Association of food insecurity with overall and disease-specific mortality among cancer survivors in the US.

PURPOSE: To investigate the association of food insecurity with overall and disease-specific mortality among US cancer survivors. METHODS: Data from the National Health and Nutrition Examination Survey (NHANES 1999-2018) were used to examine the impact of food insecurity on mortality risks among cancer survivors in the US. Study participants aged ≥ 20 years who had a history of cancer and completed the Adult Food Security Survey Module were included. Mortality data [all-cause, cancer, and cardiovascular (CVD) specific] through December 31, 2019 were obtained through linkage to the National Death Index. Using multivariable Cox proportional hazard regression, hazard ratios of mortality based on food security status were estimated. RESULTS: Among 5032 cancer survivors (mean age 62.5 years; 58.0% women; 86.2% non-Hispanic White), 596 (8.8%) reported food insecurity. Overall, 1913 deaths occurred (609 cancer deaths and 420 CVD deaths) during the median follow-up of 6.8 years. After adjusting for age, food insecurity was associated with a higher risk of overall (HR = 1.93; 95% CI = 1.56-2.39), CVD-specific (HR = 1.95; 95% CI = 1.24-3.05), and cancer-specific (HR = 1.70; 95% CI = 1.20-2.42) mortality (P < 0.001). However, after adjusting for socioeconomic characteristics and health-related factors (physical activity, diet quality measured by healthy eating index), the association between food insecurity and overall mortality was no longer statistically significant. CONCLUSIONS: Food insecurity was associated with a greater risk of overall mortality among cancer survivors. Further studies are needed to confirm these findings and evaluate whether the observed association represents a causal phenomenon and, if so, whether the effect is modifiable with food assistance programs.

Characterising individual variability in associations between self-monitoring and weight change during and after a behavioral weight management program.

Objective: Greater self-monitoring of caloric intake and weight has been associated with success at both initial weight loss and long-term maintenance. Given the existence of wide variability in weight loss outcomes and the key role of self-monitoring within behavioral weight management interventions, this study examined individual variability in associations between self-monitoring and weight change and whether demographic factors could predict who may best benefit from self-monitoring. Methods: Participants were 72 adults with overweight or obesity (mean ± SD, age = 50.6 ± 10.3; body mass index = 31.2 ± 4.5 kg/m2; 71%Female; 83%White) enrolled in a 12-week weight loss program followed by a 40-week observational maintenance period. Participants were encouraged to self-monitor caloric intake and weight daily and to report these data via a study website each week. Multilevel mixed models were used to estimate week-to-week associations between self-monitoring and weight change, by individual and linear regressions and ANOVAs were used to explore demographic differences in these associations. Results: Most participants (68%) demonstrated statistically significant negative associations between self-monitoring of either caloric intake or weight and weight change. Of these, 76% benefited from self-monitoring both caloric intake and weight, 18% from self-monitoring caloric intake only, and 6% from self-weighing only. The magnitude of associations between self-monitoring and weight change did not significantly differ by age, gender, race/ethnicity, education, or income, all ps > 0.05. Conclusions: Differences in the effectiveness of self-monitoring for weight loss were not observed by demographic characteristics. Future research should examine if other factors may predict the effectiveness of self-monitoring.

Importance of self-weighing to avoid post-cessation weight gain: A secondary analysis of the fit and quit randomized trial.

Background: Smoking cessation is associated with weight gain, and the risk of weight gain is a common deterrent to quitting smoking. Thus, the identification of strategies for reducing post-smoking cessation weight gain is critical. Objective: Conduct secondary analysis of data from the Fit & Quit trial to determine if greater frequency of self-weighing is associated with less weight gain in the context of smoking cessation. Methods: Participants (N = 305) were randomized to one of three 2-month weight interventions (i.e., Stability, Loss, Bibliotherapy), followed by a smoking cessation intervention. Stability and Loss conditions received different types of self-weighing feedback. All participants received e-scales at baseline, to capture daily self-weighing data over 12 months. General linear models were applied to test the main objective. Results: Frequency of self-weighing was (mean ± SD) 2.67 ± 1.84 days/week. The Stability condition had significantly higher self-weighing frequency (3.18 ± 1.72 days/week) compared to the Loss (2.51 ± 1.99 days/week) and the Bibliotherapy conditions (2.22 ± 1.63 days/week). Adjusting for baseline weight and treatment condition, self-weighing 3-4 days/week was associated with weight stability (-0.77 kg, 95% CI: -2.2946, 0.7474, p = 0.3175), and self-weighing 5 or more days/week was associated with 2.26 kg weight loss (95% CI: -3.9249, -0.5953, p = 0.0080). Conclusions: Self-weighing may serve as a useful tool for weight gain prevention after smoking cessation. Feedback received about self-weighing behaviors and weight trajectory (similar to the feedback Stability participants received) might enhance adherence.

