Examining the effectiveness of promotional nudges increasing plant-based food choices in a post-secondary education dining hall: a pilot study.

OBJECTIVE: To evaluate nudge strategies that increase the consumption of plant-based foods, defined as vegetarian or vegan food items, compared with meat-based options in post-secondary dining hall settings. DESIGN: A pilot study. SETTING: This study took place in the University of British Columbia Vancouver Campus's Gather Dining Hall (GDH) over a 6-week intervention period and two control periods. The intervention incorporated several nudges (proportion increases, item placement, taste-focused labelling, Chef's featured special verbal prompts, social media and promotional posters) into the menu and dining hall area with the goal of increasing the purchases of plant-based items. Sales data from meals that were purchased during the intervention period were compared with sales data from the two control periods. PARTICIPANTS: Students and staff who purchased meals in the GDH. RESULTS: The proportion of plant-based items sold significantly increased during the intervention period (56·7 %; P < 0·01) compared with the last 6 weeks of term one (53·6 %) and the first 6 weeks of term two (53·4 %). The proportion of plant-based 'main' menu items was significantly higher in the intervention period (46·4; P < 0·01) when compared with the last 6 weeks of term one (40·9 %) and the first 6 weeks of term two (41·7 %). CONCLUSIONS: The combination of nudges was effective at significantly increasing the selection of plant-based options over meat-based options in a post-secondary dining hall setting.

Barriers and facilitators to diet, physical activity and lifestyle behavior intervention adherence: a qualitative systematic review of the literature.

BACKGROUND: Consuming a balanced diet and regular activity have health benefits. However, many adults have a difficult time adhering to diet and activity recommendations, especially in lifestyle interventions. Adherence to recommendations could be improved if common facilitators and barriers are accounted for in intervention design. The aim of this systematic review was to understand perceived barriers and facilitators to lifestyle (diet and/or activity) intervention guidelines. METHODS: This review follows the Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines. Studies included relied on qualitative methods to explore the barriers and facilitators healthy adults ([Formula: see text] 18 years) experienced in lifestyle interventions. Google Scholar, Cochrane Reviews, Medline, PubMed, and Web of Science were searched from January 2005 to October 2021. Main themes from each paper were thematically analyzed and reported as a barrier or facilitator to adherence at the individual, environment or intervention level using inductively derived themes. Study quality was assessed using the Critical Appraisal Skills Programme. RESULTS: Thirty-five papers were included. Of these, 46% were conducted in North America and the majority had more female participants (86% in mixed-sex studies, 26% females only). Similar themes emerged across all three levels as facilitators and barriers. At the individual level, attitudes, concern for health and physical changes. At the environmental level, social support, social accountability, changeable and unchangeable aspects of the community. Finally, delivery and design and content at the intervention level. An additional facilitator at the intervention level included fostering self-regulation through Behavior Change Taxonomies (BCT). CONCLUSIONS: Lifestyle interventions that foster self-regulatory skills, opportunities for social engagement and personalization of goals may improve behaviour adherence. This can be achieved through inclusion of BCT, tapering off of intervention supports, identification of meaningful goals and anticipated barriers with participants.

Confronting Colonialism in Canadian Dietetics Curricula.

Many Canadian universities have committed to becoming more accountable to Indigenous Peoples by confronting the systemic, historical, and ongoing colonialism and anti-Indigenous racism that shape their campuses. In this Perspective in Practice piece, we invite the field of dietetics to consider how colonialism has shaped dietetics research, teaching, and practice. We also consider how we might transform the field of dietetics in ways that accept settler responsibility for interrupting racism and colonial harm; support the resurgence of Indigenous food and health practices; and recognise the connections between struggles to ensure that Indigenous Peoples can access culturally appropriate food and health care, and struggles for Indigenous sovereignty and self-determination. We do this by reviewing the history of the dietetics field, examining critical responses to existing Indigenisation and decolonisation efforts, and reflecting on recent changes to required dietetics competencies. We argue that curricula in dietetics programmes must teach the history of the colonial food system and equip students to identify and interrupt the individual and institutional colonial dynamics that contribute to the ongoing dispossession of Indigenous Peoples' lands and food sources and negatively impact Indigenous patients.

