Stretch your SNAP: Stakeholder perspectives of a novel benefits program to enhance diet quality.

Objective: Families enrolled in the Supplemental Nutrition Assistance Program (SNAP) report persistent barriers to purchasing nutritious foods. This mixed-methods study explored SNAP users' food and beverage purchasing patterns and perspectives regarding potential modifications to SNAP to inform the design of SNAP+, a healthy incentive program to increase fruit and vegetable (FV) and decrease sugar-sweetened beverage (SSB) purchases. Methods: Participants were recruited through a non-profit organizational network to participate in an online survey. Survey measures included: SNAP usage patterns, meal/shopping patterns, and perceptions of potential changes to SNAP. A subset (N = 28) was invited to participate in an interview to further explore these domains. Frequencies were calculated to explore trends in quantitative data, with thematic analysis applied to qualitative data. Results: Participants (N = 278) identified as female (81.0 %), head of household (90.8 %) and mothers (70.5 %), with most (66.5 %) using SNAP ≥ 1 year. Most spend >$15 of SNAP (87.1 %) and >$15 of non-SNAP (60.8 %) dollars on FVs/month. Respondents spend <$5 of SNAP (34.2 %) and non-SNAP (47.5 %) dollars on SSBs/month. Factors shaping purchasing behaviors included: cost (71.6 %), health (80.2 %) and avoiding waste (73.0 %). Inflation and existing purchasing patterns motivated interest in potentially enrolling in SNAP +. Diminished autonomy and a need to reallocate other funds to purchase SSBs were identified as enrollment deterrents. Conclusion: SNAP users were generally receptive to modifications that would pair FV incentives with SSB restrictions, yet strategies to maintain autonomy are needed. Results can inform the design of SNAP + to enhance its potential as strategy to positively shape dietary intake patterns.

Study design and rationale for TEENS+REACH: Evaluating ripple effects of a family-based lifestyle intervention to untreated family members.

Background: Understanding the effects of family-based lifestyle intervention beyond the treated adolescent is important, given that obesity is a familial disease and there are likely bidirectional relations between an adolescent's treatment success and broader household changes. However, it is unknown if recommended household-wide changes are adopted or if untreated family members experience weight-related benefits. Methods: TEENS + REACH leverages our ongoing randomized clinical trial of TEENS+, a family-based lifestyle intervention for adolescents with obesity, to determine: 1) if household-wide changes to the shared home environment are implemented, 2) if ripple effects to untreated family members are observed, and 3) whether these changes are predictive of adolescents' weight management success. TEENS + REACH will expand trial assessments to include comprehensive assessments of the shared home feeding, weight, and physical activity environment of the target adolescents. Specifically, we will enroll untreated children (8-17yrs) and caregivers living in the same household as the target parent/adolescent dyad (N = 60 families). At 0, 2, 4 (primary endpoint), and 8-months, the target parent/adolescent dyad and other untreated children and caregivers in the home will complete anthropometric assessments. Discussion: Results will determine the familial reach of TEENS+ and reveal potential mediators of treatment response, which can inform future efforts to optimize family-based lifestyle interventions. Trial registration: TEENS + REACH was retrospectively registered in Clinicaltrials.gov March 22, 2023 (NCT05780970) as an observational study ancillary to the TEENS + clinical trial, registered February 22, 2019 (NCT03851796).

School Nutrition Personnel Perceptions of School Salad Bars before and after COVID-19.

Many schools have salad bars as a means to increase students' fruit and vegetable intake. School nutrition programs experienced drastic changes to the school food environment due to COVID-19. The aim of the current study was to understand cafeteria personnel's experiences related to salad bar implementation before the COVID-19 pandemic and in the current school environment to inform efforts to enhance salad bar sustainability. Seven elementary schools (N = 30 personnel) installed salad bars prior to COVID-19; three of these schools (n = 13 personnel) re-opened salad bars after COVID-19. Cafeteria personnel completed surveys assessing their experiences with salad bars at both time points. Satisfaction with salad bar implementation and training was high pre- and post-COVID-19. Most agreed that salad bars increased students' fruit and vegetable intake, yet had concerns about cleanliness and waste. Perceived job difficulty increased post-COVID-19 (p = 0.01), and satisfaction with student salad bar training decreased (p = 0.001). Additional staff support and greater student training were needed post-COVID-19. Overall, salad bars were viewed favorably; however, more challenges and lower satisfaction were reported following COVID-19. Increasing support for cafeteria personnel is needed for salad bar sustainability and improving the school food environment.