Hunger, temptation, and dietary adherence during weight management.

Preliminary evidence suggests that hunger and temptation may predict nonadherence to dietary intake goals; however, no studies have investigated the potential interaction between hunger and temptation in relation to dietary nonadherence nor have any investigated whether these associations may be different after the end of active behavioral intervention. Thus, the current study examined the week-to-week associations between hunger, temptation, and dietary adherence in 74 adults with overweight or obesity (mean ± SD age = 50.7 ± 10.4, BMI = 31.2 ± 4.5 kg/m2) enrolled in a 12-week, Internet-based weight loss program followed by a 40-week post-intervention observational maintenance period. Each week during the study, participants completed a questionnaire on which they rated their hunger, temptation, and dietary adherence on 7-point scales. Multilevel models demonstrated that higher levels of hunger and temptation were associated with lower ratings of dietary adherence during the same week, ps < 0.0001, such that 1-point higher ratings of hunger or temptation were associated with 0.2- and 0.5-point lower ratings of dietary adherence, respectively. Further, there was an interaction between hunger and temptation such that the association between temptation and dietary nonadherence was stronger when ratings of hunger were lower, p = .028. There were no differences in associations between the initial weight loss period and the maintenance period. Results suggest that hunger and temptation may serve as potential treatment targets for interventions aimed at improving adherence to dietary intake goals. Future studies should investigate whether interventions targeting hunger and temptation can improve dietary adherence and weight loss outcomes.

Parents of minor children lose less weight during a behavioral weight loss intervention: Findings from the Rural LEAP trial.

Objective: The transition to parenthood is associated with worsening health behaviors, yet the impact of parental status on successful weight loss has rarely been examined. The purpose of this study was to examine the effect of parental status of minor children on weight loss and behavioral adherence in a rural community-based weight loss intervention. Methods: Five hundred and twenty-eight adults (age 21-75 years, body mass index [BMI] 30-45 kg/m2) were enrolled in a group-based weight loss intervention consisting of 16 weekly sessions delivered in face-to-face group sessions at Cooperative Extension Service (CES) offices. Participants who were parents with at least one minor child (≤18 years old) in the home were compared to participants with no minor children in the home. Measures included percent weight loss, session attendance, adherence to self-monitoring, and achieving calorie and physical activity goals. Results: Compared to participants without minor children, parents with minor children lost significantly less weight (7.5% vs. 6.2%, respectively; p = 0.01), and were less likely to lose ≥5% of baseline weight (59.2% vs. 70.2%, respectively; p = 0.02). In addition, parents with minor children attended significantly fewer sessions, had lower adherence to self-monitoring, and met calorie and step goals less often (all ps < 0.001). The association between parental status and percent weight loss was not significantly moderated by gender of the parent. Conclusions: Parents of minor children had greater difficulty adhering to intervention goals and lost less weight than participants without minor children. Future research should investigate whether tailoring intervention to meet the unique needs of parents can enhance outcomes, especially given the large segment of the population represented by this group.

Assessment of Physical Activity and Healthy Eating Behaviors Among US Adults Receiving Bariatric Surgery.

