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INTRODUCTION: To examine the prevalence and patterns of tobacco purchases at low-income, urban corner stores. METHODS: Data on tobacco products and other purchases were collected through direct observation of customers' purchases (n=6369) at 120 urban corner stores in Philadelphia, Pennsylvania, from April to September 2012. RESULTS: Overall 13% of corner store purchases included tobacco products. The majority (61%) of tobacco purchases did not include any other products, and 5.1% of all purchases from corner stores included a food or beverage and tobacco product. Approximately 24% of tobacco purchases were for lower-cost tobacco products such as cigars and cigarillos, and nearly 5% of tobacco purchases were an illegal purchase of a single, unpackaged tobacco product that is not intended for individual sale (ie, loosies). There was no difference in the average amount spent on food or beverages when purchased with (US$2.55, 95% CI: 2.21 to 2.88) or without (US$2.55, 95% CI: 2.48 to 2.63) tobacco products. CONCLUSIONS: In low-income, urban corner store settings, 87% of purchases did not include tobacco; most tobacco purchases did not include the sale of non-tobacco items and spending on non-tobacco items was similar whether or not tobacco was purchased. These findings can help inform retail-level tobacco sales decisions, such as voluntary discontinuation of tobacco products or future public health policies that target tobacco sales. The results challenge prevailing assumptions that tobacco sales are associated with sales of other products in corner stores, such as food and beverages.
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Comercio/estadística & datos numéricos , Comportamiento del Consumidor/estadística & datos numéricos , Pobreza/estadística & datos numéricos , Productos de Tabaco/economía , Población Urbana/estadística & datos numéricos , Humanos , PhiladelphiaRESUMEN
UNLABELLED: Emotional eating may contribute to variability in weight loss and may warrant specialized treatment, although no randomized studies of specialized treatments exist for individuals who engage in emotional eating. This pilot study tested a new weight loss intervention for individuals who emotionally eat and compared it to the standard behavioral weight loss treatment (SBT). 79 predominantly female (95 %), predominantly African American (79.7 %) individuals who emotionally eat (BMI = 36.2 ± 4.1 kg/m(2)) were randomized to (1) a new enhanced behavioral treatment (EBT), incorporating skills for managing emotions and emotional eating or (2) a SBT. Primary outcomes were weight and emotional eating at 20 weeks. Weight decreased significantly in both groups (SBT: -5.77 kg (-7.49, -4.04); EBT: -5.83 kg (-7.57, -4.09)), with no significant between-group differences. Similar results were produced for emotional eating. Results suggest that SBT may be effective for reducing weight and emotional eating in individuals who emotionally eat, and that adding emotional-eating specific strategies may not provide additional benefits beyond those produced by SBT interventions in the short-term.Registration site: www.clinicaltrials.gov . REGISTRATION NUMBER: NCT02055391.
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Terapia Conductista/métodos , Ingestión de Alimentos/psicología , Emociones/fisiología , Obesidad/terapia , Pérdida de Peso/fisiología , Adulto , Negro o Afroamericano , Peso Corporal , Femenino , Humanos , Masculino , Persona de Mediana Edad , Obesidad/psicología , Proyectos PilotoRESUMEN
As more epidemiologic data on childhood obesity become available, researchers are faced with decisions regarding how to determine biologically implausible values (BIVs) in height, weight, and body mass index. The purpose of the current study was 1) to track how often large, epidemiologic studies address BIVs, 2) to review BIV identification methods, and 3) to apply those methods to a large data set of youth to determine the effects on obesity and BIV prevalence estimates. Studies with large samples of anthropometric data (n > 1,000) were reviewed to track whether and how BIVs were defined. Identified methods were then applied to a longitudinal sample of 13,662 students (65% African American, 52% male) in 55 urban, low-income schools that enroll students from kindergarten through eighth grade (ages 5-13 years) in Philadelphia, Pennsylvania, during 2011-2012. Using measured weight and height at baseline and 1-year follow-up, we compared descriptive statistics, weight status prevalence, and BIV prevalence estimates. Eleven different BIV methods were identified. When these methods were applied to a large data set, severe obesity and BIV prevalence ranged from 7.2% to 8.6% and from 0.04% to 1.68%, respectively. Approximately 41% of large epidemiologic studies did not address BIV identification, and existing identification methods varied considerably. Increased standardization of the identification and treatment of BIVs may aid in the comparability of study results and accurate monitoring of obesity trends.
