Undergraduates' knowledge, attitudes, and behaviours associated with fad diets.

PURPOSE: We aimed to determine undergraduate students' use and knowledge of fad diets as well as examine how appealing students found these diets given the goal of rapid weight loss and/or improved health. Twenty-three students from a Midwestern university (mean age = 19.2, mean BMI = 27.35, 69.6% female) were recruited through new student orientations for this qualitative study. Approximately 52% of participants identified as White, 30% as Black, 13% as Asian, and 4% as multi-racial. METHODS: Knowledge and opinions about fad diets were collected via focus groups and individual interviews. Coding of transcripts was conducted by hand using the constant comparative method and data were analysed based on grounded theory. RESULTS: Two primary themes emerged: very negative views of fad diets and the importance of healthy eating. Although few participants had tried fad diets, they thought these diets: 1) did not lead to sustained weight loss, 2) were associated with disappointment and health issues, and 3) were money-making schemes delivered heavily through social media. Participants also valued healthy eating. CONCLUSION: Experimental studies are needed to examine how healthy eating among university students can be supported through credible sources, accurate information, and established connections via innovative social media platforms.

Bad situation, treat yourself: a qualitative exploration of the factors influencing healthy eating habits during the COVID-19 pandemic.

Purpose: To explore barriers and facilitators to healthy eating during the COVID-19 pandemic among adults enrolled in an internet-based weight loss program. Methods: Adults in an internet-delivered weight loss program were recruited to participate. Participants completed online study surveys and a semi-structured interview via telephone between June 1, 2020 and June 22, 2020. The interview included questions to explore how the COVID-19 pandemic has influenced dietary behaviors. Constant comparative analysis was used to identify key themes. Results: Participants (n = 30) were primarily female (83%) and white (87%), 54.6 ± 10.0 years old, and had a mean body mass index of 31.1 ± 4.5 kg/m2. Barriers included snacking/ease of access to food, eating as a coping mechanism, and lack of routine/planning. Facilitators included calorie control, regular routine/scheduling, and self-monitoring. General themes with eating were a change in eating out frequency or modality, cooking more, and changes in alcohol consumption. Conclusion: Eating habits among adults enrolled in a weight loss program changed during the COVID-19 pandemic. Future weight loss programs and public health recommendations should consider modifying recommendations to place increased emphasis on strategies to overcome barriers to healthy eating and promote facilitators that may help with healthy eating, particularly during unexpected circumstances or events.

Night eating syndrome subtypes: differences in binge eating and food addiction symptoms.

PURPOSE: The purpose of the current study was to examine differences in binge eating and food addiction symptoms between Night Eating Syndrome (NES) latent subtypes: evening hyperphagia with nocturnal ingestions (EHNI), evening hyperphagia-only (EHO), and nocturnal ingestions-only (NIO). It was hypothesized that the EHNI group would report more binge eating behaviors and more food addiction symptoms than both the EHO and NIO groups. Further, it was hypothesized that the EHO and NIO groups would differ with the EHO group reporting more binge eating behaviors and the NIO group reporting more food addiction symptoms. METHODS: Participants completed measures online relating to night eating, binge eating, and food addiction. Average age of the final sample was 34.3 (SD = 10.5) and 62.0% were men. Responses to the Night Eating Questionnaire (NEQ; Allison et al., 2008) were used to create an EHNI group (n = 65), an EHO group (n = 32), and a NIO group (n = 69). ANOVAs were conducted to examine between-group differences on disordered eating symptoms. RESULTS: Participants in the EHNI group reported more severe binge eating and food addiction symptoms than those in the EHO and NIO groups. However, there were no significant differences in binge eating or food addiction between the EHO and NIO groups. CONCLUSION: Individuals who meet both NES core criteria (evening hyperphagia and nocturnal ingestions) are likely at a higher risk for experiencing other, more severe disordered eating pathologies. Implications concerning assessment and future research on NES typology are discussed. LEVEL OF EVIDENCE: Level V, cross-sectional descriptive study.

Factors impacting implementation of nutrition and physical activity policies in rural schools.