Importance: Bariatric surgery effectively treats severe obesity and metabolic diseases. However, individual outcomes vary depending on sustainable lifestyle change. Little is known about lifestyle patterns after bariatric surgery among the US population. Objective: To compare the level of physical activity and eating behavior among postbariatric surgery patients, individuals eligible for surgery, and those with normal weight. Design, Setting, and Participants: A cross-sectional study using nationally representative survey data from National Health and Nutrition Examination Survey 2015-2018. Respondents included for analysis were age 18 years or older, and categorized by individuals with normal weight, individuals who received bariatric surgery, and individuals clinically eligible for bariatric surgery. Analyses were performed from February to October 2021. Main Outcomes and Measures: Self-reported measures were used to assess physical activity (moderate-to-vigorous physical activity [MVPA], sedentary activity, and whether PA guidelines were met) and eating behaviors (total energy intake and Healthy Eating Index [HEI]-2015 diet quality scores). Results: Of 4659 study participants (mean [SD] age, 46.1 [18.6] years; 2638 [weighted percentage, 58.8%] women; 1114 [weighted percentage, 12.7%] Black, 1570 [weighted percentage, 68.6%] White), 132 (3.7%) reported that they had undergone any bariatric surgery. Median (IQR) time since surgery was 7 (3-10) years. After propensity-score weighting, individuals who underwent bariatric surgery reported more time spent in MVPA than those eligible for surgery (147.9 min/wk vs 97.4 min/wk). Among respondents with normal weight, 45.6% (95% CI, 40.8% to 52.4%) reported meeting PA guidelines, almost 2 times higher than those in the bariatric surgery (23.1%; 95% CI, 13.8% to 32.4%) or in the surgery-eligible group (20.3%; 95% CI, 15.6% to 25.1%). Propensity-score weighted overall HEI was higher for individuals with normal weight (54.4; 95% CI, 53.0 to 55.9) than those who underwent bariatric surgery (50.0; 95% CI, 47.2 to 52.9) or were eligible for the surgery (48.0; 95% CI, 46.0 to 50.0). Across all HEI components, mean scores were similar between the bariatric surgery and surgery-eligible groups. Total energy intake was the lowest among those who underwent bariatric surgery (1746 kcal/d; 95% CI, 1554 to 1937 kcal/d), followed by those with normal weight (1943 kcal/d; 95% CI, 1873 to 2013 kcal/d) and those eligible for bariatric surgery (2040 kcal/d; 1953 to 2128 kcal/d). Conclusions and Relevance: In this cross-sectional study, individuals who underwent bariatric surgery had beneficial lifestyle patterns compared with those eligible for surgery; however, these improvements seemed suboptimal based on the current guidelines. Efforts are needed to incorporate benefits of physical activity and a healthy, balanced diet in postbariatric care.

Rural/urban weight-loss outcomes following bariatric surgery.

Obesity disproportionately affects rural populations; however, there is limited research examining disparities in bariatric surgery outcomes between patients from rural versus urban areas. This study aimed to compare the demographic characteristics of patients undergoing bariatric surgery from rural versus urban bariatric areas and to explore differences in weight-loss outcomes between these groups. A retrospective chart review identified a sample of 170 patients (52 rural, 118 urban) who underwent Roux-en-Y gastric bypass or vertical sleeve gastrectomy procedures over a 1-year period. Data collected included age, race, gender, insurance status, surgery type, height, and pre- and postoperative weights at 3 and 6 months. Significant differences in race, ethnicity, and surgery type were observed between rural/urban patients (ps < 0.05). Patients from rural areas demonstrated significantly greater percent total weight losses at 3 months (p = 0.018; however, there were no significant differences between groups at 6 months (p > 0.05). The results suggest that patients from rural counties experience postoperative weight-loss outcomes comparable to those of their urban counterparts.

Associations between the built environment and dietary intake, physical activity, and obesity: A scoping review of reviews.

There exists a large body of literature examining the association between built environment factors and dietary intake, physical activity, and weight status; however, synthesis of this literature has been limited. To address this gap, we conducted a scoping review of reviews and identified 74 reviews and meta-analyses that investigated the association between built environment factors and dietary intake, physical activity, and/or weight status. Results across reviews were mixed, with heterogeneous effects demonstrated in terms of strength and statistical significance; however, preliminary support was identified for several built environment factors. For example, quality of dietary intake appeared to be associated with the availability of grocery stores, higher levels of physical activity appeared to be most consistently associated with greater walkability, and lower weight status was associated with greater diversity in land-use mix. Overall, reviews reported substantial concern regarding methodological limitations and poor quality of existing studies. Future research should focus on improving study quality (e.g., using longitudinal methods, including natural experiments, and newer mobile sensing technologies) and consensus should be drawn regarding how to define and measure both built environment factors and weight-related outcomes.

"Memory bias" for recall of experiences during initial weight loss is affected by subsequent weight loss outcome.

Research has suggested that memories of mood, emotions, and behaviors are not purely unbiased retrieval, but more similar to reconstructions based on current opinions, positive or negative experiences associated with the memory, and how a person believes they would have felt, thought, or acted. We investigated this memory bias in 66 adult participants with overweight/obesity who rated their mood, emotions, and behaviors during a 12-week, Internet-based behavioral weight loss program and later recalled these ratings at Month 3 (immediate post-test) and Month 12 (follow-up). At Month 3, participants recalled the intervention more positively than reported previously, p = .010, but reported remembering the intervention more negatively at the Month 12 follow-up, p = .004. Memory bias was associated with initial weight loss and regain, ps < .05, such that participants who lost more weight at Month 3 remembered their mood, emotions, and behaviors during intervention more positively, and those who regained more weight at Month 12, more negatively. Future research should investigate whether this bias is associated with willingness to re-engage with intervention.

Overeat today, skip the scale tomorrow: An examination of caloric intake predicting nonadherence to daily self-weighing.