Body Composition Asymmetry in University Rugby Players: Influence of Sex, Position, and Injury.

CONTEXT: Measures of side-to-side asymmetry in body composition may help identify players who are predisposed to lower limb injuries (LLI) or lower back pain (LBP). This study aimed to examine (1) side-to-side asymmetry in college rugby players according to sex and position and (2) whether side-to-side asymmetry is associated with LBP or LLI. DESIGN: Cross-sectional study. METHODS: Thirty-six rugby players (61% female) underwent a dual-energy X-ray absorptiometry assessment for total and regional (appendicular, truncal) outcomes of fat mass, lean mass, and bone mass. A subsample (n = 23) of players had a second dual-energy X-ray absorptiometry assessment 2 months postbaseline. Two-way analysis of variance was used to assess the effect of position (forward and backs) and sex on body composition asymmetry. Student paired t tests were used to assess side-to-side difference in body composition and compare baseline and follow-up measures. Logistic regression was used to assess possible associations between LLI, LBP, and the degree of side-to-side asymmetry in body composition. RESULTS: Male players had greater asymmetry in arm bone mass compared with female players (P = .026), and trunk fat mass asymmetry was greater in forwards as compared with backs (P = .017). Forwards had significantly greater fat mass (P = .004) and percentage of fat (P = .048) on the right leg compared with the left. Backs had significantly greater bone mass in the right arm compared with the left (P = .015). From baseline to postseason, forwards had a significant increase in side-to-side asymmetry in arm lean mass (P = .006) and a significant decrease in side-to-side asymmetry in leg fat mass (P = .032). In backs, side-to-side asymmetry at baseline compared with postseason was significantly different (P = .011) for trunk fat mass. There were no significant associations between body composition asymmetry, LLI, or LBP by sex or position. CONCLUSION: Our results revealed the presence of side-to-side asymmetries in body composition in university rugby players between sex and position. The amount of asymmetry, however, was not associated with LBP and LLI.

Body-composition phenotypes and their associations with cardiometabolic risks and health behaviours in a representative general US sample.

Body mass index is poor at distinguishing between adiposity and muscle. Based on dual energy X-ray absorptiometry data, a diagnostic framework to analyze body composition by categorizing fat- and muscle-mass body composition into four phenotypes has been proposed. The objective of this study was to assess the association between body-composition phenotypes with adiposity measures, health behaviours and cardiometabolic risks in a representative U.S. adult population. Data were from NHANES (1999-2006: n = 9867; 2011-2018: n = 10,454). Four phenotypes based on being above/below the 50th percentile of age- and sex- adjusted reference curves of fat-mass and muscle-mass were identified. Multiple linear and logistic regressions were used to assess phenotypes (high [H] or low [L] adiposity [A] or muscle mass [M]) against adiposity measures, health behaviours, cardiometabolic risk, and dietary intake. Low-adiposity/high-muscle (LA-HM) was the referent. Analyses incorporated the complex sampling design and survey weights, and were adjusted for age, sex, race, and education. Compared to the LA-HM reference group, the HA-LM phenotype was less physically active, had higher total and lower high-density lipoprotein cholesterol, and had lower intake of all examined nutrients (all p < 0.01). For the HA-HM phenotype, unfavourable values were detected for all adiposity and cardiometabolic measures compared to the LA-HM phenotype (all p < 0.01). The two high adiposity phenotypes were associated with poorer health behaviours and cardiovascular risk factors, regardless of muscle-mass, but associations differed across the phenotypes. Results further underscores the importance of accounting for both adiposity and muscle mass in measurement and analysis. Further longitudinal investigation is needed.