POSITION STATEMENT: Pass the RESTORE (Re-entry Support Through Opportunities for Resources and Essentials) Act.

Under the Personal Responsibility and Work Opportunity Reconciliation Act (PRWORA), current federal policy mandates a lifetime ban for individuals with a past felony drug conviction from receiving Supplemental Nutrition Assistance Program (SNAP) and Temporary Assistance for Needy Families (TANF) benefits. Denying nutritional and financial assistance to individuals with a past felony conviction will widen existing structural health inequities, set back individuals' successful re-entry into society, and contribute to recidivism and poorer health outcomes. Therefore, the Society of Behavioral Medicine supports the RESTORE ACT (Re-Entry Support Through Opportunities for Resources and Essentials Act), which would repeal the lifetime ban on receiving SNAP and TANF benefits for individuals convicted of a drug felony.

Current US law bans people who have been convicted of felony drug crime from participating in nutritional and financial assistance programs (i.e. Supplemental Nutrition Assistance Program [SNAP] and Temporary Assistance for Needy Families [TANF]). By not allowing people who have been convicted of a drug felony to access these programs, this law risks worsening health outcomes and perpetuating existing health disparities. The Society of Behavioral Medicine supports the RESTORE Act (Re-Entry Support Through Opportunities for Resources and Essentials Act), which would end the federal ban and allow all income-eligible people to access SNAP and TANF benefits.

Parent involvement approach and changes in eating pathology within an adolescent obesity intervention.

BACKGROUND: Although adolescents with obesity have heightened risk for eating pathology, the impact of differential parent involvement on eating pathology after obesity treatment is unknown. We examined differences in eating pathology in adolescents whose parents were randomized to distinct interventions within adolescent obesity treatment. METHODS: Participants were 82 adolescent/parent dyads (adolescents: 63 % female; 55 % racial/ethnically marginalized) enrolled in TEENS+, a 4-month behavioral weight loss intervention. Parents were randomized to either a parent weight loss treatment (TEENS+PWL) or parent skills training (TEENS+PAC). Adolescents completed the Eating Disorder Examination-Questionnaire with Instructions (EDE-Q-I) and Child Depression Inventory (CDI) at baseline, 4 m, and 7 m. Group differences in eating pathology (global score; eating concern, weight concern, shape concern, restraint) and depression across time points were evaluated with linear mixed models. RESULTS: No significant differences were observed between TEENS+PAC and TEENS+PWL in eating pathology or depression, nor were there group by time interactions. Time point differences were observed for all EDE-Q-I and CDI outcomes, except eating concerns; pairwise contrasts revealed a variety of change patterns. Weight and shape concerns decreased from 0 to 4 m; observed reductions were maintained at 7 m. Restraint was highest at 4 m and decreased at 7 m but did not return to baseline. EDE-Q-I global scores significantly declined over time. Depression decreased over time, but a significant difference was only observed between 0 and 7 m. CONCLUSIONS: Neither parent intervention yields harm related to eating pathology in adolescents engaged in obesity treatment. Obesity treatment does not appear to have iatrogenic effects on eating pathology in adolescents.

The role of parents in behavioral treatment for adolescent obesity: design and rationale for the TEENS+ randomized clinical trial.