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Negro o Afroamericano/estadística & datos numéricos , Índice de Masa Corporal , Obesidad Mórbida/epidemiología , Obesidad Infantil/epidemiología , Adolescente , Antropometría , Sesgo , Estatura , Peso Corporal , Niño , Interpretación Estadística de Datos , Femenino , Humanos , Estudios Longitudinales , Masculino , Obesidad Mórbida/etnología , Obesidad Infantil/etnología , Philadelphia/epidemiología , PrevalenciaRESUMEN
OBJECTIVES: The purpose of this study was to assess one-year changes in corner store purchases (nutritional characteristics, amount spent) of children, adolescents, and adults in a low-income urban environment before and after implementing an environmental intervention to increase the availability of healthier products. METHODS: Corner store owners were provided tools (trainings, signage, refrigeration) to increase the promotion and availability of several healthy foods. Based on the degree of support provided, stores were classified as "basic" or "high-intensity" intervention stores. Data on purchases and their nutrient content were gathered (n = 8671 at baseline, n = 5949 at follow-up) through customer purchase assessment interviews and direct observation outside of 192 corner stores in Philadelphia from March 2011 to August 2012. RESULTS: At baseline, shoppers spent $2.81 ± 3.52 for 643 ± 1065 kcal. Energy, select nutrients, and the total amount spent did not significantly change in the overall sample from baseline to follow-up. Similarly, there was no effect on energy and nutrient content when comparing changes over time between basic and high-intensity stores. CONCLUSIONS: There were no significant changes in the energy or nutrient content of corner store purchases one year after implementation of environmental changes to increase the availability of healthier products.
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Conducta Alimentaria , Abastecimiento de Alimentos/economía , Evaluación Nutricional , Características de la Residencia , Adolescente , Adulto , Niño , Preescolar , Costos y Análisis de Costo , Femenino , Estudios de Seguimiento , Abastecimiento de Alimentos/normas , Conductas Relacionadas con la Salud , Humanos , Masculino , Evaluación de Programas y Proyectos de Salud , Población UrbanaRESUMEN
OBJECTIVE: Corner stores, also known as bodegas, are prevalent in low-income urban areas and primarily stock high-energy foods and beverages. Little is known about individual-level purchases in these locations. The purpose of the present study was to assess corner store purchases (items, nutritional characteristics and amount spent) made by children, adolescents and adults in a low-income urban environment. DESIGN: Evaluation staff used 9238 intercept surveys to directly examine food and beverage purchases. SETTING: Intercepts were collected at 192 corner stores in Philadelphia, PA, USA. SUBJECTS: Participants were adult, adolescent and child corner store shoppers. RESULTS: Among the 9238 intercept surveys, there were 20 244 items. On average, at each corner store visit, consumers purchased 2.2 (sd 2.1) items (1.3 (sd 2.0) foods and 0.9 (sd 0.9) beverages) that cost $US 2.74 (sd $US 3.52) and contained 2786.5 (sd 4454.2) kJ (666.0 (sd 1064.6) kcal). Whether the data were examined as a percentage of total items purchased or as a percentage of intercepts, the most common corner store purchases were beverages, chips, prepared food items, pastries and candy. Beverage purchases occurred during 65.9% of intercepts and accounted for 39.2% of all items. Regular soda was the most popular beverage purchase. Corner store purchases averaged 66.2 g of sugar, 921.1 mg of sodium and 2.5 g of fibre per intercept. Compared with children and adolescents, adults spent the most money and purchased the most energy. CONCLUSIONS: Urban corner store shoppers spent almost $US 3.00 for over 2700 kJ (650 kcal) per store visit. Obesity prevention efforts may benefit from including interventions aimed at changing corner store food environments in low-income, urban areas.