Intuitive eating and its association with psychosocial health in adults: A cross-sectional study in a representative Canadian sample.

Intuitive eating has been proposed as a weight-inclusive, effective, and sustainable approach to eating that benefits psychosocial health compared to traditional restrictive dieting. This cross-sectional study examined the associations of intuitive eating with psychosocial health indicators and demographic characteristics in a representative Canadian sample of adults (n = 1,466). Participants completed an online survey consisting of validated measures on intuitive eating and psychosocial health. Average participant engagement in intuitive eating was moderate with males eating more intuitively than females. Intuitive eating was higher in participants ≥65 years compared to those <65 years, and no differences were found among ethnicities. Correlation tests revealed that intuitive eating was positively correlated with self-esteem and negatively correlated with perceived sociocultural pressure, weight concern, disordered eating behaviour, and cognitive restraint in eating. Compared to males, intuitive eating in females was more strongly correlated with sociocultural pressure and weight concern. Regression analyses showed that intuitive eating interacted with sex in predicting sociocultural pressure and weight concern after controlling for age and ethnicity. Sex-stratified regressions resulted in intuitive eating scores being significantly associated with all psychosocial health indicators investigated. This study provides evidence that intuitive eating is associated with better psychosocial health in a sex-balanced, ethnically diverse Canadian adult sample. Study findings suggest that intuitive eating can be an accessible approach to support a healthy lifestyle and demographic differences should be considered when designing interventions. Future studies need to determine whether intuitive eating improves eating behaviour and reduces disordered eating as well as interacts with other health-related behaviours at a population level.

Does the 2019 Canada's Food Guide meet the needs of young athletes?

Background: The Canada's Food Guide (CFG) encourages Canadians to consume a balanced plate. However, this recommendation may not meet the nutritional needs of young athletes who have increased nutritional requirements. Aim: To evaluate how the 2019 CGF can be used to meet the nutritional needs of young athletes. Method: Five menu scenarios were created using the CFG's balanced plate and recipes from Health Canada. Each menu was analyzed to compare nutrient and energy needs of an index athlete (15-year-old male, 71 kg). Estimated energy requirements were based on nutrition guidelines set by National and International sports-nutrition position statements. Results: The adjusted CFG balanced plate plus an energy dense beverage at every meal was the closest to meeting the index athlete's nutrient requirements. Conclusion: The 2019 CFG's balanced plate needs to be adjusted to meet the nutritional requirements of individuals with active lifestyles.

Evaluation of the Diet Tracking Smartphone Application Keenoa™: A Qualitative Analysis.

Keenoa™ is a novel Canadian diet application (app) currently used by Canadian dietitians to collect diet-related data from clients. The goal of this study was to evaluate Keenoa™ based on user feedback and compare it to a conventional pen and paper method. One hundred and two participants were recruited and randomly assigned to record their diets using this application for 3 nonconsecutive days. Following this, participants were invited to complete an online "exit" survey. Seventy-two subjects responded, with 50 completing an open-ended question asking for general feedback about the app. Data were reviewed and 3 main themes emerged: strengths, challenges, and future recommendations. Strengths associated with the app consisted of picture recognition software, the additional commentary feature, and the overall pleasant data collection process. Challenges that were identified included inconsistencies with the barcode scanning features, the limited food database, time to enter food details, and software issues. Future recommendations included using a larger food database, pairing dietary intake with physical activity monitoring, and having accessible nutritional data. Despite these limitations, participants preferred using mobile apps to record diet compared with traditional written food diaries.

Changes in eating behavior and plasma leptin in children with obesity participating in a family-centered lifestyle intervention.