BACKGROUND: Rural Latino children have higher rates of obesity compared to non-Latino Whites. Schools are in a unique position to address rural childhood obesity through policies. While evidence exists on factors that promote or impede school-based physical activity (PA) and nutrition policies, only a fraction has been in rural communities. This study seeks to understand 1) the knowledge and perceptions of school nutrition and PA policies and 2) barriers and facilitators to their implementation among rural school stakeholders from Washington State. METHODS: We conducted 20 semi-structured, in-depth interviews with school stakeholders (e.g., principals and school nutrition directors) from four K-12 school districts in the Lower Yakima Valley of Eastern Washington State. Thematic analysis was conducted using inductive, constant comparison approach to identify themes around knowledge and perceptions of policies and barriers and facilitators of policy implementation. RESULTS: Three main themes were identified: perceptions and knowledge of school PA and nutrition policies, barriers to policy implementation, and facilitators of policy implementation. The majority of stakeholders were supportive of school-based policies promoting PA and a healthy diet, even when lacking a specific understanding of these policies. Four subthemes were identified as barriers to policy implementation: viewing PA as a low priority, misuse of recess time, funding constraints, and lack of strong leadership. Facilitators of implementation included strong leadership at the district level, creating healthy norms through school-community linkages and pooling community resources to improve nutrition and PA among children. CONCLUSIONS: Schools provide a unique setting to promote healthy diet and PA behaviors among children and their families. Study findings show that while knowledge of specific nutrition and PA policies may vary, support for such policies were high among rural stakeholders. Study findings can inform policy development and support strategies for policy implementation in rural settings. Future studies may want to examine whether implementation of strategies addressing the barriers and enhancing facilitators lead to success in rural school settings.

"The stomach I have now has a brain connection:" changes in experiences of hunger and fullness following bariatric surgery.

The rate of obesity in the U.S. is at an all-time high of 42.4%, with 9.2% of cases falling in the severe obesity category. Bariatric surgery results in significant weight loss through two of the most popular options, sleeve gastrectomy and Roux-en-Y gastric bypass. One of the mechanisms through which these surgeries work is via the alteration of neural and hormonal appetite signaling, which leads to decreases in hunger and increases in fullness. The available measures for assessing hunger and fullness were not developed for use in bariatric surgery patients and do not capture physical hunger feelings or normal fullness. A longitudinal mixed-method study of 30 bariatric surgery patients (20% male, 20% African American) was designed to explore the physical and psychological feelings associated with hunger and fullness. Participants were recruited from an accredited bariatric surgery center and interviewed prior to surgery and 6 and 12-months after surgery. Transcripts were coded using a constant comparative method. Themes were created using a grounded theory approach. Different pathways were discovered such that participants' experiences of hunger and fullness varied compared to each other, as well as over time. Hunger had physical and psychological qualities, whereas fullness was generally only described as being physical. These results suggest that pre-surgery and post-surgery counseling should be customized in regard to appetite. Measures should be developed to better capture the true experiences of hunger and fullness among bariatric surgery patients.

The comparison of brief, online mindfulness and relaxation interventions to reduce stress and improve sleep-related outcomes in college students.

OBJECTIVE: The current study aimed to examine whether brief online stress reduction exercises supplemented with sleep improvement strategies would reduce stress, arousal, and sleep difficulties in college students who were not required to use the sleep improvement strategies for participation. PARTICIPANTS: A sample of 114 college student participants were enrolled because they were experiencing stress and/or wanted to improve their sleep. METHODS: Participants were randomized into an abbreviated progressive muscle relaxation, a mindful breathing, or a self-monitoring control condition for the 4-week intervention. Measures of physical relaxation, mindfulness, perceived stress, pre-sleep arousal, and insomnia symptom severity were collected. RESULTS: The APMR group improved on five of the six dependent measures and was significantly different than the SM group at posttest, but not different than the MB group. CONCLUSION: The results suggests promise for brief, online, scaled back stress reduction interventions to reduce stress, arousal, and sleep difficulties in college students.

School staff and immunization governance: Missed opportunities for public health promotion.