BACKGROUND: There is an urgent need for innovative approaches to adolescent obesity treatment, particularly among individuals from racially and ethnically marginalized backgrounds, who face increased risk of obesity and its associated morbidity and mortality. There is a particular dearth of research on the long-term efficacy of adolescent obesity treatments. Further, research and clinical practice guidelines consistently recommend parents' inclusion in their adolescents' obesity treatment, yet the most effective strategy to engage parents in adolescent obesity treatment remains unclear. Towards that end, this investigation will conduct a fully-powered, randomized clinical trial to examine the efficacy of two distinct approaches to involving parents in their adolescents' obesity treatment. METHODS: Participants will be 210 12-16 year old adolescents (body mass index [BMI]≥85th percentile) and parents (BMI≥25 kg/m2) with overweight or obesity. Dyads will be randomized to one of two 4-month treatments: 1) TEENS+Parents as Coaches (PAC), engaging parents as helpers in their child's weight management via parent skills training based on authoritative parenting, or 2) TEENS+Parent Weight Loss (PWL), engaging parents in their own behavioral weight management. All adolescents will participate in the TEENS+ protocol, which includes nutrition education with dietary goals, supervised physical activity, and behavioral support, and integrates motivational interviewing to enhance treatment engagement. Assessments of anthropometrics, dietary intake, physical activity, parenting and home environment variables will be completed at 0, 2, 4, 8, and 12 months with the primary endpoint at 12-month follow-up. DISCUSSION: Results of this investigation have the potential to significantly advance science in this area and ultimately inform clinical practice guidelines related to the role of parents in adolescent obesity treatment. TRIAL REGISTRATION: Clinicaltrials.gov NCT03851796. Registered: February 22, 2019.

Rationale, formative research, and protocol for Calma, Conversa, y Cría: A pilot mindful parenting intervention with Latina women.

Background: Latina mothers' stress is associated with their children's health behaviors and risk for obesity; however, existing pediatric health promotion programs have not focused on maternal stress reduction. Methods: Herein we describe a study design that will examine the acceptability and feasibility of Calma, Conversa, y Cría (CCC) a 6-week mindful parenting intervention designed to reduce stress. We present the results of qualitative research with Latina mothers and experts in Latinx health and mindfulness who provided culturally-relevant feedback on existing mindful parenting strategies to inform the development of CCC. Fifty Latina mothers of children ages 3-11 years will be randomly assigned to CCC or an enhanced usual care health education intervention. Acceptability will be assessed through participant satisfaction surveys and exit interviews. Feasibility will be determined through detailed tracking of recruitment, retention, and attendance rates. A signal regarding any group differences in maternal stress, health-related parenting practices, child diet, child physical activity, and child quality of life will be explored. Discussion: The development of interventions that can reduce maternal stress and risk for obesity in Latinx children is critical to significantly reduce negative health impacts in this underserved population. Our approach includes the identification of effective cultural adaptations that should improve the feasibility and acceptability of mindful parenting strategies in Latinx families, ideally reducing maternal stress and improving parenting behaviors related to child health. If successful, CCC will be examined in a larger efficacy trial involving the measurement of objective biomarkers of children's chronic disease risk.

Eating disorders in weight-related therapy (EDIT): Protocol for a systematic review with individual participant data meta-analysis of eating disorder risk in behavioural weight management.

The Eating Disorders In weight-related Therapy (EDIT) Collaboration brings together data from randomised controlled trials of behavioural weight management interventions to identify individual participant risk factors and intervention strategies that contribute to eating disorder risk. We present a protocol for a systematic review and individual participant data (IPD) meta-analysis which aims to identify participants at risk of developing eating disorders, or related symptoms, during or after weight management interventions conducted in adolescents or adults with overweight or obesity. We systematically searched four databases up to March 2022 and clinical trials registries to May 2022 to identify randomised controlled trials of weight management interventions conducted in adolescents or adults with overweight or obesity that measured eating disorder risk at pre- and post-intervention or follow-up. Authors from eligible trials have been invited to share their deidentified IPD. Two IPD meta-analyses will be conducted. The first IPD meta-analysis aims to examine participant level factors associated with a change in eating disorder scores during and following a weight management intervention. To do this we will examine baseline variables that predict change in eating disorder risk within intervention arms. The second IPD meta-analysis aims to assess whether there are participant level factors that predict whether participation in an intervention is more or less likely than no intervention to lead to a change in eating disorder risk. To do this, we will examine if there are differences in predictors of eating disorder risk between intervention and no-treatment control arms. The primary outcome will be a standardised mean difference in global eating disorder score from baseline to immediately post-intervention and at 6- and 12- months follow-up. Identifying participant level risk factors predicting eating disorder risk will inform screening and monitoring protocols to allow early identification and intervention for those at risk.