The goal of childhood obesity lifestyle interventions are to positively change body composition, however it is unknown if interventions also modulate factors that are related to energy intake. This study aimed to examine changes in eating behaviors and plasma leptin concentrations in overweight and obese children participating in a 1-year family-centered lifestyle intervention. Interventions were based on Canadian diet and physical activity (PA) guidelines. Children were randomized to 1 of 3 groups: Control (Ctrl; no intervention), Standard treatment (StnTx: 2 servings milk and alternatives/day (d), 3x/wk weight-bearing PA), or Modified treatment (ModTx: 4 servings milk and alternatives/day; daily weight-bearing PA). Study visits occurred every 3-months for 1-y; interventions were held once a month for 6-months with one follow-up visit at 8-months. Ctrl received counselling after 1-y. Caregivers completed the Children's Eating Behavior Questionnaire (CEBQ) and reported on diet and activity. Plasma leptin were measured from morning fasted blood samples. Seventy-eight children (mean age 7.8 ±â€¯0.8 y; mean BMI 24.4 ±â€¯3.3 kg/m2) participated; 94% completed the study. Compared to baseline, at 6-months StnTx reduced Emotional Overeating and Desire to Drink scores (p < 0.05) while Food Responsiveness scores were reduced in both StnTx and ModTx (p < 0.05). At 1-year, scores for Desire to Drink in StnTx remained reduced compared to baseline (p < 0.05). Plasma leptin concentrations were significantly lower in ModTx at 6-months compared to baseline (p < 0.05). This study resulted in intervention groups favorably changing eating behaviors, supporting the use family-centered lifestyle interventions using Canadian diet and PA recommendations for children with obesity.

Bone Health is Maintained, While Fat Mass is Reduced in Pre-pubertal Children with Obesity Participating in a 1-Year Family-Centered Lifestyle Intervention.

Diet and physical activity (PA) influence bone health in children. This study tested whether increasing milk and milk products and weight-bearing types of PA favorably changed bone outcomes assessed by dual-energy X-ray absorptiometry (DXA) and bone biomarkers in children with obesity participating in a 1-year family-centered lifestyle intervention. Children were randomized to one of three groups: Control (Ctrl; no intervention), Standard treatment (StnTx: two servings milk and milk products/day; meet PA guidelines plus weight-bearing PA three times/week), or Modified treatment (ModTx: four servings milk and milk products/day; meet PA guidelines plus daily weight-bearing PA). Baseline and 12-month measurements included DXA scans for whole body (WB), lumbar spine (LS), lumbar lateral spine (LLS), and ultra-distal (UD) ulna + radius for bone mineral content (BMC), areal bone mineral density (aBMD) and BMD z-scores. Fat mass index (FMI), fat-free mass index (FFMI), and biomarkers of bone metabolism were assessed. Seventy-eight children 6-8 years old were recruited (mean body mass index for-age z-score: 3.3 ± 1.2). Compared to baseline, all groups increased BMC of WB, LS, and LLS (p < 0.001), whereas only StnTx increased UD ulna + radius BMC at 12 months (p < 0.05). At 12 months, WB-BMD z-scores were significantly lower in Ctrl (p < 0.05), whereas WB and LLS aBMD increased in StnTx and ModTx (p < 0.001) but not in Ctrl. All groups increased FFMI (p < 0.001), while only Ctrl increased FMI (p < 0.001). Bone biomarkers did not change over time. Participating in a family-centered lifestyle intervention based on Canadian diet and PA guidelines maintained bone health in obese children.

Assessment of pedometer accuracy in capturing habitual types of physical activities in overweight and obese children.