BACKGROUND: In US states, childhood immunization mandates are enforced for school registration by front-line school staff, usually secretaries. Despite substantial changes to mandate policies in several states and many countries, little attention has been paid to the people who enforce them. This qualitative pilot study aimed to uncover beliefs, attitudes, and practices regarding immunization governance of Michigan school staff. METHOD: Front-line administrative workers from Michigan schools and district offices were solicited by email. Sixteen were interviewed remotely. RESULTS: Front-line school staff believed in vaccines, but did not advocate for vaccination while registering children. Instead, they sought low-friction bureaucratic transactions, privileging the collection of data over the promotion of public health goals. This revealed a mismatch between the goals of the front-line staff who enforce vaccine mandates in schools and the goals of the policymakers who created school vaccine mandates. CONCLUSIONS: This study found low mobilization of front-line enforcers of mandates in public-facing school administration roles, a problem likely to afflict the majority of American states with the 'mandates + exemptions' model of immunization governance. Schools would have stronger incentives to promote vaccination if state funding were better tied to immunization compliance. Front-line staff could better enforce vaccine mandates if they were provided with resources and training about vaccine promotion.

Neighborhood social cohesion and physical activity and obesity outcomes among Native Hawaiian and Pacific Islander individuals.

OBJECTIVE: Native Hawaiian and Pacific Islander (NHPI) individuals report high obesity rates and low physical activity (PA) levels. This study examined associations between neighborhood social cohesion, obesity, and PA among NHPI adults. METHODS: Cross-sectional data from the 2014 NHPI National Health Interview Survey were analyzed. Social cohesion was assessed using a summative scale and categorized as low, medium, and high. PA was measured via self-report and categorized as insufficiently active (0-149 min/wk) or sufficiently active (150+ min/wk). Obesity status was based on self-reported height and weight measures converted into standard BMI categories. Multivariable logistic regression models estimated odds of obesity and sufficient PA associated with social cohesion level. RESULTS: The study sample included n = 2,590 NHPI adults. Compared with those in low social cohesion neighborhoods, participants in high social cohesion neighborhoods had increased sufficient PA odds (odds ratio [OR] = 1.59, 95% CI: 1.19-2.12; p = 0.003) and decreased obesity odds (OR = 0.57, 95% CI: 0.40-0.83; p = 0.005). No associations were observed between social cohesion and obesity and PA outcomes comparing individuals in medium versus low social cohesion neighborhoods. CONCLUSIONS: High social cohesion was associated with reduced obesity odds and increased sufficient PA odds. Findings highlight the importance of enhancing social connectivity as a potential strategy to promote PA and healthy weight among NHPI individuals.

BMI and related risk factors among U.S. Marshallese with diabetes and their families.

Objective: Examine cross-sectional associations between body mass index (BMI) and related health behaviors, barriers and facilitators to health care, and perceived health status among a sample of U.S. Marshallese adults with Type 2 diabetes and evaluate associations of interest between participants and their family members.Design: Cross-sectional baseline data were analyzed from participants in a diabetes self-management education intervention trial.Setting: Data collection took place in home or community settings through a community-academic partnership in Arkansas.Participants: Study participants consisted of U.S. Marshallese adults with Type 2 diabetes (N = 221) and their family members (N = 211) recruited through community settings.Intervention(s): N/A.Main Outcome Measure(s): Participants' height and weight were measured using standard protocols to calculate BMI (kg/m2). Diet, physical activity, health care access, financial strain related to health care, perceived health status, and health care satisfaction were measured using self-report surveys.Results: Participants' mean BMI was 31.0 (95% CI: 30.2-31.7), with over half of study participants and their family members' BMI falling in the obese category. Participants' BMI was positively associated with spreading health care bill payments over time (ß = 1.75 (SE = 0.87); p = 0.045). Positive associations between participants and their family members were observed for self-reported health status conditions, health care coverage, health care utilization, and health care satisfaction.Conclusion: Study findings highlight the high prevalence of obesity and related risk factors among U.S. Marshallese adults with Type 2 diabetes and emphasize the need for intervention strategies that build upon cultural strengths and target community, policy, systems, and environmental changes to address obesity and chronic disease in this marginalized community.

Perspectives of public health nurses on the ethics of mandated vaccine education.