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Comercio , Preferencias Alimentarias , Población Urbana , Adolescente , Adulto , Niño , Femenino , Abastecimiento de Alimentos/economía , Humanos , Masculino , Pennsylvania , Características de la Residencia , Encuestas y CuestionariosRESUMEN
The present multi-centre randomised weight-loss trial evaluated the efficacy of a low-intensity 12-week online behavioural modification programme, with or without a fortified diet beverage using a 2 × 2 factorial design. A total of 572 participants were randomised to: (1) an online basic lifestyle information (OBLI) intervention, consisting of one online informational class about tips for weight management; (2) an online behavioural weight management (OBWM) intervention, entailing 12 weekly online classes focused on weight-loss behaviour modification; (3) an OBLI intervention plus a fortified diet cola beverage (BEV) containing green tea extract (total catechin 167 mg), soluble fibre dextrin (10 g) and caffeine (100 mg) (OBLI+BEV); (4) OBWM+BEV. Assessments included height, weight, dual-energy X-ray absorptiometry-derived body composition, and waist circumference (WC). Attrition was 15·7 %. Intention-to-treat (ITT) models demonstrated a main effect for type of Internet programme, with those assigned to the OBWM condition losing significantly more weight (F= 7·174; P= 0·008) and fat mass (F= 4·491; P= 0·035) than those assigned to the OBLI condition. However, there was no significant main effect for the OBWM condition on body fat percentage (F= 2·906; P= 0·089) or WC (F= 3·351; P= 0·068), and no significant main effect for beverage use or significant interactions between factors in ITT models. A 12-week, low-intensity behaviourally based online programme produced a greater weight loss than a basic information website. The addition of a fortified diet beverage had no additional impact.
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Bebidas/análisis , Pérdida de Peso/efectos de los fármacos , Programas de Reducción de Peso/organización & administración , Adulto , Cafeína/química , Dextrinas/química , Femenino , Humanos , Persona de Mediana Edad , Oportunidad Relativa , Extractos Vegetales , Té/química , Reino Unido , Estados Unidos , Programas de Reducción de Peso/métodosRESUMEN
BACKGROUND: Increasing school breakfast participation has been advocated as a method to prevent childhood obesity. However, little is known about children's breakfast patterns outside of school (e.g., home, corner store). Policies that increase school breakfast participation without an understanding of children's breakfast habits outside of school may result in children consuming multiple breakfasts and may undermine efforts to prevent obesity. The aim of the current study was to describe morning food and drink consumption patterns among low-income, urban children and their associations with relative weight. METHODS: A cross-sectional analysis was conducted of data obtained from 651 4th-6th graders (51.7% female, 61.2% African American, 10.7 years) in 2012. Students completed surveys at school that included all foods eaten and their locations that morning. Height and weight were measured by trained research staff. RESULTS: On the day surveyed, 12.4% of youth reported not eating breakfast, 49.8% reported eating one breakfast, 25.5% reported eating two breakfasts, and 12.3% reported eating three or more breakfasts. The number of breakfasts consumed and BMI percentile showed a significant curvilinear relationship, with higher mean BMI percentiles observed among children who did not consume any breakfast and those who consumed ≥ 3 breakfasts. Sixth graders were significantly less likely to have consumed breakfast compared to younger children. A greater proportion of obese youth had no breakfast (18.0%) compared to healthy weight (10.1%) and overweight youth (10.7%, p = .01). CONCLUSIONS: When promoting school breakfast, policies will need to be mindful of both over- and under-consumption to effectively address childhood obesity and food insecurity. CLINICAL TRIAL REGISTRATION: NCT01924130 from http://clinicaltrials.gov/.
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Desayuno , Etnicidad/estadística & datos numéricos , Conducta Alimentaria , Pobreza/estadística & datos numéricos , Población Urbana/estadística & datos numéricos , Índice de Masa Corporal , Peso Corporal , Niño , Estudios Transversales , Femenino , Humanos , Masculino , Obesidad/prevención & control , Sobrepeso , PhiladelphiaRESUMEN
Childhood obesity is rapidly increasing in prevalence. We compared circulating membrane-bound tissue factor (FIII, F3) procoagulant activity (TF-PCA) and plasma markers of coagulation, fibrinolysis and endothelial dysfunction in 21 obese (10·1 ± 1·5 years, mean ± standard deviation) and 22 healthy weight children (9·9 ± 1·6 years), classified by Body Mass Index (BMI). TF-PCA and factor VII coagulant activity (FVII:C), plasminogen activator inhibitor (PAI-1, SERPINE1) and soluble vascular cell adhesion molecule 1 (sVCAM1) were higher in obese children. BMI correlated positively with TF-PCA, FVII:C, and PAI-1. Childhood obesity is associated with a procoagulant state and endothelial dysfunction. Studies are needed to assess whether weight reduction reverses these abnormalities.