Free Healthy School Meals for All as a Means to Advance Child Health Equity.

This Viewpoint discusses how providing free, healthy meals to all schoolchildren can advance health equity.

Food Insecurity and Nutritional Challenges in Adolescent and Young Adult Cancer Survivors in the U.S.A.: A Narrative Review and Call to Action.

Advancements in cancer treatments over the past several decades have led to improved cancer survival in adolescents and young adults (AYAs, ages 15-39 years). However, AYA cancer survivors are at an increased risk for "late effects", including cardiovascular, pulmonary and bone diseases as well as fatigue, infertility and secondary cancers. The treatments for cancer may also alter taste, lead to nutritional deficiencies and increase financial burdens that, when taken together, may increase the risk of food and nutrition security in AYA cancer survivors. Furthermore, although AYAs are often merged together in cancer survivorship studies, adolescents and young adults have distinct developmental, psychosocial and pathophysiological differences that may modify their risk of nutritional challenges. In this narrative review and "Call to Action", rationale is provided for why there is a need to better understand nutritional challenges and food insecurity in AYA cancer survivors as a special population. Then, recommendations for next steps to advance knowledge and policy in this field are provided. In particular, integrating screening for food and nutrition insecurity and enhancing awareness of existing resources (e.g., the Supplemental Nutrition Assistance Program, SNAP) might help AYA cancer survivors combat nutritional deficiencies and reduce late effects while improving their overall survival and quality of life.

Food Insecurity, Federal Nutrition Support, and Parent Feeding Practices During COVID-19: A 1-Year Follow-up Study.

OBJECTIVES: COVID-19 caused stark increases in food insecurity. To maintain food provision, policy changes to the National School Lunch Program (NSLP) and Supplemental Nutrition Assistance Program (SNAP) were instated. This longitudinal study examined (1) food security patterns across the timeline of COVID-19; (2) the relationship among food security patterns, NSLP/SNAP use, and parent feeding practices; and (3) parent perceptions of NSLP/SNAP policy changes. METHODS: A total of 333 US parents completed online surveys during the COVID-19 pandemic: May 2020 (T1), September 2020 (T2), and May 2021 (T3). Food security and parent feeding practices were reported at each time point; pre-COVID-19 behaviors were retrospectively reported at T1. Use and perceptions of NSLP/SNAP policy changes were reported at T3. We examined associations between food security and parent feeding practices using repeated-measures mixed models. RESULTS: The percentage of parents with very low food security increased from pre-COVID-19 (9.6%) to T1 (29.1%) and remained elevated at T3 (16.8%). One-third (31.2%) of families fluctuated between food security and food insecurity, with 27.0% remaining food insecure at T3. Thirty percent of consistently food-insecure families reported not receiving school-provided meals, and 45% did not receive SNAP benefits. Most parents reported that pickup school meal sites (71.4%), Pandemic Electronic Benefit Transfer cards (51.4%), and increased SNAP benefits (79.6%) were beneficial. Initial changes in parent feeding practices reported at T1 returned to pre-COVID-19 levels by T3, yet concern for child overweight remained significantly elevated. CONCLUSION: Continued policy efforts to support food-insecure families via expanded food access in NSLP/SNAP are critical.

Development and Implementation of a Pilot Transition Preparation Intervention for Young Adults With Type 1 Diabetes in an Integrated Healthcare Setting.