BACKGROUND: Since 2015, Michigan has required parents who request nonmedical exemptions (NMEs) from school or daycare immunization mandates to receive education from local public health staff (usually nurses). This is unlike most other US states that have implemented mandatory immunization counseling, which require physicians to document immunization education, or which provide online instruction. PURPOSE: To attend to the activity and dispositions of the public health staff who provide "waiver education". METHOD: This study reports results of focus group interviews with 39 of Michigan's vaccine waiver educators (37 nurses), conducted during 2016 and 2017, and analyzed in 2018. FINDINGS: Four themes emerged from analysis of the transcripts of these interviews: Participants had (1) complex and nuanced observations and evaluations of parents' judgments and feelings about vaccines and vaccine education; (2) sympathetic attitudes about alternative vaccine schedules; (3) critical and supportive evaluations of institutional policies and the background political context of immunization education; and (4) consistent commitments to respect parents, affirm their values, and protect their rights. DISCUSSION: These results show that public health nurses are sensitive to the burdens mandatory immunization education places on families, the motivations for parents' requests for nonmedical exemptions, and the values implicated by personal immunization decisions and government immunization policies. In light of the unique training, experiences, and public reputation of nurses, there is good reason for additional investigation into the roles that nurses can play in immunization education and in vaccine mandate policies, more generally.

Project STARLIT: protocol of a longitudinal study of habitual sleep trajectories, weight gain, and obesity risk behaviors in college students.

BACKGROUND: Obesity in the United States is a serious and preventable health concern. Previous research suggests that habitual short sleep may influence obesity-risk behaviors, such as increased caloric intake, decreased physical activity and increased engagement in sedentary activities (e.g., media consumption, computer usage). Given that existing longitudinal research studies have methodological concerns preventing conclusive interpretations, Project STARLIT was designed to address these limitations and identify future intervention targets. METHODS: A sample of young adults (n = 300) will be recruited during the summer prior to entering college. Participants will be screened for eligibility requirements prior to the inclusion in the Time 1 assessment though phone and in-person interviews. Once enrolled, participants will complete four assessments over a two year period (i.e., approximately 8, 16 and 24 months after Time 1). Each assessment will consist of one week of data collection including both objective (i.e., habitual sleep, physical activity, body fat composition) and subjective (i.e., sleep diary, 24-h food recall, technology use, and sleep-related beliefs/behaviors) measures. DISCUSSION: Project STARLIT is designed to address methodological concerns of previous research. In addition to clarifying the relationship between habitual short sleep and weight gain among young adults, the proposed study will identify problematic obesity risk behaviors associated with habitual short sleep (e.g., increased caloric intake, physical/sedentary activity). The results will identify prevention or intervention targets related to obesity risk. TRIAL REGISTRATION: ClinicalTrials.gov NCT04100967, 9/23/19, Retrospectively registered.

The evolution of immunization waiver education in Michigan: A qualitative study of vaccine educators.

BACKGROUND: In 2015, Michigan implemented an education requirement for parents who requested nonmedical exemptions from school or daycare immunization mandates. Michigan required parents to receive education from public health staff, unlike other states, whose vaccine education requirements could be completed online or at physicians' offices. METHODS AND FINDINGS: Results of focus group interviews with 39 of Michigan's vaccine waiver educators, conducted during 2016 and 2017, were analyzed to identify themes describing educators' experiences of waiver education. The core theme that emerged from the data was that educators changed their perception of the purpose of waiver education, from convincing vaccine-refusing parents to vaccinate their children to promoting more diffuse and forward-looking goals. CONCLUSIONS: Michigan, and other communities that require vaccine waiver education, ought to investigate whether and how waiver education contributes to public health goals other than short-term vaccination compliance. Research shows that education requirements can decrease nonmedical exemption rates by discouraging some parents from applying for exemptions, but further studies are needed to identify ways in which waiver education can promote other public health goals, while minimizing costs and burdens on staff.

Technology-based interventions for weight management: current randomized controlled trial evidence and future directions.