OBJECTIVE: Daily self-weighing is an effective weight loss strategy. Little is known about "micro" factors influencing nonadherence to self-weighing (e.g., daily overeating). It was hypothesized that increased caloric intake on a given day would increase odds of not self-weighing the following day. METHODS: Daily self-reports of weight and caloric intake were collected from 74 adults with overweight and obesity (mean BMI = 31.2 ± 4.5 kg/m2 , age = 50.6 ± 10 years, 69% female, 87% Caucasian) throughout a 12-week Internet-based weight management intervention. Multilevel logistic regression investigated odds of nonadherence to self-weighing on a given day based on the previous day's caloric intake. RESULTS: Self-monitoring adherence was high (weights: 87%; calories: 85%); adherence was associated with greater 12-week weight loss (weighing: r = -0.24, P = 0.04; calories: r = -0.26, P = 0.04). Increased caloric intake on a given day, relative to the individual's average intake, was associated with increased odds of nonadherence to self-weighing the next day (F(1,5106) = 12.66, P = 0.0004, ß = 0.001). For example, following a day of eating 300 calories more than usual, odds of not self-weighing increased by 1.33. CONCLUSIONS: Odds of nonadherence to self-weighing increased following a day with higher-than-usual caloric intake. Weight management interventions collecting daily self-monitoring data could provide support to participants who report increased caloric intake to prevent self-weighing nonadherence.

Successful weight loss maintenance associated with morning chronotype and better sleep quality.

It is not known whether individuals successful at long term weight loss maintenance differ in chronotype (i.e., being a "morning" or "evening" person) or sleep habits compared to those who are overweight and obese. We compared Morningness-Eveningness Questionnaire (MEQ) and Pittsburgh Sleep Quality Index scores of 690 National Weight Control Registry (NWCR) members (73 % female, 93 % white, age = 51.7 ± 12.5, BMI = 26.4 ± 5.1) to 75 enrollees in two behavioral weight loss interventions (INT; 77 % female, 88 % white, age = 55.7 ± 10.4, BMI = 36.2 ± 4.7). Controlling for age, MEQ scores were higher in NWCR than INT, p = .004, such that more NWCR than INT were morning-types and fewer were evening types, p = .014. Further, NWCR participants reported better sleep quality, longer sleep duration, and shorter latency to sleep onset compared to INT, ps < .05, and fewer NWCR participants reported <6 or <7 h of sleep, ps < .01. Future studies should examine if these factors change as a result of weight loss or are predictors of weight outcome.

Ambiguity and judgments of obese individuals: no news could be bad news.

Stigmatization towards obese individuals has not decreased despite the increasing prevalence of obesity. Nonetheless, stigmatization remains difficult to study, given concerns about social desirability. To address this issue, this study used paired comparisons and cluster analysis to examine how undergraduates (n=189) categorized scenarios describing the health-related behaviors of obese individuals. The cluster analysis found that the scenarios were categorized into two distinct clusters. The first cluster included all scenarios with health behaviors indicating high responsibility for body weight. These individuals were perceived as unattractive, lazy, less likeable, less disciplined, and more deserving of their condition compared to individuals in the second cluster, which included all scenarios with health behaviors indicating low responsibility for body weight. Four scenarios depicted obese individuals with ambiguous information regarding health behaviors; three out of these four individuals were categorized in the high-responsibility cluster. These findings suggested that participants viewed these individuals as negatively as those who were responsible for their condition. These results have practical implications for reducing obesity bias, as the etiology of obesity is typically not known in real-life situations.

Problem solving, treatment adherence, and weight-loss outcome among women participating in lifestyle treatment for obesity.

OBJECTIVE: This study examined whether improvements in problem-solving abilities mediate the relation between treatment adherence and weight-loss outcome in the behavioral treatment of obesity. METHOD: 272 women (mean+/-SD age=59.4+/-6.2 years, BMI=36.5+/-4.8) participated in a 6-month lifestyle intervention for obesity. Body weight and problem-solving skills (as measured by the Social Problem Solving Inventory-Revised) were assessed pre- and posttreatment. The completion of self-monitoring logs during the intervention served as the marker of treatment adherence. RESULTS: At posttreatment, participants lost 8.4+/-5.8 kg, an 8.8% reduction in body weight. Changes in weight were associated with increased problem-solving skills and with higher levels of treatment adherence. Improvements in problem-solving skills partially mediated the relation between treatment adherence and weight-loss outcome. Moreover, participants with weight reductions > or = 10% demonstrated significantly greater improvements in problem-solving skills than those with reductions <5%. DISCUSSION: Improvements in problem-solving skills may enable participants to overcome barriers to adherence and thereby enhance treatment-induced weight losses.