OBJECTIVE: To evaluate the feasibility, acceptability, and preliminary efficacy of a multisystem transition preparation intervention, SHIFT, for young adults (YAs) with type 1 diabetes (T1D). METHODS: A single-arm, clinic-based pilot was conducted with 25 YAs with T1D (M age = 18.9 ± 1.0 years; 80% female), their parents (n = 25), and their providers (n = 10). Young adults and parents participated in a 6-month intervention designed to enhance transition readiness and independent diabetes management. Providers viewed a video module highlighting their role preparing YAs for transition and received individualized reports of YA's goals and transition readiness. Intervention feasibility (i.e., recruitment, retention, and engagement) and acceptability (e.g., program satisfaction) were assessed. Assessments of transition readiness, diabetes engagement, hemoglobin A1c (HbA1c), and related psychosocial variables were conducted at baseline, post-intervention (6 m), and follow-up (9 m). Paired t-tests examined 0-6 m and 0-9 m changes in study constructs. RESULTS: SHIFT was feasible, evidenced by recruitment (100% of sample recruited in 4 m), retention (100% at 6 m), and YA session attendance (100%). Program satisfaction was high for YAs, parents, and providers (9.12 ± 1.40, 8.79 ± 1.56, 8.20 ± 1.30, respectively, [out of 10]). Significant improvements (with effect sizes ranging from small to medium) were observed in parent and YA-reported transition readiness at 6 and 9 m (ps<.05) and diabetes engagement at 9 m (ps<.05). Although based on limited data due to COVID-19-related disruptions, a potential reduction in HbA1c was also observed. CONCLUSION: Findings support the feasibility, acceptability, and preliminary efficacy of SHIFT (although limited by the single arm design and homogeneous sample), and suggest a larger randomized controlled trial is warranted.

Design and rationale for evaluating the impact of salad bars on elementary school students' fruit, vegetable, and energy intake: a wait list control, cluster randomized controlled trial.

BACKGROUND: Most children do not consume the recommended amount of fruit and vegetable (FV) servings. Changing the school food environment can be a cost-efficient, effective approach to improving children's dietary quality. There is great popular support for school salad bars as a means to increase children's FV intake within the National School Lunch Program (NSLP), yet empirical research is limited. Further, although FV consumption can facilitate healthy weight management if these foods replace high calorie items, there is a need to enhance understanding of salad bars' influence on children's diet quality and energy intake within the NSLP. This is particularly important to investigate in schools in communities characterized by high poverty, as students they serve are particularly likely to rely on school meals. METHODS: This report describes the design and rationale of a federally-funded investigation that uses validated methods to evaluate school salad bars. This district plans to install salad bars into 141 elementary schools over 5-years, facilitating the conduct of a waitlist control, cluster randomized controlled trial. Specifically, 12 pairs of matched schools will be randomly selected: half receiving a salad bar (Intervention) and half serving pre-portioned FVs only, standard under the NSLP (Control). Thus, groups will have different FV presentation methods; however, all schools will operate under a policy requiring students to take at least one FV serving. Schools will be matched on Title I status and percent of racial/ethnic minoritized students. Intake will be objectively assessed at lunch in each school pair, prior to (baseline), and 4-6 weeks after salad bars are installed (post), yielding ~ 14,160 lunch observations throughout the study duration. Cafeteria sales and NSLP participation data will be obtained to determine how salad bars impact revenues. Finally, implementation factors and cafeteria personnel's perspectives will be assessed, to identify barriers and facilitators to salad bars use and inform sustainability efforts. Proposed methods and current status of this investigation due to COVID-19 are described. DISCUSSION: Results will have great potential to inform school nutrition policies and programs designed to improve dietary quality and reduce obesity. TRIAL REGISTRATION: Retrospectively registered (10/28/22) in clinicaltrials.gov (NCT05605483).

Effect of a Lifestyle Intervention on Cardiometabolic Health Among Emerging Adults: A Randomized Clinical Trial.