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Factores de Coagulación Sanguínea/análisis , Obesidad/sangre , Biomarcadores/sangre , Coagulación Sanguínea/fisiología , Recolección de Muestras de Sangre/métodos , Índice de Masa Corporal , Niño , Factor VII/análisis , Femenino , Fibrinólisis/fisiología , Humanos , Masculino , Inhibidor 1 de Activador Plasminogénico/análisis , Tromboplastina/análisisRESUMEN
OBJECTIVE: To evaluate the effects of water versus beverages sweetened with non-nutritive sweeteners (NNS) on body weight in subjects enrolled in a year-long behavioral weight loss treatment program. METHODS: The study used a randomized equivalence design with NNS or water beverages as the main factor in a trial among 303 weight-stable people with overweight and obesity. All participants participated in a weight loss program plus assignment to consume 24 ounces (710 ml) of water or NNS beverages daily for 1 year. RESULTS: NNS and water treatments were non-equivalent, with NNS treatment showing greater weight loss at the end of 1 year. At 1 year subjects receiving water had maintained a 2.45 ± 5.59 kg weight loss while those receiving NNS beverages maintained a loss of 6.21 ± 7.65 kg (P < 0.001 for difference). CONCLUSIONS: Water and NNS beverages were not equivalent for weight loss and maintenance during a 1-year behavioral treatment program. NNS beverages were superior for weight loss and weight maintenance in a population consisting of regular users of NNS beverages who either maintained or discontinued consumption of these beverages and consumed water during a structured weight loss program. These results suggest that NNS beverages can be an effective tool for weight loss and maintenance within the context of a weight management program.
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Edulcorantes no Nutritivos/administración & dosificación , Obesidad/dietoterapia , Agua/administración & dosificación , Pérdida de Peso/fisiología , Adulto , Bebidas , Índice de Masa Corporal , Peso Corporal , Ingestión de Energía , Femenino , Humanos , Estudios Longitudinales , Masculino , Persona de Mediana EdadRESUMEN
OBJECTIVE: We examined the perspectives of low-income, urban youth about the corner store experience to inform the development of corner store interventions. DESIGN: Focus groups were conducted to understand youth perceptions regarding their early shopping experiences, the process of store selection, reasons for shopping in a corner store, parental guidance about corner stores, and what their ideal, or "dream corner store" would look like. Thematic analysis was employed to identify themes using ATLAS.ti (version 6.1, 2010, ATLAS.ti GmbH) and Excel (version 2010, Microsoft Corp). SETTING: Focus groups were conducted in nine kindergarten-through-grade 8 (K-8) public schools in low-income neighborhoods with 40 fourth- to sixth-graders with a mean age of 10.9±0.8 years. RESULTS: Youth report going to corner stores with family members at an early age. By second and third grades, a growing number of youth reported shopping unaccompanied by an older sibling or adult. Youth reported that the products sold in stores were the key reason they choose a specific store. A small number of youth said their parents offered guidance on their corner store purchases. When youth were asked what their dream corner store would look like, they mentioned wanting a combination of healthy and less-healthy foods. CONCLUSION: These data suggest that, among low-income, urban youth, corner store shopping starts at a very young age and that product, price, and location are key factors that affect corner store selection. The data also suggest that few parents offer guidance about corner store purchases, and youth are receptive to having healthier items in corner stores. Corner store intervention efforts should target young children and their parents/caregivers and aim to increase the availability of affordable, healthier products.
