A Dietary Pattern With More Fruits and Vegetables in Children of Mothers Who Immigrated to the United States From Latin America Is Associated With Healthful Nutrient Intake and Weight Status.

BACKGROUND: Children from families who immigrated to the United States may consume a lower-quality diet compared with their US-born peers. However, specific features of their dietary patterns, which could be a focus for improving diet quality, are not well-studied. OBJECTIVE: The aim of this study was to examine dietary patterns that distinguish interpersonal variability in dietary intake and explore the association of dietary patterns with nutrient intake and weight status. DESIGN: This study was a cross-sectional analysis of baseline data from the Live Well randomized controlled trial collected between 2009 and 2010. PARTICIPANTS/SETTING: Study participants included 313 children (3-12 years) whose mothers immigrated to the United States from Latin America and resided in Somerville, Massachusetts. MAIN OUTCOME MEASURES: Dietary patterns (derived using principal component analysis); nutrient intake (derived from dietary data collected using the Block Food Screener); and weight status (categorized using body mass index z score based on measured height and weight). STATISTICAL ANALYSES PERFORMED: Nutrient intake levels were compared across quartiles for dietary patterns using analysis of covariance. Multivariable logistic or linear regression models were used to determine the associations between dietary pattern scores and odds of overweight or obesity or z scores. RESULTS: Two dietary patterns emerged: "fruits and vegetables" and "meat and sweets." Highest adherence to the fruits and vegetables pattern was associated with more healthful nutrient intake and lower odds of having overweight or obesity (odds ratio 0.37; 95% CI 0.16 to 0.98), but not body mass index z score (ß = -.07; 95% CI -.51 to 0.36) compared with the lowest adherence. Adherence to the meat and sweets pattern was associated with less healthful nutrient intake but not with the odds of experiencing overweight or obesity (odds ratio 0.48; 95% CI 0.16 to 1.46). CONCLUSIONS: A healthful dietary pattern in children of families who immigrated to the United States from Latin America may include a variety of fruits and vegetables. Longitudinal studies should be conducted to further assess the role of dietary intake patterns on the health of these children.

Negative familial weight talk and weight bias internalization in a US sample of children and adolescents.

BACKGROUND: Negative familial weight talk may contribute to higher weight bias internalization in pre- and early adolescents (hereafter referred to as children) and may differ by gender, weight status, and race and ethnicity. OBJECTIVE: Examine the relationship between negative familial weight talk and weight bias internalization and examine differences by gender, weight status, and race and ethnicity. METHODS: We cross-sectionally analysed 5th-7th graders (10-15 years old) living in Massachusetts (n = 375, 52.3% girls, 21.3% BMI ≥85th percentile, 54.8% non-Hispanic White). Negative familial weight talk frequency during the past 3 months was self-reported and discretized as 'never,' 'occasionally' (1-9 times) and 'often' (>9 times); the Modified Weight Bias Internalization Scale assessed weight bias internalization. Generalized linear models estimated the relationship between negative familial weight talk and weight bias internalization and sub-analyses estimated the relationship across gender, weight status, and race and ethnicity. Results are summarized as ratios of means (RoM). RESULTS: Children experiencing negative familial weight talk occasionally (RoM = 1.12, p = 0.024) and often (RoM = 1.48, p < 0.001) had significantly higher weight bias internalization than children who never experienced it. In sub-analyses, experiencing negative familial weight talk often was associated with higher weight bias internalization among girls (RoM = 1.66, p < 0.001), boys (RoM = 1.32, p = 0.007), children with BMI <85th percentile (RoM = 1.44, p = 0.007) and BMI ≥85th percentile (RoM = 1.39, p = 0.001), and non-Hispanic White children (RoM = 1.78, p < 0.001), but not Hispanic (RoM = 1.25, p = 0.085) or non-Hispanic Black children (RoM = 1.20; p = 0.31). CONCLUSIONS: Frequent negative familial weight talk was associated with higher weight bias internalization across gender and weight status and in non-Hispanic White children only.

Changes in Physical Activity Associated With a Multicomponent Weight-Loss Randomized Controlled Trial for Youth With Intellectual Disabilities.