Importance: The prevalence of obesity has increased substantially among emerging adults, yet no previous large-scale behavioral weight loss trials have been conducted among this age group. Objective: To test the effect of 2 theory-based motivational enhancements on weight loss within a primarily digital lifestyle intervention designed for emerging adults. Design, Setting, and Participants: In this randomized clinical trial conducted at an academic medical research center, 382 participants aged 18 to 25 years with a body mass index (BMI; calculated as weight in kilograms divided by height in meters squared) of 25 to 45 were enrolled between February 2, 2016, and February 6, 2019. Data collection was completed February 8, 2020. Analysis was performed on an intention-to-treat basis. Interventions: Participants were randomized to 1 of 3 groups: developmentally adapted behavioral weight loss (aBWL), aBWL plus behavioral economics (aBWL + BE), or aBWL plus self-determination theory (aBWL + SDT). All groups received a 6-month intervention with 1 group session, 1 individual session, and a digital platform (digital tools for self-monitoring, weekly lessons, tailored feedback, text messages, and optional social media). The aBWL + BE group received modest financial incentives for self-monitoring and weight loss; the aBWL + SDT group received optional experiential classes. Coaching and message framing varied by group. Main Outcomes and Measures: The primary outcome was mean (SE) weight change (in kilograms) at 6 months. Secondary outcomes included proportion of participants achieving weight loss of 5% or more, percentage weight change, waist circumference, body composition, and blood pressure. Results: Among the 382 participants (mean [SD] age, 21.9 [2.2] years), 316 (82.7%) were female, mean (SD) BMI was 33.5 (4.9), 222 (58.1%) were of underrepresented race and/or ethnicity, and 320 (83.8%) were retained at the primary end point. There was a significant time effect for mean (SE) weight loss (-3.22 [0.55] kg in the aBWL group; -3.47 [0.55] kg in the aBWL + BE group; and -3.40 [0.53] kg in the aBWL + SDT group; all P < .001), but no between-group differences were observed (aBWL vs aBWL + BE: difference, -0.25 kg [95% CI, -1.79 to 1.29 kg]; P = .75; aBWL vs aBWL + SDT: difference, -0.18 kg [95% CI, -1.67 to 1.31 kg]; P = .81; and aBWL + SDT vs aBWL + BE: difference, 0.07 kg [95% CI, -1.45 to 1.59 kg]; P = .93). The proportion of participants achieving a weight loss of 5% or more was 40.0% in the aBWL group (50 of 125), 39.8% in the aBWL + BE group (51 of 128), and 44.2% in the aBWL + SDT group (57 of 129), which was not statistically different across groups (aBWL vs aBWL + BE, P = .89; aBWL vs aBWL + SDT, P = .45; aBWL + SDT vs aBWL + BE, P = .54). Parallel findings were observed for all secondary outcomes-clinically and statistically significant improvements with no differences between groups. Conclusions and Relevance: In this randomized clinical trial, all interventions produced clinically significant benefit, but neither of the motivational enhancements promoted greater reductions in adiposity compared with the developmentally adapted standard group. Continued efforts are needed to optimize lifestyle interventions for this high-risk population and determine which intervention works best for specific individuals based on sociodemographic and/or psychosocial characteristics. Trial Registration: ClinicalTrials.gov Identifier: NCT02736981.

Patterns Of Food Security And Dietary Intake During The First Half Of The Child Tax Credit Expansion.

Temporary expansion of the Child Tax Credit (CTC) during the COVID-19 pandemic provided additional monthly income for US families, with no restrictions on use, from July through December 2021. This study examined food security and children's dietary intake after three months of expanded CTC payments. Parents completed online surveys before and after three months of CTC payments. Among parents participating in the expansion, food and beverage purchases were the most common use of expanded CTC funds (45.9 percent), particularly in households with very low food security (63.0 percent). From before to midway through the CTC expansion, very low food security decreased from 12.7 percent to 5.6 percent, and simultaneously, food security increased from 57.4 percent to 66.4 percent. The CTC expansion was also associated with decreases in children's consumption of added sugar, sugar-sweetened beverages, and sweetened fruit beverages. No changes were observed in children's intake of other dietary components. Our findings suggest that the expanded CTC payments may have helped lessen food insecurity and supported reductions in children's intake of added sugar in participating households.