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Conducta Infantil , Conducta de Elección , Conducta Alimentaria/psicología , Conductas Relacionadas con la Salud , Población Urbana , Niño , Estudios de Evaluación como Asunto , Femenino , Grupos Focales , Preferencias Alimentarias , Abastecimiento de Alimentos , Humanos , Masculino , Obesidad/prevención & control , Philadelphia , Pobreza , Ensayos Clínicos Controlados Aleatorios como Asunto , Características de la Residencia , Encuestas y CuestionariosRESUMEN
OBJECTIVE: Although many initiatives exist to improve the availability of healthy foods in corner stores, few randomized trials have assessed their effects. This study evaluated, in a randomized controlled trial, the effects of a first-generation healthy corner store intervention on students' food and beverage purchases over a 2-year period. METHODS: Participants (n = 767) were fourth-, fifth-, and sixth-grade students. Ten schools and their nearby corner stores (n = 24) were randomly assigned to the healthy corner store intervention or an assessment-only control. Intercept surveys directly assessed the nutritional characteristics of students' corner store purchases at baseline, 1 and 2 years. Students' weight and heights were measured at baseline, 1 and 2 years. RESULTS: There were no differences in energy content per intercept purchased from control or intervention schools at year 1 (P = 0.12) or 2 (P = 0.58). There were no differences between control and intervention students in BMI z score (year 1, P = 0.83; year 2, P = 0. 98) or obesity prevalence (year 1, P = 0.96; year 2, P = 0.58). CONCLUSIONS: A healthy corner store initiative did not result in significant changes in the energy content of corner store purchases or in continuous or categorical measures of obesity. These data will help to inform future interventions.
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Preferencias Alimentarias/psicología , Abastecimiento de Alimentos/clasificación , Alimentos Orgánicos/estadística & datos numéricos , Promoción de la Salud/tendencias , Pobreza , Características de la Residencia , Población Urbana , Factores de Edad , Estatura , Peso Corporal , Niño , Femenino , Abastecimiento de Alimentos/economía , Alimentos Orgánicos/economía , Humanos , Masculino , Obesidad/epidemiología , Obesidad/prevención & control , Prevalencia , Instituciones Académicas , Clase Social , EstudiantesRESUMEN
OBJECTIVE: To compare the efficacy of non-nutritive sweetened beverages (NNS) or water for weight loss during a 12-week behavioral weight loss treatment program. METHODS: An equivalence trial design with water or NNS beverages as the main factor in a prospective randomized trial among 303 men and women was employed. All participants participated in a behavioral weight loss treatment program. The results of the weight loss phase (12 weeks) of an ongoing trial (1 year) that is also evaluating the effects of these two treatments on weight loss maintenance were reported. RESULTS: The two treatments were not equivalent with the NNS beverage treatment group losing significantly more weight compared to the water group (5.95 kg versus 4.09 kg; P < 0.0001) after 12 weeks. Participants in the NNS beverage group reported significantly greater reductions in subjective feelings of hunger than those in the water group during 12 weeks. CONCLUSION: These results show that water is not superior to NNS beverages for weight loss during a comprehensive behavioral weight loss program.
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Bebidas , Agua Potable/administración & dosificación , Edulcorantes no Nutritivos/administración & dosificación , Pérdida de Peso , Programas de Reducción de Peso , Adulto , Anciano , Índice de Masa Corporal , Ingestión de Energía , Femenino , Estudios de Seguimiento , Humanos , Masculino , Persona de Mediana Edad , Actividad Motora , Estudios Prospectivos , Conducta Sedentaria , Adulto JovenRESUMEN
PURPOSE: This study aimed to objectively measure the physical activity (PA) characteristics of a racially and ethnically diverse sample of inner-city elementary schoolchildren and to examine the influence of sex, race/ethnicity, grade level, and weight status on PA. METHODS: A total of 470 students in grades 4-6 from six inner-city schools in Philadelphia wore an ActiGraph GT3X+ accelerometer (Actigraph, Pensacola, FL) for up to 7 d. The resultant data were uploaded to a customized Visual Basic EXCEL macro to determine the time spent in sedentary (SED), light-intensity PA (LPA), and moderate- to vigorous-intensity PA (MVPA). RESULTS: On average, students accumulated 48 min of MVPA daily. Expressed as a percentage of monitoring time, students were sedentary for 63% of the time, in LPA 31% of the time, and in MVPA 6% of the time. Across all race/ethnicity and grade level groups, boys exhibited significantly higher levels of MVPA than girls did; fifth-grade boys exhibited significantly lower MVPA levels than fourth- and sixth-grade boys did, and sixth-grade girls exhibited significantly lower MVPA levels than fourth- and fifth-grade girls did. Hispanic children exhibited lower levels of MVPA than children from other racial/ethnic groups did, and overweight and obese children exhibited significantly lower MVPA levels than children in the healthy weight range did. Across the entire sample, only 24.3% met the current public health guidelines for PA. Physical inactivity was significantly greater among females, Hispanics, and overweight and obese students. CONCLUSIONS: Fewer than one in four inner-city schoolchildren accumulated the recommended 60 min of MVPA daily. These findings highlight the need for effective and sustainable programs to promote PA in inner-city youth.