Youth with intellectual disabilities engage in low levels of physical activity (PA). An aim of this family-based weight-loss behavioral intervention (FBBI) trial was to increase and sustain PA in these youth. Accelerometry data were available from 21 individuals with intellectual disabilities, age 14-22 years. Each completed the 6-month FBBI, after which 10 completed a 6-month maintenance intervention (FBBI-M), and 11 received no further intervention (FBBI-C). Twenty participated in a further 6-month follow-up. Accelerometry data were analyzed using linear mixed models. During FBBI, mean (SE) moderate to vigorous PA increased by 4.1 (2.5) min/day and light PA by 24.2 (13.5) min/day. Mean (SE) difference in moderate to vigorous PA between participants in FBBI-M and FBBI-C at 18 months was 14.0 (5.1) min/day (p = .005); mean (SE) difference in light PA was 47.4 (27.4) min/day (p = .08). Increasing PA through behavioral intervention is possible in youth with intellectual disabilities.

Results from "Live Well", a randomized controlled community-based participatory intervention to prevent obesity in new immigrant mother-child dyads.

BACKGROUND: Upon arrival, the prevalence of overweight and obesity is lower in new immigrants than their native counterparts in the U.S. With longer residency in the U.S., these differences converge over time, followed by higher prevalence among immigrants than native U.S. residents. Results from the Live Well project in the Greater Boston area demonstrate the viability of utilizing a culturally adapted, community-based participatory research (CBPR) approach to reduce weight gain among newly immigrated mother-child dyads. METHODS: Haitian, Latina, and Brazilian mother-child dyads (n = 390), new to the U.S. (fewer than 10 years) were enrolled in a one- to two-year long CBPR lifestyle intervention that targeted dietary and physical activity behaviors. Attendance was recorded to establish dose. Demographics, anthropometrics, and relevant covariates were collected from participants at baseline, 6, 12, 18, and 24 months. Body Mass Index (BMI) was calculated using objectively measured height and weight. Linear mixed regression models were used to assess change in BMI and BMI z-score of mothers and children respectively. RESULTS: At baseline, nearly 75% of mothers and 50% of children were either overweight or obese (BMI ≥ 25.0 and BMI z-score ≥ 85th percentile, respectively). Only 20% of mothers attended all 12 intervention sessions in year 1. Using intent-to-treat analyses, no significant time, intervention, or time × intervention effects were observed for weight change of mothers or children at follow-up. Mothers in the highest quantile (those who attended all 12 intervention sessions) had significant reductions in BMI at 18 months (1.76 units lower, 95%CI: -3.14, -0.37) and 24 months (2.61 units, 95%CI -3.92, -1.29) compared to mothers in the lower quantiles, including those with no exposure. Such dose effects on BMI z-scores were not noted for children. CONCLUSIONS: Findings from Live Well demonstrate the viability of utilizing a CBPR approach to address overweight and obesity among immigrant mothers. Given the higher-than-expected prevalence of overweight and obesity among mother-child dyads by ~ 6 years of U.S. residency, and lower maternal participation rates in the intervention, additional research is necessary to identify the optimal intervention length, retention strategies, and approach to jointly support healthy maternal and child weight.

GamerFit-ASD beta test: adapting an evidence-based exergaming and telehealth coaching intervention for autistic youth.

Background: Health disparities faced by autistic youth are exacerbated by inadequate physical activity (PA) and sleep, whereas healthy PA and sleep may improve mood and function. Adaptive Game Squad (AGS) is an evidence-based telehealth coaching and exergaming intervention to improve PA and sleep for adolescents with diverse neurodevelopmental and psychiatric conditions. This study aimed to adapt AGS for autistic youth ages 10-15 years; beta-test the modified intervention for feasibility, accessibility, and engagement; and further refine the intervention for a larger planned demonstration pilot. Methods: Interdisciplinary experts adapted AGS to create GamerFit-ASD, a 12-week intervention that included a progressive exergame schedule, Fitbit step-tracking, weekly health coaching, and health tip/exercise videos. For beta testing, the intervention was shortened to a 4-week trial with 5 parent/child dyads. Children completed exit surveys and parents and children were interviewed about intervention feasibility, accessibility, and engagement. Exit survey data were summarized with descriptive statistics. Qualitative data were analyzed using a modified grounded-theory approach. Results: All participants (n = 5; ages 10-14 years) attended all 4 planned coaching sessions and completed an average of 9 of 12 planned exergame challenges for a weekly average of 50 min. All participants reported enjoying coaching sessions, 4 of 5 reported enjoying exergames, and 3 of 5 reported enjoying on-demand exercise videos. In interviews, children generally reported finding participation feasible, exergaming challenges active and fun, and coaches friendly and helpful. Parents reported high feasibility of supporting their children's involvement and valued child goal-setting and intervention flexibility; however, some found telehealth sessions overly scripted. Several adaptations to coaching scripts, coach training, and parent materials were made for the larger demonstration pilot, including changes to reduce scriptedness of coaching sessions, to provide parents with more information specific to autism, and to make video content more appropriate to children's needs/preferences. Discussion: A telehealth coaching and exergaming intervention appears feasible, accessible, and engaging for autistic youth aged 10-15. Future studies with larger, more diverse samples, longer study durations and/or follow-up periods, and more rigorous study designs are needed to advance understanding of the appropriateness and effectiveness of this type of intervention for this population.