Home Food Environment Changes and Dietary Intake during an Adolescent Behavioral Weight Loss Intervention Differ by Food Security Status.

Behavioral weight loss (BWL) for pediatric obesity includes guidance on improving the home food environment and dietary quality; yet food insecurity presents barriers to making these changes. This study examined if home food environment, dietary quality, energy intake, and body weight changes during adolescent obesity treatment differed by food security status, and if changes in the home food environment were associated with changes in dietary quality and energy intake by food security status. Adolescents (n = 82; 13.7 ± 1.2 years) with obesity participated in a 4-month BWL treatment. Food insecurity, home food environment (Home Food Inventory [HFI]), dietary quality (Healthy Eating Index [HEI]), energy intake, and body mass index (BMI) were assessed at baseline and post-treatment. A reduced obesogenic home food environment and improved dietary quality were observed for food secure (ps < 0.01), but not insecure households (ps > 0.05) (mean difference, HFI: −6.6 ± 6.4 vs. −2.4 ± 7.4; HEI: 5.1 ± 14.4 vs. 2.7 ± 17.7). Energy intake and BMI decreased for adolescents in food secure and insecure households (ps < 0.03) (mean difference; energy intake: −287 ± 417 vs. −309 ± 434 kcal/day; BMI: −1.0 ± 1.4 vs. −0.7 ± 1.4). BWL yielded similar reductions in energy intake and body weight yet did not offer the same benefits for improved dietary quality and the home food environment for adolescents with food insecurity.

Nutrient Intake During School Lunch in Title I Elementary Schools With Universal Free Meals.

BACKGROUND: The National School Lunch Program (NSLP) provides >30 million meals to children daily; however, the specific nutrient composition of NSLP-selected and consumed meals for students from lower income and racial/ethnic minoritized backgrounds is unknown. AIMS: To quantify the nutrients in school lunch selection and consumption among students participating in the NSLP and compare these values to nutrient recommendations. METHOD: Students (1st-5th graders; 98.6% from racial/ethnic minoritized backgrounds; 92.5% NSLP participation) from six Title I elementary schools serving universal free meals participated. Digital images of students' lunch meal selection and consumption were obtained (n = 1,102 image pairs). Plate waste analyses quantified portions consumed. Nutrient composition of students' lunch selection and consumption were calculated and compared with the 2010 Healthy Hunger-Free Kids Act and 2009 Institute of Medicine recommendations. RESULTS: Most lunches selected (59%-97%) met recommendations for all nutrients except for total calories (23%), vitamin C (46%), and dietary fiber (48%). Based on lunch consumption, most students' lunches met recommendations for sodium (98%), protein (55%), calories from fat (82%), and saturated fat (89%); however, few met recommendations for total calories (5%), calcium (8%), iron (11%), vitamin A (18%), vitamin C (16%), and fiber (7%). DISCUSSION: Meals selected met most nutrient recommendations for the majority of children; yet overall consumption patterns reflect suboptimal nutrient intake. CONCLUSION: Meals served under the NSLP policy mandates align with recommended nutrient patterns, highlighting the importance of maintaining these standards. Strategies to optimize children's intake of nutrient-rich portions of these meals are needed to optimize policy impact.

The role of parents in adolescent obesity treatment: Results of the TEENS+ randomized clinical pilot trial.

