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

Jessica Gokee Larose,Laura J Caccavale,Melanie K Bean,Elizabeth L Adams,Hollie A Raynor

doi:10.3390/nu14050976

Abstract

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.

Highlights

Multicomponent, behavioral intervention is the first-line standard of care for treating adolescents with obesity [1,2]
Despite these widely known social and economic barriers, few investigations have examined how food insecurity is associated with adolescents’ ability to make dietary changes during obesity treatment, or if treatment response differs based on food security status
The aim of this paper is to examine whether food security is associated with changes in the home food environment, dietary intake, and body mass index (BMI) during a behavioral weight loss intervention for adolescents with obesity

Summary

Introduction

Multicomponent, behavioral intervention is the first-line standard of care for treating adolescents with obesity [1,2]. A fundamental component of this treatment approach is intensive dietary guidance to yield an energy imbalance for weight loss [2]. This dietary guidance often includes daily energy goals, with a prescription to increase low-energy-dense, nutrient-rich foods (e.g., fruits and vegetables) and decrease consumption of energy-dense, nutrient-poor items (e.g., sugar-sweetened beverages) [3]. Food insecurity presents a multitude of challenges to adopting healthful dietary patterns, including less availability, affordability, and accessibility of nutrient-rich foods [5]. Despite these widely known social and economic barriers, few investigations have examined how food insecurity is associated with adolescents’ ability to make dietary changes during obesity treatment, or if treatment response differs based on food security status

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Methods

Conclusion