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Etnicidad/estadística & datos numéricos , Actividad Motora , Población Urbana/estadística & datos numéricos , Actigrafía , Negro o Afroamericano/estadística & datos numéricos , Peso Corporal , Distribución de Chi-Cuadrado , Niño , Femenino , Conductas Relacionadas con la Salud/etnología , Hispánicos o Latinos/estadística & datos numéricos , Humanos , Modelos Logísticos , Masculino , Obesidad/psicología , Factores SexualesRESUMEN
Universal free access to school breakfast is available in large urban schools, but participation rates are less than half of what they are at lunch. The purpose of this qualitative study was to understand the discrepancy between access and participation in school breakfast in a low-income, urban school district. Youth (n=23) and parents (n=22) were recruited from three middle schools where ≥ 50% of students were eligible for free or reduced-price meals. Parent focus groups (n=2) and student focus groups (n=4) were conducted in the fall/winter of 2009/2010. Content analysis was conducted to code transcripts and a constant comparative technique was used to identify emergent themes. Findings were validated using triangulation methods. The following themes emerged from the student and parent perceptions: sociocultural beliefs, physical availability, economic accessibility, social stigma, and consumption practices. There was agreement between students and parents across most themes, except consumption practices. Students were commonly purchasing food and beverages on the way to school, which was in conflict with parent rules. Parents desired access to copies of the school menus to be more involved in breakfast decisions with their child and students desired input into menu planning and taste testing to overcome school meal quality concerns. Future research aiming to improve participation in the breakfast program should examine the impact of student involvement in school menu planning and environmental modifications to reduce the social stigma associated with the program.
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Desayuno/psicología , Servicios de Alimentación , Padres/psicología , Estudiantes/psicología , Niño , Fenómenos Fisiológicos Nutricionales Infantiles/fisiología , Comportamiento del Consumidor , Femenino , Grupos Focales , Preferencias Alimentarias/psicología , Servicios de Alimentación/economía , Servicios de Alimentación/normas , Servicios de Alimentación/estadística & datos numéricos , Humanos , Masculino , Planificación de Menú , Percepción , Pobreza , Instituciones Académicas , Estigma Social , Factores de Tiempo , Estados Unidos , Población Urbana/estadística & datos numéricosRESUMEN
PURPOSE: The purpose of the study was to examine the association of self-monitoring of blood glucose (SMBG) to weight loss and A1C among participants in a behavioral weight loss intervention. METHODS: Multivariate analyses were employed to evaluate the relationship between SMBG and changes in patient weight and A1C levels. Bootstrapping was used to determine whether there was an indirect effect of SMBG on weight loss through diet adherence and an indirect effect of SMBG on A1C through weight loss. RESULTS: The relationship between increased SMBG and greater weight loss was mediated by better adherence to diet. The relationship of increased SMBG and greater reductions in A1C were mediated by greater weight loss. CONCLUSIONS: Results of the study were consistent with the hypothesis that SMBG leads to an increased adherence to dietary recommendations. For patients who are taught to use their diet to lose weight, increased adherence to dietary recommendations is associated with increased weight loss and subsequently better glucose control. SMBG may be of value as an adjunctive intervention in behavioral programs for type 2 diabetes.