Obesity is a prevalent health care issue associated with disability, premature morality, and high costs. Behavioral weight management interventions lead to clinically significant weight losses in overweight and obese individuals; however, many individuals are not able to participate in these face-to-face treatments due to limited access, cost, and/or time constraints. Technological advances such as widespread access to the Internet, increased use of smartphones, and newer behavioral self-monitoring tools have resulted in the development of a variety of eHealth weight management programs. In the present paper, a summary of the most current literature is provided along with potential solutions to methodological challenges (e.g., high attrition, minimal participant racial/ethnic diversity, heterogeneity of technology delivery modes). Dissemination and policy implications will be highlighted as future directions for the field of eHealth weight management.

Are overeating and food addiction related to distress tolerance? An examination of residents with obesity from a U.S. metropolitan area.

OBJECTIVE: Low distress tolerance (DT) is an inability to handle negative emotions. There is strong support for the connection between low DT and substance addiction, which suggests that the former might be related to food addiction (FA). Previous work found that low DT was related to overeating in a college sample. The current study had two primary aims: (1) to determine whether low DT is associated with overeating in a sample of participants with diverse races and incomes, and (2) to investigate the relationships among DT and body mass index (BMI) as well as DT and FA symptoms. DT as a moderator of the association between general overeating and FA was also explored. METHODS: One hundred and ninety residents of Metropolitan Detroit communities (mean age: 41.71; 45.8% male; 34.7% non-White race; 47.4% with obesity) completed the DT Scale, Dutch Eating Behavior Questionnaire, Three Factor Eating Questionnaire, and Yale FA Scale. BMI was based on measured weight and height. RESULTS: After adjusting for covariates, linear regression models found significant negative relationships between DT and emotional eating (P<0.001), external eating (P<0.001), disinhibition (P<0.001), FA (P<0.001), and BMI (P<0.01). DT was determined to be a moderator, such that among individuals who endorsed high levels of overeating, those with low DT reported more FA symptoms than those with high DT. CONCLUSION: These findings suggest interventions targeting low DT should be considered to reduce overeating, which is a precursor and maintenance factor of obesity and FA.

The effect of D-cycloserine on social anxiety treatment using a behavioral outcome measure and a post-session administration strategy.

BACKGROUND: The drug D-Cycloserine (DCS) has been used as an adjunct to increase the pace of symptom reductions during exposure therapy for anxiety disorders. This procedure has met with mixed results andmany questions remain. Aims: The findings from two investigations are reported here, highlighting important domains for furthering our understanding of DCS effects. METHOD: Study 1 (n = 16) treated social anxiety among a sample of emerging adults, and in addition to self-report utilized a behavioral measure of symptom improvement to evaluate outcomes. Study 2 (n = 16), utilizing a similar design, introduced an algorithm based post-session administration strategy following sessions where anxiety reductions were evident. Both investigations were double-blind, placebo controlled, randomized trials with participants diagnosed with social anxiety. Treatment was an exposure-based CBT-protocol adopted in other investigations that tested DCS. RESULTS: Findings of Study 1 yielded an interaction effect in favor of DCS for self-reported distress ratings (p=.02) and on a behavioral measure of anxiety (p=.01). Findings from Study 2 revealed a significant effect for self-reported subjective distress ratings (p=.002). CONCLUSIONS: Although limitations of small sample size constrain generalization and limit power, results illustrate some beneficial effects of DCS within the context of exposure-based intervention for social anxiety, yet are discussed in the context of statistical vs. clinical significance and the DCS literature as a whole. Present findings highlight the potential usefulness of a post-session administration strategy and the behavioral measure for future efforts with an eye towards preventing bias through more nuanced and powered studies.

Patient's experience with comorbidity management in primary care: a qualitative study of comorbid pain and obesity.

AIM: The aim of this research is to examine perceptions of those with comorbid chronic pain and obesity regarding their experience of comorbidity management in primary care settings. BACKGROUND: Chronic pain and obesity are common comorbidities frequently managed in primary care settings. Evidence suggests individuals with this comorbidity may be at risk for suboptimal clinical interactions; however, treatment experiences and preferences of those with comorbid chronic pain and obesity have received little attention. METHODS: Semi-structured interviews conducted with 30 primary care patients with mean body mass index=36.8 and comorbid persistent pain. The constant comparative method was used to analyze data. FINDINGS: Participants discussed frustration with a perceived lack of information tailored to their needs and a desire for a personalized treatment experience. Participants found available medical approaches unsatisfying and sought a more holistic approach to management. Discussions also focused around the need for providers to initiate efforts at education and motivation enhancement and to show concern for and understanding of the unique difficulties associated with comorbidity. Findings suggest providers should engage in integrated communication regarding weight and pain, targeting this multimorbidity using methods aligned with priorities discussed by patients.