BACKGROUND: The optimal role for involving parents in adolescent obesity treatment is unknown. OBJECTIVE: To demonstrate that two parent approaches within adolescent obesity treatment are distinct, as evidenced by differential parent outcomes, and determine the preliminary efficacy of each approach on adolescent weight loss. METHODS: Adolescent/parent dyads (N = 82; mean adolescent age = 13.7 ± 1.2 years) participated in TEENS+, a 4-month behavioural weight loss treatment. Participants were randomized to: (1) TEENS+parents as coaches (PAC; parent skills training), or (2) TEENS+parent weight loss (PWL; adult behavioural weight loss). Assessments occurred at 0, 4 (post-treatment), and 7-months. Within- and between-group repeated measures general linear mixed models examined change in parent weight (∆kg; primary outcome); parenting, feeding, weight control strategies, home environment, and adolescent body mass index (∆BMI; secondary outcomes). RESULTS: PWL parents had greater 4-month weight losses (∆kg0-4m  = -5.14 ± 4.87 kg) compared to PAC (-2.07 ± 3.89 kg; between-group p < 0.01). Key constructs differed between groups as expected. Both groups yielded significant within-group adolescent ∆BMI0-4m (PWL: -0.97 ± 1.38 kg/m2 vs. PAC: -0.93 ± 1.42 kg/m2 ; ps < 0.01); during maintenance, adolescents in PWL had ∆BMI4-7m increases (+0.41 ± 1.07 kg/m2 ; p = 0.02) while PAC did not (+0.05 ± 1.31 kg/m2 ; p = 0.82). CONCLUSION: Parent treatments were distinct in implementation and both yielded significant 4-month adolescent weight loss. Differential weight patterns were observed during maintenance, favouring PAC, warranting further exploration.

Salad bars and energy intake in Virginia elementary schools with free meals.

School salad bars are widely promoted as a means to increase adherence to National School Lunch Program (NSLP) nutrition mandates. Yet it is unknown how salad bars or fruit and vegetable (F&V) intake relates to energy intake within the NSLP, or if F&Vs displace energy from other sources. This relation is particularly important to understand among children from minoritized backgrounds, who are at high risk of obesity and food insecurity, and the most likely to be impacted by school food policies, given their reliance on school meals. This study purpose was to evaluate if school salad bars and F&V intake are associated with lower lunch energy intake. Energy intake in Virginia elementary schools with and without salad bars, and associations between F&V energy and other energy sources, were examined. Cross-sectional plate waste assessments were conducted in matched school pairs (3 with, 3 without salad bars; N = 1,102 students; >90% Black and Latinx; 100% free meals). Two-level hierarchical models assessed group differences in energy intake and the proportion of energy from each meal component. Mean total lunch energy intake was 304 ± 157 kcal (salad bar); 269 ± 152 kcal (no salad bar). Students in salad bar schools consumed more energy from vegetables (+11 kcal; P < .001). Energy intake patterns were inconsistent across pairs. F&V energy was not associated with non-F&V energy (F = 1.04, P = .31). Findings do not suggest that salad bars were associated with lower energy intake. Evidence was inconsistent regarding F&V displacement of other lunch calories. Further research regarding F&V, salad bars, and energy intake is needed.

Longitudinal patterns of food insecurity, the home food environment, and parent feeding practices during COVID-19.

Background: The economic impacts of the coronavirus disease 2019 (COVID-19) have drastically increased food insecurity in the United States. Initial data, collected a few months into the pandemic, showed that families, particularly those experiencing food insecurity, reported detrimental changes to their home food environment and parent feeding practices, compared to before COVID-19. Objective: This follow-up study obtained longitudinal data from a sample of parents in the United States to quantify changes in food security status, the home food environment, and parent feeding practices, from before to across COVID-19 as the pandemic continued to persist. Methods: Parents (N = 433) completed online surveys May (T1) and September (T2) 2020 during COVID-19. Food security, home food environment, and parent feeding practices were reported at each timepoint. At T1, parents also retrospectively reported on these factors pertaining to before COVID-19. Chi square analyses and repeated measure mixed models examined associations among study variables. Results: Low or very low food security increased from before COVID-19 (37%) to T1 (54%) and decreased by T2 (45%). About 30% of families who became food insecure, and 44% who stayed food insecure from T1 to T2, reported a decrease in total food in their home; only 3%-6% who became/stayed food secure reported this decrease. Parents' concern for child overweight and use of monitoring increased from before COVID-19 to T1, and decreased by T2, but remained elevated above pre-COVID-19 values. Conclusion: Rates of food insecurity remain high as this pandemic persists. Continued assessment of nutrition-related factors and increased economic supports are critical for families to endure COVID-19 and prevent long-term obesity and health risks.