BACKGROUND: Currently, there is a limited amount of research exploring physical activity measurement tools in overweight and obese (OW/OB) children using pedometers. Thus, our objective was to determine the accuracy of one spring-levered (SC-T2) and two piezoelectric pedometers (NL-1000 and Piezo) in OW/OB children. METHODS: A total of 26 boys and 34 girls (n = 60) participated. Pedometer step-counts were compared to observed step counts for walking (walking, stair ascent and decent) and hopping tests. Pedometer accuracies were compared with Friedman tests while Bland-Altman plots were used to establish the accuracy of each pedometer against direct observations. RESULTS: Boys (n = 26) and females (n = 34) were 96 and 91% OB, respectively. The two piezoelectric pedometers (NL-1000 and Piezo) were accurate for walking and stair climbing tasks, however all pedometers were inaccurate for hopping tests. Averaged over all three walking activities, the NL-1000 was the most accurate with 6.7% median error (interquartile range (IQR): 0.0-13.3); followed by the Piezo with 10.0% median error (IQR: 3.3-18.1); SC-T2 was the least accurate with -14.7% median error (IQR: -54.8-3.5). CONCLUSION: These results support the use of the piezoelectric pedometers for walking and stair climbing types of activities, which are typical for OW/OB children in a nonlaboratory setting.

The Longitudinal Evidence on Social Ties and Fruit and Vegetable Intake among Aging Adults: A Systematic Review.

CONTEXT: Social ties are associated with the mortality and morbidity of aging populations; however, the role of social ties in healthy eating practices or gender differences in this link is less understood. OBJECTIVE: The objective of this study was to examine the longitudinal evidence for the impact of changes in social ties on fruit and vegetable (FV) intakes among aging adults, with attention to gender differences. DATA SOURCES: Medline, Embase, Scopus, CINAHL, and ProQuest databases were searched until December 2022. DATA EXTRACTION: Longitudinal studies evaluating changes in living arrangement, marital status, social network, or social participation and changes in FV intake among middle- and older-age adults were included. Data from the included studies were extracted using a standardized template and analyzed using a narrative approach. DATA ANALYSIS: A total of 4956 titles were eligible after deduplication, and 75 full texts were screened. Seven studies met the inclusion criteria, and all examined marital transitions only. Five marital transitions were assessed: staying married, becoming widowed, becoming divorced, remaining unmarried, and becoming married. Both the quantity and variety of fruit and/or vegetables eaten were studied. Three of the included studies had only male or only female populations. The studies found that marital dissolution (divorce or widowhood), and remaining unmarried, were associated with reduced FV intakes in older women or men, compared with staying married. The associations were stronger in men than in women. Two studies showed that becoming married was associated with increased vegetable intakes, but 3 reported null results. The included studies were of medium quality. CONCLUSIONS: There is a paucity of longitudinal research on whether changes in social ties are associated with changes in FV intakes among aging adults. This review showed that specific marital transitions may influence healthy eating habits, especially in older men. No evidence exists on whether changes in other social ties might alter healthy eating. SYSTEMATIC REVIEW REGISTRATION: PROSPERO registration No. CRD42022365795.

Greater lactate accumulation does not alter peripheral concentrations of key appetite-regulating neuropeptides.

The potential mechanisms involved in lactate's role in exercise-induced appetite suppression requires further examination. We used sodium bicarbonate (NaHCO3) supplementation in a double-blind, placebo controlled, randomized crossover design to explore lactate's role on neuropeptide Y (NPY), agouti-related peptide (AgRP), and alpha-melanocyte stimulating hormone (α-MSH) concentrations. Twelve adults (7 males; 24.2±3.4 kg‧m-2; 42.18±8.56 mL‧kg-1‧min-1) completed two identical high-intensity interval training sessions following ingestion of NaHCO3 (BICARB) or sodium chloride (PLACEBO) pre-exercise. Blood lactate, acylated ghrelin, NPY, AgRP, α-MSH, and appetite perceptions were measured pre-exercise, 0-, 30-, 60-, and 90-min post-exercise. Free-living energy intake (electronic food diaries) was measured the day before, of, and after each experimental session. In BICARB, blood lactate was greater post-exercise (p<0.002, d>0.70) though acylated ghrelin was similar (p=0.075, =0.206) at all time-points post-exercise (p>0.034, d<0.22). NPY (p=0.006, >0.509) and AgRP (p<0.001, >0.488) had main effects of time increasing following exercise and returning to baseline, with no differences between sessions (NPY: p=0.0.192, =0.149; AgRP: p=0.422, =0.060). α-MSH had no main effect of time (p=0.573, =0.063) or session (p=0.269, =0.110). Appetite perceptions were similar during BICARB and PLACEBO (p=0.007, d=0.28) increasing in both sessions post-exercise (p<0.088, d>0.57). Energy intake had a main effect of day (p=0.025, =0.825), where the experimental session day was greater than the day before (p=0.010, d=0.59) with no other differences between days (p>0.260, d<0.38). The lower accumulation of lactate than our previous work did not generate exercise-induced appetite suppression as there were no differences in acylated ghrelin, appetite perceptions, or peripheral concentrations of neuropeptides.