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Automonitorización de la Glucosa Sanguínea/métodos , Glucemia/metabolismo , Diabetes Mellitus Tipo 2/sangre , Hemoglobina Glucada/metabolismo , Obesidad/sangre , Programas de Reducción de Peso/métodos , Automonitorización de la Glucosa Sanguínea/psicología , Peso Corporal , Estudios Cruzados , Diabetes Mellitus Tipo 2/epidemiología , Diabetes Mellitus Tipo 2/psicología , Diabetes Mellitus Tipo 2/terapia , Dieta con Restricción de Grasas , Ejercicio Físico , Femenino , Humanos , Masculino , Obesidad/epidemiología , Obesidad/prevención & control , Obesidad/psicología , Cooperación del Paciente , Estados Unidos/epidemiología , Pérdida de PesoRESUMEN
Obesity is remarkably refractory to treatment. Despite a plethora of quantitative studies, little qualitative research has been conducted on the topic of weight loss maintenance. This study used six focus groups to explore which factors promoted or prevented maintaining weight loss among a diverse, urban population. Eligible participants were those who had intentionally lost ≥10% of their body weight in the past 2 years and were categorized as either "regainers" or "maintainers" using self-reported length of weight maintenance and amount (%) regained. Regainers had regained ≥33% of their weight loss and maintainers had regained ≤15%. Participants (n=29) were predominantly African-American (58.6%) females (65.6%) with a mean age of 46.9±11.2 years. Four themes reflected similarities between regainers and maintainers, and four reflected differences between the groups. Both groups experienced lapses, used clothing fit for feedback on weight status, desired greater support during maintenance, and decreased self-monitoring of food intake over time. When compared with regainers, maintainers more often continued strategies used during weight loss, weighed themselves regularly, and used productive problem-solving skills and positive self-talk. Regainers experienced greater difficulty independently continuing food and exercise behaviors during maintenance, identifying decreased accountability and waning motivation as barriers. These findings suggest that weight loss maintenance efforts can be improved by addressing challenges such as long-term self-monitoring and problem-solving skills, and that maintenance success might depend on how people think as much as what they do.
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Ejercicio Físico/psicología , Conducta Alimentaria/psicología , Conductas Relacionadas con la Salud , Obesidad/prevención & control , Pérdida de Peso/fisiología , Negro o Afroamericano/psicología , Femenino , Grupos Focales , Hispánicos o Latinos/psicología , Humanos , Estilo de Vida , Masculino , Persona de Mediana Edad , Motivación , Obesidad/psicología , Obesidad/terapia , Solución de Problemas , Autoimagen , Apoyo Social , Factores de TiempoRESUMEN
BACKGROUND: Increased consumption of nuts has been advocated because of their health benefits, but the role of nuts in the treatment of obesity is unclear given their high energy density. OBJECTIVE: This study was designed to evaluate the effects of a hypocaloric, almond-enriched diet (AED) compared with a hypocaloric nut-free diet (NFD) on body weight and cardiovascular disease risk factors in the context of an 18-mo behavioral weight-management program. DESIGN: Overweight and obese individuals [n = 123; age = 46.8 y, BMI (in kg/m(2)) = 34.0] were randomly assigned to consume an AED or NFD and instructed in traditional behavioral methods of weight control. Anthropometric and metabolic measurements were made at baseline, 6 mo, and 18 mo. RESULTS: Those in the AED group lost slightly but significantly less weight than did those in the NFD group at 6 mo (-5.5 compared with -7.4 kg; P = 0.04), but there were no differences at 18 mo. No significant differences in body composition were found between the groups at 6 or 18 mo. The AED, compared with the NFD, was associated with greater reductions in total cholesterol (P = 0.03), total:HDL cholesterol (P = 0.02), and triglycerides (P = 0.048) at 6 mo, and no differences were observed between the groups at 18 mo. CONCLUSIONS: The AED and NFD groups experienced clinically significant and comparable weight loss at 18 mo. Despite smaller weight loss in the AED group at 6 mo, the AED group experienced greater improvements in lipid profiles. This trial was registered at clinicaltrials.gov as NCT00194428.
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Restricción Calórica , Dieta , Nueces , Obesidad/dietoterapia , Sobrepeso/dietoterapia , Adulto , Composición Corporal , Índice de Masa Corporal , Peso Corporal , Enfermedades Cardiovasculares/fisiopatología , Enfermedades Cardiovasculares/prevención & control , HDL-Colesterol/sangre , LDL-Colesterol/sangre , Ingestión de Energía , Femenino , Humanos , Masculino , Persona de Mediana Edad , Prunus , Factores de Riesgo , Resultado del Tratamiento , Triglicéridos/sangreRESUMEN
The purpose of the current study was to examine the relative contributions of weight status, race/ethnicity, sex, and age on body dissatisfaction in a large group of diverse children. Participants were 4th-6th graders (N=1212) in ten inner-city schools who participated in an obesity prevention study previously published. Children completed the body dissatisfaction subscale of the Eating Disorder Inventory-2 (EDI-2), and weight status was assessed by measured weights and heights. Multiple regression analyses were conducted. Relative weight status was the strongest predictor of body dissatisfaction, followed by race/ethnicity, and sex. Body dissatisfaction was greatest in obese, Asian, and female children. Overall, results indicated that children's body dissatisfaction varies based on relative weight status, as well as race/ethnicity and sex among urban children. Results highlight the strong need for additional research so that more definitive conclusions may be drawn regarding the development of body image among diverse groups of children.
