HomeStyles-2: Randomized controlled trial protocol for a web-based obesity prevention program for families with children in middle childhood.

BACKGROUND: Parents are children's primary role models, are food and physical activity gatekeepers, and create the home structure/lifestyle environment. Thus, parents strongly influence children's weight-related behaviors and have the opportunity to cultivate a "culture of health" within the home. Yet, there is a dearth of evidence-based obesity prevention intervention programs, especially for families with children aged 6-11 years, commonly called middle childhood. METHODS: The aim of the HomeStyles-2 online learning mode RCT is to determine whether this novel, age-appropriate, family intervention enables and motivates parents to shape home environments and weight-related lifestyle practices (i.e.,diet, exercise, sleep) to be more supportive of optimal health and reduced obesity risk in middle childhood youth more than those in the control condition. The RCT will include the experimental group and an attention control group. The participants will be parents with school-age children who are systematically randomly assigned by computer to study condition. The HomeStyles intervention is predicated on the social cognitive theory and a social ecological framework. The RCT will collect sociodemographic characteristics of the participant, child, and partner/spouse; child and parent health status; parent weight-related cognitions; weight-related behaviors of the parent and child; and weight-related characteristics of the home environment. Deliverables Enrollment for this study will begin in 2022. DISCUSSION: This paper describes these aspects of the HomeStyles-2 intervention: rationale; sample eligibility criteria and recruitment; study design; experimental group intervention theoretical and philosophical underpinnings, structure, content, and development process; attention control intervention; survey instrument development and components; outcome measures; and planned analyses. TRIAL REGISTRATION: ClinicalTrials.gov, Protocol #NCT04802291, Registered March 14, 2021.

Disordered Eating Behaviors Are Not Increased by an Intervention to Improve Diet Quality but Are Associated With Poorer Glycemic Control Among Youth With Type 1 Diabetes.

OBJECTIVE: This study examines whether participation in an 18-month behavioral intervention shown previously to improve overall diet quality inadvertently increases disordered eating behaviors (DEBs) in youth with type 1 diabetes and investigates the association of DEB with multiple measures of glycemic control and variability. RESEARCH DESIGN AND METHODS: Participants reported DEB and diabetes management at baseline and 6, 12, and 18 months; masked continuous glucose monitoring, HbA1c, and 1,5-anhydroglucitol (1,5-AG) were obtained concurrently. Linear mixed models estimated the intervention effect on DEB, the association of DEB with diabetes adherence and measures of glycemic control and variability, and whether DEB modified glycemic trajectories. RESULTS: There was no intervention effect on DEB (P = 0.84). DEB was associated with higher HbA1c (P = 0.001), mean sensor glucose (P = 0.001), and percent sensor glucose values >180 mg/dL (P = <0.001); with lower 1,5-AG (P = 0.01); and with worse diabetes adherence (P = 0.03). DEB was not associated with percent sensor glucose values <70 mg/dL or any measures of glycemic variability. There was a significant DEB × time interaction effect for mean sensor glucose (P = 0.05) and percent sensor glucose values >180 mg/dL (P = 0.04). Participants reporting less DEB had a developmentally expected deterioration in glycemic control throughout the study. Participants reporting more DEB had poor glycemic control at baseline that remained poor throughout the study. CONCLUSIONS: Findings show a potential to improve diet quality without increasing DEB and indicate an association of DEB with persistent hyperglycemia but not hypoglycemia or glycemic variability.

Disordered eating, socio-cultural media influencers, body image, and psychological factors among a racially/ethnically diverse population of college women.

This study examined disordered eating, socio-cultural media influencers, body image, and psychological factors among a large, racially/ethnically diverse sample of college women (n=1445; 58% White, 21% Asian, 11% Hispanic, 11% Black) who completed an online survey. Black women were significantly more satisfied with their weight and shape and had lower eating concerns, disinhibited eating, and emotional eating than all other racial/ethnic groups. Black women tended to have significantly higher levels of self-esteem, were less likely to compare their body to those of people in the media, felt less pressured to attain the physical appearance standard set by the media, and had less awareness of the societal appearance norms set by the media than other racial groups. Findings suggest that Black college women, independent of weight status, may be protected from disordered eating, negative body image, and societal media pressures.

Eating Disorders Examination Questionnaire (EDE-Q): norms for US college students.