A family-centered lifestyle intervention to improve body composition and bone mass in overweight and obese children 6 through 8 years: a randomized controlled trial study protocol.

BACKGROUND: Childhood obesity gives rise to health complications including impaired musculoskeletal development that associates with increased risk of fractures. Prevention and treatment programs should focus on nutrition education, increasing physical activity (PA), reducing sedentary behaviours, and should monitor bone mass as a component of body composition. To ensure lifestyle changes are sustained in the home environment, programs need to be family-centered. To date, no study has reported on a family-centered lifestyle intervention for obese children that aims to not only ameliorate adiposity, but also support increases in bone and lean muscle mass. Furthermore, it is unknown if programs of such nature can also favorably change eating and activity behaviors. The aim of this study is to determine the effects of a 1 y family-centered lifestyle intervention, focused on both nutrient dense foods including increased intakes of milk and alternatives, plus total and weight-bearing PA, on body composition and bone mass in overweight or obese children. METHODS/DESIGN: The study design is a randomized controlled trial for overweight or obese children (6-8 y). Participants are randomized to control, standard treatment (StTx) or modified treatment (ModTx). This study is family-centred and includes individualized counselling sessions on nutrition, PA and sedentary behaviors occurring 4 weeks after baseline for 5 months, then at the end of month 8. The control group receives counselling at the end of the study. All groups are measured at baseline and every 3 months for the primary outcome of changes in body mass index Z-scores. At each visit blood is drawn and children complete a researcher-administered behavior questionnaire and muscle function testing. Changes from baseline to 12 months in body fat (% and mass), waist circumference, lean body mass, bone (mineral content, mineral density, size and volumetric density), dietary intake, self-reported PA and sedentary behaviour are examined. DISCUSSION: This family-centered theory-based study permits for biochemical and physiological assessments. This trial will assess the effectiveness of the intervention at changing lifestyle behaviours by decreasing adiposity while enhancing lean and bone mass. If successful, the intervention proposed offers new insights for the management or treatment of childhood obesity. TRIAL REGISTRATION: ClinicalTrials.gov, NCT01290016.

Boys and girls differ in their rationale behind eating: a systematic review of intrinsic and extrinsic motivations in dietary habits across countries.

Background: Boys' and girls' food habits diverge in adolescence (13-18 years). This contributes to unequal risks of adverse health outcomes based on sex and gender in adulthood (e.g., heart diseases in men vs. disorder eating in women). Though multi-factorial, why these dietary differences occur is unclear. Purpose: To identify the reasons why adolescents' motivation behind dietary habits differs among genders. Methods: Four databases were searched following PRISMA guidelines. Eligible studies had to use qualitative methodology and report at least one gender unique theme. Reported themes were thematically analyzed, with a sub-analysis by country where the studies were conducted. Quality appraisals were assessed using the Critical Appraisal Skills Programme checklist. Results: In the 34 eligible articles (n = 1,694 returned) two overarching themes emerged that dictated dietary habits in adolescents: Self-motivators and Uncontrollable factors. Gender differences arose whereby girls highlighted more external motivators (e.g., eat healthier, change dietary habits around boys and be thin to fit traditional norms) over their dietary habits. In contrast, boys focused on more internal motivators (e.g., gain autonomy, eat for enjoyment and pursue gains in physical performance). This suggests that motivation underlying how boys and girls eat differs. These trends were largely consistent across countries. Conclusion: Boys' and girls' food habits are not motivated by the same factors. To create more effective dietary interventions targeting health promotion, unique motivations behind food habits need to be understood and incorporated. Systematic review registration: Identifier: CRD42022298077.