Exploring health behaviors and the role of pet dogs in households with autistic children: the DANE study.

Introduction: Autism spectrum disorder (ASD) often presents a unique set of risk factors that impact healthy eating and physical activity. Animal-assisted interventions (AAI) are a promising approach for autistic children. There is growing evidence for the positive impact of AAIs on self-regulation, which is necessary for initiating and maintaining behavioral changes. Pet dogs offer several potential advantages as a vehicle for an AAI focused on health behaviors. However, little is known about the experiences of autistic children and their families with respect to dog ownership and the mechanisms through which such an AAI might operate. Methods: We conducted interviews with ten parent-child dyads to explore the role of pet dogs in the lives and lifestyle habits of families with an autistic child. Interview guides were designed to explore the relationship between the autistic child and the pet dog and the role of the dog in family life; attitudes and practices related to physical activity and nutrition; and thoughts about intervention strategies. We used a directed qualitative content analysis approach for analysis. Results: Themes indicate a strong bond between the child and the dog, the child's enjoyment in caring for their dog, and successful integration of dogs within family routines. In contrast, minor themes emerged around the challenges that owning a pet dog posed for families with an autistic child. In terms of nutrition and physical activity, a major theme among children was that healthy eating and exercise were important for both them and their dogs. However, minor themes suggest challenges with healthy eating and exercise and room for improvement for these behaviors. Parents held favorable views toward an intervention that would incorporate the family dog to teach children about nutrition and physical activity, although they expressed some concerns about feasibility. Discussion: This exploratory work suggests that AAIs to improve nutrition and physical activity could build on the strong bond that children have with their pet dogs, but should consider the specific needs of each family, including the needs of the pet dog.

Parental perception of facilitators and barriers to health among young children with down syndrome: a qualitative study.

Background: Despite high rates of obesity and weight-related conditions observed in children with Down syndrome, little is known about how to prevent these conditions. Purpose: The purpose of this study was to identify parent-perceived facilitators and barriers to health for toddlers (12-36 months old) with Down syndrome. Materials and methods: We conducted in-depth, semi-structured interviews with the mothers of 25 toddlers with Down syndrome. All interviews were conducted using Zoom Video Technology, audio recorded and transcribed before being coded in NVivo software using a structured protocol. Thematic analysis was used to identify themes in perceived facilitators and barriers to health at the level of the child, family, and community. Data were triangulated using reflective journaling, video review of child meals, and member-checking techniques. Results: We identified unique themes for facilitators (on the move and sound sleep) and barriers (co-occurring conditions and eating behaviors) at the level of the child. At the level of the family and community, overarching themes that were viewed as either a facilitator or barrier, depending on the context, were identified (role models matter, time is critical, the importance of place, and social support). Conclusion: These themes can help clinicians and researchers tailor their health promotion interventions to meet the unique needs of children with Down syndrome by using strength-based approaches and providing families with the tools to overcome barriers.

Racial and ethnic disparities in obesity and contributions of social determinants of health among boys with autism spectrum disorder.

