Student and faculty perceptions of nutrition education in medical school.

BACKGROUND & AIM: There is abundant evidence to support the beneficial role of nutrition in the prevention, management and treatment of many health conditions including non-communicable diseases and malnutrition. Despite the increasing prevalence of these conditions around the world, research over the past decades has identified that many medical schools lack adequate nutrition education and training for medical students. With the Czech Republic not represented in these findings, this qualitative study aimed to assess and describe the perceptions of nutrition education at a Czech medical school. METHODS: Thirty-six participants, including students in all grades (n = 30) and faculty members from different disciplines (n = 6), completed individual, semi-structured interviews. Interviews were audio-recorded and transcribed verbatim. Inductive coding and thematic analysis were used to analyze data and identify key themes. RESULTS: Participants emphasized the important and wide-ranging role of nutrition, describing it as significant and essential for both prevention and treatment of many medical conditions. The first main theme, 'Nutrition in Medical Care and Health' identified support for the important role that nutrition plays in medical care and health. Participants acknowledged that doctors have an important role to promote good nutrition and thus require sufficient education in medical school to offer general nutrition information to patients. In the second theme, 'Nutrition Education in the Current Curriculum' some participants acknowledged that while the medical school offers a good theoretical education about nutrition, and training for specific populations such as pediatrics and oncology, overall, the current education about nutrition was 'inadequate,' not emphasized like other subjects and lacked practical application in clinical practice. The third main theme 'Opportunities for Nutrition Education in Medical School' identified the students' interest in learning more about nutrition to improve their knowledge in preparation for future practice and to promote healthy eating during medical school. In addition to identifying specific topics of interest, the participants shared preferred methods of learning nutrition information. CONCLUSIONS: The participants in this study recognized the importance of nutrition in medical care and perceived that nutrition education is not emphasized consistently in medical school. Students desired additional nutrition education to include current topics, promote self-care, and improve the emphasis in clinical training.

Nondiet Weight-Neutral Curricula Limited in Current Accredited US Dietetic Programs.

OBJECTIVE: Determine awareness and prevalence of, and interest in nondiet weight-neutral (NDWN) focused curriculum and factors associated with the presence in accredited dietetic programs throughout the US. METHODS: Online cross-sectional survey sent to directors of US Coordinated Programs (n = 60) and Didactic Programs in Dietetics (n = 214). RESULTS: 116 programs (42%) responded, 95% reported knowledge of NDWN approaches to weight management like Health at Every Size. Most schools (72%) included NDWN in their curriculum, mostly in a single lecture (53%). Most respondents (74%) reported interest in an NDWN curriculum. Common factors for not including NDWN were: lack of trained and knowledgeable staff (35%) and insufficient space in the curriculum to incorporate additional topics (35%). CONCLUSIONS AND IMPLICATIONS: Most knew of NDWN approaches and included in curricula but only as 1 lecture. Faculty training and curriculum flexibility may help support the increased incorporation of NDWN approaches.

Food Selection Factors and Perceived Influence on Household Foods Post-Arrival to the U.S. of Newcomer Immigrant and Refugee Adolescents.

The objective of this study was to examine food selection factors and influence on household food selection by newcomer immigrant and refugee adolescents. Participants (n = 68) reported healthfulness (70.1%) and taste (44.2%) as their primary influencing factors. Adolescents' Refugee camp experience, BMI, sex, and ethnicity were associated with reported influences on food selection. Most (85.3%) had tried new foods, reported influence on household food selection (81%) and new food consumption was associated with adolescents' influence on the overall household's food selection. In summary, a variety of factors influence adolescent newcomer's food selection and influence on household food selection is high.

Diet, Physical Activity and Weight-Related Behaviors, Changes and Risks with Newly-Arrived (< 1 Year) Immigrant and Refugee Adolescents (Ages 12-17).