A qualitative exploration on the needs of health care providers working with adolescents who are undergoing bariatric surgery.

Background: With increasing prevalence of severe obesity in youth, more adolescents are becoming candidates for bariatric surgery. In Canada, bariatric surgery in adolescents is in its infancy, and long-term health outcomes are not well known. It is unknown what health care providers (HCPs) are using to prepare and guide their adolescent patients for bariatric surgery. The needs of HCPs should be explored with the aim to improve patient outcomes. Therefore, the purpose of this study was to investigate the resource needs of HCPs working with adolescents living with severe obesity who are undergoing bariatric surgery. Methods: This qualitative study consisted of a focus group with seven HCPs from an adolescent bariatric program using a semi-structured interview guide. The focus group discussion was audio-recorded, and the recording was transcribed verbatim. A thematic analysis was conducted. Results: Four data-generated themes emerged highlighting the perceived needs and challenges faced by HCPs. These included (1) gaps in patient education materials on the subject of the bariatric surgery process, obesity as a chronic disease and mental health, (2) the need for designing resources that are teen-friendly, adaptable, and accessible, (3) the need for resources to facilitate decision-making and patient evaluation delivering more streamlined care and; (4) challenges to addressing resource needs due to limited clinical time and budgets. Conclusion: This needs assessment study highlights the need for appropriate resources for patient education, as well as pre and post-operative preparation. The hope is that HCPs can improve quality of care delivered and positively impact surgical outcomes in their patients.

A Qualitative Evaluation of a Plate-Method Dietary Self-Monitoring Tool in a Sample of Adults Over 50.

Background: Self-monitoring is an important behavioral change technique to help users initiate and maintain dietary changes. Diet self-monitoring tools often involve the itemization of foods and recording of serving sizes. However, this traditional method of tracking does not conform to food guides using plate-based approach to nutrition education, such as the 2019 Canada's Food Guide (CFG). Objective: To explore the acceptability, facilitators and barriers of using a plate-based dietary self-monitoring tool based on the 2019 CFG (Plate Tool) compared with a traditional Food Journal (Food Journal). Methods: The 2 dietary self-monitoring tools were compared using a crossover study design over 2 wk. Adults over 50 (n = 47) from Montreal, Canada, were randomly assigned to use one tool over 3 d during 1 wk, then used the other tool the next week. Semistructured interviews (n = 45) were conducted after completing the second tool. A qualitative description of the interviews was conducted through an inductive determination of themes. Results: Facilitators to using the Plate Tool were its simplicity, quick completion time compared with the Food Journal and easiness to use, increased awareness of dietary habits and accountability, with participants expressing that it could help users make informed dietary changes aligning with the CFG. However, barriers to using the Plate Tool were its lack of precision, the participants' difficulty categorizing foods into the CFG categories and recording intake of foods not present on the CFG. Conclusions: The Plate Tool is an acceptable dietary self-monitoring tool for healthy adults over 50. Self-monitoring tools based on the plate method should take the barriers described in this study into account. Future studies should compare dietary self-monitoring methods to assess adherence and effectiveness at eliciting dietary behavior change.

Changes in Adiposity without Impacting Bone Health in Nine- to Twelve-Year-Old Children with Overweight and Obesity after a One-Year Family-Centered Lifestyle Behavior Intervention.