Children with autism spectrum disorders (ASD) are at greater obesity risk compared to typically developing peers. Although many potential risk factors for this relationship have been identified, the causal chain must be better understood, particularly modifiable social determinants of obesity risk in ASD, and especially for children with ASD from minoritized racial/ethnic groups. We aimed to: (1) examine racial/ethnic disparities in obesity status in boys with ASD; (2) assess associations between social determinants of health and obesity status; and (3) understand if social determinants of health factors mediate the relationship between race/ethnicity and obesity status for these youth. We used data for 124 boys, aged 9-10 with ASD enrolled in an ongoing longitudinal study. Social determinants of health explored included socioeconomic position, Area Deprivation Index, neighborhood safety, food and housing insecurity, and racial/ethnic discrimination. The racial/ethnic distribution was: 17.1% Black, 14.6% Latino, and 68.3% White; average age was 10 years. Both Black (PR 2.57, 95% CI: 1.26-5.26) and Latino boys (PR 2.08, 95% CI: 1.08-4.03) with ASD were more likely to be obese than their White peers. While there were significant differences in some social determinants of health by race/ethnicity, only food insecurity mediated associations between race/ethnicity (Black vs. White) and obesity. The striking disparities in obesity and differences in social determinants of health between Black and Latino children with ASD compared to White children emphasize the need to identify factors that contribute to healthy weight among these children and to address these factors in practice.

Passive and social screen time in children with autism and in association with obesity.

Background: Screen time has been identified as a risk factor for childhood obesity, but the media landscape has evolved rapidly. Children with autism tend to be heavy users of screens and have an elevated prevalence of obesity. We know little about screen use patterns among children with autism vs. typically developing (TD) peers and in association with obesity. Methods: Baseline data from 10,842 participants in the Adolescent Brain Cognition Development Study was used to characterize time spent with child-reported passive screen use (television/movies/watching videos), playing video games, and using social media. Duration of screen time by autism status and gender was summarized as mean time per day; obesity was defined using CDC/WHO criteria. A propensity score analysis was used to create a matched dataset for analysis. Results: Overall, 1.7% of children were was identified as having autism. Significant mean differences were observed by autism status and gender for both passive viewing and playing video games. Compared to TD children, boys with autism spent more time (2.9 vs. 2.3 h, p < 0.001) watching TV, movies or videos, as did girls (3.0 vs. 2.0 h, p = 0.002). Compared to TD peers, boys with autism reported more video game time (102.7 vs. 77.5 min, p = 0.001), as did girls with autism (64.4 vs. 37.9 min, p = 0.03); girls with autism also spent more time on social media sites or video chat (45.5 vs. 21.9 min, p = 0.04). Overall, obesity prevalence increased with increasing screen time duration, significantly for passive screen time (p-value = 0.002) and texting (p-value = 0.02). Associations between obesity and screen time duration did not differ by autism status. Discussion: Children with autism spend more time playing video games and on passive and social screen activities than their TD peers, with some variations by gender. High rates of social media use among girls with autism and multiplayer video game use among both boys and girls with autism may challenge the notion that the high levels of screen time reflect social isolation in the group. Given potential positive aspects of screen time in children with autism movement to focus on content and context is appropriate.

Relationship Between Childhood Obesity and Autism Spectrum Disorder Varies by Child's Age and Parents' Weight Status in a Sample of Sibling Dyads.

Background: Children with autism spectrum disorder (ASD) are more likely to have obesity compared to children without ASD, but studies may report biased estimates because of limitations accounting for potentially important factors that may differ between these two groups of children. This study of siblings in "simplex" families (i.e., families that include only one offspring with ASD) avoids these potential pitfalls. Methods: The Simons Simplex Collection was used to create sibling dyads comprising a child with a clinically confirmed diagnosis of ASD and a full sibling without ASD within the same biological family. Child obesity, determined from measured heights and weights, was compared across three child age strata (4-7.9, 8-10.9, 11-18.0 years) and by parents' weight status using generalized estimating equations log-binomial regression models. Results: Among 1378 sibling dyads, 4-18 years of age, the prevalence of obesity significantly increased with age, with larger sibling differences at older ages. For ages 4-7.9 years, the obesity prevalence for children with ASD was 15.0% compared to 16.2% for siblings (p = 0.57). For ages 11-18.0 years, prevalence for children with ASD was 30.7% compared to 21.4% for siblings (p = 0.003). Parental obesity significantly affected sibling obesity. Conclusion: From this unique data resource that accounted for shared family environments, the prevalence of obesity diverged significantly at older ages between children with ASD and their full siblings without ASD and was associated with parental obesity status similarly for children with and without a diagnosis of ASD. Recognizing these age-related differences has important implications for targeting preventive interventions.

