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OBJECTIVE: Social influences play an important role in shaping adolescents' dietary and physical activity behaviors. We examined the role of perceived modeling and perceived social support from family and friends on diet and physical activity behaviors among overweight and obese adolescents participating in a weight management trial. METHODS: Six high schools were randomized to a school-nurse delivered behavioral weight management intervention or an information attention-control. Data on perceived support and modeling of healthy eating and physical activity from family and friends and dietary and physical activity behaviors were obtained from participants (N=82) at baseline and 2- and 6-months follow-up. RESULTS: Linear mixed models were used to examine associations between social factors at baseline and diet and physical behaviors at 6 months. Friend support was correlated with increased fruit and vegetable consumption (0.4 servings/day) and decreased added sugar intake (-14.2 grams/day) (p's<0.05). Family support for physical activity, friend support for physical activity, and family modeling of physical activity were associated with increased number of days/week active for ≥ 60 minutes/day (0.7 days/week; 0.6 days/week; and 0.4 days/week, respectively, p's<0.05). CONCLUSIONS: Among overweight and obese high school adolescents, support from family and friends was associated with a greater number of improvements in diet and physical activity at follow-up than modeling. Strategies to solicit support may maximize efficacy of adolescent obesity intervention efforts.
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PURPOSE: The purpose of this study was to explore the perceptions of healthy eating by youth with diabetes as well as facilitators of and barriers to healthy eating behavior. METHODS: One hundred forty youth aged 7 to 16 years with diabetes participated in 18 focus groups. Sample race/ethnicity was 71% white, 18% African American, 6% Hispanic, and 5% other; 69% of the participants were female. RESULTS: Healthy eating was defined primarily in terms of eating fruits and vegetables, low fat, low sugar, and eating to keep blood sugar in range. However, there were notable differences in perceptions of healthy eating versus perceptions of eating practices good for diabetes management. Specifically, "free" foods (foods high in fat but low in carbohydrate) were commonly reported as being good for diabetes management. Major barriers to healthy eating included widespread availability of unhealthy foods, preparation time, and social situations. Parental behaviors, including monitoring food choices and positive modeling, were the most commonly reported facilitators of healthy eating. CONCLUSION: Findings suggest that youth with diabetes have a general understanding of healthy eating and face similar barriers and facilitators to healthy eating as nondiabetic children do. However, the diabetes regimen may influence their understanding of healthy eating, sometimes negatively. Diabetes nutrition education sessions should emphasize the connection between healthy eating and both short- and long-term diabetes outcomes, and they should highlight strategies to reduce saturated fat consumption while avoiding excessive carbohydrate consumption. The diabetes educator can play an integral role in promoting healthy dietary practices by facilitating parental involvement, designing action plans for managing social situations, and increasing awareness of healthier alternatives to widely available unhealthy foods.
