate the association of childhood food insufficiency with older adulthood cardiometabolic conditions. We conducted cross-sectional analyses using data from the Puerto Rican Elderly: Health Conditions Project (n = 2712), a population-based sample of elderly adults (>60 y) living in Puerto Rico. Childhood food insufficiency was ascertained with a proxy question on childhood economic hardships that prevented eating. Participants self-reported hypertension, diabetes, and cardiovascular disease (CVD; including heart attack, heart disease, or stroke). Obesity was assessed as body mass index using measured height and weight. Multivariable-adjusted, sex-stratified, complex survey logistic regression models tested associations of childhood food insufficiency with each condition, number of cardiometabolic conditions (0-6), and age of onset. Nearly a third (29.4%) of the sample reported childhood food insufficiency; 68.7% reported hypertension, 29.6% reported type 2 diabetes, 34.2% reported CVD, 29.9% were categorized with obesity, and 55.4% had two or more cardiometabolic conditions. In men, but not women, childhood food insufficiency was associated with higher odds of hypertension (Odds Ratio (OR) (95% Confidence Intervals (CI)): 1.7 (1.1, 2.7)), CVD (1.7 (1.1, 2.6)), and having two (1.9 (1.0, 3.4) or three to four (2.3 (1.2, 4.4)) cardiometabolic conditions. Childhood food insufficiency was marginally associated with higher odds of early age of onset of CVD among men (2.2 (1.0, 4.7)). Childhood food insufficiency may increase the likelihood of having cardiometabolic conditions in Puerto Rican older men. Programs that enable access to sufficient, healthy food in childhood may help prevent eventual cardiovascular-related diseases.

Disproportionate Use of Over-the-counter Diet Pills Among Latinx Youth and Increased Use Over Time Among Latinx Females: Results of US National Study.

PURPOSE: Over-the-counter diet pills are target-marketed to Latinx communities, raising concerns about youth use of these harmful products. METHODS: Multivariable logistic models estimated odds ratios (ORs) of diet-pill use in a representative sample of US Latinx and White students (2009-2013; N = 33,824). RESULTS: Latinx students had 30%-40% higher odds of past-30-day diet-pill use than White peers (males: OR = 1.39; 95% confidence interval = 1.10, 1.76, females: OR = 1.34; 95% confidence interval = 1.12, 1.61), and inequities among females widened, with one in 10 Latinx females reporting past-30-day use by 2013 (10.0% Latinx females vs. 6.2% White non-Latinx females). DISCUSSION: Higher prevalence of over-the-counter diet-pill use in Latinx relative to white youth-and increasing use over time for Latinx females-underscores the need for stronger restrictions on marketing and sale to youth.

A systematic review and meta-analysis of the Everyday Discrimination Scale and biomarker outcomes.

Discrimination has consistently been associated with multiple adverse health outcomes. Like other psychosocial stressors, discrimination is thought to impact health through stress-related physiologic pathways including hypothalamic-pituitary-adrenal (HPA) axis activation, dysregulation of inflammation responses, and accelerated cellular aging. Given growing attention to research examining the biological pathways through which discrimination becomes embodied, this systematic review and meta-analysis synthesizes empirical evidence examining relationships between self-reported discrimination and four biomarker outcomes (i.e., cortisol, C-reactive protein (CRP), interleukin-6 (IL-6), and telomere length) among studies that have used the Everyday Discrimination Scale. We conducted a systematic review of studies discussing self-reported, everyday, or chronic discrimination in the context of health by searching Medline / PubMed (National Library of Medicine, NCBI), PsycInfo (APA, Ebsco) and Web of Science Core Collection (Clarivate). Twenty-five articles met the criteria for meta-analysis, with several reporting on multiple outcomes. Discrimination was associated with elevated CRP levels (r = 0.11; 95% CI: 0.01, 0.20, k = 10), though not cortisol (r = 0.05; 95% CI: -0.06, 0.16, k = 9), IL-6 (r = 0.05; 95% CI: -0.32, 0.42, k = 5), or telomere length (r = 0.03; 95% CI: -0.01, 0.07, k = 6). We identify several points of consideration for future research including addressing heterogeneity in assessment of biomarker outcomes and the need for longitudinal assessments of relationships between discrimination and biomarker outcomes.

"It's Not the Stereotypical 80s Movie Bullying": A Qualitative Study on the High School Environment, Body Image, and Weight Stigma.

BACKGROUND: Schools are crucial for preventing negative health outcomes in youth and are an ideal setting to address weight stigma and poor body image. The current study sought to examine and describe the nature of weight stigma and body image in adolescents, ascertain aspects of the school environment that affect body image, and identify recommendations for schools. METHODS: We conducted 24 semi-structured interviews with students at 2 high schools in 2020. Qualitative data were analyzed using inductive coding and an immersion/crystallization approach. RESULTS: Students did not report weight discrimination or harmful body image messaging from teachers or administrators. Physical education (PE) class and dress codes were 2 instances where covert weight stigma appeared. The most common forms of peer weight stigma reported were weight-based teasing and self-directed appearance critiques. Students recommended that schools eliminate dress codes, diversify PE activities, address body image issues in school, and be cognizant of teasing within friend groups. CONCLUSIONS: Weight stigma presents itself in unique ways in high school settings. Schools can play a role in reducing experiences of weight stigma and negative body image. Weight-related teasing within friend groups was common and may not be captured in traditional assessments of bullying. More nuanced survey instruments may be needed.

The Role of Polyphenols in Human Health and Food Systems: A Mini-Review.

This narrative mini- review summarizes current knowledge of the role of polyphenols in health outcomes-and non-communicable diseases specifically-and discusses the implications of this evidence for public health, and for future directions for public health practice, policy, and research. The publications cited originate mainly from animal models and feeding experiments, as well as human cohort and case-control studies. Hypothesized protective effects of polyphenols in acute and chronic diseases, including obesity, neurodegenerative diseases, type 2 diabetes, and cardiovascular diseases, are evaluated. Potential harmful effects of some polyphenols are also considered, counterbalanced with the limited evidence of harm in the research literature. Recent international governmental regulations are discussed, as the safety and health claims of only a few specific polyphenolic compounds have been officially sanctioned. The implications of food processing on the bioavailability of polyphenols are also assessed, in addition to the health claims and marketing of polyphenols as a functional food. Finally, this mini-review asserts the need for increased regulation and guidelines for polyphenol consumption and supplementation in order to ensure consumers remain safe and informed about polyphenols.