Food Access, Dietary Intake, and Nutrition Knowledge of Adults on Probation.

OBJECTIVE: To examine food access, dietary intake, and perceptions about diet and associations with health among adults on probation. DESIGN: Using a mixed-methods approach, interviews were used to understand food access, dietary intake, and diet and associations with health. A survey measured self-assessed diet quality and diet and associations with health. SETTING: One probation office in Rhode Island. PARTICIPANTS: English-speaking adults on probation in 2016 (n = 22 interviews, n = 304 surveys). MAIN OUTCOME MEASURE(S): Food access, dietary intake, knowledge about diet and health, and perceptions about healthy food. ANALYSIS: We used a thematic analytic approach to analyze the interviews. Descriptive statistics were performed for the survey. RESULTS: Many interviewees had inadequate food access, although most participated in the Supplemental Nutrition Assistance Program, and some received food from food banks. Interviewees primarily shopped at grocery stores and prepared food at home, and dietary intakes did not meet the 2020-2025 Dietary Guidelines for Americans. Almost two-thirds (64.2%) of survey participants reported good or fair diet quality. Based on the survey results, the majority of participants strongly agreed and agreed with the statements, "The types of foods I eat affect my health" and "The types of food I eat affect my weight." CONCLUSIONS AND IMPLICATIONS: This study identified low-quality dietary intake and food acquisition strategies, such as shopping sales, buying bulk, and going to multiple stores, by US adults on probation to access food with limited resources. Participants reported interest in eating healthier foods and knew there was a connection between dietary intake and health. These data support addressing ways to improve food access and dietary quality, focusing on future programs and policies for this population.

A Pilot Dance Intervention to Encourage Physical Activity Engagement for Adolescent Girls with Intellectual Disabilities.

Adolescent girls with intellectual disabilities (ID) are at risk for low physical activity (PA) participation due to their limited opportunities. PURPOSE: To evaluate the feasibility and preliminary efficacy of a 12-week dance intervention to promote engagement in moderate-to-vigorous PA (MVPA) and increase cardiorespiratory fitness. METHODS: The 12-week intervention included two 75-min weekly dance sessions. Continuous heart-rate (HR) monitoring assessed time spent below/at/above each girl's target HR zone. Cardiorespiratory fitness was measured by the 6-min walk test (6MWT). Survey items assessed participant enjoyment and participant and parent satisfaction. RESULTS: The mean (SD) age of 18 adolescent girls was 17.3 (2.7) years. Overall, girls attended 88% of sessions and spent 52.3% of each session in MVPA. Mean MVPA was unchanged across the 12 weeks, but the pattern differed across the three sites. We observed a non-significant pre-post increase of 74.6 feet on the 6MWT. Post-intervention surveys indicated that most girls liked the program, perceived improved fitness, and wished to continue dancing. The majority also reported a preference for a girls-only dance program exclusively for those with ID. CONCLUSION: Our findings suggest that dance is viable for promoting PA for girls with ID. More frequent exercise training is likely needed to improve cardiorespiratory fitness.

Association of Bone Mineral Density with Lean Mass, Fat Mass, and Physical Activity in Young Overweight and Obese Women.

To examine the associations between bone mineral density (BMD), body composition and habitual physical activity in women who are overweight/obese. We measured whole-body bone, and body composition (lean mass, fat mass, and total fat percent) via dual-energy x-ray absorptiometry (model General Electric Lunar whole-body scanner) in a diverse group of women (N=48, age 26.6+/-4.7 years, 63% Black) living in an urban setting. The relations between BMD with total fat percent [%]), lean mass (kg), fat mass (kg), and physical activity were examined using Pearson correlations and multiple linear regression models, adjusted for race, age, and dietary calcium. BMD was positively correlated with lean mass (r=0.43, p=0.002) and negatively correlated with total fat percentage (r=-0.31, p=0.03). Multiple linear regression models indicated BMD was positively associated with lean mass (ß: 0.007, p<0.001), and negatively associated with fat mass (kg) and total fat percentage (ß: -0.003, p=0.03; ß: -0.004, p=0.03, respectively). When stratified by race, these relations were maintained in white women but only lean mass in Black women. When stratified by age, the positive correlation between BMD and lean mass was significant in younger women (<30y) only. There were no significant relationships between BMD and any physical activity measures. Our results indicate that in young women who are overweight/obese BMD is significantly associated with body composition, both lean mass and total fat percentage, but not habitual physical activity. An emphasis on lean mass accrual may be valuable for young women, particularly Black women, to improve bone health.