Background: Few family-centered lifestyle interventions (FCLIs) for children with overweight or obesity (OW/OB) have assessed regional adiposity and bone health. This study assessed changes in adiposity in 9- to 12-year olds with OW/OB in a 1-year FCLI. Methods: Children were randomized to FCLI (six registered dietitian-led sessions) or no intervention (Control, CTRL). The FCLI focused on physical activity, nutrition education, and behavioral counseling children with families present. Assessments occurred at baseline and every 3 months for 1 year to assess changes in waist circumference (WC), body mass index for age-and-sex Z-scores (BAZ), body composition (dual-energy x-ray absorptiometry), and cardiometabolic biomarkers. Mixed models were used to determine the effects of group and time or group-by-time interactions for all outcomes. Results: Sixty children (age: 11.1 ± 1.1 years, BAZ: 2.7 ± 0.6) were enrolled; 55 participants (n = 28 CTRL, n = 27 FCLI) completed the study. There were no between group differences from baseline to follow-up for any measure. The FCLI group had significant decreases in BAZ over 12 months (-0.18 ± 0.27, p = 0.03) but not CTRL (-0.05 ± 0.32, p = 0.92). WC and android fat mass did not change in FCLI (p > 0.20) but increased in CTRL (p < 0.02). Whole body bone area, content, and areal bone mineral density (aBMD) increased in both groups (p < 0.010); whole body aBMD Z-score decreased by 5.8% and 1.6% in CTRL and FCLI, respectively (p < 0.001). There were no significant within group changes in biomarkers. Conclusion: The FCLI resulted in small reductions in BAZ and a plateau in android fat mass, which suggest that FCLIs are suitable as an intervention for 9- to 12-year-old children with OW/OB. Clinical Trial Registration number: NCT01290016.

SMART goals of children of 6-12 years enrolled in a family-centred lifestyle intervention for childhood obesity: Secondary analysis of a randomized controlled trial.

This study demonstrates how SMART (Specific, Measurable, Attainable, Realistic and Timely) goals set by children in a lifestyle intervention contributed favorably to weight outcomes. Children (6-12 years) set goals with a registered dietitian over six months. Goals were classified according to their type (diet or activity), direction, (increase healthy or decrease unhealthy), and theoretical constructs. Theoretical constructs included the Theory of Planned Behavior's attitudes (i.e., changing beliefs about behaviour outcomes), subjective norm (i.e., incorporation of health recommendations) and perceived behavioural control (i.e., over goal barriers and facilitators). Constructs from a Socio-Ecological Model (family or individual) were also applied. Participants who maintained or decreased their body mass index for-age-and-sex z-scores (BAZ) after six months created significantly more goals related to the subjective norm compared to those whose BAZ increased (p = 0.003). Future interventions using SMART goals should incorporate health recommendations (i.e., the subjective norm) through actionable items among children to promote success.

Assessment of electronic patient education materials for adolescent bariatric surgery candidates: An environment scan.

Objective: Adolescents who opt for metabolic and bariatric surgery (MBS) will use the internet to learn about the procedure. The objective of this study is to assess the suitability of electronic patient education materials (ePEM) of North American centers that perform adolescent bariatric surgery. Methods: Canadian and American bariatric centers that perform adolescent MBS were identified from the Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program and Google web-based searches. Suitability of ePEM for the adolescent readership was evaluated using the Suitability Assessment of Materials (SAM). Results: Sixty-five centers were evaluated from June to July 2020 with 41% citing adolescent specific material. Six percent of the ePEM were evaluated as 'not suitable', 69% were evaluated as 'adequate', and 25% were evaluated as 'superior'. Conclusion: Adequate ePEM scoring was obtained, but centers had little resources tailored to adolescent patients. Further research is needed to evaluate all the resources provided to adolescents (i.e., resources provided by the health team) to ensure the tools are appropriate for the adolescent readership. Innovation: This environmental scan provided insights to ePEM available for adolescents considering MBS.