PURPOSE: To present normative data for the Eating Disorders Examination Questionnaire, 6th edition (EDE-Q) from a large (n = 2,448), diverse (56 % White) sample of college students. METHODS: Participants completed the EDE-Q online. Mean scores and percentile ranks for global and subscale (restraint and eating, weight, and shape concerns) scores and binge eating and inappropriate compensatory behavior (dietary restraint, self-induced vomiting, medicine misuse, excessive exercise) frequencies were computed. RESULTS: Women had higher global and subscale scores and tended to engage in inappropriate compensatory behaviors more often than men. Women with clinically significant restraint, and eating, shape, and weight concerns scores equaled 5.4, 2.0, 18.6, and 13.0 %, respectively, and, for men, equaled 3.0, 0.3, 6.0, and 2.0 %. Compared with less diverse samples, women in this study had significantly higher shape concern and lower restraint and eating concern scores and men had lower shape and weight concern scores. CONCLUSIONS: Normative data from this diverse sample can help healthcare professionals and researchers better interpret EDE-Q scores.

Chronic illness and disordered eating: a discussion of the literature.

This paper describes the prevalence of eating disorders and disordered eating behaviors, the reasons why these practices are endorsed, and the potential consequences in youths and young adults with selected diet-related chronic health conditions (DRCHCs) and provides recommendations for eating disorder prevention interventions and research efforts. Although it remains unclear whether the prevalence of eating disorders is higher in those with DRCHCs compared with the general population, overall findings suggest that young people with DRCHCs may be at risk of endorsing disordered eating behaviors that may lead to diagnosis of an eating disorder and other health problems over the course of their treatment. Thus, health care providers should be aware that young people with DRCHCs may be at risk of eating disorders and carefully monitor psychological changes and the use of unhealthy weight control methods. It is also important to develop and evaluate theory-based interventions and disease-specific eating disorder risk screening tools that are effective in halting the progression of eating disorders and negative health outcomes in young people with chronic health conditions.

Fatty, fatty, two-by-four: weight-teasing history and disturbed eating in young adult women.

OBJECTIVE: We investigated the long-term effect of weight teasing during childhood. METHODS: Young adult women (n = 1533; aged 18-26 years) from 3 large universities participated in a survey (Fall 2009 to Spring 2010) that assessed disturbed eating behaviors; weight status at ages 6, 12, and 16 years; and weight-teasing history. RESULTS: Nearly half of the participants were weight-teased as a child. Participants who experienced childhood weight teasing were significantly more likely to have disturbed eating behaviors now than non-weight-teased peers. As the variety of weight teasing insults recalled increased, so did disturbed eating behaviors and current body mass index. Those who recalled their weight at ages 6, 12, or 16 years as being heavier than average endured weight teasing significantly more frequently and felt greater distress than their lighter counterparts. CONCLUSIONS: Weight teasing may contribute to the development of disturbed eating and eating disorders in young women. Health care professionals, parents, teachers, and other childcare givers must help shift social norms to make weight teasing as unacceptable as other types of bullying. To protect the health of children, efforts to make weight teasing unacceptable are warranted.

Case-control study of disturbed eating behaviors and related psychographic characteristics in young adults with and without diet-related chronic health conditions.

Young adults with diet-related chronic health conditions (DRCHCs; i.e., type 1 diabetes, celiac disease, cystic fibrosis, inflammatory bowel diseases, irritable bowel syndrome) face challenges complying with dietary restrictions required to effectively manage their health condition. These restrictions could put them at risk for disturbed eating. The purpose of this study was to determine if young adults with and without DRCHCs differed with regard to disturbed eating behaviors and related psychographics characteristics (i.e., body image attributes, mental disorders, intrapersonal characteristics and sociocultural environment [i.e., media and family]). Each DRCHC participant (cases=166) was matched to 4 healthy participants (controls=664) based on gender and BMI (±0.50 BMI units). Conditional logistic regression analyses indicate cases were twice as likely to have been diagnosed by a healthcare provider with an eating disorder (p=0.08, OR=1.99, CI(90) [1.03-3.83]). Cases were significantly more likely to use Inappropriate Compensatory Behaviors to manage their weight, i.e., excessive exercise (p=0.04, OR=1.41, CI(95) [1.02-1.94]) and misuse medication (p=0.04, OR=1.14, CI(95) [1.00-1.29]) than controls. Depression and anxiety were significantly higher, and health status was significantly poorer in cases compared with controls. DRCHC participants were less likely to report feeling body image pressures from the media, placed a greater value on their health, used social diversion, and recalled a greater emphasis being placed on their mothers' weights and mealtimes being less structured than control participants. Findings indicate that nutrition and other healthcare professionals should incorporate screening DRCHC patients for disturbed eating behaviors and eating disorders in their standards of care.