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Asiático/psicología , Negro o Afroamericano/psicología , Imagen Corporal , Peso Corporal/etnología , Identidad de Género , Hispánicos o Latinos/psicología , Obesidad/etnología , Obesidad/psicología , Sobrepeso/etnología , Sobrepeso/psicología , Satisfacción Personal , Delgadez/etnología , Delgadez/psicología , Población Urbana , Población Blanca/psicología , Índice de Masa Corporal , Niño , Comparación Transcultural , Femenino , Humanos , Masculino , Inventario de Personalidad/estadística & datos numéricos , Philadelphia , PsicometríaRESUMEN
OBJECTIVE: To evaluate patient opinions on acceptable risks in exchange for a given degree of weight loss and their implications for sample size determination in obesity randomized clinical trials (RCTs). DESIGN: . Survey of patients entering RCTs for weight loss in a university-based clinical research setting and power calculations based on their responses. Participants. Men (n = 8) and women (n = 66) between 24 and 73 years of age with body mass indices ranging from 26.8 to 40.5 kg/m(2). Measurements. Survey responses to questions assessing the added risk of serious adverse events (SAEs) or death one is willing to assume for a given degree of weight loss. RESULTS: For 5% and 10% weight loss against risk for death per se, the mean acceptable risk tended to be about 3.5%, but the median (0.00) and mode (0.00) suggested that for most individuals, only a risk of < or = 1% would be acceptable. Figures, estimated dropout rates, and base rates of SAEs (including deaths) from recent obesity trials indicate that 1-year 2-group obesity RCTs would need tens of thousands of participants per group to have 80% power to detect risks that are meaningful to patients at the 2-tailed 0.05 alpha level. CONCLUSION: Patient education is needed to explain which risks are realistically detectable in RCTs so that patients may provide truly informed consent, or RCT standards should be modified to meet patients' implicit expectations.
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Obesidad , Pacientes/psicología , Ensayos Clínicos Controlados Aleatorios como Asunto , Tamaño de la Muestra , Adulto , Anciano , Recolección de Datos , Femenino , Humanos , Consentimiento Informado , Masculino , Persona de Mediana Edad , Medición de Riesgo , Pérdida de Peso/fisiología , Adulto JovenRESUMEN
OBJECTIVE: Childhood obesity is higher among ethnic minorities. One reason may be the limited access to affordable, healthy options. The disparate prevalence of urban corner stores in low-income and high-minority communities has been well documented. There are no data, however, on what children purchase in these environments before and after school. The purpose of this study was to document the nature of children's purchases in corner stores proximal to their schools. METHODS: This was an observational study from January to June 2008. Participants were children in grades 4 through 6 from 10 urban K-8 schools with >or=50% of students eligible for free or reduced-price meals. A total of 833 intercept surveys of children's purchases were conducted outside 24 corner stores before and after school. The main outcomes were type and energy content of items purchased. RESULTS: The most frequently purchased items were energy-dense, low-nutritive foods and beverages, such as chips, candy, and sugar-sweetened beverages. Students spent $1.07 +/- 0.93 on 2.1 +/- 1.3 items (1.6 +/- 1.1 food items and 0.5 +/- 0.6 beverage items) per purchase. The total number of calories purchased per trip was 1497.7 +/- 1219.3 kJ (356.6 +/- 290.3 kcal). More calories came from foods than from beverages. CONCLUSIONS: Purchases made in corner stores contribute significantly to energy intake among urban school children. Obesity prevention efforts, as well as broader efforts to enhance dietary quality among children in urban settings, should include corner store environments proximal to schools.