A Stakeholder-Engaged Approach to Development of an Animal-Assisted Intervention for Obesity Prevention Among Youth With Autism Spectrum Disorder and Their Pet Dogs.

Stakeholder involvement in research has been demonstrated to increase the effectiveness, validity, and quality of a study. This paper describes the engagement of a stakeholder panel in the development and implementation of an animal-assisted intervention (AAI) assessment and program for children diagnosed with Autism Spectrum Disorder (ASD). Canines for Autism Activity and Nutrition (CAAN) aims to promote physical activity and wellness among children diagnosed with ASD by integrating activities with their pet dog during the child's ongoing Applied Behavioral Analysis (ABA) in-home therapy sessions. Feedback from stakeholders guided program development at each stage of the research process, including this publication. Utilizing a stakeholder-informed approach was essential for the development of assessment tools, program materials, and program design. Methods that may assist others to effectively partner with stakeholders to implement an AAI among children diagnosed with ASD or related disorders are described.

Validation and refinement of the Stakeholder-driven Community Diffusion Survey for childhood obesity prevention.

BACKGROUND: Whole-of-community interventions hold promise in addressing childhood obesity. The COMPACT Stakeholder-driven Community Diffusion theory posits that stakeholders' knowledge of childhood obesity prevention efforts and engagement with the issue contribute to successful intervention implementation. Building on completed formative research and pilot testing, we describe the validation and refinement of knowledge and engagement measures. METHODS: We assessed content validity using a modified Delphi process with science (n=18) and practice-based (n=16) experts. Next, we refined the survey based on input from science- and practice-based experts, cognitive response testing, and item analysis of extant survey data. Field testing of the refined survey involved community stakeholders in Greenville County, South Carolina (n=50), East Boston, Massachusetts (n=30), and Tucson, Arizona (n=84) between 2019 and 2020. Construct validity was assessed with confirmatory factor analysis (CFA). Two-week test-retest reliability was assessed among a subsample of 14 paired respondents in South Carolina. RESULTS: Experts rated existing knowledge domains (intervention factors, roles, sustainability, problem, resources) and engagement domains (dialogue/mutual learning, flexibility, influence/power, leadership/stewardship, trust) highly for their importance in addressing childhood obesity. Expert input resulted in 11 new knowledge items and 7 new engagement items that mapped onto existing domains. Correspondingly, two domain names were modified: implementation/sustainability and trust/trustworthiness. We also eliminated 8 extant items (4 knowledge and 4 engagement) and adapted item language for comprehension and consistency. Further modifications based on CFA results and item analyses resulted in 23 knowledge items across four domains (roles and resources merged) and 23 engagement items across five domains. Modified knowledge and engagement scales had adequate fit and strong item factor loadings (most >0.7 and all >0.5). Knowledge (α=0.86-0.87) and engagement (α=0.75-0.90) subscales had high internal scale consistency. Knowledge intraclass correlation coefficients (ICCs) for test-retest agreement of subscale scores ranged from 0.50 for intervention factors to 0.86 for roles/resources. For engagement subscale scores, ICCs ranged from 0.70 for trust/trustworthiness to 0.96 for leadership/stewardship. CONCLUSIONS: Findings from this multi-method survey development process increase our confidence of the knowledge and engagement measures' content validity, construct validity, and reliability.

A family-based weight loss randomized controlled trial for youth with intellectual disabilities.