Weight regulation practices of young adults. Predictors of restrictive eating.

Young adults frequently use restrictive eating (i.e., going for long periods [≥ 8h] without eating to influence their shape or weight) to control their weight. The purpose of this study was to determine the prevalence of restrictive eating in young adults, compare eating behaviors of restrictive and non-restrictive eaters, and predict restrictive eaters. A diverse (56% white, 63% female) sample of young adults (n=2449) completed an online survey that included eating behavior scales (Restraint, Eating, Shape, and Weight Concerns, and Inappropriate Compensatory Behaviors from the Eating Disorder Examination-Questionnaire, Emotional and Disinhibited Eating from the Three-Factor Eating Questionnaire, and Night Eating from the Night Eating Questionnaire) and demographics. A quarter of women and 20% of men were classified as restrictive eaters. Independent t-tests revealed restrictive eaters had significantly (p<0.001) higher BMIs than non-restrictive eaters. Restrictive eaters also had significantly higher scores on all eating behavior scales than non-restrictive eaters even after controlling for potential confounding factors (BMI, race). Stepwise binary logistic regression revealed that increased eating, shape, and weight concerns, higher BMI, endorsement of inappropriate compensatory behaviors and night eating, being female, and white increased the odds of participants being restrictive eaters. This study can help healthcare professionals become more aware of weight control practices of young adults and create appropriate interventions.

Disturbed Eating Severity Scale (DESS) places disturbed eating risk on a continuum.

The purpose of this study was to develop a tool for assessing the severity of disturbed eating, use the tool to place disturbed eating behavior severity on a continuum, and to investigate how demographic and psychographic characteristics associated with disturbed eating differ across this continuum. Young adults (n=2438; 58% White; 63% female) from three north coast universities completed an online survey (fall 2009 to summer 2010) assessing eating behaviors and psychographic characteristics. Eating behavior scores were used to calculate the Disturbed Eating Severity Score (DESS), which placed participants along a continuum of four disturbed eating severity (non- disturbed to highly-disturbed) categories. Analysis of covariance and post hoc tests revealed significant differences among DESS categories on all eating behavior scales and nearly all psychographic characteristics. Thus, the DESS scale may help health care practitioners identify patients with varying degrees of disturbed eating behaviors and offer early interventions that could halt progress toward an eating disorder.

Sneakers and spokes: an assessment of the walkability and bikeability of U.S. postsecondary institutions.

The purpose of the study described in this article was to assess the walkability and bikeability of 15 U.S. postsecondary education campuses. The Centers for Disease Control and Prevention's evidence-based Healthier Worksite Initiative Walkability Audit was modified to rate campus walking and biking path segments for path safety, quality, and comfort. Universities (n = 13) assessed an average of 44 path segments, which earned a mean score of 72.71 +/- 10.77 SD (possible range 0 to 100). Postsecondary technical schools (n = 2) assessed 20 path segments, which received an average score of 76.56 +/- 13.15. About 70% of path segments received a grade A or B, but almost 1 in 10 received a failing or poor support score for walking and biking. Nearly half or more campus environments scored significantly below an acceptable score on many path safety and quality criteria. Postsecondary education campuses that are supportive of walking and biking offer numerous benefits to the environment and people. Findings from environmental assessments like the data reported here can provide valuable input to campus planners.

Sweet and salty. An assessment of the snacks and beverages sold in vending machines on US post-secondary institution campuses.

This study assessed the nutritional quality of snacks and beverages sold in vending machines. The contents of snack and beverage vending machines in 78 buildings on 11 US post-secondary education campuses were surveyed. Of the 2607 snack machine slots surveyed, the most common snacks vended were salty snacks (e.g., chips, pretzels) and sweets (i.e., candy and candy bars). The 1650 beverage machine slots assessed contained twice as many sugar-sweetened beverages as non-calorie-containing beverages. Only two institutions sold both milk and 100% juice in vending machines. The portion of snacks and beverages sold averaged more than 200 cal. Neither snacks nor beverages were nutrient dense. The majority of snacks were low in fiber and high in calories and fat and almost half were high in sugar. Most beverages were high in calories and sugar. This study's findings suggest that vending machines provide limited healthful choices. Findings from benchmark assessments of components of the food environment, like the vending options reported here, can provide valuable input to campus administrators, health services, food service, and students who want to establish campus policies to promote healthful eating.