Does self-management counseling in patients with heart failure improve quality of life? Findings from the Heart Failure Adherence and Retention Trial (HART).

PURPOSE: Heart failure (HF) is associated with poor health-related quality of life (HRQOL). The purpose of our study is to determine the effect of a self-management intervention on HRQOL domains across time, overall, and in prespecified demographic, clinical, and psychosocial subgroups of HF patients. METHODS: HART was a single-center, multi-hospital randomized trial. Patients (n = 902) were randomized either to a self-management intervention with provision of HF educational information or an enhanced education control group which received the same HF educational materials. HRQOL was measured by the Quality of Life Index, Cardiac Version, modified, and the Medical Outcomes Study 36-item Short-Form Health Survey physical functioning scale. Analyses included descriptive statistics and mixed-effects regression models. RESULTS: In general, overall, study participants' HRQOL improved over time. However, no significant differences in HRQOL domain were detected between treatment groups at baseline or across time (p > 0.05). Subgroup analyses demonstrated no differences by treatment arm for change in HRQOL from baseline to 3 years later. CONCLUSIONS: We conclude that in our cohort of patients, the self-management intervention had no benefit over enhanced education in improving domains of HRQOL and HRQOL for specified HF subgroups.

Persuading students to exercise: what is the best way to frame messages for normal-weight versus overweight/obese university students?

OBJECTIVE: The authors investigated the effect of gain-framed (GF) compared with loss-framed (LF) messages on exercise behaviors in normal weight and among overweight/class I obese. The authors also examined which groups would have significantly improved exercise behaviors over time. PARTICIPANTS: Sixty-four undergraduates were randomized to the 4 groups by message type and weight category from September 2008 to December 2011. METHODS: After screening, students received messages and attended an exercise instruction session. RESULTS: There were no significant differences between GF or LF message groups among normal weight or overweight/obese on the primary outcomes at posttest. After receiving the GF messages, the overweight/obese group was the only group to have a significant increase on all 3 primary outcomes: fitness center attendance (p = .038), combined moderate- and vigorous-intensity activity (p = .005), and strength training (p = .037). CONCLUSIONS: The exercise behaviors of undergraduate students who are overweight or obese can benefit from GF messages.

Integrating technology into standard weight loss treatment: a randomized controlled trial.

BACKGROUND: A challenge in intensive obesity treatment is making care scalable. Little is known about whether the outcome of physician-directed weight loss treatment can be improved by adding mobile technology. METHODS: We conducted a 2-arm, 12-month study (October 1, 2007, through September 31, 2010). Seventy adults (body mass index >25 and ≤40 [calculated as weight in kilograms divided by height in meters squared]) were randomly assigned either to standard-of-care group treatment alone (standard group) or to the standard and connective mobile technology system (+mobile group). Participants attended biweekly weight loss groups held by the Veterans Affairs outpatient clinic. The +mobile group was provided personal digital assistants to self-monitor diet and physical activity; they also received biweekly coaching calls for 6 months. Weight was measured at baseline and at 3-, 6-, 9-, and 12-month follow-up. RESULTS: Sixty-nine adults received intervention (mean age, 57.7 years; 85.5% were men). A longitudinal intent-to-treat analysis indicated that the +mobile group lost a mean of 3.9 kg more (representing 3.1% more weight loss relative to the control group; 95% CI, 2.2-5.5 kg) than the standard group at each postbaseline time point. Compared with the standard group, the +mobile group had significantly greater odds of having lost 5% or more of their baseline weight at each postbaseline time point (odds ratio, 6.5; 95% CI, 2.5-18.6). CONCLUSIONS: The addition of a personal digital assistant and telephone coaching can enhance short-term weight loss in combination with an existing system of care. Mobile connective technology holds promise as a scalable mechanism for augmenting the effect of physician-directed weight loss treatment. TRIAL REGISTRATION: clinicaltrials.gov Identifier: NCT00371462.