Adolescent immigrants and refugees are at elevated risk for obesity, however, gaps remain regarding specific diet and lifestyle changes. This study examined: (1) weight status, behaviors and perceptions, (2) diet patterns and changes, (3) sociodemographic and dietary factors associated with BMI. Cross sectional survey, anthropometric measures were conducted at a school for newcomer youth in North Carolina. Data analysis included descriptive, frequency, bivariate and linear regression. Participants (n = 68, 55% female, < 1 year US) included immigrants and refugees ages 12-17. Thirty-one percent were overweight or obese. Forty-seven percent had attempted to lose weight. Positive weight perceptions were associated with normal BMI (p = 0.010). Fruit, milk, fruit juice, soda, and meat consumption increased post-arrival (p = 0.037, p = 0.010, p = 0.003, p = 0.044, p = 0.014, respectively). Dietary change was positively associated with BMI (p = 0.002). Adverse diet and lifestyle changes occur rapidly, are associated with obesity, and weight control behaviors and concerns warrant early intervention.

Qualitative Analysis of Maternal Barriers and Perceptions to Participation in a Federal Supplemental Nutrition Program in Rural Appalachian North Carolina.

Background: Little is known about barriers to and perceptions of participation in the in Women, Infants, and Children (WIC) program in rural Appalachia. Purpose: To gain a deeper understanding of maternal barriers and perceptions related to WIC participation in rural Appalachia. Methods: Pregnant women and mothers were recruited in-person and via flyers from WIC offices in three counties in Appalachian North Carolina. Four semi-structured focus groups were conducted between May to July 2018. Each focus group was approximately 60 minutes long and included open-ended questions about the overall WIC experience in rural Appalachia. Focus groups were audio-recorded, transcribed verbatim, and content analysis of transcripts was performed by two trained researchers. Identified themes were discussed and consensus was reached by the researchers to generate final themes for four areas of interest: (1) most valued aspects of WIC program, (2) barriers to program participation and benefit redemption, (3) experiences during appointments, and (4) suggestions for improving experiences in program. Results: The most valued aspects of participation were financial benefits and support/resources provided by WIC staff. In contrast, lack of variety of WIC-approved foods and social stigma were perceived as major barriers to participation and redeeming benefits. Implications: This study contributes to a better understanding of the barriers and perceptions related to WIC participation in this geographically and culturally unique area of rural Appalachia. Findings are valuable for informing WIC state-agencies and policymakers whose efforts focus on the identification and development of effective recruitment and retention strategies for WIC-eligible families in rural Appalachia.

Use of Digital Photography With Newcomer Immigrant and Refugee Youth to Examine Behaviors and Promote Health.

This project examined health behaviors of newly arrived immigrant and refugee youth through digital photography as part of a health promotion intervention. Students (n = 23) aged 12 to 17 years at a school for newcomer youth in North Carolina used digital cameras to record dietary and physical activity behaviors, barriers, and promoters in their home environment. Eighteen participants completed individual photography projects that revealed consumption of soda, processed foods, limited calcium-rich foods, and limited evidence of physical activity. Photography project results and topics from nutrition education provided during the program were used to tailor health promotion resources. Students used digital cameras and props to create visual health-promoting materials (e.g., large posters for school hallways) that included and represented the wide range of cultures and ethnicities at the school. Facilitated discussion analysis revealed students preferred positive health promotion messages (health benefits of fruits and vegetables) versus negative (sugar or salt content of foods). Students reported they enjoyed using the cameras and developing materials and that as result of their experience they want to increase fruit and vegetable consumption, reduce sugar sweetened beverages, and increase physical activity. Digital photography shows promise as a tool to identify health behaviors and environmental barriers and to tailor health messages, especially with populations experiencing language, literacy, and/or cultural barriers.

A qualitative study examining medical provider advice, barriers, and perceived effectiveness in addressing childhood obesity to patients and families from a low-income community health clinic.

OBJECTIVE: To examine medical provider (n = 16) perceptions in addressing and managing pediatric obesity with a diverse, low-income patient population. METHODS: Semi-structured audio-recorded interviews were performed at three pediatric clinics. Transcripts were reviewed using content analysis and consensus was reached among authors for themes. Themes were grouped into categories including: (1) initiation of weight discussions, (2) advice and perceived effectiveness, and (3) barriers. RESULTS: Most providers reported being comfortable addressing weight and use a variety of methods to initiate conversations; however, many challenges were reported, which include limited time and parent misperceptions of child's weight. A broad range of lifestyle advice was utilized, but preference to discuss physical activity over nutrition was reported. CONCLUSION: Results suggest that successful management of children's weight involves addressing issues at both the parent and the provider levels. Improved nutrition resources or training for providers is suggested; however, time must also be available for individualized counseling. Incorporation of registered dietitians may also reduce the burden.