BACKGROUND: Scant data exist on weight loss interventions for youth with intellectual disabilities (ID). OBJECTIVE: To compare weight loss among youth with ID randomized to a 6-month, family-based behavioural intervention (FBBI) or a waitlist and to compare weight loss among youth who completed a 6-month maintenance (FBBI-M) intervention to a control group (FBBI-C). METHODS: Youth with ID and overweight/obesity, aged 14-22 years, were randomized to the FBBI or to a waitlist and subsequently randomized to a maintenance intervention or a control group. Sessions were held weekly during the FBBI and biweekly during the FBBI-M. Using an intention-to-treat approach, we used linear mixed models to test differences in the change in weight and in BMI from the start of FBBI. RESULTS: The 24 participants who received the FBBI lost, on average (SE), 5.1 (1.1) kg (P < .001) over 6 months. The 13 participants who were waitlisted gained, on average (SE), 1.2 (1.6) kg over the 6-month waiting period. At 12 months, those who received FBBI-M lost, on average (SE), 4.4 (1.7) kg more than those who received FBBI-C (-7.6 vs -3.2 kg, P-value = .008). CONCLUSION: Participation in an intensive FBBI for weight loss with ID was efficacious, and continued participation in a maintenance intervention yielded additional weight loss.

Gender and racial/ethnic differences in food selectivity in children with intellectual disabilities.

BACKGROUND: We examined differences in food selectivity by gender and parent race/ethnicity in children with intellectual disabilities. METHOD: A convenience sample of 56 children with intellectual disabilities was analysed. A modified Youth/Adolescent Food Frequency Questionnaire and a 3-day food record were used to measure child food refusal rate and food repertoire, respectively. RESULTS: Boys were about twice as likely to refuse total foods (rate ratio = 2.34, 95%CI = 1.34-4.09) and fruits (rate ratio = 2.03, 95%CI = 1.04-3.95) and 54% more likely to refuse vegetables (rate ratio = 1.54, 95%CI = 0.93-2.54). Children with Hispanic parents were twice as likely to refuse vegetables compared to children with non-Hispanic White parents (rate ratio = 2.00, 95%CI = 1.03-3.90). In analyses stratified by the presence or absence of co-occurring probable autism spectrum disorder, boys had greater food selectivity than girls. CONCLUSIONS: This study expands our understanding of food selectivity in children with intellectual disabilities.

The Adaptive GameSquad Xbox-Based Physical Activity and Health Coaching Intervention for Youth With Neurodevelopmental and Psychiatric Diagnoses: Pilot Feasibility Study.

BACKGROUND: The prevalence of neurodevelopmental and psychiatric diagnoses (NPDs) in youth is increasing, and unhealthy physical activity (PA), diet, screen time, and sleep habits contribute to the chronic disease disparities and behavioral challenges this population experiences. OBJECTIVE: This pilot study aims to adapt a proven exergaming and telehealth PA coaching intervention for typically developing youth with overweight or obesity; expand it to address diet, screen, and sleep behaviors; and then test its feasibility and acceptability, including PA engagement, among youth with NPDs. METHODS: Participants (N=23; mean age 15.1 years, SD 1.5; 17 males, 9 people of color) recruited in person from clinic and special education settings were randomized to the Adaptive GameSquad (AGS) intervention or wait-list control. The 10-week adapted intervention included 3 exergaming sessions per week and 6 real-time telehealth coaching sessions. The primary outcomes included feasibility (adherence to planned sessions), engagement (uptake and acceptability as reported on process questionnaires), and PA level (combined light, moderate, and vigorous as measured by accelerometer). Descriptive statistics summarized feasibility and engagement data, whereas paired, two-tailed t tests assessed group differences in pre-post PA. RESULTS: Of the 6 coaching sessions, AGS participants (n=11; mean age 15.3 years, SD 1.2; 7 males, 4 people of color) completed an average of 5 (83%), averaging 81.2 minutes per week of exergaming. Of 9 participants who completed the exit questionnaire, 6 (67%) reported intention to continue, and 8 (89%) reported feeling that the coaching sessions were helpful. PA and sleep appeared to increase during the course of the intervention over baseline, video game use appeared to decrease, and pre-post intervention PA per day significantly decreased for the control (-58.8 min; P=.04) but not for the intervention group (-5.3 min; P=.77), despite potential seasonality effects. However, beta testers and some intervention participants indicated a need for reduced complexity of technology and more choice in exergames. CONCLUSIONS: AGS shows promise in delivering a health behavior intervention remotely to youth with NPDs, but a full-scale efficacy trial with a larger sample size is needed to confirm this finding. On the basis of feedback from beta testers and intervention participants, the next steps should include reduced technology burden and increased exergame choice before efficacy testing. TRIAL REGISTRATION: ClinicalTrials.gov NCT03665415; https://clinicaltrials.gov/ct2/show/NCT03665415.